A previously healthy 67-year-old female collapses in the parking lot of a supermarket.
A bystander initiates cardiopulmonary resuscitation, that is chest compression without breathing,
until the medical technicians arrive, the EMTs,
and she - they checked the rhythm, the initial rhythm is ventricular fibrillation,
I'll show you that in a moment.
The patient is shocked and her heart rhythm returns to normal sinus rhythm
and of course she’s transported to the nearest tertiary care hospital.
So she has this possible syncopal episode, turns out actually to be a cardiac arrest
and she has a completely irregular heart activity which is not effective in maintaining the blood pressure
and here's a typical example of ventricular fibrillation, this is not an effective heart rhythm,
the blood pressure would be close to zero.
So if untreated eventually this becomes a flat line EKG and the patient dies.
And so she comes to the hospital and here is her EKG and for her this is fortunate
it shows an acute inferior wall myocardial infarction.
That is we see there's ST elevation in leads 2, 3 and AVF.
There are reciprocal changes in 1 and AVL telling us that the ST elevation is the real thing
and she even has some involvement of the right ventricle.
A right ventricular lead 4 shows a little ST elevation as well.
So this is a fairly substantial inferior wall myocardial infarction
and she has some right ventricular involvement so she's taken urgently to the cath lab,
her right coronary artery is obstructed and is opened using a drug-eluting stent.
She's admitted to the intensive care unit placed on total body hypothermia for 24 hours
and of course we are breathing for her, she's intubated,
she's sedated and of course the ventilator is doing her breathing.
After two days of hypothermia she's gradually rewarmed and the patient is weaned from the hypothermia device
and gradually weaned from the ventilator and she gradually wakes up
and is found to be, fortunately, neurologically intact, this is very fortunate
because this occurs only in about 20% or even less of sudden cardiac death events.
The good news for her was that somebody in the parking lot at the supermarket knew how to do CPR
and that probably accounted for her good neurological outcome.
Eventually, she’s now has her right coronary opened,
she's put on a beta blocker an angiotensin receptor blocker, aspirin, clopidogrel, and a statin.
An electrophysiology expert is consulted besides this patient doesn’t need an implantable cardioverter defibrillator
because her VF was the result of an acute myocardial infarction
and so therefore it isn't that she has poor left ventricular function,
in fact, her left ventricular function turns out to be normal 65% left ventricular ejection fraction.
Cardiac rehabilitation nurse begins ambulation and after two days of successful ambulation,
patient’s transferred to an in-patient rehab center for physical therapy,
and in two weeks she returns to the outpatient clinic for cardiology follow up
and she does well in the long term.