When a Fragile Heart Breaks

Nellowe Candelario, M.D., Jamelle Sy, M.D. 

June 30, 2017

A 31-year-old Hispanic male with no known past medical history presented to the emergency room after experiencing a witnessed episode of syncope while having dinner. There were no other noted symptoms prior to this event. Upon arrival of emergency medical services (EMS), advanced cardiac life support for ventricular fibrillation was initiated. By the time the patient reached his local emergency department, he had experienced return of spontaneous circulation (ROSC). He did not regain any consciousness at this time. An electrocardiogram (EKG) obtained after ROSC is displayed in Figure 1.  He was admitted to the Coronary Care Unit where he was placed on hypothermia protocol for 48 hours, after which he regained consciousness without any residual neurologic deficits. He denied any family history of sudden cardiac death or any previous episode of palpitations or syncope. An echocardiogram revealed an ejection fraction of less than 20%. No wall motion, valvular or structural abnormalities were seen. His Troponin I level, which was elevated to 18 ng/mL post-arrest, subsequently normalized over the following days and no electrolyte abnormalities were noted. A subsequent cardiac catheterization did not reveal any coronary artery disease. 

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Author Bio
Dr. Nellowe Candelario is a 3rd year Internal Medicine Resident at Einstein Medical Center Philadelphia, USA
Dr. Jamelle Sy is a graduate of Doctor of Medicine from University of Santo Tomas Faculty of Medicine and Surgery, Philippines