An ambulance drives around a recent car accident – the car went off the road and crashed at low speed into a wooden fence. In the car, there was an unconscious older man found at the place of the driver. He was not breathing, no significant sign of trauma found. ECG check shows ventricular fibrillation, repeated defibrillations delivered, 6 mg of adrenalin in total and 300 mg of amiodarone were administered, heart rhythm was restored with a well palpable pulse, artificial ventilation was initiated, and the patient was transferred to our hospital.
Short history acquired from hospital information system: a 79-year-old man, chronic ischemic heart disease, takes acetylsalicylic acid. During admission, the patient´s circulation was stable with a minimal need for noradrenaline support. ECG: ST depressions in V2-V4, echocardiography found the akinetic anterior wall of the left ventricle. The patient was indicated to immediate coronarography, the CT with contrast agent was performed (trauma protocol: head, neck, chest, abdomen, pelvis) during transfer to the cath-lab – there were some rib fractures, but no other complications or injuries.
Coronarography was performed and LAD closure found. After the PCI of the vessel, two drug-eluting stents were implanted. The patient needed circulation support by the administration of noradrenaline. After that, he was admitted to the ICU.
Admission echocardiography at ICU shows hypokinesis of the anterior wall of the left ventricle (improvement compared to the finding during first echocardiography, images were not saved). A prophylactic dose of heparin as well as clopidogrel was already administered. The patient was left under sedation and mechanical ventilated. Invasive therapeutic hypothermia protocol was started (target temperature of 35 °C).
Bedside echocardiography checks were performed: