Cardiac arrest following protamine administration: a case series
Lisa W M Leung1, Mark M Gallagher1, Banu Evranos1
1Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, London, UK.
Summary
Serious adverse events from protamine sulfate, including ventricular fibrillation (VF), can occur after cardiac procedures. Prompt recognition and management are crucial for patient outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Protamine sulfate is used to reverse heparin anticoagulation post-cardiac ablation.
- Serious adverse events are rare but require prompt recognition and management.
Observation:
- Three patients experienced sudden hypotension and ventricular fibrillation (VF) post-protamine infusion.
- All cases involved protamine from the same supplier, though different batches.
- Serum tryptase levels were measured post-event.
Findings:
- Protamine administration can precipitate profound hypotension and VF in susceptible individuals.
- Two patients survived with intensive support; one patient died.
- The exact mechanism of protamine-induced VF remains unclear.
Implications:
- Clinicians should exercise caution and selectivity when administering protamine sulfate.
- Further research is needed to understand and prevent these rare but severe reactions.
- Enhanced vigilance and preparedness are essential in electrophysiology settings.
Related Concept Videos
01:10Resistors In Series
6.4K
A resistor is an ohmic device that limits the flow of charge in a circuit. Most circuits have more than one resistor. If several resistors are connected together and connected to a battery, the current supplied by the battery depends on the equivalent resistance of the circuit. The equivalent resistance of a combination of resistors depends on both their individual values and how they are connected. The simplest combination of resistors is the series combination.
In a series circuit, the...
In a series circuit, the...
6.4K
01:17Series Resonance
802
The RLC circuit impedance is defined as the ratio of the supply voltage to the circuit current. Resonance in such a circuit occurs when the imaginary part of this impedance equals zero. This specific condition means that the inductive reactance is exactly equal to the capacitive reactance. The frequency at which this happens is known as the resonant frequency. Mathematically, the resonant frequency is inversely proportional to the square root of the product of the inductance (L) and capacitance...
802
01:14Series and Parallel Capacitors
9.3K
Capacitors, fundamental components in electronic circuits, can be connected in series and/or parallel configurations. Each configuration has different impacts on the overall behavior of the circuit.
First, consider capacitors connected in series to a battery. In this configuration, the plate connected to the battery's positive terminal develops a positive charge, while the plate attached to the negative terminal becomes negatively charged. An equal magnitude of charge is induced on the...
First, consider capacitors connected in series to a battery. In this configuration, the plate connected to the battery's positive terminal develops a positive charge, while the plate attached to the negative terminal becomes negatively charged. An equal magnitude of charge is induced on the...
9.3K
01:17Trigonometric Fourier series
794
Fourier series is a foundational mathematical technique that decomposes periodic functions into an infinite series of sinusoidal harmonics. This method enables the representation of complex periodic signals as sums of simple sine and cosine functions, facilitating their analysis and interpretation in various fields, including signal processing, acoustics, and electrical engineering.
The trigonometric Fourier series specifically expresses a periodic function with a defined period T using sine...
The trigonometric Fourier series specifically expresses a periodic function with a defined period T using sine...
794
01:21Convergence of Fourier Series
400
The Fourier series is a powerful mathematical tool for representing periodic signals as an infinite sum of complex exponentials. In practice, this infinite series is truncated to a finite number of terms, yielding a partial sum. This truncation makes the approximation of the signal feasible but introduces certain challenges, particularly near discontinuities, known as the Gibbs phenomenon.
The Gibbs phenomenon refers to the persistent oscillations and overshoots that occur near discontinuities...
The Gibbs phenomenon refers to the persistent oscillations and overshoots that occur near discontinuities...
400
01:22Series R—L Circuit Transients
395
In a series resistor-inductor (R-L) circuit, closing the switch at the start of the time period simulates a three-phase short circuit, a fault condition where all three phases of an unloaded synchronous machine are short-circuited. When there is no fault impedance and no initial current, the initial voltage is determined by the phase angle of the source voltage.
Using Kirchhoff's Voltage Law (KVL) to analyze this circuit helps determine the total asymmetrical fault current, which consists...
Using Kirchhoff's Voltage Law (KVL) to analyze this circuit helps determine the total asymmetrical fault current, which consists...
395