Peripartum Cardiac Arrest with Terminal QRS Distortion: A Case Report
Timothy D Kelly1, Nicholas E Harrison2
1Indiana University School of Medicine Emergency Medicine Residency, Indianapolis, Indiana.
Clinical Practice and Cases in Emergency Medicine
|March 28, 2024
Summary
Peripartum cardiac arrest requires emergency physicians to recognize subtle myocardial infarction (MI) signs on ECGs. Early identification of terminal QRS distortion can improve diagnosis and outcomes in pregnant patients experiencing cardiac arrest.
Area of Science:
- Cardiology
- Emergency Medicine
- Obstetrics
Background:
- Peripartum cardiac arrest incidence is rising, with myocardial infarction (MI) becoming a leading cause of pregnancy-related death.
- Pulmonary embolism (PE) is a significant cause of peripartum morbidity, but other cardiovascular emergencies are increasingly prevalent.
- Emergency physicians require enhanced knowledge of subtle electrocardiographic (ECG) findings for diagnosing coronary ischemia in peripartum cardiac arrest.
Purpose of the Study:
- To highlight the importance of recognizing subtle ECG signs of myocardial infarction (MI) in peripartum cardiac arrest.
- To emphasize the diagnostic utility of terminal QRS distortion in identifying acute coronary occlusion.
- To advocate for earlier diagnosis and intervention in peripartum cardiac emergencies.
Main Methods:
- Case report of a postpartum patient in cardiac arrest.
- Utilized serial electrocardiograms (ECGs) and computed tomography angiography (CTA) for diagnosis.
- Interpreted ECG findings in the context of advanced cardiac life support (ACLS).
Main Results:
- Initial ECG suggested PE, but CTA ruled it out.
- Repeat ECG revealed ST-segment elevation myocardial infarction (STEMI) criteria.
- Cardiac catheterization identified a 99% occlusion of the left anterior descending artery.
Conclusions:
- Emergency physicians must maintain a high suspicion for MI in peripartum cardiac arrest.
- Recognizing ECG findings beyond classic STEMI criteria, such as terminal QRS distortion, can expedite diagnosis.
- Prompt diagnosis and treatment of acute MI are crucial for improving outcomes in peripartum cardiac arrest.
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