Rapid Evolution of Sine-Wave Electrocardiographic Morphology Preceding Cardiac Arrest
Ahmed Y M El-Medany1, Shahid Aziz2
1Cardiology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Case Summary:
We describe the case of a 21-year-old man with severe traumatic brain injury requiring prolonged sedation and vasopressor support, subsequently developing a sudden broad-complex sinusoidal rhythm, and degenerating into electromechanical dissociation and cardiac arrest. A differential diagnosis is discussed.
Take-Home Messages:
Suspect propofol infusion syndrome in patients receiving high-dose propofol (>4 mg/kg/h) or infusions >48 hours and recognize acidosis, rhabdomyolysis, and hypertriglyceridemia as the principal early warnings, followed by a "Brugada-like" electrocardiogram pattern. Minimize exposure in neurotrauma and intensive care unit patients; once sinusoidal rhythms appear, toxicity is often refractory, and early cessation is the only effective strategy.
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