KEYWORDS:
Polymorphic ventricular tachycardia
QTc interval
Autonomic imbalance
Heart rate variability
Abstract- Cardiovascular disturbances are the leading causes of
morbidity and mortality in patients of spinal cord particularly cervical
cord injury accounting for approximately 30% of deaths. Most common
cardiovascular dysfunctions are sinus bradycardia, hypotension, cardiac
arrest, supraventricular tachycardia and all these occurs due to
sympathetic withdrawal and unopposed vagal action. Here we are reporting
a case of acute cervical cord injury with neurogenic shock in a 25 year
young patient who developed polymorphic ventricular tachycardia, which
degenerated to ventricular fibrillation and cardiac arrest. We described
all possible mechanisms of development this arrythmia and its
management.
Introduction - Cardiovascular disturbances are the leading
causes of morbidity and mortality in patients of spinal cord
particularly cervical cord injury. Cardiovascular dysfunctions are
common cause of death, accounting for approximately 30% of deaths (1).
Most common cardiovascular dysfunctions are sinus bradycardia,
hypotension, supraventricular tachycardia rarely cardiac arrest. All
these occurs due to sympathetic withdrawal and unopposed vagal action
(2). However polymorphic ventricular tachycardia has not been described
in these patients. Here we are reporting a case of acute cervical spinal
cord injury with neurogenic shock in a 25 year young patient who
developed polymorphic ventricular tachycardia degenerating to
ventricular fibrillation and cardiac arrest. We described all possible
mechanisms of development this arrythmia and its management
Case- A 25 year old male was admitted to emergency room with
history of road traffic accident. On arrival he was in shock with pulse
rate 65/ min, systolic blood pressure of 60 mm of Hg. He was in
respiratory distress with type 1 respiratory failure. He was intubated,
started inotropes dopamine and shifted to radiology department for
imaging of spine. Imaging revealed fracture dislocation of cervical
vertebra at level C5 and C6 with injury to cervical cord at that level
(Fig-1). So a diagnosis of acute cervical spinal cord injury with
neurogenic shock was made and planned for spinal cord decompression and
fixation of fractured and dislocated cervical vertebra.
Electrocardiogram (ECG) showed sinus rhythm with heart rate of around
100 per minute and QTc interval of 448 m sec(Fig-2). Screening
echocardiography showed structurally normal heart. Patient developed
intermittent sinus bradycardia for which atropine was given. For
refractory hypotension midodrine was advised and after 2 hours of giving
first dose of midodrine 10 mg through ryles tube, he developed sudden
polymorphic ventricular tachycardia (Fig-3). This VT degenerated to
ventricular fibrillation and cardiac arrest. Immediately cardiopulmonary
resuscitation was done and patient was revived. Then he developed
accelerated idioventricular rhythm transiently (Fig-4). Injectable
magnesium sulphate was given. All electrolytes like sodium, potassium
magnesium and calcium were found to be normal. Intravenous lidocaine was
started. ECG post event showed normal QTc interval of 445 m sec (
Fig-5). After stabilisation patient was taken for cervical spinal cord
decompression and fixation. Subsequent ECG had normal range of QTc
interval. Patient was discharged in a stable condition after few days.