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.