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. 2024 Feb;8(1):22-25.
doi: 10.5811/cpcem.1323.

Peripartum Cardiac Arrest with Terminal QRS Distortion: A Case Report

Timothy D Kelly  1 , Nicholas E Harrison  2
Affiliations

Peripartum Cardiac Arrest with Terminal QRS Distortion: A Case Report

Timothy D Kelly et al. Clin Pract Cases Emerg Med. 2024 Feb.

Abstract

Introduction: Peripartum cardiac arrest is increasing in incidence. While pulmonary embolism (PE) remains an important cause of peripartum morbidity and mortality, other cardiovascular emergencies such as myocardial infarction (MI) are now the leading cause of pregnancy-related death. Emergency physicians (EP) need to be well versed in subtle electrocardiographic (ECG) signs of coronary ischemia to better care for peripartum patients in cardiac arrest.

Case report: A 38-year-old gravida 2 parity1 female three days post-partum presented in cardiac arrest. After approximately 12 minutes of Advanced Cardiac Life Support including electric defibrillation, the patient experienced sustained return of spontaneous circulation. The physician team was primarily concerned for PE based on an initial ECG demonstrating terminal QRS distortion in V2 but no ST-segment elevation myocardial infarction (STEMI). Computed tomography angiography (CTA) of the chest did not reveal PE. Repeat ECG after CTA demonstrated STEMI criteria, and the patient was emergently taken to the cardiac catheterization laboratory where she was found to have 99% occlusion of the left anterior descending artery.

Conclusion: Emergency physicians should have a high index of suspicion for MI when managing peripartum patients in cardiac arrest. The ECG findings specific for coronary-occlusive acute MI but not included in the classic STEMI criteria increase accuracy and prevent delays in diagnosis; however, the clinical uptake of this paradigm has been slow. Early recognition of terminal QRS distortion can help EPs more rapidly diagnose the etiology of cardiac arrest.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. This publication was made possible with support from Grant Numbers, KL2TR002530 (Sheri L. Robb, PI), and UL1TR002529 (Sharon M. Moe and Sarah E. Wiehe, co-PIs) from the National Institutes of Health (NIH), National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award. Nicholas Harrison and their institution Indiana University has received grant money to conduct investigator-initiated research conceived and written by Nicholas Harrison from the Blue Cross Blue Shield of Michigan Foundation, the Doris Duke Foundation, the NIH (5KL2TR002530-05), and the Indiana Clinical and Translational Sciences Institute (UL1TR002529). NH’s institution, Indiana University, has received grant money for industry-initiated research from Abbott Laboratories, Siemens, and Beckman-Coulter. Nicholas Harrison has received funding from Vave Health Inc. for consulting.

Figures

Image 1.
Image 1.
Initial electrocardiogram in a patient post-cardiac arrest demonstrating terminal QRS distortion (arrows) in lead V2 which is not captured by traditional ST-segment elevation myocardial infarction criteria.
Image 2.
Image 2.
Repeat electrocardiogram in a patient post-cardiac arrest demonstrating ST-segment elevation in leads V1-V4 (black arrows) with reciprocal depressions in the inferior leads (blue arrows) consistent with ST-segment elevation myocardial infarction criteria.
See this image and copyright information in PMC

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