![]() Catecholamines were withdrawn after 15 days, although an echocardiogram showed no improvement in ventricular function. The patient’s progress was slow, but satisfactory. ![]() Serum creatine-phosphokinase reached 7233 IU/l with an MB fraction of 284 IU/l. Upon insertion of a Swan-Ganz catheter, it was determined that the patient had a low cardiac index, elevated systemic vascular resistance, and high wedge capillary pressure. Echocardiography demonstrated severe left ventricular dysfunction (ejection fraction 30%) with anteroseptal akinesia, and apical aneurysm without valve regurgitation, aortic dissection, or pericardial effusion. After 24 hours, he presented sudden hemodynamic deterioration with associated ventricular tachycardia. The patient was admitted to the Intensive Care Unit. ![]() Įlectrocardiogram on admission depicting 1 mm ST segment elevation in lateral leads with associated right bundle branch block and ventricular beats in couplet The electrocardiogram showed a 1-mm ST segment elevation in lateral leads with associated right bundle branch block. An exploratory laparotomy was conducted, proceeding to splenectomy due to spleen rupture. A radiograph of the chest showed inferior left and right costal fractures, and free pelvic and abdominal liquid was observed by abdominal ultrasound. Episodes of ventricular tachycardia were treated with amiodarone and a complete atrioventricular block with a transitory pacemaker. Tension pneumothorax was suspected and thoracic tubes were inserted into both sides of the chest. The patient recovered sinus rhythm but again presented hemodynamic instability with bilateral lung hypoventilation at auscultation. During clinical evaluation, he presented a cardiac arrest due to ventricular fibrillation that required four cardiac defibrillations, intubation, and mechanical ventilation. On admission, the patient was awake and reported abdominal and thoracic pain. A 47-year-old man was referred to our hospital after a fall impact from a height of 6 m.
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