J Dent Anesth Pain Med.  2018 Feb;18(1):57-64. 10.17245/jdapm.2018.18.1.57.

Cardiac arrest due to an unexpected acute myocardial infarction during head and neck surgery: A case report

• Kim J
• So E
• Kim HJ
• Seo KS
• Karm MH

• KMID: 2405384
• DOI: http://doi.org/10.17245/jdapm.2018.18.1.57

Abstract

Major cardiac complication such as acute myocardial infarction can occur unexpectedly in patients without risk factors. We experienced cardiac arrest due to an unexpected acute myocardial infarction in a patient without any risk factors during head and neck reconstructive surgery. The patient was diagnosed with acute myocardial infarction after return of spontaneous circulation. With immediate percutaneous coronary intervention, the patient recovered without complications.

Keyword

Cardiopulmonary Resuscitation; Myocardial Infarction; Percutaneous Coronary Intervention; Reconstructive Surgery

MeSH Terms

Cardiopulmonary Resuscitation
Head*
Heart Arrest*
Humans
Myocardial Infarction*
Neck*
Percutaneous Coronary Intervention
Risk Factors

Figure

• 

  Fig. 1 Preoperative electrocardiography (heart rate 94, PR 154 ms, QRS 80 ms, QT/QTc 338/422 ms).

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  Fig. 2 Flowchart during general anesthesia and percutaneous coronary intervention. EM = emergency medicine; ER = emergency room; OP = operation; PCI = percutaneous coronary intervention; RCA = right coronary artery; ROSC = return of spontaneous circulation; W/U = work up.

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  Fig. 3 Vital signs during myocardial infarction event.

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  Fig. 4 Changes in lead II on electrocardiogram and arterial blood pressure during anesthesia. (A) Cardiac arrest; ventricular fibrillation, (B) Sinus tachycardia with ST segment elevation.

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  Fig. 5 Postoperative electrocardiogram in the emergency room (heart rate 51, QRS 88 ms, QT/QTc 418/385 ms).

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  Fig. 6 Coronary angiography and percutaneous coronary intervention. (A) Normal left coronary angiography (RAO 7.1 CAU 28.9), (B) Angiography showing complete luminal occlusion of the mid RCA (arrow) (LAO 29.4, CAU 0.6), (C) Successful wiring to distal RCA and ballooning (arrow) (LAO 32.1, CAU 0.5), (D) After percutaneous coronary intervention, the stent placed at mid RCA showing good final result (LAO 32.1, CAU 0.5). CAU = caudal; LAO = left anterior oblique; LCA = left coronary artery; RAO = right anterior oblique; RCA = right coronary artery.

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