Methods (Differential Diagnosis, Investigations, and
Treatment):
Cardiovascular assessment, including an echocardiogram performed
immediately after the second cardiac arrest, revealed a dilated left
ventricle with a severely reduced ejection fraction, initially estimated
to be between 5-10%. A repeat echocardiogram 48 hours later showed an
improved ejection fraction of 20-25% while on IV inotropic agent
Milrinone and multiple IV vasopressors. The initial EKG upon admission
showed sinus tachycardia at 133 beats per minute, with no evidence of ST
elevation or infarct pattern.
The patient’s clinical course was further complicated by multi-system
organ failure, encompassing anoxic encephalopathy and acute renal
failure. Urine toxicology screening upon admission indicated positive
results for amphetamines but negative for cocaine and other substances,
aligning with the patient’s history of substance abuse.
Significantly, the patient had a prior hospitalization in 2019 for an
overdose and toxicity related to cocaine, amphetamines, and
cannabinoids. His family history was notable for familial dilated
cardiomyopathy and cardiac arrhythmias. The patient’s father had a
history of familial dilated cardiomyopathy, heart failure with reduced
ejection fraction (HFrEF), necessitating implantable
cardioverter-defibrillator (ICD) placement, electrophysiological
ablation for atrial fibrillation, and a diagnosis of cardiomyopathy.
Furthermore, two of the patient’s paternal uncles had cardiomyopathy
with advanced heart failure, and both underwent cardiac transplant
procedures. Genetic testing revealed a TTN mutation in one of the
patient’s uncles.