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.