PMC9142782_01
ECG tracings obtained immediately before, and during ACLS interventions; A - C: Sinoventricular rhythm, wide complex tachycardia with absent ST segment, or ST elevation in some leads, and peaked T waves; D: P-waves transiently reappear after the administration of epinephrine, calcium chloride and sodium bicarbonate during ACLS
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F1
He was noted to be in a wide complex tachycardia that was clinically a pulseless electrical activity (PEA) (Figure 1A). There was transient reappearance of p-waves after the administration of these temporizing therapies for hyperkalemia (Figure 1D), supporting a diagnosis of sinoventricular rhythm.
apical 4-chamber view, there is severe dilation of all the chambers and a small amount of pericardial effusion without tamponade physiology, and very subtle granular elements in LV chamber consistent with SEC
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F2
The beginning images showed severe biventricular hypokinesis, LVEF approximately 20%, bi-atrial enlargement, severe mitral regurgitation, and moderate tricuspid regurgitation (Figure 2).
representative frames of echo images obtained during ACLS procedures; image 46 is an apical 4-chamber view showing a small amount of circumferential pericardial effusion present (47 - 48, 51 - 56); there was an abrupt appearance of SE, which begins in frame #54 in the LV, and persists until the final heartbeat
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F3
We documented a rapid progressive echogenicity and dense thrombus formation in the LV chamber, cessation of cardiac wall motion and excursion of AV valves, followed instantaneously by the appearance of coagulation in all the other chambers (Figure 3).
final heartbeat; dense amorphous echogenic material fills the entire LV chamber; this represents hemostatic instantaneous coagulation on echo, HICE, a no-flow state with a complete absence of electrical and mechanical activity
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F4
The AV valves appeared to be tethering with a fixed gap in mid annular-position, and an expanding rapid appearance of pleural effusion was appreciated at the end (Figure 4).