Exertional heat stroke is a medical emergency that uncommonly results in severe cardiac dysfunction. The military physician diagnosed a 19-year-old military recruit from an elite unit to have exertional heat stroke. Immediate treatment in the field with rapid ice water cooling and vigorous fluid administration resulted in pulmonary edema. Transthoracic echocardiography on admission to the emergency department revealed moderate reduction in left and right ventricular function. After treatment, within a few days, rapid myocardial recovery was noted and persisted after 6 months of follow-up. Possible mechanisms of cardiac dysfunction in exertional heat stroke and treatment strategies are discussed. It is suggested that intravenous fluid administration to patients with suspected exertional heat stroke should preferably be done with appropriate hemodynamic monitoring and after cardiac dysfunction has been ruled out.

Background. Sinus node artery occlusion (SNO) is a rare complication of percutaneous coronary intervention (PCI). We analyze both the short- and long-term consequences of SNO. Methods. We retrospectively reviewed 1379 consecutive PCI’s involving RCA and Cx arteries performed in our heart institute from 2016 to 2019. Median follow-up was 44 ± 5 months. Results. Among the 4844 PCIs performed during the study period, 284 involved the RCA and the circumflex’s proximal segment. Periprocedural SNO was estimated by angiography observed in 15 patients (5.3%), all originated from RCA. The majority of SNO occurred during urgent and primary PCIs following acute coronary syndrome (ACS). Sinus node dysfunction (SND) appeared in 12 (80%) of patients. Four (26.6%) patients had sinus bradycardia, which resolved spontaneously, and 8 (53.3%) patients had sinus arrest with an escaped nodal rhythm, which mostly responded to medical treatment during the first 24 hours. There was no association between PCI technique and outcome. Three patients (20%) required urgent temporary ventricular pacing. One patient had permanent pacemaker implantation. Pacemaker interrogation during follow-up revealed a recovery of the sinus node function after one month. Conclusion. SNO is rare and seen mostly during angioplasty to the proximal segment of the RCA during ACS. The risk of developing sinus node dysfunction following SNO is high. SND usually appears during the first 24 h of PCI. The majority of SND patients responded to medical treatment, and only in rare cases were permanent pacemakers required.

SOUHRNŠestačtyřicetiletý muž pociťoval mírnou bolest v horní části břicha, jež se šířila do oblasti zad, a nevolnost; po týdnu si začal stěžovat i na diskomfort na hrudníku, který se šířil do oblasti krku; proto se dostavil na oddělení urgentního příjmu. Dvanáctisvodový elektrokardiogram prokázal velké hrotnaté vlny T ve svodech II-III-AVF a obrovské inverze vln T ve svodech aVL a V 1 až k V 6 ; o půl hodiny později diskomfort na hrudníku ustoupil a elektrokardiografi cké změny vymizely. Biochemické vyšetření séra prokázalo zvýšené hodnoty pankreatických enzymů, zatímco hodnoty elektrolytů, kreatinkinázy a troponinu T v séru zůstaly normální. Koronarografi e prokázala nepostižené koronární tepny. Pacient byl následně léčen konzervativně. I když elektrokardiografi cké abnormality již byly u nemocných s akutní pankreatitidou zaznamenány, široké, vysoké a hrotnaté vlny T, které jsme objevili na elektrokardiogramu našeho pacienta, dosud popsány nebyly. ABSTRACTA 46-year-old man suffered from mild upper abdominal pain radiating to the back and nausea; after a week he began to complain also of chest discomfort radiating to the neck and presented to the emergency room. A 12-lead electrocardiogram showed large peaked T waves in leads II-III-AVF and giant T waves inversion in AVL, V 1 through V 6 ; half an hour later the chest discomfort and the electrocardiographic changes resolved. Serum biochemistry results showed elevated serum pancreatic enzymes; electrolytes, creatinine kinase and troponin T serum values remained normal. Coronary angiography showed normal coronary arteries. The patient was conservatively managed. Electrocardiographic abnormalities were reported in patients with acute pancreatitis but broad, tall and peaked T waves, as found in our patient electrocardiogram, have not been yet reported.

Background Therapeutic Hypothermia (TH) is a standard of care after out-of-hospital cardiac arrest (OHCA). Previous reports failed to prove a significant benefit for survival or neurological outcomes. We examined whether the proper selection of patients would enhance treatment efficacy. Method We conducted a retrospective cohort study. Data was collected from January 2000 and August 2018. Patients were enrolled after OHCA and classified into two groups, patients treated with TH and patients who were not treated with TH. Results A total of 92 patients were included in the study. 57 (63%) patients were in the TH Group and 34 (37%) in the Non-TH group. There was no statistical difference in favorable neurological outcomes between the groups. Patients presenting with ventricular fibrillation had a higher 1-year survival rate from TH, while patients with asystole were found to benefit only if they were younger than 65 years (p < .007, p < .02, respectively).

Cardiac involvement in electrical injury is rare yet poses serious manifestations with high mortality rate. In most cases, symptoms occur immediately after the incident. We present a case of cardiac arrest six hours following uneventful electrocution. The case emphasis the potential late sequel of cardiac injury. Key clinical MessageCardiac injury following electrocution is rare and mostly seen immediately after the event. Our case demonstrate a late sequel of cardiac arrest after an uneventful event which emphasis the potential progressive nature of electrical injury.