Koo Alex Y, Gao Lei
Emergency Medicine, Madigan Army Medical Center, Tacoma, USA.
Cardiology, Highline Medical Center, Burien, USA.
Cureus. 2022 Mar 28;14(3):e23573. doi: 10.7759/cureus.23573. eCollection 2022 Mar.
A 73-year-old female with a history of coronary artery disease, hypertension, and diabetes presented to the emergency department in cardiac arrest. After cardiopulmonary resuscitation (CPR) and return of spontaneous circulation (ROSC), a post-ROSC electrocardiogram demonstrated Accelerated Idioventricular Rhythm (AIVR). The patient was found to have hyperkalemia due to anuric acute renal failure and antecedent severe pancreatitis. After medical management and dialysis, the patient recovered with good neurological recovery. AIVR traditionally has been seen or documented as occurring after ischemia and subsequent coronary artery reperfusion. However, etiologies that promote ventricular automaticity must be considered as well. Electrolyte disturbances, drug toxicities such as digoxin, volatile anesthetics, cardiomyopathies, and ischemia can lead to AIVR. Treatment involves considering and correcting any underlying etiology with avoidance of antiarrhythmics, which may precipitate hemodynamic instability and asystole.
一名73岁女性，有冠状动脉疾病、高血压和糖尿病病史，因心脏骤停被送往急诊科。经过心肺复苏（CPR）并恢复自主循环（ROSC）后，ROSC后的心电图显示为加速性室性自主心律（AIVR）。该患者因无尿性急性肾衰竭和先前的严重胰腺炎而出现高钾血症。经过药物治疗和透析，患者康复，神经功能恢复良好。传统上，AIVR被视为或记录为在缺血及随后的冠状动脉再灌注后发生。然而，也必须考虑促进心室自律性的病因。电解质紊乱、药物毒性（如地高辛、挥发性麻醉剂）、心肌病和缺血都可导致AIVR。治疗包括考虑并纠正任何潜在病因，避免使用可能会导致血流动力学不稳定和心搏停止的抗心律失常药物。
