Fargaly Hithem, Schultz Rebecca J, Chung Un Yong, Rossi Noreen F
Nephrology, Wayne State University Detroit Medical Center, Detroit, USA.
Nephrology, Wayne State University School of Medicine, Detroit, USA.
Cureus. 2023 Feb 14;15(2):e34971. doi: 10.7759/cureus.34971. eCollection 2023 Feb.
Ventricular tachyarrhythmias are common in patients with heart failure. It is one of the important preventable causes of death in these patient populations. Hypokalemia is prevalent in patients with heart failure due to various reasons. Hypokalemia can trigger ventricular arrhythmias through different mechanisms. In this case report, we present a middle-aged man with congestive heart failure (CHF) and an automated intracardiac defibrillator (AICD) on multiple diuretic medications (unintended) who presented with acute chest pain. He was found to have severe hypokalemia, hyponatremia, and an acute kidney injury. Interrogation of the AICD revealed multiple episodes of ventricular fibrillation. The patient was managed by holding his diuretic medications, cautious volume repletion, and potassium replacement. Fortunately, the patient showed rapid clinical improvement and his plasma potassium level improved. On discharge, we reconciled the patient's medications to avoid the recurrence of hypokalemia from over-diuresis and arranged a close follow-up outpatient visit with his cardiologist.
室性快速性心律失常在心力衰竭患者中很常见。它是这些患者群体中重要的可预防死亡原因之一。由于各种原因，低钾血症在心力衰竭患者中普遍存在。低钾血症可通过不同机制引发室性心律失常。在本病例报告中，我们介绍了一名中年男性，患有充血性心力衰竭（CHF），植入了自动体内除颤器（AICD），正在服用多种利尿剂（意外情况），出现急性胸痛。发现他患有严重低钾血症、低钠血症和急性肾损伤。对AICD的问询显示有多次室颤发作。通过停用利尿剂、谨慎补液和补钾对患者进行治疗。幸运的是，患者临床症状迅速改善，血浆钾水平也有所提高。出院时，我们调整了患者的药物治疗方案，以避免过度利尿导致低钾血症复发，并安排患者与心脏病专家进行密切的门诊随访。
