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<p>A&#xa0;45-year-old woman was admitted to the emergency department after successful defibrillation following out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation. The husband, who had performed cardiopulmonary resuscitation, reported that his wife had been in a&#xa0;normal condition until the event and had been working in her job as a&#xa0;hairdresser until shortly beforehand. She had no relevant medical history other than arterial hypertension. Physical examination of the patient under mechanical ventilation and analgetic sedation was without obvious abnormalities. Focused sonography revealed no abnormalities, with normal systolic cardiac function but moderate left-ventricular hypertrophy. The point-of-care laboratory values showed pronounced hypokalemia but otherwise normal laboratory values, including renal function. Electrocardiography showed relevant bradycardia, QTc prolongation, and ST segment depression in the inferior leads, so that immediate coronary angiography was performed, which showed no coronary obstruction. After a&#xa0;CT scan of the skull, thorax, and abdomen for further diagnostic evaluation, the patient was transferred to the intensive care unit. The CT showed a&#xa0;tumorous lesion of the right adrenal gland with otherwise normal results, suggesting severe primary aldosteronism (Conn syndrome). Due to persistent hypokalemia and bradycardia under ongoing potassium substitution, a&#xa0;temporary pacemaker was implanted, which stabilized the hemodynamic situation. Further laboratory analysis confirmed the suspected diagnosis of primary hyperaldosteronism. After initiation of aldosterone antagonists, the patient could be weaned from the ventilator and extubated 72 h after the initial event. After a&#xa0;short period of delirium following extubation, the patient was fully orientated without any neurologic deficits. She was later referred to a&#xa0;nearby university hospital for surgical adrenalectomy. The report illustrates a&#xa0;case of severe primary hyperaldosteronism, which was asymptomatic apart from arterial hypertension, as a&#xa0;very rare cause of ventricular fibrillation. It underscores the importance of a&#xa0;thorough diagnostic examination of younger patients with secondary arterial hypertension, although such severe courses of Conn syndrome are rare.</p>

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Seltene Ursache für einen OHCA einer 45-jährigen Patientin

  • 期刊论文

  • 发表日期：

    2025年4月29日

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  • Oliver Kolks,
  • Andreas Knipper,
  • Kevin Willy

摘要

A 45-year-old woman was admitted to the emergency department after successful defibrillation following out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation. The husband, who had performed cardiopulmonary resuscitation, reported that his wife had been in a normal condition until the event and had been working in her job as a hairdresser until shortly beforehand. She had no relevant medical history other than arterial hypertension. Physical examination of the patient under mechanical ventilation and analgetic sedation was without obvious abnormalities. Focused sonography revealed no abnormalities, with normal systolic cardiac function but moderate left-ventricular hypertrophy. The point-of-care laboratory values showed pronounced hypokalemia but otherwise normal laboratory values, including renal function. Electrocardiography showed relevant bradycardia, QTc prolongation, and ST segment depression in the inferior leads, so that immediate coronary angiography was performed, which showed no coronary obstruction. After a CT scan of the skull, thorax, and abdomen for further diagnostic evaluation, the patient was transferred to the intensive care unit. The CT showed a tumorous lesion of the right adrenal gland with otherwise normal results, suggesting severe primary aldosteronism (Conn syndrome). Due to persistent hypokalemia and bradycardia under ongoing potassium substitution, a temporary pacemaker was implanted, which stabilized the hemodynamic situation. Further laboratory analysis confirmed the suspected diagnosis of primary hyperaldosteronism. After initiation of aldosterone antagonists, the patient could be weaned from the ventilator and extubated 72 h after the initial event. After a short period of delirium following extubation, the patient was fully orientated without any neurologic deficits. She was later referred to a nearby university hospital for surgical adrenalectomy. The report illustrates a case of severe primary hyperaldosteronism, which was asymptomatic apart from arterial hypertension, as a very rare cause of ventricular fibrillation. It underscores the importance of a thorough diagnostic examination of younger patients with secondary arterial hypertension, although such severe courses of Conn syndrome are rare.