Effect of aminophylline on complete atrioventricular block with ventricular asystole following blunt chest trauma

Abstract

A 39-year-old man was the driver of a car involved in an accident, in which he was thrown forward against the steering wheel. On presentation to the emergency room of a local hospital, he was hypotensive and in respiratory distress. The electrocardiogram (ECG), as reported, showed sinus tachycardia. He was intubated, stabilized and transferred to our institution 5 h later. Upon arrival, his pulse was faint and slow. The ECG showed evidence of complete AV-block with ventricular asystole (Fig. 1A). He received 1 mg of atropine IV three times at 3 min intervals and 1 mg of epinephrine IV to no avail. Arrangements for internal cardiac pacing were made, however, following the administration of 500 mg of aminophylline IV, his heart rate increased to 75 (Fig. 1B) and then 150 beats/min (Fig. 1C), at 3 and 5 min, respectively. His ECG reverted to normal sinus rhythm (Fig. 2) with left anterior hemiblock (LAHB) and T-wave inversion in I and aVL 10 min later with a blood pressure of 120/80 mmHg. Echocardiography revealed flailing of the anterior leaflet of the tricuspid valve with severe tricuspid regurgitation. He was admitted to the intensive care unit with a smooth course. Two months later, he was asymptomatic but with persistent LAHB and grade II–III tricuspid regurgitation.