Early morning 10/27/13

Nicole's heart initially did well without the need for rhythm-stabilizing meds. Her heart was beating regularly, and the treatment team worked on maintaining good blood pressure.  She remained on the ventilator with sedation. The cardiac workup was puzzling, as there were not the typical signs of a viral infection which could have caused the arrest, although the team would continue working on that avenue through the day. An echo showed no significant changes in her pre-existing heart enlargement or mitral valve issue (for which she was already being followed at Childrens). Thankfully she had been in regular follow-up with a cardiologist at Childrens for a structural abnormality of her heart.  Her most recent visit was just 3 weeks prior to this, so there were plenty of records against which to compare her current clinical findings.  However now there is a significant change in the function of her left ventricle, and her ejection fraction is under 30%. The heart is not contracting as strong as normal.  Additionally, there is concern about the effect of the cardiac arrest on her brain. So the plan is to heavily sedate her, keeping her on the ventilator for breathing, and cool her core temperature tonight to reduce any trauma to her brain due to anoxia that may have occurred during CPR.

This worked well through the night.  Unfortunately in the morning, her heart began acting up, with a number of rhythm irregularities. A code was called, but thankfully her heart returned to a sustainable rhythm on its own before the team could intervene. This is actually a blessing, as the treatment team believes this revealed the source of the cardiac arrest, which allows better diagnosis and treatment.  With this information the doctors were able to start her on strong medications to manage the rhythm of her heart, and they appear effective so far.