Protamine sulfate
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Haemodynamic collapse due to acute pulmonary vasoconstriction: case report A 23-year-old woman developed haemodynamic collapse due to acute pulmonary vasoconstriction after treatment with protamine sulfate for heparin reversal. The woman, who had undergone orthotropic heart transplantation, presented with palpitations and dyspnoea on exertion related to paroxysmal supraventricular tachycardia including right ventricular enlargement and dysfunction. Electrophysiology study showed focal atrial tachycardia, which was successfully ablated. Post-ablation, she received protamine sulfate 30mg infusion for heparin reversal preceded by 5mg test dose. However, a few minutes later, she developed pulseless electrical arrest. The woman underwent cardiopulmonary resuscitation, and spontaneous circulation was achieved. An echocardiogram showed a severely enlarged and dysfunctional RV. A pulmonary angiogram revealed elevated pulmonary artery pressures. During resuscitation, she was intubated and ventilated and initiated on inhaled nitric oxide, with significant improvement in pulmonary pressures. She also treated with milrinone in the intensive care unit; however, it was weaned off over 72 hours. One week later, she was discharge and did well. On follow-up, no further episodes of paroxysmal atrial tachycardia were noted. Lee JZ, et al. To the Editor-Hemodynamic collapse following protamine sulfate: The impact of acute pulmonary vasoconstriction. HeartRhythm Case Reports 6: 547, No. 8, 803501017 Aug 2020. Available from: URL: http://doi.org/10.1016/j.hrcr.2020.04.023
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Reactions 12 Sep 2020 No. 1821
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