Post-Cardiac Arrest: Understanding the Complications of Recovery After Psychosis and Brain Injury
Background: A 49-year-old male with a congenital heart condition known as complete heart block has been reliant on a pacemaker since the age of 19, with his device and leads being replaced in 2015. In recent years, he has been inconsistent with regular medical follow-ups, although he continued his cholesterol medication but neglected his blood pressure treatment. Incident Summary: Last Wednesday morning marked a critical event. The exact duration of his cardiac arrest is unknown, but it is estimated to be under five minutes. Emergency services were contacted promptly, leading to around three minutes of CPR before paramedics arrived, who utilized defibrillation twice to restore his pulse. Upon arrival at the hospital, he was intubated and placed under an intensive cooling protocol aimed at safeguarding his brain during his ICU stay. Although a CT scan conducted in the emergency room yielded normal results, multiple EEGs showed no seizure activity. An MRI could not be performed due to his pacemaker and unstable condition while sedated. By Monday, August 18, he was successfully weaned off sedation and extubated. He demonstrated awareness, albeit with some slowness and confusion, expressing gratitude to visitors, eating and drinking normally, and even requesting personal grooming items. Remarkably, he could identify his caregivers and engage in coherent conversations, recalling their names. However, that evening, despite being administered Benadryl and melatonin, he experienced insomnia. On Tuesday, he underwent an angiogram under fentanyl and Versed sedation, which, according to the medical team, had minimal impact on his consciousness. The angiogram revealed no arterial blockages, prompting a decision to transfer him to a facility equipped for advanced cardiac care, where he could receive a complete pacemaker extraction and replacement with a defibrillator. That night, despite receiving Ambien and trazodone, he continued to struggle with sleep. By Wednesday morning, he exhibited signs of hallucination, consistently recognizing his nurses and maintaining conversations without difficulty, but I sensed a gradual decline in his mental state. Following his transfer to the new hospital that evening, we observed him hallucinating once more, though less severely than earlier in the day. He described events that were untrue, indicating further cognitive deterioration. Upon returning the following morning, it was evident he had not consumed food or liquids. A speech therapist assessed him, discovering he could no longer use a straw, a skill he had managed all week. Unusual tongue posturing was also noted. His ability to communicate had deteriorated, and throughout the day, various physicians assessed his awareness of current time, location, birthday, and name, with his responses becoming increasingly incorrect. We consulted with several specialists including his hospitalist, neurologist, speech therapist, dermatologist due to a rash on his fingers, and psychiatrist. An EEG was performed, and he is currently undergoing a CT scan. In a surprising turn of events, his echocardiogram revealed a return to normal cardiac function, but his scheduled surgery might be postponed due to his mental decline. Conclusion: I understand his brain endured a period of oxygen deprivation, yet I am perplexed that he initially appeared stable upon awakening, only to see his condition worsen over the course of four days. If anyone has experience with similar cases, I would appreciate insights into whether this decline can be attributed to brain injury resulting from his cardiac arrest. Does it resonate that his condition would deteriorate as such post-recovery? Medical professionals are contemplating metabolic causes and psychosis, but it seems they are inclined to attribute the developments solely to the cardiac event, without considering the recent progression of his symptoms. Many thanks for taking the time to read this. Your perspectives would be greatly valued.
Answers (1)
8/22/2025, 12:22:17 AM
OpenHealth AI
It's understandable to feel overwhelmed when navigating the complexities of medical recovery, especially following a serious incident like cardiac arrest. The decline you are witnessing may be related to various factors, including brain injury due to oxygen deprivation, metabolic disturbances, and potential psychological effects from the stress of his condition.
Explanation:
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Hypoxic-Ischemic Injury: After a cardiac arrest, even for a short duration, brain cells can suffer due to lack of oxygen. Initially, a patient may seem stable but, over days, complications can arise as brain cells continue to struggle or swell, affecting cognitive function and behavior.
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Metabolic and Medication Effects: His medical history indicates the possibility of metabolic imbalances, especially given his inconsistent management of blood pressure and cholesterol. Medications, especially sedatives like Ambien and trazodone, can also complicate recovery by causing confusion or hallucinations.
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Psychosis and Delirium: Post-cardiac arrest, patients can experience delirium, a state of confusion and agitation, sometimes leading to hallucinations. This is not uncommon and may be exacerbated by isolation, medications, or changes in environment.
Next Steps:
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Close Monitoring: Ensure he is closely monitored for changes in mental status, nutritional intake, hydration, and medication effects. Regular assessments by a healthcare team can help identify and manage any further decline.
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Nutrition and Hydration Support: Encourage nutrition and hydration—consider working with a speech therapist or dietitian to facilitate eating and drinking safely, especially if he struggles with using a straw or verbal communication.
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Neurological and Metabolic Evaluation: Await results from ongoing diagnostic tests (CT scan, EEG) to assess brain function and rule out metabolic causes. Engaging a neurologist to interpret these findings and consider a comprehensive neuropsychological assessment can be beneficial.
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Engagement and Comfort: Providing familiarity and social interactions can aid in mental stimulation — try to involve family members in his care, as stability in familiar surroundings can help mitigate some psychological effects.
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Medication Review: Collaborate with physicians to review all medications to ensure they align with his current needs and conditions, minimizing sedative effects while managing his symptoms.
This situation requires ongoing support and coordination among healthcare providers and family members for both physical and mental health stabilization. Your involvement is crucial, and advocating for his needs may significantly impact his recovery trajectory.
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