Case 37-2005: A 35-Year-Old Man with Cardiac Arrest while Sleeping

A 35-year-old man screamed during sleep and became unresponsive. Personnel from emergency medical services found him in ventricular fibrillation; normal rhythm was restored, but he did not regain consciousness. An electrocardiographic examination in the emergency department showed ST-segment elevation, and there was evidence of pseudoephedrine in the serum. The results of cardiac catheterization were normal. A diagnostic procedure was performed. A 35-year-old man screamed during sleep and became unresponsive. Personnel from emergency medical services found him in ventricular fibrillation. An electrocardiographic examination in the emergency department showed ST-segment elevation. Presentation of Case Dr. Alex Manini (Emergency Medicine): A 35-year-old man was brought to the emergency department of this hospital by ambulance after a cardiac arrest while sleeping. According to his partner and his brother, the patient had been in good health. His partner reported being awakened from sleep by a scream from the patient, who groaned once and then became unresponsive, with agonal breathing and a bluish skin color. The patient's partner called 911 and initiated mouth-to-mouth “rescue” breathing, but not chest compressions. Personnel from emergency medical services arrived at the scene 6 to 8 minutes later, approximately 11 . . .