tag:blogger.com,1999:blog-549949223388475481.post3746009962381846916..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Repost: 63 minutes of ventricular fibrillation, followed by shock. What is going on?Unknownnoreply@blogger.comBlogger3125tag:blogger.com,1999:blog-549949223388475481.post-70559695595406477122020-07-01T12:08:49.336-05:002020-07-01T12:08:49.336-05:00I have just heard back from Dr. Adrian Baranchuk, ...I have just heard back from Dr. Adrian Baranchuk, who co-authored the Circulation manuscript that you reference. He consulted lead author Dr. Derek Crinion. From Dr. Crinion — “Authors of Ref. #2 explain that immediately after the ablation, the patient developed non-sustained PMVT and SHS. They hypothesized that the ablation itself caused acute central sympathetic activation. Within hours the ECG normalized, and the patient had NO further VT or SHS. In the longterm sympathetic blockade would reduce the QT, risk of VA and SHS.” — From Dr. Baranchuk — “Even when counterintuitive, ANS ablation can produce ANS storm.” BOTTOM LINE ( = My Synthesis of the above Comments by Drs. Crinion and Baranchuk) — The fact that stellate ganglion ablation may initially (within the first few hours) precipitate sympathetic “storm”, and that this WAS accompanied by brief appearance right after the ablation of the Spiked Helmet Sign DOES support the theory that a “hyperadrenergic state” IS associated with SHS. But long-term — there is sympathetic blockade which reduces the risk of subsequent PMVT (and hopefully results in improved longterm outcome.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-930853690310196622020-06-28T14:54:41.727-05:002020-06-28T14:54:41.727-05:00Thanks for your comment. Please take a look at the...Thanks for your comment. Please take a look at the Addendum that I just now wrote on the Spiked Helmet Sign = SHS (I wrote this today, which was after you had submitted your question). I tried to synthesize my understanding of the proposed pathophysiology for SHS. That said — I agree with your comment. I also don't understand why persistence of Spiked Helmet Sign after stellate block (that should reduce sympathetic tone) would support a hyperadrenergic mechanism for causing SHS. I’ve referred your question to Dr. Adrian Baranchuk (corresponding author of the Circulation article), as well as to Dr. Smith. I’ll let you know their response.ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-60996616968687555642020-06-28T10:12:54.551-05:002020-06-28T10:12:54.551-05:00In your post on the SHS there is a reference to th...In your post on the SHS there is a reference to the Circulation article. This states that it is thought to be due to hyperadrenergic tone but then states that there are reports of SHS occuring with stellate ganglion blockade. This doesn't make sense to me - stellate ganglion blockade will decrease sympathetic tone and so I would think that if anything this would get rid of a SHS. Am I interpreting this wrong? Thanks again for posting, as always.Anonymoushttps://www.blogger.com/profile/12064432725132724281noreply@blogger.com