Key result
Severe hypokalemia from over-diuresis triggers recurrent VF in CHF, resolving with potassium replacement.
Why the study?
Ventricular tachyarrhythmias are a preventable cause of death in heart failure, where prevalent hypokalemia can trigger ventricular arrhythmias.
Case Report (n=1)
No
This case highlights the critical importance of careful medication reconciliation and electrolyte monitoring to prevent severe hypokalemia and subsequent life-threatening ventricular arrhythmias in heart failure patients on diuretics.
Urges close electrolyte monitoring in diuretic-treated HF; case report leaves open need for prospective prevention trials.
Ventricular tachyarrhythmias are common in patients with heart failure. It is one of the important preventable causes of death in these patient populations. Hypokalemia is prevalent in patients with heart failure due to various reasons. Hypokalemia can trigger ventricular arrhythmias through different mechanisms. In this case report, we present a middle-aged man with congestive heart failure (CHF) and an automated intracardiac defibrillator (AICD) on multiple diuretic medications (unintended) who presented with acute chest pain. He was found to have severe hypokalemia, hyponatremia, and an acute kidney injury. Interrogation of the AICD revealed multiple episodes of ventricular fibrillation. The patient was managed by holding his diuretic medications, cautious volume repletion, and potassium replacement. Fortunately, the patient showed rapid clinical improvement and his plasma potassium level improved. On discharge, we reconciled the patient's medications to avoid the recurrence of hypokalemia from over-diuresis and arranged a close follow-up outpatient visit with his cardiologist.
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Fargaly et al. (2023) conducted a case report in Congestive Heart Failure and Hypokalemia (n=1). Potassium replacement and holding diuretics was evaluated on Clinical improvement and resolution of hypokalemia. Severe hypokalemia from unintended over-diuresis triggered recurrent episodes of ventricular fibrillation in a 52-year-old man with congestive heart failure, which resolved with potassium replacement.
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