This 79 year old gentleman, normally fit and well apart from deafness, was broght in by ambulance after community  VF arrest. He received one shock before emergency department, which was followed by a long pause before an episode of sinus tachycardia.

On arrival, GCS was 8. ABC was maintained. Anaesthetist on-call intubated. My role was to asses patient and to start initial management. I was no so sure the cause of cardiac arrest. CXR NAD. Electrolytes were normal. ECG showed sunus tachy and ? high take off or ST elevation. After discussed with cardiologist on-call, we agreed to start ACS protocol, but not for urgent PCI in view of time lapse.

He was in ICU for a few days. Echo was moderate LV impairment. Respiratory weaned off . The cardiologsit reviewed hima agian and suggested that no clear evidence of acute MI in repeat ECG and enzyme test. (Trop I already high since admitted) , but agreed to do cardiac catheter in view of unexplained cardiac arrest.

Angiography showed triple vessel disease. Clearly, he was a candidate for CABG.

He had opeartion 2 weeks later. He was well when discharged.