When Every Second Counts: Cardiac Arrest Reversed, Life Restored

A 58-year-old male with diabetes, hypertension, and dyslipidaemia arrived at BSH's Emergency Department complaining of severe substernal chest pain. Within moments of arrival, he collapsed — pulseless. The Code Blue team responded immediately, initiating Advanced Cardiac Life Support (ACLS). Return of Spontaneous Circulation (ROSC) was successfully achieved.

Emergent coronary angiography revealed a critical occlusion of the Left Anterior Descending (LAD) artery — the vessel responsible for supplying the majority of the heart's left ventricle. The patient was transferred directly to the cardiac catheterisation laboratory where our team performed successful Primary Percutaneous Coronary Intervention (PCI) with coronary stent implantation, restoring blood flow to the threatened myocardium.

The patient was stabilised in the ICU on minimal inotropic support, which was successfully weaned within 12 hours. He made a complete neurological and haemodynamic recovery, was mobilised gradually on guideline-directed medical therapy, and was discharged home in stable condition.

This case carries an important clinical message: jaw pain, often dismissed as a dental problem, can represent referred pain from cardiac ischaemia. Three days before his collapse, this patient had undergone a dental procedure for severe toothache — underscoring the critical importance of considering cardiac causes in patients presenting with jaw or facial pain, particularly those with cardiovascular risk factors.

Key Learning Points:

• Acute LAD occlusion may present with sudden cardiac arrest — immediate Code Blue activation is life-saving.
• Jaw pain can be referred cardiac pain; a dental diagnosis must never divert attention from potential ischaemia.
• Rapid ROSC followed by emergent primary PCI offers excellent survival and neurological outcomes.
• Coordinated multidisciplinary care — Emergency, Cardiology, Critical Care, and the Cath Lab team — is the cornerstone of STEMI management.

Credits: Case managed and reported by Dr. Shaikh Swalehin Bux, Consultant Interventional Cardiology, BSH Apollo Heart Center