Pulseless Electrical Activity Clinical Presentation

  • Author: Sandy N Shah, DO, MBA, FACC, FACOI; Chief Editor: Jeffrey N Rottman, MD   more...
 
Updated: Dec 16, 2011
 

History and Physical Examination

Knowledge of prior medical conditions allows prompt identification and correction of reversible causes. For example, a debilitated patient who develops acute respiratory failure and then manifests pulseless electrical activity (PEA) may have a pulmonary embolus. If an elderly woman develops PEA 2-5 days after a myocardial infarction, a cardiac etiology should be considered (ie, cardiac rupture, recurrent infarction). History of prior drug intake is crucial, enabling prompt treatment of patients in whom drug overdose is suspected. The presence of PEA in the setting of trauma makes hemorrhage (hypovolemia), tension pneumothorax, and cardiac tamponade the more likely causes.

By definition, patients with pulseless electrical activity (PEA) have no pulse in the presence of organized electrical activity. The physical examination should focus on identification of reversible causes; for example, tracheal shift or the unilateral absence of breath sounds indicates tension pneumothorax, while normal lung sounds and distended jugular veins point to cardiac tamponade.

Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Sandy N Shah, DO, MBA, FACC, FACOI,  Cardiologist, Houston, Texas

Sandy N Shah, DO, MBA, FACC, FACOI, is a member of the following medical societies: American College of Cardiology, American College of Osteopathic Internists, and American Osteopathic Association

Disclosure: Nothing to disclose.

Coauthor(s)

Patrick O'Beirne, MD  Fellow in Cardiovascular Medicine, University of Massachusetts Memorial Medical Center

Patrick O'Beirne, MD is a member of the following medical societies: American College of Cardiology, American Medical Association, Massachusetts Medical Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Dionyssios A Robotis, MD, MPH, FACC  Clinical Associate Professor of Medicine, University of Massachusetts Medical School; Consulting Staff Cardiologist/Electrophysiologist, University of Massachusetts Memorial Medical Center

Dionyssios A Robotis, MD, MPH, FACC is a member of the following medical societies: American College of Cardiology, Cardiac Electrophysiology Society, Heart Rhythm Society, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Lawrence Rosenthal, MD, PhD, FACC, FHRS  Associate Professor of Medicine, Director, Section of Cardiac Pacing and Electrophysiology, Director of EP Fellowship Program, Division of Cardiovascular Disease, University of Massachusetts Memorial Medical Center

Lawrence Rosenthal, MD, PhD, FACC, FHRS is a member of the following medical societies: American College of Cardiology, American Heart Association, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD  Professor of Medicine and Pharmacology, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE)

Disclosure: Nothing to disclose.

Additional Contributors

Steven J Compton, MD, FACC, FACP Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals

Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, and Heart Rhythm Society

Disclosure: Nothing to disclose.

David S Marks, MD Director of Cardiac Catheterization Laboratory, Froedtert Memorial Lutheran Hospital; Associate Professor, Department of Internal Medicine, Section of Cardiology, Medical College of Wisconsin

David S Marks, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, American Medical Association, Medical Association of Georgia, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric Vanderbush, MD, FACC Chief, Department of Internal Medicine, Division of Cardiology, Harlem Hospital Center; Clinical Assistant Professor of Cardiology, Columbia University College of Physicians and Surgeons

Eric Vanderbush, MD, FACC is a member of the following medical societies: American College of Cardiology and American Heart Association

Disclosure: Nothing to disclose.

Sumit Verma, MD, FACC Staff Electrophysiologist, Cardiology Consultants, Pensacola Heart Institute

Sumit Verma, MD, FACC is a member of the following medical societies: American College of Cardiology

Disclosure: Nothing to disclose.

References

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  16. Kotak D. Comment on Grmec et al.: A treatment protocol including vasopressin and hydroxyethyl starch solution is associated with increased rate of return of spontaneous circulation in blunt trauma patients with pulseless electrical activity. Int J Emerg Med. Apr 2009;2(1):57-8. [Medline].

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