Management of Rhabdo

Has anyone actually ever seen or heard of stone heart happening?

Apollyon said:

Has anyone actually ever seen or heard of stone heart happening?

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Yeah, one of my attendings was telling me he did it to a patient once... K was up but didn't knwo they were on Dig (they had AMS)... said it was pretty impressive...

Q

Pardon the SMS question (silly medical student) but what is stone heart?

Thanks and take care,
Jeff

Stone Heart is impairment of diastolic relaxation. Since digoxin increases myocardial contractility by increasing intracellular calcium, added calcium may increase this effect. Digoxin prevents the calcium from leaving the cell through the Ca/Na antiporter. The extra calcium is stored in the SR inside the cell so more is released with each depolarization, thus giving a stronger contraction. Overwhelming the mechanisms which store Ca in the SR would lead to free calcium in the cytosol, which can't keep its hands off troponin. Thus you will have tetany of the heart muscle. High levels of potassium are somewhat protective in dig toxicity because they bind the same site as digoxin on the Na/K ATPase pump.

Giving Ca to someone on dig is pretty risky. In the scenario you mentioned (high K, not dig toxic per se, though serum levels would be expectably increased), I don't think that I would do it, preferring instead to get a neb of albuterol, insulin and D50, kayexelate enema, and dialysis ready as soon as possible. With serious EKG changes you could justify an amp or two of bicarb as well.

There are some case reports of "stone heart" in the literature, thought it occurs with alarming frequency among my ex-girlfriends.


'zilla

There've been so many girls that I've known
I've made so many cry and still I wonder why
Here comes the little girl
I see her walking down the street
She's all by herself
I try and knock her off her feet
But, she'll never break, never break, never break, never break
This heart of stone
Oh, no, no, this heart of stone

What's different about her? I don't really know
No matter how I try I just can't make her cry
'Cause she'll never break, never break, never break, never break
This heart of stone
Oh, no, no, no, this heart of stone

Don't keep on looking that some old way
If you try acting sad, you'll only make me glad
Better listen little girl
You go on walking down the street
I ain't got no love, I ain't the kind to meet
'Cause you'll never break, never break, never break, never break
This heart of stone
Oh, no, no, you'll never break this heart of stone darlin'
No, no, this heart of stone
You'll never break it darlin'
You won't break this heart of stone
Oh no no no
You better go
You better go home
'Cause you'll, you'll never break this heart of stone

--your friendly neighborhood rolling stone caveman