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Peer-reviewedCC BY-NC-ND 4.0JACC Case Reports

Pulseless Ventricular Tachycardia With Propofol Infusion Syndrome in Severe Acute Respiratory Distress Syndrome

  • Haffiz Emamalie1
  • Srihita Patibandla2
  • Gulaab Brar3
  • Robert Neamtu3
  • Ali Zia Ansari4
  • Sarah Faress1
  • Joey Davis1
  • Abbas Musaji1
  • Jerry Hyer5
5 affiliations
  1. 1Department of Emergency Medicine, Merit Health Wesley, Hattiesburg, Mississippi, USA
  2. 2Department of Internal Medicine, Trinity Health Grand Rapids, Grand Rapids, Michigan, USA
  3. 3Department of Internal Medicine, William Carey University College of Osteopathic Medicine, Hattiesburg, Mississippi, USA
  4. 4Department of Family Medicine, Prisma Health Tuomey Hospital, Sumter, South Carolina, USA
  5. 5Department of Pulmonology and Critical Care Medicine, Merit Health Wesley, Hattiesburg, Mississippi, USA
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Abstract

Background: Propofol Infusion Syndrome (PRIS) is a rare, potentially fatal complication of prolonged or high-dose propofol exposure characterized by mitochondrial dysfunction, rhabdomyolysis, metabolic derangements, and cardiovascular collapse. The classically described mode of cardiac death is bradycardia progressing to asystole.

Case Summary: A previously healthy 21-year-old woman presented 5 days after a vaginal delivery with severe acute respiratory distress syndrome requiring sedation with propofol escalated to 100 μg/kg/min. She developed rhabdomyolysis, acute kidney injury, hyperkalemia, acidosis, and progressive ventricular ectopy that evolved into pulseless ventricular tachycardia. Propofol was stopped, and continuous renal replacement therapy was arranged, but the patient experienced cardiac arrest before initiation. No arrhythmias occurred after metabolic correction.

Discussion: This case highlights pulseless ventricular tachycardia as a rare cardiac manifestation of PRIS with evolving metabolic abnormalities before cardiovascular collapse occurs.

Take-Home Messages: Rhabdomyolysis and hyperkalemia during prolonged propofol therapy should prompt evaluation for PRIS. Early propofol discontinuation and aggressive metabolic correction may prevent fatal ventricular arrhythmias.

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Cite

BibTeXRIS
BibTeX
@article{emamalie2026pulseless,
  title = {{Pulseless Ventricular Tachycardia With Propofol Infusion Syndrome in Severe Acute Respiratory Distress Syndrome}},
  author = {Haffiz Emamalie and Srihita Patibandla and Gulaab Brar and Robert Neamtu and Ali Zia Ansari and Sarah Faress and Joey Davis and Abbas Musaji and Jerry Hyer},
  journal = {JACC Case Reports},
  year = {2026},
  month = nov,
  doi = {10.1016/j.jaccas.2026.110253},
  url = {https://doi.org/10.1016/j.jaccas.2026.110253},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Pulseless Ventricular Tachycardia With Propofol Infusion Syndrome in Severe Acute Respiratory Distress Syndrome
AU  - Haffiz Emamalie
AU  - Srihita Patibandla
AU  - Gulaab Brar
AU  - Robert Neamtu
AU  - Ali Zia Ansari
AU  - Sarah Faress
AU  - Joey Davis
AU  - Abbas Musaji
AU  - Jerry Hyer
PY  - 2026
DA  - 2026/11/04
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.110253
UR  - https://doi.org/10.1016/j.jaccas.2026.110253
AB  - Background: Propofol Infusion Syndrome (PRIS) is a rare, potentially fatal complication of prolonged or high-dose propofol exposure characterized by mitochondrial dysfunction, rhabdomyolysis, metabolic derangements, and cardiovascular collapse. The classically described mode of cardiac death is bradycardia progressing to asystole.  Case Summary: A previously healthy 21-year-old woman presented 5 days after a vaginal delivery with severe acute respiratory distress syndrome requiring sedation with propofol escalated to 100 μg/kg/min. She developed rhabdomyolysis, acute kidney injury, hyperkalemia, acidosis, and progressive ventricular ectopy that evolved into pulseless ventricular tachycardia. Propofol was stopped, and continuous renal replacement therapy was arranged, but the patient experienced cardiac arrest before initiation. No arrhythmias occurred after metabolic correction.  Discussion: This case highlights pulseless ventricular tachycardia as a rare cardiac manifestation of PRIS with evolving metabolic abnormalities before cardiovascular collapse occurs.  Take-Home Messages: Rhabdomyolysis and hyperkalemia during prolonged propofol therapy should prompt evaluation for PRIS. Early propofol discontinuation and aggressive metabolic correction may prevent fatal ventricular arrhythmias.
SN  - 2666-0849
ER  -