RESUMO
A 73-year-old woman first visited our emergency room with multiple syncopal attacks. Before admission, she had received an antibiotic (Garenoxacin) for 3 days from a local clinic. First electrocardiogram (ECG) showed no ST-segment deviation but mild QT interval prolongation with a positive U wave. Second ECG recording 3 h later showed slightly slower heart rate and revealed marked QTU interval prolongation suggesting the cause of her syncopal attacks. After cessation of Garenoxacin, the QTU interval prolongation shortened. However, both epinephrine infusion and treadmill exercise test reproduced similar QTU interval prolongation and T wave deformities. Later, genetic analysis demonstrated that this patient had a mutation in KCNH2 gene, and she was diagnosed as a type-2 long-QT syndrome which was accentuated by use of garenoxacin. At the emergency out-patient clinic, repetitive ECG recordings can be useful and should be considered in order to identify the cause of syncopal attacks in patients who were prescribed antibiotics and had mild QT interval abnormalities.
Assuntos
Antibacterianos/efeitos adversos , Eletrocardiografia , Serviço Hospitalar de Emergência , Fluoroquinolonas/efeitos adversos , Frequência Cardíaca/efeitos dos fármacos , Síndrome do QT Longo/diagnóstico , Síncope/induzido quimicamente , Agonistas Adrenérgicos/administração & dosagem , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Idoso , Canal de Potássio ERG1/genética , Epinefrina/administração & dosagem , Teste de Esforço , Feminino , Predisposição Genética para Doença , Humanos , Síndrome do QT Longo/complicações , Síndrome do QT Longo/tratamento farmacológico , Síndrome do QT Longo/genética , Síndrome do QT Longo/fisiopatologia , Metoprolol/uso terapêutico , Mutação , Fenótipo , Valor Preditivo dos Testes , Recidiva , Fatores de Risco , Síncope/diagnóstico , Síncope/fisiopatologiaRESUMO
A 33-year-old woman experienced near-syncope at a hospital. Electrocardiography revealed an intermittent ventricular rhythm. The echocardiogram at admission indicated mild hypokinesis and severe diffuse hypokinesis with reverse takotsubo cardiomyopathy on the following day. The patient experienced abdominal pain on the admission day, and computed tomography identified a large left adrenal mass. Her catecholamine levels increased remarkably on the third day. The wall motion improved on the twelfth day. The tumor was successfully resected and the patient was diagnosed with an ectopic pheochromocytoma. The ventricular rhythm with myocardial damage and hypotension induced by the reverse takotsubo cardiomyopathy masked the characteristic symptoms of pheochromocytoma.