Drink, drugs, and the QT interval.

The effects of several prescription and illicitly-used drugs on electrocardiographic repolarization are well documented, most frequently manifested as prolongation of the corrected QT (QTc) interval. The combination of multiple repolarization-modulating drugs taken in high dosage can occasionally lead to extreme abnormalities of the QTc interval and ST-segment on the surface ECG, which can lead to the erroneous diagnosis of underlying myocardial ischemia and inappropriate treatment. We report on one such case in which the acute management of a syncopal patient was detrimentally influenced by misinterpretation of a very unusual ECG.

Cardiac and extracardiac abnormalities detected by cardiac magnetic resonance in a post-myocardial infarction cohort.

OBJECTIVES: All patients should undergo formal assessment of ventricular function following acute myocardial infarction (AMI). Cardiac magnetic resonance (CMR) is not widely used as a test before discharge in AMI patients. This study sought to determine the impact of contrast-enhanced CMR (ceCMR) scanning before discharge in addition to standard transthoracic echocardiography (TTE) on patient care following AMI. METHODS: 100 patients admitted with AMI, all of whom had a left ventricular ejection fraction (LVEF) <40% on TTE, underwent ceCMR imaging before discharge. Abnormalities of clinical relevance detected on ceCMR, which influenced patient management, are reported. RESULTS: Each patient (77% male, mean age 58.9 years, SD 12) underwent TTE and ceCMR at a mean 1.4 (range 0.8-3.2) and 4.2 days (range 2-11), respectively, following admission. ceCMR significantly influenced the management of 24/100 (24%) of the patient cohort, through detection of LV thrombus, right ventricular infarction, intracardiac neoplasia, and a variety of intrathoracic and intra-abdominal pathology. There were no issues regarding safety in this high-risk group of patients. CONCLUSION: In a cohort of AMI patients with reduced LVEF, ceCMR scanning before discharge improved the management of 24% of the cohort. ceCMR is a useful and safe adjunct to standard care after AMI.

Diagnosis and targeted percutaneous management of a critical subclavian artery stenosis in a patient with absent peripheral pulses with the use of cardiac computed tomography.

Current clinical practice dictates that invasive management strategies frequently are adopted in patients with both ST-segment elevation and non-ST-segment elevation acute coronary syndromes. Such strategies rely on obtaining vascular access and, as such, are not always technically feasible. We report a case in which cardiac computed tomography was used to great effect in the diagnostic and (targeted) interventional management of a patient who was the recipient of a previous coronary artery bypass grafting and presented with global myocardial ischemia, in whom the lack of peripheral pulses had previously rendered an early invasive strategy hazardous.