[Atypical complaint in myocardial ischaemia: belching]. / Atípusos panasz myocardialis ischaemiában: böfögés.

While educating non-medical personnel on acute coronary syndrome we often emphasize the importance of early recognition and urgent transfer to acute cardiac center of patients with acute myocardial infarction. Aside from typical symptoms of chest tightness and pain radiating to shoulder, arm and jaw, angina often presents with atypical, non-cardiac complaints. These symptoms, often suggesting gastrointestinal problems, can sometimes mislead even the most experienced physicians. We would like to present the case of an 83-year-old woman with several decades long history of ischaemic heart disease, who recently developed a new anginal symptom: lound, uncontrollable belching. Within the past eight months she was admitted four times with complaints of belching followed by chest pain. Even though initially it was thought as an incidental finding, in all four cases she had proven coronary occlusion requiring cardiac intervention. Orv. Hetil., 2017, 158(5), 183-186.

[Takotsubo cardiomyopathy: a novel beta-adrenergic blocker withdrawal syndrome]. / Béta-blokkoló-megvonás okozta takotsubo cardiomyopathia.

The authors describe two cases of takotsubo cardiomyopathy developing after an abrupt withdrawal of carvedilol and bisoprolol. Takotsubo or stress cardiomyopathy is characterized by acute and reversible cardiac dysfunction without coronary artery disease. It is triggered by acute emotional or physical stress, drugs or drug withdrawal. The immediate discontinuation of the long acting vasodilator beta-blocker, carvedilol has not yet been described to cause takotsubo cardiomyopathy. The authors recommend cautious withdrawal of beta-blockers.

Therapeutic hypothermia-induced QT prolongation and "torsade de pointes" ventricular tachycardia / Terápiás hypothermia okozta QT-megnyúlás és "torsade de pointes" kamrai tachycardia.

Összefoglaló. A szerzok egy 44 éves, autoimmun betegségben szenvedo nobeteg kórlefolyását ismertetik. A váratlan kórházi kamrafibrillációt követo sikeres resuscitatio után a beteg comatosus állapotban maradt, ezért terápiás hypothermiában részesült. A hypothermiás kezelés hatására jelentos QT-megnyúlás és "torsade de pointes" kamrai tachycardia lépett fel. A hypothermia okozta szívritmuszavar oka a homérséklet-csökkenés kiváltotta QT-megnyúlás és korai utódepolarizációs mechanizmusú triggerelt aktivitás. A szerzok felhívják a figyelmet arra, hogy jelen tudásunk szerint enyhe hypothermiát javasolt alkalmazni az ajánlásban szereplo hypothermiás tartományon belül. Orv Hetil. 2022; 163(13): 523-526. Summary. The authors describe the course of disease in a 44-year-old female patient with autoimmune disease. After successful resuscitation following unexpected hospital ventricular fibrillation, the patient remained in a comatose state and therefore received therapeutic hypothermia. Hypothermic treatment resulted in significant QT prolongation and "torsade de pointes" ventricular tachycardia. The probable cause of arrhythmia is the QT prolongation caused by the hypothermia and the consequential early afterdepolarization and triggered activity. The authors draw attention to the fact that - to the best of our knowledge - milder hypothermia is recommended within the preset hypothermic range. Orv Hetil. 2022; 163(13): 523-526.

Syncope as the only symptom of SARS-CoV-2 infection / Syncope mint a SARS-CoV-2-fertozés egyedüli tünete

Összefoglaló. Egy 61 éves, SARS-CoV-2-fertozött, traumás syncopés nobeteg rosszullétének hátterében orthostaticus hypotonia igazolódott. A vírusfertozés megszunése után az orthostaticus hypotonia megszunt, de a posturalis tachycardia fennmaradt. A syncopénak egyéb okát kimutatni nem tudtuk. A SARS-CoV-2-fertozésnek egyéb tünete, illetve szervi manifesztációja nem volt. Tudomásunk szerint ez az elso eset, amelyben a SARS-CoV-2-infekció egyedüli tünete a syncope. Orv Hetil. 2021; 162(7): 243-245. Summary. Orthostatic hypotension was demonstrated in the background of malaise in a 61-year-old SARS-CoV-2 infected female traumatic syncope. After cessation of the virus infection, orthostatic hypotension resolved, but postural tachycardia persisted. No other cause of syncope could be detected. There were no other symptoms or organ manifestations of SARS-CoC-2 infection. To our knowledge, this is the first case where the only symptom of SARS-CoV-2 virus infection is syncope. Orv Hetil. 2021; 162(7): 243-245.

[A new ECG marker of anterior acute myocardial infarction]. / Az akut anterior myocardialis infarctus új EKG-jele.

ST-segment elevation is the hallmark of acute transmural myocardial ischemia caused by acute occlusion of a coronary artery. ST-segment elevation is the major criterion for the patients with chest pain to immediate reperfusion therapy. Despite its clinical importance, the mechanism of ST-elevation remains unclear. Two patients are reported with proximal left anterior descending coronary occlusion but without ST-segment elevation. The distinct ECG patterns were tall, with symmetrical T-waves and upsloping and digoxin-like ST-segment depression. Patients with these ECG patterns need immediate coronary intervention.

[ECG pearl: transient De Winter sign]. / EKG-gyöngyszem: tranziens De Winter-jel.

A 42-year-old man is presented with acute coronary syndrome and De Winter ECG sign. The De Winter sign is a rare ECG manifestation of proximal LAD occlusion. The ECG sign was misinterpreted and the patient was transmitted to our percutan coronaria intervention centrum with 3 hours delay. The hyperacute T-waves and the precordial ST-depressions disappeared, but the biomarkers showed a marked elevation. Coronary angiography revealed LAD proximal thrombotic dissection treated with a drug-eluting stent. The authors suggest that in patients with this ECG pattern the immediate coronary intervention is the best treatment. Orv Hetil. 2019; 160(43): 1711-1713.

[Transient left ventricular dysfunction: special form of stress cardiomyopathy]. / Reverzibilis, stressz indukálta cardiomyopathiak.

INTRODUCTION: The phenomenon of stress induced left ventricular dysfunction has been long recognised. A special reversible form of it, characterized by left ventricular apical dilatation, is the so-called "tako-tsubo" or ampoule cardiomyopathy, based on its first description by Sato et al. in 1990. The tako-tsubo cardiomyopathy and stress cardiomyopathy are considered almost equivalent in the referring publications. METHODS: Retrospective analysis of patient data between 2002 and 2007: these patients suffered from transient left ventricular dysfunction and coronary artery disease and myocarditis were disclosed. RESULTS: 6 female patients between 55 and 80 years. In 5 of 6 cases the different forms of stress could be found before the patients were admitted to our department. CONCLUSIONS: The presented cases shed light to the fact that the apical dilatation of the left ventricle is only one of the possible presentations of stress induced cardiomyopathy. The main feature of this entity is not the tako-tsubo-like left ventricular dilatation, which is not always present, but the almost universal QT prolongation and negative T waves. These ECG features come a few days after the appearance of the reversible left ventricular dysfunction.

[Reverse Takotsubo syndrome pattern induced by local anaesthesia]. / Reverz Takotsubo-szindróma lokális anesztézia után.

We report a new entity of the Takotsubo syndrome. While the classic form of Takotsubo syndrome presents as transient apical ballooning, in reverse Takotsubo syndrome we see just the opposite, i.e. transient dilatation of the basal segments and a hyperkinetic apex. The reverse Takotsubo phenomenon was seen in a 36-year-old female patient who had an injection of lidocaine with adrenaline for plastic surgery of the ear. Coronary artery disease was excluded as the cause of this patient's prolonged chest pain and troponin positivity. Echocardiography revealed akinesis of the basal segments and a hyperkinetic apex. The wall motion abnormalities resolved in three days.

Massive pulmonary embolism causing large T-wave inversion and QT prolongation.

We present a case of massive pulmonary embolism where the electrocardiogram (ECG) demonstrated transient T-wave inversion and marked QT-prolongation. The pathomechanism and clinical significance of these changes are discussed.

[Acute myocardial infarction triggered by salbutamol in asthma bronchiale]. / Salbutamollal kapcsolatos akut myocardialis infarctus asthma bronchialeban.

The authors report the case of an 77-year-old woman with no evidence of previous cardiac disease who developed a non-Q-wave myocardial infarction after beta2-mimetic treatment for the exacerbation of her chronic bronchial asthma. After the five dose of salbutamol spray she developed chest pain. The electrogram showed ST segment elevation in leads I-aVL-V4-6. Urgent coronary angiography showed only non significant left anterior coronary artery stenosis (20%). A subsequent echocardiogram also revealed anterolateral hypokinesia and acute reversible left ventricular dysfunction (LVEF:30%). Both troponin T concentration and creatine kinase rose. Next day in the lateral leads negative T-waves developed with QT-prolongation and without pathologic Q-waves. Although myocardial infarction and acute reversible left ventricular dysfunction is a rare complication following beta2 mimetic treatment one should use high-dose beta2-agonists with caution.

N-terminal pro-brain natriuretic peptide and tombstoning ST-segment elevation in patients with anterior wall acute myocardial infarction.

Tombstoning ST-segment elevation myocardial infarction (STEMI) has been associated with a poor prognosis ever since Wimalaratna's first description of this clinical entity, and the reasons for this are not fully understood. We studied 87 consecutive patients who had anterior STEMI (January 2004 to September 2004) to compare the form of STEMI, coronary anatomy, and initial N-terminus pro-brain natriuretic peptide (NT-pro-BNP) level. Patients who had tombstoning STEMI had higher levels of NT-pro-BNP despite significant differences in cardiac enzyme levels or extent of coronary disease. This finding suggests that, in addition to changing the shape of repolarization, decreased microcirculation plays a role in the development of increased wall tension. Increased wall tension in turn is the probable cause of higher NT-pro-BNP levels and increased mortality.

[Malignant arrhythmias caused by hyperkalemia: a new area of drug-induced electrolyte abnormalities]. / Hyperkalaemia okozta malignus ritmuszavarok: a gyógyszer indukálta elektrolitzavarok új korszaka.

INTRODUCTION: High dose of angiotensin converting enzyme inhibitor is indicated in the treatment of heart failure and it is part of the treatment in the patients suffering from diabetes mellitus and nephropathy. The patients with preexisting renal insufficiency could have slowly elevated serum potassium level treated by angiotensin converting enzyme inhibitor. PATIENTS: Seven acute admitted cases is presented with severe hyperkalaemia and life threatening arrhythmias caused by ACEI administration. Wide QRS accelerated rhythm was detected in two cases and bradyarrhythmias in five cases. Two patients died among the bradyarrhythmias. CONCLUSIONS: The authors call the attention of danger of high dose angiotensin converting enzyme inhibitor in patients with preexisting renal insufficiency and concomittant drugs elevating serum potassium level.