RESUMEN
We present the case of a 67-year-old man with a carcinoma of the lung and a metastatic tumor of the heart. The diagnosis was made on the basis of echocardiogram. In this patient, the first and unique cardiac symptom was irreversible sustained ventricular arrhythmia leading to death.
Asunto(s)
Carcinoma de Células Escamosas/secundario , Neoplasias Cardíacas/secundario , Neoplasias Pulmonares/patología , Anciano , Arritmias Cardíacas/etiología , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/diagnóstico , Ecocardiografía , Resultado Fatal , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico , Humanos , Imagen por Resonancia Magnética , MasculinoRESUMEN
A 40-year-old man was referred to our Cardiology Unit because of three syncopal episodes. The ECG showed atrial fibrillation with a mean heart rate of 104 bpm. The patient was unable to maintain the upright position because of marked orthostatic hypotension associated with bradycardia and presyncope. Two days later the patient underwent direct current shock with sinus rhythm restoration. After the procedure both symptoms and orthostatic hypotension disappeared. A tilt test induced marked hypotension and bradycardia only after nitroglycerine. This is the first report of a patient with persistent atrial fibrillation associated with syncope caused by orthostatic hypotension and bradycardia. The patient's clinical features and positive tilt test only after nitroglycerine lead us to hypothesize that the arrhythmia plays a more important role in the etiology of symptoms with respect to autonomic impairment and that the pathophysiological mechanism responsible for these symptoms could be mainly the baroreceptor reflex.