RESUMO
Pacemaker lead fracture is one of the most common causes of pacemaker malfunction and is most frequently associated with weight lifting or chest trauma. These patients usually present with symptoms of dizziness, syncope, chest discomfort, and palpitations or less commonly with extracardiac symptoms. Diagnosis is made by ECG and careful review of chest imaging such as chest X-ray or fluoroscopy. Treatment involves placement of a new lead with or without extraction of the fractured lead. We present an interesting case of complete severance of the tip of a dual-chamber pacemaker's atrial lead after a high-velocity theme park ride. In our case, the fracture occurred during amusement park rides and went undiagnosed until the patient presented for routine pacemaker evaluation. This case indicates that extreme physical forces in the absence of direct trauma, such as during amusement park rides, may result in lead fractures and patients with pacemakers should be cautioned regarding such activities.
RESUMO
A variety of cardiomyopathies are due to familial disease. Most are primarily associated with cardiac involvement and can lead to hypertrophic, dilated, or restrictive cardiomyopathy. Myotonic dystrophy (MD) is a multisystem disease with autosomal dominant inheritance and variable penetrance. Cardiac diseases are important causes of morbidity and mortality in MD patients. Patients with primary MD should be carefully investigated with an electrocardiogram, stress test, and an echocardiogram to identify preclinical cardiac involvement and to prevent life-threatening complications. Any new onset of atrial flutter or atrial fibrillation in a young patient without any underlying cardiac abnormality should be investigated for underlying myopathy. The authors report on a male adolescent with MD who presented with atrial flutter. The patient had been diagnosed with MD at birth. He had an impaired ejection fraction of 38% to 45%. The patient described sharp chest pain in the retrosternal area, with no radiation, that was induced by exercise.
Assuntos
Flutter Atrial/diagnóstico , Ablação por Cateter , Distrofia Miotônica/diagnóstico , Adolescente , Flutter Atrial/etiologia , Flutter Atrial/terapia , Dor no Peito/diagnóstico , Humanos , Masculino , Distrofia Miotônica/complicações , Distrofia Miotônica/genética , Fatores de Risco , Volume SistólicoRESUMO
Marfan's syndrome is a common connective tissue disease with different musculoskeletal, ophthalmic and cardiac manifestations. Marfan's patients carry increased risk for cardiac arrhythmias. Only three cases of atrial flutter in Marfan's patients are described in the literature. We report a fourth case of a young Marfan's patient who presents with typical atrial flutter after motor vehicle accident. After electrical cardioversion, sinus rhythm was restored but he had recurrent atrial flutter on follow up. The patient then underwent electrophysiological study and successful radiofrequency catheter ablation of the flutter circuit. Since discharge, the patient has had no documented arrhythmias on follow up.
Assuntos
Flutter Atrial/etiologia , Flutter Atrial/cirurgia , Ablação por Cateter , Síndrome de Marfan/complicações , Acidentes de Trânsito , Adulto , Anticoagulantes/uso terapêutico , Humanos , MasculinoRESUMO
A 74-year old white man was undergoing treatment with palliative chemotherapy for Stage IV Prostate Adenocarcinoma with multiple osteoblastic metastases. He was started on intravenous Zoledronic acid for reduction of bone pain and prevention of skeletal complication from multiple bone metastases. Four days after intravenous Zoledronic acid, the patient presented to emergency room with complaints of carpopedal spasm and bronchospasm. On admission, serum calcium and albumin was 3.5 mg/dl and 3.7 g/dl respectively. QT interval was more than 500 m sec. The patient was started on intravenous calcium gluconate. He received 174 gm of intravenous calcium for total of 12 days. His serum calcium returned to a normal range in three months with Vitamin D and calcium supplement. Before starting Zoledronic acid therapy, the patient's serum calcium level was 6.9 mg/dl.
Assuntos
Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Reabsorção Óssea/prevenção & controle , Difosfonatos/efeitos adversos , Hipocalcemia/induzido quimicamente , Imidazóis/efeitos adversos , Adenocarcinoma/patologia , Idoso , Difosfonatos/administração & dosagem , Humanos , Imidazóis/administração & dosagem , Masculino , Dor/tratamento farmacológico , Neoplasias da Próstata/patologia , Ácido ZoledrônicoRESUMO
We report a patient with an evidence of bilateral calf deep vein thrombosis, hemodynamically significant pulmonary embolism, and echocardiographic evidence of right heart thromboemboli with "popcorn" appearance. She responded well to thrombolytics and low molecular weight heparin with resolution of symptoms and improvement of echocardiographic abnormalities.