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1.
Medicine (Baltimore) ; 100(14): e25370, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832121

RESUMO

RATIONALE: Dual atrioventricular node non-reentrant tachycardia (DAVNNRT) is a rare arrhythmia. We present a case of inappropriate implantable cardioverter defibrillator (ICD) therapy caused by DAVNNRT. DAVNNRT is easily misdiagnosed as atrial fibrillation and is often identified as ventricular tachycardia (VT) by the supraventricular tachycardia-ventricular tachycardia (SVT-VT) discriminator of the ICD. PATIENT CONCERNS: A 73-year-old man with ischemic heart disease (IHD) presented with palpitations accompanied by dyspnea and syncope. Frequent multifocal premature ventricular beats and non-sustained ventricular tachycardia were observed on ambulatory electrocardiography. The left ventricular ejection fraction decreased to 32%. DIAGNOSIS: He was diagnosed with IHD, heart failure with reduced ejection fraction (HFrEF), and VT. INTERVENTIONS: : Initially, the patient received a single-chamber ICD implantation for secondary prevention of sudden death. He then suffered from inappropriate anti-tachycardia pacing (ATP)/shock therapy many times after the procedure. DAVNNRT was confirmed in an electrophysiology study (EPS), and radiofrequency ablation of the slow pathway successfully terminated this tachycardia. OUTCOMES: No episode of inappropriate ICD therapy or tachycardia occurred during the follow-up. LESSONS: In conclusion, it is essential to have a full understanding of DAVNNRT and eliminate slow pathways for patients with DAVNNRT and be prepared to implant an ICD.


Assuntos
Desfibriladores Implantáveis/estatística & dados numéricos , Insuficiência Cardíaca/diagnóstico , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia , Idoso , Eletrofisiologia Cardíaca/métodos , Desfibriladores Implantáveis/efeitos adversos , Erros de Diagnóstico , Eletrocardiografia Ambulatorial/métodos , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Isquemia Miocárdica/complicações , Ablação por Radiofrequência/métodos , Volume Sistólico/fisiologia , Taquicardia Supraventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia
2.
Adv Clin Exp Med ; 30(3): 279-288, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33754502

RESUMO

BACKGROUND: Prediction of sudden cardiac death remains a significant challenge. There is some evidence that ventricular ectopic activity could be regarded as a predictive marker. OBJECTIVES: We carried out an analysis to explore whether premature ventricular complexes (PVCs) are a risk factor in implantable cardioverter-defibrillator (ICD) interventions. MATERIAL AND METHODS: The study method was a RR interval series analysis (n = 184) of arrhythmic events and controls from the ICD. Study group consisted of patients with a mean age of 55 ±27 years; 74% of them were male, 85% were secondary prevention patients, 62% had coronary artery disease (CAD), 15% hypertropic cardiomyopathy (HCM), 15% dilated cardiomyopathy (DCM), and 8% diseases of other etiology. The mean follow-up time was 64 months (range: 3-126 months). The study population was divide into patients with at least 1 appropriate intervention ventricular tachycardia/ventricular fibrillation (VT/VF) (group A, n = 101) and controls without interventions (group B, n = 83). The number of PVC/4000 RR cycles, the shortest coupling intervals between a PVC and preceding R as well as the number of PVCs of very short (180-220 ms), short (220-280 ms) and different cycle lengths (CL) as well as the incidence of short-long-short (SLS) sequences were compared. RESULTS: The number of PVCs/4000 RR cycles was significantly higher in group A (263 ±32 compared to 43 ±17, p < 0.0001). The mean shortest PVC CL was significantly shorter in group A (320 ±13 compared to 400 ±38, p = 0.029). The number of PVCs with a very short CL was 1 ±0.4 compared to 0.1 ±0.1 (p = 0.028). The number of PVCs with a short CL was 5 ±1.2 compared to 0.6 ±0.4 (p = 0.0007) in groups A and B, respectively. The incidence of SLS sequences was significantly higher in group A than in group B (67 (94% of patients) and 4 (33% of patients) respectively (p < 0.0001)). CONCLUSIONS: Significant differences were found in the characteristics of PVCs and SLS sequences between patients with appropriate ICD interventions and controls. A newly developed basic computer program called PCRR was applied for RR interval analysis. This simple method could be a predictor of PVC burden and life-threatening arrhythmias in different populations.


Assuntos
Desfibriladores Implantáveis , Taquicardia Ventricular , Complexos Ventriculares Prematuros , Adulto , Idoso , Idoso de 80 Anos ou mais , Morte Súbita Cardíaca/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/terapia , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/terapia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/terapia
3.
Int Heart J ; 62(2): 224-229, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33731515

RESUMO

This study aimed to evaluate the characteristics and prognosis of patients with vasospastic angina (VSA) diagnosed by a provocation test with a secondary prevention implantable cardioverter defibrillator (ICD), compared with patients with organic coronary stenosis. We retrospectively evaluated 309 consecutive patients who received an ICD implantation between January 2010 and March 2018 in our institutions. Of these patients, 206 were implanted with an ICD for secondary prevention. In these 206 patients, 40 with VSA and 72 with organic coronary stenosis were evaluated. Patients with VSA were characterized by younger age (56.1 ± 13.1 versus 69.2 ± 9.5 years, respectively), and a lower prevalence of diabetes (15.0% versus 40.3%, respectively) and heart failure (2.5% versus 26.4%, respectively) than patients with organic coronary stenosis (P < 0.001). Using the Kaplan-Meier analysis, with the VSA group as the reference, the incidence of appropriate ICD shock was similar between the two groups (hazard ratio, 0.85; 95% confidence interval, 0.341-2.109; P = 0.722). The incidence of ventricular fibrillation was significantly higher in the VSA group (hazard ratio, 0.22; 95% confidence interval, 0.057-0.814; P = 0.024), whereas the incidence of major adverse cardiac events, including cardiac death, nonfatal myocardial infarction, hospitalization for unstable angina pectoris, and heart failure, was significantly higher in the organic coronary stenosis group (hazard ratio, 13.1; 95% confidence interval, 1.756-98.17; P = 0.012). In conclusion, patients with VSA with an ICD implanted for secondary prevention have a higher risk of ventricular fibrillation and lower risk of major adverse cardiac events than patients with organic coronary stenosis.


Assuntos
Vasoespasmo Coronário/diagnóstico , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Medição de Risco/métodos , Prevenção Secundária/métodos , Taquicardia Ventricular/terapia , Idoso , Vasoespasmo Coronário/complicações , Vasoespasmo Coronário/prevenção & controle , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taquicardia Ventricular/complicações
4.
Int Heart J ; 62(2): 427-431, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33731522

RESUMO

In this study, we present a case of a 22-year-old female with a family history of syncope, suffering from recurrent syncope since childhood. She had an obvious prolonged QTc interval of up to 651 ms, a bifid T wave pattern on electrocardiogram, and torsade de pointes, corresponding to a syncope episode. Additionally, her echocardiogram showed left ventricular non-compaction in the apex. After treatment with mexiletine, the QTc interval has been observed to shorten immediately, and the T wave morphology recovered. A similar effect was also observed in her mother and young sister. Administration of propranolol prolonged her QTc interval. Target sequencing of candidate genes revealed a missense mutation in the pore area of the hERG protein, coded by KCNH2. We diagnosed this as a case of type 2 long QT syndrome in which mexiletine could be effective in shortening the QTc interval.


Assuntos
Eletrocardiografia/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Síndrome do QT Longo/tratamento farmacológico , Mexiletina/farmacologia , Taquicardia Ventricular/complicações , Função Ventricular Esquerda/fisiologia , Antiarrítmicos/farmacologia , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Síndrome do QT Longo/etiologia , Síndrome do QT Longo/genética , Linhagem , Taquicardia Ventricular/fisiopatologia , Adulto Jovem
5.
Orv Hetil ; 162(12): 468-470, 2021 Mar 21.
Artigo em Húngaro | MEDLINE | ID: mdl-33764024

RESUMO

Összefoglaló. Egy 78 éves férfi széles-QRS-tachycardiás esetét mutatjuk be. A betegnél a pitvar-kamrai disszociáció igazolta a ritmuszavar kamrai eredetét, amelyet a Valsalva-manoverrel több alkalommal is átmenetileg meg lehetett szüntetni. A szerzok ismertetik a manover lehetséges patomechanizmusait, illetve felhívják a figyelmet arra, hogy a vagusmanoverre megszuno reguláris tachycardia nem jelent feltétlenül supraventricularis eredetet. Orv Hetil. 2021; 162(12): 468-470. Summary. A 78-year-old man is presented with wide QRS tachycardia (WQRST). The ventricular origin of WQRST was confirmed by atrioventricular dissociation. The Valsalva maneuver terminated the tachycardia repeatedly. The authors discuss the possible mechanisms of Valsalva maneuver in the arrhythmia termination. This case highlights that Valsalva maneuver or carotid massage terminated tachycardia are not necessarily supraventricular tachycardia. Orv Hetil. 2021; 162(12): 468-470.


Assuntos
Taquicardia Ventricular , Manobra de Valsalva , Idoso , Eletrocardiografia , Humanos , Masculino , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/prevenção & controle
6.
Int Heart J ; 62(1): 135-141, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33518652

RESUMO

Although it is well known that patients with hypertrophic cardiomyopathy (HCM) have serious adverse events, such as life-threatening arrhythmia and heart failure, the prediction of such evens is still difficult. Recently, it has been reported that one of the causes of these serious adverse events is microvascular dysfunction, which can be noninvasively evaluated by employing cardiac magnetic resonance (CMR) imaging.We analyzed 32 consecutive HCM patients via CMR imaging and myocardial scintigraphy and divided them into two groups: ventricular tachycardia (VT) group and non-VT group. Myocardial perfusion studies were conducted quantitatively using the QMass® software, and each slice image was divided into six segments. The time-intensity curve derived from the perfusion image by CMR imaging was evaluated, and the time to 50% of the peak intensity (time 50% max) was automatically calculated for each segment.Although no difference was observed in various parameters of myocardial scintigraphy between the two groups, the VT group exhibited a higher mean of time 50% max and wider standard deviation (SD) of time 50% max in each segment than the non-VT group. The cutoff values were obtained by the receiver operating characteristic curves derived from the mean of time 50% max and SD of time 50% max. The two groups divided by the cutoff values exhibited significant differences in the occurrence of serious adverse events.CMR imaging may be useful for predicting serious adverse events of patients with HCM.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Imagem por Ressonância Magnética , Imagem de Perfusão do Miocárdio , Taquicardia Ventricular/diagnóstico por imagem , Adulto , Idoso , Cardiomiopatia Hipertrófica/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taquicardia Ventricular/etiologia
7.
Herzschrittmacherther Elektrophysiol ; 32(1): 21-26, 2021 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-33533995

RESUMO

The advances in imaging and 3D mapping systems in the last decade allowed a better correlation of ventricular premature contractions (PVCs) with anatomical structures. With regard to PVCs, interpretation of the 12-lead ECG is still crucial for the management of patients and the planning of therapies. Although there is an armamentarium of indices and algorithms to exactly pinpoint the origin of a PVC in advance, a thorough understanding of cardiac anatomy and impulse propagation, together with an awareness of the surface ECGs limitations, provides a sufficiently close approximation. PVCs from the diaphragmatic part of the ventricular cavae exhibit a superiorly directed axis, whereas PVCs from superior parts of the heart show an inferior axis. A right bundle branch block morphology or positive concordance of the precordial leads yields a high probability of left ventricular origin of a PVC. A left bundle branch block morphology is indicative of a right ventricular or septal origin of a PVC. Using the transition zone, one can estimate the origin of a PVC with regard to anterior or posterior regions of the heart: A late precordial transition is indicative of a right ventricular origin, an early precordial transition suggests a left ventricular focus. An absent transition in the sense of negative concordance is indicative for an apical origin. The intertwined course of the ventricular outflow tracts makes PVC localization more difficult. Here, shape and height of the R­wave in V1-V3 help to narrow the origin down. PVCs from structures like the papillary muscles, the moderator band or infundibular bands are challenging to interpret and evidence of the limitations of the surface ECG. Based on the information gained by the aforementioned approach, a prediction of prognosis and possible treatment success is possible.


Assuntos
Ablação por Cateter , Taquicardia Ventricular , Complexos Ventriculares Prematuros , Bloqueio de Ramo , Eletrocardiografia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Taquicardia Ventricular/cirurgia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/cirurgia
9.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563689

RESUMO

A 67-year-old African-American woman with remote history of complete heart block (s/p pacemaker 3 years ago) and recent onset of ventricular tachycardia (VT) (s/p VT ablation and cardiac resynchronisation therapy defibrillator upgrade 3 months ago) presented to the hospital with VT storm. Workup showed newly reduced left ventricular ejection fraction with global hypokinesis (20%) and restrictive physiology. Positive technetium pyrophosphate scan was suspicious for TTR amyloid while serological workup revealed a monoclonal gammopathy. Cardiac MRI was contraindicated given remote brain aneurysm clip. Given clinical suspicion for cardiac sarcoidosis and divergent non-invasive workup, endomyocardial biopsy was performed which showed non-necrotising granulomas consistent with cardiac sarcoidosis. She was started on steroids with clinical improvement. Cardiac sarcoidosis is a challenging clinical diagnosis, particularly in patients without extracardiac manifestations. This case highlights the importance of a detailed and thorough workup of non-ischaemic cardiomyopathy and being cognizant of infiltrative disease as it can change patient management and outcomes.


Assuntos
Cardiomiopatias/diagnóstico , Sarcoidose/diagnóstico , Taquicardia Ventricular/diagnóstico , Idoso , Biópsia , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/patologia , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Sarcoidose/tratamento farmacológico , Sarcoidose/patologia , Esteroides/uso terapêutico
10.
Ann Thorac Surg ; 111(4): e295-e296, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33419566

RESUMO

Cardiac sympathetic denervation (CSD) for refractory ventricular tachycardia (VT) has been shown to decrease VT recurrence and defibrillator shocks in patients with ischemic and nonischemic cardiomyopathy. Here and in the accompanying Video, we demonstrate the technique for minimally invasive CSD, highlight important technical points, and report surgical outcomes. CSD is accomplished through bilateral resection of the inferior one-third to one-half of the stellate ganglion en bloc with T2-T4 sympathectomy. Despite the high potential for perioperative risk, most patients do not have serious complications. We find that surgical CSD can be performed safely in an attempt to liberate patients from refractory VT.


Assuntos
Ganglionectomia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca/fisiologia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Taquicardia Ventricular/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/fisiopatologia , Vértebras Torácicas
11.
Arch Cardiovasc Dis ; 114(2): 140-149, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33478860

RESUMO

Ventricular tachycardia has a significant recurrence rate after ablation for several reasons, including inaccessible substrate. A non-invasive technique to ablate any defined areas of myocardium involved in arrhythmogenesis would be a potentially important therapeutic improvement if shown to be safe and effective. Early feasibility studies of single-fraction stereotactic body radiotherapy have demonstrated encouraging results, but rigorous evaluation and follow-up are required. In this document, the basic concepts of stereotactic body radiotherapy are summarized, before focusing on stereotactic arrhythmia radioablation. We describe the effect of radioablation on cardiac tissue and its interaction with intracardiac devices, depending on the dose. The different clinical studies on ventricular tachycardia radioablation are analysed, with a focus on target identification, which is the key feature of this approach. Our document ends with the indications and requirements for practicing this type of procedure in 2020. Finally, because of the limited number of patients treated so far, we encourage multicentre registries with long-term follow-up.


Assuntos
Ventrículos do Coração/efeitos da radiação , Radiocirurgia , Taquicardia Ventricular/radioterapia , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Animais , Feminino , Frequência Cardíaca , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiocirurgia/efeitos adversos , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento
12.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431453

RESUMO

Mitochondrial diseases are rare, often go undiagnosed and can lead to devastating cascades of multisystem organ dysfunction. This report of a young woman with hearing loss and gestational diabetes illustrates a novel presentation of a cardiomyopathy caused by a previously described mutation in a mitochondrial gene, MT-TL1. She initially had biventricular heart dysfunction and ventricular arrhythmia that ultimately recovered with beta blockade and time. She continues to participate in sport without decline. It is important to keep mitochondrial diseases in the differential diagnosis and understand the testing and management strategies in order to provide the best patient care.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Cardiomiopatias/diagnóstico , Miopatias Mitocondriais/diagnóstico , RNA de Transferência de Leucina/genética , Taquicardia Ventricular/genética , Adulto , Cardiomiopatias/complicações , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/genética , Angiografia Coronária , Análise Mutacional de DNA , Diagnóstico Diferencial , Ecocardiografia , Feminino , Testes Genéticos , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Artes Marciais/fisiologia , Miopatias Mitocondriais/complicações , Miopatias Mitocondriais/tratamento farmacológico , Miopatias Mitocondriais/genética , Mutação , Taquicardia Ventricular/diagnóstico , Resultado do Tratamento , Troponina/sangue
13.
Cardiol Young ; 31(3): 344-351, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33407975

RESUMO

The COVID-19 pandemic has had a huge influence in almost all areas of life, affecting societies, economics, and health care systems worldwide. The paediatric cardiology community is no exception. As the challenging battle with COVID-19 continues, professionals from the Association for the European Paediatric and Congenital Cardiology receive many questions regarding COVID-19 in a Paediatric and Congenital Cardiology setting. The aim of this paper is to present the AEPC position on frequently asked questions based on the most recent scientific data, as well as to frame a discussion on how to take care of our patients during this unprecedented crisis. As the times are changing quickly and information regarding COVID-19 is very dynamic, continuous collection of evidence will help guide constructive decision-making.


Assuntos
Antiarrítmicos/uso terapêutico , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Cardiopatias Congênitas/terapia , Fatores Imunológicos/uso terapêutico , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Síndrome de Brugada/tratamento farmacológico , Síndrome de Brugada/epidemiologia , Síndrome de Brugada/fisiopatologia , /fisiopatologia , Procedimentos Cirúrgicos Cardíacos , Cardiologia , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/fisiopatologia , Transplante de Coração , Humanos , Transmissão Vertical de Doença Infecciosa , Síndrome do QT Longo/tratamento farmacológico , Síndrome do QT Longo/epidemiologia , Síndrome do QT Longo/fisiopatologia , Miocardite/epidemiologia , Miocardite/fisiopatologia , Miocárdio , Pediatria , Medição de Risco , Sociedades Médicas , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Taquicardia Ventricular/tratamento farmacológico , Taquicardia Ventricular/epidemiologia , Taquicardia Ventricular/fisiopatologia
14.
Praxis (Bern 1994) ; 110(1): 19-21, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33406936

RESUMO

CME ECG 67/Answers: Arrhythmia on Exertion Abstract. Ventricular tachycardias are potentially life-threatening cardiac arrhythmias with a heart rate >100 beats/min, originating from the specific conduction system below the His or the ventricular myocardium. The morphology of the surface ECG can provide valid information about the underlying mechanism and the associated cardiac disorder. The according pathomechanism is of paramount importance for further management. This article is intended to provide an insight into the various causes and treatment options as well as the differential diagnosis of ventricular tachycardias.


Assuntos
Esforço Físico , Taquicardia Ventricular , Arritmias Cardíacas/diagnóstico , Eletrocardiografia , Sistema de Condução Cardíaco , Humanos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia
16.
Medicine (Baltimore) ; 100(1): e24225, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429817

RESUMO

RATIONALE: Primary cardiac lymphoma is a rare tumor, especially a tumor located in coronary sinus (CS). The most common symptom of cardiac tumors is dyspnea, accounting for 64%, followed by chest pain, accounting for 26%. However, the cases with paroxysmal supraventricular tachycardia (SVT) as a major clinical presentation are extremely rare. PATIENT CONCERNS: We report a 55-year-old female patient with primary CS lymphoma and paroxysmal SVT. DIAGNOSES: After the surgical resection, pathology revealed the evidence of diffuse large B-cell lymphoma. INTERVENTIONS: The patient underwent chemotherapy after CS tumor resection. OUTCOMES: The patient was disease-free during the 6-month follow-up. LESSONS: CS enlargement may be the cause of SVT. Echocardiography should focus on the CS section to arrive at the right diagnosis.


Assuntos
Seio Coronário , Linfoma de Células B/diagnóstico , Taquicardia Ventricular/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos , Linfoma de Células B/complicações , Linfoma de Células B/diagnóstico por imagem , Pessoa de Meia-Idade , Taquicardia Ventricular/etiologia
18.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495177

RESUMO

Pheochromocytoma occasionally engenders catecholamine-induced hypertension crisis. Pheochromocytoma is clinically identified in 0.1%-5.7% of patients with neurofibromatosis type 1 (NF1), which is 10 times more frequently than in healthy individuals. This report describes a case of newly diagnosed NF1 presenting with pheochromocytoma crisis, with severe electrolyte depletion and deteriorating recurrent ventricular tachycardia storm. Characteristic skin lesions such as café-au-lait macules and neurofibromas contributed to the diagnosis of NF1 and pheochromocytoma. No recurrence of electrolyte depletion was found after the adrenalectomy. Primary care physicians must distinguish the characteristic skin lesions of NF1, such as café-au-lait macules and neurofibromas and recognise the risk for pheochromocytoma.


Assuntos
Neurofibromatose 1/diagnóstico , Feocromocitoma/diagnóstico , Taquicardia Ventricular/terapia , Desequilíbrio Hidroeletrolítico/terapia , 3-Iodobenzilguanidina , Adrenalectomia , Alcoolismo/complicações , Catecolaminas/urina , Cloretos/sangue , Humanos , Hipopotassemia/etiologia , Hipopotassemia/metabolismo , Hipopotassemia/terapia , Hiponatremia/etiologia , Hiponatremia/metabolismo , Hiponatremia/terapia , Hipofosfatemia/etiologia , Hipofosfatemia/metabolismo , Hipofosfatemia/terapia , Masculino , Metanefrina/urina , Pessoa de Meia-Idade , Feocromocitoma/complicações , Feocromocitoma/metabolismo , Feocromocitoma/cirurgia , Cintilografia , Compostos Radiofarmacêuticos , Taquicardia Ventricular/etiologia , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/metabolismo
20.
Am J Cardiol ; 143: 125-130, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33352208

RESUMO

Cardiac involvement in amyloidosis is associated with a poor prognosis. Data on the burden of arrhythmias in patients with cardiac amyloidosis (CA) during hospitalization are lacking. We identified the burden of arrhythmias using the National Inpatient Sample (NIS) database from January 2016 to December 2017. We compared patient characteristics, outcomes, and hospitalization costs between CA patients with and without documented arrhythmias. Out of 5,585 hospital admissions for CA, 2,020 (36.1%) had concurrent arrhythmias. Propensity-score matching for age, sex, income, and co-morbidities was performed with 1,405 CA patients with arrhythmias and 1,405 patients without. The primary outcome of all-cause mortality was significantly higher in CA patients with arrhythmia than without(13.9% vs 5.3%, p-value <0.001). Atrial fibrillation (AF) was the most common (72.2%) arrhythmia in CA patients with concurrent arrhythmia. The secondary outcomes of AF-related mortality (11.95% vs 9.16%, p-value = 0.02) and acute and acute on chronic as heart failure (HF) exacerbation (32.38% vs 24.91%, p-value <0.0001) were significantly higher in CA and concurrent arrhythmia compared with CA patients without. The total length of hospital stay (6[3 to 12] vs 5[3 to 10], p-value <0.001) and cost of hospitalization were ($ 15,086[7,813 to 30,373] vs $ 12,219[6,865 to 23,997], p-value = 0.001) were significantly greater among CA with arrhythmia compared with those without. These data suggest that the presence of arrhythmias in CA patients during hospital admission is associated with a poorer prognosis and may reflect patients with a higher risk of HF exacerbation and mortality.


Assuntos
Amiloidose/epidemiologia , Arritmias Cardíacas/epidemiologia , Cardiomiopatias/epidemiologia , Custos Hospitalares/estatística & dados numéricos , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/mortalidade , Flutter Atrial/epidemiologia , Estudos de Casos e Controles , Comorbidade , Progressão da Doença , Feminino , Parada Cardíaca/epidemiologia , Bloqueio Cardíaco/epidemiologia , Insuficiência Cardíaca/epidemiologia , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Taquicardia Supraventricular/epidemiologia , Taquicardia Ventricular/epidemiologia , Estados Unidos/epidemiologia , Fibrilação Ventricular/epidemiologia , Adulto Jovem
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