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Zhang J, Zou Y, Chen X, Pan J, Yu H, Wang Y, Wu Y, Zou H. Extremely dangerous hypopituitarism related long QT syndrome and transient ST-segment elevation: A case report. SAGE Open Med Case Rep 2023; 11:2050313X221147194. [PMID: 36636098 PMCID: PMC9829875 DOI: 10.1177/2050313x221147194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023] Open
Abstract
Acquired long QT syndrome caused by hypopituitarism and transient ST-segment elevation has not been reported in cardiac arrest patients. We report a case of extremely dangerous acquired long QT syndrome and transient ST-segment elevation. A 44-year-old Chinese woman with renal failure experienced sudden cardiac arrest in the haemodialysis room. Subsequent electrocardiogram showed QT prolongation and transient ST-segment elevation. This patient's medical history, subsequent laboratory results and pituitary magnetic resonance imaging suggested hypopituitarism. Transient ST-segment elevation on the electrocardiogram was considered to be caused by repeated direct current shocks. The patient was diagnosed with acquired long QT syndrome and was not taking any antiarrhythmic drugs. Her corrected QT interval normalized after hormone replacement therapy. This case highlights the importance of the awareness of hypopituitarism; early identification and intervention can prevent the occurrence of this life-threatening arrhythmia. ST-segment elevation is not always due to acute myocardial infarction, and a variety of other causes, especially electrical cardioversion, should be considered.
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Affiliation(s)
- Jia Zhang
- Department of Inspection Medical, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China
| | - Yingying Zou
- Digestive System Department, The Third Affiliated Hospital of Qiqihar Medical College, Qiqihar, China
| | - Xiaoshu Chen
- Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China
| | - Jingye Pan
- Department of General and Intensive Care Medical, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haizhu Yu
- Department of General Practice, Zhejiang Hospital, Hangzhou, China
| | - Yi Wang
- Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China
| | - Yanran Wu
- Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China
| | - He Zou
- Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China,He Zou, Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou 325035, Zhejiang, China.
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Viskin S, Chorin E, Viskin D, Hochstadt A, Schwartz AL, Rosso R. Polymorphic Ventricular Tachycardia: Terminology, Mechanism, Diagnosis, and Emergency Therapy. Circulation 2021; 144:823-839. [PMID: 34491774 DOI: 10.1161/circulationaha.121.055783] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Polymorphic ventricular tachyarrhythmias are highly lethal arrhythmias. Several types of polymorphic ventricular tachycardia have similar electrocardiographic characteristics but have different modes of therapy. In fact, medications considered the treatment of choice for one form of polymorphic ventricular tachycardia, are contraindicated for the other. Yet confusion about terminology, and thus diagnosis and therapy, continues. We present an in-depth review of the different forms of polymorphic ventricular tachycardia and propose a practical step-by-step approach for distinguishing these malignant arrhythmias.
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Affiliation(s)
- Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Dana Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Arie Lorin Schwartz
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
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Cardoso AF, Akamine MAV, Pessoa RM, Takitani ET, Kairiyama JV, Naritoni MK. Spiked Helmet Sign: An Atypical Case of Transient ST-Segment Elevation on ECG. Arq Bras Cardiol 2021; 116:1165-1168. [PMID: 34133605 PMCID: PMC8288532 DOI: 10.36660/abc.20201017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/14/2020] [Accepted: 01/27/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Acácio F Cardoso
- Serviço de Cardiologia do Hospital Nipo-Brasileiro , São Paulo , SP - Brasil
| | | | - Rafael M Pessoa
- Serviço de Cardiologia do Hospital Nipo-Brasileiro , São Paulo , SP - Brasil
| | | | - José V Kairiyama
- Serviço de Cardiologia do Hospital Nipo-Brasileiro , São Paulo , SP - Brasil
| | - Manfredo K Naritoni
- Serviço de Cardiologia do Hospital Nipo-Brasileiro , São Paulo , SP - Brasil
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Abdalla KAS, Sorgente A, Brugada P. Transient appearance of Brugada-like Type 1 electrocardiogram pattern immediately after biphasic synchronized electrical cardioversion for atrial fibrillation: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:1-8. [PMID: 32123800 PMCID: PMC7042143 DOI: 10.1093/ehjcr/ytz198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/16/2019] [Accepted: 10/09/2019] [Indexed: 11/14/2022]
Abstract
Background ST-segment deviation post-electrical cardioversion is a common finding amongst a significant number of patients. However, the mechanism by which this phenomenon occurs and its clinical implications are not fully understood. Case summary Four patients presented to our department with complaints of palpitations. They were found to have atrial fibrillation and were cardioverted using a synchronized direct current shock at 200 J. However, their telemetry immediately after the shock showed transiently an ST-segment elevation resembling Brugada Type 1 pattern. All telemetries normalized within 6 s from cardioversion. Discussion Through this report, we aim to raise mild concern about a possible safety issue related to synchronized electrical cardioversion with electrodes positioned in an anteroposterior fashion. Also, we try to give a pathophysiological explanation to this finding on the base of the knowledge accumulated through the years on Brugada syndrome.
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Affiliation(s)
- Khalid A S Abdalla
- Academic Affairs, Mafraq Hospital, Bani Yas, PO Box 2951, Abu Dhabi, United Arab Emirates
| | - Antonio Sorgente
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi Global Market Square, 112412 Abu Dhabi, United Arab Emirates
| | - Pedro Brugada
- Cardiovascular Division, Free University of Brussels (UZ Brussel) VUB, Avenue du Laerbeek 101, 1090 Jette, Brussels, Belgium.,CEO Medical Centre Prof. Brugada, Brusselse Steenweg 161, 9300 Aalst, Belgium.,Arrhythmia Unit, Hospiten Estepona, Carretera Nacional 340, Km. 162, 29680 Estepona, Málaga, Spain
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Divanji P, Badhwar N, Goldschlager N. Post-cardioversion ST-segment elevation: a case-based review of the pathophysiology. J Thorac Dis 2017; 9:5503-5506. [PMID: 29312760 DOI: 10.21037/jtd.2017.11.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Punag Divanji
- Division of Cardiology, University of California, San Francisco, California, USA
| | - Nitish Badhwar
- Division of Cardiology, University of California, San Francisco, California, USA
| | - Nora Goldschlager
- Division of Cardiology, University of California, San Francisco, California, USA
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ST-segment Elevation Following Cardioversion of Atrial Fibrillation in the Emergency Department: Unmasked Myocardial Infarction due to Left Main Coronary Artery Plaque Rupture or Unspecific Finding? CAN J EMERG MED 2016; 19:312-316. [PMID: 27619976 DOI: 10.1017/cem.2016.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atrial fibrillation (AF) is a frequent reason for emergency department visits. According to current guidelines either rate- or rhythm-control are acceptable therapeutic options in such situations. In this report, we present the complicated clinical course of a patient with AF and a rapid ventricular response. Because of paroxysmal AF, the patient was on chronic oral anticoagulation therapy with warfarin. Pharmacological treatment was ineffective to control ventricular rate, and immediate synchronized electrical cardioversion was performed. One hour later, the patient complained of chest pain in combination with marked ST-segment elevation in the anterior leads. Cardiac catheterization with optical coherence tomography disclosed plaque rupture in the left main coronary artery without other significant stenosis. Stent implantation was performed successfully. During the course of the hospital stay, the patient remained asymptomatic and the ST-segment elevations resolved. However, despite treatment with amiodarone it was not possible to keep the patient permanently in sinus rhythm. Therefore, a biventricular pacemaker was implanted and AV node ablation performed.
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