Adrenal adenoma presenting with torsade de pointes--a case report

Lethal Arrhythmia Induced by Severe Hypokalemia with Primary Aldosteronism: A Case Report and Literature Review

A 26-year-old woman experienced sudden loss of consciousness with respiratory arrest while engaged in a heated conversation shortly after consuming a carbohydrate-rich meal; she was resuscitated immediately. Severe hypokalemia became evident and was deemed to have caused lethal arrhythmia. She was diagnosed with a left aldosterone-producing adenoma and achieved remission following partial adrenalectomy. Primary aldosteronism is frequently complicated by hypokalemia; however, hypokalemia-induced lethal arrhythmias are rare. Clinicians should recognize that primary aldosteronism can potentially cause sudden death in apparently healthy individuals; hence, an early diagnosis and proper treatment are critical.

Relationship With Calcium, Nutrition Risk, QTc Interval, Tp-e Interval, and Tp-e/QTc Ratio of Critical Care Patients

BACKGROUND

To our knowledge, there are studies related to QTc interval in critical care patients whose nutrition scores are evaluated but no studies evaluating T-wave peak and end interval (Tp-e interval), Tp-e/QT ratio, and Tp-e/QTc ratio, used to evaluate cardiac arrhythmia risk and ventricular repolarization change rates. Therefore, we aimed to investigate whether there is a change in Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients whose nutrition scores are evaluated.

METHODS

This study was planned as a retrospective cross-sectional study. Forty-four patients with a risk score of ≤3 were defined as low-risk group, and 45 patients with a score of ≥4 were defined as high-risk group. Forty-five healthy patients of similar age and gender were included in the control group. All patients underwent 12-lead electrocardiography (ECG). The Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were measured on ECG. The study data were grouped as patients with high Nutritional Risk Screening 2002 (NRS-2002) risk score, low NRS-2002 risk score, and healthy control.

RESULTS

QTc interval, Tp-e interval, and Tp-e/QTc ratios were significantly higher in patients with high nutrition risk. In a correlation analysis, Tp-e interval and Tp-e/QTc ratio were found to be independently associated with calcium, corrected calcium, and serum albumin level.

CONCLUSION

QTc interval, Tp-e interval, and Tp-e/QTc ratios are significantly increased in patients with high nutrition risk score compared with healthy people and are independently associated with calcium and serum albumin levels; thus, they can be used more effectively in the follow-up of cardiac fatal arrhythmias.

Aldosteronism with mild hypokalemia presenting as life-threatening ventricular arrhythmias: A case report

RATIONALE

Primary aldosteronism (PA) with hypokalemia increases the risk of life-threatening ventricular arrhythmias. Cases of PA with malignant arrhythmia as the first symptom have been reported. The role of severe hypokalemia in triggering malignant ventricular arrhythmia is well documented. However, few cases of PA with mild hypokalemia that presented with life-threatening ventricular tachycardia have been reported.

PATIENT CONCERNS

A 74-year-old man was admitted to our hospital 25 hours after suffering from syncope caused by ventricular tachycardia without chest pain. Electrocardiogram showed ST segment depression and T wave inversion in leads III, avF, V4-V6. Mild QT prolongation was observed during sinus rhythm. Blood tests showed mild hypokalemia and elevated plasma aldosterone level. Abdominal computed tomography showed a nodule in the left adrenal gland. Coronary angiography revealed stenosis in the right coronary artery.

DIAGNOSIS

Prolonged QT interval, hypokalemia, high level plasma aldosterone, a nodule in the left adrenal gland and right coronary artery stenosis led to a diagnosis of aldosterone hyperplasia and adrenal nodule with ischemic heart disease.

INTERVENTION

Intravenous potassium and magnesium were administered to correct hypokalemia and a stent was implanted in the right coronary artery for vascularization. A prescription aldosterone receptor antagonist, spironolactone, was prescribed for hyperaldosteronemia.

OUTCOMES

During 6 months of follow-up, no episodes of ventricular tachycardia or syncope occurred, and serum potassium level remained normal.

LESSONS

In patients with ventricular tachycardia and mild hypokalemia, physicians need to consider that PA and ischemia heart disease may be one of the possible causes of electrical storm.

Torsade de pointes--a rare presentation of primary hyperaldosteronism

Primary aldosteronism was the most common form of endocrine hypertension resulting in hypertension, metabolic alkalosis, and hypokalemia. Ventricular arrhythmia in association with primary hyperaldosteronism is an uncommon presentation that has previously been described in literature. We presented one case of torsades de pointes due to primary hyperaldosteronism.

QT interval is prolonged but QT dispersion is maintained in patients with primary aldosteronism

The relationship between QT duration and its dispersion in patients with primary hyperaldosteronism is not clearly known. We studied 26 patients (nine males and 17 females) with primary hyperaldosteronism. The serum potassium levels were low (2.32 +/- 0.52 mmol/l), did not correlate with serum renin or aldosterone levels, or aldosterone/renin ratio (ARR). The maximum QT intervals (QTmax) were prolonged (502 +/- 62 ms), correlated well with ARRs (p = 0.005) and aldosterone levels (p = 0.019), but not to renin (p = 0.517) or potassium levels (p = 0.196). The QT dispersions (QTd) were small (60 +/- 28.8 ms) and did not correlate with potassium, renin or aldosterone levels. QTmax but not QTd correlate with aldosterone levels in patients with primary aldosteronism. The maintenance of repolarisation homogeneity with relatively unchanged QT dispersion may contribute to our understanding of the clinical observation that ventricular tachydysrhythmia is rare among patients with primary aldosteronism.