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Zkib J, Sattout R, Faour S, Haddad S, Bassut R, Swed W, Hritani S, Mansouer M, Ghabally M. Corticosteroid-induced bradycardia following high-dose methylprednisolone administration: a case report. Ann Med Surg (Lond) 2024; 86:6300-6302. [PMID: 39359755 PMCID: PMC11444592 DOI: 10.1097/ms9.0000000000002530] [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: 06/20/2024] [Accepted: 08/26/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction Besides their wide use in the clinical field due to their anti-inflammatory and immune-modulating effect, corticosteroids still have a lot of adverse effects. The most common adverse effects are hyperglycemia, hypertension, osteoporosis, psychosis, immunosuppression, weight gain, and hyperlipidemia. Another important side effect is cardiac arrhythmias. Case presentation We report a case of a 43-year-old woman with multiple sclerosis who developed symptomatic bradycardia after 3 days of treatment with a high dose of methylprednisolone. The patient received a dose of atropine and her bradycardia resolved after 36 h of stopping methylprednisolone. Discussion While tachyarrhythmias are more common, bradyarrhythmias such as bradycardia and premature atrial or ventricular contraction are rare but crucial to be considered. Conclusion Corticosteroid-induced bradycardia is usually in sinus rhythm and has an unknown etiology, possibly occurring at high and low doses. The majority of cases in the literature were asymptomatic and resolved spontaneously.
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Affiliation(s)
- Jwil Zkib
- Arab International University, Daraa, Syrian Arab Republic
| | - Raneem Sattout
- Faculty of Medicine, Aleppo University, Aleppo, Syrian Arab Republic
| | - Sabah Faour
- Faculty of Medicine, Aleppo University, Aleppo, Syrian Arab Republic
| | - Sultaneh Haddad
- Children’s University Hospital, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | | | - Wajd Swed
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Shahd Hritani
- Faculty of Medicine, Aleppo University, Aleppo, Syrian Arab Republic
| | - Milad Mansouer
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Mike Ghabally
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Aleppo, Aleppo, Syria
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2
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Ahmed M, Oyibo ST, Dalvi S, Cowell R. Hydrocortisone-induced symptomatic sinus bradycardia. Drug Ther Bull 2024; 62:93-95. [PMID: 38316449 DOI: 10.1136/dtb.2024.252878rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Mohammed Ahmed
- Department of Cardiology, Betsi Cadwaladr University Health Board, Wrexham, Gwynedd, UK
| | - Success Tobore Oyibo
- Department of Cardiology, Betsi Cadwaladr University Health Board, Wrexham, Gwynedd, UK
| | - Shailesh Dalvi
- Department of Cardiology, Betsi Cadwaladr University Health Board, Wrexham, Gwynedd, UK
| | - Richard Cowell
- Department of Cardiology, Betsi Cadwaladr University Health Board, Wrexham, Gwynedd, UK
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3
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Ahmed M, Oyibo ST, Dalvi S, Cowell R. Hydrocortisone-induced symptomatic sinus bradycardia. BMJ Case Rep 2022; 15:e252878. [PMID: 36375852 PMCID: PMC9664291 DOI: 10.1136/bcr-2022-252878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Steroids are commonly prescribed medications that have a wide range of adverse effects. Bradycardia is one of the rare but significant side effects of steroid use, and only a few cases have been reported with bradycardia as a side effect. In this report, we present a case of a woman in her early 50s who developed severe symptomatic sinus bradycardia following high-dose administration of intravenous hydrocortisone, initiated for acute exacerbation of Crohn's disease. Her symptoms entirely resolved after discontinuation of the steroid. This case highlights the importance of obtaining baseline ECG and cardiac monitoring in patients treated with pulsed high-dose steroids.
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Affiliation(s)
- Mohammed Ahmed
- Department of Cardiology, Betsi Cadwaladr University Health Board, Wrexham, Gwynedd, UK
| | - Success Tobore Oyibo
- Department of Cardiology, Betsi Cadwaladr University Health Board, Wrexham, Gwynedd, UK
| | - Shailesh Dalvi
- Department of Cardiology, Betsi Cadwaladr University Health Board, Wrexham, Gwynedd, UK
| | - Richard Cowell
- Department of Cardiology, Betsi Cadwaladr University Health Board, Wrexham, Gwynedd, UK
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4
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de Asmundis C, Pannone L, Lakkireddy D, Beaver TM, Brodt CR, Lee RJ, Sorgente A, Gauthey A, Monaco C, Overeinder I, Bala G, Almorad A, Ströker E, Sieira J, Brugada P, Chierchia GB, La Meir M, Olshansky B. Targeted Treatment of Inappropriate Sinoatrial Node Tachycardia Based on Electrophysiological and Structural Mechanisms. Am J Cardiol 2022; 183:24-32. [PMID: 36127177 DOI: 10.1016/j.amjcard.2022.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/01/2022]
Abstract
The purpose of this review is to determine the causal mechanisms and treatment of inappropriate sinoatrial tachycardia (IST), defined as a non-physiological elevation in resting heart rate. IST is defined as a resting daytime sinus rate >100 beats/minute and an average 24-hour heart rate >90 beats/minute. Potential causal mechanisms include sympathetic receptor hypersensitivity, blunted parasympathetic tone, or enhanced intrinsic automaticity within the sinoatrial node (SAN) pacemaker-conduction complex. These anomalies may coexist in the same patient. Recent ex-vivo near-infrared transmural optical imaging of the SAN in human and animal hearts provides important insights into the functional and molecular features of this complex structure. In particular, it reveals the existence of preferential sinoatrial conduction pathways that ensure robust SAN activation with electrical conduction. The mechanism of IST is debated because even high-resolution electroanatomical mapping approaches cannot reveal intramural conduction in the 3-dimensional SAN complex. It may be secondary to enhanced automaticity, intranodal re-entry, or sinoatrial conduction pathway re-entry. Different pharmacological approaches can target these mechanisms. Long-acting β blockers in IST can act on both primarily increased automaticity and dysregulated autonomic system. Ivabradine targets sources of increased SAN automaticity. Conventional or hybrid ablation may target all the described abnormalities. This review provides a state-of-the-art overview of putative IST mechanisms. In conclusion, based on current knowledge, pharmacological and ablation approaches for IST, including the novel hybrid SAN sparing ablation, are discussed.
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Affiliation(s)
- Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | | | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | | | - Randall J Lee
- Section of Cardiology, University of California at San Francisco, San Francisco, California
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Anaïs Gauthey
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Brian Olshansky
- Division of Cardiology, University of Iowa Hospitals, Iowa City, Iowa
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5
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İLDEMİR S, ERCAN BN, EKİN A, COŞKUN BN, PEHLİVAN Y, DALKILIÇ HE. A case of sinus bradycardia in a patient treated with pulse steroids for Adult-onset Still’s Disease. TURKISH JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.46310/tjim.1072983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Khandelwal K, Madathala RR, Chennaiahgari N, Yousuffuddin M. Steroid-Induced Sinus Bradycardia. Cureus 2021; 13:e15065. [PMID: 34141509 PMCID: PMC8205859 DOI: 10.7759/cureus.15065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Steroids are one of the most commonly used drugs and known to be associated with several side effects. There have been case reports about the associated sinus bradycardia with pulse dose corticosteroids administration both IV and oral. We present a case of asymptomatic sinus bradycardia associated with oral prednisone 40 mg. A 69-year-old male was admitted to the ICU for sepsis and subsequently was found to have gastrointestinal (GI) bleed. He developed an acute gout attack during hospitalization and was treated with prednisone 40 mg. Over the next 24 hours, the patient's heart rate dropped to 30s to 40s beats/minute while other vitals have remained stable. He was monitored on telemetry and review of the rhythm strips, as well as a 12-lead electrocardiogram (EKG), that showed sinus bradycardia; no pauses or atrio-ventricular (AV) nodal blocks were identified. The patient was not on any beta blocker or other therapies commonly associated with sinus bradycardia. His steroids were stopped while all other medications were continued. His heart rate slowly started to improve over the next 24 hours. He was not found to have any further episodes of bradycardia. Our case is unusual as we noted transient asymptomatic bradycardia with oral prednisone 40 mg dose. While bradycardia is reversible and may go unnoticed, it is important for the clinician to be aware of this adverse effect and include it in the list of potential differentials for bradycardia.
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7
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Shahidi-Dadras M, Pishgahi M, Tabary M, Kheradmand Z, Araghi F, Dadkhahfar S, Robati RM. Cardiac function in pemphigus vulgaris patients before and after steroid pulse therapy. J DERMATOL TREAT 2019; 32:855-859. [PMID: 31868046 DOI: 10.1080/09546634.2019.1708850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pemphigus vulgaris which is an autoimmune dermatological disorder characterized by vesiculobullous lesions over the skin and mucosae may also give rise to cardiac disease. Global Longitudinal Strain (GLS) measurement may help to predict cardiac dysfunction in these patients. METHOD In this prospective study, the GLS was measured before and after steroid pulse therapy in pemphigus vulgaris patients using 2 D speckle-tracking echocardiography. Moreover, blood pressure, pulse rate, and corrected QT (cQT) interval were recorded before and after steroid pulse therapy. RESULTS We included 23 pemphigus patients. The mean age of patients was 34.5(±6.4). Mean GLS decreased significantly after the administration of steroid pulse therapy. The mean GLS decreased regardless of age, however, the patients with the age range of 40-50 years showed the highest change in GLS. There was no interaction between gender and GLS change. Mean cQT increased significantly after pulse therapy (p=.007). Heart rate increased significantly from 88.5 ± 10.8 to 97.0 ± 13.4 (p<.001). Mean systolic and diastolic blood pressure did not show any significant change. CONCLUSIONS The steroid pulse therapy may associate with the progression of cardiac dysfunction in pemphigus patients. GLS, as a predictor, may be a valuable marker of cardiac subclinical dysfunction in this condition.
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Affiliation(s)
| | - Mehdi Pishgahi
- Department of Cardiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Zohreh Kheradmand
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farnaz Araghi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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8
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Sodero A, Squitieri M, Mazzeo S, Pasca M, Matà S, Pieri F, Bessi V, Sorbi S. Acute Symptomatic Sinus Bradycardia in High-Dose Methylprednisolone Therapy in a Woman With Inflammatory Myelitis: A Case Report and Review of the Literature. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619831026. [PMID: 30828250 PMCID: PMC6390212 DOI: 10.1177/1179547619831026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 12/02/2022]
Abstract
High dose corticosteroid therapy is widely used as attack therapy of inflammatory central nervous system disorders and can induce several adverse reactions. Bradycardia is an infrequent event after corticosteroids administration and is often asymptomatic. We report a case of a woman admitted to the neurological department of our hospital for paraesthesias of the lower limbs. She received adiagnosis of inflammatory myelitis and high dose corticosteroid therapy was prescribed. During the therapy she complained of chest tightness, dyspnoea, weakness and malaise. An electrocardiogram revealed sinus bradycardia. A significant increase in body weight, probably due to plasma volume expansion, was detected. Bradycardia and high blood pressure spontaneously resolved in few days. We provide a collection and a statistical analysis of literature data about steroid induced bradycardia. We found that higher total doses are associated with lower pulse rate and symptomatic bradycardia. Bradycardia is more frequent in older patients and those with underlying cardiac disease or with autonomic disturbance. However clinicians must be aware about the occurrence of symptomatic bradycardia in all patients who undergo high dose corticosteroid therapy, not only in those at risk, to early detect and treat this potentially dangerous condition.
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Affiliation(s)
- Alessandro Sodero
- Department of Neurological and
Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Careggi University Hospital, Neurology
unit, Florence, Italy
| | - Martina Squitieri
- Department of Neurological and
Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Careggi University Hospital, Neurology
unit, Florence, Italy
| | - Salvatore Mazzeo
- Department of Neurological and
Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Careggi University Hospital, Neurology
unit, Florence, Italy
| | - Matteo Pasca
- Department of Neurological and
Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Careggi University Hospital, Neurology
unit, Florence, Italy
| | - Sabrina Matà
- Department of Neurological and
Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Careggi University Hospital, Neurology
unit, Florence, Italy
| | - Francesco Pieri
- Department of Cardiology, Careggi
University Hospital, Florence, Italy
| | - Valentina Bessi
- Department of Neurological and
Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Careggi University Hospital, Neurology
unit, Florence, Italy
| | - Sandro Sorbi
- Department of Neurological and
Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
- Careggi University Hospital, Neurology
unit, Florence, Italy
- IRCCS Don Carlo Gnocchi, Florence,
Italy
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9
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Üsküdar Cansu D, Bodakçi E, Korkmaz C. Dose-dependent bradycardia as a rare side effect of corticosteroids: a case report and review of the literature. Rheumatol Int 2018; 38:2337-2343. [PMID: 30276424 DOI: 10.1007/s00296-018-4167-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/25/2018] [Indexed: 12/18/2022]
Abstract
Corticosteroids rank at the first place among the most commonly used immunosuppressive agents in the rheumatology practice. Although their conventional adverse effects including hyperglycemia, hypertension, hyperlipidemia, and osteoporosis are well-recognized and managed, steroid-induced cardiac arrhythmias are known to a lesser extent. In this regard, steroid-associated bradycardia is rarely expected and not very well known. Reported cases of steroid-associated bradycardias in the literature predominantly have emerged during the course of intravenous high-dose (pulse) methylprednisolone (MP) administrations. In this paper, we report a patient who developed sinus bradycardia following 52 mg of oral MP administration, improved once the drug was discontinued but repeated with the re-administration. Hence, the patient was shifted to prednisolone (PRED), and again suffered bradycardia which recovered upon dose reduction. Presenting this case along with other similar rare cases in the literature, our aim is to draw attention of fellow rheumatologists, who widely use steroids, to bradycardia-a rare and dose-dependent side effect of steroids.
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Affiliation(s)
- Döndü Üsküdar Cansu
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey.
| | - Erdal Bodakçi
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey
| | - Cengiz Korkmaz
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey
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10
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Pishgahi M, Dadkhahfar S, Robati RM, Kheradmand Z, Shahidi-Dadras M, Zargari O, Elpern DJ. Electrocardiographic changes after high-dose corticosteroid pulse therapy in pemphigus patients. J DERMATOL TREAT 2018; 29:802-805. [PMID: 29668335 DOI: 10.1080/09546634.2018.1466980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The objective of the current study was to evaluate the effect of intravenous methylprednisolone pulse therapy on myocardial repolarization alterations, especially QT dispersion in anticipation of cardiovascular risks in patients with pemphigus vulgaris. METHODS The current study is a prospective-controlled study on the electrocardiographic changes after methylprednisolone pulse therapy in 50 patients with pemphigus vulgaris. RESULTS A total of 50 patients (28 female and 22 male) were included in our study. The mean heart rate was significantly higher in male patients both before (92 ± 10.80 versus 82.75 ± 12.01 ms) and after pulse therapy (102.73 ± 14.26 versus 91.07 ± 15.02 ms) (p value < .01). The value of heart rate was significantly greater after receiving steroid pulse therapy. Corrected QT dispersion before pulse therapy was 19.92 ± 8.2 ms that increased to 40.68 ± 18.12 ms after treatment (p value < .001). CONCLUSION Our study shows that there is a relationship between pulse steroid infusion and increased predisposition to the occurrence of cardiac arrhythmias. QT dispersion could be a good marker to assess this risk in these patients.
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Affiliation(s)
- Mehdi Pishgahi
- a Department of Cardiology , Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Sahar Dadkhahfar
- b Skin Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Reza M Robati
- b Skin Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Zohreh Kheradmand
- b Skin Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Altunbas G, Sucu M, Zengin O. Ventricular repolarization disturbances after high dose intravenous methylprednisolone Theraphy. J Electrocardiol 2017; 51:140-144. [PMID: 28912075 DOI: 10.1016/j.jelectrocard.2017.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE There are no randomized trials evaluating the effects of pulse steroid treatment on cardiac electrophysiologic functions. The data are limited only to case series. In this study, we sought to evaluate the effects of high dose intravenous methylprednisolone therapy on indices of ventricular repolarization. METHODS Fifty patients with various autoimmune and inflammatory disorders were enrolled to the study. Electrocardiography (ECG) was obtained 4h before and 12h after the pulse steroid treatment. All ECGs were thoroughly evaluated by an experienced electrophysiologist. Indices of ventricular repolarization including QTc, JT, Tp-Te, Tp-Te/QTc were measured and compared with before and after-treatment ECGs. RESULTS There were 36 female and 14 male patients. Mean age was 36±13years. Heart rate was significantly reduced after the therapy (87,16±17,45bpm vs 73,86±17,45 p:0,001). QT interval (361,0±29,91 vs 388,20±42,84 p:0,001) and corrected QT interval (QTc) was significantly prolonged (401,60±19,79 vs 413,72±26,38 p:0,01) after pulse steroid therapy. Also, JT interval (273,0±28,73 vs. 299,60±45,66 p:0,001) and JT interval index (JTI%) was significantly prolonged (118,18±17,54 vs. 110,56±13,92 p:0,01). Tp-e interval was significantly prolonged after high-dose steroid treatment (74,60±13,12 vs. 83,80±13,68 p:0.001). The ratio of Tp-Te to QTc was also significantly increased after pulse steroid therapy (0,18±0,03 vs 0,20±0,03 p:0,009). CONCLUSION Our study shows that indices of ventricular repolarization are significantly prolonged after pulse steroid treatment. These findings indicate an increased risk of arrhythmias related to high dose intravenous methylprednisolone therapy.
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Affiliation(s)
- Gokhan Altunbas
- Gaziantep University School of Medicine, Department of Cardiology, Turkey.
| | - Murat Sucu
- Gaziantep University School of Medicine, Department of Cardiology, Turkey
| | - Orhan Zengin
- Gaziantep University School of Medicine, Department of Rheumatology, Turkey
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12
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An Unexpected Cause of Bradycardia in a Patient with Bacterial Meningitis. Case Rep Med 2017; 2017:4297372. [PMID: 28713431 PMCID: PMC5497651 DOI: 10.1155/2017/4297372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/29/2017] [Indexed: 11/17/2022] Open
Abstract
Sinus bradycardia which is a sinus rhythm with a resting heart rate of less than 60 bpm is caused by intrinsic cardiac disorders like sick sinus syndrome or inferior myocardial infarction, metabolic and environmental causes (such as hypothyroidism and electrolyte disorders), medications (such as beta-blockers and amiodarone), infection (such as myocarditis), increased intracranial pressure, and toxic exposure, while it can sometimes be a normal phenomenon, especially during sleep, in athletes, and during pregnancy. Symptomatic sinus bradycardia should warrant a thorough work-up in order to identify any reversible causes; otherwise, placement of a permanent pacemaker could be needed. We present the case of a patient who was admitted due to confusion and fever and was found to have pneumococcal meningitis and bacteremia, and during his hospital stay he developed symptomatic sinus bradycardia that was of intractable cause and persistent. Placement of a permanent pacemaker was chosen until the night staff of the hospital discovered by chance the neglected cause of his bradycardia.
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