Lung cancer presenting as cardiac tamponade associated with transmural myocardial ischaemia

Cardiac tamponade due to carcinomatous pericarditis is a life-threatening complication of malignancy and is uncommon as its initial manifestation [Chest 88 (1985) 70; Cancer 45 (1980) 1697; J Am Med Assoc 257 (1987) 1088]. A case of lung cancer presenting with cardiac tamponade associated with transient ST-segment elevation and life-threatening arrhythmias is presented. To our knowledge, this is the first reported case of transmural myocardial ischaemia related to malignancy.

Pentavalent antimonial-induced torsade de pointes

Unexplained sudden deaths following use of pentavalent antimonial drugs have been described, presumably owing to ventricular arrhythmias. A patient is reported with QT interval prolongation and syncopal episodes related to torsade de pointes following treatment of visceral leishmaniasis with meglumine antimoniate. This is the first reported case of documented torsade de pointes following treatment with pentavalent antimonial drugs.

Paroxysmal nodal reentrant tachycardia. Surgical cure with preservation of atrioventricular conduction

In a patient with repetitive disabling tachycardias refractory to pharmacologic treatment, the electrophysiologic study suggested the existence of atrioventricular nodal reciprocating tachycardia. During ventricular pacing, endoepicardial mapping of the lower atrium showed the atrial breakthrough point in an area of the lower interatrial septum close to the AV node crista. A selective atriotomy was performed. The postoperative electrophysiologic studies showed absence of ventriculoatrial conduction at several ventricular pacing rates, while antegrade conduction is preserved. The patient remained free of arrhythmias 21 months after surgery, taking no antiarrhythmic drugs.