Torsades de pointes in amiodarone-associated acquired long-QT syndrome Amiodarone was developed in Belgium in 1961 and became popular in Europe for the treatment of angina. Based on Dr. Bramah Singh's investigation, (1) the Argentine physician Dr. Mauricio Rosenbaum started using amiodarone for the treatment of ventricular and supraventricular arrhythmias with good outcomes. (2, 3) This drug is a class III agent in the Vaughan Williams scheme, with class I. II and IV antiarrhytmic effects. Amiodarone produces bradycardia, prolongs myocardial action potential and delays ventricular repolarization. Due to this three pharmacological properties amiodarone prolongs the QT-interval, predisposing to torsade de pointes (TDP), a polymorphic ventricular …show more content…
Figure 1 shows the electrocardiogram (ECG) after the angiography. A carotid endarterectomy was performed 5 months before due to an atheroembolic stroke. During the postoperative period, she presented atrial fibrillation with rapid ventricular response and amiodarone was added to her habitual treatment. Her current treatment is ASA 325 mg/day, atenolol 50 mg bid, enalapril 20 mg bid and amiodarone 200 mg bid. One month before the event she attended the outpatient clinic and an echocardiogram was performed, which showed: normal left ventricular dimensions, wall thickness mildly increased, normal left atrium and aorta, mild left ventricular dysfunction with an estimated ejection fraction of 50%, hypokinetic basal inferior and mid inferior segments and mitral inflow filling pattern of delayed relaxation (according to her age). Right chambers dimensions and right ventricular function were normal (TAPSE of 20 mm Hg), a calcific trileaflet aortic valve with normal leaflet excursion was observed, with normal gradients and no regurgitation. Mitral valve was normal, without regurgitation, and tricuspid valve and pulmonary valve were also normal. There was absence of pericadial effusion and both septae were …show more content…
It may be congenital or acquired. Several mutations have been identified distributed in 10 genes. The severe form of the disease is sporadic ,but there are a number of common polymorphisms that may confer susceptibility to the development of the disease when specific drugs are being administered. (5) Patients with long QT syndrome are predisposed to sudden death due to polymorphic VT (TDP). Torsade de pointe is a polymorphic VT associated with LQTS which may be terminated by increasing the heart rate.
Pathophysiology When Pulmonary Stenosis is present, resistant to blood flow cause right ventricular hypertrophy – right atrial pressure will increase – reopening of the foramen ovale, shunting of unoxygenated blood into the left atrium, systemic circulation. Clinical manifestation: Cyanosis, characteristic murmur , cardiomegaly . Treatment: Baloon angioplasty (neonate).
She should complete this course but her lung exam is much improved. Persistent atrial fibrillation: She was in sinus rhythm today but has been known to be in atrial fibrillation most of the time. She is on digoxin for rate control and her amiodarone has been discontinued.
The American Society of Echocardiography (ASE) established
Angina, Myocardial Infarction, and Cardiac Arrest Comparison and Contrast Hannah Bunce Fayetteville Technical Community College Angina, Myocardial Infarction, and Cardiac Arrest Comparison and Contrast Three of the most commonly occurring cardiac related events: angina, myocardial infarction, and cardiac arrest, are commonly confused. However, there is a huge difference between each of them. It is crucial to be informed of each of these cardiovascular emergencies and to be able to differentiate between them. As a medical professional it is also very important to know the appropriate care for each these cardiac related emergencies.
5. Approach to the diagnosis. 5.1. Is it cardiac or not? 5.2.
Localization of the pain was consistent from the T4 to T5dermatome (on the right anterior, lateral and posterior chest wall). He described the pain as severe stabbing and lancinating with a numeric rating scale (NRS) of 8/10. The patient also reported sleep disturbances due to the pain, which had begun 20 day earlier but had aggravated within the last 1 week. He had a 3-year history of taking anticoagulants for the management of arterial fibrillation. At our pain clinic we prescribed tramadol and low dose pregabalin, but they failed to provide pain relief.
E.g. 99mTc-tetrofosmin (Myoview, GE healthcare), 99mTc-sestamibi (Cardiolite, Bristol-Myers Squibb now Lantheus Medical Imaging). Following this, the heart rate is raised to induce myocardial stress, either by exercise or pharmacologically with adenosine, dobutamine or dipyridamole (aminophylline can be used to reverse the effects of
Their death is primarily due to cardio-respiratory failure. We report this case of trisomy
Atrial Fib: In atrial fibrillation, the atrial rhythm and ventricular rhythms are irregular. The atrial rhythm is greater than 400 beats/minute. The atrial activity looks erratic and irregular. Causes of Atrial fibrillation include COPD, heart failure (which EM has),hyrotoxicosis, constrictive pericarditis, ischemic heart disease, sepsis, pulmonary embolus, rheumatic heart disease, hypertension, mitral stenosis, atrial irritation, or complication of coronary bypass or valve replacement surgery. If a patients condition is stable, treatment includes drug therapy that may commonly include calcium channel blockers, and beta blockers.
• Therapeutic Classification: • Antihypertensive • Pharmacologic Classifications: • Calcium Channel Blocker • Mechanism of Action: • Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation contraction coupling and frequent contraction. • Relates mechanism of action to pt diagnosis: • The patient has a history of CAD, which damages or disease in the hearts major blood vessels. So this medication is helping to excite a contraction. • Why
The following case study is conducted in regards to a 34-year-old women diagnosed with pheochromocytoma after an episode of malignant hypertension. Pheochromocytoma has been studied extensively, and the pathophysiology has been determined to be a result of a rare tumor that starts in the cells of the adrenal glands and causes increased and inappropriate hormone secretion. The resulting symptoms of the tumor are unspecific and includes, high blood pressure, sweating, irregular heartbeat and headache. The vague signs and symptoms of pheochromocytoma lead to a difficult and commonly misdiagnosed disease. The treatment options are limited to the surgical removal of the tumor.
A 64 year-old man with a past medical history of mechanical aortic valve replacement on Coumadin, coronary artery disease with a history of coronary artery bypass graft, permanent
Drugs may produce certain effects on the cardiac muscles example ephedrine may increase heartbeat, stimulation of nerve ending in the nervous system is caused by amphetarine drug which produces changes in
Most people speak highly about the staff in ICU and the care they received even if they could not always remember their names. The overall care they received was extremely good but they often did not see the same nurse or doctor twice, sometimes this made it difficult to build a trusting relationship. That is why continuity of care very important when I make assignment I try to give the same patient to the nurse who took care of the patient previous day. Outcomes: Enhances patient, family and caregivers satisfaction.
Kent, M., 2013. Advanced biology, 2nd ed. Laizzo, P., 2016. HANDBOOK OF CARDIAC ANATOMY, PHYSIOLOGY, AND DEVICES. SPRINGER, S.l.