Anthony H Masso, Carlo Uribe, James T Willerson, Benjamin Y Cheong, Barry R Davis
In a previous cross-sectional screening study of 5,169 middle and high school students (mean age, 13.1 ± 1.78 yr) in which we estimated the prevalence of high-risk cardiovascular conditions associated with sudden cardiac death, we incidentally detected by cardiac magnetic resonance (CMR) 959 cases (18.6%) of left ventricular noncompaction (LVNC) that met the Petersen diagnostic criterion (noncompaction:compaction ratio >2.3). Short-axis CMR images were available for 511 of these cases (the Short-Axis Study Set). To determine how many of those cases were truly abnormal, we analyzed the short-axis images in terms of LV structural and functional variables and applied 3 published diagnostic criteria besides the Petersen criterion to our findings. The estimated prevalences were 17.5% based on trabeculated LV mass (Jacquier criterion), 7.4% based on trabeculated LV volume (Choi criterion), and 1.3% based on trabeculated LV mass and distribution (Grothoff criterion). Absent longitudinal clinical outcomes data or accepted diagnostic standards, our analysis of the screening data from the Short-Axis Study Set did not definitively differentiate normal from pathologic cases. However, it does suggest that many of the cases might be normal anatomic variants. It also suggests that cases marked by pathologically excessive LV trabeculation, even if asymptomatic, might involve unsustainable physiologic disadvantages that increase the risk of LV dysfunction, pathologic remodeling, arrhythmias, or mural thrombi. These disadvantages may escape detection, particularly in children developing from prepubescence through adolescence. Longitudinal follow-up of suspected LVNC cases to ascertain their natural history and clinical outcome is warranted.
{"title":"Left Ventricular Noncompaction Detected by Cardiac Magnetic Resonance Screening: A Reexamination of Diagnostic Criteria.","authors":"Anthony H Masso, Carlo Uribe, James T Willerson, Benjamin Y Cheong, Barry R Davis","doi":"10.14503/THIJ-19-7157","DOIUrl":"https://doi.org/10.14503/THIJ-19-7157","url":null,"abstract":"<p><p>In a previous cross-sectional screening study of 5,169 middle and high school students (mean age, 13.1 ± 1.78 yr) in which we estimated the prevalence of high-risk cardiovascular conditions associated with sudden cardiac death, we incidentally detected by cardiac magnetic resonance (CMR) 959 cases (18.6%) of left ventricular noncompaction (LVNC) that met the Petersen diagnostic criterion (noncompaction:compaction ratio >2.3). Short-axis CMR images were available for 511 of these cases (the Short-Axis Study Set). To determine how many of those cases were truly abnormal, we analyzed the short-axis images in terms of LV structural and functional variables and applied 3 published diagnostic criteria besides the Petersen criterion to our findings. The estimated prevalences were 17.5% based on trabeculated LV mass (Jacquier criterion), 7.4% based on trabeculated LV volume (Choi criterion), and 1.3% based on trabeculated LV mass and distribution (Grothoff criterion). Absent longitudinal clinical outcomes data or accepted diagnostic standards, our analysis of the screening data from the Short-Axis Study Set did not definitively differentiate normal from pathologic cases. However, it does suggest that many of the cases might be normal anatomic variants. It also suggests that cases marked by pathologically excessive LV trabeculation, even if asymptomatic, might involve unsustainable physiologic disadvantages that increase the risk of LV dysfunction, pathologic remodeling, arrhythmias, or mural thrombi. These disadvantages may escape detection, particularly in children developing from prepubescence through adolescence. Longitudinal follow-up of suspected LVNC cases to ascertain their natural history and clinical outcome is warranted.</p>","PeriodicalId":48680,"journal":{"name":"Texas Heart Institute Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529067/pdf/i1526-6702-47-3-183.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38534955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It was the first Thanksgiving after both my parents had died, and we had come from Hartford to gather at my sister Judy's house in my hometown of Stamford, Connecticut. My youngest daughter, Gail, had never seen much of my hometown. So after dinner, I invited her to take a sentimental journey with me to visit the places where I had grown up. We drove by the old junior high, the temple where I had celebrated my Bar Mitzvah and confirmation, the Jewish Center where my childhood friends and I used to meet, and the high school from which I had graduated.
{"title":"Behind the Red Door.","authors":"Marc Brownstein","doi":"10.14503/THIJ-16-5950","DOIUrl":"https://doi.org/10.14503/THIJ-16-5950","url":null,"abstract":"It was the first Thanksgiving after both my parents had died, and we had come from Hartford to gather at my sister Judy's house in my hometown of Stamford, Connecticut. My youngest daughter, Gail, had never seen much of my hometown. So after dinner, I invited her to take a sentimental journey with me to visit the places where I had grown up. We drove by the old junior high, the temple where I had celebrated my Bar Mitzvah and confirmation, the Jewish Center where my childhood friends and I used to meet, and the high school from which I had graduated.","PeriodicalId":48680,"journal":{"name":"Texas Heart Institute Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979379/pdf/i1526-6702-43-4-283.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34324944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The first reported use of salicylate-rich plants as an analgesic and anti-inflammatory agent comes from the Ebers Papyrus, an Egyptian medical text from ca. 1,543 bc.1 It wasn't until the mid-1800s that silicon was isolated as the active component from willow tree bark extract, and then purified to acetylsalicylic acid. Bayer patented the compound in 1900, after the German chemist Felix Hoffmann's successful use of it to treat his father's severe arthritis. Finally, in 1950, the physician Lawrence Craven recognized that aspirin reduced the risk of heart attacks in men.2
{"title":"Aspirin for Primary and Secondary Prevention of Cardiovascular Disease.","authors":"Robert W Godley, Eduardo Hernandez-Vila","doi":"10.14503/THIJ-16-5807","DOIUrl":"https://doi.org/10.14503/THIJ-16-5807","url":null,"abstract":"The first reported use of salicylate-rich plants as an analgesic and anti-inflammatory agent comes from the Ebers Papyrus, an Egyptian medical text from ca. 1,543 bc.1 It wasn't until the mid-1800s that silicon was isolated as the active component from willow tree bark extract, and then purified to acetylsalicylic acid. Bayer patented the compound in 1900, after the German chemist Felix Hoffmann's successful use of it to treat his father's severe arthritis. Finally, in 1950, the physician Lawrence Craven recognized that aspirin reduced the risk of heart attacks in men.2","PeriodicalId":48680,"journal":{"name":"Texas Heart Institute Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.14503/THIJ-16-5807","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34324953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 57-year-old woman presented with effort angina. A coronary angiogram revealed critical 2-vessel disease, for which she subsequently underwent percutaneous coronary intervention. During angioplasty, a coronary guidewire-inadvertently passed into the right ventricle through the septal branches of the posterior descending coronary artery-caused a coronary artery-to-right ventricular fistula. This fistula was successfully closed percutaneously by coil embolization. To our knowledge, this is the first report of a case in which a coronary artery-to-right ventricular fistula caused by a guidewire was managed successfully by coil embolization.
{"title":"Coronary-Cameral Fistula Caused by Guidewire Trauma and Resolved by Coil Embolization.","authors":"Suvro Banerjee, Soumya Patra","doi":"10.14503/THIJ-15-5177","DOIUrl":"https://doi.org/10.14503/THIJ-15-5177","url":null,"abstract":"<p><p>A 57-year-old woman presented with effort angina. A coronary angiogram revealed critical 2-vessel disease, for which she subsequently underwent percutaneous coronary intervention. During angioplasty, a coronary guidewire-inadvertently passed into the right ventricle through the septal branches of the posterior descending coronary artery-caused a coronary artery-to-right ventricular fistula. This fistula was successfully closed percutaneously by coil embolization. To our knowledge, this is the first report of a case in which a coronary artery-to-right ventricular fistula caused by a guidewire was managed successfully by coil embolization. </p>","PeriodicalId":48680,"journal":{"name":"Texas Heart Institute Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979395/pdf/i1526-6702-43-4-338.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34669877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kunal Kumar, Stephanie A Coulter, Kelty R Baker, Benjamin Y C Cheong
A 59-year-old immunocompetent man presented at the emergency department, reporting several days of constant substernal chest pain without recent weight loss, night sweats, or fever. Clinical examination and laboratory results yielded nothing unusual. No adenopathy was identified. An electrocardiogram revealed T-wave inversion in the inferior and anterolateral leads. A chest computed tomogram showed diffuse thickening of the right ventricular (RV) myocardium. No lymphadenopathy or pleural effusion was noted. Cardiac magnetic resonance (CMR) images revealed diffuse RV myocardial hypertrophy (Fig. 1); the maximum RV myocardial thickness was 2 cm during end-diastole. The RV end-diastolic volume was 213 mL (indexed value, 104 mL/m2), its mass was 210 g (indexed mass, 102 g/m2), and the ejection fraction was 0.37. The RV myocardium had an intermediate T2 signal and contained no fat. Mild circumferential pericardial effusion was detected. During first-pass perfusion, gadolinium uptake was biventricular (Fig. 2); delayed spin-echo images showed greater gadolinium enhancement in the RV than in the left ventricle (LV) (Fig. 3). The LV interventricular septum was 1.3 cm thick, but the LV otherwise had normal size, systolic function, and mass. Delayed-enhancement CMR revealed biventricular diffuse patchy enhancement (Fig. 4). Fig. 1 Cardiac magnetic resonance steady-state free-precession gradient-echo sequence (4-chamber view in end-diastole) shows 2-cm-thick myocardium at the right ventricular free wall and a 1.3-cm-thick interventricular septum. Encasement of the mid right coronary ... Fig. 2 Cardiac magnetic resonance first-pass perfusion scan (4-chamber view), obtained with use of a fast gradient-echo sequence and gadolinium enhancement, reveals limited enhancement immediately after gadolinium bolus administration. Biventricular uptake of ... Fig. 3 Cardiac magnetic resonance spin-echo images obtained A) before and B) after gadolinium-chelate administration. The latter image shows more enhancement in the right ventricle than in the left ventricle by region-of-interest measurement. Fig. 4 Delayed-enhancement cardiac magnetic resonance images in the A) 4-chamber and B) short-axis views, acquired approximately 15 minutes after gadolinium-chelate administration, show patchy enhancement (arrows) in both ventricles, suggesting biventricular ... Although we initially suspected biventricular hypertrophic cardiomyopathy, the delayed-enhancement pattern suggested an infiltrative process. Coronary angiograms showed no coronary disease. Biopsy specimens of the RV myocardium had a hard consistency; histologic analysis revealed diffuse large B-cell lymphoma with myocyte necrosis. The patient underwent 6 cycles of chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, and remained in remission 2 years after diagnosis.
{"title":"Diffuse Large B-Cell Lymphoma Presenting as a Cardiac Mass.","authors":"Kunal Kumar, Stephanie A Coulter, Kelty R Baker, Benjamin Y C Cheong","doi":"10.14503/THIJ-14-4643","DOIUrl":"https://doi.org/10.14503/THIJ-14-4643","url":null,"abstract":"A 59-year-old immunocompetent man presented at the emergency department, reporting several days of constant substernal chest pain without recent weight loss, night sweats, or fever. Clinical examination and laboratory results yielded nothing unusual. No adenopathy was identified. An electrocardiogram revealed T-wave inversion in the inferior and anterolateral leads. \u0000 \u0000A chest computed tomogram showed diffuse thickening of the right ventricular (RV) myocardium. No lymphadenopathy or pleural effusion was noted. Cardiac magnetic resonance (CMR) images revealed diffuse RV myocardial hypertrophy (Fig. 1); the maximum RV myocardial thickness was 2 cm during end-diastole. The RV end-diastolic volume was 213 mL (indexed value, 104 mL/m2), its mass was 210 g (indexed mass, 102 g/m2), and the ejection fraction was 0.37. The RV myocardium had an intermediate T2 signal and contained no fat. Mild circumferential pericardial effusion was detected. During first-pass perfusion, gadolinium uptake was biventricular (Fig. 2); delayed spin-echo images showed greater gadolinium enhancement in the RV than in the left ventricle (LV) (Fig. 3). The LV interventricular septum was 1.3 cm thick, but the LV otherwise had normal size, systolic function, and mass. Delayed-enhancement CMR revealed biventricular diffuse patchy enhancement (Fig. 4). \u0000 \u0000 \u0000 \u0000Fig. 1 \u0000 \u0000Cardiac magnetic resonance steady-state free-precession gradient-echo sequence (4-chamber view in end-diastole) shows 2-cm-thick myocardium at the right ventricular free wall and a 1.3-cm-thick interventricular septum. Encasement of the mid right coronary ... \u0000 \u0000 \u0000 \u0000 \u0000 \u0000Fig. 2 \u0000 \u0000Cardiac magnetic resonance first-pass perfusion scan (4-chamber view), obtained with use of a fast gradient-echo sequence and gadolinium enhancement, reveals limited enhancement immediately after gadolinium bolus administration. Biventricular uptake of ... \u0000 \u0000 \u0000 \u0000 \u0000 \u0000Fig. 3 \u0000 \u0000Cardiac magnetic resonance spin-echo images obtained A) before and B) after gadolinium-chelate administration. The latter image shows more enhancement in the right ventricle than in the left ventricle by region-of-interest measurement. \u0000 \u0000 \u0000 \u0000 \u0000 \u0000Fig. 4 \u0000 \u0000Delayed-enhancement cardiac magnetic resonance images in the A) 4-chamber and B) short-axis views, acquired approximately 15 minutes after gadolinium-chelate administration, show patchy enhancement (arrows) in both ventricles, suggesting biventricular ... \u0000 \u0000 \u0000 \u0000Although we initially suspected biventricular hypertrophic cardiomyopathy, the delayed-enhancement pattern suggested an infiltrative process. Coronary angiograms showed no coronary disease. Biopsy specimens of the RV myocardium had a hard consistency; histologic analysis revealed diffuse large B-cell lymphoma with myocyte necrosis. The patient underwent 6 cycles of chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, and remained in remission 2 years after diagnosis.","PeriodicalId":48680,"journal":{"name":"Texas Heart Institute Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979404/pdf/i1526-6702-43-4-369.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34681803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Loheetha Ragupathi, Drew Johnson, Gregary D Marhefka
Surgically created arteriovenous fistulae (AVF) for hemodialysis can contribute to hemodynamic changes. We describe the cases of 2 male patients in whom new right ventricular enlargement developed after an AVF was created for hemodialysis. Patient 1 sustained high-output heart failure solely attributable to the AVF. After AVF banding and subsequent ligation, his heart failure and right ventricular enlargement resolved. In Patient 2, the AVF contributed to new-onset right ventricular enlargement, heart failure, and ascites. His severe pulmonary hypertension was caused by diastolic heart failure, diabetes mellitus, and obstructive sleep apnea. His right ventricular enlargement and heart failure symptoms did not improve after AVF ligation. We think that our report is the first to specifically correlate the echocardiographic finding of right ventricular enlargement with AVF sequelae. Clinicians who treat end-stage renal disease patients should be aware of this potential sequela of AVF creation, particularly in the upper arm. We recommend obtaining preoperative echocardiograms in all patients who will undergo upper-arm AVF creation, so that comparisons can be made postoperatively. Alternative consideration should be given to creating the AVF in the radial artery, because of less shunting and therefore less potential for right-sided heart failure and pulmonary hypertension. A multidisciplinary approach is optimal when selecting patients for AVF banding or ligation.
{"title":"Right Ventricular Enlargement within Months of Arteriovenous Fistula Creation in 2 Hemodialysis Patients.","authors":"Loheetha Ragupathi, Drew Johnson, Gregary D Marhefka","doi":"10.14503/THIJ-15-5353","DOIUrl":"https://doi.org/10.14503/THIJ-15-5353","url":null,"abstract":"<p><p>Surgically created arteriovenous fistulae (AVF) for hemodialysis can contribute to hemodynamic changes. We describe the cases of 2 male patients in whom new right ventricular enlargement developed after an AVF was created for hemodialysis. Patient 1 sustained high-output heart failure solely attributable to the AVF. After AVF banding and subsequent ligation, his heart failure and right ventricular enlargement resolved. In Patient 2, the AVF contributed to new-onset right ventricular enlargement, heart failure, and ascites. His severe pulmonary hypertension was caused by diastolic heart failure, diabetes mellitus, and obstructive sleep apnea. His right ventricular enlargement and heart failure symptoms did not improve after AVF ligation. We think that our report is the first to specifically correlate the echocardiographic finding of right ventricular enlargement with AVF sequelae. Clinicians who treat end-stage renal disease patients should be aware of this potential sequela of AVF creation, particularly in the upper arm. We recommend obtaining preoperative echocardiograms in all patients who will undergo upper-arm AVF creation, so that comparisons can be made postoperatively. Alternative consideration should be given to creating the AVF in the radial artery, because of less shunting and therefore less potential for right-sided heart failure and pulmonary hypertension. A multidisciplinary approach is optimal when selecting patients for AVF banding or ligation. </p>","PeriodicalId":48680,"journal":{"name":"Texas Heart Institute Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979398/pdf/i1526-6702-43-4-350.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34669880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ashok Tholpady, Arthur W Bracey, Kelty R Baker, Ross M Reul, Alice J Chen
Cold hemagglutinin disease with broad thermal amplitude and high titers presents challenges in treating cardiac-surgery patients. Careful planning is needed to prevent the activation of cold agglutinins and the agglutination of red blood cells as the patient's temperature drops during surgery. We describe our approach to mitigating cold agglutinin formation in a 77-year-old man with severe cold hemagglutinin disease who underwent off-pump coronary artery bypass surgery without the use of preoperative plasmapheresis. This experience shows that the use of an intravascular warming catheter can maintain normothermia and prevent the activation and subsequent formation of cold agglutinins. To our knowledge, this is the first reported use of this technique in a patient with cold hemagglutinin disease. The chief feature in this approach is the use of optimal thermal maintenance-rather than the more usual decrease in cold-agglutinin content by means of therapeutic plasma exchange.
{"title":"Use of an Intravascular Warming Catheter during Off-Pump Coronary Artery Bypass Surgery in a Patient with Severe Cold Hemagglutinin Disease.","authors":"Ashok Tholpady, Arthur W Bracey, Kelty R Baker, Ross M Reul, Alice J Chen","doi":"10.14503/THIJ-15-5672","DOIUrl":"https://doi.org/10.14503/THIJ-15-5672","url":null,"abstract":"<p><p>Cold hemagglutinin disease with broad thermal amplitude and high titers presents challenges in treating cardiac-surgery patients. Careful planning is needed to prevent the activation of cold agglutinins and the agglutination of red blood cells as the patient's temperature drops during surgery. We describe our approach to mitigating cold agglutinin formation in a 77-year-old man with severe cold hemagglutinin disease who underwent off-pump coronary artery bypass surgery without the use of preoperative plasmapheresis. This experience shows that the use of an intravascular warming catheter can maintain normothermia and prevent the activation and subsequent formation of cold agglutinins. To our knowledge, this is the first reported use of this technique in a patient with cold hemagglutinin disease. The chief feature in this approach is the use of optimal thermal maintenance-rather than the more usual decrease in cold-agglutinin content by means of therapeutic plasma exchange. </p>","PeriodicalId":48680,"journal":{"name":"Texas Heart Institute Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979402/pdf/i1526-6702-43-4-363.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34669884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammad Khalid Mojadidi, Ninel Hovnanians, Michael R Kaufmann, James A Hill
A 55-year-old woman with a history of chronic bronchitis, Clostridium difficile colitis, and alcohol and tobacco abuse was admitted with altered mentation, hyponatremia, and necrotizing right-upper-lobe pneumonia. She was started on cefepime and vancomycin; metronidazole was added for colitis. A resting electrocardiogram (ECG) showed sinus tachycardia with a QS pattern in the precordial leads, normal intervals, and small T-wave inversions in leads V5 and V6. Four days later, significant changes in her baseline telemetry rhythm prompted a repeat 12-lead ECG; the patient's pulse rate was 75 beats/min with a QT interval of 720 ms and QTc of 746 ms (Fig. 1). Her troponin T level was <0.03 ng/mL, and she had no new symptoms. Her medications at that time were aspirin, metoprolol, lisinopril, cefepime, atorvastatin, pantoprazole, metronidazole, oral vancomycin, and subcutaneous heparin. Her potassium level was 2.9 mEq/L, and her magnesium level was 1.6 mEq/L. An echocardiogram showed severe left ventricular dysfunction with wall motion that suggested stress-induced cardiomyopathy.
{"title":"An Unusual Presentation of QT Prolongation.","authors":"Mohammad Khalid Mojadidi, Ninel Hovnanians, Michael R Kaufmann, James A Hill","doi":"10.14503/THIJ-16-5931","DOIUrl":"https://doi.org/10.14503/THIJ-16-5931","url":null,"abstract":"A 55-year-old woman with a history of chronic bronchitis, Clostridium difficile colitis, and alcohol and tobacco abuse was admitted with altered mentation, hyponatremia, and necrotizing right-upper-lobe pneumonia. She was started on cefepime and vancomycin; metronidazole was added for colitis. A resting electrocardiogram (ECG) showed sinus tachycardia with a QS pattern in the precordial leads, normal intervals, and small T-wave inversions in leads V5 and V6. Four days later, significant changes in her baseline telemetry rhythm prompted a repeat 12-lead ECG; the patient's pulse rate was 75 beats/min with a QT interval of 720 ms and QTc of 746 ms (Fig. 1). Her troponin T level was <0.03 ng/mL, and she had no new symptoms. Her medications at that time were aspirin, metoprolol, lisinopril, cefepime, atorvastatin, pantoprazole, metronidazole, oral vancomycin, and subcutaneous heparin. Her potassium level was 2.9 mEq/L, and her magnesium level was 1.6 mEq/L. An echocardiogram showed severe left ventricular dysfunction with wall motion that suggested stress-induced cardiomyopathy.","PeriodicalId":48680,"journal":{"name":"Texas Heart Institute Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979403/pdf/i1526-6702-43-4-367.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34681802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}