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torsades de pointes episode in a woman with high-grade fever and inflammatory activation: A case report

World Journal of Clinical Cases 2021年第12期9卷 2899-2907页

作者： Hui Qiu Hong-Wei Li Shu-Hong Zhang Xiao-Ge Zhou Wei-Ping Li department of Cardiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China department of Pathology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

BACKGROUND QT interval prolongation can induce torsades de pointes(TdP),a potentially fatal ventricular ***,an increasing number of non-cardiac drugs have been found to cause QT prolongation and/or TdP ***,recent findings have demonstrated the key roles of systemic inflammatory activation and fever in promoting long-QT syndrome(LQTS)and TdP *** SUMMARY A 30-year-old woman was admitted with a moderate to high-grade episodic fever for two *** patient was administered with multiple antibiotics after hospitalization but still had repeating fever and markedly elevated C-reactive *** after a high fever,the patient suddenly lost consciousness,and electrocardiogram(ECG)showed transient TdP onset after frequent premature ventricular *** patient recovered sinus rhythm and consciousness spontaneously,and post-TdP ECG revealed a prolonged QTc interval of 560 *** patient’s clinical manifestations and unresponsiveness to the antibiotics led to the final diagnosis of adult-onset Still’s disease(AOSD).There was no evidence of cardiac *** the AOSD diagnosis,discontinuation of antibiotics and immediate initiation of intravenous dexamethasone administration resulted in the normal temperature and QTc *** genetic analysis identified that the patient and her father had heterozygous mutations in KCNH2(c.1370C>T)and AKAP9(c.7725A>C).During the 2-year follow-up period,the patient had no recurrence of any arrhythmia and maintained normal QTc *** This case study highlights the risk of systemic inflammatory activation and antibiotic-induced TdP/LQTS *** analysis should be considered to identify individuals at high risk of developing TdP.

关键词： torsades de pointes Long QT syndrome Adult-onset Still’s disease Antibiotics Inflammation Case report

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Exercise-induced torsades de pointes as an unusual presentation of cardiac sarcoidosis: A case report and review of literature

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World Journal of Cardiology 2020年第6期12卷 291-302页

作者： Chadi Ghafari Frédéric Vandergheynst Emmanuel Parent Kaoru Tanaka Stéphane Carlier department of Cardiology Centre Hospitalier Universitaire Ambroise ParéMons 7000Belgium department of Cardiology Universitéde MonsMons 7000Belgium department of Internal Medicine Cliniques Universitaires de Bruxelles-ErasmeBruxelles 1070Belgium department of Cardiology Universitair Ziekenhuis BrusselsJette 1090Belgium

BACKGROUND Sarcoidosis is a rare multisystem disease characterized histologically by noncaseating granuloma formation in the affected *** cardiac sarcoidosis is found on autopsy in up to 25%of sarcoidosis cases,it is still underdiagnosed and is associated with a poor *** the etiology of sarcoidosis remains unclear,an antigen triggered exaggerated immune response has been *** detection and prompt management of cardiac sarcoidosis remains *** SUMMARY A 60-year-old female,with pulmonary sarcoidosis in remission,presented to the cardiology outpatient clinic for evaluation of weeks-long dyspnea on moderate exertion(New York Heart Association class II)that was relieved by *** exercise stress test showed multifocal ventricular extrasystoles,followed by a self-limiting torsades de *** magnetic resonance imaging showed nondilated and normotrophic left ventricle with basoseptal and mid-septal *** magnetic resonance imaging-derived left ventricular ejection fraction was 45%.delayed enhancement showed patchy transmural fibrosis of the septum and hyperenhancement of the papillary muscles,all in favor of extensive cardiac involvement of sarcoidosis.A double-chamber implantable cardiac defibrillator was implanted,and methylprednisolone(12 mg/d)and methotrexate(12.5 mg/wk)treatment was ***-up and implantable cardiac defibrillator interrogation showed episodes of asymptomatic nonsustained ventricular tachycardia and an asymptomatic episode of nonsustained ventricular tachycardia ending by the first antitachycardia pacing *** Along an extensive review of the literature,this unusual case report highlights the importance of early detection of cardiac involvement of sarcoidosis,in order to avoid potential complications and increase survival.

关键词： Sarcoidosis Cardiac sarcoidosis torsades de pointes Ventricular tachycardia Immunotherapy Case report

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torsades de pointes Secondary to Excessive Loperamide Use

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Journal of Pharmacy and Pharmacology 2016年第7期4卷 322-327页

作者： Joseph S. Van Tuylt Gail Brock Kristen Bova Campbell Sana M. Al-Khatib department of Pharmacy Practice St. Louis College of Pharmacy 4588 Parkview Place St. Louis MO 63110 department of Medicine Duke University Hospital DUMC 3850 Durham NC 27710

Abstract： Loperamide is a common, over-the-counter, antidiarrheal medication that has been implicated in cases of ventricular tachycardia. A 32 year-old female patient with a history of opioid abuse and no prior history of cardiovascular disease experienced torsades de pointes. An electrocardiogram at the time of hospital presentation revealed a prolonged QT interval at 636 msec. Diagnostic evaluation was unremarkable for any underlying cardiovascular pathology. Further investigation revealed the patient had been taking 30-40 loperamide 2 mg tablets oral daily for 2 weeks prior to the onset of torsades de pointes. At high doses, loperamide may prolong the QT interval through antagonism of the human ether-a-go-go potassium current, thus increasing the risk of ventricular arrhythmias. Clinicians should be cautious with administration of high doses of loperamide to all patients, especially patients at high risk for QT interval prolongation.

关键词： torsades de pointes loperamide QT prolongation.

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KN-93, A CaMKⅡ Inhibitor, Suppresses Ventricular Arrhythmia Induced by LQT2 Without decreasing TDR

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2013年第5期33卷 636-639页

作者：王文隆张双双邓洁赵俊燕赵崇强林立张存泰吕家高 department of Cardiology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology department of Nephrology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology

Summary： Abnormal enhanced transmural dispersion of repolarization （TDR） plays an important role in the maintaining of the severe ventricular arrhythmias such as torsades de pointes （TDP） which can be induced in long-QT （LQT） syndrome. Taking advantage of an in vitro rabbit model of LQT2, we de- tected the effects of KN-93, a CaM-dependent kinase （CaMK） II inhibitor on repolarization heteroge- neity of ventricular myocardium. Using the monophasic action potential recording technique, the action potentials of epicardium and endocardium were recorded in rabbit cardiac wedge infused with hypo- kalemic, hypomagnesaemic Tyrode＇s solution. At a basic length （BCL） of 2000 ms, LQT2 model was successfully mimicked with the perfusion of 0.5 μmol/L E-4031, QT intervals and the interval from the peak of T wave to the end of T wave （Tp-e） were prolonged, and Tp-e/QT increased. Besides, TDR was increased and the occurrence rate of arrhythmias like EAD, R-on-T extrasystole, and TDP increased under the above condition. Pretreatment with KN-93 （0.5μmol/L） could inhibit EAD, R-on-T extrasys- tole, and TDP induced by E-4031 without affecting QT interval, Tp-e, and Tp-e/QT. This study demon- strated KN-93, a CaMK II inhibitor, can inhibit EADs which are the triggers of TDP, resulting in the suppression of TDP induced by LQT2 without affecting TDR.

关键词： KN-93 long-QT syndrome transmural dispersion of repolarization early afterdepolariza-tion torsades de pointes

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Survey concerning internal medicine physicians and prolonged QT interval:Knowledge and treatment practices

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World Journal of Cardiology 2021年第3期13卷 42-45页

作者： Elizabeth Wendl Nelson Telles Geoff C Wall department of Medical Education Internal Medicine Residency ProgramIowa Methodist Medical CenterDes MoinesIA 50311United States department of Cardiology Internal Medicine Residency ProgramIowa Methodist Medical CenterDes MoinesIA 50311United States department of Pharmacy Practice Drake University College of Pharmacy and Health SciencesDes MoinesIA 50311United States Internal Medicine Residency Program Iowa Methodist Medical CenterDes MoinesIA 50311United States

Prolongation of the QT interval is associated with adverse cardiac events specifically torsades de pointes(TdP).There are multiple mediations that have a known,possible,or conditional risk for prolonged QT interval,but general practitioners’knowledge of these medications is *** conducted a survey to assess internal medicine(IM)providers’knowledge of risk factors and medications associated with prolonged QT as well as provider experience and comfort when treating patients with prolonged QT.A 17-question,anonymous survey was constructed in 2019 and distributed to IM providers and residents at a tertiary care *** included demographic information,6 Likert-scale questions gauging provider experience with prolonged QT,and 10 multiple choice clinical vignettes to assess clinical *** was analyzed *** was assessed via clinical vignettes and compared by level of ***-one responses were received out of a total of 87 possible respondents(47.1%response rate).About 70%of respondents see patients with acquired prolonged QT once monthly or more.95%rarely see congenital prolonged *** presented with QTc drug issues,73%of providers seldom or sometimes consulted pharmacy,but about half used online *** average correct score on the clinical vignettes was 5.59/10,with the highest scores seen in attending physicians in their first five years of practice(6.96/10).Our survey suggests that IM providers commonly encounter QT prolonging *** efforts to improve knowledge of drug and patient risk factors for TdP may be needed.

关键词： QTc torsades de pointes Pharmacotherapy Survey Long QT syndrome Drug interactions

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