1/668. Ultrasound detection of ventricular fibrillation disguised as asystole. ultrasonography in the emergency department is being used for many purposes, including the evaluation of patients with cardiac arrest. Ultrasound testing has been shown to be useful in such patients in determining the presence of true electromechanical dissociation and pericardial effusions. We report a case of ventricular fibrillation identified by ultrasonography that appeared as asystole on ECG monitoring. Recognition of this ultrasound application can aid in the prompt diagnosis of occult ventricular fibrillation and allow for proper treatment with defibrillation. ( info) |
2/668. Potential proarrhythmic effects of implantable cardioverter-defibrillators. Implantable cardioverter-defibrillator (ICD) interventions have the potential to be proarrhythmogenic. New arrhythmias can occur in the setting of clinically appropriate therapies, as well as during a cardiac rhythm for which therapy is not intended. Cardioversion/defibrillation therapies, antitachycardia pacing, and antibradycardia pacing are potential triggers for the development of new arrhythmias. Newer ICDs allow better recognition and interpretation of the arrhythmias that are induced by delivered therapies. Two cases of ICD-induced proarrhythmias are described. Based on the course of these patients and review of previous reports, proarrhythmic effects of ICD interventions along with prevention and management strategies are discussed. ( info) |
| Prolongation of QT time interval may be provoked by a limited number of drugs, especially macrolide antibiotics. We describe a case of QT time interval prolongation induced by clindamycin with subsequent repeated ventricular fibrillation and resuscitation; there is no previous report in the literature of QT time prolongation caused by lincosamides. ( info) |
| The long qt syndrome (LQTS) is associated with syncopal attacks or even sudden death at a young age due to ventricular fibrillation. We report a patient with an undiagnosed LQTS who had an episode of cardiac arrest during the final part of general anesthesia, immediately after the drugs for reversal of the neuromuscular blockade were given. We suggest that the administration of glycopyrronium might have been the provoking factor in this patient. ( info) |
| patients with primary aldosteronism often present with hypokalemia and hypertension. Primary aldosteronism presenting as sudden death due to ventricular fibrillation is described in an otherwise healthy 37-year-old woman. After successful direct current cardioversion, serum potassium was 1.4 mmol/L. Investigations revealed a suppressed renin level, elevated serum aldosterone and a right adrenal nodule found on imaging. ventricular fibrillation has not previously been described as a presention of a biochemically and surgically proven aldosterone-producing adenoma. This case highlights the importance of early detection and proper diagnosis of secondary hypertension before serious sequelae occur. ( info) |
6/668. Significant complications can occur with ischemic heart disease and tilt table testing. We present an elderly patient who had syncope, with known coronary artery disease and a conduction abnormality. Because of a possible vasovagal reaction, the patient underwent a tilt table test prior to evaluation of ischemia or her LV function. During the tilt table test on isoproterenol, the patient developed ventricular fibrillation which was corrected immediately by cardioversion. Subsequently, the patient was found to have significant coronary artery disease which was treated with stenting and angioplasty. After treatment, there were no inducible arrhythmias on full dose isoproterenol. This case reports a significant complication that may occur when tilt table testing with isoproterenol and ischemia. ( info) |
| TdP is a serious complication of AV block. We report a case of complete AV block with QT prolongation who had bouts of TdP resistant to lidocaine and isoproterenol. Temporary pacing could not be performed, because insertion of a pacing lead triggered TdP that deteriorated into ventricular fibrillation. nicorandil, a potassium channel opener, shortened the QT interval and abolished TdP. This may suggest that potassium channel opening drugs are clinically effective against TdP associated with bradycardia-dependent QT prolongation. ( info) |
| Despite the use of protective gear, a 15-year-old hockey player died when he was struck in the chest by a puck. This is the fifth recorded hockey death related to so-called commotio cordis, that is, blunt chest injury without myocardial structural damage. In light of inadequacies of commercial chest protectors currently in use for hockey, the authors hope to educate players and coaches about the danger of blocking shots with the chest. physicians should be aware that commotio cordis represents a distinctive pathological condition, in the event of which immediate recognition, precordial thump, CPR, and defibrillation are potentially lifesaving. Appropriate medical supervision at amateur hockey games, 911 telephone access, and on-site automated external defibrillators are issues that deserve careful consideration. ( info) |
9/668. Inappropriate implantable cardioverter-defibrillator therapy due to the detection of premature ventricular complexes. Inappropriate shocks delivered by implantable cardioverter-defibrillators may occur in 15%-40% of patients treated with these devices. This article describes a rare cause for inappropriate shocks. Two patients received inappropriate shocks due to the presence of premature ventricular complexes during attempted reconfirmation of ventricular fibrillation. knowledge of device algorithms for detection and reconfirmation of ventricular fibrillation, designed to have a high degree of sensitivity and therefore lower specificity, allows for reprogramming to avoid further inappropriate shocks. ( info) |
10/668. Idiopathic verapamil-sensitive left ventricular tachycardia complicated by right ventricular outflow tract ventricular tachycardia and ventricular fibrillation. Idiopathic ventricular tachycardias (VTs) are generally divided into those arising from the right ventricle and those arising from the left ventricle. There has been few reports of two morphologically distinct VT occurring in patients with no apparent structural heart disease. We report a patient with verapamil-sensitive left VT with a right bundle branch block pattern that spontaneously changed to VT with a left bundle branch block pattern. Ventricular fibrillation was induced by the application of programmed stimulation. Although it is unclear if our patient with pleomorphic VT has ventricular vulnerability, it is necessary to investigate further and follow him carefully. ( info) |