Looking above the heart: A rare cause of ventricular tachycardia (original) (raw)
Chest, 1992
Myocardial hypertrophy and interstitial fibrosis are common in acromegalic hearts and may induce left ventricular (LV) dysfunction. The transmitral flow pattern was exammed by pulsed-wave Doppler in 20 patients with active acromegaly and nine with acromegaly cured by pituitary microsurgery. Control groups consisted of 25 normal subjects and 13 patients with systemic hypertension. We related Doppler indices of LV filling (E and A peak velocities and EtA ratio) to the duration of acromegalic disease, the GH plasma levels and LV mass. The LV mass/BSA was significantly greater in active acromegaly (187 ± 53 g/sq m) and systemic hypertension groups (161 ± 48 g/sq m) than in cured acromegaly (125 ± 35 g/sq m) and the normal control group (109 ± 36 g/sq m) (p<O.Ol for both). No differences were found in the E peak velocity, A peak velocity, and EtA ratio in the groups with active acromegaly
LEFT VENTRICULAR STRUCTURAL AND FUNCTIONAL CHARACTERISTICS IN ACROMEGALY
Journal of Hypertension, 2004
This study was designed to evaluate left ventricular (LV) anatomy and function in patients with Cushing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome. A high prevalence of LV hypertrophy and concentric remodeling has been reported in Cushing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome, although no data have been reported on LV systolic and diastolic function. Forty-two consecutive patients with Cushing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome and 42 control subjects, matched for age, gender, and blood pressure, were studied. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were measured by echocardiography, endocardial and midwall fractional shortening (FS) were assessed, and diastolic filling was measured by Doppler transmitral flow. The RWT was significantly greater in Cushing patients than in controls. Left ventricular hypertrophy and concentric remodeling were observed in 10 and 26 patients with Cushing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome, respectively. In Cushing patients, midwall FS was significantly reduced compared with controls (16.2 +/- 3% vs. 21 +/- 4.5%, p = 0.01). The ratio of transmitral E and A flow velocities was reduced and E deceleration time was prolonged in Cushing patients compared with controls (p = 0.03 and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, respectively). In patients with Cushing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome, cardiac structural changes are associated with reduced midwall systolic performance and with diastolic dysfunction that may contribute to the high risk of cardiovascular events observed in these patients.
Journal of Cardiovascular Electrophysiology, 2005
originating from the right ventricular outflow tract (RVOT-VT) and idiopathic RVOT-extrasystoles are generally considered benign arrhythmias. We described three cases who originally presented with typical "benign looking" RVOT-extrasystoles or RVOT-VT but developed malignant polymorphic VT during follow-up. The unusual aspect of their RVOT-extrasystoles was their coupling interval, which appears to be intermediate between the ultra-short coupling interval of idiopathic VF and the long coupling interval seen in the truly benign RVOT-VT. (J Cardiovasc Electrophysiol, Vol. 16, pp. 912-916, August 2005) ventricular tachycardia, ventricular fibrillation, right ventricular outflow tract Ventricular tachycardias (VTs) occurring in patients without organic heart disease are conventionally categorized as "idiopathic monomorphic" or "idiopathic polymorphic" VTs. 1 The right ventricular outflow tract (RVOT) area is the site of origin of the most common type of idiopathic monomorphic VT 1 ; this RVOT-VT has a distinctive morphology (QRS complexes with left bundle branch block pattern and tall R waves in the inferior leads) and, in general, does not lead to hemodynamic decompensation. Therefore, recording of ventricular extrasystoles that appear to originate from the RVOT, in patients presenting with palpitations, is reassuring. This follows the assumption that any sustained arrhythmia originating from the RVOT-if it ever occurs-will be well tolerated. Recently, Haissaguerre et al. called our attention to the fact that the RVOT area may also be the site of origin of malignant polymorphic arrhythmias. 2,3 Indeed, ventricular fibrillation (VF) originating from the RVOT has been described in patients with Brugada syndrome 2 and idiopathic VF. 3 Nevertheless, distinguishing patients with benign idiopathic monomorphic RVOT-VT from those with these malignant polymorphic forms has not been a clinical problem. This is because the former group generally presents with palpitations that have been present for months to years and have frequent RVOT-extrasystoles with a long coupling interval. In contrast, patients in the latter group present with syncope or cardiac arrest and have rare extrasystoles with a uniquely short coupling interval. 2-5 This coupling interval is so short that idiopathic VF has also been referred to as the "shortcoupled variant of torsade de pointes." 5 We now present patients who-based on their clinical presentation and frequent RVOT-extrasystoles-were initially given the diagnosis of
Progress in cardiovascular diseases, 1998
Different polymorphic ventricular tachyarrhythmias may cause syncope or cardiac arrest in patients with no heart disease: (1) Catecholamine-sensitive polymorphic ventricular tachycardia (VT) presents during childhood: the hallmark is the reproducible provocation of atrial and polymorphic ventricular arrhythmias during exercise, despite a normal QT. 13-Blockers are the treatment of choice. (2) In the long QT syndromes (LQTS), malfunction of ion channels leads to prolonged ventdcular repolarization, early afterdepolarizations, and triggered ventricular arrhythmias. Therapeutic options include: 13-blockers, genotype-specific therapy, cardiac sympathetic denervation, and implantation of pacemakers or defibrillators. The "short-coupled variant of torsade de pointes" is a malignant disease that shares several characteristics with idiopathic ventricular fibrillation. Although verapamil is frequently recommended, mortality rates remain high. (4) Idiopathic ventricular fibrillation (VF) with normal electrocardiogram (ECG) strikes young adults of both genders. In contrast to other polymorphic tachyarrhythmias, idiopathic VF is not generally related to stress. Also, familial involvement is rare. Therapeutic options include implantation of defibrillators and therapy with class 1A drugs. (5) The "Brugada syndrome" and the "syndrome of nocturnal sudden death" strike males almost exclusively. Right bundle branch block (RBBB) with ST elevation in the right precordial leads--the "Brugada sign"--is seen in the ECG of both patient populations. Implantation of defibrillators is recommended.
Octreotide-induced sinus bradycardia in a male patient with acromegaly
Endocrinología y Nutrición (English Edition), 2013
Octreotide-induced sinus bradycardia in a male patient with acromegaly ଝ Bradicardia sinusal inducida por octreotide en un varón con acromegalia Acromegaly is a disease characterized by excess growth hormone (GH), starting after the closure of the epiphyseal plates of long bones. Somatostatin is a peptide hormone with a short half-life (2-3 min) which is synthesized in multiple tissues, including the hypothalamus, to inhibit GH secretion. This hormone mediates its actions through five receptor subtypes (SSRs), of which SSR2 and SSR5 are the most widely expressed in pituitary adenomas. 1 Octreotide is a synthetic analog of somatostatin with an inhibitory action on the secretion of GH and various gastrointestinal and pancreatic hormones. 1 We report the case of a 37-year-old male patient from Mérida (Venezuela) with no personal or familial pathological history who was referred to the endocrinology unit for physiognomic changes over the previous seven years, highly severe holocranial headache, and bitemporal heteronymous hemianopsia starting five months before. The physical examination findings included: a body weight of 102 kg, a height of 185.0 cm, a body mass index (BMI) of 29.8 kg/m 2 , a heart rate of 72 bpm, blood pressure of 130/80 mmHg, and coarse facial features characterized by nose enlargement, prognathism, bulging of the forehead, and prominent cheeks. Thick skin with an oily texture, upper thoracic lordosis with compensatory lumbar hyperlordosis, prominence of the lower part of the sternum, and big hands and feet were also found, and confrontation campimetry showed bitemporal heteronymous hemianopsia. No cardiovascular or respiratory changes were found. Laboratory tests revealed no hematological changes. Blood chemistry showed normal glucose, kidney and liver function, calcium, and phosphorus levels. Additional test results included: basal plasma GH, 9.7 g/L (NR, 0-2.5); GH 2 h after a 75 g oral glucose tolerance test, 8.2 g/L (NR, less than 1); IGF-1 (insulin-like growth factor), 355 ng/mL (NR for age, 109-284); thyroid-stimulating hormone (TSH), 2.45 IU/mL (NR, 0.3-4.2); free thyroxine (FT4), 1.20 ng/dL ଝ Please cite this article as: Lima-Martínez MM, López-Méndez G, Mangupli R. Bradicardia sinusal inducida por octreotide en un varón con acromegalia. Endocrinol Nutr. 2013;60:e7-e9.
Idiopathic Ventricular Tachycardia: Good Prognosis but Debilitating Symptoms
International Journal of Biomedicine
Ventricular arrhythmias may occur in patients without anatomical heart abnormalities, a condition that is known as idiopathic ventricular arrhythmias. The most common form originates at the level of the outflow tracts. It can manifest as PVCs, non-sustained ventricular tachycardia (VT), and sustained VT. A 52-year-old female patient was admitted for 2 episodes of syncope related to a high burden of premature ventricular contractions (PVCs) and several episodes of VT with the same QRS morphology as the PVCs. A diagnosis of sustained monomorphic VT was formulated in a patient with no structural heart disease and a normal ejection fraction. Antiarrhythmic drugs such as metoprolol, propafenone, and amiodarone failed to reduce the number of PVCs, hence catheter ablation was suggested to the patient. The patient consented to the treatment, and following catheter ablation, the patient no longer experienced syncope. The 24-hour Holter ECG monitoring revealed no PVCs or VTs. PVCs and VTs fro...
Young Male With Incessantly Wide Complex Tachycardia: What Is the Substrate of the Arrhythmia?
Circulation, 2018
A 26-year-old male with no past medical issues presented with 24-hour sudden onset palpitations, chest discomfort, and dizziness. He was hemodynamically stable and his heart rate was 189 bpm, with no other remarkable findings on physical examination. A 12-lead ECG (Figure 1) showed regular wide complex tachycardia with right bundle-branch block and extreme superior axis. Stepwise management was provided with vagal maneuvers, escalating doses of adenosine, uptitrated intravenous verapamil, and cardioversion with serial discharges ≤270 J of biphasic energy. However, all interventions were ineffective, and the tachycardia remained incessant. What is the arrhythmia, and what cardiac structure is involved in its origin? Please turn the page to read the diagnosis.