Cardiol J
-
Prolonged corrected QT interval (QTc) holds independent prognostic importance in predicting mortality in patients with coronary artery disease, diabetes mellitus and congestive heart failure. However, its association with all cause or cardiac mortality in the general population remains unclear. We evaluated the relationship between prolonged QTc and total mortality among patients with syncope. ⋯ In elderly patients presenting to the emergency department with syncope, QTc interval ≥ 500 ms helps identify patients at higher risk of adverse outcomes.
-
We report the case of a 69 year-old Chinese lady with pheochromocytoma who developed chest pain and acute ST-segment elevation in the anterior leads on electrocardiography. She was given intravenous phenoxybenzamine for alpha-blockade before undergoing urgent coronary angiography. ⋯ The Tako-tsubo cardiomyopathy eventually resolved with surgical removal of the pheochromocytoma. This case highlights the challenging management of suspected acute myocardial infarction in pheochromocytoma crisis and also reinforces the notion that Tako-tsubo cardiomyopathy is likely precipitated by catecholamine excess.
-
Levosimendan (L) is used in clinical practice for the treatment of severe heart failure (HF); it has inotropic and vasodilatory effects, without increasing myocardial oxygen consumption. In acute HF, levosimendan improves hemodynamic parameters; previous studies have demonstrated that it has favorable effects on left ventricular (LV) diastolic function. The aim of our study was to evaluate the effect of on LV long-axis function that represents the earlier marker of diastolic dysfunction. ⋯ L therapy, without loading dose, improves NYHA class and ventricular function in patients with acute HF; we believe that these prolonged hemodynamic effects are due to active metabolities of L.
-
The interval from the pacemaker stimulus to the onset of the earliest paced QRS complex (latency) may be prolonged during left ventricular (LV) pacing. Marked latency is more common with LV than right ventricular (RV) pacing because of indirect stimulation through a coronary vein and higher incidence of LV pathology including scars. During simultaneous biventricular (BiV) pacing a prolonged latency interval may give rise to an ECG dominated by the pattern of RV pacing with a left bundle branch block configuration and commonly a QS complex in lead V1. ⋯ During LV only pacing (RV channel turned off) RV anodal pacing may also occur in a more obvious form so that the ECG looks precisely like that during BiV pacing. RV anodal stimulation may complicate threshold testing and ECG interpretation and should not be misinterpreted as pacemaker malfunction. Programming the V-V interval (LV before RV) in the setting of RV anodal stimulation cancels the V-V timing to zero.
-
Case Reports
Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza A virus.
The prevalence of myocardial involvement in influenza infection ranges from 0% to 11% depending on the diagnostic criteria used to define myocarditis. Whether such an association holds for the novel influenza A strain, pandemic-2009-H1N1, remains unknown. ⋯ Although history, physical examination, laboratory data points, and electrocardiogram are helpful in distinguishing myocarditis from myocardial infarction, differential diagnosis can sometimes be difficult. Here, we present the first known report of acute myocarditis mimicking acute myocardial infarction associated with the pandemic influenza A virus (H1N1) infection.