Zeitschrift für Kardiologie
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A 69 year old female with history of coronary heart disease, myocardial infarction and paroxysmal atrial fibrillation suffered from occipital apoplexy. Under treatment with amiodarone 600 mg daily and concomitant medication with beta-acetyldigoxine (0.1 mg daily) and bisoprolole (1.25 mg daily), significant QT-prolongation (max. 700 ms; QTc: 614 ms) could be documented. ⋯ This case report is the first to describe induction of amiodarone-associated "torsade de pointes" tachycardia during concomitant beta-blocker and digitalis medication in a patient with atrial fibrillation and structural heart disease. This points towards an elevated risk for proarrhythmia under this triple therapy.
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Review Case Reports
[Peripartum cardiomyopathy-the (un)known obstetricalcardiologic emergency situation].
Peripartum cardiomyopathy (PPCM) is rare cardiac complication afflicting women during pregnancy or until 5 months post partum with the typical signs of acute cardiac failure. PPCM is similar to dilated cardiomyopathy (DCM) in terms of symptoms, histopathology and treatment but is characterized by a better outcome with a high rate of spontaneous normalization of left-ventricular size and function. The understanding of the etiology is limited. ⋯ It has to be assumed that PPCM is often undetected or misdiagnosed because of the low incidence, the unspecific symptoms and the fact that other pregnancy-related factors have similar clinical appearance. The treatment is also unspecific and similar to DCM and acute cardiac failure. The severity of the disease requires an interdisciplinary approach in a perinatal center with consequent follow-up of the patients for risk stratification including echocardiography.
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The present case will focus on the potential of hypoperfusion detection with myocardial contrast echocardiography (MCE) using power Doppler harmonic imaging (PDHI). PDHI is normally performed in a triggered mode. Microbubbles were destroyed by the ultrasound energy in the myocardium, and myocardium has to be refilled with microbubbles within the time interval between the ultrasound pulses to obtain repetitive information about perfusion. ⋯ The present case suggests that different MCE techniques can analyze different compartments of the myocardial vasculature in clinical practice. This methodological comparison between triggered and real-time PDHI shows obviously differences in the DI signal detection due to the different microbubble behavior. Clinicians should be aware of the potentials of MCE to improve noninvasive diagnostic procedures in patients with ischemic heart disease.