Limits...
QT Prolongation Complicated with Torsades de Pointes in Prosthetic Mitral Valve Endocarditis: A Case Report.

Tounsi A, Abid L, Akrout M, Hentati M, Kammoun S - Case Rep Med (2012)

Bottom Line: The clinical course and the long QTc interval with deep inverted T wave were completely normalized 4 weeks after.He continued on triple antibiotic therapy for 45 days with a good revolution.The clinical features and the possible mechanisms of QT prolongation (inflammation, infection) of this patient are discussed.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Department, Hedi Chaker University Hospital, Sfax 3029, Tunisia.

ABSTRACT
We present the case of a 49-year-old male patient with prosthetic mitral valve endocarditis associated with QT prolongation and torsades de pointes. He was asymptomatic until the end of January 2012, when he was admitted to our hospital emergency unit because of syncope, fever, and suspicion of endocarditis. Cardiologic evaluation was requested and the transthoracic (TTE) and transesophageal (TEE) echocardiograms revealed vegetations on the prosthetic mitral valve. All cultures were positive for methicillin-sensitive Staphylococcus aureus. The corrected QT (QTc) interval was markedly prolonged upon admission (QTc 540 ms). He experienced torsades de pointes (TdP) several times and he was recovered after bystander cardiopulmonary resuscitation. The clinical course and the long QTc interval with deep inverted T wave were completely normalized 4 weeks after. He continued on triple antibiotic therapy for 45 days with a good revolution. The clinical features and the possible mechanisms of QT prolongation (inflammation, infection) of this patient are discussed.

No MeSH data available.


Related in: MedlinePlus

QTc was normalized to 390 ms after day 30.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3472411&req=5

fig4: QTc was normalized to 390 ms after day 30.

Mentions: On the third day of admission, the patient lost consciousness, ceased spontaneous breathing, BP was unmeasurable, the SpO2 was 36%, and the ECG showed ventricular fibrillation. A direct current of 200 J was applied 3 times using a biphasic defibrillator. The ECG showed resolution of the ventricular fibrillation. However, shortly thereafter TdP-type polymorphic ventricular tachycardia was developed. Defibrillation was performed 3 times, and 1 mg epinephrine and 100 mg lidocaine were intravenously administered. Additionally, magnesium sulfate 2 g was given intravenously over 10 min. The BP increased to 146/80 mmHg and the SpO2 to 95%. The patient was moved to the intensive care unit (ICU) with endotracheal intubation in a stable condition. An ECG showed bradyarrhythmia, a HR of 48 beats/min, QTc interval prolongation (610 ms), and deep inverted T wave (Figure 3). Isoproterenol was continuously administered intravenously at a rate of 3 μg/min. Then, a temporary pacemaker was inserted in the right ventricle apex via the right femoral vein. An echocardiogram showed no remarkable change of left ventricular systolic function. The vital signs stabilized. All electrolytes were within normal limits including potassium (4.1 mmol/L), magnesium (2.2 mg/dL), and calcium (2.45 mmol/L). The patient was moved to the general ward on the 3rd day without relapse of TdP. He did not have any recurrence of arrhythmia and QTc was normalized to 390 ms after day 30 of antimicrobial therapy (Figure 4). He was clinically and hemodynamically stabilized. C-reactive protein decreased to 13 mg/L (Figure 5). He continued on twin antibiotic therapy for 45 days. The patient has remained symptom- and arythmia-free over a 6-month followup.


QT Prolongation Complicated with Torsades de Pointes in Prosthetic Mitral Valve Endocarditis: A Case Report.

Tounsi A, Abid L, Akrout M, Hentati M, Kammoun S - Case Rep Med (2012)

QTc was normalized to 390 ms after day 30.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472411&req=5

fig4: QTc was normalized to 390 ms after day 30.
Mentions: On the third day of admission, the patient lost consciousness, ceased spontaneous breathing, BP was unmeasurable, the SpO2 was 36%, and the ECG showed ventricular fibrillation. A direct current of 200 J was applied 3 times using a biphasic defibrillator. The ECG showed resolution of the ventricular fibrillation. However, shortly thereafter TdP-type polymorphic ventricular tachycardia was developed. Defibrillation was performed 3 times, and 1 mg epinephrine and 100 mg lidocaine were intravenously administered. Additionally, magnesium sulfate 2 g was given intravenously over 10 min. The BP increased to 146/80 mmHg and the SpO2 to 95%. The patient was moved to the intensive care unit (ICU) with endotracheal intubation in a stable condition. An ECG showed bradyarrhythmia, a HR of 48 beats/min, QTc interval prolongation (610 ms), and deep inverted T wave (Figure 3). Isoproterenol was continuously administered intravenously at a rate of 3 μg/min. Then, a temporary pacemaker was inserted in the right ventricle apex via the right femoral vein. An echocardiogram showed no remarkable change of left ventricular systolic function. The vital signs stabilized. All electrolytes were within normal limits including potassium (4.1 mmol/L), magnesium (2.2 mg/dL), and calcium (2.45 mmol/L). The patient was moved to the general ward on the 3rd day without relapse of TdP. He did not have any recurrence of arrhythmia and QTc was normalized to 390 ms after day 30 of antimicrobial therapy (Figure 4). He was clinically and hemodynamically stabilized. C-reactive protein decreased to 13 mg/L (Figure 5). He continued on twin antibiotic therapy for 45 days. The patient has remained symptom- and arythmia-free over a 6-month followup.

Bottom Line: The clinical course and the long QTc interval with deep inverted T wave were completely normalized 4 weeks after.He continued on triple antibiotic therapy for 45 days with a good revolution.The clinical features and the possible mechanisms of QT prolongation (inflammation, infection) of this patient are discussed.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Department, Hedi Chaker University Hospital, Sfax 3029, Tunisia.

ABSTRACT
We present the case of a 49-year-old male patient with prosthetic mitral valve endocarditis associated with QT prolongation and torsades de pointes. He was asymptomatic until the end of January 2012, when he was admitted to our hospital emergency unit because of syncope, fever, and suspicion of endocarditis. Cardiologic evaluation was requested and the transthoracic (TTE) and transesophageal (TEE) echocardiograms revealed vegetations on the prosthetic mitral valve. All cultures were positive for methicillin-sensitive Staphylococcus aureus. The corrected QT (QTc) interval was markedly prolonged upon admission (QTc 540 ms). He experienced torsades de pointes (TdP) several times and he was recovered after bystander cardiopulmonary resuscitation. The clinical course and the long QTc interval with deep inverted T wave were completely normalized 4 weeks after. He continued on triple antibiotic therapy for 45 days with a good revolution. The clinical features and the possible mechanisms of QT prolongation (inflammation, infection) of this patient are discussed.

No MeSH data available.


Related in: MedlinePlus