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Sustained ventricular tachycardia in a patient with thalassemia major.

Bayar N, Arslan S, Erkal Z, Küçükseymen S - Ann Noninvasive Electrocardiol (2013)

View Article: PubMed Central - PubMed

Affiliation: Antalya Education And Research Hospital, Cardiology Department, Antalya, Turkey.

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Although improvements in the treatment of thalassemia with transfusion and chelation therapy have been achieved, iron overload because of repeated red blood cell transfusions continue to cause organ dysfunction... There was increase in dyspnea and palpitation in the past few months... During the application, blood pressure was 90/50 mm Hg, the pulse 176/minute, an electrocardiogram showed wide-complex tachycardia (Fig. 1)... Transthoracic echocardiography revealed normal left ventricular systolic function, left ventricular hypertrophy and diastolic dysfunction have a restrictive filling pattern (Figs. 3, 4, and 5)... The hemogram reveals profound anemia with a hemoglobin level of 8.4 g/dL, diluted ferritin was 1300 ng/mL, thyroid hormones, electrolyte levels and cardiac enzymes were normal... Erythrocyte suspension were given the suggestion of hematology clinic, chelation therapy was continued... Follow-up of patient without complication and was discharged with metoprolol and amiodarone therapy. β-thalassemia is an inherited blood disease caused by mutations leading to reduction or absence of the β-globin chain production... Clinical features of β-thalassemia include haemolytic and hyperchromic anemia, ineffective erythropoiesis that causes profound anemia... PR prolongation, T-wave abnormalities, low QRS voltage, intraventricular conduction defect, and atrial fibrillation have been reported in patients with thalassemia... Twenty-four hour Holter monitoring in patients with iron overload, atrial and ventricular extrasystoles and intermittent episodes of VT were determined... Isma'eel et al., the incidence of ventricular late potentials on signal averaged ECG in patients with thalassemia is more than the normal individuals were determined... These studies in patients with thalassemia, show that the tendency to ventricular arrhythmias increased... Our patient had sustained VT with hemodynamic instability and an ICD implantation was decided for secondary prevention... Thalassemia major patients are predisposed to arrhythmias, thus early recognition of cardiac involvement is important for life quality and expectancy of patients.

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ECG after being defibrillated.
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fig02: ECG after being defibrillated.

Mentions: Thirty-year-old male patient, who followed with a diagnosis of β-thalassemia major, was admitted to the emergency room with palpitations and chest tightness before half an hour. There was a history of blood cell transfusion for thalassemia since the age, 8 years old began to deferoxamine, 10-year-old splenectomy was performed and before 4 months was started deferiprone in addition to deferoxamine. There was increase in dyspnea and palpitation in the past few months. During the application, blood pressure was 90/50 mm Hg, the pulse 176/minute, an electrocardiogram showed wide-complex tachycardia (Fig.1). The patient initially received intravenous amiodarone (300 mg/30 min) and transfered to coronary intensive-care unit. 15th minute of infusion, the patient became hypotensive and hemodynamically unstable, lost consciousness, pulseless ventricular tachycardia (VT) were defibrillated with 200 joules and sinus rhythm was achieved (Fig.2). Then installation of intravenous amiodarone was completed and the maintenance of oral treatment was passed, metoprolol 50 mg/day and ramipril 2.5 mg/day was administered. Transthoracic echocardiography revealed normal left ventricular systolic function, left ventricular hypertrophy and diastolic dysfunction have a restrictive filling pattern (Figs.3, 4, and 5). The hemogram reveals profound anemia with a hemoglobin level of 8.4 g/dL, diluted ferritin was 1300 ng/mL, thyroid hormones, electrolyte levels and cardiac enzymes were normal. Erythrocyte suspension were given the suggestion of hematology clinic, chelation therapy was continued. The patient was taken to control ventricular arrhythmias with amiodarone, ICD implantation was performed for the purpose of secondary prevention. Patient's ECG, has viewed repolarization changes during follow-up (Fig.6). Follow-up of patient without complication and was discharged with metoprolol and amiodarone therapy.


Sustained ventricular tachycardia in a patient with thalassemia major.

Bayar N, Arslan S, Erkal Z, Küçükseymen S - Ann Noninvasive Electrocardiol (2013)

ECG after being defibrillated.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4544285&req=5

fig02: ECG after being defibrillated.
Mentions: Thirty-year-old male patient, who followed with a diagnosis of β-thalassemia major, was admitted to the emergency room with palpitations and chest tightness before half an hour. There was a history of blood cell transfusion for thalassemia since the age, 8 years old began to deferoxamine, 10-year-old splenectomy was performed and before 4 months was started deferiprone in addition to deferoxamine. There was increase in dyspnea and palpitation in the past few months. During the application, blood pressure was 90/50 mm Hg, the pulse 176/minute, an electrocardiogram showed wide-complex tachycardia (Fig.1). The patient initially received intravenous amiodarone (300 mg/30 min) and transfered to coronary intensive-care unit. 15th minute of infusion, the patient became hypotensive and hemodynamically unstable, lost consciousness, pulseless ventricular tachycardia (VT) were defibrillated with 200 joules and sinus rhythm was achieved (Fig.2). Then installation of intravenous amiodarone was completed and the maintenance of oral treatment was passed, metoprolol 50 mg/day and ramipril 2.5 mg/day was administered. Transthoracic echocardiography revealed normal left ventricular systolic function, left ventricular hypertrophy and diastolic dysfunction have a restrictive filling pattern (Figs.3, 4, and 5). The hemogram reveals profound anemia with a hemoglobin level of 8.4 g/dL, diluted ferritin was 1300 ng/mL, thyroid hormones, electrolyte levels and cardiac enzymes were normal. Erythrocyte suspension were given the suggestion of hematology clinic, chelation therapy was continued. The patient was taken to control ventricular arrhythmias with amiodarone, ICD implantation was performed for the purpose of secondary prevention. Patient's ECG, has viewed repolarization changes during follow-up (Fig.6). Follow-up of patient without complication and was discharged with metoprolol and amiodarone therapy.

View Article: PubMed Central - PubMed

Affiliation: Antalya Education And Research Hospital, Cardiology Department, Antalya, Turkey.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Although improvements in the treatment of thalassemia with transfusion and chelation therapy have been achieved, iron overload because of repeated red blood cell transfusions continue to cause organ dysfunction... There was increase in dyspnea and palpitation in the past few months... During the application, blood pressure was 90/50 mm Hg, the pulse 176/minute, an electrocardiogram showed wide-complex tachycardia (Fig. 1)... Transthoracic echocardiography revealed normal left ventricular systolic function, left ventricular hypertrophy and diastolic dysfunction have a restrictive filling pattern (Figs. 3, 4, and 5)... The hemogram reveals profound anemia with a hemoglobin level of 8.4 g/dL, diluted ferritin was 1300 ng/mL, thyroid hormones, electrolyte levels and cardiac enzymes were normal... Erythrocyte suspension were given the suggestion of hematology clinic, chelation therapy was continued... Follow-up of patient without complication and was discharged with metoprolol and amiodarone therapy. β-thalassemia is an inherited blood disease caused by mutations leading to reduction or absence of the β-globin chain production... Clinical features of β-thalassemia include haemolytic and hyperchromic anemia, ineffective erythropoiesis that causes profound anemia... PR prolongation, T-wave abnormalities, low QRS voltage, intraventricular conduction defect, and atrial fibrillation have been reported in patients with thalassemia... Twenty-four hour Holter monitoring in patients with iron overload, atrial and ventricular extrasystoles and intermittent episodes of VT were determined... Isma'eel et al., the incidence of ventricular late potentials on signal averaged ECG in patients with thalassemia is more than the normal individuals were determined... These studies in patients with thalassemia, show that the tendency to ventricular arrhythmias increased... Our patient had sustained VT with hemodynamic instability and an ICD implantation was decided for secondary prevention... Thalassemia major patients are predisposed to arrhythmias, thus early recognition of cardiac involvement is important for life quality and expectancy of patients.

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