Acute polymyositis and hyperthyroidism in a patient on long-term amiodarone therapy

A 52-year-old male received continuous oral amiodarone therapy for 3 years for the management of ventricular tachycardia nonresponsive to other antiarrhythmics, after he sustained a Q wave anterior myocardial infarction. He developed pain and weakness in both thigh and shoulder muscles in addition to weight loss and profuse sweating. His investigations confirmed the diagnosis of acute polymyositis and hyperthyroidism. His symptoms disappeared and the abnormal biochemical tests returned to normal after the withdrawal of amiodarone. We have not been able to find any other such report and believe that these were adverse side-effects of this drug

Significance of early and late atrioventricular block in patients with a Q wave acute inferior myocardial infarction

One hundred and seventeen consecutive patients [mean age 55 years] with Q wave acute inferior myocardial infarction [MI] were studied. Of these, 62 developed atrioventricular [AV] conduction disorders [group I] and 55 did not [group II]. The AV block occurred early [within 24 h] in 38 [la] and later in 24 patients [Ib]. We report the in-hospital morbidity and mortality of these acute MI patients. There were no significant differences between group la and Ib patients with respect to coronary artery disease risk factors. Right ventricular MI was diagnosed in 14 [36%] and 7 [29%] group la and Ib patients, respectively [p = NS], and in 5 [9%] of group II patients. Mean peak serum creatine kinase was highest in group la patients [2,403 IU/1] compared to 1,860 IU/1 in group Ib and 1,369 IU/1 in group II. There was cardiogenic shock in 11 patients with 10 deaths in group la, while in group II, 2 patients had cardiogenic shock and 3 died [p < 0.01]. Only mortality was significantly higher in group la compared to group Ib [p > 0.05]. Cardiogenic shock was twice the rate in group Ib [n = 4] compared to group II [n = 2; p < 0.05], but there was no difference in mortality. A complete AV block was present in 32 patients [84%], with 25 [66%] requiring a pacemaker in group la, compared to 9 [37%], with 8 [33%] requiring a pacemaker, in group Ib [p < 0.01]. We conclude that prognosis is poor with the appearance of an AV block