ABSTRACT
The QT interval prolongation may determine a type of polymorphic ventricular tachycardia named torsades de pointes. This ventricular arrhythmia could also appear after thrombolysis of acute myocardial infarction.Case reports. A 57 years old man was admitted 2 hours after the onset of a posterior-inferior-lateral acute myocardial infarction (reinfarction). He underwent pharmacological revascularization with reteplase. In the first 24 hours after thrombolysis a sustained polymorphic ventricular tachycardia was unregistered after the second dose of a quinolone recommended for a urological problem. Despite of the normal serum potassium and magnesium QTc suffered an augmentation from 400 ms to 480 ms. After beta-blocker augmentation dose and the antibiotic changing, ventricular arrhythmia disappeared without repetition during hospitalization. This ventricular tachycardia was considered precipitated by the quinolones therapy by increasing of QTc interval. It could also be considered a reperfusion sign or a complication of the reinfarction in the same area, which means different therapeutical solutions.
ABSTRACT
UNLABELLED: Left atrial size, most frequently assessed for practical reasons by echocardiography, is important in clinical decision-making. Left atrium volume measurements allow an accurate assessment of asymmetric remodeling and reverse remodeling in atrial fibrillation (AF) patients. AIM: To assess a new method (CTEL2) derived from CT scan by ellipsoid formula (CTEL1) to measure LA volume, we compared the conventional echocardiography-ellipsoid method (EEL), as a reference, with CTEL1 and with the new method-CTEL2. MATERIAL AND METHOD: Left atrium volume was measured by EEL and CTEL2 in 40 consecutive pts (group 1, 56 +/- 12 years, 80% men) and by EEL and CTEL1, in another 46 consecutive patients (group 2, 58 +/- 11 years, 80% men) with AF. For measurements by CTEL2 we used the same formula as the ellipsoid method but as optimal view for the orthogonal dimensions were taken every time the last axial section just under the superior veins (atrialized in dilated left atrium). Usual, the dimensions are taken on the largest axial left atrium area. The correlation coefficients were compared by Z test with Fisher inverse tank transformation. RESULTS: Mean left atrium volume irrespective of methods was > 50 mL. We found a good and significant correlation between CTEL1 and EEL (r1 = 0.769; p < 0.001) but a much better between CTEL2 and EEL (r1 = 0.915; p < 0.001). Both r1 and r2 coefficients were significantly stronger for the correlation with CTEL2 and with CTEL1 (p = 0.016). CONCLUSIONS: This new technique evaluation for left atrium volume is adequacy and could avoid an overestimation or underestimation of LA remodelation assessment, as standard ellipsoid method, in specific situations as cardioversion or AF ablation.
