Prolonged ventricular pauses in an asymptomatic athlete with "apparent Mobitz type II second-degree atrioventricular block".

We report the case of a 30-year-old basketball player with asymptomatic, nocturnal ventricular pauses of >3,000 ms, the longest being ∼12,000 ms, who was misdiagnosed with Mobitz type II second-degree atrioventricular (AV) block. Conversely, the tracings were characteristic of a vagally mediated AV block, a phenomenon first described by Massie and called "apparent Mobitz type II AV block." Although the patient was asymptomatic with ventricular pauses occurring only at night, it was decided to implant a permanent pacemaker to prevent neurological damage or life-threatening ventricular arrhythmias resulting from repeated, abnormally prolonged ventricular pauses. The persistence of AV block after a 3-month detraining period led us to believe that our decision was reasonable.

Tako-tsubo cardiomyopathy complicated by recurrent torsade de pointes in a patient with anorexia nervosa.

We report the case of a 57-year-old woman with anorexia nervosa showing evidence of "tako-tsubo" cardiomyopathy complicated by several syncopes due to recurrent episodes of torsades de pointes. Prolongation of QT interval and QT dispersion have been reported both in the "tako-tsubo" cardiomyopathy and in anorexia nervosa. The QT prolongation and the QT dispersion has been linked as risk indicators for sudden cardiac death. The combination of "tako-tsubo" cardiomyopathy with a condition associated with the prolongation of QT and/or with an increase of QT dispersion, such as anorexia nervosa, makes the acute and subacute prognosis of this disease much more severe than usual.

Osborn waves in severe accidental hypothermia secondary to prolonged immobilization and malnutrition.

We report the case of a 77-year-old man, in whom accidental hypothermia was secondary to prolonged immobilization and malnutrition. The electrocardiogram showed typical Osborn waves, which disappeared with the rewarming of the patient. The diagnosis of hypothermia is easy in patients with a history of prolonged exposure to a cold environment but accidental hypothermia may also occur as a consequence of prolonged immobilization and malnutrition. ECG analysis is very important for a correct and fast diagnosis.

Tako-tsubo cardiomyopathy in a patient with pacemaker syndrome.

We report the case of a 71-year-old woman, with a dual chamber pacemaker (PM), in whom a PM syndrome, due to loss of atrial sensing and pacing, was associated with a tako-tsubo cardiomyopathy (TTC). The repositioning of the atrial lead immediately improved symptoms, whereas complete regression of left ventricular wall motion abnormalities occurred after 1 month. We hypothesize that haemodynamic and hormonal responses associated with a PM syndrome, such as increased levels of catecholamines, may account for TTC in our patient.

[Electrocardiographic pattern of Brugada syndrome during fever and podagra]. / Elettrocardiogramma tipico della sindrome di Brugada in corso di episodio febbrile da podagra.

We report the case of a 42-year-old man from Madagascar who, having fever and pain in his left big toe, underwent electrocardiography, which showed the pattern of Brugada syndrome. These peculiar electrocardiographic abnormalities in Brugada syndrome warrant caution for physicians working in the emergency room because they may be mistaken as signs of acute myocardial infarction or acute pericarditis. In this case report the typical electrocardiographic abnormalities, their variability, the effects of fever, and the role of electrode position are discussed.