RESUMO
We present a case of a 45 year-old woman with epilepsy diagnosed 24 years earlier. Epilepsy was confirmed by EEG and many seizures episodes were treated with different combination of anticonvulsive drugs. A 24-h Holter ECG monitoring revealed an episode of asystole lasting 82 s. The pacemaker was implanted and antiepileptic therapy with valproic acid chrono (1800 mg/d.) was continued. We review in this article present data on arrhythmic epilepsy.
Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/complicações , Parada Cardíaca/etiologia , Marca-Passo Artificial , Ácido Valproico/uso terapêutico , Eletroencefalografia/métodos , Epilepsia/terapia , Feminino , Parada Cardíaca/terapia , Humanos , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
Wellens syndrome is characterised by negative or biphasic T waves in V2-V4 leads and critical stenosis of proximal part of the left descending coronary artery. These ECG changes without atherosclerotic changes in coronary angiography, i.e. coronary artery spasm are called pseudo-Wellens syndrome. We describe a patient with acute coronary syndrome and pseudo-Wellens syndrome as a cause of vasospastic angina. These ECG abnormalities need differentiation with acute pulmonary embolism.
Assuntos
Síndrome Coronariana Aguda/fisiopatologia , Angina Pectoris Variante/fisiopatologia , Arritmias Cardíacas/etiologia , Vasoespasmo Coronário/fisiopatologia , Embolia Pulmonar/fisiopatologia , Síndrome Coronariana Aguda/complicações , Angina Pectoris Variante/etiologia , Arritmias Cardíacas/fisiopatologia , Vasoespasmo Coronário/complicações , Diagnóstico Diferencial , Eletrocardiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , SíndromeRESUMO
67-year-old woman with thrombocytopenia (treated with prednisolon and azathiopryn) was admitted because of acute myocardial infarction without ST segment elevation (NSTEMI). From the 2nd day we observed increasing QTc interval from 461 ms with normal potassium level. Suddenly on the 6th day of the so far uncomplicated AMI ventricular fibrillation developed and was successfully treated with DC shock, and amiodarone (150 mg i.v.) was administered because of recurrent NSVT. Potassium level was 2.9 mmol/l. Within the next 2 days in the morning hours we observed episodes of recurrent polymorphic ventricular tachycardia (PMVT), always progressing into ventricular fibrillation (VF). The ECG showed QT interval--520 ms, QTc--602 ms. The patient was given an increasing dose of beta-blocker and lidokaine in i.v. infusion. After this regimen PMVT/VF did not recur and QT was normalized. Additionally successful PCI of LAD with 80% stenosis was performed. The paper discusses the problem of PMVT in the settings of AMI.
