RESUMO
Long QT syndrome (LQTS) is a disorder of myocardial repolarization characterized by a prolonged QT interval on the electrocardiogram (ECG). This disorder is associated with an increased risk of torsade de pointes (TdP). We report a case of TdP induced by citalopram, a selective serotonin reuptake inhibitor (SSRI), taken in conjunction with amiodarone.
Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Citalopram/efeitos adversos , Transtorno Depressivo/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Torsades de Pointes/induzido quimicamente , Idoso de 80 Anos ou mais , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Citalopram/uso terapêutico , Diagnóstico Diferencial , Interações Medicamentosas , Eletrocardiografia/efeitos dos fármacos , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/diagnóstico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Torsades de Pointes/diagnósticoRESUMO
The authors report the case of a 34-year old woman with no previous cardiovascular disease who was admitted to hospital for acute ischaemia of the right arm due to embolism, preceded by two episodes of pain and tingling of the left arm related to subacute ischaemia. After right embolectomy, with no possibility of controlateral disobliteration an effective anticoagulation, no cardiac source of embolism could be found; However, transoesophageal echography showed a large mobile thrombus in the aortic arch implanted just before the origin of the left subclavian artery. The only explanation for embolism to the right arm was a retro-oesophageal subclavian artery which was confirmed by scanner. Doppler and arteriography. These investigations, however, did not allow visualisation of the aortic thrombus. In view of the risk of recurrent embolism, a thrombectomy was performed without cardiopulmonary bypass, associated with correction of the vascular abnormality with no complications. This case shows that oesophageal echography is a useful investigation in the work up of acute arterial obstruction in young patients with no cardiac disease.
