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PP-311 THERAPY-RESISTANT VENTRICULAR TACHYCARDIA DUE TO AMIODARONE-INDUCED THYROTOXICOSIS: A CASE REPORT OF ELECTRICAL STORM
S202
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
Results: Her ECG revealed prolonged QT interval (QT; 580 msn, QTc; 600 msn). Laboratory examinations showed that serum potassium was 3.7 mmol/L, glucose was 155 mg/dl, sodium and magnesium values and cardiac enzyme levels were normal (CK:140 U/L, CK-MB: 22 U/L, Troponin T: 0.01) and these did not increase during monitoring. The patient was observed to have torsades de pointes attacks during monitoring and thus overdrive pacing was performed (figure 1). In her coronary angiography, right coronary artery was totally occluded and filling retrogradely. LAD and Cx were observed to be normal. Right coronary artery occlusion was thought to be chronic and invasive intervention was not deemed necessary. The patient was stabilized and thus discharged from hospital by advising her not to consume licorice root tea. Conclusions: Here, we present a case admitted to emergency service due to polymorphic VT (torsades de pointes) as a result of drinking 5–6 glasses of licorice root tea for constipation for 2 days before admission to hospital. Licorice root consumption should be taken into account in all patients applying hospital for cardiac arrythmia and it may cause cardiac arrythmia when consumed regularly and in excessive amounts.
time, pulseless monomorphic VT developed 4 times, and DC shocks were performed successfully. Twelve-lead ECG after DC shock revealed sinus rhythm and the corrected QT interval was 420 msec. On the first day of hospitalization, the patients had 10 attacks of pulseless VT treated with successful DC shocks. Occasionally, VT attacks degenerated to ventricular fibrillation. Lidocain infusion was started. Coronary angiography was performed because of suspicion of ischemia-induced VT attacks. Coronary angiography revealed normal coronary anatomy and the stent in the LAD was open without signs of thrombosis. On the second day of hospitalization, temporary overdrive pacing was initiated, but the VT attacks persisted despite overdrive pacing. The patient was under intravenous amiodarone infusion since hospitalization. Because of suspicious of amiodarone-induced thyrotoxicosis (AIT), thyroid function was tested and increased production of thyroid hormones were observed: TSH was 0.01 mIU/L (0.34–5.6 mIU/L), and free T4 2.68 pg/dl (0.61–1.12 ng/dl). Free T3 was 2.25 pg/dl (2.5–3.9 pg/dl). AIT was diagnosed and propylthiouracil therapy was started in doses up to 1000 mg/day, in combination with 40 mg propranolol. Also high-dose prednisone therapy was initiated. In addition, amiodarone was withdrawn. After antithyroid therapy, no attacks of VT were observed. The patient was followed-up in the CCU and was discharged on the sixth day of admission without any VT attacks. Conclusions: In conclusion, we want to emphasize the importance of recognizing potential life-threatening complications of amiodarone treatment, such as thyrotoxicosis-induced ES, which may require early aggressive therapy (surgery and/or antithyroid agents).
Figure 1. Torsades de pointes attacks during monitoring in coronary care unit. PP-311 THERAPY-RESISTANT VENTRICULAR TACHYCARDIA DUE TO AMIODARONE-INDUCED THYROTOXICOSIS: A CASE REPORT OF ELECTRICAL STORM H.I. Erdogan1 , E.E. Gul1 , H. Gok1 , K.C. Nikus2 . 1 Department of Cardiology, Meram School of Medicine, Selcuk University, Konya, Turkey; 2 Department of Cardiology, Heart Center, Tampere University Hospital, Tampere, Finland Objective: Electrical storm (ES) is defined as hemodynamically significant VT occurring at least three times over a 24-hour period and requiring DC shocks. Determining the etiology of ES is quite challenging. Methods: A 63-year-old man was admitted to the emergency department with complaints of breathlessness and syncope. Two weeks before, he was hospitalized because of acute anterior myocardial infarction and primary stenting was performed in the left anterior descending (LAD) artery. He was administered oral amiodarone (600 mg/day) because of sustained ventricular tachycardia (VT). Twelve-lead electrocardiogram (ECG) revealed atrial fibrillation. Transthoracic echocardiography was performed and the ejection fraction was 34% based on the modified Simpson method. In the CCU, sustained VT developed and because of hemodynamic impairment, defibrillation with 50 J was performed (Fig. 1). After direct current (DC) shock, sinus rhythm was restored. After amiodarone loading (300 mg), continuous intravenous infusion was initiated. Biochemical parameters including electrolytes were within normal values. Within short
Figure 1. Twelve-lead tachycardia.
ECG
showing
sustained
ventricular
PP-312 CHINESE RESTAURANT SYNDROME: A RARE CAUSE OF SYMPTOMATIC PAROXYSMAL SINUS TACHYCARDIA S. Okutucu, B. Evranos, U.N. Karakulak, F. Jam, C. Sabanov, S.G. Fatihoglu, M.L. Sahiner, E.B. Kaya, K. Aytemir, G. Kabakci, L. Tokgozoglu, A. Oto. Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Monosodium glutamate (MSG) is the sodium salt of the excitatory amino acid, glutamic acid. MSG is a food additive (flavour enhancer), which is widely used in the preparation of certain ethnic foods as well as in a large percentage of canned, frozen and prepared foods, especially soups, sauces, broths and dressings. Chinese restaurant syndrome (CRS) is a clinical syndrome associated with consumption of the westernized version of Chinese food, characterized by various symptoms such as burning and tingling sensations, palpitation and drowsiness, and tentatively ascribed to MSG in the food. Herein, we present a patient with symptomatic paroxysmal sinus tachycardia who consumed Chinese food before her paroxysmal symptoms onset. Methods: A 24-year-old woman was admitted to the hospital with episodic palpitations. She had episodic palpitations for 5 months and it became more severe during last month. She did not use any drug or cigarette. From the detailed history it has been learned that she has been consuming Chinese food frequently for 5 months. At the time of admission her heart rate was
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
Results: Her ECG revealed prolonged QT interval (QT; 580 msn, QTc; 600 msn). Laboratory examinations showed that serum potassium was 3.7 mmol/L, glucose was 155 mg/dl, sodium and magnesium values and cardiac enzyme levels were normal (CK:140 U/L, CK-MB: 22 U/L, Troponin T: 0.01) and these did not increase during monitoring. The patient was observed to have torsades de pointes attacks during monitoring and thus overdrive pacing was performed (figure 1). In her coronary angiography, right coronary artery was totally occluded and filling retrogradely. LAD and Cx were observed to be normal. Right coronary artery occlusion was thought to be chronic and invasive intervention was not deemed necessary. The patient was stabilized and thus discharged from hospital by advising her not to consume licorice root tea. Conclusions: Here, we present a case admitted to emergency service due to polymorphic VT (torsades de pointes) as a result of drinking 5–6 glasses of licorice root tea for constipation for 2 days before admission to hospital. Licorice root consumption should be taken into account in all patients applying hospital for cardiac arrythmia and it may cause cardiac arrythmia when consumed regularly and in excessive amounts.
time, pulseless monomorphic VT developed 4 times, and DC shocks were performed successfully. Twelve-lead ECG after DC shock revealed sinus rhythm and the corrected QT interval was 420 msec. On the first day of hospitalization, the patients had 10 attacks of pulseless VT treated with successful DC shocks. Occasionally, VT attacks degenerated to ventricular fibrillation. Lidocain infusion was started. Coronary angiography was performed because of suspicion of ischemia-induced VT attacks. Coronary angiography revealed normal coronary anatomy and the stent in the LAD was open without signs of thrombosis. On the second day of hospitalization, temporary overdrive pacing was initiated, but the VT attacks persisted despite overdrive pacing. The patient was under intravenous amiodarone infusion since hospitalization. Because of suspicious of amiodarone-induced thyrotoxicosis (AIT), thyroid function was tested and increased production of thyroid hormones were observed: TSH was 0.01 mIU/L (0.34–5.6 mIU/L), and free T4 2.68 pg/dl (0.61–1.12 ng/dl). Free T3 was 2.25 pg/dl (2.5–3.9 pg/dl). AIT was diagnosed and propylthiouracil therapy was started in doses up to 1000 mg/day, in combination with 40 mg propranolol. Also high-dose prednisone therapy was initiated. In addition, amiodarone was withdrawn. After antithyroid therapy, no attacks of VT were observed. The patient was followed-up in the CCU and was discharged on the sixth day of admission without any VT attacks. Conclusions: In conclusion, we want to emphasize the importance of recognizing potential life-threatening complications of amiodarone treatment, such as thyrotoxicosis-induced ES, which may require early aggressive therapy (surgery and/or antithyroid agents).
Figure 1. Torsades de pointes attacks during monitoring in coronary care unit. PP-311 THERAPY-RESISTANT VENTRICULAR TACHYCARDIA DUE TO AMIODARONE-INDUCED THYROTOXICOSIS: A CASE REPORT OF ELECTRICAL STORM H.I. Erdogan1 , E.E. Gul1 , H. Gok1 , K.C. Nikus2 . 1 Department of Cardiology, Meram School of Medicine, Selcuk University, Konya, Turkey; 2 Department of Cardiology, Heart Center, Tampere University Hospital, Tampere, Finland Objective: Electrical storm (ES) is defined as hemodynamically significant VT occurring at least three times over a 24-hour period and requiring DC shocks. Determining the etiology of ES is quite challenging. Methods: A 63-year-old man was admitted to the emergency department with complaints of breathlessness and syncope. Two weeks before, he was hospitalized because of acute anterior myocardial infarction and primary stenting was performed in the left anterior descending (LAD) artery. He was administered oral amiodarone (600 mg/day) because of sustained ventricular tachycardia (VT). Twelve-lead electrocardiogram (ECG) revealed atrial fibrillation. Transthoracic echocardiography was performed and the ejection fraction was 34% based on the modified Simpson method. In the CCU, sustained VT developed and because of hemodynamic impairment, defibrillation with 50 J was performed (Fig. 1). After direct current (DC) shock, sinus rhythm was restored. After amiodarone loading (300 mg), continuous intravenous infusion was initiated. Biochemical parameters including electrolytes were within normal values. Within short
Figure 1. Twelve-lead tachycardia.
ECG
showing
sustained
ventricular
PP-312 CHINESE RESTAURANT SYNDROME: A RARE CAUSE OF SYMPTOMATIC PAROXYSMAL SINUS TACHYCARDIA S. Okutucu, B. Evranos, U.N. Karakulak, F. Jam, C. Sabanov, S.G. Fatihoglu, M.L. Sahiner, E.B. Kaya, K. Aytemir, G. Kabakci, L. Tokgozoglu, A. Oto. Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Monosodium glutamate (MSG) is the sodium salt of the excitatory amino acid, glutamic acid. MSG is a food additive (flavour enhancer), which is widely used in the preparation of certain ethnic foods as well as in a large percentage of canned, frozen and prepared foods, especially soups, sauces, broths and dressings. Chinese restaurant syndrome (CRS) is a clinical syndrome associated with consumption of the westernized version of Chinese food, characterized by various symptoms such as burning and tingling sensations, palpitation and drowsiness, and tentatively ascribed to MSG in the food. Herein, we present a patient with symptomatic paroxysmal sinus tachycardia who consumed Chinese food before her paroxysmal symptoms onset. Methods: A 24-year-old woman was admitted to the hospital with episodic palpitations. She had episodic palpitations for 5 months and it became more severe during last month. She did not use any drug or cigarette. From the detailed history it has been learned that she has been consuming Chinese food frequently for 5 months. At the time of admission her heart rate was