BACKGROUND Bradycardia-induced cardiomyopathy(BIC),which is a disease resulting from bradycardia,is characterized by cardiac chamber enlargement and diminished cardiac function.The correction of bradycardia can allow ...BACKGROUND Bradycardia-induced cardiomyopathy(BIC),which is a disease resulting from bradycardia,is characterized by cardiac chamber enlargement and diminished cardiac function.The correction of bradycardia can allow for significant improvements in both cardiac function and structure;however,this disease has been infrequently documented.In this case,we conducted a longitudinal followup of a patient who had been enduring BIC for more than 40 years to heighten awareness and prompt timely diagnosis and rational intervention.CASE SUMMARY A woman who presented with postactivity fatigue and dyspnea was diagnosed with bradycardia at the age of 7.Since she had no obvious symptoms,she did not receive any treatment to improve her bradycardia during the 42-year follow-up,except for the implantation of a temporary pacemaker during labor induction surgery.As time progressed,the patient's heart gradually expanded due to her low ventricular rate,and she was diagnosed with BIC.In 2014,the patient developed atrial fibrillation,her ventricular rate gradually increased,and her heart shape gradually returned to normal.This report describes the cardiac morphological changes caused by the heart rate changes in BIC patients older than 40 years,introduces another possible outcome of BIC,and emphasizes the importance of early intervention in treating BIC.CONCLUSION BIC can induce atrial fibrillation,causing an increased ventricular rate and leading to positive cardiac remodeling.展开更多
AIM To examine whether wearable cardioverter defibrillator(WCD) alarms for asystole improve patient outcomes and survival.METHODS All asystole episodes recorded by the WCD in 2013 were retrospectively analyzed from a ...AIM To examine whether wearable cardioverter defibrillator(WCD) alarms for asystole improve patient outcomes and survival.METHODS All asystole episodes recorded by the WCD in 2013 were retrospectively analyzed from a database of device and medical record documentation and customer call reports. Events were classified as asystole episodes if initial presenting arrhythmia was asystole(< 10 beats/minor ≥ 5 s pause). Survival was defined as recovery at the scene or arrival to a medical facility alive, or not requiring immediate medical attention. Episodes occurring in hospitals, nursing homes, or ambulances were considered to be under medical care. Serious asystole episodes were defined as resulting in unconsciousness, hospital transfer, or death.RESULTS Of the total 51933 patients having worn the WCD in 2013, there were 257 patients(0.5%) who had asystole episodes and comprised the study cohort. Among the 257 patients(74% male, median age 69 years), there were 264 asystole episodes. Overall patient survival was 42%. Most asystoles were considered "serious"(n = 201 in 201 patients, 76%), with a 26% survival rate. All 56 patients with "non-serious" asystole episodes survived. Being under medical care was associated with worse survival of serious asystoles. Among acute survivors, 20% later died during WCD use(a median 4 days post asystole episode). Of the 86 living patients at the end of WCD use period, 48(56%) received ICD/pacemaker and 17(20%) improved their condition.CONCLUSION Survival rates after asystole in patients with WCD are higher than historically reported survival rates. Those under medical care at time of asystole exhibited lower survival.展开更多
We present a case of ictal asystole in an 81-year-old female, with no prior history of epileptic activity, or cardiac history suggestive of arrhythmia, who suffered several seemingly unrelated epileptic and asyst...We present a case of ictal asystole in an 81-year-old female, with no prior history of epileptic activity, or cardiac history suggestive of arrhythmia, who suffered several seemingly unrelated epileptic and asystolic episodes prior to finally having a witnessed seizure followed by an asystolic event. Following this event, all atrioventricular (AV) nodal blockers, and medications with potential seizure threshold lowering activity were stopped, and anti-epileptic medication was optimized. Due to the wishes of the patient’s family, no invasive interventions were pursued.However, the patient continued to be medically treated with anti-epileptic therapy and had no further asystolic events. Unfortunately, the patient’s overall clinical status deteriorated, and she subsequently passed during her hospital stay after being made do not resuscitate and do not intubate (DNR/DNI) by the family and then subsequently comfort care. Prior to her passing, however, she had remained free of epileptic events for 10 days and free of asystolic events for 21 days.展开更多
BACKGROUND Hyperthyroidism often leads to tachycardia,but there are also sporadic reports of hyperthyroidism with severe bradycardia,such as sick sinus syndrome(SSS)and atrioventricular block.These disorders are a cha...BACKGROUND Hyperthyroidism often leads to tachycardia,but there are also sporadic reports of hyperthyroidism with severe bradycardia,such as sick sinus syndrome(SSS)and atrioventricular block.These disorders are a challenge for clinicians.CASE SUMMARY We describe three cases of hyperthyroidism with SSS and found 31 similar cases in a PubMed literature search.Through the analysis of these 34 cases,we found 21 cases of atrioventricular block and 13 cases of SSS,with 67.6%of the patients experiencing bradycardia symptoms.After drug treatment,temporary pacemaker implantation,or anti-hyperthyroidism treatment,the bradycardia of 27 patients(79.4%)was relieved,and the median recovery time was 5.5(2-8)d.Only 7 cases(20.6%)needed permanent pacemaker implantation.CONCLUSION Patients with hyperthyroidism should be aware of the risk of severe bradycardia.In most cases,drug treatment or temporary pacemaker placement is recommended for initial treatment.If the bradycardia does not improve after 1 wk,a permanent pacemaker should be implanted.展开更多
Objective Castleman disease, also known as giant lymph node hyperplasia, involves lesions in the lymph nodes usually located in the chest_ENREF_1, particularly in the mediastinum. Meanwhile, sinus bradycardia is a sin...Objective Castleman disease, also known as giant lymph node hyperplasia, involves lesions in the lymph nodes usually located in the chest_ENREF_1, particularly in the mediastinum. Meanwhile, sinus bradycardia is a sinus rhythm slower than 60 beats per min, and it can occur in both healthy and sick individuals. However, the comorbidity of these two disorders has not been previously reported. In this paper, we report a case of a 46-year-old woman who presented with persistent sinus bradycardia and irondeficiency anemia. Diagnostic work-up revealed hepatosplenomegaly and a giant mass near the splenic hilum. The mass was removed surgically; after which, the patient's bradycardia resolved immediately, while her anemia was corrected after subsequent chemotherapy. Pathological examination revealed lymph nodes with benign lesions, and the patient was diagnosed with hyaline-vascular variant of Castleman disease. This is the first documented case of sinus bradycardia associated with Castleman disease. In this paper, we describe the case characteristics, discuss the possible pathogenesis, and consider the appropriate treatment of symptomatic sinus bradycardia accompanying Castleman disease.展开更多
After cervical spinal cord injury (SCI), the autonomic nervous system (ANS) becomes impaired and then, bradycardia can develop. In view of this, we performed to prescribe aminophylline as pharmacotherapy for bradycard...After cervical spinal cord injury (SCI), the autonomic nervous system (ANS) becomes impaired and then, bradycardia can develop. In view of this, we performed to prescribe aminophylline as pharmacotherapy for bradycardia. The study population consisted of 36 patients with cervical SCI. Bradycardia developed in 20 patients (55.6%), of these patients, 8 showed spontaneous recovery. Twelve patients had persistent bradycardia, therefore, aminophylline was administered at 0.5 mg/kg/hr by intravenous infusion. Their average heart rate increased within 24 hours after the start of infusion. In heart rate variability analysis for 7 preliminarily selected patients, the spectral waveforms of “oligowave type” indicating ANS impairment tended to appear in relatively early phase after injury (i.e., 2 days to 2 weeks after injury), whereas “normal type” was observed in the late phase (i.e., at 4 weeks). “Sympathetic block type” was observed throughout the follow-up period (2 days to 4 weeks). “Sympathetic block type” was also observed in a non-bradycardic patient on day 2. These results underscore the importance of treating ANS impairment with aminophylline while keeping in mind that bradycardia can occur even in post-SCI patients without clinical manifestations.展开更多
Weight gain, Osteoporosis, Glucose intolerance, Hypertension, and Cataract are the common complications associated with Dexamethasone. However, here we report a case of Multiple Myeloma who received chemotherapy invol...Weight gain, Osteoporosis, Glucose intolerance, Hypertension, and Cataract are the common complications associated with Dexamethasone. However, here we report a case of Multiple Myeloma who received chemotherapy involving Dexamethasone. Although this patient has no previous comorbid cardiac condition, he developed Sinus Bradycardia during the latter part of chemo regimen. Ironically Sinus Bradycardia was asymptomatic in these cases. The exact mechanism of how Dexamethasone causes Sinus Bradycardia is yet not properly understood, and some of the possible mechanisms of Dexamethasone causing Sinus Bradycardia have been postulated below.展开更多
Cardiovascular disease is defined as a heart rate that is less than 60 bpm. Implantable cardiac devices such as pacemakers are widely used nowadays. In this paper, design and implementation of the heart model can be c...Cardiovascular disease is defined as a heart rate that is less than 60 bpm. Implantable cardiac devices such as pacemakers are widely used nowadays. In this paper, design and implementation of the heart model can be controlled to be the heart of a patient suffering from a decrease in heart rate (Bradycardia). A system is designed to sense and calculate the heart rate per minute and it is considered as an input to the controller. The design and implementation of Mamdani fuzzy controller to generate electric pulses that mimic the natural pacing system of the heart maintains an adequate heart rate by delivering controlled, rhythmic electrical stimuli to the chambers of the patient heart. The proposed controller is tested by using Matlab/Simulink program.展开更多
Background: Beflex is an active fixation atrial and ventricular lead with a retractable screw;X-Fine is a passive fixation ventricular lead. These two bradycardia lead models were evaluated in the FINE study, an obser...Background: Beflex is an active fixation atrial and ventricular lead with a retractable screw;X-Fine is a passive fixation ventricular lead. These two bradycardia lead models were evaluated in the FINE study, an observational prospective trial conducted in France and Spain. Methods: Patients enlisted for pacemaker or defibrillator implants were enrolled. The primary objective was to assess acute dislodgement rates at the 3-month follow-up visit. Safety and electrical performances of the leads were assessed in acute conditions at implant and at the follow-up visit up to three months later. A handling questionnaire was submitted to implanting investigators immediately after implant. Results: A total of 2254 patients were enrolled in 95 centers;investigators implanted 1153 active atrial leads, mainly in the right atrium;1021 active right ventricular leads, mainly in the septum and 712 passive right ventricular leads, mainly in the apex. After a mean follow-up of 54.9 ± 37.6 days, dislodgement rates were 1.0% and 1.6% for atrial and ventricular active, and 3.2% for ventricular passive leads. No unexpected adverse reactions were observed during the course of the study and the electrical performances at implant and follow-up visits remained within normal ranges. Overall, most investigators (84%) rated leads’ handling as superior (better or best) to what observed with other bradycardia leads. Conclusion: Different bradycardia leads showed a dislodgement rate of 1.0% and 1.6% for atrial and ventricular active leads, and 3.2% for ventricular passive leads, at 3-month follow-up. Acute safety and electrical performances were within expected ranges and very good handling performances were observed.展开更多
Positive pressure generated in peritoneal cavity by gas insufflation during laparoscopic procedures can cause hemodynamic instability. There are a few case reports suggesting similar occurrences during thoracoscopic p...Positive pressure generated in peritoneal cavity by gas insufflation during laparoscopic procedures can cause hemodynamic instability. There are a few case reports suggesting similar occurrences during thoracoscopic procedures as well. The mechanism behind the conditions above is explained to be due to stretch force applied to peritoneum and pleura which causes vagal stimulation. We wish to present a case where a high negative pressure applied to pleural cavity lead to treatment-resistant bradycardia. The possible mechanism behind this occurrence was traction pressure on pleura which triggered vagal activity. The bradycardia subsided on reducing or discontinuing negative suction pressure. To best of our knowledge this the first case report on bradycardia associated with high negative suction pressure applied to inter costal drain.展开更多
BACKGROUND Cardiac arrhythmias,including bradyarrhythmias,have been described as manifestations of coronavirus disease 2019(COVID-19).Herein,we present a case of junctional bradycardia secondary to possible sinus node...BACKGROUND Cardiac arrhythmias,including bradyarrhythmias,have been described as manifestations of coronavirus disease 2019(COVID-19).Herein,we present a case of junctional bradycardia secondary to possible sinus node dysfunction in a patient with COVID-19.CASE SUMMARY The patient was a 32-year-old woman with no significant medical history.On the third day of hospitalization,she developed junctional bradycardia while being hemodynamically stable.The episodes of nodal dysrhythmia with a low heart rate persisted for the next few days and were associated with elevated levels of systemic inflammatory markers.The patient received antiviral and anti-inflammatory treatments for the viral infection but no antiarrhythmic medications.She had a normal sinus rhythm on day 12.CONCLUSION Cardiac rhythm monitoring,focusing on the association between cardiac arrhythmias and the systemic inflammatory response,is important in COVID-19 patients.展开更多
BACKGROUND Intravenous steroid pulse therapy is the treatment of choice for acute exacerbation of multiple sclerosis(MS).Although steroid administration is generally welltolerated,cases of cardiac arrhythmia have been...BACKGROUND Intravenous steroid pulse therapy is the treatment of choice for acute exacerbation of multiple sclerosis(MS).Although steroid administration is generally welltolerated,cases of cardiac arrhythmia have been reported.Herein,we describe a young woman who developed marked sinus bradycardia and T-wave abnormalities after corticosteroid administration.We also present plausible explanations for the abnormalities observed in this patient.CASE SUMMARY An 18-year-old woman experienced vertiginous dizziness and binocular diplopia 1 wk prior to admission.Neurological examination revealed left internuclear ophthalmoplegia with left peripheral-type facial palsy.The initial laboratory results were consistent with those of type 2 diabetes.Brain magnetic resonance imaging revealed multifocal,non-enhancing,symptomatic lesions and multiple enhancing lesions.She was diagnosed with MS and maturity-onset diabetes of the young.Intravenous methylprednisolone was administered.On day 5 after methylprednisolone infusion,marked bradycardia with T-wave abnormalities were observed.Genetic evaluation to elucidate the underlying conditions revealed a hepatocyte nuclear factor 4-alpha(HNF4A)gene mutation.Steroid treatment was discontinued under suspicion of corticosteroid-induced bradycardia.Her electrocardiogram changes returned to normal without complications two days after steroid discontinuation.CONCLUSION Corticosteroid-induced bradycardia may have a significant clinical impact,especially in patients with comorbidities,such as HNF4A mutations.展开更多
基金Supported by National Natural Science Foundation of China,No.81970241Tianfu Qingcheng Project-Tianfu Science and Technology Elite,No.1358.
文摘BACKGROUND Bradycardia-induced cardiomyopathy(BIC),which is a disease resulting from bradycardia,is characterized by cardiac chamber enlargement and diminished cardiac function.The correction of bradycardia can allow for significant improvements in both cardiac function and structure;however,this disease has been infrequently documented.In this case,we conducted a longitudinal followup of a patient who had been enduring BIC for more than 40 years to heighten awareness and prompt timely diagnosis and rational intervention.CASE SUMMARY A woman who presented with postactivity fatigue and dyspnea was diagnosed with bradycardia at the age of 7.Since she had no obvious symptoms,she did not receive any treatment to improve her bradycardia during the 42-year follow-up,except for the implantation of a temporary pacemaker during labor induction surgery.As time progressed,the patient's heart gradually expanded due to her low ventricular rate,and she was diagnosed with BIC.In 2014,the patient developed atrial fibrillation,her ventricular rate gradually increased,and her heart shape gradually returned to normal.This report describes the cardiac morphological changes caused by the heart rate changes in BIC patients older than 40 years,introduces another possible outcome of BIC,and emphasizes the importance of early intervention in treating BIC.CONCLUSION BIC can induce atrial fibrillation,causing an increased ventricular rate and leading to positive cardiac remodeling.
文摘AIM To examine whether wearable cardioverter defibrillator(WCD) alarms for asystole improve patient outcomes and survival.METHODS All asystole episodes recorded by the WCD in 2013 were retrospectively analyzed from a database of device and medical record documentation and customer call reports. Events were classified as asystole episodes if initial presenting arrhythmia was asystole(< 10 beats/minor ≥ 5 s pause). Survival was defined as recovery at the scene or arrival to a medical facility alive, or not requiring immediate medical attention. Episodes occurring in hospitals, nursing homes, or ambulances were considered to be under medical care. Serious asystole episodes were defined as resulting in unconsciousness, hospital transfer, or death.RESULTS Of the total 51933 patients having worn the WCD in 2013, there were 257 patients(0.5%) who had asystole episodes and comprised the study cohort. Among the 257 patients(74% male, median age 69 years), there were 264 asystole episodes. Overall patient survival was 42%. Most asystoles were considered "serious"(n = 201 in 201 patients, 76%), with a 26% survival rate. All 56 patients with "non-serious" asystole episodes survived. Being under medical care was associated with worse survival of serious asystoles. Among acute survivors, 20% later died during WCD use(a median 4 days post asystole episode). Of the 86 living patients at the end of WCD use period, 48(56%) received ICD/pacemaker and 17(20%) improved their condition.CONCLUSION Survival rates after asystole in patients with WCD are higher than historically reported survival rates. Those under medical care at time of asystole exhibited lower survival.
文摘We present a case of ictal asystole in an 81-year-old female, with no prior history of epileptic activity, or cardiac history suggestive of arrhythmia, who suffered several seemingly unrelated epileptic and asystolic episodes prior to finally having a witnessed seizure followed by an asystolic event. Following this event, all atrioventricular (AV) nodal blockers, and medications with potential seizure threshold lowering activity were stopped, and anti-epileptic medication was optimized. Due to the wishes of the patient’s family, no invasive interventions were pursued.However, the patient continued to be medically treated with anti-epileptic therapy and had no further asystolic events. Unfortunately, the patient’s overall clinical status deteriorated, and she subsequently passed during her hospital stay after being made do not resuscitate and do not intubate (DNR/DNI) by the family and then subsequently comfort care. Prior to her passing, however, she had remained free of epileptic events for 10 days and free of asystolic events for 21 days.
基金the Clinical Medical Research Center Project of Hainan Province,China,No.LCYX202207Key R&D Plan Project of Hainan Province,China,No.ZDYF2020118.
文摘BACKGROUND Hyperthyroidism often leads to tachycardia,but there are also sporadic reports of hyperthyroidism with severe bradycardia,such as sick sinus syndrome(SSS)and atrioventricular block.These disorders are a challenge for clinicians.CASE SUMMARY We describe three cases of hyperthyroidism with SSS and found 31 similar cases in a PubMed literature search.Through the analysis of these 34 cases,we found 21 cases of atrioventricular block and 13 cases of SSS,with 67.6%of the patients experiencing bradycardia symptoms.After drug treatment,temporary pacemaker implantation,or anti-hyperthyroidism treatment,the bradycardia of 27 patients(79.4%)was relieved,and the median recovery time was 5.5(2-8)d.Only 7 cases(20.6%)needed permanent pacemaker implantation.CONCLUSION Patients with hyperthyroidism should be aware of the risk of severe bradycardia.In most cases,drug treatment or temporary pacemaker placement is recommended for initial treatment.If the bradycardia does not improve after 1 wk,a permanent pacemaker should be implanted.
文摘Objective Castleman disease, also known as giant lymph node hyperplasia, involves lesions in the lymph nodes usually located in the chest_ENREF_1, particularly in the mediastinum. Meanwhile, sinus bradycardia is a sinus rhythm slower than 60 beats per min, and it can occur in both healthy and sick individuals. However, the comorbidity of these two disorders has not been previously reported. In this paper, we report a case of a 46-year-old woman who presented with persistent sinus bradycardia and irondeficiency anemia. Diagnostic work-up revealed hepatosplenomegaly and a giant mass near the splenic hilum. The mass was removed surgically; after which, the patient's bradycardia resolved immediately, while her anemia was corrected after subsequent chemotherapy. Pathological examination revealed lymph nodes with benign lesions, and the patient was diagnosed with hyaline-vascular variant of Castleman disease. This is the first documented case of sinus bradycardia associated with Castleman disease. In this paper, we describe the case characteristics, discuss the possible pathogenesis, and consider the appropriate treatment of symptomatic sinus bradycardia accompanying Castleman disease.
文摘After cervical spinal cord injury (SCI), the autonomic nervous system (ANS) becomes impaired and then, bradycardia can develop. In view of this, we performed to prescribe aminophylline as pharmacotherapy for bradycardia. The study population consisted of 36 patients with cervical SCI. Bradycardia developed in 20 patients (55.6%), of these patients, 8 showed spontaneous recovery. Twelve patients had persistent bradycardia, therefore, aminophylline was administered at 0.5 mg/kg/hr by intravenous infusion. Their average heart rate increased within 24 hours after the start of infusion. In heart rate variability analysis for 7 preliminarily selected patients, the spectral waveforms of “oligowave type” indicating ANS impairment tended to appear in relatively early phase after injury (i.e., 2 days to 2 weeks after injury), whereas “normal type” was observed in the late phase (i.e., at 4 weeks). “Sympathetic block type” was observed throughout the follow-up period (2 days to 4 weeks). “Sympathetic block type” was also observed in a non-bradycardic patient on day 2. These results underscore the importance of treating ANS impairment with aminophylline while keeping in mind that bradycardia can occur even in post-SCI patients without clinical manifestations.
文摘Weight gain, Osteoporosis, Glucose intolerance, Hypertension, and Cataract are the common complications associated with Dexamethasone. However, here we report a case of Multiple Myeloma who received chemotherapy involving Dexamethasone. Although this patient has no previous comorbid cardiac condition, he developed Sinus Bradycardia during the latter part of chemo regimen. Ironically Sinus Bradycardia was asymptomatic in these cases. The exact mechanism of how Dexamethasone causes Sinus Bradycardia is yet not properly understood, and some of the possible mechanisms of Dexamethasone causing Sinus Bradycardia have been postulated below.
文摘Cardiovascular disease is defined as a heart rate that is less than 60 bpm. Implantable cardiac devices such as pacemakers are widely used nowadays. In this paper, design and implementation of the heart model can be controlled to be the heart of a patient suffering from a decrease in heart rate (Bradycardia). A system is designed to sense and calculate the heart rate per minute and it is considered as an input to the controller. The design and implementation of Mamdani fuzzy controller to generate electric pulses that mimic the natural pacing system of the heart maintains an adequate heart rate by delivering controlled, rhythmic electrical stimuli to the chambers of the patient heart. The proposed controller is tested by using Matlab/Simulink program.
文摘Background: Beflex is an active fixation atrial and ventricular lead with a retractable screw;X-Fine is a passive fixation ventricular lead. These two bradycardia lead models were evaluated in the FINE study, an observational prospective trial conducted in France and Spain. Methods: Patients enlisted for pacemaker or defibrillator implants were enrolled. The primary objective was to assess acute dislodgement rates at the 3-month follow-up visit. Safety and electrical performances of the leads were assessed in acute conditions at implant and at the follow-up visit up to three months later. A handling questionnaire was submitted to implanting investigators immediately after implant. Results: A total of 2254 patients were enrolled in 95 centers;investigators implanted 1153 active atrial leads, mainly in the right atrium;1021 active right ventricular leads, mainly in the septum and 712 passive right ventricular leads, mainly in the apex. After a mean follow-up of 54.9 ± 37.6 days, dislodgement rates were 1.0% and 1.6% for atrial and ventricular active, and 3.2% for ventricular passive leads. No unexpected adverse reactions were observed during the course of the study and the electrical performances at implant and follow-up visits remained within normal ranges. Overall, most investigators (84%) rated leads’ handling as superior (better or best) to what observed with other bradycardia leads. Conclusion: Different bradycardia leads showed a dislodgement rate of 1.0% and 1.6% for atrial and ventricular active leads, and 3.2% for ventricular passive leads, at 3-month follow-up. Acute safety and electrical performances were within expected ranges and very good handling performances were observed.
文摘Positive pressure generated in peritoneal cavity by gas insufflation during laparoscopic procedures can cause hemodynamic instability. There are a few case reports suggesting similar occurrences during thoracoscopic procedures as well. The mechanism behind the conditions above is explained to be due to stretch force applied to peritoneum and pleura which causes vagal stimulation. We wish to present a case where a high negative pressure applied to pleural cavity lead to treatment-resistant bradycardia. The possible mechanism behind this occurrence was traction pressure on pleura which triggered vagal activity. The bradycardia subsided on reducing or discontinuing negative suction pressure. To best of our knowledge this the first case report on bradycardia associated with high negative suction pressure applied to inter costal drain.
文摘BACKGROUND Cardiac arrhythmias,including bradyarrhythmias,have been described as manifestations of coronavirus disease 2019(COVID-19).Herein,we present a case of junctional bradycardia secondary to possible sinus node dysfunction in a patient with COVID-19.CASE SUMMARY The patient was a 32-year-old woman with no significant medical history.On the third day of hospitalization,she developed junctional bradycardia while being hemodynamically stable.The episodes of nodal dysrhythmia with a low heart rate persisted for the next few days and were associated with elevated levels of systemic inflammatory markers.The patient received antiviral and anti-inflammatory treatments for the viral infection but no antiarrhythmic medications.She had a normal sinus rhythm on day 12.CONCLUSION Cardiac rhythm monitoring,focusing on the association between cardiac arrhythmias and the systemic inflammatory response,is important in COVID-19 patients.
文摘BACKGROUND Intravenous steroid pulse therapy is the treatment of choice for acute exacerbation of multiple sclerosis(MS).Although steroid administration is generally welltolerated,cases of cardiac arrhythmia have been reported.Herein,we describe a young woman who developed marked sinus bradycardia and T-wave abnormalities after corticosteroid administration.We also present plausible explanations for the abnormalities observed in this patient.CASE SUMMARY An 18-year-old woman experienced vertiginous dizziness and binocular diplopia 1 wk prior to admission.Neurological examination revealed left internuclear ophthalmoplegia with left peripheral-type facial palsy.The initial laboratory results were consistent with those of type 2 diabetes.Brain magnetic resonance imaging revealed multifocal,non-enhancing,symptomatic lesions and multiple enhancing lesions.She was diagnosed with MS and maturity-onset diabetes of the young.Intravenous methylprednisolone was administered.On day 5 after methylprednisolone infusion,marked bradycardia with T-wave abnormalities were observed.Genetic evaluation to elucidate the underlying conditions revealed a hepatocyte nuclear factor 4-alpha(HNF4A)gene mutation.Steroid treatment was discontinued under suspicion of corticosteroid-induced bradycardia.Her electrocardiogram changes returned to normal without complications two days after steroid discontinuation.CONCLUSION Corticosteroid-induced bradycardia may have a significant clinical impact,especially in patients with comorbidities,such as HNF4A mutations.
