BACKGROUND Sarcoidosis is a rare multisystem disease characterized histologically by noncaseating granuloma formation in the affected organ.While cardiac sarcoidosis is found on autopsy in up to 25%of sarcoidosis case...BACKGROUND Sarcoidosis is a rare multisystem disease characterized histologically by noncaseating granuloma formation in the affected organ.While cardiac sarcoidosis is found on autopsy in up to 25%of sarcoidosis cases,it is still underdiagnosed and is associated with a poor prognosis.Although the etiology of sarcoidosis remains unclear,an antigen triggered exaggerated immune response has been hypothesized.Early detection and prompt management of cardiac sarcoidosis remains pivotal.CASE SUMMARY A 60-year-old female,with pulmonary sarcoidosis in remission,presented to the cardiology outpatient clinic for evaluation of weeks-long dyspnea on moderate exertion(New York Heart Association class II)that was relieved by rest.Submaximal exercise stress test showed multifocal ventricular extrasystoles,followed by a self-limiting torsades de pointes.Cardiac magnetic resonance imaging showed nondilated and normotrophic left ventricle with basoseptal and mid-septal dyskinesis.The magnetic resonance imaging-derived left ventricular ejection fraction was 45%.Delayed enhancement showed patchy transmural fibrosis of the septum and hyperenhancement of the papillary muscles,all in favor of extensive cardiac involvement of sarcoidosis.A double-chamber implantable cardiac defibrillator was implanted,and methylprednisolone(12 mg/d)and methotrexate(12.5 mg/wk)treatment was initiated.Follow-up and implantable cardiac defibrillator interrogation showed episodes of asymptomatic nonsustained ventricular tachycardia and an asymptomatic episode of nonsustained ventricular tachycardia ending by the first antitachycardia pacing run.CONCLUSION Along an extensive review of the literature,this unusual case report highlights the importance of early detection of cardiac involvement of sarcoidosis,in order to avoid potential complications and increase survival.展开更多
BACKGROUND QT interval prolongation can induce torsades de pointes(TdP),a potentially fatal ventricular arrhythmia.Recently,an increasing number of non-cardiac drugs have been found to cause QT prolongation and/or TdP...BACKGROUND QT interval prolongation can induce torsades de pointes(TdP),a potentially fatal ventricular arrhythmia.Recently,an increasing number of non-cardiac drugs have been found to cause QT prolongation and/or TdP onset.Moreover,recent findings have demonstrated the key roles of systemic inflammatory activation and fever in promoting long-QT syndrome(LQTS)and TdP development.CASE SUMMARY A 30-year-old woman was admitted with a moderate to high-grade episodic fever for two weeks.The patient was administered with multiple antibiotics after hospitalization but still had repeating fever and markedly elevated C-reactive protein.Once after a high fever,the patient suddenly lost consciousness,and electrocardiogram(ECG)showed transient TdP onset after frequent premature ventricular contraction.The patient recovered sinus rhythm and consciousness spontaneously,and post-TdP ECG revealed a prolonged QTc interval of 560 ms.The patient’s clinical manifestations and unresponsiveness to the antibiotics led to the final diagnosis of adult-onset Still’s disease(AOSD).There was no evidence of cardiac involvement.After the AOSD diagnosis,discontinuation of antibiotics and immediate initiation of intravenous dexamethasone administration resulted in the normal temperature and QTc interval.The genetic analysis identified that the patient and her father had heterozygous mutations in KCNH2(c.1370C>T)and AKAP9(c.7725A>C).During the 2-year follow-up period,the patient had no recurrence of any arrhythmia and maintained normal QTc interval.CONCLUSION This case study highlights the risk of systemic inflammatory activation and antibiotic-induced TdP/LQTS onset.Genetic analysis should be considered to identify individuals at high risk of developing TdP.展开更多
Abstract： Loperamide is a common, over-the-counter, antidiarrheal medication that has been implicated in cases of ventricular tachycardia. A 32 year-old female patient with a history of opioid abuse and no prior hist...Abstract： Loperamide is a common, over-the-counter, antidiarrheal medication that has been implicated in cases of ventricular tachycardia. A 32 year-old female patient with a history of opioid abuse and no prior history of cardiovascular disease experienced Torsades de pointes. An electrocardiogram at the time of hospital presentation revealed a prolonged QT interval at 636 msec. Diagnostic evaluation was unremarkable for any underlying cardiovascular pathology. Further investigation revealed the patient had been taking 30-40 loperamide 2 mg tablets oral daily for 2 weeks prior to the onset of Torsades de pointes. At high doses, loperamide may prolong the QT interval through antagonism of the human ether-a-go-go potassium current, thus increasing the risk of ventricular arrhythmias. Clinicians should be cautious with administration of high doses of loperamide to all patients, especially patients at high risk for QT interval prolongation.展开更多
Acquired long QT syndromes and torsade de points often occur with underlying hypokalemia andbradycardia. With its fast inactivation property, the rapid activating component (Ikr) of the delayed rectifierpotassium curr...Acquired long QT syndromes and torsade de points often occur with underlying hypokalemia andbradycardia. With its fast inactivation property, the rapid activating component (Ikr) of the delayed rectifierpotassium current (IK) plays an important role in maintaining normal QT intervals. In this study, we evaluated the effects of different extracellular potassium ([K].) on the fast inactivation current of Ikr in guinea pigventricular myocytes. The results showed that [K]. had strong effects on the fast inactivation current ; thelower [K].(1, 3 mmol/L) significantly decreased the inactivation outward current (P＜0. 05); while higher[K]. (8, 10, 20 mmol/L) slightly increased the inactivation current (P>0. 05). These results may be of greatclinical significance. The lower [K]. decreased Ikr inactivation current, which may help to explain why acquired long QT syndromes and torsade de points often occur in the lower [K]. The correction of hypokalemia can increase the inactivation current, therefore, it is critical in the treatment of acquired long QTsyndromes and torsade de points.展开更多
目的观察耳穴疗法联合中药塌渍治疗膝骨关节炎的临床疗效及对骨代谢和炎症因子的影响。方法将100例膝骨关节炎患者,随机分为对照组和研究组,每组50例。对照组采用中药塌渍治疗,研究组在对照组的基础上采用耳穴疗法(耳穴贴压联合耳部铜...目的观察耳穴疗法联合中药塌渍治疗膝骨关节炎的临床疗效及对骨代谢和炎症因子的影响。方法将100例膝骨关节炎患者,随机分为对照组和研究组,每组50例。对照组采用中药塌渍治疗,研究组在对照组的基础上采用耳穴疗法(耳穴贴压联合耳部铜砭刮痧)治疗。比较两组临床疗效及治疗前后中医证候积分、血清骨代谢指标[Ⅱ型胶原C-端肽(C-terminal telopeptides of typeⅡcollagen,CTX-Ⅱ)、骨钙素(bone Gla-protein,BGP)、骨保护素(osteoprotectin,OPG)]、炎性因子[白细胞介素-1(interleukin-1,IL-1)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、基质金属蛋白酶-3(matrix metalloproteinase-3,MMP-3)]水平、滑膜血流超声信号等级、疼痛视觉模拟量表(visual analog scale,VAS)评分、膝骨关节炎严重性指数(index of severity for osteoarthritis,ISOA)评分和关节炎影响评估表2(arthritis impact measurement scale 2,AIMS2)评分。结果研究组总有效率为90.0%,高于对照组的74.0%(P<0.05)。治疗1、2个疗程后及治疗后,研究组膝关节酸痛、屈伸不利、四肢寒冷、舌淡苔白积分低于对照组(P<0.05);研究组血清BGP、OPG水平较对照组升高(P<0.05),CTX-Ⅱ水平较对照组降低(P<0.05);研究组血清TNF-α、IL-1、MMP-3水平低于对照组(P<0.05)。治疗后,两组滑膜血流超声信号等级优于治疗前(P<0.05),且研究组优于对照组(P<0.05);两组VAS、ISOA、AIMS2评分低于治疗前(P<0.05),且研究组低于对照组(P<0.05)。结论耳穴疗法联合中药塌渍治疗能改善膝骨关节炎患者临床症状,缓解疼痛,抑制炎症反应,改善骨代谢,从而维持良好生活质量。展开更多
许多广泛使用的药物都可能导致QT间期/QTc延长,继而引起尖端扭转型室性心动过速(torsade de pointes,TdP)等心律失常,后者可能会进一步恶化为心室颤动,甚至造成心脏性猝死。因此,为了预防和降低药源性QT间期延长和TdP的风险,对危险因素...许多广泛使用的药物都可能导致QT间期/QTc延长,继而引起尖端扭转型室性心动过速(torsade de pointes,TdP)等心律失常,后者可能会进一步恶化为心室颤动,甚至造成心脏性猝死。因此,为了预防和降低药源性QT间期延长和TdP的风险,对危险因素的发现、预警和纠正至关重要。近年来,临床已开始应用决策支持系统等预警策略,通过识别多种风险因素预测QT间期/QTc延长和警示TdP高风险人群。本文总结了可引起长QT间期和TdP风险的药物及相关危险因素,并归纳现有的预警措施,期望为暴露于相关风险的患者管理提供参考。展开更多
Background Torsade de pointes (TdP) is a form of polymorphic ventricular tachycardia featuring prolonged QT intervals. Female gender is associated with an increased risk of TdP. However, the causes of the sex differe...Background Torsade de pointes (TdP) is a form of polymorphic ventricular tachycardia featuring prolonged QT intervals. Female gender is associated with an increased risk of TdP. However, the causes of the sex difference in risk are poorly understood. Recently, transmural dispersion of repolarization (TDR) has been implicated in the genesis of TdP. Consequently, we compared TdP incidence and TDR between male and female rabbit hearts in order to investigate the mechanism of sex difference in TdP risk in rabbits in vitro. Methods By means of monophasic action potential recording techniques, the monophasic action potential of the epicardium, midmyocardium, and endocardium were simultaneously recorded using specially designed plunge-needle electrodes placed across the left ventricular free wall of both female (n=8) and male (n=8) rabbit hearts purfused by the Langendorff method. TdP was induced by bradycardia, d-sotalol, and low-K +, Mg 2+ Tyrode solution. Results TDR measurements in all three myocardial layers of male and female rabbit hearts were (18±2) ms and (21±2) ms, respectively (n=8, P>0.05). After perfusion with d-sotalol, the 90% monophasic action potential duration was prolonged in both male and femlae rabbits. TDR in male and female rabbit hearts increased to (29±2) ms and (61±2) ms, respectively, a difference that is significant. Eight female rabbit hearts had early afterdepolarization and 7 of them developed TdP. Seven male rabbit hearts had early after depolarization, but only one of these hearts developed TdP.Conclusion Greater TDR may play an important role in the higher incidence of TdP in female rabbit hearts.展开更多
文摘BACKGROUND Sarcoidosis is a rare multisystem disease characterized histologically by noncaseating granuloma formation in the affected organ.While cardiac sarcoidosis is found on autopsy in up to 25%of sarcoidosis cases,it is still underdiagnosed and is associated with a poor prognosis.Although the etiology of sarcoidosis remains unclear,an antigen triggered exaggerated immune response has been hypothesized.Early detection and prompt management of cardiac sarcoidosis remains pivotal.CASE SUMMARY A 60-year-old female,with pulmonary sarcoidosis in remission,presented to the cardiology outpatient clinic for evaluation of weeks-long dyspnea on moderate exertion(New York Heart Association class II)that was relieved by rest.Submaximal exercise stress test showed multifocal ventricular extrasystoles,followed by a self-limiting torsades de pointes.Cardiac magnetic resonance imaging showed nondilated and normotrophic left ventricle with basoseptal and mid-septal dyskinesis.The magnetic resonance imaging-derived left ventricular ejection fraction was 45%.Delayed enhancement showed patchy transmural fibrosis of the septum and hyperenhancement of the papillary muscles,all in favor of extensive cardiac involvement of sarcoidosis.A double-chamber implantable cardiac defibrillator was implanted,and methylprednisolone(12 mg/d)and methotrexate(12.5 mg/wk)treatment was initiated.Follow-up and implantable cardiac defibrillator interrogation showed episodes of asymptomatic nonsustained ventricular tachycardia and an asymptomatic episode of nonsustained ventricular tachycardia ending by the first antitachycardia pacing run.CONCLUSION Along an extensive review of the literature,this unusual case report highlights the importance of early detection of cardiac involvement of sarcoidosis,in order to avoid potential complications and increase survival.
基金the Beijing Key Clinical Subject Program and Beijing Municipal Administration of Hospitals Incubating Program,No.PX2018002.
文摘BACKGROUND QT interval prolongation can induce torsades de pointes(TdP),a potentially fatal ventricular arrhythmia.Recently,an increasing number of non-cardiac drugs have been found to cause QT prolongation and/or TdP onset.Moreover,recent findings have demonstrated the key roles of systemic inflammatory activation and fever in promoting long-QT syndrome(LQTS)and TdP development.CASE SUMMARY A 30-year-old woman was admitted with a moderate to high-grade episodic fever for two weeks.The patient was administered with multiple antibiotics after hospitalization but still had repeating fever and markedly elevated C-reactive protein.Once after a high fever,the patient suddenly lost consciousness,and electrocardiogram(ECG)showed transient TdP onset after frequent premature ventricular contraction.The patient recovered sinus rhythm and consciousness spontaneously,and post-TdP ECG revealed a prolonged QTc interval of 560 ms.The patient’s clinical manifestations and unresponsiveness to the antibiotics led to the final diagnosis of adult-onset Still’s disease(AOSD).There was no evidence of cardiac involvement.After the AOSD diagnosis,discontinuation of antibiotics and immediate initiation of intravenous dexamethasone administration resulted in the normal temperature and QTc interval.The genetic analysis identified that the patient and her father had heterozygous mutations in KCNH2(c.1370C>T)and AKAP9(c.7725A>C).During the 2-year follow-up period,the patient had no recurrence of any arrhythmia and maintained normal QTc interval.CONCLUSION This case study highlights the risk of systemic inflammatory activation and antibiotic-induced TdP/LQTS onset.Genetic analysis should be considered to identify individuals at high risk of developing TdP.
文摘Abstract： Loperamide is a common, over-the-counter, antidiarrheal medication that has been implicated in cases of ventricular tachycardia. A 32 year-old female patient with a history of opioid abuse and no prior history of cardiovascular disease experienced Torsades de pointes. An electrocardiogram at the time of hospital presentation revealed a prolonged QT interval at 636 msec. Diagnostic evaluation was unremarkable for any underlying cardiovascular pathology. Further investigation revealed the patient had been taking 30-40 loperamide 2 mg tablets oral daily for 2 weeks prior to the onset of Torsades de pointes. At high doses, loperamide may prolong the QT interval through antagonism of the human ether-a-go-go potassium current, thus increasing the risk of ventricular arrhythmias. Clinicians should be cautious with administration of high doses of loperamide to all patients, especially patients at high risk for QT interval prolongation.
文摘Acquired long QT syndromes and torsade de points often occur with underlying hypokalemia andbradycardia. With its fast inactivation property, the rapid activating component (Ikr) of the delayed rectifierpotassium current (IK) plays an important role in maintaining normal QT intervals. In this study, we evaluated the effects of different extracellular potassium ([K].) on the fast inactivation current of Ikr in guinea pigventricular myocytes. The results showed that [K]. had strong effects on the fast inactivation current ; thelower [K].(1, 3 mmol/L) significantly decreased the inactivation outward current (P＜0. 05); while higher[K]. (8, 10, 20 mmol/L) slightly increased the inactivation current (P>0. 05). These results may be of greatclinical significance. The lower [K]. decreased Ikr inactivation current, which may help to explain why acquired long QT syndromes and torsade de points often occur in the lower [K]. The correction of hypokalemia can increase the inactivation current, therefore, it is critical in the treatment of acquired long QTsyndromes and torsade de points.
文摘目的观察耳穴疗法联合中药塌渍治疗膝骨关节炎的临床疗效及对骨代谢和炎症因子的影响。方法将100例膝骨关节炎患者,随机分为对照组和研究组,每组50例。对照组采用中药塌渍治疗,研究组在对照组的基础上采用耳穴疗法(耳穴贴压联合耳部铜砭刮痧)治疗。比较两组临床疗效及治疗前后中医证候积分、血清骨代谢指标[Ⅱ型胶原C-端肽(C-terminal telopeptides of typeⅡcollagen,CTX-Ⅱ)、骨钙素(bone Gla-protein,BGP)、骨保护素(osteoprotectin,OPG)]、炎性因子[白细胞介素-1(interleukin-1,IL-1)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、基质金属蛋白酶-3(matrix metalloproteinase-3,MMP-3)]水平、滑膜血流超声信号等级、疼痛视觉模拟量表(visual analog scale,VAS)评分、膝骨关节炎严重性指数(index of severity for osteoarthritis,ISOA)评分和关节炎影响评估表2(arthritis impact measurement scale 2,AIMS2)评分。结果研究组总有效率为90.0%,高于对照组的74.0%(P<0.05)。治疗1、2个疗程后及治疗后,研究组膝关节酸痛、屈伸不利、四肢寒冷、舌淡苔白积分低于对照组(P<0.05);研究组血清BGP、OPG水平较对照组升高(P<0.05),CTX-Ⅱ水平较对照组降低(P<0.05);研究组血清TNF-α、IL-1、MMP-3水平低于对照组(P<0.05)。治疗后,两组滑膜血流超声信号等级优于治疗前(P<0.05),且研究组优于对照组(P<0.05);两组VAS、ISOA、AIMS2评分低于治疗前(P<0.05),且研究组低于对照组(P<0.05)。结论耳穴疗法联合中药塌渍治疗能改善膝骨关节炎患者临床症状,缓解疼痛,抑制炎症反应,改善骨代谢,从而维持良好生活质量。
文摘许多广泛使用的药物都可能导致QT间期/QTc延长,继而引起尖端扭转型室性心动过速(torsade de pointes,TdP)等心律失常,后者可能会进一步恶化为心室颤动,甚至造成心脏性猝死。因此,为了预防和降低药源性QT间期延长和TdP的风险,对危险因素的发现、预警和纠正至关重要。近年来,临床已开始应用决策支持系统等预警策略,通过识别多种风险因素预测QT间期/QTc延长和警示TdP高风险人群。本文总结了可引起长QT间期和TdP风险的药物及相关危险因素,并归纳现有的预警措施,期望为暴露于相关风险的患者管理提供参考。
文摘Background Torsade de pointes (TdP) is a form of polymorphic ventricular tachycardia featuring prolonged QT intervals. Female gender is associated with an increased risk of TdP. However, the causes of the sex difference in risk are poorly understood. Recently, transmural dispersion of repolarization (TDR) has been implicated in the genesis of TdP. Consequently, we compared TdP incidence and TDR between male and female rabbit hearts in order to investigate the mechanism of sex difference in TdP risk in rabbits in vitro. Methods By means of monophasic action potential recording techniques, the monophasic action potential of the epicardium, midmyocardium, and endocardium were simultaneously recorded using specially designed plunge-needle electrodes placed across the left ventricular free wall of both female (n=8) and male (n=8) rabbit hearts purfused by the Langendorff method. TdP was induced by bradycardia, d-sotalol, and low-K +, Mg 2+ Tyrode solution. Results TDR measurements in all three myocardial layers of male and female rabbit hearts were (18±2) ms and (21±2) ms, respectively (n=8, P>0.05). After perfusion with d-sotalol, the 90% monophasic action potential duration was prolonged in both male and femlae rabbits. TDR in male and female rabbit hearts increased to (29±2) ms and (61±2) ms, respectively, a difference that is significant. Eight female rabbit hearts had early afterdepolarization and 7 of them developed TdP. Seven male rabbit hearts had early after depolarization, but only one of these hearts developed TdP.Conclusion Greater TDR may play an important role in the higher incidence of TdP in female rabbit hearts.
