Incessant ventricular tachycardia as a manifestation of septic cardiomyopathy – case report

Incessant ventricular tachycardia is defined as frequent, repetitive and persistent ventricular arrhythmia or appropriate activation of an implantable cardioverter-defibrillator when present, which occurs more than three times within 24 hours and is ultimately followed by hemodynamic collapse. It is usually associated with structural heart disease ischaemia and often has a poor prognosis. The treatment strategy involves defining the aetiology through a targeted medical history and a physical examination (toxins, drugs, etc.), a 12-lead ECG, laboratory tests (electrolytes, etc.) and the detection of ischaemia. This report presents a case of young puerpera with peripartal sepsis, with no evidence of peripartal cardiomyopathy or ischaemia, which manifested itself initially with an arrhythmic cardiac arrest and a sequentially lethal outcome after a prolonged resuscitation procedure

VASCULAR VIBRATION INJURY AND PAGET-SHROETTER SYNDROME

Sindrom Paget-Schroetter je relativno rijetko medicinsko stanje koje označava primarnu trombozu aksilarne vene odnosno vene supklavije na kostoklavikularnom spoju. Vibracijska ozljeda rijedak je etiološki čimbenik u nastanku ovog kliničkog entiteta. Prikazujemo slučaj 28-godišnjeg muškarca koji se prezentirao s akutno nastalim edemom lijeve ruke nakon cjelodnevnog rada s pneumatskom bušilicom. Vaskularnim ultrazvukom dokazan je tromb u lijevoj aksilarnoj veni te u veni supklaviji, te je započeta terapija niskomolekularnim heparinom.Paget-Schroetter syndrome is a relatively uncommon condition related to primary thrombosis of the axillary/subclavian vein at the costoclavicular junction. Vibration injury is an unusual cause of this syndrome. We report on a 28-year-old man who presented with acute onset left arm swelling after whole-day work with a pneumatic drill. Duplex ultrasound confirmed the presence of a thrombus in his left axillary and subclavian vein, which was treated with low molecular weight heparin, eventually switched to oral anticoagulation

Sindrom dugog QT intervala: sustavni pregled

Congenital long QT syndrome (LQTS) is a disorder of myocardial repolarization defined by a prolonged QT interval on electrocardiogram (ECG) that can cause ventricular arrhythmias and lead to sudden cardiac death. LQTS was first described in 1957 and since then its genetic etiology has been researched in many studies, but it is still not fully understood. Depending on the type of monogenic mutation, LQTS is currently divided into 17 subtypes, with LQT1, LQT2, and LQT3 being the most common forms. Based on the results of a prospective study, it is suggested that the real prevalence of congenital LQTS is around 1:2000. Clinical manifestations of congenital LQTS include LQTS-attributable syncope, aborted cardiac arrest, and sudden cardiac death. Many patients with congenital LQTS will remain asymptomatic for life. The initial diagnostic evaluation of congenital LQTS includes obtaining detailed personal and multi-generation family history, physical examination, series of 12-lead ECG recordings, and calculation of the LQTS diagnostic score, called Schwartz score. Patients are also advised to undertake 24-hour ambulatory monitoring, treadmill/cycle stress testing, and LQTS genetic testing for definitive confirmation of the diagnosis. Currently available treatment options include lifestyle modifications, medication therapy with emphasis on betablockers, device therapy and surgical therapy, with beta-blockers being the first-line treatment option, both in symptomatic and asymptomatic patients.Sindrom dugog QT intervala (LQTS) nasljedni je poremećaj repolarizacije miokarda obilježen produženim QT intervalom u elektrokardiogramu (EKG) koji može uzrokovati maligne ventrikulske aritmije i iznenadnu srčanu smrt. LQTS prvi je puta opisan 1957. godine, a iako je njegova genetska podloga mnogo puta istraživana, etiologija još uvijek nije u potpunosti razjašnjena. Ovisno o tipu monogenske mutacije LQTS se može podijeliti u 17 podtipova od kojih su najčešći LQTS1, LQTS2 i LQTS3. Procjenjuje se da učestalost kongenitalnog LQTS iznosi oko 1:2000. Klinička slika LQTS može uključivati sinkopu, srčani zastoj i iznenadnu srčanu smrt. Velik dio bolesnika s kongenitalnim LQTS ostaje asimptomatski tijekom cijeloga života. Dijagnostičku obradu kongenitalnog LQTS čini detaljna osobna i obiteljska anamneza, fizikalni pregled, serijsko praćenje 12-kanalnog EKG-a te izračun Schwartzovih dijagnostičkih kriterija. Također treba isključiti moguće sekundarne uzroke stečenog LQTS. Uz to, bolesnicima se savjetuje učiniti 24-satni holter EKG i test opterećenja, a za konačnu potvrdu dijagnoze genetsko testiranje. Terapijske mogućnosti uključuju promjene životnih navika, medikamentnu terapiju s naglaskom na beta-blokatore, implantaciju kardioverter defibrilatora i kirurško liječenje, pri čemu su beta-blokatori prvi izbor terapije i kod simptomatskih i asimptomatskih bolesnika