Flecainide toxicity with high pacemaker capture thresholds and associated takotsubo syndrome

We describe a case of a woman in her 80s with persistent atrial fibrillation (AF) despite being on flecainide who was admitted for AF with rapid ventricular response. Attempts with direct-current cardioversions were unsuccessful despite increased doses of the antiarrhythmic therapy. At atrioventricular (AV) nodal ablation, very high right ventricular capture thresholds resulted in abortion of the procedure as back-up ventricular pacing could not be assured with adequate margin for safety. Shortly following the electrophysiology (EP) study, the patient developed cardiogenic shock with new apical left ventricular regional wall motion abnormality suggestive of apical ballooning and a toxic-appearing wide QRS complex electrocardiogram (EKG). The patient was successfully treated with sodium bicarbonate infusion for presumed flecainide toxicity. The regional wall motion abnormality and EKG changes resolved along with normalisation of capture thresholds after 2 days of treatment. The patient underwent an uncomplicated successful AV nodal ablation several weeks later.

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Regional wall motion abnormality at the lateral wall disturbs correlations between tissue Doppler E/e′ ratios and left ventricular diastolic performance parameters measured by invasive methods

Journal of Echocardiography ◽

10.1007/s12574-013-0193-x ◽

2013 ◽

Vol 11 (4) ◽

pp. 138-146 ◽

Cited By ~ 1

Author(s):

Toshiharu Fujii ◽

Koichiro Yoshioka ◽

Masataka Nakano ◽

Gaku Nakazawa ◽

Mari Amino ◽

...

Keyword(s):

Wall Motion Abnormality ◽

Wall Motion ◽

Lateral Wall ◽

Regional Wall Motion ◽

Tissue Doppler ◽

Left Ventricular ◽

Regional Wall Motion Abnormality ◽

Performance Parameters ◽

Regional Wall

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Left Ventricular Regional Wall Motion Abnormality is a Strong Predictor of Cardiotoxicity in Breast Cancer Patients Undergoing Chemotherapy

Arquivos Brasileiros de Cardiologia ◽

10.5935/abc.20180220 ◽

2018 ◽

Cited By ~ 1

Author(s):

Márcio Vinícius Lins de Barros ◽

Ariane Vieira Scarlatelli Macedo ◽

Sebastian Imre Sarvari ◽

Monica Hermont Faleiros ◽

Patricia Tavares Felipe ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Wall Motion Abnormality ◽

Wall Motion ◽

Strong Predictor ◽

Regional Wall Motion ◽

Left Ventricular ◽

Regional Wall Motion Abnormality ◽

Breast Cancer Patients ◽

Regional Wall

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Echocardiographic Findings and Associated Factors in HIV Infected Patients at a Tertiary Hospital in Ethiopia

10.21203/rs.3.rs-783271/v1 ◽

2021 ◽

Author(s):

Esubalew Woldeyes ◽

Hailu Abera Mulatu ◽

Abiy Ephrem ◽

Henok Benti ◽

Mehari Wale Alem ◽

...

Keyword(s):

Blood Pressure ◽

Left Ventricular Hypertrophy ◽

Diastolic Dysfunction ◽

Wall Motion Abnormality ◽

Ventricular Hypertrophy ◽

Wall Motion ◽

Regional Wall Motion ◽

Left Ventricular ◽

Regional Wall Motion Abnormality ◽

Regional Wall

Abstract Background: Non-communicable diseases including cardiovascular diseases are becoming an important part of Human Immunodeficiency Virus (HIV) care. Echocardiography is a useful non-invasive tool to assess for cardiac disease and different echocardiographic abnormalities have been seen previously. Available evidence on the echocardiographic abnormalities in Ethiopia is scarce. The aim of this study was to investigate the echocardiographic abnormalities in HIV infected patients and factors associated with the findings.Methods: A cross-sectional study was conducted on 285 patients with HIV infection including collection of clinical and echocardiographic data. Logistic regression was used to examine the association between echocardiographic abnormalities and associated factors with variables with a p-value of < 0.05 in the multivariate model considered statistically significant.Results: Diastolic dysfunction was the most common abnormality seen in 30.1% of the participants followed by regional wall motion abnormality (22.2%), left ventricular hypertrophy (10.3%), enlarged left atrium (8.1%), pulmonary hypertension (3.5%) and pericardial effusion (2.1%). Almost all patients had normal left ventricle systolic function. Diastolic dysfunction was independently associated with increasing age, elevated blood pressure and left ventricular hypertrophy while regional wall motion abnormality was associated with male gender, increasing age and abnormal fasting blood glucose. Left ventricular hypertrophy was associated with increasing age and blood pressure and the later was associated with left atrial enlargement. The level of immunosuppression did not affect echocardiography findings. Conclusions: A high prevalence of echocardiographic abnormalities was found and included diastolic dysfunction, regional wall motion abnormality, left ventricular hypertrophy and left atrial enlargement. Male gender, age above 50 years, elevated blood pressure and elevated fasting blood glucose were associated with echocardiographic abnormalities. Appropriate screening and treatment of echocardiographic abnormalities is needed.

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Global Myocardial Work in Coronary Artery Disease Patients Without Regional Wall Motion Abnormality: Correlation With Gensini Score

10.21203/rs.3.rs-908574/v1 ◽

2021 ◽

Author(s):

Miao Li ◽

Yuhao Wang ◽

Lin Li ◽

Wenfang Wu ◽

Pingyang Zhang

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Wall Motion Abnormality ◽

Wall Motion ◽

Regional Wall Motion ◽

Left Ventricular ◽

Regional Wall Motion Abnormality ◽

Gensini Score ◽

Regional Wall ◽

Artery Disease

Abstract PurposeThis study aimed to investigate global myocardial work (GMW), derived from non-invasive left ventricular (LV) pressure-strain loops (PSLs) in coronary artery disease (CAD) patients without regional wall motion abnormality (RWMA), and explored the relationship between GMW and severity of CAD using Gensini score (GS) . Methods120 patients prepared for coronary angiography (CAG) who had left ventricular ejection fraction≥55%, no resting RWMA in two-dimensional echocardiography were enrolled. Global longitudinal strain (GLS), GMW parameters (including global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW) and global myocardial work efficiency (GWE)) were quantified. The severity of coronary lesions was evaluated by GS system based on CAG findings. We divided CAG-confirmed CAD patients into three subgroups according to the tertiles of GS: low 0<GS 16, mid 16<GS 38, and high GS>38. ResultsCAD patients showed a significantly reduced GLS and GWE, but an increased GWW. GLS, GWE, GWI and GCW were significantly decreased in the high-GS group while GWW was increased. GLS, GWE, GWI and GCW was negatively correlated with the GS, GWW was positively correlated with GS. Multivariate regression analysis showed that GWE was the independent factor of predicting coronary stenosis. ROC analysis demonstrated that GWE was the most powerful predictor of high-GS and was superior to GLS. GWE under 91% had the optimal sensitivity and specificity for identifying high-GS. ConclusionThe proposed GWE, which outperformed the GLS, showed the optimal performance and could be considered as a potential predictive indicator to detect severe coronary disease in non-RWMA CAD patients.

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