scholarly journals Successful Refractory of Acute Myocardial Infarction-induced Electrical Storm by Defibrillations and Amiodarone: A Case Report

2020 ◽  
Author(s):  
Huanhuan Guo ◽  
Quan Gan

Abstract Background: Acute myocardial infarction (AMI) often complicated with multiple arrhythmias, especially ventricular arrhythmias, including sustained ventricular tachycardia (SVT) and ventricular fibrillation (VF) are often presages progressive heart failure in 48 hours. The present study reports a case of electrical storm (ES) occurring in an 84-year-old woman with acute myocardial infarction (AMI).Case presentation: With the defibrillations or amiodarone, the recurrence of ventricular tachycardia inhibited and the electrocardiographic pattern normalized.Conclusions: The results suggest that defibrillations and amiodarone may be able to improve the survival rate of patients with ES with AMI and would be considered as an alternative treatment for implantable cardioverter defibrillator (ICD) and invasive catheter ablation in the management of cardiac ES.

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kobara ◽  
N Naseratun ◽  
Y Watanabe ◽  
H Toba ◽  
T Nakata

Abstract Background Myocardial infarction (MI) is a major cause of death in western countries and Japan, and hypertension is a major risk factor of MI. In hypertensive heart, acute myocardial infarction often leads to lethal ventricular arrhythmia. Nicorandil, an ATP sensitive potassium channel (KATP) opener, is usually used in the treatment of acute myocardial infarction. The effects of nicorandil on ischemic myocyte are fully defined. On the other hand, KATP in neuroterminals is known to regulate norepinephrine release, but the effect of nicorandil on ischemic norepinephrine release in cardiac tissue has remained unexplored. Purpose We examined whether nicorandil suppressed norepinephrine release via neuronal KATP and ventricular arrhythmia during acute ischemia in pressure overload-induced hypertrophic hearts. Methods SD Rats were divided into two groups; abdominal aortic constriction (AAC) group and sham-operated (Sham) group. Four weeks after constriction, cardiac geometry and function were examined using echocardiography. Then, myocardial ischemia was induced by the left anterior descending artery occlusion for 100 minutes in the presence or absence of intravenous infusion of nicorandil. Cardiac interstitial norepinephrine concentration in ischemic region was measured using the microdialysis method and concentration of cyclic AMP, a second messenger of norepinephrine, in cardiac tissue was measured by ELISA. Ventricular arrhythmias were monitered by ECG during whole ischemic period. Results Four weeks after constriction, remarkable left ventricular wall thickening was observed in AAC group. Before ischemia, ventricular arrhythmia was not found in both groups. Number of ventricular arrhythmia, including ventricular tachycardia and ventricular fibrillation, was increased in early ischemic period (- 40 min) in both groups, and was grater in AAC group. Before ischemia, interstitial norepinephrine concentration in cardiac tissue was higher level in AAC group than in Sham group. Ischemia obviously increased norepinephrine concentration in both groups time dependently and AAC further increased norepinephrine than Sham group. Concentration of cyclic AMP in cardiac tissue was raised in early ischemic period (- 40 min) and then gradually decreased. Nicorandil significantly suppressed the number of ventricular arrhythmias, and abolished the ventricular tachycardia and fibrillation without hemodynamic alterations. Nicorandil also attenuated norepinephrine and cAMP enhancement in acute ischemic period in both groups. Conclusion Ischemia-induced ventricular arrhythmia was more frequent and severe in hypertrophic hearts and interstitial norepinephrine enhancement may play a role in this ischemic arrhythmia. Nicorandil suppressed ischemia-induced interstitial norepinephrine release by neuronal KATP opening, which attenuated ventricular arrhythmias in normal and hypertrophic hearts.


2020 ◽  
Vol 48 (11) ◽  
pp. 030006052097144
Author(s):  
Yanan Xie ◽  
Jingzhe Han ◽  
Jinming Liu ◽  
Jie Hao ◽  
Xiuguang Zu ◽  
...  

Background Bidirectional ventricular tachycardia (BVT) is a rare, but serious, arrhythmia. Hypokalemia is commonly found in clinical practice, but hypokalemia-induced BVT has rarely been reported. Case presentation A 74-year-old male patient with the symptoms of chest distress and palpitations was admitted owing to frequent discharge of his implantable cardioverter defibrillator (ICD) for 4 days. Before admission, the patient experienced diarrhea after intake of crabs, and felt frequent discharge of his ICD with a total of approximately 17 discharges in 4 days. He had no history of digitalis use. The serum potassium level after admission was 3.1 mmol/L and an electrocardiogram was consistent with BVT. The diagnosis was ventricular tachycardia, electrical storm, and hypokalemia. His ventricular tachycardia was completely relieved after correction of hypokalemia. Conclusions After correction of hypokalemia in this patient, the episode of BVT was terminated and no recurrence of BVT was observed during long-term follow-up. Our findings suggest the diagnosis of hypokalemia-induced BVT.


1998 ◽  
Vol 13 (2) ◽  
pp. 68-77
Author(s):  
Simon Chakko ◽  
Raul Mitrani

This review discusses the treatment of ventricular arrhythmias and bradyarrhythmias. Recent studies addressing the management of nonsustained ventricular arrhythmias in patients with congestive heart failure and those recovering from myocardial infarction are discussed. Determination of the origin of wide QRS complex tachycardia is usually possible at the bedside and the diagnostic criteria are provided. Therapy to prevent recurrent ventricular tachycardia or ventricular fibrillation is difficult and controversial. A widely accepted approach based on electrophysiologic testing and implantable defibrillators appears to be the most effective. Recognition and management of common bradyarrhythmias including the indications for pacemakers are discussed.


2017 ◽  
Vol 36 (4) ◽  
pp. 107-110
Author(s):  
Aleksandar Selaković ◽  
Predrag Đuran ◽  
Milica Zarić

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Simone Savastano ◽  
Alessandra Greco ◽  
Benedetta Matrone

Cardiac arrest and electrical storm are two major emergencies. The use of beta blockers in these clinical conditions has been proposed however, definite data about the emergency use of beta blockers in recurrent ventricular tachycardia with pulse have never been published. We report two cases of recurrent ventricular tachycardia which were unresponsive to the standard pharmacological treatment but successfully responsive to esmolol infusion. Both cases showed a reduced left ventricle ejection fraction due to an acute myocardial infarction and to an idiopathic dilated cardiomyopathy respectively. Nevertheless, the use of esmolol was shown to be both safe and effective without inducing low output syndrome.


2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Guibin Li ◽  
Shengxin Liu ◽  
Jiali Jin ◽  
Kejun Ding ◽  
Caizhen Qian

Ventricular arrhythmias (VTA) usually occur following acute myocardial infarction (AMI). However, risk factors for VTA attack after AMI have been not well-recognized. The purpose of the study is to identify risk factors associated with the incidence of VTA complicating AMI. A total of 200 patients with AMI who were admitted to our hospital from February 2018 to February 2020 were retrospectively analyzed. These 200 patients were classified into a non-VTA group ( n = 140 ) and a VTA group ( n = 60 ) based on the occurrence of VTA within 24 after AMI. Patients in the VTA group were older than those in the non-VTA group. The VTA group had more numbers of WBCs and neutrophils than the non-VTA group. The level of serum potassium was lower, but the levels of cTnT and CK-MB were higher in the VTA group than in the non-VTA group. The VTA group presented an increase in proportions of anterior MI, TpTe, and proportions of Killip classification ≥ class II but a decline in LVEF when comparable to the non-VTA group. The two groups were not significantly different concerning other variables including sex, tobacco use, alcohol consumption, diabetes mellitus, hypertension, heart rate, Scr, SUA, BUN, PTL counts, TC, TG, HDL-C, LDL-C, D-dimer, BNP, LVS, LVP, and LVEDd. The levels of hsCRP, endothelin-1, and TNF-α were remarkably higher in the VTA group than in the non-VTA group ( P < 0.001 ). Multivariate logistic regression analysis was performed, with clinical variables including age, WBCs, neutrophils, serum potassium, cTnT, CK-MB, hsCRP, endothelin-1, TNF-α, anterior MI, TpTe, proportions of Killip classification ≥ class II, and LVEF as an independent variable and with the occurrence of VTA as a dependent variable. It was revealed that serum potassium, cTnT, CK-MB, hsCRP, endothelin-1, TpTe, proportions of Killip classification ≥ class II, and LVEF were independent risk factors of VTA complicating AMI. Compared with the non-VTA group, the incidence rate of simple left heart failure, total heart failure, stroke, and dyslipidemia in the VTA group was significantly higher than those in the non-VTA group ( P < 0.05 ). It was found that the proportion of all-cause deaths within one year outside the hospital was higher in the VAT group than in the non-VAT group ( P < 0.05 ). Collectively, the study demonstrates serum potassium, cTnT, CK-MB, hsCRP, endothelin-1, TpTe, proportions of Killip classification ≥ class II, and LVEF were independent risk factors of VTA complicating AMI.


2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Sayaka Ohsawa ◽  
Hiroki Isono ◽  
Eiji Ojima ◽  
Masahiro Toyama ◽  
Yasuhisa Kuroda ◽  
...  

Abstract Background The definition of electrical storm is still debated. For example, an electrical storm is defined as a clustering of three or more separate episodes of ventricular tachycardia/ventricular fibrillation within 24 hours or one or more episodes occurring within 5 minutes of termination of the previous episode of ventricular tachycardia/ventricular fibrillation. When it is refractory to medications, prompt assessments by coronary angiography, sedation, and overdrive pacing should be performed. An electrical storm may occur anytime, including at night or after the patient leaves an intensive care unit. Case presentation A 70-year-old Japanese man with type 2 diabetes mellitus was diagnosed as having ST-elevation myocardial infarction. His clinical course after an urgent percutaneous coronary intervention was uneventful, but he developed electrical storm that was refractory to antiarrhythmic medications on day 11 of hospitalization. We used sedative medications and performed ventricular overdrive pacing and transferred him to a university hospital for further treatment, which included electrical ablation and cardioverter-defibrillator implantation. Conclusion An electrical storm is a relatively rare and fatal complication of acute myocardial infarction. It is important that the treatment choices for this condition are known by non-cardiologist physicians who might encounter this rare condition.


1993 ◽  
Vol 74 (5) ◽  
pp. 346-348
Author(s):  
A. A. Simakov ◽  
Yu. A. Panfilov ◽  
N. I. Kryukov ◽  
N. A. Tomashevskaya

The course and prognosis in myocardial infarction (MI) depend on various factors, but are largely determined by the development of complications of the underlying disease. Thromboendocarditis is one of the complications of acute myocardial infarction. Thromboembolic complications associated with thromboendocarditis develop despite intensive thrombolytic and anticoagulant therapy and often lead to disability or death of patients. So, embolism of arteries of the corresponding localization can cause stroke, renal infarction, gangrene of the extremities, as well as progressive heart failure and other complications. In this regard, timely diagnosis of acute myocardial infarction complicated by thromboendocarditis is extremely important not only for predicting the further course of the underlying disease, but also for choosing an adequate and effective therapy.


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