Abdalla Hassan
United States
Title: Strain Analysis in Anorexia Nervosa-Induced Takotsubo Cardiomyopathy
Biography
Biography: Abdalla Hassan
Abstract
“Torsades de Pointes” (TdP) ventricular tachycardia carry a high risk of sudden death even when it occurs in patients with structurally normal heart. Ultra short-coupled ventricular extrasystole (<300ms) has shown to be a trigger for TdP. This was first described in 1994 by Leenhardt et al and is known as Coumel sign.
Case
We present a 65-year-old man with medical history of cocaine abuse and coronary artery disease (CAD); who had just received 4 vessels coronary artery bypass grafts a week prior to his presentation. He presented to an outside hospital with palpitations and dizziness after using cocaine. His symptoms were due to fast polymorphic ventricular tachycardia (VT) with a rate of 230 beats per minute. He received eleven direct current cardioversion treatments. He was initially started on Amiodarone, which was changed to Lidocaine later as he continued to experience VT while on Amiodarone. His cardiac catheterization showed occlusion of one his bypass grafts for which medical management was recommended.
Lidocaine was stopped upon arrival to our facility as patient’s mental status was declining and Lidocaine toxicity was suspected. The following day, patient started experiencing episodes of TdP and required intubation due to hemodynamic instability. Careful telemetry review of his TdP events showed that short-coupled monomorphic ventricular extrasystole triggered each TdP episode. Patient was immediately started on Verapamil with resolution of his events. Meanwhile, patient was evaluated for implantable cardiovertor defibrillator, but he expired during his hospitalization due to sepsis.
Decision-making
Recognizing short-coupled ventricular extrasystole or Coumel sign as a trigger to TdP is crucial as it affects the patient’s management. Verapamil has been reported to be effective in managing patients with TdP with Coumel findings.
Conclusion
Short-couple variant of TdP has a high incidence of sudden death. It is very important to identify it and treat it promptly. Long term Verapamil treatment is effective but still insufficient and patients should be considered for implantable cardiovertor defibrillator therapy