Objective: To report a case of ventricular fibrillation caused by severe hypokalemia probably associated with sertraline use. Case Summary: A 48-year-old male patient experienced ventricular fibrillation and cardiac arrest 2 hours after an uneventful coronary angiography procedure, which revealed normal, unobstructed coronary arteries. Blood chemistry was immediately obtained, revealing a very low potassium (K + ) level of 2.44 mEq/L. Other blood electrolytes, including magnesium, ECG, and corrected QT intervals, were all within normal limits. A thorough search for an etiology of hypokalemia, including adrenal gland causes, herbal product consumption, and toxic exposure, did not reveal any identifiable cause. This led us to consider the only drug he was on—sertraline 50 mg per day—as the possible culprit. Discussion: There has been no clear identification of severe hypokalemia associated with sertraline use in the literature. However, there have been a considerable number of self-reported cases of hypokalemia in patients on sertraline therapy. Scoring according to the Naranjo adverse drug reaction scale revealed a probable relationship between severe hypokalemia and sertraline use in our patient. No clear pathogenic mechanism for the effect of sertraline on serum K equilibrium is known. However, considering the number of self-reported incidences and this case report, the effect of sertraline on serum K levels warrants consideration. Conclusions: This is the first documented case report of severe hypokalemia probably associated with sertraline use.
We describe a unique case of congenital absence of a right pulmonary artery presenting in a patient of advanced age and initially misdiagnosed as coronary artery disease. Perfusion of the affected lung was accomplished via anomalous collaterals from right and left circumflex coronary arteries which induced myocardial ischemia, as demonstrated by myocardial perfusion scan. To our knowledge there are only three reports in the international literature, describing unilateral pulmonary artery agenesis with the coronary artery supplying the abnormal lung. All these reports described that the existence of such vessels does not affect the myocardial perfusion. However, here we describe, to our knowledge, for the first time that in a patient with unilateral pulmonary artery agenesis, the existence of collaterals from the coronary arteries to the affected lung can actually have a negative effect in myocardial perfusion and can induce myocardial ischemia. In conclusion, clinicians should be aware of the possibility of undiagnosed cases of unilateral pulmonary artery agenesis presenting with chest pain in advanced age.
Mitral flow Doppler study has been used to evaluate left ventricle (LV) diastolic function. Through its use, greater A wave than E wave, pseudonormal pattern, and restrictive pattern were observed progressively in patients with more LV diastolic dysfunction. Differentiation of normal or pseudonormal mitral flow is very important. In this study, left atrium (LA) diameter change during diastole was used as a new method for the differentiation of normal and pseudonormal mitral flow. Method: Sixty‐eight patients ( 30 men, 38 women; mean age 53 ± 13 years ) with echocardiographically determined diastolic dysfunction and 60 healthy volunteers ( 36 men, 24 women; mean age 49 ± 12 years ) were included in the study. Mitral flow E/A ratio, isovolumetric relaxation time (IVRT), and deceleration time (DT) of E wave were used for determination of the diastolic dysfunction. Thirty of 68 diastolic dysfunction patients had A>E wave, 20 had pseudonormal mitral flow pattern, and 18 had restrictive mitral flow pattern. Left parasternal long‐axis echocardiographic window was used for the measurement of LA diameter. Left atrium emptying fraction (LAEF) was defined as ratio of end‐diastolic LA diameter to end‐systolic diameter. Results: LAEF was found 0.69 ± 0.01 ( mean ± SE ) in the control group, 0.76 ± 0.01 in the A>E group ( P < 0.05, control vs A>E group ), 0.83 ± 0.05 in the pseudonormal pattern group ( P < 0.05, control vs pseudonormal pattern group ), and 0.87 ± 0.01 in the restrictive pattern group ( P < 0.001, control vs restrictive pattern group ). Conclusion: (1) LV diastolic dysfunction reduces the filling of LA content to the LV during diastole; (2) LA diameter changes during diastole as a new and practical method for the differentiation of the normal‐pseudonormal mitral flow pattern.
Background Coronary artery disease (CAD) causes electrical heterogeneity on ventricular myocardium and ventricular arrhythmia due to myocardial ischemia linked to ventricular repolarization abnormalities. Objective Our aim is to investigate the impact of increased level of CAD spectrum and severity on ventricular repolarization via Tp-e interval, Tp-e/QT and Tp-e/QTc ratios. Methods 127 patients with normal coronary artery (group 1), 129 patients with stable CAD (group 2) and 121 patients with acute coronary syndrome (group 3) were enrolled. Tp-e interval, Tp-e/QT [...]
Although myocardial bridge is asymptomatic in most patients, it can lead to myocardial ischemia, myocardial infarction, cardiac arrhythmias, and sudden death. We successfully treated a myocardial bridge, which caused a severe stenosis in left anterior descending (LAD) artery together with myocardial ischemia and disturbance in intracoronary hemodynamics, with stent implantation. (J Interven Cardiol 2004;17:33–36)
In this report we describe an unusual case of cardiac echinococcus located in the interventricular septum invaded by a cystic mass. It was demonstrated by using transthoracic echocardiography (TTE) and confirmed with magnetic resonance imaging (MRI). Surgical excision (cystopericystectomy) was performed on the patient as a curative therapy. Early recurrence was observed despite additional medical therapy with albendazole.
