Sinergistički efekat patofizioloških i farmakoloških faktora na nastanak torsade de pointes

Luka Milićević; Nataša Nakalamić; Goran Davidović

doi:10.5937/halo 19432-66305

Luka Milićević Fakultet medicinskih nauka, Univerzitet u Kragujevcu, Kragujevac, Srbija https://orcid.org/0009-0005-1698-1012
Nataša Nakalamić Fakultet medicinskih nauka, Univerzitet u Kragujevcu, Kragujevac, Srbija https://orcid.org/0009-0007-7920-2703
Goran Davidović Katedra za internu medicinu, Fakultet medicinskih nauka, Univerzitet u Kragujevcu; Kragujevac, Srbija;Klinika za kardiologiju, Univerzitetski klinički centar Kragujevac, Srbija. https://orcid.org/0000-0001-5851-5857

DOI: https://doi.org/10.5937/halo%2019432-66305

Ključne reči: Torsade de pointes, Amjodaron, Kalijum, Magnezijum, karcinom mokraćne bešike

Sažetak

Uvod: Torsade de pointes predstavlja polimorfnu ventrikularnu aritmiju asociranu sa odloženom repolarizacijom komora. Manifestuje se u vidu prolaznih epizoda vrtoglavice i sinkope. U retkim situacijama ovo stanje uvodi pacijenta u ventrikularnu fibrilaciju i iznenadnu smrt. Među najčešćim uzrocima se navodi elektrolitni disbalans (hipomagnezijemija i hipokalemija), primena antiaritmika Ia i III grupe i antibiotika, usporeni srčani ritam, kao i pojedini maligniteti.

Prikaz slučaja: Muškarac starosti 74 godine inicijalno je hospitalizovan na Klinici za urologiju UKC Kragujevac radi operativnog lečenja karcinoma mokraćne bešike. Kardiološkom opservacijom je registrovana ventrikulska tahikardija po tipu torsade. Naknadnim analizama kod pacijenta nisu evaluirane morfološke promene koje su mogle da dovedu do pojave aritmije. Razmatranjem uticaja komorbiditeta, targetirani su potencijalni uzroci navedenog stanja. Usklađivanjem terapijskog režima i elektrolitnog statusa došlo je do stabilizacije opšteg stanja pacijenta.

Zaključak: Kompleksnost farmakoterapije starijih pacijenata zahteva racionalnu primenu antiaritmika zbog paradoksalnog proaritmogenog efekta istih, sa posebnim akcentom na češću kontrolu elektrolitnog statusa.

Biografije autora

Luka Milićević, Fakultet medicinskih nauka, Univerzitet u Kragujevcu, Kragujevac, Srbija

Autor

Nataša Nakalamić, Fakultet medicinskih nauka, Univerzitet u Kragujevcu, Kragujevac, Srbija

Koautor

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