Emocionalni stres kao uzrok sinkope i torsade de pointes kod bolesnika sa produženim QT intervalom

  • Mihailo Čedomir Vukmirović Center of Cardiology, Clinical Center of Montenegro, Podgorica, Montenegro.
  • Irena Tomašević Vukmirović Center of Radiology, Clinical Center of Montenegro, Podgorica, Montenegro
  • Lazar Angelkov Institute of Cardiovascular Disease Dedinje, Belgrade Serbia
  • Filip Vukmirović Center of Patology, Clinical Center of Montenegro, Podgorica, Montenegro
DOI: https://doi.org/10.2298/2981
Ključne reči: syncope||, ||sinkopa, stress, psychological||, ||stres, psihički, torasades de pointes||, ||torsad de puant, drug therapy||, ||lečenje lekovima, electrophysiologic techniques, cardiac||, ||elektrostimulator srca,

Sažetak


Uvod. Sindrom produženog QT intervala (LQTS) je poremećaj repolarizacije miokarda koji se karakteriše prolongacijom QT intervala i sklonosti ka ventrikularnim aritmijama koje mogu dovesti do sinkope, srčanog zastoja i iznenadne smrti. Epizode aritmija mogu biti izazvane različitim stimulusima, u zavisnosti od tipa LQTS. Prikaz bolesnika. Bolesnica, stara 25 godina, hospitalizovana je zbog krize svesti koja se javila neposredno nakon solističkog koncerta. Na prijemnom elektrokardiogramu (EKG-u) registrovane su učestale komorske ekstrasistole (VES), a potom i polimorfna ventrikularna tahikardija – torsade de pointes (TdP), koja se degenerisala u ventrikularnu fibrilaciju (VF). Pristupilo se hitnoj električnoj kardioverziji, nakon čega je ordiniran magnezijum i beta-blokatori. U daljem toku, u par navrata, ponovo je registrovana TdP kojoj su prethodile VES. Urađeno je merenje korigovanog QT intervala (QTc) koji je iznosio 516 msec. Zbog sekundarne prevencije iznenadne srčane smrti bolesnici je implantiran kardioverter defibrilator, a nastavljena je i terapija beta-blokatorima. Nakon jednogodišnjeg praćenja nije bilo epizoda ponovnog javljanja TdP, a izmereni QTc redukovan je na 484 msec. Zaključak. Bolesnica sa sinkopom nastalom neposredno nakon intenzivnog emocionalnog stresa, trebalo bi da se ispita zbog mogućeg postojanja maligne aritmije u sklopu LQTS.

Biografija autora

Mihailo Čedomir Vukmirović, Center of Cardiology, Clinical Center of Montenegro, Podgorica, Montenegro.

internista kardiolog

magistar kardiologije

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Objavljeno
2015/07/08
Broj časopisa
Vol. 72 Br. 2 (2015)
Rubrika
Prikaz bolesnika