Background
Patients with chronic kidney disease (CKD) are at increased risk of life‐threatening cardiovascular arrhythmias. Although these arrhythmias are usually secondary to structural heart diseases that are commonly associated with CKD, a significant proportion of cases with sudden cardiac death have no obvious structural heart disease. This study aims to explore the relationship of cardiac repolarization in patients with CKD and worsening kidney function.
Hypothesis
There is cardiac repolarization abnormalities among patients with chronic kidney disease.
Methods
This was a retrospective, chart‐review study of admissions or clinic visits to a university hospital between 2005 and 2010 by patients with a diagnosis of CKD. Inclusion criteria selected patients who had 12‐lead surface electrocardiography (ECG), renal function tests within 24 hours, and transthoracic echocardiography within 6 months. Cases with a documented etiology for the corrected Qt (Qtc) interval prolongation including structural heart disease, QT prolonging drugs, or relevant disease conditions, were excluded.
Results
Our sample size was 154 ECGs. Two‐thirds of patients with CKD had QTc interval prolongation, and about 20% had a QTc interval >500 ms. QTc interval was significantly different and increased with each successive stage of CKD using the Bazett (P < 0.006) or Fridericia (P = 0.03) formula. QTc interval correlated significantly with serum creatinine (P = 0.01). These finding were independent of age, gender, potassium, and calcium concentrations.
Conclusions
The progression of CKD resulted in a significant delay of cardiac repolarization, independent of other risk factors. This effect may potentially increase the risk of sudden cardiac death, and may also increase the susceptibility of drug‐induced arrhythmia.
Coronary artery fistula is a rare condition that can be congenital or acquired. Most patients with these anomalies remain asymptomatic, but symptoms and complications may develop with increasing age. We discuss the clinical presentation, diagnostic work-up, and management options for this condition. (
Level of Difficulty: Intermediate.
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Coronary angiography is the golden choice for coronary artery disease evaluation and management. However, as with any invasive procedures, there is a risk of complications. We are reporting a case of 69-year-old male with past medical history of cardiac bypass surgery, CHF, hypertension, and hyperlipidemia who was admitted to the hospital to evaluate his chest pain. He had treadmill stress test that showed ischemic induced exercise. Patient underwent coronary angiography that showed proximal complete occlusion of the RCA with a patent graft. At the end of the procedure, the patient did not wake up and remained minimally responsive. An urgent brain MRI was ordered and showed infarctions consistent with an artery of Percheron infarction. Later, patient has improved slowly and was discharged home. We briefly here discuss this rare complication including the risk factor, clinical presentation, and the management.
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