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Rationale: Tachycardia-induced cardiomyopathy (TIC) is defined as systolic and/or diastolic dysfunction of the left ventricle resulting from prolonged elevated heart rates, completely reversible upon control of the arrhythmia. Atrioventricular reentrant tachycardia (AVRT) is one of the most frequent causes of TIC. In its incessant form, it is unlikely to be controlled by pharmacological treatment, catheter ablation being the principal therapeutic option. The coexistence of left bundle branch block (LBBB) in patients with AVRT may cause difficulties in the early diagnosis and management of tachycardia because of the wide complex morphology, making it harder to localize the accessory pathway (AP). Patient concerns: A 60-year-old woman, presented incessant episodes of palpitations and shortness of breath due to a LBBB tachycardia leading to hemodynamic instability. Diagnosis: The patient had a wide QRS tachycardia, with LBBB morphology and a heart rate of 160/minute. Echocardiography showed global hypokinesia with 25% left ventricular ejection fraction (LVEF). Considering the patient's clinical picture, TIC was suspected. Interventions: The electrophysiological study revealed a left lateral accessory pathway. Catheter ablation was successfully performed at the level of the lateral mitral ring. Outcomes: One week after the ablation the patient had no signs of heart failure and the LVEF normalized to 55%. During 6-months follow-up the patient presented no more episodes of tachycardia or heart failure and the LVEF remained normal. Lessons: AVRT is rarely associated with intrinsic LBBB, being a potential cause of TIC. In these patients, it is unlikely to control the arrhythmia pharmacologically, catheter ablation being the best therapeutic option. The variation of QRS complex duration between LBBB pattern in SR and AVRT could be useful for early diagnosis of an ipsilateral AP on surface ECG.

ObjectiveThis study aimed to detect and quantify depressive disorders following strokes and to follow the evolution of such patients after administering anti-depressive medication in association with the rehabilitation program.Materials and methodThis is a prospective study on 36 patients suffering from post stroke hemiplegia, situated in an interval of two to twelve months after the stroke. The patients have been randomly divided into two groups, the study group consisting of 21 patients who received anti-depressive medication in addition to the rehabilitation program, and the control group (15 patients) who only received the rehabilitation therapy. All patients were evaluated for depression using the Hamilton depression scale (HAM-D) at the beginning of the study and after two months of anti-depressive medication. Their clinical and functional evolution was evaluated using standardized scales and quality of life scales (FIM). Other parameters were noted such as age, sex, level of education and family support.ResultsAs expected, both the depression and the functional scores improved significantly after two months of rehabilitation treatment associated with anti-depressive medication in the study group compared to the initial evaluation. Also, improvement was noted when compared to the results of the control group.Conclusionsin accordance with others published studies, this analysis shows the importance of early detection and treatment of post stroke depressionA multi disciplinary team that includes a psychiatrist must be assembled for the treatment of stroke patients, as such a team brings the most benefit to the patients.

Funding Acknowledgements Type of funding sources: None. Background Ethanol Infusion in the Vein of Marshall (EIVOM) has been recently introduced as an efficient technique that helps achieving mitral isthmus block during ablation procedures for persistent atrial fibrillation (PAF) or peri-mitral atrial flutter. Purpose We have evaluated the safety of EIVOM and the duration required to perform this procedure.  Methods  We performed EIVOM in 121 patients for PAF (mean age of 65 years (range 40-83, 73% men; Mean EF 50%. The main steps of the EIVOM were as follows: the procedure commenced with catheterization of the coronary sinus, followed by the subsequent introduction of an angiography catheter that allowed for iodine contrast injection and vein of Marshall (VOM) localization, 1.5-2.5 mm angioplasty balloon over 0.014" guidewire placement and finally the ethanol injection up to 10 ml.  Results No major complications were observed during the ablation procedure or before hospital discharge. In 62 patients in whom procedure duration data was available the mean EIVOM procedure time was 41 min (range from 13 to 105 min). After the first 20 procedures, where the learning curve for the operators has to be taken into consideration, a reduction in the time required to achieve EIVOM was consistently noted, with an average of less than 30 min. and for the last 20 procedures less than 20 min. Factors which increase the time required for successful EIVOM include: difficulty in visualizing the ostium of the VOM, a VOM ostium located proximally, difficulty in advancing the angioplasty wire into the VOM and balloon displacement and repositioning. Conclusions Ethanol infusion in the Vein of Marshall is a safe and efficient technique that can be performed in an acceptable amount of time after an initial learning curve. Abstract Figure. Image 1 VOM

IntroductionDescribed since the 19th century, menstrual psychosis is considered a forgotten disorder. Current classification systems do not include the diagnosis of menstrual psychosis, a condition comprising in psychotic episodes recurring during each menstrual or premenstrual period, but remitting the rest of the month. The world literature consists mainly of case reports. To our knowledge this is the first Romanian report of menstrual psychosis.ObjectivesTo describe the course of the condition in a patient with multiple and rapid recurring psychotic episodes from onset until the most recent hospitalization.AimsTo better understand if this case could be considered a true menstrual psychosis.MethodsReview of the medical charts of the 57 hospitalizations the patient has had between 1977 and 2012 in the “Prof. Dr. Al. Obregia” Psychiatry Hospital.ResultsInitial diagnosis included discordant psychosis and atypical depressive state that shifted in time to schizoaffective disorder and various forms of schizophrenia. The history reveals cyclic episodes with short-term remissions and multiple hospitalizations. Treatment approaches also varied during the course of the disease, from ECT to second generation of antipsychotics without any consistent long-term remission. The frequency of episodes started to dramatically reduce only when the menopause installed.ConclusionPatients with a history of numerous admissions might benefit from a record review aimed at identifying temporal patterns. Clinicians should be aware of menstrual psychotic symptoms exacerbations in a minority of women with chronic mental disorders and therapeutic strategies need to be carefully considered and adjusted to each individual patient.