The authors describe two cases of takotsubo cardiomyopathy developing after an abrupt withdrawal of carvedilol and bisoprolol. Takotsubo or stress cardiomyopathy is characterized by acute and reversible cardiac dysfunction without coronary artery disease. It is triggered by acute emotional or physical stress, drugs or drug withdrawal. The immediate discontinuation of the long acting vasodilator beta-blocker, carvedilol has not yet been described to cause takotsubo cardiomyopathy. The authors recommend cautious withdrawal of beta-blockers.
A Lyme-kór az egyik leggyakoribb antropozoonosis, a Borrelia kórokozója kullancs csípésével kerül az emberi szervezetbe, Magyarországon évente 10000 friss fertőzést okozva. A Lyme-kór tünetei és lefolyása változatosak, késői formában nemritkán carditist okoz. Esetünkben szerológiailag igazolt borreliosis okozott teljes atrioventricularis blokkot fi atal férfi nél, aki praesyncope miatt került intézetünkbe. A blokk hátterében, a közeli kullancscsípésre való tekintettel, Lyme-carditist gyanítottunk, antibiotikum adását és monitoros obszervációt kezdtünk. A betegségre jellemző bőrtünetek nem jelentkeztek, a laborvizsgálat kórosat nem igazolt. Elektrofi ziológiai vizsgálattal domináló supra-His atrioventricularis blokkot regisztráltunk. Az obszerváció másnapjától a blokk regressziót mutatott, később teljesen megjavult. Szerológiai vizsgálat egy évnél régebbi borreliosist igazolt. Terápiás ajánlás a potenciálisan reverzíbilis Lyme-carditisben egyelőre nincs. Fiataloknál rizikófaktor nélkül jelentkező ingerületvezetési zavar esetén is cél-szerű Lyme-carditisre gondolni, segítséget a pontos anamnézis felvétele és megfelelő labordiagnosztika jelenthet, amellyel elkerül-hető a pacemakerbeültetés. Orv. Hetil., 2010, 39, 1585-1590. Kulcsszavak: praesyncope, atrioventricularis blokk, pacemaker, Lyme-borreliosis Acute atrioventricular block in chronic Lyme diseaseThe tick bite transmitted Lyme disease is one of the most common antropozoonosis, about 10 000 new infections are reported in Hungary each year. The progress and clinical presentation can vary, and carditis can occur in later stages. A serologically verifi ed Lyme disease caused third degree atrioventricular block in young male presenting with presyncope. Based on the tick-bites mentioned a few weeks prior to hospital admission, Lyme carditis was considered with the administration of antibiotics and monitor observation. Typical skin lesions were not recognized and laboratory fi ndings showed no pathology. An electrophysiological study recorded a predominant supra-His atrioventricular block. Total regression of conduction could be detected later and the serological tests established an underlying Lyme disease. Currently no defi nite treatment recommendation is available for the potentially reversible Lyme carditis. The tick bite seemed to be the key on our way to diagnosis; however, serological tests proved the disease to be older than one year. A detailed medical history and serological tests are essential in identifying the cause and pacemaker implantation can be avoided. Orv. Hetil., 2010, 39, 1585-1590 Keywords: presyncope, atrioventricular block, pacemaker, Lyme infection (Beérkezett: 2010. július 25.; elfogadva: 2010. augusztus 19.) A Lyme-borreliosist elsőként 1975-ben írták le az Egyesült Államokban, miután rejtélyes rheumatoid arthritisjárvány tört ki fi atalok között az északkeleti Connecticut tagállamban, Lyme városától nem messze [1]. Ezt követően 7 évvel Willy Burgdorfer azonosította a később róla elnevezett borreliát, amelyet az Ixodes specieshez tar...
A 77-year-old female patient was admitted to our emergency department with syncope and suspected pacemaker dysfunction. An AAI pacemaker implantation () is mentioned in her medical history due to tachycardiabradycardia syndrome 3 years earlier with the prescription of 300-mg propafenone orally to be taken twice a day. The patient was free of complaints for over 2 years and had no documented or long-lasting arrhythmias since then. The pacemaker interrogation 1 week before recent admission showed good device function; with battery voltage at 2.77 V, battery impedance at 0.7 kOhm, lead impedance at 593 Ohm, as well as pacing thresholds at 0.8 V/0.75 ms and 1.2 V/0.40 ms. The atrial sensing was measured to be between 1.7 mV and 2.2 mV at a spontaneous sinus rate of 47 beats/min. The initial programmed parameters were atrial pulse amplitude at 2.4 V, pulse width 0.40 ms, and sensitivity at 0.8 mV. On the morning of the admission our patient felt palpitations again and therefore took another 300-mg propafenone as advised by the "pill in the pocket" concept (900-mg propafenone within 13 hours). Four hours later, she first felt dizziness with nausea, then lost consciousness for a few moments shortly afterwards. The emergency electrocardiogram performed on-site revealed normal regular, but ineffective, atrial pacemaker stimuli with 800 ms as well as a narrow QRS ventricular escape rhythm with cycle lengths of 1,920 ms (Fig. 1). The emergency therapy given from the medical staff at her home was 3-mg atropine given intravenously as well as 500-mL saline infusion. On admission to our Coronary Care Unit, the cycle length of the escape rhythm was already shorter at 550 ms Address for reprints: János Tomcsányi, M.D., Budai Irgalmasrendi Kórház Kardiológia,Árpád fejedelem u.7,
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