Elusive cardiac dysrhythmia in high-risk syncope

Mu, Yijia; Supino, Mark

doi:10.1016/j.ajem.2019.158381

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…In this instance, electrocardiography in between episodes revealed sinus rhythm and an absence of AV block [ 4 ]. Mu et al in 2019 described a case of a 70-year-old male with a syncopal episode, who had an initially normal ECG that was later recognized as PVS [ 9 ]. To better comprehend the discrepancy between the electrophysiology data and the symptomatology that is detailed in these two cases, as well as our own, we need a more definitive pathophysiologic mechanism for PVS.…”

Section: Discussionmentioning

confidence: 99%

Incidental Findings of Asystole in a Patient With Complaints of Near Syncope: A Case Report on Paroxysmal Ventricular Standstill

Moles¹,

Barnes²,

Khan³

et al. 2021

Cureus

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Paroxysmal ventricular standstill (PVS) is an unusual cardiac phenomenon in which the heart experiences episodes of absent ventricular activity despite normal atrial functioning, often leading to cardiac arrest and syncope. In this case, we report the hospital stay of a 70-year-old male who was admitted to the hospital following an episode of near syncope at home. On admission, the patient's initial electrocardiogram (ECG) showed sinus rhythm at 60 beats per minute without atrioventricular (AV) block. However, as orthostatic vitals were obtained, the patient became lightheaded for several seconds upon standing, which was noted to correspond with a nine second episode of asystole on telemetry and spontaneous return to sinus bradycardia afterward. Cardiology was immediately consulted and confirmed the diagnosis of paroxysmal ventricular standstill (PVS). Given continued episodes of PVS, the patient underwent successful urgent dual-chamber pacemaker placement, following which he became asymptomatic with resolution of bradycardia. Given the high mortality risk associated with PVS, this condition is an important differential to consider in any patient presenting with syncope or near syncope of unclear etiology.

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Section: Discussionmentioning

confidence: 99%

Incidental Findings of Asystole in a Patient With Complaints of Near Syncope: A Case Report on Paroxysmal Ventricular Standstill

Moles¹,

Barnes²,

Khan³

et al. 2021

Cureus

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“…16 Abubakar also reported a patient with thyroid storm managed with IV Propanolol then showing a severe drop of MAP shortly following administration of IV Propranolol with reduced LVEF by 15% compared to TTE done 2 months prior. 15 In the case reported by Dalan and Leow, there was no clinical evidence of HF at presentation, and yet the patient developed cardiac arrest shortly after administration of propranolol. 17 Our case demonstrates a typical clinical scenario where propranolol was administered in the treatment of hyperthyroid.…”

Section: Propranolol Usagementioning

confidence: 90%

“…Propranolol has been a preferred NCBB due to its additional benefit of inhibiting the peripheral conversion of inactive T4 to active form T3. 15 Several case reports describe side effects of β-blocker in hyperthyroid settings. Ngo and Tan reported a patient with Grave disease with cardiomegaly and mild congestion, managed with propranolol 10 mg PO, later he had a hypotensive condition with post-β-blockers TTE showed EF of 25%.…”

Section: Propranolol Usagementioning

confidence: 99%

A Rare Case of Ventricular Standstill and High-Grade AV Block in Patient with Thyrotoxicosis

Aryaputra,

Bagaswoto

2023

IJC

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Background Stokes-Adams Syndrome can be caused by high-grade AV Block, ventricular tachycardia, and one of the uncommon cause, ventricular standstill. Although thyrotoxicosis is commonly presented as tachycardia, it’s unusual for AV blocks to occur, especially a high-grade one.Case Illustration A 45-year-old female was admitted with fatigue, dizziness, and recurrent episodes of unconsciousness. She had a history of hyperthyroid, routinely managed with Propylthiouracil and Propranolol. Physical examination showed HR: 30 x/min, and other unremarkable systemic examinations. Initial ECG showed 3:1 AV Block. Patient was managed with Dopamin and moved to ICU for further observation. In the ICU, suddenly she had a Stokes-Adam episode presented as a seizure, her monitor showing P waves with an absence of ventricular activity lasting for few seconds. Due to the condition of ventricular standstill, a Temporary Pacemaker (TPM) was installed urgently, and so patient’s vital sign was stable with pacing rhythm. We found Free Thyroxine (T4) level of 46.85 pmol/l, TSH of 0.005 ulU/ml, and unremarkable echocardiographic findings. Considering these results, we suspect that the cause of the ventricular standstill was due to thyrotoxicosis. Propylthiouracil and dexamethasone were given to manage the disease. After 7 days of treatment, she was discharged with sinus rhythm on her ECG. Conclusion Ventricular standstill is frequently associated with conduction blockages, but it can sometimes occur without them. Ventricular standstill treatment often necessitates the use of temporary pacing wires or a pacemaker. In thyroid crises, high-degree AV-block is uncommon, but when the euthyroid condition is restored, clinical status and conduction problems can be reversible.

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Incorrect interpretation of a high-risk electrocardiogram

Littmann

Gibbs

2020

The American Journal of Emergency Medicine

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Elusive cardiac dysrhythmia in high-risk syncope

Cited by 5 publications

References 12 publications

Incidental Findings of Asystole in a Patient With Complaints of Near Syncope: A Case Report on Paroxysmal Ventricular Standstill

Incidental Findings of Asystole in a Patient With Complaints of Near Syncope: A Case Report on Paroxysmal Ventricular Standstill

A Rare Case of Ventricular Standstill and High-Grade AV Block in Patient with Thyrotoxicosis

Incorrect interpretation of a high-risk electrocardiogram

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