QT Prolongation Complicated with Torsades de Pointes in Prosthetic Mitral Valve Endocarditis: A Case Report

Tounsi, A.; Abid, Leïla; Akrout, M.; Hentati, Mourad; Kammoun, S.

doi:10.1155/2012/574923

Cited by 5 publications

(11 citation statements)

References 15 publications

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“…Accordingly, in a large cohort of 186 patients with myocarditis, Ukena et al ( 16 ) demonstrated that a QTc prolongation ≥440 ms was frequent (~25% of cases) and predicted a poor clinical outcome, including cardiac death. Moreover, several cases of marked QTc prolongation complicated with TdP have been reported in patients with acute infective carditis (myo/endocarditis), independently from the specific etiologic agent involved ( 45 – 57 ). A peculiar form of diffuse myocarditis is Chagas’s disease, triggered by the protozoan Trypanosoma cruzi , and then progressing for (auto)immune-mediated mechanisms ( 58 ).…”

Section: Inflammation As a Cause Of Acquired Lqtsmentioning

confidence: 99%

Long QT Syndrome: An Emerging Role for Inflammation and Immunity

Lazzerini

Capecchi

Laghi‐Pasini

2015

Front. Cardiovasc. Med.

134

123

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The long QT syndrome (LQTS), classified as congenital or acquired, is a multi-factorial disorder of myocardial repolarization predisposing to life-threatening ventricular arrhythmias, particularly torsades de pointes. In the latest years, inflammation and immunity have been increasingly recognized as novel factors crucially involved in modulating ventricular repolarization. In the present paper, we critically review the available information on this topic, also analyzing putative mechanisms and potential interplays with the other etiologic factors, either acquired or inherited. Accumulating data indicate inflammatory activation as a potential cause of acquired LQTS. The putative underlying mechanisms are complex but essentially cytokine-mediated, including both direct actions on cardiomyocyte ion channels expression and function, and indirect effects resulting from an increased central nervous system sympathetic drive on the heart. Autoimmunity represents another recently arising cause of acquired LQTS. Indeed, increasing evidence demonstrates that autoantibodies may affect myocardial electric properties by directly cross-reacting with the cardiomyocyte and interfering with specific ion currents as a result of molecular mimicry mechanisms. Intriguingly, recent data suggest that inflammation and immunity may be also involved in modulating the clinical expression of congenital forms of LQTS, possibly triggering or enhancing electrical instability in patients who already are genetically predisposed to arrhythmias. In this view, targeting immuno-inflammatory pathways may in the future represent an attractive therapeutic approach in a number of LQTS patients, thus opening new exciting avenues in antiarrhythmic therapy.

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Section: Inflammation As a Cause Of Acquired Lqtsmentioning

confidence: 99%

Long QT Syndrome: An Emerging Role for Inflammation and Immunity

Lazzerini

Capecchi

Laghi‐Pasini

2015

Front. Cardiovasc. Med.

134

123

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“…Other causes of acquired QT prolongation include cocaine abuse, myocardial ischemia, subarachnoid hemorrhage, stroke, autonomic neuropathy, HIV infection, and chronic renal disease requiring dialysis [Khan 2002;Familoni 2006;Yuan 2009]. The majority of cases are pause-dependent, characterized by bradyarrhythmia or sinus pause causing QT interval prolongation and arrhythmia [Tounsi 2012]. In the cases described herein, the development of torsades de pointes was preceded by bradyarrhythmias, characteristic of the pausedependent subtype of QT prolongation.…”

Section: Discussionmentioning

confidence: 86%

“…In cases of extension of infection into the cardiac septum, the conduction system may be affected, leading to arrhythmias [Mylonakis 2001]. Torsades de pointes is a form of polymorphic ventricular arrhythmia associated with QT interval prolongation [Tounsi 2012]. QT prolongation of 0.45 in males and 0.47 in females is diagnostic of long QT syndrome [Yuan 2009].…”

Section: Discussionmentioning

confidence: 99%

“…QT prolongation of 0.45 in males and 0.47 in females is diagnostic of long QT syndrome [Yuan 2009]. Acquired QT prolongation may be attributed to electrolyte abnormalities, such as hypokalemia, hypomagnesemia, and hypocalcemia [Yuan 2009;Tounsi 2012]. Certain medications, such as calcium channel blockers, psychiatric medications, antihistamines, antibiotics, immunosuppressants, and diuretics may cause QT prolongation as well [Yap 2003;Yuan 2009].…”

Section: Discussionmentioning

confidence: 99%

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Torsades de Pointes in Intravenous Drug Abuse–Associated Infective Endocarditis

Eapen

Firstenberg

2018

HSF

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Intravenous drug abuse rates in the United States have increased exponentially in recent years. Ohio is one of 5 states with the highest age-adjusted drug overdose death rates, with drug overdose causing 39.1 of every 100,000 deaths. In patients who survive, the associated morbidity poses a significant public health burden. Infective endocarditis, defined as an infection of the endocardium of the heart, is a potentially lethal consequence of bacteremia related to intravenous drug abuse. Methicillin-sensitive Staphylococcus aureus (MSSA) is the most commonly implicated organism and may affect the tricuspid valve. Indications for surgery include failure of medical management, worsening embolization, heart failure, and arrhythmias—typically bradyarrhythmias from infectious extension into the conduction system. Vegetation size and type of infection, such as drug-resistance pattern, fungal infection, and presence of prosthetic material, are becoming known risk factors for complications. Studies have demonstrated that early surgery tends to have a better prognosis than delayed intervention. Established guidelines for right-sided surgery are slowly evolving. Tricuspid valve surgery is becoming more common in these cases, but there is known risk for heart block owing to proximity of the conduction system to the tricuspid valve annulus. If patients develop complete heart block postoperatively, pacemaker placement may be indicated. There may be reluctance to implantation because of the risk of device infection with infective endocarditis. In addition, many may recover conduction as infection and edema resolve. Generally, bradyarrhythmias are well tolerated. However, we present 2 cases of torsades de pointes related to post-tricuspid-valve-replacement bradyarrhythmia. Torsades de pointes is a potentially lethal form of polymorphic ventricular arrhythmia associated with QT interval prolongation. Post-tricuspid-valve- replacement mortality may be secondary to induced lethal ventricular arrhythmias.

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“…A literature review of pubmed was done. We found cases of QT interval prolongation complicated with TDP in a prosthetic mitral valve endocarditis [6], in an IV drug abuse-associated IE [7], in a prosthetic mitral valve Brucella endocarditis complicated with TDP [8]. Interestingly our patient had a unique presentation: he was not an IV drug abuser, had no prosthetic valve, and the infective pathogen was enterococcus.…”

Section: Discussionmentioning

confidence: 91%

A Twisting Tale of Infective Endocarditis

Akram¹,

Ibe

Kazi³

2019

Cureus

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We present a case of a unique complication of enterococcus endocarditis in an elderly man with a cardiac pacemaker who presented with low-grade fever and cough. He had no history of IV drug use. Blood cultures were positive for Enterococcus faecalis, Both trans-thoracic echo and trans-esophageal echo showed vegetation on the aortic valve. He was discharged on adequate antibiotic coverage but later presented again with near syncope. On cardiac monitoring, he was found to have episodes of torsades. Unlike heart failure or peri-valvular abscess, torsades is a rare complication of endocarditis. We aim to present a case report of a rare complication of infective endocarditis (IE) which if not identified timely, can lead to lethal outcomes. Unfortunately, our patient did not survive, but we learnt that though rare, we should always anticipate rhythm problems such as torsades as complications of endocarditis and should promptly treat with magnesium and antiarrhythmic drugs such as lidocaine if needed.

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QT Prolongation Complicated with Torsades de Pointes in Prosthetic Mitral Valve Endocarditis: A Case Report

Cited by 5 publications

References 15 publications

Long QT Syndrome: An Emerging Role for Inflammation and Immunity

Long QT Syndrome: An Emerging Role for Inflammation and Immunity

Torsades de Pointes in Intravenous Drug Abuse–Associated Infective Endocarditis

A Twisting Tale of Infective Endocarditis

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