Acute respiratory distress syndrome with transiently impaired left ventricular function and Torsades de Pointes arrhythmia unmasking congenital long QT syndrome in a 25-yr-old woman

We report a case of recurrent episodes of Torsades de Pointesarrhythmia in the setting of transiently impaired left ventricularejection fraction, acute respiratory distress syndrome, transienthypokalaemia and QT-prolonging drugs, in a previously healthy25-yr-old female patient. In the course of the clinical andgenetic work-up this patient was newly diagnosed with a mutationin KCNH2 encoding the     

Cardiac risk and perioperative management

Cardiovascular complications are the major cause of perioperative and late morbidity and mortality in patients undergoing major vascular surgery. This is related to the frequent presence of underlying coronary artery disease (CAD). CAD may be asymptomatic because of reduced exercise capacity due to pre-existing non-cardiac conditions like stroke or claudication. Careful preoperative evaluation of CAD and perioperative management with beta-blockers and statins may offer the physician a unique opportunity to improve patients' perioperative and long-term outcome.     

心脏移植围术期右心衰的危险因素与治疗

目的 探讨临床心脏移植围术期发生移植心脏右心功能衰竭(右心衰)的危险因素及针对肺动脉高压的治疗效果。方法 回顾性分析经筛选出的96例心脏移植患者的临床资料,建立移植心脏右心衰诊断标准,采用logistic回归分析确定危险因素,建立风险模型。以术前肺动脉收缩压(SPAP)为标准分为A组(SPAP ＜40 mm Hg,1 mm Hg =0.133 kPa)和B组(SPAP≥40 mm Hg)。比较组间各临床数据之间的差异。结果 年龄、瓣膜病、心衰病史、术前SPAP是移植心脏右心衰的危险因素。术前SPAP的危险系数最高是6.725,其次是心衰病史1.712、瓣膜病1.351、年龄1.051;冠心病和术前应用5-PDEs-Ⅰ为保护性因素,危险系数分别为0.056和0.034。A组与B组患者的年龄、原发病(瓣膜病)、心衰病史存在显著差异,右心衰发生率虽差异无统计学意义,但B组明显较A组为高(67.6％对45.8％)。两组应用体外膜氧合(ECMO)和右心衰死亡的比例差异无统计学意义。结论 心脏移植受者术前的肺动脉高压是移植心脏右心衰的主要风险因素,而针对肺动脉高压的靶向性药物治疗和ECMO辅助循环,虽然缺乏循证医学证据,但临床取得了较好的疗效。     

Relationship between QT interval prolongation and structural abnormalities in cirrhotic cardiomyopathy: A change in the current paradigm

It is postulated that cardiac structural abnormalities observed in cirrhotic cardiomyopathy (CCM) contribute to the electrophysiologic abnormality of QT interval (QTc) prolongation. We sought to evaluate whether QTc prolongation is associated with intrinsic abnormalities in cardiac structure and function that characterize CCM. Consecutive patients undergoing liver transplant work-up between 2010 and 2018 were included. Measures of cardiac function on stress testing including cardiac reserve and chronotropic incompetence were collected prospectively and a corrected QTc ≥ 440 ms was considered prolonged. Overall, 439 patients were included and 65.1% had a prolonged QTc. There were no differences in markers of left ventricular and atrial remodeling, or resting systolic and diastolic function across QTc groups. The proportion of patients that met the criteria for a low cardiac reserve (39.2 vs 36.6%, p = .66) or chronotropic incompetence (18.1 vs 21.3%, p = .52) was not different in those with a QTc ≥ 440 vs <440 ms. Further, there was no association between QTc prolongation and CCM by either the 2005 World College of Gastroenterology or modified 2020 Cirrhotic Cardiomyopathy Consortium criteria. QT interval prolongation was not associated with structural or functional cardiac abnormalities that characterize CCM. These findings suggest that CCM and QT interval prolongation in cirrhosis may be two separate entities with distinct pathophysiological origins.     

Torsade de pointes and long QT syndrome following major blood transfusion

We report a rare complication following transfusion of a large volume of blood in an adult patient. An electrophysiological disturbance of the cardiac cycle with prolongation of the QT interval developed, which was followed by recurrent episodes of torsade de pointes, a unique form of ventricular tachycardia. The most likely cause of this acquired long QT syndrome was hypomagnesaemia secondary to massive blood transfusion. Treatment with a magnesium infusion restored the QT interval to normal and temporary ventricular pacing prevented further ventricular arrhythmias.     

食管癌术后发生急性肾损伤危险因素分析及处理

目的探讨食管癌术后急性肾损伤(acute kidney injury,AKI)的危险因素、临床意义及围手术期处理。方法回顾性分析397例食管癌手术患者的临床资料,统计术后AKI的发生情况,按有无AKI发生分为AKI组和非AKI组,将发生AKI患者与非AKI患者进行相关因素比较分析。结果本组研究397例食管癌手术患者中25例发生AKI,其中Ⅰ期15例,Ⅱ期4例,Ⅲ期6例,总患病率为6.3%。25例发生AKI的患者中,出院时存活21例(占84%),死亡4例(占16%)。AKI与非AKI的相关因素比较:年龄、冠心病、慢性阻塞性肺疾病、术前血肌酐、术前化疗、淋巴结清扫数、术中失血量、手术时间、术后呼吸机应用时间等因素差异,无统计学意义(P0.05);糖尿病、高血压、术后肺部感染及肾外器官衰竭差异有统计学意义(P0.05)。Logistic多因素回归分析结果显示,糖尿病、高血压、术后肺部感染及肾外器官衰竭是食管癌术后并发AKI的独立危险因素。结论 AKI是食管癌患者术后常见的并发症且易被忽视,须注意引起AKI的常见原因,对于存在AKI危险因素的患者加强围手术期管理,严密监测肾功能。一旦发生AKI,预后极差,因此,要早期选择最佳的治疗方案,提高食管癌患者术后生存率,减少病死率。     

Does Low-dose Droperidol Administration Increase the Risk of Drug-induced QT Prolongation and Torsade de Pointes in the General Surgical Population?

Background: The US Food and Drug Administration issued a black box warning regarding the use of droperidol and the potential for torsade de pointes (TdP).

Methods: The primary objective of this retrospective study was to determine whether low-dose droperidol administration increased the incidence of TdP in the general surgical population during a 3-yr time period before and after the Food and Drug Administration black box warning. A random sample of 150 surgical patients during each time interval was selected to estimate the droperidol use for each time period.

Results: During the time period before the black box warning (July 1, 1998 to June 30, 2001), 2,321/139,932 patients (1.66%) had QT prolongation, TdP, or death within 48 h after surgery. We could identify no patients who clearly developed TdP before the black box warning. There was one patient for whom the cause of death could not positively be ruled out as due to TdP. In the time period after the black box warning (July 1, 2002 to June 30, 2005), 2,207 patients (1.46%) had documented QT prolongation, TdP, or death within 48 h after surgery, including only two cases (<0.1%) of TdP. The incidence of droperidol exposure was approximately 12% (exact 95% confidence interval, 7.3-18.3%) before the black box warning and 0% after placement of the black box warning on droperidol. Therefore, we estimate that approximately 16,791 patients (95% confidence interval, 10,173-25,607) were exposed to droperidol, none of whom experienced documented TdP.     

围术期脑卒中的发病机制和相关的危险因素

背景 围术期脑卒中是围术期非常严重的并发症之一,发病率为0.05％～7％,是围术期患者死亡的一个重要原因. 目的 旨在提高医疗工作者对该病的认识. 内容 围术期脑卒中的定义、发病率、发病机制及其相关危险因素. 趋向 对围术期脑卒中发病机制和相关危险因素的深入研究,将为其防治提供更好的策略.     

QT interval measurement: evaluation of automatic QTc measurement and new simple method to calculate and interpret corrected QT interval

BACKGROUND: Assessment of repolarization duration is often recommended to avoid administration of QT-prolonging drugs in patients with prolonged QTc interval, a frequent situation in the postoperative period. Bazett QT correction inappropriately increases QTc when heart rate is increased, and the use of the Fridericia formula may avoid a falsely prolonged QTc interval. The authors assessed automatic QT interval measurement to detect prolonged QTc interval (women >450 ms; men >440 ms) in the postoperative setting. METHODS: Automatic and manual electrocardiograms were performed in 108 patients after anesthesia. Automatic electrocardiographic measurement used the Bazett formula. Manual measurements were made from each electrocardiogram and used as the reference. Agreement between the two methods was analyzed. Bazett and Fridericia QT corrections were compared in this population. RESULTS: Agreement between automatic and manual measurements was low. The Fridericia correction, but not the Bazett correction, was independent from heart rate and allowed adequate QT correction. Sensitivity of automatic measurements to detect prolonged QTc-Bazett interval was 54%. Automatic QTc-Bazett interval less than 430 ms ruled out a manual prolonged QTc interval. When automatic QTc-Bazett was greater than 430 ms, this value was converted according to Fridericia. Automatic QTc-Fridericia greater than 430 ms identified all patients with prolonged manual QTc with a negative predictive error of 0% (95% confidence interval, 0-7%). QTc-Fridericia can be approximated by respectively adding or subtracting 5% to the uncorrected QT for each increase or decrease by 10 beats/min in heart rate from 60 beats/min. CONCLUSIONS: Automatic QTc-Bazett measurement, if abnormal, associated with calculation of QTc-Fridericia reliably identifies patients in whom manual QTc measurement must be performed to confirm postoperative prolonged QTc interval.