Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Incessant supraventricular tachycardia: An unexpected nightmare
Session:
Casos Clínicos: Arritmias e Dispositivos Cardíacos
Speaker:
Marta Catarina Bernardo
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.4 Arrhythmias, General – Treatment
Session Type:
Sessão de Casos Clínicos
FP Number:
---
Authors:
Marta Catarina Bernardo; Catarina Ribeiro Carvalho; José P. Guimarães; Luís Azevedo; Isabel Moreira; Sílvia Leão; Renato Margato; Luís Adão; Ana Lebreiro; Sofia Silva Carvalho; Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A 58-year-old male presented to the emergency department with worsening sustained palpitations and dyspnoea in the prior weeks. A recent Holter revealed supraventricular tachycardia (SVT) with a heart rate of 190 bpm lasting 13 hours. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">He had past medical history of SVT submitted to electrophysiologic study (EPS) 12 years before, with radiofrequency (RF) ablation of a concealed posteroseptal accessory pathway. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At admission, he had acute heart failure and tachycardia. The electrocardiogram showed narrow QRS tachycardia with a heart rate of 170 bpm (Figure 1). Sinus rhythm (SR) was restored after adenosine but with SVT recurrence. He initiated amiodarone and repeated bolus of adenosine. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In the blood test analysis, thyroid function was normal, there was mildly elevated T-troponin with plateau levels and the pro-BNP level was 2477 pg/ml. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Echocardiogram showed non-dilated left ventricle with global hypokinesis and severe left ventricular (LV) dysfunction. Depression of right ventricular systolic function. Severe secondary mitral regurgitation and no pericardial effusion. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Despite amiodarone perfusion, the patient developed incessant SVT, with the need for repeated boluses of adenosine. His condition deteriorated into cardiogenic shock with hypotension, hyperlactacidemia, tachypnoea, desaturation and olygoanuria. He initiated non-invasive ventilation, inotropic and vasopressor support. Despite medical measures, he maintained recurrent and sustained episodes of SVT, cardiogenic shock with progressive multi-organ failure and severe biventricular dysfunction being referred to ECMO for hemodynamic support. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After initiation of ECMO, there was clinical improvement allowing withdrawal of vasopressor support. However, he maintained recurrent episodes of SVT. On 5<sup>th</sup> day, he was submitted to EPS (Fig.1) which revealed retrograde conduction with fixed ventriculoatrial interval and induction of orthdromic atrioventricular reentrant tachycardia. The accessory pathway was identified in relation to coronary sinus diverticulum and successful RF ablation was performed. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After EPS, amiodarone was suspended, there was no SVT recurrence and ECMO support was discontinued on the 6<sup>th</sup> day. He remained hemodynamically stable in sustained SR. Echocardiogram at discharge showed: Mildly reduced LV ejection fraction (49%), normal right ventricular systolic function and mild to moderate mitral regurgitation. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This is a rare presentation of an incessant SVT, with poor response to medical therapy and challenging ablation, leading to tachycardiomyopathy and cardiogenic shock. The use of ECMO allowed hemodynamic support and EPS was performed with ablation of concealed accessory pathway. Although an uncommon finding, coronary sinus diverticulum is a well-recognized cause of difficult accessory pathway ablation.</span></span></p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site