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long qt interval syndrome, polymorph ventricular tachycrdia长QT间期综合征，多形性室性心动过速.doc

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long qt interval syndrome, polymorph ventricular tachycrdia长QT间期综合征，多形性室性心动过速

LONG QT-INTERVAL SYNDROME, POLYMORPHIC VENTRICULAR TACHYCARDIA (“TORSADE DE POINTES”) Prof. Ji?ina Martínková, M.D., PhD1, Prof. Ji?í Kvasni?ka, M.D., PhD2 1 Department of Pharmacology, Charles University in Prague, Faculty of Medicine in Hradec Králové, 500 01 Hradec Králové, ?imkova 870, tel: +420 49 5816 233, fax: +420 49 55 13 597, e-mail: martinkova@lfhk.cuni.cz 2 First Academic Department of Internal Medicine, 500 05 Hradec Králové, University Hospital, tel: +420 49 55 14 869, fax: +420 49 583 2006, e-mail: kvasnicka@fnhk.cz A 60-year-old man, J. P., was admitted to hospital because of short-term unconsciousness. Patient’s history: 1 year ago he was admitted to hospital for an acute myocardial infarction (the anterior type of MI, complicated by a monomorphic ventricular tachycardia). He was short of breath if doing mild exercise (going up-stairs). He has been treated with Moduretic (amiloride) and Cordarone (amiodarone) since. 5 days before the admission to hospital, the patient was diagnosed with atrial fibrillation (in another medical institution) for which he was prescribed quinidine sulphate orally in addition to the previous medication. 2 days before the admission he suddenly fainted for a short period (10 min) twice within 7 hr. The first syncope occurred while watching TV in the morning. The second episode occurred while the patient was shopping in the afternoon. It resulted in mild injury to the patient′s head. The prescribed medication at admission was as follows: quinidine sulphate (Kinitard) 250 mg 4 times/ day (for 5 days), hydrochlorothiazide 25 mg coadministered with amiloride 2.5 mg (Moduretic 1/2 tabl)/day, and amiodarone 200 mg (Cordarone – 1 tabl)/day. Physical examinations: The patient was pale. Jugular filling was adequate, there were no signs of dehydration, acral congestion was normal. Lungs: sonorous percussion, clear, vesicular breathing, no rales in basal parts. Heart: heart action is accompanied with presystolic beat