Cargando…
When Manual Analysis of 12-Lead ECG Holter Plays a Critical Role in Discovering Unknown Patterns of Increased Arrhythmogenic Risk: A Case Report of a Patient Treated with Tamoxifen and Subsequent Pneumonia in COVID-19
Several medicines, including cancer therapies, are known to alter the electrophysiological function of ventricular myocytes resulting in abnormal prolongation and dispersion of ventricular repolarization (quantified by multi-lead QTc measurement). This effect could be amplified by other concomitant...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136377/ https://www.ncbi.nlm.nih.gov/pubmed/34018126 http://dx.doi.org/10.1007/s12012-021-09659-w |
_version_ | 1783695430653050880 |
---|---|
author | Brisinda, Donatella Merico, Barbara Fenici, Peter Fenici, Riccardo |
author_facet | Brisinda, Donatella Merico, Barbara Fenici, Peter Fenici, Riccardo |
author_sort | Brisinda, Donatella |
collection | PubMed |
description | Several medicines, including cancer therapies, are known to alter the electrophysiological function of ventricular myocytes resulting in abnormal prolongation and dispersion of ventricular repolarization (quantified by multi-lead QTc measurement). This effect could be amplified by other concomitant factors (e.g., combination with other drugs affecting the QT, and/or electrolyte abnormalities, such as especially hypokalemia, hypomagnesaemia, and hypocalcemia). Usually, this condition results in higher risk of torsade de point and other life-threatening arrhythmias, related to unrecognized unpaired cardiac ventricular repolarization reserve (VRR). Being VRR a dynamic phenomenon, QT prolongation might often not be identified during the 10-s standard 12-lead ECG recording at rest, leaving the patient at increased risk for life-threatening event. We report the case of a 49-year woman, undergoing tamoxifen therapy for breast cancer, which alteration of ventricular repolarization reserve, persisting also after correction of concomitant recurrent hypokalemia, was evidenced only after manual measurements of the corrected QT (QTc) interval from selected intervals of the 12-lead ECG Holter monitoring. This otherwise missed finding was fundamental to drive the discontinuation of tamoxifen, shifting to another “safer” therapeutic option, and to avoid the use of potentially arrhythmogenic antibiotics when treating a bilateral pneumonia in recent COVID-19. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12012-021-09659-w. |
format | Online Article Text |
id | pubmed-8136377 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-81363772021-05-21 When Manual Analysis of 12-Lead ECG Holter Plays a Critical Role in Discovering Unknown Patterns of Increased Arrhythmogenic Risk: A Case Report of a Patient Treated with Tamoxifen and Subsequent Pneumonia in COVID-19 Brisinda, Donatella Merico, Barbara Fenici, Peter Fenici, Riccardo Cardiovasc Toxicol Article Several medicines, including cancer therapies, are known to alter the electrophysiological function of ventricular myocytes resulting in abnormal prolongation and dispersion of ventricular repolarization (quantified by multi-lead QTc measurement). This effect could be amplified by other concomitant factors (e.g., combination with other drugs affecting the QT, and/or electrolyte abnormalities, such as especially hypokalemia, hypomagnesaemia, and hypocalcemia). Usually, this condition results in higher risk of torsade de point and other life-threatening arrhythmias, related to unrecognized unpaired cardiac ventricular repolarization reserve (VRR). Being VRR a dynamic phenomenon, QT prolongation might often not be identified during the 10-s standard 12-lead ECG recording at rest, leaving the patient at increased risk for life-threatening event. We report the case of a 49-year woman, undergoing tamoxifen therapy for breast cancer, which alteration of ventricular repolarization reserve, persisting also after correction of concomitant recurrent hypokalemia, was evidenced only after manual measurements of the corrected QT (QTc) interval from selected intervals of the 12-lead ECG Holter monitoring. This otherwise missed finding was fundamental to drive the discontinuation of tamoxifen, shifting to another “safer” therapeutic option, and to avoid the use of potentially arrhythmogenic antibiotics when treating a bilateral pneumonia in recent COVID-19. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12012-021-09659-w. Springer US 2021-05-20 2021 /pmc/articles/PMC8136377/ /pubmed/34018126 http://dx.doi.org/10.1007/s12012-021-09659-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Article Brisinda, Donatella Merico, Barbara Fenici, Peter Fenici, Riccardo When Manual Analysis of 12-Lead ECG Holter Plays a Critical Role in Discovering Unknown Patterns of Increased Arrhythmogenic Risk: A Case Report of a Patient Treated with Tamoxifen and Subsequent Pneumonia in COVID-19 |
title | When Manual Analysis of 12-Lead ECG Holter Plays a Critical Role in Discovering Unknown Patterns of Increased Arrhythmogenic Risk: A Case Report of a Patient Treated with Tamoxifen and Subsequent Pneumonia in COVID-19 |
title_full | When Manual Analysis of 12-Lead ECG Holter Plays a Critical Role in Discovering Unknown Patterns of Increased Arrhythmogenic Risk: A Case Report of a Patient Treated with Tamoxifen and Subsequent Pneumonia in COVID-19 |
title_fullStr | When Manual Analysis of 12-Lead ECG Holter Plays a Critical Role in Discovering Unknown Patterns of Increased Arrhythmogenic Risk: A Case Report of a Patient Treated with Tamoxifen and Subsequent Pneumonia in COVID-19 |
title_full_unstemmed | When Manual Analysis of 12-Lead ECG Holter Plays a Critical Role in Discovering Unknown Patterns of Increased Arrhythmogenic Risk: A Case Report of a Patient Treated with Tamoxifen and Subsequent Pneumonia in COVID-19 |
title_short | When Manual Analysis of 12-Lead ECG Holter Plays a Critical Role in Discovering Unknown Patterns of Increased Arrhythmogenic Risk: A Case Report of a Patient Treated with Tamoxifen and Subsequent Pneumonia in COVID-19 |
title_sort | when manual analysis of 12-lead ecg holter plays a critical role in discovering unknown patterns of increased arrhythmogenic risk: a case report of a patient treated with tamoxifen and subsequent pneumonia in covid-19 |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136377/ https://www.ncbi.nlm.nih.gov/pubmed/34018126 http://dx.doi.org/10.1007/s12012-021-09659-w |
work_keys_str_mv | AT brisindadonatella whenmanualanalysisof12leadecgholterplaysacriticalroleindiscoveringunknownpatternsofincreasedarrhythmogenicriskacasereportofapatienttreatedwithtamoxifenandsubsequentpneumoniaincovid19 AT mericobarbara whenmanualanalysisof12leadecgholterplaysacriticalroleindiscoveringunknownpatternsofincreasedarrhythmogenicriskacasereportofapatienttreatedwithtamoxifenandsubsequentpneumoniaincovid19 AT fenicipeter whenmanualanalysisof12leadecgholterplaysacriticalroleindiscoveringunknownpatternsofincreasedarrhythmogenicriskacasereportofapatienttreatedwithtamoxifenandsubsequentpneumoniaincovid19 AT feniciriccardo whenmanualanalysisof12leadecgholterplaysacriticalroleindiscoveringunknownpatternsofincreasedarrhythmogenicriskacasereportofapatienttreatedwithtamoxifenandsubsequentpneumoniaincovid19 |