Deutsche medizinische Wochenschrift (1946) · 2000
[Recurrent syncope in a 34-year-old woman triathlete].
Клинический случайАннотация на английскомСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Carlsson J, Erdogan A, Rolf A, Schulte B, Klingenbeck R, Sperzel J, Neuzner J, Pitschner H F
Аннотация
HISTORY: Some weeks previously a 34-year old athlete, specializing in the triathlon, had 6 syncopes in one day. They had caused abrasions and contusions resulting from the falls. At another hospital paroxysmal atrial fibrillation had been diagnosed and treatment with disopyramide (2 x 200 mg) initiated, but she had about 15 further syncopes within 2 weeks. She was admitted for establishing their cause.
INVESTIGATIONS: Initial ECGs and neurological examination failed to provide a diagnosis and she was discharged with an "event recorder".
DIAGNOSIS, TREATMENT AND COURSE: Three weeks after discharge she had another syncope. The event recorder was activated by the patient's partner and revealed polymorphous ventricular tachycardia. She underwent extensive invasive cardiological tests, including a right ventricular biopsy, but no abnormality was demonstrated. However, a provocation test with ajmaline produced ST segment elevations in V1 and V2 typical of the syndrome previously described by the Brugadas (right bundle branch block, precordial ST elevations in V1-V3 and sudden cardiac death). A cardioverter-defibrillator was implanted. During the subsequent observation period of 2 month the ICD delivered one countershock, triggered by the onset of polymorphous ventricular tachycardia with syncope.
CONCLUSION: In patients with serious ventricular arrhythmias but no diagnostic findings, including a normal resting ECG, a drug provocation test should be performed to exclude a Brugada syndrome.
INVESTIGATIONS: Initial ECGs and neurological examination failed to provide a diagnosis and she was discharged with an "event recorder".
DIAGNOSIS, TREATMENT AND COURSE: Three weeks after discharge she had another syncope. The event recorder was activated by the patient's partner and revealed polymorphous ventricular tachycardia. She underwent extensive invasive cardiological tests, including a right ventricular biopsy, but no abnormality was demonstrated. However, a provocation test with ajmaline produced ST segment elevations in V1 and V2 typical of the syndrome previously described by the Brugadas (right bundle branch block, precordial ST elevations in V1-V3 and sudden cardiac death). A cardioverter-defibrillator was implanted. During the subsequent observation period of 2 month the ICD delivered one countershock, triggered by the onset of polymorphous ventricular tachycardia with syncope.
CONCLUSION: In patients with serious ventricular arrhythmias but no diagnostic findings, including a normal resting ECG, a drug provocation test should be performed to exclude a Brugada syndrome.