Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

BACKGROUND Takotsubo cardiomyopathy is characterized by a transient left ventricular dysfunction without obstructive coronary artery disease that mimics an acute myocardial infarction. The electrocardiogram findings of Takotsubo cardiomyopathy usually present with ST-segment elevation or depression, T-wave inversion, left bundle branch block or high-grade atrioventricular block. CASE REPORT This is a report of a case of a 58-year-old male diagnosed with Takotsubo cardiomyopathy that occurred in the setting of an acute asthma exacerbation and psychiatric exacerbation with novel electrocardiogram findings of right bundle branch block. Transthoracic echocardiogram showed a preserved ejection fraction with left ventricular apical ballooning and hyperkinesis of the basal segments. The nuclear stress test showed a fixed perfusion defect at the apical segment, but the patient refused further testing such as coronary angiography. The patient was managed medically, and a repeat echocardiogram done after 8 weeks from discharge showed a complete resolution of the apical ballooning. CONCLUSIONS It is important to recognize that patients with psychiatric illness and asthma exacerbation are predisposed to develop Takotsubo cardiomyopathy. It is also reasonable to suspect Takotsubo cardiomyopathy in the presence of new electrocardiogram findings aside from those typically seen in acute myocardial infarction, especially if it is associated with apical ballooning.
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PMID:Rare Association of Takotsubo Cardiomyopathy with Right Bundle Branch Block in the Dual Setting of Asthma Exacerbation and Psychiatric Illness. 3195 39

ST-elevation myocardial (STEMI) is frequently associated with conduction disorders. Regional myocardial ischemia or injury may affect the cardiac conduction system at various locations, and neural reflexes or changes in the balance of the autonomous nervous system may be involved. Sinoatrial and atrioventricular block are more frequent in inferior than anterior STEMI, while new left anterior fascicular block and right bundle branch block indicate proximal occlusion of the left anterior descending coronary artery. New left bundle branch block is associated with multi-vessel disease. Most conduction disorders associated with STEMI are reversible with reperfusion therapy, but they may still impair prognosis, because they indicate a large area at risk, extensive myocardial infarction or severe coronary artery disease. Acute STEMI recognition is possible in patients with fascicular or right bundle branch block, but future studies need to define the cut-off values for ST depression in the leads V1-V3 in inferolateral MI and for ST elevation in the same leads in anterior STEMI. In left bundle branch block, concordant ST elevation is a specific sign of acute coronary artery occlusion, but the ECG feature has low sensitivity.
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PMID:Conduction Disorders in the Setting of Acute STEMI. 3261 49

Brugada electrocardiographic pattern, or Brugada phenocopy (BrP), can be found in conditions other than Brugada syndrome. We present the case of a 34-year-old woman who was found convulsing at home followed by ventricular tachycardia (VT) cardiac arrest upon arrival to the emergency department. Electrical direct cardioversion led to a return of spontaneous circulation, and she was started on intravenous amiodarone. The patient had four additional episodes of pulseless VT that returned to sinus rhythm with electrical cardioversion. A subsequent electrocardiogram taken in sinus rhythm revealed a right bundle branch block pattern with a coved ST segment elevation and inverted T waves in leads V1 and V2, suggestive of BrP type 1. Further inquiry revealed that an empty bottle of nortriptyline was found at her home. Nortriptyline intoxication was subsequently confirmed by a serum level of 1581 ng/mL. Treatments with intravenous sodium bicarbonate resolved the BrP, and she fully recovered with supportive care. Intoxication with drugs that inhibit cardiac sodium channels, such as nortriptyline, can trigger a BrP in otherwise normal individuals. Nortriptyline and other tricyclic antidepressants (TCAs) are used to treat chronic pain, depression, and other conditions but have dose-related side effects and can lead to fatal overdose. Intoxication by these TCAs should be on the differential when a BrP is observed.
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PMID:Brugada Phenocopy: A Case of Incessant Ventricular Tachycardia in a Patient with Tricyclic Antidepressant Overdose. 3313 62


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