Management of patient with acute lymphocytic myocarditis and congenital long QT syndrome presenting with electrical storm and incessant Torsade de Pointes: a case report
Abstract Background This case highlights the management of concomitant acute myocarditis and congenital long QT syndrome with electrical storm and incessant Torsade de Pointes. Case presentation An 18 years-old Southeast Asian para 1 abortus 0 (P1A0) postpartum patient with cesarean section owing to...
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2024-12-01
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| Online Access: | https://doi.org/10.1186/s13256-024-04919-z |
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| author | Giky Karwiky Raymond Pranata Alberta Claudia Undarsa Mohamad Iqbal Hawani Sasmaya Prameswari Mohammad Rizki Akbar |
| author_facet | Giky Karwiky Raymond Pranata Alberta Claudia Undarsa Mohamad Iqbal Hawani Sasmaya Prameswari Mohammad Rizki Akbar |
| author_sort | Giky Karwiky |
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| description | Abstract Background This case highlights the management of concomitant acute myocarditis and congenital long QT syndrome with electrical storm and incessant Torsade de Pointes. Case presentation An 18 years-old Southeast Asian para 1 abortus 0 (P1A0) postpartum patient with cesarean section owing to severe preeclampsia, acute lymphocytic myocarditis, and prolonged QT interval owing to long QT syndrome. She has incessant Torsade de Pointes treated with beta-blocker, lidocaine, overdrive pacing with a temporary transvenous pacemaker, left cardiac sympathetic denervation per video-assisted thoracoscopic surgery, and implantable cardioverter-defibrillator implantation. We initially used bisoprolol, then switched to propranolol and finally to carvedilol, which reduced the Torsade de Pointes frequency. The longest QTc interval was 696 ms, and the shortest was 624 ms, 2 months after initial corticosteroid administration and left cardiac sympathetic denervation. Device interrogation at 9 months follow up showed three episodes of ventricular fibrillation, 2 spontaneously resolved and one necessitates shock. Conclusion Management of concomitant acute myocarditis and congenital long QT syndrome with incessant Torsade de Pointes requires beta-blockers, anti-inflammatory drugs, autonomic modulation, and short-term measures, such as overdrive pacing with deep sedation. Implantable cardioverter-defibrillator is vital to prevent sudden cardiac death. |
| format | Article |
| id | doaj-art-ad4b8cbbc93448f9a6f27e94d8a2f2b2 |
| institution | Kabale University |
| issn | 1752-1947 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
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| series | Journal of Medical Case Reports |
| spelling | doaj-art-ad4b8cbbc93448f9a6f27e94d8a2f2b22025-08-20T03:43:11ZengBMCJournal of Medical Case Reports1752-19472024-12-011811710.1186/s13256-024-04919-zManagement of patient with acute lymphocytic myocarditis and congenital long QT syndrome presenting with electrical storm and incessant Torsade de Pointes: a case reportGiky Karwiky0Raymond Pranata1Alberta Claudia Undarsa2Mohamad Iqbal3Hawani Sasmaya Prameswari4Mohammad Rizki Akbar5Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General HospitalDepartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General HospitalDepartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General HospitalDepartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General HospitalDepartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General HospitalDepartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General HospitalAbstract Background This case highlights the management of concomitant acute myocarditis and congenital long QT syndrome with electrical storm and incessant Torsade de Pointes. Case presentation An 18 years-old Southeast Asian para 1 abortus 0 (P1A0) postpartum patient with cesarean section owing to severe preeclampsia, acute lymphocytic myocarditis, and prolonged QT interval owing to long QT syndrome. She has incessant Torsade de Pointes treated with beta-blocker, lidocaine, overdrive pacing with a temporary transvenous pacemaker, left cardiac sympathetic denervation per video-assisted thoracoscopic surgery, and implantable cardioverter-defibrillator implantation. We initially used bisoprolol, then switched to propranolol and finally to carvedilol, which reduced the Torsade de Pointes frequency. The longest QTc interval was 696 ms, and the shortest was 624 ms, 2 months after initial corticosteroid administration and left cardiac sympathetic denervation. Device interrogation at 9 months follow up showed three episodes of ventricular fibrillation, 2 spontaneously resolved and one necessitates shock. Conclusion Management of concomitant acute myocarditis and congenital long QT syndrome with incessant Torsade de Pointes requires beta-blockers, anti-inflammatory drugs, autonomic modulation, and short-term measures, such as overdrive pacing with deep sedation. Implantable cardioverter-defibrillator is vital to prevent sudden cardiac death.https://doi.org/10.1186/s13256-024-04919-zMyocarditisTorsade de pointesLong QT syndromeIncessant ventricular tachycardiaLeft cardiac sympathetic denervation |
| spellingShingle | Giky Karwiky Raymond Pranata Alberta Claudia Undarsa Mohamad Iqbal Hawani Sasmaya Prameswari Mohammad Rizki Akbar Management of patient with acute lymphocytic myocarditis and congenital long QT syndrome presenting with electrical storm and incessant Torsade de Pointes: a case report Journal of Medical Case Reports Myocarditis Torsade de pointes Long QT syndrome Incessant ventricular tachycardia Left cardiac sympathetic denervation |
| title | Management of patient with acute lymphocytic myocarditis and congenital long QT syndrome presenting with electrical storm and incessant Torsade de Pointes: a case report |
| title_full | Management of patient with acute lymphocytic myocarditis and congenital long QT syndrome presenting with electrical storm and incessant Torsade de Pointes: a case report |
| title_fullStr | Management of patient with acute lymphocytic myocarditis and congenital long QT syndrome presenting with electrical storm and incessant Torsade de Pointes: a case report |
| title_full_unstemmed | Management of patient with acute lymphocytic myocarditis and congenital long QT syndrome presenting with electrical storm and incessant Torsade de Pointes: a case report |
| title_short | Management of patient with acute lymphocytic myocarditis and congenital long QT syndrome presenting with electrical storm and incessant Torsade de Pointes: a case report |
| title_sort | management of patient with acute lymphocytic myocarditis and congenital long qt syndrome presenting with electrical storm and incessant torsade de pointes a case report |
| topic | Myocarditis Torsade de pointes Long QT syndrome Incessant ventricular tachycardia Left cardiac sympathetic denervation |
| url | https://doi.org/10.1186/s13256-024-04919-z |
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