Kukla Piotr, Bryniarski Leszek, Dragan Jacek, Słowiak-Lewińska Teresa, Czamara Marcin, Bromblik Alicja, Szczuka Kazimierz
Oddział Wewnetrzny, Szpital Specjalistyczny, ul. Wegierska 21, 38-300 Gorlice.
Kardiol Pol. 2006 Sep;64(9):1008-13; discussion 1013-4.
67-year-old woman with thrombocytopenia (treated with prednisolon and azathiopryn) was admitted because of acute myocardial infarction without ST segment elevation (NSTEMI). From the 2nd day we observed increasing QTc interval from 461 ms with normal potassium level. Suddenly on the 6th day of the so far uncomplicated AMI ventricular fibrillation developed and was successfully treated with DC shock, and amiodarone (150 mg i.v.) was administered because of recurrent NSVT. Potassium level was 2.9 mmol/l. Within the next 2 days in the morning hours we observed episodes of recurrent polymorphic ventricular tachycardia (PMVT), always progressing into ventricular fibrillation (VF). The ECG showed QT interval--520 ms, QTc--602 ms. The patient was given an increasing dose of beta-blocker and lidokaine in i.v. infusion. After this regimen PMVT/VF did not recur and QT was normalized. Additionally successful PCI of LAD with 80% stenosis was performed. The paper discusses the problem of PMVT in the settings of AMI.
一名67岁患有血小板减少症（接受泼尼松龙和硫唑嘌呤治疗）的女性因非ST段抬高型急性心肌梗死（NSTEMI）入院。从第二天起，在血钾水平正常的情况下，我们观察到QTc间期从461毫秒开始增加。在迄今为止病情未复杂的急性心肌梗死第6天，突然发生室颤，并通过直流电除颤成功治疗，因反复非持续性室性心动过速（NSVT）给予胺碘酮（150毫克静脉注射）。血钾水平为2.9毫摩尔/升。在接下来的两天早晨，我们观察到反复出现多形性室性心动过速（PMVT）发作，总是进展为室颤（VF）。心电图显示QT间期为520毫秒，QTc为602毫秒。给患者静脉输注递增剂量的β受体阻滞剂和利多卡因。采用该治疗方案后，PMVT/VF未再复发，QT恢复正常。此外，对狭窄80%的左前降支成功进行了经皮冠状动脉介入治疗（PCI）。本文讨论了急性心肌梗死情况下PMVT的问题。
