Sharifkazemi Mohammadbagher, Ghazinour Mohammad, Lotfi Mehrzad, Khorshidi Soorena, Davarpasand Tahereh
Department of Cardiology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Surgery, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Front Cardiovasc Med. 2024 May 20;11:1331873. doi: 10.3389/fcvm.2024.1331873. eCollection 2024.
Myocardial infarction is among the top causes of mortality worldwide. Survivors may also experience several complications. Infarct-related torsade de pointes (TdP) is an uncommon complication. In the context of myocardial infarction, coronary artery bypass graft (CABG) surgery is the prevalent therapeutic modality associated with several early and late complications. Ventricular tachyarrhythmias, including TdP, because of electrical inhomogeneity, would potentially be a lethal complication of CABG. Here, we report the occurrence of medically intractable TdP in the presence of an uncommon case of a post-CABG retrosternal hematoma. Arrhythmia was properly resolved after hematoma removal surgically. It showed the possibility of a "cause and effect" relationship between these two complications. This unique case emphasizes the post-CABG medically-resistant TdP, considering the mechanical pressure effect of retrosternal hematoma that stimulates this potentially malignant arrhythmia, especially in the absence of electrolyte disturbances and evident symptoms of ongoing ischemia.
心肌梗死是全球范围内主要的死亡原因之一。幸存者也可能会出现多种并发症。梗死相关的尖端扭转型室速（TdP）是一种罕见的并发症。在心肌梗死的背景下，冠状动脉旁路移植术（CABG）是一种常见的治疗方式，但会伴有一些早期和晚期并发症。由于电不均一性导致的室性快速心律失常，包括TdP，可能会成为CABG的致命并发症。在此，我们报告了1例罕见的冠状动脉旁路移植术后胸骨后血肿病例出现药物难治性TdP的情况。手术清除血肿后心律失常得到妥善解决。这表明这两种并发症之间可能存在“因果”关系。考虑到胸骨后血肿的机械压力效应可诱发这种潜在的恶性心律失常，尤其是在没有电解质紊乱和明显持续缺血症状的情况下，这一独特病例凸显了冠状动脉旁路移植术后药物难治性TdP的情况。
