1. T-wave alternans in a case with systemic lupus erythematosus-related myocarditis
- Author
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Mikiko Harada, Naoto Hashizume, Chie Nakamura, Hiroshi Imamura, Yuichiro Kashima, Dai Kishida, Koichiro Kuwahara, and Hirohiko Motoki
- Subjects
medicine.medical_specialty ,Myocarditis ,medicine.diagnostic_test ,Pleural effusion ,business.industry ,T wave alternans ,030204 cardiovascular system & hematology ,medicine.disease ,QT interval ,Article ,03 medical and health sciences ,0302 clinical medicine ,Pleurisy ,Heart failure ,Internal medicine ,Prednisolone ,medicine ,Cardiology ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography ,medicine.drug - Abstract
A 42-year-old woman presented with fever, dyspnea, lower-leg edema, significant pulmonary congestion, pleural effusion, and severely reduced left ventricular contractions. She was resistant to treatment for heart failure, including catecholamines, furosemide, phosphodiesterase III inhibitors, and human atrial natriuretic peptide, and antibiotics failed to reduce her inflammation. She had renal dysfunction and hypocomplementemia and was positive for anti-nuclear and anti-ds-DNA antibodies. The patient was diagnosed with myocarditis and pleurisy associated with systemic lupus erythematosus (SLE). Prednisolone administration improved her general condition, reducing inflammation and improving left ventricular function. On day 1, an electrocardiography (ECG) revealed a T-wave inversion similar to a T-U complex configuration in leads II, aVF, and V3-6. By day 8, however, ECG showed prolonged corrected QT (QTc) and T-wave alternans (alternating beat-to-beat T-wave patterns) in lead V3-6. Careful ECG monitoring should be used to identify potentially fatal ventricular arrhythmias during the recovery phase of SLE-related myocarditis. .
- Published
- 2018