Cruel surprise — stroke in the shadow of chloroquine and prolonged QT interval: a case report
, 23, 4, 5, 23
Abstract
Stroke is one of the leading causes of death and disability in adults. It can present itself in many different ways beginning with focal neurological symptoms and ending with sudden cardiac arrest. Stroke predisposes to ventricular arrhythmias due to prolongation of the QT interval. This problem mainly affects patients with additional risk factors that affect QT interval prolongation. The following case report presents the story of a 68-year-old patient with diabetes mellitus, hypertension, heart failure and rheumatoid arthritis taking chronic chloroquine diagnosed in the ED and subsequently admitted to the Cardiac Intensive Care Clinic for out-of-hospital ventricular fibrillation cardiac arrest in the course of recurrent ventricular
tachyarrhythmias, who was diagnosed with ischaemic stroke. Coordinated management is presented to achieve a stable outcome.
Keywords: defibrillatorsimplantableischaemic strokeout-of-hospital cardiac arresttachycardiaventricular
References
- Morgenstern LB, Zahuranec DB, Lim J, et al. Tissue-Based stroke definition impacts stroke incidence but not ethnic differences. J Stroke Cerebrovasc Dis. 2021; 30(6): 105727.
- Fure B, Bruun Wyller T, Thommessen B. Electrocardiographic and troponin T changes in acute ischaemic stroke. J Intern Med. 2006; 259(6): 592–597.
- Algra A, Tijssen JG, Roelandt JR, et al. QTc prolongation measured by standard 12-lead electrocardiography is an independent risk factor for sudden death due to cardiac arrest. Circulation. 1991; 83(6): 1888–1894.
- Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) endorsed by: association for european paediatric and congenital cardiology (AEPC). Europace. 2015; 17(11): 1601–1687.
- com/comprehensive-list-of-drugs-causing-qt-prolongation-torsade-de-pointes-and-long-qt-syndrome-lqts. https://ecgwaves (Accessed 8th October 2023).
- Berge E, Whiteley W, Audebert H, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021; 6(1): I–LXII.
- Correction to: Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019; 50(12).
- Fukuda T, Ohashi-Fukuda N, Kondo Y, et al. Epidemiology, risk factors, and outcomes of out-of-hospital cardiac arrest caused by stroke: a population-based study. Medicine (Baltimore). 2016; 95(14): e3107.
- Liu MB, Vandersickel N, Panfilov AV, et al. R-From-T as a common mechanism of arrhythmia initiation in long QT syndromes. Circ Arrhythm Electrophysiol. 2019; 12(12): e007571.