失神で来院しtorsade de pointesを繰り返したQT延長症候群の1症例 A case of torsade de pointes and ventricular fibrillation caused by congenital long QT syndrome with hypokalemia as impending emergency

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切迫緊急症に相当するQT延長症候群でtorsade de pointes (TdP) , 心室細動 (Vf) を起こした症例を経験した。62歳の女性で, 失神で来院し, 著明なQT時間の延長と低カリウム血症のため, TdPを疑いICUに収容した。その後T波の交互性変化が出現し, TdPからVfとなり直流除細動を行った。さらにマグネシウムの静注とカリウムを補正することでTdPは消失した。その後家族歴を確認し, 先天性QT延長症候群と診断した。QT時間は先天性素因とさまざまな後天性要素が関与して延長するが, これらの因子を把握し, QT延長の危険性を判断することが重要であると考えられた。

A 62-year-old woman with syncope was transferred to our emergency room. Electrocardiogram (ECG) showed a marked QT prolongation (QTc 680 ms) with a notch in the T wave. The serum potassium concentration was 2.8 mmol per liter. The patient was admitted to ICU because we judged this QT prolongation indicated an impending emergency. On the electrocardial monitoring, an extrasystole generated as R on T wave, which developed torsade de pointes (TdP) and ventricular fibrillation (VF) . Repeated countershock was required for defibrillation. Intravenous administration of magnesium effectively suppressed the ventricular arrhythmias. However, the QTc interval shortened by 520 ms as the serum potassium concentration improved, and the patient was finally diagnosed the congenital long QT syndrome because her sister and brother had both died suddenly when young and her son's ECG showed QT prolongation. We consider that constant electrocardial monitoring and prompt treatment for VF in ICU were important factors in life-saving. It is necessary to evaluate the causes of QT prolongation and the possibility of development to TdP and VF in the emergency room.

収録刊行物

  • 蘇生

    蘇生 20(2), 187-191, 2001-07-20

    The Japanese Society of Reanimatology

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