The Korean Association of Internal Medicine
286 32nd World Congress of Internal Medicine (October 24-28, 2014)
PS 1164 Cardiology
Radiation Dermatitis in a Patient Undergoing Radiofre- quency Catheter Ablation
Mi Joo Kim1, Jae-Hyeong Park1 Chungnam National University Hospital, Korea1
Radiation dermatitis, or damage to the skin caused by exposure to radiation, is one of the most common side effects of high-dose radiotherapy for cancer treatment.
However, repeated exposure to low-dose radiation can also cause radiation dermatitis when the time interval between repeated exposures is insuffi cient to allow repair of DNA or tissue damage. We present a case of radiation dermatitis as a complication of radiofrequency catheter ablation (RFCA). A 52-year-old man was admitted to our clinic for RFCA for paroxysmal atrial fi brillation. About 3 weeks after treatment, he was readmitted to the clinic with redness in the right axilla that extended around the right side of the back. At the time of his visit, the patient’s skin had erythematous patches and dry desquamation (see fi gure). He was diagnosed with radiation dermati- tis. Despite conventional treatment, the lesions worsened and the pain became more severe. The patient underwent wide debridement with a local fl ap twice, owing to delayed wound recovery and local infl ammation. The patient’s condition subsequently improved. Radiation dermatitis is a rare complication of RFCA. Given its seriousness, physicians should be aware of its potential development when performing RFCA, and should minimize risk by decreasing the extent of radiation exposure.
PS 1165 Cardiology
A Case of Stress-Induced Cardiomyopathy with Inces- sant Ventricular Tachycardia
In-Ho Yang1, Hyae min Lee1, Hui-Jeong Hwang1, Chang-Bum Park1, Eun-Sun Jin1 Department of Cardiology, Kyung Hee University Hospital at Gangdong, Korea1
Background: Stress-induced cardiomyopathy (SICM) is a disease entity expressing transient and reversible left ventricular (LV) apical wall motion abnormalities with chest symptoms, electrocardiographic (ECG) changes and myocardial enzymatic re- lease similar to acute myocardial infarction, but without defi nite angiographic stenosis on coronary angiogram (CAG). Ventricular tachycardia (VT) is a rare but possible ar- rhythmia which can be accompanied by SICM. We report a rare case of SICM revealed as incessant VT as the fi rst clinical manifestation.
Case Report: A 75-year old woman with history of diabetis mellitus (DM) and hy- pertension had undergone lumbar epidural adhesiolysis at a local anesthetic clinic.
After the procedure, the patient expressed severe anxiety, nausea and altered mental state. The patient was transferred to our emergency department. During monitoring, repetitive VT rhythm appeared on the single-lead ECG monitoring, and direct current (DC) cardioversion was done to convert the VT to sinus rhythm. Cardiac markers such as Creatinine kinase-MB (CK-MB) and Troponin I (TnI) were both slightly elevated.
Transthoracic echocardiography (TTE) showed akinesia of apical-mid whole segments and hyperdynamic basal segments with relatively preserved LV systolic function, but no defi nite stenosis was found by coronary angiogram. Follow-up TTE after 1 week showed slightly improved apical wall motion abnormality, and no documented VT appeared on the ECG since the day patient admitted. The patient has discharged after 15 days, and follow-up TTE done 2 months later revealed no regional wall motion ab- normality. Although we could not exclude the cause of VT as idiopathic origin, this is a rare case of SICM presenting as VT as initial manifestations.
PS 1166 Cardiology
Swallowing Induced Supraventricular Tachycardia
Jihye Kim1, Kyoung-Min Park2
Konkuk University Medical Center, Korea1, Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea2
Introduction: Supraventricular tachycardia (SVT) induced by swallowing is rare phenomenon postulated to be a vagally medicated phenomenon due to mechanical stimulation. We report the case of a patient who experienced symptomatic atrial tachycardia induced swallowing and successful treatment with the use of fl ecainide with no episode of arrhythmia during swallowing.
Case: A 62-year-old man presented to the emergency department with brief episodes of recurrent palpitations. Symptom started 20 days ago and lasts 4-5 seconds, occur- ring only while swallowing. He felt mild chest discomfort, otherwise denied chest pain, dyspnea, lightheadedness. A 12-lead electrocardiogram (EKG) was obtained. The initial EKG revealed a normal sinus rhythm. When swallowing, the patient complained of pal- pitations and EKG was also obtained. The EKG revealed atrial tachycardia with a rate of 145 beats/min. 24-hour Holter monitoring were recorded to confi rm the occurrence of the arrhythmia during a swallow. It shows recurrent episodes of atrial tachycardia less than 10 seconds in accordance with palpitation spontaneously converting to nor- mal sinus rhythm. He is placed on Flecainide 100 mg twice a day. One month later, his symptoms became sudsiding completely. Follow-up rhythm stripe ECG and 24-hour Holter monitoring maintained normal sinus rhythm without any episode of SVT during swallowing.
Discussion: Based on the prior case reports, SVT induced by swallowing can be de- scribed as having the following clinical features. Patients are usually males, more than 35 years, generally without apparent structural heart disease or esophageal disease.
The arrhythmia duration ranged from a few seconds to a few hours, but the total duration of the palpitations was usually short (Medical therapy with agents such as ß-blockers, calcium channel blockers, amiodarone, class I antiarrhythmic drugs can be used and successfully control the arrhythmias.
PS 1167 Cardiology
Cardiac Vein Anatomy in Koreans; Application of Car- diac Resynchronization Therapy
Je Wook Park1, Tae-Hoon Kim1, Hancheol Lee1, Junbeom Park1, Jin-Kyu Park1, Boyoung Joung1, Hui-Nam Pak1, Moon-Hyoung Lee1, Jae-Sun Uhm1
Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Korea1
Background: Although cardiac resynchronization therapy (CRT) is important therapy in patients with heart failure, it is known that it is diffi cult to approach cardiac veins for left ventricular lead in Asian patients. We performed the present study for eluci- dating accessibility of the cardiac veins in Koreans.
Method: In 165 patients, cardiac venogram was performed during electrophysiologic study due to various tachyarrhythmias. We measured diameters of proximal parts of the posterior and lateral cardiac veins and angles between the great cardiac vein and posterior or lateral cardiac veins on LAO and RAO view. We considered accessibility of the cardiac veins to be larger than 1.6 mm (5-Fr) in diameter with obtuse angle.
Results: In 110 patients, the posterior or lateral cardiac veins were visible. In 39 pa- tients (35.4%), the diameter of the posterior cardiac vein was larger than 1.6 mm. In 11 patients (10%), the angle between the posterior cardiac vein and the great cardiac vein was obtuse. In 102 patients (92.7%), the diameter of the lateral cardiac vein was larger than 1.6 mm. In 52 patients (47.2%), the angle between the lateral cardiac vein and the great cardiac vein was obtuse. In 50 patients (45.5%), both cardiac veins were diffi cult to access.
Conclusion: In Koreans, the lateral cardiac vein for left ventricular lead insertion is more accessible than the posterior cardiac vein. Cardiac vein accessibility for CRT im- plantation in Korean patients is low.
