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Suggest Treatment For Polymorphic Ventricular Tachycardia
Question: Hi,
My wife is currently in coronary care unit and has had some very unusual events. In the last four days she has had two events at home, one with an ambulance crew that saw her with no pulse, that had restored itself inexplicably. Whilst in hospital, my wife has had three heart attacks which has had the medical teams perplexed. Each attack different from the other. Earlier this morning she flatlined for around a minute and was detected by medical crews. However, the findings are that my wife isn't aware that she has had a heart attack. For example, this morning when she flatlined, she was sitting in her hospital bed when the crash crews attended. After laying her down, they asked where is the pain, and she had none. She didn't know that she had an attack. Two previous incidents were also similar with no knowledge or sense of having had an attack. My wife is to be discharged tomorrow and I am concerned that if she has an attack at home I wont even be aware of it occurring due to her not knowing she has suffered an attack. I am enquiring if there is a wearable medical alert system she can wear 24 hours a day that will set off an alarm at home so that I can render her assistance and call for an ambulance?
My wife is currently in coronary care unit and has had some very unusual events. In the last four days she has had two events at home, one with an ambulance crew that saw her with no pulse, that had restored itself inexplicably. Whilst in hospital, my wife has had three heart attacks which has had the medical teams perplexed. Each attack different from the other. Earlier this morning she flatlined for around a minute and was detected by medical crews. However, the findings are that my wife isn't aware that she has had a heart attack. For example, this morning when she flatlined, she was sitting in her hospital bed when the crash crews attended. After laying her down, they asked where is the pain, and she had none. She didn't know that she had an attack. Two previous incidents were also similar with no knowledge or sense of having had an attack. My wife is to be discharged tomorrow and I am concerned that if she has an attack at home I wont even be aware of it occurring due to her not knowing she has suffered an attack. I am enquiring if there is a wearable medical alert system she can wear 24 hours a day that will set off an alarm at home so that I can render her assistance and call for an ambulance?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your wife medical history and would explain that heart attacks without pain, could be explained by a neuropathy of the pain fibers, especially in patients suffering from diabets.
Does your wife suffer from diabetes?
What kind of tests did she perform? Did they perform a coronary angiography to examine for the coronary arteries stenosis or the blood flow in them?
Could you please upload her last ECG ?
Are you sure that she suffered repeated heart attacks? It would be a little strange that after three repeated heart attacks they are discharging her home.
Her symptoms seem to be more related to cardiac arrhythmias.
In such case an ambulatory 24-48 hours ECG monitoring would help study her heart rhythm during the day and exclude possible cardiac arrhythmia.
In such case some modifications to her therapy would be necessary.
What is her actual therapy?
Could you please upload her last performed tests (cardiac ultrasound report, ECG or any other performed tests) for me to review?
Hope to have been of help!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your wife medical history and would explain that heart attacks without pain, could be explained by a neuropathy of the pain fibers, especially in patients suffering from diabets.
Does your wife suffer from diabetes?
What kind of tests did she perform? Did they perform a coronary angiography to examine for the coronary arteries stenosis or the blood flow in them?
Could you please upload her last ECG ?
Are you sure that she suffered repeated heart attacks? It would be a little strange that after three repeated heart attacks they are discharging her home.
Her symptoms seem to be more related to cardiac arrhythmias.
In such case an ambulatory 24-48 hours ECG monitoring would help study her heart rhythm during the day and exclude possible cardiac arrhythmia.
In such case some modifications to her therapy would be necessary.
What is her actual therapy?
Could you please upload her last performed tests (cardiac ultrasound report, ECG or any other performed tests) for me to review?
Hope to have been of help!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. My wife has been discharged from hospital and is having LQTS investigated. You are right, our family Dr says my wife is suffering from severe arrhythmia. More investigations are pending such as tests by a geneticist, sleep apnoea study and more. I'll send you a discharge referral letter to various Drs., issued to my wife. The questions I need to know and will try to get them from the hospital as the dietician and physiotherapist have not contacted us before we left the hospital. Answer is acceptable, but still need to know the answer to my original question. Thank you. Report is forthcoming.
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again,
Thank you for providing me with additional information regarding your wife's medical condition.
As she suffers from LQTS and consequently polymorphic ventricular arrhythmia (Torsades de Pointes) which is a dangerous and life-threatening arrhythmia the main issues to be followed are:
(1) Investigating for the cause of LQTS (reversible or irreversible).
Many drugs may induce QT interval prolongation on ECG and lead to this syndrome. Plaquenil (that is used by your wife) is a reversible cause. Once interrupted no further risk persists.
But, if after thorough medical investigation (including genetics) a congenital syndrome is concluded then, the best thing to do is:
(2) Implantable Cardioverter Defibrillator (ICD), which effectively treat potential episodes of that dangerous cardiac arrhythmia.
Meanwhile, all the above mentioned alternatives are reviewed I would recommend (and this is also the complete answer to your first question) applying any kind of LOOP RECORDER controlled by telemetry, which means a continuous monitoring device used for a prolonged period (more than a day or week) and in case of frequent and disturbing episodes of any arrhythmia, the technician from the other side at the central control unit would raise the adequate alertness (notifying you and the emergency system).
But generally speaking this kind of arrhythmia should be treated promptly because it needs a fast medical response (drugs and even electrical defibrillation) otherwise it could seriously risk her life.
The fact doctor has discharged your wife home, means probably they are more convinced of a reversible cause (such as Plaquenil) and once it has been stopped no further important risks exist.
Please, let me know about the full medical conclusions.
I remain at your disposal in case of further uncertainties.
Kind regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again,
Thank you for providing me with additional information regarding your wife's medical condition.
As she suffers from LQTS and consequently polymorphic ventricular arrhythmia (Torsades de Pointes) which is a dangerous and life-threatening arrhythmia the main issues to be followed are:
(1) Investigating for the cause of LQTS (reversible or irreversible).
Many drugs may induce QT interval prolongation on ECG and lead to this syndrome. Plaquenil (that is used by your wife) is a reversible cause. Once interrupted no further risk persists.
But, if after thorough medical investigation (including genetics) a congenital syndrome is concluded then, the best thing to do is:
(2) Implantable Cardioverter Defibrillator (ICD), which effectively treat potential episodes of that dangerous cardiac arrhythmia.
Meanwhile, all the above mentioned alternatives are reviewed I would recommend (and this is also the complete answer to your first question) applying any kind of LOOP RECORDER controlled by telemetry, which means a continuous monitoring device used for a prolonged period (more than a day or week) and in case of frequent and disturbing episodes of any arrhythmia, the technician from the other side at the central control unit would raise the adequate alertness (notifying you and the emergency system).
But generally speaking this kind of arrhythmia should be treated promptly because it needs a fast medical response (drugs and even electrical defibrillation) otherwise it could seriously risk her life.
The fact doctor has discharged your wife home, means probably they are more convinced of a reversible cause (such as Plaquenil) and once it has been stopped no further important risks exist.
Please, let me know about the full medical conclusions.
I remain at your disposal in case of further uncertainties.
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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