Heart Asia最新文献

{"title":"Incidence and predictors of 30-day mortality in patients with ventricular septal rupture complicating acute myocardial infarction.","authors":"Akshyaya Pradhan,&nbsp;Nirdesh Jain,&nbsp;Salvatore Cassese,&nbsp;Pravesh Vishwakarma,&nbsp;Rishi Sethi,&nbsp;Sharad Chandra,&nbsp;Gaurav Chaudhary,&nbsp;Sudhanshu Kumar Dwivedi,&nbsp;Varun Shankar Narain","doi":"10.1136/heartasia-2018-011062","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011062","url":null,"abstract":"<p><strong>Objective: </strong>We sought to investigate the incidence and predictors of 30-day mortality associated with ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI) in a cohort of patients admitted to a single centre in India.</p><p><strong>Methods: </strong>From October 2013 to February 2016, a total of 6560 patients with a diagnosis of AMI were admitted to our institution. Among these patients, those with a diagnosis of VSR were retrospectively included in this registry. Clinical and echocardiographic features were collected in all cases. The primary outcome was 30-day mortality. A Cox proportional hazard regression analysis explored the predictors of 30-day mortality.</p><p><strong>Results: </strong>During the observation period, a total of 51 consecutive patients (mean age 63.8 years (9.1); 51.0% male, 41.2% were patients with diabetes) with a diagnosis of VSR complicating AMI were included. On echocardiography, left ventricular ejection fraction was 42.5% (6.5), and the most frequent location of VSR was apical (78.4%). Overall, 27.4% of the patients received reperfusive therapy (pharmacological, 23.5%; mechanical, 3.9%) and 19.6% of the patients underwent surgical repair. The mean time to surgery was 7.7 days (2.4). At 30-day follow-up, death occurred in 80.4% of patients. Advanced age (HR 1.07, 95% CI (1.02 to 1.13), p=0.004), previous cerebrovascular accident (HR 52.2, 95% CI (3.98 to 685.06), p=0.003) and surgical repair (HR 0.05, 95% CI (0.01 to 0.26), p<0.001) were effect modifiers of the 30-day risk of death.</p><p><strong>Conclusions: </strong>In this retrospective cohort of patients with AMI, the occurrence of VSR was not rare and carried a considerable risk of 30-day mortality. Advanced age, previous cerebrovascular accident and surgical repair influenced the risk for 30-day mortality.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"10 2","pages":"e011062"},"PeriodicalIF":0.0,"publicationDate":"2018-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36449427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cystic mediastinal mass.","authors":"Jayaprasad Narayanapillai,&nbsp;Suresh Madhavan,&nbsp;B Hosgoudru Shankaragouda","doi":"10.1136/heartasia-2018-011071","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011071","url":null,"abstract":"<p><strong>Case presentation: </strong>A 32-year-old woman with no other medical history presented with 1-month history of fever, weight loss and dyspnoea. On examination she had elevated jugular venous pressure and tachycardia. Her chest X-ray posterioranterior view (figure 1A) showed a rounded mass in the right cardiophrenic angle obscuring the right atrial margin, producing a 'silhouette' sign. Echocardiography showed a large cystic mass with thickened pericardium, lateral to the right atrium, causing right atrial compression (figure 1B). CT image of the chest showed a cystic lesion compressing the right atrium with thickened pericardium (figure 2A). There were no other lesions found in the lungs or other organs. Laboratory tests showed elevated erythrocyte sedimentation rate (ESR: 96 mm/hour) and C reactive protein (CRP: 32 mg/L). Excision of the mass with partial pericardiectomy was done. Intraoperatively, there was a cyst with thickened pericardial wall and thick yellowish brown fluid. Histopathology of the tissue is shown in figure 2B.Figure 1(A) Chest X-ray posterioranterior view showing a rounded mass in the right cardiophrenic angle. (B) Transthoracic echocardiography apical four-chamber view showing the cystic mass.Figure 2(A) CT of the chest sagittal view showing cystic lesion compressing the right atrium with thickened pericardium. (B) Histopathology specimen of the pericardial tissue.</p><p><strong>Question: </strong>What is the diagnosis and what should be the management strategy?Congenital pericardial cyst and no further evaluation required.Features are suggestive of tuberculous pericardial cyst and needs treatment with antituberculosis regimen.Features suggestive of pericardial hydatid cyst and requires treatment with albendazole.Features are suggestive of viral pericarditis with encysted effusion.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"10 2","pages":"e011071"},"PeriodicalIF":0.0,"publicationDate":"2018-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36404679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical implication of LAVI over A' ratio in patients with acute coronary syndrome.","authors":"Hideaki Matsuura,&nbsp;Akira Yamada,&nbsp;Kunihiko Sugimoto,&nbsp;Keiko Sugimoto,&nbsp;Masatsugu Iwase,&nbsp;Takashi Ishikawa,&nbsp;Junichi Ishii,&nbsp;Yukio Ozaki","doi":"10.1136/heartasia-2018-011038","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011038","url":null,"abstract":"Purpose The ratio of the left atrial volume index (LAVI) and late diastolic mitral annular velocity (A′) is a useful echocardiographic index for identifying advanced left ventricular (LV) diastolic dysfunction in patients with dyspnoea. We investigated the clinical implications and prognostic value of the aforementioned ratio (LAVI/A′) in patients with ST elevation (STE) or non-STE (NSTE) acute coronary syndrome (ACS). Methods We studied 212 patients with ACS. All patients underwent electrocardiography, echocardiography and measurement of plasma B-type natriuretic peptide (BNP) level on admission. The study endpoints were hospitalisation and mortality because of heart failure (HF). Results There was a significant, moderate positive correlation between LAVI/A′ and natural logarithm (Ln) BNP level among the participants (r=0.48, p<0.0001). During a mean follow-up of 17 months, eight patients died and nine patients were hospitalised because of HF. The receiver operating characteristics curve indicated that LAVI/A′≥3.0 predicted these events (log-rank, p=0.0021). A significant and moderate positive correlation existed between LAVI/A′ and Ln BNP level in the NSTE-ACS group (n=128; r=0.58, p<0.0001). However, the correlation between LAVI/A′ and Ln BNP level was weaker in the STE-ACS group (n=84; r=0.33, p=0.0017). Conclusion LAVI/A′ was related to plasma BNP levels in patients with ACS, particularly in those with NSTE-ACS. This index was useful for predicting cardiac events in patients with ACS.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"10 2","pages":"e011038"},"PeriodicalIF":0.0,"publicationDate":"2018-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36322155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inverse association of ApoB and HSP60 antibodies with coronary artery disease in Indian population.","authors":"Thiruvelselvan Ponnusamy,&nbsp;Srikanth K Venkatachala,&nbsp;Manjunatha Ramanjappa,&nbsp;Vijay V Kakkar,&nbsp;Lakshmi A Mundkur","doi":"10.1136/heartasia-2018-011018","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011018","url":null,"abstract":"<p><strong>Objective: </strong>Atherosclerosis is an autoimmune condition and the underlying cause of coronary artery disease (CAD). Circulating antibodies to self-antigens can have a pathogenic or protective function in atherosclerosis. The objective of the study was to understand the association of autoantibody levels with CAD and its correlation with circulating immune cells.</p><p><strong>Methods: </strong>We assessed antigen concentration and antibodies to apolipoprotein B (ApoB) and heat shock protein (HSP)60 by ELISA in 252 acute coronary syndromes (ACS), 112 patients with stable angina (SA) and 203 healthy controls from Indian population. T cells in peripheral blood mononuclear cells (PBMC) were enumerated by flow cytometry. Cytokine concentrations were measured by multiplex assay.</p><p><strong>Results: </strong>IgG and IgM antibodies to ApoB and HSP60 proteins were significantly lower in patients with ACS while only IgG levels to ApoB were lower in patients with SA, compared with control. Subjects in the highest tertile of antibodies showed significantly lower OR for ACS (IgG 0.52, 95% CI 0.31 to 0.88, p=0.02 and IgM 0.58, 95% CI 0.34 to 0.98, p=0.04), ApoB100 (IgG 0.52, 95% CI 0.31 to 0.88, p=0.02 and IgM 0.58, 95% CI 0.34 to 0.99, p=0.04) and HSP60, respectively. Interestingly, T helper 17 (TH17) cells showed an inverse relationship with ApoB and HSP60 IgG antibodies (r²=-0.17, p<0.001 and r²=-0.20, p<0.001, respectively), while interleukin 17 concentrations were negatively correlated with IgM antibodies to the proteins.</p><p><strong>Conclusion: </strong>This study shows that higher antibodies to ApoB and HSP60 proteins are less often associated with ACS and that these antibodies are inversely associated with inflammatory Th17 cells.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"10 2","pages":"e011018"},"PeriodicalIF":0.0,"publicationDate":"2018-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36322154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of comorbidities and clinical prediction model on neurological prognostication post out-of-hospital cardiac arrest.","authors":"Weiting Huang,&nbsp;Gary Kuan Wee Teo,&nbsp;Jack Wei-Chieh Tan,&nbsp;Nur Shahidah Ahmad,&nbsp;Hwee Hong Koh,&nbsp;Marcus Eng Hock Ong","doi":"10.1136/heartasia-2018-011016","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011016","url":null,"abstract":"<p><strong>Background: </strong>Survival with good neurological function post out-of-hospital cardiac arrest (OHCA), defined as cerebral performance category (CPC) 1-2, ranges from 1.6% to 3% in Asia. We aim to study the influence of comorbidities and peri-OHCA event factors on neurological recovery and develop a model that can help clinicians predict neurological function among patients with post-OHCA admitted to the hospital.</p><p><strong>Methods: </strong>This was a retrospective cohort study. All patients admitted post-OHCA from 1 January 2011 to 31 December 2015 to a tertiary centre were identified through the hospital OHCA registry. Patients who survived till hospital admission were included. Logistic regression was used to identify patient and peri-arrest factors that were significantly associated with survival with CPC 1-2. The significant factors for survival with CPC 1-2 were then put into a multivariable model and the discriminative ability was tested using the receiver operator characteristic (ROC) curve. Calibration and internal validation of the model were also performed. External validation in a small prospective cohort was also performed.</p><p><strong>Results: </strong>In our derivation cohort of 129 patients, 30.23% survived with CPC 1-2. Significant factors associated with survival with good neurological outcomes were age-adjusted Charlson Comorbidity Index ≤5, time to first return of spontaneous circulation ≤40 min, the presence of immediate bystander cardiopulmonary resuscitation and shockable rhythms. We also developed a nomogram which showed good internal (ROC curve 0.84; 95% CI 0.77 to 0.91) and external validation (ROC curve 0.90; 95% CI 0.81 to 1.00).</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"10 2","pages":"e011016"},"PeriodicalIF":0.0,"publicationDate":"2018-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36256020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended trans-septal versus left atrial approach in mitral valve surgery: 1017 patients<b>'</b> experience.","authors":"Syed Saleem Mujtaba,&nbsp;Stephen C Clark","doi":"10.1136/heartasia-2018-011008","DOIUrl":"10.1136/heartasia-2018-011008","url":null,"abstract":"<p><strong>Objective: </strong>The mitral valve may be accessed directly through the left atrium but visualisation can sometimes be challenging. A trans-septal interatrial approach provides better exposure and easy access for concomitant tricuspid procedures especially in difficult cases. This retrospective study evaluates the safety and effectiveness of the extended vertical trans-septal approach (EVTSA) for routine mitral valve exposure.</p><p><strong>Method: </strong>1017 consecutive patients undergoing an isolated primary mitral valve procedure (repair/replacement) through a median sternotomy were retrospectively studied between 2000 and 2015. Up to 135 patients were operated by EVTSA (group A) while 882 patients underwent a traditional left atrial (LA, group B) approach.</p><p><strong>Results: </strong>There were 135 patients (M/F=56/79) in group A and 882 patients (M/F=398/484) in group B. Logistic EuroSCORE was significantly lower in EVTSA group (0.61 vs 0.90, p=0.000001). In the LA group there were more patients with preoperative transient ischaemic attack or stroke (94 vs 6, p=0.005). Cumulative cross-clamp time was 82 (44-212) min (EVTSA group) and 78 (30-360) min (LA group) (p=0.271) while cardiopulmonary bypass time was 107 (58-290) and 114 (43-602) min, respectively (p=0.121).Postoperative blood loss was 415 mL (EVTSA) vs 427 mL (LA) (p=0.273). No significant difference was found in the incidence of postoperative atrial fibrillation (p=0.22) or heart block requiring permanent pacemaker (p=0.14).</p><p><strong>Conclusion: </strong>In our opinion, EVTSA to the mitral valve is safe and reproducible. It gives excellent exposure of the mitral valve under all circumstances without any significant increase in cross-clamp or bypass time, postoperative arrhythmia, heart block/pacemaker rate or bleeding.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"10 2","pages":"e011008"},"PeriodicalIF":0.0,"publicationDate":"2018-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36256018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasculitis of ascending aorta detected on FDG PET/CT in a patient with fever of unknown origin.","authors":"Alireza Emami-Ardekani,&nbsp;Sara Harsini,&nbsp;Mohammad Eftekhari","doi":"10.1136/heartasia-2018-011064","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011064","url":null,"abstract":"A 59-year-old man was admitted for fever of unknown origin. Fever was associated with chills. His medical record revealed the history of aortic valve replacement 11 years earlier, as well as enterococcal endocarditis 4 months prior to the current admission. The patient was found to have normal left ventricular size with borderline systolic function, left ventricular hypertrophy, right ventricle at the upper limit of normal size, mild systolic dysfunction and mild transvalvular aortic insufficiency on transthoracic echocardiography; while no vegetations were observed on transesophageal echocardiography. Sequential blood cultures were negative; however, a blood culture sample obtained 5 …","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"10 2","pages":"e011064"},"PeriodicalIF":0.0,"publicationDate":"2018-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36256021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A challenging broad-complex tachycardia.","authors":"Nithin Ramesh Iyer,&nbsp;Adrianus W G J Oomen,&nbsp;Raymond W Sy","doi":"10.1136/heartasia-2018-011054","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011054","url":null,"abstract":"<p><p>A 53-year-old man presented with chest pain, palpitations and presyncope, without history of overt cardiac disease. The patient was alert. His heart rate was 206 beats per minute, and his blood pressure was 100/50 mm Hg. An intravenous bolus of amiodarone 150 mg was administered in the emergency department. His ECGs preamiodarone and postamiodarone are shown in figure 1. Echocardiography showed low-normal left ventricular systolic function.Figure 1(A) ECG of index arrhythmia. (B) ECG following amiodarone.</p><p><strong>Question: </strong>What should the next diagnostic test be?Referral for electrophysiology study.Referral for urgent coronary angiography.12-lead ECG with posterior lead placement.Bedside adenosine challenge.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"10 2","pages":"e011054"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36256019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of socioeconomic status on adverse cardiac events after coronary angioplasty: a cohort study.","authors":"Hashir Kareem,&nbsp;Prasad Narayana Shetty,&nbsp;Tom Devasia,&nbsp;Yeshwanth Rao Karkala,&nbsp;Ganesh Paramasivam,&nbsp;Vasudev Guddattu,&nbsp;Ajit Singh,&nbsp;Sheetal Chauhan","doi":"10.1136/heartasia-2017-010960","DOIUrl":"https://doi.org/10.1136/heartasia-2017-010960","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic status (SES) has been associated with adverse cardiovascular events in coronary atherosclerotic disease. However, it is unclear how SES impacts adverse cardiac events in patients treated with percutaneous coronary intervention (PCI).</p><p><strong>Methods: </strong>We determined SES based on educational, economic and occupational parameters for 630 consecutive patients who underwent PCI at our centre between 01 June 2015 and 01 June 2016. The patients were divided into low and high SES groups, and they were followed up for 12 months. Patients were matched at baseline for demographic and procedural characteristics; multivariate analysis was used to adjust for baseline and procedural variables. Postprocedure compliance to medications was analysed. At 12 months, the primary composite end point of major adverse cardiac events (MACE) - consisting of death, non-fatal myocardial infarction, target lesion revascularisation, target vessel revascularisation - was compared between the groups.</p><p><strong>Results: </strong>The high SES group had a higher prevalence of diabetes mellitus (p=0.03; OR 0.74%, 95% CI 0.53% to 1.03%) and a stronger family history of ischaemic heart disease (p=0.003; OR 0.53%, 95% CI 0.33% to 0.84%). Low SES was associated with lower compliance with medication (p=0.01; OR 2.22%, 95% CI 1.19% to 4.15%). At 12 months, the primary composite end point of MACE was found to be higher in the low SES group (p=0.01); higher MACE was primarily driven by cardiac mortality (p<0.001). Low SES was found to be an independent predictor of MACE (HR 1.84%, 95% CI 1.16% to 2.96%).</p><p><strong>Conclusion: </strong>Low SES was associated with a higher incidence of major adverse cardiac events in patients undergoing PCI and was an independent predictor of MACE at 12 months.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"10 2","pages":"e010960"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2017-010960","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36256017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DKA-induced Brugada phenocopy mimicking STEMI.","authors":"Christian Abrahim,&nbsp;Satish Maharaj","doi":"10.1136/heartasia-2018-011027","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011027","url":null,"abstract":"<p><strong>Case presentation: </strong>A 47-year-old Caucasian woman with type 1 diabetes presented with epigastric pain and vomiting. She had not been adherent with her diet and insulin therapy for the past 3 weeks. She never had a personal or family history of arrhythmia-related symptoms, ventricular tachycardia or fibrillation (VT/VF) or premature sudden cardiac death (SCD). Examination revealed dry mucosa, tachycardia and epigastric tenderness to palpation. Her ECG showed ST elevations (V1-V3) with associated T wave inversions (figure 1A). A baseline ECG 1 year ago had no abnormalities. Serial troponin I and T were negative, but Creatinine Kinase MB (CKMB) was elevated. Her biochemistry test showed sodium of 118 mM, potassium of 6.7 mM, bicarbonate of 4 mM, anion gap of 40, glucose of 985 mM and beta hydroxyl-butyrate of >45.0 mg/dL. Cardiac catheterisation revealed normal anatomy with all vessels widely patent; left ventricular end diastolic pressure (LVEDP) was 1 mm Hg. With treatment, diabetic ketoacidosis (DKA) resolved after 8 hours and repeat ECG showed all changes had resolved (figure 1B). She was monitored on telemetry without any VT/VF episodes. Serial ECGs were done with resolution of changes. She had no positive studies for inducible VT. The rest of her admission was uneventful.Figure 1(A) ECG on presentation. (B) ECG 8 hours after admission.</p><p><strong>Question: </strong>Which of the following is the best next step in managing this patient?Quinidine therapy.Implantable cardioverter-defibrillator (ICD) placement. <i>SCN5A</i> gene mutation testing.Observation without therapy.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"10 2","pages":"e011027"},"PeriodicalIF":0.0,"publicationDate":"2018-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36192726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}