一名患有哮喘的青少年因服用阿布特罗而引发先天性长 QT 综合征。

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Jad Zreik BS , Martin J. LaPage MD , Hani Zreik MD
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引用次数: 0

摘要

背景:先天性长 QT 综合征(LQTS)患者容易出现室性心律失常,但最初可能没有症状,静息心电图(ECG)上的 QTc 间期正常。阿布特罗被列为对先天性 LQTS 患者有 "特殊风险 "的药物,但其影响却鲜有描述。我们介绍了一例以前未知的、无症状的先天性 LQTS 病例,该病例是由一名患有哮喘的青少年服用盐酸阿布特罗引起的:一名有哮喘病史的 12 岁女孩因气短、喘息和心动过速 24 小时到急诊科就诊,符合哮喘急性加重的症状。就诊前 2 小时,她在家中服用了两剂阿布特罗吸入剂。初始心电图显示 QTc 为 619 毫秒。她的其他病史、临床检查和实验室检查(包括电解质)均无异常。对她进行了心电监护,然后在病情稳定的情况下从急诊室出院,第二天接受儿科心脏病学门诊随访。诊室静息心电图显示 QTcs 为 440-470 毫秒。运动负荷试验显示,在恢复期的第2分钟和第4分钟,QTc分别延长了520毫秒和500毫秒。基因检测发现该患者存在 KCNQ1 杂合致病变异,与 1 型 LQTS 一致。急诊医生为什么要注意这一点?阿布特罗可能会导致有潜在先天性 LQTS 的急诊患者出现明显的 QTc 延长,这可能会成为以前无法识别的患者的诊断线索。极度 QTc 延长也可作为急诊科心内科会诊、电解质失衡实验室评估和心脏监护观察的指征。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Congenital Long QT Syndrome Unmasked by Albuterol in an Adolescent with Asthma

Background

Patients with congenital long QT syndrome (LQTS) are prone to ventricular dysrhythmia but may be initially asymptomatic with a normal QTc interval on resting electrocardiogram (ECG). Albuterol is listed as a medication that poses a “special risk” to patients with congenital LQTS, but its effects have been rarely described. We present a case of previously unknown, asymptomatic congenital LQTS unmasked by albuterol in an adolescent with asthma.

Case Report

A 12-year-old girl with a history of asthma presented to the emergency department (ED) with shortness of breath, wheezing, and tachycardia for 24 h, consistent with acute asthma exacerbation. She received two doses of her home albuterol inhaler 2 h prior to presentation. Initial ECG demonstrated a QTc of 619 ms. Her remaining history, clinical examination, and laboratory workup, including electrolytes, were unremarkable. She was observed with cardiac monitoring before being discharged from the ED in stable condition for next-day outpatient pediatric cardiology follow-up. Resting office ECGs revealed QTcs from 440–470 ms. Exercise stress test revealed QTc prolongation of 520 ms and 500 ms at minute-2 and minute-4 of recovery, respectively. Genetic testing revealed heterozygous pathogenic variants in KCNQ1, consistent with type 1 LQTS.

Why Should an Emergency Physician Be Aware of This?

Albuterol may be a cause of marked QTc prolongation in ED patients with underlying congenital LQTS, which can be a diagnostic clue in previously unidentified patients. Extreme QTc prolongation also serves as an indication in the ED for Cardiology consultation, laboratory evaluation for electrolyte imbalances, and observation with cardiac monitoring.

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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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