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Torsade de pointes in severe aortic stenosis: case report
Jui-Peng Tsai1, Ping-Ying Lee, Kuang-Te Wang
1Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital Taitung Branch and Taipei, Taiwan.
The Journal of Heart Valve Disease
|October 20, 2007
Summary
Severe aortic stenosis (AS) can lead to sudden cardiac death, potentially due to ventricular arrhythmias. This case highlights the importance of recognizing this risk in AS patients.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
Background:
- Aortic stenosis (AS) is a common heart valve disease, often caused by bicuspid aortic valves or age-related calcification.
- Sudden cardiac death (SCD) complicates severe AS in approximately 20% of fatalities, yet underlying mechanisms are poorly understood.
Observation:
- A 67-year-old man with severe AS presented with exertional dyspnea and chest tightness.
- He experienced syncope with documented torsade de pointes, a life-threatening ventricular arrhythmia.
- Electrocardiogram showed corrected QT interval (QTc) prolongation upon admission.
Findings:
- The patient's syncope episode was associated with torsade de pointes, suggesting a ventricular arrhythmia.
- Aortic valve replacement led to a decrease in QTc prolongation towards normal levels.
- Coronary arteries were found to be patent, ruling out ischemic causes for his symptoms.
Implications:
- Ventricular arrhythmias and associated syncope may be a significant mechanism for sudden cardiac death in severe aortic stenosis.
- Early recognition and management of AS, including timely valve replacement, could potentially mitigate the risk of fatal arrhythmias.
- Further research is warranted to elucidate the precise mechanisms linking severe AS to cardiac electrophysiological instability.
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