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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 8-9

Look says it all - Clinically recognizable electrical storm


Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110 029, India

Date of Submission20-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Rajiv Narang
Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2258_19

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How to cite this article:
Narang R, Reddy S S. Look says it all - Clinically recognizable electrical storm. Indian J Med Res 2020;152, Suppl S1:8-9

How to cite this URL:
Narang R, Reddy S S. Look says it all - Clinically recognizable electrical storm. Indian J Med Res [serial online] 2020 [cited 2021 Jul 29];152, Suppl S1:8-9. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/8/316799

Patient's consent obtained to publish clinical information and images.


A 59 yr old female presented to the Cardiology department, All India Institute of Medical Sciences, New Delhi, India, in June 2019, with four syncopal episodes and palpitations. Examination showed hypothermia, bradycardia, carotenaemia [Figure 1] and drowsiness. Electrocardiography showed sinus bradycardia, long QT (580 msec) [Figure 2] malignant ventricular premature contractions [Figure 3], leading to runs of ventricular flutter (electrical storm) [Figure 4]. Laboratories showed undetectable thyroid-stimulating hormone (0.001 mU/L), low T3, T4 and all other anterior pituitary hormones were low. Her history revealed lactation failure 30 years back. The diagnosis of Sheehan's syndrome presenting with myxoedema coma and ventricular flutter secondary to acquired long QTc due to hypothyroidism was made and treated with high-dose levothyroxine and corticosteroids. The patient showed dramatic clinical improvement with normalization of QTc interval on five months of follow up. Uniqueness of the case is to highlight that not all ventricular arrhythmias need anti-arrhythmics, and clinical examination is of utmost importance even in the era of artificial intelligence. Sheehan's syndrome is an important reversible cause of electrical storm.
Figure 1: Characteristic carotenaemia, myxoedemic facies before treatment, with remarkable disappearance following treatment on five-month follow up.

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Figure 2: Baseline electrocardiography – Sinus bradycardia with prolonged QTc of 580 msec.

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Figure 3: Electrocardiography showing short-coupled ventricular premature contraction with R on T phenomenon.

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Figure 4: Ventricular flutter evident on lead I.

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Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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