APRIL 5–8, 2018

20 mg IV prednisolone. On the fifth day of treatment, minimal pericar-

Topic: AJC » Cardiac Imaging - dial effusion was detected in the ECO (Figure 2).
When symptoms of cardiac disease occur in a RA patient, cardiac in-
Echocardiography volvement associated with drug use should be kept in mind and the drug
should be discontinued immediately.

PP-612
Topic: AJC » Arrhythmias and
Acute Pericarditis Due to the Use of Sulphalazine in Rheumatoid
Arthritis Patient. Hakki Simsek, and Ahmet Ferhat Kaya. Dicle Antiarrhythmic Therapy
University Cardiyology Hospital, Diyarbakir.

Pericarditis is a life-threatening condition that can be seen in rheu- PP-622

matic diseases. It may also depend on the medication used as well as
the disease itself. A Life-Threatening Condition: Hyperkalemia-Induced Complete
A 47-year-old woman was admitted to the emergency department with Heart Block. Uğur Aksu1, Zakir Lazoglu2, Kamuran Kalkan1,
complaints of chest pain, palpitation and shortness of breath. 6 years before Selim Topcu2, and Ibrahim Halil Tanboga2. 1Erzurum Regional
methotrexate and corticosteroid treatment were started with diagnosis Training and Research Hospital, Erzurum; 2Ataturk University,
RA. And 3 weeks before sulphasalazine treatment was added. Physical Erzurum.
examination showed decreased heart sounds and dyspnea and orthop-
nea. There was minimal ral in the bilateral lung sub-zones. Blood pressure Hyperkalemia is a frequently encountered electrolyte abnormality. Peaked
was 110/70 mm Hg, pulse rate was 96/min and fever was 37°C. His labo- T waves are usually the first ECG findings. If left untreated, progres-
ratory showed leucocyte: 18,000, Hgb: 11.5 g/dl, platelet count: 365,000, sion of hyperkalemia leads to slowing of conduction, wide, low p waves,
erythrocyte sedimentation rate (ESR): 34 mm/h, CRP: 18.5 mg/dl. On long PR interval, and a wide QRS complex. Ultimately it might cause
ECG we found sinus tachycardia (102/min). Transthoracic malignant ventricular arrhythmias and asystole. Renal dysfunction and
echocardiography revealed pericardial effusion in the moderate to severe electrolyte imbalances caused by cardiac procedures and chronic medi-
(Figure 1). The patient’s fluid was evacuated with pericardiocentesis. There cations may be precipitate hyperkalemia. Therefore physicians should
was no identified any microorganism in the patient’s pericardiocentesis be aware of this procedures and medications during medical history taking.
fluid and blood cultures. Pericarditis due to sulfalazine use was diagonsed In this case, we present a case of malignant AV block resolved by di-
finally. Sulphalazin therapy was cessasieted and the patient was given alysis, in a patient who was receiving medical treatment for cardiac failure.
Case report: A 69-year-old female was admitted to the hospital with
a new onset dyspnea. Two months ago, she underwent to coronary an-
giography due to severe coronary artery stenosis and her home drug
regimen included metoprolol 50 mg daily, perindopril 10 mg daily, aspirin
P 100 mg daily, clopidogrel 75 mg daily and atorvastatin 20 mg daily. The
patient’s vital signs on admission were temperature, 36,4°C; pulse rate,
O 30 beat per minute and regular; blood pressure, 140/90 mm Hg, equal
in both arms. Respiratory rate 24 breaths/minute. She was in acute re-
S spiratory distress with fluctuating consciousness, oxygen saturation 85%
while she was breathing room air. Initial ECG showed wide QRS complex
T with an S wave that merges with a peaked T wave without an isoelec-
E Figure 1. tric ST segment (Figure 1A). After initial examination patient clinical
and electrocardiographic features hyperkalemia was suspected and calcium
R gloconate was administered. After a while patient’s heart block was re-
solved (Figure 1B). Laboratory tests revealed a significantly high potassium
(K) level (8,1 meq/ml). Patient was immediately transferred to hemo-
dialysis unit for normalization of K levels. Through 3 hours of
A hemodialysis, serial control ECGs revealed that hyperkalemia related wide
B QRS complex pattern at a rate of 75 beats per minute were transform-
ing to a normal sinus rhythm at a rate of 95 beats per minute (Figure 1C)
S as the K levels were brought to normal range.

T
R
A
C
T
S
Figure 2. Figure 1.

e160 The American Journal of Cardiology® APRIL 5–8, 2018 14th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY
AND CARDIOVASCULAR SURGERY / Poster
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