«Torsades de pointes» y farmacogenómica, amenaza latente en los servicios de urgencias. (Spanish)

Torsades de pointes and pharmacogenomic latent life-threatening in the setting of emergency department. (English)

Torsades de Pointes is a polymorphic lethal potentially ventricular taquiarrhythmia characterized by a change in the amplitude and morphology of the QRS complexes, consequence previously QT long acquired or congenital. In patients with severely injury of the CNS it is a latent risk. We present the case of a child with neurological impairment secondary to near drowning who present non-congenital QT long and late develop TdP, the treatment was magnesium sulfate for the acute episode and propranolol for prevention controll ing the arrhythmia and become hemodynamic stability. Other risk factors in the development of TdP, are as cardiac (congestive heart failure, a QT myocardial infarction, congenital long QT syndrome) and such as extracardiac (female sex, polipharmacy, electrolytes imbalance) mediated farmacogenomic complex mechanisms. The diagnosis has to be opportune and the outcome with electrocardiogram impressed. [ABSTRACT FROM AUTHOR]

«Torsades de pointes» (TdP) es una taquiarritmia ventricular polimorfa potencialmente letal, caracterizada por cambio en la amplitud y morfología del complejo QRS, precedida por un QT prolongado, adquirido o congénito. En niños críticamente enfermos con lesión severa del Sistema Nervioso Central constituye un riesgo latente, aquí se presenta el caso de un preescolar con lesión neurológica severa, secundaria a casi ahogamiento que en su electrocardiograma tuvo un QT prolongado no congénito con desarrollo de TdP, en el episodio agudo fue tratado con sulfato de magnesio y propranolol como preventivo, controlándose la arritmia y logrando una estabilidad hemodinámica. Factores cardiacos que dan lugar al TdP son: insuficiencia cardiaca congestiva, infarto agudo al miocardio y síndrome de QT prolongado congénito, y factores extracardiacos: sexo, abuso de medicamentos, modificaciones electrolíticas por mediación de los mecanismos farmacogenéticos complejos. El diagnóstico debe de ser oportuno y el seguimiento con electrocardiograma impreso. [ABSTRACT FROM AUTHOR]

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