mycophenolic-acid and Arrhythmias--Cardiac

With an increasing number of heart transplants being performed around the world and the improvement in survival rates, more transplant recipients may present to the emergency department with comorbidities unique to the transplanted heart and related immunosuppression, including heart failure. This article is aimed at enabling the emergency department physician identify and better manage this unique group of patients for whom time is life.

Topics: Arrhythmias, Cardiac; Contraindications; Coronary Artery Disease; Diagnosis, Differential; Dyspnea; Electrocardiography; Emergency Service, Hospital; Heart Failure; Heart Transplantation; Humans; Immunosuppressive Agents; Mycophenolic Acid; Myocardium; Natriuretic Peptides; Postoperative Complications; Transplantation, Homologous; Ventricular Dysfunction, Left

A 45-year-old male with cardiac sarcoidosis verified by cardiac biopsy presented with multiple coexisting arrhythmias, including ventricular tachycardia of more than 1000 episodes per 24 h, paroxysmal atrial fibrillation, and third-degree atrioventricular block. He did not respond to corticosteroids dose of 20-60 mg once daily and mycophenolate mofetil dose of 1 g twice daily for 6 months. Cardiac magnetic resonance (CMR) demonstrated inflammation and late gadolinium enhancement on right ventricular wall and interventricular septum. Positron emission tomography-computed tomography (PET-CT) showed multifocal

Topics: Adalimumab; Arrhythmias, Cardiac; Atrioventricular Block; Cardiomyopathies; Contrast Media; Fluorodeoxyglucose F18; Gadolinium; Humans; Inflammation; Male; Middle Aged; Mycophenolic Acid; Myocarditis; Positron Emission Tomography Computed Tomography; Sarcoidosis