Tachycardie Ventriculaire Mal Tolérée Révélatrice d’Une Cardiomyopathie Dilatée Post-Myocardique chez un Enfant de 8 Ans au Burkina Faso
Poorly Tolerated Ventricular Tachycardia Revealing Post-Myocardial Dilated Cardiomyopathy in an 8-Year-Old Child in Burkina Faso
DOI :
https://doi.org/10.5281/hra.v2i6.5724Mots-clés :
Tachycardie ventriculaire, myocardite, cardiomyopathie dilatéeRésumé
RÉSUMÉ
L’incidence de la myocardique aigue est en nette augmentation avec la récurrence d’infection virale. Nous rapportons un cas de cardiomyopathie dilatée post-myocardique complique de tachycardie ventriculaire chez une fille de 8 ans, élève, avec comme facteur de risque cardiovasculaire la sédentarité, et l’obésité modérée (Z_score P/T ˃ 3 écarts type). Elle a été admise pour des palpitations, une dyspnée et des précordialgies. L’examen physique notait une TA : 110/73 mmHg, une tachycardie à 207 battements par minutes (bpm), une température :37.7, une tachypnée à 21cycles par minute et un syndrome d’insuffisance cardiaque gauche. L’électrocardiogramme retrouvait une tachycardie ventriculaire monomorphe à 207 cpm. A l’échocardiographie Doppler Transthoracique on notait une volumineuse cardiomyopathie dilatée avec altération de la fraction d’éjection du ventricule gauche à 21 %. Le bilan biologique était normal. Le diagnostic de tachycardie ventriculaire soutenue révélatrice d’une cardiomyopathie dilatée post-myocardique fut retenu. Un double traitement antiarythmiques fait de Digoxine et de l’Amiodarone (à la Pousse Seringue Electrique) a permis d’obtenir un rythme sinusale régulier à 95 bpm et une régression de l’insuffisance cardiaque gauche au bout de 72 heures. La myocardite autrefois rare en Afrique doit être évoque devant une insuffisance cardiaque aigue fébrile et faire instituer un traitement d’urgence afin d’éviter la survenue de complications.
ABSTRACT
The incidence of acute myocarditis is on the rise with the recurrence of viral infections. We report a case of post-myocardial dilated cardiomyopathy complicated by ventricular tachycardia in an 8-year-old girl, a student, with sedentary lifestyle and moderate obesity (Z_score P/T > 3 standard deviations) as cardiovascular risk factors. She was admitted for palpitations, dyspnea, and chest pain. Physical examination revealed a blood pressure of 110/73 mmHg, tachycardia at 207 beats per minute (bpm), temperature of 37.7°C, tachypnea at 21 breaths per minute, and signs of left heart failure. The electrocardiogram showed monomorphic ventricular tachycardia at 207 bpm. Transthoracic Doppler echocardiography revealed a large dilated cardiomyopathy with an ejection fraction of the left ventricle at 21%. Laboratory tests were normal. The diagnosis of sustained ventricular tachycardia revealing post-myocardial dilated cardiomyopathy was made. A combination antiarrhythmic treatment with Digoxin and Amiodarone (via electric syringe pump) restored a regular sinus rhythm at 95 bpm and regression of left heart failure within 72 hours. Myocarditis, once rare in Africa, should be considered in cases of acute febrile heart failure and prompt emergency treatment should be initiated to prevent complications.
Références
Hn S, Gw D, Mg F, Lt C. Noninvasive imaging in myocarditis. Journal of the American College of Cardiology. J Am Coll Cardiol; 2006;48(10
Re M, Jp B, Rh H, Gm H, Ek K, Jm H, et al. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. The New England journal of medicine. N Engl J Med; 2000;342(10).
Mg G, M B, P DR, S P, R P, C M. Usefulness of magnetic resonance imaging for diagnosis of acute myocarditis in infants and children, and comparison with endomyocardial biopsy. The American journal of cardiology. Am J Cardiol; 15 oct 1991;68(10).
Am F, D M. Myocarditis. The New England journal of medicine [Internet]. N Engl J Med; 2000;343(19).
Valérian Valiton A , David Carballo A , Jörg D. Seebach B, Philippe Meyer : Myocarditis in 2020 696_1133.
Ammirati E, Cipriani M, Moro C, Raineri C, Pini D, Sormani P, et al. Clinical Presentation and Outcome in a Contemporary Cohort of Patients With Acute Myocarditis: Multicenter Lombardy Registry. Circulation. 2018;138(11):1088‑99.
Combes A, Trouillet J-L, Chastre J, Luyt C-É. Myocardites aiguës. Réanimation. 2011;20(3):192‑8.
Ferreira VM, Schulz-Menger J, Holmvang G, Kramer CM, Carbone I, Sechtem U, et al. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. J Am Coll Cardiol. 2018;72(24):3158‑76.
Holzmann M, Nicko A, Kühl U, Noutsias M, Poller W, Hoffmann W, et al. Complication rate of right ventricular endomyocardial biopsy via the femoral approach: a retrospective and prospective study analyzing 3048 diagnostic procedures over an 11-year period. Circulation. 2008;118(17):1722‑8.
Mirabel M, Luyt C-E, Leprince P, Trouillet J-L, Léger P, Pavie A, et al. Outcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support. Crit Care Med. 2011;39(5):1029‑35.
Meune C, Spaulding C, Mahé I, Lebon P, Bergmann J-F. Risks versus benefits of NSAIDs including aspirin in myocarditis: a review of the evidence from animal studies. Drug Saf. 2003;26(13):975‑81.
Escher F, Westermann D, Gaub R, Pronk J, Bock T, Al-Saadi N, et al. Development of diastolic heart failure in a 6-year follow-up study in patients after acute myocarditis. Heart. 2011;97(9):709‑14.
Téléchargements
Publié-e
Comment citer
Numéro
Rubrique
Licence
(c) Tous droits réservés Wendlassida Martin Nacanabo, Eric Dabiré,, Taryètba André Arthur Segda, André Koudnoaga Samadoulougou 2024
Cette œuvre est sous licence Creative Commons Attribution - Pas de Modification 4.0 International.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License CC BY-NC-ND 4.0 that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
