Akute Pneumonitis bei einem trainierten Individuum unter Amiodaron-Behandlung

Patients undergoing treatment with amiodarone can develop severe pulmonary side effects. This effect, which is often highly underestimated, can lead to dyspnea, pneumonitis, and further fibrosis. A recent change in the labeling of amdiodarone by the American Food and Drug Administration (FDA) supports this suspicion. Tracing the symptoms back to the causing agent can be difficult, as shown in our report.The subject of this case report is an endurance-trained 65 year old male marathon runner who appeared with atrial fibrillation during a routine check up in autumn 2003. After medical cardioversion with flecainide a complaint free interval of 8 months was followed by a relapse, which resulted in a change of medication to amiodarone. Due to misunderstandings the patient kept on taking the amiodarone loading dose for six weeks and returned with severe dyspnea on exertion. Losses in CO diffusing capacity, a lowered macrophages count and a positive lymphocyte transformation test were the only first hand clinical evidence of amiodarone intoxication, despite the sensation of dyspnea. This case shows that special care has to be taken in treatment with amiodarone. Side effects can be hard to trace and do not evidently show a clear connection to amiodarone.Wir beschreiben den Fall eines 65-jährigen Ausdauersportlers, der sich im Herbst 2003 mit Vorhofflimmern vorstellte. Nach medikamentöser Kardioversion mit Flecainid folgte ein beschwerdefreies Intervall von acht Monaten. Rezidive des Vorhofflimmerns erforderten die Umstellung auf Amiodaron. Aufgrund von Missverständnissen nahm der Patient die Aufsättigungsdosis über einen Zeitraum von sechs Wochen ein, wobei die ersten vier Wochen beschwerdefrei verliefen und sich über die nächsten zwei Wochen eine ausgeprägte Atemnot entwickelte. Dieser Fallbericht zeigt, dass die Behandlung mit Amiodaron besonderer Sorgfalt bedarf. Nebenwirkungen sind bisweilen sehr schwer erkennbar und zeigen nicht immer eine klare Beziehung zu der Amiodaroneinnahme

Assessment of left ventricular function and volumes by myocardial perfusion scintigraphy - comparison of two algorithms

Summary Aim: Left ventricular volume and function can be computed from gated SPECT myocardial perfusion imaging using Emory Cardiac Toolbox (ECT) or Gated SPECT Quantification (GS-Quant). The aim of this study was to compare both programs with respect to their practical application, stability and precision on heart-models as well as in clinical use. Methods: The volumes of five cardiac models were calculated by ECT and GS-Quant. 48 patients (13 female, 35 male) underwent a one day stress-rest protocol and gated SPECT. From these 96 gated SPECT images, left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV) were estimated by ECT and GS-Quant. For 42 patients LVEF was also determined by echocardiography. Results: For the cardiac models the computed volumes showed high correlation with the model-volumes as well as high correlation between ECT and GS-Quant (r ≥ 0.99). Both programs underestimated the volume by approximately 20-30% independent of the ventricle-size. Calculating LVEF, EDV and ESV, GS-Quant and ECT correlated well to each other and to the LVEF estimated by echocardiography (r ≥ 0.86). LVEF values determined with ECT were about 10% higher than values determined with GS-Quant or echocardiography. The incorrect surfaces calculated by the automatic algorithm of GS-Quant for three examinations could not be corrected manually. 34 of the ECT studies were optimized by the operator. Conclusion: GS-Quant and ECT are two reliable programs in estimating LVEF. Both seem to underestimate the cardiac volume. In practical application GS-Quant was faster and easier to use. ECT allows the user to define the contour of the ventricle and thus is less susceptible to artifacts.</jats:p