QT prolongation: a case of arsenical pericardial and pleural effusion.
Arsenic trioxide is an effective treatment for patients with acute promyelocytic leukaemia (APL) who have relapsed from or are refractory to all trans-retinoic acid and anthracycline chemotherapy. Cardiac effects observed include electrocardiographic changes such as QTc prolongation, T-wave abnormalities, torsades de pointes and sudden death. We describe a case of a man, 76 years old, who was admitted to our department for dyspnoea in APL in treatment with arsenic trioxide. Chest radiograph illustrated an enlarged cardiac silhouette and bilateral pleuric effusion and the ECG evidenced QT prolongation. The patient was also submitted to transthoracic echocardiography that revealed moderate pericardial effusion without signs of cardiac tamponade and a normal biventricular function. This condition was considered to be associated with arsenic trioxide polyserosit and the drug therapy was immediately discontinued and steroid drugs started. After 2 weeks of arsenic trioxide therapy suspension there was evidence of complete resolution of pericardial and pleuric effusion and the ECG showed normal QT interval.
Vizzardi
Enrico
E
Section of Cardiovascular Disease, Department of Applied Experimental Medicine, Brescia Study University, Brescia, Italy.
Zanini
Gregoriana
G
Antonioli
Elena
E
D'Aloia
Antonio
A
Raddino
Riccardo
R
Cas
Livio Dei
LD
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000009:adverse effects*; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000503:physiopathology; D008297:Male; D010087:Oxides / Q000009:adverse effects*; D010490:Pericardial Effusion / Q000139:chemically induced* / Q000503:physiopathology; D010996:Pleural Effusion / Q000139:chemically induced* / Q000503:physiopathology; D020127:Recovery of Function; D028761:Withholding Treatment
D000970:Antineoplastic Agents; D001152:Arsenicals; D010087:Oxides; D000077237:Arsenic Trioxide