title: [Unexpected complication following esophageal variceal hemorrhage - Case 2/2011].
abstract: METHODS
  A 50-year-old patient with alcoholic liver cirrhosis was admitted due to hematemesis and melaena.
  
  
  METHODS
  Endoscopy showed esophageal variceal hemorrhage. A dose of erythromycin was administered before endoscopy for optimal endoscopic view.
  
  
  METHODS
  After conservative treatment with hemopressin, ciprofloxacin, and substitution with blood and fresh frozen plasma, the patient had an episode of atrial fibrillation with rapid ventricular response. The episode was terminated by intravenous administration of amiodarone, with subsequent conversion to sinus rhythm. Later on, the patient suffered from torsades de pointes tachycardia.
  
  
  CONCLUSIONS
  Secondary torsades de pointes tachycardias have a low incidence, but often fatal outcome. Torsades de pointes tachycardias mostly are the result of administration of QT-active drugs, and other cofactors. Emergency treatment addresses the reestablishment, and stabilization of sinus rhythm. Preferably, drug-induced torsades de pointes tachycardias are prevented by permanent critical review of administered drugs with respect to indications, interactions, and adverse reactions.
authors.affiliation: Abteilung für Gastroenterologie, Hepatologie und Infektiologie, Medizinische Universitätsklinik Tübingen. christoph.werner@med.uni-tuebingen.de
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Werner
authors.forename: Reimer
authors.initials: R
authors.lastname: Riessen
authors.forename: Michael
authors.initials: M
authors.lastname: Gregor
authors.forename: Michael
authors.initials: M
authors.lastname: Bitzer
mesh_terms: D000638:Amiodarone / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000009:adverse effects*; D051544:Cytochrome P-450 CYP3A; D065692:Cytochrome P-450 CYP3A Inhibitors; D003937:Diagnosis, Differential; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004554:Electric Countershock; D015716:Electrocardiography, Ambulatory; D004917:Erythromycin / Q000008:administration & dosage / Q000009:adverse effects*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000188:drug therapy*; D004945:Esophagoscopy; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology*; D006454:Hemoglobins / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008133:Long QT Syndrome / Q000139:chemically induced / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage / Q000009:adverse effects*; D012008:Recurrence; D012307:Risk Factors; D013610:Tachycardia / Q000139:chemically induced* / Q000188:drug therapy; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D065692:Cytochrome P-450 CYP3A Inhibitors; D006454:Hemoglobins; D010446:Peptide Fragments; C473218:hemopressin; D002939:Ciprofloxacin; D004917:Erythromycin; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human; D000638:Amiodarone