Swimming-triggered aborted sudden cardiac death in a patient with Andersen–Tawil syndrome

The Role of Nutrition and Physical Activity as Trigger Factors of Paralytic Attacks in Primary Periodic Paralysis

Background:

Primary periodic paralysis (PPP) are rare inherited neuromuscular disorders including Hypokalemic periodic paralysis (HypoPP), Hyperkalemic periodic paralysis (HyperPP) and Andersen-Tawil syndrome (ATS) characterised by attacks of weakness or paralysis of skeletal muscles. Limited effective pharmacological treatments are available, and avoidance of lifestyle related triggers seems important.

Objective:

Our aim was to search and assess the scientific literature for information on trigger factors related to nutrition and physical activity in PPP.

Methods:

We searched Ovid Medline and Embase database for scientific papers published between January 1, 1990, to January 31, 2020.

Results:

We did not identify published observation or intervention studies evaluating effect of lifestyle changes on attacks. Current knowledge is based on case-reports, expert opinions, and retrospective case studies with inadequate methods for description of nutrition and physical activity. In HypoPP, high carbohydrate and salt intake, over-eating, alcohol, dehydration, hard physical activity, and rest after exercise are frequently reported triggers. Regarding HyperPP, fasting, intake of potassium, alcohol, cold foods or beverages, physical activity, and rest after exercise are frequently reported triggers. No nutrition related triggers are reported regarding ATS, exercise can however induce ventricular arrhythmias.

Conclusions:

Our results support that dietary intake and physical activity may play a role in causing paralytic attacks in PPP, although the current scientific evidence is weak. To provide good evidence-based patient care, several lifestyle aspects need to be further assessed and described.

Exercise-induced Ventricular Tachycardia/Ventricular Fibrillation in the Normal Heart: Risk Stratification and Management

Exercise-induced ventricular tachycardia (VT) rarely occurs in the absence of organic heart disease. Idiopathic monomorphic VT has an excellent prognosis. The main aspect of the risk stratification process is recognizing subtle forms of organic heart disease, particularly arrhythmogenic right ventricular cardiomyopathy. Exercise-induced polymorphic VT is potentially malignant. Exercise-induced polymorphic VT has also been seen in mitral valve prolapse. Some patients with stable coronary disease, and even healthy athletes, sometimes have short bursts of polymorphic VT during exercise tests but these arrhythmias are usually not reproducible during repeated testing and have unknown long-term clinical significance.

Unintentional drowning in northern Iran: a population-based study

The Iranian Ministry of Health documented that about 1500 people died from drowning annually in Iran between years 2000 and 2001. This study is a descriptive, retrospective, population-based analysis of 342 unintentional drowning deaths occurring to residents and tourists in Guilan and Mazandran Provinces in Iran over a 1-year period (2005-2006), using multiple data sources. The findings from this study demonstrate that the drowning rate for residents of the study population, 4.24 per 100,000, is much higher than drowning rates for populations in developed economies in Europe. Risk factors for drowning in the study populations include male gender, young age, and swimming in unsupervised areas. Drownings occurred most frequently in rivers, followed by canals and lakes. While much more remains to be done to investigate the problems associated with drowning deaths and injuries in Iran, the information obtained from this study can help point the way to targeted interventions.

Oral verapamil effectively suppressed complex ventricular arrhythmias and unmasked U waves in a patient with Andersen-Tawil syndrome

Andersen-Tawil syndrome (ATS) is a rare, heterogeneous, autosomal dominant, or sporadic disorder characterized by the clinical triad of periodic paralysis, dysmorphic features, and ventricular arrhythmias such as bidirectional ventricular tachycardia (BVT). We present a case of an elderly patient with ATS whose symptomatic ventricular arrhythmias including BVT were effectively suppressed by oral verapamil therapy.