1
|
Gogu AE, Jianu DC, Parv F, Motoc AGM, Axelerad A, Stuparu AZ, Gogu AA. Case report: Clinical profile, molecular genetics, and neuroimaging findings presenting in a patient with Kearns-Sayre syndrome associated with inherited thrombophilia. Front Neurol 2024; 14:1320757. [PMID: 38249739 PMCID: PMC10799339 DOI: 10.3389/fneur.2023.1320757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024] Open
Abstract
Background Kearns-Sayre syndrome (KSS) is classified as one of the mitochondrial DNA (mtDNA) deletion syndromes with multisystemic involvement. Additionally, the negative prognosis is associated with inherited thrombophilia, which includes the presence of homozygous Factor V G1691A Leiden mutation, MTHFR gene polymorphisms C677T and A1298C, and PAI-1 675 homozygous genotype 5G/5G. Case presentation This case report presents a 48-year-old man with chronic progressive external ophthalmoplegia, bilateral ptosis, cerebellar ataxia, cardiovascular signs (syncope, dilated cardiomyopathy, and cardiac arrest) with electrocardiographic abnormalities (first-degree atrioventricular block and major right bundle branch block), endocrine dysfunction (short stature, growth hormone insufficiency, primary gonadal insufficiency, hypothyroidism, and secondary hyperparathyroidism), molecular genetic tests (MT-TL2 gene), and abnormal MRI brain images, thus leading to the diagnosis of KSS. The patient came back 4 weeks after the diagnosis to the emergency department with massive bilateral pulmonary embolism with syncope at onset, acute cardiorespiratory failure, deep left femoral-popliteal vein thrombophlebitis, and altered neurological status. In the intensive care unit, he received mechanical ventilation through intubation. Significant improvement was seen after 2 weeks. The patient tested positive for inherited thrombophilia and was discharged in stable conditions on a new treatment with Rivaroxaban 20 mg/day. At 6 months of follow-up, ECG-Holter monitoring and MRI brain images remained unchanged. However, after 3 months, the patient died suddenly while sleeping at home. Conclusion The genetic tests performed on KSS patients should also include those for inherited thrombophilia. By detecting these mutations, we can prevent major complications such as cerebral venous sinus thrombosis, coronary accidents, or sudden death.
Collapse
Affiliation(s)
- Anca Elena Gogu
- Department of Neurology, “Victor Babeş” University of Medicine and Pharmacy, Timișoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (Neuropsy-Cog), Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Timișoara, Romania
| | - Dragos Catalin Jianu
- Department of Neurology, “Victor Babeş” University of Medicine and Pharmacy, Timișoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (Neuropsy-Cog), Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Timișoara, Romania
| | - Florina Parv
- Department of Cardiology, “Victor Babeş” University of Medicine and Pharmacy, Timișoara, Romania
| | | | - Any Axelerad
- Department of Neurology, General Medicine Faculty, “Ovidius” University, Constanța, Romania
| | - Alina Zorina Stuparu
- Department of Neurology, General Medicine Faculty, “Ovidius” University, Constanța, Romania
| | - Andreea Alexandra Gogu
- Medicine Faculty, “Victor Babeş” University of Medicine and Pharmacy, Timișoara, Romania
| |
Collapse
|
2
|
Epstein R, Liberman L, Silver ES. Long-Term Follow-Up of Second-Degree Heart Block in Children. Pediatr Cardiol 2023; 44:1529-1535. [PMID: 37658175 DOI: 10.1007/s00246-023-03195-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/20/2023] [Indexed: 09/03/2023]
Abstract
Little is known about the outcomes of children with second-degree heart block. We aimed to determine whether children with structurally normal hearts and Mobitz 1, 2:1 block or Mobitz 2 are at increased risk for progressing to complete heart block (CHB) or requiring a pacemaker (PM) at long-term follow-up. We searched our institutional electrophysiology database for children with potentially concerning second-degree block on ambulatory rhythm monitoring between 2009 and 2021, defined as frequent episodes of Mobitz 1 or 2:1 block, episodes of Mobitz 1 or 2:1 block with additional evidence of conduction disease (i.e. first-degree heart block, bundle branch block), or episodes of Mobitz 2. Ambulatory rhythm monitor, ECG, and demographic data were reviewed. The primary composite outcome was CHB on follow-up rhythm monitor or PM placement. 20 patients were in the final analysis. Six (30%) patients either developed CHB but do not have a PM (4 = 20%) or have a PM (2 = 10%). Median follow-up was 5.8 years (IQR 4.4-7.0). Patients with CHB or PM were more likely to have second-degree block at maximum sinus rate (67% vs. 0%, p = 0.003), a below normal average heart rate (67% vs. 14%, p = 0.04), and 2:1 block on initial ECG (50% vs. 0%, p = 0.02). In this study of children with potentially concerning second-degree block, 30% of patients progressed to CHB or required a PM. Second-degree block at maximum sinus rate, a low average heart, and 2:1 block on initial ECG were associated with increased risk of disease progression.
Collapse
Affiliation(s)
- Rebecca Epstein
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, 3959 Broadway, New York, NY, 10032, USA.
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, 3959 Broadway, New York, NY, 10032, USA
| | - Eric S Silver
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, 3959 Broadway, New York, NY, 10032, USA
| |
Collapse
|
3
|
Groh WJ, Bhakta D, Tomaselli GF, Aleong RG, Teixeira RA, Amato A, Asirvatham SJ, Cha YM, Corrado D, Duboc D, Goldberger ZD, Horie M, Hornyak JE, Jefferies JL, Kääb S, Kalman JM, Kertesz NJ, Lakdawala NK, Lambiase PD, Lubitz SA, McMillan HJ, McNally EM, Milone M, Namboodiri N, Nazarian S, Patton KK, Russo V, Sacher F, Santangeli P, Shen WK, Sobral Filho DC, Stambler BS, Stöllberger C, Wahbi K, Wehrens XHT, Weiner MM, Wheeler MT, Zeppenfeld K. 2022 HRS expert consensus statement on evaluation and management of arrhythmic risk in neuromuscular disorders. Heart Rhythm 2022; 19:e61-e120. [PMID: 35500790 DOI: 10.1016/j.hrthm.2022.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
This international multidisciplinary document is intended to guide electrophysiologists, cardiologists, other clinicians, and health care professionals in caring for patients with arrhythmic complications of neuromuscular disorders (NMDs). The document presents an overview of arrhythmias in NMDs followed by detailed sections on specific disorders: Duchenne muscular dystrophy, Becker muscular dystrophy, and limb-girdle muscular dystrophy type 2; myotonic dystrophy type 1 and type 2; Emery-Dreifuss muscular dystrophy and limb-girdle muscular dystrophy type 1B; facioscapulohumeral muscular dystrophy; and mitochondrial myopathies, including Friedreich ataxia and Kearns-Sayre syndrome, with an emphasis on managing arrhythmic cardiac manifestations. End-of-life management of arrhythmias in patients with NMDs is also covered. The document sections were drafted by the writing committee members according to their area of expertise. The recommendations represent the consensus opinion of the expert writing group, graded by class of recommendation and level of evidence utilizing defined criteria. The recommendations were made available for public comment; the document underwent review by the Heart Rhythm Society Scientific and Clinical Documents Committee and external review and endorsement by the partner and collaborating societies. Changes were incorporated based on these reviews. By using a breadth of accumulated available evidence, the document is designed to provide practical and actionable clinical information and recommendations for the diagnosis and management of arrhythmias and thus improve the care of patients with NMDs.
Collapse
Affiliation(s)
- William J Groh
- Ralph H. Johnson VA Medical Center and Medical University of South Carolina, Charleston, South Carolina
| | - Deepak Bhakta
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | | | - Anthony Amato
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Denis Duboc
- Cardiology Department, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Minoru Horie
- Shiga University of Medical Sciences, Otsu, Japan
| | | | | | - Stefan Kääb
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | | | - Neal K Lakdawala
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pier D Lambiase
- Barts Heart Centre, St Bartholomew's Hospital, University College London, and St Bartholomew's Hospital London, London, United Kingdom
| | | | - Hugh J McMillan
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | | | | | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute, Bordeaux, France
| | | | | | | | | | - Claudia Stöllberger
- Second Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstraße, Vienna, Austria
| | - Karim Wahbi
- Cardiology Department, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | | | | | | | | |
Collapse
|
4
|
Rossi M, Wainsztein N, Merello M. Cardiac Involvement in Movement Disorders. Mov Disord Clin Pract 2021; 8:651-668. [PMID: 34307738 DOI: 10.1002/mdc3.13188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023] Open
Abstract
Background Several conditions represented mainly by movement disorders are associated with cardiac disease, which can be overlooked in clinical practice in the context of a prominent primary neurological disorder. Objectives To review neurological conditions that combine movement disorders and primary cardiac involvement. Methods A comprehensive and structured literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria was conducted to identify disorders combining movement disorders and cardiac disease. Results Some movement disorders are commonly or prominently associated with cardiac disease. Neurological and cardiac symptoms may share underlying physiopathological mechanisms in diseases, such as Friedreich's ataxia and Wilson's disease, and in certain metabolic disorders, including Refsum disease, Gaucher disease, a congenital disorder of glycosylation, or cerebrotendinous xanthomatosis. In certain conditions, such as Sydenham's chorea or dilated cardiomyopathy with ataxia syndrome (ATX-DNAJC19), heart involvement can present early in the course of disease, whereas in others such as Friedreich's ataxia or Refsum disease, cardiac symptoms tend to present in later stages. In another 68 acquired or inherited conditions, cardiac involvement or movement disorders are seldom reported. Conclusions As cardiac disease is part of the phenotypic spectrum of several movement disorders, heart involvement should be carefully investigated and increased awareness of this association encouraged as it may represent a leading cause of morbidity and mortality.
Collapse
Affiliation(s)
- Malco Rossi
- Sección Movimientos Anormales, Departamento de Neurociencias Instituto de Investigaciones Neurológicas Raúl Carrea, Fleni Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council Buenos Aires Argentina
| | - Nestor Wainsztein
- Departamento de Medicina Interna Unidad de Cuidados Críticos, Fleni Buenos Aires Argentina
| | - Marcelo Merello
- Sección Movimientos Anormales, Departamento de Neurociencias Instituto de Investigaciones Neurológicas Raúl Carrea, Fleni Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council Buenos Aires Argentina.,Pontificia Universidad Católica Argentina Buenos Aires Argentina
| |
Collapse
|
5
|
Montano V, Gruosso F, Simoncini C, Siciliano G, Mancuso M. Clinical features of mtDNA-related syndromes in adulthood. Arch Biochem Biophys 2020; 697:108689. [PMID: 33227288 DOI: 10.1016/j.abb.2020.108689] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/06/2020] [Accepted: 11/15/2020] [Indexed: 01/26/2023]
Abstract
Mitochondrial diseases are the most common inheritable metabolic diseases, due to defects in oxidative phosphorylation. They are caused by mutations of nuclear or mitochondrial DNA in genes involved in mitochondrial function. The peculiarity of "mitochondrial DNA genetics rules" in part explains the marked phenotypic variability, the complexity of genotype-phenotype correlations and the challenge of genetic counseling. The new massive genetic sequencing technologies have changed the diagnostic approach, enhancing mitochondrial DNA-related syndromes diagnosis and often avoiding the need of a tissue biopsy. Here we present the most common phenotypes associated with a mitochondrial DNA mutation with the recent advances in diagnosis and in therapeutic perspectives.
Collapse
Affiliation(s)
- V Montano
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Italy
| | - F Gruosso
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Italy
| | - C Simoncini
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Italy
| | - G Siciliano
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Italy
| | - M Mancuso
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Italy.
| |
Collapse
|
6
|
Imamura T, Sumitomo N, Muraji S, Mori H, Osada Y, Oyanagi T, Kojima T, Yoshiba S, Kobayashi T, Ono K. The necessity of implantable cardioverter defibrillators in patients with Kearns-Sayre syndrome - systematic review of the articles -. Int J Cardiol 2019; 279:105-111. [DOI: 10.1016/j.ijcard.2018.12.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/06/2018] [Accepted: 12/21/2018] [Indexed: 01/21/2023]
|
7
|
Sharma AK, Jain N, Kharwar RB, Narain VS. Classical triad of Kearns-Sayre syndrome. BMJ Case Rep 2016; 2016:bcr-2016-216500. [PMID: 27389730 DOI: 10.1136/bcr-2016-216500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Akhil Kumar Sharma
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nirdesh Jain
- Department of Cardiology, CSMMU (earlier KGMU), Lucknow, Uttar Pradesh, India
| | - Rajiv Bharat Kharwar
- Department of Cardiology, U.N Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Varun Shankar Narain
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
8
|
Sehgal S, Choudhry S, Debelenko L, L'Ecuyer T. Dilated cardiomyopathy with cardiogenic shock in a child with Kearns-Sayre syndrome. BMJ Case Rep 2016; 2016:bcr-2015-213813. [PMID: 26884075 DOI: 10.1136/bcr-2015-213813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Kearns-Sayre syndrome (KSS) is a mitochondrial myopathy resulting from mitochondrial DNA deletion. This syndrome primarily involves the central nervous system, eyes, skeletal muscles and the heart. The most well-known cardiac complications involve the conduction system; however, there have been case reports describing cardiomyopathy. We describe a case of a child with KSS who presented with decompensated cardiac failure from dilated cardiomyopathy representing cardiomyocyte involvement of KSS. Our patient had a rapidly progressing course, despite maximal medical management, requiring emergent institution of extracorporeal membrane oxygenation and transition to a ventricular assist device. To the best of our knowledge, this is the youngest patient in the literature to have dilated cardiomyopathy in KSS.
Collapse
Affiliation(s)
- Swati Sehgal
- Department of Pediatric Cardiology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, USA
| | - Swati Choudhry
- Children's Hospital of Michigan, Detroit Medical Center and Washington University School of Medicine, St Louis, Missouri
| | - Larisa Debelenko
- Department of Pathology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan
| | - Thomas L'Ecuyer
- Department of Pediatric Cardiology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, USA
| |
Collapse
|
9
|
Abstract
Mitochondrial dysfunction has been shown to be involved in the pathophysiology of arrhythmia, not only in inherited cardiomyopathy due to specific mutations in the mitochondrial DNA but also in acquired cardiomyopathy such as ischemic or diabetic cardiomyopathy. This article briefly discusses the basics of mitochondrial physiology and details the mechanisms generating arrhythmias due to mitochondrial dysfunction. The clinical spectrum of inherited and acquired cardiomyopathies associated with mitochondrial dysfunction is discussed followed by general aspects of the management of mitochondrial cardiomyopathy and related arrhythmia.
Collapse
Affiliation(s)
- David Montaigne
- Lille University, Inserm U1011, European Genomic Institute for Diabetes, Place de Verdun-amphi J&K, Lille F-59045, France; Institut Pasteur de Lille, Boulevard Louis XV, Lille F-59019, France; Cardiovascular Explorations Department, University Hospital of Lille, Lille F-59000, France.
| | - Anju Duva Pentiah
- Cardiovascular Explorations Department, University Hospital of Lille, Lille F-59000, France; Division of Cardiomyopathy, Department of Cardiology, University Hospital of Lille, Rue du Pr Laguesse, Lille F-59000, France
| |
Collapse
|
10
|
Kabunga P, Lau AK, Phan K, Puranik R, Liang C, Davis RL, Sue CM, Sy RW. Systematic review of cardiac electrical disease in Kearns–Sayre syndrome and mitochondrial cytopathy. Int J Cardiol 2015; 181:303-10. [DOI: 10.1016/j.ijcard.2014.12.038] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/06/2014] [Accepted: 12/12/2014] [Indexed: 11/27/2022]
|
11
|
Khambatta S, Nguyen DL, Beckman TJ, Wittich CM. Kearns-Sayre syndrome: a case series of 35 adults and children. Int J Gen Med 2014; 7:325-32. [PMID: 25061332 PMCID: PMC4086664 DOI: 10.2147/ijgm.s65560] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Kearns–Sayre syndrome (KSS) is a rare mitochondrial cytopathy, first described at Mayo Clinic in 1958. Aims We aimed to define patient and disease characteristics in a large group of adult and pediatric patients with KSS. Methods We retrospectively searched the Mayo Clinic medical index patient database for the records of patients with KSS between 1976 and 2009. The 35 patients identified with KSS were analyzed in terms of demographic characteristics, presenting signs and symptoms, diagnostic features, clinical evolution, and associations between disease features and the development of disability. Results The mean (standard [SD]) age at KSS presentation was 17 (10) years, but the mean age at diagnosis was 26 (15) years. Ophthalmologic symptoms developed in all patients, and neurologic and cardiac involvement was common. Only four patients (11%) in the series died, but all deaths were from sudden cardiac events. The development of physical disability was significantly associated with cognitive decline (P=0.004) but not with other clinical features, such as sex or sudden cardiac death. Conclusion We report the largest case series to date of patients with KSS from a single institution. In addition to the conduction system abnormalities identified in previous series, our cohort included patients with syncope and sudden cardiac death. This underscores the need to consider formal electrophysiologic studies and prophylactic defibrillators in patients with KSS.
Collapse
Affiliation(s)
| | - Douglas L Nguyen
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Thomas J Beckman
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
12
|
Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NAM, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2012; 61:e6-75. [PMID: 23265327 DOI: 10.1016/j.jacc.2012.11.007] [Citation(s) in RCA: 552] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
13
|
Puri A, Pradhan A, Chaudhary G, Singh V, Sethi R, Narain VS. Symptomatic complete heart block leading to a diagnosis of Kearns-Sayre syndrome. Indian Heart J 2012; 64:515-7. [PMID: 23102393 PMCID: PMC3860714 DOI: 10.1016/j.ihj.2012.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 05/04/2012] [Accepted: 07/23/2012] [Indexed: 02/08/2023] Open
Abstract
Kearns-Sayre syndrome (KSS) is a rare syndrome characterized by the triad of progressive external ophthalmoplegia, pigmentary retinopathy and cardiac conduction system disturbances; it is a mitochondrial encephalomyopathy with which usually presents before the patient reaches the age of 20. Here we present a case report of a patient with KSS who presented with symptomatic complete heart block.
Collapse
Affiliation(s)
- Aniket Puri
- Chhatrapati Shahuji Maharaj Medical University, Lucknow, India.
| | | | | | | | | | | |
Collapse
|
14
|
Abstract
Although much attention has been focused on the neurological sequelae of the hereditary ataxias, patients with these conditions also may develop cardiac complications that represent a significant cause of disability and even death. In this article, the authors describe the hereditary ataxias with known cardiac involvement, discuss underlying causes, and review guidelines for screening and treatment. Continued progress will require coordinated clinical trial networks, interdisciplinary care teams, and team science.
Collapse
Affiliation(s)
- Sean Moore
- Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, USA
| | - Subha V. Raman
- Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, USA
| |
Collapse
|
15
|
Limongelli G, Masarone D, D’Alessandro R, Elliott PM. Mitochondrial diseases and the heart: an overview of molecular basis, diagnosis, treatment and clinical course. Future Cardiol 2012; 8:71-88. [DOI: 10.2217/fca.11.79] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The mitochondrion is the main site of production of ATP that represents the source of energy for a large number of cellular processes. Mitochondrial diseases that result in a deficit in ATP production can affect almost every organ system with a large spectrum of clinical phenotypes. Cardiomyocytes are particularly vulnerable to limited ATP supply because of their large energy requirement. Abnormalities in the mitochondrial function are increasingly recognized in association with dilated and hypertrophic cardiomyopathy, cardiac conduction defects, endothelial dysfunction and coronary artery disease. Cardiologists should, therefore, be alerted to symptoms and signs suggestive of mitochondrial diseases and become familiar with the general issues related to multisystem disease management, genetic counseling and testing.
Collapse
Affiliation(s)
- Giuseppe Limongelli
- Monaldi Hospital Second University of Naples (SUN), Naples, Italy
- The Heart Hospital, University College of London (UCL), London, UK
| | - Daniele Masarone
- Monaldi Hospital Second University of Naples (SUN), Naples, Italy
| | | | - Perry M Elliott
- The Heart Hospital, University College of London (UCL), London, UK
| |
Collapse
|
16
|
Abstract
Conduction diseases (CD) include defects in impulse generation and conduction. Patients with CD may manifest a wide range of clinical presentations, from asymptomatic to potentially life-threatening arrhythmias. The pathophysiologic mechanisms underlying CD are diverse and may have implications for diagnosis, treatment, and prognosis. Known causes of functional CD include cardiac ion channelopathies or defects in modifying proteins, such as cytoskeletal proteins. Progress in molecular biology and genetics along with development of animal models has increased the understanding of the molecular mechanisms of these disorders. This article discusses the genetic basis for CD and its clinical implications.
Collapse
Affiliation(s)
- Roy Beinart
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | | | | |
Collapse
|
17
|
Lang T, Laver N, Strominger MB, Witking A, Pfannl R, Alroy J. Morphological findings of extraocular myopathy with chronic progressive external ophthalmoplegia. Ultrastruct Pathol 2010; 34:78-81. [PMID: 20192704 DOI: 10.3109/01913121003624684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mitochondrial diseases are a large group of disorders resulting from mutations of nuclear DNA (nDNA) and mitochondrial DNA (mtDNA). Patients present clinically with multiple manifestations, including myopathies and multiple system disorders. Establishing a specific diagnosis often requires extensive clinical and laboratory evaluation. In this study of 2 adult patients with presumptive mitochondrial disease, the authors have identified distinctive morphological changes in medial rectus muscle biopsies that confirm the diagnosis of chronic progressive external ophthalmoplegia (CPEO). These findings demonstrate the usefulness of electron microscopy using medial rectus muscle in the diagnosis of adult patients with a slowly progressive course of mild skeletal weakness and CPEO.
Collapse
Affiliation(s)
- Tee Lang
- Department of Pathology, Tufts University School of Medicine and Tufts Medical Center, Boston Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
18
|
Zásady pro implantace kardiostimulátorů, implantabilních kardioverterů-defibrilátorů a systémů pro srdeční resynchronizační léčbu 2009. COR ET VASA 2009. [DOI: 10.33678/cor.2009.147] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
19
|
Venugopal B, Wong KT, Goto YI, Bhattacharjee MB. Mitochondrial Disorder, Diabetes Mellitus, and Findings in Three Muscles, Including the Heart. Ultrastruct Pathol 2009; 30:135-41. [PMID: 16825114 DOI: 10.1080/01913120600689624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The authors describe the case of a 50-year-old man with chronic progressive external ophthalmoplegia (CPEO), diabetes mellitus (DM), and coronary artery disease. The patient had no cardiac conduction abnormalities. During coronary artery bypass surgery, his heart and two skeletal muscles were biopsied. All three muscles showed ragged red fibers. The heart muscle showed significant glycogen accumulation. Analysis of mitochondrial DNA (mtDNA) showed a 5019-base-pair deletion, with no duplications. There were morphologically abnormal mitochondria in all 3 muscles, with clinically apparent difference in preservation of function. The combination of diabetes mellitus and mtDNA deletion is fortuitous, as they can be causally linked. The cardiac pathology allows speculation about the possible adaptive processes that may occur in the heart in DM. There are few reported cases with CPEO and excess glycogen in the heart. Most show deposition of fat and poorer clinical outcomes as compared to those with glycogen deposition. This observation may lend support to the hypothesis that in the myocardium, adaptive responses are mediated via changes in glucose handling, whereas alterations in fat metabolism likely represent maladaptation.
Collapse
MESH Headings
- Chromosome Deletion
- Coronary Artery Bypass
- Coronary Artery Disease/complications
- DNA, Mitochondrial/genetics
- Diabetes Mellitus, Type 2/complications
- Glycogen/metabolism
- Humans
- Male
- Middle Aged
- Mitochondria, Heart/enzymology
- Mitochondria, Heart/ultrastructure
- Mitochondria, Muscle/enzymology
- Mitochondria, Muscle/ultrastructure
- Mitochondrial Myopathies/complications
- Muscle, Skeletal/enzymology
- Muscle, Skeletal/pathology
- Myocardium/enzymology
- Myocardium/pathology
- Myocytes, Cardiac/enzymology
- Myocytes, Cardiac/ultrastructure
- Ophthalmoplegia, Chronic Progressive External/complications
Collapse
Affiliation(s)
- B Venugopal
- National Heart Institute, Kuala Lumpur, Malaysia
| | | | | | | |
Collapse
|
20
|
Baldwin MK, Nembhard VN. Anesthetic considerations in a teenager with advanced symptoms of Kearns-Sayre syndrome. Paediatr Anaesth 2009; 19:639-40. [PMID: 19645998 DOI: 10.1111/j.1460-9592.2009.02937.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
21
|
Rapid development of life-threatening complete atrioventricular block in Kearns-Sayre syndrome. Eur J Pediatr 2009; 168:757-9. [PMID: 18813949 DOI: 10.1007/s00431-008-0831-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
Abstract
Kearns-Sayre syndrome is a rare mitochondrial disorder with defined diagnostic criteria. Knowledge of these diagnostic criteria and early diagnosis are important to ensure periodic electrocardiograms for identification of cardiac conduction disorders, which are the most important prognostic factor of the disease. We report on a 9-year-old girl with rapid development of a life-threatening complete atrioventricular block within 10 months and discuss the importance and time interval of regular electrocardiograms. Our patient survived by placing a temporary transvenous pacemaker lead followed by permanent pacemaker implantation a few days later.
Collapse
|
22
|
Yeşil M, Bayata S, Postaci N, Arikan E. Progression of conduction system disease in a paced patient with Kearns-Sayre syndrome. Clin Cardiol 2009; 32:E65-7. [PMID: 19306361 DOI: 10.1002/clc.20242] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Kearns-Sayre syndrome is a rare condition characterized by external ophthalmoplegia, retinal pigmentary degeneration and progressive impairment of cardiac conduction. We report a patient with the permanent pacemaker. The spontaneous cardiac impulse formation disappeared during long-term follow-up in this patient with Kearns-Sayre Syndrome.
Collapse
Affiliation(s)
- Murat Yeşil
- Department of Cardiology, Atatürk Teaching Hospital, Izmir, Turkey
| | | | | | | |
Collapse
|
23
|
Akaike M, Kawai H, Yokoi K, Kunishige M, Mine H, Nishida Y, Saito S. Cardiac dysfunction in patients with chronic progressive external ophthalmoplegia. Clin Cardiol 2009; 20:239-43. [PMID: 9068909 PMCID: PMC6656238 DOI: 10.1002/clc.4960200310] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Chronic progressive external ophthalmoplegia (CPEO), which includes Kearns-Sayre syndrome, is a mitochondrial disorder with large deletions of mitochondrial DNA. Recently, mtDNA deletions in cardiac muscle cells were thought to be a cause of dilated cardiomyopathy. However, the cardiac involvement in patients with CPEO is generally considered to be limited to the cardiac conduction system. HYPOTHESIS The purpose of this study was to evaluate left ventricular function in patients with CPEO. METHODS We evaluated the cardiac function of five patients with CPEO by means of carotid pulse recording and Doppler echocardiography. RESULTS The ratio of the pre-ejection period to ejection time was increased to 0.67 in one patient and to 0.50 in another. Echocardiography showed left ventricular dilatation and diffuse hypokinetic wall motion in both cases. Left ventricular fractional shortening was decreased to 5 and 19%, respectively, and the mean rate of circumferential shortening was decreased to 0.12 and 0.63 circ/s, respectively. One of the two patient died of congestive heart failure 2 months after the study. The Doppler pattern of left ventricular filling in the three remaining patients showed a decrease in the ratio of peak flow velocity in early diastole to that in late diastole, with an increase in deceleration time. CONCLUSION Although cardiac involvement in patients with CPEO is generally considered to be limited to the cardiac conduction system, left ventricular dysfunction may be present and should receive more attention in the management of patients with CPEO.
Collapse
Affiliation(s)
- M Akaike
- First Department of Internal Medicine, School of Medicine, University of Tokushima, Japan
| | | | | | | | | | | | | |
Collapse
|
24
|
Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 51:e1-62. [PMID: 18498951 DOI: 10.1016/j.jacc.2008.02.032] [Citation(s) in RCA: 1090] [Impact Index Per Article: 68.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
25
|
ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm 2008; 5:e1-62. [PMID: 18534360 DOI: 10.1016/j.hrthm.2008.04.014] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Indexed: 01/27/2023]
|
26
|
Epstein AE, Dimarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: executive summary. Heart Rhythm 2008; 5:934-55. [PMID: 18534377 DOI: 10.1016/j.hrthm.2008.04.015] [Citation(s) in RCA: 267] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Indexed: 11/16/2022]
|
27
|
|
28
|
Skinner JR, Yang T, Purvis D, Chung SK, Roden DM, Rees MI. Coinheritance of long QT syndrome and Kearns-Sayre syndrome. Heart Rhythm 2007; 4:1568-72. [DOI: 10.1016/j.hrthm.2007.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 08/13/2007] [Indexed: 10/22/2022]
|
29
|
Subbiah RN, Kuchar D, Baron D. Torsades de pointes in a patient with Kearns-Sayre syndrome: a fortunate finding. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:137-9. [PMID: 17241330 DOI: 10.1111/j.1540-8159.2007.00590.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present a case of a 33-year-old woman with Kearns-Sayre syndrome (KSS) who had a pacemaker implanted for complete heart block postpartum and was found to have torsades de pointes. KSS is a rare encephalomyopathy associated with varying levels of central nervous system involvement, typically resulting in progressive external opthalmoplegia and retinal degeneration. Onset of cardiac conduction disease can be insidious and is a strong predictor of sudden cardiac death. The mainstay of treatment has been the judicious implantation of pacemakers. However, as highlighted in this case, patients who have an underlying cardiomyopathy may be more appropriately treated with an implantable cardioverter defibrillator.
Collapse
Affiliation(s)
- Rajesh N Subbiah
- Cardiology Dept, St Vincent's Hospital, Darlinghurst, Sydney, NSW 2010, Australia.
| | | | | |
Collapse
|
30
|
Hernández-Luis C, García-Morán E, Rubio-Sanz J, Fernández-Avilés F. Síndrome de Kearns-Sayre: síncopes de repetición y aleteo auricular. Rev Esp Cardiol 2007. [DOI: 10.1016/s0300-8932(07)74995-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
31
|
Marian AJ, Willerson JT. Cardiac Involvement in Skeletal Myopathies and Neuromuscular Disorders. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
32
|
Guías de Práctica Clínica del ACC/AHA/ESC 2006 sobre el manejo de pacientes con arritmias ventriculares y la prevención de la muerte cardiaca súbita.Versión resumida. Rev Esp Cardiol 2006. [DOI: 10.1157/13096582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
33
|
Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48:e247-346. [PMID: 16949478 DOI: 10.1016/j.jacc.2006.07.010] [Citation(s) in RCA: 863] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
34
|
Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Myerburg RJ, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Moss AJ, Priori SG, Antman EM, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death—Executive Summary. J Am Coll Cardiol 2006. [DOI: 10.1016/j.jacc.2006.07.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
35
|
Letsas KP, Efremidis M, Pappas LK, Gavrielatos G, Sideris A, Charitos C. Pathophysiology and Management of Syncope in Kearns-Sayre Syndrome. ACTA ACUST UNITED AC 2006; 4:301-2. [PMID: 17086014 DOI: 10.1111/j.1541-9215.2006.06040.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 20-year-old woman with known Kearns-Sayre syndrome was transferred to the emergency department due to syncopal episodes. The electrocardiogram on admission showed complete atrioventricular block. The diagnosis of mitochondrial encephalomyopathy was made when she was 14 years old. At the time of the initial diagnosis, she displayed a normal electrocardiogram pattern. At the age of 17, electrocardiogram recordings demonstrated right bundle branch block with left anterior fascicular block and a prolonged QTc interval of 485 milliseconds (Figure). She was taking coenzyme Q10, oral nicotinamide adenine dinucleotide (reduced), piribedil, amantadine, and primidone. Transthoracic echocardiography revealed normal wall motion of both ventricles and mitral valve prolapse without regurgitation. A permanent dual-chamber pacemaker was immediately implanted.
Collapse
Affiliation(s)
- Konstantinos P Letsas
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece.
| | | | | | | | | | | |
Collapse
|
36
|
Affiliation(s)
- B Lemke
- Klinikum Lüdenscheid, Innere Klinik III, Kardiologie und Angiologie, Paulmannshöher Str. 14, 58515, Lüdenscheid.
| | | | | |
Collapse
|
37
|
Young TJ, Shah AK, Lee MH, Hayes DL. Kearns-Sayre Syndrome: A Case Report and Review of Cardiovascular Complications. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:454-7. [PMID: 15869681 DOI: 10.1111/j.1540-8159.2005.40049.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Kearns-Sayre syndrome (KSS) is a rare genetic abnormality. Classified as a mitochondrial cytopathy, the primary pathology of this syndrome is a disturbance of mitochondrial DNA, which codes for the proteins required for the respiratory chain reaction. Onset occurs before age 20, and is manifest as chronic progressive external ophthalmoplegia and retinal degeneration. Management issues of KSS include prophylactic cardiac pacing for conduction defects, which has been shown to improve survival. Other clinical considerations relate to dietary supplements to attempt to control the progressive effects of the disease.
Collapse
Affiliation(s)
- Timothy J Young
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
| | | | | | | |
Collapse
|
38
|
Oginosawa Y, Abe H, Nagatomo T, Mizuki T, Nakashima Y. Sustained polymorphic ventricular tachycardia unassociated with QT prolongation or bradycardia in the Kearns-Sayre syndrome. Pacing Clin Electrophysiol 2003; 26:1911-2. [PMID: 12930512 DOI: 10.1046/j.1460-9592.2003.00292.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cardiac dysfunction, including congestive heart failure and impulse conduction abnormalities, have been implicated in the sudden death of patients suffering from the Kearns-Sayre syndrome. This report describes a 29-year-old woman who suffered syncopal episodes due to sustained polymorphic VT. Sustained polymorphic VT was not associated with prolongation of the QT interval or bradycardia on the ECG. The implantation of a cardioverter defibrillator should be considered in this syndrome.
Collapse
Affiliation(s)
- Yasushi Oginosawa
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | | | | | |
Collapse
|
39
|
Ohkusu Y, Takahashi N, Ishikawa T, Sumita S, Kobayashi T, Matsushita K, Yamakawa Y, Uchino K, Kimura K, Inoue T, Umemura S. Quantitative assessment of the total myocardial uptake ratio of 123I-BMIPP by using the Ishii-MacIntyre method is useful for predicting cardiac complications in patients with mitochondrial encephalomyopathy or myotonic dystrophy. Nucl Med Commun 2003; 24:183-90. [PMID: 12548043 DOI: 10.1097/00006231-200302000-00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We evaluated the usefulness of the total myocardial uptake ratio (TMUR) of 15-(p-[123I]iodophenyl)-3(R,S)-methyl-pentadecanoic acid (123I-BMIPP) for predicting cardiac complications in patients with mitochondrial encephalomyopathy or myotonic dystrophy. Six patients with mitochondrial encephalomyopathy, four with myotonic dystrophy, and 10 control subjects were studied. Quantitative assessment of 123I-BMIPP dynamic myocardial imaging was performed, and the TMUR of 123I-BMIPP was calculated according to the Ishii-MacIntyre method. Then, the TMUR was compared in the 10 patients and 10 healthy controls, and all patients were followed for 56.1+/-22.1 months to evaluate cardiac complications. TMUR in patients (2.69+/-0.64) was significantly (P =0.01) lower than that in controls (3.28+/-0.25). Three patients in whom the TMUR value was above 3.00 had no cardiac complications. On the other hand, all patients in whom TMUR was below 3.00 had some kind of cardiac complication during the follow-up period. Two patients showed progressive conduction abnormality and underwent pacemaker implantation, one patient had sick sinus syndrome and underwent pacemaker implantation, another patient showed non-sustained ventricular tachycardia and paroxysmal atrial fibrillation, and four of seven patients, including one with a pacemaker, showed an increased cardiothoracic ratio value over 50%. In conclusion, measurement of the TMUR by the Ishii-MacIntyre method is useful for evaluating the development of cardiac complications in patients with mitochondrial encephalomyopathy or myotonic dystrophy.
Collapse
Affiliation(s)
- Y Ohkusu
- Second Department of Internal Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, Kerber RE, Naccarelli GV, Schoenfeld MH, Silka MJ, Winters SL. ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). J Am Coll Cardiol 2002; 40:1703-19. [PMID: 12427427 DOI: 10.1016/s0735-1097(02)02528-7] [Citation(s) in RCA: 270] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Gabriel Gregoratos
- Resource Center, American College of Cardiology Foundation, 9111 Old Georgetown Road, Bethesda, MD 20814-1699, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Terasaki F, Tanaka M, Kawamura K, Kanzaki Y, Okabe M, Hayashi T, Shimomura H, Ito T, Suwa M, Gong JS, Zhang J, Kitaura Y. A case of cardiomyopathy showing progression from the hypertrophic to the dilated form: association of Mt8348A-->G mutation in the mitochondrial tRNA(Lys) gene with severe ultrastructural alterations of mitochondria in cardiomyocytes. JAPANESE CIRCULATION JOURNAL 2001; 65:691-4. [PMID: 11446509 DOI: 10.1253/jcj.65.691] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This report describes a case of cardiomyopathy with a novel point mutation of mitochondrial DNA coding lysine tRNA in association with severe ultrastructural alterations of the mitochondria in the cardiomyocytes. Abnormalities of energy production and/or abnormal protein synthesis because of the mutation of mitochondrial DNA may have played an important role in the pathogenesis of this case, which showed severe cardiomyocyte degeneration and deterioration from hypertrophic cardiomyopathy to severe dilated cardiomyopathy.
Collapse
Affiliation(s)
- F Terasaki
- Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Kakura H, Tachibana Y, Nakamura K, Tanaka Y, Sanada J, Arima T. Mitochondrial encephalomyopathy (Kearns-Sayre syndrome) with complete atrioventricular block: a case report. JAPANESE CIRCULATION JOURNAL 1998; 62:623-5. [PMID: 9741743 DOI: 10.1253/jcj.62.623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A pacemaker was implanted into a 17-year-old man with cardiac failure due to complete atrioventricular block complicated by mitochondrial encephalomyopathy (Kearns-Sayre syndrome). Due to the possible complication of latent myocardial dysfunction, it was decided to implant the dual chamber pacemaker (DDD) and the operation mode was set to DDD 70 ppm 1 year after implantation; this alleviated the cardiac failure. In this case, the necessity of preventive pacemaker implantation in the early stage of cardiac failure was recognized.
Collapse
Affiliation(s)
- H Kakura
- The Second Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Sakuragaoka, Japan
| | | | | | | | | | | |
Collapse
|
43
|
Bower S, Nicole S, Kirkland G, Byrne E. Exercise intolerance in Kearns-Sayre syndrome. J Clin Neurosci 1996; 3:386-9. [DOI: 10.1016/s0967-5868(96)90039-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/1994] [Accepted: 04/06/1995] [Indexed: 11/24/2022]
|
44
|
|
45
|
Abstract
Kearns-Sayre syndrome is the triad of progressive external ophthalmoplegia, pigmentary retinopathy, and complete AV block. The etiology is unknown, but is thought to be due to a mitochondrial DNA deletion. Reported electrocardiographic abnormalities include first-degree AV block, fascicular blocks, and complete heart block, as well as non-specific S-T segment changes and T wave abnormalities, but has not included sinus node dysfunction. We report a case with episodes of sinus arrest in an asymptomatic patient with Kearns-Sayre syndrome resulting in pauses lasting up to 6 seconds.
Collapse
Affiliation(s)
- K S Ulicny
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill
| | | | | |
Collapse
|
46
|
Blankenship DC, Hug G, Balko G, van der Bel-Kann J, Coith RL, Engel PJ. Hemodynamic and myocyte mitochondrial ultrastructural abnormalities in arrhythmogenic right ventricular dysplasia. Am Heart J 1993; 126:989-95. [PMID: 8213461 DOI: 10.1016/0002-8703(93)90718-o] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- D C Blankenship
- Department of Internal Medicine, University of Cincinnati College of Medicine, OH 45267
| | | | | | | | | | | |
Collapse
|
47
|
Remes AM, Hassinen IE, Majamaa K, Peuhkurinen KJ. Mitochondrial DNA deletion diagnosed by analysis of an endomyocardial biopsy specimen from a patient with Kearns-Sayre syndrome and complete heart block. Heart 1992; 68:408-11. [PMID: 1449926 PMCID: PMC1025142 DOI: 10.1136/hrt.68.10.408] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Defects of mitochondrial DNA have been found at necropsy in the myocardium of patients with Kearns-Sayre syndrome. A patient with characteristics typical of Kearns-Sayre syndrome and a complete heart block is described. Southern blot analysis showed a deletion of 3.3 kb in the mitochondrial DNA in an endomyocardial biopsy specimen and in skeletal muscle. The deletion led to the disappearance of the genes for four transfer RNAs and four subunits of complex I (NADH:ubiquinone oxidoreductase) in the mitochondrial respiratory chain. The defect could not be demonstrated in whole blood despite amplification of the mitochondrial DNA region of interest by the polymerase chain reaction technique. There can be heteroplasmy--that is, normal and abnormal mitochondrial DNA populations in one cell--in different tissues, and the degree of heteroplasmy may be crucial in the development of organ-specific symptoms. This patient raises the possibility that some tissues can be specifically enriched with mitochondria with DNA defects and emphasises the need for elective sampling of the target tissue and polymerase chain reaction technique to exclude these defects. The role of mitochondrial DNA defects in idiopathic cardiomyopathies could perhaps be studied by analysis of mitochondrial DNA from endomyocardial biopsy specimens.
Collapse
Affiliation(s)
- A M Remes
- Department of Medical Biochemistry, Oulu University, Finland
| | | | | | | |
Collapse
|
48
|
|
49
|
Kosmorsky G, Johns DR. Neuro-ophthalmologic Manifestations of Mitochondrial DNA Disorders: Chronic Progressive External Ophthalmoplegia, Kearns-Sayre Syndrome, and Leber’s Hereditary Optic Neuropathy. Neurol Clin 1991. [DOI: 10.1016/s0733-8619(18)30308-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
50
|
Affiliation(s)
- D Kenny
- Department of Medicine (Division of Cardiology), Medical College of Wisconsin, Milwaukee 53226
| | | |
Collapse
|