RECURRENT SYNCOPE EPISODES IN A MIDDLE-AGE WOMAN WITH HYPERTROPHIC CARDIOMYOPATHY: A CASE REPORT

Abstract

Macrolides are identified as a potential source of drug-induced arrhythmias in susceptible patients such as females,
electrolyte alterations, and those with underlying prolonged QT interval. However, we usually find provocative
agents or risk factors rather than main causes of arrhythmias. Herein, a 40 year-old woman with history of HCM
who had undergone ICD implantation 18 months ago presented with malaise, low-grade fever, and non-productive
cough. After her admission, three episodes of syncope occurred at rest. Interrogation of ICD revealed that
ventricular tachycardia was responsible for loss of consciousness. Although appropriate ICD shocks disrupted the
arrhythmia, these episodes stopped only after cessation of Levofloxacin. We reviewed ECG strips, which confirmed
prolongation of QT intervals with a decreasing trend by elimination of Levofloxacin. In conclusion, we should
observe small details and changes in clinical history as well as Para clinical data of the patient. Adverse effects of
medications should be addressed in clinically relevant cases.