CARDIOVASCULAR JOURNAL OF AFRICA • SMC-PAFCIC Abstracts October 2022 59 AFRICA Submission ID: 1704 AN EXCEPTIONAL OBSERVATION OF A TICAGRELOR INDUCED DELUSION BELGHAIT ELHAJJAJ, SAMAH EL-MHADI, YASSINE ELGRINI, OUSSAMA AIT KAJJATE, DRISS BRITEL, ZOUHAIR LAKHEL, AATEF BENYASS MOROCCO Introduction: The use of cardiovascular medications can have a variety of neuropsychiatric consequences. Case reports of medicationinduced cognitive disturbances exist for many cardiovascular drugs. P2Y12 inhibitors have not been associated with significant neuropsychiatric symptoms. Object: This is the second reported case in literature of Ticagrelor induced delusion, in a patient admitted for a very late stent thrombosis. Case report: We report the case of a 64-year-old patient, who had a history of anterior STEMI, treated 15 months ago with percutaneous coronary intervention with a drug eluting stent and discharged home on an optimal long term pharmacotherapy including Clopidogrel for 12 months. He had no psychiatric history. He was admitted in our emergency department for an anterior STEMI management. An urgent coronarography showed a stent thrombosis. A percutaneous coronary intervention was conducted, and a Ticagrelor based therapy was introduced. Within the next few hours, the patient started showing signs of confusion and disturbed thoughts, and progressively became delusional. Brain CT scan, then a brain MRI were performed revealing no organic abnormality. Hydroelectrolytic, metabolic, toxicologic tests and cerebrospinal fluid analysis were normal. Ticagrelor induced neuropsychiatric adverse effect was then suspected since the drug was the only pharmacotherapic medication modification. Ticagrelor was switched to Clopidogrel. Psychiatric symptoms progressively faded away, and completely disappeared after three days. The patient was discharged home the fourth day. Conclusion: Though a given agent may not consistently cause neuropsychiatric symptoms in the general population, idiosyncratic reactions are possible. This type of reactions is diagnosed by exclusion. The symptoms must clear once the plasma concentrations of the given drug are below a clinically relevant concentration. Submission ID: 1705 PROPHYLACTIC PACEMAKER IMPLANTATION IN STEINERT DISEASE: CASE REPORT BENSSIED ASMAE, EL KARROUMI NASSIMA MOROCCO Introduction: Steinert Disease, known as myotonic dystrophy type I (DM1) is a rare multisystemic genetic disorder with major cardiac involvement. In DM1, cardiac dysrhythmia is the second leading cause of death after respiratory failure. Pacing therapy is required to prevent sudden death in DM1. Case report A 55 year old man, recently diagnosed with Steinert disease, was reffered to our rythmology department to manage a dyspnea related to a first degree atrio-ventricular block. The clinical examination found a bradycardia (50 bpm) with typical physical signs of Steinert disease. The EKG showed a sinusal regular rythm (52cpm), a left axis deviation, a first degre AV block with a PR = 240ms, left anterior fascicular block, wide QRS =160ms, an intraventricular conduction delay 24h holter EKG revealed a mild ventricular hyperexcitability. An electrophysiological study concluded a long HV interval (73ms). The patient was implanted with prophylactic dual chamber pacemaker. Discussion Patient with DM1, a multisystemic neuromuscular disease, may experience conduction disturbances and tachyarrhythmias as major cardiac events. If non-invasive testing (12 lead EKG completed with a 24H ambulatory EKG) indicate elevated risk for serious conduction block or arrhythmias, the electrophysiology study is considered in order to evaluate the distal conduction impairment (His-Purkinje disease) by determining the HV interval. Following the 2021 ESC Guidelines on cardiac pacing, in DM1 patients, permanent pacing: • May be considered if PR ≥ 240 or QRS duration ≥ 120ms • Is indicated in a second or third AV block or HV interval ≥ 70 ms on electrophysiological study regardless of symptoms. Indeed, studies suggest that cardiac pacing improves survival of Steinert disease patients with severe ECG conduction abnormalities. In our case, the patient presented a high risk of severe conduction abnormalities, as well as a long HV interval found through the electrophysiological study which justified the implantation of a prophylactic dual chamber pacemaker. Conclusion The prevention of sudden death in DM1 is central and relies on annual follow-up and prophylactic permanent pacing in patients with conduction defects on electrocardiogram and/or infrahisian blocks on electrophysiological study. MODERATED POSTER SESSION
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