A 38-year-old patient with no relevant past medical history was diagnosed with depressive syndrome and treated with venlaparin (75 mg-150 mg - 150 mg v.o.) and alprazolam (1-2/8 mg v.o).
He comes to the Primary Care doctor after an episode of oppressive chest pain, non-irradiated and non-cutting, which oscillates intensity during the day but which does not go away despite rest.
An electrocardiogram (ECG) showed sinus tachycardia around 120 bpm with changes in repolarization.
He was transferred to the hospital and was admitted to the intensive care unit where a new ECG confirmed persistent sinus tachycardia with very diffuse changes in repolarization, as well as negative T waves in the anterior space QTg around 500 ms.
It is diagnosed as an Acute Coronary Syndrome and conventional treatment with dual antiplatelet therapy (acetylsalicylic acid 100 mg v.o./24 h and clopidogrel 75 mg v.o.oxaparin 80 mg/24 h), anticoagulation (en
As sinus tachycardia continues, treatment is started with low doses of beta-blockers (athenol 25 mg q.o./12 h).
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The absence of cardiac marker abnormalities was the reason for a new ECG that indicated regional contractility abnormalities.
A coronary angiographic study showed a normal left ventricle with an ejection fraction of 65% and a normal segmental analysis, showing epicardial coronary arteries without significant coronary stenosis, ruling out active coronary stenosis.
Although suspected that the cardiovascular effects may be produced by its posterior venlain, the drug is withdrawn and treatment with sertraline 50 mg daily is started, decreasing the dose of nitroglycerin to 5 mg daily.
The patient progressed adequately and continued on treatment with sertraline and atenolololol, achieving QT interval repolarization and maintaining heart rates around 80 bpm, with ECG evolution toward normalization.
