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23-07-2018 | Heart Beat | Uitgave 9/2018 Open Access

Netherlands Heart Journal 9/2018

Swinging beats: transient heart block in cardiac lymphoma

Netherlands Heart Journal > Uitgave 9/2018
J. W. Buikema, W. R. Goodyer, S. Koudstaal, J. van ’t Sant, P. W. Verheggen, E. A. de Vrey, B. J. de Smet
A 20-year-old man receiving chemotherapy for diffuse large B‑cell lymphoma with vascular involvement presented to the emergency room with dyspnoea. Chest radiography showed left-sided pleural effusion and an enlarged cardiac silhouette. Transthoracic echocardiography demonstrated large circumferential pericardial effusion with a so-called swinging heart with inflow obstruction (Fig.  1a). Remarkably, the patient was bradycardic and follow-up electrocardiography (ECG) revealed a junctional escape rhythm. Symptoms resolved after pericardiocentesis and drainage of 1,100 ml pericardial fluid containing B cells. Despite the drainage, a junctional rhythm persisted and after 24 h of continuous ECG the patient was discharged. Several weeks later, drainage was repeated for recurring pericardial effusion. ECG then showed an atrial flutter with 2:1 conduction. While in remission, follow-up electrocardiograms showed various ectopic atrial foci rhythms before returning to sinus rhythm 6 months later (Fig.  1b). Cardiac involvement of lymphomas is not uncommon. However, when patients develop transient blocks or arrhythmias this can be life-threatening and require additional vigilance during management [ 13].
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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