1. Salmonella saved his life
Salmonella saved his life! Rinka Rani,1 MBBS, Lonika Sood, 2-3 MD, FACP 1Isra University Hyderabad, Pakistan; 2Aurora Health Care, Green Bay; 3University of Wisconsin School of Medicine and Public Health
Introduction
Discussion
Laboratory Data
Nontyphoidal Salmonella bacteremia can cause chest pain by causing myopericarditis. However, cardiac arrest is not common unless caused due to septic shock, cardiac tamponade or ventricular free wall rupture. Since these conditions did not occur in our patient, we postulate that the presence of an acute febrile illness precipitated an arrhythmia in the setting of a previously undiagnosed congenital short QT syndrome.
Making a diagnosis of short QT syndrome is challenging, especially given the yield of genetic testing is only 20%. Using the diagnostic criteria proposed by Gollob et al2, our patient scored 3 points (for cardiac arrest and a QT interval of less than 370 msec) placing him in the intermediate-probability for short QT syndrome.
Short QT Syndrome is an inherited channelopathy (disorder which affects the movement of ions through channels with the cell membrane) associated with markedly shortened QT intervals and sudden cardiac death (SCD) in individuals with a structurally normal heart1.
Troponin
Potassium
Magnesium
WBC
53 ng/ml
3.2 mmol/L
2.1 mg/dl
10.5 K/mcl
Blood cultures grew Salmonella enterica
Case Presentation
History: A 24 year-old male presented with chest pain and diarrhea. His complaints started two weeks ago with intermittent chest pain which was described as being retrosternal, aggravated on lying down and improving on sitting up. One week following this, he started experiencing fever, chills along with nausea, vomiting and diarrhea.
On examination: He appeared diaphoretic, pale with systolic blood pressures in the 90s, and heart rate in the 80s. In the emergency room, he suddenly lost consciousness and was found to be in cardiac arrest due to ventricular fibrillation. He was resuscitated using ACLS protocol.
Shortened QT intervals
 CONCLUSION
Normal EKG
Short QT interval
Although rare, short QT syndrome can be lethal, especially in the face of an acute illness.
References
Antzelevitch, C., & Cordeiro, JM. (2016). Short QT syndrome. In M. Link (ed) UpToDate. Retrieved April 21, 2017, from
Gollob, M. H., Redpath, C. J., & Roberts, J. D. (2011). The short QT syndrome: proposed diagnostic criteria. Journal of the American College of Cardiology, 57(7),
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