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Other Comments:
Bari, April, 13th, 2012
Title: “A Unique Case of Quincy Complicated by Complete Heart Block and Ventricular Tachycardia: A Case Report”.
Dear Editor,
We have read through the manuscript and we think that the manuscript is well-written and deserve attention due to the future prospective it could open about the field.
Yours sincerely,
Prof. Marco Matteo Ciccone
Address:
Piazza G. Cesare 11 - 701242 Bari Italy
Tel +39-080-54787691, Fax +39-080-5478796
e-mail: ciccone@cardio.uniba.it
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Competing interests:
none to declare
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Invited by the author to review this article? :
No -
Have you previously published on this or a similar topic?:
No
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References:
None -
Experience and credentials in the specific area of science:
I am am associate professor in Cardiovascular Diseases, author of hundreds of publication about cardiology subjects.
- How to cite: Ciccone M M.A Unique Case of Quincy Complicated by Complete Heart Block and Ventricular Tachycardia: A Case Report[Review of the article 'A Unique Case of Quincy Complicated by Complete Heart Block and Ventricular Tachycardia: A Case Report ' by Hussain M].WebmedCentral 2012;3(4):WMCRW001680
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Other Comments:
none
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Competing interests:
None
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Invited by the author to review this article? :
No -
Have you previously published on this or a similar topic?:
Yes
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References:
JThorac Cardiovasc Surg : In Press -
Experience and credentials in the specific area of science:
Clinical and interventional cardiology- 6 years
- How to cite: Adhyapak S .A Unique Case of Quincy Complicated by Complete Heart Block and Ventricular Tachycardia: A Case Report [Review of the article 'A Unique Case of Quincy Complicated by Complete Heart Block and Ventricular Tachycardia: A Case Report ' by Hussain M].WebmedCentral 2012;3(4):WMCRW001678
This is a good example of a case report of particular interest in this subject category.
The introduction section seems somewhat ambivalent regarding its target audience and background knowledge but this may be something we need to clarify within the WebmedCentral publication schema.
Atrioventricular block complicating acute streptococcal tonsillitis is very rare but has been previously reported (e.g. Br Heart J 1988, 59: 389-390). It may be due to myocarditis, though the sinus bradycardia observed in the present case lends some credence to the suggested high vagal tone mechanism. Mild myocarditis may also explain the mild Troponin elevation in this patient.
Bradycardia-induced polymorphic VT is also well described and likely the mechanism for the ventricular rhythm disturbancein this case. In view of this, amiodarone was arguably not an appropriate therapy in this case; transvenous pacing would likely have been sufficient. It is important to note that pacing at a fairly rapid ventricular rate may be necessary in these cases to suppress the VT, rather than simple backup pacing. The pacing parameters used in this case are unclear.
Some of the tables in this submission are suboptimal. In Table 1 for example the past medical and social history could have easily been incorporated into the text. The drug history uses non-defined abbreviations. In figure 1 there is a change in complex morphology. This is, I suspect, due to a change in lead during the record but this is not made explicitely clear and may be confused for intermittent block. Table 2 is poor in lacking laboratory reference ranges or, at least, measurement units used. A 12-lead EKG would have been preferrable for figure 2. The QRS appears borderline prolonged and there is no clear P wave preceding the first two QRS complexes.
I agree with the author, however, that despite it being a rare complication, raising awareness of possible cardiac involvement in these patients is important.
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http://casereports.bmj.com/content/2011/bcr.01.2011.3703.abstract
Interventional Cardiology