Reasons for delay in permanent pacemaker insertion.
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Adult↗
Biomedical subjects
A F Mackintosh
Publications and source records attributed to A F Mackintosh.
Sinus node function in first three weeks after cardiac transplantation.
Donor sinus node function was studied in 10 patients from day 4 to day 24 after cardiac transplantation. Cycle length, atrial arrhythmias, corrected sinus node recovery time, and estimated sinoatrial conduction time were recorded daily. Five patients had at least two sets of results suggesting sinus node dysfunction (group A) while five patients had no such abnormalities (group B). The prognosis in group A was poor, with four of the five patients dying within four months of the operation; one unexpected death from arrhythmias was recorded by ambulatory electrocardiographic monitoring. All five patients in group B survived for at least eight months. In nine patients sinus node function varied from day to day, with corrected sinus node recovery time reaching a peak at 11 to 18 days after operation. The longest corrected sinus node recovery time was 11 160 ms. Neither the differences between the patients, nor the day to day variation, could be explained solely by the degree of rejection as assessed by biopsy or by the ischaemia time of the heart during procurement. Sinus node dysfunction soon after transplantation is associated with a poorer prognosis and might be the terminal event in some cases.
Adult↗
Sinuatrial disease in young people.
A survey at three cardiac centres disclosed nine patients under the age of 25 years with sinus node dysfunction in the absence of other forms of heart disease. All were male and seven were above the 90th centile for height. Ambulatory monitoring was performed on all the first-degree relatives of six of the patients and three families showed conducting system disturbances in the form of sinuatrial disorders or delayed atrioventricular conduction. A genetic factor may be involved in the aetiology of sinuatrial disease in young people.
Adolescent↗
Cardiac damage presenting late after road accidents.
Six examples of cardiac damage secondary to non-penetrating trauma in road accidents are described. In all six cases the lesion was not recognised at the time of the accident but became clinically important two days to 17 years later. As the patients were young or had unusual lesions, the damage could be attributed to the accident. In older patients with common cardiac problems the trauma might not be recognised as the underlying cause.
Accidents, Traffic↗
A flexible signal-averaging system for cardiac waveforms.
The repetitive nature of cardiac waveforms renders them suitable for processing by signal averaging. A flexible system is described, based on a general-purpose digital computer, capable of averaging a variety of cardiac signals in excess of 0.5 microV containing frequency components below a theoretical Nyquist limit of 5 kHz. Important features of the system include real-time processing capability at a high level of interactive control, and the facility to trigger the averaging process accurately from any part of either the data or a synchronous reference waveform. Application of the system to electrocardiographic and phonocardiographic signals at conventional gain has enabled clinically useful records to be obtained in the face of obtrusive environmental noise. The averaging of signals of a similar nature after considerably increased amplification has revealed cardiac activity unseen in conventional records in a total of 81 subjects.
Analog-Digital Conversion↗
Coronary care units: Where now?
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Acute Disease↗
Hospital resuscitation from ventricular fibrillation in Brighton.
The overall results over three and a half years of the treatment of ventricular fibrillation secondary to ischaemic heart disease in the Royal Sussex County Hospital were reviewed. Records of all patients who were brought to hospital by resuscitation ambulances or who were admitted to the coronary care unit from any source were analysed. Eighty-seven of the 174 patients (50%) who developed ventricular fibrillation were discharged. The survivors included 13 out of 61 patients (21%) in whom fibrillation was secondary to cardiogenic shock or severe left ventricular failure. The presence of resuscitation equipment and nursing staff trained to use it in the general wards and emergency areas ensured a uniformly high success rate throughout the hospital, similar to that achieved in the coronary care unit. Prompt defibrillation in the general wards and the accident and emergency department may improve overall survival.
Adult↗
Low voltage electrical activity preceding right atrial depolarisation in man.
Electrical recordings were made in the high right atrium in 28 patients undergoing cardiac catheterisation and in 3 healthy volunteers. After filtering and amplification by 3 to 10 million times, the signals were passed through a signal averaging process in a digital computer. Of the 28 subjects who had technically satisfactory recordings, 23 showed low voltage electrical activity preceding the conventionally-recorded atrial depolarisation. The low voltage activity started 50 to 200 ms before the atrial deflection and was variable in shape. These early signals may be the result of activity in the region of the sinus node.
Arrhythmia, Sinus↗
Sinus node disease affecting both parents and both children.
A family is described in which both parents and both of their children developed conducting system disease before the age of 40. They all had evidence of possible sinus node dysfunction. The father and son had an unexplained polyneuritis during childhood.
Adolescent↗
Wolff-Parkinson-White syndrome (type A) complicated by heart block in both normal and accessory pathways.
A 67-year-old man with Wolff-Parkinson-White syndrome type A presented with second degree atrioventricular block in anomalous pathway and complete infra-Hisian block in the His-Purkinje pathway. He had increasingly frequent attacks of dizziness not related to exercise. A permanent ventricular demand pacemaker was successfully implanted following intracardiac electrophysiological studies.
Aged↗
Comparison of two methods of transporting paramedics to cardiac arrests outside hospital.
OBJECTIVE: To compare the deployment of paramedics in a separate rapid response unit with their deployment in a standard emergency ambulance. DESIGN: A one year period of each deployment. SETTING: Throughout the community in some parts of West Yorkshire. PARTICIPANTS: All patients receiving resuscitation for cardiac arrest by paramedics. INTERVENTIONS: Using the same group of paramedics and central control, 12 months with the paramedics deployed in separate cars in addition to the standard ambulances (period 1) were followed by another 12 months when they were deployed as one crew member of a standard emergency ambulance (period 2). MAIN OUTCOME MEASURES: Number of arrests attended, number of patients in ventricular fibrillation at paramedic arrival, response times, survival to leave hospital. RESULTS: In period 1, 580 arrests were attended with 31 survivors. In period 2, 462 arrests resulted in 25 survivors. The mean response time was shorter in period 1 (6.24 versus 6.60 min, Cl--0.01-0.73 min). In period 1, 217 patients were found in ventricular fibrillation (23 survivors): In period 2, 141 patients were found in ventricular fibrillation (11 survivors). CONCLUSION: Separating paramedics from the standard emergency ambulances increases the number of survivors of cardiac arrest but the difference may not be sufficiently large to justify the additional expenditure.
Ambulances↗
Management and health status in the first year after out-of-hospital cardiac arrest.
The one-year survival, functional and cerebral capacity and patient management following out-of-hospital cardiac arrest were examined in a follow-up study of 143 prospectively identified patients discharged from a West Yorkshire hospital between January 1987 and July 1993. One-year survival was 87%; 13 of the 18 deaths were cardiac related; 89% of survivors had no further cardiac related admissions; 98% of patients surviving to one year were capable of independent daily activities. There was low utilisation of simple drug therapy: 23% of patients were discharged taking beta-blockers and 52% aspirin; 50% of patients discharged after a primary arrhythmic event were taking antiarrhythmic therapy or were given an implantable defibrillator. Irrespective of the availability of invasive cardiac facilities, there was underutilisation of investigations: only 39% of patients were seen by a cardiologist and 54% were not evaluated for ischaemic risk. Significant improvements in patient management could probably be achieved quickly without substantial increases in resources.
Adolescent↗