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Biomedical subjects

R F Lewin

Publications and source records attributed to R F Lewin.

At least 73 records · Page 4Linked to original sources
PubMed1984

Advanced early and late atrioventricular block in acute inferior wall myocardial infarction.

Seventy-six patients with acute inferior acute myocardial infarction (AMI) and advanced atrioventricular (AV) block are described. According to pre-established ECG criteria and time of appearance of the advanced AV block, patients were divided into two groups. The early block group consisted of 31 patients who developed advanced AV block during the hyperacute ECG stage of AMI. Advanced AV block in these patients was characterized by early appearance, short duration, third-degree type block, poor response to atropine, and increased need for pacemaker therapy. The late block group consisted of 45 patients who developed advanced AV block during subsequent ECG stages of AMI. Advanced AV block in these patients was characterized by late appearance, longer duration, second-degree type block, positive response to atropine, and diminished need for pacemaker therapy. Morbidity and mortality also differed between both groups. Patients with early block had more syncope (32% vs 2%, p less than 0.0001), more left heart failure (36 vs 7%, p less than 0.005), and more cardiogenic shock (39% vs 2%, p less than 0.001) than patients with late block. The mortality rate in the early block group was high (23%) and similar to that reported in the literature, whereas the mortality rate in the late block group was low (7%, p less than 0.05) and similar to the mortality rate reported for acute inferior AMI without advanced AV block. These data identify a subgroup of patients with acute inferior AMI and advanced AV block, which accounts for the high mortality rate reported in this group of patients.

Adult↗
PubMed1984

Right axis deviation in acute myocardial infarction. Clinical significance, hospital evolution, and long-term follow-up.

The incidence, in-hospital evolution, and long-term follow-up were studied in patients who developed acute deviation of the mean (frontal) QRS axis to the right during an acute myocardial infarction (AMI). Among 3,160 patients evaluated, 13 (0.41 percent) developed left posterior hemiblock (LPHB) and 57 (1.8 percent) developed an incomplete form of LPHB, the right axis deviation group (RAD). Patients in the LPHB group had a statistically significant higher incidence of in-hospital morbidity (69 percent incidence of congestive heart failure) and mortality (38.5 percent). Follow-up revealed a statistically significant higher incidence of cardiac symptomatology (angina pectoris and congestive heart failure) in the RAD group than in the control group, mainly in patients in whom RAD persisted for more than 24 hours. Patients developing LPHB during AMI constitute a high risk population with a high incidence of morbidity and mortality. Patients developing RAD constitute an intermediate group (between the LPHB and the control group) characterized by a high incidence of cardiac symptoms at the time of follow-up.

Angina Pectoris↗
PubMed1984

Life-threatening ventricular arrhythmias in septicemia.

Sixteen episodes of ventricular tachycardia and/or fibrillation, 12 of which occurred during shaking chills, were recorded in six patients with septicemia. All patients were greater than 60 years of age and had suffered a previous myocardial infarction. Patients who survived the condition sustained no further arrhythmias during a follow-up period of 1 to 4 years, despite the fact that no antiarrhythmic medication was administered. It is suggested that patients greater than 60 years of age who had suffered a previous myocardial infarction should be carefully monitored during septic episodes and especially during shaking chills, since these may represent vulnerable periods facilitating the precipitation of potentially lethal arrhythmias.

Aged↗
PubMed1983

Amiodarone-induced polymorphous ventricular tachycardia.

Five cases of amiodarone-induced polymorphous ventricular tachycardia (torsade de pointes) are presented. All patients had recurrent syncope or dizziness due to polymorphous ventricular tachycardia and in all cases the QT interval was prolonged. In two cases hypokalemia was present at the time the arrhythmia was first recorded, but in both cases polymorphous ventricular tachycardia persisted despite correction of the electrolyte imbalance. Standard treatment for polymorphous ventricular tachycardia (isoproterenol, ventricular pacing, or both) was successful in all patients, however, therapy had to be continued for 5 to 10 days, most probably because of the long elimination half-life of amiodarone.

Aged↗
PubMed1983

Multiform accelerated idioventricular rhythm in acute myocardial infarction: electrocardiographic characteristics and response to verapamil.

Thirteen patients with acute myocardial infarction with multiform accelerated idioventricular rhythm (AIVR) occurring during the first 12 hours of monitoring in the coronary care unit are described. This arrhythmia, similar to the more common uniform AIVR, was intermittent, did not cause hemodynamic compromise, and was not related to more serious ventricular arrhythmias. There was no correlation between the bundle branch block pattern of the multiform AIVR and the electrocardiographic location of the myocardial infarction, but there was a perfect correlation between the frontal plane electrical axis of the multiform AIVR and the electrocardiographic location of the myocardial infarction. The presence of fusion beats between the different forms of AIVR suggests multifocality rather than multiformity. Intravenous verapamil (3 to 5 mg bolus) was administered to 6 patients with multiform AIVR in whom the arrhythmias were persistent enough to allow the evaluation of the effect of verapamil on the arrhythmia. Verapamil caused no change in the rate of AIVR in 1 patient, but in a second patient it decreased the rate by 20 beats/min. In 4 patients, verapamil abolished the arrhythmia: in 2 patients carotid sinus pressure (induced sinus slowing) allowed the emergence of the AIVR at a lower rate, and in the remaining 2 patients the arrhythmia was not observed.

Adult↗
PubMed1983

Serial two-dimensional echocardiography in infective endocarditis of the pulmonic valve.

Infective endocarditis was diagnosed in a 15-yr-old patient following closure of a patent ductus arteriosus several weeks previously. Pulmonic valve vegetations were detected by both M-mode and two-dimensional echocardiograms. The serial echocardiographic examinations revealed the emergence of a vegetation on the pulmonic valve, a marked decrease in its size subsequent to pulmonary embolism, reemergence of a vegetation upon relapse of the disease and its resolution 4 mo later. The echocardiographic findings and their correlation to the various stages of the disease are described.

Adolescent↗
PubMed1981

Ventricular fibrillation complicating temporary ventricular pacing in acute myocardial infarction: significance of right ventricular infarction.

Five patients with acute myocardial infarction had ventricular fibrillation as a complication of indicated temporary pacing. All five patients had evidence of right ventricular infarction (three patients with postmortem confirmation). The presence of right ventricular infarction seems to be a contributing mechanism involved in the induction of ventricular fibrillation during temporary pacing for bradyarrhythmia complicating acute myocardial infarction.

Adult↗
PubMed1981

Paroxysmal atrial flutter and fibrillation associated with preexcitation syndrome: treatment with ajmaline.

Ajmaline was administered intravenously to six patients with the Wolff-Parkinson-White syndrome for the acute management of paroxysmal atrial flutter (three patients) or fibrillation (three patients) with a fast ventricular response (over the accessory pathway). Ajmaline increased refractoriness in the accessory pathway in all three patients with atrial flutter and stopped the flutter in one. The drug completely abolished preexcitation in two of the three patients with atrial fibrillation, decreasing the means ventricular rate of 240 and 300 beats/min to 110 and 180 beats/min, respectively. In the third patient with atrial fibrillation, ajmaline increased refractoriness over the accessory pathway, decreasing the mean ventricular rate of 300 beats/min to 160 beats/min. In two patients ajmaline was continued as an intravenous maintenance infusion until sinus rhythm was restored. It is concluded that ajmaline is an effective drug for the acute management of atrial flutter or fibrillation with a fast ventricular response in patients with the Wolff-Parkinson-White syndrome.

Adult↗
PubMed1979

Polymorphous ventricular tachycardia: clinical features and treatment.

Thirty-four cases of ventricular tachyarrhythmia characterized by polymorphy of the QRS complexes with changing R-R intervals and a heart rate of 150 to 300 beats/min, termed polymorphous ventricular tachycardia, are described. The factors involved in the appearance of this arrhythmia were the administration of antiarrhythmic drugs (quinidine 22 patients, procainamide 5 patients, ajmaline 1 patient), antianginal drugs (prenylamine [Synadrin] 4 patients) and antidepressant drugs (thioridazine 1 patient). Twenty-one patients were treated for premature ventricular complexes, three for chronic recurrent ventricular tachycardia, six for atrial flutter and fibrillation, three for anginal pain and one patient for mental depression. All patients except one had a drug-induced prolonged corrected Q-T interval before the appearance of polymorphous ventricular tachycardia. Most of the patients with this arrhythmia were considered to have severe myocardial disease. Lidocaine and electric cardioversion were administered to all patients, but were effective only in seven patients whose tachycardia occurred in short, single episodes. The most effective treatment (17 patients) was temporary ventricular pacing at rates ranging from 100 to 140 beats/min. Intravenous isoproterenol proved to be successful in another 10 cases. It is concluded that patients with severe myocardial involvement receiving antiarrhythmic drugs for premature ventricular complexes, especially the multiform variety, are at high risk for the development of polymorphous ventricular tachycardia.

Adult↗
PubMed1979

Left anterior hemiblock obscuring the diagnosis of right bundle branch block in acute myocardial infarction.

Thirty cases in which transient left anterior hemiblock (LAHB) obscured the diagnosis of right bundle branch block (RBBB) appearing during the first days of an acute myocardial infarction (AMI) are presented. Twenty-eight of the patients with AMI had a clear septal wall involvement, while the remaining two had an anterolateral and lateral wall AMI, respectively. These intraventricular conduction defects developed 2-120 hours (mean 64.9 +/- 26 hours) after the acute event, and persisted for 24 hours to 7 days (mean 63.1 +/- 35 hours). The ECG was characterized by a pure LAHB with wide QRS complexes and the presence of RBBB was shown by recording high V1 and right-sided chest leads. The vectorcardiogram was also useful in several cases. The clinical course of this type of bifascicular block was transient and benign, with an in-hospital mortality of 6.7%. No patient developed trifascicular or complete atrioventricular block and, therefore, we conclude that prophylactic installation of a temporary pacemaker is not indicated in this type of bifascicular block. The possible role of extracellular potassium released during acute myocardial necrosis in the pathophysiological mechanism of these blocks is discussed.

Acute Disease↗