Letter: Atypical causes of Adams-Stokes attacks.
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Biomedical subjects
Publications and source records attributed to S Stern.
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Plasma lipids and lipoprotein levels were measured in 100 patients who underwent coronary angiography for chest pains. The coronary arteries were normal in 33 patients (22 males and 11 females), moderately pathological (30--60% narrowing) in 4, and markedly pathological (greater than 60% narrowing) in 63 (53 males and 10 females). Plasma cholesterol and triglyceride levels and very low and low density lipoprotein cholesterol levels were higher by 20--40% in both males and females with pathological coronary arteries as compared to normals. The high density plasma lipoprotein cholesterol level was lower in females with pathological arteries than in normals, but did not differ between the male groups. 67% of the males with pathological arteries had hyperlipoproteinemia as compared to 26% of the normals, and hyperlipoproteinemia was as frequent among males emigrating to Isreal from Europe or America as among those born in Asia or Africa. Hyperlipoproteinemia types IIA, IIB and IV were encountered among the patients at similar rates.
A 58-year-old male presented with a three-year-long history of short attacks of loss of consciousness. Epilepsy was suspected and phenobarbital and diphenylhydantoin were given, but without effect. Ambulatory ECG monitoring for four days revealed episodes of sinus bradycardia, marked sinus arrhythmia, and episodes of atrial and ventricular standstill. The longest asystolic period, without escape of lower pacemakers, was 20 sec and was recoreded during undisturbed sleep. Another long atrial and ventricular asystolic period with a duration of 19 sec, recorded during daily activity, was accompanied by dizziness but without loss of consciousness. The patient's symptoms were relieved by implantation of a pacemaker.
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Fifty patients with precordial pain were evaluated by 24 hour ambulatory ECG monitoring during normal everyday activities, and by coronary arteriography. The monitoring was regarded as positive if deviation of the ST segment of 1 mm or more from the resting pattern was observed, or if major T wave inversion occurred. Comparison of the results of the two tests showed a good correlation. Among the 32 patients with positive abnormalities on ECG monitoring, 28 had severe coronary disease (greater than 60% obstruction). Among the 18 patients with negative monitoring, only three had severe coronary disease. All seven patients with major T inversion had significant coronary obstruction. The type of chest pain and the resting ECG were less indicative of coronary pathology. The good correlation demonstrated between the ambulatory ECG monitoring and coronary arteriograms validates the monitoring as a reliable tool for uncovering latent ischemic heart disease (IHD) and for evaluation of patients with established IHD.
Continuous ambulatory ECG monitoring was performed in 110 patients because of a history of dizziness, alleged syncope of vague cerebral manifestations. The resting ECG failed to provide an explanation for symptoms in any of the patients. In 12 patients the monitoring revealed a variety of arrhythmic mechanisms which required pacemaker implantation. Five of these patients had sick sinus syndrome with episodes of prolonged sinus arrest, while in the others various degrees of A-V block were detected. Implantation of a pacemaker relieved the symptoms in all. It is concluded that ambulatory ECG monitoring is essential in evaluating cases of unexplained cerebral symptoms.
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