Sustained atrial fibrillation after conversion of paroxysmal reciprocating junctional tachycardia by intravenous verapamil.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
S Viskin
Publications and source records attributed to S Viskin.
The importance of creatine kinase determination in identifying acute myocardial infarction among patients complaining of chest pain in an emergency room.
The contribution of serum creatine kinase (CK) levels to the diagnosis of acute myocardial infarction (AMI) in an emergency room was studied in 252 patients presenting with chest pain. Thirty percent were ultimately diagnosed as having AMI. The electrocardiogram (ECG) identified 66% of patients with AMI who were evaluated within 4 h of onset of symptoms; while CK serum levels were elevated in only 9%. Among patients evaluated more than 4 h after the onset of symptoms, the ECG was helpful in diagnosing AMI in only 36.6%, while serum CK levels were high in 63.4%. CK testing added significantly to the diagnosis of AMI in patients already studied by ECG. We suggest that determination of serum CK levels in the emergency room is of value in the evaluation of patients complaining of chest pain 4 or more hours after the onset of symptoms.
Adult↗
Serum enzyme assays in acute myocardial infarction.
Explore the source record for details and available documents.
Clinical Enzyme Tests↗
Does adequate control of diabetes in the preinfarction period improve the short-term postinfarction course?
It is uncertain whether adequate preinfarction diabetes control would alter the clinical outcome in diabetic patients once myocardial infarction has occurred. This study attempts an evaluation. Diabetic patients admitted successively to the cardiac intensive care unit with their first acute myocardial infarction were enrolled and followed throughout hospitalization. Every fourth consecutive patient with infarction, but not diabetic, was assigned to a control group. All patients were kept in the cardiac care unit for at least 48 h and vital signs and cardiac arrhythmias were continuously monitored. Radionuclide ventriculography was done within 24 h of admission and again upon discharge. When feasible, patients with postinfarction angina underwent coronary balloon angioplasty. During a 1-year period, 49 diabetic patients were studied, while 18 comparable nondiabetic patients served as controls. Diabetes was considered adequately controlled in 16 patients with glycosylated hemoglobin (HbA1c) of 8.8 +/- 0.7%, whereas in 33 patients diabetes was uncontrolled (HbA1c 14 +/- 3%), p < 0.001. No difference was found in the extent of infarct size, occurrence of heart failure, arrhythmias, and mortality when comparing the adequately with the inadequately controlled diabetics during a hospitalization period of 11 days. In diabetics, no differences were found in the short-term clinical course after acute myocardial infarction, whether the diabetes was adequately controlled or not in the preinfarction period.
Analysis of Variance↗
Polymorphic ventricular tachyarrhythmias in the absence of organic heart disease: classification, differential diagnosis, and implications for therapy.
Different polymorphic ventricular tachyarrhythmias may cause syncope or cardiac arrest in patients with no heart disease: (1) Catecholamine-sensitive polymorphic ventricular tachycardia (VT) presents during childhood: the hallmark is the reproducible provocation of atrial and polymorphic ventricular arrhythmias during exercise, despite a normal QT. Beta-blockers are the treatment of choice. (2) In the long QT syndromes (LQTS), malfunction of ion channels leads to prolonged ventricular repolarization, early afterdepolarizations, and triggered ventricular arrhythmias. Therapeutic options include: beta-blockers, genotype-specific therapy, cardiac sympathetic denervation, and implantation of pacemakers or defibrillators. (3) The "short-coupled variant of torsade de pointes" is a malignant disease that shares several characteristics with idiopathic ventricular fibrillation. Although verapamil is frequently recommended, mortality rates remain high. (4) Idiopathic ventricular fibrillation (VF) with normal electrocardiogram (ECG) strikes young adults of both genders. In contrast to other polymorphic tachyarrhythmias, idiopathic VF is not generally related to stress. Also, familial involvement is rare. Therapeutic options include implantation of defibrillators and therapy with class 1A drugs. (5) The "Brugada syndrome" and the "syndrome of nocturnal sudden death" strike males almost exclusively. Right bundle branch block (RBBB) with ST elevation in the right precordial leads-the "Brugada sign"--is seen in the ECG of both patient populations. Implantation of defibrillators is recommended.
Adrenergic beta-Antagonists↗