[Polytopical ectopic rhythms].
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Biomedical subjects
Publications and source records attributed to V L Doshchitsin.
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Holter monitoring was performed on days 1-2, 6-9 of the disease and on days 30-60 before their discharge from hospital in 54 patients with acute gross myocardial infarction. The presence of cardiac rhythm and conduction disturbances and ischemic ST-segment depression or elevation was evaluated. The patients having frequent and prolonged (more than 3 hours during a 2-day follow-up) showed a complicated course of the disease: recurrent pain syndrome, signs of heart failure, prolonged cardiac arrhythmias, and fatal outcomes. The patients with uncomplicated acute myocardial infarction had no long-term episodes of ischemic ST-segment depression or elevation, as recorded by Holter monitoring in the first 2 days of the disease. On days 6-9 no cardiac rhythm and conduction disturbances that had been observed in them were recorded. The patients in whom the episodes of silent myocardial infarction remained on their discharge exhibited a high (35%) incidence of myocardial infarction recurrence within a year.
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The precursors of ventricular fibrillation and asystole developing after ligation of a branch of the coronary artery and adrenalin injection were studied in 30 albino rats. The comparative efficacy of antiarrhythmic agents (ajmalin, lidocaine, isoptin, visken) in the prevention of ventricular fibrillation induced by electric current was determined in 40 rats. Ventricular extrasystole and tachysystole as well as the block of the bundle of His branch were the most common precursors of ventricular fibrillation. In some experiments fibrillation was preceded by complete atrioventricular block, cardiac fibrillation, sinus bradycardia, nonparoxysmal ventricular tachycardia, and excaped ventricular contractions. Ventricular asystole was most frequently preceded by complete atrioventricular block and the bundle of His branch block. Among the antiarrhythmic agents studied, ajmalin proved most effective in prevention of ventricular fibrillation; it raised the fibrillation threshold in all animals. Lidocaine, which produced a prophylactic effect in 50% of experiments, was second in effectiveness. Changes in the ventricular fibrillation threshold due to the effect of these agents were statistically significant on the average. Isoptin and visken proved to be less effective.
Allorhythmia in the broad sense is defined as a regular sequence of similar groups of ECG-complexes associated with various disorders of cardiac rhythm and conduction. The following classification of allorhythmias is suggested. A. True allorhythmias. I. Due to extrasystoles: 1) noncomplicated; 2) complicated by disorders of conduction. II. Allorrhythmias due to ectopic rhythms with capture beats: 1) paroxysmal or nonparoxysmal ectopic tachycardia; 2) escaping rhythms. III. Allorrhythmias due to impulse conduction block: 1) II degree S--A block; 2) II degree A--V-block; 2, atrial flutter and atrial tachycardia with A--V-block 3 : 2, 4 : 2, etc. B. Pseudoallorrhythmias due to regular alterations in the shape of the QRS complex: 1) transient bundle-branch block; 2) transient WPW syndrome; 3) bidirectional tachycardia. Differential diagnosis of various types of allorrhythmia is of great importance in choosing the measures and methods for antiarrhythmic therapy.
The observation was conducted in 24 patients with parasystolic arrhythmias, 13 of them having parasystolic extrasystoles, and 11--paroxysmal and non-paroxysmal parasystolic tachycardia. Ventricular parasystole was found in 21 patients, atrial--in 3, atrioventricular--in 2; three patients had double parasystole with two ectopic centers. In the majority of patients their parasystole took a persistent, but relatively benign course, however one patient with ventricular parasystolic tachycardia persisting for many years had repeated ventricular fibrillations. For the treatment of supraventricular parasystolic arrhythmias beta-adrenergic receptors blocking agents, Isoptine, cardiac glycosides were used; in ventricular parasystole the more effective drugs are Lidocain, Novocainamid, Ajmalin.
The observation was conducted in 92 patients with rhythm and conductivity disorders induced by cardiac glycosides. Most of the patients had ischaemic heart disease, 60 of them having had acute myocardial infarction. All patients were prescribed cardiac glycosides (usually Strophantin and digitalis preparations) due to the appearance of cardiac insufficiency. The most frequently observed rhythm disorder consisted in ventricular extrasystole (69.5% of the cases), bigeminy, polytopic or group extrasystole being observed in many cases. Often arrhythmias consisted in atrial extrasystole, atrial fibrillation, atrial and ventricular tachycardia, atrioventricular block. "Digitalis" arrhythmias were treated with beta-adrenergic blockers: Inderal, Viskene, Eraldin, Trasicor and Aptin. These drugs proved effective in most cases with atrial arrhythmias and in some--with ventricular arrhythmias. Lidocain was more effective in cases of ventricular arrhythmias. Effective drugs of a broad spectrum are also Aimalin, Pulsenorma and Ritmodan.
Ventricular fibrillation and asystole are a frequent cause of death in myocardial infarction. The data of continuous monitoring the heart in 134 patients with acute myocardial infarction and ventricular fibrillation and asystole. The immediate precursors of ventricular fibrillation were predominantly ventricular extrasystoles. A frequent precursor of ventricular fibrillation consists in paroxysmal ventricular tachycardia. In some patients the ventricular fibrillation was preceded by the block of the bundle of His, non-paroxysmal ventricular tathycardia, escaping contractions and some other arrhythmias. A factor providing for the development of ventricular fibrillation consists in the Q-T interval lengthening on ECG. Ventricular asystole is usually preceeded by atrioventricular block, Stage II-III, and the block of the bundle of His, as well as by ventricular tachycardia and extrasystole, in some cases--by sinus bradycardia and sinoauricular block (weakness of the sinus node). The examination of the rhythm and conductivity disorders preceeding the ventricular fibrillation is of great importance in view of the possibilities of prevention of "arrhythmic death".
Under observation were kept 80 patients with signs pointing to the sick sinus syndrome. Most of them suffered from ischemic heart disease, from atherosclerotic cardiosclerosis and acute myocardial infarction. Persistent sinus bradycardia with active and passive heterotopic arrhythmias were recorded in 42 patients. Sino-auricular block of the II and III degrees or asystolia of the atria with ectopic arrhythmias were observed in 37 cases. A number of patients displayed fibrillary bradyarrhythmia, extrasystole with post-extrasystolic depression of the rhythm and other disturbances. The so-called tachycardia-bradycardia syndrome characterized by the presence of tachycardiac arrhythmias occurring against the background of a marked bradycardia was registered in 25 persons. Fifteen patients demonstrated attackes of the Morgagni-Adams-Stokes syndrome, usually associated with lengthy periods of cardiac asystole. The treatment of ectopic arrhythmias in patients with the sick sinus syndrome presents considerable difficulties, but in many of them these disorders could be successfully eliminated by a careful and rigidly controlled application of antiarrhythmic agents (isoptin, ajmalin, pulsnorma, rhythmodan, beta-adrenergical blocking agents). For some patients exhibiting a tendency toward asystole electric stimulation of the heart is indicated.
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Cardiac rhythm disorders called atrioventricular dissociation, especially the so-called dissociation with interference have been causing controversy among the cardiologists for a long time. The latter term implies an independent activity of the atria and ventricles, that is in no way connected with an orthograde atrioventricular block, and that develops in the presence of intermittent normal conductivity of sinus impulses. This disorder is always of a secondary nature and it may be due to the disorders in the formation of the primary rhythm, or conductivity of the impulse (passive form), or acceleration of the secondary rhythm (active form). The causes of such atrioventricular dissociation may lie in sinus bradycardia, sinoauricular or incomplete atrioventricular block, compensatory pauses after extra-systoles, atrioventricular and ventricular tachycardia (paroxysmal or nonparoxysmal) with a retrograde atrioventricular block, etc. Examples of ECG patterns illustrating most of the above mechanisms are presented. Due to the existence of several mechanisms that cause atrioventricular dissociation, and due to the fact that individual authors imply different meanings by the term "interference", it seems reasonable to abandon the term "dissociation with interference". In such case it would seem more appropriate to call the state a primary rhythm or conductivity disorder indicating an incomplete atrioventricular dissociation for a proper choice of therapy.
The paper summarizes the experience gained in treating 830 patients with various cardiac rhythm disorders by employing new antirhythmic agents (propranolol, practolol, pindolol, alprenolol, oxyprenolol, benzoral, verapamil, lidocaine, imaline, sparteine, pulsonorma, disopyramide and quinidine durules). Comparative data on the efficacy of these agents are presented and indications and counterindications for their use are discussed.