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At least 253 records · Page 14Linked to original sources
PubMed1977

Pacing techniques in assessing cardiac function in the horse.

The problem of transitory cardiac arrhythmias in equidae is discussed particularly with regard to the referral of suspect cases to specialist institutions for second opinion. Recently developed electro-stimulation techniques designed to uncover problem arrythmias, are briefly described and their potential in the analysis of cardiac electrical function under varying conditions is reviewed. The author cautions on the too rapid evaluation of the techniques for this purpose while remaining optimistic of the potential of electro-stimulation in the objective analysis of cardiac electric parameters.

Animals↗
PubMed1979

Effect of beta-blockers on arrhythmias during six weeks after suspected myocardial infarction.

Twenty-four-hour electrocardiographic tape-recording was used to investigate the incidence of arrhythmias in patients with suspected myocardial infarction who were receiving either propranolol, atenolol, or placebo. Recordings begun within 24 hours after admission to a coronary care unit showed that 76% of patients eventually found to have had a myocardial infarction had ventricular arrhythmias of a type generally regarded as serious, whereas of patients in whom myocardial infarction was not substantiated, only 24% had such arrhythmias. At one and six weeks after admission the incidence of arrhythmias ranged from 25% to 33% irrespective of diagnosis. Of patients monitored at both one and six weeks, however, only 5% had arrhythmias on each occasion. Patients treated with propranolol and atenolol showed a similar incidence of arrhythmias to those taking placebo. There was no difference in the incidence or type of arrhythmias recorded between patients who died and those who were still alive at six weeks.These results confirm that "serious" ventricular arrythmias occur in most patients during the acute phase of myocardial infarction and suggest that they do not constitute an independent risk factor. Beta-blockers showed little evidence of useful antiarrhythmic action in the dosage used, but increasing the dosage in suspected myocardial infarction is not practicable because of the risk of hypotension. The findings raise grave doubts about the value of studying arrhythmias to assess drugs intended to reduce mortality from myocardial infarction.

Arrhythmias, Cardiac↗
PubMed1968

Report of 24 cases of myocardial infarction treated at home.

During a four-year period in one general practice 50 patients suffered myocardial infarction; 24 were dead before their general practitioner saw them. Of the surviving 26, 2 were admitted to hospital for social reasons and the others were treated in their homes.One woman suffered a pulmonary embolus on the tenth day of her illness and was admitted to hospital. Three patients were found to develop arrythmias; one of these died. One other patient died, but the others made uneventful recoveries.These results compare well with those obtained by specialist units, perhaps because the advantages of such a unit are balanced by the hazards of transportation to it.

Adult↗
PubMed1977

Prognostic significance of isolated left anterior hemiblock and left axis deviation in the course of acute myocardial infarction.

In 700 patients with acute myocardial infarction admitted to the intensive coronary care unit of our hospital, the incidence and significance of left anterior hemiblock and left axis deviation has been studied in the acute phase of disease. In 102 (14.6%) of the 700 patients, isolated left axis deviation (mean QRS axis-45 degrees) was found and 69 of them (9.9%) met the criteria of left anterior hemiblock. Of the 69 patients with left anterior hemiblock, 61 had acute anterior myocardial infarction, 5 had inferior infarction, and 3 had subendocardial infarction. The anterior hemiblock was transient in 5 patients, but persisted in 64. All patients with and without isolated left anterior hemiblock and left axis deviation were compared statistically with reference to mortality rate and the incidence of arrythmias; no significant difference was noted. However, in patients over the age of 65 and also in those with hypertension, the incidence of left axis deviation was significantly higher (P less than 0.05 and P less than 0.001, respectively). It was concluded that isolated left anterior hemiblock and left axis deviation occurring in the course of acute myocardial infarction no influence on the prognosis of acute myocardial infarction.

Acute Disease↗
PubMed1981

Cardiac arrhythmias 48 hours before, during, and 48 hours after discharge from hospital following acute myocardial infarction.

The cardiac rate and rhythm were studied by 24-hour ambulatory electrocardiographic recording in 44 patients before, during, and after being discharged from hospital following an acute myocardial infarction. The first recordings were started 48 hours before discharge, the second on the morning of the day of discharge, and the third 48 hours after discharge (at home). While in hospital and after returning home the heart rate fell during sleep but there was no diurnal variation in the frequency of ventricular extrasystoles. Daytime heart rate and both the frequency and grade (severity) of ventricular arrhythmias were significantly raised 48 hours after discharge. The frequency of ventricular extrasystoles during sleep was also increased in the 48 hours post-discharge recording. Rises in heart rate and frequency and severity of ventricular extrasystoles were observed on the morning of the day of discharge, increasing up to the time of leaving hospital, but during the journey home they all diminished. No relation was found between ventricular arrythmias during early convalescence and (i) ventricular arrhythmias during the acute phase of acute myocardial infarction (including ventricular fibrillation); (ii) peak aspartate aminotransferase; (iii) the level of anxiety; or (iv) the personality type. Six patients taking beta-blocking drugs behaved similarly. Five patients taking anxiolytic drugs has significantly raised frequency of ventricular extrasystoles during each 24-hour electrocardiogram. In spite of the above findings, at the time of leaving hospital after acute myocardial infarction there does not appear to be a serious risk from the development of major cardiac arrhythmias.

Aged↗
PubMed1990

Clinical hyperthyroidism due to non-neoplastic inappropriate thyrotrophin secretion.

We report a case of hyperthyroidism due to inappropriate thyrotrophin (TSH) secretion in a patient with selective pituitary resistance to thyroid hormone action. Symptoms of hyperthyroidism in patients with this disorder are usually mild, implying some peripheral tissue resistance to the metabolic effects of thyroid hormone. Our patient had unusually severe symptoms, including marked weight loss and cardiac arrythmias which required carbimazole and beta-blocker therapy for control. Somatostatin was ineffective in suppressing TSH secretion. The introduction of sensitive thyrotrophin assays should facilitate the accurate diagnosis of TSH-induced hyperthyroidism and avoid inappropriate treatment.

Adult↗
PubMed2006

Reduced morbidity for elderly patients with a hip fracture after implementation of a perioperative evidence-based clinical pathway.

BACKGROUND: Hip fractures, common in the elderly population, result in significant morbidity and mortality. A study was undertaken to determine how an evidence based clinical pathway (CP) for treatment of elderly patients with hip fracture affected morbidity, in-hospital mortality, and health service utilization. METHODS: A pre-post study design using two population based inception cohorts of hip fracture patients aged > or =65 years was used. The control group (n = 678) was enrolled between July 1996 and September 1997 before implementation of the pathway and the CP group (n = 663) was enrolled between July 1999 and September 2000 following pathway implementation. Chart reviews were completed during study time frames to determine complications, mortality, and health service utilization. RESULTS: Only nine patients (1%) in the CP group experienced postoperative congestive heart failure compared with 37 (5%) control patients (p<0.001). Postoperative cardiac arrythmias were significantly lower in the CP group than in the control group (8 (1%) v 36 (5%); p<0.001). Postoperative delirium occurred in 22% of the CP group and 51% of the control group (p<0.001). There was no difference in risk adjusted in-hospital mortality between the two groups. Overall length of stay (LOS) and costs were unchanged between the groups; however, hospital LOS increased while rehabilitation LOS decreased in the CP group. CONCLUSION: Implementation of an evidence based clinical pathway reduced postoperative morbidity and did not affect in-hospital mortality or overall costs of inpatient care. The effect of changing trends in medical care cannot be ruled out, but the reduction in complications in several clinical areas lends support to the positive impact of the clinical pathway. Perioperative CP is one successful management approach for this fragile patient population as patient morbidity was reduced without negatively affecting resource utilization.

Aged↗
PubMed2006

Statin-induced apoptosis and skeletal myopathy.

Over 100 million prescriptions were filled for statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) in 2004. Statins were originally developed to lower plasma cholesterol in patients with hypercholesterolemia and are the most effective drugs on the market in doing so. Because of the discovered pleiotropic effects of statins, the use has expanded to the treatment of many other conditions, including ventricular arrythmias, idiopathic dilated cardiomyopathy, cancer, osteoporosis, and diabetes. The elderly population is growing. Therefore, it is estimated that the number of statin users will also increase. Fortunately, the use of statins is relatively safe with few side effects. Myopathy is the most common side effect with symptoms ranging from fatigue, weakness, and pain to symptoms associated with rhabdomyolysis which is a life-threatening condition. The development of statin-induced rhabdomyolysis is rare occurring in approximately 0.1% of patients; however, the occurrence of less severe symptoms is underreported and may be 1-5% or more. Physical exercise appears to increase the likelihood for the development of myopathy in patients taking statins. It is thought that as many as 25% of statin users who exercise may experience muscle fatigue, weakness, aches, and cramping due to statin therapy and potentially dismissed by the patient and physician. The mechanisms causing statin-induced myopathy have not been elucidated; however, research efforts suggest that apoptosis of myofibers may contribute. The mitochondrion is considered a regulatory center of apoptosis, and therefore its role in the induction of apoptosis will be discussed as well as the mechanism of statin-induced apoptosis and myopathy.

Anticholesteremic Agents↗
PubMed1984

Rhythmic variations in R-R interval during sleep and wakefulness in puppies and dogs.

We studied the short-term oscillations in the R-R interval in five puppies at 4 wk of age and five adult dogs during sleep and wakefulness. The R-R interval was measured using an R-R preprocessor, and respiration was recorded using barometric plethysmography. Puppies showed much smaller fluctuations in the R-R interval (SD between 6 and 40 ms) than adult dogs (SD between 124 and 367 ms) in both rapid eye movement (REM) and quiet sleep. Spectral analysis demonstrated that these oscillations were primarily of low frequencies, and the contribution of respiratory sinus arrythmia (RSA) to total power was low. In contrast, in adult dogs during sleep, the spectral distributions were peaked in frequency bands corresponding to mean respiratory rate, and the percent contribution of low frequencies to power was small. Furthermore, the mean R-R interval was considerably larger during expiration than during inspiration in adult dogs (showing 20-140% increase), but not in puppies (showing only -0.4 to 4.4% increase). We conclude that 1) the mechanisms responsible for RSA mature postnatally in the dog; 2) the magnitude of RSA depends on the state of consciousness in the adult dog, being greater in sleep than during wakefulness; and 3) low-frequency oscillations, not related to breathing and independent of sleep state, characterize the variations in the R-R interval in early life but are insignificant in the adult dog.

Animals↗
PubMed2001

Giant cell myocarditis, in a patient with Crohn's disease, treated with etanercept--a tumour necrosis factor-alpha antagonist.

Cardiac disease in association with inflammatory bowel disease (IBD) is uncommon. Reports include pericarditis, pericardial effusion, myocarditis, myocardial infarction, endocarditis and arrythmias. Myocardial inflammation related to IBD may be due to a drug hypersensitivity reaction or micronutrient deficiency, or may be secondary to the underlying IBD as an extraintestinal manifestation. In this setting, myocarditis usually presents as congestive heart failure and/or refractory arrhythmia. Prognosis varies among reported cases, including complete recovery, remission with recurrence and fatal disease. Treatment of myocarditis has included aminosalicylates and immunosuppressive medications. Recently, newer therapies for IBD have been developed, such as tumour necrosis factor-alpha (TNF-a) antagonists. The present report describes a case of a 46-year-old man with clinical and endoscopic evidence of moderately active colonic Crohn's disease who developed congestive heart failure due to giant cell myocarditis. Little clinical improvement occurred with immunosuppressive therapy. Only after the addition of etanercept, a TNF-a p75 receptor antagonist, did complete clinical resolution occur. These authors conclude that the use of TNF-a antagonists may be considered in the treatment of life-threatening extraintestinal manifestations of inflammatory bowel disease.

Acute Disease↗
PubMed1975

Aortic sinus of Valsalva aneurysms simulating primary right-sided valvular heart disease.

While acute regurgitation is the most common valvular lesion associated with aortic sinus of Valsalva aneurysms, this report describes the pathological findings in five patients in whom primary right-sided valve dysfunction was simulated by sinus of Valsalva aneurysms. In two patients aneurysms of the noncoronary sinus projected into the right atrium at the level of the tricuspid valve and caused tricuspid incomptence. In three patients aneurysms of the right sinus of Valsalva projected into the right ventricle immediately below the pulmonic valve and caused pulmonary outflow tract obstruction. In only one of these patients was the aneurysm perforated at necropsy. Although valvular dysfunction was evident clinically, in none was there a clinical suspicion of a sinus of Valsalva aneurysm. In addition to valvular dysfunction, two patients had conduction disturbances and two, right coronary arterial occlusions found to be the result of aneurysms. The risks of valve dysfunction, arrythmias, aneurysm rupture, and sudden death and the ability to correct this lesion surgically make it especially important to consider aortic sinus of Valsalva aneurysm as a cause of obscure right-sided valvular disease.

Adolescent↗
PubMed1988

Emergency stenting for acute occlusion after coronary balloon angioplasty.

Acute coronary artery occlusion complicates 2-12% of the balloon angioplasty procedures, and despite repeat angioplasty, emergency surgical revascularization is often necessary. We report our initial experience with the emergency implantation of endoluminal stents for acute vessel closure after coronary balloon angioplasty. Nine patients received one stent, and two patients received two stents during the study period. Implantation was technically successful in all patients; there were no deaths, no myocardial infarctions as evidenced by Q wave on the electrocardiogram, and no need for emergency surgery. One additional patient, not satisfying the study inclusion criteria, died 16 hours after stent implantation from left ventricular failure and intractable arrythmias. Two patients in the study group had a moderate creatinine phosphokinase rise during the first 48 hours after implantation. During a median follow-up period of 3 months (range, 1-20 months), there have been no deaths and no need for elective coronary bypass surgery. One patient required emergency recanalization 3 months after implantation because of acute occlusion of the stented segment with limited myocardial infarction. Six patients have undergone control angiography, and none has developed chronic restenosis within the stented segment. For selected patients, coronary artery stenting appears to be a promising alternative to emergency bypass surgery after acute vessel occlusion during balloon angioplasty.

Adult↗
PubMed1976

Effect of amiodarone on serum triiodothyronine, reverse triiodothyronine, thyroxin, and thyrotropin. A drug influencing peripheral metabolism of thyroid hormones.

2-n-Butyl-3-(4'-diethylaminoethoxy-3',5'-diiodobenzoyl)-benzofurane (amiodarone), a drug used in arrythmias and angina pectoris, contains 75 mg of organic iodine/200 mg active substance. Four studies were performed to test its effect on thyroid hormone metabolism: (a) nine male subjects were treated with 400 mg of amiodarone for 28 days; (b) five male subjects received, for the same period of time, 150 mg of iodine in the form of Lugol's solution; (c) five subjects received 300 mug L-thyroxine (T4) for 16 days; from the 10th to the 16th day, 400 mg of amiodarone was added; and (d) five euthyroid subjects received 300 mug L-T4 for 16 days. The changes in serum thyroid-stimulating hormone (TSH), serum total T4, 3,5,3'-triiodothyronine (T3), free T3, and 3,5',3'-triiodothyronine (reverse T3, rT3) were measured, and the pituitary reserve in TSH was evaluated by a thyrotropin-releasing hormone (TRH) test. The results show that amiodarone induced a decrease in serum T3 (28+/-5.1 ng/100 ml, mean+/-SEM, P less than 0.0S and 82.7+/-9.3 ng rT3/100 ml, P less than 0.01). The control study with an equal amount of inorganic iodine did not induce these opposite changes but slightly lowered serum rT3, T3, and T4. In the third study, serum rT3 increased as under amiodarone treatment, thereby proving that these changes were peripheral. It is suggested that amiodarone changes thyroid hormone metabolism, possibly by reducing deiodination of T4 to T3 and inducing a preferential production of rT3. Amiodarone also increased the response of TSH to TRH. The maximal increment of serum TSH above base line was 32+/-4.5 muU/ml under treatment and 20+/-3 muU/ml before treatment (P less than 0.01). During this test, the serum T3 increase was more pronounced than during the control period (83+/-13 and 47+/-7.4 ng/100 ml, P less than 0.05).

Adult↗
PubMed2006

Imaging of pericardial tumours: a case report.

BACKGROUND: Pericardial tumours are unusual and may be difficult to characterise with imaging. They manifest as large, non-contractile, solid masses within the pericardium. Presenting symptoms include heart failure, arrythmias, sudden death, cyanosis and chest pain. CASE PRESENTATION: We describe a case of massive pericardial fibroma in a 52 year old woman, who presented with palpitations only. CONCLUSION: We illustrate the different imaging modalities available to image this tumour prior to surgical resection, and indicate the strengths and weaknesses of each.

Echocardiography↗
PubMed2006

Off-pump coronary artery bypass grafting for acute myocardial infarction.

BACKGROUND: The aim of this study was to evaluate the surgical results of off-pump coronary artery bypass grafting (OPCAB) for patients with acute myocardial infarction (AMI) within 14 days of the infarction. METHODS AND RESULTS: From April 2000 to January 2005 among 841 patients who underwent OPCAB, 43 consecutive patients (5.1%) were examined. Mean age at operation was 69.5 years and mean time from the onset of AMI to surgery was 4.6 days. Seventeen patients (39.5%) had left main trunk disease. Three patients (7.0%) underwent OPCAB following unsuccessful percutaneous coronary intervention, and 1 patient (2.3%) underwent redo procedure 9 years after previous coronary artery bypass grafting (CABG). Six patients (14%) were admitted in cardiogenic shock. Intraaortic balloon pumping was inserted preoperatively in 20 patients (46.5%). The average maximum creatine kinase-myocardial band was 139+/-181 (U/L). The mean number of grafts was 3.2 and the rate of complete revascularization was 91%. Two of six patients with preoperative cardiogenic shock were converted to on-pump beating CABG due to ventricular arrythmia. The early graft patency rate was 98%. All patients survived except 2 with preoperative cardiogenic shock. CONCLUSIONS: OPCAB can be performed after AMI as a relatively low-risk procedure with an acceptable mortality rate, even within 14 days of the infarction.

Aged↗
PubMed1976

A clinical study on familial heart diseases.

Clinical pictures of 107 cases of familial heart diseases belonging to 30 families were studied. 1. Initial manifestations frequently observed were palpitation, chest pain, becoming aware of irregular heart beats, dyspnea and a syncopal attack. The initial manifestation was most frequently observed in the second or the third decade. In familial idiopathic cardiomyopathy a systolic murmur was the most common auscultatory findingd followed by the third and fourth heart sounds. 2. The cardiothoracic ratio was not necessarily increased. 3. In the ECG of familial idiopathic cardiomyopathy, arrythmia was frequently observed. A-V block was rare but a premature ventricular contraction was frequent. During a syncopal attack, the ECG showed ventricular trachycardia. An abnormal Q-wave, ST segment depression and a negative T-wave were also observed but their incidence did not differ from one lead to the other. Some cases of familial heart diseases showed QTc-prolongation but QTc was not over 0.47 seconds and was not as markedly prolonged as in familial QT-prolongation syndrome. 4. A similarity of clinical findings was observed among cases belonging to the same family. There was a striking similarity among the patients belonging to the same family in initial symptoms, characters of a systolic murmur, morphology of the cardiac silhouette, morphology of an abnormal Q-wave or ST segment depression and in the leads which showed these abnormalities. 5. The most frequent mode of death was sudden death. A cardiothoracic ratio of 0.6 or more, an abnormal R-wave in V1 suggesting high dorsal wall damage, left axis deviation, and the low voltage of Sv1 + Rv5 of 1.5 mV or less suggested a poor prognosis.

Adolescent↗
PubMed1993

Effects of phospholipase C on action potentials and intracellular Ca2+ concentration in guinea pig heart.

To clarify the role of phospholipase C (PLC) in arrythmias and cell injury during myocardial ischemia/reperfusion, we studied its effects on electrophysiology and [Ca2+]i in guinea pig hearts. After exposure to PLC (1 and 2 U/ml), the action potential durations of right ventricular papillary muscles were decreased. Delayed afterdepolarizations were observed in all of the preparations, and some developed into triggered activities. Developed tension decreased after an initial increase for the first 5 min, while resting tension increased consistently. The effects of PLC (0.02, 0.1, and 0.2 U/ml) on [Ca2+]i of ventricular myocytes were measured using fura-2 fluorescence. The ratio of rod-shaped cells to all cells decreased in a time- and a concentration-dependent manner. Perfusion with 0.1 U/ml PLC elevated [Ca2+]i from 56 +/- 5 nM to 245 +/- 47 nM before cell rounding, and to 1167 +/- 172 nM after cell rounding, suggesting that PLC causes Ca2+ overload. In conclusion, activation of PLC may play a role in arrhythmias and cell injury during ischemia/reperfusion. The increase in [Ca2+]i during ischemia/reperfusion may activate phospholipase, which would further increase [Ca2+]i to form a vicious cycle.

Action Potentials↗