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PubMed2004

[Single nucleotide polymorphism in SCN5A and the distribution in Chinese Han ethnic group].

Mutations in voltage-gated sodium channel type (SCN5A) may evoke severe, life-threatening disturbances in cardiac rhythm, including long QT syndrome, idiopathic ventricular fibrillation (Brugada Syndrome), and isolated cardiac conduction disease. There is increasing awareness of the role of common polymorphisms in altering gene function and in susceptibility to diseases. The aim of the present study was to investigate single nucleotide polymorphism (SNP) in SCN5A gene and the distribution of these identified SNPs in Chinese Han nationality. SCN5A gene was sequenced by fluorescent labeling automatic sequencing method in 120 unrelated samples from Han nationality in South China. Allele frequency distribution was tested by Hardy-Weinberg equilibrium. The results showed that a total of 5 SNPs were identified in SCN5A gene, including three SNPs in code region, one SNP in regulatory region and the other in intron 23 adjacent to donor splicing site. The distribution of the SNPs in SCN5A gene was uneven. These allele frequencies in Han population of South China were as follows: G87A (A29A) 27.5%, A1673G (H588R) 10.4%, 4245+82A>G 32.8%, C5457T (D1819D) 41.3% and G6174A 44.9% respectively. The SNPs G87A (A29A), 4245+82A>G and G6174A were reported for the first time. There was no significant difference in the allele frequency of A1673G (H558R) within different ethical populations (P>0.05). C5457T (D1819D) allele frequency of Han population in South China was similar to that observed in Japanese (P>0.5), but higher than that in American (p<0.005). There was no significant difference in the distribution of the SNPs between male group and female group (all p>0.05). S1102Y and other 10 SNPs identified in other ethnic populations have not been detected in Chinese Han population. The allele distribution of SNPs was in good unity with the Hardy-Weinberg equilibrium. It is suggested that the SNP distribution of SCN5A gene varies within different nationalities. These data will be of use for genetic association studies of acquired arrythmias and investigation of sensitivity to drug therapy.

Arrhythmias, Cardiac↗
PubMed1979

[Cardiac anti-arrhythmic effect of various N-substituted piperazine derivatives with respect to aconitine in the rat].

Anti-arrhythmic activity of some piperazine derivatives has been investigated upon cardiac arrythmia induced by aconitine in albinos rat. Among mono-substituted derivatives trimetazidine is active. Among di-substituted derivatives cinepazide and hydroxyzine are active but medibazine have a doubtful activity and piribedil and cinnarizine are devoid of activity.

Aconitine↗
PubMed2004

[Cardiotoxicity of 5-fluorouracil].

5-fluorouracil (5FU) is a largely employed antimetabolite, responsible for several well-known toxicities like hand-foot syndrome, diarrhoea, mucositis or leucopenia. Cardiotoxicity of 5-FU is known but uncommon and usually not life-threatening. The incidence has varied from 1.5 and 18%. The physiopathology is controversial, although more recent data suggest a myocardial toxicity. Clinical presentation include chest-pain, cardiac arrythmia, myocardial infarction or global cardiac failure. Electrocardiographic features are usually aspecific, with ischemic signs. The main treatment is to stop the 5-FU infusion and to introduce symptomatic cardiologic treatment. Although the prognosis is good, the mortality ranges between 2.2 and 13% in case of symptomatic cardiotoxicity. Secondary prophylaxis remains controversial.

Antimetabolites, Antineoplastic↗
PubMed2004

[Cardiac toxicity of cancer treatment regimes in children and adolescents: physiopathology, clinical data and the paediatric oncologist's point of view].

Over the last 20 years, the increase in the cure rate of childhood cancer and leukemia of almost 80% has facilitated the observation of middle and long-term sequelae, particularly of cardiovascular origin; such after-effects are the consequence of cytotoxic damage to the cells of the cardiovascular system, in particular by anthracyclines and radiotherapy, and all the more so by their combined use. Such destructive lesions to myocytes greatly hinder the capacity of the cardiac muscle to hypertrophy to meet the needs of bodily growth, pregnancy and certain intense sports activities. Endothelial cells also accelerate an early arteriosclerotic process, a potential cause of sudden death in the case of ostial stenosis. All such phenomena build up over time, together with the usual adult cardio-vascular risk factors. Finally, no cardiac tissue, pericardial, valvular endocardium or autonomic nervous tissue escapes these cytotoxic effects, giving rise to pericarditis, calcification, valvular leaks and arrythmias and conduction abnormalities. The resulting excessive cardiac mortality is one of the major concerns of paediatric oncologists, along with secondary tumours and leukaemia. This article analyses physiopathological consequences that are often asymptomatic or clinical, together with diagnostic, screening and follow-up methods for these patients, encouraging lifestyle modifications where appropriate or, when possible, treatment before the appearance of cardiac failure, myocardial infarction or sudden death. Other cytotoxic drugs such as high-dose cyclophosphamide, amsacrin, 5-FU and tubulin acting agents are also mentioned as a result of their cardiac toxicity, but this is not usually dose-cumulative.

Adolescent↗
PubMed2005

[Non-compaction of the myocardium in childhood].

Non compaction of the ventricular myocardium is a rare and severe myocardiopathy with numerous trabeculations and deep intertrabecular recesses directly connected with the ventricular cavity. Many complications may occur: heart failure, arrythmia, thrombotic events. However, phenotypic and genotypic presentations vary. Non compaction affects infants in almost half of the cases. A pediatric national cohort study (directed by the filiale de cardiologie pédiatrique de la société française de cardiologie) should allow to analyse the clinical and epidemiological characteristics of the patients as well as to accurate both non compaction's diagnosis and prognosis. Inclusion criteria of this retrospective multicenter study were: age lesser than 18, echographic and/or histologic criteria of non compaction, no congenital heart disease such as pulmonary atresia. This population included 38 patients: 21 were asymptomatic at diagnosis. Ten familial forms were detected. The ECG was abnormal in 77% of the cases, the chest-X ray in 80%. Echocardiography remains the usual technique for diagnosis. However, previously reported quantitative criteria are not easy to use in a retrospective study. Treatment was symptomatic as the etiology of non compaction is unknown. The prognosis is severe: 31.5% of the patients died or had a cardiac transplantation. Only 30% of the patients were free of cardiac events for a 2-year period. Inclusion of new patients must go on to set up a prospective study and biomolecular analysis in informative families.

Adolescent↗
PubMed1992

[Adrenal gland pheochromocytomas. Apropos of 35 operated patients].

Thirty-five patients (20 female and 15 male, mean age = 47 years) operated on for an adrenal pheochromocytoma were reviewed. Catecholamine excessive production was symptomatic in 33 patients (94%). Urinary excretion of vanyl-mandelic acid, catecholamines and metanephrine was abnormal in 84%, 75% and 90% of cases, respectively. Tumor was presumed benign (no metastasis) in 31 cases. Sensitivity of CT scan (n = 35) and magnetic resonance imaging (n = 13) was 100%. Meta-iodo-benzylguanidine scan (n = 19) always recognized the main tumor, but did not visualize 1 second tumor in 1 patient and 1 metastasis in 1 other patient. An anterior intraperitoneal approach was performed in all cases. Operative mortality rate was 5.7%. In the last 15 patients, systematic preoperative treatment by prazosine did not lead to fall in rates of peroperative arrythmia and hemodynamic disorders. Twenty-two of 25 (88%) hypertensive patients remained normotensive without medication postoperatively. The risk of undiagnosed pheochromocytoma and problems in resection of large right-sided tumors are discussed.

Adolescent↗
PubMedDate not supplied

[Sudden cardiac death: state of the art].

Sudden cardiac death (SCD) is an integral term for several heart diseases among which SCD caused by ischemic heart disease (IHD) designated as sudden coronary death (SCD) ranks first. SCD associated with alcoholic cardiomyopathy ranks second. Risk factors and pathologic manifestations of SCD correspond to those of IHD, atherosclerosis, myocardial infarction. Cardiac arrest takes place because of fibrillation of ventricular myocardium. Factor inducing fibrillation is an advanced irreversable myocardial ischemia complicated with reperfusion. The latter promotes elimination of arrythmogenic substances from the ishemic zone leading to electric unstability of the myocardium and fatal arrythmia. Possibility of idiopathic ventricular fibrillation and its mechanisms is discussed.

Cardiomyopathy, Alcoholic↗
PubMed2005

Clinical trials using autologous bone marrow and peripheral blood-derived progenitor cells in patients with acute myocardial infarction.

This paper discusses the current data concerning the results of major clinical trials using bone marrow-derived and peripheral blood-derived stem/progenitor cells in treatment of patients with acute myocardial infarction (AMI) and depressed left ventricular ejection fraction. In all major trials (TOPCARE-AMI, BOOST), the primary outcome measure was increase in left ventricular systolic function (LVEF) and left ventricle remodeling. The most consistent finding is the significant increase in LVEF. Some trials suggest also reduction of left ventricular remodeling. Although the absolute LVEF increase is small (6-9%), it may substantially contribute to the improvement of global LV contractility. None of the studies in AMI patients treated with intracoronary infusion of progenitor cells revealed excess risk of arrythmia, restenosis or other adverse effects attributable to the therapy. The exact mechanism of improved myocardial contractile function remains unknown, however, there are several possible explanations: therapeutic angiogenesis improving the blood supply to the infarct border zone, paracrine modulation of myocardial fibrosis and remodeling (e.g. inhibition of myocyte apoptosis) and transdifferentiation of stem/progenitor cells into functional cardiomyocytes. No study showed the superiority of the particular subpopulation of autologous progenitor cells in terms of left ventricular function improvement in AMI. In fact, most of the clinical trials used the whole population of mononuclear bone marrow-derived progenitor cells, peripheral blood derived progenitor cells (endothelial progenitors).

Acute Disease↗
PubMed1976

[Technics, value and limitations of hemodilution in extracorporeal circulation].

Hemodilution during E.C.C. is into use for more than 15 years. Its interest is obvious (blood economy, beneficient action on viscosity, prevention of "sludging"), but opinions are different concerning the best level of hemodiultion. The authors defend the notion of a moderate dilution (hematocrit larger than or equal to 25 p. 100) required to maintain a high perfusion pressure. For atherosclerotic patients, they describe the hemodilution technics tried on more than 4,000 cases since 1964. The advantages of hemodilution concern on one hand the diminution or the disparition of drawbacks and complications due to the obtainment and to the administration of homologous blood and on the other hand the beneficient intrinsical effects of the blood dilution on the tissular perfusion. In convenients are those due to changes in the concentration of sodium, chlore and specially potassium which may be responsible of serious cardiac arrythmias. Because of increasing difficulties concerning the use of homologous blood (obtaining difficulties and complications relative to its use), the authors consider the utilization of autologous blood taken off before the operation on the patient and freezed.

Blood Viscosity↗
PubMed1991

Infantile spasms. A retrospective study of 105 cases.

This paper is a summary of our observations on 105 cases of infantile spasms. The age of onset was around six months after birth, but the patients came for treatment mainly about one year after onset. Fever of unknown cause, asphyxia, birth injury, infection of the central nervous system, tuberous sclerosis, phenylketonuria and recent immunization etc. were complained. Clinically, it is characterized by head nodding, mental retardation, myoclonic jerks and various neurologic deficits. EEG findings showed classical or modified arrythmia or other epileptiform patterns. About one third of 22 cases examined had abnormal brain stem auditory evoked potentials. Among 42 patients who underwent CT scanning before ACTH treatment, 18 were normal and 7 abnormal; during ACTH treatment 3 normal and 4 abnormal; after completion of treatment, 4 normal and 6 abnormal, suggesting no further atrophy of the brain. Examination of trace elements of the hair by particle-induced X-ray emission (PIXE) method in 23 patients revealed a significant difference in lead, calcium and zinc contents between patients and 101 controls, but no statistical difference in iron and copper contents between the two groups. Sodium valproate, prednisone and ACTH appear to be effective in the treatment of infantile spasms. Eight patients fully recovered, and they can go to school without difficulty. Many patients derived various degrees of improvement to the satisfaction of their parents. Two patients were still amented and often attacked by myoclonus. The effects, side effects of these drugs, and the possible pathogenesis were discussed.

Adrenocorticotropic Hormone↗
PubMed2006

[Purkynje fibers of the heart conduction system--history and the present time].

It has been 160 years now since Purkynje published the finding of conduction fibers in the heart in Archiv f. Anatomie u. Physiologie and it has been 166 years since his publication in polish version. Already during Purkynje's life, some anatomists had solved the morphology of these fibers but nobody at that time knew of what great physiological and medical importance this discovery would be for medicine. It was seen as late as in the 20th century and in contemporary times. Purkynje's work indicated the cascade of these discoveries, which were leading in the beginning of the previous century to the formulation of the basic scheme of the conduction system. Purkynje fibers or Purkynje cardiomyocytes are part of the whole complex of the cardiac conduction system which today is classified as specific heart muscle tissue, being responsible for the generation of the heart impulses. From the point of view of ultrastructural composition, the cells of different parts of the cardiac conduction system are partly similar. In contrast to the heart contractile cardiomyocytes, the cells of the cardiac conduction system including Purkynje fibers have a small amount of myofibrils,small mitochondrias, light cytoplasm and a higher glycogen content, but no T-tubular system. They can be detected with some morphological methods. Nevertheless the cells of the conduction system are not completely uniform. They differ in size, number of nexuses-gaps and intercalar discs in individual parts of the conduction system. Nevertheless, these specialized cells work as a whole-unit. Nowadays, the morphology research of all the parts of cardiac conduction system, including Purkynje fibers, is focused on ultrastructural, histochemical and genetical problems. The question is, wheather with future gene/cell therapy disturbances of the conduction system such as arrythmias, can be prevented and cured by replacing the electrical pacemakers with biological ones. If Jan Evangelista Purkynje lived today, he would be surprised but surely delighted with the high degree of research concerning his discovery and its clinical application.

Animals↗
PubMed2004

[Prevalence of atrial fibrillation and use of warfarin among patients with ischemic stroke.].

OBJECTIVE: Atrial fibrillation (AF) is the most common sustained cardiac arrythmia and a significant cause of morbidity. Stroke and transient ischemic attack (TIA) are well known serious complications of AF. In the last decade, a number of studies have shown that the risk of stroke in patients with AF is reduced by anticoagulation therapy with warfarin. The aim of this study was to assess the prevalence of AF in patients with acute ischemic stroke or TIA and to look at the use of anticoagulation therapy in patients who either had a previously known AF or were diagnosed to have AF during hospitalisation for ischemic stroke or TIA. METHODS: Medical records of 918 patients admitted to Landspitali University Hospital in Iceland in 1997-2000 with the diagnosis of TIA or ischemic stroke were reviewed to detect a subgroup with AF. In addition to demographic data and cardiac function studies, information was collected about other possible coexisting stroke risk factors. RESULTS: A total of 159 patients (17%) had AF in 124 (78%) of whom the AF was previously known. In 35 patients AF was diagnosed during the hospitalisation.The majority of those patients also had at least one other risk factor for stroke. On admission, 27 patients (22%) of those with previously known AF were being treated with warfarin. In eleven (41%) the anticoagulation was subtherapeutic as the INR was found to be lower than 2,0. At discharge, 74 patients of those 131 (56%) who were alive were receiving warfarin anticoagulation. CONCLUSION: The prevalence of AF in patients with TIA or ischemic stroke was somewhat high in this study. AF and other risk factors for stroke were found to commonly coexist. Despite the well documented effect of warfarin in such patients, this therapy was underused for both primary and secondary stroke prevention.

English Abstract↗
PubMed1991

Cardio-vascular effects of vecuronium & pancuronium in patients undergoing elective closed mitral valvotomy.

Vecuronium, a monoquaternary analogue of pancuronium, the neuromuscular blocker, was compared with pancuronium in 50 patients undergoing elective closed mitral valvotomy. The patients were randomly divided into two groups of 25 each, and the muscle relaxants were administered in a dose of 0.1 mg/kg body weight. Both the agents produced identical intubating conditions at 3 min. Vecuronium showed a significantly shorter onset of action, as compared to pancuronium. The latter significantly increased the heart rate throughout the period of study whereas vecuronium significantly decreased the heart rate, 25 min after administration. There was significant increase in the mean arterial pressure (MAP) at tracheal intubation in both the groups, which persisted throughout the period of study in pancuronium group. There was a significant fall in MAP at 30 min after relaxant in vecuronium group. The incidence of arrythmias was similar and significant in both the groups. Vecuronium, thus showed a quicker onset of action with minimal haemodynamic effects, as compared to pancuronium in patients undergoing closed mitral valvotomy.

Adolescent↗
PubMed2006

[Incidence, pathogenesis and importance of nocturnal hypoxaemia in patients with chronic obstructive pulmonary disease].

Noctural hypoxaemia (NH) in patients with chronic obstructive pulmonary disease (COPD) was first described over 40 years ago, however, its importance is not fully established. NH is defined most frequently as a drop in oxygen saturation below 90% and it occurs in almost all COPD patients PaO2 < 55 mmHg and in 30-40% of those with PaO2 < 60 mmHg. The main reason for NH is alveolar hypoventilation which is most pronounced during ohase REM. It is known that even short term episodes of NH increase pulmonary artery pressure, yet, the impact of chronic, isolated NH on pulmonary hypertension development was not found. Also, the relationship of induced by NH cardiac arrythmias with sudden death in COPD was not documented and association of NH with prognosis in COPD was not proved. Actually, there is no need to perform NH examination routinely. According to the ATS/ERS latest standards, the determination of NH can be helpful to qualify COPD patients with PaO2 55-65 mmHg to longterm oxygen therapy.

Causality↗
PubMed2006

[Subclinical hypothyroidism influences ventricular repolarization measured by QTc interval].

UNLABELLED: Thyroid disorders exert a major effect on cardiac function and on ECG. Few studies examined the effect of thyroid hormones on ventricular repolarization, measured by corrected QT interval (QTc). Prolonged QTc is associated with increased risk of arrythmias and cardiac mortality. The aim of this study was to examine the influence of subclinical hypothyroidism on ventricular repolarization measured by corrected QTc in standard 12-lead electrocardiogram. The examined group consisted of 32 patients with hypothyroidism, the controls were 39 healthy individuals. The mean corrected QTc was 0.434, SD +/- 0.0296 seconds and 0.414, SD +/- 0.0208 in the examined groups and in controls, respectively (p < 0.01). QTc did not correlate with free thyroxine concentrations (p = 0.4064). In the group with subclinical hypothyroidism we did not observe a significant difference in heart rate (74.3 vs. 73.7, SD +/- 13.58, NS). CONCLUSION: Corrected QT intervals were significantly prolonged in patients with subclinical hypothyroidism.

Arrhythmias, Cardiac↗
PubMed1991

[Salvage chemotherapy with IMV-triple P for relapsed or refractory malignant lymphoma].

Twelve patients with relapsed or refractory malignant lymphoma were treated with IMV-triple P regimen consisting of ifosfamide (IFM), mitoxantrone (MIT), vindesine (VDS), pepleomycin (PEP), procarbazine (PCZ) and prednisolone (PDN). Three of 12 patients achieved complete remission (CR), and 5 patients achieved partial remission (PR). Hence, the overall response rate was 66.7% (8/12). Of 9 relapsed patients who had attained CR after the former chemotherapy, 3 had CR and 4 had PR. The overall response rate was 77.8% (7/9). Side effects were relatively mild, including leukopenia (less than 1,000/microliters) (33.3%) and thrombocytopenia (less than 5 X 10(4)/microliters) (8.3%). There was no severe cardiac toxicity such as heart insufficiency and severe arrythmia. These results suggest that IMV-triple P regimen is effective in the treatment of relapsed or refractory malignant lymphoma.

Adult↗
PubMed1995

Study of different risk factor profiles in stroke patients in Alexandria.

The study included 94 stroke cases. They were admitted at the Internal Medicine Department between October 1994 and March 1995. For each case studied, an attempt was made to obtain, from the same hospital, age and sex matched control patient. The aims of this work are to identify different stroke risk factors and to measure the strength of association of the different risk factors and stroke. Results of this work revealed that hypertension, diabetes mellitus, ischemic heart diseases, arrythmias possible symptoms of transient ischemic attacks and android type of fat distribution are major risk factors of stroke in Alexandria. This necessitates initiation and continuation of stroke control program in Alexandria.

Adult↗
PubMedDate not supplied

Recovery of end-stage organ dysfunction by circulatory assist.

To clarify the effectiveness of left ventricular assist on recovery of critical organ dysfunction, 18 patients with ventricular septal rupture or free wall rupture after acute myocardial infarction were retrospectively studied. Fifteen patients were managed with an intraaortic balloon pump (IABP group), and three with a left ventricular assist device (LVAD group) after surgery. In the IABP group, nine patients survived and six died. There were no significant differences between survivors and nonsurvivors with respect to age, cardiopulmonary bypass time, or preoperative renal function. In addition, there were no significant differences in the early postoperative changes in cardiac index. Larger doses of catecholamines were required in nonsurvivors than in survivors, however; blood urea nitrogen and creatinine levels were significantly higher in nonsurvivors than in survivors, and the nonsurvivors' creatinine clearance values stayed under 20 ml/min during the postoperative course, so that all nonsurvivors required renal assist. All in the LVAD group were weaned. Two patients were lost, however, because of cardiac arrythmia and massive gas embolism. Cardiac index in the LVAD was maintained at over 2.1 L/min/m2 with a minimum dose of catecholamines, regardless of poor left ventricular function, and creatinine clearance recovered to over 20 ml/min during circulatory assist. From these data, high doses of catecholamines depressed renal function after surgery. Therefore, it has been concluded that the major role of circulatory assist is to maintain more of the physiologic circulation with minimum doses of drugs.

Aged↗