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PubMedDate not supplied

Proarrhythmic effects of class Ic drugs.

Three cases managed with class Ic antiarrhythmic drugs but with subsequent aggravation of arrhythmias are reported herein. A 58-year-old man given 300 mg of flecainide for atrial flutter developed sinus arrest and transient ventricular fibrillation. A 42-year-old man with a postoperative condition of tetralogy of Fallot who received 300-mg doses of flecainide for sustained ventricular tachycardia had spontaneous sustained ventricular tachycardia. A 74-year-old man given 150 mg of propafenone for atrial tachycardia developed sustained ventricular tachycardia. The present cases illustrate that class Ic drugs may exacerbate ventricular arrhythmias, and their use may reveal concealed sinus node dysfunction. This may be due to marked slowing of conduction and prolonged ventricular refractoriness, which are characteristic of the class Ic drugs; also, it is probable that the patients' underlying cardiac conditions served as contributing factors.

Adult↗
PubMed1993

A case report of siblings with hypertrophic cardiomyopathy that progressed to dilated cardiomyopathy--case reports.

The authors encountered 2 brothers with hypertrophic cardiomyopathy (HCM), both of whom were later found to have progressed to dilated cardiomyopathy (DCM). Case No. 1 (younger brother): A diagnosis of HCM without left ventricular (LV) dilatation was made at age two by cardiac catheterization and echocardiogram. However, he had been well until age thirteen when dyspnea developed. Echocardiograms showed LV wall thickening (septum 20 mm, and posterior 18 mm) and LV dilatation (left ventricular diastolic diameter [LVDd] 60 mm) accompanied by LV dysfunction (ejection fraction [EF] 18%). At autopsy, the heart weighed 875 g and showed LV dilatation with thickened walls. Case No. 2 (elder brother): At age twelve, he was found to have an increased heart size on x-ray when his family was evaluated owing to his brother's condition. Cardiac catheterization and echocardiogram showed HCM without LV dilatation. He remained asymptomatic until age twenty when dyspnea developed, at which echocardiography showed a dilated LV. The authors speculate that the HCM with progression to DCM is an atypical type of familial HCM and that progression to DCM is genetically determined.

Adolescent↗
PubMedDate not supplied

3-D mapping of body surface potentials.

A new system has been developed in which the human body surface potentials are displayed in a 3-dimensional format using computer graphics. A wire-frame model of the human torso is constructed using geometrical data from several cross-sectional slices. The body surface potentials are measured and the isopotential lines drawn. By mapping the co-ordinates obtained with the isopotential line subroutine to the X, Y and Z torso arrays, a 3-dimensional representation of the depolarization wave travelling across the body surface can be displayed. The deviations from its normal path are clearly seen in the 2 clinical cardiac conditions presented (right bundle branch block and left ventricular premature beat). The increased realism and spatial resolution, as compared to ECG and the 2-dimensional contour map, lead to a clear understanding and interpretation of the underlying electrical phenomena of the heart while making a diagnosis or presenting experimental results.

Bundle-Branch Block↗
PubMed2006

Pre-closure of femoral venous access sites used for large-sized sheath insertion with the Perclose device in adults undergoing cardiac intervention.

BACKGROUND: Interventional procedures in adults with congenital cardiac conditions often require insertion of large-sized sheaths into the femoral veins. Data on the use of suture-mediated devices for femoral venous access site closure are scant and no data are available regarding venous patency after device use. OBJECTIVE: To assess the efficacy of the 6Fr Perclose (Abbott Vascular Devices, CA, USA) suture-mediated device in achieving haemostasis and venous patency after closure. DESIGN AND SETTING: 146 consecutive patients (80 women, mean (SD) age 45 (14) years) undergoing closure of 205 femoral venous access sites in a tertiary cardiac centre were studied. All received heparin and were taking concomitant aspirin or clopidogrel, or both. The majority (98%) had a >or=10Fr sheath inserted. RESULTS: Immediate haemostasis was achieved in 202 (99%) sites. Two patients (1.4%) had a major complication. On follow-up (111 patients, mean (SD) 71 (33) days) there was no evidence of haematoma or fistula formation. Doppler studies from a subgroup of 43 (29%) patients (mean (SD) age 45 (15) years, mean (SD) follow-up 47 (18) days) showed a common femoral venous diameter of 11.6 (2.7) mm on the device closed right and 12.2 (2.5) mm on the left vein (p>0.05). All accessed veins were patent with no pseudoaneurysm or arteriovenous fistula formation. CONCLUSION: Pre-closure of large-size sheath femoral venous access sites using the suture-mediated Perclose device is efficacious in achieving rapid haemostasis in the presence of anticoagulation. Doppler follow-up shows no loss of venous patency or luminal venous diameter as compared with the contralateral side.

Aged↗
PubMedDate not supplied

Transcranial Doppler assessment of cerebral embolic disorders.

Transcranial Doppler ultrasound allows noninvasive monitoring of the large intracranial vessels. Microembolic signals (MES) have been observed under a variety of circumstances, especially in symptomatic carotid stenosis, high-risk cardiac conditions, and surgical procedures (such as carotid endarterectomy and cardiopulmonary bypass surgery). Technical considerations have presented numerous challenges to the interpretation of these signals, many of which appear to represent small emboli traveling in the blood flow. The technical aspects of these MES are discussed and their significance in relation to cerebral ischemia and its prevention are examined in some detail.

Artifacts↗
PubMed1993

Tissue gas stores of the body and head-out immersion in humans.

Breath-by-breath gas exchange was studied in 10 subjects during and after transitions between dry conditions and head-out immersion in thermoneutral conditions. Cardiac index (CI) was estimated by means of impedance cardiography. Previous largely qualitative models of changes in tissue gas stores after blood volume shifts could be confirmed and extended to include a quantitative analysis of O2 and CO2 tissue stores. An increase in CI by 47.0% during immersion was associated with an increase in the tissue O2 stores by 122 ml/m2 and a decrease in the tissue CO2 stores by 148 ml/m2. The time constants for the recovery of O2 uptake (tau O2) and CO2 elimination after initial increases after the dry-to-immersion transition were 32.4 and 79.3 s, respectively. The decrease in CI on return to the dry conditions was associated with a drop in tissue O2 stores and a tau O2 of 144 s. The increase in tissue O2 stores during immersion as well as the difference in tau O2 between the two transitions were larger than could be explained by the change in CI only. This was attributed to changes in the distributions of peripheral blood flow and venous blood volume. Compared with the O2 stores, the decrease in CO2 stores was better predicted by the change in CI. The present results emphasize that the changes in pulmonary and tissue gas exchange imposed by head-out immersion transients mainly reflect movement of gas in and out of body stores.

Adolescent↗
PubMedDate not supplied

Cardiovascular causes for sudden infant death.

Although sudden infant death syndrome (SIDS) is a cause for sudden infant death, other causes should be ruled out before diagnosing SIDS. Cardiac causes for sudden infant death include viral myocarditis, congential heart disease particularly congential aortic stenosis, endocardial fibroelastosis, and anomalous origin of the left coronary artery from the pulmonary artery. Other cardiac conditions that may result in sudden death include rhabdomyomas of the heart in tuberous sclerosis and conduction system disorders. The most frequent conduction system disorders resulting in sudden death include histiocytoid cardiomyopathy, congential heart block that may be associated with maternal lupus erythematosus, arrhythmogenic right ventricular dysplasia, noncompaction of the left ventricle, and long QT syndromes.

Arrhythmias, Cardiac↗
PubMed1980

Suicide attempt by pacemaker system abuse: a case report with comments on the psychological adaptation of pacemaker patients.

Thirty patients selected at random from a pacemaker clinic were interviewed to gain an understanding of how psychological symptoms in these patients related to their cardiac condition. In 20% veiled depression or even a wish to die was elicited. Joking, fantasies, and denial were common psychological mechanisms used to adapt to their illness and the pacemaker itself. A dramatic example of attempted suicide in which the patient tried to cut the subcutaneously implanted pacemaker leads is presented and illustrated.

Adaptation, Psychological↗
PubMed1975

Generalized pulmonary hyperinflation and Fallot's tetralogy in a neonate investigated by pulmonary physiological and radioisotopic methods.

An infant is described who presented a complex cardiopulmonary problem which was evaluated with the help of new physiological techniques. the infant was born at term after an emergency Caesarian section for fetal distress and was found to have meconium aspiration. He remained persistently tachypnoeic and hypoxic despite high ambient oxygen. Chest radiography suggested cystic lesions at the lung bases, and lung function tests confirmed hyperinflation with delayed nitrogen washout. In addition the child had signs of Fallot's tetralogy, and this diagnosis was confirmed by cardiac catheterization. Because of persistent hypoxia and tachypnoea disproportionate to the cardiac condition, the possibility of localized lung disease was considered. Regional lung function tests were carried out in the neonatal period and again at six months of age useing radioisotopic 13N given by both inhalation and injection. These studies showed gross ventilation/perfusion imbalance in the lungs, particularly marked at the bases, but with enough generalized abnormality to preclude the possibility of surgical intervention. The principles of the measurement of lung mechanics in the newborn by whole-body plethysmography, nitrogen washout, and regional radioisotopic spirometry are outlined. The particular value of these techniques in the evaluation of complex disorders is discussed, especially where both cardiac and pulmonary abnormalities are present.

Airway Resistance↗
PubMed1964

THE ROLE OF SURGERY IN THE TREATMENT OF TRANSPOSITION OF THE GREAT VESSELS.

In 28 infants and children with complete transposition of the great vessels, atrial septal defects were created utilizing an open technique with inflow caval occlusion and moderate hypothermia. Of the 12 infants for whom operation was necessary during the first two weeks of life only two survived, suggesting that this technique is not adequate for infants at this age. Only four of the 16 children operated on between the ages of two weeks and three years failed to survive. Two of these died because of pre-existing non-cardiac conditions. Seven children with associated systemic-to-pulmonary shunts survived; the open technique may be preferable in this particular group. Despite the initial improvement afforded by this procedure, three sudden late deaths occurred. For this reason, and because of the danger of early development of pulmonary vascular disease, total operative correction of the malformation should be performed early.

Angiocardiography↗
PubMed1998

Genetics of congenital heart disease: strategies.

Congenital malformations of the heart are the most common of all birth defects. Traditionally, a multifactorial model combining genetic predisposition with environmental influence has been cited as the cause of greater than 90% of heart disease. This may be too broad inasmuch as linkage analysis combined with the explosion of information derived from the Human Genome Project has allowed the identification of genetic defects for many types of acquired and congenital diseases of the heart. This review provides a summary of cardiac conditions for which genetic etiologies are apparent, as well as an introduction to some basic clinical genetic concepts. Despite significant advances, it is important to remember that we are still very early in our understanding of the relationship of genotype to phenotype and that the clinical implications of the genetic defects identified are incompletely understood and have only begun to be studied.

Aortic Valve Stenosis↗
PubMed2002

The need for paediatric palliative care in New Zealand.

AIM: To estimate the incidence of life-limiting conditions requiring palliative care in New Zealand children. METHODS: Mortality data was obtained for all children who died aged 0-17 years during the period 1996-1998. Based on the cause of death and hospitalisation data, cases were classified as either 'palliative' or 'not palliative'. A separate analysis was performed to allow comparison with overseas estimates of paediatric palliative care need. RESULTS: Of a total of 2,122 deaths during the study period, 348 cases (16%) were assessed as potentially having required palliative care, giving a rate of 1.14 per 10 000 children per year. 37% of these deaths were due to cancer, 11% cardiac conditions, 24% congenital anomalies, and 28% other conditions. 29% of these children died in hospital. CONCLUSIONS: The findings of this study are consistent with estimates from overseas studies and will be valuable in planning paediatric palliative care services in New Zealand.

Adolescent↗
PubMed2006

Pitfalls in the diagnosis of left ventricular hypertrabeculation/non-compaction.

Left ventricular hypertrabeculation/non-compaction (LVHT) is a cardiac abnormality, characterised by >3 trabeculations apically to the papillary muscles and intertrabecular spaces. LVHT may occur with other cardiac abnormalities, heart failure, electrocardiographic abnormalities and neuromuscular disorders. This study gives an overview about (1) patients with LVHT in whom LVHT was initially overlooked and (2) cardiac conditions that may lead to falsely diagnosed LVHT. In 50 reported cases, LVHT has been overlooked and misdiagnosed as dilated (n = 20), hypertrophic (n = 14) or restrictive cardiomyopathy (n = 2), endocardial fibroelastosis (n = 5), endomyocardial fibrosis (n = 1), myocarditis (n = 3), thrombus (n = 2), localised left ventricular hypertrophy (n = 1), left ventricular mass (n = 1) or myocardial/pericardial disease (n = 1). In 14 patients, LVHT was diagnosed only by transoesophageal echocardiography (n = 1), computed tomography (n = 2) ventriculography (n = 2), magnetic resonance imaging (n = 3) or pathoanatomic findings (n = 6). Falsely diagnosed LVHT comprises false tendons, aberrant bands, thrombi, apical hypertrophic cardiomyopathy, fibroma, obliterative processes, intramyocardial haematoma, cardiac metastases and intramyocardial abscesses. Echocardiographers should be more aware of LVHT and consider its differential diagnoses.

Diagnostic Errors↗
PubMed2001

Patient puzzle. Use systematic assessment to detect & correct patient conditions.

Medic 27 responds to a report of a fall victim at 27 West Pinnacle Lane. En route, the crew learns from dispatch that the patient fell approximately 25 feet from the roof of a three-story structure onto the roof of an adjacent garage. The caller reports the patient "going in and out of consciousness." The EMS crew requests the dispatch of a rescue unit and ladder company to assist on scene and the placement of a medical helicopter on standby. On scene, the patient's wife reports her husband accidentally disturbed a hornets' nest as he secured a weather vane to the top of the family home. She says the hornets stung her husband repeatedly. In his attempt to avoid the stings, his movements jarred the ladder, causing him to fall to the roof below. As you walk to the side of the patient's home, his wife adds that her husband has a cardiac condition and now complains of chest pain and trouble breathing. You wonder what you'll find when you reach the victim. Is he a medical patient with traumatic injuries or a trauma patient with medical complications?

Accidents, Home↗
PubMed2000

Detection of iatrogenic cardiac tamponade by transesophageal echocardiography during vena cava filter procedure.

PURPOSE: To present a patient who developed cardiac tamponade during insertion of an inferior vena cava (IVC) filter. Intraoperative transesophageal echocardiography (TEE) was used as a means to diagnose the cardiac tamponade and to facilitate guiding of pericardiocentesis. CLINICAL FEATURES: A 45-yr-old man with protein S deficiency complicated by repeated attacks of deep vein thrombosis and pulmonary thromboembolism was scheduled for insertion of an IVC filter. He had history of chronic renal insufficiency, heart failure, and cerebral infarction with mild left hemiparesis. Current medication included diltiazem (30 mg, I tab tid ), prednisolone (5 mg, 2 tabs qd ), and warfarin (2.5 mg daily). Preoperative transthoracic echocardiography demonstrated bilateral pleural effusions, moderate mitral regurgitation and tricuspid regurgitation, left atrial appendage thrombus and severe generalized hypokinesia of left ventricle. Nuclear medicine examination by (99)Tc showed ejection fractions of left ventricle and right ventricle as 20% and 22%, respectively. Under the impression of protein S deficiency with multiple attacks of thromboembolism and failure of anticoagulant therapy, he was arranged for the procedure of vena caval filter insertion. Unfortunately, iatrogenic cardiac tamponade occurred during the course of the procedure with rapid hemodynamic deterioration. Because of the expedient of routine monitoring of cardiac condition with TEE, a prompt diagnosis was made. We successfully improved the patient's hemodynamic status after transthoracic echo-guided pericardiocentesis. CONCLUSION: Intraoperative TEE is recommended to be used routinely in patients undergoing vena cava filter procedures. The availability of echocardiographic monitoring in the operation room allows the confirmation of the diagnosis and facilitation pericardiocentesis.

Cardiac Tamponade↗
PubMed1997

Crosstalk of the heart and periphery: skeletal and cardiac muscle as therapeutic targets in heart failure.

Heart failure syndrome is initiated as the body's metabolic needs temporarily exceed the pumping capacity of the heart. In most cases, this phenomenon tends to occur during physical exercise. Although not always subjectively recognized, limited exercise capacity remains the clinical hallmark of congestive heart failure. It can be measured objectively as reduced skeletal muscle performance and maximal whole-body oxygen uptake, which are not necessarily explained by central haemodynamic abnormalities. In fact, the initial cardiac condition sets forth a series of peripheral adaptations that are potentially life-saving during acute decompensation but become disadvantageous and symptom-generating in stable heart failure. Inodilator drugs were theoretically ideal to revert the adverse haemodynamic crosstalk between the heart and periphery. However, these drugs failed to improve prognosis in congestive heart failure, whereas drugs that did so showed typically unimpressive haemodynamic effects. Exercise therapy has recently emerged as a safe and effective way to enhance physical performance and subjective well-being in congestive heart failure. A dual therapeutic approach is suggested, consisting of exercise training to improve the periphery and the use of cardioprotective drugs to limit cardiac cellular damage from neurohormonal activation.

Adrenergic beta-Antagonists↗
PubMed1999

The absence of relation between anxiety sensitivity and fear conditioning using 20% versus 13% CO2-enriched air as unconditioned stimuli.

Anxiety sensitivity has been implicated as a risk factor in the development and maintenance of anxiety and fear-related disorders. Indeed, persons who score high on the anxiety sensitivity index (ASI) are generally more responsive to biological challenge procedures such as CO2-inhalation that directly evoke the feared bodily events. One would expect, therefore, that persons high on anxiety sensitivity should be more conditionable and hence more likely to acquire fears, than persons low on anxiety sensitivity when CO2-enriched air is used as an unconditioned stimulus (UCS). Undergraduates (N = 96), scoring high, medium and low on the ASI received 8 repeated 20-s inhalations of either 20 or 13% CO2-enriched air (UCSs) paired with one of three CSs differing in fear-relevance (snake, heart and flowers). Several autonomic and self-report measures were assessed. Contrary to expectation, electrodermal and cardiac conditioned responses failed to discriminate between ASI groups. Yet, SUDS and severity and frequency of DSM-IV panic symptoms varied reliably as a function of anxiety sensitivity. Overall, the findings suggest that anxiety sensitivity is related to subjective fear-related complaints, but not autonomic responding and conditionability. We discuss clinical and theoretical implications for understanding the place fo anxiety sensitivity in fear onset.

Adolescent↗
PubMed1992

[Long-term nasogastric feeding and complications of acute gastric ulcer in two elderly patients].

Some elderly patients with chronic illness such as stroke, or Parkinsonism cannot take food orally because of dysphagia. In such cases, tube feeding can be used as a supplement to oral intake when malnutrition is present. This route allows for easier nursing care and decreases the frequency of aspiration pneumonia. Complications of tube feeding include nutrient deficiency states, pulmonary aspiration, gastrointestinal and metabolic disorders. We report two cases with complications of acute gastric ulcer which was thought to be induced with long-term tube feeding. Case 1 was a 61-year-old male patient with Parkinson's disease for ten years. L-DOPA had been administered with good control of his condition. However, his ability to swallow has deteriorated gradually. As he often suffered from aspiration pneumonia, nasogastric tube feeding was performed. After three years of tube feeding, he suddenly vomited much bloody material. He died from massive bleeding with acute gastric dilatation. Autopsy showed giant acute gastric ulcer covered with coagulated blood. UL3, 50 mm in maximum diameter, was observed in the middle portion of the greater curvature, where the top of tube probably came in contact with the gastric wall. Case 2 was an 83-year-old female patient with stroke and chronic heart failure. She had been hospitalized for about one year because of the intermittent deterioration of her cardiac condition. Furthermore, her inability to swallow increased during her hospitalization. She also suffered from aspiration pneumonia. Nasogastric tube feeding was performed to prevent aspiration pneumonia and malnutrition. She died of acute heart failure after twelve months. Autopsy revealed heart dilatation, old myocardial infarction and stroke. In addition, two acute gastric ulcers (UL3.10 and 30 mm in diameter) were recognized; one was in the upper portion of the greater curvature, the other in the lower portion of the greater curvature. The location of these gastric ulcers was unusual. Moreover, they coincided with location of top of the nasogastric tube. From these two cases, we conclude that in long-term tube feeding the tip of the tube often comes in contact with the gastric wall, and gastric ulcer could be produced by repeated mechanical stimulus of the wall. Reports of acute gastric ulcer induced by tube feeding have not been published previously. Therefore, we should pay much attention to this complication in the care of the elderly people with long-term tube feeding.

Acute Disease↗