Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0012833 (dizziness)
 9,689 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Compare the chest film with previous films, if possible. Changes in heart size and interstitial and vascular markings can thus be seen more readily, as can air trapping; this also aids in differentiation of acute from chronic changes. A Holter monitor study should be obtained if dyspnea occurs irregularly, has acute onset and termination, or is associated with dizziness or syncope; or if the resting ECG shows frequent premature atrial contractions, premature ventricular contractions, bradycardia, or periods of advanced heart block.
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PMID:Dyspnea in the elderly: cardiac or pulmonary? 398 43

Twenty six patients (aged 46-80, mean age 64) with bifascicular block in the presence of prolonged H-V interval (trifascicular block), were followed for an average of 31 months after inserting an R-wave inhibited pacemaker (PM) because of syncope and/or dizzy attacks. The underlying rhythm was evaluated at 4-6-month intervals by three different techniques: 1) 12-lead ECG when intrinsic patient rate was faster than PM rate; 2) abrupt PM inhibition (APMI) by the rapid chest-wall stimulation technique, and 3) progressive PM inhibition (PPMI) using a programmed chest-wall stimulation technique capable of decreasing the PM rate gradually to 30 beats/min before complete PM inhibition. In addition, the PPMI allowed the underlying rhythm to be induced and sustained and properly evaluated without any discomfort to the patient. Following PM insertion, 4 patients (15%) developed complete heart block after a mean follow-up of 43 months, and one patient (4%) developed 2nd degree 2:1 A-V block (VX) after 83 months. The P-R interval increased in 5 patients (19%) and decreased in 2 (8%). No change of A-V conduction was found in 9 patients (34%). Three patients developed low atrial rhythm, atrial flutter and atrial fibrillation, respectively (12%). After PM insertion 2 patients still complained of dizziness. None reported syncope. Two patients died during follow-up, both of congestive heart failure (8%). By detection of intrinsic rhythm it was recognized that a long symptomatic paroxysmal phase may precede the development of chronic complete A-V block. Therefore, the insertion of a permanent PM is recommended in patients with unexplained neurologic symptoms and trifascicular disease, without waiting for documented episodes of complete A-V block.
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PMID:Programmed chest-wall stimulation to evaluate the progress of A-V block after pacemaker insertion in patients with trifascicular disease. 618 36

Young adults with nonsurgically induced complete heart block (CHB) do not necessarily have a benign prognosis and pacemaker (PM) implantation may be necessary. No one has reported long-term PM follow-up in young adults with CHB. We studied 13 patients aged 15 to 37 years (mean 24 years) at PM implantation. There were nine female and four male patients. All were functional class II or III (NYHA) before PM implantation. Syncope, dizziness, fatigue, shortness of breath, and dyspnea on exertion were the most common symptoms. Cardiac catheterization findings (11 of 13 patients) were normal in five, and additional cardiac anomalies were present in six. His bundle studies (9 of 13 patients) showed absent AH intervals in all patients, with HV intervals not identified in two, 20 to 30 msec in one, and 30 to 50 msec in six patients. Holter monitor recordings (8 of 13 patients) demonstrated CHB in all eight with intermittent second- to third-degree block in two of three patients. Two patients had occasional premature ventricular contractions. Stress exercise tests (9 of 13 patients) demonstrated increased ventricular rate response (although subnormal in some patients); symptoms developed in seven. One patient had ventricular ectopy. All 13 patients were contacted 3 months to 7 years (mean 4 years) after PM implantation. Two patients had died, but the deaths were not related to PM dysfunction. All patients who are currently alive had marked improvement in functional symptomatology and all are currently functional class I. CHB is not a benign condition in young adults and may require PM implantation, which improves symptoms and allows the patient to lead a normal life.
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PMID:Long-term follow-up of young adults following permanent pacemaker placement for complete heart block. 680 42

To evaluate subsidiary ventricular pacemaker function in 20 children with congenital or surgically induced complete heart block, we measured recovery times following overdrive ventricular pacing. Long-term ECG tape recordings were performed in eight of these children. Ages ranged from 1 month to 17 years. The resting R-R intervals ranged from 595 to 1,740 msec. The ventricles were paced at various cycle lengths of 400 to 1,000 msec with either transvenous electrode catheters or surgically implanted epicardial electrodes. His bundle recordings showed that the site of block did not allow separation of patients with symptoms from those without symptoms. Prolonged recovery times were present in patients with block above the His bundle recording site who had symptoms of syncope or dizziness, as well as in patients who had a wide QRS. However, some asymptomatic patient with heart block above the His bundle recording site also had long recovery times. None of the asymptomatic patients who had ECG tape recordings had paroxysmal tachycardia in more than 300 hours of recordings. However, one symptomatic patient with congenital heart block and a prolonged recovery time had brief episodes of paroxysmal ventricular tachycardia that produced no symptoms at the time of recording. The results suggest that the coexistence of prolonged recovery times and paroxysmal tachycardia may be predisposing factors to the development of symptoms in patients with complete heart block. We believe that further electrophysiologic investigation of this possibility is warranted in patients with heart block.
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PMID:Heart block in children. Evaluation of subsidiary ventricular pacemaker recovery times and ECG tape recordings. 706 26

Twenty-four hour ambulatory ECG records were obtained from 163 patients attending a general medical unit of a district general hospital. The main indications for recording were palpitations, syncope and dizziness and 262 tapes were suitable for analysis. Problems and benefits of the system were discussed. Abnormalities detected were supraventricular tachycardia, ventricular tachycardia, atrial fibrillation, intermittent heart block, sinoatrial disease and pacemaker malfunction. Sixty-one patients were reassured and in 78 patients an alteration in drug regime was advised with clinical improvement in 63 cases. Vertebrobasilar insufficiency was diagnosed in 14 patients, 4 patients were referred for further cardiac investigations, 4 required insertion or replacement of a pacemaker, 1 was referred for psychiatric opinion, and 1 patient died. Selected 24-hour ambulatory ECG monitoring in a district general hospital provides a valuable service for investigation of symptoms that may be caused by cardiac arrhythmias. The question of local or centralised analysis of recordings should be decided on the grounds of time and staff available and the capital cost of equipment.
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PMID:The contribution of 24-hour ambulatory ECG monitoring in a general medical unit. 719 16

A patient presented with orthostatic dizziness and syncope caused by postural heart block. When the patient was supine, atrioventricular conduction was normal and he was asymptomatic; when he was standing he developed second degree type II block and symptoms. The left bundle-branch block on his electrocardiogram and intracardiac electrophysiological study findings suggest that this heart block occurred distal to the His bundle. Orthostatic symptoms are usually presumed to be secondary to an inappropriate distribution of intravascular volume or to autonomic nervous system abnormalities. As shown in this patient, these symptoms may be the result of orthostatic heart block. Ambulatory monitoring may be useful in patients with orthostatic neurological symptoms, particularly when conduction abnormalities are present on the electrocardiogram.
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PMID:Postural heart block. 742 77

We studied 16 patients aged 77-88 years to determine whether elderly patients gain significant benefit from dual-chamber (DDD) compared with single-chamber ventricular demand (VVI) pacing. The study was designed as a double-blind randomized two-period crossover study--each pacing mode was maintained for 7 days. End points included: (i) overall symptoms scores; (ii) exercise tests related to daily activities; and (iii) perceived level of difficulty (Borg score). The mean symptom score in DDD mode was 7.07 (6.38) vs. 12.27 (7.29) in VVI mode (p < 0.006). Dizziness, breathlessness and fatigue were the most noticed symptoms during VVI pacing. One patient dropped out from follow-up and three patients requested early reprogramming, all from VVI mode. Overall, no patient preferred VVI mode, 11 preferred DDD mode and four expressed no preference. There were significant improvements in all objective test performances in DDD mode. Mean (SD) total Borg scores in DDD mode and VVI mode were 36.57 (5.85) and 41.93 (6.49), respectively (p < 0.002). Ventricular demand pacing in elderly patients with complete heart block is associated with higher symptom scores, reduced exercise ability and greater perceived exercise difficulty compared with dual-chamber pacing.
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PMID:DDD vs. VVI pacing in patients aged over 75 years with complete heart block: a double-blind crossover comparison. 820 15

This report describes an unusual case of secondary nocturnal enuresis presumptively secondary to progressive bradycardia from complete heart block. Congenital complete heart block occurs in approximately 1 of 22,000 livebirths and is typically associated with structural congenital heart disease or maternal collagen vascular diseases. It can be entirely asymptomatic during infancy and childhood, depending in part on the escape rate and rhythm and other hemodynamic variables. The case described above was not diagnosed until the patient coincidentally underwent cardiac monitoring. The picture was confusing initially, as a tricyclic antidepressant medication had been ingested. Heart block is one of the known cardiovascular effects of tricyclic antidepressant overdose. However, the conduction disturbance should have resolved as the drug was excreted from the body. As children with congenital complete heart block get older, the ventricular escape rate typically decreases. In addition, as activity increases with age, more demand is placed for cardiac output. The resting end-diastolic volume is increased to elevate stroke volume in compensation for lower heart rate. As the escape rate decreases and the metabolic demand increases, patients with congenital complete heart block then may begin to develop symptoms. Typical symptoms in children include dizziness, Stokes-Adams syncopal attacks, fatigue, daytime somnolence, and other somatic complaints. Bedwetting has not been reported as an initial symptom, but in this case is likely secondary to the excessive somnolence and difficulty with arousal.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Nocturnal enuresis secondary to heart block: report of cure by cardiac pacemaker implantation. 833 31

Propranolol, a nonselective beta-adrenergic blocking agent, although prescribed frequently, has not been monitored for its adverse reactions in Indian population. A collaborative ADR monitoring study was planned in 2661 hypertensive patients. Exclusion criteria were associated circulatory insufficiency, heart block, left ventricular failure, diabetic mellitus and airway obstruction. The incidence of ADR was 2.1%, which is lower than reported incidence of 8.7 to 43.7 percent in other studies. This could be attributed to improper selection of patients, differences in methodology of monitoring, or to racial variation. In the present study ADR of fatigue (1.1%), dizziness (0.4%) and headache (0.2%) constituted the bulk. Additional reaction of pain in chest (0.2%), heart block (0.1%), hypoglycemia (0.1%), loss of libido (0.1%) and shock (0.03%), were also observed.
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PMID:Adverse reactions to propranolol, a non-selective beta-adrenergic blocking agent in hypertensive patients--a collaborative study. 844 49

This study examined the incidence and significance of catheter-induced atrioventricular nodal block (AVNB) during a radiofrequency ablation procedure that uses stiff large-tip steerable ablation catheters. AVNB was noted in 10 (1.6%) of 613 consecutive patients undergoing radiofrequency ablation therapy for atrioventricular nodal (AVN) reentrant tachycardia (592 patients) or atrioventricular reentry tachycardia incorporating a midseptal accessory pathway (21 patients). Of these 10 patients, 9 underwent AVN modification for AVN reentrant tachycardia and 1 for ablation of a midseptal accessory pathway. One patient had two episodes of AVNB during two sessions undertaken because of recurrence of tachycardia. No patient had a preexisting conduction defect before the study. In all 10 patients, AVNB was transient, and it lasted for a mean of 9.1 +/- 19 minutes. It occurred during positioning of the ablation catheter in the junctional area before (8 patients) or after (2 patients) the start of radiofrequency current applications. Complete AVNB was noted on six occasions, second-degree AVNB on four occasions, and first-degree AVNB on one occasion. All blocks were associated with narrow QRS ventricular beats and with a site of block proximal to the His bundle. The mean ventricular heart rate during AVNB was 60 +/- 23 beats/min. Two patients had transient asystole, with one having loss of consciousness. No patient required special treatment for heart block. One-to-one conduction resumed after repositioning of the catheters, and the subsequent ablation procedure was successfully completed in 8 of the 10 patients. During a follow-up of 20 +/- 12 months, none of the patients had severe dizziness or syncope, and none required implantation of a permanent pacemaker. In conclusion, transient AVNB due to mechanical injury occurs during positioning of a stiff large-tip steerable ablation catheter in the junctional area. Delivery of radiofrequency current to the site that provokes catheter-induced AVNB should be avoided.
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PMID:Catheter-induced atrioventricular nodal block during radiofrequency ablation. 889 71


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