Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: 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)

Seventy-four patients with chest pain and no prior history of organic heart disease were interviewed with a structured psychiatric interview immediately after coronary arteriography. The majority of patients with both negative and positive coronary angiographies had undergone previous exercise tolerance tests, but the patients with angiographic coronary artery disease were significantly more likely to have had positive results on a treadmill test. Patients with chest pain and negative coronary arteriograms were significantly younger; more likely to be female; more apt to have a higher number of autonomic symptoms (tachycardia, dyspnea, dizziness, and paresthesias) associated with chest pain, and more likely to describe atypical chest pain. Patients with chest pain and normal coronary arteriographic results also had significantly higher psychologic scores on indices of anxiety and depression and were significantly more likely to meet criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition, for panic disorder (43 percent versus 6.5 percent), major depression (36 percent versus 4 percent), and two or more phobias (36 percent versus 15 percent) than were patients with chest pain and a coronary arteriography study demonstrating coronary artery stenosis.
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PMID:Chest pain: relationship of psychiatric illness to coronary arteriographic results. 333 15

The management of patients with cerebral transient ischemic attacks and carotid artery stenosis remains controversial. Noninvasive techniques help to determine which patients require surgical intervention without exposing the majority of patients to the risk and discomfort of invasive procedures. Measurement of ophthalmic artery pressure by ophthalmodynamometry or oculoplethysmography gives a representation of perfusion pressure in the internal carotid artery circulation. Doppler ultrasound studies can define the extent of obstruction to flow at the carotid artery bifurcation and assess collateral flow from the external carotid artery. Real time B-mode ultrasonography can detect nonobstructive ulcerated plaque in the carotid artery bifurcation. Employing these examinations in a test battery can identify hemodynamically significant lesions, which are more likely to precipitate a stroke. The information obtained from these studies can be utilized in patients with episodes of cerebral transient ischemic attacks, asymptomatic carotid artery bruits and vertebrobasilar insufficiency. Noninvasive carotid artery testing is also useful in screening patients with nonspecific symptoms, such as dizziness or light-headedness, which may be related to decreased flow in the carotid circulation. Noninvasive carotid artery testing can provide valuable anatomic and physiologic information required in the appropriate management of patients with cerebrovascular disease. It is of particular value in managing patients with heart disease who are at high risk for complications from invasive procedures.
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PMID:Clinical applications of noninvasive carotid artery testing. 388 May 66

The natural history of patients with asymptomatic prolonged ventricular pauses and the indications for permanent pacing are controversial. To examine this problem, 6,470 consecutive 24-hour Holter recordings were reviewed between 1979 and 1983 for the presence of ventricular pauses of at least 3 seconds. Fifty-two patients (0.8% of total), 22 men and 30 women, were identified with an average longest pause duration of 4.1 seconds. Holter recordings were requested to evaluate syncope in 14 patients (27%), dizziness in 9 (17%) and other reasons in 29 (56%). Causes of the pauses were sinus arrest in 22 patients, atrial fibrillation with slow ventricular response in 18 patients and atrioventricular block in 12. Holter recordings were also evaluated for the presence of tachyarrhythmias. Six patients had nonsustained ventricular tachycardia and 7 had supraventricular tachycardia. Five of the 52 patients (10%) had dizziness or syncope during pauses. Twenty-six patients (50%) received permanent pacemakers. The paced (26 patients) and unpaced (26 patients) groups were similar in the length and etiology of pause, associated tachyarrhythmias, presence of bradycardia-related symptoms, prevalence of organic heart disease, medications and length of follow-up. Four patients in the paced group and 2 in the unpaced group died, yielding 3-year actuarial survival probabilities of 78% and 85%, respectively. It is concluded that ventricular pauses of 3 seconds or longer are uncommon, these pauses usually do not cause symptoms, and the presence of these pauses does not necessarily portend a poor prognosis or the need for pacing in asymptomatic patients.
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PMID:Significance of ventricular pauses of three seconds or more detected on twenty-four-hour Holter recordings. 398 58

To examine the clinical course of sinus node dysfunction that necessitates permanent pacing in the pediatric and young adult populations, we studied the records of the 39 patients 40 years of age or younger (mean age, 23 years) who underwent implantation of a permanent pacemaker for treatment of this disorder at our medical center between 1960 and 1983. The tachycardia-bradycardia syndrome was the most common rhythm disturbance, and syncope was the most frequent initial symptom. All symptomatic patients noted resolution of symptoms after pacemaker implantation. Twenty-five of the 39 patients (64%) had associated cardiovascular disease, most commonly transposition of the great arteries. In each of the 11 patients with this anomaly, sinus node dysfunction developed after a surgical procedure for correction of the defect. Of the total patient population, 20 patients (51%) had previously undergone a cardiac operation. The mean interval between pacemaker implantation and the previous operation was 105 months. After a mean follow-up of 50.5 months, the patients with no obvious underlying heart disease have done well. Each of the eight patients who have died had underlying cardiovascular disease. None of the deaths was thought to be pacemaker related. Sinus node dysfunction should be considered in the differential diagnosis of young patients with syncope or dizziness, especially if they have undergone a reparative cardiac surgical procedure. If symptomatic sinus node dysfunction is confirmed, permanent pacing is an effective therapeutic modality. In the absence of associated heart disease, the prognosis seems to be excellent.
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PMID:Sinus node dysfunction in pediatric and young adult patients: treatment by implantation of a permanent pacemaker in 39 cases. 403 31

Sixty-five of 118 university cardiologists responded to a survey of indications for treatment of ventricular ectopy, particularly in the completely asymptomatic patient or those with palpitations as the only symptom. The percentage of cardiologists treating these patients increased as the complexity of ventricular ectopy increased, as the severity of underlying heart disease increased, as the symptoms increased from completely asymptomatic to palpitations or skipped beats, if the patient experienced dizziness or syncope, and if the patient had complex VPBs or asymptomatic VT after MI. Ninety-eight percent of respondents had patients who experienced exacerbation of arrhythmia with antiarrhythmic drugs. Of the conventional type 1 drugs, the drug of first choice was quinidine for 60%, procainamide for 37%, and disopyramide for 3%. The accepted indications for electrophysiologic testing included survivors of sudden cardiac arrest and patients with symptomatic VT.
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PMID:How the university cardiologist treats ventricular premature beats: a nationwide survey of 65 University Medical Centers. 405 Jun 69

Congenital or idiopathic complete A-V block with no detectable heart disease may be complicated by near syncope, syncope or sudden death. The proposed predictive "risk factors" of these events have not proved sufficiently reliable so far. This study was undertaken in order to re-evaluate the correlation between symptoms and clinical and electrophysiological data with particular regard to the junctional recovery time in 10 patients (4 M; 6 F; mean age 24.4 +/- 9.6 at our first observation) with congenital or idiopathic complete A-V block. Patients were divided into 2 groups: group A (3 M; 3 F; mean age 27.8 +/- 10.6 at our first observation) with patients who complained of vertigo, near syncope or syncope before our study; group B (1 M; 3 F; mean age 19.2 +/- 4.1 at first observation) without cardiovascular symptoms before our study. In group A, Holter monitoring revealed periods of asystole longer than 3000 ms in 2, and ectopic ventricular arrhythmias mainly during effort in 2; ergometric stress test performed in 3 patients demonstrated ectopic ventricular arrhythmias in 2 (those who had ectopic ventricular arrhythmias at rest). In all patients the site of the block was suprahisian (demonstrated by electrophysiologic endocavitary study) with a normal H-V interval; mean junctional recovery time was 4.600 +/- 1.620 ms and corrected junctional recovery time was 3.088 +/- 1.500. Four patients had vertigo during the electrophysiologic endocavitary study. After Atropine 0.02 mg/Kg i.v. junctional recovery time and corrected junctional recovery time decreased respectively to 1052 +/- 238 and 166 +/- 38 ms (the measurement was made in 5 patients). In group B Holter monitoring revealed periods of asystole longer than 3000 ms in 1 case. All patients had ectopic ventricular arrhythmias, confirmed by the stress test. In this group too, the block was suprahisian (electrophysiologic endocavitary study) with normal H-V. Mean junctional recovery time was 5162 +/- 2408 ms; and corrected junctional recovery time 3687 +/- 2202. Two patients complained of dizziness during the electrophysiologic endocavitary study. After Atropine 0.02 mg/Kg i.v., junctional recovery time and corrected junctional recovery time decreased respectively to 1300 +/- 356 and 260 +/- 145 ms. Four group A and 1 group B patients received a permanent pacemaker and have remained asymptomatic since.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Clinico-electrophysiologic relations in isolated complete atrioventricular block, congenital or idiopathic]. 637 52

Sixteen patients, aged 4 to 42 years, operated for congenital heart disease, presented, months or years after surgery, complete atrioventricular (11 cases) or sinoatrial block (5 cases). Six patients had transient complete atrioventricular block in the immediate postoperative period, the maximum duration of which was less than 30 days. The late postoperative period was defined as at least 6 months after surgery. The period between surgery and the implantation of a pacemaker varied from 9 months to 19 years, average 6,3 years. Analysis of long term electrocardiographic studies distinguished three types of progression: --group I: alternation of sinus rhythm and conduction defect until definitive block, sometimes presenting with syncope; --group II: sudden, severe conduction defect after a long period of sinus rhythm; --group III: progressive lengthening of the PR interval. Seven patients developed syncope; 4 had dizziness, 2 were short of breath; only 3 were asymptomatic. All underwent permanent pacing. The incidence of late conduction defects appears to be 1 to 2% of operated patients. The causes include progressive fibrosis, slow sclerosis extending over conduction pathways which are congenitally fragile. Most late blocks are of an advanced degree. Some may be responsible for unexplained sudden death. It is therefore desirable to avoid this complication by the judicious and considered implantation of a cardiac pacemaker. Some authors mention the following factors in deciding on the indications for pacing: --complete, transient atrioventricular block during the operation or the immediate postoperative period; --ECG appearances of right bundle branch block and left anterior hemiblock, or trifascicular block; --His bundle studies.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Severe postoperative heart blocks appearing late. 16 cases]. 641 89

Sinus node (SN) function was analyzed with and without autonomic blockade (AB) in 31 patients (mean age: 57.6 +/- 12.8) with intermittent sinoatrial block. Twenty-one patients had organic heart disease; in the remaining ten signs of underlying heart disease were not present. Nineteen patients had dizziness or syncope. Sinus cycle length, sinus rate, corrected sinus node recovery time (CSRT) and sinoatrial conduction time (SACT) were analyzed. After control measurements, AB was produced by i.v. propranolol (0.2 mg/Kg) and atropine (0.04 mg/Kg). Measurements of electrophysiological parameters were then repeated. After AB sinus rate and CSRT did not show statistically significant differences, whereas SACT decreased significantly (P less than 0.001). When intrinsic heart rate (IHR) was abnormal (11 cases), intrinsic CSRT was always abnormal, whereas when IHR was normal, intrinsic CSRT was normal in 11 patients and abnormal in nine. In several cases, when sinus rate increased after AB, CSRT decreased and vice-versa. The parameters of intrinsic SN function were normal in 80% of patients with a normal heart and only in 14.2% of patients with organic heart disease. These data indicate that: (1) during the control period SACT is mainly conditioned by the vagal tone; (2) abnormalities in control CSRT are not uniformly abolished after AB in patients with normal IHR; (3) AB has a differential effect on the two variables of SN automaticity; i.e. sinus rate and CSRT; and (4) in patients without underlying heart disease, the SN dysfunction is almost exclusively related to alterations of the autonomic nervous system.
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PMID:The role of the autonomic nervous system on sinus node function in patients with intermittent sinoatrial block. 669 22

To elucidate electrophysiologic mechanism of exercise-induced ventricular tachycardia (VT), electrophysiologic studies were performed in 12 patients in whom sustained VT had developed during treadmill exercise testing. Six patients had arteriosclerotic coronary heart disease, 3 had cardiomyopathy, and 3 had no clinical evidence of organic heart disease. All patients had had documented episodes of sustained VT related to exertion and had experienced dizziness, syncope, or both. In addition, 3 patients had had nonfatal cardiac arrest. Electrophysiologic studies provoked paroxysms of sustained VT identical to those observed during treadmill exercise testing in 10 patients and provoked ventricular flutter/fibrillation in 1. Seven patients had VT suggestive of a reentrant mechanism, as the VT could be readily initiated with programmed ventricular extrastimulation or terminated by ventricular overdrive pacing, or both. Three patients had VT suggestive of catecholamine-sensitive automaticity. The VT could not be initiated with programmed electrical stimulation, but it could be provoked by intravenous isoproterenol infusion; furthermore, the VT could not be terminated with ventricular overdrive pacing, but it could be abolished by discontinuing isoproterenol infusion. Reproduction of VT in these 10 patients allowed serial pharmacologic testing in selecting an effective antiarrhythmic regimen. Thus (1) exercise-induced VT can be caused by either reentry or catecholamine-sensitive automaticity, and (2) electrophysiologic studies are of use in defining the underlying mechanism of exercise-induced sustained VT.
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PMID:Electrophysiologic mechanism of exercise-induced sustained ventricular tachycardia. 682 68

Twenty-four-hour ambulatory electrocardiography was performed in 25 young and 29 active elderly subjects. Sinus bradycardia and sinus arrhythmia were common in the young but uncommon in the elderly. Ventricular and supraventricular premature beats and brief runs of supraventricular tachycardia were common in the elderly but uncommon in the young. Complex ventricular arrhythmias only occurred in the elderly but brief episodes of nocturnal Wenckebach AV block were quite common in young and old alike. No significant difference in arrhythmia frequency was found between elderly subjects with heart disease and those without heart disease or between elderly subjects without symptoms and those with non-episodic symptoms such as dizziness. None of the arrhythmias in the young or elderly subjects was associated with symptoms. In follow-up at 30 months, only one elderly subject was deceased (from pneumonia) and none had suffered a stroke or heart attack. It is concluded that transient cardiac arrhythmias are commoner in the elderly than in the young. However, their long-term significance remains unknown, but it is likely that they are relatively benign.
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PMID:The significance of cardiac arrhythmias in the aged. 684 89


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