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Query: UMLS:C0012833 (dizziness)
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The clinical and electrophysiological features and the natural history of median intra-His block with a normal resting electrocardiogram were studied: 11 patients had a fixed split H1-H2 potential with a spontaneous or induced block between H1 and H2. The patients (5 men and 6 women) were aged 17 to 70 years (average 53 years). Associated pathology included 2 cases of aortic stenosis (1 severe), 1 case of ischaemic heart disease (effort angina), 1 case of mitral valve prolapse and 2 cases of hypertension. The presenting symptoms were syncope (4 cases), dizziness (2 cases), effort angina (1 case) and tiredness (3 cases); 1 patient was asymptomatic. Holter monitoring (24 hours) was performed in 8 patients and s-owed paroxysmal conduction defects in 6 cases; 4 Mobitz II 2nd degree AV block, 1 3rd degree AV block with narrow QRS complexes and 1 case of blocked atrial extrasystoles at coupling intervals longer than 480 ms and sinus cycle lengths of over 800 ms. Exercise testing by bicycle ergometry (4 patients) was normal in 1 case and revealed Mobitz II 2nd degree AV block in 3 cases. Baseline electrophysiological studies showed an A-H1 interval ranging from 60 to 100 ms (average 78 ms), a H1-H2 interval of 20 to 40 ms (average 31 ms) and a H2-V interval of 30 to 50 ms (average 32 ms). Block between H1 and H2 was observed: "spontaneously" during electrophysiological investigation in 6 cases, after IV atropine in 1 case, during overdrive atrial pacing at rates slower than 150/min in 7 cases, after atrial extrastimulus with a functional intra-His refractory period of over 420 ms in 7 cases, after ajmaline in 3 of the 4 cases in which this test was performed. A cardiac pacemaker was implanted in 10 patients in whom the initial symptoms have all regressed; the remaining patient considered to be "epileptic" had another syncopal attack under therapy and was finally paced. This series demonstrates that the diagnosis of median intra-His block depends on precise electrophysiological criteria and should be looked for even when the presenting symptoms are atypical; some of our patients complained only of tiredness. The value of Holter monitoring and careful endocavitary investigation is emphasised. Median intra-His block should be distinguished from longitudinal and functional His bundle dissociation.
Arch Mal Coeur Vaiss 1985 Jul
PMID:[Clinical and electrophysiological aspects of median intra-His bundle block with normal electrocardiogram at rest]. 392 29

A retrospective study of Holter monitoring of 250 patients referred for syncope and short spells of dizziness suspected of being cardiac in origin was undertaken to assess the diagnostic value of the investigation. The arrhythmias observed were classified in 3 groups, significant, suspect and physiological with respect to their true or potential severity and to previously reported results of Holter monitoring in healthy subjects. The following arrhythmias were classified as significant: supraventricular tachycardia with a ventricular rate greater than or equal to 200 bpm; sustained ventricular tachycardia (greater than 30 s and greater than or equal to 150 bpm), bradycardia (less than bpm), sinus arrest (waking greater than 2 s sleeping greater than or equal to 6 s), complete AV block with wide QRS complexes and pacemaker dysfunction. The following arrhythmias were classified as suspect: paroxysmal supraventricular tachycardia with a ventricular rate less than 200 bpm, salvos of ventricular tachycardia (120 greater than 150 bpm); R/T phenomenon and doublets (greater than or equal to 50/24 hours), sinus arrest of 2 to 6 seconds during sleep, complete AV block with narrow QRS complexes or second degree Mobitz II block. This classification led to a diagnosis of certitude in 20 patients (5.7%) with significant arrhythmias concomitant with syncope or a minor form in only 5 cases, supraventricular tachycardia (4 cases), ventricular tachycardia (4 cases), AV block (5 cases), sinus arrest (3 cases), pacemaker dysfunction (4 cases); a diagnosis of presumption in 74 patients (21.1%) with suspect arrhythmias in the absence of syncope or minor equivalent.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1985 Sep
PMID:[Syncopes and brief spells of feeling faint: value of Holter monitoring?]. 393 46

A case of thrombosis of a Blalock anastomosis in a woman with Fallot's tetralogy is presented. She had the anastomosis at age 7 years, and had symptoms of dyspnea, dizziness, and a systolic murmur at the time of a miscarriage at age 21. 5 days after starting a 5 mg combination of norethynodrel and mestranol she was hospitalized for acute dyspnea, cyanosis, fainting, and painful hepatosplenomagaly suggestive of failure of the anastomosis. This was documented by angiography and during surgery when an aortic-pulmonary shunt was done. After several relapses the woman was doing well with some cyanosis and Stage 2 dyspnea. The evidence that oral contraceptives may cause some thromboembolic disease, particularly pulmonary, cerebral, and cardial accidents, is discussed.
Arch Mal Coeur Vaiss 1970 Feb
PMID:[Thrombosis of a Blalock's anastomosis for Fallot's tetralogy, in the course of a contraceptive treatment (by an anovulatory steroid)]. 498 79

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)
Arch Mal Coeur Vaiss 1983 Oct
PMID:[Severe postoperative heart blocks appearing late. 16 cases]. 641 89

In order to determine the significance of prolongation of the direct sinoatrial conduction time (DSACT), an attempt was made to record the sinus node potential in 110 patients which was successful in 84 cases. The DSACT was normal in 45 cases (Group A) and prolonged (over 130 ms) in 39 cases (Group B). The symptomatology, standard ECG and the results of investigation of sinus node function by atrial stimulation of the two groups were compared. The DSACT was prolonged in all 13 patients with paroxysmal sinoatrial block or the sick sinus syndrome, in 71% of 15 patients with permanent sinus bradycardia, in 88% of 22 patients with a corrected sinus node recovery time of over 525 ms, in 82% of 38 patients with a sinoatrial conduction time estimated by the extrastimulus method of over 130 ms or an abnormal zone II, in 80% of 39 patients with sinoatrial conduction times estimated by Narula's method of over 130 ms; therefore, 87% of the 35 patients with probable sinus node dysfunction had long DSACT. On the other hand only 2 out of 35 patients (6%) with apparently normal sinus node function had prolonged DSACT. These results indicate that prolongation of the DSACT is a sensitive and specific criterion of sinus node dysfunction. In cases of sinus node dysfunction dizziness and/or syncope without any known cause were common complaints in patients in Group B but absent in patients in Group A. A prolonged DSACT could be of prognostic significance in sinus node dysfunction.
Arch Mal Coeur Vaiss 1983 Dec
PMID:[Lengthening of the direct sinoatrial conduction time: a criterion of sinus node dysfunction]. 642 78

This study was undertaken to test the validity of methods of evaluating ventricular tachycardia and in therapeutic surveillance. One hundred and thirty nine patients aged 16 to 84 years, with and without severe ventricular arrhythmias (ventricular tachycardia, VT, and fibrillation, VF) were divided into two groups after clinical, echocardiographic and 24 hour Holter investigations: Group I comprised 26 patients with a least one documented attack of VT or VF; Group II comprised 113 patients without these arrhythmias, who complained of dizziness, syncope, and/or their ECG showed a conduction defect, and so electrophysiological investigation was undertaken. A protocol of ventricular stimulation was undertaken in addition to the usual measurements of conduction times, comprising incremental ventricular stimulation from 100 to 200/min, single and paired extrastimulus in sinus rhythm and during ventricular pacing at rates of 100 and 150/min, the first extrastimulus being programmed 10 ms after the end of the ventricular effective refractory period. Excluding bundle to bundle reentry, the following results were obtained: In Group I: VT was triggered 16 times (61,5 p. 100), and in 4 of these cases VF occurred and required defibrillation. Ten patients had previous myocardial infarction; 5 patients had left ventricular dilatation. In 2 cases runs of 3 or 4 VES were recorded. No arrhythmia could be induced in 8 cases (30,8 p. 100); 5 of these patients had apparently normal hearts. In Group II: VT (greater than 5 VES) was triggered in 22 cases (19,5 p. 100) and in 4 cases this degenerated to VF requiring defibrillation. 11 patients had apparently normal hearts; 6 patients had left ventricular dilatation and 4 patients had previous myocardial infarction. 1 to 4 repetitive VES were observed in 67 cases (59,3 p. 100): the heart was judged to be normal in all patients except those with previous infarction. No correlation was established between the ability to induce VT and age, syncope, or ECG changes (especially bundle branch block). However, a correlation was found between the induction of VT and underlying cardiac disease and the method of induction of VT; in Group II, all episodes of VT were triggered by delivering paired ventricular extrastimuli on a background paced rhythm. These results show that repetitive ventricular responses can easily be triggered and that this has no pathological significance.(ABSTRACT TRUNCATED AT 400 WORDS)
Arch Mal Coeur Vaiss 1984 Mar
PMID:[Results of the systematic application of ventricular stimulation methods]. 642 12

The aim of this study was to assess the incidence and natural history of carotid sinus hypersensitivity (CSH) with respect to treatment and symptoms. Between May 1976 and December 1981, 714 patients underwent carotid sinus massage (CSM) during electrophysiological investigation (271 for syncope, 163 for dizziness); 79 had a pathological response (sinus arrest for over 3 s or two successive pauses of over 2 s each). Twenty five of these patients were excluded from the study group; 23 had the sick sinus syndrome or an associated AV block, and two were lost to follow-up. The remaining 54 patients were divided into two groups: Group I, comprising 33 patients who were given no treatment, and Group II, comprising 21 patients who were treated by permanent pacing. The patients in Group I were followed up for an average of 29 +/- 16 months and those in Group II for 25 +/- 22 months. Nine of the 18 patients in Group I, hospitalised for syncope, but none of the 5 patients admitted for dizziness alone, relapsed during follow-up. Only 1 patient without syncope or dizziness at the time of investigation reported having had a syncope during follow-up. The actuarial graph of absence of syncope fell regularly in Group I (58 p. 100 at 5 years), 4 patients in Group I were then given demand pacemakers and there was no further recurrence of syncope (follow-up: 34 +/- 15 months). Only 1 patient, admitted for dizziness, out of the 21 patients in Group II (13 syncopes, 8 cases of dizziness) continued to complain of the symptoms for which he had been paced.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1984 Mar
PMID:[Carotid sinus hypersensitivity. Median-term development as a function of treatment and symptoms]. 642 19

The clinical history and 24 hour Holter monitoring of 749 patients without ECG appearances of ventricular preexcitation were compared with the results of electrophysiological investigations to determine whether supraventricular arrhythmias initiated during endocavitary electrophysiological investigations had any pathological significance. Endocavitary studies were undertaken to investigate symptoms of dizziness, syncope and/or conduction defects except in the group of paroxysmal junctional tachycardia (PJT) where the indication was investigation of a tachycardia (78 cases). In 544 patients (Group I) no arrhythmias were initiated. Thirty five patients (6.4%) had supraventricular tachycardia (SVT), atrial flutter (AFI), atrial tachycardia (PAT), atrial fibrillation (AF) or PJT. The anterograde Wenckebach point (AV) was over 200/min in 22 cases (4%). In 400 patients the Wenckebach point or the retrograde Mobitz II (VA') point was 170/min in 56 patients (14%). In 28 patients with spontaneous SVT in whom retrograde conduction was studied, 3 had a Wenckebach 200/min (17.7%) and 9 had a Wenckebach point (VA') greater than 170/min (32%). In 86 patients (Group II) paired atrial stimulation induced PJT. Seventy nine patients (91.8%) had PJT : AV was greater than 200/min in 19 cases (22%) and VA was greater than or equal to 170/min in 69 cases (80.2%). In 119 patients (Group III) a supraventricular tachycardia (other than PJT) was induced. Manipulation of the catheter in the atrium led to AF, AFI or PAT in 9 patients. Eight patients had SVT (80.8%), AV was greater than 200/min in one case (11.1%) and VA' greater than or equal to 170/min in 5 of the 7 cases in which it was measured (71.4%). Paired atrial stimulation induced atrial echos in 63 patients; 47 presented spontaneous SVT : AV was greater than 200/min in 7 cases (11.2%) and VA' greater than or equal to 170/min in 23 of the 60 patients investigated (38.3%). Paired atrial extrastimuli triggered AF or PAT in 18 cases : 16 cases (88.8%) had spontaneous SVT. AV was greater than 200/min in 3 cases (16.6%), VA' was greater than or equal to 170/min in 10 of the 17 cases investigated (58.8%) : 11 of these patients also had atrial echos. Fixed atrial stimulation (less than 200/min) triggered AF or AFI in 14 patients. Nine had spontaneous SVT (64.3%) : AV was greater than 200/min in 2 cases (14.2%) and VA' greater than or equal 170/min in 2 of the 10 cases studied (20%). Ventricular stimulation induced SVT in 15 patients, 14 of whom had SVT (92%).(ABSTRACT TRUNCATED AT 400 WORDS)
Arch Mal Coeur Vaiss 1984 Apr
PMID:[Significance of a supraventricular arrhythmia precipitated during an electrophysiological study]. 642 25

A prospective study of arrhythmias was performed in 33 patients with hypertrophic cardiomyopathy with obstruction by Holter monitoring. The aim of the study was to assess the incidence of "occult" arrhythmias in this condition and to establish a "profile" of high risk patients from clinical, echocardiographic and haemodynamic data. The Holter monitoring demonstrated asymptomatic arrhythmias in 31 of the 33 patients (94%). A supraventricular arrhythmia was detected in 15 cases (45%), including 7 episodes of supraventricular tachycardia (21%). Ventricular arrhythmias were observed in 28 patients (85%), including 5 episodes of ventricular tachycardia (15%). Some patients presented several types of arrhythmia. A number of patients with arrhythmia including short bursts of ventricular tachycardia were asymptomatic during Holter monitoring; conversely, other patients complained of dizziness or syncope but had no arrhythmias. A retrospective study of clinical, echocardiographic and haemodynamic data showed no difference between patients with and patients without arrhythmias. Medium-dose betablocker therapy (propranolol, 110 mg/day) did not seem to protect patients with hypertrophic cardiomyopathy with obstruction from arrhythmias. We conclude that Holter monitoring should form part of the routine evaluation of patients with cardiomyopathy with obstruction, and that potentially dangerous arrhythmias should be treated by anti-arrhythmic agents other than betablockers. This attitude could reduce the incidence of syncope and eventually decrease the risk of sudden death in this condition.
Arch Mal Coeur Vaiss 1984 Jul
PMID:[Long-duration electrocardiographic recording in 33 patients with obstructive cardiomyopathy]. 643 35

20 cases of pregnancy in women with complete atrioventricular block (AVB) (12 patients) or with permanent pacemakers (8 patients) were observed in a French cooperative series and compared with I30 previously reported cases. Most patients were asymptomatic but an increase in the number of syncopes during gestation might be observed : 4 out of 12 in our series. Although AVB remains functionally latent during pregnancy, regular cardio-obstetric follow-up is advised. Hospital admission a few days before the expected date of delivery is desirable, and it is essential that the patients are delivered in department specialised in high risk pregnancies. The need for prophylactic temporary pacing during delivery is not universally accepted. On the other hand, dizziness and syncope are clear cut indications for permanent cardiac pacing ; programmable pacers are excellent choices in young women of childbearing age ; nuclear pulse generators (Pu 238) do not seem to expose the mothers or foetus to serious complications. Rejection of pulse generators during pregnancy is rare. Nearly all mothers with AVB, whether paced or not, now have normal pregnancies resulting in normal viable children. This conduction defect is not therefore an indication for therapeutic abortion.
Arch Mal Coeur Vaiss 1981 Aug
PMID:[Auriculo-ventricular block and pregnancy]. 679 7


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