Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of right ventricular dilated cardiomyopathy which also involved the left ventricle was reported. On health screening, a 16-year old woman was pointed out to have multifocal PVC and cardiomegaly. Subsequently, she was admitted to our hospital because of general fatigue. CTR was enlarged to 54.9% on chest X-ray. ECG showed LBBB-type PVC, right axis deviation, low voltage and T wave changes. On UCG, RVdD was dilated to 40 mm and LVdD was 37 mm. There was no finding of abnormality of the tricuspid valve. On cardiac catheterization, there was no shunt disease. Intracardiac pressure was normal. The end-diastolic volume index (ml/m2) of RV and LV was 196.7 and 67.4, respectively. And ejection fraction (%) was 20 and 40. Ventriculography revealed diffuse dilatation of the right ventricle. And lowered contractility existed not only in the right ventricle but also in the anterior and apical segment of the left ventricle. T(1)201 myocardial perfusion imaging showed irregular perfusion defect of the left ventricle. Endomyocardial biopsy revealed marked hypertrophy, partial atrophy, disarrangement of myocyte and interstitial fibrosis of the right ventricle. This case was considered to be right ventricular dilated cardiomyopathy. It seemed to be an intermediate form of dilated cardiomyopathy since it also involved the left ventricle. It was an interesting case to illustrate the spectrum of expression of cardiomyopathy.
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PMID:[A case of right ventricular dilated cardiomyopathy, which involved left ventricle]. 228 24

In this report we describe fatigue of the His-Purkinje system during retrograde stimulation of the His bundle by ventricular programmed stimulation. The patient underwent electrophysiologic evaluation for syncope. Antegrade conduction and supraventricular studies were normal with the exception of baseline left bundle branch block. During programmed ventricular stimulation, the patient developed intra-Hisian and infra-Hisian block with symptomatic 3:1 atrioventricular heart block requiring insertion of a permanent pacemaker. This case demonstrates the need for careful study of both antegrade and retrograde conduction properties of the His bundle and atrioventricular node when performing standard His bundle studies in evaluation of syncope.
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PMID:Fatigue of the His-Purkinje system during routine electrophysiologic studies. 245 12

Ventricular preexcitation, as seen in Wolff-Parkinson-White syndrome, results in a high frequency of positive exercise electrocardiographic responses. Why this occurs is unknown but is not believed to reflect myocardial ischemia. Exercise thallium testing is often used for noninvasive assessment of coronary artery disease in patients with conditions known to result in false-positive electrocardiographic responses. To assess the effects of ventricular preexcitation on exercise thallium testing, 8 men (aged 42 +/- 4 years) with this finding were studied. No subject had signs or symptoms of coronary artery disease. Subjects exercised on a bicycle ergometer to a double product of 26,000 +/- 2,000 (+/- standard error of mean). All but one of the subjects had at least 1 mm of ST-segment depression. Tests were terminated because of fatigue or dyspnea and no patient had chest pain. Thallium test results were abnormal in 5 patients, 2 of whom had stress defects as well as abnormally delayed thallium washout. One of these subjects had normal coronary arteries on angiography with a negative ergonovine challenge, and both had normal exercise radionuclide ventriculographic studies. Delayed thallium washout was noted in 3 of the subjects with ventricular preexcitation and normal stress images. This study suggests that exercise thallium testing is frequently abnormal in subjects with ventricular preexcitation. Ventricular preexcitation may cause dyssynergy of ventricular activation, which could alter myocardial thallium handling, much as occurs with left bundle branch block. Exercise radionuclide ventriculography may be a better test for noninvasive assessment of coronary artery disease in patients with ventricular preexcitation.
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PMID:Exercise thallium testing in ventricular preexcitation. 357 50

Thirty patients with ischemic (n = 14) or idiopathic dilated (n = 16) cardiomyopathy were followed long-term to determine the prognostic value of measuring entry exercise capacity. At the time of referral for management of symptomatic heart failure, studies included radionuclide angiography, M-mode echocardiography, 24-hour Holter and graded exercise testing with measured oxygen peak consumption (peak VO2). Inclusion criteria were NYHA class II (n = 16) or III (n = 14) despite at least 3 months of treatment with digitalis and diuretics, left ventricular ejection fraction less than 50%, left ventricular end-diastolic diameter (LVEDD) greater than 50 mm, and exercise capacity limited by dyspnea or fatigue. Patients were treated with diuretics (100%), digitalis (83%), and vasodilators (60%) and were followed for at least 6 months (mean 15). The 1-, 2- and 3-year cumulative survival rates were 75.4%, 70.2%, and 70.2%, respectively. Univariate predictors of survival included measured peak VO2 (p = 0.0026), as well as age, estimated peak VO2 (based on exercise time), presence of left bundle branch block, LVEDD, and frequency of ventricular arrhythmias. Multivariate analysis revealed that measured peak VO2 was the single best independent predictor of survival (p less than 0.001). We conclude that assessment of functional capacity provides useful independent prognostic information in patients with mild to moderate heart failure.
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PMID:The prognostic value of functional capacity in patients with mild to moderate heart failure. 360 95

A 75-year-old woman with complete left bundle branch block underwent electrophysiological study (EPS) to assess the conduction in the His-Purkinje conduction system and to further investigate the electrical instability in the ventricle, which was suggestive by the findings of nonsustained ventricular tachycardia in ambulatory monitoring. Transient complete atrioventricular (AV) block was provoked by ventricular pacing, and the intracardiac recordings proved that the site of AV block was distal to the His bundle. This phenomenon was not related to the rate or the duration of the ventricular pacing. The transient impairment of the conduction appeared to be due to the fatigue phenomenon in the His-Purkinje system.
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PMID:Transient complete atrioventricular block provoked by ventricular pacing in a patient with nonsustained ventricular tachycardia. 1033 38

A 78-year-old man who had been treated with maintenance hemodialysis for chronic renal failure was admitted with severe edema in left arm for 1 month. Venous angiography showed a severe stenosis in left innominate vein, then, he underwent percutaneous balloon angioplasty and venous stenting (Wall Stent RP). His arm edema soon improved after angioplasty, however, he complained of general fatigue and bradycardia 2 days after the venous angioplasty. Electrocardiogram showed complete atrioventricular block with 35 wide QRS complexes per minute. His echocardiogram showed a pipe-shaped structure with multiple slit and acoustic shadow in right ventricle. His radiographical right ventriculogram revealed the migrated venous stent from innominate vein to right ventricle. We tried to perform percutaneous transvenous stent extraction using Goose-Neck snare catheter, however, the wall stent stuck in the right external iliac vein, and contrast media leaked to the outside of the vascular wall. Therefore, we implanted this stent in the iliac vein with optimal-sized balloon inflation, and succeeded in stopping bleeding. Complete atrioventricular block was recovered to sinus rhythm with left bundle branch block just after the removal of the venous stent from right ventricle, and no cardiovascular events occurred after the treatment.
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PMID:Complete atrioventricular block due to venous stent migration from innominate vein to right ventricle: a case report. 1947 90

An 83-year-old woman with chronic left bundle branch block and remote history of pacemaker implantation for intermittent AV block was hospitalized for fatigue and leg swelling. She had no cardiac complaints. Routine 12-lead electrocardiogram showed sinus rhythm with left bundle branch block. There were diffuse negative T waves in the inferior and anterolateral leads that were concordant with the QRS complexes. Echocardiogram was normal and nuclear perfusion heart scan showed no abnormality. It was noted that the negative T waves during left bundle branch block were in the exact same leads as were the deep negative QRS complexes during ventricular pacing. The electrocardiographic changes were consistent with cardiac memory. This case is unique because cardiac memory in patients with intermittent left bundle branch block typically occurs when the QRS complexes normalize and not during left bundle branch block itself. Our findings indicate that memory Ts can develop not only after normalization of wide complex rhythms but also with alternating wide complex rhythms as in the presented case where a ventricular paced rhythm was replaced by left bundle branch block.
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PMID:Cardiac memory during rather than after termination of left bundle branch block. 2517 85

A 73-year-old gentleman with dilated cardiomyopathy, left bundle branch block and a left ventricular (LV) ejection fraction of 20% was implanted with two LV leads in a tri-ventricular cardiac resynchronisation therapy defibrillator (CRT-D) trial. As a part of the trial he was programmed with fusion-based CRT therapy with dual LV lead only pacing. The patient presented to local heart failure service 12 years after implant, after a positive response to CRT therapy, with increase in fatigue, shortness of breath and bilateral pitting oedema. The patient sent a remote monitoring transmission that suggested loss of capture on one of the LV leads. This coupled with atrial ectopics was producing a high burden of pacemaker-mediated tachycardia (PMT) that was not seen when both LV leads had been capturing. What is the mechanism for this? Dual LV-lead tri-ventricular leads have been shown to have variable improvements in CRT response but with an increased complexity of implant procedure. This is the first case report of PMT-induced heart failure exacerbation in a tri-ventricular device following loss of LV capture of one lead.
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PMID:Pacemaker-mediated tachycardia in a dual-lead CRT-D: What is the mechanism? 3305 15