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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical data of patients with cardiac arrhythmias managed between May 1986 and March 1988 were reviewed to determine their mode of presentation and clinical course. Of the 5,768 admissions, 62 (1.07%) patients had arrhythmias. During the same period, 21 patients were managed as outpatients with 13 being new referrals. Thirty-eight patients had undergone corrective cardiac procedures, 8 others had congenital heart lesions, 3 were associated with acquired cardiac pathology and the remaining had isolated arrhythmias. The cardiac arrhythmias were: right bundle branch block 36, premature atrial and ventricular contractions 15, supraventricular tachycardia (SVT) 15, atrioventricular (AV) block 7, sinus bradycardia 3, atrial fibrillation 2, ventricular tachycardia and fibrillation 2, Wolff-Parkinson-White syndrome without SVT 2, bradytachyarrhythmia 1. There were 3 patients with foetal SVT, one persisting till day 1. High grade AV block occurred in 2 patients post-surgically and needed pacing. Only 2 others were symptomatic. Other than the 38 patients who underwent corrective procedures (2 had balloon valvuloplasty for pulmonary stenosis), 8 others had structural heart disease. There was 1 sudden death and 5 died from their primary heart disease.
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PMID:Cardiac arrhythmias in paediatric practice. 247 68

The aim of this paper was to study atrial natriuretic factor, plasma renin activity and antidiuretic hormone values during paroxysmal atrial arrhythmias with different ventricular rates before and after pharmacological cardioversion and during chronic atrial flutter-fibrillation. The study was carried out: 1) during acute arrhythmias (atrial flutter-fibrillation or supraventricular tachycardia) and after restoration of normal sinus rhythm in 2 patients without heart disease, in 13 with chronic heart disease and in 6 with acute myocardial infarction; 2) during chronic atrial flutter-fibrillation in 5 patients with chronic ischemic heart disease, without congestive heart failure. Atrial natriuretic factor, aldosterone, plasma renin activity and antidiuretic hormone values were measured by radio-immunoassay. During paroxysmal atrial arrhythmias atrial natriuretic factor levels were higher than normal in all patients, particularly in those with supraventricular tachycardia. Most of the aldosterone measurements were above the normal range. As far as plasma renin activity and antidiuretic hormone values are concerned, levels higher than the normal range were found in the patients with severe hemodynamic impairment. Central venous pressure was above normal in all patients except in the 2 without heart disease, and there was a positive correlation between atrial natriuretic factor and central venous pressure values. After restoration of normal sinus rhythm atrial natriuretic factor values returned to normal except in acute myocardial infarction patients, in 1 chronic ischemic heart disease patient with congestive heart failure and in 3 patients with mitral valve disease. In all patients with chronic atrial flutter-fibrillation and in 5 patients with acute atrial flutter-fibrillation and low rate, above normal atrial natriuretic factor values were found with normal central venous pressure values. Atrial distension due to high central venous pressure values, lack of atrial contraction and rhythmic detension of the atrial stretch receptors, may be considered the major stimuli responsible for atrial natriuretic factor release during acute paroxysmal atrial arrhythmias and atrial flutter-fibrillation with low ventricular rate, respectively.
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PMID:[Atrial natriuretic factor in acute atrial hyperkinetic arrhythmia and chronic atrial fibrillo-flutter]. 252 75

Transesophageal electrophysiologic study has recently been proposed for the evaluation of supraventricular arrhythmias. In this report we present 13 cases, with palpitations occurring only during effort, due to a suspected supraventricular tachycardia, in which the usefulness of the transesophageal electrophysiologic study performed during stress test was evaluated. Of these 13 patients, nine were male and four were female, mean age was 29 yrs. Twelve cases had no heart disease, one had a moderate mitral valve insufficiency. Nine cases had a normal ECG, four had a WPW pattern. In 9/13 cases no significant arrhythmia was ever documented, in 1/13 ventricular premature beats were present in the basal ECG, in 1/13 a atrial fibrillation and in 2/13 a supraventricular reciprocating tachycardia was recorded. In all cases a maximal exercise test and a 24-hour Holter monitoring were performed. In all pts a transesophageal electrophysiologic study was performed both at rest and during extra-stimuli and incremental atrial pacing. The end point of transesophageal study was the induction of a sustained (greater than 30") supraventricular tachycardia. RESULTS. Maximal exercise test was negative in 11/13 cases; it showed ventricular premature beats in one case and initiated a supraventricular tachycardia in one. The 24 hour Holter monitoring was negative in 12/13 cases while it showed frequent ventricular premature beats in one. Resting transesophageal electrophysiologic study revealed dual A-V nodal pathways in six pts: in one of them a junctional re-entry was induced; in two a single echo beat was observed, while in three no reentry was observed. In three cases a supraventricular tachycardia was induced which was sustained in one and unsustained (7" and 24") in two cases. In 4 cases transesophageal electrophysiologic study gave no information. Transesophageal stimulation during exercise induced a greater than 30" reciprocating tachycardia in all patients, at work loads of 30-180 watts. Six pts had an intranodal tachycardia (V-A less than 70 msec) a further six pts had a atrioventricular tachycardia involving a Kent bundle (V-A greater than or equal to 70 msec), which was concealed in two, and one had a atrial tachycardia. In four cases (3 with intranodal and 1 with atrioventricular tachycardia), exercise transesophageal study was repeated after chronic therapy with betablockers (sotalol 240 mg/die or metoprolol 200 mg/die). In all cases, after therapy, the induced tachycardia had a longer cycle and in two cases it was induced at a higher work load. In a further two cases flecainide (200 mg/die) was tested. In one case (with atrial tachycardia), the arrhythmia was no longer inducible after therapy, in another case (with intranodal tachycardia) the drug had no effect. CONCLUSIONS. In patients with paroxysmal supraventricular tachyarrhythmias occurring during effort the basal ECG is normal or shows a WPW pattern. The maximal exercise test and 24 hour Holter monitoring give no information in over 90% of cases.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Usefulness of transesophageal electrophysiological study during the ergometric test in the evaluation of supraventricular paroxysmal tachycardia occurring during exertion]. 257 99

A patient who had received balloon atrioseptotomy and B-T shunt operation previously experienced recurrent episodes of supraventricular tachycardia, and was refractory to medical treatment since the age to 3. At 9 years, the patient underwent intraoperative electrophysiological mapping which confirmed the earliest breakthrough at the crux of posterior septal region. Rastelli's operation and division of posterior septal Kent was simultaneously performed successfully. Post operative ECG was normalized with abolition of delta wave, and PSVT was gone. We concluded that the division of Kent bundle should be simultaneously performed with operative reconstruction in patients with congenital heart disease and WPW syndrome on postoperative care for SVT.
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PMID:[A case report of successful one-stage operation in TGA (group III) with WPW syndrome]. 262 69

The records of 28 children whose first episode of paroxysmal supraventricular tachycardia occurred before 12 years (median age 10 months) were reviewed. There were 17 males and 11 females. In 17 cases the first attack occurred before the first year and in 11 of these it occurred after the first year. One case had congenital heart disease (ASD). The WPW syndrome was diagnosed in 3 cases. When first seen, most of the infants presented with signs of incipient or manifest congestive heart failure. In almost nine-tenth of cases there was an increased of serum enzymes (lactic dehydrogenase, creatine-phosphokinase and glutamic oxaloaccetic transaminase. Digitals was effective against congestive heart failure and when continued, might prevent failure during subsequent attacks. Antiarrhythmic agents other than digitals were not used. It is recommended to continue digitalis treatment for at least one year in all patients with SVT, whether or not the first episode terminated spontaneously.
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PMID:Paroxysmal supraventricular tachycardia in children: the role of infectious diseases and its relationship to serum enzyme. 263 Oct 23

We compared the frequency and severity of cardiac arrhythmias during combined oral theophylline and inhaled salbutamol vs. salbutamol therapy alone in 18 patients with moderate to severe chronic obstructive pulmonary disease who had concurrent cardiac disease. Seventeen patients showed at least one supraventricular premature complex (SVPC) on the 24-h ECG recording when receiving salbutamol alone: eight patients had isolated SVPCs, less than 10/h; five patients had greater than or equal to 10 SVPCs/h; eight patients showed runs of supraventricular tachycardia or paroxysmal atrial fibrillation. Seventeen patients also had at least one ventricular premature complex: seven patients had less than 10 isolated PVCs/h, five patients greater than or equal to 10 PVCs/h; eight patients had paired or multifocal PVCs and one patient a run of ventricular tachycardia. The addition of oral theophylline at an average dose of 600 mg in the evening (blood concentrations showed a mean maximum of 13.4 +/- 4.0 (SD) and minimum of 5.5 +/- 2.9 mg/l) had no influence on the frequency or severity of either ventricular or supraventricular arrhythmias. Thus, cardiac arrhythmias are very common in patients with chronic obstructive pulmonary disease and concomitant heart disease, but oral theophylline added to a regimen of salbutamol does not seem to affect the occurrence or severity of arrhythmias.
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PMID:Theophylline and salbutamol in combination in patients with obstructive pulmonary disease and concurrent heart disease: effect on cardiac arrhythmias. 268 5

In clinical arrhythmias, the main therapeutic role of calcium channel entry blockers is related to their effect on the sinus and atrioventricular (AV) node. Consequently, in cardiac arrhythmias where the AV node is part of the reentry circuit, a beneficial effect of diltiazem and verapamil can be demonstrated. These include AV nodal reentry and orthodromic tachycardia in patients with Wolff-Parkinson-White syndrome. In addition, the ventricular response by the AV node during atrial tachycardias can also be controlled with these agents. A specific type of ventricular tachycardia seen in the absence of structural heart disease has also been reported to respond to intravenous and oral verapamil. Calcium channel blockers have no proven depressant effect on accessory pathway conduction. Similarly, the value of these agents in the treatment of ventricular tachycardia in association with chronic coronary artery disease and idiopathic dilated cardiomyopathy is rather limited. The use of calcium entry blockers in patients with wide QRS tachycardia, therefore, is to be discouraged unless it can be proved that supraventricular tachycardia with aberrant conduction is the underlying basis.
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PMID:Use of calcium channel entry blockers in the treatment of cardiac arrhythmias. 268 83

The efficacy of amiodarone was evaluated in 85 patients with supraventricular tachycardia (SVT) refractory to several antiarrhythmic agents (mean 3.8 +/- 1.0). All but six patients had organic heart disease. Patients were followed for 19 months (range 2-60 months). Response to amiodarone treatment was considered excellent (no recurrence of SVT) in 22 of 52 patients with paroxysmal atrial fibrillation (PAF), in four of 13 patients with chronic atrial fibrillation (CAF), and in three of 15 patients with Wolff-Parkinson-White syndrome-related circus movement tachycardia (WPW-CMT). Response was improved (marked improvement in symptoms with partial suppression of SVT) in 22 patients with PAF, in seven patients with CAF, in 10 patients with WPW-CMT, and in four patients with atrioventricular nodal reentry tachycardia. Response was considered poor (insignificant or no suppression of SVT) in three patients with PAF, in one patient with CAF, and in one patient with WPW-CMT. Seven patients required discontinuation of amiodarone due to adverse effects. We conclude that amiodarone is efficacious and relatively safe for control of SVT refractory to conventional antiarrhythmic agents irrespective of the underlying electrophysiologic mechanism.
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PMID:The usefulness of amiodarone in management of refractory supraventricular tachyarrhythmias. 274 45

The purpose of this study was to define the natural history of 99 patients with unexplained syncope who underwent an electrophysiologic test that either was entirely normal or demonstrated nonspecific abnormalities that were nondiagnostic (inducible polymorphic ventricular tachycardia or ventricular fibrillation, a mildly prolonged sinus node recovery time of less than 2 s, a His-ventricular interval of 55 to 99 ms or supraventricular tachycardia not associated with hypotension). The mean age (+/- SD) of the patients was 56 +/- 19 years; structural heart disease was present in 47 patients and absent in 52. Complete follow-up was available in 95 patients. During 20 +/- 11 months of follow-up, 2 patients (2%) died suddenly, 19 patients (20%) had recurrent syncope and 74 patients (78%) had no further episodes of syncope. Among the 19 patients who continued to have syncope after the electrophysiologic testing, the cause of syncope was established clinically in 4 and was found to be high degree atrioventricular (AV) block (2 patients) or sinus node dysfunction (2 patients). No clinical or laboratory findings distinguished patients who had sudden death or syncope during follow-up from patients who did not. In conclusion, in patients with unexplained syncope who undergo an electrophysiologic test that is nondiagnostic 1) the incidence of sudden death is low (2%); 2) the remission rate of syncope is high (80%); 3) the electrophysiologic test may be documented to have been falsely negative in greater than or equal to 20% of patients who continue to have syncope, syncope in these patients being caused by AV block or sinus node dysfunction; and 4) patients at risk of sudden death or recurrent syncope, or both, cannot be readily identified prospectively.
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PMID:Natural history of patients with unexplained syncope and a nondiagnostic electrophysiologic study. 275 28

Because anecdotal reports suggest that concentrations of atrial natriuretic peptide are raised during tachycardias, plasma immunoreactive atrial natriuretic peptide concentrations were measured in 34 consecutive patients when tachycardia was diagnosed and again five and 15 minutes after conversion to sinus rhythm. Plasma atrial natriuretic peptide concentrations were raised in all but four patients, and were higher in patients with known heart disease than in those without. The concentrations were higher with ventricular tachycardia than with atrial fibrillation or supraventricular tachycardia, and in acute versus chronic tachycardia. There was only a weak positive relation between ventricular rate and atrial natriuretic peptide (r = 0.31); but there was a closer inverse correlation between atrial natriuretic peptide and systolic arterial pressure (r = -0.60). Conversion to sinus rhythm was associated with a definite fall in plasma atrial natriuretic peptide concentrations. Despite very high baseline concentrations of atrial natriuretic peptide only two patients reported polyuria. It is likely that atrial pressure rather than ventricular rate determines atrial natriuretic peptide release during tachycardia. Despite the absence of polyuria in all but two patients in this study atrial peptides could still contribute to, or cause, the polyuria of tachycardias.
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PMID:Atrial natriuretic peptide in spontaneous tachycardias. 295 81


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