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

A follow-up study of 49 individuals with paroxysmal atrial tachycardia in infancy is reported. Forty subjects had supraventricular tachycardia and nine had atrial flutter/fibrillation. The mean follow-up period was 24 years. Males whose ECGs showed preexcitation displayed the highest rate of recurrences (approximately 60%) in the long-term follow-up. Approximately 30% of the subjects without preexcitation in the ECG displayed episodes of supraventricular tachycardia in their third decade. Eight-six percent of the children of the subjects in the present series were males. The prognosis is good in the absence of congenital heart disease.
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PMID:Paroxysmal atrial tachycardia in infancy: long-term follow-up study of 49 subjects. 712 64

Twenty-four hour recordings of respiratory wave form and ECG were made on low-birth-weight and/or premature infants within one week of discharge from eight neonatal intensive care units. Eight infants (0.7%) had episodes of apnea greater than 30 seconds in duration, all of which were accompanied by bradycardia less than 100 beats per minute; 25 infants (2.3%) had a total of 36 apneic episodes between 20 and 30 seconds in duration, 29 of which were accompanied by bradycardia less than or equal to 100 beats per minute; and 19 infants (1.7%) had episodes of bradycardia less than or equal to 50 beats per minute without prolonged apnea (as shown by a lack of breathing movement). Five infants had ventricular premature beats (including one with ventricular tachycardia). Eleven infants had supraventricular premature beats (including two with supraventricular tachycardia and one with preexcitation). Four infants had both supraventricular and ventricular premature beats. Two infants had preexcitation. Eleven infants who underwent 24-hour recordings died. Five infants were victims of sudden infant death syndrome. One infant death was sudden and unexpected and was attributed to bronchopneumonia. Two deaths were associated with congenital heart disease and three were associated with major cerebral disorders. None of the six babies who died suddenly and unexpectedly had apnea greater than or equal to 20 seconds, bradycardia less than or equal to 50 beats per minute, or cardiac arrhythmias on their 24-hour recordings.
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PMID:Prolonged apnea and cardiac arrhythmias in infants discharged from neonatal intensive care units: failure to predict an increased risk for sudden infant death syndrome. 714 36

We reviewed the records of 217 children whose first episode of supraventricular tachycardia occurred before 18 years (median age 24 months). There were 112 males and 105 females. Of the 49 with congenital heart disease, SVT began before any operation in 26 and greater than 2 weeks postoperatively in 23. Wolf-Parkinson-White syndrome was present on surface ECG in 47/217 (22%). Congestive heart failure accompanied the first episode of SVT in 38% of the patients who were 4 months of age or younger, and in only 19% of those over 4 months (P less than 0.001). Treatment was successful in stopping SVT within 48 hours in 90/142 (63%). Successful short-term treatment included digoxin 57/184 (68%), cardioversion 12/20 (60%), vagal maneuvers 12/19 (63%), phenylephrine 3/9, and overdrive pacing 4/5. SVT recurred at least once in 83% of all patients. On follow-up (mean 4.6 years), episodes of SVT were still present in 56%. Three patients died--two from incessant SVT and one from a CVA after VSD repair. We conclude that long-term status was difficult to predict, but SVT was present in fewer patients whose age at onset was less than 4 months and in those with unoperated CHD. Early recurrence was not a poor prognostic sign. We recommended treatment for at least one year in all patients with SVT, whether or not the first episode terminates spontaneously.
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PMID:Supraventricular tachycardia in children: clinical features, response to treatment, and long-term follow-up in 217 patients. 722 88

Disorders of rhythm and conduction are characteristic of the cardiac involvement in progressive systemic sclerosis (PSS), but their over-all frequency in PSS is not well established. Therefore, 46 ambulatory patients with PSS underwent several tests of cardiopulmonary function, including a 24-hour continuous electrocardiogram (Holter monitor). Conduction disturbances (sinus node dysfunction, first-degree heart block, pre-excitation), supraventricular arrhythmias (supraventricular tachycardia, atrial fibrillation, premature contractions of atrial or junctional origin) and ventricular arrhythmias (ventricular tachycardia, multifocal premature contractions) were observed on Holter monitoring in 26 subjects. Although these arrhythmias and conduction disorders were predictably observed in patients who complained of palpitations or syncope, or who had an electrocardiogram which showed first-degree heart block, ventricular bigeminy, left anterior superior hemiblock, prolonged p wave, right or left axis deviation, right or left ventricular hypertrophy, pathologic Q waves or low voltage, they were often found in patients who lacked other clinical evidences of heart disease. Arrhythmias and conduction disturbances were not significantly more frequent among patients with cardiomegaly or interstitial change on chest roentgenogram nor were they related to the presence or severity of abnormal lung function. This study suggests that Holter monitoring may be a valuable adjunct in evaluating heart disease in PSS.
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PMID:The relationship arrhythmias and conduction disturbances to other manifestations of cardiopulmonary disease in progressive systemic sclerosis (PSS). 724 82

We investigated the clinical features, surface ECG findings, associated with congenital heart disease (CHD), and status at follow-up in 103 children who underwent intracardiac electrophysiologic evaluation of supraventricular tachycardia (SVT). Age at catheterization ranged from 2 days to 17 years (mean 4.2 years). Diagnosis of the mechanism was based upon standard electrophysiologic techniques. Of the 103 patients, 37 had reentry without a bypass tract (10 sinoatrial node, two atrial muscle, and 25 atrioventricular node); 51 had reentry with a bypass tract (28 manifest Wolff-Parkinson-White [WPW], 18 unidirectional retrograde accessory pathway [URAP], an five Lown-Ganong-Levine); and 15 had an ectopic focus (11 atrial, four junctional). Distinguishing features among the common types are depicted in Table III. We conclude that in children the various mechanisms of SVT (1) are likely to be found in different clinical situations, (2) have a different potential for surgical cure, and (3) have a different prognosis for long-term treatment. Since curative surgery was theoretically possible in 57% of our patients (WPW, concealed WPW, atrial, and junctional ectopic), we recommend electrophysiologic study in any patient who has had frequent recurrences of SVT for longer than 1 year and who requires drugs in addition to digoxin for treatment.
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PMID:Electrophysiologic studies of supraventricular tachycardia in children. I. Clinical-electrophysiologic correlations. 725 98

The technique, indications and results of surgical division of accessory atrioventricular connections in 10 infants and children with drug-resistant supraventricular tachycardia are described. The patients ranged in age from 6 months to 15 years. Four patients had associated congenital heart disease. Division of accessory connections were performed on free wall pathways in nine patients (seven right atrial, two left atrial) and on a septal pathway in one patient. Four patients had both anterograde and retrograde conduction over the accessory connection (manifest Wolff-Parkinson-White conduction) whereas six had only retrograde conduction (concealed Wolff-Parkinson-White conduction). The manifst Wolff-Parkinson-White conduction was abolished by surgical division in all four patients. In 8 of the 10 patients the procedure stopped the attacks of paroxysmal supraventricular tachycardia for follow-up periods ranging from 9 months to 3 1/2 years; no patient receives medication to date.
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PMID:Surgical treatment of supraventricular tachycardia in infants and children. 740 42

The incidence and significance of dual atrioventricular (A-V) nodal pathways are described in 78 children with associated congenital or acquired heart disease. None of these patients had clinical or electrocardiographic evidence of arrhythmia. Dual A-V nodal pathways were observed in 35 percent of the preoperative group and in 33 percent of the postoperative group. Despite this substrate for A-V nodal reentry, supraventricular tachycardia was neither induced during electrophysiologic evaluation nor did it develop clinically over a follow-up period of 1 month to 15 years. It is concluded that dual A-V nodal pathways are common and may be a benign finding in arrhythmia-free children with heart disease.
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PMID:Dual atrioventricular nodal pathways: a benign finding in arrhythmia-free children with heart disease. 744 15

Experience with oral sotalol, a beta-blocker with class III-antiarrhythmic properties, is limited in the pediatric population. Sotalol was administered to 32 patients with a mean age of 8.7 years (range 1 day-19.9 years). Mean dosage was 4.6 (1.5-9.4) mg/kg or 122.1 (52-306) mg/m2, respectively. In 27/32 patients, at least 1 antiarrhythmic agent had failed to control the dysrhythmia before sotalol was started. Cardiac diagnoses included normal heart (n = 16), status after correction of congenital heart disease (n = 13), and cardiomyopathy (n = 3). Success (based on symptoms and 24-h electrocardiogram) was achieved in 16/18 patients with reentry supraventricular tachycardia, in 7/8 patients with atrial flutter, and in 4/6 patients with ventricular tachycardia. During a mean follow-up of 15.6 (2-78) months, proarrhythmia occurred in five (16%) patients (symptomatic bradycardia n = 2, QT-prolongation and ventricular extrasystoles n = 1, ventricular extrasystoles n = 1, 2 degrees av-block n = 1), requiring dosage reduction (n = 3), cessation of treatment (n = 1) and pacemaker implantation in one patient, respectively. Symptomatic hypotension was noted in two patients, in whom therapy had to be stopped. Sotalol was a very effective agent for the treatment of various pediatric cardiac dysrhythmias. However, incidence of proarrhythmic effects warrants close electrocardiographic monitoring.
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PMID:[Results of oral sotalol therapy in children with supraventricular and ventricular arrhythmias]. 753 74

We sought to determine the prevalence of acute cardiovascular complications of endoscopy and to describe the clinical features associated with such events. Acute cardiovascular complications were identified from a computerized database of all endoscopies performed at our institution, and their clinical histories were abstracted from the medical records. Of 21,946 endoscopic procedures performed between August 1, 1988, and December 31, 1992, 9 women and 22 men (0.14%) developed acute cardiovascular complications including vasovagal reaction (24), supraventricular tachycardia (4), myocardial infarction (2) and congestive heart failure (1). Fourteen patients had underlying coronary artery disease and 4 others exertional angina; 20 of 25 electrocardiograms available before the endoscopy were abnormal. Twenty patients required treatment during endoscopy, but only 3 needed continued therapy. One patient died of a periprocedural acute myocardial infarction. Seven (23%) patients experienced additional cardiac events during the follow-up period of 21.8 +/- 15.8 months. In conclusion, acute cardiovascular complications of endoscopy are infrequent and usually self-limited; serious complications occurred exclusively in the setting of known underlying heart disease.
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PMID:Acute cardiovascular complications of endoscopy: prevalence and clinical characteristics. 758 33

Wide complex tachycardias present diagnostic challenges for emergency physicians. The history, physical examination, and ECG provide information required to arrive at the correct diagnosis. When a previous history of heart disease exists, VT should be suspected; however, no single clinical feature is sufficiently reliable for distinguishing VT from SVT. Patients with VT may tolerate their dysrhythmias for several hours and maintain hemodynamic stability. ECG analysis is the most useful process in differentiating SVT and VT. Characteristics suggestive of VT include evidence of AV dissociation, QRS duration of longer than 0.16 seconds, and QRS axis between -90 degrees +/- 180 degrees. Predictive QRS morphologic criteria also have been established for VT. A four-step approach to ECG analysis has been reported to accurately identify patients with VT, but prospective validation in an ED setting is lacking. The initial approach to treating patients with wide QRS tachycardias depends on hemodynamic stability. Until the identify of a dysrhythmia is certain, consider all patients to be suffering from VT. Unstable patients require immediate cardioversion. Acute treatment of stable patients includes lidocaine or procainamide. Adenosine is appropriate when wide QRS SVT is the diagnosis, and it also has been used as a diagnostic aid to identify dysrhythmias. Reports of complications with the use of adenosine as a diagnostic agent have not yet appeared but may occur after sufficient numbers of cases have accumulated. Magnesium sulfate may be useful in refractory cases of VT and torsades de pointes. Chronic treatment of patients prone to VT may include complex pharmacotherapy and AICDs. Development of new class III agents and enhancement of AICD technology may result in improved patient outcomes and the availability of more choices for emergent therapy of wide QRS tachycardias.
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PMID:Wide complex tachycardia. 758 95


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