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

The onset of serious arrhythmias during potassium depletion occurs rather frequently in female subjects who have undergone hypotensive-diuretic treatment, independently from the duration and doses of drugs. These arrhythmias which produce a cardiac arrest, can also occur in subjects not affected with heart disease. They are not necessarily preceeded by clinical prodrumus or other types of minor arrhythmias not accompanied by other important electrocardiographic or serum-logical alterations of hypokaliemia. The most commonly observed type is the "torsades de pointe", though cases of ventricular tachycardia or ventricular fibrillation are also documented. The ethiopathogenesis is discussed with regard to the alterations of the basic electrocardiogram as well as to the kind of major arrhythmia. In most cases , lidocaine has given the most satisfactory thmias, results in the treatment of these arrhythmias, probably because of the modality of the action which is substantially different from the other antiarrhythmic drugs.
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PMID:[Syncope during potassium depletion (author's transl)]. 101 Jan 79

In 1912 Goulston advocated glucose therapy for several different kinds of heart disease, and in 1933 Shirley-Smith recommended glucose and insulin for coronary artery disease. Thirty years later, Laborit noted that treatment of rabbits with glucose and insulin prevented ventricular fibrillation induced by potassium chloride solutions. Sodi-Pallares et al, pioneers in glucose-insulin-potassium (GIK) therapy for heart disease, showed not only that potassium may be a major excitant in the genesis of ventricular tachycardia in the ischemic heart but that GIK solution was capable of enhancing oxidative phosphorylation in the ischemic heart. Interest in GIK therapy for ischemic heart disease has been renewed as the effects of GIK solutions on myocardial infarct size, metabolism and electrical properties are better understood. In this paper, selected new information regarding the actions of GIK and the clinical applications will be reviewed.
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PMID:Glucose-insulin-potassium (GIK) therapy for ischemic heart disease. 110 62

A fatal case of the pre-excitation syndrome in a 3 10/12 years old girl with no other heart disease is presented. Her death is thought to be the consequence of ventricular fibrillation. This observation is in contrast to the reported benign course in infants and children with the Wolff-Parkinson-White syndrome without other heart disease.
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PMID:Wolff-Parkinson-White syndrome. A fatal case in a girl with no other heart disease. 111 92

Cardiac arrest developed in two patients after the administration of oral potassium. Neither patient had renal insufficiency, but both had underlying heart disease. In one patient fatal ventricular fibrillation developed 4 days after he received an aortic valve replacement for aortic stenosis and while he was receiving oral potassium supplements. The serum potassium level before cardiac arrest was 8.1 meq. The second patient had angina and was given 40 meq of potassium orally 15 minutes after an exercise test which produced chest pain and S-T segment depression. One hour later, ventricular fibrillation developed. Resuscitation was successful. Both patients had electrocardiographic evidence of hyperkalemia. Oral administration of potassium may produce severe cardiac toxicity in patients with heart disease even when renal function is clinically normal.
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PMID:Cardiac arrest due to oral potassium administration. 111 63

Ventricular tachycardia and ventricular fibrillation are frequent complications of organic heart disease. There is sufficient evidence that serial electrophysiologic testing is able to predict long-term efficacy of antiarrhythmic agents in patients with malignant ventricular tachyarrhythmias. This approach has not only been useful for the evaluation of class I drugs, but recent studies have shown that this invasive method may also be useful for the management of patients undergoing treatment with class III antiarrhythmic agents such as amiodarone and sotalol. The results of several studies suggest that class III agents are more effective than class I drugs in patients presenting with ventricular tachycardia or ventricular fibrillation. Proarrhythmic complications in patients treated with class III antiarrhythmic drugs are mainly characterized by torsades de pointes. Their incidence does not exceed 5%. Further studies are necessary to elucidate the mechanisms underlying this type of proarrhythmia. By the use of currently available stimulation techniques, patients who might develop torsades de pointes while on therapy with a class III agent cannot be identified.
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PMID:How to evaluate class III antiarrhythmic drug efficacy clinically: the benefits and shortcomings of the invasive approach. 127 7

The pathogenesis of cardiac arrest in the absence of any apparent heart disease remains unclear. Based on the hypothesis that coronary spasm may be a cause of cardiac arrest in the absence of apparent heart disease, ergonovine testing and/or electrophysiologic studies (EPS) were performed to evaluate the cause of cardiac arrest. Fourteen patients resuscitated from cardiac arrest had no apparent heart disease. A spontaneous episode of angina with ST-segment elevation occurred in 4 patients while under observation. Ergonovine testing was performed in 9 patients, and coronary spasm was induced in 5. EPS were performed in 8 patients, including 3 patients with coronary spasm. No electrophysiologic abnormalities were found in the 3 patients with coronary spasm. Ventricular fibrillation was induced by programmed ventricular stimulation in 2 patients with documented ventricular fibrillation at the time of resuscitation. All but one of the patients with coronary spasm had chest pain preceding cardiac arrest or at least a history of chest pain at rest, while 4 of 5 patients without coronary spasm had no prodromal symptoms. Patients with coronary spasm had a good prognosis when treated with a Ca-antagonist and/or long-acting nitrate. In conclusion, coronary spasm is the most frequent cause of cardiac arrest in cardiac arrest survivors with no apparent heart disease. Ergonovine testing should be performed to evaluate the cause of cardiac arrest when patients have no apparent heart disease.
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PMID:High prevalence of coronary artery spasm in survivors of cardiac arrest with no apparent heart disease. 841 43

A variety of therapeutic options including pharmacological treatment, surgical procedures, ablation interventions and electrotherapy are available for the management of patients who are subject to symptomatic ventricular tachyarrhythmias. Patients with documented sustained ventricular tachycardia or ventricular fibrillation are usually controlled by serial electrophysiological studies. About 30 to 60% of these patients respond to antiarrhythmic drugs during serial electrophysiological testing. Patients with severe left-ventricular function respond less frequently than those of well-preserved function. Long-term follow-up studies have demonstrated that, if ventricular tachyarrhythmias can no longer be induced on antiarrhythmic drugs or if inducibility is at least rendered more difficult, the rate of recurrences is low. In contrast, patients with still inducible ventricular tachyarrhythmias may have a poor prognosis and may suffer from frequent recurrences or may even die suddenly. Thus, nonpharmacological strategies such as an implantable cardioverter/defibrillator, transvenous catheter ablation and map-guided antitachycardia surgery have become important alternatives for drug refractory patients. Since the introduction of the implantable cardioverter/defibrillator using a nonthoracotomy approach, the intraoperative and perioperative mortality and morbidity has been significantly reduced. A widespread use of these newer devices required the establishment of guidelines for the appropriate application of this new treatment modality. Surgical, medical and economic considerations make it imperative that defibrillator therapy should be chosen on a basis of careful patient selection. The presenting clinical arrhythmia and its hemodynamic stability, underlying heart disease and left-ventricular ejection fraction should be taken into consideration.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical assessment and indications for automatic defibrillation]. 151 87

The prevalence of proarrhythmic events during moricizine therapy was studied in 144 patients who were treated for symptomatic ventricular tachycardia or ventricular fibrillation. The overall incidence of proarrhythmia was 15.3%. (Twenty-two patients exhibited 23 events.) Ventricular fibrillation occurred in six patients (which led to three deaths), incessant ventricular tachycardia occurred in seven, and new sustained ventricular tachycardia in four. Patients with proarrhythmia had significantly lower left ventricular ejection fraction (24% vs 39%; p less than 0.0001), higher prevalence of congestive heart failure (68% vs 36%; p less than 0.005), and higher incidence of previous proarrhythmia (45% vs 9%; p less than 0.0001). No significant difference between the two groups was found in respect to age, arrhythmia at presentation, underlying heart disease, moricizine dose, or concomitant drug therapy.
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PMID:The prevalence of proarrhythmic events during moricizine therapy and their relationship to ventricular function. 152 3

The usefulness and limitations of antiarrhythmic drugs in ventricular tachycardias (VT) associated with congestive heart failure remain uncertain. The purpose of this study is to evaluate the proarrhythmic effects of antiarrhythmic drugs in patients with refractory VT associated with left ventricular dysfunction using electrophysiologic study (EPS). Twenty-four patients with left ventricular dysfunction, defined by left ventricular ejection fraction (LVEF) lower than 40% using left ventriculography, were studied. The average LVEF was 29.5%. As for underlying heart disease, 14 had old myocardial infarction, 8 cases had dilated cardiomyopathy and 2 had aortic regurgitation. As a control to this group, 23 cases with underlying heart disease and LVEF higher than 40%, and 27 cases with no obvious heart disease were studied. We considered a drug to have proarrhythmic effects if 1) it decreased by one the number of stimuli needed to induce VT, 2) induced non-sustained VT in the control study which changed to induced sustained VT, 3) the sustained VT or ventricular fibrillation was newly induced, or 4) the induced sustained VT which was stopped by pacing in the control study changed to induced VT which could not be terminated by pacing and required DC shock. Proarrhythmic effects were recognized in 17 of 24 cases with left ventricular dysfunction. Of the 67 drug trials, proarrythmic effects were seen in 26. Proarrhythmias were observed in 9 of 23 cases (39.1%) with organic heart disease associated with LVEF higher than 40%. In 12 of 69 drug trials (17.4%) proarrhythmias were observed. Of 27 cases with no obvious heart disease 10 cases (37%) had proarrhythmias. In 14 of 130 drug trials (10.8%), proarrhythmias were recognized.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Evaluation of proarrhythmic effect of antiarrhythmic drugs on ventricular tachycardia associated with congestive heart failure. 153 78

To determine the cardiac pathology underlying ventricular tachyarrhythmias, endomyocardial biopsy was performed in 14 patients, 10 men and 4 women, with a mean age of 40 years (range 17-63) and no apparent structural heart disease, presenting with high-density symptomatic nonsustained ventricular tachycardia (VT) (n = 4), sustained VT (n = 6), and ventricular fibrillation (n = 4). The absence of coronary or valvular heart disease was documented by cardiac catheterization. The mean left ventricular ejection fraction was 56 +/- 10%. Noninvasive assessment of the ventricular arrhythmia was made in all patients with Holter monitoring and/or exercise testing, while invasive evaluation with programmed electrical stimulation was performed in 13 patients. Biopsy findings included subendocardial and interstitial fibrosis in 7 patients, and monocytes containing periodic acid Schiff (PAS) positive vacuoles in 1 patient; biopsy was normal in 6 patients. There was no relationship between the presence or absence of pathologic abnormalities on biopsy and left ventricular ejection fraction, presenting or induced arrhythmias, or prognosis. Pathologic evidence supporting a specific treatable diagnosis was not present in any biopsy. Drugs to suppress spontaneous (3 patients) or induced (8 patients) VT were instituted, while 2 patients were not treated. In 1 patient who was resuscitated from out-of-hospital cardiac arrest an automatic defibrillator was implanted. In 24.6 months of mean follow-up there was 1 nonfatal arrhythmia recurrence, 1 noncardiac death, and 1 sudden death in a patient with fibrosis on biopsy, an ejection fraction of 45%, and both inducible and spontaneous sustained VT suppressed with an antiarrhythmic agent.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Limited clinical utility of endomyocardial biopsy in patients presenting with ventricular tachycardia without apparent structural heart disease. 154 Oct 71


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