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

Electrophysiological studies (His bundle recordings and atrial stimulation) were performed in nine patients who manifested periods of both right and left bundle branch block (RBBB and LBBB). In seven of the patients, alternating bundle branch block appeared to reflect intermittent or chronic bundle branch block superimposed on incomplete (but electrocardiographically complete) block of the contralateral bundle branch. In three of these seven, shift from one bundle branch block pattern to the other was associated with reproducible change in H-V (mean change 30 msec), and could be induced by alteration of cardiac rate with carotid massage, coupled atrial stimulation, and rapid atrial pacing. In one of the seven, RBBB with a P-R of 0.20 seconds preceded chronic LBBB with a P-R of 0.24 seconds, implying that RBBB had been incomplete. In three of the seven, although a definite mechanism of alternation could not be demonstrated, transient contralateral bundle branch block occurred superimposed on chronic ipsilateral bundle branch block, implying that the ipsilateral block was incomplete. Two patients manifested periods of narrow QRS, LBBB, RBBB, and paroxysmal A-V block. Based upon pathological data (one case), this pattern appeared to reflect a lesion involving the distal His bundle and proximal bundle branches. In the total group of patients, clinical course was primarily determined by the severity of heart disease and not by occurrence of A-V block. The conduction defect in the majority of patients was surprisingly benign.
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PMID:Electrophysiological and clinical observations in patients with alternating bundle branch block. 124 77

A ventricular tachycardia (VT) with right bundle branch block (RBBB) QRS morphology and left axis originating from the inferoapical segment of the left ventricle is described in a 49-year-old man without structural heart disease. This VT could be initiated during isoproterenol infusion and was terminated with intravenous administration of adenosine and verapamil. Radiofrequency ablation eliminated the tachycardia. Previous reports have suggested reentry as the mechanism for a verapamil-sensitive VT with this ECG morphology, while cAMP-mediated triggered activity has been proposed as a mechanism for VTs sensitive to adenosine. The latter more typically arise in the right ventricular outflow tract. The electrophysiological and electropharmacological characteristics of the tachycardia in this patient suggest that this VT morphology is not specific for a mechanism but rather for the location of the site of origin.
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PMID:Adenosine and verapamil-sensitive ventricular tachycardia originating from the left ventricle: radiofrequency catheter ablation. 769 26

The ECG is useful in diagnosing acute myocardial infarction and unrecognized Q-wave myocardial infarction in the elderly. Unrecognized myocardial infarction and myocardial infarction associated with clinical symptoms have a similar incidence of new coronary events. Ischemic ST-segment depression on the resting ECG is associated with an increased incidence of new coronary events. The ECG is useful in the diagnosis of LV hypertrophy but is less sensitive and less specific than echocardiography in diagnosing LV hypertrophy. ECG LV hypertrophy is associated with an increased incidence of cardiovascular events in the elderly. However, echocardiographic LV hypertrophy is more sensitive in predicting new coronary events, atherothrombotic brain infarction, and congestive heart failure than is ECG LV hypertrophy. The ECG is also useful in diagnosing conduction defects and arrhythmias in the elderly. In the elderly, left bundle branch block, intraventricular conduction defect, Type II second-degree atrioventricular block, and pacer rhythm are associated with an increased incidence of new cardiac events, whereas right bundle branch block, left anterior fascicular block, and first-degree atrioventricular block are not. In the elderly, atrial fibrillation is associated with an increased incidence of thromboembolic stroke and new cardiac events. Premature atrial complexes and paroxysmal supraventricular tachycardia are not associated with an increased cardiac risk. Complex ventricular arrhythmias on the resting ECG are associated with an increased incidence of cardiac events in elderly patients with heart disease but not in elderly patients without heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Usefulness of the resting electrocardiogram in the elderly. 147 52

The aim of this study was to evaluate the late potentials (LPs) in postoperative patients with congenital heart disease (CHD) and to study the association with the clinical characteristics in the postoperative patients with LPs. Signal averaged electrocardiogram (SA-ECG) was recorded in 119 postoperative patients aged 4 to 23 years and compared with those in age matched 49 healthy volunteers with and without right bundle branch block. Based on control data, criterias of LP were defined and altered in the presence of bundle branch block. Abnormal SA-ECGs were not detected in the patients with non-cyanotic CHD. However, abnormal and borderline SA-ECGs were recognized in 5 (12%) of 42 patients after intracardiac operation for tetralogy of Fallot and 3 (30%) of 9 patients after Rastelli's operation. The patients with abnormal and borderline SA-ECGs were significantly older at the time of operation, and had more frequent ventricular arrhythmias (7/8: 3/111, p less than 0.01) and depression of the ST-T segment on ECG (7/8: 11/111, p less than 0.01), compared with the normal SA-ECG group. Abnormal SA-ECGs including those of borderline patients were 50% sensitive and 96% specific for documented ventricular arrhythmias. However, there was no association between abnormalities of SA-ECGs and cardiomegaly on chest X-ray or left ventricular ejection fraction on echocardiogram. These results indicate that prolonged exposure to hypoxia may be the main cause of the primary role in the development of LPs. And late surgical intervention may result in histological background for the development of LPs.
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PMID:Clinical significance of late potentials in patients after intracardiac operation for congenital heart disease. 149 57

We report the electrocardiographic and electrophysiologic effects of magnesium (Mg) sulfate infusion in 25 normomagnesemic patients (16 men and 9 women, aged 22-74 years; mean +/- SD, 60.4 +/- 11.9) with different cardiac conduction impairments. Ten patients had chronic ischemic heart disease, two had idiopathic dilated cardiomyopathy, two had hypertensive heart disease, three had valvular heart disease, five had sclerodegenerative heart disease and three had no clinical evidence of cardiac disease. Five patients had trifascicular block [first degree atrioventricular (A-V) block+right bundle branch block (RBBB)+left anterior hemiblock (LAH)], eight had bifascicular block (6 RBBB+LAH, 2 first degree A-V block+RBBB), four had isolated first degree A-V block and eight had bundle branch block [5 RBBB, 3 left bundle branch block (LBBB)]. Before and during Mg infusion (50 mg/min/60 min) we evaluated the A-V (P-R), intraatrial (P-A), suprahisian (A-H), infrahisian (H-V) conduction times, electrical ventricular systole (Q-T), Q-T index (Q-Tc) intraventricular conduction time (QRS) and heart rate. At the end of infusion the P-R, P-A, A-H, H-V increased from 215.4 +/- 36.6, 33.6 +/- 9.1, 112.8 +/- 37.3, 69.0 +/- 12.8 ms to 217.6 +/- 37.1 (p less than 0.002), 33.8 +/- 9.4 (NS), 114.2 +/- 38.1 (p less than 0.005), 69.6 +/- 13.3 (NS) ms. QRS complex did not change (125 +/- 16.9 ms).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Electrophysiologic effects of magnesium sulfate infusion in patients with cardiac conduction defects. 150 2

In an 82-year-old female case of endocardial cushion defect (ECD), a systolic regurgitant murmur was heard at the apex, and her ECG showed atrial fibrillation without right bundle branch block or left axis deviation. An echocardiogram demonstrated atrial septal defect (ASD) and a cleft of the anterior mitral leaflet with calcification. She died of refractory congestive heart failure. Autopsy revealed ECD (intermediate type) with mitral and tricuspid cleft, and ASD (ostium primum type, 2.0 x 1.0 cm in diameter). In addition, mitral ring calcification and calcification of the cleft mitral valve was disclosed, causing mitral stenosis in addition to mitral regurgitation due to the cleft mitral valve. This was the second oldest Japanese autopsy case of ECD. We concluded that echocardiographic examinations, including color flow imaging, in aged patients with heart murmur are necessary to confirm the diagnosis of congenital heart disease in the aged.
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PMID:[An autopsy case of endocardial cushion defect (ECD) in an 82-year-old female]. 150 14

Clinical, ECG, and electrophysiologic data from 47 patients who had episodes of sustained or nonsustained monomorphic VT with no evidence of structural heart disease were reviewed. According to the QRS configuration during tachycardia, four groups were distinguished. Nine patients had a right bundle branch block configuration and superior frontal plane QRS axis (group 1). Nine patients had a right bundle branch block configuration but an intermediate or right QRS axis (group 2). Group 3 consisted of five patients with a left bundle branch block configuration and a left axis deviation, and in group 4 there were 24 patients who had a left bundle branch block configuration with an intermediate or right frontal axis. Patients in group 1 had dizziness during tachycardia less frequently, but they needed cardioversion to terminate their arrhythmias more often. They experienced tachycardia during exercise less often, and tachycardia was not initiated during exercise testing. They had fewer ventricular premature beats according to the Holter recording. During the electrophysiologic study, VT was induced and terminated by pacing more often in this group. Patients with idiopathic VT with a right bundle branch block configuration and a superior axis seem to be a unique group of patients with idiopathic VT, and reentry seems to be the most likely arrhythmia mechanism in this group. The other ECG configurations share the same clinical and electrophysiologic characteristics, which suggest that the underlying arrhythmia mechanism is the same.
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PMID:The electrocardiographic, clinical, and electrophysiologic spectrum of idiopathic monomorphic ventricular tachycardia. 151 3

Three cases of symptomatic bradycardia due to topical ocular timolol administration are reported. Two patients had syncope related to atrioventricular block, and the other one complained of dizziness due to sinus bradycardia. Heart disease was not present in any case, although a right bundle branch block was observed in one patients. A normal sinus rhythm resumed in all patients after discontinuation of timolol.
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PMID:[Bradyarrhythmias secondary to the use of ophthalmic timolol. A report of 3 cases]. 154 65

We describe a case of a 46 years old female with chagasic heart disease. In one year she presented six episodes of sustained ventricular tachycardia, heart rate 230 beats per minute, morphology of RBBB AQRS -60 degrees, with hemodynamic deterioration that needed electrical cardioversion. She was treated with several antiarrhythmic drugs but not good response was obtained. Programmed electrical stimulation was done and it show three different types of ventricular tachycardia, trough pace-mapping the site of the clinical tachycardia was located in the portion inferior and inferior-posterior of the left ventricle that was confirmed by entrainment. Epicardial mapping was performed in 38 ventricular sites following the modified Harken sketch and the location of the site of outlet was confirmed in the posterior base of the left ventricle, at this point the surgical resection was done with no complication. The results were satisfactory. Eight days later programmed electrical stimulation was done and the ventricular tachycardia could not be induced. Six months afterwards the patient is asymptomatic without medical treatment.
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PMID:[Surgical resection of a focus of ventricular tachycardia guided by endocardial and epicardial mapping]. 156 11

The follow-up and characteristics of 20 patients with ventricular tachycardia (VT) and no detectable heart disease is reported. These were 16 men and four women with a mean age of 44 years. Symptoms were present in 18 patients (eight had syncope and ten palpitations or dizziness), VT was sustained in 11 patients and a left bundle branch block morphology with inferior axis was found in 17 patients. In three patients, VT had a right bundle branch block morphology and left-axis deviation. The VT was inducible in 13 patients during the electrophysiological testing (EP) and was sustained in five patients. Medical treatment was introduced in 19 patients. During a mean follow-up of 10 years from the onset of the symptoms and 6 years from the EP testing, one patient died suddenly. He had stopped taking amiodarone 5 months before. In seven patients symptoms recurred and were due to discontinuation of therapy in two cases and inefficacy of previous effective treatment in five patients. After modification of the treatment (three cases), implantation of a pacemaker (one case) and catheter ablation (one case), all patients became asymptomatic. Eleven patients became asymptomatic with the first administered antiarrhythmic therapy. One patient continues to be asymptomatic in spite of discontinuation of his medical therapy. We conclude that patients with VT and no detectable heart disease have a good long-term prognosis and that appropriate therapy can be found in almost all patients.
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PMID:Ten-years follow-up of 20 patients with idiopathic ventricular tachycardia. 170 11


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