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

Ten patients with an unusual form of ventricular tachycardia (VT) are described. All were young (mean age 21 years) at the onset of VT, symptoms were of long duration (mean 7 years), none had symptomatic organic heart disease, VT was induced by atrial and ventricular stimulation, VT had a characteristic QRS morphologic picture resembling right bundle branch block with left-axis deviation and 9 had early retrograde His deflections during VT. Supraventricular tachycardia (SVT) was excluded in every patient by electrophysiologic study, although QRS morphologic characteristics and clinical stability of these patients during tachycardia frequently led to the diagnosis of SVT before referral. Four patients received verapamil during electrophysiologic testing. Verapamil slowed and terminated VT in all. Three patients are being treated chronically with oral verapamil, 3 patients with conventional antiarrhythmic agents and 1 with a radiofrequency ventricular pacemaker.
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PMID:Ventricular tachycardia induced by atrial stimulation in patients without symptomatic cardiac disease. 665 Apr 8

The records of 22 patients with transient atrioventricular (AV) block after open-heart surgery for congenital heart disease from 1972 to 1978 were reviewed to determine the natural history of this entity. Preoperatively, no patient had AV block; 3 had right bundle branch block (BBB), 1 had left BBB and 5 had nonspecific intraventricular conduction delay. Complete AV block developed in 20 patients and Mobitz II AV block in 2. Transient AV block occurred intraoperatively in 14 patients and within 48 hours postoperatively in 8; AV block persisted for greater than or equal to 48 hours postoperatively in all patients, for a mean of 7.3 days (range 2 to 28). During a follow-up of 5.5 years (range 2.5 to 10), late AV block developed in 2 patients. None of the 18 patients whose escape QRS complex morphology during AV block was similar to the final QRS complex during normal sinus rhythm or atrial fibrillation with AV conduction had late AV block, whereas 2 of the 4 in whom it differed did (p less than 0.01). There was no difference in the escape rate between the 2 groups. Thus, late development of high-grade AV block is infrequent among patients with transient postoperative AV block. An escape QRS complex during postoperative AV block that differs from the QRS complex seen on recovery of normal sinus rhythm or atrial fibrillation with anterograde conduction may identify those at high risk of late AV block.
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PMID:Transient atrioventricular block after open-heart surgery for congenital heart disease. 669 Dec 62

Three cases of radiation-related chronic heart disease are reported. All three patients had been treated for Hodgkin's disease with a mantle technique six to ten years earlier. Ten years after radiation treatment, a 34-year-old woman had dyspnea during exercise. Her heart was enlarged, and an ECG showed a RBBB. An echocardiogram showed pericardial effusion. Right-sided catheterization revealed an infundibular stenosis. A 31-year-old man had chest pain nine years after radiation. An ECG showed complete RBBB and an exercise stress test signs of ischemia; a coronary angiogram showed three proximal stenoses; and an echocardiogram revealed pericardial effusion. A 12-year-old boy had angina pectoris six years after radiation; one year later, he suffered an acute posterior infarction. Two weeks later he died suddenly. An autopsy showed a severe fibrotic and calcified narrowing of the proximal part of the left main coronary artery. Regardless of the patient's age, radiation-related cardiac complications must be kept in mind. Echocardiograms and, in cases of chest pain, exercise stress tests should be a part of routine postradiation follow-up.
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PMID:Radiation-related chronic heart disease. 685 89

Electrophysiologic evaluation before and after the serial administration of verapamil, lidocaine, propranolol, and procainamide was undertaken in 4 young, asymptomatic patients with recurrent, sustained ventricular tachycardia (VT). No patient had obvious organic heart disease. The electrocardiogram during sinus rhythm showed S-T depression and T-wave inversion over the inferior and lateral precordial leads in 3 patients. QRS morphologic characteristics during episodes of VT showed a pattern of right bundle branch block and left axis deviation. In all 4 patients, VT could be both induced and terminated with electrical stimulation. Verapamil terminated VT and prevented the induction of sustained VT in 3 patients, and markedly slowed the rate of VT in 1 patient. Procainamide effectively prevented the induction of sustained VT in 2 patients, and although ineffective in preventing induction in 2 patients, it slowed the rate of tachycardia in both. Lidocaine and propranolol did not prevent the induction of VT in any patient. These findings suggest that slow-response tissues may be involved in the genesis of VT in these patients, and that VT in these patients may represent a unique clinical entity with distinct electrocardiographic, electrophysiologic, and electropharmacologic properties.
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PMID:Idiopathic paroxysmal ventricular tachycardia with a QRS pattern of right bundle branch block and left axis deviation: a unique clinical entity with specific properties. 685 37

A case of progressive systemic sclerosis with syncopal symptoms is reported. The presenting ECG pattern was that of an anterior myocardial infarction. The clinical history and the coronary angiography excluded significant coronary atherosclerotic heart disease. The ECG pattern evolved from the infarctual pattern associated with right bundle branch block to probably major degree of right bundle branch block associated with left posterior fascicular block. M-mode echocardiography, heart catheterization and angiographic studies did not reveal significant mechanical impairment of the left or right ventricle function. His bundle electrogram documented a markedly prolonged H-V interval, confirming an advanced impairment of distal conducting system. This case supports the suggestion that intraventricular conduction disorders in sclerodermal heart disease are not always related to diffuse myocardial involvement. The risk of sudden death justifies accurate electrophysiological evaluation in selected patients with sclerodermal cardiopathy.
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PMID:Severe involvement of the conduction system in a patient with sclerodermal heart disease. An electrophysiological study. 697 44

A total of 14,500 E.C.G. tracings were reviewed to determine the incidence of bifascicular block and those patients were followed up to assess prognosis. Forty patients with bifascicular block (complete right bundle branch block associated with left anterior hemiblock), diagnosed with standard E.C.G., according to Medrano's criteria from January 1978 to September 1980 were studied in our Service. The incidence of this intraventricular conduction defect was 0.0033 (3.3 per thousand). Males predominated over females at a rate of 2.4 to 1. This block was more frequent from the sixth to the ninth decades of life. Thirty five percent of the patients had no evidence of cardiovascular pathology; 32.5 percent had high blood pressure, 2.5 percent had coronary heart disease, 2.5 percent rheumatic heart disease, 5 percent chronic pulmonale, and 37.5 percent had diabetes mellitus as an associated finding. During the follow up which covered 20.2 months/patient, only one patient developed junctional rhythm and periods of asystolia and syncope; this case was treated with a permanent pacemaker with good results. Two patients died, one from digitalis intoxication and the other at home, the cause was not determined. It is necessary to study this conduction defect with longer follow up periods and according to the underlying heart disease, in order to assess properly the prognosis and behavior of this conduction defect.
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PMID:[Bifascicular block: long-term follow-up. Report of 40 cases]. 708 98

We examined the characteristics, long-term follow-up, and prognosis of right bundle branch block (RBBB) detected on a routine ECG in men with no apparent heart disease. During the 29-year period, 59 cases of RBBB were observed in men with a mean age of 44.4 +/- 1.9 years. Because marked right or left axis deviation may identify cases with concomitant involvement of the left bundle branch system, subsets of frontal plane QRS (A QRS) were examined. Comparisons were made with groups of similar ages who were free of RBBB. Cases with RBBB were observed for 936 person-years (mean 15.9 +/- 1.6 years per case), showing no excess ischemic heart disease incidence, no cases of progression to advanced AV block (second- or third-degree), or sudden death. Right bundle branch block was associated with a greater proportion of both right axis (greater than or equal to +90 degrees) and marked left axis (-45 degrees to -90 degrees) deviation compared with those of the same age without this conduction disturbance. In apparently healthy men, RBBB had no adverse long-term prognosis regardless of frontal plane QRS axis.
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PMID:The natural history of right bundle branch block and frontal plane QRS axis in apparently healthy men. 724 65

A review of the electrocardiogram in the aged and the comparison of prevalence of ECG abnormalities in the young and aged suggest that: 1. The same criteria for normal ECG should be applied to both groups. Some minor changes in advancing age can be accepted as normal and reflecting physiologic changes attending growth, changes in anteroposterior diameter of the chest and lung volume, and so on. 2. The abnormal ECG is most likely a marker of anatomic heart disease or clinical heart disease, or both. 3. The incidence of abnormal electrocardiograms increases with age and heart disease. 4. The specific ECG abnormalities which have a high degree of correlation with clinically evident heart disease include atrial fibrillation, left bundle branch block, intraventricular conduction defects, and ST segment and T wave changes. 5. Myocardial infarction, left anterior hemiblock and right bundle branch block did not correlate with presence of clinical disease, but strong evidence suggests that these findings reflect anatomic disease.
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PMID:The electrocardiogram in the aged. 728 46

To investigate the right ventricular activation, filtered bipolar recordings (1 cm interelectrode distance) of Apex (RVA), Inflow tract (RVIT) and Outflow tract (RVOT) of the right ventricle were obtained in 4 groups of subjects. 1st group: 25 cases with normal QRS; 2nd group: 7 cases with left ventricular conduction disturbances (4 LBBB and 3 LAH patterns); 3rd group: 20 cases with chronic coronary heart disease (CCHD) and RBBB alone (5 cases) or combined with LAH (15 cases); 4th group: 9 young subjects without heart disease (7 cases) or ostium secundum atrial septal defect (2 cases) and RBBB pattern. The activation times were calculated from the beginning of the QRS in the first endocavitary rapid deflection. The data obtained (average +/- s.d.) for QRS duration (QRSd), RVA, RVIT and RVOT were respectively: 1st group: 97 +/- 9, 23 +/- 9, 36 +/- 9, 39 +/- 8; 2nd group: 133 +/- 43, 20 +/- 14, 25 +/- 9, 42 +/- 6; 3rd group: 152 +/- 12, 49 +/- 13, 61 +/- 18, 82 +/- 20; 4th group: 130 +/- 17, 39 +/- 12, 58 +/- 12, 55 +/- 27. Activation times as expected were similar in 1st and 2nd groups. Significant differences were noted between 1st and 3rd groups (p less than 0.001) in activation times of RVA, RVIT and RVOT. Between 1st and 4th group significant differences were noted in activation times of RVA and RVIT (p less than 0.001) while no significant differences were observed for RVOT (p greater than 0.05). In 2 cases of the third group (CCHD) and in the 2 cases of atrial septal defect the activation time of RVA was within the normal range suggesting a peripheral block. In the cases of the 3rd group with troncular RBBB activation times of RVIT and RVOT were significantly related to the QRSd (r = 0.79 and 0.65, p less than 0.001 and less than 0.01 respectively), while there was no significant correlation between the activation time of RVA and the QRSd. In accordance with other Authors our study demonstrates that: 1) the RBBB pattern in ASD has a peripheral electrogenesis; 2) the RBBB pattern in CCHD is generally due to a troncular block but our study also suggests the possibility of a distal block in these patients. In contrast with some Authors the RBBB pattern in young people without heart disease was due to a troncular and not to a peripheral block. Finally, the absence of correlation observed in the cases with troncular block of the 3rd group: 152 +/- 12, 49 +/- 13, 61 +/- 18, 82 +/- 20; 4th group: 130 +/- 17, 39 +/- 12, 58 +/- 12, 55 +/- 27. QRSd and RVIT and RVOT activation times might be explained as follows: 1) in high degree troncular block the RVA activation time is due to the time employed byt the wave front to cross the septum which is probably similar in all the cases; 2) the QRSd depends on the activation time of the peripheral areas which depends on the variable spread of activation of the right ventricle probably due to a variable participation of the specialized conduction system.
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PMID:[The right ventricular activation in ventricular activation delays. An endocardial mapping study (author's transl)]. 732 20

Echocardiography was used to study the quantitative and qualitative alterations of pulmonary valve echograms. 228 infants and children with congenital heart disease and with known pulmonary artery pressure were studied to evaluate which echocardiographic parameters would be most useful in predicting pulmonary artery hypertension. Right ventricular systolic time intervals (RVSTI) were studied and when patients with complete right bundle branch block (CRBBB) or transposition of the great arteries (TGA) had been excluded the strongest correlation was found between right ventricular preejection period/right ventricular ejection time (RPEP/RVET) and pulmonary artery diastolic pressure (PADP) (r = 0.73). In patients with TGA the correlation coefficient for LPEP/LVET and PADP was r = 0.88. We did not find a significant correlation between right ventricular isovolumetric contraction time (RICT) or RICT/RVET and PADP in patients with CRBBB. The correlation between the amplitude of the a-wave and PADP was fair (r = 0.48). BC slope, EF slope and the maximum amplitude of opening of the pulmonary valve were all related to PADP but the correlation coefficients were low. A-wave of 2 mm or less, systolic fluttering or systolic notching of the pulmonary valve echo were seen significantly more often in patients with PADP above 20 mm Hg but were less valuable in predicting pulmonary artery hypertension. RVSTI seem to be more useful than the other echocardiographic parameters for evaluation of pulmonary artery hypertension and RPEP/RVET appears to be the most reliable of them.
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PMID:Echocardiographic estimation of pulmonary artery pressure in infants and children with congenital heart disease. 744 12


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