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

Tricyclic antidepressant drugs are known to cause often electrocardiographic abnormalities and to induce sometimes cardiac rhythm disturbances. We report a case of a patient on antidepressant therapy (Desipramine Hydrochloride, 50 mg/die, and Dothiepin Hydrochloride, 150 mg/die), without any underlaying heart disease, admitted to our Coronary Care Unit for recurrent syncopal episodes. An ECG on admission showed Sinus Tachycardia with Ectopic Ventricular Beats and recurrent runs of Torsade de Pointes, a distinctive form of Ventricular Tachycardia. Lignocaine i.v. was only transiently effective. Both Isoprenaline and Atropine Sulphate i.v. were uneffective. Ventricular Fibrillation occurred and cardioversion was achieved by a single DC shock. Amiodarone i.v. and electrical overdrive only temporarily suppressed ventricular arrhythmias. Magnesium Sulphate i.v. (bolus + infusion) induced a definitive suppression of Torsades de Pointes. One day later no more arrhythmias were present.
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PMID:[Torsade de pointes caused by tricyclic antidepressive agents. Description of a clinical case]. 355 44

To assess whether the level of risk of having significant electrophysiologic abnormalities can be determined, 29 clinical variables were analyzed in 104 patients with unexplained syncope who underwent electrophysiologic testing. A positive electrophysiologic study was defined as: a sinus node recovery time greater than or equal to 3 seconds; HV interval greater than or equal to 100 ms; infranodal block during atrial pacing; unimorphic ventricular tachycardia; and supraventricular tachycardia associated with hypotension. Thirty-one patients had a positive study, with inducible ventricular tachycardia being the most common finding (71% of positive studies). A left ventricular ejection fraction less than or equal to 0.40 was the most powerful predictor of a positive electrophysiologic study (p less than 0.00001), followed by the presence of bundle branch block (p less than 0.00003), coronary artery disease (p less than 0.0003), remote myocardial infarction (p less than 0.00006), use of type 1 antiarrhythmic drugs (p less than 0.00003), injury related to loss of consciousness (p less than 0.01) and male sex (p less than 0.01). A negative electrophysiologic study was associated with an ejection fraction greater than 0.40 (p less than 0.00001), the absence of structural heart disease (p less than 0.00001), a normal electrocardiogram (ECG) (p less than 0.0001) and normal ambulatory ECG monitoring (p less than 0.0001). The probability of a negative study increased as the number and duration of syncopal episodes increased.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Electrophysiologic testing in patients with unexplained syncope: clinical and noninvasive predictors of outcome. 359 6

We have investigated 13 patients with monomorphic ventricular tachycardia which originated from the right ventricular outflow tract. No patient had evidence of organic heart disease. There were 3 males and 10 females, aged 13-53 years. All had non-invasive investigations including an exercise electrocardiogram, chest radiography, echocardiograms and gated blood pool scintigraphy. Ten patients underwent cardiac catheterisation. Five patients had a prolonged QTc on their resting electrocardiogram. The remaining investigations showed no evidence of organic heart disease. Ten patients had ventricular arrhythmias which were completely suppressed during maximal exercise but which recurred in the immediate post-exercise period. A further 2 patients with no arrhythmias before exercise had ventricular tachycardia in the post-exercise period. Electrophysiology studies were performed in 5 patients with syncopal episodes, suggesting an automatic focus in 4. Four patients required specific antiarrhythmic surgery for symptoms refractory to medical therapy. Pace-mapping at operation confirmed the origin to be within the right ventricular outflow tract in all. Thus, we have identified a group of patients who have ventricular tachycardia originating from the right ventricular outflow tract in whom there is no apparent structural heart disease. Their arrhythmias are influenced by exercise and are probably due to an automatic focus. Four patients required surgery for ventricular tachycardias and recurrent syncopal episodes refractory to medical therapy.
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PMID:Right ventricular outflow tract tachycardias in patients without apparent structural heart disease. 394 39

Recently a unique clinical entity has been suggested in subjects without apparent heart disease presenting with recurrent ventricular tachycardia (VT) characterized by RBBB + LAH electrocardiographic pattern, relatively slow rate, induction by atrial stimulation, and interruption by verapamil. According to these characteristics, three cases (2 M and 1 F, aged 18, 33 and 66 years) are presented in this study. They have had palpitations from one to twenty years, but not syncopal episodes. During VT the cycle length ranged from 300 to 480 msec. VT was terminated both by verapamil and by ajmaline. VT was inducible in 3/3 cases by incremental atrial pacing when cycle length of pacing became similar to that of spontaneous VT; in 2/3 cases VT was induced by programmed right atrial stimulation and in 2/3 cases by programmed ventricular stimulation. Serial electrophysiological studies for pharmacological and therapeutic evaluation applied to 1/3 cases showed: amiodarone given orally (200 mg/die) for two months prevented the induction of VT while verapamil, propranolol, mexiletine, and propafenone tested intravenously were ineffective. In the remaining two patients amiodarone, tested only intravenously, was not effective to prevent the induction of VT but lengthened its cycle length. All patients received amiodarone orally (200 mg/die) and were followed for 2,7 and 8 years respectively. Two of them had no more episodes of VT and one, while asymptomatic, continued to present with. The electrophysiological mechanism of this form of VT cannot be identified with certainty, but many data suggest a reentry in the posterior fascicle of left bundle branch as the most probable mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Idiopathic ventricular tachycardia responsive to verapamil. Presentation of 3 cases and review of the literature]. 400 54

Carotid sinus syncope was diagnosed during a 2-year period in 21 men and 5 women, aged 51 to 80 years, who had experienced 1 to 30 syncopal episodes during periods of time which varied from 1 day to 6 years. In 19 of these patients there was evidence of organic heart disease. Carotid sinus hypersensitivity of the cardioinhibitory type was present in 14 patients, the vasodepressor type in 1 patient, and a mixed type in 7 patients. In four patients with the cardioinhibitory response, the possibility of the vasodepressor response was not excluded. A pacemaker was placed in 17 patients, deferred in 4 patients and refused by 5 patients. Follow-up of patients with pacemakers over 9.5 +/- 7.0 (SD) months revealed recurrence of symptoms in two patients due to a previously unrecognized vasodepressor response. Follow-up of the patients without pacemakers was brief (4.6 +/- 3.7 months), and they remained asymptomatic, except for one patient with recurring vertigo.
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PMID:Carotid sinus syndrome: an overlooked cause of syncope. 401 27

Hypertrophic cardiomyopathy is a cardiac disorder of unknown aetiology which is characterised by hypertrophy of a non-dilated left ventricle. The course of hypertrophic cardiomyopathy may be relatively benign, but the risk of sudden death due to ventricular arrhythmias is an important clinical problem. Those patients at greatest risk of sudden death appear to be those with the combination of diagnosis in childhood, a family history of hypertrophic cardiomyopathy and sudden death, and syncopal episodes. The treatment of hypertrophic cardiomyopathy-associated ventricular tachycardia with 'conventional' antiarrhythmic agents (disopyramide, quinidine, mexiletine) has seldom been successful. However, treatment of this arrhythmia with amiodarone in well-matched but non-parallel groups of patients has resulted in suppression of arrhythmia and improved survival compared with that seen with 'conventional' antiarrhythmic agents.
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PMID:Does treatment influence the natural history of patients with hypertrophic cardiomyopathy? 403 53

The rate of positive head-up tilt (HUT), specificity, and same-day reproducibility of an HUT at 60 degrees combined with a low-dose isoproterenol infusion was assessed in the following patients: 120 consecutive patients with recurrent unexplained syncope, 30 healthy patients in a control group, and 30 patients with documented syncope not related to a vasodepressor reaction. HUT was positive in 61% (73 of 120) of patients with unexplained syncope. The false-positive rate in both the control and documented syncope groups was 6.6%. The mean isoproterenol dose infused was 1.4 +/- 0.5 microgram/min, 1.3 +/- 0.4 micrograms/min, 1.3 +/- 0.5 microgram/min, respectively (p = NS). HUT was positive during the drug free stage in 30 (25%) of 120 patients, and isoproterenol infusion was necessary in the remaining 43 (36%) patients. Immediate reproducibility was assessed in 75 patients, and HUT response was reproduced in 37 (82%) of 45 patients with a baseline positive HUT and in 28 (93%) of 30 patients with a baseline negative response. Overall, "sensitivity," specificity, and reproducibility were 61%, 93%, and 86%, respectively. Clinical variables that increased the probability of a positive outcome were age < or = 50 years and two or more syncopal episodes in the preceding 6 months in the absence of structural heart disease. These data support the use of an HUT protocol with low-dose isoproterenol infusion for the assessment of patients with recurrent syncope.
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PMID:Diagnostic accuracy of a low-dose isoproterenol head-up tilt protocol. 773 79

Incidence and malignant forms of imported Plasmodium falciparum malaria are increasing, and chemoprevention is more and more replaced by stand-by treatment and radical cure in preventing access on return from malaria areas. Halofantrine is recommended for this radical cure: it's an habitually well-tolerated amino-alcohol with very few side-effects. We report three cases of long QT-interval due to halofantine: three different young women coming back from Africa took halofantrine (500 mg (2 tablets) six hourly for three doses on the first and the seventh day) and all presented with syncopal episodes. Serum electrolyte concentrations and echocardiograms were normal. In one case only, a diagnosis of Plasmodium falciparum malaria was made, without severe manifestations, and in the two other cases, treatment was a radical cure. In two cases, several bursts of torsades de pointes ventricular tachycardia due to halofantrine were proven and electrophysiological cardiac tests concluded that they had a congenital long QT-interval/Romano-Ward syndrome). So far halofantrine cardiac toxicity was unknown with single dose of 24 mg/kg/d. This phenomenon can be very severe in case of preexisting cardiopathy. In spite of the rarity on the congenital Romano-Ward syndrome, systematic electrocardiogram is necessary before giving halofantrine.
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PMID:[Ventricular arrhythmia and halofantrine intake. Probable deleterious effect. Apropos of 3 cases]. 812 7

Pregnancy carries substantial maternal and fetal risks in patients with uncorrected or palliatively corrected cyanotic congenital heart disease (CHD). In tricuspid valve Ebstein's anomaly, pregnancy is well tolerated. Maternal mortality in tetralogy of Fallot seems to be less than 10%, but it exceeds 50% in Eisenmenger's syndrome and primary pulmonary hypertension (PPH). Maternal hematocrit greater than 60%, arterial oxygen saturation lower than 80%, right ventricular hypertension, and syncopal episodes are poor prognostic signs. Maternal risk could be reduced by vaginal delivery. Continuous monitoring of arterial and central venous pressure, electrocardiography, and pulse oximetry are recommended for every anesthetic procedure. The use of a pulmonary artery catheter is controversial and probably should be avoided in parturients with cyanotic CHD or PPH. The choice of anesthetic technique and drugs per se is of secondary importance and should be governed by individual preferences. Titration of anesthetic drugs, general anesthesia with controlled ventilation, or, preferably, regional anesthesia with spontaneous breathing should be used cautiously to avoid worsening of the preexisting condition. Prevention of excessive erythrocytosis, volume and blood loss substitution, cardiocirculatory pharmacologic support, prophylaxis of infective endocarditis, and judicious use of anticoagulant drugs should be applied as indicated by the type and presentation of CHD. Poor outcome of pregnancy in PPH requires an early consideration of heart-lung or lung transplantation. Multidisciplinary team effort and prolonged monitoring in the intensive care unit are mandatory to ensure a favorable outcome for cyanotic CHD and PPH parturients.
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PMID:Cyanotic congenital heart disease and pregnancy: natural selection, pulmonary hypertension, and anesthesia. 837 15

To study the age-related differences in Wolff-Parkinson-White syndrome an elderly group of 20 patients aged 40-65 years was compared to a younger group of 26 patients aged 18-39 years with respect to clinical profile and electrophysiological characteristics. The two groups were comparable in terms of the mechanism of reentry tachycardia, accessory pathway location, the number of patients reporting syncopal episodes, and the incidence of inducible and/or documented atrial flutter/fibrillation while only elderly patients had also atrial tachycardias. The elderly group was characterized by a higher incidence of associated organic heart disease and a significantly higher percentage of resuscitation from circulatory arrest. Cardiocirculatory arrest due to arrhythmias was the event leading to transferral to our hospital in 30% of elderly patients compared with 7.7% in the younger group. Analogous results were obtained when stratified according to the age at manifestation of tachyarrhythmias (< 30, > or = 30 years), a history of cardiopulmonary resuscitation being the only significant difference between the two groups. There was no difference in any electrophysiologic parameter between the two age groups or with respect to the age at manifestation of arrhythmias. It is concluded that elderly patients with the Wolf-Parkinson-White syndrome should be managed as aggressively as their younger counterparts. In particular, manifestation of arrhythmias due to Wolff-Parkinson-White syndrome beyond age 30 should not be regarded as a more benign variation of the syndrome. Explanations for the more frequent history of resuscitation in the elderly include the presence of organic heart disease with impairment of left or right ventricular function and differences in the management of these patients.
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PMID:Management of elderly patients with the Wolff-Parkinson-White syndrome: is less aggressive treatment justified? 837 43


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