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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The diagnosis of supraventricular tachycardia has become much more important with the advent of radiofrequency ablation. This is usually best done at presentation in an acute setting. A 12-lead electrocardiogram should be a routine aid in making the diagnosis. A continuous rhythm strip must be obtained during administration of adenosine and at the termination of tachycardia. Most recent treatment guidelines would include adenosine as first-line therapy. If adenosine fails to restore normal sinus rhythm, diltiazem or a beta blocker should then be considered. If there is significant heart failure, digoxin may be useful. In the presence of wide complexes, agents that produce atrioventricular nodal block should be avoided.
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PMID:The acute treatment of supraventricular tachycardia. 905 73

We report a case of fetal supraventricular tachycardia with intra uterine cardiac failure, treated with oral administration of flecainide acetate (Flecaine) to the mother. This treatment was rapidly effective. The fetus converted to sinus rythm in 5 days and the ascites had completely resolved in 10 days. We believe that flecainide acetate can be used as the "first line agent" for fetal supraventricular tachycardias with cardiac failure.
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PMID:[Flecaine: drug of choice for supraventricular tachycardias with anasarca. A case report]. 909 42

We report a case of fetal supraventricular tachycardia with intra-uterine cardiac failure, who complicate benign premature beats. It was treated with oral administration of flecainide acetate (Flecaine) to the mother. This treatment was rapidly effective. The fetus converted to sinus rhythm in 5 days and the ascites had completely resolved in 10 days. We conclude, that fetus with premature beats must be observed every 15 days, and we believe that flecainide acetate can be used as the "first line agent" to the fetal supraventricular tachycardias with cardiac failure.
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PMID:[Fetal supraventricular tachycardia with anasarca complicating benign extrasystole: treatment with flecainide. Apropos of a case]. 923 80

Neonatal thyrotoxicosis may occur by transplacental transfer of thyroid stimulating immunoglobins from the mother. Although the clinical manifestations may vary in the new-born period, hyperthyroidism has been associated with several cardiac complications including supraventricular tachycardia, cardiomyopathy and congestive cardiac failure. We report the case of a nine day old baby who presented with severe pulmonary hypertension in association with congestive cardiac failure secondary to neonatal thyrotoxicosis. Treatment of the heart failure and restoration of the thyroid function resulted in complete regression of the pulmonary hypertension. The recognition and reversibility of pulmonary hypertension in neonatal Graves disease has not been previously described.
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PMID:Reversible pulmonary hypertension in neonatal Graves disease. 926 95

Cardiac arrhythmias can present as benign ectopics or as life-threatening arrhythmias and sudden cardiac death. Clinical cardiac electrophysiology is the study of the electrophysiology of the heart and all aspects of management of cardiac arrhythmias. The invasive electrophysiological study was initially purely diagnostic, but recent advances in technology has allowed us to intervene and hence the term interventional electrophysiology. The interventional therapies include permanent pacing for bradyarrhythmias, arrhythmia surgery for arrhythmias, percutaneous catheter ablation and implantable devices for tachyarrhythmias. The treatment of bradyarrhythmias with permanent pacemaker implantation represents the first interventional therapy for patients with cardiac arrhythmias. From 1973 to June 1996, a total of 791 pacemakers have been implanted at the Singapore General Hospital. Previously, patients with tachyarrhythmias could only be cured by open heart surgery utilising intraoperative map guided surgery and ablation of the arrhythmia. Only 17 patients with supraventricular tachycardia (SVT) and 3 patients with VT have undergone this procedure. Catheter ablation has completely revolutionised the treatment of these patients. From October 1991 until December 1996, 860 patients have undergone radiofrequency (RF) catheter ablation for SVT and non-ischaemic VT. Ninety-eight per cent of the patients with SVT have been successfully ablated and 94% of the patients with VT were successfully ablated. RF ablation has become the technique of choice to cure patients with recurrent paroxysmal SVT due to AV re-entrant tachycardia using an accessory pathway, AV nodal re-entrant tachycardia, atrial tachycardia and atrial flutter. It is also used for AV nodal ablation followed by pacemaker insertion or AV nodal modification in patients with poorly controlled atrial fibrillation. Patients with idiopathic non-ischaemic VT arising from the left ventricle or right ventricular outflow tract can similarly be cured. For all these patients, RF ablation offers curative therapy, thus eliminating recurrent symptoms, life-threatening attacks, tachycardia cardiomyopathy and need for life-long drug therapy. For patients with resuscitated sudden cardiac death or at high risk for sudden death, the implantable cardioverter defibrillator (ICD) is the only technique that has significantly improved survival from sudden cardiac death. Since August 1992, 11 patients have had the ICD implanted, with 9 surviving. The 2 deaths were due to cardiac failure and not to sudden death. Thus the ICD can prevent sudden death, but the main limitation is the cost of the device and it is not suitable in patients who have severe heart failure. In conclusion, interventional electrophysiology represents a tremendous leap forward in the management of cardiac arrhythmias. With catheter ablation, it offers a safe curative therapy for patients with recurrent SVTs and VTs and with the ICD, prevents sudden cardiac death in patients who have been resuscitated from it or who are at risk for it. The future will see us improving our success in ablating patients with monomorphic ischaemic VT and even atrial fibrillation, and the role of prophylactic ICDs in high risk patients will be better defined.
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PMID:Interventional electrophysiology and its role in the treatment of cardiac arrhythmia. 966 19

In view of the large number of inappropriate shocks observed in patients with implanted defibrillators, improved detection of ventricular arrhythmias has become a major objective. The addition of an atrial catheter has been proposed to improve discrimination between ventricular and non-ventricular arrhythmias. Besides this function, the additional catheter could be used for DDD pacing without risk of interaction between the pacemaker and defibrillator. The authors report their initial experience in 16 patients implanted with a DDD pacemaker. The indication was resuscitated sudden death (N = 5) or ventricular tachycardia (N = 11). The choice of a DDD defibrillator was justified by a bradycardia (N = 9), haemodynamic factors (N = 4) or supraventricular tachycardia (N = 3). The devices used were the Defender 9001 (ELA Medical SA, France, N = 3), the Ventak AV 1810 and the Ventak AV II DR 1821 (Guidant/CPI, Inc. USA, N = 11 and N = 2 respectively). There were three immediate complications. After 2 to 29 months' follow-up, 5 patients had received appropriate treatment by their devices. Five patients had inappropriate shocks : one patient received a shock triggered by electrical interference, two others had no active sensing algorithme when the shocks were delivered, and the other two had an activated algorithme with 1/1 conduction of a supraventricular arrhythmia. No recurrences were recorded after reprogramming the device. DDD or VDD pacing was permanent in 9 patients and intermittent in 3 others. Seven patients had dilated cardiomyopathy and severe cardiac failure and were clinically improved by dual chamber pacing. In many patients, candidates for a defibrillator, this new generation of devices has improved specificity of arrhythmia detection and cardiac pacing without risk of interaction. The authors propose a classification of the indications for a DDD defibrillator.
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PMID:[Dual-chamber implantable automatic defibrillators. Experiences apropos of 16 cases]. 974 90

The circadian heart rate course was assessed in 3 groups of patients with left ventricular ejection fraction (LVEF) 10-15%, 20-25% and 30-35%. The study comprised 36 persons. In 9 patients heart failure was due to MI and in 17--to dilated cardiomyopathy. Those with atrial fibrillation, ventricular tachycardia, supraventricular tachycardia, diabetes, valvular heart diseases and with central system disorders were excluded from the study. Left ventricular ejection fraction was evaluated by echocardiography. Heart rate, calculated as a mean value every 5 minutes, was taken in patients during 24 hour recordings. For each patient separately, mean value of all measurement was calculated. Then a ratio of each actual value to the mean value was calculated. This ratio was defined as relative heart rate; [formula: see text] Circadian heart rate courses were approximated by Fourier row: [formula: see text]. The 24 harmonics were analyzed. Statistically significant differences in circadian courses were closed to amplitudes of 1st, 12th, 13th, 14th, 16th, 18th harmonics. Using test of variance homogeneity it has been demonstrated that variability of amplitudes of 12th and 17th harmonics as well as phase of 5th harmonic depend on left ventricular ejection fraction.
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PMID:[Use of fourier row as a method for analyzing the course of circadian heart rate in patients with left ventricular ejection fraction impairment]. 1008 2

We report our experiences with tachycardia-induced cardiomyopathy. Nine patients (3-56 years old) had incessant supraventricular tachycardia and congestive heart failure. The cardiac eco-Doppler evidenced a significant increase of cardiac volumes and mild tricuspid and mitral regurgitation. The ejection fraction (EF) was 0.31 +/- 0.12, the end diastolic volume was 162 +/- 48 cc and the end systolic volume, 116 +/- 54 cc. Four patients had accessory pathways, 3 atrial flutter, 1 A-V nodal reentrant tachycardia, and 1 ectopic atrial tachycardia. Two patients had Chagasic myocarditis. Only in one chagasic patient a decreased number of tachycardia episodes was achieved, this patient died. The autopsy revealed cerebellar and pulmonary emboli. In the other 8 patients the arrhythmia was well controlled. In these, the ventricular volumes decreased, the EF increased to 0.51 +/- 0.14 (p = 0.00006), and the congestive heart failure remitted. We conclude that incessant tachycardia produces a symptomatic dilated cardiomyopathy in patients with and without structural heart disease. The arrhythmia control is followed by an increase in cardiac function and a remission of heart failure symptoms.
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PMID:[Tachycardiomyopathy in patients with and without subacute cardiac pathology. Experiences at the Cardiovascular Center of Merida, Venezuela]. 1036 28

The deleterious effect of chronic or incessant supraventricular tachycardia on ventricular function is well-known and it has been demonstrated than can ultimately lead to dilated cardiomyopathy if unrecognized. Any variety of supraventricular tachycardia with chronic evolution may lead to left ventricular dysfunction, ectopic atrial tachycardia because of its persistent nature, often incessant and poorly responsive to antiarrhythmic drugs is a frequent cause of reversible congestive heart failure in patients without other demonstrable organic heart disease. Five patients (aged 14 to 52 years) were referred with symptoms of heart failure, NYHA functional class II (one patient), class III (one patient) and class IV (3 patients) associated with an incessant ectopic atrial tachycardia. Four patients underwent radiofrequency catheter ablation of the ectopic focus and one patient was treated with amiodarone. All patients were successfully treated and the echocardiographic assessment of left ventricular function indicated regression of the cardiomyopathy picture with recovery of systolic function, (mean left ventricular ejection fraction 39.2 +/- 6.1% before vs mean 62.4 +/- 4.8% after (p < 0.01). The clinical and echocardiographic picture of cardiomyopathy induced by incessant ectopic atrial tachycardia is reversible after successful treatment. This stresses the necessity of recognizing such arrhythmia as cause of primary heart failure.
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PMID:[Dilated cardiomyopathy induced by ectopic atrial tachycardia]. 1095 59

A young man with previously unrecognized Graves' disease presented with atrial fibrillation and severe low-output heart failure due to dilated cardiomyopathy. The patient's cardiomyopathy resolved and cardiac function recovered shortly after hyperthyroidism and tachycardia were treated during hospitalization. The temporal relationship between heart rate and cardiac function during the recovery period suggests that chronic tachycardia may have been an important cause of his cardiac dysfunction. Thyrotoxicosis seemed to be directly responsible for the development of sustained supraventricular tachycardia in this patient, which then led to tachycardia-induced cardiomyopathy causing severe low-output heart failure. Although relatively infrequent, this etiology should not be overlooked in patients thyrotoxicosis and heart failure. This is the first case in which the time course and the temporal relationship between the control of heart rate and the recovery of cardiac function are illustrated in a thyrotoxic patient.
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PMID:Tachycardia-induced cardiomyopathy secondary to thyrotoxicosis: a young man with previously unrecognized Graves' disease. 1108 Dec 59


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