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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiac transplantation is the gold standard therapy for patients below 60 years presenting with severe heart failure (HF) despite maximal medical therapy, who have no other surgical option and no contraindications to this procedure. We evaluated our experience with this important form of heart failure therapy. Between February 1987 and December 2002, 32 patients, aged 37 +/- 16 years, 19 males, with ejection fraction of 18 +/- 7%, underwent heart transplantation in our center. Seven (22%) patients were in NYHA class IV with hemodynamic support. Seventeen (53%) patients had idiopathic dilated cardiomyopathy (DCM), 7 (22%) had ischemic DCM, 3 (9%) had valvular DCM and the remainder had other causes of left ventricular dysfunction. Overall survival rate was 68% at first year post-transplantation, 59% at 5 years and 59% at 10 years. One year after cardiac transplantation, 95% of patients were in NYHA class I and the rest were in NYHA class II. Among the 13 patients who died, in five (18%) death occurred during the first month: the most frequent cause was hemodynamic failure. Causes of late death were: allograft vasculopathy (n = 3), allograft rejection (n = 1), infection (n = 1), sudden death (n = 1), hemodynamic failure (n = 1) and bradyarrhythmia (n = 1). Among the patients followed for more than one year, only three died. Early complications were: infection (8 episodes, 7 of respiratory location), right heart failure (3 patients), pericardial effusion (5 patients) and others (7 patients). Late complications were: a) allograft rejection: 17 (53%) patients, 72 episodes (10 ISHLT grade 3, 6 of whom were treated with intravenous corticotherapy, 8 grade 2 and 54 grade 1); b) infections: 19 (59%) patients; 35 episodes, 25 requiring hospitalization: 10 (28%) involving the respiratory tract, 6 (17%) the oropharynx, 5 (14%) the urinary tract, 4 (11%) the skin and 10 (28%) of undetermined location; c) chronic allograft rejection: 6 (19%) patients; d) arterial hypertension: 14 (45%) patients; d) renal failure: 5 (16%) patients; e) diabetes: 2 (6%) patients; f) cancer: 2 (6%) patients. Patients with severe heart failure and a very poor prognosis who underwent cardiac transplantation in our hospital showed marked improvement in functional capacity and quality of life and had an overall survival similar to the results of international heart transplantation registries. Complications during follow-up were similar to those usually described in the literature.
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PMID:Heart transplantation. A Portuguese hospital center's experience. 1537 3

Atrial fibrillation (AF) is the most common dysrhythmia in North America. Paroxysmal or persistent AF affects an estimated 2.8 million individuals, causes significant morbidity, and is associated with 1 billion dollars in healthcare costs each year in the United States. An aging population, the prevalence of hypertension, and the emergence of heart failure as the final common pathway of heart disease finds us in an age where the incidence of AF is ever increasing and the management challenges are indeed an expanding clinical problem. Although guidelines for selection of the appropriate pacing mode have been published, device therapy for the control of AF and paroxysmal AF is an emerging clinical management strategy. In 2001 The American College of Cardiology (ACC)/American Heart Association (AHA) published a document to revise the 1998 guidelines for device therapy, and even now these guidelines require elucidation and inclusion for the use of cardiac pacing device therapy for the control of atrial dysrhythmia. Choosing a complex system, in particular for the patient with persistent and symptomatic atrial dysrhythmia, is a most intricate challenge for the healthcare professional and the healthcare system. Rate dependent effects on refractoriness, reduction of ectopy, remodeling of the substrate, and prevention of pauses have been described as the potential mechanisms responsible for the rhythmic control effect attributed to atrial pacing. However, while permanent cardiac pacing is required for patients with symptomatic bradycardia with atrioventricular block and AF, the concept of pacing for the primary prevention of AF is novel. Pacing algorithms, single site, biatrial, and dual-site atrial pacing and site-specific pacing have all been studied as substrate modulators to prevent recurrent atrial dysrhythmia.A dilemma exists surrounding the primary approach for the control of symptomatic AF with rapid ventricular response. The question remains: should it be to maintain the sinus rhythm or to control the ventricular response rate to the AF and anticoagulate? Variations in the population studied, differences in the pacing algorithms and protocols, and a lack of definitive end points account for the variable results of the studies completed thus far. With the current data available, it appears that for individuals with sinus node dysfunction and paroxysmal AF in combination with a bradyarrhythmia indication for pacing, suppression algorithms may play an additive role with full atrial pacing in the management and reduction of episodes and burden of paroxysmal AF. The goal of these therapies is to reduce the symptoms and hopefully decrease the healthcare costs associated with paroxysmal and persistent AF with uncontrolled ventricular response.
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PMID:Cardiac pacing device therapy for atrial dysrhythmias: how does it work? 1547 12

Modern cancer therapy employs a combination of chemotherapy, antibody-based therapy, radiotherapy, and surgery to prolong life and provide cure. However, many of the chemotherapy agents and antibodies, either singly or in combination, can affect the cardiovascular system. Common cardiovascular manifestations of these therapies include heart failure, ischemia, hypotension, hypertension, edema, QT prolongation, bradyarrhythmia, and thromboembolism. The patient's age, underlying cardiovascular status, and genetic background, as well as the route of drug administration and dosage, can all contribute to the development of cardiotoxicity. Strategies to monitor for and to manage these effects are discussed in this review.
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PMID:Cardiotoxicity induced by chemotherapy and antibody therapy. 1640 62

Bradyarrhythmias (BA) have been reported in patients with sleep apnea (SA), but the incidence of SA in patients with BA remains unclear. A case-control study was conducted to assess the prevalence of high-risk features of SA in patients with documented BA on 24-hour Holter monitoring compared with patients without BA. Controls were age-matched patients selected from those with no evidence of BA on 24-hour Holter monitoring. BA were defined as the presence of pauses of >3 seconds, regardless of the mechanism, and/or heart rate <40 beats/min during presumed waking hours (8 a.m. to 8 p.m.). High-risk features of SA were determined by the Berlin Questionnaire, with positive results defined as having '2 of 3 positive high-risk categories. Body mass index (BMI), hypertension, beta-blocker use, and other underlying characteristics were cataloged. Nineteen patients with documented BA and 47 with no BA were identified. The mean ages and BMIs in the active and control groups were not statistically significant. High-risk features for SA were present in 57.8% of patients in the BA group compared with 21.3% in the control group (p = 0.003). After controlling for age, BMI, hypertension, and beta-blocker use, patients with BA were 6 times more likely to have high-risk features of SA compared with those without BA (logistic regression odds ratio 6.1, 95% confidence interval 1.5 to 24, p = 0.012). In conclusion, irrespective of BMI, age, and other underlying risk factors, the presence of daytime BA was highly associated with high-risk features of SA.
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PMID:Relation of daytime bradyarrhythmias with high risk features of sleep apnea. 1839 49

Epileptic seizures are accompanied by changes in autonomic function that in turn influence the cardiovascular system (hypertension and bradyarrhythmia). We have studied possible cardioprotective activity (during the ictal state in conscious animals) of valproic acid, nifedipine, and verapamil, alone and in combination, during pentylenetetrazole (PTZ)-induced seizures. Telemetry system was used for recording EEG, blood pressure, and heart rate in conscious, freely moving rats during seizures. We observed that PTZ-induced seizures were accompanied by hypertension and bradyarrhythmia. Pretreatment with valproic acid did not block seizure-induced hypertension and bradyarrhythmia. Nifedipine alone and in combination with valproic acid blocked seizure-induced hypertension and bradyarrhythmia significantly. We also observed that pretreatment with verapamil alone and in combination with valproic acid did not block seizure-induced hypertension and bradyarrhythmia significantly. Our results suggest that pretreatment with nifedipine alone or in combination with valproic acid provides protection against seizure-induced hypertension and bradyarrhythmia.
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PMID:Epileptic seizure-induced hypertension and its prevention by calcium channel blockers: a real-time study in conscious telemetered rats. 1976 81

Free wall rupture, the most fearful complication of myocardial infarction, mostly attacks anterior walls. Acute rupture is characterized by rapid development of mechanical arrest accompanied with bradyarrhythmia or electromechanical dissociation. The majority of patients succumb to death as the result of cardiac tamponade. Risk factors are advanced age, female gender, the first-time myocardial infarction, hypertension, and ST-segment elevation. We report a rare case of posterior wall myocardial infarction complicated with left ventricular rupture initially presenting with junctional escape rhythm.
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PMID:Acute left ventricular rupture following posterior wall myocardial infarction. 2064 53

In the setting of increased intracranial pressure (ICP), various rhythm disturbances have been associated, ranging from tachyarrhythmias to bradyarrhythmias with atrioventricular dissociation. Although most of these observations have been in patients with traumatic brain injuries, it is known that children with acute bacterial meningitis may also have severe intracranial hypertension. We present the case of a previously healthy 2-year-old boy diagnosed with listeria meningitis. Along with clinical signs suggestive of increased ICP and brainstem involvement, our patient had persistent bradyarrhythmia with hemodynamic compromise that was refractory to epinephrine and successfully managed with isoproterenol.
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PMID:Listeria meningitis-associated bradyarrhythmia treated with isoproterenol. 2506 9

The risk of sudden cardiac death (SCD) is high in chronic kidney disease patients, and it increases with the progression of kidney function deterioration. The most common causes of SDC are the following: ventricular tachycardia, ventricular tachyarrhythmia, tachycardia torsade de pointes, sustained ventricular fibrillation and bradyarrhythmia. Dialysis influences cardiovascular system and results in hemodynamic disturbances as well as electrolyte shifts altering myocardial electrophysiology. Studies suggest that this procedure exerts both detrimental (poor volume control can exacerbate hypertension and left ventricle hypertrophy) and beneficial effects (associated with fluid removal and subsequent decrease in left ventricle stretch). Dialysis-related vulnerability to serious arrhythmias is the result of sudden shifts in fluid status and electrolytes, particularly potassium, which alter the physiological milieu. Also Ca(2+) ions, in which concentration alters during dialysis, are of key importance in the contraction of vascular smooth muscle cells and cardiac myocytes, thus exerting significant effects on hemodynamics. Due to the fact that SCD occurs with similar frequency in peritoneal dialysis and in hemodialysis patients, it seems that end-stage renal disease factors are more important than the specific ones associated with dialysis type. The results of randomized trials suggested that hemodialysis patients may not derive the same benefit of cardiovascular disease therapy including beta-blockers, calcium channel blockers and angiotensin-converting enzyme inhibitors as the general population with normal kidney function. Noninvasive tests used to stratify SCD risk in HD patients have poor positive value, and thus, combining tests including HRV, baroreceptor sensitivity and effectiveness index as well as its function indices and heart rate turbulence should be implemented. There are only few large randomized placebo-controlled trials assessing the influence of cardioprotective medications or implantable cardioverter defibrillator (ICD) implantation in dialysis patients on life quality and survival, and their results are sometimes contradictory. The decision concerning treatment and/or ICD implantation in this group of patients should be made on the basis of careful assessment of individual risk factors. Moreover, due to the high hazard of cardiovascular mortality including SCD in dialysis patients, physicians should concentrate on the early selection of high-risk patients, monitoring them and introduction of preventive measures.
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PMID:Sudden cardiac death in CKD patients. 2615 80

Pheochromocytomas are rare catecholamine-producing neuroendocrine tumors that can lead to detrimental outcomes; if identified and treated, they are associated with a good prognosis. The clinical presentation can vary greatly but is classically associated with tachycardia, headaches, and hypertension. Bradyarrhythmias and sinus node dysfunction are uncommon complications of this condition. We present a case of pheochromocytoma associated with sinus pauses and junctional escape rhythms that had complete resolution of sinus node dysfunction after adrenalectomy.
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PMID:Pheochromocytoma and sinus node dysfunction. 3095 4

A 0.5 kg, 5-yr-old male bearded dragon (Pogona vitticeps) presented with a 2-mo history of lethargy, anorexia, and impaired locomotion. Upon physical examination, bradyarrhythmia (heart rate: 20 beats/min) and balance disorders were noted. Electrocardiography revealed a first-degree atrioventricular block (P-R interval: 360 ms). On echocardiography, all cardiac chambers were slightly above normal ranges. Complete blood count, blood biochemistry, and T4 were unremarkable except for mildly elevated aspartate aminotransferase. Adenovirus testing was negative by polymerase chain reaction. Following euthanasia, necropsy revealed marked thickening of the arterial trunks and histopathology confirmed multifocal atherosclerosis of efferent heart vessels, arteriosclerosis of cerebral arterioles, and multifocal spongiosis of brain tissue, more pronounced in the optic chiasma. Owing to its severity, atherosclerosis may have contributed to chronic arterial hypertension with damages to the heart, brain vessels, and brain tissue-optic chiasma.
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PMID:HYPERTENSIVE HEART DISEASE AND ENCEPHALOPATHY IN A CENTRAL BEARDED DRAGON (POGONA VITTICEPS) WITH SEVERE ATHEROSCLEROSIS AND FIRST-DEGREE ATRIOVENTRICULAR BLOCK. 3126 Feb 20


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