Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

3 cases of carbamazepine (CBZ)-induced Stokes-Adams attacks caused by intermittent total atrioventricular block, sino-atrial block with junctional escapade-rhytm and intermittent asystolia are reported. After cessation of CBZ treatment, the cardiac conduction disturbances disappeared. In 2 of the patients, the diagnosis was confirmed by resumption of treatment with CBZ after insertion of a demand pacemaker. If syncopes or changes in seizure-type occur in patients treated with CBZ, evaluation of cardiac conduction is recommended. Furthermore, it is recommended that cardiac function is evaluated before CBZ-treatment, especially in elderly patients.
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PMID:Cardiac conduction disturbances during carbamazepine therapy. 661 26

A case of rheumatoid arthritis with an involvement of the cardiac conduction system was described. The patient was a 65-year-old man who had a 15-year history of classical rheumatoid arthritis combined with an advanced atrioventricular (AV) block resulting in Adams-Stokes seizure. Prior to the occurrence of the AV block, a complete right bundle branch block with a left axis deviation and a first-degree AV block were found on an electrocardiogram (ECG). The histological examination of the conduction system according to the serial sectioning method disclosed that the branching portion of the His bundle and anterior fascicle of the left bundle branch were replaced by the scarring tissue and that the penetrating portion of the His bundle, the AV node and the right bundle branch had rheumatoid granulomatous lesions. The extent and localization of the lesions in the conduction system were well correlated with the findings on the ECG.
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PMID:An autopsy case of rheumatoid arthritis with an involvement of the cardiac conduction system. 685 21

Myocarditis with complete atrioventricular block is a very unusual complication of the herpex simplex infection. We report a 10-year-old boy infected very likely by the herpes simplex virus and who presented with high fever, erythema multiforme, complete atrioventricular block, and Adams-Stokes seizures. Emergent temporary pacemaker was performed for bradycardia. A sixteen-fold rise in herpes simplex antibody titer by a complement fixation method occurred within two weeks. Normal cardiac rhythm recovered 11 days later with a sequela of complete right bundle branch block after 2 years follow-up.
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PMID:Myocarditis with complete atrioventricular block associated with herpes simplex virus infection: report of one case. 940 Nov 83

Complete atrioventricular block (CAVB) can be either congenital or acquired in children. Acquired CAVB is occasionally seen in myocarditis patients. To determine the etiology, natural history, and outcome of children with acquired nonsurgical CAVB, we retrospectively reviewed nine children who had suffered CAVB caused by suspected infectious myocarditis. All of them had CAVB with a wide QRS escape ventricular rhythm on admission. Three of them had ventricular tachycardia in addition to CAVB. Seven of them had a preceding upper respiratory tract infection. All of them had congestive heart failure. Five of them had Stokes-Adams seizures. Three etiologies were identified in four of the children. All patients received inotropic agents and emergency temporary pacing. In all except one case, the cardiac rhythm returned to sinus rhythm within 10 days. During a follow-up period of 9 to 96 months, all were asymptomatic and drug-free. Electrocardiograms showed that four patients were completely normal, there was complete RBBB in four and left anterior fascicular block in one patient. We conclude that although CAVB associated with myocarditis can be life-threatening, the long-term prognosis is good if patients are diagnosed early and proper management is employed.
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PMID:Complete atrioventricular block following myocarditis in children. 1218 8

The transistorized implanted pacemaker is proving to be an effective and reliable method for long-term pacing of the heart. All patients suffering from Stokes-Adams seizures were first given a trial period of conservative therapy, including isoproterenol (Isuprel), ephedrine, atropine and steroids. Twenty-four pacemaker implants were performed on 23 patients over a 21-month period. The preoperative insertion of a pacemaker cardiac catheter was a very valuable safety precaution. In this way the heart could be safely and reliably paced during the period of preoperative assessment and during the critical periods of anesthetic induction and thoracotomy. Infection did not occur, probably because of careful gas sterilization of the units. Various models of pacemakers are compared, and the reasons for two pacemaker failures are presented. There were two early deaths and one late death in the series. The relationship of progressive coronary disease to recent infarction is stressed. Patients having intermittent heart block frequently showed the picture of "competing pacemakers" postoperatively, but without deleterious effect. Twenty patients, between 54 and 88 years of age, are alive and well at the time of reporting, with excellent pacemaker response and no further Stokes-Adams attacks.
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PMID:THE IMPLANTABLE CARDIAC PACEMAKER. 1411 81

Nine patients with complete heart block and Stokes-Adams disease were treated with subcutaneously implanted, fixed-rate, artificial cardiac pacemakers. All of these patients were refractory to medical treatment and confined to bed by the frequency of their attacks. One patient died in uremia one month after operation; in the remaining eight, the implanted pacemakers are providing adequate stimulation at present. These patients are free of seizures and show an improvement in the amount of their physical activity. A fixed rate of 60 to 65 per minute was adequate in all cases. The results of our clinical experience with cardiac pacemakers is satisfactory, but the possibility of mechanical failure limits their use to situations in which the patient is incapacitated despite medical treatment.
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PMID:ARTIFICIAL CARDIAC PACEMAKERS. 1418 May 43

The importance of a good clinical history has been emphasized by reviewing the most common diagnostic criteria in cardiac patients. Dyspnea of cardiac origin should be differentiated from respiratory disturbances, neuroses, unfitness, etc. Orthopnea, paroxysmal nocturnal dyspnea, cardiac asthma and acute pulmonary edema are manifestations of left ventricular failure. Peripheral edema is most frequently due to circulatory disturbances of the lower extremities. Edema of cardiac origin is bilateral, related to postural changes and associated with cardiomegaly. Hepatic and renal problems are also common causes of edema. Chest pain due to myocardial ischemia (angina pectoris) is characteristic in its location, radiation, onset and relief. It should be differentiated from the many other causes of chest pain (neurosis, pericarditis, myalgia, etc.) by a carefully taken history. Palpitations and syncope are common symptoms of severe cardiac disease. Patients with these complaints should be thoroughly investigated. Syncope of cardiac origin (Stokes-Adams attack) should be differentiated from epileptic seizures.
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PMID:Importance of the history in diagnosing cardiac patients. 2046 42

BACKGROUND Transient abrupt loss of consciousness due to sudden but pronounced decrease in cardiac output caused by a change in heart rate and rhythm is termed Stokes-Adams disease. Causes of Stokes-Adams syndrome are 1) transition from normal rhythm to high grade block, 2) slowing of idioventricular rhythm in the course of complete heart block, and 3) abnormal ventricular rhythm such as ventricular tachycardia and ventricular fibrillation. Paroxysmal ventricular standstill is one of the rarest causes of Stokes-Adams attack. It is well documented that some patients with a diagnosis of epilepsy actually have a cardiac cause for their convulsions. Brevity of these episodes sometimes makes diagnosis difficult. CASE REPORT We present a case of 40-year-old builder who was normally fit and healthy who developed paroxysmal ventricular standstill. He presented to the Emergency Department with multiple episodes of seizure-like activity. Blood tests which included antibody screen were normal except for hypophosphatemia. Computed tomography head scan was normal. He was commenced on intravenous phenytoin infusion which did not abort his seizure-like episodes. Eventually, ventricular standstill was recorded on cardiac monitoring. The seizure-like episodes were determined to be Stokes-Adams attacks. He underwent transcutaneous pacing and then transvenous pacing with eventual permanent pacemaker insertion. He did not have further episodes at yearly follow-up. CONCLUSIONS This case serves as a reminder of the diagnostic dilemma between syncope and seizures. Misdiagnosing cardiac dysrhythmia for epilepsy could lead to adverse consequences for the patient. It is incumbent upon the emergency physician to perform cardiac monitoring on all patients who present with syncope or convulsion in order that dysrhythmia is observed during such episode.
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PMID:Paroxysmal Ventricular Standstill: A Rare Cardiac Manifestation of Syncope. 3259 37


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