Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0042510 (ventricular fibrillation)
 10,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

9 figures form the core of this article describing and discussing a case of sudden death, 2 hours after a 30-year old woman presented at a hospital emergency with chest pains. She had taken no medications other than oral contraceptives (OCs) for 10 years. The patient was admitted to the coronary care unit where findings included a palpable blood pressure of 94 mm of Hg, a heart rate of 128/min, and a respiratory rate of 28/minute. Cyanosis was noted, jugular veins were distended, and there were rales over the lung bases bilaterally; cardiac sounds were soft and a third heart sound was audible. Arterial oxygen tension was 15 mm of Hg, and carbon dioxide tension was 42 mm of Hg; pH was 7.2. Ventricular tachycardia developed and ventricular fibrillation ensued. The patient was intubated and well oxygenated, external cardiac compression was performed, sodium bicarbonate, epinephrine, and calcium were administered, and electrical defibrillation was performed. After several attempts, the latter resulted in a slow idioventricular rhythm on the electrocardiogram, but neither the blood pressure nor pulse was detectable. Asystole subsequently developed, and cardiac activity could not be restored. After discussion by a panel of physicians, the final anatomic diagnoses are chronic active nonspecific myocarditis; organizing and acute myocardial microvascular and endocardial mural thrombi; platelet-rich microthrombi in the heart, lungs, and liver; chronic passive pulmonary congestion and edema; and congestive hepatomegaly (2900 g). Any of these may be assciated with longterm OC usage.
 ...
PMID:Chest pain, shock, arrhythmias and death in a young woman. 44 59

Disturbances of heart rhythm, observed during 700 heart catheterizations in infants and children, are discussed. Paroxysmal supraventricular tachycardia has been observed in 25 investigations (3,6%), sinus bradycardia in 18 (2,6%), junctional rhythm in 10 (1,4%), second degree AV-block in 9 (1,3%), ventricular fibrillation in 8 (1,1%), sinus tachycardia in 7 (1%), complete block in 7 (1%), asystole and atrial flutter in 2 (0,3%) each, and ventricular tachycardia in 1 (0,15%). Supraventricular tachycardia occurred equally in all ages without preference of a special malformation. The two patients with WPW-syndrome, however, showed this disorder in each of three catheterizations. Propranolol and verapamil succeeded in terminating the attacks. Junctional rhythm and sinus tachycardia presented equal behavior and benignity. Sinus bradycardia, second and third degree AV-block, and especially ventricular fibrillation occurred mostly in neonates and infants, many of them cyanotic and suffering from complex malformations and therefore needing multiple catheter manipulations. Bradycardia was in two, asystole in one of the very sick neonates associated with subsequent death within 24 hours. Once asystole resulted in immediate death after pulmonary angiography in a child with severe pulmonary hypertension. Ventricular fibrillation could be terminated promptly by DC countershock in all patients, but three of the children died subsequently. Complete block occurred only in children with systemic right ventricular pressure, 4 of the 7 patients having pulmonary hypertension, too. In two instances the block subsided spontaneously, the rest could successfully be treated with orciprenaline (Alupent R). Life threatening arrhythmias became less frequent as a consequence of earlier investigation, if severe heart disease was suspected, and by closer control of cyanosis, acidosis and temperature before, during, and after catheterization.
 ...
PMID:[The risks involved in the heart catheter examination. A retrospective evaluation of the complications after 700 examination. III. Irregularities of heart (author's transl)]. 53 Jul 27

Hypothermia is a common intraoperative and immediate postoperative complication. Hypothermia causes morbidity from shivering, hypotension, cyanosis, and respiratory diseases. In severe cases, bradycardia, premature ventricular contractions, and even ventricular fibrillation may occur. The various causes of excessive heat loss, both intraoperatively and during the postanesthesia period, the methods of prevention, and the rewarming measures are important factors in administering patient care. Predisposing factors are large exposed body surface areas, open body cavities, prolonged exposure to low operating room temperature, rapid infusion of cold blood and intravenous (IV) fluids, cold irrigating solutions, ventilation with cold gases in long surgical procedures, age over 60 years, premedication that relaxes muscle tone, and the subcutaneous vasodilatation that occurs during anesthesia. Attempted prevention measures include active warming blankets, increased ambient temperatures, warmed IV and irrigating solutions, and metallized plastic sheeting. Restoration of normal body temperature is achieved by radiant heaters, heated mattresses, and heated humidifiers. Astute assessment, quick response, and correct interventions by the nurse can often minimize risk of postanesthesia hypothermia. These principles are illustrated in a case study of a PACU patient in a large teaching trauma hospital.
 ...
PMID:Help! This postanesthesia care unit patient is hypothermic. 235 57

An autopsy case of cardiac rhabdomyoma associated with tuberous sclerosis in a 27-day-old infant is presented. He was born with severe cyanosis. Echocardiogram revealed the presence of multiple mass lesions, some of which protruded into the left ventricle at the level of subaortic valve. From the age of 4 days, cardiac arrhythmia developed and lasted until his death. The arrhythmia started as WPW syndrome and atrial extrasystoles and then additional paroxysmal supraventricular tachycardia, ventricular fibrillation, sinus arrest, and S-A block occurred. Computed tomographic scanning of the brain revealed the presence of symmetric high-density spots around the central part of lateral ventricle. Before his death paroxysmal supraventricular tachycardia occurred frequently which changed to ventricular fibrillation and he collapsed without urination and then died. Autopsy examination revealed the presence of generalized congestion, multiple nodules of cardiac rhabdomyoma, some of which causing subaortic stenosis, and tuberous sclerosis in the brain. From the clinical and autopsy findings, the direct cause of death was attributable to the cardiac rhabdomyoma.
 ...
PMID:Cardiac rhabdomyoma associated with tuberous sclerosis. An autopsy case of newborn infant died of cardiac failure. 361 25

One hundred thirty-eight children underwent 164 operations through repeat median sternotomy. Ages ranged from 4 months to 21 years (mean, 8.6 +/- 5.0 years). The technique consisted of opening the sternum with chisel and mallet, avoidance of sudden separation of sternal edges and blunt dissection, elimination of the electrocautery during lysis of adhesions, and judicious use of fresh blood and components. Several variables were analyzed comparing the initial and repeat procedures on each patient. Time from incision to bypass was an hour longer with the repeat procedure (174 +/- 45 minutes versus 96 +/- 37 minutes). Operative transfusions and postoperative bleeding (first 48 hours) were not significantly different between the two procedures. Cyanosis, however, significantly increased bleeding in both groups. There were eight injuries (5%) at reoperation. During sternal reentry in 2 patients, a tear occurred in a valved conduit coursing underneath the sternum. A right ventricular tear occurred in 1 patient while the sternal edges were being separated. Ventricular fibrillation was noted in 2 patients during lysis of adhesions with the electrocautery used early in the series. Intimal disruption occurred in two valved conduits during intraoperative manipulations. An aortic tear occurred and was repaired without cardiopulmonary bypass. There were 13 (8%) hospital deaths, all unrelated to the technique. We believe that the current approach can be a valuable alternative for surgeons dealing with repeat median sternotomy in children.
 ...
PMID:Repeat median sternotomy in pediatrics: experience in 164 consecutive cases. 394 71

Fresh autologous thrombus, 1.0 to 1.5 ml, was injected into the left anterior descending and/or left diagonal coronary arteries of 19 open-chest dogs to produce evolving acute myocardial infarction (AMI). Thrombotic obstruction was documented by coronary angiography. Multilead epicardial ECGs showed ST segment elevations of affected left ventricular (LV) areas within 2 minutes after thrombus injection, and LV segmental wall cyanosis with hypocontraction was observed within 10 minutes in the myocardial areas supplied by the thrombosed artery. Ten animals then received an initial dose of streptokinase (STK), 250,000 U (intravenous), followed by STK, 1000 to 3000 U/min (intracoronary), while nine control dogs untreated with STK received normal saline infusion. All but one STK-treated animal (all nine animals receiving intracoronary STK) had reestablishment of blood flow in the previously occluded vessels within 1 1/2 hours, disappearance of ventricular cyanosis, return of normal LV contractile function, and normalization of elevated ST segments within 1 hour after intracoronary STK therapy. In contrast, in the non-STK-treated control group, all animals had continued coronary obstruction, progressive ST elevations, and worsening LV cyanosis and hypocontraction until death or for more than 3 hours post thrombus; three control animals died of ventricular fibrillation (VF) within 1 hour of thrombus occlusion, three more died of VF within 2 hours post thrombus, and only three survived beyond 2 hours post thrombus. Postmortem examination of non-STK-treated animals revealed extensive residual coronary thrombus. All intracoronary STK-treated animals evidenced absence of residual coronary thrombus at postmortem examination. These data provide clinically relevant evidence that early intracoronary STK effects thrombolysis in AMI by reopening coronary vessels occluded by fresh thrombus, thereby protecting myocardium from further ischemia and necrosis, preserving LV function, and also reversing cardiac muscle injury.
 ...
PMID:Experimental reversal of acute coronary thrombotic occlusion and myocardial injury in animals utilizing streptokinase. 731 18

This publication presents the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of the pediatric patient and the 2005 American Academy of Pediatrics/AHA guidelines for CPR and ECC of the neonate. The guidelines are based on the evidence evaluation from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American Heart Association in Dallas, Texas, January 23-30, 2005. The "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" contain recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. The evidence evaluation process that was the basis for these guidelines was accomplished in collaboration with the International Liaison Committee on Resuscitation (ILCOR). The ILCOR process is described in more detail in the "International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations." The recommendations in the "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" confirm the safety and effectiveness of many approaches, acknowledge that other approaches may not be optimal, and recommend new treatments that have undergone evidence evaluation. These new recommendations do not imply that care involving the use of earlier guidelines is unsafe. In addition, it is important to note that these guidelines will not apply to all rescuers and all victims in all situations. The leader of a resuscitation attempt may need to adapt application of the guidelines to unique circumstances. The following are the major pediatric advanced life support changes in the 2005 guidelines: There is further caution about the use of endotracheal tubes. Laryngeal mask airways are acceptable when used by experienced providers. Cuffed endotracheal tubes may be used in infants (except newborns) and children in in-hospital settings provided that cuff inflation pressure is kept <20 cm H2O. Confirmation of tube placement requires clinical assessment and assessment of exhaled carbon dioxide (CO2); esophageal detector devices may be considered for use in children weighing >20 kg who have a perfusing rhythm. Correct placement must be verified when the tube is inserted, during transport, and whenever the patient is moved. During CPR with an advanced airway in place, rescuers will no longer perform "cycles" of CPR. Instead, the rescuer performing chest compressions will perform them continuously at a rate of 100/minute without pauses for ventilation. The rescuer providing ventilation will deliver 8 to 10 breaths per minute (1 breath approximately every 6-8 seconds). Timing of 1 shock, CPR, and drug administration during pulseless arrest has changed and now is identical to that for advanced cardiac life support. Routine use of high-dose epinephrine is not recommended. Lidocaine is de-emphasized, but it can be used for treatment of ventricular fibrillation/pulseless ventricular tachycardia if amiodarone is not available. Induced hypothermia (32-34 degrees C for 12-24 hours) may be considered if the child remains comatose after resuscitation. Indications for the use of inodilators are mentioned in the postresuscitation section. Termination of resuscitative efforts is discussed. It is noted that intact survival has been reported following prolonged resuscitation and absence of spontaneous circulation despite 2 doses of epinephrine. The following are the major neonatal resuscitation changes in the 2005 guidelines: Supplementary oxygen is recommended whenever positive-pressure ventilation is indicated for resuscitation; free-flow oxygen should be administered to infants who are breathing but have central cyanosis. Although the standard approach to resuscitation is to use 100% oxygen, it is reasonable to begin resuscitation with an oxygen concentration of less than 100% or to start with no supplementary oxygen (ie, start with room air). If the clinician begins resuscitation with room air, it is recommended that supplementary oxygen be available to use if there is no appreciable improvement within 90 seconds after birth. In situations where supplementary oxygen is not readily available, positive-pressure ventilation should be administered with room air. Current recommendations no longer advise routine intrapartum oropharyngeal and nasopharyngeal suctioning for infants born to mothers with meconium staining of amniotic fluid. Endotracheal suctioning for infants who are not vigorous should be performed immediately after birth. A self-inflating bag, a flow-inflating bag, or a T-piece (a valved mechanical device designed to regulate pressure and limit flow) can be used to ventilate a newborn. An increase in heart rate is the primary sign of improved ventilation during resuscitation. Exhaled CO2 detection is the recommended primary technique to confirm correct endotracheal tube placement when a prompt increase in heart rate does not occur after intubation. The recommended intravenous (IV) epinephrine dose is 0.01 to 0.03 mg/kg per dose. Higher IV doses are not recommended, and IV administration is the preferred route. Although access is being obtained, administration of a higher dose (up to 0.1 mg/kg) through the endotracheal tube may be considered. It is possible to identify conditions associated with high mortality and poor outcome in which withholding resuscitative efforts may be considered reasonable, particularly when there has been the opportunity for parental agreement. The following guidelines must be interpreted according to current regional outcomes: When gestation, birth weight, or congenital anomalies are associated with almost certain early death and when unacceptably high morbidity is likely among the rare survivors, resuscitation is not indicated. Examples are provided in the guidelines. In conditions associated with a high rate of survival and acceptable morbidity, resuscitation is nearly always indicated. In conditions associated with uncertain prognosis in which survival is borderline, the morbidity rate is relatively high, and the anticipated burden to the child is high, parental desires concerning initiation of resuscitation should be supported. Infants without signs of life (no heartbeat and no respiratory effort) after 10 minutes of resuscitation show either a high mortality rate or severe neurodevelopmental disability. After 10 minutes of continuous and adequate resuscitative efforts, discontinuation of resuscitation may be justified if there are no signs of life.
 ...
PMID:2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support. 1631 75

Commotio cordis or ventricular fibrillation caused by a blow to the chest is a rare cause of cardiac arrest in a well child. We report a case of a young child falling from a low height landing chest first with rapid onset of unconsciousness, apnoea and cyanosis. Cardiopulmonary resuscitation was given by parents under telephone instruction from an ambulance dispatch centre. On arrival of officers, 7 min after the fall, ventricular fibrillation was present but responded to defibrillation (biphasic 3 J/kg). No clinical or CT evidence of chest or brain trauma was present and investigations (ECGs, cardiac MRI, echocardiography, viral tests, metabolic tests, drug tests, serum electrolytes) did not reveal any cardiac illness or abnormal cardiac anatomy. Specifically, a long QT was absent and a Flecainide challenge for Brugada syndrome was negative. There was no family history of sudden death. No further dysrrhythmia occurred and the child recovered neurologically well after 3 days of therapeutic hypothermia (for cerebral ischaemia) and 7 days of mechanical ventilation.
 ...
PMID:A case of Commotio cordis in a young child caused by a fall. 1816 18