Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of multiple, inducible sustained arrhythmias during electrophysiologic studies is unknown. We have identified five patients who had several sustained tachycardias, some of which were not previously recognized clinically. Three patients had documented sustained supraventricular tachycardia (one of these also had nonsustained ventricular tachycardia) and two had documented sustained ventricular tachycardia. The clinically documented tachycardia was successfully reproduced in all cases; however, the three cases of supraventricular tachycardia also had sustained ventricular tachycardia initiated, and the two cases of ventricular tachycardia also had sustained supraventricular tachycardia, which had not previously been seen. The underlying common denominators for all five patients were poor left ventricular function due to ischemic heart disease and a history of syncope. In one case of clinical supraventricular tachycardia, the second sustained tachycardia appeared following drug therapy (procainamide), which seemed to convert nonsustained to sustained ventricular tachycardia. In another patient with clinical ventricular tachycardia, the supraventricular tachycardia was also initiated following drug therapy (indecainide). We conclude that: (1) patients with syncope may have multiple arrhythmic etiologies and (2) complete electrophysiologic evaluation, during control studies as well as serial drug studies, are important in the management of these patients.
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PMID:Unexpected coexistence of supraventricular and ventricular tachycardia in patients with syncope. 258 78

During the years 1974-86 in the Israel Defense Force (IDF), 83 soldiers aged 17-39 years died suddenly and unexpectedly. Cardiac causes accounted for 56% of the deaths, neurological causes for 19%, other diseases for 8% and in 17% the cause of death was unknown. Causes of death varied between soldiers younger and those older than 30 years of age. Ischemic heart disease accounted for 58% of deaths in soldiers greater than 30 years old but was an infrequent cause of death in subjects less than 30 years (4%). Congenital cardiac anomalies (27%) and myocarditis (15%) accounted for most deaths in subjects less than 30 years of age. Epilepsy was a common cause of sudden death (10%), occurring mainly during sleep, and was related to poor medical control. Effort-related deaths occurred in 25 cases (30%) and were mainly associated with cardiac causes. Syncope (18%) and chest pain (18%) were common symptoms prior to death. According to our data and previous reports, sudden death continues to be an unresolved medical problem in young adults. Preventive measures should include a more thorough evaluation of symptoms such as syncope and chest pain, particularly when occurring during or after exercise. Furthermore, early coronary artery disease should not be disregarded in subjects as young as 30 years of age.
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PMID:Sudden death in young Israeli soldiers. Analysis of 83 cases. 268 3

A 79 year old man with sudden dyspnea, syncope and third degree heart block underwent a pacemaker (PM) implantation. He persisted with these symptoms and on the third day after the procedure it was detected a precordial holosystolic murmur. A ventricular septal rupture consequence of PM implantation was suspected. The coronary-ventriculography revealed a 99% stenosis in right coronary artery, inferior myocardial infarction and an interventricular communication. Previously, there were no other clinical manifestations nor electrocardiographic alterations suggestive of myocardial ischemia or infarction in this patient. We discuss about the rare association of an unrecognized acute myocardial infarction complicated by ventricular septal rupture.
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PMID:[Rupture of the interventricular septum after acute myocardial infarction in the absence of typical symptoms and electrocardiographic changes. A case report]. 260 67

The purpose of this study is to investigate the long-term prognosis of ventricular tachycardia (VT) mainly with respect to sudden death (SCD) in patients with ischemic heart disease (IHD), idiopathic cardiomyopathy (ICM), miscellaneous heart disease (MHD) and idiopathic ventricular tachycardia (IVT). The study included 117 patients with VT (80 male, 37 female). The number of patients with IHD, ICM, MHD and IVT were 40, 18, 26 and 33, respectively. Follow-up was conducted by means of a mailed standardized questionnaire. The mean follow-up period was 46.8 +/- 32.0 months (range from 6 to 125 months). In 24 out of the 117 patients the cause of death was SCD, in 9 there was no sudden cardiac death and in 5 no cardiac death. The other 76 were surviving. The number of SCD in IHD, ICM, MHD and IVT was 14/40 (35%), 4/17 (24%), 6/25 (24%) and zero (0%), respectively. The number of having had syncope in IHD, ICM, MHD and IVT was 19/40 (48%), 7/18 (39%), 6/26 (23%) and 6/33 (18%), respectively. Out of the 19 IHD patients with syncope, 15 had had ventricular fibrillation (VF). As for IVT with syncope, only one of the 6 had VF, which was induced by a disopyramide injection. In IVT, the patients with syncope had a significantly higher VT rate than those without syncope (p less than 0.01). There were no significant differences in the electrocardiographical high risk parameters for SCD, the age, follow-up periods, the presence or absence of VF and ejection fraction between the SCD and the surviving groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term prognostic assessment of ventricular tachycardia with respect to sudden death in patients with and without overt heart disease. 263 26

The clinical, ECG and electrophysiological data of 37 patients (28 males and 9 females) with spontaneous intra-hisian block are reported. Of these patients, 11 had hypertensive heart disease and 5 had ischemic heart disease with previous myocardial infarction; in 21 patients, clinical signs of heart disease were not evident. In 18 patients, a single or recurrent episode of syncope had occurred. One patient had junctional rhythm and 36 sinus rhythm; among these, 12 patients presented PR greater than 200 msec (7 with a narrow and 5 with a wide QRS); 12 patients had a single or bilateral bundle branch block; 12 had a normal ECG. The electrophysiological study showed a split H-H1 in 22 patients, a wide His deflection (H greater than 25 msec) in 4 and HV greater than 65 msec with narrow QRS in 11. In 17 patients a more or less marked sinoatrial node and/or atrioventricular node dysfunction was present. Atrial pacing, performed in all, induced 2nd degree Mobitz 2 intra-hisian block in 9 patients. Ajmaline was used in 16 patients but induced a complete intra-hisian block in only one. In 28 patients a preventive pacemaker was implanted after electrophysiological study. During the follow-up (mean 25 months/pt.), 38% of the patients developed complete atrioventricular block. No recurrence of syncope occurred in the paced patients. Comparison of patients who developed atrioventricular block and those who maintained normal atrioventricular conduction did not show differences as far as heart disease, previous syncope, ECG pattern and results were concerned.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Spontaneous grade I bundle of His block. Clinical, electrocardiographic and electrophysiological studies in 37 patients]. 274 10

We have described six centenarians who have benefited from permanent pacemakers. In all of these patients, their initial symptoms of syncope, presyncope, dyspnea, and transient cerebral ischemic attacks resolved promptly after pacemaker implantation. In most of these patients quality of life, as measured by lifestyle and independence, improved after pacemaker implantation. None of these patients exhibited evidence of ischemic heart disease or cardiac failure. Because of increasing longevity and age-related degenerative and destructive changes in the conduction system and the sinus node, we expect that the number of patients requiring pacemakers in this age group will continue to grow. Ischemic heart disease as an underlying pathology necessitating pacemaker implantation appears to be rare in this age group.
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PMID:Permanent pacemakers in centenarians. 275 61

Idiosyncratic and proarrhythmic reactions to antiarrhythmic drugs are a well-recognized phenomenon and appear to correlate poorly with Q-T prolongation or with the serum concentration of the drug. It therefore becomes difficult to identify patients clinically with an underlying electrophysiologic substrate for ventricular tachycardia which was made manifest by an antiarrhythmic drug, or to determine whether the drug is causing an idiosyncratic reaction (the classic "long Q-T syndrome"). We recently studied a patient with ischemic heart disease and a prolonged corrected Q-T interval (Q-Tc) due to chronic left bundle-branch block. She developed "quinidine syncope," and the Q-Tc was unchanged despite stopping administration of the drug; however, electrophysiologic studies demonstrated reproducibly inducible "torsade de pointes" while the patient was being rechallenged with quinidine, while no inducible arrhythmia was seen during control studies. We conclude that electrophysiologic studies are of clinical value in the clarification of possible drug-induced arrhythmias.
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PMID:"Quinidine syncope" without lengthening of Q-Tc interval in the presence of left bundle branch block. Role of programmed ventricular stimulation studies. 338 22

Prolongation of the PR interval is a nonspecific condition. Etiologies include normal physiologic variance, idiopathic bundle branch fibrosis, calcific valvular heart disease, ischemic heart disease, cardiomyopathies, infections resulting in myocarditis, drugs (especially type I antidysrhythmic medications), collagen vascular diseases, tumors, trauma, electrolyte imbalances, and many other miscellaneous causes. Isolated first degrees atrioventricular block is generally not associated with an increased risk of sudden death, syncope, or progression to higher degrees of atrioventricular block. Exceptions include patients with intra-atrial conduction delays prone to atrial fibrillation, acute myocardial infarction, or bundle branch disease where higher degrees of atrioventricular block may develop. Treatment consists of correction of the underlying disorder or discontinuation of the offending medication.
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PMID:First degree atrioventricular block. 358 15

Myocardial ischemia, particularly when transmural as in variant angina pectoris, may be associated with ventricular tachycardia, ventricular fibrillation and paroxysmal atrioventricular block (15%). Syncope (7%) and sudden death (3%) due to these malignant arrhythmias are sometimes a unique marker of myocardial ischemia. Two-hundred fifty-four patients (220 males and 34 females), aged 5 +/- 9 years with transmural myocardial ischemia related to coronary artery spasm, were studied. Particular attention was paid to the role of syncopal attacks as unique clinical manifestation of silent ischemia. Patients examined were divided into 3 Groups. Group 1 includes 5/254 (2%) patients with atrial fibrillation during acute ischemia. Group 2 was divided into four subgroups: subgroup A includes 17/254 (7%) patients with syncopal attacks due to malignant arrhythmias (ventricular tachycardia and advanced A-V block); subgroup B, 15/254 (6%) patients with documented malignant arrhythmias, without syncopal attacks; subgroup C, 7/254 (3%) with ventricular fibrillation during acute ischemia and subgroup D, 18/254 (7%) patients with history of syncopal attacks without documented arrhythmias during hospital observation. Group 3 includes 17/254 (7%) patients with left anterior hemiblock in basal condition, 7/254 (3%) patients with left anterior hemiblock and one left posterior hemiblock during acute ischemia and one patient with right bundle branch block during acute ischemia. Syncopal symptoms are present in many of these cases of angina pectoris; paroxysmal A-V block is documented in nearly half of the cases with syncope (65%); ventricular tachycardia is frequently demonstrated during ischemia but leads to syncope in only a few cases; patients with syncope do not present specific clinical features.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:When are arrhythmias and conduction disturbances markers of myocardial ischemia at rest? 375

24 hour ambulatory electrocardiography was performed in a representative group of people born in 1897. Out of 73 people included in the study, 22 were without known heart disease, 15 had definite ischaemic heart disease (IHD) and 36 symptoms of possible cardiac origin. An R-R interval in excess of 2000 ms was seen in only 3 subjects and Wenckebach A-V block in only one. One subject without a history of syncope had a nocturnal episode of complete A-V block with an escape interval of 8000 ms. The most striking difference between healthy subjects and patients with IHD was the higher number of patients with more than 1000 ventricular premature beats (VPBs) per 24 hour and ventricular couplets compared with the number of healthy subjects with such findings. At follow-up two years later 11% had died, with the highest mortality in patients with IHD (33%), and out of 8 patients with IHD who had more than 1000 VPBs per 24 hour, 4 (50%) had died compared with only one (14%) of those with less than 1000 VPBs. Our results seem to indicate that more than 1000 VPBs per 24 hour is a very unusual finding in healthy 85 year old individuals. When it occurs in very old people, it is usually in connection with IHD, and in this setting it signifies a poor prognosis.
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PMID:Prevalence and prognostic significance of cardiac arrhythmias detected by ambulatory electrocardiography in subjects 85 years of age. 375 90


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