Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0392680 (shortness of breath)
 5,217 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To investigate whether the preservation of atrioventricular (AV) synchronization matters for quality-of-life during pacemaker treatment we assessed 17 consecutive patients with high degree AV block and preserved sinus node function in a double-blind, long-term crossover study. A questionnaire with regard to cardiovascular symptoms, sleep disturbances, cognitive functioning, physical ability, social interaction, emotional functioning, and self-perceived health was completed after 2 months of atrial synchronous (DDD) and rate modulated ventricular pacing (VVI,R), respectively. A significant improvement in shortness of breath, dizziness and palpitations as well as an improvement of cognitive functioning was observed during DDD pacing. Nine patients preferred the DDD mode and three the VVI,R mode. The remaining five patients did not express any preference. The preference for the DDD mode was explained by a significant reduction of cardiovascular symptoms and an improved self-perceived health, physical ability, and psychological well-being during DDD pacing. All differences in quality-of-life parameters between the two modes of pacing favored the DDD mode and no adverse effects of this mode were found. Thus, the maintenance of AV synchrony adds further symptomatic relief compared to rate increase alone. The results indicate that DDD pacing is the preferred mode of pacing in patients with high degree AV block and preserved sinus node function.
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PMID:Quality-of-life in patients treated with atrioventricular synchronous pacing compared to rate modulated ventricular pacing: a long-term, double-blind, crossover study. 138 58

In patients affected by high degree AV block without preexisting congestive heart failure there is no definite demonstration that DDD pacing gives real clinical advantages in respect to VVIR pacing. We performed an intrapatient, long-term study between the two pacing modes in 14 high degree AV block patients, using the Medtronic Synergyst 7027 dual chamber pacemaker, who could be programmed alternatively in DDD or VVIR mode. After a 4-week run-in period following the pacemaker implant, patients completed a randomized, double-blind, cross-over study to compare the effect of 6-week period VVIR and DDD pacing on symptoms and cardiovascular parameters. A semiquantitative score scale was used to quantify the symptoms of general well-being, palpitations, dizziness, pulsating sensation in the neck or abdomen, shortness of breath at rest and during effort, chest pain, and NYHA classification. The sum of symptom scores was 10.4 +/- 6.7 in VVIR period and 4.6 +/- 2.7 in DDD period (P less than 0.001); five patients (36%) crossed over early from VVIR to DDD because of intolerable symptoms; overall, eight patients preferred the DDD mode and no one preferred the VVIR. Cardiac output at rest (echo-Doppler method) was 4.7 +/- 1.4 versus 5.7 +/- 1.6 liter/min (P less than 0.01), body weight was 65.9 +/- 6.6 versus 64.9 +/- 6.1 kg (P less than 0.02), atrial natriuretic peptide was 236 +/- 112 versus 198 +/- 110 pg/mL (P less than 0.01), respectively, during VVIR and DDD modes. Effort tolerance was similar with the two modes of pacing (68 +/- 15 vs 70 +/- 18 watts/min).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intrapatient comparison between chronic VVIR and DDD pacing in patients affected by high degree AV block without heart failure. 170 47

The effects of DDD (fully automatic) and VVI (ventricular demand) pacing modes on exercise tolerance, symptom diary cards, and Holter monitoring were investigated in a randomised double blind crossover study of 16 patients who had had DDD pacemakers implanted because of frequent syncope. Eight patients presented with sick sinus syndrome and, with one exception, retrograde atrioventricular conduction and eight age and sex matched patients presented with 2:1 or complete atrioventricular block. Maximal symptom limited exercise in those with atrioventricular block was significantly higher after one month of DDD pacing than after VVI pacing. In those with sick sinus syndrome, however, maximal effort tolerance was not significantly different for the two pacing modes. In all but one patient with sick sinus syndrome sinus rhythm developed during exercise in VVI pacing. For both VVI and DDD modes maximal atrial rates were significantly lower in those with sick sinus syndrome. Palpitation and general wellbeing were significantly improved during DDD pacing in the eight patients with sick sinus syndrome. Shortness of breath was improved by DDD pacing in the eight patients with atrioventricular block but not in those with sick sinus syndrome. Holter monitoring showed that sick sinus syndrome patients remained in paced rhythm, either DDD or VVI, for most of the 24 hour period. DDD pacing was better than VVI pacing in sick sinus syndrome with retrograde atrioventricular conduction. Despite their ability to show sinus rhythm and inhibit their pacemakers on exercise patients with sick sinus syndrome are just as likely to have symptomatic benefit from DDD pacing as patients with atrioventricular block.
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PMID:Benefits of dual chamber pacing in sick sinus syndrome. 305 77

Over a five-year period, hemodynamic exercise capacity studies and a randomized controlled trial have been performed in a total of 50 patients. DVI vs. VVI pacing showed an increase in stroke work index (P less than 0.005) and a fall in left ventricular filling pressure (P less than 0.05) in 17 patients. VDD/DDD pacing vs. VVI showed an exercise capacity benefit in 44 patients (P less than 0.01) including 8 patients with sinus node disease and a lower peak heart rate (P less than 0.02). Maintenance of benefit was also shown of VDD/DDD pacing in the longer term (13 months) vs. acute (P - NS). The controlled trial VDD/DDD vs. VVI showed benefit in shortness of breath (P less than 0.01) and general well being (P less than 0.01). It is concluded that atrial synchronous ventricular pacing (VDD/DDD) is the mode of choice in suitable patients.
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PMID:Physiological benefits of atrial synchrony in paced patients. 618 74

A 68-year-old man with sick sinus syndrome and a history of intermittent atrial fibrillation was treated by implantation of a DDD pacemaker. He subsequently developed recurrent episodes of shortness of breath and tachycardia. Investigation revealed two different arrhythmias, both induced by the pacemaker: (1) a tachycardia in which the dual-chamber pacemaker system provided the antegrade limb and the AV node provided the retrograde limb and (2) a triggered, ventricularly paced tachycardia caused by the pacemaker sensing atrial fibrillation waves. Both rhythms were abolished by reprogramming to the DVI mode.
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PMID:Two mechanisms of arrhythmia induction by a DDD pacemaker: a case report. 619 22

Venticular paced rhythm makes diagnosis of acute myocardial infarction difficult. We present a case of a 77-year-old woman with cardiac DDD pacemaker, suffering from diabetes, arterial hypertension and renal insufficiency. She was admitted to hospital due to heavy chest pain, radiated to neck and jaw and shortness of breath. The electrocardiogram recorded on admission showed ventricular paced rhythm and ST segment elevation > 0.5 mV, which fulfilled Sgarbossa's criteria for indetermined acute coronary syndrome in a patient with pacemaker. Troponin levels were not increased. Severe stenosis of left anterior descendent coronary artery was revealed in coronarography and percutaneus coronary angioplasty with stent implantation was performed immediately.
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PMID:[Undetermined type of acute coronary syndrome in a patient with a pacemaker]. 1952 44