| According the literature atrio-ventricular blockade (AVB) is the most frequent and well-known symptom of Lyme carditis. Typical signs of complete AVB include fatigue, lethargy and syncope- Morgagni-adams-stokes syndrome (MAS). The authors present their results and experience with 5 patients selected from a long-term study (conducted between 1987 and 1998) comprising 58 patients who developed MAS. The authors tried to evaluate the changes especially in the cardiovascular system. They correlated the clinical state with ECG findings, as well as with the levels of the borrelia burgdorferi antibodies. The following results were obtained: 1) all patients had typical syncope, 2) the clinical course was not complicated (except one patient who developed ventricular fibrillation), 3) two patients had frequent symptomatic and asymptomatic arrhythmia including chest pain and episodic rest dyspnea, 4) subjective difficulties (usually palpitations) correlated with ECG findings (Lown 3a, 3b). The authors also looked for any relationship between clinical difficulties and levels of antibodies. The results obtained with an early permanent pacemaker were less favourable than those reported in the literature. Despite early treatment 2 patients had repeated palpitations and ECG correlates during the next years. ( info) |
2/37. Simultaneous EEG and ECG recording during a Stokes-Adams attack. Simultaneous electroencephalographic and electrocardiographic recordings were obtained from a 77-year-old patient during a Stokes-Adams attack. The recordings showed a clear temporal relationship between symptoms, electroencephalographic and electrocardiographic changes during the Stokes-Adams attack. This case shows the usefulness of simultaneous EEG and ECG recordings in the investigation of patients with unexplained episodes of disturbed consciousness. ( info) |
3/37. Complete heart block and systemic lupus erythematosus. An 18-year-old girl with systemic lupus erythematosus developed progressive electrocardiographic abnormalities over a period of 16 years, culminating in complete heart block with Adams-Stokes attacks. A permanent ventricular pacing system was implanted successfully. ( info) |
4/37. Adams-Stokes seizures due to ventricular tachydysrhythmias in patients with heart block: prevalence and problems of management. One hundred and twelve patients with heart block and chronic tendency to syncope were ECG-monitored during syncope. Ventricular tachycardia and/or fibrillation (VT-VF) was observed as the cause of syncope in 11 patients: in 6 of 20 patients with chronic third degree A-V block, in 3 of 65 with paroxysmal A-V block and in 2 of 27 with S-A block. The R-R interval preceding the escape beat which initiated VT-VF varied between 1.2 and 2.2 seconds. The cerebral attacks were amenable to long-term pacemaker treatment. However, relapses of VT-VF were observed during pacing with a low rate of 55 per minute and during short interruptions in pacing, as produced by intermittent pacemaker failure or threshold determination. In one patient, supplementary treatment with a beta-blocking agent had to be given to suppress exercise-induced attacks of VT-VF after pacemaker implantation. ( info) |
5/37. A-V block. In this report, 61 A-V block patients were analysed using HBE. According to the site of the block, these cases were classified into P(A)-H block, BH block H V block and mixed block. In P(A) H block group (23 cases), the permanent pacemaker implantation was not needed except for one patient with persistent heart failure due to marked bradycardia. Postmortem histology of this patient was well coincident to the results of HBE. In BH block group (18 cases), moderate number of patients were needed to have permanent pacemakers implanted (33%). RA pacing induced split H block with H-V prolongation and varied H and QRS configuration in two cases of this group. These phenomena may be well explained by the longitudinal dissociation theory. In H-V block patients, permanent pacemakers were implanted in all patients (12 cases). In this group, it is difficult to decide the exact location of block, either distal His, bifurcation or bundles, because of the difficulty to record the left or right bundle potentials in clinical practise. Finally, it is important to record the HBE in order to decide the exact site of block, and to choose the suitable therapy for A-V block patients. ( info) |
6/37. 'Cardiogenic vertigo'--true vertigo as the presenting manifestation of primary cardiac disease. BACKGROUND: A 90-year-old woman presented to a hospital emergency department with a brief loss of consciousness that was heralded by spinning vertigo lasting approximately 2 min. She had a long history of intermittent brief episodes of rotatory vertigo, presyncope, and non-vertiginous dizziness, occurring either with or without loss of consciousness. Although initially attributed to symptomatic carotid artery stenosis, these episodes persisted, despite surgical restoration of carotid artery blood flow 1 year after her first syncope. Her medical history was otherwise notable for hypertension, mild depression and a gradual decline in gait and balance function attributed to left hip arthritis and older age. INVESTIGATIONS: Bedside history and examination, non-contrast head CT scan, electrocardiogram, transthoracic echocardiogram, and bedside cardiac telemetry. diagnosis: sick sinus syndrome or severe reflex bradycardia with asystole causing recurrent, episodic vertigo, presyncope, non-vertiginous dizziness and syncope (Stokes-Adams attacks). MANAGEMENT: Placement of a temporary pacing wire, followed by surgical implantation of a single-chamber ventricular (VVI) pacemaker. ( info) |
7/37. Paradoxical induction of endless loop tachycardia by magnet application over a DDD pacemaker. It is well known that removal of a testing magnet from a DDD pulse generator may cause endless loop tachycardia in patients with retrograde ventriculoatrial conduction; application of the magnet then terminates the tachycardia. We have observed the opposite response to the magnet and in this report we describe the paradoxical induction of endless loop tachycardia by magnet application over a DDD pulse generator and its persistence despite repeated removal and reapplication of the magnet. This unusual behavior occurred only in the "magnet off" function and is due to magnet-induced signals sensed by the atrial channel circuitry. ( info) |
8/37. Rate dependent depression of subsidiary ventricular impulse formation--cause of Stokes-Adams attacks in a patient with rate modulated pacing. Following His bundle ablation and implantation of a rate adaptive pacemaker (Vitatron TX 911) a 52-year-old gentleman experienced several presyncopal attacks while driving a car. On examination pectoralis muscle contraction caused temporary pacemaker inhibition. Incremental overdrive stimulation demonstrated progressive depression idioventricular automaticity and was associated with similar symptoms following overdrive at high pacing rates. Following appropriate pacemaker programming the patient remained symptom free. ( info) |
9/37. Acute inflammatory demyelinating polyradiculoneuropathy presenting as complete heart block and Stoke-Adams attacks. A patient with acute inflammatory demyelinating polyradiculoneuropathy (AIDP, guillain-barre syndrome) whose presenting complaints were related to autonomic dysfunction in the form of parasympathetic and sympathetic overactivity is reported. Parasympathetic overactivity was severe enough to cause complete atrioventricular block (atropine-responsive) and Stoke-Adams attacks, for which a demand pacemaker was required. Limb weakness was apparent 48 hours later. To our knowledge no such presentation of AIDP has been previously recorded. ( info) |
10/37. Long-term ECG monitoring in suspected Adams-Stokes disease. Long-term ECG recording techniques have facilitated the diagnosis in atypical cases of Adams-Stockes syndrome. In the use of ambulatory ECG monitoring, new and mainly technical problems have been arisen. In 200 ECG recordings on cassette tape, 78% was considered sufficient for an accurate diagnosis. More than 50% of the unsuccessful recordings were unreadable due to electrode problems. The use of ambulatory monitoring demands that electrode fixation and placement be handled carefully and that the mechanical and electronic equipment be serviced frequently. patients with third-degree atrioventricular block and syncopes of fainting spells run a high risk of sudden death. It is therefore not recommended to use ambulatory monitoring techniques on these patients. ( info) |