1/311. deceleration-dependent shortening of the QT interval: a new electrocardiographic phenomenon?In clinical cardiology, deceleration-dependent QT interval shortening is considered to be an extraordinary electrocardiographic phenomenon. We present an early premature born 4-year-old African-American girl with complications related to her premature birth, developmental delay, and several episodes of cardiac arrest. An episode of severe transient bradyarrhythmia was documented on Holter monitoring. The unique feature of the rhythm strips was paradoxical gradual shortening of the QT interval to 216 ms with accompanying transient T-waves abnormalities. The activation of the Ik, ACh due to an unusually high vagal discharge to the heart is proposed as a possible mechanism responsible for both slowing of the heart rate and shortening of the QT interval.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
2/311. hypotension, bradycardia, and asystole after high-dose intravenous methylprednisolone in a monitored patient.We report a case of hypotension, bradycardia, and asystole after intravenous administration of high-dose methylprednisolone in a 73-year-old patient who underwent electrocardiographic (ECG) monitoring throughout the episode. There was a history of ischemic cardiac disease 9 years earlier. The patient was admitted with a pulmonary-renal syndrome with hemoptysis, rapidly progressive renal failure, and hypoxemia that required mechanical ventilation in the intensive care unit. After receiving advanced cardiopulmonary resuscitation, the patient recovered cardiac rhythm. The ECG showed a junctional rhythm without ventricular arrhythmia. This study reviews the current proposed mechanisms of sudden death after a high dose of intravenous methylprednisolone (IVMP). These mechanisms are not well understood because, in most cases, the patients were not monitored at the moment of the event. Rapid infusion and underlying cardiac disease were important risk factors in the case reported here, and the authors discount ventricular arrhythmia as the main mechanism.- - - - - - - - - - ranking = 2keywords = rhythm (Clic here for more details about this article) |
3/311. Pseudo second degree atrioventricular block with bradycardia. Successful treatment with quinidine.Pseudo second degree atrioventricular block resulting from blocked His premature beats was successfully treated with quinidine. The diagnosis was proved by His bundle electrogam which showed both blocked and conducted His premature beats. The blocked His prematures produced second degree atrioventricular block by making the atrioventricular junction refractory. quinidine abolished both conducted and blocked His extrasystoles. There has been no recurrence of arrhythmia during a one-year follow-up.- - - - - - - - - - ranking = 0.5keywords = rhythm (Clic here for more details about this article) |
4/311. Sudden death after a cold drink: case report.We report a case of sudden cardiac death in a 12-year-old boy after rapid ingestion of a frozen slurry drink. The cause of death was determined to be a cardiac arrhythmia secondary to a previously undiagnosed cardiac rhabdomyoma with associated myocardial scarring. Ingestion of cold liquids has been associated with syncope, but not sudden cardiac death. In this case, bradycardia induced by cold-induced vasovagal reflex may have precipitated the terminal arrhythmia. Ingestion of cold liquids should be considered a potential trigger for fatal cardiac arrhythmias in patients with underlying heart disease.- - - - - - - - - - ranking = 1.5keywords = rhythm (Clic here for more details about this article) |
5/311. Ictal bradycardia in a patient with a hypothalamic hamartoma: a stereo-EEG study.Little is known about bradycardia and cardiac asystole which occur during partial epileptic seizures, especially whether they relate to ictal involvement of well-defined cortical areas. Several reports based on simultaneous electrocardiographic and intracranial depth electroencephalographic monitoring have shown that either the fronto-orbital cortex or the amygdalohippocampal complex could be responsible for such cardiac variations. We performed stereo-EEG recordings in a patient with refractory localization-related epilepsy associated with a hypothalamic hamartoma. We found that other cortical areas, such as the frontocentral region and the temporal neocortex, can contribute to the genesis of ictal bradyarrhythmia. Second, the lesion per se, although located within the hypothalamus, is not involved with this phenomenon.- - - - - - - - - - ranking = 0.5keywords = rhythm (Clic here for more details about this article) |
6/311. Accurate diagnosis of convulsive syncope: role of an implantable subcutaneous ECG monitor.Convulsive syncope due to transient bradycardia is recognized as a cause of treatment-resistant seizures. However, the diagnosis may be difficult to make with conventional electrocardiographic devices if attacks are infrequent. We present a case of apparent epilepsy in which a new implantable electrocardiographic event recorder (the 'Reveal' insertable loop recorder) was used to show that attacks were caused by prolonged asystole of up to 36 s in duration. The insertable loop recorder may have an important role in the investigation of patients with treatment-resistant seizures, particularly where there is a strong suspicion of an underlying cardiac arrhythmia.- - - - - - - - - - ranking = 0.5keywords = rhythm (Clic here for more details about this article) |
7/311. Pneumoencephalus and convulsions after ventriculoscopy: a potentially catastrophic complication.A nine-year-old boy with hydrocephalus underwent ventriculoscopy under general anesthesia. After introduction of ventriculoscope the patient had sudden bradycardia, hypotension, and shrinkage of ipsilateral cerebral hemisphere. The ventriculostomy was abandoned. At the end of anesthesia and endotracheal extubation, the patient developed generalized convulsions. Reexploration of wound did not reveal anything significant; however, postoperative CT scan of head showed massive pneumoencephalus. The patients received elective ventilation of lungs for 24 hours and made complete recovery. The authors describe the reasons for these complications and further management.- - - - - - - - - - ranking = 0.00011776947095855keywords = hour (Clic here for more details about this article) |
8/311. Familial association of congenital left heart abnormalities and sustained fetal arrhythmia.hypoplastic left heart syndrome (HLHS) is the most common cause of death from heart disease in the first week of life. There are reports about familial concordance by presumed morphogenetic mechanisms of abnormal embryonic blood flow with phenotypes of varying severity. The risk of having a child with a left heart lesion after a previously affected child may be as high as 5% to 12%. We present case reports from four families in which sustained fetal arrhythmia (three ectopic atrial tachycardias and one severe bradycardia due to excessive ectopic atrial beats) was demonstrated. Within these four families a close relative of the mother (a previous child, a brother, or a nephew) had severe left heart abnormality (three with HLHS and one with severe aortic valve stenosis). The association of sustained fetal arrhythmia of ectopic atrial origin and severe left heart abnormalities could be expected to occur by chance in a very low percentage of cases. We conclude that sustained fetal atrial ectopic arrhythmia is a congenital abnormality and should be considered as a risk factor for inherited congenital heart abnormalities.- - - - - - - - - - ranking = 3.5keywords = rhythm (Clic here for more details about this article) |
9/311. Atrial standstill in a case of Kugelberg-Welander syndrome with cardiac involvement: an electrophysiologic study.A patient with Kugelberg-Welander syndrome associated with junctional rhythm and restrictive cardiomyopathy is presented. An electrophysiologic study was performed. Persistent atrial standstill was demonstrated by detailed right atrium and coronary sinus mapping and failure of capture of both right atrium and coronary sinus pacing. A prolonged junctional recovery time, normal HV interval and normal pacing threshold of the right ventricle were also noted. The patient was successfully treated with cardiac pacing and diuretics.- - - - - - - - - - ranking = 0.5keywords = rhythm (Clic here for more details about this article) |
10/311. Swallow syncope.Swallowing (or deglutition) syncope is an uncommon, vagally-mediated etiology for syncope that may be seen in children and adults. The mechanism of syncope involves afferent impulses from the upper gastrointestinal tract and efferent impulses to the heart that can produce a variety of bradyarrhythmias with atrioventricular block. Two cases of swallow syncope are reported, one associated with drinking a cold carbonated beverage, and the other precipitated by eating a large bolus of food (which we have termed "Vaso-Bagel" syncope). In evaluating patients with syncope, a history of a temporal relationship to eating or drinking should be sought. While changes in eating habits may be effective in some cases, permanent pacemaker placement is often indicated and is curative.- - - - - - - - - - ranking = 0.5keywords = rhythm (Clic here for more details about this article) |
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