1/48. Left ventricular end-diastolic extrasystole with pseudonormalization of a left bundle branch block unmasking inferior ischemia.An electrocardiogram tracing of a patient in conducted sinus rhythm with left bundle branch block is shown, in which occasional pseudonormalization of intraventricular conduction is seen. This event is attributed to ventricular fusions with end-diastolic extrasystoles of the left His-Purkinje system distal to the block site. This type of extrasystole is discussed. In this case, normalization of ventricular activation allowed for diagnosis of inferior subepicardial ischemia.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
2/48. Significant complications can occur with ischemic heart disease and tilt table testing.We present an elderly patient who had syncope, with known coronary artery disease and a conduction abnormality. Because of a possible vasovagal reaction, the patient underwent a tilt table test prior to evaluation of ischemia or her LV function. During the tilt table test on isoproterenol, the patient developed ventricular fibrillation which was corrected immediately by cardioversion. Subsequently, the patient was found to have significant coronary artery disease which was treated with stenting and angioplasty. After treatment, there were no inducible arrhythmias on full dose isoproterenol. This case reports a significant complication that may occur when tilt table testing with isoproterenol and ischemia.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
3/48. Dental anesthetic management of a patient with ventricular arrhythmias.During routine deep sedation for endodontic therapy, a dentist-anesthesiologist observed premature ventricular contractions (PVCs) on a 62-yr-old woman's electrocardiogram (EKG) tracing. The dentist was able to complete the root canal procedure under intravenous (i.v.) sedation without any problems. The dentist-anesthesiologist referred the patient for medical evaluation. She was found to be free from ischemic cardiac disease with normal ventricular function. The patient was cleared to continue her dental treatment with deep sedation. She subsequently continued to undergo dental treatment with deep intravenous sedation without incident, although her EKG exhibited frequent PVCs, up to 20 per minute, including couplets and episodes of trigeminy. This article will review indications for medical intervention, antiarrhythmic medications, and anesthetic interventions for perioperative PVCs.- - - - - - - - - - ranking = 5keywords = rhythm (Clic here for more details about this article) |
4/48. Giant cervico-mediastinal lipoma. A clinical case.The lipoma is a circumscribed mesenchymal tumour originating from adipose tissue. The lesion is usually small and asymptomatic, and is most frequently located in the neck region. The case of a 77-year-old woman with chronic extrasystolic arrhythmia caused by a non-specified ischemic cardiopathy is reported. The woman presented a swelling at the front of her neck, observed for the first time about 6 months previously. This swelling progressively increased in size, provoking dysphagia, dysphonia, persistent cough, dyspnea, light jugular turgor and palpitations. Chest x-rays showed and opaque area at the front of the neck, which extended beyond the jugular incisure by about 2 cm. NMR of the neck showed a gross lipomatous formation at the front, mainly of the left, continuing in the front mediastinal region; the trachea was dislocated to the right and compressed at the back; the vasculo-nervous fasciculus, especially on the left, was compressed and enveloped by the adipose formation. The Holter test confirmed the presence of ventricular and supra-ventricular extrasystoles. Surgery was carried out under local anaesthesia because the displacement of the laryngo-tracheal axes precluded intubation. Histological analysis of the 9 x 4 x 2.2 cm mass confirmed the diagnosis of lipoma. After removal of the mass all the symptoms, which had been provoked by compression, as well as the cardiac arrhythmias disappeared. The prompt disappearance of the latter was particularly surprising. The possibility of the external compression of the nervous structures of the neck should be taken into consideration in cases of ventricular arrhythmia of unknown origin, and systematic study of the region carried out.- - - - - - - - - - ranking = 3keywords = rhythm (Clic here for more details about this article) |
5/48. heart rate variability analysis of patients with idiopathic left ventricular outflow tract tachycardia: role of triggered activity.There have been several reports with respect to idiopathic ventricular tachycardias (VTs) originating from the left ventricular outflow tract (LVOT). A previous report suggested that triggered activity plays a partial role in idiopathic LVOT tachycardia from the electrophysiological as well as the electropharmacological viewpoint. However, the exact role of triggered activity in this type of VT remains unknown. In the present study the relationship of the frequency of premature ventricular contractions (PVCs) and heart rate was examined and heart rate variability (HRV) was analyzed in 2 cases of LVOT tachycardia using 24-h Holter electrocardiographic (ECG) monitoring. The relation between the PVCs frequency and heart rate showed a persistently positive correlation, indicating frequent PVCs as heart rate increased. In HRV analysis, NN50(%), a time-domain variable of parasympathetic activity, showed no change prior to ventricular arrhythmias. In frequency-domain analysis of HRV, the high frequency (HF) component tended to fall prior to repetitive PVCs and VTs. The ratio of the low frequency to high frequency (LF/HF) components increased prior to single PVCs, repetitive PVCs and VTs. Sympathetic predominance predisposes the genesis of these kinds of arrhythmias originating from the LVOT and it is suggested that triggered activity plays an important role in LVOT tachycardia, at least in its initiation.- - - - - - - - - - ranking = 2keywords = rhythm (Clic here for more details about this article) |
6/48. Isolated congenital left ventricular diverticulum with perinatal dysrhythmia: a case report and review of the literature.We report a case of isolated congenital left ventricular diverticulum (LVD) with perinatal dysrhythmia, which disappeared spontaneously 1 week after birth. The LVD arose from the lateral wall of the LV, and the contraction of the LVD was synchronous with the kinetics of the main LV chamber. The LVD changed very little in size during the first 30 months after birth, and its relative size to the growing LV main chamber decreased. The patient had neither any symptoms nor complications during this time. The available literature on prenatal and neonatal cases with isolated LVD or LV aneurysm is also reviewed.- - - - - - - - - - ranking = 5keywords = rhythm (Clic here for more details about this article) |
7/48. The heart-brain connection.We have long known that patients with vascular disease in one system are at risk for vascular disease in other systems. Beyond this, we are recognizing the increased risk for cardiovascular patients to develop stroke not only as the result of arrhythmia, but also at the time of cardiovascular events or procedures. This presents clinical challenges to nurses with either neurological or cardiovascular expertise, requiring development of new awareness, clinical and critical thinking skills, and collaboration with their colleagues in other specialties. Three case studies illustrate patient presentations ranging from the subtle to the obvious. Pathophysiology of stroke is reviewed. Leading-edge management strategies and supporting literature highlight the benefits of prompt identification and management of the stroke patient. The stroke Watch Action Team (SWAT) has proved to be an effective means of expediting patient identification and access to effective stroke treatment.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
8/48. serum KL-6 as a possible marker for amiodarone-induced pulmonary toxicity.amiodarone is a useful drug for the treatment of life-threatening cardiac arrhythmias. However, amiodarone can induced pulmonary toxicity (APT) and may cause life-threatening lung damage. APT can be difficult to diagnose, but early diagnosis is important. Here, in a 51-year-old man with APT, the high serum KL-6 level was correlated with the severity of symptoms and chest X-ray findings, and it was inversely correlated with PaO2 and diffusion capacity for carbon monoxide levels. The findings suggest that the serum KL-6 level may be increased in APT and that therefore it's the determination of serum KL-6 may provide a useful indicator and/or monitoring marker of APT. KL-6 is believed to be produced and secreted by type II pneumocytes. Typical pathological findings of APT include proliferation of type II pneumocytes which may produce KL-6, and result in increased serum KL-6 levels.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
9/48. Inactivation of a ventricular tachycardia preventive algorithm during automatic mode switching for atrial tachyarrhythmia.A patient with a dual chamber implantable defibrillator and pause dependent VT in whom a rate smoothing algorithm failed to operate during automatic mode switching due to device idiosyncrasy is reported. Preventive measures are discussed.- - - - - - - - - - ranking = 4keywords = rhythm (Clic here for more details about this article) |
10/48. disopyramide-induced pneumonitis, diagnosed by lymphocyte stimulation test using bronchoalveolar lavage fluid.A 72-year-old man was admitted to our hospital with fever and cough. He had been on disopyramide treatment for nine days to control cardiac arrhythmia. On admission, chest X-ray examination revealed reticulonodular opacities in both lungs, and impending respiratory failure was evident. A differential cell count of the bronchoalveolar lavage fluid (BALF) showed a marked increase of lymphocytes. A lymphocyte stimulation test (LST) for disopyramide using BALF was positive, although the test using peripheral blood was negative. This case suggests that LST using BALF is useful for the diagnosis of drug-induced pneumonitis.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
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