1/31. Frightening dreams and spells: a case of ventricular asystole from lyme disease.We present a case of a 20-year-old woman who presented with a febrile illness, frightening dreams and repeated short episodes of apparent seizure activity. Third degree heart block and ventricular asystole were noted on the monitor when the patient experienced a spell during conscious sedation for a lumbar puncture. The combination of heart block and a predominantly lymphocytic cerebrospinal fluid led to the diagnosis of lyme disease. Lyme titres were strongly positive and subsequently confirmed by Western Blot analysis. Cardiac aetiologies and specifically heart block associated with lyme disease should be considered in patients from endemic areas presenting with fever and unexplained spells or seizure-like activity.- - - - - - - - - - ranking = 1keywords = illness (Clic here for more details about this article) |
2/31. Swallow syncope associated with complete atrioventricular block and vasovagal syncope.A 21 year old man presented with multiple, recurrent episodes of complete atrioventricular (AV) block associated with swallowing. Electrophysiological study revealed an AV block with swallowing of carbonated beverages and balloon inflation in the lower oesophagus. Evaluation did not demonstrate any underlying oesophageal or cardiac disease, and the AV block was not induced after intravenous atropine administration. The AV block was probably caused by a hypersensitive vagotonic reflex triggered by mechanical receptors in the lower oesophagus, resulting in suppression of the AV node. head up tilt test revealed an increase in the high frequency spectrum of heart rate variability before the onset of the syncope. These findings suggest that the amplitude of the continual fluctuations in response to a variety of stimuli and derangement from both intrinsic and extrinsic environments was greater in this patient than in normal subjects. Swallow syncope is an unusual but treatable disorder. These reflexes that become exaggerated to the point of causing illness are poorly understood.- - - - - - - - - - ranking = 1keywords = illness (Clic here for more details about this article) |
3/31. DDD pacing and interatrial conduction block: importance of optimal AV interval setting.The case of a 83-year-old patient undergoing DDD pacemaker implantation for sick sinus syndrome with postimplant detection of advanced interatrial conduction block is described. At nominal AV interval programming values (175 ms), absence of P wave following an atrial spike was observed, and the presence of an interatrial conduction disturbance was demonstrated by a Doppler transmitral flow pattern analysis and transesophageal ECG recording. AV interval lengthening up to 300 ms resulted in proper timing of atrial and ventricular contractions. Awaiting for conclusive data about biatrial pacing, interatrial conduction blocks can be managed in some cases by proper programming of conventional DDD systems.- - - - - - - - - - ranking = 1565.6762783545keywords = sick (Clic here for more details about this article) |
4/31. Morbitz type I second degree AV block during recovery from dengue hemorrhagic fever.Two patients with serologically-proven dengue virus infection and Morbitz type I second degree atrioventricular (AV) block are described. A 7 years old boy (patient 1) with grade 2 and a 7 years old girl (patient 2) with grade 3 illness were admitted to the hospital on the 3rd and the 5th day of the illness, respectively. Both had typical resentation for dengue hemorrhagic fever including fever, hepatomegaly, thrombocytopenia and signs of extravascular leakage. The 7 year old girl also had epistaxis and anemia (Hct 24%). Morbitz type I second degree and 2:1 AV block developed on day 7 (patient 1) and day 8 (patient 2) of the illness, both during recovery periods. Patient 1 also had occasional monomorphic premature ventricular contraction (PVC). There was no other abnormality in the 12-lead EKGS and echocardiograms showed normal ventricular systolic function in both. Other than mild hypokalemia (3.3 and 3.4 mgq/l), serum electrolytes were normal. Neither patients had elevation of serum creatine phosphokinase (CPK). In patient 1, exercise (on day 10) normalized AV conduction and abolished the PVC. Follow up EKG and physical examination at 10 months after the illness was normal. The rhythm in patient 2 resolved to 1st degree AV block (with occasional morbitz type I second degree at night) on day 12. In this patient, exercise resulted in shortening of the PR interval and valsalva maneuver resulted in further PR prolongation. The patient was well at 1-month follow up with a mormal EKG. Morbitz type I second degree AV block during recovery from dengue hemorrhagic fever may be a transient functional impairment of the AV node, in which altered autonomic tone may play a role.- - - - - - - - - - ranking = 4keywords = illness (Clic here for more details about this article) |
5/31. Spontaneous regression over a 16-year period of tachyarrhythmias to sick sinus syndrome and complete atrioventricular block in a young patient with Ebstein's anomaly.A 25-year-old man with Ebstein's anomaly showed spontaneous regression of tachyarrhythmias to sick sinus syndrome and complete atrioventricular block over a 16-year period. This is the first clinical report supporting the hypothesis that abnormal cell death might contribute to the disturbance of the heart conduction system in Ebstein's anomaly.- - - - - - - - - - ranking = 7828.3813917724keywords = sick (Clic here for more details about this article) |
6/31. Cardiac pacing as emergency care for serious bradyarrhythmia with circulatory shock.Three cases of bradyarrhythmia with serious illness of extracardiac organs are reported. Case 1 had sick sinus syndrome. He was admitted to our hospital complaining of syncope and developed apnea. Case 2 had complete atrioventricular block and serious hepatic failure in the hospital. Case 3 had paroxysmal atrioventricular block. He complained of syncope which followed convulsions. Their symptoms might be due to circulatory shock caused by a lazy lower pacemaker from the ventricle. Emergent temporary pacing successfully improved the extracardiac organ dysfunction. Although their bradyarrhythmias were transient, permanent pacemakers were implanted to inhibit the recurrence. A quick temporary pacing should be indicated in patients with critical bradyarrhythmia like our cases for survival.- - - - - - - - - - ranking = 1566.6762783545keywords = sick, illness (Clic here for more details about this article) |
7/31. Transient atrioventricular standstill. Etiology and management.Four patients with different clinical conditions had transient cardiac standstill for periods of up to 22.5 seconds. All patients showed signs of cerebral ischemia and required cardiac resuscitation. In one patient, the standstill was thought to be the result of a transient increase in the vagal tone, and no long-term therapy was required. In the second patient, cardiac standstill occurred during hospitalization for impending myocardial infarction. Coronary arteriography followed by coronary artery surgery was performed, and there was no further episodes of standstill. In the third patient, standstill was probably related to long-term ingestion of propranolol hydrochloride, and was not observed after this medication was discontinued. In the fourth patient, standstill was the result of the sick sinus syndrome, and a permanent pacemaker was inserted. Standstill of both atria and ventricles may occur under different clinical settings, and management of arrhythmia should be guided by thf etiology of the arrhythmia.- - - - - - - - - - ranking = 1565.6762783545keywords = sick (Clic here for more details about this article) |
8/31. Familial congenital sinus rhythm anomalies: clinical and pathological correlations.We describe pathological abnormalities in a 72-year-old male member of a family with a congenital absence of sinus rhythm and a tendency to develop atrial fibrillation at an early age, and in a 54-year-old female member of a family with cardiomyopathy and progressive conduction system disease manifested by first-degree atrioventricular (AV) block, left bundle branch block, and atrial arrhythmias. Both patients died suddenly. The absence of sinus rhythm in case 1 could be explained by marked atrophy, degeneration, and isolation of the sinoatrial (SA) node. The SA node was also diseased in the member of the other family with atrial arrhythmias. Additional common features in both cases included: fatty metamorphosis and degenerative changes of the approaches to the SA node, the atrial preferential fibers, and the approaches to the AV node, a small AV node, degenerative changes of the bundle branches, and floppy AV valves. These findings show that the pathological substrate of familial supraventricular arrhythmias consists of a diffuse involvement of the entire conduction system, bearing resemblance to pathological findings in elderly subjects with acquired sick sinus syndrome.- - - - - - - - - - ranking = 1565.6762783545keywords = sick (Clic here for more details about this article) |
9/31. A case of pacemaker and pacemaker-like syndrome.This report describes the occurrence of both pacemaker syndrome and a pacemaker-like syndrome (so-called "pseudopacemaker syndrome") in a patient who exhibited an atrioventricular junctional rhythm probably on the basis of sick sinus syndrome. The clinical and hemodynamic manifestations of the two clinical situations were similar and associated with regular retrograde ventriculoatrial conduction. The abnormalities during the junctional rhythm were reproduced during ventricular pacing. Surprisingly, the occurrence of the pacemaker-like syndrome during junctional rhythm in patients with normal left ventricular function has rarely been described.- - - - - - - - - - ranking = 1565.6762783545keywords = sick (Clic here for more details about this article) |
10/31. Adverse effects of direct current cardioversion on cardiac pacemakers and electrodes Is external cardioversion contraindicated in patients with permanent pacing systems?Use of pacing in sick sinus syndrome and recent developments in pacemaker therapy for intermittent atrial fibrillation raise the question of whether external electrical cardioversion should be used for termination of atrial fibrillation. This paper analyzes three cases of pacemaker and/or electrode dysfunction appearing after direct current (DC) cardioversion for termination of atrial fibrillation. Despite similar conditions during cardioversion in all cases, different dysfunctions reflecting damage to the pulse generator and/or a rise of the stimulation threshold in both, atrial and ventricular leads, have been observed. The possible mechanisms for these effects are discussed and recommendations for the management of cardioversion in patients with permanent pacemaker systems are given.- - - - - - - - - - ranking = 1565.6762783545keywords = sick (Clic here for more details about this article) |
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