1/14. Homicidal commotio cordis in two children.This paper's objective is to describe two cases of fatal commotio cordis resulting from the deliberate striking of children's chests by adults with their fists. These deaths involve two male children, ages 3 years and 14 months. The clinical histories, events in the households prior to the deaths, behaviors of the children, autopsy findings, and investigation results are all similar. In both cases, fatal blows were delivered to the anterior chest with a closed fist. Both children collapsed immediately, unable to be resuscitated. Confessions were obtained in both cases by investigators soon after the children's deaths. Autopsies showed chest contusions in only one child, presumably due to knuckle impact. The cardiac rhythms noted by paramedics were ventricular fibrillation and asystole. Due to the lack of physical findings, an immediate and thorough investigation is critical. An accurate history of events preceding death must be obtained.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/14. ventricular fibrillation caused by electrocoagulation during laparoscopic surgery.A 35-year-old man with morbid obesity was admitted to our hospital to undergo gastric banding gastroplasty by the laparoscopic approach. Aside from his morbid adiposity, with a body mass index (BMI) of 49.9 kg/m2, the patient was healthy. During the procedure, he developed ventricular fibrillation (VF) while a diathermic knife was being used. After defibrillation, his heart rate returned to normal. The postoperative clinical course was uneventful, and there was no evidence of permanent heart failure. Although the VF could have been caused by patient- or material-related variables, it was most likely the result of unwanted electrical effects. Specifically, the occurrence of an arc between the patient's tissue and the tip of the electrode during cutting in the coagulation mode can lead to low-frequency current. The modified low-frequency current may produce arrhythmias. Thus, the use of the coagulation mode to cut tissue in the cardiac region during laparoscopic procedures could increase the risk for arrhythmias. An understanding of the physical principles of electrosurgery, as well as familiarity with the equipment and its various functions, is essential for the patient's safety. In addition, cardioversion equipment should be readily available on every surgical unit.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/14. mutation in the KCNQ1 gene leading to the short QT-interval syndrome.BACKGROUND: The electrocardiographic short QT-interval syndrome forms a distinct clinical entity presenting with a high rate of sudden death and exceptionally short QT intervals. The disorder has recently been linked to gain-of-function mutation in KCNH2. The present study demonstrates that this disorder is genetically heterogeneous and can also be caused by mutation in the KCNQ1 gene. methods AND RESULTS: A 70-year man presented with idiopathic ventricular fibrillation. Both immediately after the episode and much later, his QT interval was abnormally short without any other physical or electrophysiological anomalies. Analysis of candidate genes identified a g919c substitution in KCNQ1 encoding the K channel KvLQT1. Functional studies of the KvLQT1 V307L mutant (alone or coexpressed with the wild-type channel, in the presence of IsK) revealed a pronounced shift of the half-activation potential and an acceleration of the activation kinetics leading to a gain of function in I(Ks). When introduced in a human action potential computer model, the modified biophysical parameters predicted repolarization shortening. CONCLUSIONS: We present an alternative molecular mechanism for the short QT-interval syndrome. Functional and computational studies of the KCNQ1 V307L mutation identified in a patient with this disorder favor the association of short QT with mutation in KCNQ1.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/14. Severe cardiac arrhythmias in young patients with myotonic dystrophy type 1.Cardiac tachyarrhythmias have rarely been studied in young patients with myotonic dystrophy type 1 (DM1). The authors observed major cardiac rhythm disturbances in 11 patients aged 10 to 18 years. Tachyarrhythmic events were more frequent than impulse conduction disorders. Wide variations in CTG expansion were observed among the population. Since physical exercise was a prominent arrhythmogenic factor, systematic exercise tests with EKG monitoring may be indicated in young patients with DM1.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/14. Implantable cardioverter defibrillator storm: nursing care issues for patients and families.Implantable cardioverter defibrillators (ICDs) are being used for primary and secondary prevention of life-threatening cardiac arrhythmias, and evidence suggests that increased use is likely in the future. ICD storm, the delivery of two or more shocks within 24 hours, occurs in 10% to 20% of patients who have ICDs and can have long-lasting psychological and physical consequences. An understanding of the factors associated with ICD storm, relevant assessment, and patient and family teaching and counseling can help clinicians to better meet the needs of patients who have experienced ICD storm.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/14. Genetic and biophysical basis for bupivacaine-induced ST segment elevation and VT/VF. anesthesia unmasked brugada syndrome.BACKGROUND: brugada syndrome is an inherited disease associated with sudden cardiac death. The electrocardiographic pattern associated with brugada syndrome has been linked to the use of sodium channel blockers, including antiarrhythmics, trycyclics and anesthetics. OBJECTIVE: We report a case of bupivacaine-induced brugada syndrome, in which we investigated the genetic, biophysical and path physiological mechanism involved. methods AND RESULTS: The patient developed a Brugada-like electrocardiographic pattern twice under the influence of bupivacaine. The first occurrence was accompanied by ventricular tachycardia (VT) which subsided after withdrawal of the anesthetic. The VT was also observed during co-administration of diltiazem and isosorbide-5-mononitrate, agents thought to facilitate ST segment elevation in the brugada syndrome. Genetic analysis revealed a missense mutation in the alpha subunit of the cardiac sodium channel, SCN5A. Biophysical analysis by whole-cell patch-clamping revealed a reduction in sodium current as a result of the mutation. The study of bupivacaine in the wedge model revealed use-dependent changes in conduction, heterogeneous loss of the action potential dome in RV epicardium and phase 2 re-entry when the preparations were pretreated with low concentrations of the calcium channel blocker verapamil. CONCLUSION: Our findings indicate that bupivacaine may induce the electrocardiographic and arrhythmic manifestations of the brugada syndrome in silent carriers of SCN5A mutations. The data have important implications in the management of patients who develop ST segment elevation when under the influence of anesthetics such as bupivacaine.- - - - - - - - - - ranking = 6keywords = physical (Clic here for more details about this article) |
7/14. Use of an implantable left ventricular assist device for irreversible ventricular fibrillation secondary to massive myocardial infarction--a case study.Mechanical circulatory support devices are currently being developed. The indications for their use are presently following acute myocardial infarction; in post cardiac-surgical cardiogenic shock; and as a mechanical 'bridge' to cardiac transplantation. Devices are being developed for permanent implantation in patients with end-stage left ventricular failure who are unacceptable for or denied transplantation. intensive care nurses are required to care for patients who receive such mechanical support. These patients need intensive physical care with extensive nursing intervention and psychological support. The following case study describes the care of a patient who received an implantable left ventricular assist device (LVAD). The study illustrates the nursing care required in the management of such patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/14. Sudden cardiac death in a southeast Asian immigrant: clinical, electrophysiologic, and biopsy characteristics.The syndrome of sudden cardiac death in southeast Asians has only recently been given attention in the American medical literature. This case report describes a patient who presented with this rare syndrome. The physical examination, Holter monitor, 2-D echocardiogram, exercise treadmill test, radionuclide ventriculogram, coronary angiography, and endomyocardial biopsy were all normal. Programmed ventricular stimulation reproducibly induced sustained polymorphic ventricular tachycardia. Oral procainamide, oral quinidine and oral quinidine plus propranolol were not successful in suppressing inducible polymorphic ventricular tachycardia. The arrhythmia remained inducible after six weeks of oral amiodarone therapy. However, he has no clinical recurrences while on amiodarone after one year of follow-up.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/14. ventricular fibrillation in a patient with unsuspected mitral valve prolapse and a prolonged Q-T interval.mitral valve prolapse is a common cardiac abnormality associated with arrhythmias and sudden death. In most instances it can be diagnosed on the basis of physical findings. Those patients who are symptomatic or who display electrocardiographic abnormalities appear to be most susceptible to arrhythmias and, therefore, may be at increased risk for anaesthesia. Because the syndrome is relatively common and may present a very innocent clinical picture, anaesthetists should be aware of this condition and the problems it may present. A case of mitral valve prolapse syndrome associated with ventricular fibrillation on induction of anaesthesia is reported. The symptoms and pathophysiology of the disorder are reviewed and the potential problems and the anaesthetic management are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/14. Liquid protein diets and torsade de pointes.Three women, aged 27, 33, and 35 years, experienced recurrent syncope five months after losing 36 to 41 kg using liquid protein diets. No abnormalities were noted during physical examination except in one who was hypothyroid. serum potassium levels varied between 2.9 and 3.9 mEq/liter. The ECGs demonstrated prominent U waves, QUc prolongation, and ST and T wave abnormalities, with left axis deviation in two patients. Syncopal episodes were due to ventricular tachycardia and fibrillation, which were not responsive to conventional antiarrhythmic agents used in two patients. patients using liquid protein diets may thus experience reversible QUc prolongation giving rise to serious arrhythmias that are probably best treated with drugs that shorten the QTc interval. Caution should be exercised in the use of liquid protein diets for weight reduction in obesity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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