1/87. Transient left posterior hemiblock during myocardial ischemia-eliciting exercise treadmill testing: a report of a case and a critical analysis of the literature.We describe a 75-year-old male patient with two-vessel coronary artery disease, who developed transient left posterior hemiblock (LPH) while undergoing an exercise treadmill test (ETT). The intraventricular conduction abnormality initially had the features of alternating LPH, which evolved to stable LPH prior to dissipating, and it occurred at the first minute of recovery. The exercise electrocardiogram and the associated thallium-201 myocardial perfusion scintigraphy (Tl) revealed severe reversible myocardial ischemia. This rare occurrence is discussed in the context of the observed coronary lesions, the distribution of the radionuclide-detected ischemia, and the previous experience from the literature. An insight regarding the low prevalence of transient LPH is afforded, since the described case derives from a series of 2,160 consecutive patients who underwent ETT in conjunction with Tl. Finally, a comment is provided on the complexities of deciphering the specific pathophysiologic mechanism(s) of transient LPH, occurring during ETT.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/87. Left posterior fascicular tachycardia: a diagnostic and therapeutic challenge.A wide QRS complex tachycardia with right bundle-branch block morphology and left axis deviation observed in a young patient without structural heart disease may pose a diagnostic and therapeutic challenge. The surface ECG may provide several diagnostic clues to make a correct diagnosis of left posterior fascicular tachycardia and may help to differentiate it from both a supraventricular tachycardia with aberrant conduction and a typical ventricular tachycardia related to coronary artery disease. Although this tachycardia is sensitive to verapamil, this medication may probably cause transient infertility in males. The presence of a Purkinje potential preceding the QRS complex during tachycardia and optimal pace mapping may guide radio-frequency ablation resulting in a definite cure.- - - - - - - - - - ranking = 0.5keywords = coronary (Clic here for more details about this article) |
3/87. 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 = coronary (Clic here for more details about this article) |
4/87. Arrhythmias in the coronary-care unit. IV. Physiologic bases of paroxysmal tachycardia-dependent bundle branch block.Paroxysmal BBB may be either tachycardia-dependent which is referred to as "phase 3 block" or bradycardia-dependent, referred to as "phase 4 block." tachycardia-dependent BBB is related to prolonged recovery. bradycardia-dependent BBB is related to hypopolarization and SDD. These fundamental electrophysiological properties aid in understanding of transient BBB occurring during an acute MI.- - - - - - - - - - ranking = 2keywords = coronary (Clic here for more details about this article) |
5/87. A young man with recurrent syncopes, right bundle branch block and ST segment elevation.We report on the case of a 33-year-old man with recurrent syncopes appearing suddenly due to sustained monomorphic ventricular tachycardias. The electrocardiogram (ECG) showed a right bundle branch block pattern and ST segment elevation in the precordial leads V1 to V2, not explained by ischemia, electrolyte disturbances, toxic ingestion, or structural heart disease (coronary and right ventricle angiograms as well as biopsies of the right ventricle were normal). ECG image was compatible with the so-called brugada syndrome, first described in 1992. This entity is very rare. Missed diagnosis can be disastrous because life-threatening ventricular arrhythmias often develop in patients.- - - - - - - - - - ranking = 0.5keywords = coronary (Clic here for more details about this article) |
6/87. Acquired left bundle branch block in an asymptomatic fighter pilot: a case report.This report describes a case of acquired left bundle branch block (LBBB) in an asymptomatic F/A-18 fighter pilot of the Royal Australian air Force. The previously fit and healthy pilot was found to have LBBB on routine electrocardiographic screening prior to his annual aircrew medical. He was completely asymptomatic, and the only potential etiological factor was a short-lived acute gastrointestinal infectious illness some 4 mo previously. The pilot was extensively investigated with the full range of available diagnostic procedures, including coronary angiography and cardiac biopsy. No cause was determined for his LBBB pattern, and he was assessed as having normal cardiovascular function. The aeromedical disposition of this aviator and the issues involved in determining fitness to fly in such a case are discussed. The importance of thorough clinical investigation and appropriate follow-up are highlighted.- - - - - - - - - - ranking = 0.5keywords = coronary (Clic here for more details about this article) |
7/87. Electrocardiographic manifestations: patterns that confound the EKG diagnosis of acute myocardial infarction-left bundle branch block, ventricular paced rhythm, and left ventricular hypertrophy.The 12-lead electrocardiogram (EKG), a powerful tool used in evaluating the chest pain patient, has its shortcomings. One such failing is encountered in a patient with one of the following electrocardiographic patterns: left bundle branch block (LBBB), ventricular paced rhythm (VPR), and left ventricular hypertrophy (LVH). These patterns reduce the ability of the EKG to detect acute coronary ischemic change and acute myocardial infarction (AMI). Several strategies are available to assist in the correct interpretation of these complicated electrocardiographic patterns, including a knowledge of the ST segment-T wave changes associated with these confounding patterns, performance of serial EKGs, and comparison with previous EKGs if available. This article suggests guidelines and interpretive tools for diagnosing AMI on EKG in patients with these confounding patterns.- - - - - - - - - - ranking = 0.5keywords = coronary (Clic here for more details about this article) |
8/87. Dangerous impact--commotio cordis.Sudden death following blunt chest trauma is a frightening occurrence known as 'commotio cordis' or 'concussion of the heart'. It is speculated that commotio cordis could be caused by ventricular fibrillation secondary to an impact-induced energy that was transmitted via the chest wall to the myocardium during its vulnerable repolarization period. We describe a survivor of commotio cordis caused by a baseball. In this patient, an initial ventricular fibrillation was documented and converted by direct current defibrillation. Serial electrocardiographic changes (bifascicular conduction block and T wave inversion in precordial leads) were noticed in this patient. Our case suggested that coronary vasospasm might also play a role in commotio cordis.- - - - - - - - - - ranking = 0.5keywords = coronary (Clic here for more details about this article) |
9/87. Vasospastic angina accompanied by Brugada-type electrocardiographic abnormalities.brugada syndrome and Vasospastic Angina. We present two patients with vasospastic angina and Brugada-type ECG abnormalities. The first patient complained of chest pain, and transient ST segment elevation was confirmed on ECG. Coronary angiogram showed no organic stenosis. The second patient had syncopal episodes following anginal chest pain, and the same symptoms were reproduced by intracoronary acetylcholine injection that induced vasospasm. In both patients, ECG at rest showed ST segment elevation in leads V1 and V2 and a right bundle branch block pattern that were accentuated by a Class I antiarrhythmic drug. ventricular fibrillation also was induced by programmed electrical stimulation. Susceptibility to ventricular fibrillation can be modulated by the interaction of coronary vasospasm with brugada syndrome or vice versa; therefore, it is important to study the clinical implications of the coexistence of the two diseases in such patients.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
10/87. exercise-induced left bundle branch block during thallium 201 myocardial perfusion scintigraphy--a case report.exercise-induced left bundle branch block (Ex-LBBB) is a rare entity encountered during exercise testing. The authors present a 53-year-old woman who developed intermittent Ex-LBBB asymptomatically during Tl 201 myocardial perfusion scintigraphy. Scintigraphic findings revealed septal-anteroseptal ischemia while the coronary arteriogram appeared normal. False-positive septal-anteroseptal scintigraphic findings suggesting ischemia in patients with persistent left bundle branch block (LBBB) is well known, but since the LBBB in this case was induced by exercise testing and was spontaneously terminated at rest, scintigraphic findings may be attributed to microcirculatory ischemia, which cannot be detected angiographically, as the cause of Ex-LBBB.- - - - - - - - - - ranking = 0.5keywords = coronary (Clic here for more details about this article) |
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