1/183. 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 = heart (Clic here for more details about this article) |
2/183. Vanishing pulmonary hypertension in mixed connective tissue disease.A 29-year-old woman with mixed connective tissue disease presented with signs of progressive pulmonary hypertension. After admission to the hospital her condition worsened rapidly and she developed a cardiac arrest resistant to cardiopulmonary resuscitation. Therefore, emergency extracorporeal assist was performed. No pulmonary embolism was found. Right heart catheterisation showed severe pulmonary hypertension, which was treated with nitric oxide ventilation. She was weaned from the extracorporeal assist with high doses of inotropic agents. Because of suspicion of exacerbation of her underlying disease, which led to pulmonary hypertension, immunosuppressive treatment was started with high doses of corticosteroids and plasma exchange. This resulted in slow recovery over the next four weeks. Control echocardiography showed complete normalisation of cardiac function without signs of pulmonary hypertension. Two months after admission she was discharged from the hospital in good condition.- - - - - - - - - - ranking = 0.5keywords = heart (Clic here for more details about this article) |
3/183. Non-heart-beating donors: a case study in procurement.To help meet the increasing need for transplantable organs, especially kidneys, organ procurement organizations are recovering organs from non-heart-beating patients. This article outlines the successful recovery and transplantation of kidneys from such a donor. Consent issues and historical background are also discussed.- - - - - - - - - - ranking = 2.5keywords = heart (Clic here for more details about this article) |
4/183. Gas embolism during hysteroscopy.PURPOSE: Gas embolism during hysteroscopy is rare but sometimes fatal. A fatal case of gas embolism during diagnostic hysteroscopy using carbon dioxide (CO2) is presented. CLINICAL FEATURES: A 68 yr old woman was admitted for treatment of myoma and cancer of the uterus. hysteroscopy using CO2 was performed without monitoring or anesthesia on the ward. At the end of the examination, just after the hysteroscope was removed, she developed tonic convulsions, lost consciousness, and her pulse was impalpable. Cardiac massage was started, anesthesiologists were called and the trachea was intubated. She was transferred to the intensive care unit with continuous cardiac massage. Cardiac resuscitation was successful. A central venous line was inserted into the right ventricle under echocardiography in an attempt to aspirate gas with the patient in the Trendelenberg position, but the aspiration failed. Positive end expiratory pressure and heparin for emboli, midazolam for brain protection, and catecholamines were administered. Fifteen hours after resuscitation, the pupils were enlarged and she died 25 hr after resuscitation. CONCLUSION: Gas embolism is a rare complication of hysteroscopy. The procedure should be performed with monitoring of blood pressure, heart rate, oxygen saturation and end-tidal CO2 concentration.- - - - - - - - - - ranking = 0.5keywords = heart (Clic here for more details about this article) |
5/183. myocardial infarction and death after caesarean section in a woman with protein s deficiency and undiagnosed phaeochromocytoma.We describe the case of a 36-year-old woman, with a previous history of recurrent abortion due to protein s deficiency, undergoing an elective Caesarean section at 39-weeks gestation. During pregnancy no signs of hypertension or cardiovascular disease were reported, but at the end of the surgical procedure, the patient developed acute hypertension, leading to myocardial infarction, severe heart failure and death. The autopsy revealed a 2-cm undiagnosed phaeochromocytoma in the right adrenal gland. Clinical diagnostic features of phaeochromocytoma during pregnancy as well as the main therapeutic approaches suggested in the literature are discussed.- - - - - - - - - - ranking = 0.5keywords = heart (Clic here for more details about this article) |
6/183. ephedrine-induced complete atrioventricular block with ventricular asystole during rapid concomitant phenytoin infusion: a case report.ephedrine is widely used to elevate blood pressure, however, one should be cautious to use it concomitantly with phenytoin infusion in neurosurgical procedures. A 59-year-old female was admitted for craniotomy with removal of metastatic brain tumor. During operation phenytoin infusion was given to forestall postoperative seizure. hypotension, bradycardia and complete atrioventricular block followed by ventricular asystole suddenly occurred when the patient was given ephedrine to elevate the blood pressure to see the hemostatic effect close to the end of operation. We discontinued the phenytoin infusion and immediately injected 1.5 mg epinephrine. She was successfully resuscitated. We conclude that when phenytoin is used intraoperatively it should be administered by an infusion pump at a rate of less than 25 mg/min and under continuous monitoring of cardiac rhythm, heart rate, and blood pressure. When pressure support is required, the use of a pure alpha-agonist may minimize the risk of adverse reactions in the presence of phenytoin infusion.- - - - - - - - - - ranking = 0.5keywords = heart (Clic here for more details about this article) |
7/183. Advanced heart block as a manifestation of a paraneoplastic syndrome from malignant thymoma.Malignant thymoma is a rare tumor that is associated with paraneoplastic syndrome. myocarditis as a paraneoplastic syndrome has been rarely described. Reported herein is a young male patient with malignant thymoma and myocarditis as part of a paraneoplastic syndrome. This resulted in high-degree heart block and an asystolic cardiac arrest despite placement of a permanent pacemaker.- - - - - - - - - - ranking = 2.5keywords = heart (Clic here for more details about this article) |
8/183. Non-heart-beating organ donation: process and review.To combat the national shortage of donor organs and meet the needs of more than 60,000 patients awaiting transplant, many organ procurement organizations have reevaluated non-heart-beating organ donation (NHBD) as one solution. Non-heart-beating donation is the process by which organs are recovered from patients after the pronouncement of death by cardiopulmonary criteria. Recent media reports have misled health care providers to believe that this is a new donation procedure; however, NHBD provided the foundation for modern clinical transplantation. This article describes non-heart-beating donor evaluation criteria, the donation process, associated ethical considerations and the role of the advance practice nurse in assisting families with this end-of-life decision. A case study will be presented followed by a summary of transplant recipient patient and graft survival outcomes.- - - - - - - - - - ranking = 3.5keywords = heart (Clic here for more details about this article) |
9/183. Cardiac arrhythmia as initial presentation of aneurysmal subarachnoid hemorrhage.Cardiac arrhythmia and sudden death are most frequently caused by preexisting heart disease. Rarely, cardiac arrhythmia is a first symptom of an acute neurological event. We describe a patient with asystole and other cardiac arrhythmias, as initial symptoms of acute aneurysmal subarachnoid hemorrhage. Several aspects of cardiac arrhythmias and acute aneurysmal subarachnoid hemorrhage are discussed.- - - - - - - - - - ranking = 0.5keywords = heart (Clic here for more details about this article) |
10/183. 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 = 1.5keywords = heart (Clic here for more details about this article) |
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