1/279. Reversion to sinus rhythm 11 years after surgically induced heart block.A patient is presented in whom the heart reverted spontaneously to sinus rhythm 11 years after surgical closure of a ventricular septal defect complicated by complete heart block. It seems unlikely that regeneration of fibres in the bundle of his, if these had indeed been destroyed, could account for the restoration of sinus rhythm after so long an interval.- - - - - - - - - - ranking = 1keywords = long (Clic here for more details about this article) |
2/279. Pacemaker Wenckebach phenomenon due to antiarrhythmic drug toxicity.Two patients with intractable ventricular arrhythmia were managed with ventricular pacing and antiarrhythmic drugs. Toxic levels of these drugs results in unusual conduction disturbances at the level of Purkinje ventricular junction which caused pacemaker Wenckebach phenomenon and marked QRS prolongation. Sodium bicarbonate and sodium lactate infusion improved the conduction velocity probably by hyperpolarizing the membrane and reversed the conduction disturbance.- - - - - - - - - - ranking = 1keywords = long (Clic here for more details about this article) |
3/279. bacillus popilliae endocarditis with prolonged complete heart block.bacillus popilliae, a fastidious, aerobic, gram-positive, spore-forming bacillus, has never been reported as a pathogen in human infectious diseases. We report the first case of a human infected by the pathogen B. popilliae, which presented as endocarditis involving the bicuspid aortic valve and complicated with prolonged (> 30 days; to our knowledge, the longest in the literature) complete heart block. Although surgery may be warranted by previous reports, the patient was successfully managed by medical treatment instead, because of the absence of evidence from various approaches that support the existence of perivalvular extension of infection.- - - - - - - - - - ranking = 6keywords = long (Clic here for more details about this article) |
4/279. nicorandil, a potassium channel opener, abolished torsades de pointes in a patient with complete atrioventricular block.TdP is a serious complication of AV block. We report a case of complete AV block with QT prolongation who had bouts of TdP resistant to lidocaine and isoproterenol. Temporary pacing could not be performed, because insertion of a pacing lead triggered TdP that deteriorated into ventricular fibrillation. nicorandil, a potassium channel opener, shortened the QT interval and abolished TdP. This may suggest that potassium channel opening drugs are clinically effective against TdP associated with bradycardia-dependent QT prolongation.- - - - - - - - - - ranking = 2keywords = long (Clic here for more details about this article) |
5/279. hypokalemia with syncope caused by habitual drinking of oolong tea.A 61-year-old woman developed hypokalemia, atrioventricular block and ventricular tachycardia with syncope after habitual drinking 2 to 3 liters of oolong tea per day. She had been suffering from rheumatoid arthritis and sjogren's syndrome and her serum albumin was decreased (2.9 g/dl). Oolong tea contains caffeine at approximately 20 mg/dl. Great quantities of caffeine can induce hypokalemia. The serum protein binding caffeine is albumin. Accordingly, in patients with hypoalbuminemia, caffeine is apt to induce hypokalemia. This case suggested that great quantities of oolong tea, one of the so-called "healthy" drinks, result in serious symptoms for patients with hypoalbuminemia.- - - - - - - - - - ranking = 7keywords = long (Clic here for more details about this article) |
6/279. Coexisting preexcitation syndrome and intermittent heart block presenting as neonatal seizures.An infant presented with neonatal syncope and seizures. An ECG showed a preexcitation pattern, most compatible with Wolff-Parkinson-White (WPW) syndrome. Rhythm monitoring during an event demonstrated prolonged periods of complete AV block with no ventricular escape mechanism. We postulated that ventricular asystole was initiated by mechanical or autonomic influences on the accessory pathway and sustained by electrophysiologic interactions between the accessory pathway and the junctional escape focus. This is the first case report of a newborn having coexisting congenital AV block and WPW syndrome.- - - - - - - - - - ranking = 1keywords = long (Clic here for more details about this article) |
7/279. Complete heart block as a rare complication of treatment with chloroquine.antimalarials are well established disease modifying antirheumatic drugs. A rare and underappreciated treatment difficulty is cardiac complication, in particular conduction disturbances. We describe 2 more patients that developed complete heart block after high dose, longterm treatment. Patient 1, a 73-year-old woman with longstanding rheumatoid arthritis, had taken chloroquine (250 mg/day) for 12 years when she developed complete heart block requiring a permanent pacemaker. Patient 2, a 40-year-old woman with discoid lupus erythematosus, was taking chloroquine from 1979 until 1996. Depending on the clinical disease activity, she intermittently increased the dose from 250 to 750 mg/day. In 1994, she developed complete heart block and a permanent pacemaker had to be implanted. Intensive investigations in both cases did not reveal another underlying cause for conduction disturbances; the atrioventricular block was probably due in both cases to chloroquine related cardiac toxicity. This toxicity seems to be restricted to longterm, high dose treatment; however, it should be kept in mind in patients with preexisting conduction disturbances during longterm treatment.- - - - - - - - - - ranking = 4keywords = long (Clic here for more details about this article) |
8/279. Complete atrioventricular block after arsenic trioxide treatment in an acute promyelocytic leukemic patient.AV block after arsenic trioxide (As2O3) treatment for refractory acute promyelocytic leukemia is very rare. In this patient, the block was at A-H level and manifested with complete AV block and Wenckebach second-degree type 3:2 block. The junctional recovery time during complete AV block did not significantly prolong after administration of more arsenic trioxide. The effect of heart block of arsenic trioxide seemed reversible after the discontinuation of arsenic trioxide and was not correlated to the leukemic status as observed in this patient.- - - - - - - - - - ranking = 1keywords = long (Clic here for more details about this article) |
9/279. Reciprocal beats initiated by artificial pacemaker.In conclusion, the underlying mechanism for this rhythm disturbance in our patient is the re-entry phenomenon, which is dependent upon a localized unidirectional block in the A-V junction. The predisposing factors, including digoxin and Inderal which tend to prolong A-V conduction, are considered for the mechanism of the production of the reciprocal beats in our case. Upon temporary withdrawal of digoxin and Inderal, the re-entry phenomenon has disappeared.- - - - - - - - - - ranking = 1keywords = long (Clic here for more details about this article) |
10/279. Prominent bifid T waves observed in the QT prolongation caused by complete atrioventricular blockade in a hypokalemic diabetic patient.A 63-year-old diabetic man was admitted with general fatigue. Electrocardiogram (ECG) on admission showed complete atrioventricular (AV) blockade associated with prominent bifid T waves. The second component of the bifid T waves was distinguished from U waves by the beat-to-beat varying bifidity and the nadir between the two components located at > or = 1 mm above the isoelectric line. Range of absolute QT interval was 535 to 650 ms. hypokalemia (3.6 mEq/L) was noted at admission. Partial restoration of the potassium level (3.9 mEq/L) prior to temporary ventricular demand pacing obscured the bifid T waves and attenuated the QT prolongation and dispersion to some extent (absolute QT interval ranging 520 to 620 ms). It was concluded that marked bradycardia caused by complete AV blockade (ie, a junctional escaped rhythm at a rate of 42 beats/min), hypokalemia, and underlying diabetes mellitus contributed in concert to the QT prolongation and dispersion leading to the prominent bifid T waves.- - - - - - - - - - ranking = 6keywords = long (Clic here for more details about this article) |
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