1/120. A case of vasospastic angina presenting Brugada-type ECG abnormalities.An electrophysiological study and a provocative test of coronary artery spasm was attempted in a 68-year-old man who was having syncopal attacks and chest pain. His electrocardiogram had the characteristics of brugada syndrome and ventricular fibrillation (VF) was induced by programmed electrical stimulation. ST-segment elevation became exaggerated by procainamide, which could not prevent the induction of VF. coronary angiography revealed no stenotic lesions, and spasm in the left coronary artery was induced by intracoronary administration of acetylcholine with similar chest pain to that experienced before. Under treatment with diltiazem and flecainide, which suppressed the induction of VF, the patient experienced no recurrence of symptoms despite persistent ST-segment elevation. No previous reports have described coronary spasm associated with Brugada-type ECG abnormalities, and patients with syncope should be evaluated carefully.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
2/120. exercise-induced paroxysmal atrioventricular block during nuclear perfusion stress testing: evidence for transient ischemia of the conduction system.BACKGROUND: Whether tachycardia-dependent paroxysmal AV block, an uncommon complication of exercise stress testing in patients with infranodal conduction disturbances, can result from acute ischemia of the conduction system is still speculative, and is based on post-hoc evidence of right coronary artery disease and abolition of block after coronary angioplasty. methods AND RESULTS: In two patients, from a database of 3000 undergoing nuclear exercise stress testing, transient paroxysmal AV block developed 1-4 minutes after the injection of the radionuclide agent. Nuclear perfusion imaging demonstrated stress-induced ischemia of the posteroseptal segments, which corresponds to the anatomical region of the His bundle, and perfusion recovery in the images obtained at rest. Angiography disclosed critical narrowing of the right coronary artery in both cases. CONCLUSION: Nuclear myocardial perfusion imaging provides noninvasive evidence that transient ischemia of the posteroseptal segment, anatomically corresponding to the His bundle, can result in paroxysmal AV block in patients with severe right coronary artery and chronic infranodal conduction disturbances. The demonstration of the underlying pathophysiological mechanism is useful for selecting the most effective treatment strategy.- - - - - - - - - - ranking = 3.9467401285583keywords = artery disease, artery (Clic here for more details about this article) |
3/120. cocaine-induced bradyarrhythmia: an unsuspected cause of syncope.cocaine use is associated with adverse events in nearly every organ system. Cardiovascular complications include hemorrhagic and ischemic stroke, aortic dissection, cardiomyopathy, accelerated coronary artery disease, myocardial infarction, and sudden cardiac death. syncope may be the presenting symptom in these conditions. However, cocaine-induced bradyarrhythmias have been scarcely mentioned. As this case exemplifies, clinicians should be aware of this association when they evaluate syncope, especially in young patients.- - - - - - - - - - ranking = 2.9467401285583keywords = artery disease, artery (Clic here for more details about this article) |
4/120. carotid sinus syndrome masquerading as treatment resistant epilepsy.A 65 year old woman had a 12 year history of frequent, recurrent seizure-like episodes labelled as treatment resistant epilepsy after neurological evaluation and follow up and treatment with multiple antiepileptic medications. carotid sinus massage provoked 5.6 seconds asystole with symptom reproduction, and she has remained symptom-free after permanent pacemaker implantation for her carotid sinus syndrome and withdrawal of antiepileptic medications.- - - - - - - - - - ranking = 18.410216063366keywords = carotid (Clic here for more details about this article) |
5/120. Aberrant origin of the left coronary artery from the right aortic sinus: surgical intervention based on echocardiographic diagnosis.An athletic 15-year-old girl with aberrant left coronary artery from the right coronary sinus, presented with syncope during exercise. Trans-thoracic echocardiography was the only imaging technique that clearly demonstrated her anomaly. The results of magnetic resonance and selective coronary angiographic imaging were inconclusive. Surgical intervention was successfully performed on the basis of the echocardiographic diagnosis.- - - - - - - - - - ranking = 2.5keywords = artery (Clic here for more details about this article) |
6/120. subclavian steal syndrome: a rare but important cause of syncope.An elderly woman came to our emergency room for evaluation of a syncopal episode. While climbing a flight of stairs, she had turned her head to the left and abruptly passed out. Positive physical findings included blood pressure of 141/65 mm Hg (right arm) and 80/43 mm Hg (left arm), as well as nonpalpable left radial and brachial pulses that were detectable only by Doppler ultrasonography. Carotid duplex ultrasonography showed reverse flow in the left vertebral artery and an abnormal, stenotic distal left subclavian artery. magnetic resonance angiography confirmed complete occlusion of the left subclavian artery with classic subclavian steal. The patient had percutaneous transluminal angioplasty with stenting of the left subclavian artery and has remained asymptomatic through 2 years of follow-up with aggressive risk-factor modification.- - - - - - - - - - ranking = 2keywords = artery (Clic here for more details about this article) |
7/120. Diagnostic superiority of continuous-loop electrocardiographic recording over other testing in a patient with recurrent syncope and underlying coronary artery disease with severe left ventricular dysfunction.Dysrhythmic causes of syncope may elude diagnosis in postinfarction patients despite elaborate testing, including electrophysiologic study. For a correct diagnosis, capture of cardiac rhythm during patient's typical symptoms is crucial. This report describes a patient with coronary artery disease and decreased left ventricular ejection fraction who experienced recurrent syncopal episodes without obvious precipitating factors. The 12-lead electrocardiogram showed left bundle-branch block indicating a possible conduction abnormality as the underlying cause of syncope. Twenty-four-h Holter monitoring exhibited no sinus rhythm or conduction disturbances but revealed a nonsustained run of ventricular tachycardia. Findings at electrophysiologic testing led to a presumptive diagnosis of tachyarrhythmic cause of syncope; however, the correct diagnosis was only made with use of a loop monitor which documented a 15-s sinus pause during a syncopal episode.- - - - - - - - - - ranking = 4.9467401285583keywords = artery disease, artery (Clic here for more details about this article) |
8/120. Significance of inducible ventricular fibrillation in patients with coronary artery disease and unexplained syncope.OBJECTIVES: This study was designed to determine the incidence and prognostic significance of inducible ventricular fibrillation (VF) in patients with coronary artery disease (CAD) and unexplained syncope. BACKGROUND: Current American College of cardiology/american heart association practice guidelines recommend implantation of internal cardioverter-defibrillators (ICDs) in patients with unexplained syncope in whom either ventricular tachycardia (VT) or VF is inducible during electrophysiologic (EP) testing. Although the prognostic significance of inducible monomorphic VT is known, the significance of inducible VF remains undefined. methods: We evaluated 118 consecutive patients with CAD and unexplained syncope who underwent EP testing. Sustained monomorphic VT was inducible in 53 (45%) patients; in 20 (17%) patients, VF was the only inducible arrhythmia; and no sustained ventricular arrhythmia was inducible in the remaining 45 (38%) patients. The latter two groups of 65 (55%) patients make up the study population. RESULTS: There were 16 deaths among the study population during a follow-up period of 25.3 /- 19.6 months. The overall one- and two-year survival in these patients was 89% and 81%, respectively. No significant difference in survival was observed between patients with and without inducible VF (80% power to detect a fourfold survival difference). CONCLUSIONS: In 17% of patients with CAD and unexplained syncope, VF is the only inducible ventricular arrhythmia. Within the limits of this pilot study, long-term follow-up of patients with and without inducible VF demonstrates no difference in survival between the two groups. Therefore, the practice of ICD implantation in patients with CAD, unexplained syncope and inducible VF, especially with triple ventricular extrastimuli, may merit reconsideration.- - - - - - - - - - ranking = 14.733700642792keywords = artery disease, artery (Clic here for more details about this article) |
9/120. Cerebrovascular and cardiovascular responses associated with orthostatic intolerance and tachycardia.Idiopathic orthostatic intolerance syndrome is characterized by postural symptoms of cerebral hypoperfusion without arterial hypotension. Abnormal baroreceptor responses with deranged cerebral autoregulation leading to cerebral vasoconstriction have been proposed as a causative mechanism. The authors report the cerebrovascular and cardiovascular responses in a patient who recovered from orthostatic intolerance and tachycardia. Changes in the orthostatic responses of mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), and transcranial Doppler middle cerebral artery (MCA) mean blood flow velocity (Vmean) were assessed at admission and again 6 months after recovery. Normal cardiovascular responses to forced breathing and to standing indicated intact overall baroreflex integrity with normal baroreflex sensitivity (10.2 msec.mm Hg(-1)). After the patient stood for 8 minutes, presyncopal symptoms developed, with unchanged MAP but increased HR ( 41 beats/min) and reduced stroke volume (SV) (-69%), CO (-50%), and MCA Vmean (-46%; 57 to 31 cm. s(-1)). After a reconditioning program and recovery, the patient was reexamined. The supine MCA Vmean was larger (79 cm. s(-1)), as were MAP (76 versus 70 mm Hg) and CO ( 15%). The orthostatic HR increase was smaller ( 5 beats/min), as was the reduction in SV (-44%) and CO (-30%), with an increase in MAP to 93 mm Hg. The orthostatic reduction in MCA Vmean was smaller (-13 versus -26 cm.s(-1)) and standing cerebrovascular resistance decreased (1.41 versus 2.39 mm Hg.cm. s(-1)). In this patient who had intact baroreflex control and no postural decrease in blood pressure, the reduction in MCA Vmean, concomitant with a large decrease in CO, seemed reversible. The result suggests that a symptomatic reduction in cerebrovascular conductance during standing is to be interpreted as being an adaptive response to a critically limited systemic blood flow, rather than to derangement of cerebral autoregulation.- - - - - - - - - - ranking = 0.5keywords = artery (Clic here for more details about this article) |
10/120. syncope in association with Prinzmetal variant angina.A case of Prinzmetal variant angina with transient complete atrioventricular block and syncopal episodes following an anteroseptal myocardial infarction is described. The syncopal attacks were not prevented by demand cardiac pacing and were presumably caused by transient severe ischaemia of the left ventricle, with a consequent reduction in cardiac output. The left ventriculogram showed a large anterior dyskinetic area corresponding to the high grade proximal obstruction in the left anterior descending artery demonstrated by coronary angiography. All other coronary vessels appeared free of disease and it is suggested that the anginal episodes were caused by transient proximal segmental spasm of the right coronary artery. The anginal episodes were successfully prevented by a regimen of two-hourly coronary arterial vasodilator therapy.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
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