Cases reported "Bradycardia"

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1/6. Apparent bradycardia-dependent sinoatrial block associated with respiration.

    In our previous patients, apparent bradycardia-dependent block has been shown in the atrioventricular (AV) junction and in the accessory pathway. It was suggested that these previous cases were not of true bradycardia-dependent block; namely, that, as a result of periodic increases in vagal tone associated with respiration, conductivity in the AV junction or in the accessory pathway was depressed to a greater degree than automaticity in the sinus node. In the present article, 3 patients with frequent sinoatrial (SA) block were reported. In 1 patient, sinus escape-capture bigeminy caused by SA block was found. In these present patients, when the sinus cycle lengthened, SA block occurred. The purpose of the present article is to show that the patients have apparent bradycardia-dependent SA block, namely, not true bradycardia-dependent SA block. In all patients, the respiration curve was recorded simultaneously with the electrocardiogram. In all patients, during inspiration, the sinus cycle gradually shortened; on the other hand, during expiration, the sinus cycle gradually lengthened, and then a sinus impulse was blocked in the SA junction. These findings suggested that increased vagal tone during expiration depressed conductivity in the SA junction to a greater degree than automaticity in the sinus node.
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2/6. Apparent bradycardia-dependent advanced second-degree atrioventricular block.

    A 65-year-old man with repeated chest discomfort and dizzy spells was transferred by an emergency car. On the way to hospital, his pulse was palpable as regular 4 to 5 beats followed by an unpalpable period of about 4 s. His electrocardiographic monitor showed that 4 to 5 sinus QRS complexes were followed by consecutive 3 to 4 blocked sinus P waves, which occurred repeatedly. When PP intervals gradually shortened during inspiration, sinus impulses were conducted to the ventricles, whereas when PP intervals lengthened during expiration, 3 to 4 sinus impulses were blocked in succession. An attempt was made to explain the mechanism for such apparent bradycardia-dependent atrioventricular block by using the concepts of periodic increases in vagal tone due to respiration and concealed electrotonic conduction of blocked impulses. Such a peculiar form of advanced second-degree atrioventricular block has never been reported before.
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keywords = respiration
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3/6. Transient tetraplegia after cervical facet joint injection for chronic neck pain administered without imaging guidance.

    We report about a patient in whom transient tetraplegia with intact proprioception occurred immediately after infiltration of a facet joint at the C6 level guided by anatomical landmarks. After positioning the patient supine and applying atropine and oxygen, respiration and circulation were stable and all symptoms resolved within the next 30 min. The type of neurological pattern and the course of disease suggest an inadvertent injection into a cervical radicular artery that reinforces the anterior spinal artery. This complication is potentially serious and may be permanently disabling or life threatening. It should be considered by any clinician performing "blind" zygapophysial joint injections in the cervical spine. Using imaging guidance should help prevent this type of complication.
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keywords = respiration
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4/6. Respiratory and cardiac events observed and recorded during and following a "near miss" for sudden infant death syndrome episode.

    Documented observations of a 5-week-old infant during a "near miss" for a Sudden Infant Death syndrome (SIDS) episode by a physician were carried out during an in-hospital physiological recording of respiratory and cardiac activity. This "near miss" event occurred during quiet sleep and was characterized by a prolonged apneic attack with marked bradycardia, cyanosis and limpness which required immediate vigorous resuscitative efforts by a physician and trained nurse. Parental descriptions of similar events parallel these documented sudden unexpected changes in cardiorespiratory parameters. Objective polygraphic data were obtained immediately following the episode and at later ages during 24 and 48 hour continuous recordings of respiration, heart rate, sleep/wake and behavioral activity. The data show that numerous apneic episodes occurred following the "near miss" event, many accompanied by marked bradycardia. The moderately severe hypoxemia noted during these sleep-related apneas indicate that immediate intervention is required to prevent significant hypoxia and central depression in such infants.
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keywords = respiration
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5/6. Cardiorespiratory recordings from infants dying suddenly and unexpectedly at home.

    OBJECTIVE. Little is known about the mechanism of death during sudden infant death. To study the mechanism, we obtained data on six infants who died while on a memory-equipped cardiorespiratory monitor. methods. Waveforms of respiration and heart rate trend were available for five infants; an alarm log only was available for the sixth. These printouts were reviewed with attention to mechanism and time to death. RESULTS. All infants were born prematurely; autopsies reported the cause of death as sudden infant death syndrome in three cases and bronchopulmonary dysplasia in the others. bradycardia, which played a more prominent role than central apnea, was preceded by tachycardia in two deaths. resuscitation occurred within 1 minute in four cases; no response to alarms occurred in the other two cases, apparently because the parents were desensitized by prior meaningless alarms. Five patients died within 20 minutes, whereas one death due to sudden infant death syndrome was prolonged. CONCLUSION. bradycardia is an important feature in all six of these infant deaths. Although its etiology is unknown, hypoxemia or obstructive apnea may precede bradycardia. Home monitors equipped to detect these possible antecedents will yield further insight into sudden infant death.
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keywords = respiration
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6/6. Arrhythmia during extracorporeal shock wave lithotripsy.

    A prospective study of arrhythmia during extracorporeal shock wave lithotripsy (ESWL) was performed in 50 patients, using an EDAP LT01 piezoelectric lithotriptor. The 12-lead standard ECG was recorded continuously for 10 min before and during treatment. One or more atrial and/or ventricular ectopic beats occurred during ESWL in 15 cases (30%). The occurrence of arrhythmia was similar during right-sided and left-sided treatment. One patient developed multifocal ventricular premature beats and ventricular bigeminy; another had cardiac arrest for 13.5 s. It was found that various irregularities of the heart rhythm can be caused even by treatment with a lithotriptor using piezoelectric energy to create the shock wave. No evidence was found, however, that the shock wave itself rather than vagal activation and the action of sedo-analgesia was the cause of the arrhythmia. For patients with severe underlying heart disease and a history of complex arrhythmia, we suggest that the ECG be monitored during treatment. In other cases, we have found continuous monitoring of oxygen saturation and pulse rate with a pulse oximeter to be perfectly reliable for raising the alarm when depression of respiration and vaso-vagal reactions occur.
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ranking = 0.16666666666667
keywords = respiration
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