Cases reported "Bradycardia"

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1/60. 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.
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2/60. syncope caused by nonsteroidal anti-inflammatory drugs and angiotensin-converting enzyme inhibitors.

    A 85-year-old woman with diabetes mellitus and prior myocardial infarction was transferred to the emergency room with loss of consciousness due to marked bradycardia caused by hyperkalemia. The T wave during right ventricular pacing was tall and tent-shaped while the concentration of serum potassium was high, and its amplitude during pacing was decreased after correction of the serum potassium level. Simultaneously with the correction, normal sinus rhythm was restored. The cause of hyperkalemia was considered to be several doses of loxoprofen, a nonsteroidal anti-inflammatory drug (NSAID), prescribed for her lumbago by an orthopedic specialist, in addition to the long-term intake of imidapril, an angiotensin-converting enzyme inhibitor (ACEI), prescribed for her hypertension by a cardiologist. This case warns physicians that the combination of NSAID and ACEI can produce serious side effects in aged patients who frequently suffer from hypertension, diabetes mellitus, ischemic heart disease, and degenerative joint disease.
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3/60. Persistent occurrence of bradycardia during laparoscopic cholecystectomies in low-risk patients.

    BACKGROUND/AIMS: A debate has arisen about the use of carbon dioxide to distend the abdomen because of certain negative effects on venous return to the heart, and declining cardiac output. We previously reported 4 cases of bradycardia that occurred during 725 laparoscopic cholecystectomies. Now, we describe 6 cases of bradycardia that occurred in a 1-year period (May 31, 1997 to June 1, 1998) during CO(2) pneumoinsufflation at the beginning of planned, elective laparoscopic cholecystectomies. These patients appeared not to be at any special cardiac risk. To determine the frequency, and possible underlying common denominators, we reviewed the laparoscopic cholecystectomies. methods: We completely reviewed the patients' records to find any common denominators. Also, we calculated the frequency of bradycardia during laparoscopic cholecystectomies. RESULTS: Six patients experienced bradycardia during laparoscopic cholecystectomies. None had known cardiac disease or symptoms. These cases occurred during the year's 127 laparoscopic cholecystectomies (4.7% approximately). There were no common denominators between the patients. CONCLUSIONS: Although cardiac changes were noted during laparoscopic gynecologic surgery approximately 20 years ago, only in the last few years have cardiovascular changes been noted during laparoscopic cholecystectomies. Surgeons should be prepared to encounter such cardiovascular changes even with low-risk patients as it appears that bradycardia is a persistent occurrence during laparoscopic cholecystectomies.
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4/60. The 12-lead electrocardiogram in anorexia nervosa: A report of 2 cases followed by a retrospective study.

    anorexia nervosa (AN) has been associated with various cardiac disorders and several electrocardiographic abnormalities, the most prominent being sudden death and prolonged QT duration and dispersion. We report 2 cases of AN with marked repolarization abnormalities, the first clearly related to electrolyte imbalance, the second without a good explanation from metabolic, electrolytic or pharmacological sources. A retrospective analysis of 47 other consecutive patients with AN showed that sinus bradycardia was the most common ECG finding, but that QT or QTc interval prolongation was not a typical feature, being present in only 1 patient. The sole variable slightly correlated with QTc duration was the serum potassium concentration. Consequently, marked repolarization changes (QT interval and/or T wave morphology) in AN should not be taken as a feature of the disease, but should call for the search of potential causes such as metabolic and electrolytic disturbances, drug effects, or a possible genetic component.
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5/60. Delayed restoration of atrioventricular synchrony with beat-to-beat mode switch.

    This case report describes a patient with complete AV block and a VDD pacemaker who experienced repetitive episodes of symptomatic bradycardia. Episodes occurred due to activation of an automatic beat-to-beat mode switch algorithm. After mode switch to VDI operation, the pacemaker failed to immediately switch back to AV synchronous pacing when regular sinus rhythm (> or = 100 beats per minute) resumed despite adequate P wave sensing. dizziness was felt for up to several minutes of asynchronous pacing at the lower rate limit until VDD mode was restored. Episodes were completely eliminated by programming the mode switch function from an automatic beat-to-beat algorithm to a fixed rate algorithm.
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6/60. 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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7/60. prenatal diagnosis and treatment of fetal long qt syndrome: a case report.

    We report a case of a fetus presenting with bradycardia, intermittent atrioventricular (AV) block, ventricular tachycardia (VT) and the signs of fetal congestive heart failure (ascites and scrotal hydrocele) during mid-gestation. Prenatal treatment with beta-adrenergic blocker (propranolol) and digitalis glycosides was prescribed because of suspicion of long qt syndrome occurring with fetal congestive heart failure. The male baby was born at 39 weeks of gestation and showed a prolonged QT interval (QTc = 492 ms) and frequent variable AV block or alternating left and right bundle branch block, depending on the atrial rate. Prenatal administration of lidocaine failed to correct the fetal VT. Conversely, propranolol decreased the attack frequency of fetal VT. Postnatal administration of the K( ) channel opener (nicorandil) successfully shortened the QT interval and improved the outcome.
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ranking = 0.015483163862893
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8/60. Persistent atrial standstill, report of three cases.

    Three cases, of which two are brothers, of persistent atrial standstill are reported. The diagnosis was made by the lack of P wave in routine 12 leads and right atrial cavity lead, no response of atrium to electrical stimulation and absence of "a" wave in right atrial pressure curve.
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9/60. Bezold-Jarisch-like reflex during Brockenbrough's procedure for radiofrequency catheter ablation of focal left atrial fibrillation: report of two cases.

    Brockenbrough's puncture technique has been widely conducted in the electrophysiologic laboratory. We report here two cases exhibiting a rare complication of this procedure, which arose during the conduct of catheter ablation using radiofrequency energy delivered to the pulmonary vein for the treatment of focal left atrial fibrillation. These cases exhibited marked sinus bradycardia and profound hypotension, suggestive of a Bezold-Jarisch-like reflex, observed immediately after Brockenbrough's procedure but before radiofrequency application. ST elevation in the inferior leads was also observed in spite of normal coronary angiograms. This unanticipated transient complication was treated by intravenous administration of atropine, which had no influence on the ablation procedure or prognosis. This is speculated to be attributable to the elevation of vagal tone caused by the mechanical effects of transseptal puncture on the interatrial vagal network.
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10/60. Giant J wave on 12-lead electrocardiogram in hypothermia.

    Findings on standard 12-lead electrocardiogram in patients with hypothermia include sinus bradycardia, prolonged QT and PR interval, wide QRS complex, supraventricular and ventricular arrhythmia, and the most striking electrocardiographic abnormality, the J wave. Although characteristic of hypothermia, J wave also occurs in other conditions. The electro-physiologic basis of J wave in hypothermia has been recently elucidated. We present a case of giant J wave due to accidental hypothermia and in addition discuss the features, mechanism, and significance of J wave in hypothermia.
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