1/672. [Case report on the problem of individual glycoside requirements]A report is given on a patient with ischaemic heart disease, whose recompensation in tachyarrhythmia absoluta was for some times possible only by means of unusually high doses of digitoxin (fully effective dose to 5.72 mg, maintenance dose to 0.4 mg). The patient survived a severe decompensation with pulmonary oedema, which appeared under "normal" applications of glycosides, 2 1/2 years under this therapy. Thus it must again be referred to an individual glycoside treatment.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
2/672. Wide QRS complex tachycardia: ECG differential diagnosis.Wide QRS complex tachycardias (WCT) present significant diagnostic and therapeutic challenges to the emergency physician. WCT may represent a supraventricular tachycardia with aberrant ventricular conduction; alternatively, such a rhythm presentation may be caused by ventricular tachycardia. Other clinical syndromes may also demonstrate WCT, such as tricyclic antidepressant toxicity and hyperkalemia. Patient age and history may assist in rhythm diagnosis, especially when coupled with electrocardiographic (ECG) evidence. Numerous ECG features have been suggested as potential clues to origin of the WCT, including ventricular rate, frontal axis, QRS complex width, and QRS morphology, as well as the presence of other characteristics such as atrioventricular dissociation and fusion/capture beats. Differentiation between ventricular tachycardia and supraventricular tachycardia with aberrant conduction frequently is difficult despite this clinical and electrocardiographic information, particularly in the early stages of evaluation with an unstable patient. When the rhythm diagnosis is in question, resuscitative therapy should be directed toward ventricular tachycardia.- - - - - - - - - - ranking = 3keywords = rhythm (Clic here for more details about this article) |
3/672. acebutolol-induced ventricular tachycardia reversed with sodium bicarbonate.BACKGROUND: acebutolol is a unique beta blocker that possesses cardioselectivity, partial agonist activity, and membrane stabilizing activity. sodium bicarbonate is used to reverse the cardiotoxic effects of other drugs with membrane stabilizing activity. There have been no reported cases of acebutolol-induced ventricular dysrhythmias treated successfully with bolus sodium bicarbonate. CASE PRESENTATION: A 48-year-old man ingested approximately 6.4 g of acebutolol with ethanol (blood ethanol 61 mmol/L). There were no other coingestants identified. One hour after presentation, the patient had a cardiac arrest with the monitor showing ventricular tachycardia. sodium bicarbonate 50 mEq intravenous push converted the patient to sinus rhythm and the blood pressure improved to 129/90 mm Hg. CONCLUSION: This case demonstrates a temporal relationship between bolus sodium bicarbonate administration and the termination of acebutolol-induced ventricular tachycardia.- - - - - - - - - - ranking = 2keywords = rhythm (Clic here for more details about this article) |
4/672. Incessant automatic atrial tachycardia: a reversible cause of tachycardiomyopathy.We describe the case of a 23-year-old man with incessant atrial tachycardia complicated with tachycardiomyopathy. Transseptal ablation of the arrhythmia focus, located between the ostia of the left and right inferior vena pulmonalis, resulted in a restoration of normal sinus rhythm and a complete regression of the signs of tachycardiomyopathy.- - - - - - - - - - ranking = 2keywords = rhythm (Clic here for more details about this article) |
5/672. fetus with long qt syndrome manifested by tachyarrhythmia: a case report.We encountered a fetus who exhibited transient (at most 30 s), repeated episodes of tachyarrhythmia (240 bpm). This female neonate was born at 36 weeks of gestation and showed a markedly prolonged QT interval and transient, repeated episodes of polymorphic ventricular tachycardia. Congenital long qt syndrome was diagnosed. Retrospective analysis of the videotape showing fetal cardiac movement revealed that atrio-ventricular dissociation was present prenatally and thus, the fetal tachyarrhythmia was due to ventricular tachycardia. To our knowledge, there are few reports of a fetus with the long qt syndrome who exhibited ventricular tachycardia in utero. In the presence of unexplained fetal tachyarrhythmia, long QT syndrome should be considered as a possible underlying cause disorder. The presence of atrio-ventricular dissociation may be useful in prenatal diagnosis of long qt syndrome.- - - - - - - - - - ranking = 7keywords = rhythm (Clic here for more details about this article) |
6/672. Treatment of the bradycardia-tachycardia syndrome with permanent demand pacing.The bradycardia-tachycardia syndrome (paroxysmal supraventricular tachycardia alternating with sinus bradycardia and episodes of sinus node arrest) has previously presented a complicated therapeutic dilemma when excitatory and suppressive drugs have been utilized. A patient with this syndrome successfully treated with a permanent ventricular transvenous demand pacemaker is presented. Various aspects of this syndrome as well as facets of diagnosis and treatment have been reviewed and discussed. Significant underlying cardiac disease was ruled out in this patient by the usual diagnostic methods including left heart catheterization and coronary angiography. An interesting possibility of the relationship of vagal stimulation secondary to hiatus hernia as an etiologic factor in this syndrome has been discussed. The opinion is expressed that the currently preferred method of treatment is the insertion of a permanent transvenous pacemaker alone or in conjunction with antiarrhythmic drugs, preferably digitalis and propranolol.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
7/672. Left atrial tachycardia after right atrial separation for chronic atrial fibrillation with atrial septal defects.A right atrial separation procedure was performed for the ablation of chronic atrial fibrillation in four cases, concomitant with the repair of the atrial septal defect. After the operation, chronic atrial fibrillation disappeared in three of them and left atrial tachycardia occurred in the other one. Left atrial tachycardia is an arrhythmia encountered after a right atrial separation procedure.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
8/672. electrocardiography in the patient with the wolff-parkinson-white syndrome: diagnostic and initial therapeutic issues.The wolff-parkinson-white syndrome (WPW), estimated to occur in approximately 0.1% to 3% of the general population, is a form of ventricular preexcitation involving an accessory conduction pathway. The definition of WPW relies on the following electrocardiographic features: (1) a PR interval less than 0.12 seconds (2) with a slurring of the initial segment of the QRS complex, known as a delta wave, (3) a QRS complex widening with a total duration greater than 0.12 seconds, and (4) secondary repolarization changes reflected in ST segment-T wave changes that are generally directed opposite (discordant) to the major delta wave and QRS complex changes. The accessory pathway bypasses the atrioventricular (AV) node, creating a direct electrical connection between the atria and ventricles. The majority of patients with preexcitation syndromes remain asymptomatic throughout their lives. When symptoms do occur they are usually secondary to tachyarrhythmias; the importance of recognizing this syndrome is that these patients may be at risk to develop a variety of supraventricular tachyarrhythmias which cause disabling symptoms and, in the extreme, sudden cardiac death. The tachyarrhythmias encountered in the WPW patient include paroxysmal supraventricular tachycardia (both the narrow QRS and wide QRS complex varieties), atrial fibrillation, atrial flutter, and ventricular fibrillation. Diagnostic and urgent, initial therapeutic issues based on initial electrocardiographic information are presented via 5 illustrative cases.- - - - - - - - - - ranking = 3keywords = rhythm (Clic here for more details about this article) |
9/672. Recurrent ventricular tachycardia in hypothyroidism.Ventricular tachycardia associated with myxoedema is rare. Only two cases have so far been documented. In the report by Hansen, the patient had recurrent chest pain which suggested coexisting coronary heart disease. In the second case, the patient developed recurrent ventricular tachycardia only after intravenous triiodothyronine was given. This paper reports a further case of hypothyroidism with recurrent episodes of ventricular tachycardia and ventricular fibrillation which was not associated with any of the established causes of this arrhythmia.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
10/672. Pre-excitation syndrome secondary to cardiac rhabdomyomas in tuberous sclerosis.Rhabdomyomas are not uncommon in infants with tuberous sclerosis. We describe a neonate who presented with hydrops fetalis arising from a tachyarrhythmia during fetal life related to rhabdomyomas. After reversion of the arrhythmia, pre-excitation was noted on an interval electrocardiogram. Following regression of the tumours, the delta wave disappeared with no further arrhythmias noted.- - - - - - - - - - ranking = 3keywords = rhythm (Clic here for more details about this article) |
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