Cases reported "Tachycardia"

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11/99. clozapine associated dilated cardiomyopathy.

    A 31-year-old white man was referred for investigation of a persistent sinus tachycardia. His only significant past medical history was of chronic schizophrenia for which he had been taking clozapine for six years. An electrocardiogram demonstrated sinus tachycardia, voltage criteria for left ventricular hypertrophy, and a prolonged QTc. Echocardiographic findings were consistent with a dilated cardiomyopathy. Serious cardiac complications of clozapine use are rare but have been reported previously. It is important to note that sinus tachycardia may be the only obvious clinical sign, and that complications can manifest months or even years (as in this case) after starting the drug. patients on clozapine should be informed of potential cardiac symptoms and doctors should maintain a high degree of clinical suspicion throughout the duration of treatment.
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ranking = 1
keywords = cardiomyopathy
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12/99. Incessant nonreentrant tachycardia due to simultaneous conduction over dual atrioventricular nodal pathways mimicking atrial fibrillation in patients referred for pulmonary vein isolation.

    It has been reported that conduction over the fast and slow pathways of the AV node can occur simultaneously, leading to a double ventricular response from each atrial beat. We report the cases of two patients referred to us for evaluation of symptomatic, incessant, and irregular narrow-complex tachycardia, misdiagnosed as atrial fibrillation, for consideration of pulmonary vein isolation. At presentation, careful evaluation of the electrograms revealed the presence of two ventricular activations for each atrial beat. At electrophysiologic study, both patients were found to have nonreentrant tachycardias arising from simultaneous conduction over the fast and slow pathways of the AV node. In one patient, the tachycardia had resulted in cardiomyopathy. Slow AV nodal pathway ablation performed in both patients resulted in cure of their tachycardias and recovery of ventricular function in the patient with cardiomyopathy.
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ranking = 0.4
keywords = cardiomyopathy
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13/99. role of ventricular tachycardia surgery and catheter ablation as complements or alternatives to the implantable cardioverter defibrillator in the 1990s.

    Although the implantable cardioverter defibrillator is used increasingly, other nonpharmacological approaches have their indications and merits. Furthermore, as the natural history of ventricular tachyarrhythmias or their underlying structural cardiac abnormality, i.e., coronary artery disease, dilated cardiomyopathy, arrhythmogenic right ventricular disease, etc. change, the mode of therapy may be modified accordingly. Because of the disappointing results of the CAST study in previously asymptomatic patients after myocardial infarction and the evidence that failure of one or two antiarrhythmic drugs tested by programmed ventricular stimulation in patients with documented sustained ventricular tachycardia or fibrillation predicts further drug failure, there will be a significant increase in the use of implantable cardioverters defibrillators in the 1990s. However, care should be taken to avoid inappropriate use of these devices.
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ranking = 65.63773460385
keywords = arrhythmogenic, arrhythmogenic right, cardiomyopathy
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14/99. tachycardia sensing failure of an implantable cardioverter defibrillator in a patient with hypertrophic cardiomyopathy.

    A 17-year-old white male was found to have nonobstructive hypertrophic cardiomyopathy after suffering three severe syncopal episodes. He experienced an episode of sustained polymorphic ventricular tachycardia during exercise tolerance testing that required cardioversion. Electrophysiological studies were able to reproduce sustained polymorphic ventricular tachycardia that was unresponsive to standard pharmacotherapy. An automatic implantable defibrillator was placed. However, during implantation with the rate sensing electrodes on the left ventricle, it was found that the extremely polymorphic nature of the tachycardia caused such rapid fluctuations in the sensed R wave signal that the device could not properly detect the tachycardia. This was felt to be due to the automatic gain control circuit of the Ventak 1550. The problem was solved by moving the rate sensing electrodes to the lateral right ventricle. This case suggests that the unique arrhythmic substrate of hypertrophic cardiomyopathy may present sensing difficulties during automatic implantable defibrillator insertion.
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ranking = 1.2
keywords = cardiomyopathy
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15/99. Radiofrequency ablation of symptomatic but benign ventricular arrhythmias.

    Two cases are presented where ablation of severely symptomatic ventricular arrhythmias not responding to medical therapy was accomplished with radiofrequency current application. After a routine programmed stimulation protocol, a quadripolar ablation catheter with a 4-mm tip was advanced percutaneously into the left ventricle in one case and into the right ventricle in the second case; and after precise pace mapping, the arrhythmogenic focus was successfully ablated using radiofrequency current. The postablation ambulatory recording revealed virtual eradication of ventricular ectopy in both cases. In conclusion, in severely symptomatic cases of "benign" ventricular arrhythmias, radiofrequency ablation offers an effective therapeutic alternative.
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ranking = 44.617017455607
keywords = arrhythmogenic
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16/99. Permanent form of junctional reciprocating tachycardia and tachycardia-induced cardiomyopathy treated by catheter ablation: a case report.

    The permanent form of junctional reciprocating tachycardia (PJRT) is usually refractory to drug therapy, and these patients are at risk of developing tachycardia-induced cardiomyopathy. The electrocardiogram insribes inverted P waves in leads 2, 3, aVF as well as left lateral leads, along with a P-R interval shorter than R-P interval during the tachycardia. This report describes a three-year-old male patient with PJRT who underwent successful radiofrequency catheter ablation (RFA) of accessory pathway. On transthoracic echocardiography of patient, decreased ventricular systolic function was observed. RFA was performed by applying radiofrequency pulses. Echocardiograms of the patient, two months after catheter ablation, demonstrated progressive improvement of ventricular function. Transcatheter radiofrequency ablation of accessory pathways in patients with PJRT is an effective, and possibly preferable, form of treatment, especially in cases of tachycardia refractory to multiple pharmacologic treatments or when left ventricular dysfunction is present.
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ranking = 1
keywords = cardiomyopathy
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17/99. pregnancy complicated by chronic cardiomyopathy and an automatic implantable cardioverter defibrillator.

    The dismal prognosis of dilated cardiomyopathy and its resulting tachyarrhythmias has recently been improved by technical advances such as the automatic implantable cardioverter defibrillator. We report a successful pregnancy in a patient with chronic cardiomyopathy and malignant tachyarrhythmias necessitating use of this device, with a documented defibrillator discharge and monitored fetal response.
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ranking = 1.2
keywords = cardiomyopathy
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18/99. Dual antegrade response tachycardia induced cardiomyopathy.

    We report a rare case of tachycardia induced cardiomyopathy resulting from nearly incessant dual antegrade response tachycardia. Criteria necessary for sustaining dual antegrade responses are discussed, including: (1) sufficient antegrade dissociation of the AV node; (2) absence of retrograde conduction over each AV nodal pathway following antegrade conduction over its counterpart; (3) difference between fast and slow pathway conduction times exceeding His-Purkinje refractoriness; and (4) critical timing of sinus impulses relative to preceding AV nodal conduction. Both the arrhythmia and cardiomyopathy were successfully treated by slow pathway ablation.
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ranking = 1.2
keywords = cardiomyopathy
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19/99. Menometrorrhagia and tachyarrhythmia after using oral and topical ginseng.

    Widespread and uncontrolled use of ginseng has raised the question of its side effects and drug interactions. A 39-year-old female patient experienced menometrorrhagia. Her complaints had started 5 months earlier. The laboratory tests revealed follicle-stimulating hormone (FSH) and estradiol levels to be 10 mIU and 90 mIU, respectively. Endometrial biopsy was planned for the diagnosis of abnormal uterine bleeding. During the preoperative evaluation, the patient stated that she had been using both oral and topical ginseng for cosmetic reasons. The ECG revealed sinus tachycardia with occasional atrial premature beats. The procedure was postponed for 2 weeks so that the patient would stop taking ginseng, smoking, and drinking coffee. Arrhythmia stopped 10 days later. tachycardia continued during the procedure but did not require treatment, as it did not cause any hemodynamic instability. An endometrial biopsy specimen showed a disordered proliferative pattern. The patient was advised to stop using oral and topical ginseng. During a follow-up visit, she had no sign of menometrorrhagia or tachyarrhythmia and her hemoglobin levels were in the normal range. smoking and coffee consumption, along with ginseng use, can be responsible for arrhythmogenic effects. Abnormal uterine bleeding can cause tachycardia secondary to anemia. The clinical progress of this patient is consistent with our hypothesis that ginseng is responsible for menometrorrhagia, although this could be coincidental. patients should always be asked prior to surgery if they use herbal medications, food supplements, or cosmetics as well as prescription drugs. This is of great importance for both diagnosis and avoidance of drug interactions and side effects during anesthesia.
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ranking = 44.617017455607
keywords = arrhythmogenic
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20/99. tachycardia-induced cardiomyopathy: atrial fibrillation and congestive heart failure.

    tachycardia-induced cardiomyopathy occurs as a result of prolonged, excessive heart rates. ventricular function may improve significantly upon control of the heart rate. We present a case of a patient with atrial fibrillation with rapid ventricular response who showed a dramatic improvement in left ventricular function following AV nodal ablation and insertion of a pacemaker. We also review the history and pathophysiology of tachycardia-induced cardiomyopathy.
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ranking = 1.2
keywords = cardiomyopathy
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