Clinical cardiology
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Clinical cardiology · Jun 1985
Case ReportsParoxysmal vagally mediated AV block with recurrent syncope.
Paroxysmal complete atrioventricular (AV) block without associated electrocardiographic (ECG) abnormality is not a well recognized entity. A mother and her daughter had recurrent syncopal episodes, but a normal ECG. The episodes were preceded by nausea and vomiting. ⋯ Paroxysmal AV block was vagally mediated in one of the patients, as indicated by prompt response to atropine. In the second case, the vagal dependence could not be proved but appears to be the most likely explanation. It thus appears that paroxysmal, vagally mediated complete AV block should be seriously considered in patients with unexplained syncope.
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Clinical cardiology · Jun 1985
Evaluation of flecainide acetate in rapid atrial fibrillation complicating Wolff-Parkinson-White syndrome.
Flecainide is reported to be effective in patients with paroxysmal tachycardias, but its effect on rapid ventricular response over accessory atrioventricular pathway during atrial fibrillation is not known. The influence of flecainide on various electrophysiological properties of the accessory pathway with special emphasis on ventricular rate during atrial fibrillation was investigated in 9 patients with severe symptomatic Wolff-Parkinson-White syndrome. The shortest ventricular response during atrial fibrillation increased from 218 (190-270) to 320 (240-block) ms. ⋯ The rate of circus movement tachycardia decreased from 166/min to 130/min after flecainide, due to a lengthening of retrograde ventriculoatrial conduction time over the accessory pathway. Flecainide caused a significant prolongation of the effective refractory period of the accessory pathway in our subgroup with extremely fast AV conduction during atrial fibrillation and induced a depressant effect on retrograde accessory pathway conduction. This makes the drug very promising for the emergency treatment of dangerous rapid tachyarrhythias complicating this syndrome.
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Clinical cardiology · Jun 1985
Case ReportsDelayed shotgun pellet migration to the right ventricle.
Multiple case reports of bullet emboli to the heart have been documented. A unique clinical situation is presented of a patient who sustained a shotgun injury to the buttock, with retained pellets, who 7 to 10 years later demonstrated intravascular migration of one of the pellets to the intracardiac position.