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.
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Clinical cardiology · Mar 1985
Combining left ventricular systolic time intervals and M-mode echocardiography in the evaluation of primary pulmonary hypertension in women.
Eight patients with primary pulmonary hypertension underwent systolic time intervals, M-mode echocardiography, and direct hemodynamic studies in order to determine the correlation between noninvasive parameters and hemodynamic variables and to evaluate the utility of these noninvasive studies in primary pulmonary hypertension. The ratio of the pre-ejection period to left ventricular ejection time (PEP/LVET) of the systolic time intervals was abnormally increased (greater than 0.42) for each subject; the increase in the PEP/LVET was secondary to a shortening of the left ventricular ejection time in four patients, prolongation of the pre-ejection period in one, or a combination of such, noted in three patients. ⋯ These results indicate that in primary pulmonary hypertension, the performance of both systolic time intervals and M-mode echocardiography noninvasively provides useful information concerning the hemodynamic status of these patients. Systolic time intervals provide an estimation of overall cardiac-cardiovascular performance, rather than left ventricular function alone, which in turn, is validly examined by M-mode echocardiography.
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Clinical cardiology · Feb 1985
Case ReportsTreatment of perinfarction recurrent ventricular fibrillation by percutaneous pharmacological block of left stellate ganglion.
A patient suffering from an acute myocardial infarction presented on the seventh and eighth days of hospitalization recurrent episodes of ventricular fibrillation refractory to antiarrhythmic treatment. The life-threatening ventricular fibrillation was suppressed by percutaneous pharmacological block of the left stellate ganglion.