The Canadian journal of cardiology
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An association between rapid reversion of supraventricular tachycardia by carotid sinus stimulation and carotid sinus reflex hypersensitivity during sinus rhythm is described in a 55-year-old patient. The findings indicate that a high level of vagal tone facilitates vagal maneuvers in terminating some supraventricular tachyarrhythmias. The briskness of the response during tachycardia may also be a marker for underlying carotid sinus hypersensitivity.
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A 57-year-old woman underwent pulmonic valvotomy for congenital pulmonic stenosis. She developed severe pulmonic insufficiency, secondary tricuspid regurgitation, and anasarca in spite of a normal pulmonary artery pressure. Insertion of a pulmonary valve prosthesis and tricuspid valve plication reversed all clinical symptoms and signs of this rare complication of pulmonary valvotomy.
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A 22-year-old male had accidental carbon monoxide poisoning from a malfunctioning gas refrigerator, and aspiration pneumonia. Initial severe biventricular global dysfunction and hemodynamic instability was demonstrated and was at least partially due to carbon monoxide toxicity. The myocardial dysfunction normalized and the patient recovered.
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Many Canadian communities rely on non-amalgamated ambulance services to respond to out-of-hospital sudden cardiac arrest victims. These pre-hospital care systems lack a central coordinating and dispatching facility, a publicized, easily-accessible telephone number (911) and vehicles equipped with monitor-defibrillators, and are generally staffed by personnel trained only in basic cardiac life support. To receive definitive care, the victim of a cardiac arrest in these communities must be successfully transported to a hospital. ⋯ Overall, only 8 victims (8.8%) survived and were discharged from hospital. Based on the data presented, survival rate for cardiac arrest victims treated by a non-amalgamated ambulance system are inferior to those reported for pre-hospital care services capable of providing advanced cardiac life support at the scene. Whether all of the components of an established paramedic program are required to improve survival rates in individual communities remains undetermined.
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Sudden and unannounced syncope due to increased vagal tone as manifested by hypersensitivity of the carotid sinus mechanism is not uncommon. A 17 year prospective study of 89 patients with cardio-inhibitory (Type 1) hypersensitivity showed that males outnumbered females 4.5:1. The age range at the onset of symptoms was 37 to 88 years with an average of 63 years. ⋯ A new classification of Hypersensitive Carotid Sinus Syncope incorporating sinoatrial node (Type 1A) and atriaoventricular node (Type 1B) suppression in the Type 1 syndrome is presented. Many forms of treatment for cardioinhibitory Hypersensitive Carotid Sinus Syncope have been forthcoming but in our hands in these 89 patients over 17 years, there has been no single case of recurrence of syncope after implantation of a permanent VVI electronic cardiac pacemaker. Type 2 (vasodepressor) Hypersensitive Carotid Sinus Syncope is rare, occasionally seen combined with the cardioinhibitory (Type 1) response and it is not helped with cardiac pacing.