The Canadian journal of cardiology
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Electrophysiologic studies were performed in nine survivors of out-of-hospital cardiac arrest who had no overt heart disease on clinical, hemodynamic and angiographic evaluation. Cardiac arrest occurred during sedentary activity in seven patients and during exercise in two; no patient was on antiarrhythmic drugs at the time of cardiac arrest. Twenty-four hour ambulatory electrocardiographic monitoring demonstrated premature ventricular beats in four patients (44%). ⋯ Of the four patients with noninducible sustained VT or VF, three received no antiarrhythmic therapy and one was given a beta-blocker. None had recurrent cardiac arrest or symptomatic VT after an average follow-up of 17 months (range 13 to 20 months). Thus, inducibility of sustained VT or VF provided a reliable end point for long term antiarrhythmic therapy and noninducibility identified a subset of patients that had an excellent prognosis without specific antiarrhythmic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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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.