American heart journal
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American heart journal · Jul 1994
Is there an abnormal QT interval in sudden cardiac death survivors with a "normal" QTc?
Correcting the QT interval for heart rate may mask ventricular repolarization abnormalities and may lead to a misinterpretation of the physiologic and pathophysiologic findings. In this study the QT/R-R relationship was studied in eight sudden cardiac death (SCD) survivors without overt structural heart disease and compared with eight age- and sex-matched normal subjects. All patients were in a drug-free state. ⋯ However, the regression line of the QT interval against the R-R interval was significantly (p < 0.01) altered in SCD survivors compared with normal subjects. These observations suggest that there is abnormal ventricular repolarization (QT interval) despite an apparently normal QTc using Bazett's formula in these patients. Evaluation of the QT/R-R relationship by means of 24-hour ambulatory Holter ECG monitoring may provide a useful clinical tool for the assessment of ventricular repolarization abnormalities.
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American heart journal · Jun 1994
Review Case ReportsPulmonary embolectomy for intravenous uterine leiomyomatosis.
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American heart journal · May 1994
Transesophageal echocardiography in critically ill patients: feasibility, safety, and impact on management.
Transesophageal echocardiography (TEE) is being used with increasing frequency in critically ill patients in whom transthoracic echocardiography (TTE) is often unsatisfactory in providing much needed information. We reviewed the indications, feasibility, and clinical impact of TEE in the intensive care setting at our institution. TEE was performed in 77 critically ill patients (age range 19 to 83 years) in whom TTE was inadequate or inconclusive. ⋯ In these patients (n = 37), the TEE findings led to a change in medical management in 19% and to surgical intervention in 29%. While TTE remains the first line of diagnostic ultrasound and Doppler in critically ill patients, it can be technically difficult or inconclusive. In this setting, TEE provides a safe and powerful diagnostic tool that can help guide patient management.
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American heart journal · Apr 1994
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialImplantable cardioverter defibrillator compared with antiarrhythmic drug treatment in cardiac arrest survivors (the Cardiac Arrest Study Hamburg).
In 1987, the Cardiac Arrest Study Hamburg (CASH), a prospective, multicenter, randomized controlled study, was started in survivors of sudden cardiac death resulting from documented ventricular tachyarrhythmias. Through December 1991, 230 survivors (46 women, 184 men; mean age 57 +/- 11 years) of cardiac arrest caused by ventricular tachyarrhythmias were randomly assigned to receive either oral propafenone (56 patients), amiodarone (56 patients), or metoprolol (59 patients) or to have an implantable defibrillator (59 patients) without concomitant antiarrhythmic drugs. The primary endpoint of the study was total mortality. ⋯ This article presents preliminary results of the comparison of implantable defibrillator therapy with propafenone therapy. A significantly higher incidence of total mortality, sudden death (12%), and cardiac arrest recurrence or sudden death (23%) was found in the propafenone group compared with the implantable defibrillator-treated patients (0%, p < 0.05). It was concluded that, in survivors of cardiac arrest, propafenone treatment is less effective than implantable defibrillator treatment.
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American heart journal · Apr 1994
Significance of left atrial spontaneous echo contrast in rheumatic mitral valve disease as a predictor of systemic arterial embolization: a transesophageal echocardiographic study.
The association between left atrial spontaneous echo contrast (SEC) and a history of systemic arterial embolization was evaluated in 359 consecutive patients with rheumatic mitral valve disease during a 3-year period. All patients underwent transesophageal echocardiographic (TEE) and cardiac catheterization studies. Of these, 207 patients had predominant mitral stenosis, 55 had significant mitral regurgitation, and the remaining 97 with xenograft mitral valve replacement developed valvular dysfunction (32 resulted in predominant mitral stenosis and 65 in significant mitral regurgitation). ⋯ Group A patients also had a higher frequency of recent (< or = 1 week before TEE study) and remote (> 1 week before TEE study) embolization than did group B patients (recent: 19.4% vs 2.8% [p < 0.001]; remote: 13.0% vs 4.0% [p < 0.001]). Multivariate analysis showed that left atrial SEC (p = 0.01) was the only independent predictor of systemic arterial embolization. It is concluded that patients with left atrial SEC had a significantly higher risk for thromboembolism, and TEE is a useful modality to identify this subset of patients with rheumatic mitral valve disease.