American heart journal
-
American heart journal · May 1987
Case ReportsOccurrence of exercise-induced and spontaneous wide complex tachycardia during therapy with flecainide for complex ventricular arrhythmias: a probable proarrhythmic effect.
Flecainide acetate, a new antiarrhythmic agent, possesses favorable pharmacokinetic and hemodynamic properties and demonstrates highly favorable antiarrhythmic activity in patients with ventricular arrhythmias. However, the proarrhythmic potential of flecainide deserves further evaluation. In 7 (13%) of 55 consecutive patients treated with oral flecainide, 200 to 600 mg/day, for complex ventricular arrhythmias (including sustained ventricular tachycardia in 14), we observed the appearance of new or more sustained exercise-induced (five patients) or spontaneous (two patients) wide complex tachycardia. ⋯ In four patients, wide complex tachycardia did not recur during exercise testing during alternative antiarrhythmic therapy (three patients) or no antiarrhythmic therapy (one patient). These observations raise the possibility of flecainide-related proarrhythmia, manifested as an increased propensity to exercise (activity)-induced wide complex tachycardia, which was not reliably predicted by results of Holter recordings or programmed electrical stimulation. Patients with complex ventricular arrhythmias beginning long-term treatment with oral flecainide should be considered for treadmill exercise testing together with ambulatory monitoring as part of the initial assessment of drug efficacy.
-
Patients with either blunt or penetrating chest injuries may develop a variety of cardiac complications. The studies of 76 patients with suspected cardiac injury obtained over a 30-month period were reviewed in order to determine how frequently and in what manner two-dimensional echocardiography (2DE) is of value in the assessment of such patients. Thirty-nine patients had blunt trauma (group I), and 37 had penetrating trauma (group II). ⋯ In group II patients, the 2DE findings were: no visible abnormality in 14, pericardial effusions in 12, wall motion abnormalities in three, and unusual abnormalities such as foreign body or intrathoracic air in three; the studies were technically inadequate in four. This study shows that satisfactory 2DE can be performed in up to 87% of unselected patients who sustain chest injuries and does provide clinically valuable information that cannot be easily obtained by other noninvasive tests. In this series, 2DE was of greatest value in the detection of pericardial effusions that were present in 27% and of unusual abnormalities including intrathoracic air and foreign bodies such as a bullet.
-
American heart journal · Mar 1987
The value of mixed venous oxygen saturation as a therapeutic indicator in the treatment of advanced congestive heart failure.
This retrospective study attempted to determine if the mixed venous oxygen saturation (SVO2) is an appropriate therapeutic monitoring parameter in assessing the effectiveness of dobutamine administration in patients with advanced congestive heart failure (CHF). Twelve patients (mean age 56.7 +/- 3.2 years, SEM) with New York Heart Association functional class III or IV (11 patients) received increasing doses of dobutamine with hemodynamic and SVO2 determinations. Dose-dependent hemodynamic improvements occurred with dobutamine administration. ⋯ The baseline hemodynamic profile of the latter group demonstrates a trend toward a more seriously ill subset of patients compared to the former group. A parallel relationship between CO and SVO2 may not occur in seriously ill CHF patients. One possible explanation may be a changing oxygen consumption rate in the seriously ill patient, resulting in changes in CO without concomitant changes in SVO2.