Acta cardiologica
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A patient with osteogenesis imperfecta and mitral and aortic insufficiency, who underwent valve replacement, is described. The post-operative course was complicated by mitral valve dehiscence due to extreme friability of the mitral valve annulus.
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We report a case of cardiac tamponade following a penetrating wound of the heart treated surgically. The patient developed later on a pericarditis of the immunologic type complicated by new tamponade. The clinical situation was only relieved by corticotherapy.
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Comparative Study
Long term lorcainide therapy guided by electrophysiology studies.
One hundred patients inducible at electrophysiologic studies underwent serial drug testing with procainamide, lidocaine and lorcainide to determine comparative efficacy. Acute intravenous administration was followed by repeat programmed electrical stimulation (PES) studies on separate days for each antiarrhythmic drug. ⋯ Seventy percent of the patients have remained on lorcainide therapy, while 47% have continued on other drug therapies started over a 20.5 +/- 3.2 month mean follow-up period. Despite sleep-wake disturbances and a need for sedation at night, lorcainide therapy was tolerated well in this population and remained an effective antiarrhythmic with prolonged administration.
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The effectiveness and safety of intravenous lorcainide was evaluated in 14 patients with normal (QRS less than 110 ms) and in 9 patients with prolonged QRS duration (QRS greater than or equal to 110 ms) showing chronic high frequency premature ventricular complexes (mean value of PVCs 17 min-1). Lorcainide was infused intravenously by intermittent bolus at 10 mg every minute to a total dose of 160 mg with exception of 5 patients with a prolonged QRS duration who only received 100 mg. The overall reduction of PVCs 1 hour after administration of the drug was 86% (p less than 0.05) in the patients with normal QRS duration and 98.5% (p less than 0.05) in the patients with a prolonged QRS duration. ⋯ Lorcainide was well tolerated. Mild adverse effects were observed in five patients including: warmth sensation, vomiting, paresthesias, transient hypotension and the development of a junctional escape rhythm. Therefore lorcainide appears to be a safe and effective drug, that can even be administered to patients with a prolonged QRS duration.
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This is a first review of lorcainide hydrochloride, a new antiarrhythmic agent with local anaesthetic activity. The antiarrhythmic actions of lorcainide are mediated by an impairment of fast sodium conductance. Pharmacologically, this drug appears effective in suppressing reentry phenomena and ectopic pacemaker activity, especially in the ventricles. ⋯ Lorcainide-induced QRS widening is directly correlated with the plasma levels of the drug. Preliminary experience in supraventricular arrhythmias is promising but pre-excitation syndromes and the ventricular arrhythmias are the main indications for this drug since a very high response rate has been observed in these conditions. Side effects are harmless and dose-dependent, but may be clinically troublesome.