RESUMO
A 62 year-old man with hiatal hernia and complex atrial arrhythmia is reported. On the standard electrocardiogram a double atrial parasystole is found, with reversed coupling. During carotid sinus massage only one of the parasystolic foci is not influenced, and assumes the atrial activity, regularizing the cardiac rhythm.
Assuntos
Arritmias Cardíacas , Átrios do Coração , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Hérnia Hiatal/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In five patients with drug resistant ventricular tachycardia (VT) seven successful ventricular pacings were performed, using a bedside technique. The ventricular stimulation was always started with underdrive pacing, and in case of no result, continued with overdrive pacing. In two cases the underdrive pacing was successful, and in four cases only the overdrive pacing achieved suppression of tachycardia.
Assuntos
Estimulação Cardíaca Artificial/métodos , Taquicardia/terapia , Idoso , Eletrocardiografia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , RecidivaRESUMO
A rapid method using quinidine sulphate for the cardioversion of atrial fibrillation is presented. Intensive administration of the drug allows the use of lower doses (mean dose 1.159 g quinidine sulphate), with high convertibility rate (69.76%); 7 hours after the start of the procedure 94 per cent of the patients were already in sinus rhythm. The short duration of this procedure allows careful monitorization of the patients.
Assuntos
Fibrilação Atrial/tratamento farmacológico , Quinidina/administração & dosagem , Adulto , Idoso , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização FisiológicaRESUMO
Seven patients with short episodes of parasystolic ventricular tachycardia, in the absence of organic heart disease, and in good healthy state, are presented. The tachycardic episodes were analyzed through simultaneous esophageal and standard electrocardiographic recordings. The persistent fetal dispersion of nodal and Hiss bundle fragments within the ventricular septum is proposed as a possible explanation.
Assuntos
Coração/fisiopatologia , Taquicardia/fisiopatologia , Adolescente , Adulto , Eletrocardiografia , Feminino , Bloqueio Cardíaco/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Pulso Arterial , Sístole , Taquicardia/etiologiaRESUMO
A simple noninvasive method for the estimation of residual myocardial contractile reserve by using the postextrasystolic stimulation and systolic time intervals is proposed. The rational use of digitalis, avoiding the toxic effects, is possible only if the presence or absence of the residual contractile reserve is taken into consideration.
Assuntos
Glicosídeos Digitálicos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Contração Miocárdica/efeitos dos fármacos , Adulto , Idoso , Glicosídeos Digitálicos/administração & dosagem , Glicosídeos Digitálicos/efeitos adversos , Glicosídeos Digitálicos/farmacologia , Cardiopatias/tratamento farmacológico , Cardiopatias/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Pessoa de Meia-IdadeRESUMO
Digitalis glycosides have an antiarrhythmic effect in atrial fibrillation, as defibrillatory drugs. These drugs could be classified in a group of antiarrhythmic drugs close to the ventricular defibrillating drugs recently proposed. The reasons for this opinion are shown in this work.
Assuntos
Antiarrítmicos , Glicosídeos Digitálicos/classificação , Fibrilação Atrial/tratamento farmacológico , Glicosídeos Digitálicos/uso terapêutico , HumanosRESUMO
Periodic variations in PR interval from 0.16 sec to 0.36 sec is discussed in a patient without overt cardiac disease. The unequally blockage of slow and fast pathways within the A-V node is proposed as explanation of the phenomenon.
Assuntos
Bloqueio Cardíaco/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Periodicidade , Adulto , Eletrocardiografia , Feminino , Humanos , Fatores de TempoRESUMO
This clinical study was set-up to evaluate the antihypertensive effect of ketanserin in essential hypertension (EH) associated with asymptomatic ischemic heart disease (IHD) in twenty-seven patients. Every patient received 20-40 mg ketanserin, a selective S2 serotoninergic antagonist, twice daily, for a three-month period. The blood pressure (BP) was significantly lowered during the treatment with ketanserin, much more in female patients and elderly group.
Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Ketanserina/uso terapêutico , Isquemia Miocárdica/tratamento farmacológico , Antagonistas da Serotonina/uso terapêutico , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Avaliação de Medicamentos , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Caracteres SexuaisRESUMO
Using Lidocaine intravenously in 99 patients with atrial arrhythmias, it was observed that the drug has a regularising effect in 41 from 45 atrial arrhythmia, atrial tachycardia with block and accelerated ectopic supraventricular tachycardia, where the enhanced focal activity should be taken into account. No effect was observed in functional supraventricular tachycardia, paroxysmal atrial flutter and fibrillation and tachyarrhythmia in WPW syndrome, where the re-entry mechanism plays the major role. The effect of the drug is short lived, but may be prolonged by using the drug in perfusion or repeatedly with an intramuscular method. Lidocaine acts by depressing the enhanced atrial focal activity, and therefore may be of value in the treatment of these kinds of arrhythmias.
Assuntos
Antiarrítmicos , Arritmias Cardíacas/tratamento farmacológico , Lidocaína/uso terapêutico , Adolescente , Adulto , Idoso , Arritmias Cardíacas/fisiopatologia , Flutter Atrial/tratamento farmacológico , Fascículo Atrioventricular/efeitos dos fármacos , Fascículo Atrioventricular/fisiopatologia , Avaliação de Medicamentos , Humanos , Infusões Parenterais , Injeções Intramusculares , Lidocaína/administração & dosagem , Pessoa de Meia-Idade , Taquicardia/tratamento farmacológico , Fatores de Tempo , Síndrome de Wolff-Parkinson-White/tratamento farmacológicoRESUMO
Sinus node dysfunction may produce in some cases life threatening medical emergencies. From 138 patients with sinus node dysfunction followed up in our department, we present 8 cases in which emergency situations required special therapeutical approaches (precordial thump, atrial or ventricular pacing, permanent pacemaker implantation). These situations appeared spontaneously, during the investigation procedures or after conversion of atrial fibrillation, performed for therapeutic purposes, when this arrhythmia concealed a sinus node dysfunction. The tachy-brady-arrhythmia could be influenced only by the implantation of a permanent pacemaker.
Assuntos
Emergências/terapia , Marca-Passo Artificial , Síndrome do Nó Sinusal/terapia , Síndrome de Adams-Stokes/etiologia , Adulto , Idoso , Arritmias Cardíacas/etiologia , Flutter Atrial/etiologia , Doença das Coronárias/complicações , Eletrocardiografia , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Nó Sinusal/complicações , Síndrome do Nó Sinusal/etiologia , Bloqueio Sinoatrial/etiologiaRESUMO
An intermittent vanishing of the P wave from a standard electrocardiogram (ECG) while normal atrial activity was recorded on intracavitary leads was observed in a 58 year old man. This intermittent concealed atrial conduction is discussed.
Assuntos
Eletrocardiografia , Átrios do Coração/fisiopatologia , Potenciais de Ação , Cateterismo Cardíaco , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In 29 patients with atrial fibrillation, using the monophasic action potential technique, the fibrillatory waves were recorded and analyzed by statistical methods. Concerning the characteristics of the fibrillatory waves there are no differences between patients with rheumatic heart disease and with coronary heart disease. The patients with paroxysmal forms and those without heart failure and with normal heart size, have similar statistical data with regard to their fibrillatory waves. From the data presented, it could be possible to predict the efficacy of conversion to sinus rhythm and also the sinus rhythm stability after conversion.
Assuntos
Fibrilação Atrial/diagnóstico , Potenciais de Ação , Eletrocardiografia , Feminino , Humanos , MasculinoRESUMO
During a period of 20 years, 8 patients with atrial fibrillation, without other cardiac abnormalities, resistant to electroconversion, but successfully defibrillated with quinidine, were examined. All were males, aged 40 to 50 years, working with electric current and exposed for many years to frequent electric shocks. The authors consider that chronic exposure to electric current induces a special form of atrial fibrillation, resistant to electric conversion. The inefficiency of the electroshock therapy in such cases might be explained by the increase of transthoracic impedance consecutive to repeated electrocutions.
Assuntos
Fibrilação Atrial/etiologia , Eletricidade/efeitos adversos , Doenças Profissionais/etiologia , Adulto , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Cardioversão Elétrica , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Doenças Profissionais/terapia , Quinidina/uso terapêuticoRESUMO
Sinus node recovery time, used as an objective parameter of the sinus node function estimation, may be left out in the situation in which an atrial parasystolic focus is present. The overdrive suppression induced through rapid atrial pacing is without effect upon the protected parasystolic focus, and its firing will disturb the post-drive pause. This situation is noticed in two instances and demonstrated in one case.
Assuntos
Arritmias Cardíacas/fisiopatologia , Nó Sinoatrial/fisiopatologia , Estimulação Cardíaca Artificial , Eletrocardiografia , Átrios do Coração/fisiopatologia , Humanos , Síndrome do Nó Sinusal/diagnóstico , Sístole , Fatores de TempoRESUMO
For the functional estimation of artificial pacemakers, we have used two techniques: chest-wall stimulation and transesophageal stimulation. Transesophageal stimulation was always effective in inhibiting the generator, and it was used when chest-wall stimulation was ineffective. These two tests can be easily performed and are of remarkable usefulness in the follow-up of patients with permanent pacemaker.
Assuntos
Estimulação Cardíaca Artificial/métodos , Marca-Passo Artificial , Eletrodos , Esôfago , Seguimentos , Humanos , TóraxRESUMO
Two young patients with a-v conduction disturbances occurring in relation with strenuous physical effort are presented. The possible mechanism may be an excessive vagal tone.
Assuntos
Bloqueio Cardíaco/diagnóstico , Esforço Físico , Adolescente , Teste de Esforço , Bloqueio Cardíaco/fisiopatologia , Humanos , MasculinoRESUMO
Postextrasystolic potentiation may produce in some situations a negative T wave. This situation is presented in two cases, and it is assumed that this phenomenon may be considered as silent myocardial ischemia.
Assuntos
Complexos Cardíacos Prematuros/diagnóstico , Eletrocardiografia , Isquemia Miocárdica/diagnóstico , Adulto , Complexos Cardíacos Prematuros/tratamento farmacológico , Digoxina/administração & dosagem , Quimioterapia Combinada , Eletrocardiografia/efeitos dos fármacos , Humanos , Dinitrato de Isossorbida/administração & dosagem , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/tratamento farmacológicoRESUMO
Two methods to record preatrial activity, that is, sinus node potential are presented. One, during right atrial catheterization through an electrode catheter, and the other, using transthoracic recordings with a high amplification and derivation of the electric signals. The sinus node potential duration represents the sino-atrial conduction time (SACT), a useful parameter for the sinus node function evaluation.
Assuntos
Função Atrial , Nó Sinoatrial/fisiologia , Cateterismo , Condutividade Elétrica/fisiologia , Eletrodos , Humanos , MétodosRESUMO
Postextrasystolic changes in ventricular depolarization were found in patients with coronary artery disease in two situations: a) after a compensatory postextrasystolic pause and, b) after an interpolated ventricular beat. The explanation and the underlying conditions of this phenomenon are discussed. In our opinion the postextrasystolic change may be a silent myocardial ischemia.