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1.
Tohoku J Exp Med ; 248(4): 307-311, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31462599

RESUMO

Hypothyroidism is rarely included in the differential diagnosis for fetal sinus bradycardia. We report an infant with congenital hypothyroidism caused by ectopic thyroid tissue, who showed antenatal bradycardia. The baseline fetal heart rate was 100-110 bpm at 30 weeks of gestation, and fetal echocardiography revealed sinus bradycardia but no cardiac anomalies. Maternal thyroid function was normal (thyroid-stimulating hormone [TSH] 2.03 µIU/ml, free T3 2.65 pg/ml, and free T4 0.99 ng/dl) when measured at 31 weeks of gestation. Her serum anti SS-A and SS-B antibodies, anti-thyroglobulin, and microsomal antibodies were negative. A male infant without cardiac anomalies was delivered at 35 weeks and 4 days of gestation and admitted for prematurity and respiratory distress syndrome. The infant's heart rate was 70-110 bpm (normal: 120-160 bpm) on admission. On 8 days of age, thyroid function tests revealed that the infant had severe hypothyroidism (TSH 903.3 µIU/ml, free T3 1.05 pg/ml, and free T4 0.26 ng/dl). The prolonged jaundice assumed to be due to hypothyroidism. Oral levothyroxine sodium hydrate (10 µg/kg/day) was immediately started on day 8. After the treatment, the heart rate was gradually increased to 130-140 bpm as the infant's thyroid function was improved (TSH 79.8 µIU/ml, free T3 2.95 pg/dl, and free T4 1.66 ng/dl on day 22). The infant was diagnosed ectopic thyroid tissue because of the high thyroglobulin level (85.9 µg/l). In conclusion, congenital hypothyroidism should be included in the differential diagnosis in cases of fetal bradycardia without cardiac anomalies or maternal autoimmune diseases.


Assuntos
Bradicardia/complicações , Coristoma/complicações , Hipotireoidismo Congênito/complicações , Seio Coronário/anormalidades , Feto/anormalidades , Glândula Tireoide/anormalidades , Bradicardia/diagnóstico por imagem , Eletrocardiografia , Feminino , Humanos , Lactente , Recém-Nascido , Extremidade Inferior/diagnóstico por imagem , Masculino , Pescoço/diagnóstico por imagem
2.
J Int Med Res ; 47(5): 2228-2233, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30832535

RESUMO

Thalidomide is effective in inducing and maintaining clinical remission, as well as mucosal healing, in patients with refractory Crohn's disease (CD). However, long-term use of thalidomide has raised concern because of the high incidence of adverse events. Cardiovascular events induced by thalidomide have been reported in patients with multiple myeloma, amyotrophic lateral sclerosis, and transfusion-dependent refractory anemia. We report here an extremely rare case of sinus bradycardia induced by thalidomide in an adult patient with CD. This patient's heart rate converted back to a normal sinus rhythm after withdrawal of thalidomide, but recurred after restarting of thalidomide. Cardiac toxicity should be closely monitored when using thalidomide in patients with CD.


Assuntos
Bradicardia/induzido quimicamente , Bradicardia/complicações , Seio Coronário/patologia , Doença de Crohn/complicações , Doença de Crohn/tratamento farmacológico , Talidomida/efeitos adversos , Talidomida/uso terapêutico , Adulto , Bradicardia/fisiopatologia , Frequência Cardíaca , Humanos , Mucosa Intestinal/patologia , Masculino
3.
J Pak Med Assoc ; 69(2): 264-266, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30804598

RESUMO

Persistent left superior vena cava (PLSVC) is one of the commonest venous anomalies of thoracic venous system. These cases usually have normal right sided superior vena cava (SVC). Patients with PLSVC are often asymptomatic hence, it is diagnosed as an incidental finding during procedures like central venous line placement or pacemaker implantation. We report here a case that was taken to catheterization laboratory for pacemaker implantation. Due to PLSVC, we struggled to advance pacing lead into right ventricular apex. We thought of right subclavian vein access but contrast medium injection revealed absent right sided SVC. So procedure was abandoned and finally epicardial placement of the pacing lead was done through subxiphoid laparotomy incision next morning. This case report highlights a rare variant of PLSVC with absent right sided SVC in structurally normal heart and emphasizes the need of pre-procedure assessment of venous anatomy.


Assuntos
Bradicardia/complicações , Cateterismo Venoso Central , Marca-Passo Artificial , Implantação de Prótese , Malformações Vasculares/diagnóstico , Veia Cava Superior , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Bradicardia/cirurgia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Humanos , Achados Incidentais , Cuidados Intraoperatórios/métodos , Masculino , Pessoa de Meia-Idade , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Resultado do Tratamento , Veia Cava Superior/anormalidades , Veia Cava Superior/diagnóstico por imagem
4.
Medicine (Baltimore) ; 97(50): e13629, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30558049

RESUMO

RATIONALE: Co-occurrence of headache and arrhythmia is not rare. However, their causal relationship remains unclear. Here, we described a case of migraine-like headache relieving with pacemaker implantation. Our case study indicates that arrhythmia is causal for migraine-like headache, which, to our knowledge, has never been reported. PATIENT CONCERNS: A 63-year-old woman patient suffered from paroxysmal headache with a visual aura presenting like migraine for 2 years. No ophthalmic or neurological disorder was found, but cardiac examination detected bradycardia, which was confirmed by 24-hour dynamic electrocardiogram (DCG) revealing sinus bradycardia mixed with ventricular premature beats and supraventricular tachycardia. Transcranial doppler (TCD) detected an equal echo flat plaque on the anterolateral wall of the common carotid artery (CA) bifurcation. DIAGNOSIS: Migraine-like headaches secondary to arrhythmia. INTERVENTIONS: The patient underwent pacemaker implantation. OUTCOMES: Both visual aura and headache were resolved following pacemaker implantation. LESSONS: To the best of the authors' knowledge, we are the first to report migraine-like headache as a secondary symptom of arrhythmia. Arrhythmia may aggravate insufficient blood supply to the brain due to CA lesion and induce a migraine-like headache. This case study indicated that pacemaker implantation could be a fundamental treatment for migraine-like headaches caused by cardiac arrhythmia.


Assuntos
Bradicardia , Transtornos da Cefaleia Secundários , Enxaqueca com Aura/diagnóstico , Marca-Passo Artificial , Taquicardia Supraventricular , Complexos Ventriculares Prematuros , Bradicardia/complicações , Bradicardia/diagnóstico , Bradicardia/terapia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/patologia , Diagnóstico Diferencial , Eletrocardiografia Ambulatorial/métodos , Feminino , Transtornos da Cefaleia Secundários/diagnóstico , Transtornos da Cefaleia Secundários/etiologia , Transtornos da Cefaleia Secundários/terapia , Humanos , Pessoa de Meia-Idade , Taquicardia Supraventricular/complicações , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/terapia , Resultado do Tratamento , Ultrassonografia Doppler Transcraniana/métodos , Complexos Ventriculares Prematuros/complicações , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/terapia
6.
Cardiol Young ; 28(11): 1375-1377, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30070198

RESUMO

Steroids are used in the treatment of acute rheumatic fever with moderate-to-severe carditis. Corticosteroids have several cardiovascular side affects that are more common in adults than in children. Corticosteroid-related bradycardia is a rarely seen side effect. Children with bradycardia following oral corticosteroid use are rarely reported previously. We present a child who developed bradycardia after oral corticosteroid treatment and concurrent Wolff-Parkinson-White pattern.


Assuntos
Bradicardia/induzido quimicamente , Prednisolona/efeitos adversos , Febre Reumática/tratamento farmacológico , Síndrome de Wolff-Parkinson-White/etiologia , Administração Oral , Bradicardia/complicações , Criança , Ecocardiografia , Eletrocardiografia Ambulatorial , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Humanos , Prednisolona/administração & dosagem , Febre Reumática/complicações , Fatores de Tempo , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/fisiopatologia
7.
Clin Cardiol ; 41(8): 1097-1102, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29920728

RESUMO

Rate-related left bundle branch block (LBBB) is a well-studied phenomenon. Cardiac memory is another physiologic phenomenon in which T-wave abnormalities occur in the absence of ischemia. The association between these 2 phenomena has been described in several case reports. A literature review was performed through Ovid and PubMed, where at total of 93 cases of rate-related LBBB were identified. Cases were reviewed, and data were collected on rates of appearance and disappearance as well as the presence or absence of cardiac memory. There is some overlap in the rate at which LBBB appears. Cardiac memory is associated with rate-related LBBB in several cases, but its true prevalence is unknown. Cardiac memory is a phenomenon that is well described in the literature but is often underrecognized in clinical practice. As a consequence of overlooking this phenomenon and not including cardiac memory in the differential when T-wave abnormalities are observed, patients may be subjected to unnecessary invasive diagnostic testing.


Assuntos
Bradicardia/fisiopatologia , Bloqueio de Ramo/fisiopatologia , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca/fisiologia , Bradicardia/complicações , Bloqueio de Ramo/etiologia , Feminino , Humanos , Pessoa de Meia-Idade
10.
Europace ; 20(10): 1692-1698, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29579189

RESUMO

Aims: Cardiac atrial arrhythmias are the most common type of heart rhythm disorders. Its genetic elucidation remains challenging with poor understanding of cellular and molecular processes. These arrhythmias usually affect elderly population but in rare cases, young children may also suffer from such electrical diseases. Severe complications, including stroke, are commonly age related. This study aims to identify a genetic link between electro-mechanic atrial dysfunction and stroke in children. Methods and results: In two unrelated boys of 11 and 14 years with both stroke and atrial arrhythmias, the clinical phenotype was determined through a complete physical examination, electrocardiogram (ECG), Holter ECG, and computed tomography. The genetic testing was performed on a large 95 genes panel implicated in myocardial electrical imbalance, using the next generation sequencing method. The panel also includes the genes usually associated with the development of cardiomyopathies. In one child, a left atrial dilation was observed. The 2nd boy suffered from atrial standstill. Both suffered from atrial bradycardia, flutter, and fibrillation. The complete genetic testing revealed the SCN5A c.3823G>A (p.D1275N) mutation in the first family, c.1141-2A>G and c.3157G>A (p.E1053K) mutations in the second family. Conclusion: Our results strengthen the association between Nav1.5 mutations and the occurrence of stroke in young patients. It emphasizes the need to look for atrial myopathy in the decision process for anticoagulation in young patients with atrial arrhythmic events.


Assuntos
Fibrilação Atrial/complicações , Flutter Atrial/complicações , Função do Átrio Esquerdo , Bradicardia/complicações , Cardiomiopatias/complicações , Doenças Genéticas Inatas/complicações , Átrios do Coração/anormalidades , Bloqueio Cardíaco/complicações , Acidente Vascular Cerebral/etiologia , Adolescente , Arritmias Cardíacas/complicações , Arritmias Cardíacas/genética , Arritmias Cardíacas/fisiopatologia , Fibrilação Atrial/genética , Fibrilação Atrial/fisiopatologia , Flutter Atrial/genética , Flutter Atrial/fisiopatologia , Bradicardia/genética , Bradicardia/fisiopatologia , Cardiomiopatias/genética , Cardiomiopatias/fisiopatologia , Criança , Eletrocardiografia , Doenças Genéticas Inatas/genética , Doenças Genéticas Inatas/fisiopatologia , Átrios do Coração/fisiopatologia , Bloqueio Cardíaco/genética , Bloqueio Cardíaco/fisiopatologia , Humanos , Masculino , Mutação , Canal de Sódio Disparado por Voltagem NAV1.5/genética , Fenótipo
11.
Kardiol Pol ; 76(2): 347-352, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29192954

RESUMO

BACKGROUND: Cardioinhibitory syncope is related with excessive bradycardia or asystole due to parasympathetic response. AIM: We investigated whether patients with cardioinhibitory syncope have higher heart rate recovery index (HRRi) considered as a parasympathetic system activation in exercise stress testing (EST) than in those with other neurogenic syncope forms. METHODS: A total of 262 patients who had neurogenic syncope documented by head-up tilt test (HUTT) and 199 healthy control individuals were examined. A maximal EST was applied to all patients after the HUTT. The HRRi was obtained by subtracting the heart rate that was measured at the first (HRRi-1), second (HRRi-2), and third minute (HRRi-3) of the recovery period from the maximal heart rate that was measured during the test. RESULTS: Eighty patients had cardioinhibitory syncope, 118 patients had vasodepressor syncope, and 64 patients had mixed-type syncope. The HRRi-1 was higher in patients with syncope (43.3 ± 7.7) compared to the control group (34.5 ± 4.8; p < 0.001). Post hoc analysis showed that among the syncope groups, there was no difference between patients with vasodepressor syncope (42.2 ± 7.6) and those with mixed type syncope (40.7 ± 4.1) in terms of HRRi-1 (p = 0.420). However, patients with cardioinhibitory syncope (47 ± 8.7) had a higher HRRi-1 than vasodepressor and mixed-type syncope groups (p < 0.05). The threshold value of the HRRi-1, which can be used for the prediction of cardioinhibitory syncope development, was determined to be 41 with 75% sensitivity and 72% specificity. CONCLUSIONS: The HRRi-1 was higher in patients with cardioinhibitory syncope compared to the controls. The HRRi-1 has the predictive feature of differentiating cardioinhibitory syncope from other syncope types.


Assuntos
Frequência Cardíaca , Síncope Vasovagal/fisiopatologia , Adolescente , Adulto , Bradicardia/complicações , Feminino , Humanos , Masculino , Síncope Vasovagal/etiologia , Teste da Mesa Inclinada , Adulto Jovem
12.
Adv Exp Med Biol ; 1067: 255-269, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29280096

RESUMO

Patients with heart failure (HF) may develop a range of bradyarrhythmias including sinus node dysfunction, various degrees of atrioventricular block, and ventricular conduction delay. Device implantation has been recommended in these patients, but the specific etiology should be sought as it may influence the choice of the type of device required (pacemaker vs. implantable cardiac defibrillator). Also, pacing mode must be carefully set in patients with heart failure (HF) and left ventricular systolic dysfunction.In this chapter, we summarize the knowledge required for a tailored approach to bradyarrhythmias in patients with heart failure.


Assuntos
Bradicardia/complicações , Insuficiência Cardíaca/complicações , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Bradicardia/terapia , Estimulação Cardíaca Artificial , Humanos
13.
Eur J Clin Nutr ; 72(1): 168-169, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28901332

RESUMO

A diagnosis of Wernicke's encephalopathy (WE) is difficult. Transient hypotension has been reported as a rare complication of WE. We herein report a case of prolonged hypotension and dysuautonomia associated with WE in a 69-year-old man with underlying alcohol abuse. Without apparent etiology of shock, this patient remained hypotensive for 9 days, requiring a vasopressor, despite daily administration of thiamine 600 mg. Fluctuation of blood pressure caused by postural change and bradycardia in the presence of shock indicated that this patient had dysautonomia. This case hereby proposes a possible association between hypotension, dysautonomia and Wernicke's encephalopathy.


Assuntos
Hipotensão/complicações , Encefalopatia de Wernicke/complicações , Idoso , Alcoolismo/complicações , Doenças do Sistema Nervoso Autônomo/complicações , Bradicardia/complicações , Bradicardia/tratamento farmacológico , Dobutamina/administração & dosagem , Humanos , Hipotensão/tratamento farmacológico , Japão , Masculino , Norepinefrina/administração & dosagem , Choque/complicações , Tiamina/administração & dosagem , Deficiência de Tiamina/complicações , Deficiência de Tiamina/tratamento farmacológico , Encefalopatia de Wernicke/diagnóstico
14.
Neurogastroenterol Motil ; 30(5): e13278, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29266638

RESUMO

BACKGROUND: Cardiorespiratory (CR) events (apnea, bradycardia, oxygen desaturation) and gastroesophageal reflux (GER) symptoms often coexist in infants admitted to Neonatal Intensive Care Unit, leading to over-prescription of drugs and delayed discharge. We aimed to evaluate the relationships between CR and GER events. METHODS: The temporal associations between CR and GER events were analyzed in symptomatic infants who underwent synchronized CR and pH-impedance monitoring. The symptom association probability (SAP) index was used to identify infants with a significant number of temporal associations. Gastroesophageal reflux characteristics and the chronological sequence of CR and GER events occurring within 30 seconds of each other were evaluated according to SAP index. KEY RESULTS: Of the 66 infants enrolled, aged 29 (18-45) days, 58 had CR events during monitoring. From these 58 patients, a total of 1331 CR events and 5239 GER (24% acidic) were detected. The SAP index was positive in seven (12%) infants. These infants had greater GER frequency, duration, and proximal extent (P < .05). The number of temporal associations was 10 times greater in the positive SAP group. Gastroesophageal reflux events preceded CR events in 83% of these associations. These GER events had a higher proximal extent (P = .004), but showed no differences in pH values. CONCLUSIONS & INFERENCES: The simultaneous evaluation of CR and GER events could be useful to identify infants with severe GER and significant temporal associations between these events. Treatment of GER could be indicated in these infants, but as the GER events involved are mainly non-acidic, empirical treatment with antacids is, often, inappropriate.


Assuntos
Apneia/complicações , Bradicardia/complicações , Refluxo Gastroesofágico/complicações , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Avaliação de Sintomas
15.
G Ital Cardiol (Rome) ; 18(11): 774-780, 2017 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-29105672

RESUMO

Sick sinus syndrome (SSS) can be diagnosed only when there is a clear correlation between symptoms and sinus node dysfunction. In the absence of such correlation, the mechanism of undocumented intermittent symptoms such as syncopal spells in patients with permanent mild sinus bradycardia remains uncertain. Some clinical data suggest that a reflex mechanism is likely to be involved in many patients with syncope and sinus bradycardia: the course of syncopal recurrences is very variable from patient to patient and transient loss of consciousness does not recur in more than half of unpaced patients during an observation period of several years. The results of some studies seem to confirm a reflex mechanism as the cause of syncope in most cases: in patients with SSS and syncope the prevalence of positive response to tilt testing was high (~60%) and significantly higher than in patients with SSS without syncope and in other control groups. However, a depressed sinus node automaticity, roughly expressed by very prolonged sinus node recovery time, suggests a role of sinus node dysfunction in the origin of syncope. Patients with permanent mild sinus bradycardia and syncope as an isolated symptom should undergo tilt testing and electrophysiological study. In the presence of positive tilt test without very prolonged sinus node recovery time, the patient should be managed as the patients with neurally mediated syncope and normal sinus rate.


Assuntos
Bradicardia/fisiopatologia , Bradicardia/terapia , Síndrome do Nó Sinusal/fisiopatologia , Síndrome do Nó Sinusal/terapia , Bradicardia/complicações , Bradicardia/diagnóstico , Humanos , Guias de Prática Clínica como Assunto , Síndrome do Nó Sinusal/complicações , Síndrome do Nó Sinusal/diagnóstico , Síncope/etiologia , Teste da Mesa Inclinada
17.
Am J Trop Med Hyg ; 97(5): 1316-1318, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29016300

RESUMO

To investigate the relationship between heart rate and temperature, we examined 493 febrile patients with documented disease. These patients were diagnosed serologically and analyzed retrospectively: 337 (68.4%) responded to fever with increased heart rate < 10 beats/minute/°C (relative bradycardia [RB]), and 156 patients had a heart rate response ≥ 10 beats/minute/°C (general heart rate increase [GHRI]). The RB group had a higher median resting heart rate and lower heart rate at maximum temperature than the GHRI group. Despite differences in heart rate response, no significant differences were seen in clinical outcomes (acute kidney injury, systemic inflammatory response syndrome (SIRS), and death). We concluded that most patients with scrub typhus presented with RB. In scrub typhus infection, RB can be included as one of the clinical features for differential diagnosis from other infectious diseases.


Assuntos
Bradicardia/diagnóstico , Tifo por Ácaros/diagnóstico , Idoso , Temperatura Corporal , Bradicardia/complicações , Diagnóstico Diferencial , Feminino , Febre/diagnóstico , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tifo por Ácaros/complicações
18.
Pediatrics ; 140(5)2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28982711

RESUMO

A 20-month-old girl with a complex chromosomal disorder had first presentation of febrile status epilepticus and was admitted to the hospital. Two days after her initial seizure, she died suddenly and unexpectedly during a video EEG monitoring study. An advanced analysis of the physiologic changes in the hours and minutes leading up to death was undertaken. The electrocardiography over the last 19 minutes of life was reviewed, and the R-R intervals were manually measured. Heart rate variability was assessed through calculation of the SD of the R-R intervals and the root mean square of successive differences over successive 100 beat periods. Instantaneous heart rate, SD of the R-R intervals, the root mean square of successive differences, and oxygen saturation were plotted against time over the last 19 minutes of life. Diffuse cerebral suppression on EEG was observed 10 minutes before death, followed minutes later by severe bradycardia and increased heart rate variability. Although the child did not meet criteria for a diagnosis of epilepsy, the sequence of physiologic changes leading up to death suggests a pathophysiology similar to sudden unexplained death in epilepsy. A comparable pattern of diffuse cerebral suppression preceding parasympathetic overactivity has been suggested in some rare cases of adults who have experienced sudden unexplained death in epilepsy during video EEG monitoring.


Assuntos
Bradicardia/fisiopatologia , Encéfalo/fisiopatologia , Morte Súbita , Eletroencefalografia , Convulsões Febris/fisiopatologia , Índice de Gravidade de Doença , Bradicardia/complicações , Bradicardia/diagnóstico , Eletroencefalografia/tendências , Feminino , Humanos , Convulsões Febris/complicações , Convulsões Febris/diagnóstico , Adulto Jovem
19.
Yonsei Med J ; 58(6): 1216-1221, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29047247

RESUMO

PURPOSE: We aimed to establish the propofol effect-site concentration (Ce) for appropriate sedation by pharmacodynamic analysis and to determine the propofol Ce during occurrence of sedation-related side effects in pediatric patients undergoing brain magnetic resonance imaging (MRI). MATERIALS AND METHODS: In 50 pediatric patients scheduled for brain MRI, sedation was induced with 2.0 mg/kg propofol; additional propofol doses were 0.5-1 mg/kg. Propofol Ce was simulated by inputting the propofol administration profiles of patients into a pediatric compartmental model (Choi model). The relationship between propofol Ce and probabilities of sedation and recovery were analyzed using a sigmoidal Emax model. The simulated propofol Ce for sedation-related side effects was investigated. Population model parameters were estimated using the Nonlinear Mixed-Effects Modelling software. RESULTS: The mean values of propofol Ce50 for sedation during the preparation, scanning, and recovery phases were 1.23, 0.43, and 0.39 µg/mL. The simulated propofol Ce values during oxygen desaturation (SpO2 <90%) (3 patients; 6%), hypotension (16 patients; 32%), and bradycardia (12 patients; 24%) were 3.01±0.04, 2.05±0.63, and 2.41±0.89 µg/mL, respectively. CONCLUSION: The required propofol Ce50 for applying monitors during the preparation phase before the start of MRI was higher than the propofol Ce50 required during the scanning phase. During low-intensity stimulation phases, such as scanning, propofol bolus dose should be strictly titrated not to exceed the propofol Ce that can lead to oxygen desaturation because of the relatively low propofol Ce (Ce95, 1.43 µg/mL) required for sedation in most patients.


Assuntos
Encéfalo/diagnóstico por imagem , Hipnóticos e Sedativos/farmacologia , Modelos Biológicos , Propofol/farmacologia , Adolescente , Anestesia , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/farmacologia , Bradicardia/complicações , Criança , Relação Dose-Resposta a Droga , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipotensão/induzido quimicamente , Imagem por Ressonância Magnética , Masculino , Probabilidade , Propofol/administração & dosagem
20.
Int Heart J ; 58(5): 724-730, 2017 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-28966312

RESUMO

Although right ventricular (RV) pacing is the only effective treatment for patients with symptomatic bradycardia, it creates left ventricular (LV) dyssynchrony, which can induce LV dysfunction and heart failure. The current criterion for consideration of cardiac resynchronization therapy (CRT) is LV ejection fraction (LVEF) ≤ 35%, but indication for CRT in patients required for RV pacing with LVEF > 35% remains unclear.We studied 40 patients, all LVEF ≥ 35%, who had undergone implantable cardioverter-defibrillator implantation with RV pacing < 5%. Echocardiography was performed at baseline and during RV pacing. LV dyssynchrony was defined as anteroseptal-to-posterior wall delay from the mid-LV short-axis view using two-dimensional speckle-tracking radial strain (significant: ≥ 130 ms). Patients were divided into two groups based on baseline LVEF: normal LVEF ( ≥ 50%; n = 20) and mildly reduced LVEF (35-50%; n = 20).LVEF and LV dyssynchrony in patients with mildly reduced LVEF deteriorated significantly during RV pacing compared to those in patients with normal LVEF. Moreover, changes in LV dyssynchrony during RV pacing significantly correlated with changes in LVEF (r = -0.44, P < 0.01). Multivariate logistic regression analysis showed that baseline LVEF was the only independent predictor and baseline LVEF < 48% predictive of significant LV dyssynchrony during RV pacing.The extent of RV pacing-induced LV dysfunction may be associated with baseline LV function. These adverse effects on patients with mildly reduced LVEF of 35-50% and indications for RV pacing due to bradycardia can thus be prevented by CRT.


Assuntos
Bradicardia/complicações , Estimulação Cardíaca Artificial/métodos , Ventrículos do Coração/fisiopatologia , Medição de Risco/métodos , Disfunção Ventricular Direita/etiologia , Função Ventricular Esquerda/fisiologia , Idoso , Bradicardia/fisiopatologia , Bradicardia/terapia , Ecocardiografia , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Incidência , Japão/epidemiologia , Masculino , Prognóstico , Estudos Prospectivos , Fatores de Risco , Volume Sistólico/fisiologia , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/epidemiologia
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