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1.
Methodist Debakey Cardiovasc J ; 16(3): 241-244, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133361

RESUMO

BRASH syndrome is characterized by bradycardia, renal failure, use of an atrioventricular nodal blocker (AVNB), shock, and hyperkalemia. These symptoms represent an ongoing vicious cycle in a patient with a low glomerular filtration rate taking an AVNB. Decreased clearance of the medication and hyperkalemia associated with renal failure synergize to cause bradycardia and hypoperfusion. This reaction causes renal function to worsen, thereby perpetuating the cycle of BRASH syndrome.


Assuntos
Anti-Hipertensivos/efeitos adversos , Nó Atrioventricular/efeitos dos fármacos , Bradicardia/induzido quimicamente , Diltiazem/efeitos adversos , Hiperpotassemia/etiologia , Insuficiência Renal Crônica/complicações , Nó Atrioventricular/fisiopatologia , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Bradicardia/terapia , Feminino , Taxa de Filtração Glomerular , Humanos , Hiperpotassemia/diagnóstico , Hiperpotassemia/fisiopatologia , Hiperpotassemia/terapia , Rim/fisiopatologia , Pessoa de Meia-Idade , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Síndrome , Resultado do Tratamento
3.
Ther Umsch ; 77(8): 385-389, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33054647

RESUMO

Arrhythmia as an Incidental Finding Abstract. An arrhythmic pulse can be determined using clinical or technical examinations such as palpitation and ECG. Due to the rapid spread of wearables, more and more people have the opportunity to derive pulse curves or even ECGs themselves before seeking professional medical care, which increases the number of randomly detected arrhythmic pulse. Incidental findings naturally lead to relevant diagnoses in some of the people affected, but on the other hand they are also psychologically stressful for some individuals. Therefore, it is important to differentiate frequently found common benign causes from the causes with therapeutic consequence and to adequately inform patients about their rhythm. In particular bradyarrhythmias often have no therapeutic consequence as long as the patient remains asymptomatic. Pacemakers are usually only indicated for symptomatic bradycardia. Atrial fibrillation deserves special attention due to its frequency and the fact that, if undetected, this is associated with significantly increased morbidity and mortality. Supraventricular and ventricular extrasystoles increase with age. They are often "idiopathic", but they also can be an expression of still subclinical heart disease.


Assuntos
Fibrilação Atrial , Achados Incidentais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Bradicardia/diagnóstico , Bradicardia/terapia , Eletrocardiografia , Humanos
6.
Rev Cardiovasc Med ; 21(2): 297-301, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32706217

RESUMO

Myxedema coma occurs mostly in patients with long-standing untreated or undertreated hypothyroidism. Bradycardia is a well-known cardiac manifestation for myxedema coma; however, not all bradycardia with hypothyroidism are sinus bradycardia. Sick sinus syndrome is a group of arrhythmias caused by the malfunction of the natural pacemaker of the heart. Tachy-Brady syndrome is considered to be a type of sick sinus syndrome, where the heart alternates between tachycardia and bradycardia, and it is usually treated with pacemaker implantation along with rate slowing medical therapy. Here we report a case of an 83-year-old female who presented with myxedema coma and atrial fibrillation with tachycardia and intermittent slow ventricular response. We attempt to review the relationship between these two diseases and conclude that appropriate diagnosis of myxedema coma, may be beneficial in reducing the need for pacemaker implantation.


Assuntos
Bradicardia/etiologia , Coma/etiologia , Frequência Cardíaca , Hipotireoidismo/complicações , Mixedema/etiologia , Idoso de 80 Anos ou mais , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Bradicardia/terapia , Estimulação Cardíaca Artificial , Coma/diagnóstico , Coma/tratamento farmacológico , Coma/fisiopatologia , Feminino , Frequência Cardíaca/efeitos dos fármacos , Terapia de Reposição Hormonal , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/fisiopatologia , Mixedema/diagnóstico , Mixedema/tratamento farmacológico , Mixedema/fisiopatologia , Índice de Gravidade de Doença , Tiroxina/uso terapêutico , Resultado do Tratamento
7.
Circ Arrhythm Electrophysiol ; 13(8): e008267, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32701363

RESUMO

BACKGROUND: Left bundle branch pacing (LBBP) is a technique for conduction system pacing, but it often results in right bundle branch block morphology on the ECG. This study was designed to assess simultaneous pacing of the left and right bundle branch areas to achieve more synchronous ventricular activation. METHODS: In symptomatic bradycardia patients, the distal electrode of a bipolar pacing lead was placed at the left bundle branch area via a transventricular-septal approach. This was used to pace the left bundle branch area, while the ring electrode was used to pace the right bundle branch area. Bilateral bundle branch area pacing (BBBP) was achieved by stimulating the cathode and anode in various pacing configurations. QRS duration, delayed right ventricular activation time, left ventricular activation time, and interventricular conduction delay were measured. Pacing stability and short-term safety were assessed at 3-month follow-up. RESULTS: BBBP was successfully performed in 22 of 36 patients. Compared with LBBP, BBBP resulted in greater shortening of QRS duration (109.3±7.1 versus 118.4±5.7 ms, P<0.001). LBBP resulted in a paced right bundle branch block configuration, with a delayed right ventricular activation time of 115.0±7.5 ms and interventricular conduction delay of 34.0±8.8 ms. BBBP fully resolved the right bundle branch block morphology in 18 patients. In the remaining 4 patients, BBBP partially corrected the right bundle branch block with delayed right ventricular activation time decreasing from 120.5±4.7 ms during LBBP to 106.1±4.2 ms during BBBP (P=0.005). CONCLUSIONS: LBBP results in a relatively narrow QRS complex but with an interventricular activation delay. BBBP can diminish the delayed right ventricular activation, producing more physiological ventricular activation. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
Potenciais de Ação , Bradicardia/terapia , Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Frequência Cardíaca , Idoso , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Estimulação Cardíaca Artificial/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda , Função Ventricular Direita
10.
Anesth Analg ; 130(5): 1201-1210, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32287127

RESUMO

BACKGROUND: Predictive analytics systems may improve perioperative care by enhancing preparation for, recognition of, and response to high-risk clinical events. Bradycardia is a fairly common and unpredictable clinical event with many causes; it may be benign or become associated with hypotension requiring aggressive treatment. Our aim was to build models to predict the occurrence of clinically significant intraoperative bradycardia at 3 time points during an operative course by utilizing available preoperative electronic medical record and intraoperative anesthesia information management system data. METHODS: The analyzed data include 62,182 scheduled noncardiac procedures performed at the University of Washington Medical Center between 2012 and 2017. The clinical event was defined as severe bradycardia (heart rate <50 beats per minute) followed by hypotension (mean arterial pressure <55 mm Hg) within a 10-minute window. We developed models to predict the presence of at least 1 event following 3 time points: induction of anesthesia (TP1), start of the procedure (TP2), and 30 minutes after the start of the procedure (TP3). Predictor variables were based on data available before each time point and included preoperative patient and procedure data (TP1), followed by intraoperative minute-to-minute patient monitor, ventilator, intravenous fluid, infusion, and bolus medication data (TP2 and TP3). Machine-learning and logistic regression models were developed, and their predictive abilities were evaluated using the area under the ROC curve (AUC). The contribution of the input variables to the models were evaluated. RESULTS: The number of events was 3498 (5.6%) after TP1, 2404 (3.9%) after TP2, and 1066 (1.7%) after TP3. Heart rate was the strongest predictor for events after TP1. Occurrence of a previous event, mean heart rate, and mean pulse rates before TP2 were the strongest predictor for events after TP2. Occurrence of a previous event, mean heart rate, mean pulse rates before TP2 (and their interaction), and 15-minute slopes in heart rate and blood pressure before TP2 were the strongest predictors for events after TP3. The best performing machine-learning models including all cases produced an AUC of 0.81 (TP1), 0.87 (TP2), and 0.89 (TP3) with positive predictive values of 0.30, 0.29, and 0.15 at 95% specificity, respectively. CONCLUSIONS: We developed models to predict unstable bradycardia leveraging preoperative and real-time intraoperative data. Our study demonstrates how predictive models may be utilized to predict clinical events across multiple time intervals, with a future goal of developing real-time, intraoperative, decision support.


Assuntos
Bradicardia/diagnóstico , Hipotensão/diagnóstico , Aprendizado de Máquina/tendências , Monitorização Intraoperatória/tendências , Bradicardia/fisiopatologia , Previsões , Humanos , Hipotensão/fisiopatologia , Monitorização Intraoperatória/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos
11.
Am J Nurs ; 120(5): 45-47, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332366

RESUMO

Editor's note: This is the first in a new series on electrocardiography (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.


Assuntos
Bradicardia , Eletrocardiografia , Fadiga/etiologia , Tiroxina/uso terapêutico , Bradicardia/diagnóstico , Bradicardia/tratamento farmacológico , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade
16.
Dev Med Child Neurol ; 62(5): 563-568, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31872436

RESUMO

Hypoxic-ischaemic insults occurring during or after birth can cause both acute and long-term neurological impairment. The duration of the insult is a critical factor, but most published reports of duration have important limitations. After the onset of a persistent bradycardia in 125 term born infants, abnormal outcomes occurred in two by 10 minutes, in 12 out of 47 (26%) delivered between 11 and 20 minutes, and in 55 out of 65 (85%) delivered after 20 minutes. Series with unspecified gestation or including infants born preterm give comparable results in over 500 additional cases. Before 20 minutes there was little correlation with severity, while after 20 minutes most were severely impaired. Limited neuroimaging data suggest that damage restricted to the basal ganglia and thalamus may begin to occur after 10 minutes, associated Rolandic damage after 15 minutes, and other cortical involvement after 20 minutes. Associated white matter damage can occur after any duration. There were little data for other patterns of damage. WHAT THIS PAPER ADDS: Some term born infants can withstand 20 minutes of fetal bradycardia without acute or chronic damage. Durations in humans are not the same as in animal models.


Assuntos
Encefalopatias/diagnóstico , Lesões Encefálicas/diagnóstico , Hipóxia-Isquemia Encefálica/diagnóstico , Animais , Bradicardia/complicações , Bradicardia/diagnóstico , Encefalopatias/etiologia , Lesões Encefálicas/etiologia , Humanos , Hipóxia-Isquemia Encefálica/complicações , Recém-Nascido , Fatores de Tempo
17.
Trends Cardiovasc Med ; 30(5): 265-272, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31311698

RESUMO

Bradycardia is a commonly observed arrhythmia and a frequent occasion for cardiac consultation. Defined as a heart rate of less than 50-60 bpm, bradycardia can be observed as a normal phenomenon in young athletic individuals, and in patients as part of normal aging or disease (Table 1). Pathology that produces bradycardia may occur within the sinus node, atrioventricular (AV) nodal tissue, and the specialized His-Purkinje conduction system. Given the overlap of heart rate ranges with non-pathologic changes, assessment of symptoms is a critical component in the evaluation and management of bradycardia. Treatment should rarely be prescribed solely on the basis of a heart rate lower than an arbitrary cutoff or a pause above certain duration. In the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay (referred to hereafter as the 2018 Bradycardia Guideline), there was a significant shift in emphasis from prior guidelines that emphasized device-based implantation recommendations to a focus on evaluation and management of disease states [1,2]. In this review, we will highlight the changes in the new guideline as well as describe the key elements in evaluation and management of patients presenting with bradycardia.


Assuntos
Bloqueio Atrioventricular/terapia , Bradicardia/terapia , Estimulação Cardíaca Artificial , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Marca-Passo Artificial , Síndrome do Nó Sinusal/terapia , Potenciais de Ação , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Estimulação Cardíaca Artificial/efeitos adversos , Tomada de Decisão Clínica , Humanos , Seleção de Pacientes , Síndrome do Nó Sinusal/diagnóstico , Síndrome do Nó Sinusal/fisiopatologia , Resultado do Tratamento
18.
Anesth Analg ; 130(3): 685-695, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30896593

RESUMO

BACKGROUND: The anticholinesterase neostigmine and the muscarinic inhibitor glycopyrrolate are frequently coadministered for the reversal of neuromuscular blockade. This practice can precipitate severe bradycardia or tachycardia, but whether it affects the incidence of cardiovascular complications remains unclear. We hypothesized that anticholinesterase reversal with neostigmine and glycopyrrolate versus no anticholinesterase reversal increases the risk of postoperative cardiovascular complications among adult patients undergoing noncardiac surgery with general anesthesia. METHODS: We conducted a prespecified retrospective analysis of hospital registry data from a major health care network for patients undergoing surgery with general anesthesia from January 2007 to December 2015. The primary outcome was a composite of cardiac dysrhythmia, acute heart failure, transient ischemic attack, ischemic stroke, and acute myocardial infarction within 30 days after surgery. We performed sensitivity analyses in subgroups and propensity score adjustment and explored the association between exposure and outcome in subgroups of patients with high risk of cardiovascular complications. RESULTS: Of the 98,147 cases receiving neuromuscular blockade, 73,181 (74.6%) received neostigmine and glycopyrrolate, while 24,966 (25.4%) did not. A total of 5612 patients (7.7%) in the anticholinesterase reversal group and 1651 (6.6%) in the control group (P < .001) experienced the primary outcome. After adjustment for clinical covariates, neostigmine and glycopyrrolate exposure was significantly associated in a dose-dependent fashion (P for trend <.001, respectively) with tachycardia (adjusted odds ratio = 2.1 [95% CI, 1.97-2.23]; P < .001) and bradycardia (adjusted odds ratio = 2.84 [95% CI, 2.49-3.24]; P < .001) but not with postoperative cardiovascular complications (adjusted odds ratio = 1.03 [95% CI, 0.97-1.1]; P = .33). We identified a significant effect modification of anticholinesterase reversal by high age, high-risk surgery, and history of atrial fibrillation (P for interaction = .002, .001, and .02, respectively). By using linear combinations of main effect and exposure-risk interaction terms, we detected significant associations between anticholinesterase reversal and cardiovascular complications toward a higher vulnerability in these patient subgroups. CONCLUSIONS: Neuromuscular blockade reversal with neostigmine and glycopyrrolate was associated with an increased incidence of intraoperative tachycardia and bradycardia but not with 30-day postoperative cardiovascular complications. Exploratory analyses suggest that a high postoperative cardiovascular complication risk profile may modify the effects of anticholinesterase reversal toward clinical relevance.


Assuntos
Anestesia Geral/efeitos adversos , Bradicardia/induzido quimicamente , Inibidores da Colinesterase/efeitos adversos , Glicopirrolato/efeitos adversos , Frequência Cardíaca/efeitos dos fármacos , Antagonistas Muscarínicos/efeitos adversos , Neostigmina/efeitos adversos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Taquicardia/induzido quimicamente , Adulto , Idoso , Boston/epidemiologia , Bradicardia/diagnóstico , Bradicardia/epidemiologia , Bradicardia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taquicardia/diagnóstico , Taquicardia/epidemiologia , Taquicardia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
19.
Epileptic Disord ; 21(6): 598-602, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31829303

RESUMO

Ictal asystole is a rare epileptic phenomenon, though usually self-limiting, which has been associated with an increased risk of sudden death in epileptic patients. Although early recognition is desirable, the diagnosis can be delayed until prolonged video-EEG monitoring is completed. We report a case of ictal asystole in a 74-year-old patient with co-morbid cardiac conditions leading to a delay in diagnosis of approximately 10 years. Indeed, multiple cardiac investigations and EEGs failed to reveal that the recurrent syncope was seizure induced. A detailed description of the case with an emphasis on the prolonged diagnostic process, as well as the clinical and EEG findings, is provided. This case highlights the complexity of the diagnosis of some ictal asystole cases and the need to perform continuous video-EEG monitoring for confirmation. [Published with video sequence].


Assuntos
Bradicardia/diagnóstico , Diagnóstico Tardio , Epilepsia do Lobo Temporal/diagnóstico , Parada Cardíaca/diagnóstico , Idoso , Bradicardia/etiologia , Eletroencefalografia , Epilepsia do Lobo Temporal/complicações , Parada Cardíaca/etiologia , Humanos , Masculino
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