Accelerated isorhythmic ventricular rhythms
TL;DR: It is concluded that the various arrhythmias having the common feature of a relatively rapid idioventricular rate are determined by a multitude of mechanisms including parasystole, atrioventricular dissociation with an id Gioventricular focus and also a mechanism similar to that of the demand or stand-by ventricular pacemakers.
Abstract: Thirty cases of accelerated ventricular rhythms occurring in patients with a variety of cardiac diseases and in normal individuals are presented. Acute myocardial infarction was present in only 4 cases. The attribute “isorhythmic” is suggested to underline the constant and important feature of equality or proximity of the rate of the ectopic ventricular pacemaker and that of the dominant rhythm. It is shown that an identical arrhythmia can easily be produced by electrical stimulation of the ventricle at an isorhythmic rate and that an isorhythmic ectopic atrial pacemaker is capable of producing a similar arrhythmia involving the atria only. The benign nature of the arrhythmia and the underlying reasons are pointed out. Three cases are presented of an unusual type of isorhythmic ventricular rhythm caused by propulsion of the catheter tip toward the right ventricular endocardium at the time of atrial contraction. It is concluded that the various arrhythmias having the common feature of a relatively rapid idioventricular rate are determined by a multitude of mechanisms including parasystole, atrioventricular dissociation with an idioventricular focus and also a mechanism similar to that of the demand or stand-by ventricular pacemakers.
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TL;DR: Atropine is the drug of choice for management of patients with SB and hypotension and is effective in the treatment of ventricular arrhythmias as well as conduction disturbances in patients with inferior myocardial infarction.
Abstract: Fifty-six patients with acute myocardial infarction complicated by sinus bradycardia (SB) were treated with intravenous atropine and monitored in a coronary care unit. Atropine decreased or completely abolished premature ventricular contractions (PVCs) and/or bouts of accelerated idioventricular rhythm in 27 of 31 patients (87%) and brought systemic blood pressure up to normal in 15 of 17 patients (88%) with hypotension. In addition, atropine administration was associated with improved atrioventricular conduction in 11 of 13 patients (85%) with acute inferior myocardial infarction associated with 2 degrees or 3 degrees atrioventricular block. Seven patients developed ten significant adverse effects: ventricular tachycardia or fibrillation in three, sustainedsinus tachycardia in three, increased PVCs in three, and toxic psychosis in one. These major adverse effects correlated with either a higher initial dose of atropine (i.e., 1.0 mg aa compared with the usual 0.5 or 0.6 mg) or a total cumulative dose exceeding 2.5 mg over 21/2 hours. Atropine is the drug of choice for management of patients with SB and hypotension and is effective in the treatment of ventricular arrhythmias as well as conduction disturbances in patients with inferior myocardial infarction. Serious adverse effects, however, preclude use of atropine without careful medical supervision.
87 citations
TL;DR: The value of the accelerated idioventricular rhythm (AIVR) as a marker for myocardial necrosis and/or reperfusion was prospectively studied in 87 patients admitted with persistent ischemic chest pain and the QRS configuration may be useful for the noninvasive identification of the infarct vessel.
Abstract: The value of the accelerated idioventricular rhythm (AIVR) as a marker for myocardial necrosis and/or reperfusion was prospectively studied in 87 patients admitted with persistent ischemic chest pain. All patients received streptokinase. Necrosis was diagnosed by new Q waves and an increase in plasma enzymes. Reperfusion was documented angiographically. Myocardial necrosis occurred in 72 patients and reperfusion in 70 patients, 58 of whom had myocardial necrosis. Of 27 patients with AIVR, 26 had both necrosis and reperfusion (p < 0.001).
83 citations
TL;DR: A reversed pulsus paradoxus is observed in three unrelated clinical circumstances: idiopathic hypertrophic subaortic stenosis, isorhythmic ventricular rhythms and during intermittent inspiratory positive-pressure breathing in the presence of left ventricular failure.
Abstract: The term "reversed pulsus paradoxus" may be used to describe an inspiratory rise of the arterial systolic and diastolic pressures, presumably related to an inspiratory increase in left ventricular stroke output. We have observed a reversed pulsus paradoxus in three unrelated clinical circumstances: idiopathic hypertrophic subaortic stenosis, isorhythmic ventricular rhythms and during intermittent inspiratory positive-pressure breathing in the presence of left ventricular failure. These unusual respiration-related fluctuations of blood pressure must be differentiated from the usual pulsus paradoxus of cardiac tamponade. (N Engl J Med 289:1272–1275, 1973)
76 citations
TL;DR: Therapy effectively abolished ventricular tachycardia and greatly decreased the number of premature ventricular complexes in the symptomatic patients but was less effective in the asymptomatic patients.
Abstract: Thirty-eight patients aged 1 to 20 years (mean 11.2) were evaluated because of recurrent ventricular tachycardia. The follow-up period ranged from 0.5 to 12 years (mean 6). The patients were separated into two groups according to the presence or absence of known structural heart disease. Seventeen of the 21 patients with known heart disease were symptomatic (cardiac arrest in 5, syncope in 5, dizziness in 7) compared with only 6 of the 17 patients without heart disease (syncope in 3 and dizziness in 3) (p Antiarrhythmic therapy was used in 28 of the 38 patients. Effectiveness of therapy was assessed with both 24 hour Holter monitoring and graded treadmill exercise testing. Therapy effectively abolished ventricular tachycardia and greatly decreased the number of premature ventricular complexes in the symptomatic patients but was less effective in the asymptomatic patients. Thus, this study suggests that the presence of underlying heart disease, the rate of ventricular tachycardia and the results of graded treadmill exercise tests are important in predicting the prognosis of children with ventricular tachycardia.
56 citations
TL;DR: AIVR became manifest when the heart rate was slowed by increasing vagal tone, premature atrial stimulation, and high degree atrioventricular (A-V) block and could be suppressed and 1:1 A-V conduction established by increasing the atrial rate with atropine or by atrial pacing.
Abstract: Accelerated idioventricular rhythms (AIVR) are ectopic ventricular rhythms with rates intermediate between idioventricular escape rhythms (30 to 40/min) and ventricular tachycardia (120 to 180/min). Differentiation of AIVR from supraventricular arrhythmias rests primarily on demonstration of their ventricular origin. His bundle electrograms (HBE) were recorded in four patients during AIVR. HBE verified the idioventricular nature of the ectopic rhythm and excluded supraventricular rhythm with aberration as a cause. In addition, they permitted the recognition of normally conducted sinus beats, fusion beats, and idioventricular beats. The pacemaker site for the AIVR was below the bundle of His. AIVR became manifest when the heart rate was slowed by increasing vagal tone, premature atrial stimulation, and high degree atrioventricular (A-V) block. AIVR could be suppressed and 1:1 A-V conduction established by increasing the atrial rate with atropine or by atrial pacing.
51 citations
References
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TL;DR: Books and internet are the recommended media to help you improving your quality and performance.
329 citations
TL;DR: Electrocardiograms in this series of patients confirm two opinions: that arteriosclerosis occurs in young people, often to a degree that impairs coronary circulation and may produce a myocardial infarction; and that a significant portion of all infarctions occur without symptoms or with vague symptoms that are not related to the heart.
Abstract: Myocardial infarction as a result of coronary artery disease is a disorder which has particularly ominous implications for military fliers. The effects of an impaired coronary circulation and of decreased oxygenation of the blood are cumulative, and can be expected to compromise the personal health of the flier so affected and the safety of flight. Electrocardiograms have been recorded on more than 67,000 fliers in the U. S. Air Force. Abnormal electrocardiograms in this series have led to the detailed clinical evaluation of fifty-one subjects to determine whether or not they had previously suffered an infarction. Of these fifty-one, thirty-four were found to be entirely normal, but the remaining seventeen demonstrated clinical findings that could not be considered normal and they are thought to have had a previous myocardial infarction. Experience with this series of patients confirms two opinions which have been previously expressed in the literature: (1) that arteriosclerosis occurs in young people, often to a degree that impairs coronary circulation and may produce a myocardial infarction; and (2) that a significant portion (usually estimated at 25 to 30 per cent) of all infarctions occur without symptoms or with vague symptoms that are not related to the heart.
209 citations
TL;DR: The electrocardiographic and clinical aspects of nonparoxysmal nodal tachycarida were studied in 30 cases and the relative importance of the disturbance was evaluated in 3 conditions in which it is found most frequently, namely, digitalis effect, acute rheumatic fever, and recent posterior wall infarction.
Abstract: Acceleration of impulse formation in the ordinarily subsidiary A-V nodal pacemaker is manifested in clinical electrocardiograms in a paroxysmal and a nonparoxysmal variety. The former occurs as a rule in normal hearts, the latter in pathologic conditions, frequently, but not invariably also causing A-V block. The electrocardiographic and clinical aspects of nonparoxysmal nodal tachycarida were studied in 30 cases and the relative importance of the disturbance was evaluated in 3 conditions in which it is found most frequently, namely, digitalis effect, acute rheumatic fever, and recent posterior wall infarction.
113 citations
Book•
01 Jan 1973
TL;DR: This is an introduction to electrocardiography, it will really give you the good idea to be successful.
Abstract: By reading, you can know the knowledge and things more, not only about what you get from people to people. Book will be more trusted. As this an introduction to electrocardiography, it will really give you the good idea to be successful. It is not only for you to be success in certain life you can be successful in everything. The success can be started by knowing the basic knowledge and do actions.
82 citations