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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Also known as complete heart block, this occurs when there is a permanent dissociation between atrial and ventricular activity. A pacemaker is usually indicated. When the block is in the AV node: A subsidiary and usually reliable pacemaker takes over in the bundle of His, and the QRS complex is narrow.When the block is below the AV node: The residual pacemaker is in the bundle branches and gives a wide QRS complex. These pacemaker sites discharge at slower rates and are less reliable, giving rise to fainting (a Stokes–Adams attack) and sudden death. This is a medical emergency requiring urgent pacemaker implantation.
End of Life Care and Decision Making: How Far We Have Come, How Far We Have to Go
Published in Inge B. Corless, Zelda Foster, The Hospice Heritage: Celebrating Our Future, 2020
Connie Zuckerman, David Wollner
A short time later, Rose collapsed while shopping. Complete heart block and heart failure were diagnosed. With proper care and rehabilitation, Rose returned home four weeks later, assisted by a visiting nurse and a home health aide. Although deeply concerned, her remaining two daughters were largely uninvolved in her care, as they were busy with their own careers and families. But Rose was content-she didn’t want to burden them anyway.
Severe Tick-Borne Infections and Their Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Praveen Sudhindra, Gary P. Wormser
Varying degrees of atrioventricular block, with or without fever, and multiple erythema migrans lesions occurring in the summer or fall months suggest a diagnosis of Lyme carditis. A chronic cardiomyopathy has been reported in European cases of Lyme disease but not in the United States. Rare fatalities have been reported in patients with complete heart block. The usual symptoms are syncope, dizziness, and malaise. In an older case series, multiple erythema migrans lesions were present in 75% of patients with cardiac manifestations [13]. These lesions may, however, go unnoticed unless a careful head-to-toe skin examination is performed. Although meningitis and cranial nerve palsies occur in the early disseminated phase of Lyme disease, these manifestations are rarely severe enough to warrant critical care evaluation [11,12].
The BRASH syndrome, a synergistic arrhythmia phenomenon
Published in Baylor University Medical Center Proceedings, 2020
Mladen V. Grigorov, Agastya D. Belur, Diana Otero, Sirmad Chaudhary, Evgeni Grigorov, Shahab Ghafghazi
A 43-year-old woman with nonalcoholic steatohepatitis cirrhosis, atrial fibrillation, hypertension, diabetes mellitus, and bipolar disorder presented to an outside hospital with 1 week of progressive lethargy and decreased oral intake. Her home medications included oral diltiazem 180 mg daily and oral metoprolol tartrate 50 mg twice daily for rate control of atrial fibrillation. Shortly after arrival to the emergency department, she became unresponsive and went into pulseless electrical activity arrest requiring cardiopulmonary resuscitation, intubation, and vasopressor initiation. After resuscitation, she had a temperature of 98.5°F, blood pressure of 109/42 mm Hg, heart rate of 35 beats per minute, and respiratory rate of 16 breaths per minute. An electrocardiogram at the outside hospital was reported as complete heart block. Initial laboratory workup revealed AKI (creatinine 2.75 mg/dL with baseline 0.7 mg/dL), hyperkalemia (potassium 7.6 mmol/L), and anion gap metabolic acidosis (pH 6.98, partial pressure of carbon dioxide 30 mm Hg, bicarbonate 8.4 mmol/L, lactate 12.5 mmol/L). Initial interventions included lactated Ringer’s fluid boluses, norepinephrine drip, insulin, dextrose, bicarbonate drip, calcium gluconate, broad-spectrum antibiotics, and transcutaneous pacer with subsequent transfer to our hospital.
Current practice in atrial septal defect occlusion in children and adults
Published in Expert Review of Cardiovascular Therapy, 2020
Wail Alkashkari, Saad Albugami, Ziyad M. Hijazi
Transcatheter closure of ASD itself may also contribute to new-onset atrial arrhythmia [59]. In a retrospective study, there was 4.75% new atrial arrhythmias, including atrial fibrillation and flutters [76]. In another study, the 10-year cumulative incidence of atrial fibrillation in patients without preexisting atrial fibrillation was 11% after ASD closure, compared to 2% in the general cohort. There was no difference between surgical and transcatheter groups [77]. The reported prevalence of advanced heart block was less than 1%. It can occur as early as device deployment [62,63]. Late-onset complete heart block might still occur up to 4 years later. In general, most of heart block is transient and recovered within a short period [78,79]. Corticosteroid treatment has been used empirically, but there is no controlled trial for heart block caused by device implantation [80]. Careful monitoring of the development of arrhythmia and conduction disturbance is recommended, even if there is no arrhythmias in the short-term follow-up.
Can restoration of heart rate in ESRD lower BNP? A case report
Published in Renal Failure, 2021
Mahmoud M. Mohamed, Joel Raja, Atif Ibrahim, Hafiz Raza, Barry Wall, Mihaly Benjamin Tapolyai
We are pleased to present a case of End Stage Renal Disease (ESRD) on hemodialysis (HD) patient presenting with a complete heart block with an elevated B-type natriuretic peptide (BNP) from his baseline and review whether correcting the arrhythmia resulted in correction of his BNP. This is a 98-year-old gentleman with a past medical history of ESRD, who presented to the emergency department for shortness of breath and a decrease in heart rate. The patient went for his regular primary care provider visit where he was noted to be bradycardic with a heart rate in the 40 s. The patient’s significant vital signs were heart rate (HR) of 48 and blood pressure of 138/52 mm Hg. BNP was 2667 pg/mL. The electrocardiogram (ECG) revealed a complete heart block. His chest x-ray did not reveal any acute cardiopulmonary abnormalities. Cardiology service was consulted. Cardiac pacing pads were placed with the patient being promptly admitted to the Intensive Care Unit (ICU) with plans for permanent pacemaker placement. In the ICU, he remained hemodynamically stable with HR in the 30 s-40s while awaiting pacemaker placement. The patient had a dual-chamber pacemaker placement a day later. His symptoms of dyspnea resolved after the procedure. He was then transferred to a regular medical ward. The BNP was repeated 90 min after the procedure, which was still elevated at 2506 pg/ml. The patient then had his hemodialysis session with adequate ultrafiltration to reduce his body weight to his estimated dry weight, which brought down the BNP to 626 pg/mL. A repeat BNP after two more of his dialysis sessions was reduced to 409 pg/mL. The patient was discharged to a skilled nursing facility for rehabilitation.