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Ambulatory ECG recording
Published in Andrew R Houghton, Making Sense of the ECG, 2019
The patient who experiences severe but infrequent symptoms, such as unheralded syncope occurring once every few months, presents one of the most challenging problems. In this case the urgent need to identify a potentially dangerous rhythm disturbance (such as VT or intermittent third-degree atrioventricular block) is made more difficult by its infrequent occurrence. Even an event recorder is a rather hit-and-miss method of capturing symptomatic episodes and, if the patient loses consciousness, they may not be able to activate a recorder until after the rhythm disturbance has resolved and they have regained consciousness.
Evaluation and management of syncope and related disorders in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Andrea Ungar, Martina Rafanelli, Michele Brignole
The 12-lead ECG can be considered diagnostic, requiring no further evaluation before institution of treatment in the following cases: Persistent sinus bradycardia <40 bpm in awake or repetitive sinus-atrial block or sinus pauses >3 seconds.Mobitz II second- or third-degree atrioventricular block, alternating left and right bundle branch block.Ventricular tachycardia (VT) or rapid paroxysmal supraventricular tachycardia.Nonsustained episodes of polymorphic VT and long or short QT interval.Acute ischemia with or without myocardial infarction (1).
Introduction to specialist investigations
Published in Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins, The Junior Doctor’s Guide to Cardiology, 2017
Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins
Vasodilator agents should not be used in patients with second- or third-degree atrioventricular block (without permanent pacemakers), or in patients with chronic asthma or severe chronic obstructive lung disease.
Immunomodulatory properties of antihypertensive drugs and digitalis glycosides
Published in Expert Review of Cardiovascular Therapy, 2022
Paweł Bryniarski, Katarzyna Nazimek, Janusz Marcinkiewicz
Indications for the use of beta blockers are as follows: hypertension, ischemic heart disease, supraventricular arrhythmias associated with increased excitability, ventricular arrhythmias, sinus tachycardia, hyperthyroidism (propranolol), glaucoma (reduce intraocular pressure: carteolol, metipranolol, timolol), headache including migraines, alcohol abstinence (relief of psychosomatic symptoms), anxiety neurosis. Contraindications for beta-blockers are sinus bradycardia, second degree atrioventricular block and third degree atrioventricular block, cardiogenic shock, severe peripheral circulatory disorders, decompensated bronchial asthma, chronic obstructive pulmonary disease or other chronic lung diseases, and Prinzmetal’s angina. Beta-blockers have many side effects, the most common of which are as follows: bradycardia, circulatory failure, atrioventricular block, hypotension, cold hands and feet, blurred vision, hallucinations, unusual dreams, memory problems, nausea, vomiting, abdominal pain, diarrhea or constipation, exacerbation or provocation of a bronchial asthma attack, and transient impotence.
Looking back on 15 years of ultrasound-guided alcohol septal ablation for hypertrophic obstructive cardiomyopathy
Published in Acta Cardiologica, 2020
I. Vermaete, K. Dujardin, F. Stammen
Conversely, new onset or worsening of previous conduction disturbances were numerous (65%), with third-degree atrioventricular block (CHB) necessitating early postprocedural permanent pacemaker implantation in 4 out of 8 patients (15%), of whom 2 patients had a prior conduction delay (complete RBBB and LBBB). Eight other patients acutely developed RBBB, besides a first-degree AV block, LAFB or left posterior fascicular block in 3 patients, resulting in various bi- and trifascicular blocks albeit without higher degree AV blocks. De novo LBBB occurred only once, as did non-specific intraventricular conduction defect with new first-degree AV block. Of note, 1 patient with a preprocedural trifascicular block required permanent pacemaker implantation not earlier than 12 years after ASA.
Sutureless Aortic Valve Replacement In High Risk Concomitant Multivalvular and Bypass Surgery
Published in Structural Heart, 2019
Farouk Oueida, Ahmed Attia, Tamer Adel, Mustafa Alrefae, Khalid Eskander
Results: The mean age was 61 ± 11.5 years, ranging from 32 to 79 years, and 58.3% (n = 7) were male. The main valvular pathology was degenerative in 4 patients, rheumatic in 3, infective endocarditis in 3 and 2 patients because of redo malfunctioning previous valve surgery . Mean STS was 4.8 ± 4.4. Concomitant procedures were mitral valve repair (n = 6, 50%), mitral valve replacement (n = 6, 50 %), tricuspid valve repair (n = 3, 25 %), CABG (n = 3, 25 %) tricuspid valve replacement (n = 2, 6.6%), and radiofrequency ablation for atrial fibrillation (n = 4, 33.3 %). Small prosthesis size used in 5 patients, Large in 5 and X-large in 2 patients . At 1 year, there were 2 noncardiac deaths . One patient (8.3%) had third-degree atrioventricular block requiring permanent pacemaker implantation. two patients (16.6%) had mild paravalvular reugurgitation of the aortic prosthesis. Mean follow-up was 18 ± 4.5 months. Mean postoperative pressure gradient across aortic valve was 12 ± 8.5 in the immediate postoperative period decreased to 8 ± 6.4 mmHG after 6 months. There was no structural valve deterioration or migration of the prosthesis at follow-up.