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Sample records for bradycardia

  1. Bradycardia

    Science.gov (United States)

    ... right atrium, normally controls your heart rhythm by producing electrical impulses that initiate each heartbeat. These electrical ... disease can also increase the risk of bradycardia. Lifestyle changes or medical treatment might decrease the risk ...

  2. Bradycardia in neurosurgery.

    Science.gov (United States)

    Agrawal, Amit; Timothy, Jake; Cincu, Rafael; Agarwal, Trisha; Waghmare, Lalit B

    2008-04-01

    Cushing reflex' is characterized by the occurrence of hypertension, bradycardia and apnoea secondary to raised increased intracranial pressure (ICP), leading to pressure on and or stretch, or both, of the brainstem. With the wide availability of monitoring facilities and advancements in investigation techniques, observation of increased intracranial pressure resulting in haemodynamic instability and bradycardia has been increasingly recognized in relation to many neurosurgical conditions and procedures. The causes of bradycardia include space occupying lesion involving or compressing the brain parenchyma (subdural haematoma, tumours, hydrocephalus), neurosurgical procedures (neuroendoscopy, placement of extradural drains), epileptic and non-epileptic seizures, trigemino-cardiac reflex, cerebellar lesions, spinal lesions (neurogenic shock, autonomic dysreflexia) and many other rare causes (Ventricular catheter obstruction in cases of hydrocephalus, colloid cysts related acute neurogenic cardiac dysfunction, Ondine's curse syndrome, etc.). This highlights that bradycardia can be a warning sign in many neurosurgical conditions and Cushing's reflex is a protective and effective action of the brain for preserving an adequate cerebral perfusion pressure despite an increased intracranial pressure. Management of these patients include identification and treatment of the underlying cause of bradycardia, anti-cholinergics and if necessary cardiac pacing, nevertheless, other causes of haemodynamic changes (i.e. anesthetic drugs, tumor manipulation) should also be considered and managed accordingly. We believe that this knowledge and understanding will help to identify the patients' at risk and will also help in the management of neurosurgical patients with bradycardia.

  3. Bradycardia in frontotemporal dementia.

    Science.gov (United States)

    Robles Bayón, A; Gude Sampedro, F; Torregrosa Quesada, J M

    2014-03-01

    Numerous regions of the brain, such as the medial frontal cortex, orbitofrontal cortex, insula, and amygdala, participate in the autonomic control of cardiovascular functions such as heart rate. The degenerative process in frontotemporal dementia (FTD) involves the listed anatomical structures and may therefore produce dysautonomic cardiovascular symptoms. To observe whether or not non-cardiogenic bradycardia was more frequent in a group of patients with FTD than in subjects with mild cognitive impairment or dementia of a different aetiology. Once patients with primary cardiac arrhythmia were excluded, we registered the heart rates of 258 patients with cognitive symptoms (36 with FTD, 22 with Alzheimer disease, 23 with vascular dementia, 10 with other dementias, and 167 with non-dementia cognitive impairment). Bradycardia (<60 beats/minute) was significantly more frequent in patients with FTD. This difference remained significant after excluding subjects undergoing treatment with a potentially bradycardic effect. Bradycardia was more prevalent in behavioural FTD cases than in cases of the aphasic variant, and we detected a trend toward higher frequency among patients with more pronounced right hemisphere atrophy. Moreover, mean systolic blood pressure in FTD patients was lower than in other participants, and systolic hypotension (<120 and <100mm Hg) was more prevalent. Bradycardia was more frequent in the FTD sample than in other patients with cognitive symptoms. Further investigations will be necessary before we may consider bradycardia to be a sign supporting diagnosis of FTD or its behavioural variant. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  4. [The bradycardia-tachycardia syndrome].

    Science.gov (United States)

    Salazar, E; Cerda, G; Pieniak, M

    1976-01-01

    Disorders of the heart rhythm which consist basically of sinus bradicardia or sinus arrest correspond to a syndrome which has been named the sick sinus syndrome. Within the framework of this syndrome, there is a subgroup of alternating atrial bradycardia with episodes of atrial tachyarrhythmia. Generally known as the bradycardia-tachycardia syndrome, this subgroup is both electrophysiologically interesting and therapeutically challenging. This report is concerned with the experience obtained at the emergency ward and coronary care unit of the Instituto Nacional de Cardiología de México on the diagnosis and management of 8 patients with this syndrome. Various underlying heart conditions were present with predominance of ischemic heart disease. The clinical picture was dependent upon the hypoperfusion of vital organs secondary to the cardial arrhythmia. The most common symptoms were derived from cerebral circulatory deficit and coronary insufficiency. Half of the patients had moderate cardiac failure. All patients had spontaneous and transient loss of sinus function which lasted more than 2,000 msec. in seven. The bradycardia had a rate below 50 beats per minute in all cases except one. The tachyarrhythmias observed were atrial flutter, atrial fibrillation and paroxysmal supraventricular tachycardia. Three of the patients had more than one of these these tachyarrhythmias during the period of study. A discussion is made on the diagnosis of this syndrome by means of atrial pacing and interventions which modify either vagal or sympathetic tone. Considerations are also made on the frequent associated abnormality of the A-V functional tissues. Emphasis is placed on the problems encountered in the management of these patients. It is concluded that, in most cases, a satisfactory result may be obtained by the implantation of a permanent demand pacemaker associated to the administration of antiarrhythmic drugs.

  5. Blocked atrial bigeminy presenting with bradycardia.

    Science.gov (United States)

    Akdeniz, Celal; Tanidir, Ibrahim Cansaran; Tuzcu, Volkan

    2012-01-01

    Blocked premature atrial contractions can cause bradycardia by resetting sinoatrial node and prolonging the RR intervals. Herein, we report the management of a patient with frequent premature atrial contractions in bigeminal pattern. The patient presented with symptomatic bradycardia and was successfully treated with propafenone. © 2012 Wiley Periodicals, Inc.

  6. Bradycardia During Targeted Temperature Management

    DEFF Research Database (Denmark)

    Thomsen, Jakob Hartvig; Nielsen, Niklas; Hassager, Christian

    2016-01-01

    OBJECTIVES: Bradycardia is common during targeted temperature management, likely being a physiologic response to lower body temperature, and has recently been associated with favorable outcome following out-of-hospital cardiac arrest in smaller observational studies. The present study sought...... to confirm this finding in a large multicenter cohort of patients treated with targeted temperature management at 33°C and explore the response to targeted temperature management targeting 36°C. DESIGN: Post hoc analysis of a prospective randomized study. SETTING: Thirty-six ICUs in 10 countries. PATIENTS......: We studied 447 (targeted temperature management = 33°C) and 430 (targeted temperature management = 36°C) comatose out-of-hospital cardiac arrest patients with available heart rate data, randomly assigned in the targeted temperature management trial from 2010 to 2013. INTERVENTIONS: Targeted...

  7. Bradycardia in armadillos experimentally covered with soil.

    Science.gov (United States)

    Casanave, E B; García Samartino, L; Affanni, J M

    1995-04-01

    Chaetophractus villosus is able to maintain efficient respiratory movements when its nostrils are experimentally covered with soil. Under these conditions, a progressive bradycardia develops. It would depend on hypothermia and asphyxia.

  8. [Anorexia with sinus bradycardia: a case report].

    Science.gov (United States)

    Wang, Fang-fang; Xu, Ling; Chen, Bao-xia; Cui, Ming; Zhang, Yuan

    2016-02-18

    As anorexia patients always go to the psychiatric clinic, little is concerned about the occurrence of sinus bradycardia in these patients for cardiologists and psychiatrists. The aim of this paper is to discuss the relationship between anorexia and sinus bradycardia, and the feature analysis, differential diagnosis and therapeutic principles of this type of sinus bradycardia. We report a case of sinus bradycardia in an anorexia patient with the clinical manifestations, laboratory exams, auxiliary exams, therapeutic methods, and her prognosis, who was admitted to Peking University Third Hospital recently. The patient was a 19-year-old female, who had the manifestation of anorexia. She lost obvious weight in a short time (about 15 kg in 6 months), and her body mass index was 14.8 kg/m(2). The patient felt apparent palpitation, chest depression and short breath, without dizziness, amaurosis or unconsciousness. Vitals on presentation were notable for hypotension, and bradycardia. The initial exam was significant for emaciation, but without lethargy or lower extremity edema. The electrocardiogram showed sinus bradycardia with her heart rate being 32 beats per minute. The laboratory work -up revealed her normal blood routine, electrolytes and liver function. But in her thyroid function test, the free thyroid (FT) hormones 3 was 0.91 ng/L (2.3-4.2 ng/L),and FT4 was 8.2 ng/L (8.9-18.0 ng/L), which were all lower; yet the thyroid stimulating hormone (TSH) was normal 1.48 IU/mL (0.55-4.78 IU/mL). Ultrasound revealed her normal thyroid. Anorexia is an eating disorder characterized by extremely low body weight, fear of gaining weight or distorted perception of body image, and amenorrhea. Anorexia patients who lose weight apparently in short time enhance the excitability of the parasympathetic nerve, and inhibit the sympathetic nerve which lead to the appearance of sinus bradycardia, and functional abnormalities of multiple systems such as hypothyroidism. But this kind of sinus

  9. [Hypotension and bradycardia before spinal anesthesia].

    Science.gov (United States)

    Shiraishi Zapata, Carlos Javier

    I report a case of hypotension and bradycardia before spinal anesthesia in a pregnant woman with mild to moderate hypertension treated with nifedipine and methyldopa, scheduled for an elective cesarean delivery. She had the history of neurally-mediated syncopes. Two main factors (increased vagal tone and adverse effects of antihypertensive drugs) could explain the hypotension and bradycardia before spinal anesthesia. Monitoring allowed recognizing the problem and corrected it. Thus, it was avoided a disaster in anesthesia, as hemodynamic changes after spinal anesthesia, they would have joined to previous hypotension and bradycardia, which would have caused even a cardiac arrest. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. Vasovagal Bradycardia During Subarachnoid Anaesthesia for ...

    African Journals Online (AJOL)

    There is an increasing use of central neuraxial blocks for lower abdominal surgeries. Increased vagal tone under subarachnoid block is a well-known phenomenon and can have non-classical presentations. It can manifest with bradycardia, hypotension, bronchospasm, coronary artery spasm and cardiac arrest. In a patient ...

  11. Bradycardia and Hypothermia Complicating Azithromycin Treatment.

    Science.gov (United States)

    Benn, Kerri; Salman, Sam; Page-Sharp, Madhu; Davis, Timothy M E; Buttery, Jim P

    2017-08-11

    BACKGROUND Azithromycin is a macrolide antibiotic widely used to treat respiratory, urogenital, and other infections. Gastrointestinal upset, headache, and dizziness are common adverse effects, and prolongation of the rate-corrected electrocardiographic QT interval and malignant arrhythmias have been reported. There are rare reports of bradycardia and hypothermia but not in the same patient. CASE REPORT A 4-year-old boy given intravenous azithromycin as part of treatment for febrile neutropenia complicating leukemia chemotherapy developed hypothermia (rectal temperature 35.2°C) and bradycardia (65 beats/minute) after the second dose, which resolved over several days post-treatment, consistent with persistence of high tissue azithromycin concentrations relative to those in plasma. A sigmoid Emax pharmacokinetic/pharmacodynamic model suggested a maximal azithromycin-associated reduction in heart rate of 23 beats/minute. Monitoring for these potential adverse effects should facilitate appropriate supportive care in similar cases. CONCLUSIONS Recommended azithromycin doses can cause at least moderate bradycardia and hypothermia in vulnerable pediatric patients, adverse effects that should prompt appropriate monitoring and which may take many days to resolve.

  12. Sinus Bradycardia in Habitual Cocaine Users.

    Science.gov (United States)

    Franklin, Sona M; Thihalolipavan, Sudarone; Fontaine, John M

    2017-05-15

    Common physiological manifestations of cocaine are related to its adrenergic effects, due to inhibition of dopamine and norepinephrine uptake at the postsynaptic terminal. Few studies have documented bradycardia secondary to cocaine use, representing the antithesis of its adrenergic effects. We assessed the prevalence of sinus bradycardia (SB) in habitual cocaine users and postulated a mechanism for this effect. One hundred sixty-two patients with a history of cocaine use were analyzed and compared with age- and gender-matched controls. SB was defined as a rate of cocaine use as 2 or more documented uses >30 days apart. Propensity score-matching analysis was applied to balance covariates between cocaine users and nonusers and reduce selection bias. Patients with a history of bradycardia, hypothyroidism, or concomitant beta-blocker use were excluded. Mean age of study patients was 44 ± 8 years. SB was observed in 43 of 162 (27%) cocaine users and in 9 of 149 (6%) nonusers (p = 0.0001). Propensity score-matching analysis matched 218 patients from both groups. Among matched patients SB was observed in 25 of 109 (23%) cocaine users and in 5 of 109 (5%) nonusers (p = 0.0001). Habitual cocaine use was an independent predictor of SB and associated with a sevenfold increase in the risk of SB (95% CI 2.52 to 19.74, p = 0.0002). In conclusion, habitual cocaine use is a strong predictor of SB and was unrelated to recency of use. A potential mechanism for SB may be related to cocaine-induced desensitization of the beta-adrenergic receptor secondary to continuous exposure. Symptomatic SB was not observed; thus, pacemaker therapy was not indicated. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. The ictal bradycardia syndrome: A case report

    Directory of Open Access Journals (Sweden)

    Ilaria Fava

    2015-01-01

    Full Text Available We report a case of a 56-year-old man affected by frontal lobe seizures who has developed bradycardia followed by asystole. The patient had a positive family history for epilepsy. In fact, the mother, brothers, and one sister had epilepsy. Furthermore, the patient's two brothers suddenly died of unspecified heart disease at the ages of 26 and 53, respectively. The patient also experienced syncope once or twice a year. Three similar epileptic seizures, without the recurrence of asystole, were registered after pacemaker implantation.

  14. Aconite poisoning presenting as hypotension and bradycardia.

    Science.gov (United States)

    Chan, Thomas Y K

    2009-12-01

    The principal toxic ingredients of aconite roots include aconitine, mesaconitine and hypaconitine, which are known cardiotoxins and neurotoxins. A 58-year-old man took a decoction of 11 g each of processed 'chuanwu' (the main root of Aconitum carmichaeli) and processed 'caowu' (the root of A. kusnezoffii) as treatment for his neck pain. One hour later, he experienced numbness of tongue and the four limbs, generalized weakness, nausea, vomiting, diarrhoea and dizziness. Three hours after ingestion, he was admitted to hospital. His blood pressure was 106/53 mmHg and heart rate 65 beats/min. Six hours after ingestion, he became hypotensive (systolic blood pressure aconite poisoning, prolonged hypotension and sinus bradycardia may occur and supportive therapy with close monitoring of blood pressure and cardiac rhythm are essential.

  15. Modeling fear-conditioned bradycardia in humans.

    Science.gov (United States)

    Castegnetti, Giuseppe; Tzovara, Athina; Staib, Matthias; Paulus, Philipp C; Hofer, Nicolas; Bach, Dominik R

    2016-06-01

    Across species, cued fear conditioning is a common experimental paradigm to investigate aversive Pavlovian learning. While fear-conditioned stimuli (CS+) elicit overt behavior in many mammals, this is not the case in humans. Typically, autonomic nervous system activity is used to quantify fear memory in humans, measured by skin conductance responses (SCR). Here, we investigate whether heart period responses (HPR) evoked by the CS, often observed in humans and small mammals, are suitable to complement SCR as an index of fear memory in humans. We analyze four datasets involving delay and trace conditioning, in which heart beats are identified via electrocardiogram or pulse oximetry, to show that fear-conditioned heart rate deceleration (bradycardia) is elicited and robustly distinguishes CS+ from CS-. We then develop a psychophysiological model (PsPM) of fear-conditioned HPR. This PsPM is inverted to yield estimates of autonomic input into the heart. We show that the sensitivity to distinguish CS+ and CS- (predictive validity) is higher for model-based estimates than peak-scoring analysis, and compare this with SCR. Our work provides a novel tool to investigate fear memory in humans that allows direct comparison between species. © 2016 The Authors. Psychophysiology published by Wiley Periodicals, Inc. on behalf of Society for Psychophysiological Research.

  16. Modeling fear‐conditioned bradycardia in humans

    Science.gov (United States)

    Tzovara, Athina; Staib, Matthias; Paulus, Philipp C.; Hofer, Nicolas; Bach, Dominik R.

    2016-01-01

    Abstract Across species, cued fear conditioning is a common experimental paradigm to investigate aversive Pavlovian learning. While fear‐conditioned stimuli (CS+) elicit overt behavior in many mammals, this is not the case in humans. Typically, autonomic nervous system activity is used to quantify fear memory in humans, measured by skin conductance responses (SCR). Here, we investigate whether heart period responses (HPR) evoked by the CS, often observed in humans and small mammals, are suitable to complement SCR as an index of fear memory in humans. We analyze four datasets involving delay and trace conditioning, in which heart beats are identified via electrocardiogram or pulse oximetry, to show that fear‐conditioned heart rate deceleration (bradycardia) is elicited and robustly distinguishes CS+ from CS−. We then develop a psychophysiological model (PsPM) of fear‐conditioned HPR. This PsPM is inverted to yield estimates of autonomic input into the heart. We show that the sensitivity to distinguish CS+ and CS− (predictive validity) is higher for model‐based estimates than peak‐scoring analysis, and compare this with SCR. Our work provides a novel tool to investigate fear memory in humans that allows direct comparison between species. PMID:26950648

  17. [Fetal bradycardia: a retrospective study in 9 Spanish centers].

    Science.gov (United States)

    Perin, F; Rodríguez Vázquez del Rey, M M; Deiros Bronte, L; Ferrer Menduiña, Q; Rueda Nuñez, F; Zabala Arguelles, J I; García de la Calzada, D; Teodoro Marin, S; Centeno Malfaz, F; Galindo Izquierdo, A

    2014-11-01

    The aim of this study is to review the current management and outcomes of fetal bradycardia in 9 Spanish centers. Retrospective multicenter study: analysis of all fetuses with bradycardia diagnosed between January 2008 and September 2010. Underlying mechanisms of fetal bradyarrhythmias were studied with echocardiography. A total of 37 cases were registered: 3 sinus bradycardia, 15 blocked atrial bigeminy, and 19 high grade atrioventricular blocks. Sinus bradycardia: 3 cases (100%) were associated with serious diseases. Blocked atrial bigeminy had an excellent outcome, except for one case with post-natal tachyarrhythmia. Of the atrioventricular blocks, 16% were related to congenital heart defects with isomerism, 63% related to the presence of maternal SSA/Ro antibodies, and 21% had unclear etiology. Overall mortality was 20% (37%, if terminations of pregnancy are taken into account). Risk factors for mortality were congenital heart disease, hydrops and/or ventricular dysfunction. Management strategies differed among centers. Steroids were administrated in 73% of immune-mediated atrioventricular blocks, including the only immune-mediated IInd grade block. More than half (58%) of atrioventricular blocks had a pacemaker implanted in a follow-up of 18 months. Sustained fetal bradycardia requires a comprehensive study in all cases, including those with sinus bradycardia. Blocked atrial bigeminy has a good prognosis, but tachyarrhythmias may develop. Heart block has significant mortality and morbidity rates, and its management is still highly controversial. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  18. Significant Bradycardia in Critically Ill Patients Receiving Dexmedetomidine and Fentanyl

    Directory of Open Access Journals (Sweden)

    Channing Hui

    2017-01-01

    Full Text Available Purpose. To report a case series of three patients who developed significant bradycardia while receiving the combination of dexmedetomidine and fentanyl for sedation and analgesia. Materials and Methods. This is a case series of patients obtained from a mixed medical, surgical, and cardiac ICU in a community teaching hospital. Three intubated patients receiving fentanyl and dexmedetomidine infusion developed sudden bradycardia requiring intervention. In all three cases, adjustments to therapy were required. Results. All three patients experienced significant bradycardia, with a heart rate less than 50 bpm, and one patient briefly developed asystole. In Case  1, the fentanyl infusion rate was reduced by 67% and the dexmedetomidine infusion rate was reduced by 25%. In Case  2, the sedation was changed to midazolam, and in Case  3, both fentanyl and dexmedetomidine were discontinued. In all three cases, there were no further incidences of significant bradycardia following intervention. Conclusions. Fentanyl used in combination with dexmedetomidine can result in clinically significant bradycardia. Further study is warranted to identify risk factors and elucidate the mechanisms that result in life-threatening bradycardia.

  19. Association between Ophthalmic Timolol and Hospitalisation for Bradycardia

    Directory of Open Access Journals (Sweden)

    Nicole L. Pratt

    2015-01-01

    Full Text Available Introduction. Ophthalmic timolol, a topical nonselective beta-blocker, has the potential to be absorbed systemically which may cause adverse cardiovascular effects. This study was conducted to determine whether initiation of ophthalmic timolol was associated with an increased risk of hospitalisation for bradycardia. Materials and Methods. A self-controlled case-series study was undertaken in patients who were hospitalised for bradycardia and were exposed to timolol. Person-time after timolol initiation was partitioned into risk periods: 1–30 days, 31–180 days, and >180 days. A 30-day risk period prior to initiating timolol was also included. All remaining time was considered unexposed. Results. There were 6,373 patients with at least one hospitalisation for bradycardia during the study period; 267 were exposed to timolol. Risk of bradycardia was significantly increased in the 31–180 days after timolol initiation (incidence rate ratio (IRR = 1.93; 95% confidence interval (CI 1.00–1.87. No increased risk was observed in the first 30 days or beyond 180 days of continuous exposure (IRR = 1.40; 95% CI 0.87–2.26 and IRR = 1.21; 95% CI 0.64–2.31, resp.. Conclusion. Bradycardia is a potential adverse event following timolol initiation. Practitioners should consider patient history before choosing a glaucoma regime and closely monitor patients after treatment initiation with topical nonselective beta-blocker eye drops.

  20. Bradycardia Following Oral Corticosteroid Use: Case Report and ...

    African Journals Online (AJOL)

    Introduction: Corticosteroids are used in various clinical conditions that include many immune-mediated inflammatory diseases. Different side effects were described including cardiac arrhythmias. Most of those arrhythmias were in the form of bradycardia which usually occurs with high intravenous steroid doses.

  1. Acute pericarditis presenting with sinus bradycardia : A case report

    NARCIS (Netherlands)

    Gosselink, ATM; vandenBerg, MP; Crijns, HJGM

    1997-01-01

    Acute pericarditis is almost invariably associated with sinus tachycardia. Recent-onset chest pain in the presence of (sinus) bradycardia is considered to be associated with an acute ischemic syndrome rather than acute pericarditis. This report describes a patient with acute pericarditis initially

  2. Ticagrelor and bradycardia: a nested case-control study.

    Science.gov (United States)

    Turgeon, Ricky D; Fernandes, Kimberly A; Juurlink, David; Tu, Jack V; Mamdani, Muhammad

    2015-12-01

    Ticagrelor increases serum adenosine concentrations, slowing conduction and possibly leading to bradycardia. Clinical trial data have shown numerically, though not statistically significantly, higher rates of bradyarrhythmias with ticagrelor versus clopidogrel. Additionally, recent case reports have further raised concerns for this adverse effect. We explored the association between ticagrelor and hospitalization for bradycardia in a real-world setting. We conducted a population-based, nested case-control study of Ontario residents, 66 years of age or older, discharged after a first acute coronary syndrome by linking multiple healthcare databases. Cases included patients hospitalized for bradycardia within 1 year of starting a P2Y12 inhibitor. For each case, we identified 4 controls matched on age, sex, index date, and current use of a P2Y12 inhibitor. The exposure of interest was a prescription for ticagrelor within 90 days, with clopidogrel use as the reference group. From April 2012 to March 2014, we identified 140 cases and 560 controls who met the study criteria. We found no significant association between bradycardia and exposure to ticagrelor relative to clopidogrel in the previous 90 days prior to the index date (adjusted odds ratio 1.06, 95% confidence interval 0.65-2.21). Further adjustment for potential confounders also did not identify a significant association. Among older patients with a first acute coronary syndrome, use of ticagrelor was not associated with a greater risk of admission for bradycardia relative to clopidogrel. Copyright © 2015 John Wiley & Sons, Ltd.

  3. Functional basis of sinus bradycardia in congenital heart block.

    Science.gov (United States)

    Hu, Keli; Qu, Yongxia; Yue, Yuankun; Boutjdir, Mohamed

    2004-03-05

    Congenital heart block (CHB) is a conduction abnormality characterized by complete atrioventricular (AV) block. CHB affects fetuses and/or newborn of mothers with autoantibodies reactive with ribonucleoproteins 48-kDa SSB/La, 52-kDa SSA/Ro, and 60-kDa SSA/Ro. We recently established animal models of CHB and reported, for the first time, significant sinus bradycardia preceding AV block. This unexpected observation implies that the spectrum of conduction abnormalities extends beyond the AV node to also affect the SA node. To test this hypothesis, we investigated the functional basis of this sinus bradycardia by characterizing the effects of antibodies from mothers with CHB children (positive IgG) on ionic currents that are known to significantly contribute to spontaneous pacing in SA node cells. We recorded L- (I(Ca.L)) and T- (I(Ca.T)) type Ca2+, delayed rectifier K+ (I(K)), hyperpolarization-activated (I(f)) currents, and action potentials (APs) from young rabbit SA node cells. We demonstrated that positive IgG significantly inhibited both I(Ca.T) and I(Ca.L) and induced sinus bradycardia but did not affect I(f) and I(K). Normal IgG from mothers with healthy children did not affect all the currents studied and APs. These results establish that IgG from mothers with CHB children causes substantial inhibition of I(Ca.T) and I(Ca.L), two important pacemaker currents in rabbit SA node cells and point to both I(Ca.T) and I(Ca.L) as major players in the ionic mechanism by which maternal antibodies induce sinus bradycardia in CHB. These novel findings have important clinical significance and suggest that sinus bradycardia may be a potential marker in the detection and prevention of CHB. The full text of this article is available online at http://circres.ahajournals.org

  4. Symptomatic sinus bradycardia: A rare adverse effect of intravenous ondansetron

    Directory of Open Access Journals (Sweden)

    Md Shahnawaz Moazzam

    2011-01-01

    Full Text Available Ondansetron is a serotonin receptor antagonist which has been used frequently to reduce the incidence of post-operative nausea and vomiting in laparoscopic surgery. It has become very popular drug for the prevention of post-operative nausea and vomiting due to its superiority in-terms of efficacy as well as lack of side effects and drug interactions. Although cardiovascular adverse effects of this drug are rare, we found a case of symptomatic sinus bradycardia in a 43-year-old female patient, going for laparoscopic cholecystectomy, who developed the same after she was given intravenous ondansetron in operation theater during premedication. Hence, we report this case, as the rare possibility of encountering bradycardia effect after intravenous administration of ondansetron should be born in mind.

  5. Glycopyrrolate prevents extreme bradycardia and cerebral deoxygenation during electroconvulsive therapy

    DEFF Research Database (Denmark)

    Rasmussen, Peter; Andersson, John-Erik; Koch, Palle

    2007-01-01

    The stimulation phase of electroconvulsive therapy (ECT) induces bradycardia. We evaluated the effect of this bradycardia on cerebral perfusion and oxygenation by administration of the anticholinergic drug glycopyrrolate (Glp). Cerebral perfusion was estimated by transcranial ultrasound...... in the middle cerebral artery reporting the mean flow velocity (middle cerebral artery [MCA] V(mean)), and cerebral oxygenation was determined by near-infrared spectroscopy of the frontal lobe. Before ECT, heart rate (HR) was 84 beats min(-1) (66-113; median and range) and decreased to 17 (7-85) beats min(-1...... and oxygenation normalized over approximately 3 minutes, whereas the electroencephalogram was unaffected by Glp. The results demonstrate that ECT is associated with hemodynamic effects severe enough to affect cerebral oxygenation and perfusion, and that these effects can be attenuated by Glp treatment....

  6. Infection of pregnant mice with Listeria monocytogenes induces fetal bradycardia.

    Science.gov (United States)

    Hardy, Jonathan; Kirkendoll, Brittani; Zhao, Hui; Pisani, Laura; Luong, Richard; Switzer, Alexandra; McConnell, Michael V; Contag, Christopher H

    2012-05-01

    Listeriosis is one of the most lethal bacterial diseases for fetuses and infants. However, pregnant women who get infected with Listeria may experience only mild symptoms, making the diagnosis difficult, even when the fetus is fatally infected. To reveal features of this infection, we conducted a multimodality imaging study of Listeria-induced miscarriage, using a pregnant mouse model. In this model, fetal morbidity and mortality can be observed in utero, noninvasively, and the timing and extent of infection can be carefully controlled. By employing in vivo bioluminescence imaging (BLI), perinatal infections were localized over time such that a correlation of infection to outcome could be determined without the need to kill the animal subject. The morbidity and viability of fetuses were assessed with ultrasound, and fetal morphology was imaged using magnetic resonance imaging (MRI). The ultrasound revealed sustained fetal bradycardia, the slowing of the fetal heartbeat, in infected fetuses, with an association between slowed fetal heart rate and strong bioluminescent signal. Uninfected fetuses showing no bioluminescent signal in the same uterine horn exhibited normal heartbeats. Thus, fetal bradycardia during infection was localized to the infected fetus and was not systemic or disseminated.

  7. The outcomes and risk factors of fetal bradycardia associated with external cephalic version.

    Science.gov (United States)

    Suyama, Fumio; Ogawa, Kohei; Tazaki, Yukiko; Miwa, Terumi; Taniguchi, Kosuke; Nakamura, Noriyuki; Tanaka, Satomi; Tanigaki, Shinji; Sago, Haruhiko

    2017-11-02

    The objective of this study is to assess the outcomes and risk factors of fetal bradycardia after external cephalic version (ECV). We performed a retrospective study of women who underwent ECV after 35 weeks of gestation in 2010-2016. We assessed the birth outcomes, including umbilical cord artery pH, according to the duration of fetal bradycardia and the risk factors for bradycardia. Among 390 cases, 189 (48.5%) cases showed fetal bradycardia during or immediately after ECV. The duration of fetal bradycardia was 10 min occurred in three cases; emergency cesarean section was performed in each case, with delivery after 12-4 min of bradycardia. Two of three cases showed low Apgar scores at 5 min, with an umbilical cord arterial pH of 10 min after ECV was a risk factor for asphyxia. Thus, delivery should be completed within 10 min after bradycardia. A low maternal BMI and a prolonged ECV procedure were risk factors for bradycardia after ECV.

  8. Severe Bradycardia Possibly due to a Local Anesthetic Oral Mucosal Injection during General Anesthesia

    OpenAIRE

    Kenichi Satoh; Ayako Ohashi; Miho Kumagai; Hideki Hoshi; Kousei Otaka; Shigeharu Joh

    2015-01-01

    Local anesthesia may induce systemic complications leading to parasympathetic activity leading to bradycardia and hypotension. We report a case of a 50-year-old man undergoing dental surgery under general anesthesia who experienced severe bradycardia and hypotension after local anesthesia infiltration. Concerns regarding the utilization of a relatively large lumen injection needle for local anesthesia during general anesthesia are discussed.

  9. Risk factors of bradycardia in 50 cases of gastric surgery under general anesthesia

    Directory of Open Access Journals (Sweden)

    Reza Shariat Moharari

    2014-10-01

    Conclusion: The history of gastric cancer and previous chemotherapy might be the only common factors that cause to bradycardia and irresponsible asystole during gastric surgery in these patients. It seems that only close monitoring and vigilant anesthesiologist require for treatment and prevention from adverse effect of such a sever bradycardia event.

  10. Does Brief Bradycardia at the Onset of Arm-Restraint Predict Infants' Emotional Reactivity during Restraint?

    Science.gov (United States)

    Porter, Christin L.; Jones, Blake L.

    2011-01-01

    Using electrocardiogram data with 78 six-month-old infants, this study examined the presence or absence of brief orienting bradycardia during the onset of maternal arm-restraint and subsequent differences between infants on behavioral organization during restraint. Results showed that 45 of the infants exhibited brief episodes of bradycardia at…

  11. [Turkish patient with syncope and accompanying vegetative symptoms with bradycardia after eating pontin honey].

    Science.gov (United States)

    Engel, P; Blank, R; Nalenz, C

    2014-09-01

    A 52-year-old man with Turkish background presented with nausea, emesis, one experience of syncope with loss of consciousness for a few seconds, and documented sinus bradycardia. During monitoring, several phases of bradycardia were observed. After 24 h of monitoring, the patient was free of complaints. The patient's wife reported regular consumption of pontin honey. Because of the anamnesis and the typical characteristics, grayanotoxin poisoning was diagnosed. Typical symptoms of this poisoning are hypotension, bradycardia, syncope, and loss of consciousness. When these symptoms are found and a typical anamnesis exists, this kind of intoxication has to been taken into consideration as part of the differential diagnosis.

  12. Severe symptomatic bradycardia after a dinner of spicy oleander soup

    Directory of Open Access Journals (Sweden)

    Andrea Tampieri

    2016-10-01

    Full Text Available Cardiac glycosides similar to digoxin are produced by different plants in nature. Nerium oleander, commonly grown as an ornamental shrub, can be found worldwide in temperate countries. Intentional or accidental ingestion of any part of the plant can lead to clinically relevant intoxication. A 63-year-old woman came to the emergency department with acute dyspeptic symptoms after eating vegetable soup flavored with unfamiliar flowers she have collected herself. However, the electrocardiography (ECG showed abnormalities that raised suspicions for an overdose of digoxin-like cardiac glycosides. The patient was not on treatment with digoxin and a careful anamnesis revealed that she had eaten oleander leaves. Digoxin specific Fab antibody fragments were administered for marked bradycardia that was not responding to atropine administration, after counseling with the reference toxicology center. The patient was also treated with activated charcoal and magnesium sulphate, intravenous fluids and pantoprazole. Four days later she was discharged as asymptomatic, with normal sinus rhythm. Emergency physicians should be aware of this type of poisoning, especially in cases with typical ECG alterations in patients not treated with digoxin and medical history of plants ingestion. Cardio-active glycosides are present in different plants, often used inappropriately, with potential toxic effects and harmful drug interactions.

  13. [Copper deficiency with pancytopenia, bradycardia and neurologic symptoms].

    Science.gov (United States)

    Miki, Hirokazu; Kuwayama, Yasuharu; Hara, Tomoko; Oaki, Keiji; Kanezaki, Yoshiko; Yoshida, Tomonori; Shintani, Yasumi; Miya, Keiko; Goto, Tetsuya

    2007-03-01

    A 48-year-old man was referred to our hospital in December, 2005 because of general fatigue, gait disturbance and bradycardia. He had a history of polysurgery due to recurrent ileus and had been treated with home total parenteral nutrition for the short-bowel syndrome since 2003. Clinical findings on admission included marked emaciation and severe weakness of the extremities. Pancytopenia was noted in the peripheral blood. The serum levels of copper and ceruloplasmin were 3 microg/dl and 3 mg/dl, respectively, while Vit. B12 and folate were within the normal range. The bone marrow demonstrated cytoplasmic vacuolation in the myeloid and megakaryocytic series, and sideroblastic changes. No evidence of hematologic malignancies was presented. The diagnosis was copper deficiency and the patient was treated with copper supplementation. Four weeks after copper therapy, the serum level of copper rose to 50 microg/dl and ceruloplasmin to 14 mg/dl. Significant improvements in the hematologic profile, ECG findings and weakness of extremities were noted. Although bicytopenia (anemia and neutropenia) is considered to be a feature of hematologic disorders caused by copper deficiency, the present case showed pancytopenia. The exact mechanism of the unusual association of thrombocytopenia and other abnormalities with copper deficiency remains to be elucidated.

  14. Dexmedetomidine Related Bradycardia Leading to Cardiac Arrest in a Dog

    Directory of Open Access Journals (Sweden)

    C. Y. Chen2, K-S. Chen1,2, K. M. Chang2, W. M. Lee1,2, S. C. Chang1,2 and H. C. Wang1,2

    2012-10-01

    Full Text Available A 2-year-old, mixed breed female dog (16 kg underwent an exploratory laparotomy following ultrasonographic diagnosis of foreign body and a segment of small intestine intussusceptions. The patient was classified as an ASA II. Ketamine (1mg/kg, IV, and dexmedetomidine (2.5 µg/kg, IV, and morphine (0.6 mg/kg, SC were given as anesthetic premedication. Propofol (0.1 mg/kg, IV titrated to a total amount of 4 ml (2.5 mg/ kg was given for intubation. Asystole was occurred. Cardiac resuscitation was then conducted immediately. Atipamezole (0.1 ml was injected, but showed no response on ECG. Atropine (0.02 mg/kg was then injected, and a second dosage was given. Two-three mins later, the heart rate at 84 beats/min. The NIBP showed 203/132 with MAP 153 mmHg, and the SpO2 showed 95% after the cardiac function was regained. Dexmedetomidine related bradycardia leading to cardiac arrest has been suggested in this case.

  15. The intravenous adenosine test: a new test for the identification of bradycardia pacing indications? A pilot study in subjects with bradycardia pacing indications, vasovagal syncope and controls.

    Science.gov (United States)

    Parry, S W; Chadwick, T; Gray, J C; Bexton, R S; Tynan, M; Bourke, J P; Nath, S

    2009-07-01

    Intravenous adenosine has recently been used in the diagnosis of unexplained syncope, but there is no consensus as to the meaning of a 'positive' test. The objective is to determine the sensitivity and specificity of intravenous adenosine testing in the diagnosis of bradycardia-pacing indications [sinus node dysfunction(SND), atrio-ventricular block (AVB) and cardio-inhibitory carotid sinus syndrome (CSS)]. Pilot cohort study. Patients-(i) Bradycardia-pacing group: Consecutive patients referred for pacing for SND, AVB and CSS; (ii) Consecutive head-up tilt (HUT)-positive VVS patients. Controls-(i) Simple controls (S-Con: normal examination/ECG) and (ii) Electrophysiology controls (EP-Con: consecutive subjects referred for accessory pathway ablation). Pacing referrals and EP-Con had electrophysiology studies to confirm referral diagnosis and exclude others. All subjects had bolus injection of 20 mg intravenous adenosine during continuous ECG and blood pressure monitoring (positive test: >or=6 s asystole, >or=10 s high-degree AVB post-injection). Sensitivity, specificity, safety and tolerability of the test were measured. Of 264 potential participants (4 SND, 8 AVB, 7 CSS, 10 VVS, 10 EP-Con and 11 S-Con) 50 were studied. All (100%) of the bradycardia-pacing group were adenosine test-positive, as were 6 (60%) VVS. None (0%) and 3 (27%) of the EP- and S-Con groups were positive. Adenosine testing was 100% sensitive and 86% specific for bradycardia-pacing indications, and 100% specific using the diagnostically 'clean' EP-Con results. There were no significant adverse or side effects. Adenosine testing reliably identified patients with definitive bradycardia-pacing indications in whom alternative diagnoses were excluded. Further work is needed to evaluate the role of this test in the diagnosis of unexplained syncope.

  16. Involvement of GluD2 in Fear-Conditioned Bradycardia in Mice.

    Directory of Open Access Journals (Sweden)

    Hiroko Kotajima-Murakami

    Full Text Available Lesions in the cerebellar vermis abolish acquisition of fear-conditioned bradycardia in animals and human patients. The δ2 glutamate receptor (GluD2 is predominantly expressed in cerebellar Purkinje cells. The mouse mutant ho15J carries a spontaneous mutation in GluD2 and these mice show a primary deficiency in parallel fiber-Purkinje cell synapses, multiple innervations of Purkinje cells by climbing fibers, and impairment of long-term depression. In the present study, we used ho15J mice to investigate the role of the cerebellum in fear-conditioned bradycardia. We recorded changes in heart rate of ho15J mice induced by repeated pairing of an acoustic (conditioned stimulus (CS with an aversive (unconditioned stimulus (US. The mice acquired conditioned bradycardia on Day 1 of the CS-US phase, similarly to wild-type mice. However, the magnitude of the conditioned bradycardia was not stable in the mutant mice, but rather was exaggerated on Days 2-5 of the CS-US phase. We examined the effects of reversibly inactivating the cerebellum by injection of an antagonist against the α-amino-3-hydroxy-5-methyl-4-isoxazole propionate receptor (AMPAR. The antagonist abolished expression of conditioned responses in both wild-type and ho15J mice. We conclude that the GluD2 mutation in the ho15J mice affects stable retention of the acquired conditioned bradycardia.

  17. Tachycardia-bradycardia syndrome: Electrophysiological mechanisms and future therapeutic approaches (Review)

    Science.gov (United States)

    Tse, Gary; Liu, Tong; Li, Ka Hou Christien; Laxton, Victoria; Wong, Andy On-Tik; Chan, Yin Wah Fiona; Keung, Wendy; Chan, Camie W.Y.; Li, Ronald A.

    2017-01-01

    Sick sinus syndrome (SSS) encompasses a group of disorders whereby the heart is unable to perform its pacemaker function, due to genetic and acquired causes. Tachycardia-bradycardia syndrome (TBS) is a complication of SSS characterized by alternating tachycardia and bradycardia. Techniques such as genetic screening and molecular diagnostics together with the use of pre-clinical models have elucidated the electrophysiological mechanisms of this condition. Dysfunction of ion channels responsible for initiation or conduction of cardiac action potentials may underlie both bradycardia and tachycardia; bradycardia can also increase the risk of tachycardia, and vice versa. The mainstay treatment option for SSS is pacemaker implantation, an effective approach, but has disadvantages such as infection, limited battery life, dislodgement of leads and catheters to be permanently implanted in situ. Alternatives to electronic pacemakers are gene-based bio-artificial sinoatrial node and cell-based bio-artificial pacemakers, which are promising techniques whose long-term safety and efficacy need to be established. The aim of this article is to review the different ion channels involved in TBS, examine the three-way relationship between ion channel dysfunction, tachycardia and bradycardia in TBS and to consider its current and future therapies. PMID:28204831

  18. Vasovagal syncope and severe bradycardia following intranasal dexmedetomidine for pediatric procedural sedation.

    Science.gov (United States)

    Patel, Vinit J; Ahmed, Sheikh S; Nitu, Mara E; Rigby, Mark R

    2014-04-01

    We report syncope and bradycardia in an 11-year-old girl following administration of intranasal dexmedetomidine for sedation for a voiding cystourethrogram. Following successful completion of VCUG and a 60-min recovery period, the patient's level of consciousness and vital signs returned to presedation levels. Upon leaving the sedation area, the patient collapsed, with no apparent inciting event. The patient quickly regained consciousness and no injury occurred. The primary abnormality found was persistent bradycardia, and she was admitted to the hospital for telemetric observation. The bradycardia lasted ~2 h, and further cardiac workup revealed no underlying abnormality. Unanticipated and previously unreported outcomes may be witnessed as we expand the use of certain sedatives to alternative routes of administration. © 2014 John Wiley & Sons Ltd.

  19. Reflex bradycardia does not influence oxygen consumption during hypoxia in the European eel (Anguilla anguilla)

    DEFF Research Database (Denmark)

    Iversen, Nina Kerting; McKenzie, David; Malte, H.

    2010-01-01

    the bradycardia on oxygen consumption (MO2), standard metabolic rate (SMR) and the critical oxygen partial pressure for regulation of SMR in hypoxia (Pcrit) in European eels Anguilla anguilla (mean ± SEM mass 528 ± 36 g; n = 14). Eels were instrumented with a Transonic flow probe around the ventral aorta......Most teleost fish reduce heart rate when exposed to acute hypoxia. This hypoxic bradycardia has been characterised for many fish species, but it remains uncertain whether this reflex contributes to the maintenance of oxygen uptake in hypoxia. Here we describe the effects of inhibiting...... to measure cardiac output (Q) and heart rate (f H). MO2 was then measured by intermittent closed respirometry during sequential exposure to various levels of increasing hypoxia, to determine Pcrit. Each fish was studied before and after abolition of reflex bradycardia by intraperitoneal injection...

  20. Transient bradycardia induced by thiopentone sodium: a unique challenge in the management of refractory status epilepticus.

    Science.gov (United States)

    Sharma, Sushma; Nair, Pradeep P; Murgai, Aditya; Selvaraj, Raja J

    2013-10-15

    Thiopentone sodium is one of the important drugs in the armamentarium for terminating refractory status epilepticus, a neurological emergency. We report a case of thiopentone-related bradycardia during the management of the new onset refractory status epilepticus in a young man, which was circumvented by prophylactic insertion of temporary pacemaker while thiopentone infusion was continued. A systematic approach was employed to manage the status epilepticus, including infusion of thiamine and glucose followed by antiepileptic drugs. The patient was ventilated and infused with lorazepam, phenytoin, sodium valproate, levetiracetam and midazolam followed by thiopentone sodium. With the introduction of thiopentone the seizures could be controlled but the patient developed severe bradycardia and junctional rhythm. The bradycardia disappeared when thiopentone was withdrawn and reappeared when the drug was reintroduced. Propofol infusion was tried with no respite in seizures. Later thiopentone sodium was reintroduced after inserting temporary cardiac pacemaker. Seizure was controlled and patient was weaned off the ventilator.

  1. A KCNQ1 mutation causes age-dependant bradycardia and persistent atrial fibrillation.

    Science.gov (United States)

    Ki, Chang-Seok; Jung, Chae Lim; Kim, Hyun-ji; Baek, Kwan-Hyuck; Park, Seung Jung; On, Young Keun; Kim, Ki-Suk; Noh, Su Jin; Youm, Jae Boum; Kim, June Soo; Cho, Hana

    2014-03-01

    Atrial fibrillation (AF) is the most common arrhythmia. Gain-of-function mutations in KCNQ1, the pore-forming α-subunit of the slow delayed rectifier K current (IKs) channel, have been associated with AF. The purpose of this study was functional assessment of a mutation in KCNQ1 identified in a family with persistent AF and sinus bradycardia. We investigated whether this KCNQ1 missense mutation could form the genetic basis for AF and bradycardia simultaneously in this family. Sanger sequencing in a family with hereditary persistent AF identified a novel KCNQ1 variant (V241F) in a highly conserved region of S4 domain. The proband and her son developed bradycardia and persistent AF in an age-dependent fashion. The other son was a mutation carrier but he showed sinus bradycardia and not AF. Whole-cell patch clamp electrophysiology showed that V241F mutation in KCNQ1 shifted the activation curve to the left and dramatically slowed deactivation, leading to a constitutively open-like phenotype. Computer modeling showed that V241F would slow pacemaker activity. Also, simulations of atrial excitation predicted that V241F results in extreme shortening of action potential duration, possibly resulting in AF. Our study indicates that V241F might cause sinus bradycardia by increasing IKs. Additionally, V241F likely shortens atrial refractoriness to promote a substrate for reentry. KCNQ1 mutations have previously been described in AF, yet this is the first time a mutation in KCNQ1 is associated with age-dependent bradycardia and persistent AF. This finding further supports the hypothesis that sinus node dysfunction contributes to the development of AF.

  2. Sinus bradycardia during hypothermia in comatose survivors of out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Thomsen, Jakob Hartvig; Hassager, Christian; Bro-Jeppesen, John

    2015-01-01

    BACKGROUND: Bradycardia is a common finding in patients undergoing therapeutic hypothermia (TH) following out-of-hospital cardiac arrest (OHCA), presumably as a normal physiological response to low body temperature. We hypothesized that a normal physiological response with sinus bradycardia (SB...... the hypothermia phase of TH had a 17% 180-day mortality rate compared to 38% in no-SB patients (phypothermia was directly associated with lower odds of unfavorable...... neurological outcome (ORunadjusted=0.42 (0.23-0.75, phypothermia is independently associated with a lower 180-day mortality rate and may thus be a novel, early marker of favorable outcome in comatose survivors of OHCA....

  3. [Electrocardiographic study of sinus bradycardia associated with enterohemorrhagic Escherichia coli O157: H7 infection].

    Science.gov (United States)

    Sanada, M; Okano, H; Yokota, S; Kanikawa, T; Itou, T; Oh-ishi, T; Ogawa, K

    1993-07-01

    A severe outbreak of hemorrhagic colitis occurred at a kindergarten in Saitama, Japan in October, 1990. Children who were affected by enterohemorrhagic E. coli O157: H7 infection showed apparent bradycardia as well as severe bloody diarrhea, generalized convulsion, or hemolytic uremic syndrome. Cardiac involvement such as bradycardia observed in the patients of this outbreak has not been described in previous reports about EHEC infection, while bradycardia has been well known in typhoid fever due to salmonella typhosa infection. Electrocardiographic examination was performed to evaluate bardicardia, utilizing electrocardiography at rest and Holter's twenty-four hour electrocardiography. In the report, we demonstrate that the bradicardia was due to reduced frequency of sinus node. Both average heart rate and average minimum heart rate of the patients at night (74.0 +/- 5.6 BPM and 57.0 +/- 5.1 BPM, respectively) decreased significantly, as compared with controls (84.6 +/- 9.3 BPM and 66.3 +/- 8.0 BPM respectively) (p < 0.01). CVRR of the patients (0.120 +/- 0.019, respectively) increased significantly as compared with controls (0.090 +/- 0.010, respectively). These results indicate that an activated parasympathetic nervous system, that is, activation of the vagal nerve, might have induced the sinus bradycardia observed in the patients with EHEC infection.

  4. Cardiac responses of vagus nerve stimulation: Intraoperative bradycardia and subsequent chronic stimulation

    NARCIS (Netherlands)

    Ardesch, J.J.; Buschman, H.P.J.; van der Burgh, P.H.; Wagener-Schimmel, L.J.; van der Aa, H.E.; Hageman, G.

    OBJECTIVES: Few adverse events on heart rate have been reported with vagus nerve stimulation (VNS) for refractory epilepsy. We describe three cases with intraoperative bradycardia during device testing. PATIENTS AND METHODS: At our hospital 111 patients have received a VNS system. Intraoperative

  5. Emotion avoidance and fear bradycardia in patients with borderline personality disorder and healthy controls.

    Science.gov (United States)

    Stoffels, Malou; Nijs, Maurits; Spinhoven, Philip; Mesbah, Rahele; Hagenaars, Muriel A

    2017-12-01

    Exaggerated emotional reactivity is supposed to be essential in the etiology of borderline personality disorder (BPD). More specifically, models of defensive behavior would predict reduced freezing behavior -indicated by fear bradycardia-in response to threat. This study examined automatic fear bradycardia responses in BPD versus healthy controls and the role of emotion dysregulation, more specifically tendencies to avoid emotions. Patients with BPD (n = 23) and healthy controls (n = 18) completed questionnaires and then watched neutral, pleasant and unpleasant pictures while heart rate was assessed. Emotion avoidance interacted with group: it was associated with distinct autonomic responses in healthy controls but not in BPD patients. Controls with lower emotion avoidance tendencies showed bradycardia in response to unpleasant pictures, while controls with higher emotion avoidance tendencies did not. BPD patients showed no bradycardia, irrespective of their emotion avoidance tendencies. This study is limited by a small sample size. Comorbidity or medication intake were not controlled for. The results may suggest impaired automatic defense responses in BPD. Further understanding of the regulation of distress and defense responses might improve BPD treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. An Unexpected Cause of Bradycardia in a Patient with Bacterial Meningitis

    Directory of Open Access Journals (Sweden)

    Petros Ioannou

    2017-01-01

    Full Text Available Sinus bradycardia which is a sinus rhythm with a resting heart rate of less than 60 bpm is caused by intrinsic cardiac disorders like sick sinus syndrome or inferior myocardial infarction, metabolic and environmental causes (such as hypothyroidism and electrolyte disorders, medications (such as beta-blockers and amiodarone, infection (such as myocarditis, increased intracranial pressure, and toxic exposure, while it can sometimes be a normal phenomenon, especially during sleep, in athletes, and during pregnancy. Symptomatic sinus bradycardia should warrant a thorough work-up in order to identify any reversible causes; otherwise, placement of a permanent pacemaker could be needed. We present the case of a patient who was admitted due to confusion and fever and was found to have pneumococcal meningitis and bacteremia, and during his hospital stay he developed symptomatic sinus bradycardia that was of intractable cause and persistent. Placement of a permanent pacemaker was chosen until the night staff of the hospital discovered by chance the neglected cause of his bradycardia.

  7. Late Pregnancy β Blocker Exposure and Risks of Neonatal Hypoglycemia and Bradycardia.

    Science.gov (United States)

    Bateman, Brian T; Patorno, Elisabetta; Desai, Rishi J; Seely, Ellen W; Mogun, Helen; Maeda, Ayumi; Fischer, Michael A; Hernandez-Diaz, Sonia; Huybrechts, Krista F

    2016-09-01

    β blockers are widely used in the treatment of hypertensive disorders during pregnancy. These medications cross the placenta and may cause physiologic changes in neonates exposed in utero. We sought to define the risks of neonatal hypoglycemia and bradycardia associated with maternal exposure to β blockers at the time of delivery in a large, nationwide cohort of Medicaid beneficiaries. We used a cohort of 2 292 116 completed pregnancies linked to liveborn infants of Medicaid-enrolled women from 2003 to 2007. We examined the risks of neonatal hypoglycemia and neonatal bradycardia associated with maternal exposure to β blockers at the time of delivery. Propensity score matching was used to control for potential confounders including maternal demographics, obstetric and medical conditions, and exposure to other medications. There were 10 585 (0.5%) pregnancies exposed to β blockers at the time of delivery. The risk of neonatal hypoglycemia was 4.3% in the β blocker-exposed neonates versus 1.2% in the unexposed; the risk of neonatal bradycardia was 1.6% in the exposed versus 0.5% in the unexposed. After controlling for confounders, risk remained elevated for both neonatal hypoglycemia and bradycardia among exposed pregnancies versus unexposed (adjusted odds ratio, 1.68, 95% confidence interval, 1.50-1.89 and adjusted odds ratio, 1.29, 95% confidence interval, 1.07-1.55, respectively). Our findings suggest that neonates born to mothers exposed to β blockers in late pregnancy, including labetalol, are at elevated risk for neonatal hypoglycemia and bradycardia. Copyright © 2016 by the American Academy of Pediatrics.

  8. A new association of multiple congenital anomalies/mental retardation syndrome with bradycardia-tachycardia syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Muralidhar Kanchi

    2009-12-01

    Full Text Available Abstract Introduction Congenital bradycardia-tachycardia syndrome is a rare disorder. Its association with multiple congenital anomalies/mental retardation (MCA/MR syndrome is exceptional. Case presentation We report a case of a new association of MCA/MR with bradycardia-tachycardia syndrome in an 18-year-old Indian man. This syndrome is characterized by mental retardation with delayed development of milestones, progressive scoliosis, cryptorchidism, asymmetrical limbs involving both the upper and lower limbs, sleep apnea syndrome, bradycardia-tachycardia syndrome and Dandy-Walker syndrome. Our patient was admitted for septoplasty with adenoidectomy. Patients with MCA/MR with bradycardia-tachycardia syndrome pose a unique challenge to the anesthesiologist. Establishing a good rapport with these patients is imperative. In addition to that, the anesthesiologist should anticipate the difficulty in intubation and rhythm abnormalities during the peri-operative period. Bradycardia or sinus arrest is a well-known complication during the induction and maintenance of anesthesia. Lignocaine should be used with caution in patients with bradycardia-tachycardia syndrome. Monitoring of ventilation parameters (end-tidal CO2, SPO2, airway pressure is essential as these patients are prone to develop pulmonary artery hypertension secondary to sleep apnea syndrome. Conclusion Based on our clinical experience in detailed pre-operative evaluation and planning, we would emphasize peri-operative anticipation and monitoring for dysrhythmias in patients with MCA/MR and bradycardia-tachycardia syndrome undergoing any surgical procedure.

  9. Uncomplicated baseline fetal tachycardia or bradycardia in postterm pregnancies and perinatal outcome.

    Science.gov (United States)

    Sherer, D M; Onyeije, C I; Binder, D; Bernstein, P S; Divon, M Y

    1998-05-01

    to assess perinatal outcome in post-term pregnancies in which fetal heart rate (FHR) monitoring revealed either uncomplicated baseline fetal tachycardia (> or = 160 bpm) or fetal bradycardia ( or = 41 weeks of gestation by strict dating criteria (last menstrual period consistent with ultrasound biometric parameters obtained prior to 20 weeks' gestation), normal fetal anatomy, intact membranes, and reactive nonstress test with no evidence of chorioamnionitis. Patients with fetal tachy or brady arrhythmias, FHR decelerations, or loss of short-term beat-to-beat variability were excluded. Baseline FHR was recorded retrospectively by an observer blinded to maternal and neonatal clinical outcome. For each case of uncomplicated baseline fetal tachycardia (> or = 160 bpm) or bradycardia ( 120 bpm and or = 160 bpm, and 76 fetuses (5.46%) exhibited baseline FHR postterm patients are not associated with an increase in the incidence of adverse perinatal outcome.

  10. Noncardiogenic Pulmonary Edema after Amlodipine Overdose without Refractory Hypotension and Bradycardia

    Directory of Open Access Journals (Sweden)

    M. Hedaiaty

    2015-01-01

    Full Text Available Amlodipine overdose can be life-threatening when manifesting as noncardiogenic pulmonary edema. Treatment remains challenging. We describe a case of noncardiogenic pulmonary edema without refractory hypotension and bradycardia after ingestion of 500 milligram amlodipine with suicidal intent. Mechanical ventilation, dexamethasone, atrovent HFA (ipratropium, pulmicort inhalation, and antibiotic therapy were used for the management. Length of hospital stay was 11 days. The patient was discharged with full recovery.

  11. Association Between Intermittent Hypoxemia or Bradycardia and Late Death or Disability in Extremely Preterm Infants.

    Science.gov (United States)

    Poets, Christian F; Roberts, Robin S; Schmidt, Barbara; Whyte, Robin K; Asztalos, Elizabeth V; Bader, David; Bairam, Aida; Moddemann, Diane; Peliowski, Abraham; Rabi, Yacov; Solimano, Alfonso; Nelson, Harvey

    2015-08-11

    Extremely preterm infants may experience intermittent hypoxemia or bradycardia for many weeks after birth. The prognosis of these events is uncertain. To determine the association between intermittent hypoxemia or bradycardia and late death or disability. Post hoc analysis of data from the inception cohort assembled for the Canadian Oxygen Trial in 25 hospitals in Canada, the United States, Argentina, Finland, Germany, and Israel, including 1019 infants with gestational ages of 23 weeks 0 days through 27 weeks 6 days who were born between December 2006 and August 2010 and survived to a postmenstrual age of 36 weeks. Follow-up assessments occurred between October 2008 and August 2012. Episodes of hypoxemia (pulse oximeter oxygen saturation hypoxemia for the least and most affected 10% of infants were 0.4% and 13.5%, respectively. Corresponding values for bradycardia were 0.1% and 0.3%. The primary outcome was ascertained for 972 infants and present in 414 (42.6%). Hypoxemic episodes were associated with an estimated increased risk of late death or disability at 18 months of 56.5% in the highest decile of hypoxemic exposure vs 36.9% in the lowest decile (modeled relative risk, 1.53; 95% CI, 1.21-1.94). This association was significant only for prolonged hypoxemic episodes lasting at least 1 minute (relative risk, 1.66; 95% CI, 1.35-2.05 vs for shorter episodes, relative risk, 1.01; 95% CI, 0.77-1.32). Relative risks for all secondary outcomes were similarly increased after prolonged hypoxemia. Bradycardia did not alter the prognostic value of hypoxemia. Among extremely preterm infants who survived to 36 weeks' postmenstrual age, prolonged hypoxemic episodes during the first 2 to 3 months after birth were associated with adverse 18-month outcomes. If confirmed in future studies, further research on the prevention of such episodes is needed.

  12. ["Loss of breath" as a cause of postoperative hypoxia and bradycardia in children submitted to tonsillectomy].

    Science.gov (United States)

    Moro, Eduardo Toshiyuki; Goulart, Alexandre Palmeira

    2015-01-01

    The "shortness of breath" or "breathing interruption" crisis can be considered a cause of hypoxia in childhood. It is characterized by the presence of a triggering factor followed by weeping and apnea in expiration accompanied by cyanosis or pallor. The sequence of events may include bradycardia, loss of consciousness, abnormal postural toneand even asystole. A review of the literature revealed only two reports of postoperative apneacaused by "shortness of breath". This article describes the case of a child with a history of "shortness of breath" undiagnosed before the adenotonsillectomy, but that represented the cause of episodes of hypoxemia and bradycardia in the postoperative period. the "shortness of breath" crisis should be considered as a possible cause of perioperative hypoxia in children, especially when there is a history suggestive of this problem. As some events may be accompanied by bradycardia, loss of consciousness, abnormal postural tone and even asystole, observation in a hospital setting should be considered. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  13. "Loss of breath" as a cause of postoperative hypoxia and bradycardia in children submitted to tonsillectomy.

    Science.gov (United States)

    Moro, Eduardo Toshiyuki; Goulart, Alexandre Palmeira

    2015-01-01

    the "shortness of breath" or "breathing interruption" crisis can be considered a cause of hypoxia in childhood. It is characterized by the presence of a triggering factor followed by weeping and apnea in expiration accompanied by cyanosis or pallor. The sequence of events may include bradycardia, loss of consciousness, abnormal postural tone and even asystole. A review of the literature revealed only two reports of postoperative apnea caused by "shortness of breath". this article describes the case of a child with a history of "shortness of breath" undiagnosed before the adenotonsillectomy, but that represented the cause of episodes of hypoxemia and bradycardia in the postoperative period. the "shortness of breath" crisis should be considered as a possible cause of perioperative hypoxia in children, especially when there is a history suggestive of this problem. As some events may be accompanied by bradycardia, loss of consciousness, abnormal postural tone and even asystole, observation in a hospital setting should be considered. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  14. Extreme bradycardia after first doses of sofosbuvir and daclatasvir in patients receiving amiodarone: 2 cases including a rechallenge.

    Science.gov (United States)

    Renet, Sophie; Chaumais, Marie-Camille; Antonini, Teresa; Zhao, Alexandre; Thomas, Laure; Savoure, Arnaud; Samuel, Didier; Duclos-Vallée, Jean-Charles; Algalarrondo, Vincent

    2015-11-01

    Sofosbuvir and daclatasvir are direct-acting antiviral drugs used to treat chronic hepatitis C virus infection. In 2015, the Food and Drug Administration and European Medical Agency warned that bradycardia could occur when amiodarone was administered in combination with sofosbuvir, but no case reports had been published. We report extreme bradycardia within 2 hrs after intake of sofosbuvir and daclatasvir by 2 patients receiving amiodarone. The first patient had a cardiac asystole 30 min after receiving sofosbuvir and daclatasvir. Amiodarone, sofosbuvir, and daclatasvir treatment were stopped; after 10 days, the cardiac evaluation was normal and patient was discharged. The second patient was taking amiodarone and propranolol; 2 hrs after receiving sofosbuvir and daclatasvir, he had an extreme sinus node dysfunction (heart rate of 27beats/min). Amiodarone and propranolol were stopped, but the patient continued receiving sofosbuvir and daclatasvir for 3 days and sinus bradycardia was recorded each day, 2 hrs after intake of these drugs. When he stopped taking the drugs, no bradycardia was observed. Administration of sofosbuvir and daclatasvir on day 13 induced bradycardia 2 hrs after intake. However, no bradycardia occurred following a rechallenge 8 weeks after the patient stopped taking amiodarone. These observations indicate that patients treated with amiodarone should be continuously monitored within the first 48 hrs following the initiation of sofosbuvir and daclatasvir. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  15. Microinjections of urocortin1 into the nucleus ambiguus of the rat elicit bradycardia

    Science.gov (United States)

    Chitravanshi, Vineet C.

    2011-01-01

    Urocortins are members of the hypothalamic corticotropin-releasing factor (CRF) peptide family. Urocortin1 (UCN1) mRNA has been reported to be expressed in the brainstem neurons. The present investigation was carried out to test the hypothesis that microinjections of UCN1 into the nucleus ambiguus (nAmb) may elicit cardiac effects. Urethane-anesthetized, artificially ventilated, adult male Wistar rats, weighing between 300–350 g, were used. nAmb was identified by microinjections of l-glutamate (5 mM, 30 nl). Microinjections (30 nl) of different concentrations (0.062, 0.125, 0.25, and 0.5 mM) of UCN1 into the nAmb elicited bradycardic responses (26.5 ± 1, 30.1 ± 1.7, 46.9 ± 1.7, and 40.3 ± 2.6 beats/min, respectively). These heart rate responses were not accompanied by significant changes in mean arterial pressure. The bradycardic responses to maximally effective concentration of UCN1 (0.25 mM) were significantly (P elicited by UCN1 microinjections into the nAmb. Microinjections of NBI 27914 (1.5 mM) into the nAmb did not alter baroreflex responses. Bilateral vagotomy abolished the bradycardic responses to microinjections of UCN1 into the nAmb. These results indicated that 1) microinjections of UCN1 into the nAmb elicited bradycardia, 2) the bradycardia was vagally mediated, 3) activation of CRF1Rs in the nAmb was responsible for the actions of UCN1, and 4) activation of iGLURs in the nAmb also participated in the bradycardia elicited by UCN1. PMID:20952663

  16. Unaltered R-R interval variability and bradycardia in cyclists as compared with non-athletes.

    Science.gov (United States)

    Molina, Guilherme E; Porto, Luiz Guilherme G; Fontana, Keila E; Junqueira, Luiz F

    2013-06-01

    To test whether elite mountain bikers display a cardiac autonomic modulation pattern that is distinctive from that of active non-athletes. The relationship between autonomic adaptation and bradycardia during physical exercise, including high-performance sports such as the mountain biking, remains to be elucidated. Twelve elite mountain bikers and 11 matched non-athletes controls were evaluated for time- and frequency-domain heart rate variability based on a 5-min ECG R-R intervals series obtained in both the supine and the orthostatic positions. Oxygen uptake and pulse rate were obtained at ventilatory thresholds and peak effort during an incremental cardiopulmonary exercise test. Significance of differences between medians (25th, 75th percentiles) from the two groups was evaluated by the Mann-Whitney test at p ≤ 0.05. Athletes had lower heart rate [50 (47, 59) versus 63 (60, 69) bpm; p = 0.0004] and higher cardiopulmonary performance than controls [70.9 (64.6, 74.4) versus 47.7 (41.0, 51.9) mL (kg min)(-1); p = 0.01]. No statistical difference was found in heart rate variability in the group of athletes (p = 0.17-0.97), except for trend toward having lower coefficient of variation and low-frequency absolute power indices both in supine position (p = 0.06). Bradycardia and higher oxygen uptake were found in association with unaltered cardiac autonomic modulation in elite mountain bikers athletes in supine and orthostatic positions, compared to active non-athletes. This bradycardia was not dependent on distinctive resting autonomic modulation. Intrinsic adaptation of sinus node and/or a peculiar state of autonomic adaptation to this exercise can be possible mechanisms.

  17. Uterine hypertonia and nuchal cord causing severe fetal bradycardia in a parturient receiving combined spinal-epidural analgesia during labor: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Uma Srivastava

    2012-01-01

    Full Text Available Fetal bradycardia is common following spinal opioids administered for pain relief during labor. This slowing is usually benign and short lived. Although it leads to some anxiety among obstetricians and anesthesiologists, it rarely results in urgent operative delivery. Here, we are reporting a case where urgent caesarean delivery was needed due to severe and persistent fetal bradycardia following low-dose intrathecal fentanyl. Fetal bradycardia possibly was due to hypertonic uterine contractions complicated by tightly wrapped cord round the neck.

  18. Bradycardia Associated with Steroid Use for Laryngeal Edema in an Adult: A Case Report and Literature Review

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    Preeti R. John

    2016-01-01

    Full Text Available Steroids are used for specific indications in the perioperative period to reduce laryngeal or spinal cord edema, or for prophylaxis and treatment of postoperative nausea and vomiting. Given the other potential causes for hemodynamic alterations in the perioperative setting, it is important for physicians to be aware of cardiovascular side effects of short term steroids. Changes in blood pressure and heart rate, cardiac dysrhythmias, and even death have been described in patients receiving short term intravenous steroids. Bradycardia has been reported following short term methylprednisolone and dexamethasone therapy in both adult and pediatric patients. There are only two case reports in the literature of bradycardia following short term intravenous dexamethasone use in adult patients. This is the first case report that describes bradycardia following the use of dexamethasone in the postoperative setting for management of laryngeal edema in an adult. Telemetry and twelve lead electrocardiograms revealed sinus bradycardia and correlated directly with administration of dexamethasone in our patient. Bradycardia resolved following discontinuation of dexamethasone. We advocate for hemodynamic monitoring in patients receiving more than one dose of intravenous steroid therapy in the perioperative period, especially those with known cardiac and hepatic comorbidities and those taking medications with negative chronotropic effects.

  19. The Effect of Atropine on Post-ECT Bradycardia in Patients with Major Depressive Disorder

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    Hassan Farashbandi

    2014-08-01

    Full Text Available Background: Electroconvulsive therapy (ECT is utilized for treatment of a range of psychiatric disorders including major depressive disorder (MDD. One of the major complications in using ECT is cardiovascular problems i.e., bradycardia. The present study was designed to investigate the effect of atropine on the pulse rate (PR of the patients under treatment with ECT. Materials and Methods: In this randomized clinical trial, 30 patients with diagnosis of MDD who received atropine before ECT treatment (control group were compared with 30 patients with the same diagnosis without receiving atropine (experimental group under ECT treatment. Both groups received ECT under the same term and condition. The PR of the patients were recorded 7 times (twice before anesthesia and ECT and 5 fixed one min intervals immediately after receiving ECT; for 10 sessions of treatment with ECT (3 times a week. The results were analyzed using repeated measure analysis of variance. The PR under 50 was the cut off point for differentiating the patients suffering from bradycardia and those without it. Results: Slight increment in PRs for experimental group (patient who did not receive atropine in contrast to control group were observed, but it did not reach a statistically significant level. The gender (male/female did not have different PR. The age of the patients and initial PR (regarded as co-variances did not show significant effect on PR for total sample. Conclusion: There seems to be not necessary to use atropine treatment for depressed patients receiving ECT.

  20. Ictal central apnea and bradycardia in temporal lobe epilepsy complicated by obstructive sleep apnea syndrome

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    Yoko Nishimura

    2015-01-01

    Full Text Available We describe the case of a 12-year-old boy who developed temporal lobe epilepsy (TLE with daily complex partial seizures (CPS and monthly generalized seizures. Moreover, he frequently snored while asleep since early childhood. Polysomnography (PSG revealed severe obstructive sleep apnea with apnea–hypopnea index (AHI of 37.8/h. Video-PSG with simultaneous electroencephalography (EEG recording captured two ictal apneic episodes during sleep, without any motor manifestations. The onset of rhythmic theta activity in the midtemporal area on EEG was preceded by the onset of apnea by several seconds and disappeared soon after cessation of central apnea. One episode was accompanied by ictal bradycardia of <48 beats/min which persisted for 50 s beyond the end of epileptic activity. After treatment with carbamazepine and tonsillectomy/adenoidectomy, the seizures were well controlled and AHI decreased to 2.5/h. Paroxysmal discharges also disappeared during this time. Uncontrolled TLE complicated by sleep apnea should be evaluated for the presence of ictal central apnea/bradycardia.

  1. Tender Endothelium Syndrome: Combination of Hypotension, Bradycardia, Contrast Induced Chest Pain, and Microvascular Angina

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    Shivesh Goberdhan

    2016-01-01

    Full Text Available Hypotension, bradycardia, and contrast induced chest pain are potential complications of cardiac catheterization and coronary angiography. Catheter-induced coronary spasm has been occasionally demonstrated, but its relationship to spontaneous coronary spasm is unclear. We describe a 64-year-old female who underwent coronary artery bypass surgery in 1998 on the basis of an angiographic diagnosis of severe left main disease, who recently presented with increasingly frequent typical angina. Repeat coronary angiography was immediately complicated by severe chest pain, hypotension, and bradycardia but demonstrated only mild disease of the left main artery and entire coronary tree with complete occlusion of her prior grafts. This reaction was almost identical to that observed during her original coronary angiogram. We now believe her original angiogram was complicated by severe catheter-induced left main spasm, with the accompanying contrast reaction attributed to left main disease, and the occlusion of coronary grafts explained by the absence of significant left main disease. The combination of these symptoms has not been documented in the literature. In this instance, these manifestations erroneously led to coronary bypass surgery. It is unknown whether routine, systematic injection of intracoronary nitroglycerin prior to angiography might blunt the severity of such reactions.

  2. Coupled Hidden Markov Model-Based Method for Apnea Bradycardia Detection.

    Science.gov (United States)

    Montazeri Ghahjaverestan, N; Masoudi, S; Shamsollahi, M B; Beuchee, A; Pladys, P; Ge, D; Hernandez, A I

    2016-03-01

    In this paper, we present a novel framework for the coupled hidden Markov model (CHMM), based on the forward and backward recursions and conditional probabilities, given a multidimensional observation. In the proposed framework, the interdependencies of states networks are modeled with Markovian-like transition laws that influence the evolution of hidden states in all channels. Moreover, an offline inference approach by maximum likelihood estimation is proposed for the learning procedure of model parameters. To evaluate its performance, we first apply the CHMM model to classify and detect disturbances using synthetic data generated by the FitzHugh-Nagumo model. The average sensitivity and specificity of the classification are above 93.98% and 95.38% and those of the detection reach 94.49% and 99.34%, respectively. The method is also evaluated using a clinical database composed of annotated physiological signal recordings of neonates suffering from apnea-bradycardia. Different combinations of beat-to-beat features extracted from electrocardiographic signals constitute the multidimensional observations for which the proposed CHMM model is applied, to detect each apnea bradycardia episode. The proposed approach is finally compared to other previously proposed HMM-based detection methods. Our CHMM provides the best performance on this clinical database, presenting an average sensitivity of 95.74% and specificity of 91.88% while it reduces the detection delay by -0.59 s.

  3. Abolition of reflex bradycardia by cardiac vagotomy has no effect on the regulation of oxygen uptake by Atlantic cod in progressive hypoxia

    DEFF Research Database (Denmark)

    McKenzie, David; Skov, Peter Vilhelm; Taylor, E.W.T.

    2009-01-01

    difference in their mean critical PO2 (P-crit) values, which were 7.40 +/- 0.81 kPa and 8.73 +/- 0.71 kPa, respectively (n=9). Both groups exhibited significant bradycardia during progressive hypoxia, although denervated fish always had higher mean f(H). The incipient threshold for bradycardia coincided...

  4. Disruption of bradycardia associated with discriminative conditioning in combat veterans with PTSD

    Directory of Open Access Journals (Sweden)

    Jay P Ginsberg

    2008-06-01

    Full Text Available Jay P Ginsberg1,2, Edwin Ayers3, Louisa Burriss1, Donald A Powell1,41Shirley L. Buchanan Neuroscience Laboratory, Dorn VA Medical Center, Columbia, SC, USA; 2Department of Pharmacology, Physiology, and Neuroscience, School of Medicine, 4Department of Psychology, University of South Carolina, Columbia, SC, USA; 3Department of Psychology, South Carolina State University, Orangeburg, SC, USAAbstract: The effects of combat-related posttraumatic stress disorder (PTSD on heart rate (HR responding associated with a discriminative delay eyeblink (EB conditioning paradigm are reported. Combat PTSD+, Combat PTSD−, and Noncombat PTSD− veterans were assessed with psychometric self-report measures, and baseline heart rate variability (HRV was measured before receiving a 72-trial session of discriminative EB classical conditioning. Two types (red or green light of conditioned stimuli (CS were used: one (CS+ predicted a tone, followed immediately by an aversive stimulus (corneal airpuff; the other (CS− predicted a tone alone, not followed by the airpuff. The light signal was presented for 5 seconds, during which HR was measured. On all psychometric measures, the PTSD+ subgroup was significantly different from the PTSD− subgroups (Combat + Noncombat, and the PTSD− subgroups did not significantly differ from each other. A linear deceleration in HR to CS+ and CS− signals was found in the combined PTSD− subgroup and on CS− trials in the PTSD+ subgroup, but was not present on CS+ trials in the PTSD+ subgroup. Results are interpreted with respect to a behavioral stages model of conditioned bradycardia and in terms of neural substrates which are both critical to HR conditioning and known to be abnormal in PTSD.Keywords: bradycardia, PTSD, combat veterans, classical conditioning

  5. LATE POTENTIALS IN A BRADYCARDIA-DEPENDENT LONG QT-SYNDROME ASSOCIATED WITH SUDDEN-DEATH DURING SLEEP

    NARCIS (Netherlands)

    TOBE, TJM; DELANGEN, CDJ; BINKBOELKENS, MTE; MOOK, PH; VIERSMA, JW; LIE, KI; WESSELING, H

    1992-01-01

    The purpose of this study was to determine the incidence of late potentials and their relation to QT prolongation in a family with a high incidence of sudden death during sleep at a young age and bradycardia-dependent QT prolongation (n = 9) and to compare the findings with those in consanguineous

  6. Persistent fetal sinus bradycardia associated with maternal anti-SSA/Ro and anti-SSB/La antibodies

    NARCIS (Netherlands)

    Chockalingam, Priya; Jaeggi, Edgar T.; Rammeloo, Lukas A.; Haak, Monique C.; Adama van Scheltema, Phebe N.; Breur, Johannes M. P. J.; Bartelings, Margot M.; Clur, Sally-Ann B.; Blom, Nico A.

    2011-01-01

    To study the clinical course and outcome of fetal sinus bradycardia (SB) due to maternal antibody-induced sinus node dysfunction. We reviewed the maternal, prenatal, and postnatal findings of fetuses with SB associated with elevated maternal anti-SSA/Ro and anti-SSB/La antibodies. Of the 6 cases

  7. Intractable episodic bradycardia resulting from progressive lead traction in an epileptic child with a vagus nerve stimulator: a delayed complication.

    Science.gov (United States)

    Clark, Aaron J; Kuperman, Rachel A; Auguste, Kurtis I; Sun, Peter P

    2012-04-01

    Vagus nerve stimulation (VNS) is used as palliation for adult and pediatric patients with intractable epilepsy who are not candidates for curative resection. Although the treatment is generally safe, complications can occur intraoperatively, perioperatively, and in a delayed time frame. In the literature, there are 2 reports of pediatric patients with implanted VNS units who had refractory bradycardia that resolved after the stimulation was turned off. The authors report the case of a 13-year-old boy with a history of vagus nerve stimulator placement at 2 years of age, who developed intractable episodic bradycardia that persisted despite the cessation of VNS and whose imaging results suggested vagus nerve tethering by the leads. He was subsequently taken to the operating room for exploration, where it was confirmed that the stimulator lead was exerting traction on the vagus nerve, which was displaced from the carotid sheath. After the vagus nerve was untethered and the leads were replaced, the bradycardia eventually resolved with continual effective VNS therapy. When placing a VNS unit in a very young child, accommodations must be made for years of expected growth. Delayed intractable bradycardia can result from a vagus nerve under traction by tethered stimulator leads.

  8. Cold-induced bradycardia in man during sleep in Arctic winter nights

    Science.gov (United States)

    Buguet, A. G. C.

    1987-03-01

    Two young male Caucasians volunteered for a study on the effects of cold exposure during night sleep in winter in the Arctic. The 14-day experiment was divided in three consecutive periods, baseline (2 nights), cold exposure (10 night) and recovery (2 nights). Both baseline and recovery data were obtained in neutral thermal conditions in a laboratory. The subjects slept in a sleeping bag under an unheated tent during the cold exposure. Apart from polysomnographic and body temperature recordings, electrocardiograms were taken through a telemetric system for safety purposes. Heart rates were noted at 5-min intervals and averaged hourly. In both environmental conditions, heart rate decreased within the first two hours of sleep. Comparison of the data obtained during cold exposure vs. thermal neutrality revealed lower values of heart rate in the cold, while body temperatures remained within normal range. This cold-induced bradycardia supervening during night sleep is discussed in terms of the occurrence of a vagal reflex preventing central blood pressure to rise.

  9. Aromatherapy with Rosa Damascenes in Apnea, Bradycardia and Spo2 of Preterm Infants; a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Saeideh Aghagoli

    2016-06-01

    Full Text Available Background  Apnea is one of the most common problems in preterm neonates. This study aimed to evaluate the effectiveness of aromatherapy on the reduction of apnea, bradycardia, and Pulse Oximetry (SPO2 in premature infants. Materials and Methods In a clinical trial study, 60 preterm neonates randomly divided in two groups and exposed to aromatherapy with Rosa damascenes distillate or distilled water beside the routine treatment. In experimental group, two drops of 10% Rosa damascenes distillate was dropped on the pad eye in second day of birth at 6 Am. The intervention was repeated in 9 AM, 12 Am, 15 PM and 18 PM hours. A same condition applied for control group and distilled water was dropped on the pad eye. The number of apnea attacks, bradycardia and decrease in SpO2 compared between two groups using chi-square test, independent t-test and repeated measure test. Results The overall apnea attacks, bradycardia, and SPO2 in tree studied days were lower in intervention group than control group (0.47±0.13 vs. 2.6±0.41, 0.47±0.13 vs. 2.56±0.41 and 0.70±0.17 vs. 2.77±0.21, respectively. In addition, the repeated measurement test showed that the mean number of apnea attacks, decrease in heart pulse rate, and decrease in SpO2 was statistically lower in intervention group with aromatherapy than controls in first, second, third and sum of three days (P< 0.05. Conclusion Aromatherapy with Rosa damascenes distillate can reduce more and speedy the occurrence of apnea attacks, bradycardia and SPO2 in premature infants, along with other routine treatment.

  10. Modulation of Cardiac Autonomic Function by Fingolimod Initiation and Predictors for Fingolimod Induced Bradycardia in Patients with Multiple Sclerosis

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    Kai Li

    2017-10-01

    Full Text Available Objective: It is well-known that initiation of fingolimod induces a transient decrease of heart rate. However, the underlying cardiac autonomic regulation is poorly understood. We aimed to investigate the changes of autonomic activity caused by the first dose of fingolimod using a long-term multiple trigonometric spectral analysis for the first time. In addition, we sought to use the continuous Holter ECG recording to find predictors for fingolimod induced bradycardia.Methods: Seventy-eight patients with relapsing-remitting multiple sclerosis (RRMS were included. As a part of the START study (NCT01585298, continuous electrocardiogram was recorded before fingolimod initiation, and until no <6 h post medication. Time domain and frequency domain heart rate variability (HRV parameters were computed hourly to assess cardiac autonomic regulation. A long-term multiple trigonometric regressive spectral (MTRS analysis was applied on successive 1-h-length electrocardiogram recordings. Decision tree analysis was used to find predictors for bradycardia following fingolimod initiation.Results: Most of the HRV parameters representing parasympathetic activities began to increase since the second hour after fingolimod administration. These changes of autonomic regulations were in accordance with the decline of heart rate. Baseline heart rate was highly correlated with nadir heart rate, and was the only significant predicting factor for fingolimod induced bradycardia among various demographic, clinical and cardiovascular variables in the decision tree analysis.Conclusions: The first dose application of fingolimod enhances the cardiac parasympathetic activity during the first 6 h post medication, which might be the underlying autonomic mechanism of reduced heart rate. Baseline heart rate is a powerful predictor for bradycardia caused by fingolimod.

  11. Neuromodulation of Limb Proprioceptive Afferents Decreases Apnea of Prematurity and Accompanying Intermittent Hypoxia and Bradycardia.

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    Kalpashri Kesavan

    Full Text Available Apnea of Prematurity (AOP is common, affecting the majority of infants born at <34 weeks gestational age. Apnea and periodic breathing are accompanied by intermittent hypoxia (IH. Animal and human studies demonstrate that IH exposure contributes to multiple pathologies, including retinopathy of prematurity (ROP, injury to sympathetic ganglia regulating cardiovascular action, impaired pancreatic islet cell and bone development, cerebellar injury, and neurodevelopmental disabilities. Current standard of care for AOP/IH includes prone positioning, positive pressure ventilation, and methylxanthine therapy; these interventions are inadequate, and not optimal for early development.The objective is to support breathing in premature infants by using a simple, non-invasive vibratory device placed over limb proprioceptor fibers, an intervention using the principle that limb movements trigger reflexive facilitation of breathing.Premature infants (23-34 wks gestational age, with clinical evidence of AOP/IH episodes were enrolled 1 week after birth. Caffeine treatment was not a reason for exclusion. Small vibration devices were placed on one hand and one foot and activated in 6 hour ON/OFF sequences for a total of 24 hours. Heart rate, respiratory rate, oxygen saturation (SpO2, and breathing pauses were continuously collected.Fewer respiratory pauses occurred during vibration periods, relative to baseline (p<0.005. Significantly fewer SpO2 declines occurred with vibration (p<0.05, relative to control periods. Significantly fewer bradycardic events occurred during vibration periods, relative to no vibration periods (p<0.05.In premature neonates, limb proprioceptive stimulation, simulating limb movement, reduces breathing pauses and IH episodes, and lowers the number of bradycardic events that accompany aberrant breathing episodes. This low-cost neuromodulatory procedure has the potential to provide a non-invasive intervention to reduce apnea, bradycardia and

  12. Endocardial and transcutaneous cardiac pacing, calcium chloride, and epinephrine in postcountershock asystole and bradycardias.

    Science.gov (United States)

    Niemann, J T; Adomian, G E; Garner, D; Rosborough, J P

    1985-09-01

    Clinically, asystole or a bradyarrhythmia may follow countershock of ventricular fibrillation (VF) in up to 40% of attempts. This study evaluated the effects of artificial cardiac pacing, calcium chloride (CaCl2), and epinephrine in postcountershock asystole/bradycardia. Micromanometer catheters were positioned in the aorta (Ao) and right atrium (RA) of ten dogs and VF induced by right ventricular (RV) stimulation. After 2 min of VF, a 400-J countershock was given. In six animals, asystole or a pulseless bradyarrhythmia followed one countershock. In four animals, up to three countershocks were needed to terminate VF and resulted in asystole or a pulseless bradyarrhythmia. Thirty seconds after termination of VF, cardiac pacing was begun in all animals using conventional RV endocardial pacing (RVEP) or a transcutaneous transthoracic pacing (TTP) technique. RVEP and TTP produced ventricular depolarizations, but electrical capture was never associated with Ao pressure fluctuations. After 2 min of pacing, CaCl2 was given and chest compressions and artificial ventilations (CPR) initiated. CaCl2 had no effect on CPR pressures. After 2 min of CPR, RVEP and TTP were again studied; capture without Ao pressure fluctuations was seen in all animals. Epinephrine was then given and CPR reinstituted. Epinephrine produced a significant increase in CPR Ao systolic pressure (58 +/- 13 to 84 +/- 24 mm Hg, p less than .001) and end-diastolic coronary perfusion pressure (Ao-RA) (9 +/- 4 to 34 +/- 8 mm Hg, p less than .001). Within 94 +/- 53 sec after epinephrine, spontaneous circulation was restored in eight animals.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Activation of Brainstem Pro-opiomelanocortin Neurons Produces Opioidergic Analgesia, Bradycardia and Bradypnoea.

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    Serena Cerritelli

    Full Text Available Opioids are widely used medicinally as analgesics and abused for hedonic effects, actions that are each complicated by substantial risks such as cardiorespiratory depression. These drugs mimic peptides such as β-endorphin, which has a key role in endogenous analgesia. The β-endorphin in the central nervous system originates from pro-opiomelanocortin (POMC neurons in the arcuate nucleus and nucleus of the solitary tract (NTS. Relatively little is known about the NTSPOMC neurons but their position within the sensory nucleus of the vagus led us to test the hypothesis that they play a role in modulation of cardiorespiratory and nociceptive control. The NTSPOMC neurons were targeted using viral vectors in a POMC-Cre mouse line to express either opto-genetic (channelrhodopsin-2 or chemo-genetic (Pharmacologically Selective Actuator Modules. Opto-genetic activation of the NTSPOMC neurons in the working heart brainstem preparation (n = 21 evoked a reliable, titratable and time-locked respiratory inhibition (120% increase in inter-breath interval with a bradycardia (125±26 beats per minute and augmented respiratory sinus arrhythmia (58% increase. Chemo-genetic activation of NTSPOMC neurons in vivo was anti-nociceptive in the tail flick assay (latency increased by 126±65%, p<0.001; n = 8. All effects of NTSPOMC activation were blocked by systemic naloxone (opioid antagonist but not by SHU9119 (melanocortin receptor antagonist. The NTSPOMC neurons were found to project to key brainstem structures involved in cardiorespiratory control (nucleus ambiguus and ventral respiratory group and endogenous analgesia (periaqueductal gray and midline raphe. Thus the NTSPOMC neurons may be capable of tuning behaviour by an opioidergic modulation of nociceptive, respiratory and cardiac control.

  14. Association of Asymptomatic Bradycardia With Incident Cardiovascular Disease and Mortality: The Multi-Ethnic Study of Atherosclerosis (MESA).

    Science.gov (United States)

    Dharod, Ajay; Soliman, Elsayed Z; Dawood, Farah; Chen, Haiying; Shea, Steven; Nazarian, Saman; Bertoni, Alain G

    2016-02-01

    Bradycardia has been associated with lower cardiovascular disease (CVD) risk in selected populations. There is a paucity of information available about heart rate (HR) less than 50 beats per minute (bpm) among middle-aged or older adults. To determine whether asymptomatic bradycardia was associated with a lower cardiovascular risk profile, less subclinical atherosclerosis, and decreased incident CVD and mortality. This retrospective analysis includes 6733 participants of the Multi-Ethnic Study of Atherosclerosis, which recruited men and women free of clinical cardiovascular disease ages 45 to 84 years from 2000 to 2002 and followed them over 10 years for incident CVD events and mortality. The HR was measured by baseline electrocardiogram. The analysis was performed in June 2014. The association between HR categories with CVD events and all-cause mortality were examined using Cox proportional hazards models adjusted for potential confounders and mediators. The 6733 participants had a mean (SD) age of 62 (10.2) years; 47% were male. The mean (SD) HR was 63 (9.5) bpm among the 5831 participants not taking an HR-modifying drug; 5.3% had an HR lower than 50 bpm. Preliminary results revealed significant interaction for HR categories according to use of HR-modifying drugs for mortality (P = .002); thus, all further analyses were stratified. An HR of less than 50 bpm was not associated with incident CVD in either subgroup (participants taking or not taking HR-modifying drugs). Among participants not taking HR-modifying drugs, the fully adjusted mortality risk was not different for an HR less than 50 bpm (hazard ratio, 0.71 [95% CI, 0.41-1.09]; P = .12) and increased among those with an HR greater than 80 bpm (hazard ratio, 1.49 [95% CI, 1.08-2.05]; P = .01) (reference HR, 60-69 bpm). Among the 902 participants taking HR-modifying drugs there was an elevated mortality risk associated with an HR less than 50 bpm (hazard ratio, 2.42 [95% CI, 1.39-4.20]; P = .002) and

  15. Atropine sulfate for treatment of bradycardia in a patient with morbid obesity: what may happen when you least expect it

    OpenAIRE

    Carron, Michele; Veronese, Stefano

    2015-01-01

    A 74-year-old morbidly obese man was scheduled for surgical repair of an incisional ventral hernia. Anaesthesia was induced with propofol and fentanyl, and maintained with desflurane. A second dose of fentanyl 0.2 mg, given before starting surgery, resulted in sinus bradycardia and mild decrease of arterial blood pressure. Atropine sulfate 0.5 mg was administered. One minute later, the ECG rhythm on the monitor changed to third degree atrioventricular block with a ventricular response rate of...

  16. A Nearly Lethal Screw: An Unusual Cause of Recurrent Bradycardia and Asystole Episodes after Fixation of the Cervical Spine

    Directory of Open Access Journals (Sweden)

    Amit Frenkel

    2017-01-01

    Full Text Available We present a case of a 51-year-old man who was injured in a bicycle accident. His main injury was an unstable fracture of the cervical and thoracic vertebral column. Several hours after his arrival to the hospital the patient underwent open reduction and internal fixation (ORIF of the cervical and thoracic spine. The patient was hospitalized in our critical care unit for 99 days. During this time patient had several episodes of severe bradycardia and asystole; some were short with spontaneous return to sinus and some required pharmacological treatment and even Cardiopulmonary Resuscitation (CPR. Initially, these episodes were attributed to the high cervical spine injury, but, later on, CT scan suggested that a fixation screw abutted on the esophagus and activated the vagus nerve by direct pressure. After repositioning of the cervical fixation, the bradycardia and asystole episodes were no longer observed and the patient was released to a rehabilitation ward. This case is presented in order to alert practitioners to the possibility that, after operative fixation of cervical spine injuries, recurrent episodes of bradyarrhythmia can be caused by incorrect placement of the fixation screws and might be confused with the natural history of the high cervical cord injury.

  17. Oliguric acute kidney injury as a main symptom of bradycardia and arteriosclerosis resolved by pacemaker implantation: a case report.

    Science.gov (United States)

    Pliquett, Rainer U; Radler, Daniel; Tamm, Alexander; Greinert, Daniel; Greinert, Robin; Girndt, Matthias

    2014-09-01

    Cardiovascular comorbidities regularly determine renal function. We report a case of acute kidney injury (Acute Kidney Injury Network stage 3) due to an intermittent third-degree atrioventricular block, which had not been diagnosed before. A 76-year-old Caucasian man with liver cirrhosis due to non-alcoholic fatty liver disease, and type-2 diabetes was cognitively impaired and had reduced vigilance presumably caused by hepatic encephalopathy and/or Alzheimer dementia. Within 2 years, two hospitalizations occurred for syncope attributed to orthostatic failure and hypovolemia. During the last hospitalization, oliguric acute kidney injury occurred. Sonography ruled out a post-renal cause. His renal resistive index was 1.0; his heart rate was below 50 beats per minute. After cessation of beta-blocker therapy, Holter electrocardiogram showed a new intermittent third-degree atrioventricular block with pauses for less than 3 seconds. Pacemaker insertion resolved his acute kidney injury, despite resumption of beta-blocker therapy. During four months of follow-up, syncope has not occurred, and vigilance was stable. However, his renal resistive index of 1.0 remained. Here, typical neurologic symptoms of bradycardia were misclassified. Diagnostic work-up of oliguric acute kidney injury revealed intermittent third-degree heart block. The pathomechanism of acute kidney injury relates to relevant bradycardia and increased vascular stiffness attenuating arterial diastolic renal blood flow.

  18. Evidence of Reversible Bradycardia and Arrhythmias Caused by Immunogenic Proteins Secreted by T. cruzi in Isolated Rat Hearts

    Science.gov (United States)

    Rodríguez-Angulo, Héctor O.; Toro-Mendoza, Jhoan; Marques, Juan A.; Concepción, Juan L.; Bonfante-Cabarcas, Rafael; Higuerey, Yoliver; Thomas, Luz E.; Balzano-Nogueira, Leandro; López, José R.; Mijares, Alfredo

    2015-01-01

    Rationale Chagas cardiomyopathy, caused by the protozoan Trypanosoma cruzi, is characterized by alterations in intracellular ion, heart failure and arrhythmias. Arrhythmias have been related to sudden death, even in asymptomatic patients, and their molecular mechanisms have not been fully elucidated. Objective The aim of this study is to demonstrate the effect of proteins secreted by T. cruzi on healthy, isolated beating rat heart model under a non-damage-inducing protocol. Methods and Results We established a non-damage-inducing recirculation-reoxygenation model where ultrafiltrate fractions of conditioned medium control or conditioned infected medium were perfused at a standard flow rate and under partial oxygenation. Western blotting with chagasic patient serum was performed to determine the antigenicity of the conditioned infected medium fractions. We observed bradycardia, ventricular fibrillation and complete atrioventricular block in hearts during perfusion with >50 kDa conditioned infected culture medium. The preincubation of conditioned infected medium with chagasic serum abolished the bradycardia and arrhythmias. The proteins present in the conditioned infected culture medium of >50 kDa fractions were recognized by the chagasic patient sera associated with arrhythmias. Conclusions These results suggest that proteins secreted by T. cruzi are involved in Chagas disease arrhythmias and may be a potential biomarker in chagasic patients. PMID:25647069

  19. Chronic ventricular pacing with ventriculo-atrial conduction versus atrial pacing in three patients with symptomatic sinus bradycardia.

    Science.gov (United States)

    El Gamal, M I; Van Gelder, L M

    1981-01-01

    Three patients with symptomatic sinus bradycardia due to sick sinus syndrome were treated with permanent ventricular pacing for periods ranging from 2.5 to 4 years. All three patients had ventriculo-atrial conduction on routine electrocardiography. Although ventricular pacing was effective, they complained of fatigue, lightheadedness, and near syncope. Hemodynamic studies revealed the presence of regular cannon waves in the right atrium as well as in the pulmonary artery wedge pressure curves. Temporary atrial pacing resulted in disappearance of the cannon waves and a significant rise in cardiac output (32-48%). After normal atrio-ventricular conduction was confirmed by rapid atrial stimulation and His bundle electrocardiography, the pacing mode was changed to permanent atrial pacing on demand. The effort tolerance of the patients markedly improved, and the previously mentioned symptoms disappeared. Control hemodynamic studies 9 to 12 months after implantation of the atrial demand pacemaker showed that the improvement in cardiac performance was maintained.

  20. AAIR versus DDDR pacing in the bradycardia tachycardia syndrome: a prospective, randomized, double-blind, crossover trial.

    Science.gov (United States)

    Schwaab, B; Kindermann, M; Schätzer-Klotz, D; Berg, M; Franow, H; Fröhlig, G; Schieffer, H

    2001-11-01

    In 19 patients paced and medicated for bradycardia tachycardia syndrome (BTS), AAIR and DDDR pacing were compared with regard to quality of life (QoL), atrial tachyarrhythmia (AFib), exercise tolerance, and left ventricular (LV)function. Patients had a PQ interval AAIR mode. The incidence of AFib was 12 episodes in 2 patients with AAIR versus 22 episodes in 7 patients with DDDR pacing (P = 0.072). In AAIR mode, 164 events of second and third degree AV block were detected in 7 patients (37%) with pauses between 1 and 4 seconds. During CPX, exercise duration and work load were higher in AAIR than in DDDR mode (423+/-127 vs 402+/-102 s and 103+/-31 vs 96+/-27 Watt, P AAIR. Hence, AAIR and DDDR pacing seem to be equally effective in BTS patients. In view of a considerable rate of high degree AV block during AAIR pacing, DDDR mode should be preferred for safety reasons.

  1. Severe hyperkalemia can be detected immediately by quantitative electrocardiography and clinical history in patients with symptomatic or extreme bradycardia: a retrospective cross-sectional study.

    Science.gov (United States)

    Chon, Sung-Bin; Kwak, Young Ho; Hwang, Seung-Sik; Oh, Won Sup; Bae, Jun-Ho

    2013-12-01

    Detecting severe hyperkalemia is challenging. We explored its prevalence in symptomatic or extreme bradycardia and devised a diagnostic rule. This retrospective cross-sectional study included patients with symptomatic (heart rate [HR] ≤ 50/min with dyspnea, chest pain, altered mentality, dizziness/syncope/presyncope, general weakness, oliguria, or shock) or extreme (HR ≤ 40/min) bradycardia at an emergency department for 46 months. Risk factors for severe hyperkalemia were chosen by multiple logistic regression analysis from history (sex, age, comorbidities, and medications), vital signs, and electrocardiography (ECG; maximum precordial T-wave amplitude, PR, and QRS intervals). The derived diagnostic index was validated using bootstrapping method. Among the 169 participants enrolled, 87 (51.5%) were female. The mean (SD) age was 71.2 (12.5) years. Thirty-six (21.3%) had severe hyperkalemia. The diagnostic summed "maximum precordial T ≥ 8.5 mV (2)," "atrial fibrillation/junctional bradycardia (1)," "HR ≤ 42/min (1)," "diltiazem medication (2)," and "diabetes mellitus (1)." The C-statistics were 0.86 (0.80-0.93) and were validated. For scores of 4 or higher, sensitivity was 0.50, specificity was 0.92, and positive likelihood ratio was 6.02. The "ECG-only index," which sums the 3 ECG findings, had a sensitivity of 0.50, specificity of 0.90, and likelihood ratio (+) of 5.10 for scores of 3 or higher. Severe hyperkalemia is prevalent in symptomatic or extreme bradycardia and detectable by quantitative electrocardiographic parameters and history. © 2013.

  2. Apnea, bradycardia and desaturation spells in premature infants: impact of a protocol for the duration of 'spell-free' observation on interprovider variability and readmission rates.

    Science.gov (United States)

    Chandrasekharan, P; Rawat, M; Reynolds, A M; Phillips, K; Lakshminrusimha, S

    2017-11-09

    To study the impact of implementing a protocol to standardize the duration of observation in preterm infants with apnea/bradycardia/desaturation spells before hospital discharge on length of stay (LOS) and readmission rates. A protocol to standardize the duration of in-hospital observation for preterm infants with apnea, bradycardia and desaturation spells who were otherwise ready for discharge was implemented in December 2013. We evaluated the impact of this protocol on the LOS and readmission rates of very low birth weight infants (VLBW). Data on readmission for apnea and an apparent life-threatening event (ALTE) within 30 days of discharge were collected. The pre-implementation epoch (2011 to 2013) was compared to the post-implementation period (2014 to 2016). There were 426 and 368 VLBW discharges before and after initiation of the protocol during 2011 to 2013 and 2014 to 2016, respectively. The LOS did not change with protocol implementation (66±42 vs 64±42 days before and after implementation of the protocol, respectively). Interprovider variability on the duration of observation for apneic spells (F-8.8, P=0.04) and bradycardia spells (F-17.4, Pspell-free observation period as recommended by the American Academy of Pediatrics clinical report did not prolong the LOS but effectively reduced interprovider variability and readmission rates.Journal of Perinatology advance online publication, 9 November 2017; doi:10.1038/jp.2017.174.

  3. Non-expert listeners show decreased heart rate and increased blood pressure (fear bradycardia) in response to atonal music.

    Science.gov (United States)

    Proverbio, Alice M; Manfrin, Luigi; Arcari, Laura A; De Benedetto, Francesco; Gazzola, Martina; Guardamagna, Matteo; Lozano Nasi, Valentina; Zani, Alberto

    2015-01-01

    Previous studies suggested that listening to different types of music may modulate differently psychological mood and physiological responses associated with the induced emotions. In this study the effect of listening to instrumental classical vs. atonal contemporary music was examined in a group of 50 non-expert listeners. The subjects' heart rate and diastolic and systolic blood pressure values were measured while they listened to music of different style and emotional typologies. Pieces were selected by asking a group of composers and conservatory professors to suggest a list of the most emotional music pieces (from Renaissance to present time). A total of 214 suggestions from 20 respondents were received. Then it was asked them to identify which pieces best induced in the listener feelings of agitation, joy or pathos and the number of suggested pieces per style was computed. Atonal pieces were more frequently indicated as agitating, and tonal pieces as joyful. The presence/absence of tonality in a musical piece did not affect the affective dimension of pathos (being touching). Among the most frequently cited six pieces were selected that were comparable for structure and style, to represent each emotion and style. They were equally evaluated as unfamiliar by an independent group of 10 students of the same cohort) and were then used as stimuli for the experimental session in which autonomic parameters were recorded. Overall, listening to atonal music (independent of the pieces' emotional characteristics) was associated with a reduced heart rate (fear bradycardia) and increased blood pressure (both diastolic and systolic), possibly reflecting an increase in alertness and attention, psychological tension, and anxiety. This evidence fits with the results of the esthetical assessment showing how, overall, atonal music is perceived as more agitating and less joyful than tonal one.

  4. Non-expert listeners show decreased heart rate and increased blood pressure (fear bradycardia) in response to atonal music

    Science.gov (United States)

    Proverbio, Alice M.; Manfrin, Luigi; Arcari, Laura A.; De Benedetto, Francesco; Gazzola, Martina; Guardamagna, Matteo; Lozano Nasi, Valentina; Zani, Alberto

    2015-01-01

    Previous studies suggested that listening to different types of music may modulate differently psychological mood and physiological responses associated with the induced emotions. In this study the effect of listening to instrumental classical vs. atonal contemporary music was examined in a group of 50 non-expert listeners. The subjects’ heart rate and diastolic and systolic blood pressure values were measured while they listened to music of different style and emotional typologies. Pieces were selected by asking a group of composers and conservatory professors to suggest a list of the most emotional music pieces (from Renaissance to present time). A total of 214 suggestions from 20 respondents were received. Then it was asked them to identify which pieces best induced in the listener feelings of agitation, joy or pathos and the number of suggested pieces per style was computed. Atonal pieces were more frequently indicated as agitating, and tonal pieces as joyful. The presence/absence of tonality in a musical piece did not affect the affective dimension of pathos (being touching). Among the most frequently cited six pieces were selected that were comparable for structure and style, to represent each emotion and style. They were equally evaluated as unfamiliar by an independent group of 10 students of the same cohort) and were then used as stimuli for the experimental session in which autonomic parameters were recorded. Overall, listening to atonal music (independent of the pieces’ emotional characteristics) was associated with a reduced heart rate (fear bradycardia) and increased blood pressure (both diastolic and systolic), possibly reflecting an increase in alertness and attention, psychological tension, and anxiety. This evidence fits with the results of the esthetical assessment showing how, overall, atonal music is perceived as more agitating and less joyful than tonal one. PMID:26579029

  5. Non-expert listeners show decreased heart rate and increased blood pressure (fear bradycardia in response to atonal music

    Directory of Open Access Journals (Sweden)

    Alice Mado eProverbio

    2015-10-01

    Full Text Available Previous studies suggested that listening to different types of music may modulate differently psychological mood and physiological responses associated with the induced emotions. In this study the effect of listening to instrumental classical vs. atonal contemporary music was examined in a group of 50 non-expert listeners. The subjects’ heart rate and diastolic and systolic blood pressure values were measured while they listened to music of different style and emotional typologies. Pieces were selected by asking a group of composers and conservatory professors to suggest a list of the most emotional music pieces (from Renaissance to present time. A total of 214 suggestions from 20 respondents was received. Then it was asked them to identify which pieces best induced in the listener feelings of agitation, joy or pathos and the number of suggested pieces per style was computed. Atonal pieces were more frequently indicated as agitating, and tonal pieces as joyful. The presence/absence of tonality in a musical piece did not affect the affective dimension of pathos (being touching. Among the most frequently cited six pieces were selected that were comparable for structure and style, to represent each emotion and style. They were equally evaluated as unfamiliar by an independent group of 10 students of the same cohort and were then used as stimuli for the experimental session in which autonomic parameters were recorded. Overall, listening to atonal music (independent of the pieces’ emotional characteristics was associated with a reduced heart rate (fear bradycardia and increased blood pressure (both diastolic and systolic, possibly reflecting an increase in alertness and attention, psychological tension, and anxiety. This evidence fits with the results of the aesthetical assessment showing how, overall, atonal music is perceived as more agitating and less joyful than tonal one.

  6. A novel 'splice site' HCN4 Gene mutation, c.1737+1 G>T, causes familial bradycardia, reduced heart rate response, impaired chronotropic competence and increased short-term heart rate variability.

    Science.gov (United States)

    Hategan, Lidia; Csányi, Beáta; Ördög, Balázs; Kákonyi, Kornél; Tringer, Annamária; Kiss, Orsolya; Orosz, Andrea; Sághy, László; Nagy, István; Hegedűs, Zoltán; Rudas, László; Széll, Márta; Varró, András; Forster, Tamás; Sepp, Róbert

    2017-08-15

    The most important molecular determinant of heart rate regulation in sino-atrial pacemaker cells includes hyperpolarization-activated, cyclic nucleotide-gated ion channels, the major isoform of which is encoded by the HCN4 gene. Mutations affecting the HCN4 gene are associated primarily with sick sinus syndrome. A novel c.1737+1 G>T 'splice-site' HCN4 mutation was identified in a large family with familial bradycardia which co-segregated with the disease providing a two-point LOD score of 4.87. Twelve out of the 22 investigated family members [4 males, 8 females average age 36 (SD 6) years] were considered as clinically affected (heart ratesite' HCN4 gene mutation, c.1737+1 G>T, causes familial bradycardia and leads to reduced heart rate response, impaired chronotropic competence and increased short-term heart rate variability in the mutation carriers. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Effect of intravenous ondansetron on reducing the incidence of hypotension and bradycardia events during shoulder arthroscopy in sitting position under interscalene brachial plexus block: A prospective randomized trial

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    Srinivasa Rao Nallam

    2015-01-01

    Full Text Available Background and Aims: Sudden, profound hypotension and bradycardia events (HBEs have been reported in more than 20% of patients undergoing shoulder arthroscopy in the sitting position. The present study was designed to know whether intravenous (IV ondansetron (selective 5-hydroxy tryptamine 3-antagonist can help in reducing the HBEs associated with shoulder arthroscopy performed in sitting position under interscalene brachial plexus block (ISBPB. Methods: A total of 100 patients (age 20-50 years undergoing shoulder arthroscopy performed in the sitting position under ISBPB were assigned randomly to one of the two groups: Group C received 10 ml of normal saline and Group T received 4 mg of ondansetron diluted in 10 ml of normal saline` IV. All patients received ISBPB using levobupivacaine 0.5%. Assessment of motor and sensory blockade, pulse rate, systolic blood pressure, respiration, and side effects were noted every 5 min for first 30 min and every 10 min till the end of surgery. HBEs were recorded in both groups. Results: IV injection of ondansetron significantly reduces the incidence of HBEs from 11 (22.44% in Group C to 3 (6.1% in Group T. The duration of analgesia was significantly longer in Group C (8.1 ± 3.3 in comparison with Group T (6.3 ± 4.2 h. Conclusion: We conclude that 4 ml of IV ondansetron can significantly reduce the HBEs during shoulder arthroscopy done in the sitting position under ISBPB.

  8. Comparison of effects of ephedrine, lidocaine and ketamine with placebo on injection pain, hypotension and bradycardia due to propofol injection: a randomized placebo controlled clinical trial.

    Science.gov (United States)

    Ayatollahi, Vida; Behdad, Shekoufeh; Kargar, Saeed; Yavari, Tayebe

    2012-01-01

    Propofol is a widely used anesthetic drug because of its minor complication and also its fast effect. One of most popular complication in using this drug is pain during injection that is more sever in new generation of its components (lipid-free microemulsion). Other complications of propofol are bradycardia and hypotension. This study compares 3 drugs with placebo in control of these complications of propofol. In this double blinded randomized placebo controlled trial 140 patient who were candidates for elective surgery were divided in 4 groups (35 patients in each groups) and drugs (ephedrine, lidocaine, ketamine and NaCl solution (as placebo) were tried on each group by a blinded technician and responses to drugs were evaluated under supervision of a blinded anesthesiologist. Pain after injection, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were measured 5 times during anesthesia process of each patient. All gathered data were analyzed using t-test and Chi-square under SPSS software. Our data shows that in pain management all tested drugs can decrease pain significantly comparing with placebo (P=0.017). In control of hemodynamic parameters ephedrine could efficiently control SBP, DBP, MAP at the time 1 min after intubation. Based on our study ephedrine can be an appropriate suggestion for control of both pain and hemodynamic changes induced by propofol, although because of inconsistent result in other studies it is recommended to design a systematic review to draw a broader view on this issue.

  9. Frequency of apnea, bradycardia, and desaturations following first diphtheria-tetanus-pertussis-inactivated polio-Haemophilus influenzae type B immunization in hospitalized preterm infants

    Directory of Open Access Journals (Sweden)

    Spady Donald W

    2006-06-01

    Full Text Available Abstract Background Adverse cardiorespiratory events including apnea, bradycardia, and desaturations have been described following administration of the first diphtheria-tetanus-pertussis-inactivated polio-Haemophilus influenzae type B (DTP-IPV-Hib immunization to preterm infants. The effect of the recent substitution of acellular pertussis vaccine for whole cell pertussis vaccine on the frequency of these events requires further study. Methods Infants with gestational age of ≤ 32 weeks who received their first DTP-IPV-Hib immunization prior to discharge from two Edmonton Neonatal Intensive Care Units January 1, 1996 to November 30, 2000 were eligible for the study. Each immunized infant was matched by gestational age to one control infant. The number of episodes of apnea, bradycardia, and/or desaturations (ABD and the treatment required for these episodes in the 72 hours prior to and 72 hours post-immunization (for the immunized cohort or at the same post-natal age (for controls was recorded. Results Thirty-four infants who received DTP-IPV-Hib with whole cell pertussis vaccine, 90 infants who received DTP-IPV-Hib with acellular pertussis vaccine, and 124 control infants were entered in the study. Fifty-six immunized infants (45.1% and 36 control infants (29.0% had a resurgence of or increased ABD in the 72 hours post-immunization in the immunized infants and at the same post-natal age in the controls with an adjusted odds ratio for immunized infants of 2.41 (95% CI 1.29,4.51 as compared to control infants. The incidence of an increase in adverse cardiorespiratory events post-immunization was the same in infants receiving whole cell or acellular pertussis vaccine (44.1% versus 45.6%. Eighteen immunized infants (14.5% and 51 control infants (41.1% had a reduction in ABD in the 72 hours post- immunization or at the equivalent postnatal age in controls for an odds ratio of 0.175 (95%CI 0.08, 0.39. The need for therapy of ABD in the immunized

  10. Frequency of apnea, bradycardia, and desaturations following first diphtheria-tetanus-pertussis-inactivated polio-Haemophilus influenzae type B immunization in hospitalized preterm infants

    Science.gov (United States)

    Lee, Jackie; Robinson, Joan L; Spady, Donald W

    2006-01-01

    Background Adverse cardiorespiratory events including apnea, bradycardia, and desaturations have been described following administration of the first diphtheria-tetanus-pertussis-inactivated polio-Haemophilus influenzae type B (DTP-IPV-Hib) immunization to preterm infants. The effect of the recent substitution of acellular pertussis vaccine for whole cell pertussis vaccine on the frequency of these events requires further study. Methods Infants with gestational age of ≤ 32 weeks who received their first DTP-IPV-Hib immunization prior to discharge from two Edmonton Neonatal Intensive Care Units January 1, 1996 to November 30, 2000 were eligible for the study. Each immunized infant was matched by gestational age to one control infant. The number of episodes of apnea, bradycardia, and/or desaturations (ABD) and the treatment required for these episodes in the 72 hours prior to and 72 hours post-immunization (for the immunized cohort) or at the same post-natal age (for controls) was recorded. Results Thirty-four infants who received DTP-IPV-Hib with whole cell pertussis vaccine, 90 infants who received DTP-IPV-Hib with acellular pertussis vaccine, and 124 control infants were entered in the study. Fifty-six immunized infants (45.1%) and 36 control infants (29.0%) had a resurgence of or increased ABD in the 72 hours post-immunization in the immunized infants and at the same post-natal age in the controls with an adjusted odds ratio for immunized infants of 2.41 (95% CI 1.29,4.51) as compared to control infants. The incidence of an increase in adverse cardiorespiratory events post-immunization was the same in infants receiving whole cell or acellular pertussis vaccine (44.1% versus 45.6%). Eighteen immunized infants (14.5%) and 51 control infants (41.1%) had a reduction in ABD in the 72 hours post- immunization or at the equivalent postnatal age in controls for an odds ratio of 0.175 (95%CI 0.08, 0.39). The need for therapy of ABD in the immunized infants was not

  11. Bradicardia como manifestação epiléptica em epilepsia temporal: relato de caso Bradycardia during temporal lobe seizure: case report

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    CARMEN L. JORGE

    2000-09-01

    Full Text Available Descrevemos um caso de arritmia cardíaca como manifestação epiléptica. A monitorização video-eletrencefalográfica de uma paciente com 34 anos de idade que apresentava episódios de perda de consciência permitiu a detecção de períodos de assistolia como principal manifestação clínica, exigindo a implantação de marca-passo. O registro eletrencefalográfico concomitante mostrou atividade rítmica a 6-7 Hz de projeção na região temporal esquerda. A ressonância magnética mostrou lesão expansiva no giro para-hipocampal esquerdo. Alterações do ritmo cardíaco como taquicardia sinusal são frequentes em crises epilépticas. A descrição de bradicardia e/ou assistolia é rara. As conexões das estruturas mesiais temporais com estruturas profundas como o hipotálamo devem ser responsáveis pelas manifestações vegetativas durante crises epilépticas temporais.We describe a patient who had cardiac arrhythmia as epileptic manifestation. In a 34-year-old woman who had many episodes of loss of consciousness, the simultaneous ECG and video-EEG monitoring recorded bradycardia with a short episode of asystolia (4 seconds and left temporal rhythmic teta activity on EEG. MRI showed a small mass lesion in the left parahippocampal gyrus. Alterations in cardiac rhythm have been reported in epileptic seizures and taquycardia is the most common finding associated with them; bradyarrhythmia during seizures was uncommon. Many interconnections among insular cortex, limbic system and hypothalamus, may be responsible for vegetative manifestations in temporal lobe epilepsy.

  12. The clinically-tested S1P receptor agonists, FTY720 and BAF312, demonstrate subtype-specific bradycardia (S1P₁ and hypertension (S1P₃ in rat.

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    Ryan M Fryer

    Full Text Available Sphingosine-1-phospate (S1P and S1P receptor agonists elicit mechanism-based effects on cardiovascular function in vivo. Indeed, FTY720 (non-selective S1P(X receptor agonist produces modest hypertension in patients (2-3 mmHg in 1-yr trial as well as acute bradycardia independent of changes in blood pressure. However, the precise receptor subtypes responsible is controversial, likely dependent upon the cardiovascular response in question (e.g. bradycardia, hypertension, and perhaps even species-dependent since functional differences in rodent, rabbit, and human have been suggested. Thus, we characterized the S1P receptor subtype specificity for each compound in vitro and, in vivo, the cardiovascular effects of FTY720 and the more selective S1P₁,₅ agonist, BAF312, were tested during acute i.v. infusion in anesthetized rats and after oral administration for 10 days in telemetry-instrumented conscious rats. Acute i.v. infusion of FTY720 (0.1, 0.3, 1.0 mg/kg/20 min or BAF312 (0.5, 1.5, 5.0 mg/kg/20 min elicited acute bradycardia in anesthetized rats demonstrating an S1P₁ mediated mechanism-of-action. However, while FTY720 (0.5, 1.5, 5.0 mg/kg/d elicited dose-dependent hypertension after multiple days of oral administration in rat at clinically relevant plasma concentrations (24-hr mean blood pressure = 8.4, 12.8, 16.2 mmHg above baseline vs. 3 mmHg in vehicle controls, BAF312 (0.3, 3.0, 30.0 mg/kg/d had no significant effect on blood pressure at any dose tested suggesting that hypertension produced by FTY720 is mediated S1P₃ receptors. In summary, in vitro selectivity results in combination with studies performed in anesthetized and conscious rats administered two clinically tested S1P agonists, FTY720 or BAF312, suggest that S1P₁ receptors mediate bradycardia while hypertension is mediated by S1P₃ receptor activation.

  13. Bradycardia during temporal lobe seizure: case report

    OpenAIRE

    CARMEN L. JORGE; Valério, Rosa M. F.; Yacubian, Elza M.T.

    2000-01-01

    Descrevemos um caso de arritmia cardíaca como manifestação epiléptica. A monitorização video-eletrencefalográfica de uma paciente com 34 anos de idade que apresentava episódios de perda de consciência permitiu a detecção de períodos de assistolia como principal manifestação clínica, exigindo a implantação de marca-passo. O registro eletrencefalográfico concomitante mostrou atividade rítmica a 6-7 Hz de projeção na região temporal esquerda. A ressonância magnética mostrou lesão expansiva no gi...

  14. Modeling fear-conditioned bradycardia in humans

    OpenAIRE

    Castegnetti, G.; Tzovara, A.; Staib, M.; Paulus, P. C.; Hofer, N.; Bach, D. R.

    2016-01-01

    Across species, cued fear conditioning is a common experimental paradigm to investigate aversive Pavlovian learning. While fear-conditioned stimuli (CS+) elicit overt behavior in many mammals, this is not the case in humans. Typically, autonomic nervous system activity is used to quantify fear memory in humans, measured by skin conductance responses (SCR). Here, we investigate whether heart period responses (HPR) evoked by the CS, often observed in humans and small mammals, are suitable to co...

  15. Modeling fear?conditioned bradycardia in humans

    OpenAIRE

    Castegnetti, Giuseppe; Tzovara, Athina; Staib, Matthias; Paulus, Philipp C.; Hofer, Nicolas; Bach, Dominik R.

    2016-01-01

    Abstract Across species, cued fear conditioning is a common experimental paradigm to investigate aversive Pavlovian learning. While fear?conditioned stimuli (CS+) elicit overt behavior in many mammals, this is not the case in humans. Typically, autonomic nervous system activity is used to quantify fear memory in humans, measured by skin conductance responses (SCR). Here, we investigate whether heart period responses (HPR) evoked by the CS, often observed in humans and small mammals, are suita...

  16. Marca-passo cardíaco definitivo em crianças com bradicardia pós-operatória: resultados tardios Permanent cardiac pacing in children with postoperative bradycardia: long-term follow-up

    Directory of Open Access Journals (Sweden)

    Roberto Costa

    2005-12-01

    Full Text Available OBJETIVO: Avaliar a evolução tardia de crianças com marca-passo definitivo por bradicardia pós-operatória, e identificar fatores de risco para a mortalidade. MÉTODO: De 1980 a 2004, 120 crianças receberam implante de marca-passo definitivo por bradicardia pós-operatória. O intervalo médio entre a correção do defeito e o implante foi de 1,2 ± 2,8 anos, com mediana de 21 dias. Bloqueio atrioventricular esteve presente em 94,2% dos pacientes. A via de acesso transvenosa (78,3% e marca-passos (MP definitivos ventriculares (79,2% foram os mais utilizados. Empregou-se o método de Kaplan-Meier e o teste de Log-Rank para a análise de sobrevivência. RESULTADOS: Após 5,7 ± 5,9 anos de seguimento (máximo= 22,5 anos, 97 pacientes estavam vivos e 11 haviam sido perdidos para o seguimento. As principais causas de morte foram insuficiência cardíaca (10, infecção não relacionada ao marca-passo (seis e morte súbita (três. A expectativa de sobrevida aos cinco, 10 e 15 anos de seguimento mostrou, respectivamente, índices de 80,9 ± 4,1%, 75,4 ± 5,5% e 67,2 ± 7,4%. A persistência de problemas hemodinâmicos após a correção (correções paliativas, uso de próteses valvares ou defeitos residuais foi identificada como única variável preditora independente de risco para mortalidade, alterando significativamente as curvas de sobrevivência (p = 0,0123. CONCLUSÕES: O implante de marca-passo em casos de bradicardia pós-operatória possibilitou boa expectativa de sobrevida. A realização de correções paliativas, assim como a presença de defeitos residuais ou de próteses valvares, foram os únicos fatores preditores de mau prognóstico para essas crianças.OBJECTIVE: To evaluate the long-term outcomes of children submitted to permanent cardiac pacing due to postoperative bradycardia and to identify risk factors for mortality. METHODS: From 1980 to 2004, 120 children were submitted to permanent pacemaker (PM implantation. Interval

  17. Fear bradycardia and activation of the human periaqueductal grey

    NARCIS (Netherlands)

    Hermans, E.J.; Henckens, M.J.A.G.; Roelofs, K.; Fernandez, G.S.E.

    2013-01-01

    Animal models of predator defense distinguish qualitatively different behavioral modes that are activated at increasing levels of predation threat. A defense mode observed at intermediate threat levels is freezing: a cessation of locomotion that is characterized by a parasympathetically dominated

  18. Electromuscular Incapacitating Devices Discharge and Risk of Severe Bradycardia

    Science.gov (United States)

    Havranek, Stepan; Neuzil, Petr; Linhart, Ales

    2015-01-01

    Abstract Electromuscular incapacitating devices (EMDs) are high-voltage, low-current stimulators causing involuntary muscle contractions and sensory response. Existing evidence about cardiac effects of EMD remains inconclusive. The aim of our study was to analyze electrocardiographic, echocardiographic, and microvolt T-wave alternans (MTWA) changes induced by EMD discharge. We examined 26 volunteers (22 men; median age 30 years) who underwent single standard 5-second duration exposure to TASER X26 under continuous echocardiographic and electrocardiographic monitoring. Microvolt T-wave alternans testing was performed at baseline (MTWA-1), as well as immediately and 60 minutes after EMD exposure (MTWA-2 and MTWA-3, respectively). Mean heart rate (HR) increased significantly from 88 ± 17 beats per minute before to 129 ± 17 beats per minute after exposure (P < 0.001). However, in 2 individuals, an abrupt decrease in HR was observed. In one of them, interval between two consecutive beats increased up to 1.7 seconds during the discharge. New onset of supraventricular premature beats was observed after discharge in 1 patient. Results of MTWA-1, MTWA-2, and MTWA-3 tests were positive in one of the subjects, each time in a different case. Standard EMD exposure can be associated with a nonuniform reaction of HR and followed by heart rhythm disturbances. New MTWA positivity can reflect either the effect of EMD exposure or a potential false positivity of MTWA assessments. PMID:25710795

  19. Disruption of bradycardia associated with discriminative conditioning in combat veterans with PTSD

    OpenAIRE

    Ginsberg, Jay P.; Edwin Ayers; Louisa Burriss; Powell, Donald A

    2008-01-01

    Jay P Ginsberg1,2, Edwin Ayers3, Louisa Burriss1, Donald A Powell1,41Shirley L. Buchanan Neuroscience Laboratory, Dorn VA Medical Center, Columbia, SC, USA; 2Department of Pharmacology, Physiology, and Neuroscience, School of Medicine, 4Department of Psychology, University of South Carolina, Columbia, SC, USA; 3Department of Psychology, South Carolina State University, Orangeburg, SC, USAAbstract: The effects of combat-related posttraumatic stress disorder (PTSD) on heart rate (HR) responding...

  20. Hypothermia with Extreme Bradycardia following Spinal Cord Infarction of Septic Origin

    Directory of Open Access Journals (Sweden)

    Philippe Hantson

    2017-01-01

    Full Text Available Among other autonomic dysfunctions complicating acute spinal cord injury, deep hypothermia is rare but may induce serious cardiovascular complications. There are few pharmacological options to influence hypothermia. A 66-year-old woman was transferred to the intensive care unit (ICU for serious cardiac arrhythmias (atrial fibrillation and asystole in the context of a deep hypothermia (axillary temperature below 32°C. She had been admitted to the hospital two months before for an acute L4-L5 infectious spondylodiscitis without any initial neurological deficit. After surgery for epidural abscess drainage, she became paraplegic due to spinal cord infarction (from C7 to T6 levels in the upper territory of the anterior spinal artery. In the ICU, the patient experienced several episodes of asystole and hypotension associated with a core body temperature below 35°C. Common causes of hypothermia (drugs, hypothyroidism, etc. were excluded. A definitive pacemaker had to be inserted, but hypotension persisted. The prescription of oral progesterone (200 mg·d−1 helped to maintain a core temperature higher than 35°C, with a withdrawal of vasopressors. This case report illustrates that patients with incomplete spinal cord injury may present with delayed and deep hypothermia leading to serious cardiovascular complications. Progesterone could be able to influence positively central and peripheral thermal regulation.

  1. Resting Bradycardia, Enhanced Postexercise Heart Rate Recovery and Cardiorespiratory Fitness in Recreational Ballroom Dancers

    Science.gov (United States)

    da Cruz, Carlos Janssen Gomes; Molina, Guilherme Eckhardt; Porto, Luiz Guilherme Grossi; Junqueira, Luiz Fernando, Jr.

    2017-01-01

    Purpose: In a cross-sectional study design, we evaluated the resting heart rate (HR[subscript baseline]) and exercise and postexercise stress test-related chronotropic responses in male practitioners of recreational ballroom dancing (BD; n = 25, M[subscript age] = 26.6 ± 6.1 years) compared to a control group of insufficiently active nondancers…

  2. Labetalol infusion for refractory hypertension causing severe hypotension and bradycardia: an issue of patient safety

    Directory of Open Access Journals (Sweden)

    Papadimos Thomas J

    2008-05-01

    Full Text Available Abstract Incremental doses of intravenous labetalol are safe and effective and, at times, such therapy may need to be augmented by a continuous infusion of labetalol to control severe hypertension. Continuous infusions of labetalol may exceed the recommended maximum daily dose of 300 mg on occasion. We report a case in which hypertension occurring after an abdominal aortic aneurysm repair, initially responsive to intermittent intravenous beta-blockade, became resistant to this therapy leading to the choice of an intravenous labetalol infusion as the therapeutic option. The labetalol infusion resulted in a profound cardiovascular compromise in this postoperative critically ill patient. While infusions of labetalol have successfully been used, prolonged administration in the intensive care unit requires vigilance and the establishment of a therapeutic rationale/policy for interventions, such as the ready availability of glucagon, β-agonists, phosphodiesterase inhibitors, insulin, and vasopressin when severe cardiovascular depression occurs.

  3. The HCN4 channel mutation D553N associated with bradycardia has a C-linker mediated gating defect.

    Science.gov (United States)

    Netter, Michael F; Zuzarte, Marylou; Schlichthörl, Günter; Klöcker, Nikolaj; Decher, Niels

    2012-01-01

    The D553N mutation located in the C-linker of the cardiac pacemaker channel HCN4 is thought to cause sino-atrial dysfunction via a pronounced dominant-negative trafficking defect. Since HCN4 mutations usually have a minor defect in channel gating, it was our aim to further characterize the disease causing mechanism of D553N. Fluorescence microscopy, FACS, TEVC and patch-clamp recordings were performed to characterize D553N. Surprisingly, we found that D553N channels reach the plasma membrane and have no apparent trafficking defect. Co-expression of D553N with HCN4 also revealed no dominant-negative effect on wild-type channels. Consistent with the normal cell surface expression of D553N, it was possible to extensively characterize D553N mutants in Xenopus oocytes and mammalian cells. D553N channels generate currents with reduced amplitude, while the kinetics of activation and deactivation are not altered. While the regulation of D553N by tyrosine kinases is normal, we observed a change in the cAMP regulation which however cannot account for the strong loss-of-function of the mutant. The pronounced current reduction and the regular surface expression indicate a major gating defect of the C-linker gate. We hypothesize that the D553N mutation stabilizes a previously reported salt bridge important for the gating of the channel. Copyright © 2012 S. Karger AG, Basel.

  4. Pharmacological activation of rapid delayed rectifier potassium current suppresses bradycardia-induced triggered activity in the isolated guinea pig heart

    DEFF Research Database (Denmark)

    Hansen, Rie Schultz; Olesen, Søren-Peter; Grunnet, Morten

    2007-01-01

    arrhythmias. We present here data that support that NS3623 affects native I(Kr) and report the effects that activating this potassium current have in the intact guinea pig heart. In Langendorff-perfused hearts, the compound showed a concentration-dependent shortening of action potential duration, which...... was also detected as concentration-dependent shorter QT intervals. There was no sign of action potential triangulation or reverse use dependence. NS3623 decreased QT variability and distinctly decreased the occurrence of extrasystoles in the acutely bradypaced hearts. Taken together, the present data...

  5. Exercise Training and Grape Seed Extract Co-Administration Improves Lipid Profile, Weight Loss, Bradycardia, and Hypotension of STZ-Induced Diabetic Rats

    Directory of Open Access Journals (Sweden)

    Mohammad Badavi

    2013-12-01

    Full Text Available Background:: Exercise Training (ET and Grape Seed Extract (GSE as an antioxidant have many positive effects on controlling diabetes mellitus and its complications. Objectives:: This study aimed to determine the effects of GSE alone or combined with ET on body weight, plasma lipid profile, blood pressure, and heart rate in STZ-induced diabetic rats. Methods:: In this study, male Wistar rats were randomly assigned to five groups: sedentary control, sedentary diabetic, trained diabetic, GSE treated sedentary diabetic, and GSE treated trained diabetic. ET was conducted on the treadmill daily for 8 weeks. One way ANOVA followed by LSD test was used for statistical analysis. Results:: Reduction of body weight, high density lipoproteins, heart rate, and systolic blood pressure and increment of total cholesterol, triglyceride, low density lipoprotein, and very low density lipoproteins were observed after STZ injection. Co-administration of GSE and ET had more positive effects on lipid profile compared to each method alone. In addition, GSE and ET modified heart rate partially, while their combination was more effective in improvement of heart rat in conscious rats. On the other hand, administration of ET or GSE alone did not affect systolic blood pressure and body weight, while their combination restored systolic blood pressure completely and improved body weight partially. Conclusions:: The study findings indicated that ET combined with GSE had more beneficial effects compared to each one alone on the complications of STZ induced diabetes. This may constitute a convenient and inexpensive therapeutic approach to diabetic complications.

  6. COX-2–prostacyclin signaling through endothelial nitric oxide is not necessary for lipopolysaccharide-induced hypotension and bradycardia in conscious unrestrained mice

    DEFF Research Database (Denmark)

    Stæhr, Mette

    caused a concomitant decrease in mean arterial blood pressure (MAP) and heart rate (HR) that was significant after 2-3h and sustained through the experiment (8h). The LPS-induced changes in MAP and HR were not different from control in COX-2-/- mice and in eNOS-/- mice. Intravenous infusion...... of a prostacyclin receptor (IP) antagonist, (BR5064, 0.1 mg/kg bolus followed by infusion at a rate of 0.005 mg/kg/h for 8 h), effectively blocked the hypotensive effect of an IP agonist (beraprost 20 µg/kg), but did not attenuate the LPS-induced decrease in MAP and HR. LPS decreased eNOS mRNA level in liver...

  7. A Comparison of Prophylactic Intravenous Glycopyrrolate and ...

    African Journals Online (AJOL)

    Background: Spinal anaesthesia is complicated by hypotension and bradycardia. There are many risk factors for bradycardia in parturients who present for caesarean section. Due to the different pathophysiology of bradycardia, prophylactic administration of a vagolytic (glycopyrrolate) may however counter bradycardia ...

  8. Brimonidine gel: Systemic cardiovascular effects

    National Research Council Canada - National Science Library

    2017-01-01

    Safety News United Kingdom - The MHRA has informed health care professionals that systemic cardiovascular effects including bradycardia, hypotension and dizziness have been reported after application of brimonidine gel...

  9. Brain tumour as a rare cause of cardiac syncope.

    NARCIS (Netherlands)

    Sluijs, B.M. van der; Renier, W.O.; Kappelle, A.C.

    2004-01-01

    We report on a patient with a bradycardia followed by an asystole as expression of a complex partial seizure arising from a cerebral neoplasm in the medial part of the left temporal lobe. Previously published papers have shown that cardiac asystole and bradycardia as manifestation of epilepsy

  10. Case Report

    African Journals Online (AJOL)

    usually occurs with high intravenous steroid doses. More significant arrhythmias and cardiac arrest were also described. In this report we describe a case of bradycardia that developed after the use of oral corticosteroids. Case report: We report a case of bradycardia that developed in a 14 year-old male after receiving oral.

  11. Apnea of Prematurity

    National Research Council Canada - National Science Library

    Eichenwald, Eric C

    2016-01-01

    Apnea of prematurity is one of the most common diagnoses in the NICU. Despite the frequency of apnea of prematurity, it is unknown whether recurrent apnea, bradycardia, and hypoxemia in preterm infants are harmful...

  12. Apnea of Prematurity

    National Research Council Canada - National Science Library

    Eric C Eichenwald

    2016-01-01

      Apnea of prematurity is one of the most common diagnoses in the NICU. Despite the frequency of apnea of prematurity, it is unknown whether recurrent apnea, bradycardia, and hypoxemia in preterm infants are harmful...

  13. Neonatal side effects of maternal labetalol treatment in severe preeclampsia

    NARCIS (Netherlands)

    Heida, Karst Y.; Zeeman, Gerda G.; Van Veen, Teelkien R.; Hulzebos, Christian V.

    Objective: Labetalol is often used in severe preeclampsia (PE). Hypotension, bradycardia and hypoglycemia are feared neonatal side effects, but may also occur in (preterm) infants regardless of labetalol exposure. We analyzed the possible association between intrauterine labetalol exposure and such

  14. Overlevelse efter massiv verapamiloverdosis hos en 48-årig kvinde

    DEFF Research Database (Denmark)

    Johansen, Karina K; Belhage, Bo

    2007-01-01

    , was hypotensive, and ECG showed bradycardia with nodal rhythm. The patient was treated with activated charcoal, colloids, crystalloids, norepinephrine, isoprenalin and epinephrine infusion, high dose glucose-insulin infusion and calcium. The patient was discharged for rehabilitation after two weeks....

  15. Overlevelse efter massiv verapamiloverdosis hos en 48-årig kvinde

    DEFF Research Database (Denmark)

    Johansen, Karina K; Belhage, Bo

    2007-01-01

    , was hypotensive, and ECG showed bradycardia with nodal rhythm. The patient was treated with activated charcoal, colloids, crystalloids, norepinephrine, isoprenalin and epinephrine infusion, high dose glucose-insulin infusion and calcium. The patient was discharged for rehabilitation after two weeks...

  16. Evaluation of a New Cardiac Pacemaker

    Science.gov (United States)

    2013-06-25

    Atrial Fibrillation With 2 or 3° AV or Bifascicular Bundle Branch (BBB) Block; Normal Sinus Rhythm With 2 or 3° AV or BBB Block; Sinus Bradycardia With Infrequent Pauses or Unexplained Syncope With EP Findings

  17. Reduced freezing in posttraumatic stress disorder patients while watching affective pictures

    NARCIS (Netherlands)

    Fragkaki, Iro; Roelofs, Karin; Stins, John; Jongedijk, Ruud A.; Hagenaars, Muriel A.

    Besides fight and flight responses, animals and humans may respond to threat with freezing, a response characterized by bradycardia and physical immobility. Risk assessment is proposed to be enhanced during freezing to promote optimal decision making. Indeed, healthy participants showed

  18. Reduced freezing in posttraumatic stress disorder patients while watching affective pictures

    NARCIS (Netherlands)

    Fragkaki, Iro; Roelofs, Karin; Stins, John; Jongedijk, Ruud A.; Hagenaars, Muriel A.

    2017-01-01

    Besides fight and flight responses, animals and humans may respond to threat with freezing, a response characterized by bradycardia and physical immobility. Risk assessment is proposed to be enhanced during freezing to promote optimal decision making. Indeed, healthy participants showed

  19. Epidemiology of Acute Q Fever, Scrub Typhus, and Murine Typhus, and Identification of Their Clinical Characteristics Compared to Patients with Acute Febrile Illness in Southern Taiwan

    Directory of Open Access Journals (Sweden)

    Chung-Hsu Lai

    2009-05-01

    Conclusion: In southern Taiwan, acute Q fever is the most common rickettsiosis. QSM diseases should be suspected in febrile patients who present with relative bradycardia, hepatomegaly, and elevated serum aminotransferases, but without leukocytosis.

  20. Expanding spectrum of human RYR2-related disease - New electrocardiographic, structural, and genetic features

    NARCIS (Netherlands)

    Bhuiyan, Zahurul A.; van den Berg, Maarten P.; van Tintelen, J. Peter; Bink-Boelkens, Margreet T. E.; Wiesfeld, Ans C. P.; Alders, Marielle; Postma, Alex V.; van Langen, Irene; Mannens, Marcel M. A. M.; Wilde, Arthur A. M.

    2007-01-01

    Background - Catecholaminergic polymorphic ventricular tachycardia is a disease characterized by ventricular arrhythmias elicited exclusively under adrenergic stress. Additional features include baseline bradycardia and, in some patients, right ventricular fatty displacement. The clinical spectrum

  1. Munchausen Syndrome by Proxy: Unusual Manifestations and Disturbing Sequelae.

    Science.gov (United States)

    Porter, Gerald E.; And Others

    1994-01-01

    This study documents previously unreported findings in cases of Munchausen Syndrome by Proxy (in which a mother fabricates an illness in her child). In the reported case, esophageal perforation, retrograde intussusception, tooth loss, and bradycardia were found. (Author/DB)

  2. Life-threatening reaction to indigo carmine--a sulfa allergy?

    Science.gov (United States)

    Graziano, Scott; Hoyte, Lennox; Vilich, Fatima; Brubaker, Linda

    2005-01-01

    Indigo carmine is commonly used during cystoscopy when evaluating for lower urinary tract safety after gynecologic surgery. We report a case of severe hypotension and bradycardia following intravenous indigo carmine injection in a patient with known sulfa allergy.

  3. Prenatal 2D Ultrasonic Diagnosis of Fetal Complete Atrioventricular Block and Bilateral Hydroceles with Occult Maternal SS-A

    Directory of Open Access Journals (Sweden)

    Chih Yao Yi

    2006-03-01

    Conclusion: Antenatal evaluation for a maternal history of autoimmune disease (especially systemic lupus erythematosus and prevention of fetal bradycardia by reducing immune-mediated injuries on the cardiac conduction system are important.

  4. Comparison of dexmedetomidine, pethidine and tramadol in the ...

    African Journals Online (AJOL)

    However, dexmedetomidine caused a higher incidence of hypotension and bradycardia. Keywords: dexmedetomidine, pethidine, post-neuraxial anaesthesia shivering, tramadol. Introduction. Shivering may be defined as an involuntary, repetitive activity in the skeletal muscle. Shivering usually occurs as a thermoregulatory.

  5. Role of ionotropic GABA, glutamate and glycine receptors in the tonic and reflex control of cardiac vagal outflow in the rat

    Directory of Open Access Journals (Sweden)

    Goodchild Ann K

    2010-10-01

    Full Text Available Abstract Background Cardiac vagal preganglionic neurons (CVPN are responsible for the tonic, reflex and respiratory modulation of heart rate (HR. Although CVPN receive GABAergic and glutamatergic inputs, likely involved in respiratory and reflex modulation of HR respectively, little else is known regarding the functions controlled by ionotropic inputs. Activation of g-protein coupled receptors (GPCR alters these inputs, but the functional consequence is largely unknown. The present study aimed to delineate how ionotropic GABAergic, glycinergic and glutamatergic inputs contribute to the tonic and reflex control of HR and in particular determine which receptor subtypes were involved. Furthermore, we wished to establish how activation of the 5-HT1A GPCR affects tonic and reflex control of HR and what ionotropic interactions this might involve. Results Microinjection of the GABAA antagonist picrotoxin into CVPN decreased HR but did not affect baroreflex bradycardia. The glycine antagonist strychnine did not alter HR or baroreflex bradycardia. Combined microinjection of the NMDA antagonist, MK801, and AMPA antagonist, CNQX, into CVPN evoked a small bradycardia and abolished baroreflex bradycardia. MK801 attenuated whereas CNQX abolished baroreceptor bradycardia. Control intravenous injections of the 5-HT1A agonist 8-OH-DPAT evoked a small bradycardia and potentiated baroreflex bradycardia. These effects were still observed following microinjection of picrotoxin but not strychnine into CVPN. Conclusions We conclude that activation of GABAA receptors set the level of HR whereas AMPA to a greater extent than NMDA receptors elicit baroreflex changes in HR. Furthermore, activation of 5-HT1A receptors evokes bradycardia and enhances baroreflex changes in HR due to interactions with glycinergic neurons involving strychnine receptors. This study provides reference for future studies investigating how diseases alter neurochemical inputs to CVPN.

  6. Effect of ondansetron on prevention of post-induction hypotension in elderly patients undergoing general anesthesia: A randomized, double-blind placebo-controlled clinical trial

    OpenAIRE

    Mohammad Golparvar; Mahmoud Saghaei; Mohammad Ali Saadati; Shadi Farsaei

    2015-01-01

    Background: Elderly patients are susceptible to post-induction hypotension. Volume loading and vasopressors for prevention of hypotension in elderly patients may increase perioperative cardiovascular risks. Ondansetron by blocking Bezold?Jarisch reflex (BJR) through inhibition of serotonin receptors has been effective in the prevention of post-spinal hypotension, and bradycardia. Bradycardia frequently accompanies post-induction hypotension in elderly patients, which signifies a possible prev...

  7. The reflex control of heart rate and cardiac output in the rainbow trout: interactive influences of hypoxia, haemorrhage, and systemic vasomotor tone.

    Science.gov (United States)

    Wood, C M; Shelton, G

    1980-08-01

    In cannulated trout there was no cholinergic vagal tone as revealed by atropine blockade during normal heart rates. Reductions in heart rate occasionally occurred under normoxia without apparent external stimuli ('spontaneous' bradycardia) and always occurred under environmental hypoxia (hypoxic bradycardia) due to the imposition of significant vagal tone. Direct measurements of cardiac output (Q) during these bradycardias showed that increases in cardiac stroke volume compensated for the falls in heart rate so that total Q remained unchanged or increased slightly. Sudden experimental reductions in arterial blood pressure via blockade of systemic vasomotor tone with yohimbine or via haemorrhage had no effect on heart rate during normal rates, but caused cardioacceleration during both types of bradycardia. These increases in heart rate never exceeded the point of zero vagal tone (normal heart rate) and were largely or wholly due to reductions in endogenous vagal tone. These cardioaccelerations were temporary; spontaneous bradycardia could re-occur at any time, while hypoxic bradycardia always re-occurred if the hypoxic stimulus were maintained. The results are interpreted in terms of a central interaction between the baroreceptor and chemoreceptor reflexes.

  8. Cardiac arrhythmias associated with spinal cord injury.

    Science.gov (United States)

    Hector, Sven Magnus; Biering-Sørensen, Tor; Krassioukov, Andrei; Biering-Sørensen, Fin

    2013-11-01

    To review the current literature to reveal the incidence of cardiac arrhythmias and its relation to spinal cord injury (SCI). MEDLINE database, 304 hits, and 32 articles were found to be relevant. The relevant articles all met the inclusion criteria: (1) contained original data (2) on cardiac arrhythmias (3) in humans with (4) traumatic SCI. In the acute phase of SCI (1-14 days after injury) more cranial as well as more severe injuries seemed to increase the incidence of bradycardia. Articles not covering the first 14 days after injury, thus describing the chronic phase of SCI, showed that individuals with SCI did not have a higher incidence of cardiac arrhythmias compared with able-bodied controls. Furthermore, their heart rate did not differ significantly. Penile vibro-stimulation was the procedure investigated most likely to cause bradycardia, which in turn was associated with episodes of autonomic dysreflexia. The incidence of bradycardia was found to be 17-77% for individuals with cervical SCI. For individuals with thoracolumbar SCI, the incidence was 0-13%. Bradycardia was commonly seen in the acute stage after SCI as well as during procedures such as penile vibro-stimulation and tracheal suction. These episodes of bradycardia were seen more often in individuals with cervical injuries. Longitudinal studies with continuous electrocardiogram recordings are needed to uncover the true relation between cardiac arrhythmias and SCI.

  9. Seizure Triggered by Sick Sinus Syndrome.

    Science.gov (United States)

    Patel, Nilesh; Majeed, Faisal; Sule, Anupam Ashutosh

    2017-11-04

    Sick sinus syndrome (SSS) is a dysfunction of sinoatrial node resulting in symptomatic bradycardia or sinus pauses causing decreased cardiac output with cerebral hypoperfusion and usually presents as syncope, presyncope or fatigue. The occurrence of a seizure is very rare. A 69-year-old man suffered two episodes of generalised tonic-clonic seizures. MRI and electroencephalogram failed to reveal the cause of seizures. In the emergency room, he experienced presyncope simultaneous to bradycardia and sinus pauses. He was stabilised with atropine and dopamine infusion and underwent definitive therapy with a permanent dual-chamber pacemaker with complete symptom resolution. Diagnostic confounders include convulsive syncope and ictal bradycardia. Syncope may be accompanied by myoclonic jerks (convulsive syncope), but postictal confusion is absent. Bradycardia may be seen during the postictal period (ictal bradycardia syndrome), but protracted sinus dysfunction is not present. Hypoperfusion due to significant SSS triggered seizures in this patient who may have an underlying predisposition. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Partners in Crime in the Setting of Recurring Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Lida P. Papavasileiou

    2011-01-01

    Full Text Available No previous reports are available about the potential dramatic effects resulting from the combination of acquired long QT interval not associated to bradycardia and myocardial ischemia. We report the case of a man that during acute necrotic pancreatitis presented QT interval prolongation without bradycardia, TdP, and two episodes of cardiac arrest. A coronary angiogram revealed a subocclusive stenosis of left anterior descending coronary artery, treated with a percutaneous coronary intervention. After myocardial revascularization, even in presence of long QT interval, no arrhythmic events occurred suggesting the key role of myocardial ischemia in triggering TdP in acquired long QT even without bradycardia. ECG performed six months later, after complete recovery from pancreatitis, showed a normal QT interval.

  11. Partners in crime in the setting of recurring cardiac arrest.

    Science.gov (United States)

    Papavasileiou, Lida P; Forleo, Giovanni B; Santini, Luca; Martuscelli, Eugenio; Romeo, Francesco

    2011-03-03

    No previous reports are available about the potential dramatic effects resulting from the combination of acquired long QT interval not associated to bradycardia and myocardial ischemia. We report the case of a man that during acute necrotic pancreatitis presented QT interval prolongation without bradycardia, TdP, and two episodes of cardiac arrest. A coronary angiogram revealed a subocclusive stenosis of left anterior descending coronary artery, treated with a percutaneous coronary intervention. After myocardial revascularization, even in presence of long QT interval, no arrhythmic events occurred suggesting the key role of myocardial ischemia in triggering TdP in acquired long QT even without bradycardia. ECG performed six months later, after complete recovery from pancreatitis, showed a normal QT interval.

  12. Importance of Close Follow-Up in the Fetus with Premature Atrial Contractions Accompanied by Atrial Septal Aneurysm: A Case Report

    Directory of Open Access Journals (Sweden)

    Yilmaz Yozgat

    2013-01-01

    Full Text Available Rhythms that derive from parts of atria other than the sinus node are called premature atrial contractions (PACs. Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs. To the best of our knowledge, coexistence of tachycardia and bradycardia leading to hemodynamic impairment has not yet been reported. We present a fetus diagnosed with PACs and atrial septal aneurysm (ASA on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. We suggest closer follow-up of fetuses with PACs accompanied by ASA.

  13. Nicorandil-Induced Hyperkalemia in a Uremic Patient

    Directory of Open Access Journals (Sweden)

    Hung-Hao Lee

    2012-01-01

    Full Text Available Nicorandil is an antianginal agent with nitrate-like and ATP-sensitive potassium channel activator properties. After activation of potassium channels, potassium ions are expelled out of the cells, which lead to membrane hyperpolarization, closure of voltage-gated calcium channels, and finally vasodilation. We present a uremic case suffering from repeated junctional bradycardia, especially before hemodialysis. After detailed evaluation, nicorandil was suspected to be the cause of hyperkalemia which induced bradycardia. This case reminds us that physicians should be aware of this potential complication in patients receiving ATP-sensitive potassium channel activator.

  14. A reminder about the trigeminocardiac reflex in surgeries at the posterior third of the falx cerebri

    Directory of Open Access Journals (Sweden)

    Koji Takano

    2014-09-01

    Full Text Available The trigeminocardiac reflex (TCR is defined as a reproducible hypotension and bradycardia coinciding with the manipulation around the trigeminal nerve. Here, we report a case of sudden bradycardia with falcine manipulation. As the falx cerebri is innervated by the nervus tentorii, which is a recurrent branch of the ophthalmic nerve, the observed asystole is highly possible to be caused by TCR. Anesthesiologists and neurosurgeons should be fully aware of the anatomical innervation of the falx cerebri and that the posterior third of the falx cerebri is one of the highest risk structures for TCR induction for safe operation around this region.

  15. Role of arterial baroreceptors in mediating cardiovascular response to exercise

    Science.gov (United States)

    Mcritchie, R. J.; Vatner, S. F.; Patrick, T. A.; Braunwald, E.; Boettcher, D.; Heyndrickx, G. R.

    1976-01-01

    Experiments were conducted to define the role of the major arterial baroreceptors during moderately severe exercise by comparing the responses of untethered conscious dogs instrumented for the measurement of aortic pressure and cardiac output with those of dogs with total arterial baroreceptor denervation. The reflex heart rate responses to intravenous bolus doses of methoxamine were also examined in intact animals, both at rest and during exercise. Methoxamine is found to cause striking bradycardia at rest, but little bradycardia during exercise. Experimental findings suggest that the arterial baroreceptor reflex is normally inhibited during severe exercise and therefore plays little role in modulating the cardiovascular response to exercise.

  16. Peripheral 5-HT 1A and 5-HT 7 Serotonergic Receptors Modulate Parasympathetic Neurotransmission in Long-Term Diabetic Rats

    Directory of Open Access Journals (Sweden)

    Beatriz Restrepo

    2010-01-01

    Full Text Available We analyzed the modulation of serotonin on the bradycardia induced in vivo by vagal electrical stimulation in alloxan-induced long-term diabetic rats. Bolus intravenous administration of serotonin had a dual effect on the bradycardia induced either by vagal stimulation or exogenous Ach, increasing it at low doses and decreasing it at high doses of 5-hydroxytryptamine (5-HT, effect reproduced by 5-carboxamidotryptamine maleate (5-CT, a 5-HT1/7 agonist. The enhancement of the bradycardia at low doses of 5-CT was reproduced by 5-HT1A agonist 8-hydroxy-2-dipropylaminotetralin hydrobromide (8-OH-DPAT and abolished by WAY-100,635, 5-HT1A antagonist. Pretreatment with 5-HT1 antagonist methiothepin blocked the stimulatory and inhibitory effect of 5-CT, whereas pimozide, 5-HT7 antagonist, only abolished 5-CT inhibitory action. In conclusion, long-term diabetes elicits changes in the subtype of the 5-HT receptor involved in modulation of vagally induced bradycardia. Activation of the 5-HT1A receptors induces enhancement, whereas attenuation is due to 5-HT7 receptor activation. This 5-HT dual effect occurs at pre- and postjunctional levels.

  17. Studies on the nutritional value and anti-tumour property of the bark ...

    African Journals Online (AJOL)

    Most of the symptoms observed in the later such as hair loss, reduced agility, low food intake and hyperplastic nodules were reduced. Ultrasound findings showed significant tachycardia in group B rats with increased dosage of the treatment plant while the test control rats showed relative bradycardia, indicating that ...

  18. Early Disseminated Lyme Disease with Carditis Complicated by Posttreatment Lyme Disease Syndrome

    Directory of Open Access Journals (Sweden)

    Cheryl Novak

    2017-01-01

    Full Text Available Lyme disease is an infectious disease caused by the bacterium Borrelia burgdorferi. When untreated, infection may spread to the heart, nervous system, and joints. Cardiac involvement usually manifests as abnormalities of the conduction system and bradycardia. Treatment of Lyme disease is generally effective, with a subset of patients experiencing persistent, sometimes long-term symptoms called posttreatment Lyme disease syndrome.

  19. Primary congenital hypothyroidism complicated by persistent severe ...

    African Journals Online (AJOL)

    2013-12-24

    Dec 24, 2013 ... triiodothyronine and free T4 levels were both low, while the TSH level was markedly elevated, indicating primary congenital hypothyroidism. The tachycardia reflects the anaemia, rather than the typical bradycardia of hypothyroidism. The resolution of persistent anaemia following levothyroxine therapy ...

  20. Anaphylaxis in children

    African Journals Online (AJOL)

    EL-HAKIM

    dyspnea, nausea, anxiety, and bradycardia may ... anaphylaxis in children with cow's milk allergy.11 ..... Patients in severe respiratory distress may be more comfortable in the sitting position. B = Breathing. – Assess adequacy of ventilation and provide the patient with sufficient oxygen with an oxygen saturation of at.

  1. Tension pneumoventricle: A report of two cases

    African Journals Online (AJOL)

    2015-10-23

    Oct 23, 2015 ... convulsion, frontal lobe syndrome, and cardiac arrest.[2]. Episodes of bradycardia may also be seen with or without hypertension. A bruit hydro‑aerique or “succussion splash” may be heard by the patient upon postural change which may also be audible with a stethoscope.[7]. A high index of suspicion and ...

  2. Efficacy of intrathecal midazolam versus fentanyl for endoscopic

    African Journals Online (AJOL)

    Postoperative analgesia was provided with intravenous diclofenac. The onset and duration of sensory and motor blockade, postoperative pain and the time to 1st rescue analgesia was noted. Patients were observed for hypotension, bradycardia, sedation, respiratory depression, pruritus, and postoperative nausea-vomiting.

  3. ECG Changes In Patients On Chronic Psychotropic medication

    African Journals Online (AJOL)

    2006-08-31

    Aug 31, 2006 ... time.5,6 In contrast, selective serotonin reuptake inhibitors produce minor degrees of bradycardia. Tricyclic antidepressants also delay cardiac conduction, mainly ..... depressed patients with cardiac conduction disease. Arch Gen Psychiatry. 1987; 44: 273–275. 10. Wendkos MH. Cardiac changes related to ...

  4. A case of nondigitalis cardiac glycoside toxicity.

    Science.gov (United States)

    Gupta, A; Joshi, P; Jortani, S A; Valdes, R; Thorkelsson, T; Verjee, Z; Shemie, S

    1997-12-01

    A case is presented of cardiac glycoside poisoning in a 1-year-old patient from the plant Nerium oleander (common oleander). The patient had bradycardia, vomiting, altered level of consciousness, and no history of ingestion. Antibody-based digoxin assays may cross-react with other cardiac glycosides nonquantitatively. Chromatographic techniques can be used in the specific diagnosis.

  5. Mental imagery affects subsequent automatic defense responses

    Directory of Open Access Journals (Sweden)

    Muriel A Hagenaars

    2015-06-01

    Full Text Available Automatic defense responses promote survival and appropriate action under threat. They have also been associated with the development of threat-related psychiatric syndromes. Targeting such automatic responses during threat may be useful in populations with frequent threat exposure. Here, two experiments explored whether mental imagery as a pre-trauma manipulation could influence fear bradycardia (a core characteristic of freezing during subsequent analogue trauma (affective picture viewing. Image-based interventions have proven successful in the treatment of threat-related disorders, and are easily applicable. In Experiment 1 43 healthy participants were randomly assigned to an imagery script condition. Participants executed a passive viewing task with blocks of neutral, pleasant and unpleasant pictures after listening to an auditory script that was either related (with a positive or a negative outcome or unrelated to the unpleasant pictures from the passive viewing task. Heart rate was assessed during script listening and during passive viewing. Imagining negative related scripts resulted in greater bradycardia (neutral-unpleasant contrast than imagining positive scripts, especially unrelated. This effect was replicated in Experiment 2 (N = 51, again in the neutral-unpleasant contrast. An extra no-script condition showed that bradycardia was not induced by the negative related script, but rather that a positive script attenuated bradycardia. These preliminary results might indicate reduced vigilance after unrelated positive events. Future research should replicate these findings using a larger sample. Either way, the findings show that highly automatic defense behavior can be influenced by relatively simple mental imagery manipulations.

  6. Pratique du bloc axillaire au CHU Sylvanus Olympio de Lomé (Togo ...

    African Journals Online (AJOL)

    Only 15 patients had pre induction of fentanyl and diazepam in 3 patients. The axillary block was performed successfully in 73.33% of cases. There were 3 cases of hypotension and bradycardia during surgery. Postoperative analgesia was performed by the Paracetamol, Nefopam associated with NSAID and sometimes ...

  7. Propranolol in the treatment of assaultive patients with organic brain disease.

    Science.gov (United States)

    Greendyke, R M; Schuster, D B; Wooton, J A

    1984-10-01

    Propranolol in doses up to 520 mg/day was administered to eight patients with organic brain disease characterized by violent and assaultive behavior refractory to conventional treatment. Improvement was demonstrated in the seven patients able to tolerate adequate drug dosages. Hypotension, bradycardia, and interactions with other medications constituted complications.

  8. Anesthetic management of the trigeminocardiac reflex during mesiodens removal-a case report.

    Science.gov (United States)

    Webb, Michael D; Unkel, John H

    2007-01-01

    We describe a case in which reflection of a palatal flap for removal of a mesiodens is presented as the triggering factor for bradycardia caused by stimulation of the trigeminocardiac reflex. The management of the case, as well as the reflex arc, is discussed.

  9. Anesthetic Management of the Trigeminocardiac Reflex During Mesiodens Removal—A Case Report

    Science.gov (United States)

    Webb, Michael D; Unkel, John H

    2007-01-01

    We describe a case in which reflection of a palatal flap for removal of a mesiodens is presented as the triggering factor for bradycardia caused by stimulation of the trigeminocardiac reflex. The management of the case, as well as the reflex arc, is discussed. PMID:17352528

  10. Cardiac output and vasodilation in the vasovagal response

    DEFF Research Database (Denmark)

    Wieling, Wouter; Jardine, David L.; de Lange, Frederik J

    2016-01-01

    with vagal-induced bradycardia in simple faint. Studies performed by Barcroft and Sharpey-Schafer between 1940 and 1950 used volume-based plethysmography to demonstrate major forearm vasodilation during extreme hypotension and concluded that the main mechanism for hypotension was vasodilation...

  11. Prophylactic administration of atropine attenuates the negative haemodynamic effects of propofol/remifentanil induction of anaesthesia.

    NARCIS (Netherlands)

    Poterman, Marieke; Scheeren, Thomas; van der Velde, M.I.; Struys, Michel; Kalmar, A.F.

    2013-01-01

    Background and Goal of Study:   Induction of anaesthesia with propofol and remifentanil often induces unwanted bradycardia and hypotension. This raises the concern for preserving haemodynamic stability and adequate tissue oxygenation. We previously demonstrated that atropine significantly

  12. A comparative study of the haemodynamic effects of atropine and ...

    African Journals Online (AJOL)

    Background:Bradycardia following administration of halothane and suxamethonium in children leads to reduced cardiac output, which can be prevented with prophylactic anticholinergics. Anticholinergics may result in tachycardia and arrhythmias. This study was designed to compare haemodynamic changes and incidence ...

  13. Sudden unexpected death in a mouse model of Dravet syndrome

    Science.gov (United States)

    Kalume, Franck; Westenbroek, Ruth E.; Cheah, Christine S.; Yu, Frank H.; Oakley, John C.; Scheuer, Todd; Catterall, William A.

    2013-01-01

    Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in intractable epilepsies, but physiological mechanisms that lead to SUDEP are unknown. Dravet syndrome (DS) is an infantile-onset intractable epilepsy caused by heterozygous loss-of-function mutations in the SCN1A gene, which encodes brain type-I voltage-gated sodium channel NaV1.1. We studied the mechanism of premature death in Scn1a heterozygous KO mice and conditional brain- and cardiac-specific KOs. Video monitoring demonstrated that SUDEP occurred immediately following generalized tonic-clonic seizures. A history of multiple seizures was a strong risk factor for SUDEP. Combined video-electroencephalography-electrocardiography revealed suppressed interictal resting heart-rate variability and episodes of ictal bradycardia associated with the tonic phases of generalized tonic-clonic seizures. Prolonged atropine-sensitive ictal bradycardia preceded SUDEP. Similar studies in conditional KO mice demonstrated that brain, but not cardiac, KO of Scn1a produced cardiac and SUDEP phenotypes similar to those found in DS mice. Atropine or N-methyl scopolamine treatment reduced the incidence of ictal bradycardia and SUDEP in DS mice. These findings suggest that SUDEP is caused by apparent parasympathetic hyperactivity immediately following tonic-clonic seizures in DS mice, which leads to lethal bradycardia and electrical dysfunction of the ventricle. These results have important implications for prevention of SUDEP in DS patients. PMID:23524966

  14. Amodiaquine-associated adverse effects after inadvertent overdose and after a standard therapeutic dose

    DEFF Research Database (Denmark)

    Adjei, G O; Goka, B Q; Rodrigues, O P

    2009-01-01

    A case of an acute dystonic reaction in a child presumptively treated for malaria with amodiaquine, and a case of persistent asymptomatic bradycardia in another child with mild pulmonary stenosis treated with a standard dose of amodiaquine for parasitologically confirmed uncomplicated malaria, is...

  15. Reduced freezing in posttraumatic stress disorder patients while watching affective pictures

    NARCIS (Netherlands)

    Fragkaki, I.; Roelofs, K.; Stins, J.F.; Jongedijk, R.A.; Hagenaars, M.A.

    2017-01-01

    Besides fight and flight responses, animals and humans may respond to threat with freezing, an adaptive response characterized by bradycardia and physical immobility. Risk assessment is enhanced during freezing to promote optimal decision-making. Indeed, healthy participants showed freezing-like

  16. Farmacokinetiek van coffeïne bij neonaten met apneu : Op weg naar verfijning van de dosering

    NARCIS (Netherlands)

    Keijer, W.J.; Van Weissenbruch, m.M.; Van Loenen, A.C.; Diepenhorst-Kristanto, S.; Blok, G.J.; Touw, D.J.

    2002-01-01

    We describe the influence of developmental, demographic and clinical determinants on caffeine pharmacokinetics in a multi-ethnic hospital population of 104 very premature infants. We also report on the incidence of apnoeas, bradycardias and desaturations and their relationship with measured serum

  17. NJP VOLUME 41 NO 3

    African Journals Online (AJOL)

    PROF. EZECHUKWU

    2013-04-10

    Apr 10, 2013 ... line penicillin and metronidazole and lateroral erythromycin in an isolated ward. On the 6th day of admission she developed cardiac and neurologic complications– bradycardia (PR=40bpm), hypotension (BP=70/40mmHg), drooling of saliva and paraparesis. Electrocardiography confirmed a complete heart ...

  18. A comparison of single-lead atrial pacing with dual-chamber pacing in sick sinus syndrome

    DEFF Research Database (Denmark)

    Nielsen, Jens Cosedis; Thomsen, Poul Erik B; Højberg, Søren

    2011-01-01

    In patients with sick sinus syndrome, bradycardia can be treated with a single-lead pacemaker or a dual-chamber pacemaker. Previous trials have revealed that pacing modes preserving atrio-ventricular synchrony are superior to single-lead ventricular pacing, but it remains unclear if there is any ...

  19. Peripheral 5-HT1A and 5-HT7 Serotonergic Receptors Modulate Parasympathetic Neurotransmission in Long-Term Diabetic Rats

    Science.gov (United States)

    Restrepo, Beatriz; Martín, María Luisa; San Román, Luis; Morán, Asunción

    2010-01-01

    We analyzed the modulation of serotonin on the bradycardia induced in vivo by vagal electrical stimulation in alloxan-induced long-term diabetic rats. Bolus intravenous administration of serotonin had a dual effect on the bradycardia induced either by vagal stimulation or exogenous Ach, increasing it at low doses and decreasing it at high doses of 5-hydroxytryptamine (5-HT), effect reproduced by 5-carboxamidotryptamine maleate (5-CT), a 5-HT1/7 agonist. The enhancement of the bradycardia at low doses of 5-CT was reproduced by 5-HT1A agonist 8-hydroxy-2-dipropylaminotetralin hydrobromide (8-OH-DPAT) and abolished by WAY-100,635, 5-HT1A antagonist. Pretreatment with 5-HT1 antagonist methiothepin blocked the stimulatory and inhibitory effect of 5-CT, whereas pimozide, 5-HT7 antagonist, only abolished 5-CT inhibitory action. In conclusion, long-term diabetes elicits changes in the subtype of the 5-HT receptor involved in modulation of vagally induced bradycardia. Activation of the 5-HT1A receptors induces enhancement, whereas attenuation is due to 5-HT7 receptor activation. This 5-HT dual effect occurs at pre- and postjunctional levels. PMID:21403818

  20. Deep-Diving California Sea Lions: Are They Pushing Their Physiological Limit?

    Science.gov (United States)

    2014-09-30

    bradycardia during descent occurs in deep-diving emperor penguins (Wright et al. 2014), and in deep-diving bottlenose dolphins ( Tursiops truncatus ...Experimental Biology 210: 278-289. Williams, T.M., J.E. Haun and W.A. Friedl. 1999. The diving physiology of bottlenose dolphins ( Tursiops truncatus ). I

  1. Molecular Cloning and Pharmacology of Porcine 5-Hydroxytryptamine Receptors Relevant to the Study of Antimigraine Drugs

    NARCIS (Netherlands)

    P.L. Bhalla (Pankaj)

    2002-01-01

    textabstractAt the beginning of last century, Brodie (1900) described in an extensive study that injection of blood serum causes vasoconstriction and a vagally-mediated reflex resulting in a reversible bradycardia, hypotension and arrest of the respiration, while injection of blood plasma was devoid

  2. Van die Redaksie/Editorial Non-pharmacological therapy for

    African Journals Online (AJOL)

    of the natural history of specific arrhythmias is essential for such choice to ... sedation, decreased salivary secretions, bradycardia, lowered .... local anaesthetic agentsl2,15 (e.g. clonidine, fentanyl, bupivacaine) are now used for peri-operative anaesthesia and analgesia. Pain is then inhibited by three different mechanisms ...

  3. Author Details

    African Journals Online (AJOL)

    Carson, K. Vol 19, No 3 (2013) - Articles Anaesthesia for scoliosis correction surgery complicated by severe recalcitrant bradycardia upon prone positioning in an adolescent with Prader-Willi syndrome. Abstract PDF. ISSN: 2220-1173. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians ...

  4. Case Report

    African Journals Online (AJOL)

    per minute (bpm) and respiratory rate was 19 per minute. Weight was 53kg and his height was 149 cm body surface. Bradycardia Following Oral Corticosteroid Use: Case Report and Literature Review. Amar Al Shibli1*, Ibrahim Al Attrach2, Mohammad A. Hamdan3. Divisions of General Pediatrics1, Nephrology2 and ...

  5. Developmental aspects of long QT syndrome type 3 and Brugada syndrome on the basis of a single SCN5A mutation in childhood

    NARCIS (Netherlands)

    Beaufort-Krol, GCM; van den Berg, MP; Wilde, AAM; van Tintelen, JP; Viersma, JW; Bezzina, CR; Bink-Boelkens, MTE

    2005-01-01

    OBJECTIVES The aim was to investigate at what age electrocardiographic characteristics of long QT syndrome type 3 (LQT3) and Brugada syndrome (BS), based on a single SNC5A mutation, appear. BACKGROUND The QT interval (QT) in LQT3 is prolonged during bradycardia. It is not clear yet if this is

  6. Author Details

    African Journals Online (AJOL)

    Walshe, CM. Vol 19, No 3 (2013) - Articles Anaesthesia for scoliosis correction surgery complicated by severe recalcitrant bradycardia upon prone positioning in an adolescent with Prader-Willi syndrome. Abstract PDF. ISSN: 2220-1173. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians ...

  7. Induction o.t labour with intravaginal misoprostol in the second and ...

    African Journals Online (AJOL)

    the second and third trimesters of pregnancy ... restricted availability of the drug at one stage and the difficulty with division of .... hypertension. She received four doses of misoprostol. After. 9 hours of labour an oxytocin infusion was started because of slow progress. After a further 9 hours fetal bradycardia was noted and the ...

  8. The Clinical Development of Thalidomide as an Angiogenesis Inhibitor Therapy for Prostate Cancer

    Science.gov (United States)

    2006-10-01

    Blurred vision 5 Diarrhea 4 Vasovagal episode/ bradycardia 1 1 1 Cardiac 4 Memory loss 3 Urinary frequency 3 Dyspnoea...York A, Gezer S, Venugopal P, Raza A. The clinical and biological effects of thalidomide in patients with myelodysplastic syndromes . Br J Haematol

  9. The Clinical Development of Thalildomide as an Angiogenesis Inhibitor Therapy for Prostate Cancer

    Science.gov (United States)

    2005-10-01

    myelodysplastic syndromes . Zorat F, Shetty V, Dutt D, Lisak L, Nascimben F, Allampallam K, Dar S, York A, Gezer S, Venugopal P, Raza A. Br J Haematol...1 Sensory 5 Blurred vision 5 Diarrhea 4 Vasovagal episode/ bradycardia 1 1 1 Cardiac 4 Memory loss 3 Urinary frequency 3

  10. Effect of ondansetron on prevention of post-induction hypotension in elderly patients undergoing general anesthesia: A randomized, double-blind placebo-controlled clinical trial.

    Science.gov (United States)

    Golparvar, Mohammad; Saghaei, Mahmoud; Saadati, Mohammad Ali; Farsaei, Shadi

    2015-01-01

    Elderly patients are susceptible to post-induction hypotension. Volume loading and vasopressors for prevention of hypotension in elderly patients may increase perioperative cardiovascular risks. Ondansetron by blocking Bezold-Jarisch reflex (BJR) through inhibition of serotonin receptors has been effective in the prevention of post-spinal hypotension, and bradycardia. Bradycardia frequently accompanies post-induction hypotension in elderly patients, which signifies a possible preventing role for ondansetron. No previous study has evaluated the prophylactic effects of ondansetron for the prevention of post-induction hypotension. In this randomized placebo-controlled clinical trial, ondansetron 4 mg was given intravenously to 65 elderly patients, 20 min before induction of general anesthesia, and the rate of post-induction hypotension defined as 25% or more reduction in mean arterial blood pressure, compared with a placebo groups. A total of 114 patients completed the study (58 in ondansetron and 56 in the placebo group). Proportions of post-induction hypotension were 9 (16%) and 25 (45%) in ondansetron and placebo groups, respectively, (P = 0.001). Forty-five patients (40%) developed bradycardia. Rates of bradycardia were not significantly different between two groups. The results of this study show the effectiveness of intravenous ondansetron for prevention of post-induction hypotension in elderly patients. The mechanism of this effect largely is unknown. Role of ondansetron for prevention of post-induction hypotension may not fully understandable by its interaction with BJR, as has been shown in post-spinal hypotension.

  11. Dexmedetomidine: An Adjuvant Making Large Inroads into Clinical ...

    African Journals Online (AJOL)

    The various side.effects associated with dexmedetomidine include, but are not limited to hypotension, bradycardia, worsening of heart block, dry mouth, and nausea. However, large scale randomized controlled trials are still needed to establish various effects of dexmedetomidine and to clearly define its safety profile.

  12. Maternal and Neonatal Effects of Vasopressors Used for Treating Hypotension after Spinal Anesthesia for Caesarean Section: A Randomized Controlled Study

    Directory of Open Access Journals (Sweden)

    Alma Soxhuku-Isufi

    2015-12-01

    CONCLUSIONS: Ephedrine and phenylephrine have the same efficacy in treating hypotension after spinal anesthesia for caesarean section. The use of Phenylephrine was associated with better fetal acid-base status, and there were no differences on Apgar score values and on the incidence of maternal bradycardia and hypotension.

  13. Prospective Randomized Controlled Comparison of Caudal ...

    African Journals Online (AJOL)

    controlled trial (RCT) and to compare the motor blockade and hemodynamic effects caused by them. ... Subjects and Methods: This was a prospective randomized controlled study including 50 consecutive patients in the ... decrease of SBP or HR by >30% was defined as hypotension or bradycardia, respectively and was ...

  14. Effectiveness of low-dose midazolam plus ketamine in the ...

    African Journals Online (AJOL)

    2012-11-01

    Nov 1, 2012 ... Design: This was a prospective, randomised, double-blind, placebo-controlled study. Setting and subjects: ... 0.25 mg/kg (Group B), or normal saline as the control group (Group C), after an intrathecal injection of 0.5% hyperbaric bupivacaine ... shivering in patients with bradycardia, hypotension, respiratory ...

  15. 581 Refresher course.indd

    African Journals Online (AJOL)

    Short JA. Noninvasive blood pressure measurement in the upper and lower limbs of anesthetized children. Paediatric. Anaesth 2000: 10(6): 591-3. 7. Hashimoto H, Nakamura H, Hirota K. Marked reduction in the bispectral index with severe bradycardia without hypotension in diabetic patient undergoing ophthalmic surgery.

  16. Prevalence and factors associated with neonatal sepsis among ...

    African Journals Online (AJOL)

    TOSHIBA

    Clinical features were used for diagnosing neonatal sepsis. Using predator confirmed from previous study a child who showed the following symptoms: bradycardia, seizures/convulsion, fever, apnoea, reduced sucking, reduced movements, vomiting and infected umbilical cord was classified as a child with sepsis (English ...

  17. Is Nuchal Cord a Perfect Scapegoat: A Retrospective Analysis from ...

    African Journals Online (AJOL)

    Mubeen

    metabolism of glucose and gluconeogenesis are induced by cord compression. Arterial lactate elevations may be a measurable result of umbilical cord compression. These protective steps over time can give way to bradycardia, vasodilatation, fetal hypotension and acidosis, depletion of glycogen stores and blunting of the ...

  18. Isolation of Circulatory Influence in HSG

    Science.gov (United States)

    1980-03-01

    population reach bradycardia within 20 minutes. Extension of acceleration exposures beyond that point would begin to involve other factors besides...change in carotid sinus transmural pressure in man. Acta physiol. Scand. 94: 497-505. 11. Bjurstedt, H., G. Rosenhamer and G. Tyd~n, 1976

  19. VASOPRESSIN PROLONGS BEHAVIORAL AND CARDIAC RESPONSES TO MILD STRESS IN YOUNG BUT NOT IN AGED RATS

    NARCIS (Netherlands)

    BUWALDA, B; NYAKAS, C; KOOLHAAS, JM; LUITEN, PGM; BOHUS, B

    1992-01-01

    In young male Wistar rats sudden silence superimposed on low intensity background noise evokes a relative decrease in heart rate. This bradycardia is accompanied by immobility behavior. In the present study, involving young (3 month), late-adult (14 month), aged (26 month), and senescent (25 month)

  20. Facing Freeze: Social Threat Induces Bodily Freeze in Humans

    NARCIS (Netherlands)

    Roelofs, K.; Hagenaars, M.A.; Stins, J.F.

    2010-01-01

    Freezing is a common defensive response in animals threatened by predators. It is characterized by reduced body motion and decreased heart rate (bradycardia). However, despite the relevance of animal defense models in human stress research, studies have not shown whether social threat cues elicit

  1. Author Details

    African Journals Online (AJOL)

    O'Brien, K. Vol 19, No 3 (2013) - Articles Anaesthesia for scoliosis correction surgery complicated by severe recalcitrant bradycardia upon prone positioning in an adolescent with Prader-Willi syndrome. Abstract PDF. ISSN: 2220-1173. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians ...

  2. Author Details

    African Journals Online (AJOL)

    Conrick-Martin, I. Vol 19, No 3 (2013) - Articles Anaesthesia for scoliosis correction surgery complicated by severe recalcitrant bradycardia upon prone positioning in an adolescent with Prader-Willi syndrome. Abstract PDF. ISSN: 2220-1173. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for ...

  3. Biodegradation of Organophosphate Chemical Warfare Agents by Activated Sludge

    Science.gov (United States)

    2012-03-01

    bronchoconstriction Bladder (M) Urinary frequency, incontinence Cardiovascular system (M) Bradycardia, hypotension Cardiovascular system (N...15  II. Scholarly Article ..........................................................................................................16  Abstract...is written in the scholarly article format. Chapter 2 is a journal article produced from this research which is planned to be submitted to Water

  4. Acute Uterine Inversion: A Simple Modification of Hydrostatic ...

    African Journals Online (AJOL)

    loss, being a neurogenic shock, with profound hypotension, bradycardia and ... assistance and initial shock management with two wide bore intravenous .... hypovolemic shock.[4,5]. Once the diagnosis of inversion is made, measures should be undertaken to manage and correct acute blood loss and potential shock.

  5. Propofol versus Halothane in paediatric Daycase surgery: A ...

    African Journals Online (AJOL)

    Background: Inhalational induction with Halothane is commonly used for anaesthesia in children. Its drawbacks include bradycardia and hypotension. Intravenous propofol has recently challenged this position. Objective: This study sought to compare duration of and cardiovascular changes at induction of anaesthesia in ...

  6. Vasovagal Syncope during Epidural Catheterization before ...

    African Journals Online (AJOL)

    We present a case of vasovagal response in a healthy young male patient scheduled for excision of extra digits in both feet after catheterization of the epidural space but before administration of epidural medications. The uniqueness of this case is the changes in haemodynamic hypotension, bradycardia and syncope in an ...

  7. Comparison of the effects of atropine and labetalol on trigeminocardiac reflex-induced hemodynamic alterations during percutaneous microballoon compression of the trigeminal ganglion.

    Science.gov (United States)

    Chen, Chun-Yu; Luo, Chiao-Fen; Hsu, Yi-Chun; Chen, Jyi-Feng; Day, Yuan-Ji

    2012-12-01

    A significant abrupt drop in heart rate is the most frequent complication during percutaneous microballoon compression of the trigeminal ganglion. It is suggested that co-activation of the sympathetic and parasympathetic nervous systems plays an important role in this occurrence. We hypothesized that not only atropine, but also labetalol might be effective in preventing this cardiovascular reflex during percutaneous microballoon compression of the trigeminal ganglion. Patients who underwent percutaneous microballoon compression for trigeminal neuralgia between September 2007 and December 2009 were prospectively evaluated. The relationship between the hemodynamic changes and intraoperative use of atropine (0.01 mg/kg) or labetalol (0.05 mg/kg) was compared. One-way analysis of variance with Bartlett's and Tukey's post-tests was used, and a value of p labetalol, and 45 received normal saline as a control. Of the patients who received normal saline, 31.3% had moderate bradycardia (heart rate labetalol, 16.7% had moderate bradycardia, 5.6% had severe bradycardia, and 2.8% had arrhythmia. Systemic blood pressure was markedly elevated straight after compression in all groups and tended to normalize 3 minutes afterwards. Both atropine and labetalol were able to lower the frequency of bradycardia. Neither of them could abolish episodes of bradycardia during the procedure. Patients receiving labetalol before microballoon compression were subject to a smaller change in hemodynamics. Our findings verified that the sympathetic and parasympathetic nervous systems may be involved in the complex interneuronal interaction of the trigeminocardiac reflex. Copyright © 2012. Published by Elsevier B.V.

  8. Calcium channel blocker poisoning

    Directory of Open Access Journals (Sweden)

    Miran Brvar

    2005-04-01

    Full Text Available Background: Calcium channel blockers act at L-type calcium channels in cardiac and vascular smooth muscles by preventing calcium influx into cells with resultant decrease in vascular tone and cardiac inotropy, chronotropy and dromotropy. Poisoning with calcium channel blockers results in reduced cardiac output, bradycardia, atrioventricular block, hypotension and shock. The findings of hypotension and bradycardia should suggest poisoning with calcium channel blockers.Conclusions: Treatment includes immediate gastric lavage and whole-bowel irrigation in case of ingestion of sustainedrelease products. All patients should receive an activated charcoal orally. Specific treatment includes calcium, glucagone and insulin, which proved especially useful in shocked patients. Supportive care including the use of catecholamines is not always effective. In the setting of failure of pharmacological therapy transvenous pacing, balloon pump and cardiopulmonary by-pass may be necessary.

  9. Adenosinergic regulation of the cardiovascular system in the red-eared slider Trachemys scripta.

    Science.gov (United States)

    Joyce, William; Wang, Tobias

    2014-08-01

    Few studies have investigated adenosinergic regulation of the cardiovascular system in reptiles. The haemodynamic effect of a bolus intra-arterial adenosine injection (2.5 μM kg⁻¹) was investigated in nine anaesthetised red-eared sliders (Trachemys scripta). Adenosine caused a transient bradycardia, which was accompanied by systemic vasodilatation as evidenced by an increase in systemic flow and a decrease in systemic pressure. Meanwhile, pulmonary flow fell significantly. Both the bradycardia and increase in systemic conductance were significantly attenuated by theophylline (4 mg kg⁻¹), demonstrating an involvement of P₁ receptors. These results suggest that adenosine is likely to play a significant role in reptile cardiovascular physiology. In turtles specifically, adenosinergic regulation may be particularly relevant during periods of apnoea. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. The Utilization of an Insertable Cardiac Monitor in a Child With Pallid Breath-Holding Spells.

    Science.gov (United States)

    Tejman-Yarden, Shai; Ben-Zeev, Bruria; Goldshmit, Yuval; Sarquella-Brugada, Georgia; Cicurel, Assi; Katz, Uriel; Mishali, David; Glikson, Michael

    2016-11-01

    Pacing can be a successful treatment for pallid breath-holding spells, primarily in individuals with severe bradycardia. We describe an 18-month-old girl experiencing severe pallid breath-holding spells in whom repeated electrocardiographic, Holter, and electroencephalographic monitoring tests were all normal. Using a subcutaneous insertable cardiac monitor, severe bradycardia was detected during one of this girl's episodes. This finding led to a pacemaker implantation. Subsequently, her breath-holding spells completely resolved. This child illustrates the ability of the insertable cardiac monitor to help and diagnose arrhythmias in children with unresolved clinical findings. The ability to implant it with a minimal scar makes it ideal for uncooperative individuals with relative few and unexpected episodes that are hard to diagnose. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Iatrogenic tension pneumothorax in children: two case reports

    Directory of Open Access Journals (Sweden)

    Mayordomo-Colunga Juan

    2009-06-01

    Full Text Available Abstract Introduction Two cases of iatrogenic tension pneumothorax in children are reported. Case presentations Case 1: A 2-year-old boy with suspected brain death after suffering multiple trauma suddenly developed intense cyanosis, extreme bradycardia and generalized subcutaneous emphysema during apnea testing. He received advanced cardiopulmonary resuscitation and urgent bilateral needle thoracostomy. Case 2: A diagnostic-therapeutic flexible bronchoscopy was conducted on a 17-month-old girl, under sedation-analgesia with midazolam and ketamine. She very suddenly developed bradycardia, generalized cyanosis and cervical, thoracic and abdominal subcutaneous emphysema. Urgent needle decompression of both hemithoraces was performed. Conclusion In techniques where gas is introduced into a child's airway, it is vital to ensure its way out to avoid iatrogenic tension pneumothorax. Moreover, the equipment to perform an urgent needle thoracostomy should be readily available.

  12. Cardiac arrhythmias the first month after acute traumatic spinal cord injury

    DEFF Research Database (Denmark)

    Bartholdy, Kim; Biering-Sørensen, Tor; Malmqvist, Lasse

    2014-01-01

    of this prospective observational study was to investigate the occurrence of cardiac arrhythmias and cardiac arrests in patients with acute traumatic SCI. METHODS: As early as possible after SCI 24-hour Holter monitoring was performed. Additional Holter recordings were performed 1, 2, 3, and 4 weeks after SCI....... Furthermore, 12-lead electrocardiograms (ECGs) were obtained shortly after SCI and at 4 weeks. RESULTS: Thirty patients were included. Bradycardia (heart rate (HR) ... both on 12-lead ECGs obtained shortly after SCI (P = 0.030) and at 4 weeks (P = 0.041). CONCLUSION: Many patients with cervical SCI experience arrhythmias such as bradycardia, sinus node arrest, supraventricular tachycardia, and more rarely cardiac arrest the first month after SCI. Apart from sinus...

  13. Heart rate variability during abdominal surgical manipulation under general and epidural anesthesia.

    Science.gov (United States)

    Hirata, Naoyuki; Miyashita, Ryo; Maruyama, Daisuke; Kawaguchi, Ryoichi; Shimizu, Hitoshi; Yamakage, Michiaki

    2012-12-01

    Anesthesiologists occasionally encounter bradycardia during abdominal surgery and recognize the phenomenon as a vagal reflex. The presence of bradycardia implies efferent vagal dominance in the autonomic nervous system during this vagal reflex. In this study, we investigated the effect of abdominal surgical manipulation on autonomic nervous activity, using heart rate variability analysis. Abdominal surgical manipulation decreased the heart rate and enhanced not only the high-frequency power (0.15-0.4 Hz) but also the low-frequency power (0.04-0.15 Hz) calculated from the power spectral density of heart rate variability. Our results suggest that both vagal tone and sympathetic tone could be activated during the vagal reflex caused by abdominal surgical manipulation.

  14. Cardiac arrhythmias associated with spinal cord injury

    DEFF Research Database (Denmark)

    Hector, Sven Magnus; Biering-Sørensen, Tor; Krassioukov, Andrei

    2013-01-01

    CONTEXT/OBJECTIVES: To review the current literature to reveal the incidence of cardiac arrhythmias and its relation to spinal cord injury (SCI). METHODS: Data source: MEDLINE database, 304 hits, and 32 articles were found to be relevant. The relevant articles all met the inclusion criteria: (1......) contained original data (2) on cardiac arrhythmias (3) in humans with (4) traumatic SCI. RESULTS: In the acute phase of SCI (1-14 days after injury) more cranial as well as more severe injuries seemed to increase the incidence of bradycardia. Articles not covering the first 14 days after injury, thus...... as during procedures such as penile vibro-stimulation and tracheal suction. These episodes of bradycardia were seen more often in individuals with cervical injuries. Longitudinal studies with continuous electrocardiogram recordings are needed to uncover the true relation between cardiac arrhythmias and SCI....

  15. Cardiovascular Complications Resulting from Topical Lidocaine Application

    Directory of Open Access Journals (Sweden)

    Feng Lin

    2008-12-01

    Full Text Available Topical lidocaine is one of the most commonly used anesthetics in the emergency department (ED. The advantages of topical anesthesia include ease of application, minimal discomfort on administration, and rapid onset of anesthesia. Systemic toxic effects after topical lidocaine application are rare. We present a case of a man aged 48 years with no history of heart disease and no evidence of bradycardia in previous electrocardiograms. The patient had sprayed lidocaine solution on the glans of his penis before sex during the 2 weeks prior to admission. Cardiovascular adverse events occurred, including chest tightness and bradycardia. After 2 hours conservative treatment at our ED, his symptoms were alleviated. He was discharged from the ED without any medication. The case suggests that detailed patient histories are necessary for accurate diagnosis and that rapid diagnosis and implementation of treatment is necessary for successful patient outcomes in cases of cardiovascular complications resulting from topical lidocaine application.

  16. Advantages of respiratory monitoring during video-EEG evaluation to differentiate epileptic seizures from other events

    Science.gov (United States)

    Pavlova, Milena; Abdennadher, Myriam; Singh, Kanwaljit; Katz, Eliot; Llewellyn, Nichelle; Zarowsly, Marcin; White, David P.; Dworetzky, Barbara A.; Kothare, Sanjeev V.

    2014-01-01

    Distinction between epileptic (ES) and seizure-like events of non-epileptic nature(SLNE) is often difficult using descriptions of seizure semiology. Cardiopulmonary dysfunction is frequent in ES but has not been objectively examined in relationship to SLNE. Our purpose was to compare cardiopulmonary dysfunction between ES and SLNE. We prospectively recorded cardio-pulmonary function using pulse-oximetry, EKG and respiratory inductance plethysmography (RIP) in 52 ES and 22 SLNE. Comparison of cardiopulmonary complications between ES and SLNE was done using two-sample t-tests and logistic regression. Ictal bradypnea and pre-ictal bradycardia were more frequent in ES than SLNE (p1.0). Cardio-respiratory dysfunction, specifically bradypnea, apnea, pre-ictal bradycardia, and oxygen desaturation, is more frequently seen in ES than in SLNE. Tachycardia was not discriminant between ES and SLNE. PMID:24561659

  17. Treating cardiac arrhythmias detected with an implantable cardiac monitor in patients after an acute myocardial infarction

    DEFF Research Database (Denmark)

    Jøns, Christian; Thomsen, Poul Erik Bloch

    2012-01-01

    OPINION STATEMENT: Using an implantable cardiac monitor (ICM) in patients with acute myocardial infarction (MI) allows continuous electrocardiogram monitoring and provides a much more detailed picture of the incidence of brady- and tachyarrhythmias than conventional follow-up. The CARISMA study...... causes of AF such as progressive left ventricular dysfunction or myocardial ischemia. Asymptomatic, especially nightly, bradycardia episodes including high-degree 2°-3° atrioventricular (AV) block, sinus bradycardia, and sinus arrest were frequently documented by ICM in the CARISMA study. Ten percent......, and in the case of left ventricular dysfunction (LVEF ≤ 35%), an implantable cardioverter defibrillator/cardiac resynchronization therapy defibrillator (ICD/CRT-D) may be indicated. Nonsustained ventricular tachycardia (VT) is very frequent in post-MI patients, and in the CARISMA study, high-risk patients...

  18. Characterization of T cell clones from chagasic patients: predominance of CD8 surface phenotype in clones from patients with pathology

    Directory of Open Access Journals (Sweden)

    Washington R. Cuna

    1995-08-01

    Full Text Available Human Chagas' disease, caused by the protozoan Trypanosoma cruzi, is associated with pathological processes whose mechanisms are not known. To address this question, T cell lines were developed from chronic chagasic patients peripheral blood mononuclear cells (PBMC and cloned. These T cell clones (TCC were analyzed phenotypically with monoclonal antibodies by the use of a fluorescence microscope. The surface phenotype of the TCC from the asymptomatic patient were predominantly CD4 positive (86%. On the contrary, the surface phenotype CD8 was predominant in the TCC from the patients suffering from cardiomegaly with right bundle branch block (83%, bradycardia with megacolon (75 % and bradycardia (75%. Future studies will be developed in order to identify the antigens eliciting these T cell subpopulations.

  19. Amitraz: a mimicker of organophosphate poisoning.

    Science.gov (United States)

    Dhooria, Sahajal; Behera, Digambar; Agarwal, Ritesh

    2015-10-01

    Amitraz is used as an ectoparasiticide for dogs and cattle. Human poisoning due to amitraz may be misdiagnosed as organophosphate/carbamate (OPC) toxicity, since amitraz poisoning shares several clinical features (miosis, bradycardia and hypotension) encountered with OPC poisoning. A 19-year-old man with an alleged history of suicidal ingestion of a pesticide presented with drowsiness and was found to have constricted pupils, hypotension and bradycardia. He was diagnosed as a case of OPC poisoning and was treated with atropine and pralidoxime prior to presentation to our centre. Absence of a hypersecretory state, and the presence of hyperglycaemia and hypothermia along with a normal serum cholinesterase level suggested an alternate possibility. Retrieval of the poison container confirmed the diagnosis of amitraz poisoning. The patient made a rapid recovery with supportive management. Clinician awareness is key to successful management of this poisoning, which carries a good prognosis. 2015 BMJ Publishing Group Ltd.

  20. Atrial cardiomyopathy in an adult Labrador retriever dog.

    Science.gov (United States)

    Bomassi, E; Rousselot, J; Libermann, S; Raymond Letron, I; Etchepareborde, S; Misbach, C

    2017-11-01

    A 7-year-old castrated male Labrador retriever was examined for a 10-day history of weakness and syncope. Physical examination revealed bradycardia and a grade III/VI left apical systolic heart murmur. Electrocardiography demonstrated bradycardia, absence of P waves and an atrio-ventricular nodal escape rhythm. Echocardiography revealed marked biatrial enlargement. Thoracic radiographs showed no evidence of pulmonary edema. Routine plasma biochemistry and electrolytes, basal serum cortisol, total thyroxin concentration, and complete blood count were within normal limits. Serum cardiac troponin I concentration was moderately increased. Serological examinations for antibodies against vector-borne diseases were negative. A pacemaker was implanted one month after the initial presentation due to worsening of the dog's clinical condition despite medical treatment. The dog remained asymptomatic for 18 months but was then re-presented with a gastric dilatation volvulus and subsequently euthanized. Necropsy and histology of the heart yielded a diagnosis of atrial cardiomyopathy.

  1. Orthognathic surgery with or without induced hypotension.

    Science.gov (United States)

    Carlos, E; Monnazzi, M S; Castiglia, Y M M; Gabrielli, M F R; Passeri, L A; Guimarães, N C

    2014-05-01

    This study involved a retrospective evaluation of patients subjected to surgery for dentofacial deformities treated without induced controlled hypotension (group I, n=50) and a prospective evaluation of patients who were subjected to surgery under hypotensive general anaesthesia (group II, n=50). No statistical differences were found between the study groups with regard to the duration of surgery. However, there were statistically significant differences in the need for blood transfusion and the occurrence of bradycardia during the maxillary down-fracture. Hypotensive anaesthesia decreased the need for a blood transfusion and the occurrence of bradycardia, and is therefore considered highly beneficial for patients undergoing orthognathic surgery. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  2. Time-course effects of aerobic exercise training on cardiovascular and renal parameters in 2K1C renovascular hypertensive rats.

    Science.gov (United States)

    Maia, R C A; Sousa, L E; Santos, R A S; Silva, M E; Lima, W G; Campagnole-Santos, M J; Alzamora, A C

    2015-11-01

    Exercise training (Ex) has been recommended for its beneficial effects in hypertensive states. The present study evaluated the time-course effects of Ex without workload on mean arterial pressure (MAP), reflex bradycardia, cardiac and renal histology, and oxidative stress in two-kidney, one-clip (2K1C) hypertensive rats. Male Fischer rats (10 weeks old; 150-180 g) underwent surgery (2K1C or SHAM) and were subsequently divided into a sedentary (SED) group and Ex group (swimming 1 h/day, 5 days/week for 2, 4, 6, 8, or 10 weeks). Until week 4, Ex decreased MAP, increased reflex bradycardia, prevented concentric hypertrophy, reduced collagen deposition in the myocardium and kidneys, decreased the level of thiobarbituric acid-reactive substances (TBARS) in the left ventricle, and increased the catalase (CAT) activity in the left ventricle and both kidneys. From week 6 to week 10, however, MAP and reflex bradycardia in 2K1C Ex rats became similar to those in 2K1C SED rats. Ex effectively reduced heart rate and prevented collagen deposition in the heart and both kidneys up to week 10, and restored the level of TBARS in the left ventricle and clipped kidney and the CAT activity in both kidneys until week 8. Ex without workload for 10 weeks in 2K1C rats provided distinct beneficial effects. The early effects of Ex on cardiovascular function included reversing MAP and reflex bradycardia. The later effects of Ex included preventing structural alterations in the heart and kidney by decreasing oxidative stress and reducing injuries in these organs during hypertension.

  3. Acute cardiac arrhythmias following surgery for congenital heart disease: mechanisms, diagnostic tools, and management.

    Science.gov (United States)

    Payne, Linda; Zeigler, Vicki L; Gillette, Paul C

    2011-06-01

    This article focuses on the management of those cardiac arrhythmias most commonly seen in the immediate postoperative period. They include ventricular tachycardia, ventricular fibrillation, atrial flutter, junctional ectopic tachycardia, bradycardia, and atrioventricular block. The mechanisms of cardiac arrhythmias are reviewed followed by a brief overview of the predominant acute arrhythmias, tools used for the diagnostic evaluation of these arrhythmias, management strategies, and, finally, nursing considerations. Copyright © 2011. Published by Elsevier Inc.

  4. Intracranial Pressure Is a Determinant of Sympathetic Activity

    OpenAIRE

    Eric A. Schmidt; Eric A. Schmidt; Fabien Despas; Fabien Despas; Anne Pavy-Le Traon; Anne Pavy-Le Traon; Zofia Czosnyka; John D. Pickard; Kamal Rahmouni; Atul Pathak; Atul Pathak; Jean M. Senard; Jean M. Senard

    2018-01-01

    Intracranial pressure (ICP) is the pressure within the cranium. ICP rise compresses brain vessels and reduces cerebral blood delivery. Massive ICP rise leads to cerebral ischemia, but it is also known to produce hypertension, bradycardia and respiratory irregularities due to a sympatho-adrenal mechanism termed Cushing response. One still unresolved question is whether the Cushing response is a non-synaptic acute brainstem ischemic mechanism or part of a larger physiological reflex for arteria...

  5. The Mammalian Diving Response: An Enigmatic Reflex to Preserve Life?

    Science.gov (United States)

    2013-01-01

    The mammalian diving response is a remarkable behavior that overrides basic homeostatic reflexes. It is most studied in large aquatic mammals but is seen in all vertebrates. Pelagic mammals have developed several physiological adaptations to conserve intrinsic oxygen stores, but the apnea, bradycardia, and vasoconstriction is shared with those terrestrial and is neurally mediated. The adaptations of aquatic mammals are reviewed here as well as the neural control of cardiorespiratory physiology during diving in rodents. PMID:23997188

  6. An unusual presentation of mad honey poisoning: acute myocardial infarction.

    Science.gov (United States)

    Akinci, Sinan; Arslan, Uğur; Karakurt, Kamber; Cengel, Atiye

    2008-09-26

    An unusual type of food poisoning is commonly seen in the Black Sea coast of Turkey due to grayanotoxin containing toxic honey so called "mad honey" ingestion. In cases of toxication bradycardia and rhythm disturbances are commonly observed. Herein, we present a case of a patient who was admitted to the hospital because of acute myocardial infarction with normal coronary arteries after "mad honey" ingestion.

  7. A flatline Lead I in a neonate with suspected congenital heart disease.

    Science.gov (United States)

    Riniker, Kristy; Rigales, Luis; Hoffman, Irwin

    In a neonate with bradycardia and hypoxia, and clinical concern for critical congenital heart disease (CCHD), highly unusual ECG findings were present. These included a flatline Lead 1, and identical Leads 2, 3, and AVF. These abnormalities were due to bilateral arm to leg lead exchanges and not to heart disease. Complete cardiac workup including echocardiogram was normal. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Legionella pnömonisini taklit eden malignite olgusu

    OpenAIRE

    Ali Karakuş; Ersin Şükrü Erden; Cenk Babayiğit; Eyüp Büyükkaya; Mehmet Mustafa Akın; Muhammet Murat Çelik; Veyis Taşın

    2013-01-01

    Legionella pneumophila is a bacterium, which can grow inwater pipe networks and climate systems. Contaminationoccurs by aspiration of infected water or aerosol inhalation.It is usually presented with fever, bradycardia, andchange in mental status, hyponatremia, elevation of liverenzymes and deterioration of renal function. The definitediagnosis is established by detection of the antigens andcultivating in the culture medium. Also, malign lung tumorscan encounter with the same clinical finding...

  9. Isoflurane anaesthesia in an African wild dog, Lycaon pictus.

    Science.gov (United States)

    Stegmann, G F

    2000-12-01

    Anaesthesia was required in a captive female African wild dog (Lycaon pictus) for surgical wound treatment. After it was immobilised with a medetomidine-ketamine combination, bradycardia, hypothermia, systolic hypertension and metabolic acidosis were observed. Surgical anaesthesia was maintained with a 1% end-tidal isoflurane concentration. A decrease in the arterial blood pressure, rectal temperature and pH occurred during maintenance of anaesthesia.

  10. Isoflurane anaesthesia in an African wild dog, Lycaon pictus : short communication

    Directory of Open Access Journals (Sweden)

    G.F. Stegmann

    2000-07-01

    Full Text Available Anaesthesia was required in a captive female African wild dog (Lycaon pictus for surgical wound treatment. After it was immobilised with a medetomidine-ketamine combination, bradycardia, hypothermia, systolic hypertension and metabolic acidosis were observed. Surgical anaesthesia was maintained with a 1 %end-tidal isoflurane concentration. A decrease in the arterial blood pressure, rectal temperature and pHoccurred during maintenance of anaesthesia.

  11. ICD (Integrated Cardiac Device) Care through PACED (Patient-centred And Cardiac Nursing Engaged Device) Services in a Regional Hospital in Hong Kong

    OpenAIRE

    Leung, Yuen Wa; Yue, Chiu Sun; Chan, Chi Kin; Kwan, Kit Ying; Fung, Hoi Ying; Pang, Sang Hung; Lo, Suet Fong; Yiu, Fung Yi; Wong, Sam; Wu, Nonnie; Chiu, Ling Tai; Chu, Wai Ying; Law, Kwok Fai; Chow, Kit San; Ngan, Pui Ling

    2017-01-01

    Introduction: Cardiac implantable electronic devices (CIED) are effective treatment to patients with bradycardia and life-threatening arrhythmia. However, without appropriate CIED settings and adaptation to life, patient may restrict activities for years.Furthermore, population of newly-implanted CIED patient has doubled in last decade. It challenged our service greatly, since cardiologist needs to follow up CIED patient *indefinitely in HK*.United Christian Hospital is a regional hospital se...

  12. Asystole after Orthotopic Lung Transplantation: Examining the Interaction of Cardiac Denervation and Dexmedetomidine

    OpenAIRE

    Christopher Allen-John Webb; Paul David Weyker; Brigid Colleen Flynn

    2012-01-01

    Dexmedetomidine is an α 2-receptor agonist commonly used for sedation and analgesia in ICU patients. Dexmedetomidine is known to provide sympatholysis and also to have direct atrioventricular and sinoatrial node inhibitory effects. In rare instances, orthotopic lung transplantation has been associated with disruption of autonomic innervation of the heart. The combination of this autonomic disruption and dexmedetomidine may be associated with severe bradycardia and/or asystole. Since orthotopi...

  13. RNA Viruses that Cause Hemorrhagic, Encephalitic, and Febrile Disease

    Science.gov (United States)

    1990-01-01

    late fe- flow , and urine concentrating ability. In brile phase. This stage lasts 3-7 days. Most China, most patients return to light duty patients...occurred through contact with blood. The diagnosis is first suggested Crimean-Congo Hemorrhagic Fever when 3-7 days later medical personnel in...sporadic slight albuminuria , and bradycardia in rela- cases occur on a continuous basis. In the tion to the height of fever (Faget’s sign). savanna

  14. Control of the heart rate of rat embryos during the organogenic period

    Directory of Open Access Journals (Sweden)

    Ritchie HE

    2016-11-01

    Full Text Available Helen E Ritchie,1 Carolina Ragnerstam,2 Elin Gustafsson,2 Johanna M Jonsson,2 William S Webster2 1Discipline of Biomedical Science, Sydney Medical School, University of Sydney, Lidcombe, 2Department of Anatomy and Histology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia Abstract: The aim of this study was to gain insight into whether the first trimester embryo could control its own heart rate (HR in response to hypoxia. The gestational day 13 rat embryo is a good model for the human embryo at 5–6 weeks gestation, as the heart is comparable in development and, like the human embryo, has no functional autonomic nerve supply at this stage. Utilizing a whole-embryo culture technique, we examined the effects of different pharmacological agents on HR under normoxic (95% oxygen and hypoxic (20% oxygen conditions. Oxygen concentrations ≤60% caused a concentration-dependent decrease in HR from normal levels of ~210 bpm. An adenosine agonist, AMP-activated protein kinase (AMPK activator and KATP channel opener all caused bradycardia in normoxic conditions; however, putative antagonists for these systems failed to prevent or ameliorate hypoxia-induced bradycardia. This suggests that the activation of one or more of these systems is not the primary cause of the observed hypoxia-induced bradycardia. Inhibition of oxidative phosphorylation also decreased HR in normoxic conditions, highlighting the importance of ATP levels. The β-blocker metoprolol caused a concentration-dependent reduction in HR supporting reports that β1-adrenergic receptors are present in the early rat embryonic heart. The cAMP inducer colforsin induced a positive chronotropic effect in both normoxic and hypoxic conditions. Overall, the embryonic HR at this stage of development is responsive to the level of oxygenation, probably as a consequence of its influence on ATP production. Keywords: embryonic heart rate, embryo, bradycardia, in vitro, ATP, hypoxia

  15. Recurrent apnoea post immunisation: Informing re-immunisation policy.

    Science.gov (United States)

    Clifford, Vanessa; Crawford, Nigel W; Royle, Jenny; Lazzaro, Teresa; Danchin, Margie; Perrett, Kirsten P; Lee, Katherine J; Buttery, Jim P

    2011-08-05

    Preterm infants should receive immunisations according to their chronological, rather than gestational, age however concern about possible adverse events following immunisation (AEFI) in this group often means routine immunisations are delayed. A small number of infants may have apnoea with or without bradycardia temporally associated with immunisation. The risk factors for, and recurrence rate of apnoea with subsequent immunisations are unknown, which makes planning for subsequent immunisations for these highly vulnerable infants difficult. To determine recurrence rates for apnoea temporally associated with immunisation in preterm and term infants and to explore potential risk factors associated with recurrent apnoea in preterm infants. A retrospective analysis of all apnoea +/-bradycardia AEFIs in preterm and term infants, reported to the Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC), Victoria, Australia over a 3-year period from May 2007 to April 2010. Apnoea +/-bradycardia was defined as temporally associated with immunisation if it occurred up to 48h after immunisation. 7 out of 38 [18%, 95% confidence interval 6-31%] preterm infants with apnoea +/-bradycardia post initial immunisation had recurrent apnoea with subsequent immunisations. Possible risk factors for recurrence included: lower birth weight (p=0.04) and ongoing hospitalisation for complications relating to prematurity (p=0.01). No preterm infant with recurrent apnoea had a third episode of apnoea with subsequent immunisation. None of the 8 term infants with a reported apnoea AEFI had recurrence of apnoea with subsequent immunisation. There is a risk of recurrence of apnoea associated with immunisation in preterm infants. We recommend that preterm infants with apnoea post immunisation should receive reliable cardio-respiratory monitoring for a minimum of 24h following the next scheduled immunisation. Copyright © 2011 Elsevier Ltd. All rights reserved.

  16. Overdose effect of aconite containing Ayurvedic Medicine (?Mahashankha Vati?)

    OpenAIRE

    Panda, Ashok Kumar; Debnath, Saroj Kumar

    2010-01-01

    There are chances that the use of larger than recommended dose of Ayurvedic medicines containing aconite can produce drug reactions. Vatsanabha (Aconitum ferox Wall.) is a very well-known ingredient of Ayurvedic formulations and is prescribed as an antipyretic, analgesic, anti-rheumatic, appetizer and digestive. The recommended dose of purified Vatsanabha (A. ferox Wall.) root is 15 mg. We present a case of hypotension and bradycardia due to aconite poisoning caused by overdosing of an Ayurve...

  17. An unusual cause of orthopnoea-hashimoto's thyroiditis presenting as bilateral diaphragmatic palsy

    Directory of Open Access Journals (Sweden)

    N.K. Thulaseedharan, MBBS, MD(General Medicine

    2017-01-01

    Full Text Available We report a case of 36 yr old male without any comorbidities, who presented with a history of gradually progressive dyspnoea and orthopnoea for 6 months. Physical examination revealed bradycardia, paradoxical respiration suggestive of bilateral diaphragmatic palsy. Fluoroscopy demonstrated the presence of bilateral diaphragmatic paralysis. Etiological work up showed evidence of autoimmune hypothyroidism due to hashimoto's thyroiditis. Other possibilities were ruled out with appropriate tests. He was started on thyroxine and showed symptomatic improvement.

  18. Electrocardiographic characteristics in individuals with cocaine use disorder.

    Science.gov (United States)

    Mahoney, James J; Haile, Colin N; De La Garza, Richard; Thakkar, Harsh; Newton, Thomas F

    2017-04-01

    Chronic cocaine use has been linked to several abnormalities in cardiac functioning. The objective of this study was to further characterize baseline heart rate and electrocardiograph (ECG) profiles of individuals with cocaine use disorder (CUD) by evaluating demographic and drug use variables that may impact cardiovascular profiles. Participants with CUD (n = 335, primarily African-American males) provided demographic and drug use data and ECG profiles (eg, heart rate, PR Interval, QRS, and QTc) were obtained via 12-lead ECG. Forty-eight percent and ten percent of cocaine users met criteria for sinus bradycardia (heart rate ≤60) and severe bradycardia (heart rate ≤50), respectively. Females had significantly higher heart rate (p = .020, d = .30) and QTc (p cocaine positive had higher QTc (p = .025, d = .26) with a higher prevalence of bradycardia (chi-square = 3.91, p = .048) than those who were negative. Cocaine users who also used alcohol had significantly lower PR Interval (p = .003, d = .36), QRS (p = .014, d = .29), and QTc (p = .037, d = .25) than those who denied alcohol use. These findings characterize the baseline heart rate and ECG profiles of individuals with CUD, confirm previous reports of cocaine-induced alterations in cardiovascular function, and demonstrate factors impacting cardiovascular profiles. While exploratory, these results suggest the presence of bradycardia may serve as a useful biomarker for initiating therapy for individuals with CUD and averting potential adverse cardiovascular events. Future prospective studies are needed to assess this possibility. (Am J Addict 2017;26:221-227). © 2017 American Academy of Addiction Psychiatry.

  19. Fatal Overdose due to Confusion of an Transdermal Fentanyl Delivery System

    OpenAIRE

    Ingo Voigt

    2013-01-01

    Background. The use of transdermal fentanyl systems has increased over recent years, especially in patients with chronic pain. Large misuse potential and fatal outcomes have been described. Case Presentation. A 58-year-old patient presenting with clinical signs of opioid poisoning (hypoventilation, bradycardia, hypotension, and miosis) was admitted to our ICU. The first body check revealed a 75 mcg per hour fentanyl patch at the patient's right scapula. Some months ago, patient's aunt died af...

  20. Sinus node dysfunction in non-medicational treatment of atrial fibrillation

    OpenAIRE

    Bockeria L. А.; Kulikov А. А.

    2012-01-01

    Sinus node dysfunction or sick sinus syndrome (SSS) includes clinical conditions such as symptomatic sinus bradycardia, sinus pauses or arrest, sinus node exit block, atrial tachycardias and chronotropic incompetence. Even though SSS incidence increases in an exponential-like manner with age, it can occur at all ages, including in the newborn. The mean age of patients with the syndrome is 68 years, with both genders being affected in approximately equal proportion. This condition occurs in 1 ...

  1. Is Heart Rate Variability Better Than Routine Vital Signs for Prehospital Identification of Major Hemorrhage

    Science.gov (United States)

    2015-01-01

    vital signs We studied the average of reliable vital signs (heart rate [HR], respira- tory rate [RR], systolic blood pressure [SBP], and pulse pressure...defined by a large 24-hour PRBC vol) had abnormal vital signs consistent with hypovole- mia: tachycardia , tachypnea, reduced SBP, and reduced PP (ie...which alone provides some basic measure of the autonomic system; that is, tachycardia represents sympathetic activation, whereas bradycardia

  2. Prospective evaluation of early propranolol after traumatic brain injury.

    Science.gov (United States)

    Murry, Jason S; Hoang, David M; Barmparas, Galinos; Harada, Megan Y; Bukur, Marko; Bloom, Matthew B; Inaba, Kenji; Margulies, Daniel R; Salim, Ali; Ley, Eric J

    2016-01-01

    Although beta-adrenergic receptor blockade may improve outcomes after traumatic brain injury (TBI), its early use is not routine. We hypothesize that judicious early low-dose propranolol after TBI (EPAT) will improve outcomes without altering bradycardia or hypotensive events. We conducted a prospective, observational study on all patients who presented with moderate-to-severe TBI from March 2010-August 2013. Ten initial patients did not receive propranolol (control). Subsequent patients received propranolol at 1-mg intravenous every 6 h starting within 12 h of intensive care unit (ICU) admission (EPAT) for a minimum of 48 h. Heart rate and blood pressure were recorded hourly for the first 72 h. Bradycardia and hypotensive events, mortality, and length of stay (LOS) were compared between cohorts to determine significant differences. Thirty-eight patients were enrolled; 10 control and 28 EPAT. The two cohorts were similar when compared by gender, emergency department (ED) systolic blood pressure, ED heart rate, and mortality. ED Glasgow coma scale was lower (4.2 versus 10.7, P propranolol. Hypotensive events were similar between cohorts, whereas bradycardia events were higher in control (5.8 versus 1.6, P = 0.05). ICU LOS (15.4 versus 30.4 d, P = 0.02) and hospital LOS (10 versus 19.1 d, P = 0.05) were lower in EPAT. Mortality rates were similar between groups (10% versus 10.7%, P = 0.9). The administration of propranolol led to no recorded complications. Although bradycardia and hypotensive events occur early after TBI, low-dose intravenous propranolol does not increase their number or severity. Early use of propranolol after TBI appears to be safe and may be associated with decreased ICU and hospital LOS. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. The Use of Adenosine Agonists to Treat Nerve Agent-Induced Seizure and Neuropathology

    Science.gov (United States)

    2016-09-01

    of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD...reactivation and seizure will continue.14 Because current inhibitory- and oxime-based strategies are unable to control seizure activity when treatment...neuroprotective mechanism, Joosen et al. correlated sarin’s cholinergic symptoms with CPA-induced bradycardia and hypotension .39 Because a peripherally acting A1

  4. Role of the bed nucleus of the stria terminalis in cardiovascular changes following chronic treatment with cocaine and testosterone: a role beyond drug seeking in addiction?

    Science.gov (United States)

    Cruz, F C; Alves, F H F; Leão, R M; Planeta, C S; Crestani, C C

    2013-12-03

    Neural plasticity has been observed in the bed nucleus of the stria terminalis (BNST) following exposure to both cocaine and androgenic-anabolic steroids. Here we investigated the involvement of the BNST on changes in cardiovascular function and baroreflex activity following either single or combined administration of cocaine and testosterone for 10 consecutive days in rats. Single administration of testosterone increased values of arterial pressure, evoked rest bradycardia and reduced baroreflex-mediated bradycardia. These effects of testosterone were not affected by BNST inactivation caused by local bilateral microinjections of the nonselective synaptic blocker CoCl2. The single administration of cocaine as well as the combined treatment with testosterone and cocaine increased both bradycardiac and tachycardiac responses of the baroreflex. Cocaine-evoked baroreflex changes were totally reversed after BNST inactivation. However, BNST inhibition in animals subjected to combined treatment with cocaine and testosterone reversed only the increase in reflex tachycardia, whereas facilitation of reflex bradycardia was not affected by local BNST treatment with CoCl2. In conclusion, the present study provides the first direct evidence that the BNST play a role in cardiovascular changes associated with drug abuse. Our findings suggest that alterations in cardiovascular function following subchronic exposure to cocaine are mediated by neural plasticity in the BNST. The single treatment with cocaine and the combined administration of testosterone and cocaine had similar effects on baroreflex activity, however the association with testosterone inhibited cocaine-induced changes in the BNST control of reflex bradycardia. Testosterone-induced cardiovascular changes seem to be independent of the BNST. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

  5. Heart rate changes during partial seizures: A study amongst Singaporean patients

    Directory of Open Access Journals (Sweden)

    Lim Shih-Hui

    2001-09-01

    Full Text Available Abstract Introduction Studies in Europe and America showed that tachycardia, less often bradycardia, frequently accompanied partial seizures in Caucasian patients. We determine frequency, magnitude and type of ictal heart rate changes during partial seizures in non-Caucasian patients in Singapore. Methods Partial seizures recorded during routine EEGs performed in a tertiary hospital between 1995 and 1999 were retrospectively reviewed. All routine EEGs had simultaneous ECG recording. Heart rate before and during seizures was determined and correlated with epileptogenic focus. Differences in heart rate before and during seizures were grouped into 4 types: (1 >10% decrease; (2 -10 to +20% change; (3 20–50% increase; (3 >50% increase. Results Of the total of 37 partial seizures, 18 were left hemisphere (LH, 13 were right hemisphere (RH and 6 were bilateral (BL in onset. 51% of all seizures showed no significant change in heart rate (type 2, 22% had moderate sinus tachycardia (type 3, 11% showed severe sinus tachycardia (type 4, while 16% had sinus bradycardia (type 1. Asystole was recorded in one seizure. Apart from having more tachycardia in bilateral onset seizures, there was no correlation between side of ictal discharge and heart rate response. Compared to Caucasian patients, sinus tachycardia was considerably less frequent. Frequency of bradycardia was similar to those recorded in the literature. Conclusions Significant heart rate changes during partial seizures were seen in half of Singaporean patients. Although sinus tachycardia was the most common heart rate change, the frequency was considerably lower compared to Caucasian patients. This might be due to methodological and ethnic differences. Rates of bradycardia are similar to those recorded in the literature.

  6. Neiguan and Jianshi Acupoint Stimulation Aids Hemodynamic Stability in a Cervical Cord Trauma Patient

    OpenAIRE

    Adhikari, Shalini T; Suliman Al-Nabi, Mohammed Juma; Suri, Neelam; Khan, Rashid M; Kaul, Naresh K

    2012-01-01

    A 36-year-old male patient with posttraumatic cervical cord damage and resultant quadriparesis, demonstrated hypotension and periods of bradycardia. For most of his two-month stay in the Intensive Care Unit (ICU), he was dependent on dopamine support to maintain hemodynamic stability. Keeping in mind evidence from the literature, that electrostimulation of acupoints Neiguan (PC - 6) and Jianshi (PC - 5) has therapeutic efficacy in restoring hypotension, we treated this patient with two six-ho...

  7. Time-course effects of aerobic exercise training on cardiovascular and renal parameters in 2K1C renovascular hypertensive rats

    Directory of Open Access Journals (Sweden)

    R.C.A. Maia

    2015-01-01

    Full Text Available Exercise training (Ex has been recommended for its beneficial effects in hypertensive states. The present study evaluated the time-course effects of Ex without workload on mean arterial pressure (MAP, reflex bradycardia, cardiac and renal histology, and oxidative stress in two-kidney, one-clip (2K1C hypertensive rats. Male Fischer rats (10 weeks old; 150–180 g underwent surgery (2K1C or SHAM and were subsequently divided into a sedentary (SED group and Ex group (swimming 1 h/day, 5 days/week for 2, 4, 6, 8, or 10 weeks. Until week 4, Ex decreased MAP, increased reflex bradycardia, prevented concentric hypertrophy, reduced collagen deposition in the myocardium and kidneys, decreased the level of thiobarbituric acid-reactive substances (TBARS in the left ventricle, and increased the catalase (CAT activity in the left ventricle and both kidneys. From week 6 to week 10, however, MAP and reflex bradycardia in 2K1C Ex rats became similar to those in 2K1C SED rats. Ex effectively reduced heart rate and prevented collagen deposition in the heart and both kidneys up to week 10, and restored the level of TBARS in the left ventricle and clipped kidney and the CAT activity in both kidneys until week 8. Ex without workload for 10 weeks in 2K1C rats provided distinct beneficial effects. The early effects of Ex on cardiovascular function included reversing MAP and reflex bradycardia. The later effects of Ex included preventing structural alterations in the heart and kidney by decreasing oxidative stress and reducing injuries in these organs during hypertension.

  8. Myocarditis in Dengue Fever

    OpenAIRE

    Johnson Francis

    2017-01-01

    There is a wide variation in the reported incidence of cardiac involvement in dengue due to the difference in the criteria used to identify cardiac involvement. Most common cardiac rhythm abnormality noted was sinus bradycardia, which was often self limited. Fulminant and fatal myocarditis have been documented in a few cases; though in general, most cases with cardiac manifestations improve with supportive care. Only about one tenth of patients with biomarker elevation had evidence of depress...

  9. Clinical characteristics and outcomes of patients with grayanotoxin poisoning after the ingestion of mad honey from Nepal.

    Science.gov (United States)

    Sohn, Chang Hwan; Seo, Dong Woo; Ryoo, Seung Mok; Lee, Jae Ho; Kim, Won Young; Lim, Kyoung Soo; Oh, Bum Jin

    2014-03-01

    The aims of this study were to evaluate the clinical characteristics and outcomes of patients with grayanotoxin poisoning due to mad honey brought from Nepal. Medical records of patients with mad honey poisoning admitted to the emergency department between 1 January 2004 and 31 May 2012 were retrospectively reviewed. A total of 15 patients were included in this study. In all patients, mad honey was brought from the Himalayan region of Nepal. The mean age was 52.2 years, and 66.7 % were men. The mean amount of mad honey ingested was 47 cc, and the mean time from ingestion to onset of symptoms was 36 min. In all patients, initial vital signs showed hypotension and bradycardia. The initial electrocardiogram showed sinus bradycardia in eight patients, junctional bradycardia in four patients, complete atrioventricular block in two patients, and atrial fibrillation with slow ventricular response in one patient. Four patients were treated with intravenous normal saline solution only. Eleven patients were treated with intravenous normal saline solution and intravenous atropine sulfate in a dose ranging from 0.5 to 2.0 mg. In all patients, the blood pressure and pulse rate returned to normal limits within 24 h. There were no deaths. The clinical characteristics and outcome of grayanotoxin poisonings caused by the ingestion of mad honey from Nepal are similar with those of mad honey from the Black Sea region of Turkey.

  10. Atypical Findings in Massive Bupropion Overdose: A Case Report and Discussion of Psychopharmacologic Issues.

    Science.gov (United States)

    Zhu, Yuanjia; Kolawole, Tiwalola; Jimenez, Xavier F

    2016-09-01

    Bupropion is an atypical antidepressant that is structurally similar to amphetamines. Its primary toxic effects include seizure, sinus tachycardia, hypertension, and agitation; however, at higher amounts of ingestion, paradoxical cardiac effects are seen. We report the case of a 21-year-old woman who ingested 13.5 g of bupropion, a dose higher than any other previously reported. The patient presented with seizure, sinus tachycardia with prolonged QTc and QRS intervals, dilated pupils, and agitation. Four days after overdose, the patient's sinus tachycardia and prolonged QTc and QRS intervals resolved with symptomatic management, but she soon developed sinus bradycardia, hypotension, and mild transaminitis. With continued conservative management and close monitoring, her sinus bradycardia resolved 8 days after the overdose. The transaminitis resolved 12 days after the overdose. Our findings are consistent with previously reported toxic effects associated with common overdose amounts of bupropion. In addition, we have observed transient cardiotoxicity manifesting as sinus bradycardia associated with massive bupropion overdose. These findings are less frequently reported and must be considered when managing patients with massive bupropion overdose. We review the psychopharmacologic implications of this and comment on previous literature.

  11. Anesthetic Management of Patients with Congenital Insensitivity to Pain with Anhidrosis: A Retrospective Analysis of 358 Procedures Performed Under General Anesthesia.

    Science.gov (United States)

    Zlotnik, Alexander; Natanel, Dmitry; Kutz, Ruslan; Boyko, Matthew; Brotfain, Evgeny; Gruenbaum, Benjamin F; Gruenbaum, Shaun E; Bodner, Lipa

    2015-11-01

    Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive disorder characterized by recurrent episodic fevers, anhidrosis, absent reaction to noxious stimuli, self-mutilating behavior, and mental retardation. The anesthetic management of patients with CIPA is challenging. Autonomic nervous system abnormalities are common, and patients are at increased risk for perioperative complications. In this study, we describe our experience with 35 patients with CIPA who underwent 358 procedures requiring general anesthesia between 1990 and 2013. During surgery, 3 patients developed hyperthermia intraoperatively (>37.5°C) without prior fever. There were no cases of intraoperative hyperpyrexia (>40°C). Aspiration was suspected in 2 patients, and in another patient aspiration was prevented by the use of endotracheal tube, early detection of regurgitation, and aggressive suctioning. One patient had cardiac arrest requiring cardiopulmonary resuscitation. Intraoperative bradycardia was observed in 10 cases, and postoperative bradycardia was observed in 11 cases. Regurgitation, hyperthermia, and aspiration were uncommon, but the incidence of bradycardia was higher than has been reported in previous studies. CIPA remains a challenge for anesthesiologists. Because of the rare nature of this disorder, the risk of various complications is difficult to predict.

  12. Retrospective analysis of risk factors and predictors of intraoperative complications in neuraxial blocks at Faculdade de Medicina de Botucatu-UNESP.

    Science.gov (United States)

    Pereira, Ivan Dias Fernandes; Grando, Marcela Miguel; Vianna, Pedro Thadeu Galvão; Braz, José Reinaldo Cerqueira; Castiglia, Yara Marcondes Machado; Vane, Luís Antônio; Módolo, Norma Sueli Pinheiro; do Nascimento, Paulo; Amorim, Rosa Beatriz; Rodrigues, Geraldo Rolim; Braz, Leandro Gobbo; Ganem, Eliana Marisa

    2011-01-01

    Cardiovascular changes associated with neuraxial blocks are a cause of concern due to their frequency and because some of them can be considered physiological effects triggered by the sympathetic nervous system blockade. The objective of this study was to evaluate intraoperative cardiovascular complications and predictive factors associated with neuraxial blocks in patients ≥ 18 years of age undergoing non-obstetric procedures over an 18-year period in a tertiary university hospital--HCFMB-UNESP. A retrospective analysis of the following complications was undertaken: hypertension, hypotension, sinus bradycardia, and sinus tachycardia. These complications were correlated with anesthetic technique, physical status (ASA), age, gender, and preoperative co-morbidities. The Tukey test for comparisons among proportions and logistic regression was used for statistical analysis. 32,554 patients underwent neuraxial blocks. Intraoperative complications mentioned included hypotension (n=4,109), sinus bradycardia (n=1,107), sinus tachycardia (n=601), and hypertension (n=466). Hypotension was seen more often in patients undergoing continuous subarachnoid anesthesia (29.4%, OR=2.39), ≥ 61 years of age, and female (OR=1.27). Intraoperative hypotension and bradycardia were the complications observed more often. Hypotension was related to anesthetic technique (CSA), increased age, and female. Tachycardia and hypertension may not have been directly related to neuraxial blocks. Copyright © 2011 Elsevier Editora Ltda. All rights reserved.

  13. [Sex difference of functional and structural alterations in the myocardium of rats with hypothyroidism].

    Science.gov (United States)

    Khara, M R; Pavlovych, S I; Mykhaĭliuk, V M

    2013-01-01

    In experiments on sexually mature rats we studied specific cholinergic regulations of the heart and the degree of its structural damage in hypothyroidism, depending on gender and hormone-productive activity of the gonads. Hypothyroidism in sexually mature males and females was modelled with mercazolil intragastric administration (75 mg/kg) daily during 15 days. We also studied the intensity of bradycardia, which occurred in response to electrical stimulation of vagus nerve and intravenous acetylcholine administration. The degree of structural heart damage was assessed by the percentage of damaged cardiomyocytes in the ventricles of myocardium. It was found that one of the mechanisms of bradycardia in merkazolil-induced hypothyroidism is an increase of the sensitivity of sinus node cholinergic receptors and release of more quanta of acetylcholine from stimulated nerves vagus endings, what was more intense in females. The intensity of bradycardia in hypothyroidism was more significant in gonadectomized animals than in individuals with preserved gonads. The mechanisms of its occurrence in males consist of release of greater amount of acetylcholine from the endings of the nerves vagus, and in females it was the result of significant increase of the sensitivity of sinus node cholinergic receptors. Regardless of the gonads activity, structural damage of the myocardium in merkazolil-induced hypothyroidism was more intensive in female rats.

  14. BRADICARDIA SINTOMÁTICA Y USO DE MARCAPASOS EN EL SERVICIO DE URGENCIAS Symptomatic bradicardia and pacemaker use in the emergency room

    Directory of Open Access Journals (Sweden)

    2007-07-01

    Full Text Available Los marcapasos son aparatos universalmente aceptados para el manejo temporal o definitivo de diferentes tipos de bradicardia sintomática. A los servicios de urgencias consultan con frecuencia pacientes con síntomas que pueden o no estar asociados con bradicardia. En muchos casos la frecuencia cardíaca es demasiado baja y se acompaña de signos de bajo gasto, como son estado mental alterado, dolor torácico, hipotensión, mala perfusión tisular, falla cardíaca, convulsiones, síncope o choque, que pueden comprometer la vida del paciente. Saber reconocer las situaciones de emergencia relacionadas con las bradiarritmias y manejarlas de manera oportuna, es uno de los retos del médico de urgencias.Pacemakers are universally accepted devices used for the management of symptomatic bradycardia. Their use can be temporal or indefinite. Many patients assist to the emergency room service with symptoms that can or can not be associated with bradycardia. Sometimes the heart rate is too slow, and patients have signs and symptoms ase: acute alteration mental status, chest pain, hypotension, congestive heart failure, seizures, syncope or shock. These situations can compromise patients' life. Identify those emergency cases related with bradycardia and to take the correct decisions are a total challenge for emergency.

  15. Ictal asystole in temporal lobe epilepsy before and after pacemaker implantation.

    Science.gov (United States)

    Strzelczyk, Adam; Bauer, Sebastian; Knake, Susanne; Oertel, Wolfgang H; Hamer, Hajo M; Rosenow, Felix

    2008-03-01

    Events of ictal bradycardia or asystole may be of relevance in epilepsy patients presenting with ictal falls, and are a potential contributor to SUDEP. The literature on ictal bradycardia or asystole is anecdotal and consists of case reports and small case series. There are no guidelines for the care of patients with ictal arrhythmias. Insertion of cardiac pacemakers may prevent life-threatening cardiac arrest, syncope and trauma. We report the case of a 41-year-old man who presented with refractory partial seizures resulting in syncope leading to severe head trauma, as the only ictal semiology. During presurgical video-EEG monitoring, two episodes of ictal bradycardia followed by asystole and syncope were recorded. A cardiac pacemaker was implanted. At the nine-month follow-up, the patient reported no overt seizures, syncopes or traumatic falls. Our case demonstrates that implantation of a cardiac pacemaker while continuing AEDs may render a patient free from ictal symptoms and prevent ictal syncope and subsequent trauma. [Published with video sequences].

  16. Blocked Atrial Bi/Trigeminy In Utero Evolving in Supraventricular Tachycardia after Birth

    Directory of Open Access Journals (Sweden)

    V. Martucci

    2012-01-01

    Full Text Available Transient episodes of fetal bradycardia (heart rate less than 110 bpm are usually benign and typically result from increased vagal stimulation in the fetus. Causes of sustained fetal bradycardia include sinus bradycardia, blocked atrial bigeminy/trigeminy, high-degree atrioventricular block, and long QT syndrome. We present the case of a 34-year-old Caucasian patient referred to our department for “blocked atrial bigeminy with pseudobradycardia” detected elsewhere at 33 weeks of gestation. A fetal echocardiography showed during all the examination a blocked atrial trigeminy with a mean fetal heart rate of 100 bpm. After birth three subsequent ECGs until day 3 showed no evidence of atrial extrasystoles, confirming the well-known frequent regression of this kind of fetal benign arrhythmia, but on day 11 recurrence of supraventricular trigeminy and development of episodes of paroxystic supraventricular tachycardia were observed. On the basis of this observation, we recommend that fetuses with complex atrial ectopic beats should be closely monitored before and after birth for evidence of new arrhythmias.

  17. An open-label randomized controlled clinical trial for comparison of continuous phenylephrine versus norepinephrine infusion in prevention of spinal hypotension during cesarean delivery.

    Science.gov (United States)

    Vallejo, M C; Attaallah, A F; Elzamzamy, O M; Cifarelli, D T; Phelps, A L; Hobbs, G R; Shapiro, R E; Ranganathan, P

    2017-02-01

    During spinal anesthesia for cesarean delivery phenylephrine is the vasopressor of choice but can cause bradycardia. Norepinephrine has both β- and α-adrenergic activity suitable for maintaining blood pressure with less bradycardia. We hypothesized that norepinephrine would be superior to phenylephrine, requiring fewer rescue bolus interventions to maintain blood pressure. Eighty-five parturients having spinal anesthesia for elective cesarean delivery were randomized to Group P (phenylephrine 0.1μg/kg/min) or Group N (norepinephrine 0.05μg/kg/min) fixed-rate infusions. Rescue bolus interventions of phenylephrine 100μg for hypotension, or ephedrine 5mg for bradycardia with hypotension, were given as required to maintain systolic blood pressure. Maternal hemodynamic variables were measured non-invasively. There was no difference between groups in the proportion of patients who required rescue vasopressor boluses (Group P: 65.8% [n=25] vs. Group N: 48.8% [n=21], P=0.12). The proportion of patients who received ⩾1 bolus of phenylephrine was similar between groups (Group P: 52.6% [n=20] vs. Group N: 46.5% [n=20], P=0.58). However, more patients received ⩾1 bolus of ephedrine in the phenylephrine group (Group P: 23.7% [n=9] vs. Group N: 2.3% [n=1], Phypotension and can be considered as an alternative to phenylephrine. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Nociceptive afferents selectively modulate the cardiac component of the peripheral chemoreceptor reflex via actions within the solitary tract nucleus.

    Science.gov (United States)

    Boscan, P; Paton, J F R

    2002-01-01

    Our previous findings showed that the nucleus of the solitary tract (NTS) mediated part of the tachycardia evoked during somatic noxious stimulation. Here, we investigated the interaction between somatic nociceptor- and peripheral chemoreceptor-evoked cardiac changes. We sought to determine whether this interaction occurred within the NTS, the primary site of termination of chemoreceptor afferents. In a working heart-brainstem preparation of rat, mechanical noxious activation of a forelimb evoked a tachycardia of 17.5+/-3 (mean+/-S.E.M.) b.p.m., whereas sodium cyanide (7-30 microg) stimulation of peripheral chemoreceptors produced a sub-maximal bradycardia of -140+/-15 b.p.m. During nociceptor stimulation the sodium cyanide-evoked bradycardia was attenuated to -42.6+/-12 b.p.m. but could be prevented by a multiple bilateral NTS microinjection of bicuculline (i.e. -173+/-18 b.p.m.). Furthermore, the activity of NTS neurones responding to peripheral chemoreceptor stimulation increased from 2.8+/-1.3 to 9.4+/-1.9 Hz during sodium cyanide injection (n=7; Pchemoreceptor-evoked excitatory synaptic response. We conclude that somatic noxious stimulation attenuates the chemoreceptor reflex-evoked bradycardia via a GABA(A)ergic mechanism in the NTS.

  19. SEVERE AMIODARONE-INDUCED BRADICARDIA CONCEALES SICK SINUS SYNDROME: CASE REPORT.

    Science.gov (United States)

    Crăcană, Irina; Vasilcu, T F; Mardare, Alexandra; Alexa, Ioana Dana; Marcu, D T M

    2016-01-01

    Sinus node dysfunction is one of the most common arrhythmias in elderly patients; it is usually associated with intermittent and variable symptoms, thus making it difficult to diagnose. We present the case of an elderly female patient with a personal history of atrial fibrillation treated for the last three years with amiodarone; she was admitted to the Geriatric Clinic for non-specific symptoms with onset two months previously for which she had already sought care in different medical services. Clinical examination showed severe bradycardia; ECG and Holter ECG on admission confirmed severe bradycardia, with a heart rate between 29 and 50 beats/min (bpm). Given her long-term treatment with amiodarone we looked for and found hyperthyroidism; the endocrine examination led to the diagnosis of mixed type Amiodarone-induced thyrotoxicosis and initiation of corticosteroid and antithyroid treatment. The evolution of cardiac arrhythmia was monitored with the help of several Holter ECGs performed after amiodarone washout and return to the euthyroid state, which revealed a tachycardia-bradycardia syndrome initially masked by the side effects of the unsupervised therapy with amiodarone, and properly treated by the implantation of a pacemaker.

  20. Gastroesophageal reflux related to respiratory inhibition after crying and feeding hypoxemia in infants.

    Science.gov (United States)

    Minowa, Hideki; Tamura, Reiko; Mima, Aya; Arai, Ikuyo; Yasuhara, Hajime; Ebisu, Reiko; Ohgitani, Ayako

    2016-01-01

    To determine the relationships between gastroesophageal reflux (GER) and both respiratory inhibition after crying (RIAC) and feeding hypoxemia in infants. We screened for RIAC and feeding hypoxemia among infants with a gestational age of 36 weeks or greater using pulse oximetry. We investigated the infants who showed hypoxemia with a decrease in SpO2 to less than 70% and bradycardia with a heart rate of less than 100 beats per minute caused by GER. We then evaluated the relationships between these events and both RIAC and feeding hypoxemia. We examined 250 infants in the present study. RIAC and feeding hypoxemia were observed in 35 (14.0%), and 30 (12.0%) infants, respectively. Ten infants showed hypoxemia and bradycardia caused by GER. These events were correlated with RIAC (p = 0.006) and feeding hypoxemia (p = 0.031). In the infants with RIAC and feeding hypoxemia, some show severe hypoxemia and bradycardia caused by GER. Medical staff caring for infants should note the presence of RIAC and feeding hypoxemia.

  1. The in vitro zebrafish heart as a model to investigate the chronotropic effects of vapor anesthetics.

    Science.gov (United States)

    Stoyek, Matthew R; Schmidt, Michael K; Wilfart, Florentin M; Croll, Roger P; Smith, Frank M

    2017-12-01

    In addition to their intended clinical actions, all general anesthetic agents in common use have detrimental intrasurgical and postsurgical side effects on organs and systems, including the heart. The major cardiac side effect of anesthesia is bradycardia, which increases the probability of insufficient systemic perfusion during surgery. These side effects also occur in all vertebrate species so far examined, but the underlying mechanisms are not clear. The zebrafish heart is a powerful model for studying cardiac electrophysiology, employing the same pacemaker system and neural control as do mammalian hearts. In this study, isolated zebrafish hearts were significantly bradycardic during exposure to the vapor anesthetics sevoflurane (SEVO), desflurane (DES), and isoflurane (ISO). Bradycardia induced by DES and ISO continued during pharmacological blockade of the intracardiac portion of the autonomic nervous system, but the chronotropic effect of SEVO was eliminated during blockade. Bradycardia evoked by vagosympathetic nerve stimulation was augmented during DES and ISO exposure; nerve stimulation during SEVO exposure had no effect. Together, these results support the hypothesis that the cardiac chronotropic effect of SEVO occurs via a neurally mediated mechanism, while DES and ISO act directly upon cardiac pacemaker cells via an as yet unknown mechanism. Copyright © 2017 the American Physiological Society.

  2. Isolated congenital complete heart block in a five-year-old seronegative girl born to a woman seropositive for human immunodeficiency virus: a case report.

    Science.gov (United States)

    Pallangyo, Pedro; Mawenya, Isaac; Nicholaus, Paulina; Mayala, Henry; Kalombola, Amida; Sharau, Godwin; Majani, Naiz; Janabi, Mohamed

    2016-10-19

    Congenital complete heart block is a life-threatening condition which is highly associated with autoimmune and connective tissue disorders. Presence of maternal autoantibodies for associated conditions increases the risk of delivering a child with congenital complete heart block, however, less than a half of all women with such antibodies are symptomatic even after delivery. Mortality rate is highest during the neonatal period (45 %) and about two-thirds of all cases will require permanent pacing at some point in their lives. We report a case of isolated complete heart block in a 5-year-old HIV-free girl of African descent born to an HIV-infected woman with no prior history of autoimmune disorders. She was referred to us with chief complaints of recurrent syncopal attacks and effort intolerance since birth. A physical examination was unremarkable except for her being small for her age (body mass index 16.3 kg/m2) and bradycardia. Her vital signs were within acceptable range with the exception of her pulse rate, which ranged between 22 and 34 beats/minute. An echocardiogram revealed a sinus bradycardia, otherwise a structurally normal heart. An electrocardiogram showed atrioventricular dissociation in keeping with third-degree atrioventricular block. The child underwent a permanent epicardial pacemaker insertion and has been symptom-free following pacing. Despite its infrequency and life-threatening potential, patients with congenital complete heart block have an excellent survival rate with timely diagnosis and intervention. An incidental detection of bradycardia in a fetus during routine obstetrical ultrasound examination should increase the index of suspicion for congenital complete heart block and warrant a screening for associated maternal autoantibodies.

  3. Management of lercanidipine overdose with hyperinsulinaemic euglycaemia therapy: case report

    Directory of Open Access Journals (Sweden)

    Messer Ben

    2011-01-01

    Full Text Available Abstract This case report describes the first reported overdose of the dihydropyridine calcium channel blocker (CCB lercanidipine. A 49 yr old male presented to the Emergency Department 3 hrs after the ingestion of 560 mg of lercanidipine. In the department he had a witnessed seizure within 15 minutes of arrival attributed to the overdose. Following immediate recovery of consciousness after the seizure, he had refractory hypotension and bradycardia which failed to respond to fluid resuscitation, glucagon therapy, and intravenous calcium. He went on to require vasopressor support with noradrenaline and was treated with high dose insulin therapy which was successful in achieving cardiovascular stability. Vasopressor therapy was no longer required within one half life of lercanidipine, and the total stay on intensive care was one day before transfer to a ward. Calcium channel blocker overdose is an uncommon but life-threatening overdose. Treatment for severe toxicity is similar to b-blocker overdose. Hypotension is treated with intravenous fluid therapy, intravenous calcium and possibly glucagon with vasopressor or inotropic support as required. Atropine is used to attempt reversal of bradycardia. High doses of intravenous insulin with intravenous dextrose as required (hyperinsulinaemic euglycaemia or HIET, has also been successfully reported. Experimental animal data suggests that HIET is of benefit and potentially superior to fluid therapy, calcium, glucagon and potentially vasopressor therapy. HIET effectively and sustainably reverses hypotension, bradycardia and improves myocardial contractility and metabolism. Current advice in calcium channel blocker overdose is to begin therapy early in toxicity, starting with a 1.0 IU/kg insulin bolus followed by an infusion of 0.5 IU/kg/hr of insulin and dextrose as required titrated to clinical response.

  4. Comparative effects of sodium channel blockers in short term rat whole embryo culture

    Energy Technology Data Exchange (ETDEWEB)

    Nilsson, Mats F, E-mail: Mats.Nilsson@farmbio.uu.se [Department of Pharmaceutical Biosciences, Uppsala University (Sweden); Sköld, Anna-Carin; Ericson, Ann-Christin; Annas, Anita; Villar, Rodrigo Palma [AstraZeneca R and D Södertälje (Sweden); Cebers, Gvido [AstraZeneca R and D, iMed, 141 Portland Street, Cambridge, MA 02139 (United States); Hellmold, Heike; Gustafson, Anne-Lee [AstraZeneca R and D Södertälje (Sweden); Webster, William S [Department of Anatomy and Histology, University of Sydney (Australia)

    2013-10-15

    This study was undertaken to examine the effect on the rat embryonic heart of two experimental drugs (AZA and AZB) which are known to block the sodium channel Nav1.5, the hERG potassium channel and the L-type calcium channel. The sodium channel blockers bupivacaine, lidocaine, and the L-type calcium channel blocker nifedipine were used as reference substances. The experimental model was the gestational day (GD) 13 rat embryo cultured in vitro. In this model the embryonic heart activity can be directly observed, recorded and analyzed using computer assisted image analysis as it responds to the addition of test drugs. The effect on the heart was studied for a range of concentrations and for a duration up to 3 h. The results showed that AZA and AZB caused a concentration-dependent bradycardia of the embryonic heart and at high concentrations heart block. These effects were reversible on washout. In terms of potency to cause bradycardia the compounds were ranked AZB > bupivacaine > AZA > lidocaine > nifedipine. Comparison with results from previous studies with more specific ion channel blockers suggests that the primary effect of AZA and AZB was sodium channel blockage. The study shows that the short-term rat whole embryo culture (WEC) is a suitable system to detect substances hazardous to the embryonic heart. - Highlights: • Study of the effect of sodium channel blocking drugs on embryonic heart function • We used a modified method rat whole embryo culture with image analysis. • The drugs tested caused a concentration dependent bradycardia and heart block. • The effect of drugs acting on multiple ion channels is difficult to predict. • This method may be used to detect cardiotoxicity in prenatal development.

  5. Use of implantable loop recorders in patients with Brugada syndrome and suspected risk of ventricular arrhythmia.

    Science.gov (United States)

    Kubala, Maciej; Aïssou, Linda; Traullé, Sarah; Gugenheim, Anne-Lise; Hermida, Jean-Sylvain

    2012-06-01

    Implantable cardioverter defibrillator (ICD) therapy is recommended in patients with Brugada syndrome (BS) who experienced aborted sudden cardiac death (SCD) or syncope while the risk stratification of ventricular arrhythmias is a difficult step in patients with atypical symptoms. Implantable loop recorder (ILR) use has been proposed to study patients with unexplained recurrent syncopal events, but its usefulness remains to be defined in patients with BS. In this retrospective study we aimed to investigate the effectiveness of ILR as a diagnostic tool in BS patients suspected of low or moderate risk of SCD. We gathered data from 11 ILR recipients with supposed risk of ventricular arrhythmia, issue of Amiens registry of 204 patients with BS. We reported clinical events before and after implant, electrocardiogram (ECG) characteristics, ILR findings, and its limitations as well as tried to specify ILR utility in diagnosis approach and its consequent contribution to guide the optimal therapy. Within the 11 patients (8 men, 3 women), 9 were symptomatic, and 5 had a spontaneous Type 1 ECG pattern. During mean follow-up period of 33 months, 8 patients had a recurrence of symptoms with a mean delay of 9 months after implant. Bradycardia (two atrioventricular blocks and two sinus bradycardia) was detected in four out of eight patients (50%), and there was no ventricular arrhythmia in any patient during symptomatic events which included six vasovagal syncopes and two epileptic seizures. Two initially asymptomatic patients did not experience any symptoms after ILR implant and their ILR recordings did not reveal any arrhythmias. The ILR contributed to the exclusion of a ventricular arrhythmia as a mechanism of an atypical syncope in patients with electrocardiographic BS and the suspension of the ICD implant. Episodes of transient symptomatic bradycardia were the most common findings suggesting the vagal mechanism of symptoms. The use of ILR should be considered in selected

  6. Cardiac Harms of Sofosbuvir: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Caldeira, Daniel; Rodrigues, Filipe B; Duarte, Marta M; Sterrantino, Carmelo; Barra, Márcio; Gonçalves, Nilza; Pinto, Fausto J; Ferreira, Joaquim J; Costa, João

    2017-08-07

    Sofosbuvir is a new direct-acting pyrimidine nucleotide analogue antiviral drug that has shown remarkable efficacy in the treatment of hepatitis C in clinical trials. However, observational anecdotal data have recently suggested an increased risk of serious bradycardia among patients treated with sofosbuvir and amiodarone. We aimed to estimate and characterize the cardiac safety of sofosbuvir by performing a systematic review of randomized controlled trials (RCTs). We conducted a systematic review of RCTs (PROSPERO 2016: CRD42016033109) comparing sofosbuvir and non-sofosbuvir regimens in patients with chronic hepatitis C by searching the MEDLINE, Embase, and Cochrane Library databases up to January 2017. Non-published data were obtained from the sofosbuvir marketing authorization holder. Random-effects meta-analysis was performed to derive pooled estimates of relative risks (RRs) and corresponding 95% confidence intervals (CIs). Six trials, enrolling 2346 patients (1625 treated with sofosbuvir), were included. The overall risk of bias across studies was moderate. The risk of reported cardiac events (RR 0.87; 95% CI 0.41-1.85), arrhythmias (RR 0.93; 95% CI 0.34-2.51), bradycardia (RR 0.47; 95% CI 0.04-5.20), and tachycardia (RR 0.91; 95% CI 0.20-4.20) were not significantly different between sofosbuvir and non-sofosbuvir regimens. The risks of reported syncope, presyncope, loss of consciousness, or palpitations were similar among those receiving sofosbuvir regimens and controls. The pooled data from RCTs did not show an increased risk of cardiac outcomes, including arrhythmias (and bradycardia), among sofosbuvir-treated patients, although the overall quality of the evidence supporting this conclusion was very low. Registration: PROSPERO 2016:CRD42016033109 at http://www.crd.york.ac.uk/PROSPERO/ .

  7. Safety of amiodarone in the prevention of postoperative atrial fibrillation: a meta-analysis.

    Science.gov (United States)

    Patel, Aarti A; White, C Michael; Gillespie, Effie L; Kluger, Jeffrey; Coleman, Craig I

    2006-05-01

    A meta-analysis was conducted to assess the safety of amiodarone in the prevention of postoperative atrial fibrillation. A search of the medical literature was conducted to identify randomized controlled trials of prophylactic amiodarone use in cardiothoracic surgery. Studies were independently reviewed by three investigators and selected for inclusion if they met the following three criteria: (1) randomized controlled trial of amiodarone versus placebo or routine treatment, (2) patients underwent coronary artery bypass graft or valvular surgery, and (3) reported data on the frequency of at least one of the following safety endpoints: bradycardia, hypotension, heart block, nausea, cerebral vascular accident, myocardial infarction, and death. Both random- and fixed-effects models were used to determine any significant associations between amiodarone and safety endpoints. Eighteen trials were analyzed. A total of 3408 patients were enrolled in these trials (1736 received amiodarone and 1672 received placebo). Amiodarone increased the odds of developing bradycardia (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.05-2.74) and hypotension (OR, 1.62; 95% CI, 1.04-2.54). The administration of i.v. amiodarone, an average daily dose exceeding 1 g, and postoperative amiodarone administration were each associated with a greater likelihood of hemodynamic adverse effects. Amiodarone did not appear to affect other safety endpoints. Meta-analysis showed amiodarone to be associated with an increased risk of developing bradycardia and hypotension when used for the prophylaxis of postoperative atrial fibrillation. The greatest risk in the occurrence of these adverse events arose when using regimens containing i.v. amiodarone, initiating prophylaxis during the postoperative period, and using regimens with average daily doses exceeding 1 g.

  8. Characterization and correlates of exercise among adolescents with anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Nagata, Jason M; Carlson, Jennifer L; Kao, Jessica M; Golden, Neville H; Murray, Stuart B; Peebles, Rebecka

    2017-12-01

    To characterize exercise behaviors among adolescents with anorexia nervosa (AN), atypical AN, or bulimia nervosa (BN), and determine associations between exercise and medical risk. Cross-sectional electronic medical records of all patients evaluated by the Eating Disorder Program at Stanford between January 1997 and February 2011 were retrospectively reviewed. 1,083 subjects (961 females, 122 males; mean age 15.6) met eligibility criteria. Most patients (89.7%) reported exercise (mean 7.0 h per week over mean 5.4 days per week) prior to presentation. Running (49.9%), calisthenics (40.7%), walking (23.4%), soccer (20.9%), and swimming (18.2%) were the most common exercises; a majority (60.6%) reported team sport participation. Males were less likely to report team exercise (p = .005). Bradycardia (heart rate <50) at presentation was associated with team sport participation (adjusted odds ratio [AOR] 1.66, 95% confidence interval [CI] 1.02-2.72) and hours of exercise per week (AOR 1.05, 95% CI 1.02-1.09), controlling for diagnosis, sex, age, duration of illness, rate of weight loss, and percent median body mass index (%mBMI). Adolescents with AN, atypical AN, and BN reported high levels of exercise. Females reported more team sport participation. Greater exercise frequency and team sport participation were associated with bradycardia. Further studies assessing the relationship between exercise and bradycardia may help inform the medical management of adolescents with these eating disorders who are more physically active. © 2017 Wiley Periodicals, Inc.

  9. A model of cardiac ryanodine receptor gating predicts experimental Ca2+-dynamics and Ca2+-triggered arrhythmia in the long QT syndrome

    Science.gov (United States)

    Wilson, Dan; Ermentrout, Bard; Němec, Jan; Salama, Guy

    2017-09-01

    Abnormal Ca2+ handling is well-established as the trigger of cardiac arrhythmia in catecholaminergic polymorphic ventricular tachycardia and digoxin toxicity, but its role remains controversial in Torsade de Pointes (TdP), the arrhythmia associated with the long QT syndrome (LQTS). Recent experimental results show that early afterdepolarizations (EADs) that initiate TdP are caused by spontaneous (non-voltage-triggered) Ca2+ release from Ca2+-overloaded sarcoplasmic reticulum (SR) rather than the activation of the L-type Ca2+-channel window current. In bradycardia and long QT type 2 (LQT2), a second, non-voltage triggered cytosolic Ca2+ elevation increases gradually in amplitude, occurs before overt voltage instability, and then precedes the rise of EADs. Here, we used a modified Shannon-Puglisi-Bers model of rabbit ventricular myocytes to reproduce experimental Ca2+ dynamics in bradycardia and LQT2. Abnormal systolic Ca2+-oscillations and EADs caused by SR Ca2+-release are reproduced in a modified 0-dimensional model, where 3 gates in series control the ryanodine receptor (RyR2) conductance. Two gates control RyR2 activation and inactivation and sense cytosolic Ca2+ while a third gate senses luminal junctional SR Ca2+. The model predicts EADs in bradycardia and low extracellular [K+] and cessation of SR Ca2+-release terminate salvos of EADs. Ca2+-waves, systolic cell-synchronous Ca2+-release, and multifocal diastolic Ca2+ release seen in subcellular Ca2+-mapping experiments are observed in the 2-dimensional version of the model. These results support the role of SR Ca2+-overload, abnormal SR Ca2+-release, and the subsequent activation of the electrogenic Na+/Ca2+-exchanger as the mechanism of TdP. The model offers new insights into the genesis of cardiac arrhythmia and new therapeutic strategies.

  10. Pathogen-induced heart rate changes associated with cholinergic nervous system activation.

    Science.gov (United States)

    Fairchild, Karen D; Srinivasan, Varadamurthy; Moorman, J Randall; Gaykema, Ronald P A; Goehler, Lisa E

    2011-02-01

    The autonomic nervous system plays a central role in regulation of host defense and in physiological responses to sepsis, including changes in heart rate and heart rate variability. The cholinergic anti-inflammatory response, whereby infection triggers vagal efferent signals that dampen production of proinflammatory cytokines, would be predicted to result in increased vagal signaling to the heart and increased heart rate variability. In fact, decreased heart rate variability is widely described in humans with sepsis. Our studies elucidate this apparent paradox by showing that mice injected with pathogens demonstrate transient bradyarrhythmias of vagal origin in a background of decreased heart rate variability (HRV). Intraperitoneal injection of a large inoculum of Gram-positive or Gram-negative bacteria or Candida albicans rapidly induced bradyarrhythmias of sinus and AV nodal block, characteristic of cardiac vagal firing and dramatically increased short-term HRV. These pathogen-induced bradycardias were immediately terminated by atropine, an antagonist of muscarinic cholinergic receptors, demonstrating the role of vagal efferent signaling in this response. Vagal afferent signaling following pathogen injection was demonstrated by intense nuclear c-Fos activity in neurons of the vagal sensory ganglia and brain stem. Surprisingly, pathogen-induced bradycardia demonstrated rapid and prolonged desensitization and did not recur on repeat injection of the same organism 3 h or 3 days after the initial exposure. After recovery from the initial bradycardia, depressed heart rate variability developed in some mice and was correlated with elevated plasma cytokine levels and mortality. Our findings of decreased HRV and transient heart rate decelerations in infected mice are similar to heart rate changes described by our group in preterm neonates with sepsis. Pathogen sensing and signaling via the vagus nerve, and the desensitization of this response, may account for periods of

  11. Central-peripheral neural network interactions evoked by vagus nerve stimulation: functional consequences on control of cardiac function.

    Science.gov (United States)

    Ardell, Jeffrey L; Rajendran, Pradeep S; Nier, Heath A; KenKnight, Bruce H; Armour, J Andrew

    2015-11-15

    Using vagus nerve stimulation (VNS), we sought to determine the contribution of vagal afferents to efferent control of cardiac function. In anesthetized dogs, the right and left cervical vagosympathetic trunks were stimulated in the intact state, following ipsilateral or contralateral vagus nerve transection (VNTx), and then following bilateral VNTx. Stimulations were performed at currents from 0.25 to 4.0 mA, frequencies from 2 to 30 Hz, and a 500-μs pulse width. Right or left VNS evoked significantly greater current- and frequency-dependent suppression of chronotropic, inotropic, and lusitropic function subsequent to sequential VNTx. Bradycardia threshold was defined as the current first required for a 5% decrease in heart rate. The threshold for the right vs. left vagus-induced bradycardia in the intact state (2.91 ± 0.18 and 3.47 ± 0.20 mA, respectively) decreased significantly with right VNTx (1.69 ± 0.17 mA for right and 3.04 ± 0.27 mA for left) and decreased further following bilateral VNTx (1.29 ± 0.16 mA for right and 1.74 ± 0.19 mA for left). Similar effects were observed following left VNTx. The thresholds for afferent-mediated effects on cardiac parameters were 0.62 ± 0.04 and 0.65 ± 0.06 mA with right and left VNS, respectively, and were reflected primarily as augmentation. Afferent-mediated tachycardias were maintained following β-blockade but were eliminated by VNTx. The increased effectiveness and decrease in bradycardia threshold with sequential VNTx suggest that 1) vagal afferents inhibit centrally mediated parasympathetic efferent outflow and 2) the ipsilateral and contralateral vagi exert a substantial buffering capacity. The intact threshold reflects the interaction between multiple levels of the cardiac neural hierarchy. Copyright © 2015 the American Physiological Society.

  12. Cardiopulmonary arrest following administration of Cyclomydril eyedrops for outpatient retinopathy of prematurity screening.

    Science.gov (United States)

    Lee, Jung M; Kodsi, Sylvia R; Gaffar, Majida A; Rubin, Steven E

    2014-04-01

    Eyedrops used for mydriasis and cycloplegia can be systemically absorbed, causing serious side effects, including oxygen desaturation, apnea, bradycardia, transient hypertension, delayed gastric emptying, and transient paralytic ileus. These effects can be more serious in infants because of their lower body mass and immature cardiovascular and nervous systems. We report a case of a 27-week-old infant who suffered a cardiopulmonary arrest after the administration of only Cyclomydril eyedrops (Alcon Laboratories, Fort Worth, TX) during an outpatient retinopathy of prematurity examination. Copyright © 2014 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

  13. Plain film and CT observations in prostaglandin-induced bone changes

    Energy Technology Data Exchange (ETDEWEB)

    Matzinger, M.A.; Briggs, V.A.; Dunlap, H.J.; Udjus, K.; Martin, D.J.; McDonald, P. (Children' s Hospital of Eastern Ontario, Ottawa, ON (Canada). Dept. of Radiology)

    1992-08-01

    Prostaglandin E[sub 1] intravenous infusion is used in infants with ductal-dependent cogenital heart disease to maintain ductal patency and prolong life until palliative or corrective surgery is feasible. Complications of prostaglandin administration include fever, diarrhoea, hypotension, apnoea, bradycardia, pseudowidening of the cranial sutures, underossification of the calvarial bones, periostitis, and skin edema. This paper presents dramatic plain radiographic features of prostaglandin-induced bone disease, inlcuding periosteal proliferation and the unusual bone-within-bone apperance, and provides the previously unpublished CT correlation. (orig.).

  14. Cardiac arrest after anesthetic management in a patient with hereditary sensory autonomic neuropathy type IV

    Directory of Open Access Journals (Sweden)

    Ergül Yakup

    2011-01-01

    Full Text Available Hereditary sensory autonomic neuropathy type IV is a rare disorder with an autosomal recessive transmission and characterized by self-mutilation due to a lack in pain and heat sensation. Recurrent hyperpyrexia and anhydrosis are seen in patients as a result of a lack of sweat gland innervation. Self-mutilation and insensitivity to pain result in orthopedic complications and patients undergone recurrent surgical interventions with anesthesia. However, these patients are prone to perioperative complications such as hyperthermia, hypothermia, and cardiac complications like bradycardia and hypotension. We report a 5-year-old boy with hereditary sensory autonomic neuropathy type IV, developing hyperpyrexia and cardiac arrest after anesthesia.

  15. A near catastrophe from trigeminocardiac reflex

    Directory of Open Access Journals (Sweden)

    Parmod K Bithal

    2017-01-01

    Full Text Available Trigeminocardiac reflex is a brainstem reflex that results from stimulation of any branch of the trigeminal nerve along its course. It produces a constellation of signs and symptoms decrease in blood pressure (BP and heart rate, dysrhythmias, apnoea and increased gastric motility. We present a case of 80-year-old female patient who developed alarming hypotension and bradycardia during craniotomy for meningioma excision resulting from this reflex. In the face of refractory hypotension despite administering ephedrine and phenylephrine, we had to resort to adrenaline to restore her normal BP.

  16. Ictal ECG changes in temporal lobe epilepsy

    OpenAIRE

    L.M. Li; Roche,J.; Sander, J W A S

    1995-01-01

    Changes in cardiac rhythm may occur during epileptic seizures and this has been suggested as a possible mechanism for sudden unexpected death amongst patients with chronic epilepsy (SUDEP). We have studied ECG changes during 61 complex partial seizures of temporal lobe origin in 20 patients. Tachycardia was observed in 24/61 (39%) and bradycardia in 3/61 (5%). The mean and median tachycardia rate was 139 and 140 beats/min (range 120-180). The longest R-R interval observed was 9 seconds. No di...

  17. Shaping our future: animal health in a global trading environment

    Directory of Open Access Journals (Sweden)

    More Simon J

    2007-09-01

    Full Text Available Abstract In this study, the clinical findings and results of haematological and biochemical analyses of 26 cattle with botulism were evaluated. The most important clinical signs in the affected cattle included: decreased appetite, ataxia, difficulty to rise, loss of tongue tone, salivation and bradycardia. A definitive diagnosis of botulism was based on demonstration of the preformed toxin in ruminal and intestinal contents and feed materials including poultry litter, by mouse inoculation test. This study is the first confirmation, by direct toxin isolation, of Clostridium botulinum type C and Clostridium botulinum type D in cattle, in Turkey.

  18. Asystole after Orthotopic Lung Transplantation: Examining the Interaction of Cardiac Denervation and Dexmedetomidine

    Directory of Open Access Journals (Sweden)

    Christopher Allen-John Webb

    2012-01-01

    Full Text Available Dexmedetomidine is an α2-receptor agonist commonly used for sedation and analgesia in ICU patients. Dexmedetomidine is known to provide sympatholysis and also to have direct atrioventricular and sinoatrial node inhibitory effects. In rare instances, orthotopic lung transplantation has been associated with disruption of autonomic innervation of the heart. The combination of this autonomic disruption and dexmedetomidine may be associated with severe bradycardia and/or asystole. Since orthotopic lung transplant patients with parasympathetic denervation will not respond with increased heart rate to anticholinergic therapy, bradyarrhythmias must be recognized and promptly treated with direct acting beta agonists to avoid asystolic cardiac events.

  19. Asystole after orthotopic lung transplantation: examining the interaction of cardiac denervation and dexmedetomidine.

    Science.gov (United States)

    Webb, Christopher Allen-John; Weyker, Paul David; Flynn, Brigid Colleen

    2012-01-01

    Dexmedetomidine is an α(2)-receptor agonist commonly used for sedation and analgesia in ICU patients. Dexmedetomidine is known to provide sympatholysis and also to have direct atrioventricular and sinoatrial node inhibitory effects. In rare instances, orthotopic lung transplantation has been associated with disruption of autonomic innervation of the heart. The combination of this autonomic disruption and dexmedetomidine may be associated with severe bradycardia and/or asystole. Since orthotopic lung transplant patients with parasympathetic denervation will not respond with increased heart rate to anticholinergic therapy, bradyarrhythmias must be recognized and promptly treated with direct acting beta agonists to avoid asystolic cardiac events.

  20. Asystole Following Profound Vagal Stimulation During Hepatectomy

    Directory of Open Access Journals (Sweden)

    Preeta John

    2008-01-01

    Full Text Available Asystole in a non laparoscopic upper abdominal surgery following intense vagal stimulation is a rare event. This case report highlights the need for awareness of such a complication when a thoracic epidural anaesthetic has been given in addition to a general anaesthetic for an upper abdominal procedure. A combined thoracic epidural and general anaesthetic was given. The anterior abdominal wall was retracted forty minutes after administration of the epidural bolus. This maneuver resulted in a profound vagal response with bradycardia and asystole. The patient was resuscitated successfully with a cardiac massage, atropine and adrenaline and the surgery was resumed. Surgery lasted eleven hours and was uneventful.

  1. Overdose effect of aconite containing Ayurvedic Medicine ('Mahashankha Vati').

    Science.gov (United States)

    Panda, Ashok Kumar; Debnath, Saroj Kumar

    2010-07-01

    There are chances that the use of larger than recommended dose of Ayurvedic medicines containing aconite can produce drug reactions. Vatsanabha (Aconitum ferox Wall.) is a very well-known ingredient of Ayurvedic formulations and is prescribed as an antipyretic, analgesic, anti-rheumatic, appetizer and digestive. The recommended dose of purified Vatsanabha (A. ferox Wall.) root is 15 mg. We present a case of hypotension and bradycardia due to aconite poisoning caused by overdosing of an Ayurvedic medicine (Mahashankha Vati), which was primarily managed by Ayurvedic treatment.

  2. Overdose effect of aconite containing Ayurvedic Medicine (‘Mahashankha Vati’)

    Science.gov (United States)

    Panda, Ashok Kumar; Debnath, Saroj Kumar

    2010-01-01

    There are chances that the use of larger than recommended dose of Ayurvedic medicines containing aconite can produce drug reactions. Vatsanabha (Aconitum ferox Wall.) is a very well-known ingredient of Ayurvedic formulations and is prescribed as an antipyretic, analgesic, anti-rheumatic, appetizer and digestive. The recommended dose of purified Vatsanabha (A. ferox Wall.) root is 15 mg. We present a case of hypotension and bradycardia due to aconite poisoning caused by overdosing of an Ayurvedic medicine (Mahashankha Vati), which was primarily managed by Ayurvedic treatment. PMID:21170213

  3. Effects of garlic (Allium sativum) extract on the heart rate, rhythm and force of contraction in frog: a dose-dependent study.

    Science.gov (United States)

    Yadav, Raj Kumar; Verma, Nar Singh

    2004-06-01

    Garlic juice (dose equivalent to 3.3 g to 33 g garlic) mainly caused bradycardia in frog Rana tigerina. The disturbance in ventricular rhythm was observed prior to than that of atria. Rhythm was specially disturbed at higher doses causing bizarre pattern. Force of contraction of the heart also decreased with higher dose of the garlic extract. The results suggest that garlic extract has some beneficial effect on heart rate modulating the rate, rhythm and force of contraction positively but very high doses may exert non-desirable effects as well.

  4. Negative chronotropic effect of proton pump inhibitors on frog-heart preparation.

    Science.gov (United States)

    Gautam, Chander Shekhar; Utreja, Amita; Goel, Divya; Sandhu, Gurpreet; Gogia, Nidhi

    2009-01-01

    Proton pump inhibitors (PPIs) have been known to cause bradycardia. We evaluated the effect of three PPIs, i.e. omeprazole, rabeprazole and pantoprazole on the heart rate of frog. The in situ frog heart preparation was set up. Heart rate and amplitude of contraction were studied following administration of different doses of the three PPIs. Statistical analysis was done by using Graphpad statistical software system. After 1 mg of omeprazole and rabeprazole, and 2 mg pantoprazole, the heart rate was similar as compared to baseline (p >0.05). After 2 mg of omeprazole and rabeprazole, and 4 mg pantoprazole, the reduction in heart rate was significant (p frog heart prepration.

  5. Non-β-blocking R-carvedilol enantiomer suppresses Ca2+ waves and stress-induced ventricular tachyarrhythmia without lowering heart rate or blood pressure

    OpenAIRE

    Zhang, Jingqun; Zhou, Qiang; Smith, Chris D.; Chen, Haiyan; Tan, Zhen; Chen, Biyi; Nani, Alma; Wu, Guogen; Song, Long-Sheng; Fill, Michael; Back, Thomas G.; Wayne Chen, S.R.

    2015-01-01

    Carvedilol is the current β-blocker of choice for suppressing ventricular tachyarrhythmia (VT). However, carvedilol’s benefits are dose-limited, attributable to its potent β-blocking activity that can lead to bradycardia and hypotension. The clinically used carvedilol is a racemic mixture of β-blocking S-carvedilol and non-β-blocking R-carvedilol. We recently reported that novel non-β-blocking carvedilol analogues are effective in suppressing arrhythmogenic Ca2+ waves and stress-induced VT wi...

  6. Efficacy of atropine combined with paroxetine in vagus nerve excitatory panic disorder

    Directory of Open Access Journals (Sweden)

    Du N

    2015-07-01

    Full Text Available Na Du, Xue-Li Sun Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, People’s Republic of China Abstract: Panic disorder is often associated with the autonomic nervous system pattern – sympathetic activation and parasympathetic (vagal withdrawal. However, we present one special case here to show a totally reversed pathogenesis – vagal activation occupying the leading role, which requires atropine to cure the patient’s symptoms. Through this report, it is reasonably proven that panic disorder may be a heterogeneous condition, whose mechanism might be the imbalance between the sympathetic and parasympathetic tone. Keywords: panic disorder, vagal activation, bradycardia, atropine

  7. Comparison between two phenylephrine infusion rates with moderate co-loading for the prevention of spinal anaeshtesia-induced hypotension during elective caesarean section.

    Science.gov (United States)

    Ansari, Tarek; Hashem, Medhat M; Hassan, Ahmed A; Gamassy, Ahmed; Saleh, Ayad

    2011-10-01

    Phenylephrine induces maternal bradycardia in 50% of mothers when used for prevention and treatment of spinal anaesthesia-induced hypotension during caesarean delivery. Rapid fluid administration immediately after initiation of the spinal block (co-loading) may have a vasopressor sparing effect. The aim of this study was to evaluate the hypothesis that when using rapid crystalloid co-loading, an infusion of 50 mcg/minute of PE could be as effective as 100 mcg/minute in preventing maternal hypotension but with minimal maternal bradycardia and an acceptable fetal outcome. 117 mothers scheduled for elective caesarean section were recruited in this randomized controlled trial. Co-loading with 10 ml/kg of Hartmann's solution started immediately after a standard spinal anaesthesia. Parturients were then randomly allocated into two groups. Group 50 (n = 54) received phenylephrine infusion at 50 microg/min, and group 100 (n=63) 100 microg/min. Rescue phenylephrine boluses (50 mcg) were administered if needed to maintain systolic blood pressure between 80-100% of its baseline values. Systolic blood pressure was not different between mothers in both groups during the study period. All neonatal Apgar scores at 1 minute were > or =7 and at 5 minutes were > or =9. No mother had umbilical arterial pH <7.2. Umbilical arterial and venous blood gas and acid base values were not different between both groups except the umbilical arterial PCO2 that was significantly higher in group 100. There were more frequent episodes of maternal bradycardia in Group 100 than in Group 50 (eleven and one parturients respectively). There was no difference in the incidence of nausea and vomiting in both groups. In combination with rapid co-loading, an infusion rate of 50 microg/min of PE is as adequate as 100 microg/min in prevention of spinal anaesthesia-induced hypotension during elective caesarean section. Both infusions are associated with a similar neonatal outcome. PE infusion of 50 microg

  8. Central and Peripheral GABA(A) Receptor Regulation of the Heart Rate Depends on the Conscious State of the Animal

    DEFF Research Database (Denmark)

    Bentzen, Bo Hjorth; Grunnet, Morten

    2011-01-01

    Intuitively one might expect that activation of GABAergic inhibitory neurons results in bradycardia. In conscious animals the opposite effect is however observed. GABAergic neurons in nucleus ambiguus hold the ability to control the activity of the parasympathetic vagus nerve that innervates...... reviews cardiovascular outcomes of GABA activation and includes own experiments on anaesthetized animals and isolated hearts. In conclusion, the impact of changes in GABAergic input is very difficult to predict in these settings, emphasizing the need for experiments performed in conscious animals when...

  9. Varierende sygdomsbilleder hos mindre børn med Influenzavirus type A infektioner

    DEFF Research Database (Denmark)

    Olsen, P M; Hornsleth, A; Krasilnikoff, P A

    1992-01-01

    the subtype was determined, one was found to be H1- and 20 were H3-subtype. Lower respiratory tract disease was the main diagnosis in 21 children, 16 of whom had pneumonia; 14 of these patients were under three years of age. Gastro-intestinal symptoms occurred in 40% of the children over three years of age....... Eight patients had febrile convulsions, a girl aged nine years had double vision and vertigo and a female infant aged two months had periodic apnoea and bradycardia. The reasons for hospitalization were febrile convulsions, abdominal pain, lower respiratory tract symptoms and high pyrexia....

  10. Immunochromatographic purification of a nematocyst toxin from the cnidarian Chironex fleckeri (sea wasp).

    Science.gov (United States)

    Olson, C E; Pockl, E E; Calton, G J; Burnett, J W

    1984-01-01

    A cardiotoxin from "milked venom" of the sea wasp (Chironex fleckeri) was purified by immunochromatography on an immobilized mouse monoclonal anti-Portuguese man-o'war (Physalia physalis) venom antibody column. The 20,000 molecular weight toxin caused bradycardia followed by cell lysis when applied to cultured chick embryonic cardiocytes at concentrations higher than 1.7 micrograms protein per ml and was lethal to mice at 0.04 micrograms protein per g. The toxin affected ion permeability in lipid bilayer membranes by forming monovalent cation channels.

  11. Quantitative Assessment of Graded Burn Wounds in a Porcine Model using Spatial Frequency Domain Imaging (SFDI) and Laser Speckle Imaging (LSI)

    Science.gov (United States)

    2014-09-08

    employs spatial frequency domain imaging (SFDI) and laser speckle imaging (LSI) as non- invasive technologies to characterize in-vivo burn severity. We...debridement (days 0 and 4 respectively), the pig was premedicated with glycopyrrolate (0.01mg/kg, IM) to minimize salivation and bradycardia during...was used to mark areas for burn wound placement. These were located 1.5 cm from the spine and 2.5 cm away from each other (Fig. 2(a)) in order to

  12. The Ace of Spades: Reverse Takotsubo Cardiomyopathy in the Context of Angiographic Embolization of Recurrent Metastatic Serotonin-Positive Neuroendocrine Tumour of the Pancreas

    Directory of Open Access Journals (Sweden)

    Ian A. Mazzetti

    2013-01-01

    Full Text Available A 62-year-old woman undergoing embolization of recurrent neuroendocrine tumor, positive for serotonin, developed chest pain and bradycardia with lateral ST-segment depression. Cardiac biomarkers were elevated, and echocardiography revealed akinesis of all basal segments with a normally contracting apex. The absence of flow-limiting coronary disease on angiography confirmed the presence of reverse Takotsubo cardiomyopathy. After optimal medical therapy for six weeks, left ventricular function returned to normal. Takotsubo cardiomyopathy has been described across a wide variety of hyperadrenergic states; the description of the reverse-type Takotsubo cardiomyopathy in the setting of embolization of recurrent neuroendocrine with serotonergic positivity tumour is novel.

  13. [Botulism in infancy].

    Science.gov (United States)

    Gautier, E; Gallusser, A; Despland, P A

    1989-06-01

    The authors describe a case of botulism in a 3-month-old infant infected with Clostridium botulinum type A. Symptomatology developed within four days, persisted for two weeks, then regressed. Symptoms were paresis of face muscles, hyporeactive pupils, loss of succion and deglutition, axial hypotonia, weakness of peripheral muscles, lability of the autonomic nervous system with acute episodes of bradycardia and constipation. Anomalies of the electroen-cephalogram and of the auditory evoked responses suggest that the toxin penetrated the central nervous system. Treatment was symptomatic, without need for assisted ventilation. It was not possible to detect the source of infection.

  14. Myocarditis in Dengue Fever

    Directory of Open Access Journals (Sweden)

    Johnson Francis

    2017-07-01

    Full Text Available There is a wide variation in the reported incidence of cardiac involvement in dengue due to the difference in the criteria used to identify cardiac involvement. Most common cardiac rhythm abnormality noted was sinus bradycardia, which was often self limited. Fulminant and fatal myocarditis have been documented in a few cases; though in general, most cases with cardiac manifestations improve with supportive care. Only about one tenth of patients with biomarker elevation had evidence of depressed left ventricular systolic function on echocardiography. Higher incidence of depressed left ventricular ejection fraction was noted in dengue shock syndrome.

  15. Biomarkers Prognostic for Elevated Intracranial Pressure

    Science.gov (United States)

    2016-03-01

    control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE March 2016 2. REPORT TYPE Final 3. DATES COVERED 1 Dec 2010 - 31...opening pressure was 25. Overnight, patient became bradycardic and hypotensive to the 60’s diastolic requiring epi and initiation of vasopressin and...place through 6/18. The bolt removed by neurosurgery on 6/18/12. On 6/21/12, the patient had an episode of bradycardia and hypotension to which his care

  16. Does Ondansetron Modify Sympathectomy Due to Subarachnoid Anesthesia?

    DEFF Research Database (Denmark)

    Terkawi, Abdullah S; Mavridis, Dimitris; Flood, Pamela

    2016-01-01

    randomized placebo-controlled trials (1,045 subjects) were identified and analyzed. By using conventional meta-analyses, the authors determined that ondansetron was associated with reduction in the incidence of hypotension (relative risk = 0.62 [95% CI, 0.46 to 0.83], P = 0.001; TSA-adjusted CI, 0.34 to 1...... reduces the incidence of hypotension and bradycardia after subarachnoid anesthesia due to the risk of bias and information sizes less than the required. As results from meta-analysis are given significant weight, it is important to carefully evaluate the quality of the evidence that is input....

  17. Prolonged drug-induced myoclonus: is it related to palonosetron?

    Science.gov (United States)

    Chaw, Sook Hui; Chan, Lucy; Lee, Pui Kuan; Bakar, Jaseemuddeen A; Rasiah, Raveenthiran; Foo, Li Lian

    2016-12-01

    We report a case of drug-induced myoclonus possibly related to palonosetron, a second-generation 5-hydroxytryptamine-3 receptor antagonist which was administered as a prophylaxis for postoperative nausea and vomiting in a 28-year-old female. The recurrent episodes of myoclonus jerk involving the head, neck and shoulder persisted for a period of 4 days. The patient also exhibited an episode of severe bradycardia leading to hypotension 7 h after surgery. To our knowledge, this is the first report presenting these adverse events potentially associated with the use of palonosetron.

  18. Amiodarone-induced myxoedema coma.

    Science.gov (United States)

    Hassan, Syed; Ayoub, Walaa; Hassan, Mona; Wisgerhof, Max

    2014-04-12

    A 62-year-old man was found to have bradycardia, hypothermia and respiratory failure 3 weeks after initiation of amiodarone therapy for atrial fibrillation. Thyroid-stimulating hormone was found to be 168 μIU/mL (nl. 0.3-5 μIU/mL) and free thyroxine (FT4) was amiodarone-induced myxoedema coma in the literature report patient death despite supportive therapy and thyroid hormone replacement. This case represents the most thoroughly investigated case of amiodarone-induced myxoedema coma with a history significant for subclinical thyroid disease.

  19. Deglutition syncope: a manifestation of vagal hyperactivity following carotid endarterectomy.

    Science.gov (United States)

    Endean, Eric D; Cavatassi, William; Hansler, Joseph; Sorial, Ehab

    2010-09-01

    A 61-year-old man with left amaurosis fugax and bilateral >80% internal carotid artery stenoses underwent a left carotid endarterectomy. On the first postoperative day, he developed hypotension, bradycardia, and chest pain with food ingestion. He was diagnosed as having deglutition syncope and was treated with oral anticholinergics. Similar symptoms occurred when he underwent a right carotid endarterectomy. Deglutition syncope is a neurally mediated situational syncope resulting from vagus nerve over-activity. This is the first report of deglutition syncope associated with carotid endarterectomy. It is important to recognize and differentiate these symptoms from other causes of postendarterectomy hemodynamic instability.

  20. [Thalidomide-associated hypothyroidism in a patient with multiple myeloma].

    Science.gov (United States)

    Okamura, Ikue; Ikeda, Takashi; Sato, Ken; Kimura, Fumihiko

    2015-01-01

    Thalidomide is highly effective against multiple myeloma, but some patients must discontinue this medication due to adverse effects. We present herein an instructive case report on thalidomide-associated hypothyroidism in a patient with multiple myeloma. Thyroid hormone replacement therapy allowed us to restart administration of thalidomide, a potentially life-saving therapy. Known adverse effects of thalidomide, such as lethargy, constipation, and bradycardia, are potential symptoms of hypothyroidism, but we tend to overlook drug-associated hypothyroidism. Our case highlights the importance of routinely testing thyroid function in patients receiving thalidomide therapy.

  1. An uncommon but lethal poisoning – Amitraz

    Directory of Open Access Journals (Sweden)

    Joydeep Chakraborty

    2011-08-01

    Full Text Available Amitraz, a centrally acting alpha-2 adrenergic agonist, isincreasingly being used for treatment of ectoparasiticinfestation in cattle. Its effects in humans may mimicorganophosphate poisoning. We report a case of poisoningafter suicidal ingestion of Amitraz. The patient presented ina deeply comatose state with respiratory depression,bradycardia and mydriasis (instead of miosis, the morecommon presentation in previous reports. He recoveredcompletely within 24 hours with adequate supportivemeasures. The importance of this case report is highlightedby the increasing use of this compound, the life-threateningpresentation, the excellent prognosis with early recognitionand supportive management and the limited humantoxicological data.

  2. POISONING WITH GAMMA-HYDROXYBUTYRATE, GAMMA-BUTYROLACTONE AND 1.4-BUTANDIOL

    Directory of Open Access Journals (Sweden)

    Miran Brvar

    2002-09-01

    Full Text Available Background. Gamma-hydroxybutyrate (GHB is a popular recreational drug. GHB overdose typically presents with decreased level of consciousness, miosis, bradycardia, respiratory depression and death. Typically, combativeness, confusion and vomiting occur once the patient begins to recover. Gamma-butyrolactone (GBL and 1.4-butandiol (1.4-BD are the prodrugs of GHB and have similar clinical presentation. We present the case of GHB poisoning in Ljubljana.Conclusions. Physicians should suspect GHB poisoning in young ravers who present with CNS depression. Treatment is symptomatic. There is no specific antidote. Gastric lavage is not beneficial but activated charcoal is recommended.

  3. Pacing-related acute pulmonary edema and mechanical asynchrony illustrated by three-dimensional echocardiography.

    Science.gov (United States)

    Wu, Chia-Tung; Wang, Chun-Li; Luqman, Nazar; Kuo, Chi-Tai

    2007-05-01

    Sick sinus syndrome with symptomatic bradycardia is an indication for a permanent pacemaker. Either a single (AAIR) or dual-chamber (DDDR) pacemaker can be implanted in these patients with normal atrioventricular nodal function. This report presents a 92-year-old male with right ventricular apical pacing related recurrent acute pulmonary edema and mechanical asynchrony demonstrated by three-dimensional echocardiogram. Although three-dimensional echocardiography has been available for many years, it has seldom been applied to evaluate pacing-related intraventricular asynchrony. The systolic asynchrony index for this patient was 6.7% during AAIR pacing mode and 22% during DDDR pacing mode.

  4. Admission heart rate in relation to presentation and prognosis in patients with acute myocardial infarction. Treatment regimens in German chest pain units.

    Science.gov (United States)

    Perne, A; Schmidt, F P; Hochadel, M; Giannitsis, E; Darius, H; Maier, L S; Schmitt, C; Heusch, G; Voigtländer, T; Mudra, H; Gori, T; Senges, J; Münzel, T

    2016-05-01

    Higher heart rates on admission have been associated with poor outcomes in patients with an acute coronary syndrome in previous cohorts. Whether such a linear relationship still exists in contemporary high-level care is unclear. Prospectively collected data from patients presenting with myocardial infarction (MI) in centers participating in the Chest Pain Unit (CPU) Registry between December 2008 and July 2014 were analyzed. Patients were classified according to their initial heart rate (I:  90 bpm experience reduced survival at 3 months despite optimal treatment. Patients with bradycardia also seem to be at increased risk for cardiovascular events despite much earlier presentation and treatment.

  5. [Pacemaking in Cracow in years 1966-1980].

    Science.gov (United States)

    Machejek, Jakub; Lelakowski, Jacek; Bednarek, Jacek; Majewski, Jacek

    2003-01-01

    Permanent pacemaking, a new and effective bradycardia--treatment method, has appeared in the sixties. In Cracow the first emergency temporary stimulation by means of transvenously inserted intracardiac electrode was performed in 1966. Permanent technique of artificial pacing was introduced soon after. The number of pacemaker implantations grew successfully, obtaining 750 of the end of the seventies when the Institute of Cardiology of Nicolaus Copernicus Medical Academy was established. Assortment of implantable devices also became wider, including such rare constructions like nuclear pacemakers and an inductive coupled pacemaker.

  6. Analgetic treatment in acute myocardial infarction. A controlled clinical comparison of morphine, nicomorphine and pethidine

    DEFF Research Database (Denmark)

    Nielsen, J R; Pedersen, K E; Dahlstrøm, C G

    1984-01-01

    ) and for practical reasons, etc. Acute myocardial infarction (AMI) was diagnosed in about 60% of the patients, and about 30% had ischemic heart disease without AMI. All three analgesics provided equally efficient pain relief in relative doses of morphine 10, nicomorphine 10 and pethidine 75 mg/ml. Severe adverse...... reactions were few (allergy 3 cases, respiratory insufficiency 4, severe bradycardia 4), whereas nausea was recorded in 20-30%, vomiting in 5-15% and dizziness in 10-30% of the patients, with no difference between the three drugs. Significant blood pressure drop (greater than 30 mmHg) was seen in 3...

  7. Symptomatic sick sinus syndrome requiring permanent pacemaker implantation in a patient uwith mirror image dextrocardia with situs inversus and infertility.

    Science.gov (United States)

    Kahali, Dhiman; Mandal, Saroj; Mandal, Debasmita; Ghose, Arijit; Kanjilal, Souvik

    2013-01-01

    Situs inversus with dextrocardia is a congenital condition in which the heart is a mirror image of the anatomically normal heart on the right side. A patient presented with the sick sinus syndrome accompanying mirror image dextrocardia which was associated with double superior vena cava and a left sided inferior vena cava A permanent transvenous demand pacemaker was inserted because of repeated episodes of dizziness and a single episode of syncope with ECG showing bradycardia with junctional escape rhythm. Precise knowledge of the venous system and the location of the apex of the right ventricle were necessary prior to permanent pacemaker implantation. Without such knowledge pacing may be technically challenging.

  8. Activation of Brainstem Neurons by Underwater Diving in the Rat

    Science.gov (United States)

    Panneton, W. Michael; Gan, Qi; Le, Jason; Livergood, Robert S.; Clerc, Philip; Juric, Rajko

    2012-01-01

    The mammalian diving response is a powerful autonomic adjustment to underwater submersion greatly affecting heart rate, arterial blood pressure, and ventilation. The bradycardia is mediated by the parasympathetic nervous system, arterial blood pressure is mediated via the sympathetic system and still other circuits mediate the respiratory changes. In the present study we investigate the cardiorespiratory responses and the brainstem neurons activated by voluntary diving of trained rats, and, compare them to control and swimming animals which did not dive. We show that the bradycardia and increase in arterial blood pressure induced by diving were significantly different than that induced by swimming. Neuronal activation was calculated after immunohistochemical processing of brainstem sections for Fos protein. Labeled neurons were counted in the caudal pressor area, the medullary dorsal horn, subnuclei of the nucleus tractus solitarii (NTS), the nucleus raphe pallidus (RPa), the rostroventrolateral medulla, the A5 area, the nucleus locus coeruleus, the Kölliker–Fuse area, and the external lateral and superior lateral subnuclei of the parabrachial nucleus. All these areas showed significant increases in Fos labeling when data from voluntary diving rats were compared to control rats and all but the commissural subnucleus of the NTS, A5 area, and RPa were significantly different from swimming rats. These data provide a substrate for more precise experiments to determine the role of these nuclei in the reflex circuits driving the diving response. PMID:22563319

  9. Assessment of serum magnesium levels and its outcome in neonates of eclamptic mothers treated with low-dose magnesium sulfate regimen

    Science.gov (United States)

    Das, Monalisa; Chaudhuri, Patralekha Ray; Mondal, Badal C.; Mitra, Sukumar; Bandyopadhyay, Debasmita; Pramanik, Sushobhan

    2015-01-01

    Objectives: Magnesium historically has been used for treatment and/or prevention of eclampsia. Considering the low body mass index of Indian women, a low-dose magnesium sulfate regime has been introduced by some authors. Increased blood levels of magnesium in neonates is associated with increased still birth, early neonatal death, birth asphyxia, bradycardia, hypotonia, gastrointestinal hypomotility. The objective of this study was to assess safety of low-dose magnesium sulfate regimen in neonates of eclamptic mothers treated with this regimen. Materials and Methods: This was a cross-sectional observational study of 100 eclampsia patients and their neonates. Loading dose and maintenance doses of magnesium sulfate were administered to patients by combination of intravenous and intramuscular routes. Maternal serum and cord blood magnesium levels were estimated. Neonatal outcome was assessed. Results: Bradycardia was observed in 18 (19.15%) of the neonates, 16 (17.02%) of the neonates were diagnosed with hypotonia. Pearson Correlation Coefficient showed Apgar scores decreased with increase in cord blood magnesium levels. Unpaired t-test showed lower Apgar scores with increasing dose of magnesium sulfate. The Chi-square/Fisher's exact test showed significant increase in hypotonia, birth asphyxia, intubation in delivery room, Neonatal Intensive Care Unit (NICU) care requirement, with increasing dose of magnesium sulfate. (P ≤ 0.05). Conclusion: Several neonatal complications are significantly related to increasing serum magnesium levels. Overall, the low-dose magnesium sulfate regimen was safe in the management of eclamptic mothers, without toxicity to their neonates. PMID:26600638

  10. The anti-malarial drug Mefloquine disrupts central autonomic and respiratory control in the working heart brainstem preparation of the rat

    Directory of Open Access Journals (Sweden)

    Lall Varinder K

    2012-12-01

    Full Text Available Abstract Background Mefloquine is an anti-malarial drug that can have neurological side effects. This study examines how mefloquine (MF influences central nervous control of autonomic and respiratory systems using the arterially perfused working heart brainstem preparation (WHBP of the rat. Recordings of nerve activity were made from the thoracic sympathetic chain and phrenic nerve, while heart rate (HR and perfusion pressure were also monitored in the arterially perfused, decerebrate, rat WHBP. MF was added to the perfusate at 1 μM to examine its effects on baseline parameters as well as baroreceptor and chemoreceptor reflexes. Results MF caused a significant, atropine resistant, bradycardia and increased phrenic nerve discharge frequency. Chemoreceptor mediated sympathoexcitation (elicited by addition of 0.1 ml of 0.03% sodium cyanide to the aortic cannula was significantly attenuated by the application of MF to the perfusate. Furthermore MF significantly decreased rate of return to resting HR following chemoreceptor induced bradycardia. An increase in respiratory frequency and attenuated respiratory-related sympathetic nerve discharge during chemoreceptor stimulation was also elicited with MF compared to control. However, MF did not significantly alter baroreceptor reflex sensitivity. Conclusions These studies indicate that in the WHBP, MF causes profound alterations in autonomic and respiratory control. The possibility that these effects may be mediated through actions on connexin 36 containing gap junctions in central neurones controlling sympathetic nervous outflow is discussed.

  11. Sudden infant death syndrome (SIDS - The role of trigemino-cardiac reflex: A review

    Directory of Open Access Journals (Sweden)

    Gyaninder Pal Singh

    2016-12-01

    Full Text Available Sudden infant death syndrome (SIDS is an unexplained death in infants that usually occurs during sleep. The cause of SIDS remains unknown and multifactorial. In this regard, the diving reflex (DR, a peripheral subtype of trigeminocardiac reflex (TCR is also hypothesized as one of the possible mechanisms for this condition. The TCR is a well-established neurogenic reflex which manifests as bradycardia, hypotension, apnea, and gastric hyper motility. The TCR shares many similarities with the DR which is a significant physiological adaptation to withstand hypoxia during apnea in many animal species including humans in clinical manifestation and mechanism of action. The DR is characterized by breath-holding (apnea, bradycardia and vasoconstriction leading to rising in blood pressure. Several studies have described congenital anomalies of autonomic nervous system in the pathogenesis of SIDS such as hypoplasia, delayed neuronal maturation or decreased neuronal density of arcuate nucleus, hypoplasia and neuronal immaturity of the hypoglossal nucleus. The abnormalities of autonomic nervous system in SIDS may explain the role of TCR in this syndrome involving sympathetic and parasympathetic nervous system. We reviewed the available literature to identify the role of TCR in the etiopathogenesis of SIDS and the pathways and cellular mechanism involved in it. This synthesis will help to update our knowledge and improve our understanding about this mysterious, yet common condition and will open the door for further research in this field.

  12. Concept of the five ′A′s for treating emergency arrhythmias

    Directory of Open Access Journals (Sweden)

    Trappe Hans-Joachim

    2010-01-01

    Full Text Available Cardiac rhythm disturbances such as bradycardia (heart rate < 50/min and tachycardia (heart rate > 100/min require rapid therapeutic intervention. The supraventricular tachycardias (SVTs are sinus tachycardia, atrial tachycardia, AV-nodal reentrant tachycardia, and tachycardia due to accessory pathways. All SVTs are characterized by a ventricular heart rate > 100/min and small QRS complexes (QRS width < 0.12 ms during the tachycardia. It is essential to evaluate the arrhythmia history, to perform a good physical examination, and to accurately analyze the 12-lead electrocardiogram. A precise diagnosis of the SVT is then possible in more than 90% of patients. In ventricular tachycardia (VT there are broad QRS complexes (QRS width > 0.12 s. Ventricular flutter and ventricular fibrillation are associated with chaotic electrophysiologic findings. For acute therapy, we will present the new concept of the five ′A′s, which refers to adenosine, adrenaline, ajmaline, amiodarone, and atropine. Additionally, there are the ′B,′ ′C,′ and ′D′ strategies, which refer to beta-blockers, cardioversion, and defibrillation, respectively. The five ′A′ concept allows a safe and effective antiarrhythmic treatment of all bradycardias, tachycardias, SVTs, VT, ventricular flutter, and ventricular fibrillation, as well as of asystole.

  13. ["The athlete's heart": most common electrocardiographic findings].

    Science.gov (United States)

    Boraita Pérez, A; Serratosa Fernández, L

    1998-05-01

    The morphological and functional cardiac adaptations induced by physical training may be reflected in several athlete's electrocardiographic variants. Rhythm and heart rate disturbances are the most common findings, and sinus bradycardia is the most frequent adaptation. Non-specific intraventricular conduction delay and incomplete right bundle branch block are also frequent, but other bundle branch and fascicular blocks are extremely rare. While the atrioventricular conduction may be prolonged, the occurrence of first degree and type I second degree atrioventricular blocks depends on the individual's susceptibility. Advanced second and third degree atrioventricular blocks are exceptional, and when present, the possibility of underlying heart disease must be excluded. High QRS voltage is more frequent in male athletes, but its correlation with left ventricular hypertrophy is low. The ST segment elevation in the so called "early repolarization" pattern is typical of the athlete's electrocardiogram. Vagotonic or high T wave voltages and U waves are also frequent when sinus bradycardia is present. Tachyarrhythmias and increased automatism arrhythmias are rare and usually benign. The increased vagal tone is responsible for the suppression of the physiological and ectopic pacemakers. While Wolff-Parkinson-White syndrome per se does not exclude an athlete from sports activity, the risk of a sudden death makes it mandatory to perform an exhaustive cardiac evaluation. We may conclude that no sport can be considered arrhythmogenic or as a predisposing factor for malignant ventricular arrhythmias.

  14. [Adequacy of of pacemakers responsive to the volume-minute ventilation rate in heart transplantation patients].

    Science.gov (United States)

    Sant'Anna, J R; Castro, I; Lima, L L; Reis, A; Kalil, R A; Prates, P R; Lucchese, F A; Halperin, C; Pereira, E; Rodrigues, R

    1995-06-01

    To evaluate in the late post-operative period (PO) the chronotropic response to exercise of patients submitted to orthotopic cardiac transplantation (CT) and the implant of a cardiac pacemaker (PM). A rate response ventricular PM (VVI+R) which uses minute ventilation (MV) as a sensor was implanted in five patients in the early PO of CT due to chronotropic incompetence. The patients were 31 to 64 years old and the indication to implant of PM was low ventricular escape rhythm following atrial taquicardia/bradycardia (one case) or sinus bradycardia (4 cases). The study was performed by means of paired exercise tests using Naughton protocol in order to compare the heart rate in VVI (prefixed heart rate) and VVIR+MV (rate response) mode. The duration of the exercise was compared between the two modes of stimulation. In VVI mode the heart rate was significantly lower than in VVIR+MV mode for comparable periods of exercise (101 +/- 12 ppm vs 132 +/- 4 ppm; p < 0.05); in VVIR+MV mode the patients had a prolonged time of exercise as compared to VVI mode (15 +/- 7 min vs 12 +/- 7 min; NS). The MV rate response PM provided patients with satisfactory heart during exercise and may be an adequate option to patients submitted to CT who present chronotropic incompetence.

  15. Intrapartum electronic fetal heart rate monitoring and the identification of metabolic acidosis and hypoxic-ischemic encephalopathy.

    Science.gov (United States)

    Larma, Joel D; Silva, Anadir M; Holcroft, Cynthia J; Thompson, Richard E; Donohue, Pamela K; Graham, Ernest M

    2007-09-01

    The purpose of this study was to determine whether electronic fetal monitoring can identify fetuses with metabolic acidosis and hypoxic-ischemic encephalopathy. The cases were 107 nonanomalous chromosomally normal fetuses with an umbilical arterial pH electronic fetal monitoring before delivery was evaluated by 3 obstetricians who were blinded to outcome. Cases had a significant increase in late and prolonged decelerations/hour and late decelerations/contractions. Those fetuses with hypoxic-ischemic encephalopathy had significant increases in bradycardia, decreased variability, and nonreactivity but no difference in late or variable decelerations/hour. For the identification of hypoxic-ischemic encephalopathy, the sensitivity, specificity, and positive and negative predictive values were 15.4%, 98.9%, 66.7%, and 89.4%, respectively, for bradycardia; 53.8%, 79.8%, 26.9%, and 92.6%, respectively, for decreased variability; 92.3%, 61.7%, 2.7%, and 82.9%, respectively, for nonreactivity; and 7.7%, 98.9%, 50.0%, and 88.6%, respectively, for all 3 abnormalities combined. Fetal metabolic acidosis and hypoxic-ischemic encephalopathy are associated with significant increases in electronic fetal monitoring abnormalities, but their predictive ability to identify these conditions is low.

  16. Complications associated with temporary tracheostomy tubes in 42 dogs (1998 to 2007).

    Science.gov (United States)

    Nicholson, I; Baines, S

    2012-02-01

    To identify the type and frequency of tracheostomy tube complications, and to determine factors associated with these complications, and with poor outcome. A database search for dogs undergoing temporary tube tracheostomy was performed. The medical records were scrutinised. The signalment, respiratory disease history, diagnosis, surgery, type and frequency of tube care procedures, type of complications and outcome were recorded. Forty-two records were found. Complications occurred in 36 of 42 (86%) cases. Bulldogs were more likely to dislodge the tube than other breeds (P=0·0376), and cases with three or more complication types underwent more routine care procedures than those with fewer complications (P=0·0370). Thirty-four of 42 (81%) dogs had a successfully managed tracheostomy tube and survived until tube removal, or elective euthanasia without significant tube complications. Bulldogs were also significantly (P=0·0376) more likely to have an unsuccessful tube outcome, as were dogs experiencing severe bradycardia during treatment (P=0·0176). Dogs with unsuccessful tube outcome were significantly (P=0·0331) younger than dogs with successful tube outcome. Tracheostomy tubes in dogs have a high complication rate but a good outcome in most dogs. Careful management may improve the outcome of dogs with tracheostomy tubes, especially bulldogs and dogs exhibiting bradycardia during treatment. © 2012 British Small Animal Veterinary Association.

  17. Live music reduces stress levels in very low-birthweight infants.

    Science.gov (United States)

    Schwilling, Diana; Vogeser, Michael; Kirchhoff, Fabian; Schwaiblmair, Frauke; Boulesteix, Anne-Laure; Schulze, Andreas; Flemmer, Andreas W

    2015-04-01

    Music might benefit preterm infants in stressful, intensive care environments. However, data on stress level indicators, determined by salivary cortisol levels, are scarce. We evaluated the effect of live harp music on the stress level indicators of preterm infants in a neonatal intensive care unit (NICU). We exposed 20 stable preterm infants to music for 15 min on three consecutive days. Saliva was collected before the music was played and 25 min and 4 h after it ended. Salivary cortisol levels were measured by liquid chromatography-tandem mass spectrometry and vital signs, oxygen saturation, bradycardia, apnoeas and oxygen desaturations were recorded. Pain levels were assessed by the Bernese Pain Scale for Neonates. Salivary cortisol was significantly lower 25 min (18.9 nmol/L [3.9-35.6] p = 0.001) and 4 h after music (17.4 nmol/L [3.9-35.3] p = 0.003) than at baseline 4 h before exposure (19.5 nmol/L [7.2-51.1]). After music, the number of apnoeas and oxygen desaturations was significantly reduced on all three, days and the number of bradycardia episodes on day one. Pain scores significantly improved after music on all 3 days. Exposure to live music reduced salivary cortisol and had beneficial effects on the physiologic parameters of stable preterm infants in a NICU. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  18. The Brady Bunch? New evidence for nominative determinism in patients' health: retrospective, population based cohort study.

    Science.gov (United States)

    Keaney, John J; Groarke, John D; Galvin, Zita; McGorrian, Catherine; McCann, Hugh A; Sugrue, Declan; Keelan, Edward; Galvin, Joseph; Blake, Gavin; Mahon, Niall G; O'Neill, James

    2013-12-12

    To ascertain whether a name can influence a person's health, by assessing whether people with the surname "Brady" have an increased prevalence of bradycardia. Retrospective, population based cohort study. One university teaching hospital in Dublin, Ireland. People with the surname "Brady" in Dublin, determined through use of an online telephone directory. Prevalence of participants who had pacemakers inserted for bradycardia between 1 January 2007 and 28 February 2013. 579 (0.36%) of 161,967 people who were listed on the Dublin telephone listings had the surname "Brady." The proportion of pacemaker recipients was significantly higher among Bradys (n=8, 1.38%) than among non-Bradys (n=991, 0.61%; P=0.03). The unadjusted odds ratio (95% confidence interval) for pacemaker implantation among individuals with the surname Brady compared with individuals with other surnames was 2.27 (1.13 to 4.57). Patients named Brady are at increased risk of needing pacemaker implantation compared with the general population. This finding shows a potential role for nominative determinism in health.

  19. The Brady Bunch? New evidence for nominative determinism in patients’ health: retrospective, population based cohort study

    Science.gov (United States)

    Groarke, John D; Galvin, Zita; McGorrian, Catherine; McCann, Hugh A; Sugrue, Declan; Keelan, Edward; Galvin, Joseph; Blake, Gavin; Mahon, Niall G; O’Neill, James

    2013-01-01

    Objective To ascertain whether a name can influence a person’s health, by assessing whether people with the surname “Brady” have an increased prevalence of bradycardia. Design Retrospective, population based cohort study. Setting One university teaching hospital in Dublin, Ireland. Participants People with the surname “Brady” in Dublin, determined through use of an online telephone directory. Main outcome measure Prevalence of participants who had pacemakers inserted for bradycardia between 1 January 2007 and 28 February 2013. Results 579 (0.36%) of 161 967 people who were listed on the Dublin telephone listings had the surname “Brady.” The proportion of pacemaker recipients was significantly higher among Bradys (n=8, 1.38%) than among non-Bradys (n=991, 0.61%; P=0.03). The unadjusted odds ratio (95% confidence interval) for pacemaker implantation among individuals with the surname Brady compared with individuals with other surnames was 2.27 (1.13 to 4.57). Conclusions Patients named Brady are at increased risk of needing pacemaker implantation compared with the general population. This finding shows a potential role for nominative determinism in health. PMID:24336304

  20. Clinicopathological profile of salmonella typhi and paratyphi infections presenting as Fever of unknown origin in a tropical country.

    Science.gov (United States)

    Iqbal, Nayyar; Basheer, Aneesh; Mookkappan, Sudhagar; Ramdas, Anita; Varghese, Renu G'Boy; Padhi, Somanath; Shrimanth, Bhairappa; Chidambaram, Saranya; Anandhalakshmi, S; Kanungo, Reba

    2015-01-01

    Enteric fever, a common infection in the tropics and endemic to India, often manifests as an acute febrile illness. However, presentation as fever of unknown origin (FUO) is not uncommon in tropical countries. We aim to describe the clinical, laboratory and pathological features of patients hospitalized with fever of unknown origin and diagnosed as enteric fever. All culture proven cases of enteric fever were analyzed retrospectively over a period of three years from January 2011 to December 2013. Seven of 88 (8%) cases with enteric fever presented as FUO. Abdominal pain was the most common symptom besides fever. Relative bradycardia and splenomegaly were uncommon. Thrombocytopenia was the most common haematological abnormality while leucopenia was rare. Transaminase elevation was almost universal. S. Typhi and S. Paratyphi A were isolated from six cases and one case respectively. Yield of organisms from blood culture was superior to that of bone marrow aspirate. Multiple granulomas were identified in 4 out of 6 (67%) of the bone marrows studied, including that due to S. Paratyphi A and histiocytic hemophagocytosis was noted in two cases. FUO is a relatively common manifestation of enteric fever in the tropics. Clinical and laboratory features may be atypical in such cases, including absence of relative bradycardia, leucopenia, and presence of thrombocytopenia, bicytopenia or pancytopenia. In addition, in endemic countries, enteric fever should be considered as a differential diagnosis, next to tuberculosis, in the evaluation of bone marrow granulomas in cases with FUO and culture correlation should be mandatory.

  1. Perioperative Vasovagal Syncope with Focus on Obstetric Anesthesia

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    Pei-Shan Tsai

    2006-09-01

    Full Text Available Vasovagal syncope refers to a reflex cardiovascular depression that gives rise to loss of consciousness with bradycardia and profound vasodilatation. This response commonly occurs during regional anesthesia, hemorrhage or supine inferior vena cava compression in pregnancy. The changes in circulatory response from the normal maintenance of arterial pressure to parasympathetic activation and sympathetic inhibition may cause severe hypotension. This change is triggered by reduced cardiac venous return as well as episodes of emotional stress, excitement or pain. Occasionally, these vasovagal responses may be unpredictable and may dramatically proceed to asystole with circulatory collapse, and may even result in death. In these circumstances, hypotension may be more severe than that caused by bradycardia alone, because of unappreciated vasodilatation. Regional anesthesia, decreased venous return, hemorrhage and abnormal fetal presentation cumulatively increase the risk of vasovagal syncope in cesarean section patients. When a vasovagal response occurs, ephedrine is the drug of first choice because of its combined action on the heart and peripheral blood vessels. Epinephrine must be used early in established cardiac arrest, especially after high regional anesthesia.

  2. [The oculocardiac reflex in blepharoplasties].

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    Rippmann, V; Scholz, T; Hellmann, S; Amini, P; Spilker, G

    2008-08-01

    The oculocardiac reflex (OCR) is a well-known phenomenon in ophthalmic surgery, but is rarely described in aesthetic blepharoplasty surgery. It was first mentioned in 1908 by Ascher and Dagnini. Since then, ophthalmologists and anaesthesiologists have regarded the onset of the oculocardiac reflex as a significant intraoperative problem, which is undermined by several case reports that describe dysrhythmias which have haved caused morbidity and death. Per definition the OCR is caused by ocular manipulation and involves intraoperative bradycardia by a change of 20 beats/minute compared to the preoperative heart rate or any dysrhythmia during the manipulation via a trigeminal-vagal-mediated reflex arc. Having operated on a 48-year-old, healthy woman in our clinic, who underwent a cardiac arrest during the blepharoplasty procedure, followed by a successful resuscitation, we investigated the onset of the OCR in our blepharoplasty patients within the last 3 years. The onset of the OCR was noted in 22 of 110 (20 %) blepharoplasty patients, mainly affecting younger, low-weighted patients operated under local anaesthesia. Awareness and treatment of this potentially life-threatening oculocardiac reflex are necessary. In most cases the onset of the reflex may be avoided by a gentle operation technique and by refraining from severe traction to the muscle or fat pad. The best treatment of a profound bradycardia caused by the OCR is to release tension to the muscle or fat pad in order to permit the heart rate to return to normal. Intraoperative monitoring is of utmost importance.

  3. Chemical composition and cardiovascular effects induced by the essential oil of Cymbopogon citratus DC. Stapf, Poaceae, in rats

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    Flávia V. Moreira

    2010-08-01

    Full Text Available Cymbopogon citratus DC. Stapf, Poaceae, is used in the folk medicine for hypertension treatment. This work investigated the chemical composition and cardiovascular effects in rats of C. citratus essential oil (EOCC. A phytochemical screening demonstrated the presence of eight constituents, being geranial the major compound (43.08%. In rats, EOCC (1, 5, 10, and 20 mg/kg, i.v. induced transient hypotension and bradycardia that were attenuated by atropine and sodium thiopental, but not by L-NAME or indomethacin. In rings of rat superior mesenteric artery pre-contracted with phenylephrine, EOCC (1 to 3000 µg/mL induced relaxation that was not affected after removal of the endothelium, after TEA or in rings pre-contracted with KCl (80 mM. Furthermore, EOCC (1000 µg/mL was not able to induce additional effect on maximal relaxation of nifedipine (10 µM. In conclusions, EOCC induces hypotension, possibly by reduction in vascular resistance caused by inhibition of the Ca2+ influx, and bradycardia probably due to an activation of cardiac muscarinic receptors.

  4. Fingolimod for multiple sclerosis and emerging indications: appropriate patient selection, safety precautions, and special considerations

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    Ayzenberg I

    2016-02-01

    Full Text Available Ilya Ayzenberg, Robert Hoepner, Ingo Kleiter Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany Abstract: Fingolimod (FTY720, an immunotherapeutic drug targeting the sphingosine-1-phosphate receptor, is a widely used medication for relapsing-remitting multiple sclerosis (MS. Apart from the pivotal Phase III trials demonstrating efficacy against placebo and interferon-β-1a once weekly, sufficient clinical data are now available to assess its real-world efficacy and safety profile. Approved indications of fingolimod differ between countries. This discrepancy, to some extent, reflects the intermediate position of fingolimod in the expanding lineup of MS medications. With individualization of therapy, appropriate patient selection gets more important. We discuss various scenarios for fingolimod use in relapsing-remitting MS and their pitfalls: as first-line therapy, as escalation therapy after failure of previous immunotherapies, and as de-escalation therapy following highly potent immunotherapies. Potential side effects such as bradycardia, infections, macular edema, teratogenicity, and progressive multifocal leukoencephalopathy as well as appropriate safety precautions are outlined. Disease reactivation has been described upon fingolimod cessation; therefore, patients should be closely monitored for MS activity for several months after stopping fingolimod. Finally, we discuss preclinical and clinical data indicating neuroprotective effects of fingolimod, which might open the way to future indications such as stroke, Alzheimer’s disease, and other neurodegenerative disorders. Keywords: immunotherapy, bradycardia, progressive multifocal leukoencephalopathy, neuroprotection, stroke, Alzheimer’s disease 

  5. Beneficial role of tamoxifen in isoproterenol-induced myocardial infarction.

    Science.gov (United States)

    Rayabarapu, Nihar; Patel, Bhoomika M

    2014-10-01

    ER-α and ER-β agonist 17β-estradiol is reported to attenuate cardiac hypertrophy. Tamoxifen is a selective estrogen receptor modulator. Hence, the objective of this study was to investigate the effects of tamoxifen in myocardial infarction. For this, tamoxifen was administered to Sprague-Dawley rats for 1-14 days, and isoproterenol (ISO) (100 mg·(kg body mass)(-1)·day(-1)) was administered subcutaneously on the 13th and 14th days of the study in order to induce myocardial infarction, after which, various biochemical, cardiac, and morphometric parameters were evaluated. ISO produced significant dyslipidemia, hypertension, bradycardia, oxidative stress, and an increase in serum cardiac markers. Treatment with tamoxifen significantly controlled dyslipidemia, hypertension, bradycardia, oxidative stress, and reduced serum cardiac markers. The ISO control rats exhibited significant increases in the infarct size of the left ventricle (LV), LV cavity area, cardiac and LV hypertrophic indices, LV-wall thickness, cardiomyocyte diameter, and area. Treatment with tamoxifen significantly reduced infarction as well as hypertrophic and morphometric parameters. ISO also produced significant increases in the LV collagen level, decreases in Na(+)K(+) ATPase activity, and a reduction in the rate of pressure development and decay, which were prevented by tamoxifen treatment. The protective effect of tamoxifen on myocardial infarct was further confirmed by histopathological examination. Our data thus suggest that tamoxifen exerts beneficial effects in ISO-induced myocardial infarction.

  6. Anti-Arrhythmic Potential of Coriandrum sativum Seeds in Salt Induced Arrhythmic Rats

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    Nida Rehman1, Nazish Jahan1*, Khalil-ul-Rahman2, Khalid Mahmood Khan2 and Fatiqa Zafar1

    2016-11-01

    Full Text Available In the present research, the anti-arrhythmic potential of Coriandrum sativum (seeds was evaluated in BaCl2 induced tachycardia and KCl induced bradycardia in rats. Heart rate and electrocardiogram (ECG was recorded during the experimental period. The BaCl2 increased the heart rate from 111/min to 157/min while KCL decreased the heart rate from 112/min to 60/min in the rats of positive control groups. ECG patterns also confirmed the tachy- and brady-arrhythmia in the rats of both positive control groups. The changes in biochemical cardiac biomarkers (CK-MB, LDH, AST, and ALT were also the studied parameters. The level of cardiac biomarkers was significantly elevated in the serum of positive control rats as compared to their respective absolute controls. In case of both curative and preventive mode of treatment the elevated levels of enzymes, cardiac biomarkers were significantly reduced. Electrocardiogram (ECG pattern revealed that the studied plant possesses a very good anti-arrhythmic potential in case of curative mode of treatment. The antiarrhythmic potential through preventive mode of treatment was also encouraging, but comparatively less than the curative mode of treatment. Anti-tachycardial potential of C. sativum was comparable with standard drug while, recovery in bradycardia was relatively slow than standard drug. Gross pathology and ECG pattern of base line group confirmed the innoxious nature of C. sativum seeds. Treatment of rats with Coriandrum sativum (100 mgkg-1 BW normalized the heart rate and attenuated the cardiac arrhythmia.

  7. Stimulation of the mesencephalic ventral tegmental area blunts the sensitivity of cardiac baroreflex in decerebrate cats.

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    Matsukawa, Kanji; Ishii, Kei; Ishida, Tomoko; Nagai, Atsushi; Liang, Nan

    2015-05-01

    We have examined for the first time whether electrical stimulation of the mesencephalic ventral tegmental area (VTA) or the substantia nigra (SN) was capable of suppressing cardiac baroreflex sensitivity in decerebrate cats. After decerebration was performed by electrocoagulation at the precollicular-premammillary level and inhalation anesthesia was stopped, the animals were able to show spontaneous motor activity intermittently. Electrical stimulations of the mesencephalic areas (the VTA and SN) for 30s were conducted with a monopolar tungsten microelectrode (current intensity of pulse trains, 50-100 μA; frequency, 40-50 Hz; pulse duration, 0.5-1.0 ms), without producing tibial motor discharge. Stimulation of the VTA evoked the significant increases in heart rate (HR, 12 ± 2 beats/min) and mean arterial blood pressure (MAP, 12 ± 3 mm Hg). When the baroreflex bradycardia and the slope of the cardiac baroreflex curve were examined using a pressor response with brief occlusion of the abdominal aorta, the VTA stimulation blunted both the baroreflex bradycardia and the maximal slope of the baroreflex MAP-HR curve by 63-74% in the same manner as spontaneously-evoked motor activity. In contrast, stimulation of the SN elicited no modulation of cardiac baroreflex. It is likely that stimulation of the mesencephalic VTA suppresses cardiac baroreflex sensitivity and has the similar features of the effects on the cardiac baroreflex function as those during spontaneously-evoked motor activity. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. Neuronal counting and parasympathetic dysfunction in the hearts of chronically Trypanosoma cruzi - infected rats Contagem neuronal e disfunção cardíaca parassimpática em ratos cronicamente infectados pelo Trypanosoma cruzi

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    E. Chapadeiro

    1991-10-01

    Full Text Available Ten male Wistar rats, chronically infected with Colombian, São Felipe (12SF and Y strains of Trypanosoma cruzi and ten non-infected control animals were submitted to the bradycardia responsiveness test, an assessment of heart parasympathetic function, after phenylephrine injection. Six chagasic animals showed heart parasympathetic dysfuntion characterized by reduction in the index of bradycardia baroreflex responsiveness, as compared with the control group. Microscopic examination of the atrial heart ganglia of chagasic rats showed ganglionitis, but no statiscally significant reduction in the number of neurons.Dez ratos machos Wistar cronicamente infectados pelas cepas Colombiana, São Felipe (12SF, e Y do Trypanosoma cruzi, foram submetidos, após 8 meses de infecção, juntamente com dez animais controles, ao teste da resposta bradicárdica barorreflexa pela injeção endovenosa de fenilefrina. Seis ratos chagásicos exibiram disfunção cardíaca parassimpática, caracterizada pela depressão do índice da resposta bradicárdica barorreflexa. Embora o estudo histológico dos corações chagásicos mostrasse lesões dos gânglios atriais, a contagem dos neurônios em cortes seriados, não apresentou redução numérica significativa dos mesmos.

  9. Prevalence of electrocardiographic changes in patients with acute aneurysmal subarachnoid hemorrhage and their relationship with outcome

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    Saktheeswaran Mahesh Kumar

    2013-01-01

    Full Text Available Background: Electrocardiographic (ECG alterations occurring after subarachnoid hemorrhage (SAH have been described frequently, but the prognostic significance of these changes has not been well characterized. Aim and Objectives: To report the prevalence and patterns of ECG alterations in patients with acute aneurysmal SAH and to study the relationship between ECG alterations and the neurological outcome, if any. Materials and Methods: Records of consecutive patients admitted to the neurosurgical intensive care unit of the SCTIMST, Trivandrum between January 1999 and January 2011 with acute aneurysmal SAH were retrospectively analyzed. Results: Of the 321 patients with SAH, 190 (59.2% had abnormal ECGs. Repolarization abnormalities were the most common, with T wave inversion in the anterolateral leads occurring in 155 (48.3% patients. By univariate analysis, female sex, Glasgow Coma Score (GCS at admission of I, ST segment depression or T inversion in anterolateral leads, prolonged corrected QT interval, and sinus bradycardia were associated with increased risk of death. By multivariate analysis, only GCS and WFNS grade independently predicted mortality and none of the ECG changes predicted the same. Presence of tall T waves in anterior leads, T inversion in anterolateral leads, sinus bradycardia, and WFNS grade >1 were independently associated with GCS <15 and poor outcome at discharge. Conclusions: In patients with acute aneurysmal SAH, repolarization abnormalities are the commonest ECG alterations. ECG alterations do not independently predict death, but independently predict poor discharge neurological status.

  10. 41. The myocardial protective effect of dexmedetomidine in high risk patients undergoing aortic vascular surgery

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    R. Soliman

    2016-07-01

    Full Text Available Dexmedetomidine provides perioperative cardiac protection in high risk patients assessment the effect of dexmedetomidine in high risk patients undergoing aortic vascular surgery. Arandomized study included 150 patients classified into two groups(n = 75. Group D: The patients received a loading dose of 1 μg/kg dexmedetomidine over 15 min before induction and maintained as an infusion of 0.3 μg/kg/hr to the end of the procedure. Group C: The patients received an equal volume of normalsaline. The dexmedetomidine decreased heart rate and minimized the changes in blood pressure compared to control group (p < 0.05. Also, it decreased the incidence of myocardial is chemia reflected by troponin I level and ECG changes(p < 0.05. Dexmedetomidine decreased the requirement for nitroglycerine and norepinephrine compared to control group (p < 0.05. The incidence of hypotension and bradycardia were significantly higher with dexmedetomidine (p < 0.05.The dexmedetomidine is safe and effective in patients undergoing aortic vascular surgery. It decreases the changes in heart rate and blood pressure during the procedures. It provide scardiac protection in high risk patients reflected by decreasing the incidence of myocardial ischemia and serum level of troponin. The main side effects of dexmedetomidine were hypotension and bradycardia.

  11. Placement Of Cardiac PacemaKEr Trial (POCKET) - rationale and design: a randomized controlled trial.

    Science.gov (United States)

    Magnusson, Peter; Wennström, Leo; Kastberg, Robert; Liv, Per

    2017-01-01

    A pacemaker system consists of one or two leads connected to a device that is implanted into a pocket formed just below the collarbone. This pocket is typically subcutaneous, that is, located just above the pectoral fascia. Even though the size of pacemakers has decreased markedly, complications due to superficial implants do occur. An alternative technique would be intramuscular placement of the pacemaker device, but there are no randomized controlled trials (RCTs) to support this approach, which is the rationale for the Placement Of Cardiac PacemaKEr Trial (POCKET). The aim is to study if intramuscular is superior to subcutaneous placement of a pacemaker pocket. In October 2016, we started to enroll 200 consecutive patients with an indication for bradycardia pacemaker implantation. Patients are randomized to random block sizes, stratified by age group (cut-off: 65 years) and sex, and then randomized to either subcutaneous or intramuscular implant. A concealed allocation procedure is employed, using sequentially numbered, sealed envelopes. Pocket site is blinded to the patient and in all subsequent care. The primary endpoint is patient overall satisfaction with the pocket location at 24 months as measured using a visual analog scale (VAS) 0-10. Secondary endpoints are: complications, patient-reported satisfaction at 1, 12, and 24 months (overall satisfaction, pain, discomfort, degree of unsightly appearance, movement problems, and sleep problems due to device). POCKET is a prospective interventional RCT designed to evaluate if intramuscular is superior to subcutaneous placement of a bradycardia pacemaker during a two-year follow-up.

  12. A case of delayed cardiac perforation of active ventricular lead

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    Hangyuan Guo

    2011-12-01

    Full Text Available A 65-year-old man was admitted as for one month of repetitive dizziness and one episode of syncope. Electrocardiogram showed sinus bradycardia and his Holter monitoring also showed sinus bradycardia with sinus arrest, sino-atrial block and a longest pause of 4.3 s. Then sick sinus syndrome and Adam-Stokes syndrome were diagnosed. Then a dual chamber pacemaker (Medtronic SDR303 was implanted and the parameters were normal by detection. The patient was discharged 1 week later with suture removed. Then 1.5 month late the patient was presented to hospital once again for sudden onset of chest pain with exacerbation after taking deep breath. Pacemaker programming showed both pacing and sensing abnormality with threshold of?5.0V and resistance of 1200?. Lead perforation was revealed by chest X-ray and confirmed by echocardiogram. Considering the fact that there was high risk to remove ventricular lead, spiral tip of previous ventricular lead was withdrew followed by implantation of a new ventricular active lead to the septum. Previous ventricular lead was maintained. As we know that the complications of lead perforation in the clinic was rare. Here we discuss the clinical management and the possible reasons for cardiac perforation of active ventricular lead.

  13. Long-term measurement of heart rate in chicken eggs.

    Science.gov (United States)

    Akiyama, R; Matsuhisa, A; Pearson, J T; Tazawa, H

    1999-12-01

    Taking advantage of acoustocardiogram (ACG), we measured the heart rate (HR) of chick embryos continuously from day 12 until hatching and then investigated the development of HR irregularities (HRI), HR variability (HRV), and the existence of a circadian rhythm in mean HR (MHR). HRI comprised transient bradycardia and tachycardia, which first developed on day 14 and 16 in most embryos, respectively. Transient bradycardia increased in frequency and magnitude with embryonic development and occurred over periods of up to 30 min in some embryos. MHR was maximal on around days 14-15 and thereafter decreased to about 250-260 bpm on days 16-18. Baseline HRV, which is an oscillation of the MHR baseline, occurred as HR decreased from days 15-16 and became predominant on days 17-18. The magnitude of the baseline oscillations reached up to 50 bpm in some embryos and the period ranged between about 40-90 min (ultradian rhythm). A circadian rhythm of MHR was not found in late chick embryos. On days 18-19, embryonic activities were augmented and then breathing movements began to occur, disturbing ACG signals and thus making it difficult to measure the HR. Instead, the development of breathing activities was recorded. Breathing frequency was irregular at first and then increased to a maximum of about 1.5 Hz prior to hatching.

  14. Preserved Autonomic Cardiovascular Regulation With Cardiac Pacemaker Inhibition: A Crossover Trial Using High-Fidelity Cardiovascular Phenotyping.

    Science.gov (United States)

    Heusser, Karsten; Tank, Jens; Brinkmann, Julia; Schroeder, Christoph; May, Marcus; Großhennig, Anika; Wenzel, Daniela; Diedrich, André; Sweep, Fred C G J; Mehling, Heidrun; Luft, Friedrich C; Jordan, Jens

    2016-01-13

    Sympathetic and parasympathetic influences on heart rate (HR), which are governed by baroreflex mechanisms, are integrated at the cardiac sinus node through hyperpolarization-activated cyclic nucleotide-gated channels (HCN4). We hypothesized that HCN4 blockade with ivabradine selectively attenuates HR and baroreflex HR regulation, leaving baroreflex control of muscle sympathetic nerve activity intact. We treated 21 healthy men with 2×7.5 mg ivabradine or placebo in a randomized crossover fashion. We recorded electrocardiogram, blood pressure, and muscle sympathetic nerve activity at rest and during pharmacological baroreflex testing. Ivabradine reduced normalized HR from 65.9±8.1 to 58.4±6.2 beats per minute (P<0.001) with unaffected blood pressure and muscle sympathetic nerve activity. On ivabradine, cardiac and sympathetic baroreflex gains and blood pressure responses to vasoactive drugs were unchanged. Ivabradine aggravated bradycardia during baroreflex loading. HCN4 blockade with ivabradine reduced HR, leaving physiological regulation of HR and muscle sympathetic nerve activity as well as baroreflex blood pressure buffering intact. Ivabradine could aggravate bradycardia during parasympathetic activation. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00865917. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  15. 4-Aminopyridine reverses saxitoxin (STX)- and tetrodotoxin (TTX)-induced cardiorespiratory depression in chronically instrumented guinea pigs.

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    Chang, F C; Spriggs, D L; Benton, B J; Keller, S A; Capacio, B R

    1997-07-01

    The extent to which cardiorespiratory infirmity and other sublethal effects of saxitoxin (STX) and tetrodotoxin (TTX) can be reversed by 4-aminopyridine (4-AP) was investigated in guinea pigs chronically instrumented for the concurrent electrophysiological recordings of electrocorticogram (ECoG), diaphragmatic electromyogram (DEMG), Lead II electrocardiogram, and neck skeletal muscle electromyogram. Animals were intoxicated with either STX or TTX (2 and 3 microg/kg, im) to produce a state of progressive cardiorespiratory depression (depicted by decreasing DEMG amplitude, bradypnea, and bradycardia). At the point where cardiorespiratory performance was most seriously compromised (approximately 30 min posttoxin), 4-AP (1 or 2 mg/kg, im) was administered. The therapeutic effect of 4-AP was striking in that, within minutes, the toxin-induced diaphragmatic blockade, bradypnea, bradycardia, and depressed cortical activity were all restored to a level either comparable to, or surpassing, that of control. The optimal 4-AP dose level was determined to be 2 mg/kg (im) based on analyses of cardiorespiratory activity profiles throughout the course of intoxication and 4-AP treatment. At the dose levels (either 1 or 2 mg/kg) used to restore ventilatory function and cardiovascular performance, 4-AP produced no sign of seizures and convulsions. Although less serious secondary effects such as cortical excitant/arousal effect (indicated by ECoG power spectral analysis) and transient periods of skeletal muscle fasciculation were observed, these events were of minor concern particularly in view of the remarkable therapeutic effects of 4-AP.

  16. Dynamic resistance training decreases sympathetic tone in hypertensive ovariectomized rats

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    Shimojo, G.L.; Palma, R.K.; Brito, J.O.; Sanches, I.C. [Laboratório de Fisiologia Translacional, Programa de Ciências da Reabilitação, Universidade Nove de Julho, São Paulo, SP (Brazil); Irigoyen, M.C. [Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); De Angelis, K. [Laboratório de Fisiologia Translacional, Programa de Ciências da Reabilitação, Universidade Nove de Julho, São Paulo, SP (Brazil)

    2015-03-27

    The aim of this study was to investigate the effects of resistance exercise training on hemodynamics and cardiac autonomic control in ovariectomized spontaneously hypertensive rats. Female rats were divided into 4 groups: sedentary control (SC), sedentary hypertensive (SH), sedentary hypertensive ovariectomized (SHO), and resistance-trained hypertensive ovariectomized (RTHO). Resistance exercise training was performed on a vertical ladder (5 days/week, 8 weeks) at 40-60% maximal load. Direct arterial pressure was recorded. Vagal and sympathetic tones were measured by heart rate (HR) responses to methylatropine (3 mg/kg, iv) and propranolol (4 mg/kg, iv). Ovariectomy resulted in additional increases in blood pressure in hypertensive rats and was associated with decreased vagal tone. Resistance exercise trained rats had lower mean arterial pressure than untrained rats (RTHO: 159±2.2 vs SHO: 177±3.4 mmHg), as well as resting bradycardia (RTHO: 332±9.0 vs SHO: 356±5 bpm). Sympathetic tone was also lower in the trained group. Moreover, sympathetic tone was positively correlated with resting HR (r=0.7, P<0.05). The additional arterial pressure increase in hypertensive rats caused by ovarian hormone deprivation was attenuated by moderate-intensity dynamic resistance training. This benefit may be associated with resting bradycardia and reduced cardiac sympathetic tone after training, which suggests potential benefits of resistance exercise for the management of hypertension after ovarian hormone deprivation.

  17. Application of prophylactic gel-pads for transcutaneous pacing in patients with complete right bundle-branch block with axis deviation when surgical procedures are performed: 10-year experience from a single Japanese university hospital.

    Science.gov (United States)

    Okamoto, Aki; Inoue, Satoki; Tanaka, Yu; Kawaguchi, Masahiko; Furuya, Hitoshi

    2009-01-01

    This retrospective study aimed to determine whether prophylactic transcutaneous pacing is required for patients with complete right bundle-branch block (CRBBB) and axis deviation (AD), so-called bifascicular block, when surgical procedures are performed under general or local anesthesia. The authors reviewed 34 063 anesthesia cases that took place at Nara Medical University Hospital during a 10-year period (1996-2005). The anesthesia records of all identified patients having CRBBB or bifascicular block were retrospectively reviewed and the incidence of block progression to complete heart block or bradycardia requiring temporary transcutaneous pacing served as the primary endpoint. As a secondary endpoint, the incidence of block progression to complete heart block or bradycardia requiring only medical treatment was checked. Seventy of the 34 063 patients (0.2%) had CRBBB with AD. Only 1 patient with CRBBB with left AD, who underwent on-pump aorto-coronary bypass grafting surgery, developed complete heart block at the resumption of heartbeat. None of the other 69 patients, except for this cardiac case, developed complete heart block during surgery. Based on this analysis of 70 cases, prophylactic gel-pad electrode application in patients with CRBBB and AD does not appear to be necessary during surgical procedures.

  18. Electrocardiographic changes in dog after injection of different doses of the venom of the scorpion Odonthobuthus

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    Sardar Jafari Shoorijeh

    2005-02-01

    Full Text Available There is scant information about biological effects of the venoms of scorpions on different organs. Sixteen healthy native dogs aged about 2 years with average body weight of 18.5 kg of both sexes were selected for this study. Dogs were divided randomly into four equal groups (4 dogs in each group. Clinical signs are recorded and electrocardiogram was obtained for each dog prior to injection of venom. In the control group 1 ml of saline solution was injected and the amount of equal to 0.1, 0.05 and 0.01 mg of venom powder per kg bwt were dissolved in 1 ml saline solution and injected intradermal in the abdominal region or hind limb of each dog in the second, third, and four groups, respectively. Clinical signs and electorcardiogram of each dog were recorded at different time intervals (5, 15, 30, 60, 90, 120, 180, 360 and 24 hours after injection of venom. The results of ECGs, in group 1 and 2 indicated advanced sinus arrhythmia, sinus arrest, sinoatrial standstill, sever bradycardia and tachycardia, first and second degree heart block, premature ventricular contraction, sinus bradycardia and ventricular fibrillation. In group 3, partial sinus arrhythmia, sinus tachycardia, sinus arrest, advanced sinus arrhythmia and tachycardia were observed. In conclusion, the venom of the scorpion Odonthobuthus produces very changes in electrocardiogram by its effects on autonomic system and adrenal gland.

  19. The progressive onset of cholinergic and adrenergic control of heart rate during development in the green iguana, Iguana iguana.

    Science.gov (United States)

    Sartori, Marina R; Leite, Cleo A C; Abe, Augusto S; Crossley, Dane A; Taylor, Edwin W

    2015-10-01

    The autonomic control of heart rate was studied throughout development in embryos of the green iguana, Iguana iguana by applying receptor agonists and antagonists of the parasympathetic and sympathetic systems. Acetylcholine (Ach) slowed or stopped the heart and atropine antagonized the response to Ach indicating the presence of muscarinic cholinoceptors on the heart of early embryos. However, atropine injections had no impact on heart rate until immediately before hatching, when it increased heart rate by 15%. This cholinergic tonus increased to 34% in hatchlings and dropped to 24% in adult iguanas. Although epinephrine was without effect, injection of propranolol slowed the heart throughout development, indicating the presence of β-adrenergic receptors on the heart of early embryos, possibly stimulated by high levels of circulating catecholamines. The calculated excitatory tonus varied between 33% and 68% until immediately before hatching when it fell to 25% and 29%, a level retained in hatchlings and adults. Hypoxia caused a bradycardia in early embryos that was unaffected by injection of atropine indicating that hypoxia has a direct effect upon the heart. In later embryos and hatchlings hypoxia caused a tachycardia that was unaffected by injection of atropine. Subsequent injection of propranolol reduced heart rate both uncovering a hypoxic bradycardia in late embryos and abolishing tachycardia in hatchlings. Hypercapnia was without effect on heart rate in late stage embryos and in hatchlings. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Safety Profile and Effects of Pulsed Methylprednisolone on Vital Signs in Thyroid Eye Disease

    Directory of Open Access Journals (Sweden)

    Kai-Ling Yong

    2015-01-01

    Full Text Available Objective. To analyze changes in vital signs (heart rate (HR, systolic (SBP, and diastolic blood pressure (DBP during and after intravenous methylprednisolone (IVMP and any other adverse effects. Methods. Retrospective review of charts of patients who received IVMP as treatment regime for thyroid eye disease. All subjects had vital signs charted during and after infusions. Results. This study included 38 subjects and a total of 242 infusions administered. IVMP resulted in a small but significant percentage drop in mean SBP at 30 min (p<0.001 and 60 min (p=0.03 but no difference at 90 min. There was also small but significant percentage drop in mean DBP and HR (DBP: p<0.001 for 30 min, p=0.001 for 60 min, and p=0.02 for 90 min and HR: p<0.001 for 30 min, 60 min, and 90 min. There were no cumulative effects on change of blood pressure or HR. There were 6 episodes of bradycardia (2.5% and 12 episodes of moderate to severe hypertension (5%. No significant cardiovascular or hepatic toxicity was found. Conclusion. IVMP is relatively safe and efficacious. IVMP demonstrated mild and noncumulative effects on vital signs. Severe hypertension may occur in susceptible individuals such as those with underlying hypertension and uncontrolled thyroid dysfunction, whereas bradycardia may be more likely in those on beta-blockers.

  1. Clinical and laboratory findings in mad honey poisoning: a single center experience.

    Science.gov (United States)

    Yaylaci, S; Kocayigit, I; Aydin, E; Osken, A; Genc, A B; Cakar, M A; Tamer, A

    2014-01-01

    This study is aimed at analyzing the demographic and clinical characteristics, as well as the hematological-biochemical parameters of patients who admitted to the hospital with the diagnosis of mad honey poisoning. A total of 16 patients who were admitted with mad honey intoxication symptoms and treated in Emergency Department of Sakarya Education and Research Hospital between January 2009 and December 2012 were included in the study. Demographic and clinical characteristics of the patients and hematological, biochemical parameters were obtained from hospital records. Heart rate, systolic and diastolic blood pressure on admission and at discharge were obtained retrospectively. Sixteen patients (10 males and 6 females, mean age 58.5 ± 10 years, range between 41 and 79) were included in our study. Heart rate was 42 ± 6 beats/min, systolic blood pressure was 73 ± 19 mmHg, and diastolic blood pressure was 45 ± 17 mmHg on admission. In the evaluation of the patients' heart rhythms on admission to the emergency room, nine (56.3%) patients had sinus bradycardia, three (18.8%) patients had nodal rhythm, two (12.5%) patients had first degree atrioventricular block, and two (12.5%) patients had atrial fibrillation. Atropine 1.1 ± 0.4 mg and saline 1125 ± 465 ml were used to treat patients. Patients were discharged with a stable condition after an average 27.7 ± 7.2 h of follow-up. Heart rate was 75 ± 8 beats/min, systolic blood pressure was 132 ± 7 mmHg, and diastolic blood pressure was 82 ± 6 mmHg at discharge. Mortality was not observed. Hematological and biochemical parameters measured at the time of admission were within normal ranges. Mad honey poisoning should be considered in previously healthy patients with unexplained symptoms of bradycardia, hypotension, and cardiac dysrhythmias. Therefore, diet history should carefully be obtained from the patients admitted with bradycardia and hypotension, and mad honey intoxication should also be considered in the

  2. Slow and continuous delivery of a low dose of nimodipine improves survival and electrocardiogram parameters in rescue therapy of mice with experimental cerebral malaria.

    Science.gov (United States)

    Martins, Yuri C; Clemmer, Leah; Orjuela-Sánchez, Pamela; Zanini, Graziela M; Ong, Peng Kai; Frangos, John A; Carvalho, Leonardo J M

    2013-04-24

    Human cerebral malaria (HCM) is a life-threatening complication caused by Plasmodium falciparum infection that continues to be a major global health problem despite optimal anti-malarial treatment. In the experimental model of cerebral malaria (ECM) by Plasmodium berghei ANKA, bolus administration of nimodipine at high doses together with artemether, increases survival of mice with ECM. However, the dose and administration route used is associated with cardiovascular side effects such as hypotension and bradycardia in humans and mice, which could preclude its potential use as adjunctive treatment in HCM. In the present study, alternative delivery systems for nimodipine during late-stage ECM in association with artesunate were searched to define optimal protocols to achieve maximum efficacy in increasing survival in rescue therapy while causing the least cardiac side effects. The baseline electrocardiogram (ECG) and arterial pressure characteristics of uninfected control animals and of mice with ECM and its response upon rescue treatment with artesunate associated or not with nimodipine is also analysed. Nimodipine, given at 0.5 mg/kg/day via a slow and continuous delivery system by osmotic pumps, increases survival of mice with ECM when used as adjunctive treatment to artesunate. Mice with ECM showed hypotension and ECG changes, including bradycardia and increases in PR, QRS, QTc and ST interval duration. ECM mice also show increased QTc dispersion, heart rate variability (HRV), RMSSD, low frequency (LF) and high frequency (HF) bands of the power spectrum. Both sympathetic and parasympathetic inputs to the heart were increased, but there was a predominance of sympathetic tone as demonstrated by an increased LF/HF ratio. Nimodipine potentiated bradycardia when given by bolus injection, but not when via osmotic pumps. In addition, nimodipine shortened PR duration and improved HRV, RMSSD, LF and HF powers in mice with ECM. In addition, nimodipine did not increased

  3. A randomized, double-blind, placebo-controlled dose range study of dexmedetomidine as adjunctive therapy for alcohol withdrawal.

    Science.gov (United States)

    Mueller, Scott W; Preslaski, Candice R; Kiser, Tyree H; Fish, Douglas N; Lavelle, James C; Malkoski, Stephen P; MacLaren, Robert

    2014-05-01

    To evaluate dexmedetomidine as adjunctive therapy to lorazepam for severe alcohol withdrawal. Prospective, randomized, double-blind, placebo-controlled trial. Single center; medical ICU. Twenty-four adult patients with a Clinical Institute Withdrawal Assessment score greater than or equal to 15 despite greater than or equal to 16 mg of lorazepam over a 4-hour period. Patients received a symptom-triggered Clinical Institute Withdrawal Assessment protocol with lorazepam and were randomized to dexmedetomidine 1.2 μg/kg/hr (high dose), 0.4 μg/kg/hr (low dose), or placebo as adjunctive therapy for up to 5 days or resolution of withdrawal symptoms. High-dose and low-dose groups were combined as a single dexmedetomidine group for primary analysis with secondary analysis exploring a dose-response relationship. The difference in 24-hour lorazepam requirements after versus before study drug was greater in the dexmedetomidine group compared with the placebo group (-56 mg vs -8 mg, p = 0.037). Median differences were similar for high dose and low dose. The 7-day cumulative lorazepam requirements were not statistically different between dexmedetomidine and placebo (159 mg vs 181 mg). Clinical Institute Withdrawal Assessment or Riker sedation-agitation scale scores representing severe agitation (13% vs 25%) or moderate agitation (27% vs 22%) within 24 hours of initiating study drug were similar for dexmedetomidine and placebo groups, respectively. Bradycardia occurred more frequently in the dexmedetomidine group versus placebo group (25% vs 0%, p = not significant), with the majority of bradycardia occurring in the high-dose group (37.5%). Study drug rate adjustments occurred more often in the dexmedetomidine group compared with the placebo group (50% vs 0%, p = 0.02). Neither endotracheal intubation nor seizure occurred in any group while on study drug. Adjunctive dexmedetomidine for severe alcohol withdrawal maintains symptom control and reduces lorazepam exposure in the

  4. Caffeine versus theophylline for apnea in preterm infants.

    Science.gov (United States)

    Henderson-Smart, David J; Steer, Peter A

    2010-01-20

    Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia, which may be severe enough to require resuscitation including use of positive pressure ventilation. Two forms of methylxanthine (caffeine and theophylline) have been used to stimulate breathing in order to prevent apnea and its consequences. To evaluate the effect of caffeine compared with theophylline treatment on the risk of apnea and use of mechanical ventilation in preterm infants with recurrent apnea. The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of electronic databases in August 2009: Oxford Database of Perinatal Trials; Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2009); MEDLINE (1966 to April 2009); and EMBASE Drugs and Pharmacology (1990 to April 2009), previous reviews including cross references. Randomized and quasi-randomized trials comparing caffeine to theophylline for treating apnea in preterm infants and reporting effects on apnea event rates. Each author assessed eligibility and trial quality, extracted data separately and compared and resolved differences. Study authors were contacted for additional information. Five trials involving a total of 108 infants were included. The quality of most of these small trials was fair to good. No difference in treatment failure rate (less than 50% reduction in apnea/bradycardia) was found between caffeine and theophylline after one to three days treatment (based on two studies) or five to seven days treatment (based on one study). There was no difference in mean apnea rate between caffeine and theophylline groups after one to three days treatment (based on five trials) and five to seven days treatment (based on four trials).Adverse effects, indicated by tachycardia or feed intolerance leading to change in dosing, were lower in the caffeine

  5. Effects of intracerebroventricular injections of 5-HT on systemic vascular resistances of conscious rats.

    Science.gov (United States)

    Davisson, Robin L; Bates, James N; Johnson, Alan Kim; Lewis, Stephen J

    2014-09-01

    The aims of this study were to determine (i) the effects of intracerebroventricular (i.c.v.) injections of 5-hydroxytryptamine (5-HT, 10μg) on mean arterial blood pressure (MAP), heart rate (HR) and mesenteric (MR), renal (RR) and hindquarter (HQR) vascular resistances of conscious rats, (ii) the central 5-HT receptor subtype which mediates these effects, and (iii) the role of nitric oxide (NO) in the expression of these responses. The i.c.v. injection of 5-HT had minor effects on MAP but produced a decrease in HR (-18±4%), which lasted for 20min. The i.c.v. injection of 5-HT elicited marked increases in MR (+50±7%) and reductions in HQR (-31±3%). These responses occurred promptly and lasted for 25-35min. 5-HT also produced a transient decrease in RR (-26±8% at 10min). All of these responses were prevented by the prior i.c.v. injection of the 5-HT1/5-HT2-receptor antagonist, methysergide (10μg). The intravenous injection of the NO synthesis inhibitor, L-NAME (25μmol/kg), produced a sustained pressor response, bradycardia and increases in MR, RR and HQR. Subsequent i.c.v. injection of 5-HT produced a minor pressor response (+7±2%), bradycardia (-18±3%), an increase in MR (+52±8%) but no decreases in RR or HQR. This study demonstrates that i.c.v. 5-HT differentially affects peripheral vascular resistances by activation of central 5-HT1/5-HT2-receptors. It appears that L-NAME did not interfere with the central actions of 5-HT as it did not prevent the 5-HT-induced bradycardia or mesenteric vasoconstriction. Since the 5-HT-induced falls in RR and HQR were abolished by L-NAME, it is possible that these responses are mediated by an active neurogenic process involving the release of NO within the vasculature. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. The clinical value of dexmedetomidine during mechanical ventilation in ICU patients of different ages

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    Yan ZHU

    2015-10-01

    Full Text Available Objectives To provide basis for the safe use of indigenous dexmedetomidine hydrochloride by observing its sedative effect and safety when it was given to mechanically ventilated patients of different ages. Methods Three hundred and fourteen mechanically ventilated patients were admitted to our ICU. According to the age, patients were divided into two subgroups: group A (25-50 years old and group B (51-80 years old, with 157 patients in each group. Dexmedetomidine was given to achieve the target sedation level (Ramsay score 3. The changes in noninvasive blood pressure (SBP, DBP, MAP, heart rate, SpO2, respiratory rate and FiO2 were continuously monitored and recorded before treatment (T1, and 10min (T2, 30min (T3 and 120min (T4 after drug administration, on the instant moment of extubation (T5, and 30min after extubation (T6. The adverse reactions such as hypertension, hypotension, bradycardia, tachycardia, delirium were also observed and recorded after treatment. Results Patients of both A and B groups showed a lowering of SBP, DBP, MAP and HR after treatment with dexmedetomidine, especially in group B(P80mmHg, HR>60 times/min. Respiratory rate was reduced (P0.05. SpO2 was not reduced, and it even rose 30min after administration of dexmedetomidine (P0.05, and the heart rate was slightly slower in group B (P<0.05. The probability of occurrence of adverse reactions, such as hypertension, hypotension, tachycardia, bradycardia and delirium was significantly higher in group B than in group A. Conclusions Dexmedetomidine does not depress respiration, and a stable hemodynamics was maintained after extubation in ICU patients undergoing mechanical ventilation, thus it is an ideal sedative drug. But when it is used in elderly patients, proper monitoring should be maintained, especially when a loading dose is used, in order to prevent adverse reactions such as hypotension and bradycardia, and should be corrected in time. DOI: 10.11855/j.issn.0577-7402.2015.09.15

  7. Reliability of conventional and new pulse oximetry in neonatal patients.

    Science.gov (United States)

    Hay, William W; Rodden, Donna J; Collins, Shannon M; Melara, Diane L; Hale, Kathy A; Fashaw, Lucy M

    2002-01-01

    Pulse oximetry is widely used in the NICU, but clinicians often distrust the displayed values during patient motion, i.e., questionable oxygen saturation (SpO(2)) and pulse rate (PR) values. Masimo Corporation (Irvine, CA) has developed pulse oximetry with claims of resistance to sources of interference. To test this premise, we compared the performance of the Masimo SET pulse oximeter to a conventional device, Nellcor N-200, and then with three other new-generation pulse oximeters, Nellcor N-395, Novametrix MARS, and Philips Viridia 24C. We studied 26 nonsedated NICU infants who were on supplemental oxygen and/or mechanical ventilation. ECG heart rate (HR) from a bedside monitor and SpO(2) and PR from the two pulse oximeters were captured by a PC for a total of 156 hours. The ECG HR and pulse oximeter spectral waveform were analyzed at alarms for hypoxemia (SpO(2)changes in HR. Compared with Nellcor, Masimo SET had 86% fewer false alarms, which also were shorter in duration, resulting in 92% less total alarm time. Masimo SET also identified nearly all bradycardias versus 14% for the Nellcor. Compared with the new-generation pulse oximeters, false desaturations, data drop-outs, and false bradycardias were lowest for Masimo SET, as was the capture of true desaturations and bradycardias. Notably, the new-generation devices differed greatly in their ability to detect changes in HR (i.e., the frequency of frozen PR during times of ECG HR change was 0, 6, 11, and 46 for Masimo, Nellcor, Philips, and Novametrix, respectively). Masimo SET pulse oximetry recorded markedly fewer false SpO(2) and PR alarms and identified more true hypoxic and bradycardic events than either conventional or other new-generation pulse oximeters. Masimo SET also most closely reflected the ECG rate irrespective of accelerations or decelerations in HR. Routine use of Masimo SET pulse oximetry in the NICU could improve clinician confidence in the parameter leading to more judicious titration of

  8. Neonatal side effects of maternal labetalol treatment in severe preeclampsia.

    Science.gov (United States)

    Heida, Karst Y; Zeeman, Gerda G; Van Veen, Teelkien R; Hulzebos, Christian V

    2012-07-01

    Labetalol is often used in severe preeclampsia (PE). Hypotension, bradycardia and hypoglycemia are feared neonatal side effects, but may also occur in (preterm) infants regardless of labetalol exposure. We analyzed the possible association between intrauterine labetalol exposure and such side effects. From 1 January 2003 through 31 March 2008, all infants from mothers suffering severe PE admitted to one tertiary care center were included. Severe PE was defined according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Infants exposed to labetalol in utero (labetalol infants) were compared with infants, who were not exposed to labetalol (controls). Neonatal records were reviewed for hypotension (RRlabetalol, whereas 54 were not (controls). Gestational age at delivery and birthweight were similar in both groups (31.8 vs. 32.8 weeks (p=0.06) and 1510 vs. 1639 grams (p=0.25), respectively for the labetalol vs. control group). Hypotension occurred significantly more in conjunction with labetalol exposure (16, (29.1%) vs. 4 (7.4%); p=0.003), irrespective of the route of administration. Patent ductus arteriosus (PDA) was present in 9 (56%) of hypotensive labetalol infants compared to 1 (24%) infant in the hypotensive control group (NS). In a multivariate regression model, labetalol exposure, the need for intubation and PDA appeared independently associated with hypotension (Plabetalol infants and in 23 (42.6%) of control infants (p=0.62). Bradycardia occurred in 4 (7.3%) of labetalol infants and in 1 (1.9%) of control infants (p=0.18). Hypoglycemia was more common in premature infants (n=45 (48,9%) vs. n=4 (23.5%), p=0.05) in both labetalol and control infants. Hypotension is more common after maternal labetalol exposure, regardless of the dosage and route of administration. The need for intubation and the presence of a PDA also play a role. Hypoglycemia is a very common finding in this population and is merely related to

  9. Effects of experimental amitraz intoxication in cats

    Directory of Open Access Journals (Sweden)

    S.F. Andrade

    2007-10-01

    Full Text Available This work studied the effects of experimental amitraz intoxication in cats. Sixteen cats were randomly divided equally into two groups: amitraz group - animals received 1.5% amitraz at 1mg/kg IV; and the control group - animals without amitraz. Physiological parameters from blood, cardiorespiratory system, and sedation indicators were quantified over time up to 360 minutes. Blood profile, urea, creatinine, alananine aminotransferase and aspartate aminotransferase were not affected by amitraz. Sedation, loss of reflexes, hypothermia, bradycardia, bradyarrhythmia, hypotension, bradypnea, mydriasis, besides transitory hyperglycemia, hypoinsulinemia and decrease of cortisol levels were observed in cats experimentally exposed to amitraz. The alpha2-adrenergic effects induced by amitraz intoxication in cats are very similar to the same effects reported in others species, contributing with more information about this type of intoxication to veterinary toxicology.

  10. General Introduction, Classification, and Electrocardiographic Diagnosis of Cardiac Arrhythmias.

    Science.gov (United States)

    Padeletti, Luigi; Bagliani, Giuseppe

    2017-09-01

    The conduction system includes a primary pacemaker, the internodal tracts, the atrioventricular node, and the His bundle with the right and left branches. In "emergency" conditions, accessory pacemakers may be triggered. The conduction system produces very low-intensity currents; a surface electrocardiogram (ECG) detects only the big myocardial masses. Electrogenetic mechanisms are reduced automaticity and/or impaired conduction at the base of bradycardias. An increased automaticity and/or reentry phenomenon are at the base of ectopic beats and tachycardias. A "wide QRS" is a ventricular activation time of 120 milliseconds or more. The "laddergram" helps in the fast and reliable ECG interpretation. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions Part I: Supraventricular arrhythmias and pacemakers.

    Science.gov (United States)

    Heidbüchel, Hein; Panhuyzen-Goedkoop, Nicole; Corrado, Domenico; Hoffmann, Ellen; Biffi, Allessandro; Delise, Pietro; Blomstrom-Lundqvist, Carina; Vanhees, Luc; Ivarhoff, Per; Dorwarth, Uwe; Pelliccia, Antonio

    2006-08-01

    This document by the Study Group on Sports Cardiology of the European Society of Cardiology extends on previous recommendations for sports participation for competitive athletes by also incorporating guidelines for those who want to perform recreational physical activity. For different supraventricular arrhythmias and arrhythmogenic conditions, a description of the relationship between the condition and physical activity is given, stressing how arrhythmias can be influenced by exertion or can be a reflection of the (patho)physiological cardiac adaptation to sports participation itself. The following topics are covered in this text: sinus bradycardia; atrioventricular nodal conduction disturbances; pacemakers; atrial premature beats; paroxysmal supraventricular tachycardia without pre-excitation; pre-excitation, asymptomatic or with associated arrhythmias (i.e. Wolff-Parkinson-White syndrome); atrial fibrillation; and atrial flutter. A related document discusses ventricular arrhythmias, channelopathies and implantable cardioverter defibrillators.

  12. Electrocardiography in pre-participation screening and current guidelines for participation in competitive sports

    Directory of Open Access Journals (Sweden)

    Georgijević Ljubica

    2016-01-01

    Full Text Available Electrocardiography (ECG is especially significant in pre-participation screening due to its ability to discover or to rise a suspicion for certain cardiovascular diseases and conditions that represent a serious health risk in athletes. Common, conditionally benign and training related ECG changes are sinus bradycardia and sinus arrhythmia, first degree atrioventricular block, incomplete right bundle branch block, benign early repolarization, and isolated QRS voltage criteria for left ventricular enlargement. Uncommon ECG changes, unrelated to training, and some specific syndromes are ST segment depression and/or ≥ 2mm T wave inversion in two or more adjacent leads, intraventricular conduction disorder, Wolf-Parkinson-White syndrome, long QT interval syndrome, short QT interval syndrome, catecholaminergic polymorphic ventricular tachycardia, monomorphic ventricular extrasystole and benign ventricular tachycardia.

  13. A 'one in a million' case of pulsating thoracoabdominal mass.

    LENUS (Irish Health Repository)

    Tan, Lay Ong

    2012-11-01

    Ectopia cordis is a rare congenital malformation in which the heart is located partially or totally outside the thoracic cavity. It comprises 0.1% of congenital heart diseases. The authors present a case of a male baby born at term by emergency caesarean section due to prolonged fetal bradycardia, who was noted to have a large pulsating mass in the thoracoabdominal area. In view of lower thoracolumbar abdominal defect, ectopic placement of the umbilicus, deficiency of the diaphragmatic pericardium, deficiency of anterior diaphragm and intracardiac abnormalities, a diagnosis of ectopia cordis-Pentalogy of Cantrell was made. He was transferred to a tertiary centre and required oxygen supplement initially. He was sent home after 1 week, on propanolol, with weekly oxygen saturation checks. He is awaiting further surgical intervention pending the required weight gain.

  14. Asystole following positive pressure insufflation of right pleural cavity: a case report

    Directory of Open Access Journals (Sweden)

    Konia Mojca R

    2011-06-01

    Full Text Available Abstract Introduction Adverse hemodynamic effects with severe bradycardia have been previously reported during positive pressure insufflation of the right thoracic cavity in humans. To the best of our knowledge, this is the first report of asystole during thoracoscopic surgery with positive pressure insufflation. Case presentation A 63-year-old Caucasian woman developed asystole at the onset of positive pressure insufflation of her right hemithorax during a thoracoscopic single-lung ventilation procedure. Immediate deflation of pleural cavity, intravenous glycopyrrolate and atropine administration returned her heart rhythm to normal sinus rhythm. The surgery proceeded in the absence of positive pressure insufflation without any further complications. Conclusions We discuss the proposed mechanisms of hemodynamic instability with positive pressure thoracic insufflation, and anesthetic and insufflation techniques that decrease the likelihood of adverse hemodynamic events.

  15. Ivabradine in stable coronary artery disease without clinical heart failure

    DEFF Research Database (Denmark)

    Fox, Kim; Ford, Ian; Steg, Philippe Gabriel

    2014-01-01

    BACKGROUND: An elevated heart rate is an established marker of cardiovascular risk. Previous analyses have suggested that ivabradine, a heart-rate-reducing agent, may improve outcomes in patients with stable coronary artery disease, left ventricular dysfunction, and a heart rate of 70 beats per...... minute or more. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of ivabradine, added to standard background therapy, in 19,102 patients who had both stable coronary artery disease without clinical heart failure and a heart rate of 70 beats per minute or more (including 12...... without activity-limiting angina (P=0.02 for interaction). The incidence of bradycardia was higher with ivabradine than with placebo (18.0% vs. 2.3%, Pdisease without clinical heart failure, the addition of ivabradine to standard...

  16. Renal effects of anti-gravity suit inflation in man in relation to cardiovascular and hormonal changes

    Science.gov (United States)

    Geelen, G.; Kravik, S. E.; Hadj-Aissa, A.; Vincent, M.; Sem-Jacobsen, C. W.; Greenleaf, J.; Gharib, C.

    1987-01-01

    It is shown that inflation for 3 hr of an antigravity suit that covered the legs and abdomen of normal standing subjects results in significant increases in urine flow, osmolar and free water clearances, total and fractional sodium excretion, and potassium excretion, while glomerular filtration rate and renal plasma flow are transiently increased. Such changes in kidney function are the consequence of the increase in thoracic blood volume induced by inflation which also results in an immediate increase in blood pressure and reflex bradycardia, together with a progressive lowering of plasma renin activity and aldosterone. The changes in kidney excretory patterns brought about by suit inflation appear to be similar in nature and magnitude to those observed during water immersion or in the early phase of bed rest, situations known to result in a headward redistribution of blood.

  17. Myocardial Crypts: An incidental fi nding in a symptomatic patient with raised troponin

    Directory of Open Access Journals (Sweden)

    Ihab S Ramzy

    2014-01-01

    Full Text Available A 61 year old female of Asian origin presented with a two day history of intermittent sharp central chest pain radiating to the left shoulder, with each episode lasting a few seconds. Associated symptoms included exertional dyspnoea and limited exercise capacity to one fl ight of stairs. She denied any palpitations, pre-syncope or syncope. She had no orthopnoea, paroxysmal nocturnal dyspnoea or ankle swelling. She had stable pulmonary sarcoidosis, dual-chamber pacemaker insertion for symptomatic bradycardia 7 years ago, non-insulin dependent diabetes mellitus, hypertension, benign paroxysmal positional vertigo from the right ear, and hearing diffi culties. Drug history included Metformin 500 mg, Ramipril 10 mg, Bendrofl umethiazide 2.5 mg, Aspirin 75 mg and Simvastatin 20 mg. She had no known drug allergies.

  18. Inappropriate Shocks and Power Delivery Using Adult Automatic External Defibrillator Pads in a Pediatric Patient.

    Science.gov (United States)

    Tejman-Yarden, Shai; Katz, Uriel; Rubinstein, Marina; Attias, Yehuda; Yahia, Reem; Mishali, David; Glikson, Michael

    2017-02-21

    The use of automatic external defibrillators (AEDs) during pulseless resuscitations is considered safe and reliable, and was established as part of the guidelines in out-of-hospital events. Based on extensive studies, the use of the standard AED is now indicated in every age group with a preference of pediatric pad application for small children and babies. If unavailable, adult pads are recommended. We report a case of 2 inappropriate AED shocks that were delivered to a neonate during a pulseless resuscitation after application of adult pads. The 3.6-kg patient received 2 shocks, over 200 J each, for sinus bradycardia that was not detected by the device. Although treated inappropriately with high voltage, no cardiac or skin sequelae were detected, and the patient had normal cardiac and neurological development later on.

  19. Features of cardiac disorders in children with chronic respiratory diseases associated with aerogenic exposure to chemical environmental factors

    Directory of Open Access Journals (Sweden)

    О.А. Maklakova

    2016-03-01

    Full Text Available The study has involved 43 children living in areas with poor air quality due to public health indicators. In 24 % of cases during the remission the children (with bronchial asthma and recurrent bronchitis, associated with exposure to anthropogenic chemicals such as suspended solids, aromatic and oxygenated hydrocarbons, formaldehyde demonstrated peripheral signs of obstruction and the presence of functional cardiac disorders. Being under exposure to adverse effects of environmental chemical factors, the children with chronic respiratory diseases suffer from the developing of the cardiac type of vegetative dysfunction, which was manifested in bradycardia and tachycardia, eytonic and/or sympathicotonic baseline autonomic tone, hypersympathicotonic /astimpathicotonic autonomic reactivity. In 17.9 % of the children it was manifested in transient diastolic dysfunction of right ventricle and in excessive systolic blood pressure in pulmonary artery.

  20. The case of malignancy mimicking legionella pneumonia

    Directory of Open Access Journals (Sweden)

    Ali Karakuş

    2013-09-01

    Full Text Available Legionella pneumophila is a bacterium, which can grow inwater pipe networks and climate systems. Contaminationoccurs by aspiration of infected water or aerosol inhalation.It is usually presented with fever, bradycardia, andchange in mental status, hyponatremia, elevation of liverenzymes and deterioration of renal function. The definitediagnosis is established by detection of the antigens andcultivating in the culture medium. Also, malign lung tumorscan encounter with the same clinical findings, so lungcancer should be remembered in differential diagnosis.The patient hospitalized for the Legionella pneumophiladue to the physical examination and laboratory findingsduring the first evaluation in the emergency department.However, further examinations pointed to the cancer. Weaimed to emphasize the probability of malignant tumorsin terms of hyponatremia, increase in the liver enzymes,and failure in the renal functions, which were usually experiencedin emergency unit. J Clin Exp Invest 2013; 4(3: 390-392Key words: Legionella pneumophila, pneumonia, lung malignancy

  1. Amitraz poisoning: case report

    Directory of Open Access Journals (Sweden)

    Jaime Alexander Molina-Bolaños

    2017-10-01

    Full Text Available Amitraz is an insecticide compound used worldwide for controlling pests, especially in agricultural and livestock areas. However, amitraz poisoning in Colombia is rare. This article reports the case of an 18-year-old female patient who was admitted in the emergency service 3 hours after the intake of an unknown amount of Triatox® (amitraz. The patient presented with a depressed level of consciousness, respiratory distress, hypotension, bradycardia, myosis and metabolic acidosis compensated with respiratory alkalosis. Initial treatment was provided using life support measures in the emergency ward, and subsequent transfer and support in the intensive care unit. She was discharged 24 hours after admission. This case considers the clinical similarity between amitraz poisoning and poisoning caused by other more frequent toxic compounds such as carbamates, organophosphates and opioids, which require different management.

  2. Assessment of cardiorespiratory stability using the infant car seat challenge before discharge in preterm infants (<37 weeks' gestational age).

    Science.gov (United States)

    Narvey, Michael R

    2016-04-01

    Preterm infants younger than 37 weeks corrected gestational age are at increased risk for abnormal control of respiration. The infant car seat challenge has been used as a screening tool to ensure cardiorespiratory stability before discharging preterm infants from many hospitals in Canada. While it is clear that infants placed in a car seat are more likely to experience oxygen desaturation and/or bradycardia than when they are supine, neither positioning predicts an adverse neurodevelopmental outcome or mortality post-discharge. A review of the literature yielded insufficient evidence to recommend routine use of the infant car seat challenge as part of discharge planning for preterm infants. This finding has prompted a change in recommendation from a previous Canadian Paediatric Society position statement published in 2000.

  3. Haemostasis with fibrin glue injection into the pericardial space for right ventricular perforation caused by an iatrogenic procedural complication.

    Science.gov (United States)

    Arai, Hirofumi; Miyamoto, Takamichi; Hara, Nobuhiro; Obayashi, Tohru

    2016-05-17

    An 89-year-old woman with severe aortic valve stenosis and bradycardia presented with circulatory shock due to cardiac tamponade. We performed pericardiocentesis, and then diagnosed right ventricular perforation by echocardiography with microcavitation contrast medium just before inserting a drainage tube. We then inserted the drainage tube in the appropriate position and withdrew blood-filled fluid. The patient was haemodynamically stabilised, but haemorrhage from the perforation site continued for a few days. We injected fibrin glue into the pericardial space through the drainage tube and achieved haemostasis. Thus, we avoided surgery to close the perforation in this high-risk patient. There was no recurrence of haemorrhage. She subsequently had elective aortic valve replacement at another hospital. No adhesions in the pericardial space were seen during surgery. 2016 BMJ Publishing Group Ltd.

  4. Apnea in the Otherwise Healthy, Term Newborn: National Prevalence and Utilization during the Birth Hospitalization.

    Science.gov (United States)

    Levin, Jonathan C; Jang, Jisun; Rhein, Lawrence M

    2017-02-01

    To describe the prevalence of apnea in otherwise healthy term newborns, identify attributable length of stay (LOS) and healthcare utilization (cost) of apnea, and measure hospital variation in attributable LOS and cost of apnea in this population. We conducted a secondary analysis of a national administrative dataset, the 2012 Kids' Inpatient Database, which included 3.4 million newborn discharges in the US. The birth hospitalizations of approximately 2.6 million otherwise healthy, full-term newborns were included for analysis. Attributable LOS and cost of apnea were calculated using multivariate analyses. Apnea was diagnosed in 1 in 1000 healthy full-term newborns. Multivariate analyses showed that newborns with apnea had 0.6 days longer LOS (P term newborns, per birth hospitalization. Newborns diagnosed with apnea plus hypoxia and/or bradycardia had 1.4 days longer LOS (P term newborn. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Anaesthetic management of two Bengal tiger (Panthera tigris tigris cubs for fracture repair

    Directory of Open Access Journals (Sweden)

    Gareth E. Zeiler

    2013-02-01

    Full Text Available This case series describes the anaesthetic management of two sibling Bengal tiger (Panthera tigris tigris cubs that were found to have spontaneous femur fractures due to severe nutritional secondary hyperparathyroidism. Both cubs received a combination of medetomidine (25 µg/kg and ketamine (4 mg/kg intramuscularly and were maintained with isoflurane in oxygen. An epidural injection of morphine (0.1 mg/kg and ropivacaine (1.6 mg/kg was administered to both tigers, which allowed a low end-tidal isoflurane concentration to be maintained throughout the femur fracture reduction operations. Both cubs experienced profound bradycardia and hypotension during general anaesthesia, and were unresponsive to anticholinergic treatment. Possible causes for these cardiovascular complications included: drug pharmacodynamics (medetomidine, morphine, isoflurane, decreased sympathetic tone due to the epidural (ropivacaine and hypothermia. These possible causes are discussed in detail.

  6. Dermatological allergic reaction caused by dexmedetomidine in a patient administered intravenous regional anesthesia with dexmedetomidine–lignocaine combination

    Directory of Open Access Journals (Sweden)

    Ketaki Marodkar

    2014-07-01

    Full Text Available Dexmedetomidine a highly selective α2 agonist has become a frequently used drug in anesthesiologists’s armamentarium due to its sedative, anxiolytic, analgesic, neuroprotective and anesthetic sparing effects and a favorable side effect profile. Dexmedetomidine–lignocaine combination has been used recently to provide Bier’s block and was shown to improve quality of anesthesia, to reduce tourniquet pain and to reduce postoperative anesthetic requirement in patients undergoing forearm or hand surgeries. Hypotension and bradycardia are the commonly seen side effects. Only one case of dexmedetomidine skin allergy has been reported till date in literature. We present a case of dermatological allergy to dexmedetomidine, in a patient administered Bier’s block with dexmedetomidine–lignocaine combination for implant removal surgery of forearm.

  7. GC-MS analysis and cardiovascular activity of the essential oil of Ocotea duckei

    Directory of Open Access Journals (Sweden)

    José M. Barbosa-Filho

    Full Text Available The essential oils obtained by steam distillation from the roots, stems, leaves and fruits of Ocotea duckei had their composition analyzed by GC-MS. The pharmacological activity of these oils was also evaluated showing significant cardiovascular effects. Forty-nine substances were identified, consisting of a complex mixture of monoterpenes (45% and sesquiterpenes (55%. The fruits yielded (1.9% more essential oil than the stems (1.0%, roots (0.8% and leaves (0.7%. The main component in the oil of the leaves was trans-caryophyllene (60.54%, in the stem bark beta-eudesmol (27.51% and in the fruits, dl-limonene (30.12%. The predominant essential oil component in the roots was elemol (24.31%. In non-anaesthetized normotensive rats, the essential oils from different parts of Ocotea duckei (leaves, fruits, stem and roots induced significant (p < 0.05 hypotension followed by bradycardia.

  8. Usefulness of implantable loop recorder in a patient with syncope during bathing

    Directory of Open Access Journals (Sweden)

    Motohiro Nakao, MD

    2013-02-01

    Full Text Available A 27-year-old man presented to our hospital with a 1-year-hisory of repeated syncope, which particularly occurred while bathing or on a hot day. The head-up tilt test did not induce arrhythmia; however, blood pressure decreased by 39 mm Hg without any symptoms. Given that no bradycardia/tachycardia was induced on electrophysiological study and carotid sinus massage, an implantable loop recorder (ILR was implanted. After 2 months, syncope again occurred during bathing at midnight. Sinus arrest and a maximum ventricular pause of 10.2 s were documented using the ILR. After pacemaker implantation, the patient had not experienced syncope for 14 months.

  9. [Case report: severe neck injury caused by an angle grinder].

    Science.gov (United States)

    Corzillius, Michael; Storz, Christian; Gräsner, Jan-Thorsten

    2007-02-01

    EMS is called to a construction worker with serious cutting injuries of the neck from an angle grinder. The patient was found on the upper floor of a construction building accessible only through a scaffolding with narrow ladders. Primary examination reveals severe hemorrhagic shock. The Fire Department is called for evacuation of the patient with a turntable ladder. Further examination in the hospital shows complete dissection of the left carotid artery and the left internal jugular vein. The history reveals alcohol abuse and depression. Attempted suicide appears to be the most likely cause of the injury. The case report further discusses proper coordination of medical and technical measures in rescue operations, recommended treatment of hemorrhagic shock, and the unusual finding of paradoxical bradycardia despite volume depletion.

  10. [Sudden cardiac death due to sarcoidosis. Case report].

    Science.gov (United States)

    Sejben, István; Som, Zoltán; Cserni, Gábor

    2017-07-01

    Sarcoidosis is a systemic granulomatous disease of unknown aetiology, which is characterized by bilateral hilar lymphadenopathy and pulmonary disease. Clinically detected cardiac involvement occurs in 5% of sarcoid patients, although cardiac manifestations are discovered in 25% of the cases at autopsy. Sarcoid heart disease frequently causes atrioventricular block. The authors present the case of a 44-year-old man with bradycardia. On admission, second degree Mobitz II, then third degree atrioventricular block was diagnosed. Coronarography showed normal coronary arteries. 2.5 years following artificial Biotronik Entovis DR type pacemaker implantation, sudden cardiac death occurred. Autopsy revealed sarcoidosis with cardiac, pulmonary, splenic, renal and lymph node involvement. In case of young or middle-aged patients with atrioventricular block, it is best to search for other causes if the most common coronary origin can be excluded. Orv Hetil. 2017; 158(27): 1067-1070.

  11. Atrial epicardial pacing with long stimulus to P wave interval in a patient with arrhythmogenic right ventricular dysplasia complicated by right atrial thrombosis.

    Science.gov (United States)

    Kazmierczak, J; Kornacewicz-Jach, Z; Wojtarowicz, A

    1999-07-01

    Atrial epicardial pacing with a long stimulus to P wave interval in a patient with arrhythmogenic right ventricular dysplasia complicated by right atrial thrombosis is discussed. Arrhythmogenic right ventricular dysplasia (ARVD) is associated with a high incidence of malignant ventricular arrhythmias. Most patients with ARVD need antiarrhythmic drugs, catheter ablation, or an implantable cardioverter defibrillator. We report a patient with ARVD in whom effective treatment with sotalol caused severe, symptomatic sinus bradycardia requiring permanent pacing. Due to leftward displacement of the right ventricle and the presence of two thrombi in the right atrium, an epicardial atrial lead and AAI pacemaker were implanted. A long stimulus to P wave interval caused by severe dilatation of the right atrium was recorded. During a 6 months of follow-up on sotalol treatment there were neither ventricular tachycardia (VT) attacks nor pacing problems.

  12. Toxicity of Lidocaine Improved with Lipid Emulsion Treatment: Case Report

    Directory of Open Access Journals (Sweden)

    Hayriye Gonullu

    2016-01-01

    During general anesthesia and intensive care applications that require control of the airway respiratory, cardiovascular reflex responses occur thus myocardial oxygen delivery and consumption can be negatively affected. To prevent these effects, lidocaine, opioids, magnesium, calcium channel blockers, beta-blockers have been used. Local anesthetic toxicity; is usually known to occur when used over the range of safe dose of local anesthetics. It has been shown in a variety of animal and clinical studies that a lipid emulsion used for parenteral nutrition improves resistance to fatal cardiac effects caused by local anesthetics. Herein, we presented a case who had developed sudden bradycardia, asystole by iv. lidocaine which is used for tracheal intubation and improved dramatically after treatment with lipid emulsion in the light of the literatures. According to our knowledge it is the first case which is succesfully resuciatated with clinoleic in local anesthetic toxicity in literature.

  13. [Arrhythmia and sport].

    Science.gov (United States)

    Saoudi, N; Yaici, K; Zarkane, N; Darmon, J P; Rinaldi, J P; Brunner, P; Ricard, P; Mourou, M Y

    2005-12-01

    Sports arrhythmia has gained wide attention with the mediatization of the death of famous sports stars. Sport strongly modifies the structure of the heart with the development of left ventricular hypertrophy which may be difficult to differentiate from that due to doping. Intense training modifies also the resting electrocardiogram with appearance of signs of left ventricular hypertrophy whereas resting sinus bradycardia and atrioventricular conduction disturbances usually reverts upon exertion. Accordingly, arrhythmia may develop ranging from extrasystoles to atrial fibrillation and even sudden death. Recent data suggest that if benign arrhythmia may be the result of the sole intense training and are reversible, malignant ventricular arrhythmia and sudden death mostly occur in unknown structural heart disease. Hypertrophic cardiomyopathy is amongst the most frequent post mortem diagnosis in this situation. Doping is now present in many sports and further threatens the athlete in the safe practice of sport.

  14. Imported enteric fever: case series from the hospital for tropical diseases, London, United Kingdom.

    Science.gov (United States)

    Patel, Trupti A; Armstrong, Margaret; Morris-Jones, Stephen D; Wright, Stephen G; Doherty, Tom

    2010-06-01

    Our current knowledge of the clinical characteristics of enteric fever is drawn mainly from population-based studies in disease-endemic countries, and there are limited data published on cases in returning travelers. We report the clinical characteristics of enteric fever in 92 travelers returning to London, United Kingdom. Salmonella typhi and S. paratyphi resulted in an almost indistinguishable clinical picture. Rose spots and relative bradycardia were found only in a few patients. A total of 91% of the patients had a normal leukocyte count, which was associated with a markedly increased level of alanine aminotransferase in 82%. A total of 57% of the S. typhi isolates had decreased susceptibility to ciprofloxacin and resistance to nalidixic acid; these isolates were from southern Asia. Thirty percent were multidrug resistant; all were from southern Asia and Nigeria. None of the paratyphoid isolates were multidrug resistant but rates of decreased susceptibility to fluoroquinolones were higher than in S. typhi (74%).

  15. Intra-articular administration of lidocaine plus adrenaline in dogs: Pharmacokinetic profile and evaluation of toxicity in vivo and in vitro.

    Science.gov (United States)

    Di Salvo, A; Chiaradia, E; della Rocca, G; Mancini, F; Galarini, R; Giusepponi, D; De Monte, V; Cagnardi, P; Marenzoni, M L; Bufalari, A

    2016-02-01

    The aim of this study was to evaluate the safety of intra-articular (IA) lidocaine plus adrenaline for improving peri-operative analgesia in anaesthetized dogs undergoing arthroscopy of the elbow. A solution of lidocaine (L) 1.98% plus adrenaline 1:100.000 was administered via the IA route and its safety evaluated in terms of cardio-, neuro-, and chondro-toxicity. No bradycardia or hypotension was recorded from induction to the last observational time point. Signs of toxicity of the nervous system could have been masked by the general anaesthesia but lidocaine concentrations detected in the blood were lower than those thought to be capable of producing toxicity. The assessment of in vitro chondrotoxicity showed a dose- and time-dependent effect of lidocaine on the viability of articular cells. Adrenaline appeared to reduce the chondrotoxicity of 1% lidocaine, following an exposure of up to 30 min. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Probable vasovagal reaction following cystocentesis in two cats

    Directory of Open Access Journals (Sweden)

    Adesola Odunayo

    2015-05-01

    Full Text Available Case summary This case report describes an acute reaction, thought to be vagally mediated, in two cats immediately following cystocentesis. Both cats were being evaluated for feline idiopathic cystitis and developed bradycardia, hypersalivation, urination and weakness after a blind cystocentesis. Both cats recovered uneventfully with supportive care. Relevance and novel information A vagally mediated response may occur in cats after cystocentesis, which is a common procedure performed by veterinary professionals in cats. This response may be very profound and dramatic. Affected cats will likely make an uneventful recovery. This vagally mediated response to cystocentesis, though reported by word of mouth among veterinarians, has not been described in the literature. This is the first documentation of its occurrence in cats.

  17. Sedation with dexmedetomidine for conducting electroencephalogram in a patient with Angelman syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Magda Lourenço Fernandes

    2016-04-01

    Full Text Available ABSTRACT INTRODUCTION: Angelman syndrome is characterized by severe mental retardation and speech and seizure disorders. This rare genetic condition is associated with changes in GABAA receptor. Patients with Angelman syndrome need to be sedated during an electroencephalogram ordered for diagnostic purposes or evolutionary control. Dexmedetomidine, whose action is independent of GABA receptor, promotes a sleep similar to physiological sleep and can facilitate the performing of this examination in patients with Angelman syndrome. CASE REPORT: Female patient, 14 years old, with Angelman syndrome; electroencephalogram done under sedation with dexmedetomidine. The procedure was uneventful and bradycardia or respiratory depression was not recorded. The examination was successfully interpreted and epileptiform activity was not observed. CONCLUSION: Dexmedetomidine promoted satisfactory sedation, was well tolerated and enabled the interpretation of the electroencephalogram in a patient with Angelman syndrome and seizure disorder.

  18. Sedation with dexmedetomidine for conducting electroencephalogram in a patient with Angelman syndrome: a case report.

    Science.gov (United States)

    Fernandes, Magda Lourenço; do Carmo Santos, Maria; Gomez, Renato Santiago

    2016-01-01

    Angelman syndrome is characterized by severe mental retardation and speech and seizure disorders. This rare genetic condition is associated with changes in GABAA receptor. Patients with Angelman syndrome need to be sedated during an electroencephalogram ordered for diagnostic purposes or evolutionary control. Dexmedetomidine, whose action is independent of GABA receptor, promotes a sleep similar to physiological sleep and can facilitate the performing of this examination in patients with Angelman syndrome. Female patient, 14 years old, with Angelman syndrome; electroencephalogram done under sedation with dexmedetomidine. The procedure was uneventful and bradycardia or respiratory depression was not recorded. The examination was successfully interpreted and epileptiform activity was not observed. Dexmedetomidine promoted satisfactory sedation, was well tolerated and enabled the interpretation of the electroencephalogram in a patient with Angelman syndrome and seizure disorder. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  19. Dexmedetomidine overdosage: An unusual presentation

    Directory of Open Access Journals (Sweden)

    Soumya S Nath

    2013-01-01

    Full Text Available We present a case of dexmedetomidine toxicity in a 3-year-old child. The case report describes the features and outlines the treatment strategy adopted. The child presented with bradypnoea, bradycardia, hypotension, deep hypnosis and miosis. He was successfully managed with oxygen, saline boluses and adrenaline infusion. He became haemodynamically stable with adrenaline infusion. He started responding to painful stimuli in 3 h and became oriented in 7 h. Dexmedetomidine, a selective α2 adrenoceptor agonist, is claimed to have a wide safety margin. This case report highlights the fact that dexmedetomidine administered in a toxic dose may be life-threatening may present with miosis and adrenaline infusion may be a useful supportive treatment.

  20. Cisplatin induced arrhythmia; electrolyte imbalance or disturbance of the SA node?

    Science.gov (United States)

    Oun, Rabbab; Rowan, Edward

    2017-09-15

    Since its approval in 1979 cisplatin has become one of the most extensively used chemotherapeutics in the clinic and although cell resistance and toxicity hinder its efficacy it continues to be a gold standard regimen. Cisplatin's side effects primarily include nephrotoxicity, gastrointestinal toxicity, neurotoxicity and ototoxicity. Cardiotoxicity is generally not defined as a side effect of cisplatin. However, over the past decade there has been a surge in the amount of clinical cases reporting a vast array of cardio-toxic events occurring during or shortly after cisplatin infusion, these range from angina to cardiac ischemia and chronic heart failure. This review intends to discuss the clinical cardiac manifestations of cisplatin specifically tachycardia and bradycardia which can be lethal and the possible mechanisms of action. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  1. Normal dose of pilsicainide showed marked negative inotropic effects in a patient who had no underlying heart disease

    Directory of Open Access Journals (Sweden)

    Masayoshi Yoshida, MD

    2014-02-01

    Full Text Available We report the case of an otherwise healthy 64-year-old female who developed cardiopulmonary arrest after the administration of pilsicainide for treatment of paroxysmal atrial fibrillation. She had had an episode of paroxysmal atrial fibrillation, but no liver dysfunction, renal dysfunction, or echocardiographic abnormality before her admission. On the day of admission and the following day, 50 mg of pilsicainide was administered intravenously over 10 min (total 100 mg. Shortly after the second injection, she developed marked bradycardia and hypotension and eventually fell into a state of pulseless electrical activity. Immediate cardiopulmonary resuscitation was started. Although application of a temporary pacemaker restored her heart rate, echocardiography revealed no left ventricular contraction. We started percutaneous cardiopulmonary support (PCPS and intra-aortic balloon pumping (IABP. Her cardiac contraction gradually recovered and returned to completely normality 3 days after the onset. The patient was discharged in an ambulatory condition.

  2. Marcus Gerbezius (1658–1718 and his first description of a complete atrioventricular block

    Directory of Open Access Journals (Sweden)

    Zvonka Zupanič Slavec

    2016-01-01

    Full Text Available Background: Marcus Gerbezius, a distinguished Slovenian physician and scientist from the turn of the 17th to the 18th Century, published in the year 1717 an article in the annual journal of the German Academy of Natural Scientists in Halle, in which he described a patient with a clinical presentation of extreme bradycardia due to a complete atrioventricular block. Methods: methodology of history of medicine, analysis of archival materials, documents, and various publications.Results: Presentation of the life and work of Marcus Gerbezius, emphasizing the significance of his pioneering discovery of what is known today as Adams-Stokes Syndrome.Conclusion: The article by Gerbezius was published almost 50 years before Morgagni’s, and about 150 years before Adams’ or Stokes’ articles on the same subject; therefore the name of Gerbezius should be included in the eponym name of the disorder “Syndrome Gerbezius-Morgagni-Adams-Stokes” – Syndrome GMAS.

  3. Electrocardiography in pre-participation screening and current guidelines for participation in competitive sports.

    Science.gov (United States)

    Georgijević, Ljubica; Andrić, Lana

    2016-01-01

    Electrocardiography (ECG) is especially significant in pre-participation screening due to its ability to discover or to rise a suspicion for certain cardiovascular diseases and conditions that represent a serious health risk in athletes. Common, conditionally benign and training related ECG changes are sinus bradycardia and sinus arrhythmia, first degree atrioventricular block, incomplete right bundle branch block, benign early repolarization, and isolated QRS voltage criteria for left ventricular enlargement. Uncommon ECG changes, unrelated to training, and some specific syndromes are ST segment depression and/or ≥ 2 mm T wave inversion in two or more adjacent leads, intraventricular conduction disorder, Wolf-Parkinson-White syndrome, long QT interval syndrome, short QT interval syndrome, catecholaminergic polymorphic ventricular tachycardia, monomorphic ventricular extrasystole and benign ventricular tachycardia. Keywords: examination; athletes; recommendations

  4. Effects of body movement restraint on cardiac response to auditory stimulation in sleeping infants.

    Science.gov (United States)

    Kahn, A; Rebuffat, E; Sottiaux, M

    1992-12-01

    When exposed to an unfamiliar and sudden noise, infant rodents may show an abrupt bradycardia, as part of a "fear-paralysis response". The response is enhanced by body movements restraint. To investigate if this reaction is seen in humans, 15 normal infants with a median age of 12 weeks were studied polygraphically. They were exposed to a 100-dB (A) white noise, while sleeping in REM sleep. Each infant was studied in both "unrestrained" and "restrained" conditions. Restraint of body movement was obtained by means of sand bags and tightly-binding bed sheets. During movement restraint, the infants had a significantly greater and earlier decrease in heart rate compared with during the unrestrained condition. No infant had a minimal heart rate less than 95 beats/min. The present observation raises questions about the possible unfavorable effects of tightly wrapped bed sheets around sleeping infants.

  5. Pharmacokinetics of buprenorphine following intravenous and oral transmucosal administration in dogs.

    Science.gov (United States)

    Abbo, Lisa A; Ko, Jeff C H; Maxwell, Lara K; Galinsky, Raymond E; Moody, David E; Johnson, Brenda M; Fang, Wenfang B

    2008-01-01

    Pharmacokinetic analysis of buprenorphine administered to six healthy dogs via the oral transmucosal (OTM) route at doses of 20 and 120 microg/kg was conducted using liquid chromatography-electrospray ionization-tandem mass spectroscopy (LC-ESI-MS/MS). Bioavailability was 38% plus or minus 12% for the 20 microg/kg dose and 47%+/-16% for the 120 microg/kg dose. Maximum plasma concentrations were similar for buprenorphine doses of 20 microg/kg IV and 120 microg/kg OTM. Sedation and salivation were common side effects, but no bradycardia, apnea, or cardiorespiratory depressive effects were seen. When the two OTM dosing rates were normalized to dose, LC-ESI-MS/MS analysis of buprenorphine and its metabolites detected no significant difference (P>.05), indicating dose proportionality. The results of this study suggest that OTM buprenorphine may be an alternative for pain management in dogs.

  6. Combined Case of Blood-Injury-Injection Phobia and Social Phobia: Behavior Therapy Management and Effectiveness through Tilt Test

    Directory of Open Access Journals (Sweden)

    Fotini Ferenidou

    2012-01-01

    Full Text Available The efficacy of behavior therapy based mainly on real-life exposure situations as well as applied tension was examined for a combined case of blood-injury-injection (BII phobia and social anxiety disorder. Treatment involved 28 behavior therapy sessions, while applied tension technique was also described and practiced. The specific contribution of social skills techniques, fantasy, and real-life situations exposure was examined in a single case design. The subject was a 39-year-old male with anxiety symptoms when confronting an audience, as well as symptoms of the autonomic nervous system (bradycardia and syncope, which were better explained by BII. All self-report measures regarding fear, social phobia, and anxiety were reduced after behavior therapy and remained maintained at followup, while BII decreased further after applied tension techniques. The contribution of behavior therapy to the overall outcome of the case is considered significant for many reasons that are discussed in the pape.

  7. Coagulation Changes to Systemic Acidosis and Bicarbonate Correction in Swine

    Science.gov (United States)

    2011-11-01

    larly [i.m.]) for analgesia and glycopyrrolate (0.01 mg/kg, i.m.) to reduce saliva secretion and block vagally mediated bradycardia during the...experiments. Hemorrhage/hypoventilation also led to a significant rise in plasma lactate and potassium and a fall in glucose concen- tration (Table 3), which...L) 98.1 0.6 98.9 0.5 96.8 0.6* Glucose (mmol/L) 4.13 0.48 2.23 0.49* 1.58 0.34* Lactate (mmol/L) 1.61 0.19 6.48 1.16* 7.15 1.54

  8. Transient complete atrioventricular block following transvenous electrical cardioversion of atrial fibrillation in a horse.

    Science.gov (United States)

    van Loon, G; De Clercq, D; Tavernier, R; Amory, H; Deprez, P

    2005-07-01

    Transvenous electrical cardioversion was attempted in a horse with drug refractory atrial fibrillation. A temporary pacing catheter and two defibrillation catheters were inserted transvenously into the right ventricular apex, the right atrium and the pulmonary artery, respectively. Under general anaesthesia 100, 200, 300 and 360 J monophasic shocks were delivered between both defibrillation catheters but sinus rhythm could not be restored. Immediately after the 200, 300 and 360 J shock, transient third-degree atrioventricular block occurred for a period of, respectively, 15, 40 and 55 s. These periods of profound bradycardia were corrected by temporary right ventricular pacing until spontaneous conduction resumed. It is concluded that temporary right ventricular pacing should be available during electrical cardioversion of atrial fibrillation in horses.

  9. Relationship between nocturnal hypoxaemia, tachycardia and myocardial ischaemia after major abdominal surgery

    DEFF Research Database (Denmark)

    Gögenur, I; Rosenberg-Adamsen, S; Lie, C

    2004-01-01

    BACKGROUND: Episodic hypoxaemia, cardiac arrhythmias, and myocardial ischaemia may be related after major abdominal surgery. METHODS: We studied 52 patients on the second and third nights after major abdominal operations, using continuous pulse oximetry and Holter ECG. We recorded the amount...... of time spent with oxygen saturation values less than 90, 85, and 80% during the night, and noted episodes of hypoxaemia, tachycardia, bradycardia, and ST-segment changes. RESULTS: In 87 study nights there were 2403 (individual range 1-229) episodes of hypoxaemia, 3509 (individual range 1-234) episodes...... of tachycardia, and 265 (individual range 1-73) episodes of ST segment deviation. Of the 52 patients, 50 had episodes of hypoxaemia and tachycardia, and 19 patients had one or more episodes of ST segment deviation. For 38% of the episodes of ST deviation, there was an episode of hypoxaemia at the same time...

  10. EEG Suppression Associated with Apneic Episodes in a Neonate

    Directory of Open Access Journals (Sweden)

    Evonne Low

    2012-01-01

    Full Text Available We describe the EEG findings from an ex-preterm neonate at term equivalent age who presented with intermittent but prolonged apneic episodes which were presumed to be seizures. A total of 8 apneic episodes were captured (duration 23–376 seconds during EEG monitoring. The baseline EEG activity was appropriate for corrected gestational age and no electrographic seizure activity was recorded. The average baseline heart rate was 168 beats per minute (bpm and the baseline oxygen saturation level was in the mid-nineties. Periods of complete EEG suppression lasting 68 and 179 seconds, respectively, were recorded during 2 of these 8 apneic episodes. Both episodes were accompanied by bradycardia less than 70 bpm and oxygen saturation levels of less than 20%. Short but severe episodes of apnea can cause complete EEG suppression in the neonate.

  11. Asystole following regadenoson infusion in stable outpatients.

    Science.gov (United States)

    Rosenblatt, Jeffrey; Mooney, Deirdre; Dunn, Timothy; Cohen, Mylan

    2014-10-01

    Regadenoson is a selective A2A receptor agonist approved for use as a pharmacologic stress agent for myocardial perfusion imaging after several multicenter trials demonstrated its equivalence in diagnostic accuracy for the detection of coronary artery disease and a decreased incidence of serious side effects as compared to adenosine. Recently, the FDA released a safety announcement advising of the rare but serious risk of heart attack and death associated with regadenoson and adenosine in cardiac stress testing, particularly in patients with unstable angina or cardiovascular instability. We report two cases of asystole with hemodynamic collapse in stable outpatients soon after receiving a standard regadenoson injection. The prevalence of potentially life threatening bradycardia, including asystole, associated with the use of regadenoson may be greater than previously expected. These cases highlight the need for cardiac stress labs to anticipate the potential for serious side effects with all patients during the administration of coronary vasodilators.

  12. Insulin poisoning with suicidal intent

    Directory of Open Access Journals (Sweden)

    Abhay Gundgurthi

    2012-01-01

    Full Text Available We report a 27-year-old paramedical lady with no known comorbidities, who presented with rapid-onset coma with hypoglycemia (plasma glucose at admission was 35 mg/dL. Clinical alertness suspected and confirmed the diagnosis of exogenous insulin administration probably with suicidal intent. During the course of her ICU stay, she developed bradycardia and hypotension which required ionotropic support. She remained in coma for 90 hours. A total of 470 g of dextrose was infused until she regained consciousness. No other complications of insulin overdose were observed during her stay in the hospital. Recovery was complete without any residual neurological deficits. Insulin administration should be kept in differential diagnosis when any case presents with coma and hypoglycemia, especially in paramedical personnel.

  13. [Technical options of electrotherapy in patients with vasovagal syncope].

    Science.gov (United States)

    Bałczewska, Daria; Kaczmarek, Krzysztof; Ptaszyński, Paweł; Wranicz, Jerzy Krzysztof; Cygankiewicz, Iwona

    2016-10-19

    Syncope is a symptom of the disease with diverse etiology and can be evidence of both benign and very serious life-threatening conditions. Vasovagal syncope(VVS), with prevalence about 35% of the general population, is most frequent causes of transient loss of consciousness (T-LOC). Most cases of vasovagal syncope requires conservative treatment. Although cardioinhibitory type of VVS characterized by a significant bradycardia or pause of the heart rate and can be treated with continuous electrotherapy. This article discuss cardiac pacing and technical solutions for the treatment of VVS. Available cardiac pacing methods used to detect and break VVS such as Rate Drop Response (RDR), Closed Loop Stimulation (CLS) and rate response driven by variations of myocardial contractility like Peak Endocardial Acceleration (PEA), has been presented.

  14. Dural Traction a Possible Cause of Hemodynamic Changes During Single-Level Transforaminal Lumbar Interbody Fusion.

    Science.gov (United States)

    Weimer, Jonathan M; Marinov, Martin; Avitsian, Rafi

    2017-01-01

    Lumbar spinal surgery may be associated with electrophysiologic and hemodynamic abnormalities during the procedure. A 58-year-old man with grade II L4-5 spondylolisthesis and degenerative changes underwent single-level transforaminal lumbar interbody fusion. During decompression of the L4 foramina, distraction of the disc space, and placement of the interbody cage and pedicle screws, episodes of extreme bradycardia with up to 5 seconds of asystole were detected on electrocardiogram and invasive hemodynamic monitoring. The events correlated with and possibly could have been a result of traction on the dura mater. Anesthesia providers should be aware of electrophysiologic and hemodynamic abnormalities during lumbar spinal surgery and the need to respond appropriately with sympathomimetic or vagolytic interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. WiSPH: A Wireless Sensor Network-Based Home Care Monitoring System

    Directory of Open Access Journals (Sweden)

    Pedro Magaña-Espinoza

    2014-04-01

    Full Text Available This paper presents a system based on WSN technology capable of monitoring heart rate and the rate of motion of seniors within their homes. The system is capable of remotely alerting specialists, caretakers or family members via a smartphone of rapid physiological changes due to falls, tachycardia or bradycardia. This work was carried out using our workgroup’s WiSe platform, which we previously developed for use in WSNs. The proposed WSN architecture is flexible, allowing for greater scalability to better allow event-based monitoring. The architecture also provides security mechanisms to assure that the monitored and/or stored data can only be accessed by authorized individuals or devices. The aforementioned characteristics provide the network versatility and solidity required for use in health applications.

  16. Endothelial function in vasovagal syncope.

    Science.gov (United States)

    Pietrucha, Artur Z

    2014-12-01

    Vasovagal syncope (VVS) is a common form of fainting. The pathophysiology of VVS is complex and involves changes in the autonomic and vascular tone, resulting in reflex bradycardia with marked hypotension. Paradoxical peripheral vasodilation caused by endothelial dysfunction may also play a key role in inappropriate hypotension during VVS. Endothelial hyperactivity due to up regulation of nitric oxide synthase leads to profound vasodilation, much stronger than vasodilation caused by adrenergic stimulation in response to orthostatic stress alone. Studies have reported significantly higher flow-mediated dilation and higher plasma nitric oxide concentration in people with vasovagal syndrome. Patients with VVS showed decreased vasoconstrictive agent endothelin-1 levels during orthostatic stress. Coagulation and fibrinolysis activity also play important roles in endothelial function in syncopal patients. The response of the endothelium to orthostatic stress is similar to the reaction to haemorrhagic stress and is likely to be a remnant from the evolutionary adaptation of primates.

  17. Vagal reflex stimulation complicating retrieval of an unusual foreign body from the laryngotracheal lumen: Case report

    Directory of Open Access Journals (Sweden)

    H.K. Omokanye

    2016-04-01

    Full Text Available Foreign body impaction in the aero digestive tract is a life-threatening emergency, particularly in the paediatric age group. Removal under general anaesthesia poses both surgical and anaesthetic challenges and this may rarely result in mortality. We report a case of a 4 year old boy with an unusual foreign body (FB impacted in the laryngotracheal causing difficult intubation and precluding tracheostomy with attendant vasovagal reflex stimulation and cardiac arrest. Clinical presentation and radiological evaluation of the patient were highlighted with a review of pertinent literature. We conclude that dis-impacting a foreign body in the trachea could potentiate bradycardia and cardiac arrest; co-existing hypercarbia and/or sepsis increase the risk and worsen the prognosis.

  18. Peripheral chemoreceptor activation enhances 5-hydroxytryptamine release in the locus coeruleus of conscious rats.

    Science.gov (United States)

    Singewald, N; Kouvelas, D; Kaehler, S T; Sinner, C; Philippu, A

    2000-07-28

    Intravenous bolus injection of KCN (40 microg) elicited brief but pronounced tachypnea, bradycardia and pressor response, and led to a 37% increase in 5-hydroxytryptamine (serotonin) (5-HT) release in the locus coeruleus (LC) of freely moving rats. Slow infusion of KCN (15 microg/min) for 10 min induced only a slight pressor response, but increased the respiration rate (+39 breaths/min), as well as 5-HT release in the LC (+60%) throughout the infusion. In rats with transected chemoreceptor afferents, neither injection or infusion of KCN changed 5-HT release, suggesting that in intact animals, the effect on extracellular 5-HT was due to activation of peripheral chemoreceptors. In summary, we report that peripheral chemoreceptor activation enhances 5-HT release in the LC, indicating that 5-HT might be involved in the modulation of LC activity by ascending chemosensory information.

  19. Elective induction of labor conducted under lumbar epidural block. I. Labor induction by amniotomy and intravenous oxytocin.

    Science.gov (United States)

    Vroman, S; Yo Le Sian, A; Thiery, M; de Hemptinne, D; Vanderheyden, K; Van Kets, H; Martens, G; Derom, R; Rolly, G

    1977-01-01

    Epidural analgesia (bupivacaine) was administered during labor after amniotomy, in some cases supplemented by intravenous oxytocin. A higher incidence of transient uterine hypertonus was seen after blocking. Fetal heart rate changes mainly took the form of bradycardia (in association with uterine hypertonus). At birth, the maternal biochemical condition was characterized by a lower degree of metabolic acidosis, compared to normal unanesthetized controls. The fetuses displayed a slight degree of hypoxia and hypercapnia. The mechanisms underlying these modifications are discussed. Epidural blockade in combination with elective induction of labor, whether or not supplemented by intravenous oxytocin, may carry a risk. Its magnitude is considered acceptable for both mother and fetus provided they are constantly under close surveillance, limited amounts of bupivacaine are administered and the second stage of labor is kept short. However, some warnings against epidural analgesia apply to patients with placental insufficiency and very active labor.

  20. FALLING OF SENILE AGE PATIENT AS AN ADVERSE EVENT ASSOCIATED WITH THE USE OF MEDICINES: CASE REPORT

    Directory of Open Access Journals (Sweden)

    E. S. Ilina

    2017-01-01

    Full Text Available The article presents a case report of 86 years old patient S. (woman, hospitalized in the ophthalmology department of the hospital with a diagnosis of “complicated immature cataract of the left eye, open-angle glaucoma, age-related macular degeneration”. The patient experienced an episode of a fall with a short-term loss of consciousness, severe hypotension (blood pressure – 40/10 mmHg, and bradycardia (heart rate – 32 beats/min while receiving a local form of beta-blocker in combination with diuretics. In this clinical case, the development of serious adverse reaction is significantly associated with adverse drug interaction (according to Horn-Hansten scale.

  1. Unusual Presentation of Dengue Fever; A child with acute myocarditis

    Directory of Open Access Journals (Sweden)

    Moaz Aslam

    2016-02-01

    Full Text Available Dengue fever (DF is an acute febrile illness that follows a self-limiting course. However, some patients suffer from complications, including myocarditis, due to the involvement of other organs. A child presented at the Aga Khan University Hospital in Karachi, Pakistan, in June 2013 with a high-grade fever, malaise and epigastric pain radiating to the chest. Positive DF antigen and immunoglobulin M assays confirmed the diagnosis of DF. Persistent bradycardia with low blood pressure led to further cardiac investigations which showed a decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With supportive care and use of inotropes, the spontaneous normalisation of cardiac enzyme levels and ejection fraction was observed. The child was discharged five days after admission. This case highlights the importance of identifying myocarditis in DF patients suffering from cardiac symptoms that are not explained by other potential aetiologies. Awareness, early suspicion and supportive care are essential to ensure favourable outcomes.

  2. Sepsis and siderosis, Yersinia enterocolitica and hereditary haemochromatosis.

    Science.gov (United States)

    Thwaites, Phoebe A; Woods, Marion L

    2017-01-04

    A 60-year-old woman was admitted with sepsis, relative bradycardia, CT evidence of numerous small liver abscesses and 'skin bronzing' consistent with hereditary haemochromatosis (HH). Yersinia enterocolitica O:9 infection was confirmed by serology specimens taken 10 days apart. Iron overload was detected, and homozygous C282Y gene mutation confirmed HH. Liver biopsy revealed grade IV siderosis with micronodular cirrhosis. Haemochromatosis is a common, inherited disorder leading to iron overload that can produce end-organ damage from excess iron deposition. Haemochromatosis diagnosis allowed aggressive medical management with phlebotomy achieving normalisation of iron stores. Screening for complications of cirrhosis was started that included hepatoma surveillance. Iron overload states are known to increase patient susceptibility to infections caused by lower virulence bacteria lacking sophisticated iron metabolism pathways, for example, Yersinia enterocolitica Although these serious disseminated infections are rare, they may serve as markers for occult iron overload and should prompt haemochromatosis screening. 2017 BMJ Publishing Group Ltd.

  3. Prevalence of family history in patients with reflex syncope

    DEFF Research Database (Denmark)

    Holmegard, Haya N; Benn, Marianne; Kaijer, Michelle Nymann

    2013-01-01

    Reflex syncope is defined by a rapid transient loss of consciousness caused by global cerebral hypoperfusion resulting from vasodilatation and/or bradycardia attributable to inappropriate cardiovascular reflexes. A hereditary component has been suggested, but prevalence of family history may differ...... among subtypes of reflex syncope, as these have different autonomic responses and pathogeneses may be diverse. The present study aimed to assess the prevalence of a positive family history of syncope and cardiovascular characteristics in patients with cardioinhibitory and vasodepressor reflex syncope....... Patients (n=74) were classified into subtypes of reflex syncope - cardioinhibition/asystole (Vasovagal Syncope International Study subtypes II-B [VASIS II-B], n=38) or vasodepressor (VASIS III, n=36) - using the head-up tilt test. Family history was obtained by questionnaires supplemented by interview...

  4. Acquired atlantoaxial instability in children with spastic cerebral palsy.

    Science.gov (United States)

    Tsirikos, Athanasios I; Chang, Wei-Ning; Shah, Suken A; Miller, Freeman

    2003-01-01

    The development of nontraumatic atlantoaxial instability in children with spastic cerebral palsy has not been reported. The authors present three patients with severe spastic quadriplegia who developed C1-C2 instability and cervical myelopathy at mean age 12.6 years. These patients demonstrated a similar clinical picture with symptoms attributed to cervical myelopathy in varied severity including apneic episodes, opisthotonus, alteration in muscle tone, torticollis, respiratory problems, hyperreflexia, and bradycardia. Patient 1 was scheduled for surgery but died due to an apneic episode. Patient 2 refused surgery and has been followed for 3 years while his neurologic condition remains unchanged. Patient 3 underwent occipitocervical decompression and fusion, recovered neurologically, and resumed his previous functional skills. Patients demonstrating considerable functional deterioration or insidious change in their established neurologic status should undergo detailed screening to rule out developing upper cervical instability. Early surgical intervention consisting of spinal decompression and fusion may prevent the development of myelopathy.

  5. Antiarrhythmic properties of a rapid delayed-rectifier current activator in rabbit models of acquired long QT syndrome

    DEFF Research Database (Denmark)

    Diness, Thomas G; Yeh, Yung-Hsin; Qi, Xiao Yan

    2008-01-01

    effect of a novel compound (NS1643) that activates the rapid delayed-rectifier K+ current, I(Kr), in two rabbit models of acquired LQTS. METHODS AND RESULTS: We used two clinically relevant in vivo rabbit models of TdP in which we infused NS1643 or vehicle: (i) three-week atrioventricular block...... with ventricular bradypacing; (ii) dofetilide-induced I(Kr) inhibition in methoxamine-sensitized rabbits. In addition, we studied effects on ionic currents in cardiomyocytes with I(Kr) suppressed by bradycardia remodelling or dofetilide exposure. Bradypaced rabbits developed QT interval prolongation, spontaneous...... ventricular ectopy, and TdP. Infusion of NS1643 completely suppressed arrhythmic activity and shortened the QT interval; vehicle had no effect. NS1643 also suppressed ventricular tachyarrhythmias caused by infusion of dofetilide to methoxamine-sensitized rabbits, and reversed dofetilide-induced QT...

  6. Apnea of prematurity

    Directory of Open Access Journals (Sweden)

    Piermichele Paolillo

    2013-06-01

    Full Text Available Apnea of prematurity (AOP is one of the most frequent pathologies in the Neonatal Intensive Care Unit, with an incidence inversely related to gestational age. Its etiology is often multi factorial and diagnosis of idiopathic forms requires exclusion of other underlying diseases. Despite being a self-limiting condition which regresses with the maturation of the newborn, possible long-term effects of recurring apneas and the degree of desaturation and bradycardia who may lead to abnormal neurological outcome are not yet clarified. Therefore AOP needs careful evaluation of its etiology and adequate therapy that can be both pharmacological and non-pharmacological. Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge research

  7. Amitraz, an underrecognized poison: A systematic review

    Directory of Open Access Journals (Sweden)

    Sahajal Dhooria

    2016-01-01

    Results: The original search yielded 239 articles, of which 52 articles described human cases. After following the inclusion and exclusion criteria, 32 studies describing 310 cases (151 females, 175 children of human poisoning with amitraz were included in this systematic review. The most commonly reported clinical features of amitraz poisoning were altered sensorium, miosis, hyperglycaemia, bradycardia, vomiting, respiratory failure, hypotension and hypothermia. Amitraz poisoning carried a good prognosis with only six reported deaths (case fatality rate, 1.9%. Nearly 20 and 11.9 per cent of the patients required mechanical ventilation and inotropic support, respectively. The role of decontamination methods, namely, gastric lavage and activated charcoal was unclear. Interpretation & conclusions: Our review shows that amitraz is an important agent for accidental or suicidal poisoning in both adults and children. It has a good prognosis with supportive management.

  8. Evaluation of cardiac signals using discrete wavelet transform with MATLAB graphical user interface.

    Science.gov (United States)

    John, Agnes Aruna; Subramanian, Aruna Priyadharshni; Jaganathan, Saravana Kumar; Sethuraman, Balasubramanian

    2015-01-01

    To process the electrocardiogram (ECG) signals using MATLAB-based graphical user interface (GUI) and to classify the signals based on heart rate. The subject condition was identified using R-peak detection based on discrete wavelet transform followed by a Bayes classifier that classifies the ECG signals. The GUI was designed to display the ECG signal plot. Obtained from MIT database 18 patients had normal heart rate and 9 patients had abnormal heart rate; 14.81% of the patients suffered from tachycardia and 18.52% of the patients have bradycardia. The proposed GUI display was found useful to analyze the digitized ECG signal by a non-technical user and may help in diagnostics. Further improvement can be done by employing field programmable gate array for the real time processing of cardiac signals. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  9. Activitrax AAIR pacing for sinus node dysfunction after orthotopic heart transplantation: an initial report.

    Science.gov (United States)

    Loria, K; Salinger, M; McDonough, T; Frohlich, T; Arentzen, C

    1988-01-01

    Donor sinus node dysfunction is an uncommon event after orthotopic heart transplantation. In the past treatment of persistent symptomatic bradycardia in the setting of orthotopic heart transplantation has been accomplished by implantation of a single transvenous lead system with loss of atrioventricular synchrony and rate responsiveness or by implantation of a multiple transvenous lead system in which the multiple leads present a mechanical limitation to endomyocardial biopsy. To preserve atrioventricular synchrony, avoid the mechanical limitations of a ventricular lead at the time of routine biopsies, and maintain some degree of rate responsiveness during exercise, we elected to implant an activity-detecting pacing system with a single bipolar transvenous atrial lead in two of our orthotopic heart transplant recipients with persistent symptomatic donor sinus node dysfunction. This article details the techniques used and the results obtained in what we believe to be the first two implantations of this unique pacing system in orthotopic heart transplant recipients.

  10. Neonatal lupus with atypical cardiac and cutaneous manifestation

    Science.gov (United States)

    Morais, Sofia; Santos, Isabel Cristina; Pereira, Dolores Faria; Mimoso, Gabriela

    2013-01-01

    Neonatal lupus erythematosus is a rare, passively acquired autoimmune disease, caused by maternal autoantibodies. The most common manifestations are skin rash and congenital heart block. Cutaneous manifestations may be present at birth, but often develop within a few weeks after delivery. Congenital heart block may present as bradycardia in utero or during physical examination at birth. Approximately 40–60% of mothers are asymptomatic when the infants are diagnosed. We present a case of a child, born with erythematosus lesions in the face, scalp, trunk, limbs and nodules/papules on the palmar and plantar surfaces. He also had hepatosplenomegaly and thrombocytopenia. Echocardiography showed hyperechoic lesions on the anterior papilar muscle of the left ventricle and on the lateral cusp of the tricuspid valve. The mother had unexplained fever and vasculitic lesions in her hands and feet. Antinuclear antibodies, anti-SSa/Ro and anti-SSb/La were positive in the mother and child, making the diagnosis of neonatal lupus. PMID:23839605

  11. [Efficacy and safety of low dose amiodarone for paroxysmal atrial fibrillation in the aged patients with no-valvular heart diseases].

    Science.gov (United States)

    Chen, H; Yang, Y

    2001-12-28

    To study the efficacy and safety of low-dose amiodarone (AD) for paroxysmal atrial fibrillation in the aged patients with no-valvular heart diseases. 40 inpatients were treated with load-dose AD (600 mg.d-1) for 6 days and then low maintenance dose of 50 mg or 100 mg daily. Clinical efficacy was evaluated with 24 h dynamic electrocardiogram. AD maintained efficaciously sinus rhythm about 90.0% (36/40) during 6 months, about 83.3% (25/30) during 12 months, about 72.7% (16/22) during 24 months. Only 2 patients were stopped oral AD because sinus bradycardia(valvular heart diseases and paroxysmal atrial fibrillation.

  12. An autopsy case of vagus nerve stimulation following acupuncture.

    Science.gov (United States)

    Watanabe, Mayumi; Unuma, Kana; Fujii, Yusuke; Noritake, Kanako; Uemura, Koichi

    2015-03-01

    Acupuncture is one of the most popular oriental medical techniques in China, Korea and Japan. This technique is also popular as alternative therapy in the Western World. Serious adverse events are rare following acupuncture, and fatal cases have been rarely reported. A male in his late forties died right after acupuncture treatment. A medico-legal autopsy disclosed severe haemorrhaging around the right vagus nerve in the neck. Other organs and laboratory data showed no significant findings. Thus, it was determined that the man could have died from severe vagal bradycardia and/or arrhythmia resulting from vagus nerve stimulation following acupuncture. To the best of our knowledge, this is the first report of a death due to vagus nerve injury after acupuncture. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. A combination of caffeine and taurine has no effect on short term memory but induces changes in heart rate and mean arterial blood pressure.

    Science.gov (United States)

    Bichler, A; Swenson, A; Harris, M A

    2006-11-01

    Red Bull energy drink has become extraordinarily popular amongst college students for use as a study aid. We investigated the combined effects of Red Bull's two active ingredients, caffeine and taurine, on short term memory. Studies on the effects of these two neuromodulators on memory have yielded mixed results, and their combined actions have not yet been investigated. In this double-blind study, college student subjects consumed either caffeine and taurine pills or a placebo and then completed a memory assessment. Heart rate and blood pressure were monitored throughout the testing period. The combination of caffeine and taurine had no effect on short term memory, but did cause a significant decline in heart rate and an increase in mean arterial blood pressure. The heart rate decline may have been caused by pressure-induced bradycardia that was triggered by caffeine ingestion and perhaps enhanced by the actions of taurine.

  14. Use of enoximone in management of anaphylaxis complicated by labetalol use.

    Science.gov (United States)

    Hayhoe, Sophie; Navapurkar, Vilas; Conway Morris, Andrew

    2015-10-26

    A 42-year-old woman with end-stage renal failure was admitted to the intensive care unit following resuscitation from a pulseless electrical activity cardiac arrest after intravenous piperacillin/tazobactam. Persistent bradycardia and hypotension, unresponsive to epinephrine and norepinephrine, were suspected to have been exacerbated by chronic labetalol therapy for resistant arterial hypertension. As an alternative, the non-adrenergic inotrope, enoximone, was started. This, combined with thrombolysis for possible pulmonary embolism, heralded significant haemodynamic improvement, allowing weaning from inotropic support. A clear CT pulmonary angiogram 2 days post-arrest and significantly raised mast cell tryptase levels confirmed anaphylaxis rather than pulmonary embolism as the precipitating cause. We believe this to be the first case report of phosphodiesterase-III inhibitor use in the management of anaphylaxis complicated by α/β-blockade, and discuss the mechanism behind this effect and comparison with the more commonly reported use of glucagon. 2015 BMJ Publishing Group Ltd.

  15. Totally Leadless Dual-Device Implantation for Combined Spontaneous Ventricular Tachycardia Defibrillation and Pacemaker Function: A First Report.

    Science.gov (United States)

    Ahmed, Fozia Zahir; Cunnington, Colin; Motwani, Manish; Zaidi, Amir Masood

    2017-08-01

    Subcutaneous implantable cardioverter defibrillators (S-ICDs) provide effective defibrillation, while also reducing the risk of long-term lead problems. However, S-ICDs do not offer bradycardia or antitachycardia pacing and therefore use has been limited. Combined implantation of an S-ICD with a leadless pacemaker (LP) has been proposed to overcome this limitation. Although a handful of combined S-ICD/LP implantations have been reported for Nanostim (St Jude Medical, St Paul, MN) as well as Micra LP (Medtronic, Minneapolis, MN) systems, none have documented delivery of appropriate shock therapies for spontaneous ventricular tachycardia. We report the first case of effective defibrillation for spontaneous ventricular tachycardia in a patient with combined Micra LP and S-ICD. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  16. Comparison of Postoperative Analgesic Effects of Thoracic Epidural Morphine and Fentanyl

    Directory of Open Access Journals (Sweden)

    Gönül Sağıroğlu

    2011-11-01

    Full Text Available Objective: In our study, we aimed to compare epidural morphine and fentanyl analgesia and the side effects in post-thoracotomy pain management. Material and Methods: Forty patients, planned for elective thoracotomy were included. Bupivacain- morphine was administered through an epidural catheter to the patients in Group-M while bupivacain-fentanyl was given in Group-F. Pain assessment was carried out with the Visual Analogue Scale (VAS and VAS-I and VAS-II were assessed in 0, 4, 16 and 24th hour in the postoperative unit. Adverse effects were recorded after the 24th hour. Statistical analyses were performed by using Two-sample independent-t test, Mann Whitney-U test, Wilcoxon-signed ranks test and Pearson chi-squared tests. Results: Although, the VAS-I and VAS-II scores were lower in Group-M than Group-F, the difference was not significant statistically (p>0.05. When other hours were compared with initial states, beginning from the 4th hour, in both groups there was a statistically significant drop in VAS-I and VAS-II scores at all times (p<0.001. Comparing the complications between the groups, in Group-M nausea-vomiting (p<0.015 and bradycardia (p<0.012 were found significantly more frequently than in Group-F. Conclusion: We concluded that, in pain management after thoracic surgery, either morphine or fentanyl may be chosen in thoracal epidural analgesia but, especially in the early postoperative hours, close follow-up is necessary due to the risk of bradycardia development.

  17. Cardiac arrhythmias during or after epileptic seizures.

    Science.gov (United States)

    van der Lende, Marije; Surges, Rainer; Sander, Josemir W; Thijs, Roland D

    2016-01-01

    Seizure-related cardiac arrhythmias are frequently reported and have been implicated as potential pathomechanisms of Sudden Unexpected Death in Epilepsy (SUDEP). We attempted to identify clinical profiles associated with various (post)ictal cardiac arrhythmias. We conducted a systematic search from the first date available to July 2013 on the combination of two terms: 'cardiac arrhythmias' and 'epilepsy'. The databases searched were PubMed, Embase (OVID version), Web of Science and COCHRANE Library. We attempted to identify all case reports and case series. We identified seven distinct patterns of (post)ictal cardiac arrhythmias: ictal asystole (103 cases), postictal asystole (13 cases), ictal bradycardia (25 cases), ictal atrioventricular (AV)-conduction block (11 cases), postictal AV-conduction block (2 cases), (post)ictal atrial flutter/atrial fibrillation (14 cases) and postictal ventricular fibrillation (3 cases). Ictal asystole had a mean prevalence of 0.318% (95% CI 0.316% to 0.320%) in people with refractory epilepsy who underwent video-EEG monitoring. Ictal asystole, bradycardia and AV-conduction block were self-limiting in all but one of the cases and seen during focal dyscognitive seizures. Seizure onset was mostly temporal (91%) without consistent lateralisation. Postictal arrhythmias were mostly found following convulsive seizures and often associated with (near) SUDEP. The contrasting clinical profiles of ictal and postictal arrhythmias suggest different pathomechanisms. Postictal rather than ictal arrhythmias seem of greater importance to the pathophysiology of SUDEP. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Accuracy of the Defining Characteristics of the Nursing Diagnosis Hypothermia in Newborns.

    Science.gov (United States)

    de Aquino, Wislla Ketlly Menezes; Lopes, Marcos Venícios de Oliveira; da Silva, Viviane Martins; Fróes, Nathaly Bianka Moraes; de Menezes, Angélica Paixão; Almeida, Aline de Aquino Peres; Sobreira, Bianca Alves

    2017-09-18

    To analyze the accuracy of the defining characteristics of hypothermia in newborns and to verify associations between defining characteristics and clinical variables. A cross-sectional accuracy study with statistical analysis. Slow capillary refill, decrease in ventilation, peripheral vasoconstriction, and insufficient weight gain were the defining characteristics with the highest specificity values, while slow gastric emptying, skin cool to touch, irritability, and bradycardia were the defining characteristics with the highest values for both sensitivity and specificity. Slow gastric emptying, skin cool to touch, irritability, and bradycardia are good clinical indicators to infer initial stages of hypothermia and to confirm its presence. Accuracy measures may contribute to the improvement of the diagnostic inferential process. Analisar acurácia das características definidoras de Hipotermia em recém-nascidos e identificar a associação delas com variáveis clínicas. MÉTODO: Estudo de acurácia transversal com análise estatística. Preenchimento capilar lento, diminuição da ventilação, vasoconstrição periférica e ganho de peso insuficiente apresentaram valores altos de especificidade enquanto esvaziamento gástrico lento, pele fria, irritabilidade e bradicardia apresentaram valores elevados de sensibilidade e especificidade. CONCLUSÃO: Esvaziamento gástrico lento, pele fria, irritabilidade e bradicardia são úteis para inferir estágios iniciais de hipotermia e para confirmação diagnóstica. IMPLICAÇÕES PARA PRÁTICA DE ENFERMAGEM: Medidas de acurácia podem contribuir para o processo de inferência do diagnóstico hipotermia. © 2017 NANDA International, Inc.

  19. Myocardial infarction, symptomatic third degree atrioventricular block and pulmonary embolism caused by thalidomide: a case report.

    Science.gov (United States)

    Zhang, Shengyu; Yang, Jing; Jin, Xiaofeng; Zhang, Shuyang

    2015-12-18

    Thalidomide has been reported to cause numerous thromboembolic events. Deep vein thrombosis and pulmonary embolism are more common. It can also cause bradycardia and even total atrioventricular block. Rarely, it causes coronary artery spasm and even myocardial infarction. But almost simultaneous onset of myocardial infarction, third degree atrioventricular block and pulmonary embolism in one patient has not been reported so far. A 53-year old man presented because of chest pain, nausea and then syncope for several minutes. Previous medical history included neurodermitis for which thalidomide was given and hypercholesterolemia with simvastatin taking. The patient didn't exhibit any other established risk factors for coronary artery disease. Electrocardiography showed sinus rhythm with third degree atrioventricular block and complete right bundle branch block, and precordial leads ST segment elevation. The diagnosis of acute coronary syndrome was suspected, but further coronary angiography demonstrated no flow-limiting lesions in coronary arteries, and temporary pacemaker was implanted. After admission, low SpO2 and elevated D-dimer level was mentioned. Further computed tomography pulmonary angiography revealed pulmonary embolism. Thalidomide was thought to be the cause of hypercoagulability and coronary spasm, so it was ceased immediately. Therapeutic low molecule weight heparin was initiated and then switched to warfarin with appropriate INR, and nifedipine was described for coronary spasm. The patient's symptoms completely relived and SpO2 recovered, and atrioventricular block had disappeared during hospitalization with pacemaker removed. This is the very first case in which myocardial infarction, third degree atrioventricular block and pulmonary embolism almost simultaneously developed. We should be ware that anti-thrombotic prophylaxis, which needs further investigation for optimal drug and dosage, may be beneficial in thalidomide therapy. And it is also

  20. Parasympathetic neurons in the cranial medial ventricular fat pad on the dog heart selectively decrease ventricular contractility.

    Science.gov (United States)

    Dickerson, L W; Rodak, D J; Fleming, T J; Gatti, P J; Massari, V J; McKenzie, J C; Gillis, R A

    1998-05-28

    We hypothesized that selective control of ventricular contractility might be mediated by postganglionic parasympathetic neurons in the cranial medial ventricular (CMV) ganglion plexus located in a fat pad at the base of the aorta. Sinus rate, atrioventricular (AV) conduction (ventricular rate during atrial pacing), and left ventricular contractile force (LV dP/dt during right ventricular pacing) were measured in eight chloralose-anesthetized dogs both before and during bilateral cervical vagus stimulation (20-30 V, 0.5 ms pulses, 15-20 Hz). Seven of these dogs were tested under beta-adrenergic blockade (propranolol, 0.8 mg kg(-1) i.v.). Control responses included sinus node bradycardia or arrest during spontaneous rhythm, high grade AV block or complete heart block, and a 30% decrease in contractility from 2118 +/- 186 to 1526 +/- 187 mm Hg s(-1) (P 0.05) decrease in contractility but still elicited the same degree of sinus bradycardia and AV block (N = 8, P < 0.05). Five dogs were re-tested 3 h after trimethaphan fat pad injection, at which time blockade of vagally-induced negative inotropy was partially reversed, as vagal stimulation decreased LV dP/dt by 19%. The same dose of trimethaphan given either locally into other fat pads (PVFP or IVC-ILA) or systemically (i.v.) had no effect on vagally-induced negative inotropy. Thus, parasympathetic ganglia located in the CMV fat pad mediated a decrease in ventricular contractility during vagal stimulation. Blockade of the CMV fat pad had no effect on vagally-mediated slowing of sinus rate or AV conduction.

  1. Parasympathetic preganglionic cardiac motoneurons labeled after voluntary diving

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    W Michael ePanneton

    2014-01-01

    Full Text Available A dramatic bradycardia is induced by underwater submersion in vertebrates. The location of parasympathetic preganglionic cardiac motor neurons driving this aspect of the diving response was investigated using cFos immunohistochemistry combined with retrograde transport of cholera toxin subunit B (CTB to double-label neurons. After pericardial injections of CTB, trained rats voluntarily dove underwater, and their heart rates dropped immediately to 95±2bpm, an 80% reduction. After immunohistochemical processing, the vast majority of CTB labeled neurons were located in the reticular formation from the rostral cervical spinal cord to the facial motor nucleus, confirming previous studies. Labeled neurons caudal to the rostral ventrolateral medulla were usually spindle-shaped aligned along an oblique line running from the dorsal vagal nucleus to the ventrolateral reticular formation, while those more rostrally were multipolar with extended dendrites. Nine percent of retrogradely-labeled neurons were positive for both cFos and CTB after diving and 74% of these were found rostral to the obex. CTB also was transported transganglionically in primary afferent fibers, resulting in large granular deposits in dorsolateral, ventrolateral, and commissural subnuclei of the nucleus tractus solitarii and finer deposits in lamina I and IV-V of the trigeminocervical complex. The overlap of parasympathetic preganglionic cardiac motor neurons activated by diving with those activated by baro- and chemoreceptors in the rostral ventrolateral medulla is discussed. Thus the profound bradycardia seen with underwater submersion reinforces the notion that the mammalian diving response is the most powerful autonomic reflex known.

  2. Acquired hemophilia as the cause of life-threatening hemorrhage in a 94-year-old man: a case report

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    Blanchard Elizabeth

    2010-07-01

    Full Text Available Abstract Introduction Acquired factor VIII deficiency is a rare entity that can lead to severe and life-threatening bleeding. We describe a case of severe bleeding from the tongue secondary to acquired hemophilia and discuss treatment options, including aminocaproic acid and recombinant factor VIII, which have not been widely reported in the literature for the management of such patients. Case presentation A 94-year-old Caucasian man presented to our institution with diffuse bruising and extensive bleeding from the tongue secondary to mechanical trauma. He had no prior history of bleeding and his medical history was unremarkable except for dementia and hypertension. Coagulation studies revealed a prolonged activated partial thromboplastin time and a mixing study was consistent with the presence of an inhibitor. Quantitative assays revealed a reduced level of factor VIII activity (1% and the presence of a factor VIII inhibitor, measured at seven Bethesda units, in the serum. Oral prednisone therapy (60mg/day was given. He also received intravenous aminocaproic acid and human concentrate of factor VIII (Humate-P and topical anti-thrombolytic agents (100 units of topical thrombin cream. His hospital course was prolonged because of persistent bleeding and the development of profuse melena. He required eight units of packed red blood cells for transfusion. Hospitalization was also complicated by bradycardia of unclear etiology, which started after infusion of aminocaproic acid. His activated partial thromboplastin time gradually normalized. He was discharged to a rehabilitation facility three weeks later with improving symptoms, stable hematocrit and resolving bruises. Conclusions Clinicians should suspect a diagnosis of acquired hemophilia in older patients with unexplained persistent and profound bleeding from uncommon soft tissues, including the tongue. Use of factor VIII (Humate-P and aminocaproic acid can be useful in this coagulopathy but

  3. Elucidating the responses and role of the cardiovascular system in crocodilians during diving: fifty years on from the work of C.G. Wilber.

    Science.gov (United States)

    Axelsson, Michael; Franklin, Craig E

    2011-09-01

    In 1960, C.G. Wilber in a laboratory-based study described for the first time the changes in heart rate with submergence in the American alligator noting in particular the marked bradycardia that occurred during forced dives. This short review summarizes the major advances in our understanding of diving and the responses and role of the cardiovascular system of crocodilians during submergence in the 50 years since Wilber published his findings. These advances are attributable in part to the technological advances made in physiological monitoring devices and wildlife telemetry that have not only provided greater elucidation of the hemodynamics of the unique crocodilian cardiovascular system but also allowed the natural diving behaviors and heart rates in free-ranging crocodiles to be recorded. Of note, telemetric field-based studies have revealed that wild free-ranging crocodiles typically undertake only short dives, less than 20 min, yet crocodiles are also capable of dives of many hours in duration. In contrast to Wilber's study, dives recorded from free-ranging crocodiles were found to be accompanied by only a modest bradycardia, highlighting the often confounding effects associated with captive animals monitored under laboratory conditions. More recent studies have also documented the complex central flow and pressure patterns of crocodilians, including a pulmonary to systemic shunt that can be initiated by a unique intracardiac valve located in the subpulmonary conus. The role and significance of this cardiac shunt remains controversial and the focus of recent lab-based studies. We contend that elucidation of the role and significance of the cardiac shunt in crocodilians will only be achieved by monitoring telemetrically the central cardiovascular flows and pressures in non-captive animals that are undisturbed and free-ranging. This presents the challenge ahead in the next 50 years. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Clinical characteristics, background illnesses and in-hospital mortality rates of patients who

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    Rida Berilğen

    2013-06-01

    Full Text Available Objective: The aim of the study was to determine theclinical characteristics, comorbidities, responsible diseasesand in-hospital mortality of patients who received atemporary pacemakerMethods: Our study included 545 patients who received atemporary pacemaker due to various causes during theirhospitalization between January 2008 and May 2012.Results: Of the 545 patients whose records werescanned retrospectively in our study, 235 (43% were femaleand 310 (57% were male. Average age of patientswas 70±14.2 years (20,100. Leading cause for receivingpacemaker was third degree atrioventricular block (178patients, 32.6%.Other causes were bradycardia or asystoleduring procedures such as coronary angiography,catheterization etc. (101 patients, 18.5%, symptomaticsinus bradycardia (70 patients, 12.8%, pacemaker endof life (During procedure, 65 patients, 11.9%. Temporarypacemaker implantation due to drugs, hyperpotasemiaand both was 6.2% (34 patients, 3.6% (20 patients and1.1% (6 patients respectively. Eight patients used drugsfor committing suicide. While the top responsible drugsfor pacemaker implantation were digoxin, beta blockersand calcium channel blockers, only one patient was usinga noncardiac drug (oxcarbamazepin. Half of the patientshad coronary artery disease (276 patients, 51%. 101 patients(18.5% received a temporary pacemaker due toblock in the course of myocardial infarction. 85 patientsdied during their hospitalization (15.5%.Conclusıon: Although causes for temporary pacemakerimplantation has changed over time, myocardial infarctionwith block still remains fatal even a temporary pacemakeris inserted. J Clin Exp Invest 2013; 4 (2: 180-183Key words: Temporary cardiac pacemaker, mortality,acute myocardial infarction, atrioventricular conductionblock.

  5. Chronic central leptin infusion restores cardiac sympathetic-vagal balance and baroreflex sensitivity in diabetic rats.

    Science.gov (United States)

    do Carmo, Jussara M; Hall, John E; da Silva, Alexandre A

    2008-11-01

    This study tested whether leptin restores sympathetic-vagal balance, heart rate (HR) variability, and cardiac baroreflex sensitivity (BRS) in streptozotocin (STZ)-induced diabetes. Sprague-Dawley rats were instrumented with arterial and venous catheters, and a cannula was placed in the lateral ventricle for intracerebroventricular (ICV) leptin infusion. Blood pressure (BP) and HR were monitored by telemetry. BRS and HR variability were estimated by linear regression between HR and BP responses to phenylephrine or sodium nitroprusside and autoregressive spectral analysis. Measurements were made during control period, 7 days after induction of diabetes, and 7 days after ICV leptin infusion. STZ diabetes was associated with hyperglycemia (422 +/- 17 mg/dl) and bradycardia (-79 +/- 4 beats/min). Leptin decreased glucose levels (165 +/- 16 mg/dl) and raised HR to control values (303 +/- 10 to 389 +/- 10 beats/min). Intrinsic HR (IHR) and chronotropic responses to a full-blocking dose of propranolol and atropine were reduced during diabetes (260 +/- 7 vs. 316 +/- 6, -19 +/- 2 vs. -43 +/- 6, and 39 +/- 3 vs. 68 +/- 8 beats/min), and leptin treatment restored these variables to normal (300 +/- 7, -68 +/- 10, and 71 +/- 8 beats/min). Leptin normalized BRS (bradycardia, -2.6 +/- 0.3, -1.7 +/- 0.2, and -3.0 +/- 0.5; and tachycardia, -3.2 +/- 0.4, -1.9 +/- 0.3, and -3.4 +/- 0.3 beats.min(-1).mmHg(-1) for control, diabetes, and leptin) and HR variability (23 +/- 4 to 11 +/- 1.5 ms2). Chronic glucose infusion to maintain hyperglycemia during leptin infusion did not alter the effect of leptin on IHR but abolished the improved BRS. These results show rapid impairment of autonomic nervous system control of HR after the induction of diabetes and that central nervous system actions of leptin can abolish the hyperglycemia as well as the altered IHR and BRS in STZ-induced diabetes.

  6. Metoclopramide-induced cardiac arrest

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    Martha M. Rumore

    2011-11-01

    Full Text Available The authors report a case of cardiac arrest in a patient receiving intravenous (IV metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s underlying metoclopramide’s cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and

  7. Beta blockade and physical training in rats.

    Science.gov (United States)

    Harri, M

    1982-01-01

    Beta adrenergic blocking agents are widely used in the treatment of hypertension. Recent findings indicate that long-term physical training also could reduce elevated blood pressure and many physicians therefore recommend their patients to include physical training in their everyday program. However, it is not known whether a combination of beta blockade and physical training influences the responses of an organism to physical training. This problem was investigated using laboratory rats as an experimental animal model. Both swimming and running training were used, and a group of animals was trained without any medication while the other group performed their daily training session under the influence of 10 mg/kg of propranolol. Some of the effects produced by swimming training, such as hypertrophy of brown adipose tissue and heart muscle, resting bradycardia, increased tachycardic and tail skin temperature responses to isoprenaline, increased calorigenic response to noradrenaline and delayed cooling rate in cold water were similar to those produced by cold acclimation or repeated noradrenaline injections. It is thus tempting to conclude that the training-induced release of noradrenaline was responsible for the changes mentioned. Propranolol, when associated with the training, effectively hampered these changes. Running training increased the activity of oxidative enzymes in the skeletal muscle much more than did swimming training or repeated noradrenaline injections. Furthermore, running training neither induced hypertrophy of the brown fat nor enhanced calorigenic response to noradrenaline; it even led to enhanced rate of body cooling in cold water. Therefore the adaptive changes caused by running training most probably are not due to cold acclimation effects in spite of that propranolol, when associated with the running sessions, antagonized the development of running-induced changes, too. Some of these changes, such as cardiomegaly, training bradycardia and

  8. In vivo cardiovascular toxicity induced by acetochlor in zebrafish larvae.

    Science.gov (United States)

    Liu, Hongcui; Chu, Tianyi; Chen, Lili; Gui, Wenjun; Zhu, Guonian

    2017-08-01

    The risk of acetochlor to human health is still unclear, prompting concern over its risk, especially to pesticide suicides population, occupational population (farmers, retailers and pharmaceutical workers), and special population (young children and infants, pregnant women, older people, and those with compromised immune systems). This study was to explore the toxic effect and the possible mechanism of toxic action of acetochlor using zebrafish larvae whose toxicity profiles have been confirmed to be strikingly similar with mammalian. The result indicated that the toxic target organ of acetochlor was cardiovascular system. Thus, cardiovascular toxicity evaluation was investigated systematically. The main phenotypes of cardiovascular toxicity induced by acetochlor were bradycardia, pericardial edema, circulation defect, and thrombosis; Malformed heart was confirmed by histopathological examination. Thrombosis which maybe triggered by bradycardia was further studied using o-dianisidine for erythrocyte staining; Substantial thrombus in the caudal vein and significantly reduced heart red blood cells (RBCs) intensity which can reflect the thrombosis degree were observed in zebrafish in a concentration-dependent manner. Additionally, the mRNA expression level of Nkx2.5 and Gata4 related to induction of cardiac program were down-regulated significantly by quantitative real-time polymerase chain reaction (qRT-PCR), which could cause defects in the cardiovascular system. For the first time, our results demonstrated that acetochlor induced cardiovascular toxicity, and down-regulation of Nkx2.5 and Gata4 might be its possible molecular basis. Our data generated here might provide novel insights into cardiovascular disease risk following acetochlor exposure to human, especially to pesticide suicides population, occupational population and special population. Copyright © 2017. Published by Elsevier Ltd.

  9. Phase 1 dose-escalation trial evaluating the combination of the selective MET (mesenchymal-epithelial transition factor) inhibitor tivantinib (ARQ 197) plus erlotinib.

    Science.gov (United States)

    Goldman, Jonathan W; Laux, Isett; Chai, Feng; Savage, Ronald E; Ferrari, Dora; Garmey, Edward G; Just, Richard G; Rosen, Lee S

    2012-12-01

    Amplification of the mesenchymal-epithelial transition factor (MET) gene can promote tumor resistance to epidermal growth factor receptor (EGFR) inhibition. Dual EGFR-MET inhibition may overcome this resistance. Tivantinib (ARQ 197) is a selective, oral, non-ATP-competitive, small-molecule inhibitor of the MET receptor tyrosine kinase. This phase 1 trial assessed the safety, pharmacokinetics, and preliminary antitumor activity of tivantinib combined with the EGFR inhibitor erlotinib. Patients with advanced solid malignancies were administered oral tivantinib at escalating doses of 120, 240, 360, and 480 mg twice daily (BID) plus 150 mg erlotinib once daily (QD). Single or multiple intrapatient dose escalation was planned in the absence of dose-limiting toxicity in the first cycle of therapy (21 days). Thirty-two patients received combination treatment. Tivantinib serum concentrations were not dose-proportional. The most common (≥ 20%) adverse events (AEs) regardless of causality included rash (n = 17), fatigue (n = 12), nausea (n = 10), abdominal pain (n = 10), diarrhea (n = 9), bradycardia (n = 9), and anemia (n = 7). AEs considered related to study treatment occurred in 28 patients (87.5%), and 5 patients (15.6%) had treatment-related serious AEs, including neutropenia, leukopenia, syncope, sinus bradycardia, and sick sinus syndrome. Fifteen of 32 patients (46.8%) had a partial response (n = 1) or stable disease (n = 14) as assessed by Response Evaluation Criteria in Solid Tumors. Six of 8 patients with nonsmall cell lung cancer achieved stable disease. The recommended phase 2 dose is tivantinib 360 mg BID plus erlotinib 150 mg QD. Tivantinib plus erlotinib was well tolerated with encouraging clinical activity, especially in patients with nonsmall cell lung cancer. Copyright © 2012 American Cancer Society.

  10. Autonomic nervous system modulation and clinical outcome after pulmonary vein isolation using the second-generation cryoballoon.

    Science.gov (United States)

    Miyazaki, Shinsuke; Nakamura, Hiroaki; Taniguchi, Hiroshi; Hachiya, Hitoshi; Kajiyama, Takatsugu; Watanabe, Tomonori; Igarashi, Miyako; Ichijo, Sadamitsu; Hirao, Kenzo; Iesaka, Yoshito

    2017-09-01

    The intrinsic cardiac autonomic nervous system (ANS) plays a significant role in atrial fibrillation (AF) mechanisms. This study evaluated the incidence and impact of intraprocedural vagal reactions and ANS modulation by pulmonary vein isolation (PVI) using second-generation cryoballoons on outcomes. One hundred three paroxysmal AF patients underwent PVI with one 28-mm second-generation balloon. The median follow-up was 15.0 (12.0-18.0) months. ANS modulation was defined as a >20% cycle length decrease on 3-minute resting electrocardiograms at 1, 3, 6, and 12 months postindex procedure relative to baseline if sinus rhythm was maintained. Marked sinus arrests/bradycardia and atrioventricular block (intraprocedural vagal reaction) occurred in 14 and 2 patients, and all sinus arrest/bradycardia occurred in 44 patients with left superior pulmonary veins (PVs) targeted before right PVs. ANS modulation was identified in 66 of 95 (69.5%) patients, and it persisted 12-month postprocedure in 36 (37.9%) patients. Additional β-blocker administration was required in 9 patients for sinus tachycardia. ANS modulation was similarly observed in patients with and without intraprocedural vagal reactions (P = 0.443). Forty-eight (46.6%) patients experienced early recurrences, and the single procedure success at 12 months was 72.7%. Neither intraprocedural vagal reactions nor ANS modulation predicted AF freedom within or after the blanking period. Thirty-three patients underwent second procedures, and reconnections were detected in 39 of 130 (30.0%) PVs among 23 (69.7%) patients. The incidence of reconnections was similar in patients with and without ANS modulation. Increased heart rate persisted in 37.9% of patients even at 12-month post-second-generation cryoballoon PVI. Neither intraprocedural vagal reactions nor increased heart rate predicted a single procedure clinical outcome. © 2017 Wiley Periodicals, Inc.

  11. Efficacy of dexmedetomidine for pain management in knee arthroscopy: A systematic review and meta-analysis.

    Science.gov (United States)

    Li, Chen; Qu, Ji

    2017-10-01

    Dexmedetomidine showed some potential in pain control in patients undergoing knee arthroscopy. We conducted a systematic review and meta-analysis to explore the efficacy of dexmedetomidine in patients undergoing knee arthroscopy. We searched the randomized controlled trials (RCTs) assessing the effect of dexmedetomidine on knee arthroscopy in PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases. The primary outcome was pain scores. Meta-analysis was performed using the random-effect model. Five RCTs were included. Overall, compared with control intervention in patients with knee arthroscopy, dexmedetomidine intervention could significantly reduce the pain scores [Std. mean difference = -0.84; 95% confidence interval (95% CI) = -1.24 to -0.44; P < .0001] and postoperative diclofenac sodium consumption (Std. mean difference = -1.76; 95% CI = -3.32 to -0.21; P = .03), improve duration of analgesic effect (Std. mean difference = 1.78; 95% CI = 0.56-3.00; P = .004), but showed no influence on hypotension [risk ratio (RR) = 0.93; 95% CI = 0.14-5.92; P = .94], bradycardia (RR = 4.93; 95% CI = 0.91-26.58; P = .06), nausea, and vomiting (RR = 1.96; 95% CI = 0.31-12.58; P = .48). Dexmedetomidine intervention was able to significantly reduce the pain scores and postoperative diclofenac sodium consumption, and improve duration of analgesic effect in patients undergoing knee arthroscopy, but had no influence on hypotension, bradycardia, nausea, and vomiting.

  12. Pharmacological studies on Myrica rubra Sieb et zucc. Effects on the cardiovascular system and platelets.

    Science.gov (United States)

    Alajmi, M F; Al-Hadiya, B M; El Tahir, K E H

    2013-09-01

    The effects of 50% Drink of Myrica rubra (MRD) on the cardiovascular system of the rat and on the platelets aggregation of rats and guinea pigs were studied. Different groups of male Wistar rats were treated either with 50% Myrica rubra drink as drinking vehicle (4 weeks) or water. The animals were then prepared for the measurement of arterial blood pressure and heart rate, ECG, sensitivity of the baroreceptors, platelets' aggregation, blood clotting time and cardiac parasympathetic ganglia. The mechanism of action of any induced effect was elucidated using different receptor blockers. Treatment induced a significant decrease in the arterial blood pressure and heart rate on Wistar rats, but no significant changes in the ECG were observed. Pretreatment of rats with MRD 10 or 20 ml/kg (i. p.) significantly suppressed vagal electrical stimulation to the heart and nicotine-induced bradycardia, via decreasing phenylephrine-induced rise in the arterial blood pressure and the reflexly-induced bradycardia. It significantly suppressed the Baroreceptor Sensitivity Index (BSI). The treatment also significantly suppressed ADP-induced platelets aggregation in rats and arachidonic acid-induced aggregation in guinea pigs.All these actions seemed to be mediated by the MRD constituents such as proanthocyanidins, polyphenols and flavonoids. The decreases in the heart rate and BSI were probably caused by an inherent ability to block the parasympathetic ganglia. The results of this study regarding the effects of MRD actions on the cardiovascular system and platelets qualify the drink to be classified as a functional food. © Georg Thieme Verlag KG Stuttgart · New York.

  13. The management of difficult intubation in infants: a retrospective review of anesthesia record database.

    Science.gov (United States)

    Aida, Junko; Oda, Yutaka; Kasagi, Yoshihiro; Ueda, Mami; Nakada, Kazuo; Okutani, Ryu

    2015-01-01

    We retrospectively reviewed the anesthesia records of infants  10 min for tracheal intubation) or records of Cormack-Lehane grade were included. Demographic data are median age 5 (range, 0-11) months, height 61 (33-84) cm, body weight 6.0 (1.1 - 11.8) kg. The number of cases with ASA physical status I, II, III and IV was 182 (36.6 %), 135 (27.3 %), 177 (35.5 %) and 3 (0.6 %), respectively. Cormack-Lehane grade 1, 2, 3 and 4 was seen in 450 (90.5 %), 32 (6.4 %), 6 (1.2 %) and 6 (1.2 %) cases, respectively. Document of difficult intubation was found in 12 cases (2.4 %, 10 different infants) with a lack of record of Cormack-Lehane grade in 3 cases. Of these 10 infants, nine had multiple congenital anomalies including heart diseases and cleft palate. Without premedication, general anesthesia was induced with intravenous midazolam or sevoflurane in the 12 cases. Tracheal intubation was performed after disappearance of spontaneous respiration except three cases who were intubated in the awake state or under sedation. Elapsed time from induction of anesthesia to intubation was 17 (14-29) min. Although mask ventilation was adequate in all cases, two cases (one infant) developed hypoxia and bradycardia during tracheal intubation. No remarkable decrease of SpO 2 or bradycardia less than 100 bpm was detected in other cases. In conclusion, we found difficult intubation in 2.4 % of infants undergoing general anesthesia. Although muscle relaxants are useful for facilitating tracheal intubation, it should be carefully used with the preparation of other airway devices in infants with predicted difficult intubation.

  14. Cardiac arrest upon induction of anesthesia in children with cardiomyopathy: an analysis of incidence and risk factors.

    LENUS (Irish Health Repository)

    Lynch, Johanne

    2012-02-01

    INTRODUCTION: It is thought that patients with cardiomyopathy have an increased risk of cardiac arrest on induction of anesthesia, but there is little available data. The purpose of this study was to identify the incidence and potential risk factors for cardiac arrest upon induction of anesthesia in children with cardiomyopathy in our institution. METHODS: A retrospective chart review was performed. Eligible patients included patients admitted between 1998 and 2008 with the International Statistical Classification of Disease code for cardiomyopathy (ICD-9 code 425) who underwent airway intervention for sedation or general anesthesia in the operating room, cardiac diagnostic and interventional unit (CDIU) or intensive care unit. Patients undergoing emergency airway intervention following cardiovascular collapse were excluded. For each patient, we recorded patient demographics, disease severity, anesthesia location, and anesthetic technique. RESULTS: One hundred and twenty-nine patients with cardiomyopathy underwent a total of 236 anesthetic events, and four cardiac arrests were identified. One was related to bradycardia (HR<60), two were attributed to bradycardia in association with severe hypotension (systolic blood pressure<45), and the fourth arrest was related to isolated severe hypotension. Two occurred in the operating suite and two in the CDIU. There was no resulting mortality. One patient progressed to heart transplantation. Multiple combinations of anesthetic drugs were used for induction of anesthesia. CONCLUSION: We performed a review of the last 10 years of anesthesia events in children with cardiomyopathy. We report four cardiac arrests in two patients and 236 anesthetic events (1.7%). To the best of our knowledge, this is the largest review of these patients to date but is limited by its retrospective nature. The low cardiac arrest incidence prevents the identification of risk factors and the development of a cardiac arrest risk predictive clinical

  15. Nicotiana glauca (tree tobacco) intoxication--two cases in one family.

    Science.gov (United States)

    Furer, Victoria; Hersch, Moshe; Silvetzki, Noa; Breuer, Gabriel S; Zevin, Shoshana

    2011-03-01

    We present two cases of rare human poisoning in one family following ingestion of cooked leaves from the tobacco tree plant, Nicotiana glauca. The toxic principle of N. glauca, anabasine (C10H14N2), is a small pyridine alkaloid, similar in both structure and effects to nicotine, but appears to be more potent in humans. A 73-year-old female tourist from France, without remarkable medical history, collapsed at home following a few hours long prodrome of dizziness, nausea, vomiting, and malaise. The symptoms developed shortly after eating N. glauca cooked leaves that were collected around her daughter's house in Jerusalem and mistaken for wild spinach. She was found unconscious, with dilated pupils and extreme bradycardia. Following resuscitation and respiratory support, circulation was restored. However, she did not regain consciousness and died 20 days after admission because of multi-organ failure. Anabasine was identified by gas chromatography/mass spectrometry method in N. glauca leaves and in the patient's urine. Simultaneously, her 18-year-old grandson developed weakness and myalgia after ingesting a smaller amount of the same meal. He presented to the same emergency room in a stable condition. His exam was remarkable only for sinus bradycardia. He was discharged without any specific treatment. He recovered in 24 h without any residual sequelae. These cases raise an awareness of the potential toxicity caused by ingestion of tobacco tree leaves and highlight the dangers of ingesting botanicals by lay public. Moreover, they add to the clinical spectrum of N. glauca intoxication. © American College of Medical Toxicology 2010

  16. Comparison of metaraminol, phenylephrine and ephedrine in prophylaxis and treatment of hypotension in cesarean section under spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Fábio Farias de Aragão

    2014-09-01

    Full Text Available Maternal hypotension is a common complication after spinal anesthesia for cesarean section, with deleterious effects on the fetus and mother. Among the strategies aimed at minimizing the effects of hypotension, vasopressor administration is the most efficient. The aim of this study was to compare the efficacy of phenylephrine, metaraminol, and ephedrine in the prevention and treatment of hypotension after spinal anesthesia for cesarean section. Ninety pregnant women, not in labor, undergoing cesarean section were randomized into three groups to receive a bolus followed by continuous infusion of vasopressor as follows: phenylephrine group (50 μg + 50 μg/min; metaraminol group (0.25 mg + 0.25 mg/min; ephedrine group (4 mg + 4 mg/min. Infusion dose was doubled when systolic blood pressure decreased to 80% of baseline and a bolus was given when systolic blood pressure decreased below 80%. The infusion dose was divided in half when systolic blood pressure increased to 120% and was stopped when it became higher. The incidence of hypotension, nausea and vomiting, reactive hypertension, bradycardia, tachycardia, Apgar scores, and arterial cord blood gases were assessed at the 1st and 5th minutes. There was no difference in the incidence of hypotension, bradycardia, reactive hypertension, infusion discontinuation, atropine administration or Apgar scores. Rescue boluses were higher only in the ephedrine group compared to metaraminol group. The incidence of nausea and vomiting and fetal acidosis were greater in the ephedrine group. The three drugs were effective in preventing hypotension; however, fetal effects were more frequent in the ephedrine group, although transient.

  17. Excitatory amino acid receptor blockade within the caudal pressor area and rostral ventrolateral medulla alters cardiovascular responses to nucleus raphe obscurus stimulation in rats

    Directory of Open Access Journals (Sweden)

    Silva N.F.

    2002-01-01

    Full Text Available Pressor responses elicited by stimulation of the nucleus raphe obscurus (NRO depend on the integrity of the rostral ventrolateral medulla (RVLM. Therefore, to test the participation of excitatory amino acid (EAA receptors in the cardiovascular responses evoked by NRO stimulation (1 ms, 100 Hz, 40-70 µA, for 10 s, the EAA antagonist kynurenic acid (Kyn was microinjected at different sites in the ventrolateral medullar surface (2.7 nmol/200 nl of male Wistar rats (270-320 g, N = 39 and NRO stimulation was repeated. The effects of NRO stimulation were: hypertension (deltaMAP = +43 ± 1 mmHg, P<0.01, bradycardia (deltaHR = -30 ± 7 bpm, P<0.01 and apnea. Bilateral microinjection of Kyn into the RVLM, which did not change baseline parameters, almost abolished the bradycardia induced by NRO stimulation (deltaHR = -61 ± 3 before vs -2 ± 3 bpm after Kyn, P<0.01, N = 7. Unilateral microinjection of Kyn into the CVLM did not change baseline parameters or reduce the pressor response to NRO stimulation (deltaMAP = +46 ± 5 before vs +48 ± 5 mmHg after Kyn, N = 6. Kyn bilaterally microinjected into the caudal pressor area reduced blood pressure and heart rate and almost abolished the pressor response to NRO stimulation (deltaMAP = +46 ± 4 mmHg before vs +4 ± 2 mmHg after Kyn, P<0.01, N = 7. These results indicate that EAA receptors on the medullary ventrolateral surface play a role in the modulation of the cardiovascular responses induced by NRO stimulation, and also suggest that the RVLM participates in the modulation of heart rate responses and that the caudal pressor area modulates the pressor response following NRO stimulation.

  18. [Systematic review of complications for proper informed consent (9) periprocedural complications of carotid artery stenting: a review article].

    Science.gov (United States)

    Asai, Takumi; Miyachi, Shigeru; Izumi, Takashi; Matsubara, Noriaki; Yamanouchi, Takashi; Ota, Keisuke; Oda, Keiko; Wakabayashi, Toshihiko

    2013-08-01

    Carotid artery stenting(CAS)is a common procedure for the treatment of high surgical risk patients with carotid artery stenosis. Recent clinical study failed to show the non-inferiority of CAS to carotid endarterectomy(CEA)because of higher complication rates of CAS. However the result of a multicenter case study in Japan with tailored application of adequate devices including stents and protection devices revealed the safety of CAS in Japan. In this article the overall review in the previous reports of CAS are reviewed focusing on the complications and clinical outcome. Five randomized controlled trials concerning CAS versus CEA and 14 case series of CAS were reviewed, and the rates of periprocedural complications of CAS including death, stroke, myocardial infarction, hypotension and bradycardia, cranial nerve palsy, major vascular injury, cholesterol crystal embolization and hyperperfusion syndrome were summarized. Mortality within 30 days of procedures was 0.9%. The rate of any stroke was 6.0% from the five RCT results, but a recent 14-case series reported any stroke rate at 3-4% and severe stroke rate at 1-2% respectively. The rates of acute myocardial infarction, hypotension, and bradycardia were 1%, 4%, and 4-12% respectively. The rate of bleeding complication of the access root was about 2% and non-bleeding was 1-2%. Cholesterol crystal embolization occurred in 0.2%. Incidence of hyperperfusion syndrome occurred in 1.5%, and intracranial hemorrhage in 0.8%. Historically, the rapid improvement of devices and technical skills have contributed to the better clinical results. Also the lessons from complication cases have led to more appropriate indication and perfect protection to avoid adverse events. Therefore the rate of complication is always improving and those written in this article may not reflect the present real number. This article should be quoted with the previous reference as well as the newest data according to the operator's own experiences on

  19. Isoflurane depresses baroreflex control of heart rate in decerebrate rats.

    Science.gov (United States)

    Lee, Jong S; Morrow, Don; Andresen, Michael C; Chang, Kyoung S K

    2002-05-01

    Isoflurane inhibits baroreflex control of heart rate (HR) by poorly understood mechanisms. The authors examined whether suprapontine central nervous system cardiovascular regulatory sites are required for anesthetic depression. The effects of isoflurane (1 and 2 rat minimum alveolar concentration [MAC]) on the baroreflex control of HR were determined in sham intact and midcollicular-transected decerebrate rats. Intravenous phenylephrine (0.2-12 microg/kg) and nitroprusside (1-60 microg/kg) were used to measure HR responses to peak changes in mean arterial pressure (MAP). Sigmoidal logistic curve fits to HR-MAP data assessed baroreflex sensitivity (HR/MAP), HR range, lower and upper HR plateau, and MAP at half the HR range (BP50). Four groups (two brain intact and two decerebrate) were studied before, during, and after isoflurane. To assess sympathetic and vagal contributions to HR baroreflex, beta-adrenoceptor (1 mg/kg atenolol) or muscarinic (0.5 mg/kg methyl atropine) antagonists were administered systemically. Decerebration did not alter resting MAP and HR or baroreflex parameters. Isoflurane depressed baroreflex slope and HR range in brain-intact and decerebrate rats. In both groups, 1 MAC reduced HR range by depressing peak reflex tachycardia. Maximal reflex bradycardia during increases in blood pressure was relatively preserved. Atenolol during 1 MAC did not alter maximum reflex tachycardia. In contrast, atropine during 1 MAC fully blocked reflex bradycardia. Therefore, 1 MAC predominantly depresses sympathetic components of HR baroreflex. Isoflurane at 2 MAC depressed both HR plateaus and decreased BP50 in both groups. Isoflurane depresses HR baroreflex control by actions that do not require suprapontine central nervous system sites. Isoflurane actions seem to inhibit HR baroreflex primarily by the sympathetic nervous system.

  20. A preliminary experimental study on the cardiac toxicity of glutamate and the role of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor in rats.

    Science.gov (United States)

    Liu, Yan; Zhou, Lan; Xu, Hai-Fei; Yan, Li; Ding, Fan; Hao, Wei; Cao, Ji-Min; Gao, Xue

    2013-04-01

    Monosodium L-glutamate (MSG) is a food flavour enhancer and its potential harmfulness to the heart remains controversial. We investigated whether MSG could induce cardiac arrhythmias and apoptosis via the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor. Myocardial infarction (MI) was created by ligating the coronary artery and ventricular arrhythmias were monitored by electrocardiogram in the rat in vivo. Neonatal rat cardiomyocytes were isolated and cultured. Cell viability was estimated by 3-(4,5)-dimethylthiahiazo(-z-yl)-3,5-di-phenytetrazoliumromide (MTT) assay. Calcium mobilization was monitored by confocal microscopy. Cardiomyocyte apoptosis was evaluated by acridine orange staining, flow cytometry, DNA laddering, reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting. MSG (i.v.) decreased the heart rate at 0.5 g/kg and serious bradycardia at 1.5 g/kg, but could not induce ventricular tachyarrhythmias in normal rats in vivo. In rats with acute MI in vivo, however, MSG (1.5 g/kg, i.v.) induced ventricular tachyarrhythmias and these arrhythmias could be prevented by blocking the AMPA and N-methyl-d-aspartate (NMDA) receptors. Selectively activating the AMPA or NMDA receptor induced ventricular tachyarrhythmias in MI rats. At the cellular level, AMPA induced calcium mobilization, oxidative stress, mitochondrial dysfunction and apoptosis in cultured cardiomyocytes, especially when the AMPA receptor desensitization were blocked by cyclothiazide. The above toxic cellular effects of AMPA were abolished by AMPA receptor blockade or by H2O2 scavengers. MSG induces bradycardia in normal rats, but triggers lethal tachyarrhythmias in myocardial infarcted rats probably by hindering AMPA receptors. AMPA receptor overstimulation also induces cardiomyocyte apoptosis, which may facilitate arrhythmia.

  1. ECG changes in factory workers exposed to 27.2  MHz radiofrequency radiation.

    Science.gov (United States)

    Chen, Qingsong; Xu, Guoyong; Lang, Li; Yang, Aichu; Li, Shilin; Yang, Liwen; Li, Chaolin; Huang, Hanlin; Li, Tao

    2013-05-01

    To research the effect of 27.2 MHz radiofrequency radiation on electrocardiograms (ECG), 225 female workers operating radiofrequency machines at a shoe factory were chosen as the exposure group and 100 female workers without exposure from the same factory were selected as the control group. The 6 min electric field strength that the female workers were exposed to was 64.0 ± 25.2 V/m (mean ± SD), which exceeded 61 V/m, the International Commission on Non-Ionizing Radiation Protection reference root mean square levels for occupational exposure. A statistical difference was observed between the exposed group and the control group in terms of the rate of sinus bradycardia (χ(2)  = 11.48, P = 0.003). When several known risk factors for cardiovascular disease were considered, including smoking, age, alcohol ingestion habit, and so on, the exposure duration was not an effective factor for ECG changes, sinus arrhythmia, or sinus bradycardia according to α = 0.05, while P = 0.052 for sinus arrhythmia was very close to 0.05. We did not find any statistical difference in heart rate, duration of the QRS wave (ventricular depolarization), or corrected QT intervals (between the start of the Q wave and end of the T wave) between the exposed and control groups. Occupational exposure to radiofrequency radiation was not found to be a cause of ECG changes after consideration of the confounding factors. Copyright © 2012 Wiley Periodicals, Inc.

  2. [Efficacy and safety of endotracheal intubation performed in moving vs motionless environments].

    Science.gov (United States)

    Castejón de la Encina, M ª Elena; Sanjuán Quiles, Ángela; Del Moral Vicente-Mazariegos, Ignacio; García Aracil, Noelia; José Alcaide, Lourdes; Richart Martínez, Miguel

    2017-02-01

    To compare the efficacy and safety of endotracheal intubation (ETI) in a simulated clinical environment in motion vs a motionless one. Clinical simulation trial of ETI with 3 endotracheal tubes (Airtraq, Fast-trach, Macintosh laryngoscope) in mannequins with realistic physiological responses (MetiMan) in 2 scenarios: an environment in motion vs a motionless one. Thirty-six physicians expert in prehospital ETI participated. Outcome variables were successful intubation, effective intubation, number of attempts, maximum apnea time, and total maneuver time. The safety variables were the presence of bradycardia, tachycardia, or high or low systolic blood pressures (ie, 20% variation from baseline); hypoxemia (decrease in oxygen saturation to <90% or 10% below baseline), tube placement in the esophagus or main bronchus, and dental trauma. No statistically significant differences between the 2 scenarios were found in the numbers of successful ETI (motionless, 71 [65.7%]; in motion, 67 [62.0%]; P=.277) or effective ETI (motionless, 104 [96.3%]; in motion, 105 [97.2%]; P=.108). Likewise, the number of attempts were similar (motionless, 91 [84.2%]; in motion, 90 [83.3%]; P=.305). Nor did we see differences in the mean (SD) maximum apnea times (motionless, 14.0 [5.6] seconds; in motion, 14.9 [8.1] seconds; P=.570) or mean total maneuver times (motionless, 236.7 [73.4] seconds; in motion, 210.3 [77.9] seconds; P=.164). The prevalences of bradycardia, tachycardia, high or low systolic blood pressure, hypoxemia, placements in the esophagus or bronchus, and dental trauma also did not differ significantly between the 2 scenarios. Neither efficacy nor safety variables differed significantly when ETI was performed in mannequins in a motionless environment vs one simulating ambulances in motion.

  3. Bradycardic effects mediated by activation of G protein-coupled estrogen receptor in rat nucleus ambiguus.

    Science.gov (United States)

    Brailoiu, G Cristina; Arterburn, Jeffrey B; Oprea, Tudor I; Chitravanshi, Vineet C; Brailoiu, Eugen

    2013-03-01

    The G protein-coupled estrogen receptor (GPER) has been identified in several brain regions, including cholinergic neurons of the nucleus ambiguus, which are critical for parasympathetic cardiac regulation. Using calcium imaging and electrophysiological techniques, microinjection into the nucleus ambiguus and blood pressure measurement, we examined the in vitro and in vivo effects of GPER activation in nucleus ambiguus neurons. A GPER selective agonist, G-1, produced a sustained increase in cytosolic Ca(2+) concentration in a concentration-dependent manner in retrogradely labelled cardiac vagal neurons of nucleus ambiguus. The increase in cytosolic Ca(2+) produced by G-1 was abolished by pretreatment with G36, a GPER antagonist. G-1 depolarized cultured cardiac vagal neurons of the nucleus ambiguus. The excitatory effect of G-1 was also identified by whole-cell visual patch-clamp recordings in nucleus ambiguus neurons, in medullary slices. To validate the physiological relevance of our in vitro studies, we carried out in vivo experiments. Microinjection of G-1 into the nucleus ambiguus elicited a decrease in heart rate; the effect was blocked by prior microinjection of G36. Systemic injection of G-1, in addition to a previously reported decrease in blood pressure, also reduced the heart rate. The G-1-induced bradycardia was prevented by systemic injection of atropine, a muscarinic antagonist, or by bilateral microinjection of G36 into the nucleus ambiguus. Our results indicate that GPER-mediated bradycardia occurs via activation of cardiac parasympathetic neurons of the nucleus ambiguus and support the involvement of the GPER in the modulation of cardiac vagal tone.

  4. A cause of circulatory collapse that should be considered following trauma

    Directory of Open Access Journals (Sweden)

    Omar Hesham R

    2010-08-01

    Full Text Available Abstract Management of poly-trauma patients presenting to the emergency room is usually a challenging and formidable task. Two of the common problems seen in those patients are shock and neurological dysfunction. A huge differential for post-traumatic circulatory collapse exist and timely identification of the etiology is of utmost importance to avoid complications. In this report we are describing 2 cases presenting with circulatory collapse following trauma. The first case was a 29 year old female who presented after a motor vehicle accident fully conscious with severe hypotension and bradycardia. The second case presented with severe hemodynamic instability after falling at home. Physical examination of both patients revealed weakness in all 4 limbs and CT cervical spine revealed complete anterior sublaxation of C5 over C6 cervical vertebrae in the first case and partial sublaxation of C5 over C6 cervical vertebrae in the second case confirming that spinal cord injury is the likely cause for these hemodynamic alterations. A high index of suspicion for spinal cord injuries is therefore mandatory when managing a trauma patient presenting with quadriparesis and hemodynamic instability that is otherwise unexplained especially when the ensuing hypotension is associated with bradycardia instead of reflex tachycardia. Awareness of this cause of circulatory collapse is particularly important in the unconscious patient where eliciting sensory and motor deficits looking for spinal cord injury is not always feasible. Both patients were transferred to the intensive care unit and were maintained on epinephrine till becoming hemodynamically stable. The report aims to sensitize readers to this cause of post-traumatic circulatory collapse.

  5. Placement Of Cardiac PacemaKEr Trial (POCKET – rationale and design: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Peter Magnusson

    2017-04-01

    Full Text Available BackgroundA pacemaker system consists of one or two leads connected to a device that is implanted into a pocket formed just below the collarbone. This pocket is typically subcutaneous, that is, located just above the pectoral fascia. Even though the size of pacemakers has decreased markedly, complications due to superficial implants do occur. An alternative technique would be intramuscular placement of the pacemaker device, but there are no randomized controlled trials (RCTs to support this approach, which is the rationale for the Placement Of Cardiac PacemaKEr Trial (POCKET. The aim is to study if intramuscular is superior to subcutaneous placement of a pacemaker pocket.MethodsIn October 2016, we started to enroll 200 consecutive patients with an indication for bradycardia pacemaker implantation. Patients are randomized to random block sizes, stratified by age group (cut-off: 65 years and sex, and then randomized to either subcutaneous or intramuscular implant. A concealed allocation procedure is employed, using sequentially numbered, sealed envelopes. Pocket site is blinded to the patient and in all subsequent care. The primary endpoint is patient overall satisfaction with the pocket location at 24 months as measured using a visual analog scale (VAS 0-10. Secondary endpoints are: complications, patient-reported satisfaction at 1, 12, and 24 months (overall satisfaction, pain, discomfort, degree of unsightly appearance, movement problems, and sleep problems due to device.ConclusionsPOCKET is a prospective interventional RCT designed to evaluate if intramuscular is superior to subcutaneous placement of a bradycardia pacemaker during a two-year follow-up.

  6. Placement Of Cardiac PacemaKEr Trial (POCKET – rationale and design: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Peter Magnusson

    2017-04-01

    Full Text Available Background: A pacemaker system consists of one or two leads connected to a device that is implanted into a pocket formed just below the collarbone. This pocket is typically subcutaneous, that is, located just above the pectoral fascia. Even though the size of pacemakers has decreased markedly, complications due to superficial implants do occur. An alternative technique would be intramuscular placement of the pacemaker device, but there are no randomized controlled trials (RCTs to support this approach, which is the rationale for the Placement Of Cardiac PacemaKEr Trial (POCKET. The aim is to study if intramuscular is superior to subcutaneous placement of a pacemaker pocket. Methods: In October 2016, we started to enroll 200 consecutive patients with an indication for bradycardia pacemaker implantation. Patients are randomized to random block sizes, stratified by age group (cut-off: 65 years and sex, and then randomized to either subcutaneous or intramuscular implant. A concealed allocation procedure is employed, using sequentially numbered, sealed envelopes. Pocket site is blinded to the patient and in all subsequent care. The primary endpoint is patient overall satisfaction with the pocket location at 24 months as measured using a visual analog scale (VAS 0-10. Secondary endpoints are: complications, patient-reported satisfaction at 1, 12, and 24 months (overall satisfaction, pain, discomfort, degree of unsightly appearance, movement problems, and sleep problems due to device. Conclusions: POCKET is a prospective interventional RCT designed to evaluate if intramuscular is superior to subcutaneous placement of a bradycardia pacemaker during a two-year follow-up.

  7. Calsequestrin 2 deletion causes sinoatrial node dysfunction and atrial arrhythmias associated with altered sarcoplasmic reticulum calcium cycling and degenerative fibrosis within the mouse atrial pacemaker complex1

    Science.gov (United States)

    Glukhov, Alexey V.; Kalyanasundaram, Anuradha; Lou, Qing; Hage, Lori T.; Hansen, Brian J.; Belevych, Andriy E.; Mohler, Peter J.; Knollmann, Björn C.; Periasamy, Muthu; Györke, Sandor; Fedorov, Vadim V.

    2015-01-01

    Aims Loss-of-function mutations in Calsequestrin 2 (CASQ2) are associated with catecholaminergic polymorphic ventricular tachycardia (CPVT). CPVT patients also exhibit bradycardia and atrial arrhythmias for which the underlying mechanism remains unknown. We aimed to study the sinoatrial node (SAN) dysfunction due to loss of CASQ2. Methods and results In vivo electrocardiogram (ECG) monitoring, in vitro high-resolution optical mapping, confocal imaging of intracellular Ca2+ cycling, and 3D atrial immunohistology were performed in wild-type (WT) and Casq2 null (Casq2−/−) mice. Casq2−/− mice exhibited bradycardia, SAN conduction abnormalities, and beat-to-beat heart rate variability due to enhanced atrial ectopic activity both at baseline and with autonomic stimulation. Loss of CASQ2 increased fibrosis within the pacemaker complex, depressed primary SAN activity, and conduction, but enhanced atrial ectopic activity and atrial fibrillation (AF) associated with macro- and micro-reentry during autonomic stimulation. In SAN myocytes, CASQ2 deficiency induced perturbations in intracellular Ca2+ cycling, including abnormal Ca2+ release, periods of significantly elevated diastolic Ca2+ levels leading to pauses and unstable pacemaker rate. Importantly, Ca2+ cycling dysfunction occurred not only at the SAN cellular level but was also globally manifested as an increased delay between action potential (AP) and Ca2+ transient upstrokes throughout the atrial pacemaker complex. Conclusions Loss of CASQ2 causes abnormal sarcoplasmic reticulum Ca2+ release and selective interstitial fibrosis in the atrial pacemaker complex, which disrupt SAN pacemaking but enhance latent pacemaker activity, create conduction abnormalities and increase susceptibility to AF. These functional and extensive structural alterations could contribute to SAN dysfunction as well as AF in CPVT patients. PMID:24216388

  8. Postural Heart Rate Changes in Young Patients With Vasovagal Syncope.

    Science.gov (United States)

    Medow, Marvin S; Merchant, Sana; Suggs, Melissa; Terilli, Courtney; O'Donnell-Smith, Breige; Stewart, Julian M

    2017-04-01

    Recurrent postural vasovagal syncope (VVS) is caused by transient cerebral hypoperfusion from episodic hypotension and bradycardia; diagnosis is made by medical history. VVS contrasts with postural tachycardia syndrome (POTS), defined by chronic daily symptoms of orthostatic intolerance with excessive upright tachycardia without hypotension. POTS has recently been conflated with VVS when excessive tachycardia is succeeded by hypotension during tilt testing. We hypothesize that excessive tachycardia preceding hypotension and bradycardia is part of the vasovagal response during tilt testing of patients with VVS. We prospectively performed head-up tilt (HUT) testing on patients with recurrent VVS (n = 47, 17.9 ± 1.1 y), who fainted at least 3 times within the last year, and control subjects (n = 15, 17.1 ± 1.0 y), from age and BMI-matched volunteers and measured blood pressure, heart rate (HR), cardiac output, total peripheral resistance, and end tidal carbon dioxide. Baseline parameters were the same in both groups. HR (supine versus 5 and 10 minutes HUT) significantly increased in control (65 ± 2.6 vs 83 ± 3.6 vs 85 ± 3.7, P < .001) and patients with VVS (69 ± 1.6 vs 103 ± 2.3 vs 109 ± 2.4, P < .001). HUT in controls maximally increased HR by 20.3 ± 2.9 beats per minute; the increase in patients with VVS of 39.8 ± 2.1 beats per minute was significantly greater (P < .001). An increase in HR of ≥40 beats per minute by 5 and 10 minutes or before faint with HUT, occurred in 26% and 44% of patients with VVS, respectively, but not in controls. Orthostasis in VVS is accompanied by large increases in HR that should not be construed as POTS. Copyright © 2017 by the American Academy of Pediatrics.

  9. Supraclavicular brachial plexus block: Comparison of varying doses of dexmedetomidine combined with levobupivacaine: A double-blind randomised trial

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    Srinivasa Rao Nallam

    2017-01-01

    Full Text Available Background and Aims: The ideal dose of dexmedetomidine for brachial plexus block is a matter of debate. This study was carried out to evaluate 50 μg or 100 μg of dexmedetomidine added to 0.5% levobupivacaine, with regard to the duration of analgesia. Our study also sought to assess the onset and duration of sensorimotor blockade, haemodynamic effects, sedation and adverse effects. Methods: One hundred adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block were randomly allocated into two groups. Group LD50 received 29 ml of 0.5% levobupivacaine plus 50 μg of dexmedetomidine diluted in 1 ml of normal saline. Group LD100 received 29 ml of 0.5% levobupivacaine plus 100 μg of dexmedetomidine diluted in 1 ml of normal saline. Duration of analgesia was the primary outcome. Onset and duration of sensorimotor blockade, haemodynamic variables, sedation score, and adverse effects were secondary outcomes. The data were analysed with Students' t-test and Chi-square test. Results: The onset of sensory block and motor block was 14.82 ± 3.8 min and 19.75 ± 6.3 min, respectively, in group LD50, while it was 11.15 ± 1.7 min and 14.3 ± 4.2 min, respectively, in group LD100. The duration of analgesia was significantly prolonged in group LD100 (1033.6 ± 141.6 vs. 776.4 ± 138.6 min; P = 0.001. The incidence of bradycardia and sedation was observed in significantly more patients in group LD100. Significantly fewer patients in group LD100 required rescue analgesia. Conclusion: The 100 μg dose of dexmedetomidine in brachial plexus block hastens the onset and prolongs the duration of sensorimotor blockade and analgesia, but with higher incidence of bradycardia and sedation.

  10. The dive response redefined: underwater behavior influences cardiac variability in freely diving dolphins.

    Science.gov (United States)

    Noren, Shawn R; Kendall, Traci; Cuccurullo, Veronica; Williams, Terrie M

    2012-08-15

    A hallmark of the dive response, bradycardia, promotes the conservation of onboard oxygen stores and enables marine mammals to submerge for prolonged periods. A paradox exists when marine mammals are foraging underwater because activity should promote an elevation in heart rate (f(H)) to support increased metabolic demands. To assess the effect of the interaction between the diving response and underwater activity on f(H), we integrated interbeat f(H) with behavioral observations of adult bottlenose dolphins diving and swimming along the coast of the Bahamas. As expected for the dive response, f(H) while resting during submergence (40±6 beats min(-1)) was significantly lower than f(H) while resting at the water surface (105±8 beats min(-1)). The maximum recorded f(H) (f(H,max)) was 128±7 beats min(-1), and occurred during post-dive surface intervals. During submergence, the level of bradycardia was modified by activity. Behaviors such as simple head bobbing at depth increased f(H) by 40% from submerged resting levels. Higher heart rates were observed for horizontal swimming at depth. Indeed, the dolphins operated at 37-58% of their f(H,max) while active at depth and approached 57-79% of their f(H,max) during anticipatory tachycardia as the animals glided to the surface. f(H) was significantly correlated with stroke frequency (range=0-2.5 strokes s(-1), r=0.88, N=25 dives) and calculated swim speed (range=0-5.4 m s(-1), r=0.88, N=25 dives). We find that rather than a static reflex, the dive response is modulated by behavior and exercise in a predictable manner.

  11. Intravenous granisetron attenuates hypotension during spinal anesthesia in cesarean delivery: A double-blind, prospective randomized controlled study

    Directory of Open Access Journals (Sweden)

    Ahmed A Eldaba

    2015-01-01

    Full Text Available Background and Aims: This study was conducted to determine the effectiveness of intravenous (IV granisetron in the prevention of hypotension and bradycardia during spinal anesthesia in cesarean delivery. Material and Methods: A total of 200 parturients scheduled for elective cesarean section were included in this study. They were randomly divided into two groups. Group I was given 1 mg granisetron diluted in 10 ml normal saline slowly IV, 5 min before spinal anesthesia. Group II was given 10 ml of normal saline, 5 min before spinal anesthesia. Mean arterial blood pressure and heart rate (HR were recorded every 3 min until the end of surgery (for 45 min. The total consumption of vasopressors and atropine were recorded. Apgar scores at 1 and 5 min were also assessed. Results: Serial mean arterial blood pressure and HR values for 45 min after onset of spinal anesthesia were decreased significantly in group II, P < 0.0001. The incidence of hypotension after spinal anesthesia was 64% in group II and 3% in group I (P < 0.0001. The total doses of ephedrine (4.07 ± 3.87 mg vs 10.7 ± 8.9 mg, P < 0.0001, phenylephrine (0.0 microg vs 23.2 ± 55.1 microg, P < 0.0001, and atropine (0.0 mg vs 0.35 ± 0.49 mg P < 0.0001 consumed in both the groups respectively, were significantly less in group I versus group II. Conclusion: Premedication with 1 mg IV granisetron before spinal anesthesia in an elective cesarean section significantly reduces hypotension, bradycardia and vasopressors usage.

  12. Comparing the preventive effect of 2 percent Topical Lidocaine and Intravenous Atropine on oculocardiac reflex in Ophthalmological Surgeries under General Anesthesia

    Directory of Open Access Journals (Sweden)

    Parvin Sajedi

    2013-01-01

    Full Text Available Background: The current study aimed to determine preventive effect of 2 percent topical xylocaine on oculocardiac reflex in ophthalmological surgeries except strabismus, including retinal detachment and vitrectomy with scleral buckling under general anesthesia. Methods: A randomized controlled clinical trial was carried out on 150 patients aged 18-90 years undergoing ophthalmological surgeries under general anesthesia. Samples randomly divided into the experimental group (received four drops of 2 percent topical xylocaine instilled in desired eye and control group (received 0.5 mg atropine sulfate injection. Systolic, diastolic and mean arterial blood pressure of patients and baseline heart rate were recorded. They were compared regarding the incidence of bradycardia, heart rate less than 60 beats/minute, hypotension and blood pressure less than 90 mm/Hg. Data were analyzed by Statistical Package for the Social Sciences software version 20 using Chi-square and ANOVA. Results: The difference between two groups was not statistically significant regarding demographic and basic variables. The incidence of bradycardia in both groups was respectively (90.7 percent vs. 17.3 percent, heart rate less than 60 beats/minute (40 percent vs. 13.3 percent, hypotension (76 percent vs. 32 percent and blood pressure less than 90 mmHg was (28 percent vs. 8 percent. Accordingly, the differences between both groups were statistically significant (P > 0.001. Conclusions: The preventive impact of topical xylocaine upon oculocardiac reflex in ophthalmological surgeries such as retinal detachment and vitrectomy with scleral buckling under general anesthesia was less effective than that of atropine injection. Therefore, to avoid this reflex in high-risk patients, injecting atropine would be safer.

  13. Prevention of Spinal Anesthesia-Induced Hypotension During Cesarean Delivery by 5-Hydroxytryptamine-3 Receptor Antagonists: A Systematic Review and Meta-analysis and Meta-regression.

    Science.gov (United States)

    Heesen, Michael; Klimek, Markus; Hoeks, Sanne E; Rossaint, Rolf

    2016-10-01

    Hypotension remains a frequent complication of spinal anesthesia, increasing the risk of nausea and vomiting, altered mental status, and aspiration. The aim of this systematic review and meta-analysis was to determine whether 5-hydroxytryptamine3 (5-HT3) receptor antagonists, administered before the initiation of spinal anesthesia, mitigate hypotension. After a systematic literature search in various databases, randomized placebo-controlled double-blind trials studying the preventive effect of 5-HT3 receptor antagonists were included. A random-effects model was applied, risk ratio (RR, binary variables) or weighted mean difference (continuous variables) with 95% confidence intervals (CIs) were calculated. The primary outcome was the incidence of hypotension. Seventeen trials (8 obstetric, 9 non-obstetric) reporting on 1604 patients were identified. Ondansetron in doses from 2 to 12 mg was studied in 12 trials. Prophylactic 5-HT3 administration significantly reduced the risk of hypotension in the combined analysis of 17 trials, RR 0.54 (95% CI 0.36-0.81, I = 79%). In obstetric trials, the RR was 0.52, 95% CI 0.30-0.88, I = 87% (number needed to treat 4). In non-obstetric studies, the 95% CIs were wide and included a clinically relevant reduction in the risk of hypotension (RR 0.50, 95% CI 0.22-1.16; I = 66%). Contour-enhanced funnel plots confirmed publication bias. Meta-regression showed a significant ondansetron dose response in non-obstetric patients (β = -0.355, P = .04). In the combined and in the obstetric-only analysis, the risk of bradycardia was significantly reduced as was the use of phenylephrine equivalents. 5-HT3 antagonists are effective in reducing the incidence of hypotension and bradycardia; the effects are moderate and are only significant in the subgroup of patients undergoing cesarean delivery. The effects in the non-obstetric population are not significant.

  14. [Contraindications to succinylcholine in the intensive care unit. A prevalence study].

    Science.gov (United States)

    Muñoz-Martínez, T; Garrido-Santos, I; Arévalo-Cerón, R; Rojas-Viguera, L; Cantera-Fernández, T; Pérez-González, R; Díaz-Garmendia, E

    2015-03-01

    To determine the prevalence of contraindications to succinylcholine in patients admitted to the ICU. An observational study was carried out, describing the frequency of succinylcholine contraindication by stays, and associating the contraindications to population variables. The adult general ICU of a reference hospital. Clinical-surgical critically ill patients. Thirty consecutive days were analyzed. None. Population variables: age, sex, APACHE II and SOFA scores, illness, days of hospitalization, mechanical ventilation and renal replacement therapy. hyperkalemia, bedridden patients, rhabdomyolysis, muscle trauma, burns, infusion of neuromuscular blocking agents, acute renal failure, chronic renal failure, intraocular hypertension, intracranial hypertension, statin use, malignant hyperthermia, neuromuscular disease, spinal cord sectioning, bradycardia < 50 bpm, succinylcholine allergy, and pseudo-cholinesterase deficiency. A total of 102 patients were admitted, aged 60 ± 16 years (56.9% males), with the generation of 657 stays. Main diseases: elective heart surgery (33%), respiratory failure (22%) and sepsis (14%). We documented 466 stays (70.9%) with contraindications, particularly bedridden patients (n=140), neuromuscular blocking agents (n=101), acute renal failure (n=126), statin use (n=167), neuromuscular disease (n=159) and bradycardia (n=76). We recorded 74 stays (11.3%) at high risk of complications, secondary to hyperkalemic risk associated to receptor dysregulation. A high risk of complications was associated to advanced age, prolonged hospitalization, prolonged length of stay in the ICU, higher APACHE II and SOFA scores, mechanical ventilation and renal replacement therapy. Given the high prevalence of contraindications to succinylcholine observed, we discourage its use in patients admitted to the ICU. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  15. [Electrocardiographic abnormalities in anorexia nervosa: a critical review of the literature].

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    Vargas Upegui, Cristian; Gómez, Juliana

    2015-01-01

    Anorexia nervosa is an eating disorder in which cardiac arrhythmias and sudden death are frequent causes of mortality, which makes electrocardiographic monitoring indispensable in these patients. There are many suggestive findings but results are contradictory, making a critical review of the scientific literature is necessary. The most relevant studies on electrocardiographic (EKG) changes in patients with AN, found in PubMed from 1974 to February 2014, were reviewed using the MeSH terms: eating disorders, nervosa anorexia, sinus bradycardia, QT prolongation, QT dispersion, electrocardiography, EKG, and electrocardiogram. The two most common EKG findings reported in the literature are sinus bradycardia and changes in depolarization, as shown by prolongation and increased dispersion of the QT interval. Electrolyte disturbances seem to be the cause of these disturbances in some patients, but other reasons are also discussed in detail, such as QRS right axis deviation, disturbances of heart rate variability, low R wave voltage in V6, amplitude decrease of the QRS and T wave, and QRS prolongation. The majority of authors report that these changes are reversible after treatment of AN. These findings support the need for initial and follow-up EKGs in patients with AN and for early diagnosis and treatment of cardiovascular disturbances that are associated with morbidity and mortality. They also support the need for the rational use of psychopharmacology, and that does not increase the risk of arrhythmias and sudden death in these patients. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  16. Sleep-disordered breathing and daytime cardiac conduction abnormalities on 12-lead electrocardiogram in community-dwelling older men.

    Science.gov (United States)

    Kwon, Younghoon; Picel, Katherine; Adabag, Selcuk; Vo, Tien; Taylor, Brent C; Redline, Susan; Stone, Katie; Mehra, Reena; Ancoli-Israel, Sonia; Ensrud, Kristine E

    2016-12-01

    Nocturnal cardiac conduction abnormalities are commonly observed in patients with sleep-disordered breathing (SDB). However, few population-based studies have examined the association between SDB and daytime cardiac conduction abnormalities. We examined a random sample of 471 community-dwelling men, aged ≥67 years, enrolled in the multi-center Outcomes of Sleep Disorders in Older Men (MrOS Sleep) study. SDB severity was categorized using percent of total sleep time with oxygen saturation <90 % (%TST < 90) and apnea hypopnea index (AHI). Cardiac conduction parameters were assessed by resting 12-lead electrocardiography (ECG). All analyses were adjusted for age, site, β-blocker use, coronary heart disease, calcium channel blocker use, and use of antiarrhythmic medications. Mean age was 77 ± 6 years, median %TST < 90 was 0.7 (IQR 0.00-3.40), and median AHI was 7.06 (IQR 2.55-15.32). Men with greater nocturnal hypoxemia (%TST < 90 ≥ 3.5 %) compared with those without hypoxemia (%TST < 90 < 1.0 %) had a lower odds of bradycardia (OR 0.55 [0.32-0.94]) and right bundle branch block (RBBB) (OR 0.24 [0.08-0.75]) but a higher odds of ventricular paced rhythm (OR 4.42 [1.29-15.19]). Heart rate (HR) increased in a graded manner with increasing %TST < 90 (p-trend 0.01) and increasing AHI (p-trend 0.006), but these gradients were small in absolute magnitude. There were no associations of SDB measures with other ECG conduction parameters. Greater nocturnal hypoxemia in older men was associated with a lower prevalence of daytime sinus bradycardia and RBBB, a higher prevalence of ventricular paced rhythm, and higher resting HR.

  17. Physiological phenomenology of neurally-mediated syncope with management implications.

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    Christoph Schroeder

    Full Text Available BACKGROUND: Due to lack of efficacy in recent trials, current guidelines for the treatment of neurally-mediated (vasovagal syncope do not promote cardiac pacemaker implantation. However, the finding of asystole during head-up tilt -induced (presyncope may lead to excessive cardioinhibitory syncope diagnosis and treatment with cardiac pacemakers as blood pressure is often discontinuously measured. Furthermore, physicians may be more inclined to implant cardiac pacemakers in older patients. We hypothesized that true cardioinhibitory syncope in which the decrease in heart rate precedes the fall in blood pressure is a very rare finding which might explain the lack of efficacy of pacemakers in neurally-mediated syncope. METHODS: We studied 173 consecutive patients referred for unexplained syncope (114 women, 59 men, 42 ± 1 years, 17 ± 2 syncopal episodes. All had experienced (presyncope during head-up tilt testing followed by additional lower body negative suction. We classified hemodynamic responses according to the modified Vasovagal Syncope International Study (VASIS classification as mixed response (VASIS I, cardioinhibitory without (VASIS IIa or with asystole (VASIS IIb, and vasodepressor (VASIS III. Then, we defined the exact temporal relationship between hypotension and bradycardia to identify patients with true cardioinhibitory syncope. RESULTS: Of the (presyncopal events during tilt testing, 63% were classified as VASIS I, 6% as VASIS IIb, 2% as VASIS IIa, and 29% as VASIS III. Cardioinhibitory responses (VASIS class II progressively decreased from the youngest to the oldest age quartile. With more detailed temporal analysis, blood pressure reduction preceded the heart-rate decrease in all but six individuals (97% overall and in 10 out of 11 patients with asystole (VASIS IIb. CONCLUSIONS: Hypotension precedes bradycardia onset during head-up tilt-induced (presyncope in the vast majority of patients, even in those classified as

  18. Quantification of adenosine A(1) receptor biased agonism: Implications for drug discovery.

    Science.gov (United States)

    Baltos, Jo-Anne; Gregory, Karen J; White, Paul J; Sexton, Patrick M; Christopoulos, Arthur; May, Lauren T

    2016-01-01

    Adenosine A1 receptor (A1AR) stimulation is a powerful protective mechanism in cerebral and cardiac ischemia-reperfusion injury. Despite this, therapeutic targeting of the A1AR for the treatment of ischemia-reperfusion injury has been largely unsuccessful, as high concentrations of prototypical A1AR agonists impart significant hemodynamic effects, particularly pronounced bradycardia, atrioventricular block and hypotension. Exploiting the phenomenon of biased agonism to develop ligands that promote A1AR cytoprotection in the absence of adverse hemodynamic effects remains a relatively unexplored, but exciting, approach to overcome current limitations. In native systems, the atypical A1AR agonists VCP746 and capadenoson retain cytoprotective signaling in the absence of bradycardia, a phenomenon suggestive of biased agonism. The current study used pharmacological inhibitors to investigate A1AR mediated cytoprotective signal transduction in a CHO FlpIn cell background, thus identifying candidate pathways for quantitative bias profiling, including cAMP, extracellular signal-regulated kinases 1 and 2 and Akt1/2/3. Subsequently, effects on cell survival and the bias profile of VCP746 and capadenoson were determined and compared to that of the prototypical A1AR agonists, NECA, R-PIA, MeCCPA and CPA. We found that prototypical agonists do not display significant bias for any of the pathways assessed. In contrast, VCP746 and capadenoson show significant bias away from calcium mobilization relative to all pathways tested. These studies demonstrate that quantitative "fingerprinting" of biased agonism within a model system can enable ligands to be clustered by their bias profile, which in turn may be predictive of preferential physiologically relevant in vivo pharmacology. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. First Case of Autonomic Dysreflexia Following Elective Lower Thoracic Spinal Cord Transection in a Spina Bifida Adult.

    Science.gov (United States)

    Garces, Juanita; Mathkour, Mansour; Scullen, Tyler; Kahn, Lora; Biro, Erin; Pham, Alex; Sulaiman, Olawale A R; Smith, Roger; Bui, Cuong J

    2017-12-01

    Spinal cord transection is a radical but effective treatment for highly selective cases of symptomatic spinal retethering in paraplegic spina bifida patients. Autonomic dysreflexia (AD) is a potentially life-threatening syndrome involving a dysregulated sympathetic discharge reflex commonly seen following cervical and high thoracic spinal cord injury, leading to a disconnect between autonomic pathways above and below the lesion that can lead to severe complications including uncontrolled hypertension, bradycardia, stroke, and potentially death. Herein we present a case in which a paraplegic spina bifida patient presenting with symptomatic spinal retethering experienced autonomic dysreflexia following an elective spinal cord transection. A 51-year-old male with a history of complex spina bifida presented with an active cerebrospinal fluid leak. Physical examination revealed a thin covering of abnormal epidermis over the large placode. Magnetic resonance imaging revealed a large myelomeningocele defect with posterior element defects spanning from L2 to the sacrum with evidence of tethering. The patient underwent an intradural transection of the spinal cord with a "blind-pouch" closure of the dura at the level of T12/L1. Postoperatively, the patient developed intermittent episodes of hypertension, bradycardia, headaches, altered mental status, severe perspiration, and red flushing of the upper torso, face, and arms. The diagnosis of AD was made clinically and managed with a positive response to a combination of beta- and alpha-blockade along with patient education on avoidance of common AD triggers. At 5-year follow-up the patient has continued to do well on medication. This case highlights a potential major side effect from elective transection of the spinal cord. If unrecognized and untreated, AD can cause significant distress and morbidity. We hope this first case report serves to supplement existing data and aid in future surgical and medical decision

  20. Guillain-Barré Syndrome with asystole requiring permanent pacemaker: a case report

    Directory of Open Access Journals (Sweden)

    Patel Mehul B

    2009-01-01

    Full Text Available Abstract Introduction Guillain-Barré syndrome is an acute demyelinating disorder of the peripheral nervous system that results from an aberrant immune response directed at peripheral nerves. Autonomic abnormalities in Guillain-Barré syndrome are usually transient and reversible. We present a case of Guillain-Barré syndrome requiring a permanent pacemaker in view of persistent symptomatic bradyarrhythmia. Case Presentation An 18-year-old Caucasian female presented with bilateral lower limb paraesthesias followed by bilateral progressive leg weakness and difficulty in walking. She reported an episode of an upper respiratory tract infection 3 weeks prior to the onset of her neurological symptoms. Diagnosis of Guillain-Barré syndrome was considered and a lumbar puncture was performed. Cerebrospinal fluid revealed albuminocytologic dissociation (increased protein but normal white blood cell count suggestive of Guillain-Barré syndrome and hence an intravenous immunoglobulin G infusion was started. Within 48 hours, she progressed to complete flaccid quadriparesis with involvement of respiratory muscles requiring mechanical ventilatory support. Whist in the intensive care unit, she developed multiple episodes of bradycardia and asystole requiring a temporary pacemaker. In view of the persistent requirement for the temporary pacemaker for more than 5 days, she received a permanent pacemaker. She returned for follow-up three months after discharge with an intermittent need for ventricular pacing. Conclusion Guillain-Barré syndrome can result in permanent damage to the cardiac conduction system. Patients with multiple episodes of bradycardia and asystole in the setting of Guillain-Barré syndrome should be evaluated and considered as potential candidates for permanent pacemaker implantation.

  1. Effect of remifentanil with and without atropine on heart rate variability and RR interval in children.

    Science.gov (United States)

    Tirel, O; Chanavaz, C; Bansard, J Y; Carré, F; Ecoffey, C; Senhadji, L; Wodey, E

    2005-10-01

    Remifentanil can cause bradycardia either by parasympathetic activation or by other negative chronotropic effects. The high frequency (HF) component of heart rate variability (HRV) is a marker of parasympathetic activity. This study aimed to evaluate the effect of remifentanil on RR interval and on HRV in children. Forty children ASA I or II were studied after approval by the human studies committee and informed parental consent was obtained. After stabilisation at sevoflurane 1 MAC, they were randomly divided into two groups: one received a 20 microg.kg(-1) atropine injection (AT + REMI) and the other ringer lactate solution (REMI). Three minutes later, a 1 microg.kg(-1) bolus of remifentanil was administered over 1 min, followed by a continual infusion at 0.25 microg.kg(-1).min(-1) for 10 min increased to 0.5 microg.kg(-1).min(-1) for a further 10 min. A time varying, autoregressive analysis of RR sequences was used to estimate classical spectral parameters: low (0.04-0.15 Hz; LF) and high (0.15-0.45 Hz; HF) frequency, whereas the root mean square of successive differences of RR intervals (rmssd) was derived directly from the temporal sequence. Statistical analyses were conducted by means of the multiple correspondence analysis and with non parametrical tests. Remifentanil induced an RR interval lengthening, i.e. bradycardia, in both groups compared to pretreatment values and was associated with an increase of HF and rmssd only for the REMI group. The parasympathetic inhibition by atropine did not totally prevent remifentanil's negative chronotropic effect. A direct negative chronotropic effect of remifentanil is proposed.

  2. [Clinical safety and efficacy of single-chamber atrial pacing in sick sinus syndrome: long-term follow-up].

    Science.gov (United States)

    Moríñigo, Jose L; Arribas, Antonio; Ledesma, Claudio; Sánchez, Pedro L; Martín, Francisco; Martín Luengo, Cándido

    2002-12-01

    Although atrial pacing is a more physiological mode of stimulation in sinus node dysfunction, the pacing modes most often are used DDD and VVI. The aim of our study was to demonstrate that AAI/AAIR pacing is effective and safe by analyzing the complications and mortality of this pacing mode in a long-term follow-up study. Between 1982 and 2000 definitive AAI-mode pacemakers were implanted for sinus node dysfunction in mode AAI in 160 patients. We analyzed the clinical characteristics, evolution, and complications of the AAI pacing mode during a follow-up of 5.4 4.5 years. The sample was made up of 104 women and 56 men with an average age of 72 12 years. During follow-up, it was necessary to change the pacing mode for symptomatic bradycardia in 11 patients (annual incidence 1.2%), which was caused by second or third-degree atrioventricular block in 7 patients (annual incidence 0.8%), and chronic atrial fibrillation with bradycardia in 4 patients (annual incidence 0.4%). During follow-up, atrial arrhythmias occurred in 32 patients (annual incidence 3.7%), stroke in 4 patients (annual incidence 0.4%), and 27 patients (annual incidence 3.1%) died. The AAI/AAIR pacing mode was safe and effective in sinus node dysfunction, with a low percentage of pacing changes required for progression to atrioventricular block, low incidence of atrial arrhythmias, stroke and low mortality during long term follow-up.

  3. Nitric oxide and regulation of heart rate in patients with postural tachycardia syndrome and healthy subjects.

    Science.gov (United States)

    Gamboa, Alfredo; Okamoto, Luis E; Raj, Satish R; Diedrich, André; Shibao, Cyndya A; Robertson, David; Biaggioni, Italo

    2013-02-01

    The objective is to study the role of nitric oxide (NO) on cardiovascular regulation in healthy subjects and postural tachycardia syndrome (POTS) patients. Reduced neuronal NO function, which could contribute to a hyperadrenergic state, and increased NO-induced vasodilation, which could contribute to orthostatic intolerance, have been reported in POTS. In protocol 1, 13 healthy volunteers (33 ± 3 years) underwent autonomic blockade with trimethaphan and were administered equipressor doses of Nω-monomethyl-L-arginine (L-NMMA, a NO synthase inhibitor) and phenylephrine to determine the direct chronotropic effects of NO (independent of baroreflex modulation). In protocol 2, we compared the effects of L-NMMA in 9 POTS patients (31 ± 3 years) and 14 healthy (32 ± 2 years) volunteers, during autonomic blockade. During autonomic blockade, L-NMMA and phenylephrine produced similar increases in systolic blood pressure (27 ± 2 versus 27 ± 3 mm Hg). Phenylephrine produced only minimal heart rate changes, whereas L-NMMA produced a modest, but significant, bradycardia (-0.8 ± 0.4 versus -4.8 ± 1.2 bpm; P=0.011). There were no differences between POTS and healthy volunteers in the systolic blood pressure increase (22 ± 2 and 28 ± 5 mm Hg) or heart rate decrease (-6 ± 2 and -4 ± 1 bpm for POTS and controls, respectively) produced by L-NMMA. In the absence of baroreflex buffering, inhibition of endogenous NO synthesis results in a significant bradycardia, reflecting direct tonic modulation of heart rate by NO in healthy individuals. We found no evidence of a primary alteration in NO function in POTS. If NO dysfunction plays a role in POTS, it is through its interaction with the autonomic nervous system.

  4. Early Training-Induced Reduction of Angiotensinogen in Autonomic Areas-The Main Effect of Exercise on Brain Renin-Angiotensin System in Hypertensive Rats.

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    Laiali Jurdi Chaar

    Full Text Available Exercise training (T blunts functional deficits and renin-angiotensin system (RAS hyperactivity in hypertensive individuals. There is no information on T-induced temporal changes of brain RAS. We evaluate now the simultaneous effects of T on functional responses and time course changes in the expression/activity of brain RAS components in autonomic cardiovascular-controlling areas.Spontaneously hypertensive rats (SHR and age-matched normotensive controls (WKY were trained for 0, 1, 2, 4, 8 and 12 weeks. Sedentary (S groups served as time-controls. After arterial pressure (AP and heart rate (HR recordings at rest, fresh and fixed brains were harvested for qPCR and immunofluorescence assays. SHR-S vs. WKY-S exhibited higher mean AP (MAP and HR, increased pressure variability and sympathetic activity, elevated AT1 receptor (AT1 expression in nucleus tractus solitarii (NTS and higher Mas receptor expression in the rostroventrolateral medulla (RVLM. In SHR, T promptly (T2 on reduced sympathetic variability to heart/vessels and largely decreased angiotensinogen expression in the paraventricular hypothalamic nucleus (PVN and NTS, with a late RVLM reduction (T4. AT1 expression was only reduced at T12 (PVN and NTS with transient, not maintained Mas receptor changes in PVN and RVLM. These responses were accompanied by baseline MAP and HR reduction in the SHR-T (from T4 on. In the SHR group, PVN angiotensinogen expression correlated positively with sympathetic activity, resting MAP and HR. In WKY-T, a precocious (T2-T12 RVLM AT1 decrease preceded the appearance of resting bradycardia (from T8 on.Early and maintained reduction of angiotensinogen content in autonomic areas of the SHR is the most prominent effect of training on brain RAS. Down-regulation of PVN RAS expression is an essential factor to drive cardiovascular benefits in SHR-T, while resting bradycardia in WKY-T is correlated to RVLM AT1 reduction.

  5. Early Training-Induced Reduction of Angiotensinogen in Autonomic Areas-The Main Effect of Exercise on Brain Renin-Angiotensin System in Hypertensive Rats.

    Science.gov (United States)

    Chaar, Laiali Jurdi; Alves, Tatiana Pereira; Batista Junior, Alvaro Martins; Michelini, Lisete Compagno

    2015-01-01

    Exercise training (T) blunts functional deficits and renin-angiotensin system (RAS) hyperactivity in hypertensive individuals. There is no information on T-induced temporal changes of brain RAS. We evaluate now the simultaneous effects of T on functional responses and time course changes in the expression/activity of brain RAS components in autonomic cardiovascular-controlling areas. Spontaneously hypertensive rats (SHR) and age-matched normotensive controls (WKY) were trained for 0, 1, 2, 4, 8 and 12 weeks. Sedentary (S) groups served as time-controls. After arterial pressure (AP) and heart rate (HR) recordings at rest, fresh and fixed brains were harvested for qPCR and immunofluorescence assays. SHR-S vs. WKY-S exhibited higher mean AP (MAP) and HR, increased pressure variability and sympathetic activity, elevated AT1 receptor (AT1) expression in nucleus tractus solitarii (NTS) and higher Mas receptor expression in the rostroventrolateral medulla (RVLM). In SHR, T promptly (T2 on) reduced sympathetic variability to heart/vessels and largely decreased angiotensinogen expression in the paraventricular hypothalamic nucleus (PVN) and NTS, with a late RVLM reduction (T4). AT1 expression was only reduced at T12 (PVN and NTS) with transient, not maintained Mas receptor changes in PVN and RVLM. These responses were accompanied by baseline MAP and HR reduction in the SHR-T (from T4 on). In the SHR group, PVN angiotensinogen expression correlated positively with sympathetic activity, resting MAP and HR. In WKY-T, a precocious (T2-T12) RVLM AT1 decrease preceded the appearance of resting bradycardia (from T8 on). Early and maintained reduction of angiotensinogen content in autonomic areas of the SHR is the most prominent effect of training on brain RAS. Down-regulation of PVN RAS expression is an essential factor to drive cardiovascular benefits in SHR-T, while resting bradycardia in WKY-T is correlated to RVLM AT1 reduction.

  6. Efectos de la hindarina sobre las aurículas aisladas

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    Roberto Luis Rojas Martínez

    1997-12-01

    Full Text Available Se presentan los efectos de la hindarina y de la clorpromacina sobre la amplitud y la frecuencia de las contracciones espontáneas de las aurículas aisladas de rata. La hindarina produjo bradicardia moderada y aumento discreto de la amplitud de las contracciones en forma dosis-dependiente, en tanto que la clorpromacina deprimió más intensamente tanto la frecuencia como la amplitud de dichas contracciones. Se descartó una acción colinérgica o beta-bloqueadora en la producción de la bradicardia por la hindarina. Se descartó también una acción cardiotónica de la hindarina en las aurículas aisladas de cobayo deprimidas por solución hipocálcica o por hipoxia. Se sugiere su estudio como antiarrítmico.The effects of hindarine and of chlorpromazine on the amplitude and frequency of the spontaneous contractions of rats' isolated atria are presented. Hindarine produced a moderate bradycardia and a discreet increase of the contractions in a dosage-dependent way. Chlorpromazine caused a greater depression of the frequency and amplitude of these contractions. The cholinergic or beta-blocker action was discarded in the production of bradycardia brought about by hindarine. It was also eliminated a cadiotonic action of hindarine in the isolated atria of guinea pig depressed by hypocalcic solution or by hipoxia. It is suggested its study as an antiarrhythmic.

  7. Trigemino-Cardiac Reflex: A Phenomenon Neglected in Maxillofacial Surgery?

    Science.gov (United States)

    Joshi, Udupikrishna M; Munnangi, Ashwini; Shah, Kundan; Patil, Satishkumar G; Thakur, Nitin

    2017-06-01

    Trigemino-cardiac reflex is a physiologic response of the body to pressure effects in the region of distribution of the trigeminal nerve. Oral and maxillofacial surgical procedures can induce the development of this reflex, which leads to significant changes in the heart rate and sinus rhythms. This study intends to evaluate the effects of this reflex in patients with facial fractures and its subsequent management. A total of thirty-seven patients with facial fractures who reported to the Department of Oral and Maxillofacial Surgery at Basaveswar Teaching and General Hospital, Gulbarga during a period from July 2015-March 2016 were considered for the study. A male preponderance is observed with the most susceptible age group being 21-30 years. Twenty-three patients sustained mid-facial fractures alone, nine patients had isolated mandible fractures and five patients had fractures of both the mid-face and mandible. A relative bradycardia was observed in the patients with mid-facial trauma, both at the time of presentation and also during the surgical reduction of midfacial fractures which improved after completion of procedure in most of the patients. However, in two patients, the bradycardia progressed to a cardiac asystole during midface manipulation which required immediate halt of the procedure and intravenous administration of atropine. Trigeminocardiac reflex though physiologic, which usually tends to subside without complications is not to be neglected in the surgeries of the maxillofacial skeleton. A propensity for unforeseen complications due to this reflex has to be avoided by meticulous monitoring of the ECG.

  8. Effectiveness and safety of nicardipine and labetalol infusion for blood pressure management in patients with intracerebral and subarachnoid hemorrhage.

    Science.gov (United States)

    Ortega-Gutierrez, Santiago; Thomas, Jiz; Reccius, Andres; Agarwal, Sachin; Lantigua, Hector; Li, Min; Carpenter, Amanda M; Mayer, Stephan A; Schmidt, J Michael; Lee, Kiwon; Claassen, Jan; Badjatia, Neeraj; Lesch, Christine

    2013-02-01

    Nicardipine and labetalol are two commonly used antihypertensives for treating elevated blood pressures in the setting of intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). There are no studies comparing these two agents as continuous infusions. A retrospective chart review was conducted of patients admitted between November 2009 and January 2011 with ICH and SAH to compare effectiveness and safety between both agents. Percent time spent at goal was set as the primary outcome. The secondary outcomes included blood pressure variability, time to goal, incidence of bradycardia, tachycardia, and hypotension. A total of 81 patients were available for analysis, 10 initiated on labetalol (LAB), 57 on nicardipine (NIC), and 14 required the combination of these agents (COMB) to reach goal. We found no difference between NIC, LAB, and the COMB groups in the median percent time at goal [88 % (61-98); 93 % (51-99); 66 % (25-95), (p = NS)]. Median percentage of blood pressure variability, hypotension, and bradycardia were also comparable between groups, however, more tachycardia was observed in the COMB group versus both LAB and NIC groups (45 vs. 0 vs. 3 %; p < 0.001). Mean time to goal SBP in 24 patients who had BP readings available at 1st h of initiation was 32 ± 34 min in the NIC group and 53 ± 42 min in the LAB group (p = 0.03). Both agents appear equally effective and safe for blood pressure control in SAH and ICH during the initial admission hours. A prospective study is needed to validate these findings.

  9. Effects of aerobic exercise training on heart rate variability during wakefulness and sleep and cardiorespiratory responses of young and middle-aged healthy men

    Directory of Open Access Journals (Sweden)

    A.M. Catai

    2002-06-01

    Full Text Available The purpose of the present study was to evaluate the effects of aerobic physical training (APT on heart rate variability (HRV and cardiorespiratory responses at peak condition and ventilatory anaerobic threshold. Ten young (Y: median = 21 years and seven middle-aged (MA = 53 years healthy sedentary men were studied. Dynamic exercise tests were performed on a cycloergometer using a continuous ramp protocol (12 to 20 W/min until exhaustion. A dynamic 24-h electrocardiogram was analyzed by time (TD (standard deviation of mean R-R intervals and frequency domain (FD methods. The power spectral components were expressed as absolute (a and normalized units (nu at low (LF and high (HF frequencies and as the LF/HF ratio. Control (C condition: HRV in TD (Y: 108, MA: 96 ms; P<0.05 and FD - LFa, HFa - was significantly higher in young (1030; 2589 ms²/Hz than in middle-aged men (357; 342 ms²/Hz only during sleep (P<0.05; post-training effects: resting bradycardia (P<0.05 in the awake condition in both groups; VO2 increased for both groups at anaerobic threshold (P<0.05, and at peak condition only in young men; HRV in TD and FD (a and nu was not significantly changed by training in either groups. The vagal predominance during sleep is reduced with aging. The resting bradycardia induced by short-term APT in both age groups suggests that this adaptation is much more related to intrinsic alterations in sinus node than in efferent vagal-sympathetic modulation. Furthermore, the greater alterations in VO2 than in HRV may be related to short-term APT.

  10. Is there a difference in mad honey poisoning between geriatric and non-geriatric patient groups?

    Science.gov (United States)

    Yaylacı, S; Ayyıldız, O; Aydın, E; Osken, A; Karahalil, F; Varım, C; Demir, M V; Genç, A B; Sahinkus, S; Can, Y; Kocayigit, İ; Bilir, C

    2015-12-01

    /sinus bradycardia, 12 (14.6%) patients had a 1st degree atrioventricular block, 3 (3.7%) patients had nodal rhythm, 1 (1.2%) patient had atrial fibrillation and 1 (1.2%) patient had preexcitation. There were no significant pathological findings in the routine laboratory examinations of patients. It was found that all patients achieved normal sinus rhythm and normal blood pressure values after medical treatment, and were discharged approximately 5.65 hours after observation and follow-up. In our study, prolonged intensive-care need, pacemaker need and mortality caused by mad honey intoxication were not found. In the comparison of data of all patients above and below 65 years of age, there was a statistically significant finding that the geriatric patients consume mad honey mostly for hypotensive purposes and gastrointestinal complaints; in addition, the symptoms were starting early and the recovery period was longer in geriatric patients. The mad honey poisoning should be considered in previously healthy patients with unexplained symptoms of bradycardia, hypotension, and atrioventricular block. Therefore, diet history should carefully be obtained from the patients admitted with bradycardia and hypotension. And, in addition to the primary cardiac, neurological and metabolic disorders, mad honey intoxication should also be considered in the differential diagnosis. In geriatric patients admitted due to mad honey intoxication, the mad honey is usually consumed to reduce blood pressure and resolve gastrointestinal problems; and, their symptoms begin early, and last longer after mad honey consumption. In terms of other parameters, the geriatric age group has similar characteristics to non-geriatric age group.

  11. Ictal ECG changes in temporal lobe epilepsy Alterações eletrocardiográficas ictais em epilepsia do lobo temporal

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    L.M. Li

    1995-09-01

    Full Text Available Changes in cardiac rhythm may occur during epileptic seizures and this has been suggested as a possible mechanism for sudden unexpected death amongst patients with chronic epilepsy (SUDEP. We have studied ECG changes during 61 complex partial seizures of temporal lobe origin in 20 patients. Tachycardia was observed in 24/61 (39% and bradycardia in 3/61 (5%. The mean and median tachycardia rate was 139 and 140 beats/min (range 120-180. The longest R-R interval observed was 9 seconds. No difference was found in regard to the lateralisation of seizures and cardiac arrhytmia. One of the patients with bradycardia was fitted with a demand cardiac pacemaker, which appeared to decrease the number of his falls. In conclusion, ictal cardiac changes which may be seen in temporal lobe epilepsy (TLE are sinus tachycardia and occasionally sinus bradycardia. Patients presenting vague complains suggestive of either TLE or cardiac dysrhythmia, simultaneous monitoring with EEG/ECG is required, and if the episodes are frequent, video-EEG should be considered. Further studies on this subject are warranted as this may shed some light on possible mechanisms for SUDEP.Alterações no ritmo cardíaco podem ocorrer durante crises epilépticas. Estas alterações têm sido sugeridas como possível mecanismo para explicar morte súbita em pacientes com epilepsia crônica. Analisamos o eltrocardiograma (ECG em 61 crises parciais complexas do lobo temporal de 20 pacientes. Taquicardia foi observada em 24/61 (39% e bradicardia em 3/61 (5%. A média e a mediana da taquicardia foram 139 e 140 batimentos por minuto (variando de 120-180. O intervalo R-R mais longo foi 9 segundos. Não houve diferença em relação a lateralisação das crises e alteração do ritmo cardíaco. Um paciente com bradicardia recebeu marcapasso de demanda, com diminuição importante das suas quedas durante as crises. Em conclusão, as alterações cardíacas ictais em crises do lobo temporal mais

  12. [Anesthesia and Angelman syndrome].

    Science.gov (United States)

    Witte, W; Nobel, C; Hilpert, J

    2011-07-01

    patients. For the preoperative consultation and anesthetization, communication with the patients requires the aid of parents or other relatives. Water and reflecting surfaces may be used to gain contact with AS patients. Patients with AS feel pain like any other person although they are frequently smiling and laughing and this has to be considered especially in major surgery (e.g. scoliosis surgery). The most important life-threatening complication is bradycardia due to vagal hypertonia which can lead to asystole with delayed response to atropine. None of the Berlin patients had severe bradycardia but the complication has to be taken into consideration. The use of drugs to ensure complete reversal of neuromuscular relaxation should be avoided because anticholinergic agents could cause bradycardia. The use of sugammadex in cases of AS has not been tested. To avoid elevation of the vagal tone, the indications for laparascopy have to be considered very carefully. There is no evidence that any drug or hypnotic may be more appropriate or advantageous. Balanced anesthesia and total intravenous anesthesia are possible but the duration of drug effect has to be taken into account. If ketamine is used the side-effects of the drug (psychomimetic reactions, muscular rigidity) should be prevented by the consistent administration of propofol, midazolam or thiopental. Usually AS patients are agitated so that regional anesthesia techniques are difficult to administer. If regional anesthesia does have considerable advantages over general anesthesia in a particular case, peripheral regional anesthesia should be preferred, especially because scoliosis is often present. There is no evidence that AS patients cause more intubation problems but because of facial dysmorphia accurate evaluation is needed in advance. This is even more important for older AS patients because the dysmorphia tends to accelerate during the course of life. Although epilepsy is the primary feature of AS, not every EEG

  13. Safety of cardiac magnetic resonance and contrast angiography for neonates and small infants: a 10-year single-institution experience

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    Rangamani, Sheela; Li, Ling; Harvey, Lisa; Fletcher, Scott E.; Danford, David A.; Kutty, Shelby [University of Nebraska College of Medicine/Creighton University School of Medicine, Joint Division of Pediatric Cardiology, Omaha, NE (United States); Varghese, Joby [Children' s Hospital and Medical Center, Division of Pediatric Cardiac Anesthesia, Omaha, NE (United States); Hammel, James M.; Duncan, Kim F. [Children' s Hospital and Medical Center, Division of Cardiothoracic Surgery, Omaha, NE (United States)

    2012-11-15

    With increasing applications of cardiac magnetic resonance (CMR) and magnetic resonance angiography (MRA) for evaluation of congenital heart disease (CHD), safety of this technology in the very young is of particular interest. We report our 10-year experience with CMR in neonates and small infants with particular focus on the safety profile and incidence of adverse events (AEs). We reviewed clinical, anesthesia and nursing records of all children {<=}120 days of age who underwent CMR. We recorded variables including cardiac diagnosis, study duration, anesthesia type and agents, prostaglandin E1 (PGE1) dependence and gadolinium (Gd) use. Serially recorded temperature, systemic saturation (SpO{sub 2}) and cardiac rhythm were analyzed. Primary outcome measure was any AE during or <24 h after the procedure, including minor AEs such as hypothermia (axillary temperature {<=}95 F), desaturation (SpO{sub 2} drop {>=}10% below baseline) and bradycardia (heart rate {<=}100 bpm). Secondary outcome measure was unplanned overnight hospitalization of outpatients. Children (n = 143; 74 boys, 69 girls) had a median age of 6 days (1-117), and 98 were {<=}30 days at the time of CMR. The median weight was 3.4 kg (1.4-6 kg) and body surface area 0.22 m{sup 2} (0.13-0.32 m{sup 2}). There were 118 (83%) inpatients (108 receiving intensive care) and 25 (17%) outpatients. Indications for CMR were assessment of aortic arch (n = 57), complex CHD (n = 41), pulmonary veins (n = 15), vascular ring (n = 8), intracardiac mass (n = 8), pulmonary artery (n = 7), ventricular volume (n = 4), and systemic veins (n = 3). CMR was performed using a 1.5-T scanner and a commercially available coil. CMR utilized general anesthesia (GA) in 86 children, deep sedation (DS) in 50 and comforting methods in seven. MRA was performed in 136 children. Fifty-nine children were PGE1-dependent and 39 had single-ventricle circulation. Among children on PGE1, 43 (73%) had GA and 10 (17%) had DS. Twelve children (9%) had

  14. Intoxication due to Papaver rhoeas (Corn Poppy): Five Case Reports.

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    Günaydın, Yahya Kemal; Dündar, Zerrin Defne; Çekmen, Bora; Akıllı, Nazire Belgin; Köylü, Ramazan; Cander, Başar

    2015-01-01

    Introduction. In this paper, we aimed to present five Papaver rhoeas intoxication cases, which is very rare in the literature. Case 1. A 35-year-old female patient was admitted to our emergency room with the complaints of nausea, restlessness, and dyspnea developing 3 hours after eating Papaver rhoeas. On physical examination, her general condition was moderate; she was conscious and the vital findings were normal. The pupils were myotic. She was transferred to the toxicology intensive care unit as she experienced a generalized tonic clonic seizure lasting for three minutes. Case 2. A 41-year-old female patient was brought to our emergency room by 112 ambulance as she had contractions in her arms and legs, unconsciousness, and foam coming from her mouth two hours after Papaver rhoeas ingestion. On physical examination, she was confused, the pupils were myotic, and she was tachycardic. Arterial blood gases analysis revealed lactic acidosis. Case 3. A 38-year-old female patient was admitted to our emergency room with complaints of nausea and vomiting two hours after ingestion of Papaver rhoeas. Her physical examination and tests were normal. Case 4. A 34-year-old male patient was admitted to our emergency room with complaints of numbness and loss of power in his arms and legs one hour after Papaver rhoeas ingestion. He was hospitalized at the toxicology intensive care unit for follow-up and treatment. Dyspnea and bradycardia developed on the follow-up. The oxygen saturation without oxygen support was 90%. ECG revealed sinus bradycardia. The cardiac enzymes did not increase. Case 5. A 42-year-old female patient was brought to our emergency room by 112 ambulance with contractions in her arms and legs and unconsciousness two hours after Papaver rhoeas ingestion. On her physical examination, she was confused and the pupils were myotic. Arterial blood gases analysis revealed lactic acidosis. Conclusion. All patients were followed up for a few days and then discharged from

  15. SEGMENTAL EPIDURAL ANAESTHESIA FOR INGUINAL HERNIA REPAIR

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    Sachidanand

    2015-09-01

    Full Text Available BACKGROUND: Epidural anaesthesia is suitable as a sole agent for lower abdominal surgery and surgery on lower limbs. It has some definite advantages over spinal anaesthesia like avoidance of post spinal headache, minimal chances of meningitis, and minimal chances of nausea and vomiting in postoperative period. But administration of conventional dosage of local epidural anaesthetics (15ml and above for surgical anaesthesia frequently results in multiple hemodynamic changes, including decreases in chronotropism, inotro pism, dromotropism, systemic vascular resistance, cardiac output, and myocardial oxygen consumption. The segmental epidural block denotes the use of a small volume enough to block only the segments involved in the field of surgery. AIM: To study the effect iveness of segmental epidural anaesthesia for inguinal hernia repair. DESIGN: R andomized control study. METHODS: 100 pts belonging to ASA PS I & II posted for inguinal hernia repair given 5ml of 0.5% bupivacaine through epidural route at L1 - L2 level and a fter conforming the adequacy and level of analgesia, the surgery was commenced. If the patient complained of pain during needle prick, then injected local anaesthetic (0.5% Bupivacaine with an incremental dosage of 1ml at a time, till the complete onset o f analgesia Pulse Rate and Blood Pressure were recorded at an interval of 1 minute for first 5 minutes and then every 5 minutes till the end of the surgery. Oxygen saturation and ECG monitoring was done continuously. Onset of analgesia, level of analgesia ( P re & post operatively, duration of analgesia, total dosage of local anaesthetic used were recorded. Complications like bradycardia, hypotension, respiratory depression, shivering, nausea and vomiting, sweating and inadvertent dural puncture were recorde d. RESULTS: 53% of patients had excellent quality of analgesia and relaxation. 34% patients had good quality analgesia and relaxation, mild discomfort while handling sac

  16. Gender difference in autonomic and hemodynamic reactions to abrupt coronary occlusion.

    Science.gov (United States)

    Airaksinen, K E; Ikäheimo, M J; Linnaluoto, M; Tahvanainen, K U; Huikuri, H V

    1998-02-01

    We sought to determine whether there are gender-related differences in autonomic and hemodynamic responses to abrupt coronary occlusion. The risk of sudden death before hospital admission is higher in men with an acute myocardial infarction. The reasons for this gender-related difference are not well understood. Cardiovascular autonomic regulation modifies the outcome of acute coronary events, and there are gender differences in the autonomic regulation of heart rate (HR) in normal physiologic circumstances. We analyzed the changes in HR, HR variability and blood pressure and the occurrence of ventricular ectopic beats during a 2-min coronary occlusion in 140 men and 65 women referred for single-vessel coronary angioplasty. The ranges of nonspecific responses were determined by analyzing a control group of 19 patients with no ischemia during a 2-min balloon inflation in a totally occluded coronary artery. Women more often had ST segment changes (p < 0.01) and chest pain (p < 0.05) during the occlusion. Significant bradycardia or increase in HR variability as a sign of vagal activation occurred more often in women than in men (31% vs. 13%, p < 0.01 and 25% vs. 11%, p < 0.05, respectively). Coronary occlusion also more often caused (28% vs. 11%, p < 0.01) a decrease in blood pressure in women. The most pronounced female preponderance was in the incidence of Bezold-Jarisch-type reaction (i.e., simultaneous bradycardia and decrease in blood pressure [16% vs. 0.7%, p < 0.0001]). Logistic regression models developed to analyze the significance of gender while controlling for baseline variables and signs of ischemia identified female gender to be an independent predictor of bradycardic reactions (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.4 to 7.7, p < 0.01), hypotensive reactions (OR 2.6, 95% CI 1.1 to 6.0, p < 0.05) and Bezold-Jarisch-type response (OR 22.2, 95% CI 2.5 to 200, p < 0.01). Significance of female gender as a protector against early coronary

  17. Incidence of catheter-related bloodstream infections in neonates following removal of peripherally inserted central venous catheters.

    Science.gov (United States)

    Casner, Michael; Hoesli, Sandra J; Slaughter, James C; Hill, Melissa; Weitkamp, Jörn-Hendrik

    2014-01-01

    Catheter-associated bloodstream infections are a significant source of morbidity and healthcare cost in the neonatal ICU. Previous studies examining the prevalence of bloodstream infections after removal of peripherally inserted central venous catheters in neonates are equivocal. A retrospective cohort study. All infants with peripherally inserted central venous catheters treated at the Vanderbilt neonatal ICU between 2007 and 2009. We evaluated the following outcomes: 1) bloodstream infections, 2) culture-negative sepsis, 3) number of sepsis evaluations, and 4) number of significant apnea/bradycardia events comparing odds ratios between 72 hours before and 72 hours after peripherally inserted central venous catheter removal. We analyzed a total of 1,002 peripherally inserted central venous catheters in 856 individual infants with a median (interquartile range) gestational age of 31 weeks (28-37 wk) and a median birth weight of 1,469 g (960-2,690 g). Comparing 72 hours before with 72 hours after peripherally inserted central venous catheter removal did not show a difference in the prevalence of bloodstream infections (9 vs 3, p = 0.08), prevalence of culture-negative sepsis (37 vs 40, p = 0.73), number of sepsis evaluations (p = 0.42), or number of apnea/bradycardia events (p = 0.32). However, in peripherally inserted central venous catheter not used for delivery of antibiotics, there was a 3.83-fold increase in odds for culture-negative sepsis following peripherally inserted central venous catheter removal (95% confidence interval, 1.48-10.5; p = 0.001). For infants less than 1,500 g birth weight (very low birth weight), odds for culture-negative sepsis increased to 6.3-fold following removal of peripherally inserted central venous catheters not used for antibiotic delivery (95% confidence interval, 1.78-26.86; p central venous catheter removal, they suggests that very low birth weight infants not recently exposed to antibiotics are at increased odds for

  18. The heart's 'little brain' controlling cardiac function in the rabbit.

    Science.gov (United States)

    Brack, Kieran E

    2015-04-01

    using a bolus application of nicotine or electrical stimulation at each of the above sites whilst measuring heart rate and atrioventricular conduction. Nicotine applied to different ganglionic plexuses caused a bradycardia, a tachycardia or a mixture of the two, with the right atrial plexus producing the largest chronotropic responses. Electrical stimulation at these sites induced only a bradycardia. Atrioventricular conduction was modestly changed by nicotine, the main response being a prolongation. Electrical stimulation produced significant prolongation of atrioventricular conduction, particularly when the right neuronal complex was stimulated. These studies show that the intrinsic plexuses of the heart are important and could be crucial for understanding impairments of cardiac function. Additionally, they provide a strong basis from which to progress using the isolated, innervated rabbit heart preparation. © 2014 The Authors. Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.

  19. Perioperative beta blockade in noncardiac surgery: a systematic review for the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

    Science.gov (United States)

    Wijeysundera, Duminda N; Duncan, Dallas; Nkonde-Price, Chileshe; Virani, Salim S; Washam, Jeffrey B; Fleischmann, Kirsten E; Fleisher, Lee A

    2014-12-09

    To review the literature systematically to determine whether initiation of beta blockade within 45 days prior to noncardiac surgery reduces 30-day cardiovascular morbidity and mortality rates. PubMed (up to April 2013), Embase (up to April 2013), Cochrane Central Register of Controlled Trials (up to March 2013), and conference abstracts (January 2011 to April 2013) were searched for randomized controlled trials (RCTs) and cohort studies comparing perioperative beta blockade with inactive control during noncardiac surgery. Pooled relative risks (RRs) were calculated under the random-effects model. We conducted subgroup analyses to assess how the DECREASE-I (Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography), DECREASE-IV, and POISE-1 (Perioperative Ischemic Evaluation) trials influenced our conclusions. We identified 17 studies, of which 16 were RCTs (12 043 participants) and 1 was a cohort study (348 participants). Aside from the DECREASE trials, all other RCTs initiated beta blockade within 1 day or less prior to surgery. Among RCTs, beta blockade decreased nonfatal myocardial infarction (MI) (RR: 0.69; 95% confidence interval [CI]: 0.58 to 0.82) but increased nonfatal stroke (RR: 1.76; 95% CI: 1.07 to 2.91), hypotension (RR: 1.47; 95% CI: 1.34 to 1.60), and bradycardia (RR: 2.61; 95% CI: 2.18 to 3.12). These findings were qualitatively unchanged after the DECREASE and POISE-1 trials were excluded. Effects on mortality rate differed significantly between the DECREASE trials and other trials. Beta blockers were associated with a trend toward reduced all-cause mortality rate in the DECREASE trials (RR: 0.42; 95% CI: 0.15 to 1.22) but with increased all-cause mortality rate in other trials (RR: 1.30; 95% CI: 1.03 to 1.64). Beta blockers reduced cardiovascular mortality rate in the DECREASE trials (RR: 0.17; 95% CI: 0.05 to 0.64) but were associated with trends toward increased cardiovascular mortality rate in other trials (RR: 1.25; 95

  20. Time-dependent effects of training on cardiovascular control in spontaneously hypertensive rats: role for brain oxidative stress and inflammation and baroreflex sensitivity.

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    Gustavo S Masson

    Full Text Available Baroreflex dysfunction, oxidative stress and inflammation, important hallmarks of hypertension, are attenuated by exercise training. In this study, we investigated the relationships and time-course changes of cardiovascular parameters, pro-inflammatory cytokines and pro-oxidant profiles within the hypothalamic paraventricular nucleus of the spontaneously hypertensive rats (SHR. Basal values and variability of arterial pressure and heart rate and baroreflex sensitivity were measured in trained (T, low-intensity treadmill training and sedentary (S SHR at weeks 0, 1, 2, 4 and 8. Paraventricular nucleus was used to determine reactive oxygen species (dihydroethidium oxidation products, HPLC, NADPH oxidase subunits and pro-inflammatory cytokines expression (Real time PCR, p38 MAPK and ERK1/2 expression (Western blotting, NF-κB content (electrophoretic mobility shift assay and cytokines immunofluorescence. SHR-S vs. WKY-S (Wistar Kyoto rats as time control showed increased mean arterial pressure (172±3 mmHg, pressure variability and heart rate (358±7 b/min, decreased baroreflex sensitivity and heart rate variability, increased p47phox and reactive oxygen species production, elevated NF-κB activity and increased TNF-α and IL-6 expression within the paraventricular nucleus of hypothalamus. Two weeks of training reversed all hypothalamic changes, reduced ERK1/2 phosphorylation and normalized baroreflex sensitivity (4.04±0.31 vs. 2.31±0.19 b/min/mmHg in SHR-S. These responses were followed by increased vagal component of heart rate variability (1.9-fold and resting bradycardia (-13% at the 4th week, and, by reduced vasomotor component of pressure variability (-28% and decreased mean arterial pressure (-7% only at the 8th week of training. Our findings indicate that independent of the high pressure levels in SHR, training promptly restores baroreflex function by disrupting the positive feedback between high oxidative stress and increased pro

  1. Phosgene- and chlorine-induced acute lung injury in rats: comparison of cardiopulmonary function and biomarkers in exhaled breath.

    Science.gov (United States)

    Luo, Sa; Trübel, Hubert; Wang, Chen; Pauluhn, Jürgen

    2014-12-04

    This study compares changes in cardiopulmonary function, selected endpoints in exhaled breath, blood, and bronchoalveolar lavage fluid (BAL) following a single, high-level 30-min nose-only exposure of rats to chlorine and phosgene gas. The time-course of lung injury was systematically examined up to 1-day post-exposure with the objective to identify early diagnostic biomarkers suitable to guide countermeasures to accidental exposures. Chlorine, due to its water solubility, penetrates the lung concentration-dependently whereas the poorly water-soluble phosgene reaches the alveolar region without any appreciable extent of airway injury. Cardiopulmonary endpoints were continually recorded by telemetry and barometric plethysmography for 20h. At several time points blood was collected to evaluate evidence of hemoconcentration, changes in hemostasis, and osteopontin. One day post-exposure, protein, osteopontin, and cytodifferentials were determined in BAL. Nitric oxide (eNO) and eCO2 were non-invasively examined in exhaled breath 5 and 24h post-exposure. Chlorine-exposed rats elaborated a reflexively-induced decreased respiratory rate and bradycardia whereas phosgene-exposed rats developed minimal changes in lung function but a similar magnitude of bradycardia. Despite similar initial changes in cardiac function, the phosgene-exposed rats showed different time-course changes of hemoconcentration and lung weights as compared to chlorine-exposed rats. eNO/eCO2 ratios were most affected in chlorine-exposed rats in the absence of any marked time-related changes. This outcome appears to demonstrate that nociceptive reflexes with changes in cardiopulmonary function resemble typical patterns of mixed airway-alveolar irritation in chlorine-exposed rats and alveolar irritation in phosgene-exposed rats. The degree and time-course of pulmonary injury was reflected best by eNO/eCO2 ratios, hemoconcentration, and protein in BAL. Increased fibrin in blood occurred only in chlorine

  2. Treating cardiac arrhythmias detected with an implantable cardiac monitor in patients after an acute myocardial infarction.

    Science.gov (United States)

    Jons, Christian; Thomsen, Poul Erik Bloch

    2012-02-01

    Using an implantable cardiac monitor (ICM) in patients with acute myocardial infarction (MI) allows continuous electrocardiogram monitoring and provides a much more detailed picture of the incidence of brady- and tachyarrhythmias than conventional follow-up. The CARISMA study was the first to use the ICM in post-MI patients with moderate to severe left ventricular systolic dysfunction. Atrial fibrillation (AF) events lasting longer than 30 s were associated with an almost threefold increase in the risk of major cardiac events. This confirms the current definition of clinically significant AF episodes, as patients with episodes of shorter duration were not at increased risk. The association of AF to progressive heart failure, reinfarction, and cardiovascular death underlines the need for an intensive follow-up of post-MI patients with new-onset AF in order to reveal underlying causes of AF such as progressive left ventricular dysfunction or myocardial ischemia. Asymptomatic, especially nightly, bradycardia episodes including high-degree 2°-3° atrioventricular (AV) block, sinus bradycardia, and sinus arrest were frequently documented by ICM in the CARISMA study. Ten percent of patients experienced high-degree 2°-3° AV block, of which the main part was nightly and asymptomatic, and 50% of all cardiovascular deaths occurred in this group, most from severe heart failure. Therefore, in post-MI patients with paroxysmal high-degree AV block, pacemaker implantation should be done, and in the case of left ventricular dysfunction (LVEF ≤ 35%), an implantable cardioverter defibrillator/cardiac resynchronization therapy defibrillator (ICD/CRT-D) may be indicated. Nonsustained ventricular tachycardia (VT) is very frequent in post-MI patients, and in the CARISMA study, high-risk patients with nonsustained VT were implanted with an ICD. Furthermore, in 10% of the patients, the ICM recorded nonsustained VT episodes of ≥ 16 beats per minute, resulting in a twofold

  3. A STUDY OF ELECTROCARDIOGRAPHY AND KIDNEY FUNCTION TEST IN NEWLYDIAGNOSED HYPERTENSIVE PATIENTS IN COASTAL ANDHRA PRADESH

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    Ramswaroop

    2017-11-01

    Full Text Available BACKGROUND As per the fact sheet published by World Health Organisation, South East Asia, nearly one billion people have high blood pressure and are one of the most common causes of premature death worldwide. About one third of the adult population in the South East Asia region is having hypertension. In our country, the number of people with hypertension are undiagnosed and untreated, so early detection and treatment of hypertension will decrease the complication of hypertension and premature death due to it. MATERIALS AND METHODS This is a prospective study conducted in the Department of General Medicine, Konaseema Institute of Medical Sciences, Amalapuram, from May 2015 to August 2017. This study was started with an aim to know that electrocardiographic abnormalities and kidney function at the time of diagnosis of hypertension in a patient in coastal Andhra Pradesh. RESULTS We have found ECG changes in both the stages of hypertensive group patients. In stage-1 hypertensive group patients, out of 80 patients, 6 patients having sinus tachycardia, 2 having sinus bradycardia, 4 patients having left bundle-branch block and 6 having right bundle-branch block. ST elevation was found in 1 patient and ST depression was found in 8 patients. AV block was present in 2 patients. Right ventricular hypertrophy was present in 1 patient and left ventricular hypertrophy was present in 4 patients. T-wave inversion was found in 4 patients. In stage-2 hypertensive patients, sinus tachycardia in 6 patients and bradycardia in 1 patient, LBBB was found in 8 patients. ST depression was found in 6 patients and ST elevation was found in 2 patients out of 40 patients. AV block was present in 3 patients. Left ventricular hypertrophy patients 16 out of 40, but right ventricular hypertrophy was only 1. T-wave inversion was found in 6 patients. CONCLUSION In our study, we have found that stage-2 hypertensive patients have higher BMI, serum urea and creatinine than stage-1

  4. Predictors and Frequency of Conduction Disturbances After Open-Heart Surgery

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    Zahra Emkanjoo

    2008-02-01

    Full Text Available Introduction The risk of developing conduction disturbances after coronary bypass grafting (CABG or valvular surgery has been well established in previous studies, leading to permanent pacemaker implantation in about 2% to 3% of patients, and in 10% of patients undergoing repeat cardiac surgery.We sought to determine the incidence, features and predictors of conduction disorders in the immediate post-operative period of patients subjected to open-heart surgery, and the need for permanent pacemaker implantation.Material and Method We prospectively studied 374 consecutive patients who underwent open-heart surgery in our institution: coronary artery bypass (CABG (n=128, Mitral valve replacement(MVR(n=18, aortic valve replacement(AVR (n=21, MVR and AVR(n=56, repair of ventricular septal defect (VSD (n=51, repair of tetralogy of Fallot (TOF (n=57,CABG and valvular surgery (n=6, others (n=37.Results Among 374 patients included in our study (mean age 34.46±25.68; 146 males, 192 developed new conduction disorders: symptomatic sinus bradycardia in 8%, atrial fibrillation with slow ventricular response (AF in 4.5%, first-degree atrioventricular block (AVBin 6.4%, second-degree AVB in 0.3%, third-degree AVB in 7%, new right bundle branch block (RBBB in 33%, and new left bundle branch block (LBBB in 2.1%. In 5.6% patients, a permanent pacemaker was implanted, 47.6% of them underwent valvular surgery. In 44.1% of patients the conduction defects occurred in the first 48 hr. after surgery. In CABG group, 29.7% of patients developed new conduction disturbances; the most common of them was symptomatic sinus bradycardia. After valvular surgery 44.2% of patients developed conduction disturbances, of those the most common was atrial fibrillation with slow ventricular response . After VSD and TOF repair, the most common conduction disturbance was new RBBB. Perioperative myocardial infarction (MI occurred in 1.9% of patients. The occurrence conduction disturbance

  5. The effect of low-dose ketamine infusion on the remifentanil induced hemodynamic changes during general anesthesia

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    Beigmohamadi M T

    2008-05-01

    Full Text Available Background: Remifentanil is known to produce side-effects of hypotension and bradycardia. In this study, we examine the effect of low-dose ketamine infusion on the heart rate and blood pressure of patients anesthetized with remifentanil.Methods: In a randomized clinical trial, 54 patients aged 20-50 years old, with ASA physical status Ι, were studied in two groups (n=27, Ketamine- Remifentanil (K-R group and Placebo- Remifentanil (P-R group. Exclusion criteria were ASA physical status >1, gastroesophageal reflux, tachycardia, bradycardia, systemic diseases, use of antihypertensive drugs, difficult intubations, risk of aspiration and contraindications of ketamine. Remifentanil was started at a rate of 0.5 µg. kg-1. min-1 and anesthesia was induced with thiopental sodium 2 mg.kg-1. Maintenance of anesthesia included halothane and nitrous oxide/oxygen mixture. Remifentanil infusion was continued in both groups at a rate of 0.5 µg.kg-1.min-1. In the K-R group, ketamine was started with an infusion rate of 10 µg.kg-1. min-1, 10 minutes after intubation, while in the P-R group, normal saline was started with the same dose of remifentanil. Heart rate, systolic, diastolic and mean arterial blood pressure were measured and compared at 1, 3, 5, 10, 15, 20, 25 and 30 minutes.Results: No significant differences were found between basic patient characteristics of mean of age, sex, weight, systolic, diastolic and mean arterial blood pressure and heart rate (p>0.2 in the two groups. However, the rate of systolic, diastolic and mean arterial blood pressure changes in the P-R group was significantly greater than that of the K-R group (p<0.006. Heart rate changes were similar between the two groups (p=0.6. Incident of severe hypotension (a decrease of more than 25% of the basic value was less in the K-R group than that of the P-R group (11% vs. 89%; p=0.000.Conclusion: Low-dose ketamine infusion modulates the effect of remifentanil-induced hypotension and

  6. Chemical composition and cardiovascular effects induced by the essential oil of Cymbopogon citratus DC. Stapf, Poaceae, in rats Composição química e efeitos cardiovasculares do óleo essencial de Cymbopogon citratus DC. Stapf, Poaceae, em ratos

    Directory of Open Access Journals (Sweden)

    Flávia V. Moreira

    2010-12-01

    Full Text Available Cymbopogon citratus DC. Stapf, Poaceae, is used in the folk medicine for hypertension treatment. This work investigated the chemical composition and cardiovascular effects in rats of C. citratus essential oil (EOCC. A phytochemical screening demonstrated the presence of eight constituents, being geranial the major compound (43.08%. In rats, EOCC (1, 5, 10, and 20 mg/kg, i.v. induced transient hypotension and bradycardia that were attenuated by atropine and sodium thiopental, but not by L-NAME or indomethacin. In rings of rat superior mesenteric artery pre-contracted with phenylephrine, EOCC (1 to 3000 µg/mL induced relaxation that was not affected after removal of the endothelium, after TEA or in rings pre-contracted with KCl (80 mM. Furthermore, EOCC (1000 µg/mL was not able to induce additional effect on maximal relaxation of nifedipine (10 µM. In conclusions, EOCC induces hypotension, possibly by reduction in vascular resistance caused by inhibition of the Ca2+ influx, and bradycardia probably due to an activation of cardiac muscarinic receptors.C. citratus é utilizada na medicina popular para tratar hipertensão. Este trabalho investigou a composição química e os efeitos cardiovasculares do óleo essencial do C. citratus (OECC. Foram identificados oito constituintes no OECC, sendo geranial o majoritário (43,08%. Em ratos, o OECC (1, 5, 10 e 20 mg/kg, i.v. induziu hipotensão e bradicardia que foram atenuadas pela atropina e tiopental sódico, mas não por L-NAME ou indometacina. Em anéis de artéria mesentérica de ratos pré-contraídos com fenilefrina, o OECC (1 a 3000 µg/mL induziu relaxamento que não foi afetado após remoção do endotélio, após TEA ou em anéis pré-contraídos com KCl (80 mM. Além disso, o OECC (1000 µg/mL não induziu efeito adicional sobre o relaxamento máximo da nifedipina (10 µM. Em conclusão, o OECC induz hipotensão possivelmente devido à redução da resistência vascular que pode ser causada

  7. Intoxication due to Papaver rhoeas (Corn Poppy: Five Case Reports

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    Yahya Kemal Günaydın

    2015-01-01

    Full Text Available Introduction. In this paper, we aimed to present five Papaver rhoeas intoxication cases, which is very rare in the literature. Case 1. A 35-year-old female patient was admitted to our emergency room with the complaints of nausea, restlessness, and dyspnea developing 3 hours after eating Papaver rhoeas. On physical examination, her general condition was moderate; she was conscious and the vital findings were normal. The pupils were myotic. She was transferred to the toxicology intensive care unit as she experienced a generalized tonic clonic seizure lasting for three minutes. Case 2. A 41-year-old female patient was brought to our emergency room by 112 ambulance as she had contractions in her arms and legs, unconsciousness, and foam coming from her mouth two hours after Papaver rhoeas ingestion. On physical examination, she was confused, the pupils were myotic, and she was tachycardic. Arterial blood gases analysis revealed lactic acidosis. Case 3. A 38-year-old female patient was admitted to our emergency room with complaints of nausea and vomiting two hours after ingestion of Papaver rhoeas. Her physical examination and tests were normal. Case 4. A 34-year-old male patient was admitted to our emergency room with complaints of numbness and loss of power in his arms and legs one hour after Papaver rhoeas ingestion. He was hospitalized at the toxicology intensive care unit for follow-up and treatment. Dyspnea and bradycardia developed on the follow-up. The oxygen saturation without oxygen support was 90%. ECG revealed sinus bradycardia. The cardiac enzymes did not increase. Case 5. A 42-year-old female patient was brought to our emergency room by 112 ambulance with contractions in her arms and legs and unconsciousness two hours after Papaver rhoeas ingestion. On her physical examination, she was confused and the pupils were myotic. Arterial blood gases analysis revealed lactic acidosis. Conclusion. All patients were followed up for a few days and

  8. Non-ventricular, Clinical, and Functional Features of the RyR2(R420Q) Mutation Causing Catecholaminergic Polymorphic Ventricular Tachycardia.

    Science.gov (United States)

    Domingo, Diana; Neco, Patricia; Fernández-Pons, Elena; Zissimopoulos, Spyros; Molina, Pilar; Olagüe, José; Suárez-Mier, M Paz; Lai, F Anthony; Gómez, Ana M; Zorio, Esther

    2015-05-01

    Catecholaminergic polymorphic ventricular tachycardia is a malignant disease, due to mutations in proteins controlling Ca(2+) homeostasis. While the phenotype is characterized by polymorphic ventricular arrhythmias under stress, supraventricular arrhythmias may occur and are not fully characterized. Twenty-five relatives from a Spanish family with several sudden deaths were evaluated with electrocardiogram, exercise testing, and optional epinephrine challenge. Selective RyR2 sequencing in an affected individual and cascade screening in the rest of the family was offered. The RyR2(R420Q) mutation was generated in HEK-293 cells using site-directed mutagenesis to conduct in vitro functional studies. The exercise testing unmasked catecholaminergic polymorphic ventricular tachycardia in 8 relatives (sensitivity = 89%; positive predictive value = 100%; negative predictive value = 93%), all of them carrying the heterozygous RyR2(R420Q) mutation, which was also present in the proband and a young girl without exercise testing, a 91% penetrance at the end of the follow-up. Remarkably, sinus bradycardia, atrial and junctional arrhythmias, and/or giant post-effort U-waves were identified in patients. Upon permeabilization and in intact cells, the RyR2(R420Q) expressing cells showed a smaller peak of Ca(2+) release than RyR2 wild-type cells. However, at physiologic intracellular Ca(2+) concentration, equivalent to the diastolic cytosolic concentration, the RyR2(R420Q) released more Ca(2+) and oscillated faster than RyR2 wild-type cells. The missense RyR2(R420Q) mutation was identified in the N-terminus of the RyR2 gene in this highly symptomatic family. Remarkably, this mutation is associated with sinus bradycardia, atrial and junctional arrhythmias, and giant U-waves. Collectively, functional heterologous expression studies suggest that the RyR2(R420Q) behaves as an aberrant channel, as a loss- or gain-of-function mutation depending on cytosolic intracellular Ca(2

  9. Comparação da anestesia geral e bloqueio do plexo cervical superficial em tireoidectomias parciais Comparison between general anesthesia and superficial cervical plexus block in partial thyroidectomies

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    Rui Celso Martins Mamede

    2008-02-01

    Full Text Available Tireoidectomia sob efeito de bloqueio do plexo cervical superficial (BPCS tem sofrido resistência. OBJETIVO: Comparar variáveis cirúrgicas e anestésicas, custos do tratamento e grau de satisfação de pacientes submetidos à hemitireoidectomia sob efeito de anestesia geral e BPCS. CASUÍSTICA E MÉTODOS: Foram 21 pacientes submetidos à anestesia geral (AG e outro tanto ao BPCS. Após sedação, no grupo com BPCS, usou-se marcaína com vasoconstritor, e quando necessário, lidocaína a 2% com vasoconstritor. Sedação intra-operatória com diazepam endovenoso e metoprolol para controle da PA e FC eram administradas quando necessário. Usou-se anestesia geral (AG segundo padronização do serviço. RESULTADOS: Foram significantes (pThyroidectomy under the effect of superficial cervical plexus block (SCPB has met resistance. AIM: to compare variables in patients submitted to hemithyroidectomy under the effect of general anesthesia (GA and SCPB. CASE REPORT AND METHODS: GA was used in 21 patients, and SCPB was used in another 21 patients. Following sedation, marcaine 0.5% with vasoconstrictor was used in the SCPB group. Intraoperative sedation with diazepam and metoprolol to control arterial pressure and cardiac frequency was given as needed. GA followed the standard method in the unit. RESULTS: We found significant results (p<0.05, Student’s t-test for surgery time (GA - 111.4 min; SCPB - 125.5 min, anesthesia time (GA - 154.1 min; SCPB - 488.6 min, time in the surgery room (GA - 15 min; SCPB - 1 min, treatment costs (GA - R$203.2; SCPB - R$87.4, presence of bradycardia (GA - 0; SCPB - 23.8% and laryngotracheal injury (GA - 51; SCPB - 0 %. We also found the following non-significant results: hospitalization time (GA - 17.3; SCPB - 15.1 hours; bleeding volume (GA - 41,9 g; SCPB - 47.6 g, size of the operative specimen (GA - 52.1 cm3; SCPB - 93.69 cm3 and patient satisfaction level (GA - 3.8; SCPB - 3.9. CONCLUSION: Although the incidence of

  10. Effects of prophylactic ondansetron on spinal anesthesia-induced hypotension: a meta-analysis.

    Science.gov (United States)

    Gao, L; Zheng, G; Han, J; Wang, Y; Zheng, J

    2015-11-01

    A range of strategies including physical interventions, intravenous fluids and vasopressor drugs have been used to minimize or prevent spinal anesthesia-induced hypotension. Recent studies suggest that ondansetron, a commonly used antiemetic, also affects hypotension. This systematic review investigated the effects of prophylactic ondansetron on hemodynamic changes following spinal anesthesia. Medline, Embase, Cochrane Library databases and www.clinicaltrials.gov were searched for randomized controlled trials studying the effects of ondansetron on hemodynamic changes induced by spinal anesthesia. The primary outcome was hypotension. Relative risk (RR) or mean difference, with 95% confidence intervals (CI), were used to analyze outcomes. Ten randomized controlled trials with 863 patients were included in the analysis. Prophylactic ondansetron reduced the incidence of spinal anesthesia-induced hypotension in both obstetric and non-obstetric patients. The RR of spinal anesthesia-induced hypotension after ondansetron administration was 0.53 (95% CI 0.32 to 0.86) in obstetric patients and 0.16 (95% CI 0.05 to 0.51) in non-obstetric patients. There was significant heterogeneity among obstetric studies (I(2) = 71%). Ondansetron also reduced the incidence of bradycardia, nausea and vomiting after spinal anesthesia with RRs of 0.27 (95% CI 0.16 to 0.47), 0.24 (95% CI 0.14 to 0.42) and 0.48 (95% CI 0.08 to 3.08), respectively. The doses of ephedrine and phenylephrine required to treat hypotension were reduced by ondansetron with mean differences of -2.35 mg (95% CI -4.14 to -0.55 mg) and -31.16 μg (95% CI -57.46 to -4.87 μg), respectively. This review suggests that prophylactic ondansetron reduces the incidence of spinal anesthesia-induced hypotension and vasopressor consumption in both obstetric and non-obstetric patients. In addition, ondansetron can also reduce related adverse outcomes such as bradycardia, nausea and vomiting. However, given the relatively large

  11. Reflex response and convergence of pharyngoesophageal and peripheral chemoreceptors in the nucleus of the solitary tract.

    Science.gov (United States)

    Paton, J F; Li, Y W; Kasparov, S

    1999-01-01

    The pharynx is a common conduit for the passage of both ingested material and respiratory gases and may receive a dual control from medullary structures regulating deglutition and respiration. We sought both to compare the pattern of reflex response following stimulation of pharyngoesophageal and peripheral chemoreceptors and to assess whether these afferents converge in the nucleus of the solitary tract. In an arterially perfused working heart-brainstem preparation of mature rat, pharyngoesophageal receptors were stimulated by distension of the pharyngeal-oesophageal junction, whereas chemoreceptors were activated by sodium cyanide solution. In peripheral studies we recorded electromyographic activity from genioglossus, mylohyoideus and the lower thoracic oesophagus as well as hypoglossal, laryngeal and phrenic motor discharge. Sub-glottal pressure was also measured at constant airflow. In central studies, nucleus of the solitary tract neurons were recorded with blind whole-cell techniques. In peripheral studies spontaneous irregular electromyographic discharges (cycle length 99+/-26 s) occurred sequentially in genioglossus and mylohyoideus muscles (during the inter-phrenic nerve activity interval) and subsequently the oesophagus; these were accompanied by post-inspiratory discharges in both hypoglossal and laryngeal motor nerves and an atropine-sensitive bradycardia (-39+/-5 beats/min). Components of the reflex response elicited following stimulation of both pharyngoesophageal receptors and chemoreceptors were qualitatively similar and included: (i) expiratory-related increases in laryngeal pressure; (ii) sequential electromyographic discharge in genioglossus, mylohyoideus muscles and oesophagus; (iii) post-inspiratory burst discharge in hypoglossal, recurrent and superior laryngeal motor nerves; and (iv) an atropine-sensitive bradycardia (-38 to -95 beats/min). The chemoreceptor reflex-evoked responses were abolished after sinoaortic denervation. Of 135 whole

  12. "Fixing a heart": the game of electrolytes in anorexia nervosa.

    Science.gov (United States)

    Abed, Jean; Judeh, Hani; Abed, Elie; Kim, Matthew; Arabelo, Haword; Gurunathan, Rajan

    2014-09-05

    A 25-year-old woman with chronic anorexia nervosa and depression presented with sudden weakness and fatigue. Psychosocial history was notable for binge-starve cycles over the past year and a decline in overall well-being. Vitals on presentation were notable for hypothermia, hypotension, and bradycardia. Initial exam was significant for emaciation, lethargy, and lower extremity edema. Laboratory work-up revealed markedly elevated LFTs, hypoglycemia, thrombocytopenia and elevated INR and lipase. ECG showed sinus bradycardia with prolonged QTc. Ultrasound revealed normal liver and biliary tree. Serum acetaminophen, alcohol level, and urinary toxicology were unremarkable. Work up for infectious, autoimmune, and genetic causes of hepatitis was negative. Echocardiogram revealed left ventricular hypokinesis and EF 10-15%. Nutritional support was begun slowly, however electrolyte derangements began to manifest on hospital day 2, with hypophosphatemia, hypokalemia, hypocalcemia, and hypomagnesemia. Multiple medical and psychiatric disciplines were consulted, and aggressive electrolyte monitoring and repletion were done. The patient's overall clinical status improved slowly during her hospital course. Her liver enzymes trended down, and her QTc interval eventually returned toward the normal range. Repeat echocardiogram following treatment revealed improvement of her EF to 40%. Anorexia nervosa is an eating disorder characterized by extremely low body weight, fear of gaining weight or distorted perception of body image, and amenorrhea. Anorexia can lead to life threatening medical complications, and thus constitutes a major challenge to manage. Central to the pathogenesis of the refeeding syndrome is a weakened cardiopulmonary system, electrolytes abnormalities, hepatic dysfunction, liver hypoperfusion and failure. Given the clinical presentation, this patient likely presented on the brink of developing frank refeeding syndrome, with cardiac dysfunction and hypovolemia

  13. Therapeutic hypothermia in ST elevation myocardial infarction: a systematic review and meta-analysis of randomised control trials.

    Science.gov (United States)

    Villablanca, Pedro A; Rao, Gaurav; Briceno, David F; Lombardo, Marissa; Ramakrishna, Harish; Bortnick, Anna; García, Mario; Menegus, Mark; Sims, Daniel; Makkiya, Mohammed; Mookadam, Farouk

    2016-05-01

    Our objective is to gain a better understanding of the efficacy and safety of therapeutic hypothermia (TH) in patients with acute ST elevation myocardial infarction (STEMI) through an analysis of randomised controlled trials (RCTs). Several RCTs have suggested a positive outcome with the use of TH in the prevention of myocardial injury in the setting of an acute STEMI. However, there are currently no clinical trials that have conclusively shown any significant benefit. Electronic databases were used to identify RCTs of TH in the patient population with STEMI. The primary efficacy end point was major adverse cardiovascular event (MACE). Secondary efficacy end points included all-cause mortality, infarct size, new myocardial infarction and heart failure/pulmonary oedema (HF/PO). All-bleeding, ventricular arrhythmias and bradycardias were recorded as the safety end points. Six RCTs were included in this meta-analysis, enrolling a total of 819 patients. There was no significant benefit from TH in preventing MACE (OR, 01.04; 95% CI 0.37 to 2.89), all-cause mortality (OR, 1.48; 95% CI 0.68 to 3.19), new myocardial infarction (OR, 0.99; 95% CI 0.20 to 4.94), HF/PO (OR, 0.52; 95% CI 0.15 to 1.77) or infarct size (standard difference of the mean (SDM), -0.1; 95% CI -0.23 to 0.04). However, a significant reduction of infarct size was observed with TH utilisation in anterior wall myocardial infarction (SDM, -0.23; 95% CI -0.45 to -0.02). There was no significant difference seen for the safety end points all-bleeding (OR 1.32; 95% CI 0.77 to 2.24), ventricular arrhythmias (OR, 0.85; 95% CI 0.54 to 1.36) or bradycardias (OR, 1.16; 95% CI 0.74 to 1.83). Although TH appears to be safe in patients with STEMI, meta-analysis of published RCTs indicates that benefit is limited to reduction of infarct size in patients with anterior wall involvement with no demonstrable effect on all-cause mortality, recurrent myocardial infarction or HF/PO. Published by the BMJ Publishing Group

  14. Oxycodone overdose causes naloxone responsive coma and QT prolongation.

    Science.gov (United States)

    Berling, I; Whyte, I M; Isbister, G K

    2013-01-01

    Although there are limited data on oxycodone overdose, it has been suggested that, in addition to central nervous system (CNS) depression, oxycodone may cause QT prolongation. Given the high prescription rate and increasing use of oxycodone, an understanding of its effects and treatment in overdose is necessary. To investigate the clinical features, electrocardiogram (ECG) parameters and treatment of oxycodone overdose. Retrospective review of a clinical database. One hundred and thirty-seven oxycodone overdoses were identified from admissions to a toxicology unit between January 2001 and May 2011. Demographic information, details of ingestion, clinical effects, ECG parameters [heart rate (HR), QT and QRS], naloxone use and length of stay (LOS) were extracted from a clinical database. QT was measured manually and plotted on a QT nomogram. LOS was extracted for all overdoses over the same period. From 137 oxycodone overdoses, 79 (58%) ingested immediate release (IR) and 58 (42%) ingested sustained release (SR) or a combination of IR and SR. The median age was 40 years [interquartile range (IQR): 33-49 years], and 87 were female (64%). The median ingested dose of IR oxycodone was 70 mg (IQR: 40-100, range: 5-200), compared to 240 mg (IQR: 80-530, range: 30-1600) for SR oxycodone. Benzodiazepines were the most frequent co-ingested drug in 52 (38%) cases. No arrhythmias were recorded. Twenty-four patients (18%) had bradycardia of which five had a HR Naloxone boluses were required in 65 admissions (47%), and 34 (25%) required a naloxone infusion. There was higher overall naloxone use with SR and IR + SR (32/58, 55%) compared to IR oxycodone (33/79, 42%). The median LOS was 18 h (IQR: 12-35), which was greater than the median LOS for all toxicology admissions at 15 h (IQR: 8-24) over the same period. Patients requiring a naloxone infusion had an even greater LOS of 36 h (IQR: 20-62 h). In addition to the expected CNS depression, the opioid oxycodone can cause bradycardia

  15. Assessment of electrocardiography, echocardiography, and heart rate variability in dynamic and static type athletes

    Directory of Open Access Journals (Sweden)

    Ataei A

    2012-07-01

    Full Text Available Mehrnoush Toufan,1 Babak Kazemi,1 Fariborz Akbarzadeh,1 Amin Ataei,1 Majid Khalili21Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2Azerbaijan National Academy of Sciences, Baku, AzerbaijanBackground: Over the last two decades, morphological cardiac changes induced by athletic conditioning have been of great interest. Therefore, several studies have been orchestrated to delineate electrocardiography (ECG, echocardiography, and heart rate variability (HRV findings in athletes.Purpose: To assess the ECG, echocardiography, and HRV in a group of dynamic and static type athletes.Methods: Fifty professional athletes (20 static and 30 dynamic exercise athletes and 50 healthy nonathletes (control group were recruited. Standard 12-lead ECG and transthoracic echocardiography was performed on all athletes and the control group. Through echocardiography, variables including left ventricular (LV end-diastolic/systolic diameter, LV mass, and left atrial volume index were measured. In addition, both the athletes and the control group underwent ECG Holter monitoring for 15 minutes and several parameters related to HRV (time and frequency domain were recorded.Results: The most common ECG abnormalities among the athletes were sinus bradycardia and incomplete right bundle branch block. LV end-diastolic diameter and left atrial volume index were significantly greater in the dynamic athletes (P < 0.001. LV end-systolic diameter was significantly lower in the static group (P < 0.001. LV mass of the dynamic and static athletes was significantly greater than that of the controls (P < 0.001. Among the ECG Holter monitoring findings, the dynamic athletes had lower systolic blood pressure than the controls (P = 0.01. Heart rate was lowest in the control group (P < 0.001.Conclusion: The most common ECG abnormalities among adolescent Iranian athletes were sinus bradycardia and incomplete right bundle branch block. Static exercise seemed

  16. Perioperative beta blockade in noncardiac surgery: a systematic review for the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines.

    Science.gov (United States)

    Wijeysundera, Duminda N; Duncan, Dallas; Nkonde-Price, Chileshe; Virani, Salim S; Washam, Jeffrey B; Fleischmann, Kirsten E; Fleisher, Lee A

    2014-12-09

    To review the literature systematically to determine whether initiation of beta blockade within 45 days prior to noncardiac surgery reduces 30-day cardiovascular morbidity and mortality rates. PubMed (up to April 2013), Embase (up to April 2013), Cochrane Central Register of Controlled Trials (up to March 2013), and conference abstracts (January 2011 to April 2013) were searched for randomized controlled trials (RCTs) and cohort studies comparing perioperative beta blockade with inactive control during noncardiac surgery. Pooled relative risks (RRs) were calculated under the random-effects model. We conducted subgroup analyses to assess how the DECREASE-I (Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography), DECREASE-IV, and POISE-1 (Perioperative Ischemic Evaluation) trials influenced our conclusions. We identified 17 studies, of which 16 were RCTs (12,043 participants) and 1 was a cohort study (348 participants). Aside from the DECREASE trials, all other RCTs initiated beta blockade within 1 day or less prior to surgery. Among RCTs, beta blockade decreased nonfatal myocardial infarction (MI) (RR: 0.69; 95% confidence interval [CI]: 0.58 to 0.82) but increased nonfatal stroke (RR: 1.76; 95% CI:1.07 to 2.91), hypotension (RR: 1.47; 95% CI: 1.34 to 1.60), and bradycardia (RR: 2.61; 95% CI: 2.18 to 3.12). These findings were qualitatively unchanged after the DECREASE and POISE-1 trials were excluded. Effects on mortality rate differed significantly between the DECREASE trials and other trials. Beta blockers were associated with a trend toward reduced all-cause mortality rate in the DECREASE trials (RR: 0.42; 95% CI: 0.15 to 1.22) but with increased all-cause mortality rate in other trials (RR: 1.30; 95% CI: 1.03 to 1.64). Beta blockers reduced cardiovascular mortality rate in the DECREASE trials (RR:0.17; 95% CI: 0.05 to 0.64) but were associated with trends toward increased cardiovascular mortality rate in other trials (RR: 1.25; 95% CI

  17. Cardiorespiratory events in infants with gastroesophageal reflux symptoms: Is there any association?

    Science.gov (United States)

    Cresi, F; Martinelli, D; Maggiora, E; Locatelli, E; Liguori, S A; Baldassarre, M E; Cocchi, E; Bertino, E; Coscia, A

    2017-12-21

    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. 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. 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 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. 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. © 2017 John Wiley & Sons Ltd.

  18. Sweeten, soother and swaddle for retinopathy of prematurity screening: a randomised placebo controlled trial.

    LENUS (Irish Health Repository)

    O'Sullivan, A

    2012-02-01

    OBJECTIVE: To assess the efficacy of oral sucrose combined with swaddling and non-nutritive suck (NNS) as a method for reducing pain associated with retinopathy of prematurity (ROP) screening. DESIGN: Randomised placebo controlled study. SETTING: Tertiary level neonatal intensive care unit. SAMPLE: 40 infants undergoing primary eye examination for ROP screening. INTERVENTION: The control group were swaddled, and received 0.2 ml of sterile water given by mouth using a syringe and a soother. The intervention group were swaddled, and received 0.2 ml of sucrose 24% given by mouth using a syringe and a soother. RESULTS: 40 infants were included in the study. There was no difference in mean gestational age at birth, mean birth weight or corrected gestational age at first examination between both groups. The sucrose group had a significantly lower median Neonatal Pain, Agitation and Sedation Scale (N-PASS) score during ROP screening, initially following insertion of the speculum (6.5 vs 5, p=0.02) and subsequently during scleral indentation (9.5 vs 7.5, p=0.03). Fewer infants experienced episodes of desaturations or bradycardia in the intervention group (1 vs 4, p=0.18). CONCLUSION: ROP screening is a necessary but recognised painful procedure. Sucrose combined with NNS and swaddling reduced the behavioural and physiological pain responses. However, pain scores remained consistently high and appropriate pain relief for ROP screening remains a challenge.

  19. [Anaphylaxis after iron dextran administration in a pregnant woman].

    Science.gov (United States)

    Kortenhorst, Madeleine S Q; Harmsze, Ankie M; Hasaart, Tom H M

    2012-01-01

    Iron deficiency is a frequent cause of anaemia in pregnancy and often results in fatigue and malaise. To prevent complications during labour, timely iron suppletion is important. A 30-year-old multiparous female presented at the outpatient clinic in her 38th week of this pregnancy because of fatigue and lightheadedness. She had been prescribed oral iron suppletion a month earlier but had not taken the tablets. Because her haemoglobin level had decreased to 6.3 mmol/l, it was decided to start her on intravenous iron dextran treatment. During administration of the test dose, the patient experienced acute dyspnoea and severe abdominal and back pain. Foetal bradycardia was observed and the patient underwent an emergency caesarean section. She delivered a healthy boy whose arterial pH was 7.05 (base excess: -7.6 mmol/l) and venous pH was 7.18 (base excess: -6.8 mmol/l). This case demonstrates that dextran anaphylaxis can occur, with potentially lethal consequences, even when no known underlying risk factors are present.

  20. Simulation of Cardiac Arrhythmias Using a 2D Heterogeneous Whole Heart Model.

    Science.gov (United States)

    Balakrishnan, Minimol; Chakravarthy, V Srinivasa; Guhathakurta, Soma

    2015-01-01

    Simulation studies of cardiac arrhythmias at the whole heart level with electrocardiogram (ECG) gives an understanding of how the underlying cell and tissue level changes manifest as rhythm disturbances in the ECG. We present a 2D whole heart model (WHM2D) which can accommodate variations at the cellular level and can generate the ECG waveform. It is shown that, by varying cellular-level parameters like the gap junction conductance (GJC), excitability, action potential duration (APD) and frequency of oscillations of the auto-rhythmic cell in WHM2D a large variety of cardiac arrhythmias can be generated including sinus tachycardia, sinus bradycardia, sinus arrhythmia, sinus pause, junctional rhythm, Wolf Parkinson White syndrome and all types of AV conduction blocks. WHM2D includes key components of the electrical conduction system of the heart like the SA (Sino atrial) node cells, fast conducting intranodal pathways, slow conducting atriovenctricular (AV) node, bundle of His cells, Purkinje network, atrial, and ventricular myocardial cells. SA nodal cells, AV nodal cells, bundle of His cells, and Purkinje cells are represented by the Fitzhugh-Nagumo (FN) model which is a reduced model of the Hodgkin-Huxley neuron model. The atrial and ventricular myocardial cells are modeled by the Aliev-Panfilov (AP) two-variable model proposed for cardiac excitation. WHM2D can prove to be a valuable clinical tool for understanding cardiac arrhythmias.

  1. Clinical Profile of Cardiac Arrhythmias in Children Attending the Out Patient Department of a Tertiary Paediatric Care Centre in Chennai.

    Science.gov (United States)

    Premkumar, Sarala; Sundararajan, Premkumar; Sangaralingam, Thangavelu

    2016-12-01

    The presentation of symptoms of paediatric arrhythmias vary depending on the age and underlying heart disease. Physical examination of children with important arrhythmias may be entirely normal. Aim is to study the characteristics of cardiac arrhythmias in paediatric patients in a tertiary paediatric care centre in Chennai, India. The participants (n=60) were from birth to 12 years of age. Patients with sinus arrhythmias, sinus tachycardia and sinus bradycardia were excluded. Proportions of various parameters of interest like clinical features, age and sex distribution and underlying heart disease of children presenting with cardiac arrhythmias were arrived. Statistical analysis was performed using SPSS version 16.0. Ventricular ectopics were the most common type of arrhythmias observed in the present study followed by Sinus Node Dysfunction (SND). The most common type of SND was sino atrial arrest. Supra ventricular tachycardia was the most frequently sustained tachyarrhythmia in the present study. An increased association of WPW (Wolf Parkinson White Syndrome) with specific congenital cardiac defects was noted. Cardiac arrhythmias in children can present at anytime from fetal life to adolescence and their recognition requires high index of suspicion. While majority of children with arrhythmias have structurally normal heart, they are frequently encountered in children with underlying heart disease. Treatment of paediatric arrhythmias should be guided by the severity of the patient, the structure and function of the heart.

  2. [Effects of electromagnetic radiation on health and immune function of operators].

    Science.gov (United States)

    Li, Yan-zhong; Chen, Shao-hua; Zhao, Ke-fu; Gui, Yun; Fang, Si-xin; Xu, Ying; Ma, Zi-jian

    2013-08-01

    To investigate the effects of electromagnetic radiation on the physiological indices and immune function of operators. The general conditions and electromagnetic radiation awareness rate of 205 operators under electromagnetic radiation were evaluated using a self-designed questionnaire. Physical examination, electrocardiography, and routine urine test were performed in these operators. Peripheral blood was collected from the operators under electromagnetic radiation for blood cell counting and biochemical testing, and their peripheral blood lymphocytes were cultured for determination of chromosomal aberrant frequency and micronucleus frequency. The data from these operators (exposure group) were compared with those of 95 ordinary individuals (control group). The chief complaint of giddiness, tiredness, dizziness, and amnesia showed significant differences between the exposure group and control group (P electromagnetic radiation damage was significantly higher in the exposure group than in the control group. The difference in bradycardia was significant between the two groups (P Electromagnetic radiation may lead to the changes in physiological indices, genetic effects, and immune function and affect the health and immune function in operators. The adverse effects are increased as the working years increase. So it is important to strengthen occupational protection of operators under electromagnetic radiation.

  3. Primary cardiac lymphoblastic B-cell lymphoma: Should we treat more intensively?

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    Luiz Ivando Pires Ferreira Filho

    2015-01-01

    Full Text Available Primary cardiac lymphoma (PCL is a rare neoplasm, the majority of cases of which are non-Hodgkin′s, diffuse large B-cell (DLBCL. We report the first case of an adult with PCL B-cell lymphoblastic lymphoma whose disease evolution was grim. A 52-year-old male reported dyspnea and facial swelling lasting for 4 months and upon a physical examination he presented bradycardia, jugular venous engorgement, and hypophonesis of cardiac sounds. An electrocardiography (Echo revealed a right atrial mass and nodules at the pericardium. The patient was treated with R-Hyper-CVAD (rituximab plus cyclophosphamide, vincristine, doxorubicin, and dexamethasone and presented very short remission. At this time, we used R-ICE (rituximab plus ifosfamide, carboplatin, and etoposide chemotherapy and the patient underwent complete remission after two courses and received autologous bone marrow transplantation (auto-BMT. After 75 days of follow-up, the patient reported dyspnea and a new Echo showed a recurrence of the disease. The patient died due to cardiac failure. PCL is a rare disease with an unfavorable prognosis and a prompt diagnosis and treatment are fundamental to survival. We believe that more intensive therapies, such as auto-BMT, should be considered as a first treatment option.

  4. Thermal Imaging of Body Surface Temperature Distribution in Women with Anorexia Nervosa.

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    Chudecka, Monika; Lubkowska, Anna

    2016-01-01

    The drastic reduction in body weight observed in anorexia nervosa (AN) leads to various endocrine changes and consequently to disturbance in thermoregulation mechanisms and body temperature. Thermography allows for a noninvasive diagnosis of the distribution of skin surface temperatures, which is especially important for difficult patients such as women with AN, who are often very sensitive and difficult to treat. The main aim of this study was to measure the mean temperatures (Tmean ) of selected body areas in young women diagnosed with AN and identify those areas where the temperature differences were particularly significant between healthy women and them. Additionally, we determined the relationships between body mass index, body composition (especially subcutaneous and VFM) and the value of mean surface temperature (Tmean ) in AN woman. In the subjects with AN, Tmean of the abdomen, lower back and thighs were significantly higher than in the reference group, while Tmean of the hands were significantly lower. Among other things, analysis showed a significant negative correlation between Tmean of the abdomen, lower back and thighs, and the mass of subcutaneous and visceral fat. The lower Tmean of the hand was directly proportional to the reduced anthropomorphic parameters. The direct evaluation of body surface temperature distribution could provide clinical implications for the treatment of anorexic patients, including the potential use of thermotherapy in stimulating the circulatory system, especially in hypothermia, bradycardia and hypotension. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

  5. Heart rate variability in athletes and nonathletes at rest and during head-up tilt

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    F.S. Martinelli

    2005-04-01

    Full Text Available The purpose of the present study was to determine if autonomic heart rate modulation, indicated by heart rate variability (HRV, differs during supine rest and head-up tilt (HUT when sedentary and endurance-trained cyclists are compared. Eleven sedentary young men (S and 10 trained cyclists (C were studied. The volunteers were submitted to a dynamic ECG Holter to calculate HRV at rest and during a 70º HUT. The major aerobic capacity of athletes was expressed by higher values of at anaerobic threshold and peak conditions (P < 0.05. At rest the athletes had lower heart rates (P < 0.05 and higher values in the time domain of HRV compared with controls (SD of normal RR interval, SDNN, medians: 59.1 ms (S vs 89.9 ms (C, P < 0.05. During tilt athletes also had higher values in the time domain of HRV compared with controls (SDNN, medians: 55.7 ms (S vs 69.7 ms (C, P < 0.05. No differences in power spectral components of HRV at rest or during HUT were detected between groups. Based on the analysis of data by the frequency domain method, we conclude that in athletes the resting bradycardia seems to be much more related to changes in intrinsic mechanisms than to modifications in autonomic control. Also, HUT caused comparable changes in sympathetic and parasympathetic modulation of the sinus node in both groups.

  6. Real time video analysis to monitor neonatal medical condition

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    Shirvaikar, Mukul; Paydarfar, David; Indic, Premananda

    2017-05-01

    One in eight live births in the United States is premature and these infants have complications leading to life threatening events such as apnea (pauses in breathing), bradycardia (slowness of heart) and hypoxia (oxygen desaturation). Infant movement pattern has been hypothesized as an important predictive marker for these life threatening events. Thus estimation of movement along with behavioral states, as a precursor of life threatening events, can be useful for risk stratification of infants as well as for effective management of disease state. However, more important and challenging is the determination of the behavioral state of the infant. This information includes important cues such as sleep position and the status of the eyes, which are important markers for neonatal neurodevelopment state. This paper explores the feasibility of using real time video analysis to monitor the condition of premature infants. The image of the infant can be segmented into regions to localize and focus on specific areas of interest. Analysis of the segmented regions can be performed to identify different parts of the body including the face, arms, legs and torso. This is necessary due to real-time processing speed considerations. Such a monitoring system would be of great benefit as an aide to medical staff in neonatal hospital settings requiring constant surveillance. Any such system would have to satisfy extremely stringent reliability and accuracy requirements, before it can be deployed in a hospital care unit, due to obvious reasons. The effect of lighting conditions and interference will have to be mitigated to achieve such performance.

  7. Comparison of manual and automated documentation of adverse events with an Anesthesia Information Management System (AIMS).

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    Benson, M; Junger, A; Michel, A; Sciuk, G; Quinzio, L; Marquardt, K; Hempelmann, G

    2000-01-01

    In this study, an Anesthesia Information Management System (AIMS) is used for the comparison of manually recorded adverse events with automatically detected events from anesthesiological procedures. In 1998, data from all anesthesia procedures, including the data set for quality assurance defined by the German Society of Anesthesiology and Intensive Care Medicine (DGAI), were recorded online with the documentation software NarkoData 4 (IMESO GmbH, Hüttenberg, Germany) followed by storage into a relational database (Oracle Corporation). The occurrence of manually recorded adverse events, as defined by the DGAI, is compared with automatically detected events. Automated detection was done with SQL-statements. The following adverse events were selected: hypotension, hypertension, bradycardia, tachycardia and hypovolemia. Data obtained from 16,019 electronic anesthesia records show that in 911 patients (5.7%), one of the selected adverse events was documented manually whereas in 2,996 patients (18.7%) a adverse event was detected automatically. The incidence of automatically detected events is obviously higher compared to manually recorded events. With the help of an AIMS, automatic detection proved significant deficiencies in the manual documentation of adverse events.

  8. Cardiovascular complications following chronic treatment with cocaine and testosterone in adolescent rats.

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    Sheila A Engi

    Full Text Available Concomitant use of anabolic androgenic steroids and cocaine has increased in the last years. However, the effects of chronic exposure to these substances during adolescence on cardiovascular function are unknown. Here, we investigated the effects of treatment for 10 consecutive days with testosterone and cocaine alone or in combination on basal cardiovascular parameters, baroreflex activity, hemodynamic responses to vasoactive agents, and cardiac morphology in adolescent rats. Administration of testosterone alone increased arterial pressure, reduced heart rate (HR, and exacerbated the tachycardiac baroreflex response. Cocaine-treated animals showed resting bradycardia without changes in arterial pressure and baroreflex activity. Combined treatment with testosterone and cocaine did not affect baseline arterial pressure and HR, but reduced baroreflex-mediated tachycardia. None of the treatments affected arterial pressure response to either vasoconstrictor or vasodilator agents. Also, heart to body ratio and left and right ventricular wall thickness were not modified by drug treatments. However, histological analysis of left ventricular sections of animals subjected to treatment with testosterone and cocaine alone and combined showed a greater spacing between cardiac muscle fibers, dilated blood vessels, and fibrosis. These data show important cardiovascular changes following treatment with testosterone in adolescent rats. However, the results suggest that exposure to cocaine alone or combined with testosterone during adolescence minimally affect cardiovascular function.

  9. ECG changes during cerebral angiography; A comparison of low osmolality contrast media

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    Mitsumori, Michihide; Abe, Mitsuyuki (Kyoto Univ. (Japan). Faculty of Medicine); Hayakawa, Katsumi (Kyoto City Hospital (Japan). Department of Radiology)

    334 electrocardiographic recordings obtained from 109 patients who underwent cerebral angiography with low osmolality contrast media (CM) were analysed. CM used in this study included meglumine sodium ioxaglate, iopamidol and iohexol. A tachycardial effect greater than 10 percent was seen in 8.3 percent of the recordings, while a bradycardial effect greater than 10 percent was seen in 11.1 percent. Assessment was based on the type of CM used, age of the patients, usage of atropine sulfate as premedication, and the vessel injected. Patients who were under 19 years of age, and unpremedicated had a significantly higher incidence of bradycardia. On the other hand, there was no significant difference of the incidence of electrocardiographic abnormality between the 3 CM, and between the 2 injected vessel groups. The authors have also analysed the incidence of generalized adverse effect. There was no serious complication, however, 11.9 percent of the patients who under-went cerebral angiography with ioxaglate developed urticaria and this was significantly higher than in the other 2 CM groups. (author). 17 refs.; 9 tabs.

  10. Sedation management during therapeutic hypothermia for neonatal encephalopathy: atropine premedication for endotracheal intubation causes a prolonged increase in heart rate.

    Science.gov (United States)

    Gill, Hannah; Thoresen, Marianne; Smit, Elisa; Davis, Jonathan; Liu, Xun; Dingley, John; Elstad, Maja

    2014-10-01

    Heart rate (HR) plays an important role in the assessment of stress during therapeutic hypothermia (TH) for neonatal encephalopathy; we aimed to quantify the effect on HR of endotracheal (ET) intubation and drugs given to facilitate it. If atropine premedication independently increased HR, the main indicator of effective sedation, we hypothesised that increased sedation would have been given. Thirty-two, term, neonates recruited into a randomised pilot study comparing TH and TH combined with 50% Xenon inhalation were studied. Indications for ET intubation included: resuscitation at delivery, clinical need and elective re-intubation with a cuffed ET tube if randomised to Xenon. Standard intubation drugs comprised one or more of intravenous morphine, atropine, and suxamethonium. Local cooling guidelines were followed including morphine infusion for sedation. At postnatal hours five to eight atropine increased HR in a linear regression model (psedation given up to 8h into the treatment period was significantly higher (psedation and total morphine dose for sedation during early TH was increased where more than one dose of atropine was given. Bradycardia was not reported in any neonate, even without atropine premedication. We suggest that the use of atropine as part of standard premedication for ET intubation of term neonates undergoing TH should be reconsidered. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. Dexmedetomidine: the new all-in-one drug in paediatric anaesthesia?

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    Sottas, Cedric E; Anderson, Brian J

    2017-08-01

    Dexmedetomidine is a drug with sedative, anxiolytic, sympatholytic and analgesic properties, which is finding widespread practice in paediatric anaesthesia and related practices. The present review summarizes its pharmacology and current experience with the drug. Dexmedetomidine is proving useful in many diverse areas in paediatric anaesthesia where its sedative properties are useful for premedication, fibreoptic intubation and radiologic procedures. Its use as an adjunct for balanced anaesthesia where it can decrease the use of other drugs, reduce emergence delirium, postoperative shivering and vomiting. Muted apoptotic neuroprotective effects may realize benefits in neonates. Cardiac conduction delay, an adverse effect, may prove beneficial for arrhythmias after congenital cardiac surgery. Most of the paediatric published studies concerning dexmedetomidine are observational in nature, with limited control groups or comparators. Adverse effects (e.g. bradycardia) still require greater scrutiny in the paediatric population and particularly with respect to different age groups. Dexmedetomidine currently has a firm position in the armamentarium of anaesthesia pharmacology. It is not the new all-in-one drug, but it is shaping up as a valuable adjunct for diverse indications within paediatric anaesthesia. VIDEO ABSTRACT: http://links.lww.com/COAN/A44.

  12. Cardiopulmonary complications during pediatric seizures: A prelude to understanding SUDEP

    Science.gov (United States)

    Singh, Kanwaljit; Katz, Eliot S.; Zarowski, Marcin; Loddenkemper, Tobias; Llewellyn, Nichelle; Manganaro, Sheryl; Gregas, Matt; Pavlova, Milena; Kothare, Sanjeev V.

    2017-01-01

    Summary Purpose Sudden unexpected death in epilepsy (SUDEP) is an important, unexplained cause of death in epilepsy. Role of cardiopulmonary abnormalities in the pathophysiology of SUDEP is unclear in the pediatric population. Our objective was to assess cardiopulmonary abnormalities during epileptic seizures in children, with the long-term goal of identifying potential mechanisms of SUDEP. Methods We prospectively recorded cardiopulmonary functions using pulse-oximetry, electrocardiography (ECG), and respiratory inductance plethysmography (RIP). Logistic regression was used to evaluate association of cardiorespiratory findings with seizure characteristics and demographics. Key Findings We recorded 101 seizures in 26 children (average age 3.9 years). RIP provided analyzable data in 78% and pulse-oximetry in 63% seizures. Ictal central apnea was more prevalent in patients with younger age (p = 0.01), temporal lobe (p seizures (p seizures (p seizures (p seizures (p seizures (p seizures (p seizures (p = 0.01). Ictal and postictal bradycardia were directly associated (p seizures (p epileptic seizures are associated with predictable patient and seizure characteristics, including seizure subtype and duration. PMID:23731396

  13. Combined toxicity of silica nanoparticles and methylmercury on cardiovascular system in zebrafish (Danio rerio) embryos.

    Science.gov (United States)

    Duan, Junchao; Hu, Hejing; Li, Qiuling; Jiang, Lizhen; Zou, Yang; Wang, Yapei; Sun, Zhiwei

    2016-06-01

    This study was to investigate the combined toxicity of silica nanoparticles (SiNPs) and methylmercury (MeHg) on cardiovascular system in zebrafish (Danio rerio) embryos. Ultraviolet absorption analysis showed that the co-exposure system had high absorption and stability. The dosages used in this study were based on the NOAEL level. Zebrafish embryos exposed to the co-exposure of SiNPs and MeHg did not show any cardiovascular malformation or atrioventricular block, but had an inhibition effect on bradycardia. Using o-Dianisidine for erythrocyte staining, the cardiac output of zebrafish embryos was decreased gradually in SiNPs, MeHg, co-exposure groups, respectively. Co-exposure of SiNPs and MeHg enhanced the vascular endothelial damage in Tg(fli-1:EGFP) transgenic zebrafish line. Moreover, the co-exposure significantly activated the oxidative stress and inflammatory response in neutrophils-specific Tg(mpo:GFP) transgenic zebrafish line. This study suggested that the combined toxic effects of SiNPs and MeHg on cardiovascular system had more severe toxicity than the single exposure alone. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Fibrosis: a structural modulator of Sinoatrial Node physiology and dysfunction

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    Thomas A Csepe

    2015-02-01

    Full Text Available Heart rhythm is initialized and controlled by the Sinoatrial Node (SAN, the primary pacemaker of the heart. The SAN is a heterogeneous multi-compartment structure characterized by clusters of specialized cardiomyocytes, enmeshed within strands of connective tissue or fibrosis. Intranodal fibrosis is emerging as an important modulator of structural and functional integrity of the SAN pacemaker complex. In adult human hearts, fatty tissue and fibrosis insulate the SAN from the hyperpolarizing effect of the surrounding atria while electrical communication between the SAN and right atrium is restricted to discrete SAN conduction pathways. The amount of fibrosis within the SAN is inversely correlated with heart rate, while age and heart size are positively correlated with fibrosis. Pathological upregulation of fibrosis within the SAN may lead to tachycardia-bradycardia arrhythmias and cardiac arrest, possibly due to SAN reentry and exit block, and is associated with atrial fibrillation, ventricular arrhythmias, heart failure and myocardial infarction. In this review, we will discuss current literature on the role of fibrosis in normal SAN structure and function, as well as the causes and consequences of SAN fibrosis upregulation in disease conditions.

  15. Heart rate monitors and abnormal heart rhythm detection.

    Science.gov (United States)

    Boudet, G; Chamoux, A

    2000-10-01

    We test the accuracy of two third generation heart rate monitors (HRM), Accurex Plus and Vantage NV and compare these data with those of an older monitor, PE 4000. Then we investigate responses of the HRM's to abnormal heart rhythms (HR). Accurex Plus and Vantage NV, and PE 4000 were tested in the laboratory under both stable and transient conditions. The Phantom 320 HR simulator gave 7 stable heart rates, each lasting 3 min. The responses of the HRM's to abnormal heart rhythms were tested with an automatic arrhythmia program lasting 17 min. The new HRM's, Accurex Plus and Vantage NV, were more accurate (89 to 94% and over 98% at +/-3 beats per min) in the stable state than the PE 4000. They all showed a smoothing effect in transient measurements, which was stronger in decelerating HR (1st case) than in accelerating HR (2nd case). - 1st case: Accurex Plus =Vantage NV >PE 4000 -2nd case: PE 4000 >Accurex =Vantage. Most isolated heart rhythm disorders (missing beat, pause 4 s, important bradycardia or tachycardia.

  16. Case of a sigmoid colon cancer with metachronous metastases to the mesorectum and the abdominal wall

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    Hadjimarcou Andreas

    2010-03-01

    Full Text Available Abstract Backround Sigmoid colon cancer metachronous metastases commonly occur in the liver and lungs with sporadic reports also to the spleen, stomach, thyroid gland, abdominal wall and upper urinary tract. This is a rare case of metachronous metastases invading the mesorectum and the abdominal wall. Case presentation A 72-year-old female underwent sigmoidectomy for stage I (T2N0 M0 sigmoid colon cancer in May 2008. In June 2009, an abdominal computed tomography scan revealed a tumor 2 cm in size at the lower anterior mesorectum and a second mass 2 cm in size at the anterior abdominal wall midline. Total colonoscopy showed no mucosal lesion. The serum carcinoembryonic antigen level was normal. A biopsy of the mesorectum tumor showed similar histologic characteristics with the primary tumor. Since no other site of recurrence was identified, an abdominoperineal resection was attempted. During the operation and after the removal of the incision recurrence, sinus bradycardia and signs of myocardial ischemia were noticed. A loop transverse colostomy was immediately perfomed and the operation was terminated. Postoperative cardiologic examination revealed an acute myocardium infract. Chemo-radiation of the mesorectum tumor and re-evaluation for surgical excision was decided. Conclusion Metachronous metastasis of the mesorectum from sigmoid colon cancer is extremely rare. Although patterns of lymphatic spread from rectal cancer to sigmoid colon have recently been demonstrated, there is no evidence of metachronous mesorectum invasion from sigmoid colon cancer. This could be the issue for future trials.

  17. [Effect of oral cordarone in reversing persistent atrial fibrillation].

    Science.gov (United States)

    Zhao, Fu; Feng, Shao-xian; Zhao, Ping; Ma, Hong

    2006-04-01

    To observe the efficacy and safety of oral cordarone dir reversing persistent atrial fibrillation (AF). METHODS; Eighty-two symptomatic chronic AF out-patients without history of acute diseases or severe hepatic/thyroid dysfunction were given oral cordarone at the loading dose of 200 mg thrice a day for 1-4 weeks followed by a twice-daily administration for another 1-4 weeks, with the maintenance dose of 200 or 100 mg once a day. The incidence of stroke and cardiac events and the mortality rate were compared between 43 patients with restored rhythm on cordarone and 39 patients on digoxin and/or betaloc for ventricular rhythm control. Among the 82 patients, sinus rhythm restoration was achieved in 43, with a successful rate of 52%. In 18 patients, the ejection fraction increased from (32+/-8)% to (46+/-10)%, left atrium diameter decreased from (4.6+/-1.1) cm to (4.1+/-0.8) cm. Except for slight T4 increase, QT prolongation and bradycardia in 3 cases, severe side effects were not observed in this study. Only one patient with restored sinus rhythm required rehospitalization after half a year for worsened heart failure, but in patients with controlled ventricular rhythm, 1 developed stroke, 1 experienced heart attack and 1 died of heart failure with bleeding. For patients with symptomatic reversible persistent AF, active treatment with cordarone can be convenient, effective and safe for sinus rhythm restoration.

  18. Stunned myocardium after an anesthetic procedure in a pediatric patient - case report.

    Science.gov (United States)

    Faleiro Oliveira, Joana; Rebelo Pacheco, Susana; Moniz, Marta; Nunes, Pedro; Abadesso, Clara; Rebelo, Mónica; Loureiro, Helena; Almeida, Helena

    2016-06-01

    Takotsubo syndrome (TTS) is an acquired transient type of systolic dysfunction which mimics myocardial infarction clinically and electrocardiographically. TTS is also known as stress cardiomyopathy, broken heart syndrome, apical ballooning, reversible acute heart failure, neurogenic stunned myocardium or acute catecholamine cardiomyopathy. This case report describes an uncommon presentation of myocardial stunning after an anesthetic procedure. A 14-year-old girl with a history of pineal cyst and hemiplegic migraine was admitted for control brain magnetic resonance imaging. During anesthesia induction with propofol she suffered bradycardia, which was reversed with atropine, followed by tachyarrhythmia, reversed with lidocaine and precordial thump. Within hours she developed pulmonary edema and global respiratory failure due to acute left ventricular dysfunction. A transthoracic echocardiogram showed a dilated left ventricle with global hypokinesia and depressed left ventricular systolic function (ejection fraction digoxin and dopamine. The clinical course was satisfactory with clinical, biochemical and echocardiographic improvement within four days. Subsequent echocardiograms showed no ventricular dysfunction. The patient was discharged home on carvedilol, which was discontinued after normalization of cardiac function on cardiac magnetic resonance imaging. Few cases of TTS have been described in children, some of them triggered by acute central nervous system disorders and others not fulfilling all the classical diagnostic criteria. In this case the anesthetic procedure probably triggered the TTS. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  19. What we have learned from the family of multicenter automatic defibrillator implantation trials.

    Science.gov (United States)

    Moss, Arthur J

    2010-06-01

    Electrical device therapy began 50 years ago with the external defibrillator, and was followed subsequently with the introduction of implantable cardiac pacemakers, defibrillators, and resynchronization devices to prevent bradycardia, sudden arrhythmic death, and heart failure. During the past 20 years the Multicenter Automatic Defibrillator Implantation Trial (MADIT) research group has carried out a series of trials, including the MADIT-I, MADIT-II, and MADIT-III (MADIT-CRT), that have focused on improving the outcomes for patients with ischemic and nonischemic cardiac disease. The most recent MADIT-CRT trial showed that a cardiac resynchronization therapy device with defibrillator (CRT-D) was effective in reducing the risk of heart failure or death, whichever came first, in cardiac patients who were asymptomatic or minimally symptomatic (New York Heart Association class I or II) with reduced ejection fraction or =130 ms when compared with an implantable cardiac defibrillator (ICD) device. The family of MADIT ICD and CRT-D trials have provided a firm foundation for improving the clinical management of at-risk cardiac patients as the second decade of the 21(st) century begins.

  20. [Intra- and perioperative arrhythmia and ischemic signals in myocardial revascularization patients].

    Science.gov (United States)

    Rossi, L; Carbonieri, E; Fabbri, A; Franchi, G; Gerosa, G; Silvestre, G; Castello, C; Casarotto, D; Zardini, P

    1990-11-01

    In order to evaluate perioperative electrical cardiac disturbances and ST segment changes, 42 patients (38 M, 4 F, aged 57 +/- 6 ys) were studied using 24-hour Holter monitoring before, during and after coronary bypass surgery. In the 4-6 hours before cardioplegic arrest, 38% of patients had ST segment changes. No patient and malignant arrhythmias. The injection of cold cardioplegic solution was followed by bradycardia, ventricular tachycardia, ventricular fibrillation and isoelectric line within 2-4 minutes. After aortic declamping, 30 patients were defibrillated. Impulse formation and conduction disturbances, found in 55% of patients, solved themselves in 1 to 60 minutes. Bundle branch block continued in just 4 cases. A total of 59% of patients had ST segment elevation for 14 +/- 14 minutes and 19% had ST segment depression for 19 +/- 20 minutes. Successive transient ST segment changes were detected in 38% of patients. Sustained ventricular tachycardia occurred during 2 ischemic episodes. Impulse formation and conduction disturbances were not related to the duration of cardiac arrest or ventricular fibrillation, but were more frequent and lasted longer in patients with incomplete revascularization. Transient ST segment depression far from aortic declamping correlated with preclamping ischemia. Transient ST segment elevation correlated with incomplete revascularization. We concluded that ECG signs of intraoperative damage were reversible. Moreover, perioperative transitory ischemia was frequent but could be prevented by coronary active drug administration. On the other hand incomplete revascularization was associated with electrical disturbances and ischemia.