WorldWideScience

Sample records for bradycardia

  1. Sotalol-induced bradycardia reversed by glucagon.

    OpenAIRE

    Fernandes, C. M.; Daya, M. R.

    1995-01-01

    Glucagon is considered the drug of choice for treating bradycardia and hypotension encountered during beta-blocker poisoning. Its potential usefulness in reversing adverse effects encountered during therapeutic dosing with beta-blockers has not been well characterized. We present a case of sotalol-induced bradycardia reversed by glucagon.

  2. 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. PMID:22469245

  3. STUDY OF BRADYCARDIA IN DENGUE FEVER

    Directory of Open Access Journals (Sweden)

    Ramesh

    2014-03-01

    Full Text Available BACKGROUND AND OBJECTIVES: All the four serotypes of dengue virus are found in our country. Case fatality rates in endemic countries like India are 2.5%. During epidemics of dengue, attack rates among susceptible are 40-90%. Early recognition and prompt treatment are vital if disease related morbidity and mortality are to be limited. Clinical features that can be used in the initial assessment of febrile patients are essential tools for clinicians, especially in limited resource settings. Awareness of bradycardia as a clinical finding, could help in the early recognition of dengue and potentially reduce complications and death. METHOD AND RESULTS: The study was conducted in the Department of Medicine, Mysore Medical College & Research Institute, Mysore from the period of July 2010 to December 2010 who met the inclusion and exclusion criteria. A total of 100 patients of Dengue fever were analyzed. The most common age group affected in our study was 20-39 years (53%. The clinical spectrum of cases included 22% cases of Dengue fever (DF, 72% cases of Dengue Hemorrhagic fever (DHF, 6% cases of Dengue Shock Syndrome (DSS. Clinical pulse rate distribution amongst cases showed 27% with bradycardia, 61% with relative bradycardia, and 12% with tachycardia. Electrocardiographic changes in our study showed 37% with sinus bradycardia, 48% with normal sinus rhythm, 1% with first degree heart block, and 14% with sinus tachycardia. CONCLUSION: Bradycardia was a predominant occurrence amongst total of 100 cases of Dengue fever analyzed. 88% of the cases had bradycardia. (61% had relative bradycardia and 27% bradycardia. Majority of the patients on ECG showed sinus bradycardia (37% and normal sinus rhythm (48%. Hence, awareness of bradycardia as a clinical finding, can help in the early recognition of dengue and potentially reduce complications and death associated with dengue virus infection.

  4. Congenital hypothyroidism presenting with postpartum bradycardia

    International Nuclear Information System (INIS)

    Congenital hypothyroidism is a clinical condition characterized by lack of thyroid hormone because of thyroid gland developmental and thyroid hormone biosynthesis disorders. The most common cause of permanent hypothyroidism is congenital factors. Prompt diagnosis is critical. However, overt signs of hypothyroidism are rarely present at birth, and 95% of affected babies are asymptomatic. Hypoxemia, apnea, acidosis, increased intracranial pressure, vagal stimulus and central nerve system abnormalities represent the most common causes of bradycardia in the neonate. Bradycardia associated with congenital hypothyroidism is very rare. In this paper, a case of severe congenital hypothyroidism, induced by maternal blocker antibodies, who presented with bradycardia, is reported. (author)

  5. [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

  6. Severe bradycardia and prolonged hypotension in ciguatera.

    Science.gov (United States)

    Chan, Thomas Yan Keung

    2013-06-01

    Ciguatera results when ciguatoxin-contaminated coral reef fish from tropical or subtropical waters are consumed. The clinical features that present in affected persons are mainly gastrointestinal, neurological, general, and much less commonly, cardiovascular. We report the case of a 50-year-old man who developed the characteristic combination of acute gastrointestinal and neurological symptoms after the consumption of an unidentified coral reef fish head. In addition to those symptoms, he developed dizziness, severe bradycardia (46 bpm) and prolonged hypotension, which required the administration of intravenous atropine and over three days of intravenous fluid replacement with dopamine infusion. Patients with ciguatera can develop severe bradycardia and prolonged hypotension. Physicians should recognise the possible cardiovascular complications of ciguatera and promptly initiate treatment with intravenous atropine, intravenous fluid replacement and inotropic therapy if such complications are observed. PMID:23665698

  7. The Significance of Bradycardia in Anorexia Nervosa

    OpenAIRE

    Yahalom, Malka; Spitz, Marcelo; Sandler, Ludmila; Heno, Nawaf; Roguin, Nathan; Turgeman, Yoav

    2013-01-01

    Anorexia nervosa (AN) is a life-threatening condition, with a significant risk for death, due to cardiovascular complications. It is characterized by abnormal eating behavior and has the highest mortality rate of all psychiatric disorders. It has been associated with bradycardia (a heart rate [HR] of less than 60 beats per minute) (up to 95%), hypotension, mitral valve prolapse, and heart failure. The diagnosis of AN can be elusive, and more than half of all cases are undetected. The purpose ...

  8. Symptomatic 5-fluorouracil-induced sinus bradycardia.

    Science.gov (United States)

    Lee, A D; McKay, M J

    2011-07-01

    5-Fluorouracil (5-FU) is a commonly used anti-neoplastic agent. 5-FU has been not uncommonly associated with cardiotoxicity, although the many potentially causative mechanisms are yet to be established. Here, we present the case of a 61-year-old gemstone miner who developed symptomatic sinus bradycardia while receiving a continuous 5-FU infusion combined with radiotherapy for locally advanced rectal cancer. This dysrhythmia is an unusual type of 5-FU toxicity, our case being the second described. We review the actions of 5-FU and the various proposed mechanisms of its cardiotoxic effects. PMID:21762335

  9. Profound bradycardia associated with NIV removal

    Science.gov (United States)

    Echevarria, C.; Bourke, S.C.; Gibson, G.J.

    2011-01-01

    A patient with lower-limb onset ALS presented with a one-month history of vasovagal episodes and a one-week history of cough productive of green sputum and lethargy. She was drowsy and in acute on chronic type-two respiratory failure. She responded to non-invasive ventilation, however she suffered recurrent episodes of profound bradycardia on removal of the mask, which gradually resolved over ten days. We have reviewed the literature and offer a potential explanation for these events. PMID:26057781

  10. Ethanol inhibition of baroreflex bradycardia: role of brainstem GABA receptors.

    OpenAIRE

    Varga, K.; Kunos, G.

    1990-01-01

    Ethanol administered i.v. or into the nucleus tractus solitarii (NTS) of rats anaesthetized with urethane inhibits baroreflex bradycardia elicited by phenylephrine. This effect is prevented or reduced by pretreatment of rats with 3-mercaptopropionic acid, bicuculline, or RO 15-4513. Intra-NTS injection of muscimol also inhibits baroreflex bradycardia and causes a pressor response which is potentiated by intra-NTS ethanol. It is proposed that ethanol inhibits baroreflex bradycardia, at least i...

  11. 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. PMID:26950648

  12. 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

  13. 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.

  14. 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.

  15. A Magneto-Mechanical Assessment of Fetal Bradycardia

    OpenAIRE

    Nana Aba Mensah-Brown; Janette Strasburger

    2010-01-01

    Simultaneous SQUID and pulsed-Doppler ultrasound techniques have been implemented in our laboratory to assess the magneto-mechanical function of the bradycardic fetal heart. The objective is to single out the most detrimental cases of fetal bradycardia using magneto-mechanical indices. Recordings were made in a magnetically shielded room in the Biomagnetism Laboratory at the University of Wisconsin--Madison. Simultaneous echo/fetal magnetocardiography(fMCG) signals were recorded and analyzed...

  16. [Sleep disorders with nocturnal bradycardia in 2 depressed patients].

    Science.gov (United States)

    Lemoine, P; Canini, F; Ferber, C; Mouret, J

    1991-12-01

    Polygraphic sleep exploration is usually not necessary to evaluate and treat such dyssomnias as nightmares or anguish dreams, but it may be indispensable in case of severe repeated or refractory sleep disorders, particularly in patients with concomitant depression. Two cases of major depression (DSM III R) associated with wakings during the night and dreams of death are reported. In both cases, polygraphic sleep exploration performed after complete, two-weeks long discontinuation of medicines revealed sinus bradycardia during paradoxical sleep, particularly in pre-waking periods. Heart rates ranged from 33 to 43 beats/minute in the most pronounced bradycardic episodes. The possibility of organic cardiac pathology was excluded by additional examinations. Atropine (175 mg) administered alone resulted in complete disappearance of bradycardic episodes and in improvement of objective and subjective sleep parameters. In these two cases bradycardia seemed to be due to vagal dysfunction with exaggeration of the "rebound" bradycardia which follows the initial tachycardia that occurs during the phasic phenomena of paradoxical sleep. PMID:1837364

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

    OpenAIRE

    Md Shahnawaz Moazzam; Farah Nasreen; Shahjahan Bano; Syed Hussain Amir

    2011-01-01

    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,...

  18. 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......) during the stimulation phase of ECT (P < 0.001). Middle cerebral artery V(mean) decreased 43% (9%-71%; P < 0.001), and frontal lobe oxyhemoglobin (O(2)Hb) concentration decreased from 0.6 (0.0-25.3) to 0.1 (-1.9 to 7.6) microM, whereas the deoxyhemoglobin concentration increased from -0.2 (-13.9 to 0...

  19. 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) ...

  20. 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.

  1. Berberine behind the thriller of marked symptomatic bradycardia.

    Science.gov (United States)

    Cannillo, Margherita; Frea, Simone; Fornengo, Cristina; Toso, Elisabetta; Mercurio, Giancarlo; Battista, Stefania; Gaita, Fiorenzo

    2013-07-26

    Patients with chronic aortic dissections are at high risk of catheter-induced complications. We report a Berberine is used in traditional Chinese medicine for the treatment of congestive heart failure, hypertension, diabetes, and dyslipidaemia and has a good safety profile. We report a case of a 53-year-old sportsman referred to our hospital for the onset of fatigue and dyspnoea upon exertion after he started berberine to treat hypercholesterolaemia. An electrocardiogram showed sinus bradycardia (45 bpm), first-degree atrioventricular block, and competitive junctional rhythm. An ergometric stress test showed slightly reduced chronotropic competence and the presence of runs of competitive junctional rhythm, atrial tachycardia, and sinus pauses in the recovery. After 10 d of wash-out from berberine, the patient experienced a complete resolution of symptoms, and an ergometric stress test showed good chronotropic competence. An electrocardiogram Holter showed a latent hypervagotonic state. This is the first case report that shows that berberine could present certain side effects in hypervagotonic people, even in the absence of a situation that could cause drug accumulation. Therefore, berberine's use should be carefully weighed in hypervagotonic people due to the drug's bradycardic and antiarrhythmic properties, which could became proarrhythmic, exposing patients to potential health risks. PMID:23888197

  2. Profound metoprolol-induced bradycardia precipitated by acetaminophen-propoxyphene.

    Science.gov (United States)

    Marraffa, Jeanna M; Lang, Li; Ong, Gilbert; Lehmann, David F

    2006-03-01

    Pharmacokinetic studies demonstrate that propoxyphene is a potent inhibitor of cytochrome P450 (CYP) 2D6. Clinically significant sequelae have not been previously reported. We report a case of this inhibition manifested by life-threatening bradycardia in a patient receiving a CYP2D6 substrate, metoprolol. A 48-year-old man came to the emergency department complaining of dizziness 3 hours after ingesting metoprolol, at his usual dose, and 2 tablets of propoxyphene, newly begun postoperatively. Four hours after ingestion of both drugs, the patient was noted to have a ventricular rate of about 30 beats/min with underlying atrial fibrillation. The patient's ventricular response returned to normal within 11 hours of ingestion. We have demonstrated the clinical importance of the interaction between propoxyphene and metoprolol likely resulting from inhibition of hepatic clearance of metoprolol by propoxyphene. Underscoring the clinical relevance of CYP2D6 inhibition by an analgesic of questionable efficacy should proscribe its use. PMID:16513452

  3. [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. PMID:17441478

  4. Modulation of reflexly evoked vagal bradycardias by central 5-HT1A receptors in anaesthetized rabbits

    OpenAIRE

    Skinner, Matthew R; Ramage, Andrew G; Jordan, David

    2002-01-01

    The role of central 5-HT1A receptors in the control of the bradycardia and changes in central respiratory drive, renal nerve activity and blood pressure evoked by stimulating cardiopulmonary afferents with phenylbiguanide, baroreceptors by electrical stimulation of the aortic nerve and chemoreceptors by injections of sodium cyanide (NaCN) in atenolol-pretreated anaesthetized rabbits were studied.Buspirone (100 μg kg−1; i.c.) potentiated the bradycardia (increase in R-R interval) and the chang...

  5. Cholinesterase inhibitors and hospitalization for bradycardia: a population-based study.

    Directory of Open Access Journals (Sweden)

    Laura Y Park-Wyllie

    2009-09-01

    Full Text Available BACKGROUND: Cholinesterase inhibitors are commonly used to treat dementia. These drugs enhance the effects of acetylcholine, and reports suggest they may precipitate bradycardia in some patients. We aimed to examine the association between use of cholinesterase inhibitors and hospitalization for bradycardia. METHODS AND FINDINGS: We examined the health care records of more than 1.4 million older adults using a case-time-control design, allowing each individual to serve as his or her own control. Case patients were residents of Ontario, Canada, aged 67 y or older hospitalized for bradycardia between January 1, 2003 and March 31, 2008. Control patients (3:1 were not hospitalized for bradycardia, and were matched to the corresponding case on age, sex, and a disease risk index. All patients had received cholinesterase inhibitor therapy in the 9 mo preceding the index hospitalization. We identified 1,009 community-dwelling older persons hospitalized for bradycardia within 9 mo of using a cholinesterase inhibitor. Of these, 161 cases informed the matched analysis of discordant pairs. Of these, 17 (11% required a pacemaker during hospitalization, and six (4% died prior to discharge. After adjusting for temporal changes in drug utilization, hospitalization for bradycardia was associated with recent initiation of a cholinesterase inhibitor (adjusted odds ratio [OR] 2.13, 95% confidence interval [CI] 1.29-3.51. The risk was similar among individuals with pre-existing cardiac disease (adjusted OR 2.25, 95% CI 1.18-4.28 and those receiving negative chronotropic drugs (adjusted OR 2.34, 95% CI 1.16-4.71. We found no such association when we replicated the analysis using proton pump inhibitors as a neutral exposure. Despite hospitalization for bradycardia, more than half of the patients (78 of 138 cases [57%] who survived to discharge subsequently resumed cholinesterase inhibitor therapy. CONCLUSIONS: Among older patients, initiation of cholinesterase

  6. Sinus bradycardia as a predictor of right coronary artery occlusion in patients with inferior myocardial infarction.

    Science.gov (United States)

    Serrano, C V; Bortolotto, L A; César, L A; Solimene, M C; Mansur, A P; Nicolau, J C; Ramires, J A

    1999-01-01

    Differentiation of right coronary artery (RCA) from left circumflex artery (LCxA) occlusion may be difficult since both can present an electrocardiographic pattern of inferior myocardial infarction (IMI). We studied 133 patients with IMI, 92 patients with RCA occlusion and 41 patients with LCxA occlusion. Risk factors such as previous MI, arterial hypertension, diabetes, smoking, and dislipemia, were similar for RCA and LCxA occlusions. Patients with RCA occlusion had a higher incidence of isolated IMI than patients with LCxA occlusion, 50% vs. 17%, respectively (P<0.001). Arterial hypotension was more prevalent (P<0.05) among patients with RCA (18%) rather than those with LCxA occlusion (2%). RCA occlusion presented an association with sinus bradycardia, an association not observed with LCxA occlusion (15% vs. 0%, respectively; P<0.01). Total atrioventricular block was only present among patients with RCA (18%). Proximal occlusions of the RCA presented lower heart rates (sinus bradycardia) than medial and distal occlusions (13% vs. 1% and 1%, respectively; P<0.0001 and P<0.001). Therefore, regarding patients with IMI: (1) sinus bradycardia is more frequent when the infarct-related artery is the RCA; (2) proximal occlusions of the right coronary predispose low heart rates; and (3) occlusion of the LCxA rarely induces sinus bradycardia. PMID:10077404

  7. 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

    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 the bradyca...

  8. Symptomatic Bradycardia Caused By Premature Atrial Contractions Originating From Right Atrial Appendage

    OpenAIRE

    Alper, AT; Gungor, B; Turkkan, C; Tekkesin, AI

    2013-01-01

    Premature atrial contraction is a common form of supraventricular arrhythmias. In rare cases, severe symptoms other than palpitation may occur. In this report, we present a patient with symptomatic bradycardia which developed secondary to blocked premature atrial contractions and was successfully treated with radiofrequency ablation.

  9. Symptomatic bradycardia caused by premature atrial contractions originating from right atrial appendage.

    Science.gov (United States)

    Alper, At; Gungor, B; Turkkan, C; Tekkesin, Ai

    2013-05-01

    Premature atrial contraction is a common form of supraventricular arrhythmias. In rare cases, severe symptoms other than palpitation may occur. In this report, we present a patient with symptomatic bradycardia which developed secondary to blocked premature atrial contractions and was successfully treated with radiofrequency ablation. PMID:23840105

  10. 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.

  11. GABA in nucleus tractus solitarius participates in electroacupuncture modulation of cardiopulmonary bradycardia reflex

    OpenAIRE

    Tjen-A-Looi, Stephanie C.; Guo, Zhi-Ling; Longhurst, John C.

    2014-01-01

    Phenylbiguanide (PBG) stimulates cardiopulmonary receptors and cardiovascular reflex responses, including decreases in blood pressure and heart rate mediated by the brain stem parasympathetic cardiac neurons in the nucleus ambiguus and nucleus tractus solitarius (NTS). Electroacupuncture (EA) at P5–6 stimulates sensory fibers in the median nerve and modulates these reflex responses. Stimulation of median nerves reverses bradycardia through action of γ-aminobutyric acid (GABA) in the nucleus a...

  12. 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.

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

    OpenAIRE

    Eduardo Toshiyuki Moro; Alexandre Palmeira Goulart

    2015-01-01

    ABSTRACTBACKGROUND AND OBJECTIVES: 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...

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

    Directory of Open Access Journals (Sweden)

    Eduardo Toshiyuki Moro

    2015-10-01

    Full Text Available ABSTRACTBACKGROUND AND OBJECTIVES: 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".CASE REPORT: 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.CONCLUSIONS: 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.

  15. TRANSPYLORIC TUBE FEEDING IN VERY LOW BIRTHWEIGHT INFANTS WITH SUSPECTED GASTROESOPHAGEAL REFLUX: IMPACT ON APNEA AND BRADYCARDIA

    OpenAIRE

    Malcolm, WF; Smith, PB; Mears, S.; Goldberg, RN; Cotten, CM

    2009-01-01

    OBJECTIVE Our aim was to assess safety and efficacy of transpyloric tube feeding as a therapeutic option to reduce apnea and bradycardia in hospitalized very low birthweight infants with clinical signs suggestive of gastroesophageal reflux. PATIENTS AND METHODS This was a retrospective single center cohort study of VLBW infants hospitalized from 2001–2004 with signs of GER who received transpyloric enteral tube feedings. Apnea (>10 sec) and bradycardia (

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

    OpenAIRE

    Muralidhar Kanchi; Kumar Pradeep; Murugesan Chinnamuthu

    2009-01-01

    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 upp...

  17. Therapeutic class-specific signal detection of bradycardia associated with propranolol hydrochloride

    Directory of Open Access Journals (Sweden)

    Gavali Dhaval

    2009-01-01

    Full Text Available Background: Propranolol hydrochloride, one of the most widely used β-blocker in the treatment of hypertension since 1960s, shows a number of serious and non-serious adverse events. Objective: Major objectives of this study were to extract the Canadian Adverse Drug Reaction Monitoring Program (CADRMP database for possible toxic signal detection (SD of propranolol hydrochloride, evaluate the frequency of the bradycardia associated with it in different stratified groups for a putative signal, and generate awareness in healthcare professionals regarding usefulness of SD. Materials and Methods: Appropriate statistical methods were used for adverse drug reaction (ADR signal detection such as, proportional reporting ratio (PRR; reporting odds ratio (ROR; the Chi-square (λ2 statistic method; the 95% confidence interval (CI; the observed to expected ratio (O/E; and Du Mouchel method were used to calculate the possible signals. Significance of λ2 and other calculated statistics, e.g., PRR and ROR, was based on a composite criterion of regulatory guidelines and not on any particular statistical level of significance. Results: Calculated statistics by different methods were compared with the regulatory criteria of a statistic value ≥4.0 for λ2 , and ≥3.0 for the rest for SD to be declared significant. The PRR statistic was found to be 2.5054; by the ROR method it was 2.5820; the λ2 statistic was 3.2598, whereas the lower and upper limits of 95% CI of PRR were found to be 0.0778 and 1.9104, respectively, by the O/E ratio was found to be 2.3978, and PRR with the help of Du Mouchel was found to be 2.3979. Thus, the bradycardia-propranolol signals calculated in this study were not significant. Conclusions: The therapeutic class specific signal of bradycardia associated with propranolol hydrochloride was not found potent enough to cause bradycardia. However, since the calculated statistics were very high albeit not significant, the possibility of

  18. Loss of resting bradycardia with detraining is associated with intrinsic heart rate changes

    Directory of Open Access Journals (Sweden)

    Evangelista F.S.

    2005-01-01

    Full Text Available The mechanisms underlying the loss of resting bradycardia with detraining were studied in rats. The relative contribution of autonomic and non-autonomic mechanisms was studied in 26 male Wistar rats (180-220 g randomly assigned to four groups: sedentary (S, N = 6, trained (T, N = 8, detrained for 1 week (D1, N = 6, and detrained for 2 weeks (D2, N = 6. T, D1 and D2 were treadmill trained 5 days/week for 60 min with a gradual increase towards 50% peak VO2. After the last training session, D1 and D2 were detrained for 1 and 2 weeks, respectively. The effect of the autonomic nervous system in causing training-induced resting bradycardia and in restoring heart rate (HR to pre-exercise training level (PET with detraining was examined indirectly after cardiac muscarinic and adrenergic receptor blockade. T rats significantly increased peak VO2 by 15 or 23.5% when compared to PET and S rats, respectively. Detraining reduced peak VO2 in both D1 and D2 rats by 22% compared to T rats, indicating loss of aerobic capacity. Resting HR was significantly lower in T and D1 rats than in S rats (313 ± 6.67 and 321 ± 6.01 vs 342 ± 12.2 bpm and was associated with a significantly decreased intrinsic HR (368 ± 6.1 and 362 ± 7.3 vs 390 ± 8 bpm. Two weeks of detraining reversed the resting HR near PET (335 ± 6.01 bpm due to an increased intrinsic HR in D2 rats compared with T and D1 rats (376 ± 8.8 bpm. The present study provides the first evidence of intrinsic HR-mediated loss of resting bradycardia with detraining in rats.

  19. Bradycardia Associated With Drug-Eluting Beads Loaded With Irinotecan (DEBIRI) Infusion for Colorectal Liver Metastases

    International Nuclear Information System (INIS)

    Intra-arterial injection of drug-eluting beads loaded with irinotecan (DEBIRI) is a new treatment option being investigated, with encouraging results, for unresectable colorectal liver metastases that are refractory to systemic chemotherapy (Martin et al., Ann Surg Oncol 18:192–198, 2011). Toxicity related to DEBIRI has also been described (Martin et al., Cardiovasc Intervent Radiol 33:960–966, 2010). Nevertheless, experience and literature related to DEBIRI remain limited, and experience with this treatment is expected to increase. The purpose of this article is to describe bradycardia occurring during DEBIRI administration, which has not been reported thus far.

  20. Bradycardia Associated With Drug-Eluting Beads Loaded With Irinotecan (DEBIRI) Infusion for Colorectal Liver Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Pua, Uei, E-mail: druei@yahoo.com [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore)

    2013-06-15

    Intra-arterial injection of drug-eluting beads loaded with irinotecan (DEBIRI) is a new treatment option being investigated, with encouraging results, for unresectable colorectal liver metastases that are refractory to systemic chemotherapy (Martin et al., Ann Surg Oncol 18:192-198, 2011). Toxicity related to DEBIRI has also been described (Martin et al., Cardiovasc Intervent Radiol 33:960-966, 2010). Nevertheless, experience and literature related to DEBIRI remain limited, and experience with this treatment is expected to increase. The purpose of this article is to describe bradycardia occurring during DEBIRI administration, which has not been reported thus far.

  1. 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. PMID:25706937

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  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 f

  6. Investigation into the characteristics, triggers and mechanism of apnoea and bradycardia in the anaesthetized platypus (Ornithorhynchus anatinus).

    Science.gov (United States)

    Macgregor, J W; Holyoake, C; Fleming, P A; Robertson, I D; Connolly, J H; Warren, K S

    2014-01-01

    Health and conservation research on platypuses (Ornithorhynchus anatinus) may require anaesthesia to reduce stress and the risk of injury to both the animal and the researcher, as well as to facilitate examination and sample collection. Platypus anaesthesia can be difficult to manage, with reports of periods of apnoea and bradycardia described. This study investigated the conditions around sudden-onset apnoea and bradycardia in 163 field-anaesthetized platypuses as part of a health study. Anaesthesia was induced and maintained using isoflurane delivered in oxygen by face mask. Sudden-onset apnoea and bradycardia was observed in 19% of platypuses, occurring either at induction of anaesthesia, during recovery, or both. At induction, occurrence was more often recorded for adults (P = 0.19) and was correlated with low body temperature (P < 0.001), season (P = 0.06; greater incidence in summer) and longer pre-anaesthetic holding time (P = 0.16). At recovery, sudden-onset apnoea and bradycardia occurred only in platypuses that had been placed in dorsal recumbency as part of their examination, and correlated with poor body condition (P = 0.002), time in dorsal recumbency (P = 0.005), adults (P = 0.06), number of fieldworkers (P = 0.06) and females (P = 0.11). The sudden-onset apnoea and bradycardia we observed is likely to result from the irritant nature of isoflurane (stimulating the trigeminal nerve via nasal chemoreceptors). We propose that this mechanism is analogous to that of submersion of the face/nasal cavity in cold water during a natural dive response, but that the term 'nasopharyngeal response' would more appropriately describe the changes observed under isoflurane anaesthesia. Although we did not record any long-term adverse effects on platypuses that had undergone this response, the nasopharyngeal response could complicate the diagnosis of anaesthetic dose-dependent apnoea and bradycardia. Therefore, we suggest that these

  7. Diving bradycardia of elderly Korean women divers, haenyeo, in cold seawater: a field report.

    Science.gov (United States)

    Lee, Joo-Young; Lee, Hyo-Hyun; Kim, Siyeon; Jang, Young-Joon; Baek, Yoon-Jeong; Kang, Kwon-Yong

    2016-03-28

    The purpose of the present field study was to explore diving patterns and heart rate of elderly Korean women divers (haenyeo) while breath-hold diving in cold seawater. We hypothesized that the decreasing rate in heart rate of elderly haenyeos during breath-hold diving was greater and total diving time was shorter than those of young haenyeos from previous studies. Nine haenyeos participated in a field study [68 ± 10 yr in age, ranged from 56 to 83 yr] at a seawater temperature of 10 to 13 °C. Average total diving time including surface swimming time between dives was 253 ± 73 min (155-341 min). Total frequency of dives was 97 ± 28 times and they dived 23 ± 8 times per hour. All haenyeos showed diving bradycardia with a decreased rate of 20 ± 8% at the bottom time (101 ± 20 bpm) when compared to surface swimming time (125 ± 16 bpm) in the sea. Older haenyeos among the nine elderly haenyeos had shorter diving time, less diving frequencies, and lower heart rate at work (p<0.05). These reductions imply that haenyeos voluntarily adjust their workload along with advancing age and diminished cardiovascular functions. PMID:26632118

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

    Science.gov (United States)

    Kesavan, Kalpashri; Frank, Paul; Cordero, Daniella M.; Benharash, Peyman; Harper, Ronald M.

    2016-01-01

    Background Apnea of Prematurity (AOP) is common, affecting the majority of infants born at 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. Objective 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. Methods 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. Results Fewer respiratory pauses occurred during vibration periods, relative to baseline (ppremature 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 intermittent hypoxia in premature neonates. Trial Registration ClinicalTrials.gov NCT02641249 PMID:27304988

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

    OpenAIRE

    Saeideh Aghagoli; Amrollah Salimi; Mona Salimi; Zohreh Ghazavi; Maryam Marofi; Abolfazl Mohammadbeigi

    2016-01-01

    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 distill...

  11. Sinus bradycardia, junctional rhythm, and low-rate atrial fibrillation in Short QT syndrome during 20 years of follow-up: three faces of the same genetic problem.

    Science.gov (United States)

    Righi, Daniela; Silvetti, Massimo S; Drago, Fabrizio

    2016-03-01

    We describe the case of an asymptomatic girl with sinus bradycardia and short QT interval at birth, junctional bradycardia in infancy requiring single-chamber pacemaker, atrial fibrillation in adolescence, and V141M mutation in the KCNQ1 gene. Atrial fibrillation recurred and became unresponsive to electrical or anti-arrhythmic therapy. During 20 years of follow-up, a progressive evolution from sinus node dysfunction to low-rate atrial fibrillation was observed. PMID:26279191

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

    Science.gov (United States)

    Hirschberg, Stefan; Hill, Rob; Balthasar, Nina; Pickering, Anthony E.

    2016-01-01

    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%, pmelanocortin 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. PMID:27077912

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

    Science.gov (United States)

    Cerritelli, Serena; Hirschberg, Stefan; Hill, Rob; Balthasar, Nina; Pickering, Anthony E

    2016-01-01

    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. PMID:27077912

  14. Validation of visualized transgenic zebrafish as a high throughput model to assay bradycardia related cardio toxicity risk candidates.

    Science.gov (United States)

    Wen, Dingsheng; Liu, Aiming; Chen, Feng; Yang, Julin; Dai, Renke

    2012-10-01

    Drug-induced QT prolongation usually leads to torsade de pointes (TdP), thus for drugs in the early phase of development this risk should be evaluated. In the present study, we demonstrated a visualized transgenic zebrafish as an in vivo high-throughput model to assay the risk of drug-induced QT prolongation. Zebrafish larvae 48 h post-fertilization expressing green fluorescent protein in myocardium were incubated with compounds reported to induce QT prolongation or block the human ether-a-go-go-related gene (hERG) K⁺ current. The compounds sotalol, indapaminde, erythromycin, ofoxacin, levofloxacin, sparfloxacin and roxithromycin were additionally administrated by microinjection into the larvae yolk sac. The ventricle heart rate was recorded using the automatic monitoring system after incubation or microinjection. As a result, 14 out of 16 compounds inducing dog QT prolongation caused bradycardia in zebrafish. A similar result was observed with 21 out of 26 compounds which block hERG current. Among the 30 compounds which induced human QT prolongation, 25 caused bradycardia in this model. Thus, the risk of compounds causing bradycardia in this transgenic zebrafish correlated with that causing QT prolongation and hERG K⁺ current blockage in established models. The tendency that high logP values lead to high risk of QT prolongation in this model was indicated, and non-sensitivity of this model to antibacterial agents was revealed. These data suggest application of this transgenic zebrafish as a high-throughput model to screen QT prolongation-related cardio toxicity of the drug candidates. PMID:22744888

  15. 厌食症合并窦性心动过缓1例%Anorexia with sinus bradycardia:a case report

    Institute of Scientific and Technical Information of China (English)

    王方芳; 徐玲; 陈宝霞; 崔鸣; 张媛

    2016-01-01

    SUMMARY Asanorexiapatientsalwaysgotothepsychiatricclinic,littleisconcernedabouttheoccur-rence 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 bradycar-dia 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 1 9-year-old female,who had the manifestation of anorexia.She lost obvious weight in a short time (about 1 5 kg in 6 months),and her body mass index was 1 4.8 kg/m2 .The patient felt apparent palpi-tation,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 emacia-tion,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,elec-trolytes 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 -1 8.0 ng/L),which were all lower;yet the thy-roid 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 appa-rently 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 bradycardia and hypothyroidism

  16. 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

  17. 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.

  18. Factors associated with sinus bradycardia during crizotinib treatment: a retrospective analysis of two large-scale multinational trials (PROFILE 1005 and 1007).

    Science.gov (United States)

    Ou, Sai-Hong Ignatius; Tang, Yiyun; Polli, Anna; Wilner, Keith D; Schnell, Patrick

    2016-04-01

    Decreases in heart rate (HR) have been described in patients receiving crizotinib. We performed a large retrospective analysis of HR changes during crizotinib therapy. HRs from vital-sign data for patients with anaplastic lymphoma kinase (ALK)-positive nonsmall cell lung cancer enrolled in PROFILE 1005 and the crizotinib arm of PROFILE 1007 were analyzed. Sinus bradycardia (SB) was defined as HR <60 beats per minute (bpm). Magnitude and timing of HR changes were assessed. Potential risk factors for SB were investigated by logistic regression analysis. Progression-free survival (PFS) was evaluated according to HR decrease by <20 versus ≥20 bpm within the first 50 days of starting treatment. For the 1053 patients analyzed, the mean maximum postbaseline HR decrease was 25 bpm (standard deviation 15.8). Overall, 441 patients (41.9%) had at least one episode of postbaseline SB. The mean precrizotinib treatment HR was significantly lower among patients with versus without postbaseline SB (82.2 bpm vs. 92.6 bpm). The likelihood of experiencing SB was statistically significantly higher among patients with a precrizotinib treatment HR <70 bpm. PFS was comparable among patients with or without HR decrease of ≥20 bpm within the first 50 days of starting crizotinib. Decrease in HR is very common among patients on crizotinib. The likelihood of experiencing SB was statistically significantly higher among patients with a precrizotinib treatment HR <70 bpm. This is the first large-scale report investigating the association between treatment with a tyrosine kinase inhibitor and the development of bradycardia. HRs should be closely monitored during crizotinib treatment. PMID:26823131

  19. 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

    Directory of Open Access Journals (Sweden)

    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.

  20. 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

  1. 用生物学方法重建心脏起搏点的研究进展%Biological approaches to generating cardiac biopacemaker for bradycardia

    Institute of Scientific and Technical Information of China (English)

    萧永福; DanielC.Sigg

    2007-01-01

    Normal rhythm in a healthy human heart originates from the natural biological pacemaker, the sinoatrial (SA) node which locates in the right atrium. SA node dysfunction or atrial-ventricular (AV) conduction block causes improper heart rate (bradycardia).Such dysfunction, if severe enough, is currently treated by implanting an electronic pacemaker which has been well established technically, but there are some limitations and inadequacies. Recently, progress in developing engineered cardiac biopacemakers with use of genes or cells has been made in experimental animal models. The hyperpolarization-activated cyclic-nucleotide-modulated(HCN) channel (pacemaker channel) modulates cardiac automaticity via the hyperpolarization-activated cation current (If). HCN genes have been delivered to animal myocardium via viral vectors or HCN-transferred cells for recreating biological pacemakers. Approaches with non-HCN genes or transplantation of beating cells are also novel and have been investigated for generating cardiac biopacers. This article summarizes the progresses in research on recreation of cardiac biopacemakers. Genetically engineered biological pacemaker holds great promise to potentially cure severe bradycardia if critical issues, such as their stability and longevity, are properly solved.%正常人的心脏节律源于右心房的天然起搏点(pacemaker)--窦房结.窦房结的功能异常或者房室传导阻滞会导致心率异常(如心律缓慢).治疗严重的心动过缓需要植入在技术上已经相当成熟的电子起搏器,但这种治疗存在一些缺陷和不足.近年来,在动物实验模型中应用基因或细胞来重建心脏的生物起搏点已经取得了进展.超极化活化环核苷酸门控(hyperpolarization-activated cyclic-nucleotide-modulated,HCN)通道(起搏通道)通过超极化活化的阳离子电流(hyperpolarization-activated cation current,If)调制心脏的自律性.利用病毒载体或转染HCN基因的细胞将HCN基

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

    Directory of Open Access Journals (Sweden)

    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.

  3. The Clinically-tested S1P Receptor Agonists, FTY720 and BAF312, Demonstrate Subtype-Specific Bradycardia (S1P1) and Hypertension (S1P3) in Rat

    Science.gov (United States)

    Fryer, Ryan M.; Muthukumarana, Akalushi; Harrison, Paul C.; Nodop Mazurek, Suzanne; Chen, Rong Rhonda; Harrington, Kyle E.; Dinallo, Roger M.; Horan, Joshua C.; Patnaude, Lori; Modis, Louise K.; Reinhart, Glenn A.

    2012-01-01

    Sphingosine-1-phospate (S1P) and S1P receptor agonists elicit mechanism-based effects on cardiovascular function in vivo. Indeed, FTY720 (non-selective S1PX 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. PMID:23285242

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

    Directory of Open Access Journals (Sweden)

    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.

  5. 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...

  6. Bradycardia in a patient taking black cohosh.

    Science.gov (United States)

    McKenzie, Scott C; Rahman, Atifur

    2010-10-18

    Cimicifuga racemosa, better known as black cohosh, has been widely used in Western cultures as a herbal treatment for relieving symptoms of menopause. It has previously been linked to cases of liver toxicity. We report a case of reversible complete heart block in a woman who had recently begun taking a herbal supplement containing black cohosh. We review the known side effect profile of black cohosh and its relationship to our case. PMID:20955128

  7. The comparison of catheter ablation and permanent pacing on patients with paroxysmal atrial fibrillation related tachycardia-bradycardia syndrome%阵发性心房颤动合并长R-R间期导管消融和起搏治疗的对比

    Institute of Scientific and Technical Information of China (English)

    陈英伟; 董建增; 马长生

    2014-01-01

    Objective To evaluate the outcome of AF ablation in patients with paroxysmal atrial fibrillation (AF) related tachycardia-bradycardia syndrome. Methods Fifty consecutive patients with paroxysmal AF and prolonged symptomatic sinus pauses on termination of AF referred to our hospital for ablation were evaluated (ABL group). In another 61 patients, paroxysmal AF was treated with anti-arrhythmic drug and a pacemaker was implanted due to AF related tachycardia-bradycardia syndrome. These patients were used as control (PM group). Results A total of 50 patients in the ABL group fulfilled Class I indication for pacemaker implantation at baseline but they actually underwent AF ablation. Re-evaluation at the end of follow-up showed that 47 (94%) patients no longer needed a pacemaker (Class III indication) because of free from AF with no recurrences of pre-syncopal or syncopal events or documented sinus pauses after the last procedure. More patients in the PM group were on AADs (PM 42.6%, ABL 6.0%, P < 0.001) while sinus rhythm maintenance at the end of follow-up was remarkably higher in the ABL group (82.0%vs. 21.3%in PM group, P < 0.001). The total rates of cardiac related re-hospitalization was not significantly different between the two groups, but hospitalizations caused by tachyarrhythmia was significantly higher in the PM group (PM group 14.8%, ABL group 2.0%, P=0.020).The embolic events, heart failure and death rate were not significantly different between the two groups. Conclusions In patients with paroxysmal AF related tachycardia-bradycardia syndrome, AF ablation seems to be superior to a strategy of pacing plus AAD. Pacemaker implantation can be waived in the majority of patients after a successful ablation.%目的:评估导管消融对阵发性心房颤动(房颤)相关快-慢综合征的疗效。方法连续入选2010年1月至2012年9月在北京安贞医院房颤中心接受导管消融的50例阵发性房颤合并房颤终止后症状性长间歇的

  8. Electromuscular incapacitating devices discharge and risk of severe bradycardia.

    Science.gov (United States)

    Havranek, Stepan; Neuzil, Petr; Linhart, Ales

    2015-06-01

    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

  9. Coexistence of a bradycardia- and tachycardia-dependent bundle branch block

    OpenAIRE

    Al Hashimi, H.M.M.; van Es, A.J.J.; Szili-Torok, T; Gardien, M.; Molhoek, G.P.; Verhorst, P. M. J.

    2004-01-01

    Aberrant ventricular conduction is a rare phenomenon as compared with the more frequently occurring antrioventricular conduction disturbances. It leads to widening of the QRS complex, which is either due to a complete or functional block in one of the bundle branches or a block within the intramyocardial conduction system itself. Mechanisms that are potentially involved in the genesis of aberrant ventricular conduction are sudden shortening of cycle length (tachycardia-dependent phase III), a...

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

    OpenAIRE

    Ginsberg, Jay

    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...

  11. 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

    nerve X Cardiac denervation had no effect on oxygen uptake rate (M-O2), gill ventilation rate (f(G)) or opercular pressure amplitude (P-OP) under normoxic conditions, but caused a significant increase in heart rate (f(H)), to 50 +/- 1 beats min(-1) by comparison to 40 +/- 2 beats min(-1) in sham...

  12. 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.

  13. 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

    aorta while iNOS mRNA was enhanced. LPS did not change eNOS protein level in liver in wt and COX-2 -/- mice. In aortic rings, LPS depressed contraction in response to the α1-adrenoceptor agonist phenylephrine. Inhibition of COX-2 (NS 398) or COX-2 deletion (COX-2-/-) had no effect on LPS......-induced suppression of vascular reactivity. Endothelial removal did not change the effect of LPS. LPS-induced depression of vascular reactivity was prevented by incubation with the NOS-blocker, L-NAME in rings with and without endothelium. It its concluded that a serial coupling between COX-2 and eNOS is not...... necessary for LPS-induced systemic decrease in blood pressure and heart rate and suppression of vascular reactivity in mice whereas iNOS appears to be of central importance. COX-2 and eNOS do not appear as attractive therapeutic cardiovascular targets....

  14. Oral Phenytoin Toxicity Causing Sinus Arrest: A Case Report

    Science.gov (United States)

    Thimmisetty, Ravi K.; Gorthi, Janardhana Rao

    2014-01-01

    We present a case of sinus node arrest leading to symptomatic junctional bradycardia from oral phenytoin toxicity, which is a rare presentation. Our patient had no prior cardiac history and was on phenytoin therapy for seizure disorder. Although bradycardia is more commonly associated with intravenous phenytoin and there were few case reports of bradycardia with oral phenytoin reported, the literature is limited. In this case report, we also reviewed the pathophysiology of phenytoin-induced cardiac toxicity. PMID:25343048

  15. Exercise training reduces resting heart rate via downregulation of the funny channel HCN4

    OpenAIRE

    D'Sousa, Alicia; Bucchi, Annalisa; Johnsen, Anne Berit; Logantha, Sunil; Monfredi, Oliver; Yanni, Joseph; Prehar, Sukhal; Hart, George; Cartwright, Elisabeth; Wisløff, Ulrik; Dobryznski, Halina; DiFrancesco, Dario; Morris, Gwilym; Boyett, Mark

    2014-01-01

    Endurance athletes exhibit sinus bradycardia, that is a slow resting heart rate, associated with a higher incidence of sinus node (pacemaker) disease and electronic pacemaker implantation. Here we show that training-induced bradycardia is not a consequence of changes in the activity of the autonomic nervous system but is caused by intrinsic electrophysiological changes in the sinus node. We demonstrate that training-induced bradycardia persists after blockade of the autonomous nervous system ...

  16. Tachycardia | Fast Heart Rate

    Science.gov (United States)

    ... Heart patient sheets Arrhythmia • Home • About Arrhythmia Introduction Atrial Fibrillation Bradycardia Conduction Disorders Premature Contractions Tachycardia Ventricular Fibrillation Other Rhythm Disorders Types of ...

  17. Other Rhythm Disorders

    Science.gov (United States)

    ... 10/23/2014. Arrhythmia • Home • About Arrhythmia Introduction Atrial Fibrillation Bradycardia Conduction Disorders Premature Contractions Tachycardia Ventricular Fibrillation Other Rhythm Disorders Types of ...

  18. Bradyarrhythmias: Clinical Presentation, Diagnosis, and Management.

    Science.gov (United States)

    Wung, Shu-Fen

    2016-09-01

    Bradyarrhythmias are common clinical findings consisting of physiologic and pathologic conditions (sinus node dysfunction and atrioventricular [AV] conduction disturbances). Bradyarrhythmias can be benign, requiring no treatment; however, acute unstable bradycardia can lead to cardiac arrest. In patients with confirmed or suspected bradycardia, a thorough history and physical examination should include possible causes of sinoatrial node dysfunction or AV block. Management of bradycardia is based on the severity of symptoms, the underlying causes, presence of potentially reversible causes, presence of adverse signs, and risk of progression to asystole. Pharmacologic therapy and/or pacing are used to manage unstable or symptomatic bradyarrhythmias. PMID:27484658

  19. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... The next video is going to be angiographic description, really, of the sheath access into the carotid ... choice of size and pressure, but more importantly, management of hypotension/hypertension, post-procedural bradycardia and so ...

  20. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... anyway. But it may change my post-procedure management under -- if there are PO collaterals from posterior ... choice of size and pressure, but more importantly, management of hypotension/hypertension, post-procedural bradycardia and so ...

  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. Observation of blood B-type natriuretic peptide level changes in different periods and different cardiac pacing modes

    Institute of Scientific and Technical Information of China (English)

    WANG Ru-xing; LI Xiao-rong; JIANG Wen-ping; LIU Zhi-hua; YANG Xiang-jun; XIAO Chun-hui; SHAO Li-zheng; ZHU Jian-qiu

    2005-01-01

    @@ In recent years, the indications of cardiac pacing have extended continuously with the rapid development of pacing technique. Pacemaker treatment has not only limited in arrhythmias of bradycardia and the number of pacemaker treatment has increased year by year.

  3. Disease: H00729 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available y experience syncope, pre-syncope, palpitations, or dizziness. SSS has multiple manifestations on electrocardiogram... alternating patterns of bradycardia and tachycardia. Autosomal recessive type (SSS1) can be caused by compo...ita H, Higashiuesato Y, Hirano Y, Yasunami M, Takishita S, Yamashina A, Ohe T, Sunamori M, Hiraoka M, Kimura A Functional chara..., including sinus bradycardia, sinus arrest, sinoatrial block, and... (SSS2) HCN4 [HSA:10021] [KO:K04957] Atrial or dual-chamber pacemaker placement O

  4. Vasovagal syncope as a manifestation of an evolutionary selected trait

    OpenAIRE

    Paolo Alboni; Marco Alboni

    2014-01-01

    Some observations suggest that typical (emotional or orthostatic) vasovagal syncope (VVS) is not a disease, but rather a manifestation of a non-pathological trait. We conducted an extensive bibliographic research on the vasovagal reactions in animals, including humans, in order to investigate the possible factors that may explain the origin and evolution of VVS. We found two processes which appear useful for the investigation of VVS evolution: fear/threat bradycardia (alarm bradycardia) in an...

  5. Adverse Reactions to Radiographic Contrast Material

    OpenAIRE

    Bush, William H.; Mullarkey, Michael F.; Webb, D. Robert

    1980-01-01

    Major adverse reactions to radiographic contrast media will occur more often as contrast material is now also administered during computerized tomographic (CT) scanning. Differentiation of the two major contrast reactions, the vagus reaction and the anaphylactoid reaction, is essential. Bradycardia is the key finding for identifying the vagus reaction. The vagus reaction involving hypotension and bradycardia requires treatment with large doses of atropine given intravenously. The immediate ge...

  6. 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.

  7. Bradycardiac angina: haemodynamic aspects and treatment.

    Science.gov (United States)

    Fowler, P B; Ikram, H; Maini, R N; Makey, A R; Kirkham, J S

    1969-01-11

    A patient with a sinus bradycardia and angina is described who was unable to increase his heart rate on vigorous exercise by more than a few beats. His severe angina was attributed to the bradycardia. Atrial pacing of his heart abolished his angina and increased his exercise tolerance. Circulatory changes at rest, on exertion, and with atrial pacing are described. The cause of angina in this patient is discussed. PMID:5761833

  8. Transient Presyncope Secondary to Posterior Descending Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Andrew D. Moffat

    2011-01-01

    Full Text Available We describe the case of a 64-year-old male initially presenting with presyncope and bradycardia, without any anginal symptoms or objective evidence of myocardial ischemia. A stress test induced no physical symptoms but revealed a left bundle branch block with multiple preventricular contractions on electrocardiogram. Subsequent catheterization revealed severe obstructive disease throughout the coronary arteries. He was treated percutaneously on two separate heart catheterizations. The presyncope and bradycardia resolved after reperfusion of the posterior descending artery.

  9. Swallowing-induced cardio-respiratory responses in man

    OpenAIRE

    Ballal Mansour; Sanford Paul

    1998-01-01

    Swallowing transiently increases heart rate. One of the authors developed pronounced bradycardia while breath holding, particularly after an expiration. The objective, therefore, was to study his cardiac responses during swallowing as pronounced bradycardia developed. When, after a maximum inspiration (supine), the heart rate slowly fell below 50 beats min′ well-defined P waves (lead II) disappeared. By swallowing 6 times on command after the P waves disappeared his heart rate increase...

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

    OpenAIRE

    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

    2013-01-01

    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...

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

    OpenAIRE

    Yilmaz Yozgat; Ayhan Kilic; Cem Karadeniz; Rahmi Ozdemir; Onder Doksoz; Timur Mese; Nurettin Unal

    2013-01-01

    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 ...

  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. Importance of close follow-up in the fetus with premature atrial contractions accompanied by atrial septal aneurysm: a case report.

    Science.gov (United States)

    Yozgat, Yilmaz; Kilic, Ayhan; Karadeniz, Cem; Ozdemir, Rahmi; Doksoz, Onder; Mese, Timur; Unal, Nurettin

    2013-01-01

    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. PMID:24455349

  14. ECG changes during cerebral angiography

    Energy Technology Data Exchange (ETDEWEB)

    Hayakawa, K.; Nishimura, Y.; Yoshida, M.; Itoh, K.; Hayashi, N.; Aoki, J.; Nakamura, K.; Imai, M.; Ono, T.; Morikawa, S.

    1984-09-01

    We have analyzed HR changes greater than 20% among 334 patients and 942 cerebral angiographies. A tachycardial effect was seen in 14.9% of patients, while a bradycardial effect was seen in 7.1% including two patients having cardiac standstill (0.5%). These two patients were examined without atropine premedication after subarachnoid hemorrhage. Patients under 19 years of age, unpremedicated with atropine sulfate and suffering from subarachnoid hemorrhage secondary to ruptured aneurysm or arteriovenous malformation showed a significantly high incidence of bradycardia. On the other hand, patients with the neoplastic disease and having an initial sinus bradycardia showed a significantly high incidence of a tachycardial effect.

  15. 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.

  16. Fetal Heart Rate Regresses toward the Mean in the Third Trimester

    OpenAIRE

    Park, Young-Sun; Hoh, Jeong-Kyu; Park, Moon-il

    2012-01-01

    The purpose of this study was to investigate the feasibility of different fetal heart rate (FHR) ranges in the nonstress test (NST) and to better understand the meaning of mild bradycardia and/or tachycardia without non-reassuring patterns. We employed the heredity to show that mild bradycardia (100-119 beats per minute, bpm) and mild tachycardia (161-180 bpm) regressed to the normal FHR range (120-160 bpm). We used linear regression to analyze FHR data from FHR tracings recorded 10 min befor...

  17. Perioperative Beta Blockade - A Case Report

    Directory of Open Access Journals (Sweden)

    Sunitha K. Zachariah

    2009-10-01

    Full Text Available Continuation of antihypertensives preoperatively and their influence on intraoperative hemodynamics is a big concern among anesthesiologists. The Peri Operative Ischaemia Study Evaluation (POISE trial showed a significant reduction of myocardial infarction, need for coronary revascularization and the incidence of atrial fibrillation with metoprolol started 2-4 hours prior to surgery but a significant increase in total mortality and clinically significant hypotension and bradycardia. This is a case report of intraoperative severe bradycardia in a young patient on recently started beta blocker.

  18. 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.

  19. A craniopharyngioma in a seven-year-old dog

    International Nuclear Information System (INIS)

    A seven-year-old male Border Collie was presented with a history of lethargy, episodic circling, incoordination and polydypsia. Physical examination revealed depression, obesity and bradycardia. A neurological examination indicated the possible presence of a space-occupying lesion in the brain. Results of the clinical investigation revealed hyposthenuria, sinus bradycardia and increased concentration of protein in the cerobrospinal fluid. A computerised axial tomography scan revealed a mass in the region of the hypophysis. The dog was euthanased and a post mortem examination confirmed the presence of a craniopharyngioma. 17 refs., 3 figs

  20. Feasibility of repetitive lung function measurements by raised volume rapid thoracoabdominal compression during methacholine challenge in young infants

    DEFF Research Database (Denmark)

    Loland, Lotte; Bisgaard, Hans

    2008-01-01

    > 40% during the test. Short-lasting, self-limiting episodes of hypoxemia of < 80% occurred in 1% of infants and bradycardia < 90 beats/min in 19% of infants. The most common observations by parents were changes in the patterns of sleeping (95%), eating (57%), and behavior (58%) of the infant after...

  1. 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

    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....

  2. Facial immersion in cold water enhances cerebral blood velocity during breath-hold exercise in humans

    DEFF Research Database (Denmark)

    Kjeld, Thomas; Pott, Frank C; Secher, Niels H

    2009-01-01

    The diving response is initiated by apnea and facial immersion in cold water and includes, besides bradycardia, peripheral vasoconstriction, while cerebral perfusion may be enhanced. This study evaluated whether facial immersion in 10 degrees C water has an independent influence on cerebral...

  3. Low atrial septum pacing in pacemaker patients

    NARCIS (Netherlands)

    Voogt, Willem Gijsbert de

    2006-01-01

    In patients with an indication for anti bradycardia pacing, atrial fibrillation (AF) is a common arrhythmia (30-50%) even in the absence of atrial tachy arrhythmias before pacemaker implantation. Pace prevention and pace intervention for atrial tachy arrhythmias could be an interesting adjuvant trea

  4. Salusin β Within the Nucleus Tractus Solitarii Suppresses Blood Pressure Via Inhibiting the Activities of Presympathetic Neurons in the Rostral Ventrolateral Medulla in Spontaneously Hypertensive Rats.

    Science.gov (United States)

    Li, Hong-Bao; Lu, Yan; Liu, Jin-Jun; Miao, Yu-Wang; Zheng, Tian-Zhen; Su, Qing; Qi, Jie; Tan, Hong; Yuan, Zu-Yi; Zhu, Guo-Qing; Kang, Yu-Ming

    2016-07-01

    Salusin β is a newly identified bioactive peptide, which shows peripheral hypotensive, mitogenic and proatherosclerotic effects. The present study was undertaken to investigate the role of salusin β within the nucleus tractus solitarii (NTS) and the underlying mechanism in regulating blood pressure and heart rate (HR) in spontaneously hypertensive rats (SHR). Our results showed that bilateral or unilateral microinjection of salusin β (0.4-40 pmol) into the NTS in SHR decreased mean arterial pressure and HR in a dose-dependent manner. Bilateral microinjection of salusin β (4 pmol) within NTS improved baroreflex sensitivity functions in SHR. Pretreatment with glutamate receptors antagonist kynurenic acid (5 nmol) into the NTS in SHR did not alter the salusin β (4 pmol) induced hypotension and bradycardia. Likewise, bilateral vagotomy also did not alter the salusin β (4 pmol) induced hypotension and bradycardia. However, pretreatment with GABAA receptors agonist muscimol (100 pmol) within the rostral ventrolateral medulla (RVLM) in SHR almost completely abolished the hypotension and bradycardia evoked by intra-NTS salusin β (4 pmol). Our findings suggested that microinjection of salusin β into the NTS produced hypotension and bradycardia, as well as improved baroreflex sensitivity functions, via inhibiting the activities of presympathetic neurons in the RVLM in SHR. PMID:26059186

  5. Acute Atrial Fibrillation Derived by Single-Doze Fentanyl Transdermal Usage

    OpenAIRE

    Mesut Gitmez

    2014-01-01

    Fentanyl is a selective and synthetic opiate agonist. Especially in cancer-derived pain treatment fentanyl transdermal usage is preferred. Clinic impacts occur related to several systems derived by fentanyl usage. However, respiratory failure, hypothermia and bradycardia are observed the most. In this article, we aimed at presenting a case which developed atrial fibrillation derived by single-dose fentanyl transdermal usage.

  6. 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 ...

  7. Neostigmine for treatment of acute colonic pseudo-obstruction

    Directory of Open Access Journals (Sweden)

    Suri S

    2005-01-01

    Full Text Available Acute colonic pseudo-obstruction is managed with bolus neostigmine as shown in a recent prospective, double blind, placebo-controlled study. Parasympathetic stimulation with neostigmine leads to abdominal pain, salivation, and symptomatic bradycardia. We submit a more effective method may involve use of neostigmine infusion to reduce complications and improve efficacy.

  8. 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

    . Furthermore, 12-lead electrocardiograms (ECGs) were obtained shortly after SCI and at 4 weeks. RESULTS: Thirty patients were included. Bradycardia (heart rate (HR) b.p.m.) was present in 17-35% of the patients with cervical (C1-C8) SCI (n = 24) within the first 14 days. In the following 14 days...

  9. Cardiac output and vasodilation in the vasovagal response

    DEFF Research Database (Denmark)

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

    2016-01-01

    The simple faint is secondary to hypotension and bradycardia resulting in transient loss of consciousness. According to Ohm's law applied to the circulation, BP = SVR × CO, hypotension can result from a decrease in systemic vascular resistance (SVR), cardiac output (CO), or both. It is important...

  10. Serotonin receptors as cardiovascular targets

    NARCIS (Netherlands)

    C.M. Villalón (Carlos); P.A.M. de Vries (Peter); P.R. Saxena (Pramod Ranjan)

    1997-01-01

    textabstractSerotonin exerts complex effects in the cardiovascular system, including hypotension or hypertension, vasodilatation or vasoconstriction, and/or bradycardia or tachycardia; the eventual response depends primarily on the nature of the 5-HT receptors involved. In the light of current 5-HT

  11. 77 FR 16038 - Circulatory System Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2012-03-19

    ... require the creation of an abdominal pump pocket. The HVAS is indicated for use as a bridge to cardiac transplantation in patients who are at risk of death from refractory, advanced heart failure. On April 26, 2012... shocks as well as bradycardia demand mode cardiac pacing. The study provides data from the treatment...

  12. 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.

  13. 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 the ...

  14. 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

    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...

  15. Pathogenetic Mechanisms of Neurogenic Pulmonary Edema

    Czech Academy of Sciences Publication Activity Database

    Šedý, Jiří; Kuneš, Jaroslav; Zicha, Josef

    2015-01-01

    Roč. 32, č. 15 (2015), s. 1135-1145. ISSN 0897-7151 R&D Projects: GA ČR(CZ) GAP304/12/0259 Institutional support: RVO:67985823 Keywords : baroreflex-induced bradycardia * blood pressure rise * blood volume redistribution * neurogenic pulmonary edema * spinal cord injury * sympathetic nervous system Subject RIV: ED - Physiology Impact factor: 3.714, year: 2014

  16. Transient ST-segment elevation after transseptal puncture for atrial fibrillation ablation in two cases

    Institute of Scientific and Technical Information of China (English)

    CHENG Yan-li; DONG Jian-zeng; LIU Xing-peng; LONG De-yong; FANG Dong-ping; YU Rong-hui; TANG Ri-bo; MA Chang-sheng

    2012-01-01

    The present report demonstrates two cases of transient inferior ST-segment elevation accompanied by profound hypotension and bradycardia immediately after transseptal puncture for catheter ablation of atrial fibrillation.This rare complication of transseptal puncture was resolved quickly within several minutes.The most likely mechanism of this phenomenon is coronary vasospasm,although coronary embolism can not be ruled out completely.This complication is characterized as follows:(1) The right coronary artery might be the most likely involved vessel and therefore myocardial ischemia usually occurs in the inferior wall of left ventricular; (2) Reflex hypotension and bradycardia by the Bezold-Jarisch reflex secondary to inferior ischemia often occur at the same time.Though it appears to be a transient and completely reversible phenomenon,there are still potential life-threatening risks because of myocardial ischemia and profound haemodynamic instability.Clinical cardiologists should be aware of this rare complication and properly deal with it.

  17. Cardiac arrhythmias associated with spinal cord injury

    DEFF Research Database (Denmark)

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

    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...... 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...

  18. Heart rate monitoring on the stroke unit. What does heart beat tell about prognosis? An observational study

    Directory of Open Access Journals (Sweden)

    Stypmann Jörg

    2011-04-01

    Full Text Available Abstract Background Guidelines recommend maintaining the heart rate (HR of acute stroke patients within physiological limits; data on the frequency and predictors of significant deviations from these limits are scarce. Methods Demographical data, stroke risk factors, NIH stroke scale score, lesion size and location, and ECG parameters were prospectively assessed in 256 patients with ischemic stroke. Patients were continuously monitored for at least 24 hours on a certified stroke unit. Tachycardia (HR ≥120 bpm and bradycardia (HR Results HR ≥120 bpm occurred in 39 patients (15%. Stroke severity (larger lesion size/higher NIHSS-score on admission, atrial fibrillation and HR on admission predicted its occurrence. HR Conclusions Significant tachycardia and bradycardia are frequent phenomena in acute stroke; however they do not independently predict clinical course or outcome. Continuous monitoring allows detecting rhythm disturbances in stroke patients and allows deciding whether urgent medical treatment is necessary.

  19. 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.

  20. Myocardial stunning after resuscitation from cardiac arrest following spinal anaesthesia

    Directory of Open Access Journals (Sweden)

    Pranjali Madhav Kurhekar

    2014-01-01

    Full Text Available Cardiac arrest associated with spinal anaesthesia has been well researched. Myocardial stunning after successful resuscitation from cardiac arrest is seen in up to 2/3 rd of in-hospital cardiac arrests. Myocardial stunning after resuscitation from cardiac arrest associated with spinal anaesthesia has probably not been reported earlier. Our case, an ASA physical status I lady, posted for tubal reanastomosis surgery developed bradycardia followed by asystole, approximately 5 minutes after giving subarachnoid block. Return of spontaneous circulation (ROSC was achieved within 2 minutes with cardiopulmonary resuscitation (CPR and defibrillation for pulseless ventricular tachycardia. Patient developed delayed pulmonary oedema, which was probably due to myocardial stunning. In the present case, inadequate preloading could have precipitated bradycardia progressing to cardiac arrest which, after resuscitation led to reversible myocardial dysfunction. We conclude that early vasopressor infusion, titrated fluids and echocardiography should be considered in immediate post cardiac arrest phase following spinal anaesthesia.

  1. Life-threatening cardiotoxicity due to chronic oral phenytoin overdose

    Directory of Open Access Journals (Sweden)

    Su Chih-Min

    2009-01-01

    Full Text Available Severe cardiac adverse effects are often related to intravenous phenytoin overdose. However, there is no reported cardiotoxicity resulting from oral overdose of phenytoin. We report a patient with post-traumatic epilepsy who received oral phenytoin for five months and developed life-threatening junctional bradycardia, with his serum phenytoin level reaching up to 91µg/mL. The patient was successfully treated with temporary transvenous pacemaker implantation for his severe bradycardia and hypotension. To our knowledge, our patient had the most serious cardiovascular toxicity ever reported with chronic oral phenytoin overdose. From emergency department (ED physician′s perspective, when a patient with dysrhythmias and cardiovascular collapse is presented to the ED, severe phenytoin overdose should be considered in patients on oral phenytoin with hyperbilirubinemia, hypoalbuminemia, and severe electrolyte imbalance.

  2. Avoidance and management of trigeminocardiac reflex complicating awake-craniotomy.

    Science.gov (United States)

    Prabhu, Vikram C; Bamber, Norman I; Shea, John F; Jellish, W Scott

    2008-12-01

    The trigeminocardiac reflex occurs from manipulation or stimulation of peripheral branches or the central component of the trigeminal nerve and consists of bradycardia, hypotension, apnea, and increased gastric motility. The efferent limb of the response is mediated by the vagus nerve. This 65-year-old Caucasian male suffered an episode of bradycardia progressing to transient asystole during the course of an awake-craniotomy procedure for tumor resection. The cardiac rhythm changes resolved with administration of intravenous atropine, removal of the precipitating stimulus, and application of topical anesthetic on the dura of the middle cranial fossa. The trigeminocardiac response may complicate the course of a craniotomy and may place an awake, unintubated patient at increased risk for morbidity. The reflex may be prevented by anesthetizing the dura innervated by the trigeminal nerve via injection or topical application of local anesthetic. If encountered, removal of the stimulus, airway protection, and administration of vagolytic medications are measures that need to be considered. PMID:18845385

  3. Arrhythmia diagnosis and management throughout life in congenital heart disease.

    Science.gov (United States)

    Clark, Bradley C; Berul, Charles I

    2016-03-01

    Arrhythmias, covering bradycardia and tachycardia, occur in association with congenital heart disease (CHD) and as a consequence of surgical repair. Symptomatic bradycardia can occur due to sinus node dysfunction or atrioventricular block secondary to either unrepaired CHD or surgical repair in the area of the conduction system. Tachyarrhythmias are common in repaired CHD due to scar formation, chamber distension or increased chamber pressure, all potentially leading to abnormal automaticity and heterogeneous conduction properties as a substrate for re-entry. Atrial arrhythmias occur more frequently, but ventricular tachyarrhythmias may be associated with an increased risk of sudden cardiac death, notably in patients with repaired tetralogy of Fallot or aortic stenosis. Defibrillator implantation provides life-saving electrical therapy for hemodynamically unstable arrhythmias. Ablation procedures with 3D electroanatomic mapping technology offer a viable alternative to pharmacologic or device therapy. Advances in electrophysiology have allowed for successful management of arrhythmias in patients with congenital heart disease. PMID:26642231

  4. Thyroid hormone and development: the importance of transporters and deiodinases

    OpenAIRE

    Visser, Wil Edward

    2010-01-01

    textabstractThyroid hormone, which is the common name for the prohormone T4 (3,5,3’,5’-tetraiodothyronine; thyroxine) and the bioactive hormone T3 (3,5,3’-triiodothyronine), is indispensable for normal development and metabolism of all tissues. Its effects on metabolism are clearly illustrated by the clinical manifestations in primary thyroid diseases. In hypothyroidism, symptoms such as cold intolerance, constipation, weight gain and bradycardia result from a generalized slowing of metabolic...

  5. Muscarinic inhibitory receptors in pulmonary parasympathetic nerves in the guinea-pig.

    OpenAIRE

    Fryer, A D; Maclagan, J.

    1984-01-01

    In anaesthetized guinea-pigs, gallamine produced a dose-related potentiation of the bronchoconstriction induced by electrical stimulation of the cervical vagus nerves; (+)-tubocurarine and suxamethonium lacked this effect. The bronchoconstriction produced by intravenous injection of acetylcholine or histamine, however, was not potentiated by gallamine. Vagally-induced bradycardia was abolished by gallamine, confirming antagonism of the effect of acetylcholine on muscarinic receptors in the he...

  6. RGS Proteins in Heart: Brakes on the Vagus

    OpenAIRE

    RoryAlanFisher

    2012-01-01

    It has been nearly a century since Otto Loewi discovered that acetylcholine (ACh) release from the vagus produces bradycardia and reduced cardiac contractility. It is now known that parasympathetic control of the heart is mediated by ACh stimulation of Gi/o-coupled muscarinic M2 receptors, which directly activate G protein-coupled inwardly rectifying potassium (GIRK) channels via Gβγ resulting in membrane hyperpolarization and inhibition of action potential (AP) firing. However, expression of...

  7. Neonatal molecular pathologies induced by maternal anti-Ro and anti-La antibodies

    OpenAIRE

    Herrera-Esparza R.; Avalos-Díaz E

    2015-01-01

    Maternal antinuclear antibodies with anti-Ro or anti-La specificity might be pathogenic to the fetus and could induce molecular neonatal pathologies, such as neonatal lupus (NL) with or without congenital heart block (CHB). The cutaneous manifestations of neonatal lupus appear at birth or a few weeks later, and skin lesions may persist for weeks. While CHB is characterized by intrauterine bradycardia or low heart rates at birth and may persist for months, depending on the degree of blockage....

  8. Antenatal and postnatal combined therapy for autoantibody-related congenital atrioventricular block

    OpenAIRE

    Di Mauro, Antonio; Caroli Casavola, Vita; Favia Guarnieri, Giovanna; Calderoni, Grazia; Cicinelli, Ettore; Laforgia, Nicola

    2013-01-01

    Background Autoantibody-related congenital heart block (CHB) is an autoimmune condition in which trans placental passage of maternal autoantibodies cause damage to the developing heart conduction system of the foetus. Case presentation We report a case of an Italian 31–year-old woman, in a good clinical status, referred to our Centre at 26 weeks of her first pregnancy, because of foetal bradycardia, found during routine foetal ultrasonography. Foetal echocardiography revealed a 3rd degree CHB...

  9. Low atrial septum pacing in pacemaker patients

    OpenAIRE

    Voogt, Willem Gijsbert de

    2006-01-01

    In patients with an indication for anti bradycardia pacing, atrial fibrillation (AF) is a common arrhythmia (30-50%) even in the absence of atrial tachy arrhythmias before pacemaker implantation. Pace prevention and pace intervention for atrial tachy arrhythmias could be an interesting adjuvant treatment in the prevention of the arrhythmia related complications. These treatment modalities when available in pacemaker systems could come at a relative low cost as the indication for pacemaker imp...

  10. Cardiovascular complications in ciguatera fish poisoning: A wake-up call

    Directory of Open Access Journals (Sweden)

    Subramanian Senthilkumaran

    2011-01-01

    Full Text Available Ciguatera fish poisoning occurs with ingestion of fish containing ciguatoxin. It causes a clinical syndrome that comprises classic gastrointestinal, neurological and cardiovascular symptoms. Ciguatoxin is a sodium channel agonist with cholinergic and adrenergic activity. Although cardiovascular symptoms are rare with ciguatoxin, we report two cases with bradycardia and hypotension. Fatality and long-term sequelae are not uncommon with ciguatoxin poisoning and educating the general population is essential.

  11. Nasocardiac reflex during aspiration and injection through a nasogastric tube: An infrequent occurrence

    OpenAIRE

    Rudrashish Haldar; Jasleen Kaur; Sukhminder Jit Singh Bajwa

    2015-01-01

    Nasocardiac reflex is a relatively less discussed variant of trigeminovagal reflex where the afferent arc of the reflex is represented by any of the branches of the trigeminal nerves, and the efferent arc is via the vagus nerve. Elicitation of this reflex is commonly seen during surgical manipulation and is manifested as bradycardia or even asystole. We report a case where nasocardiac reflex was unusually observed in a patient when aspiration and injection were done through a nasogastric tube.

  12. The trigeminocardiac reflex – a comparison with the diving reflex in humans

    OpenAIRE

    Lemaitre, Frederic; Chowdhury, Tumul; Schaller, Bernhard

    2015-01-01

    The trigeminocardiac reflex (TCR) has previously been described in the literature as a reflexive response of bradycardia, hypotension, and gastric hypermotility seen upon mechanical stimulation in the distribution of the trigeminal nerve. The diving reflex (DR) in humans is characterized by breath-holding, slowing of the heart rate, reduction of limb blood flow and a gradual rise in the mean arterial blood pressure. Although the two reflexes share many similarities, their relationship and esp...

  13. Serotonergic Modulation of the Trigeminocardiac Reflex Neurotransmission to Cardiac Vagal Neurons in the Nucleus Ambiguus

    OpenAIRE

    Gorini, C.; Jameson, H. S.; Mendelowitz, D.

    2009-01-01

    Stimulation of the trigeminal nerve evokes a dramatic decrease in heart rate and blood pressure, and this reflex has generally been termed the trigeminocardiac reflex. A subset of the trigeminocardiac reflex is the diving reflex in which the nasal mucosa is stimulated with water or air-borne chemical irritants. Activation of the diving reflex evokes a pronounced bradycardia, mediated by increased parasympathetic cardiac activity, and is the most powerful autonomic reflex. However, exaggeratio...

  14. Dentocardiac Reflex: an Allegedly New Subform of the Trigeminocardiac Reflex

    OpenAIRE

    Amr Abdulazim; Ashkan Rashad; Behnam Bohluli; Bernhard Schaller; Fatemeh Momen-Heravi; Pooyan Sadr-Eshkevari

    2011-01-01

    Trigeminocardiac reflex (TCR) is currently defined as a sudden bradycardia and decrease in mean arterial blood pressure by 20% during the manipulation of the branches of trigeminal nerve. TCR, especially during the last decade has been mostly studied in the course of neurosurgical procedures which are supposed to elicit the central subtype of TCR. Previously the well-known oculocardiac reflex was also considered as a subtype of TCR. Recently, surgeons dealing with the other branches of the fi...

  15. Trigeminocardiac Reflex during Maxillary Reconstruction Surgery: A Case Report

    OpenAIRE

    Mayank Kulshrestha; Sahil Kapur; Col. M Kapadia

    2014-01-01

    Systemic hypotension, cardiac dysrhythmia especially bradycardia, apnoea, and gastric hypermotility occurring presumably after stimulation of any of the sensory branches of trigeminal nerve is coined as trigeminocardiac reflex (TCR). It has been described to occur in various surgeries like cerebello-pontine angle and pituitary fossa surgeries. Such bradycardic reflex responses have also been observed during maxillofacial surgeries. The TCR presents as a challenge to both the Anaesthesiologis...

  16. Cardiac arrest due to intracranial hypotension following pseudohypoxic brain swelling induced by negative suction drainage in a cranioplasty patient: a case report

    OpenAIRE

    Moon, Hyun-Soo; Lee, Soo Kyung; Kim, Su Ryun; Kim, Seon Ju

    2016-01-01

    Pseudohypoxic brain swelling (PHBS) is known to be an uncommon event that may occur during and following an uneventful brain surgery, when negative suction drainage is used. The cerebrospinal fluid loss related to suction drainage can evoke intracranial hypotension that progress to PHBS. The main presentations of PHBS are sudden unexpected circulatory collapses, such as severe bradycardia, hypotension, cardiac arrest, consciousness deterioration and diffuse brain swelling as seen with brain c...

  17. 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

    OpenAIRE

    Flávia V. Moreira; Joana F. A. Bastos; Blank, Arie F.; Péricles B. Alves; Santos, Márcio R.V.

    2010-01-01

    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-N...

  18. Detection of the mutation may guide treatment of heart and muscle in Duchenne muscular dystrophy

    OpenAIRE

    Finsterer J; Zarrouk-Mahjoub S

    2016-01-01

    Josef Finsterer,1 Sinda Zarrouk-Mahjoub21Krankenanstalt Rudolfstiftung, Vienna, Austria; 2Genomics Platform, Pasteur Institute of Tunis, Tunis, Tunisia We read with great interest the article, by Kono et al, about a 32-year-old male with Duchenne muscular dystrophy (DMD), who was admitted for dilated cardiomyopathy manifesting as heart failure, left bundle branch block, Mobitz-II block, bradycardia, and arterial hypotension. He profited from implantation of a cardiac resynchronizatio...

  19. Baclofen intoxication after accidental ingestion in a 3-year-old child

    OpenAIRE

    Dasarwar Nagesh; Shanbag Preeti; Kumbhare Nilesh

    2009-01-01

    Baclofen is a skeletal muscle relaxant, used to control spasticity in both adults and children with neuromuscular disorders. Several cases of baclofen overdose have been reported, but only a small number have involved children. We report a 3-year-old girl with accidental ingestion of baclofen, who presented with coma, bradycardia and hypotension. She recovered within 24 hours with supportive treatment. The case emphasizes the importance of warning parents about the potential toxicity of baclo...

  20. Cases of Swallow Syncope Induced by the Activation of Mechanorecepters in the Lower Esophagus

    OpenAIRE

    Kang, Ki Hoon; Cho, Wook Hyun; Kim, Myung Chan; Chang, Hee Jong; Chung, Jae Il; Won, Dong Jun

    2005-01-01

    Swallowing is a rare cause of neurally mediated syncope. The mechanism of swallow syncope that contributes to hypotension, bradycardia, or to both is complex. A 59-year-old man had experienced a recurrent loss of consciousness during swallowing of carbonated beverages or sticky foods. Another 59-year-old man had complained of intermittent syncope just after eating foods. These two patients had no significant structural or functional abnormalities in the esophagus or heart. Both cases showed b...

  1. Sinus node electrogram recording in 59 patients. Comparison with simultaneous estimation of sinoatrial conduction using premature atrial stimulation.

    OpenAIRE

    Juillard, A.; Guillerm, F; Chuong, H V; Barrillon, A; Gerbaux, A

    1983-01-01

    Directly measured sinoatrial conduction time was compared with sinoatrial conduction time assessed simultaneously by the single premature atrial stimulus technique in 59 patients: 20 with normal sinus function, 35 with sinus dysfunction, and four with sinus bradycardia but negative indirect methods. In patients with normal sinus function direct sinoatrial conduction time was 102.5 +/- 34 ms (mean +/- 2 SD) and was identical to indirect sinoatrial conduction time. Neither direct sinoatrial con...

  2. “Fixing a heart”: the game of electrolytes in anorexia nervosa

    OpenAIRE

    Abed, Jean; Judeh, Hani; Abed, Elie; Kim, Matthew; Arabelo, Haword; Gurunathan, Rajan

    2014-01-01

    Case 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 l...

  3. The use of Diagnostic Imaging for Identifying Abnormal Gas Accumulations in Cetaceans and Pinnipeds

    OpenAIRE

    Sophie eDennison; Andreas eFahlman; Michael eMoore

    2012-01-01

    Recent dogma suggested that marine mammals are not at risk of decompression sickness (DCS) due to a number of evolutionary adaptations. Several proposed adaptations exist. Lung compression and alveolar collapse that terminate gas exchange before a depth is reached where supersaturation is significant and bradycardia with peripheral vasoconstriction affecting the distribution, and dynamics of blood and tissue nitrogen levels. Published accounts of gas and fat emboli and dysbaric osteonecrosis ...

  4. Prevalence of family history in patients with reflex syncope

    DEFF Research Database (Denmark)

    Holmegard, Haya N; Benn, Marianne; Kaijer, Michelle Nymann; Haunsø, Stig; Mehlsen, Jesper

    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...

  5. Spontaneous Rupture of an Adrenal Artery in Pregnancy: A Case Report

    OpenAIRE

    Bolla, D.; V. Schyrba; Drack, G.; Dietler, S.; Hornung, R

    2012-01-01

    A spontaneous rupture of an adrenal artery is a rare cause of abdominal pain in pregnancy. We present a case of a pregnant woman who needed to be operated on because of a rupture of the right adrenal artery associated with a fetal bradycardia. An immediate caesarean section was performed. The intra-abdominal palpation identified an extensive retroperitoneal mass near the right kidney and a postoperative computer tomography confirmed an active bleeding near the kidney. For this reason our inte...

  6. Cholinergic signal activated renin angiotensin system associated with cardiovascular changes in the ovine fetus

    OpenAIRE

    Geng, Chunsong; Mao, Caiping; Wu, Lei; Cheng, Yu; Liu, Rulu; Chen, Bingxin; Chen, Ling; Zhang, Lubo; Xu, Zhice

    2010-01-01

    Aim: Cholinergic regulation is important in the control of cardiovascular and endocrine responses. The mechanisms behind cardiovascular responses induced by cholinergic activation are explored by studying hormonal systems, including renin-angiotensin and vasopressin (VP). Results: In chronically prepared fetal sheep, intravenous infusion of the cholinergic agonist carbachol increased fetal systolic, diastolic, and mean arterial pressure accompanied with bradycardia at near-term. Although int...

  7. 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.

  8. Prolonged QT interval in a man with anorexia nervosa

    OpenAIRE

    Macías-Robles, María Dolores; Perez-Clemente, Ana María; Maciá-Bobes, Carmen; Alvarez-Rueda, María Asunción; Pozo-Nuevo, Sergio

    2009-01-01

    Anorexia nervosa is an eating disorder characterized by the avoidance of food intake, which usually leads to a weight loss. Cardiac co-morbility is common and we can find sometimes a mass loss from the left ventricle, which can be seen by echocardiography. But the commonest complications are rhythm variations, typically bradycardia with a prolonged QT interval in up to a 40% of the cases, which altogether elevates ventricular tachycardia and sudden death risk. We present the case of a male wh...

  9. Nebulised fentanyl for post-operative pain relief, a prospective double-blind controlled randomised clinical trial

    OpenAIRE

    Singh, Anil P.; Jena, Sritam S; Rajesh Kr Meena; Mallika Tewari; V Rastogi

    2013-01-01

    Background and Aim: Intravenous (IV) route for fentanyl administration is the gold standard for post-operative pain relief, but complications such as respiratory depression, bradycardia and hypotension have limited this route. The aim of this randomised controlled trial was to compare the efficacy of nebulised fentanyl with IV fentanyl for post-operative pain relief after lower abdominal surgery. Methods: In the post-operative care unit, at the time of first onset of pain (visual analogue sca...

  10. Acute Atrial Fibrillation Derived by Single-Doze Fentanyl Transdermal Usage

    Directory of Open Access Journals (Sweden)

    Mesut Gitmez

    2014-02-01

    Full Text Available Fentanyl is a selective and synthetic opiate agonist. Especially in cancer-derived pain treatment fentanyl transdermal usage is preferred. Clinic impacts occur related to several systems derived by fentanyl usage. However, respiratory failure, hypothermia and bradycardia are observed the most. In this article, we aimed at presenting a case which developed atrial fibrillation derived by single-dose fentanyl transdermal usage.

  11. 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

    2013-12-01

    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. PMID:23994153

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

    Directory of Open Access Journals (Sweden)

    Mohammad Golparvar

    2015-01-01

    Full Text Available 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 preventing role for ondansetron. No previous study has evaluated the prophylactic effects of ondansetron for the prevention of post-induction hypotension. Materials and Methods: 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. Results: 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. Conclusions: 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.

  13. Co-administration of Apelin and T4 Protects Inotropic and Chronotropic Changes Occurring in Hypothyroid Rats

    OpenAIRE

    Zahra Akhondali; Mohammad Badavi; Mahin Dianat; Farzaneh Faraji

    2015-01-01

    Abstract Background: One of the most important thyroid hormone targets is the cardiovascular system. Hemodynamic changes, such as decreased resting heart rate (HR), myocardial contractility, and cardiac output, and increased diastolic pressure and systemic vascular resistance, have been observed in hypothyroid patients. Moreover, in these patients, ECG changes include sinus bradycardia and low voltage complexes (P waves or QRS complexes). Objective: This study aimed at evaluating the prophyla...

  14. Cardiac involvement in proximal myotonic myopathy

    OpenAIRE

    von zur Muhlen, F; Klass, C; Kreuzer, H.; Mall, G; Giese, A.; Reimers, C

    1998-01-01

    Proximal myotonic myopathy (PROMM) is a recently described autosomal dominantly inherited disorder resulting in proximal muscle weakness, myotonia, and cataracts. A few patients with cardiac involvement (sinus bradycardia, supraventricular bigeminy, conduction abnormalities) have been reported. The cases of three relatives with PROMM (weakness of neck flexors and proximal extremity muscles, calf hypertrophy, myotonia, cataracts) are reported: a 54 year old man, his 73 year old mother, and 66 ...

  15. Kocher-debre-semelaigne syndrome with pericardial effusion

    OpenAIRE

    Dharaskar Praveen; Tullu Milind; Lahiri Keya; Kondekar Santosh; Vaswani Rajwanti

    2007-01-01

    We report a 10-year-old female child with hypothyroidism and limb muscle pseudohypertrophy (i.e., Kocher-Debre-Semelaigne syndrome) with pericardial effusion. The child presented with generalized swelling, breathlessness and difficulty in walking and in getting up from sitting position (of chronic duration). She had bradycardia, dull facies, marked hypertrophy of both calf muscles and nonpitting edema of legs. Pericardial effusion was detected clinically and confirmed on investigations. Muscl...

  16. Cardiovascular effects of substance P and capsaicin microinjected into the nucleus tractus solitarii of the rat

    OpenAIRE

    Lukovic, L.; Jong, Wybren de; Wied, D. de

    1987-01-01

    This report deals with the effect of substance P (SP) and capsaicin on blood pressure and heart rate after administration into different sites of the nucleus tractus solitarii (NTS) of urethane-anesthetized rats. Microinjection of SP at 6 different coordinates throughout the NTS showed 3 sites where SP administration evoked changes in blood pressure and heart rate. The most sensitive sites where application of SP into the NTS evoked dose-dependent hypotension and bradycardia were at the level...

  17. Cardio-protective effects of carnitine in streptozotocin-induced diabetic rats

    OpenAIRE

    Malone Michael A; Cuthbertson David D; Malone John I; Schocken Douglas D

    2006-01-01

    Abstract Background Streptozotocin-induced diabetes (STZ-D) in rats has been associated with carnitine deficiency, bradycardia and left ventricular enlargement. Aim The purpose of this study was to determine whether oral carnitine supplementation would normalize carnitine levels and cardiac function in STZ-D rats. Methods Wistar rats (48) were made hyperglycemic by STZ at 26 weeks of age. Same age normal Wistar rats (24) were used for comparison. Echocardiograms were performed at baseline 2, ...

  18. A case of Lassa fever: experience at St Thomas's Hospital.

    OpenAIRE

    Cooper, C B; Gransden, W R; Webster, M.; M. King; O'Mahony, M.; Young, S.; Banatvala, J E

    1982-01-01

    An 18-year-old Nigerian girl, normally resident in Jos, was admitted to hospital for five days before she was diagnosed as having Lassa fever. There were several atypical features in the early stages of here illness, notably the absence of prostration, pharyngitis, or bradycardia and the development of appreciable leucocytosis. Consequent control and surveillance measures required checks for 21 days on 173 people who had had contact with as first line if they had handled her or specimens with...

  19. Characterization of cardiovascular reflexes evoked by airway stimulation with allylisothiocyanate, capsaicin, and ATP in Sprague-Dawley rats.

    Science.gov (United States)

    Hooper, J S; Hadley, S H; Morris, K F; Breslin, J W; Dean, J B; Taylor-Clark, T E

    2016-03-15

    Acute inhalation of airborne pollutants alters cardiovascular function and evidence suggests that pollutant-induced activation of airway sensory nerves via the gating of ion channels is critical to these systemic responses. Here, we have investigated the effect of capsaicin [transient receptor potential (TRP) vanilloid 1 (TRPV1) agonist], AITC [TRP ankyrin 1 (TRPA1) agonist], and ATP (P2X2/3 agonist) on bronchopulmonary sensory activity and cardiovascular responses of conscious Sprague-Dawley (SD) rats. Single fiber recordings show that allyl isothiocyanate (AITC) and capsaicin selectively activate C fibers, whereas subpopulations of both A and C fibers are activated by stimulation of P2X2/3 receptors. Inhalation of the agonists by conscious rats caused significant bradycardia, atrioventricular (AV) block, and prolonged PR intervals, although ATP-induced responses were lesser than those evoked by AITC or capsaicin. Responses to AITC were inhibited by the TRP channel blocker ruthenium red and the muscarinic antagonist atropine. AITC inhalation also caused a biphasic blood pressure response: a brief hypertensive phase followed by a hypotensive phase. Atropine accentuated the hypertensive phase, while preventing the hypotension. AITC-evoked bradycardia was not abolished by terazosin, the α1-adrenoceptor inhibitor, which prevented the hypertensive response. Anesthetics had profound effects on AITC-evoked bradycardia and AV block, which was abolished by urethane, ketamine, and isoflurane. Nevertheless, AITC inhalation caused bradycardia and AV block in paralyzed and ventilated rats following precollicular decerebration. In conclusion, we provide evidence that activation of ion channels expressed on nociceptive airway sensory nerves causes significant cardiovascular effects in conscious SD rats via reflex modulation of the autonomic nervous system. PMID:26718787

  20. Severe acute caffeine poisoning due to intradermal injections: Mesotherapy hazard

    OpenAIRE

    Perković-Vukčević Nataša; Babić Gordana; Šegrt Zoran; Vuković-Ercegović Gordana; Janković Snežana; Aćimović Ljubomir

    2012-01-01

    Introduction. Caffeine is indicated in the treatment of migraine headaches, as well as neonatal apnea and bradycardia syndrome. In mild poisoning, the most prevalent symptoms are nausea, vomiting, diarrhea, tremor, anxiety and headache. In more severe cases, symptoms consist of heart rythym abnormalities, myocardial infarction and seizures. Due to its common lipolytic effect, caffeine is used in mesotherapy, usually in combination with drugs of similar effect. We presented a patient wit...

  1. Prolonged Ventricular Asystole: A Rare Adverse Effect of Hydrocodone Use

    OpenAIRE

    Sudhakaran, Sivakumar; Surani, Saherish S.; Salim R. Surani

    2014-01-01

    Patient: Female, 56 Final Diagnosis: Ventricular asystole Symptoms: Dizziness, headache, near-syncope, weakness Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Unusual clinical course Background: Prolonged ventricular asystole is a rare vagal reaction caused by hydrocodone use. Sinus bradycardia is a characteristic presentation of the vasovagal response; examples of other presentations include arrest or atrioventricular block. Physicians need to be aware of ventricular as...

  2. Effects of tedisamil, atenolol and their combination on heart andrate-dependent QT interval in healthy volunteers

    OpenAIRE

    Démolis, Jean-Louis; Martel, Christine; Funck-Brentano, Christian; Sachse, Alisia; Weimann, Hans-Joseph; Jaillon, Patrice

    1997-01-01

    Aims Tedisamil is a new blocker of K+ currents in cardiac tissues, exerts bradycardic effects and has shown clinical efficacy in angina pectoris. Theoretically, when coadministered with a &bgr;-adrenoceptor blocker the tedisamil combination could induce dangerous bradycardia and QT interval prolongation. Therefore, the aim of this study was to evaluate the effects of tedisamil and atenolol alone and in combination, on heart rate and QT interval duration at rest and during exercise tests.

  3. Detection of fetal keratin with high molecular weight cytokeratin immunostaining in lung biopsy material from a patient with amniotic fluid embolism

    OpenAIRE

    Hacivelioglu, Servet; Oguzalp, Huseyin; Muratli, Asli; Asgun, Fatih; Kirilmaz, Bahadir; Omur, Dilek

    2013-01-01

    Abstract. Amniotic fluidembolism (AFE) is a rare and fatal disorder in which the diagnosis can bechallenging for clinicians and pathologists. A healthy 36-year-old woman(gravida 4, para 2) was admitted for delivery in the 40th week of gestation. Atthe fifth minute following birth, during expulsion of the placenta, the patientsuddenly collapsed with bradycardia, shallow respiration, and loss ofconsciousness. After evaluation, an emergent pulmonary embolectomy for acutethrombo-embolism was perf...

  4. Perioperative management and post-operative course in preterm infants undergoing vitreo-retinal surgery for retinopathy of prematurity: A retrospective study

    OpenAIRE

    Renu Sinha; Praveen Talawar; Rashmi Ramachandran; Rajvardhan Azad; Virender Kumar Mohan

    2014-01-01

    Background: Premature infants scheduled for surgery under general anesthesia are more prone to cardio-respiratory complications. Risk factors include post-conception age (PCA), cardiac and respiratory disease, anemia and opioid administration. This retrospective study evaluates the perioperative management and post-operative course (apnea and bradycardia) in premature infants undergoing surgery for retinopathy of prematurity (ROP). Materials and Methods: We analyzed the pre-operative data...

  5. The Effect of Peribulbar Block with General Anesthesia for Vitreoretinal Surgery in Premature and Ex-Premature Infants with Retinopathy of Prematurity.

    Science.gov (United States)

    Sinha, Renu; Maitra, Souvik

    2016-01-15

    Safe anesthesia in premature and ex-premature infants remains a challenge for the anesthesiologist. These infants are at risk of postoperative apnea, desaturation, and bradycardia after general anesthesia. We describe our experience of peribulbar block in 24 infants who underwent vitreoretinal surgery for retinopathy of prematurity. None of our patients had postoperative apnea or required neonatal intensive care admission. A possible opioid and muscle relaxant-sparing effect of peribulbar block might have reduced the incidence of postoperative complications. PMID:26556110

  6. Ion fluxes through KCa2 (SK) and Cav1 (L-type) channels contribute to chronoselectivity of adenosine A1 receptor-mediated actions in spontaneously beating rat atria

    OpenAIRE

    Paulo eCorreia-De-Sá

    2016-01-01

    Impulse generation in supraventricular tissue is inhibited by adenosine and acetylcholine via the activation of A1 and M2 receptors coupled to inwardly rectifying GIRK/KIR3.1/3.4 channels, respectively. Unlike M2 receptors, bradycardia produced by A1 receptors activation predominates over negative inotropy. Such difference suggests that other ion currents may contribute to adenosine chronoselectivity. In isolated spontaneously beating rat atria, blockade of KCa2/SK channels with apamin and Ca...

  7. 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...

  8. Treatment of Congenital Complete Atrioventricular Heart Block With Permanent Epicardial Pacemaker in Neonatal Lupus Syndrome

    OpenAIRE

    Tanriverdi, Sema; Ulger, Zulal; Siyah Bilgin, Betul; Kultursay, Nilgun; Yalaz, Mehmet; Atay, Yuksel; Koroglu, Ozge Altun

    2015-01-01

    Introduction: Neonatal lupus syndrome (NLS) is a passively acquired autoimmune condition due to the transplacental passage of maternal anti-Ro/SSA and anti-La/SSB antibodies in mothers with systemic lupus erythematosus (SLE), and congenital complete heart block (CHB) is its most serious manifestation. Skin and hepatic involvement may occur in later infancy. Case Presentation: A term infant with fetal bradycardia, detected at the 23rd gestational age, was diagnosed with CHB due to NLS and was ...

  9. Grayanotoxin (Mad Honey) - Ongoing Consumption After Poisoning

    OpenAIRE

    EROĞLU, Serkan Emre; Urgan, Oğuz; Onur, Özge Ecmel; Denizbaşı, Arzu; Akoğlu, Haldun

    2013-01-01

    Background: Some honey types in certain geographical regions may cause toxic effects on people. This type of honey is known as “mad honey” in Turkey. The toxic ingredient of this honey is called Grayanotoxin I. The consumption of mad honey can cause severe bradycardia, hypotension, dizziness, nausea and vomiting. Aims: Our study is aimed at analysing patients diagnosed with mad honey poisoning and their behaviour towards the consumption of this honey after diagnosis. Stud...

  10. An indispensable toxin known for 2500 years: victims of mad honey

    OpenAIRE

    AKCA, Ayşe Semra DEMİR; KAHVECİ, Fatih Ozan

    2011-01-01

    Mad honey (bitter honey) is a local name for a particular type of honey used in alternative medicine to treat gastric pain, bowel disorders, and hypertension, and as a sexual stimulant in the Black Sea coastal region of Turkey. Grayonotoxin behaves like cholinergic agents and has dosage dependent adverse effects on the cardiovascular system including bradycardia, atrioventricular block (AVB), and arterial hypotension. In this manuscript, we report 37 cases of mad honey intoxication from the w...

  11. Serotonin receptors as cardiovascular targets

    OpenAIRE

    Villalón, Carlos; De Vries, Peter; Saxena, Pramod Ranjan

    1997-01-01

    textabstractSerotonin exerts complex effects in the cardiovascular system, including hypotension or hypertension, vasodilatation or vasoconstriction, and/or bradycardia or tachycardia; the eventual response depends primarily on the nature of the 5-HT receptors involved. In the light of current 5-HT receptor classification, the authors reanalyse the cardiovascular responses mediated by 5-HT receptors and discuss the established and potential therapeutic applications of 5-HT ligands in the trea...

  12. Extending the KCNQ2 encephalopathy spectrum: clinical and neuroimaging findings in 17 patients

    DEFF Research Database (Denmark)

    Weckhuysen, S.; Ivanovic, V.; Hendrickx, R.;

    2013-01-01

    . Recurrent mutations lead to relatively homogenous phenotypes. One patient responded favorably to retigabine; 5 patients had a good response to carbamazepine. In 6 patients, seizures with bradycardia were recorded. One patient died of probable sudden unexpected death in epilepsy. CONCLUSION: KCNQ2 mutations...... cause approximately 13% of unexplained NEE. Patients present with a wide spectrum of severity and, although rare, infantile epilepsy onset is possible....

  13. Cardiac Autonomic Nerve Stimulation in the Treatment of Heart Failure

    OpenAIRE

    Kobayashi, Mariko; Massiello, Alex; Karimov, Jamshid H.; Van Wagoner, David R.; Fukamachi, Kiyotaka

    2013-01-01

    Research on the therapeutic modulation of cardiac autonomic tone by electrical stimulation has yielded encouraging early clinical results. Vagus nerve stimulation has reduced the rates of morbidity and sudden death from heart failure, but therapeutic vagus nerve stimulation is limited by side effects of hypotension and bradycardia. Sympathetic nerve stimulation that has been implemented in the experiment may exacerbate the sympathetic-dominated autonomic imbalance. In contrast, concurrent sti...

  14. Primary sleep apnoea syndrome.

    OpenAIRE

    Chokroverty, S.; Sharp, J T

    1981-01-01

    Polygraphic study in 18 men with the sleep apnoea syndrome showed central, upper airway obstructive, and mixed apnoeas. Fifty per cent of the total apnoea time was central, 33% was obstructive, and 17% was mixed. Apnoeic episodes were accompanied by oxygen desaturation, relative bradycardia and hypotonia of orofacial muscles innervated by ponto-medullary neurons. During regular breathing these muscles revealed tonic and phasic inspiratory EMG activities. The data suggest that the primary slee...

  15. Myocardial stunning after resuscitation from cardiac arrest following spinal anaesthesia

    OpenAIRE

    Pranjali Madhav Kurhekar; VSG Yachendra; Simi P Babu; Raghavelu Govindasamy

    2014-01-01

    Cardiac arrest associated with spinal anaesthesia has been well researched. Myocardial stunning after successful resuscitation from cardiac arrest is seen in up to 2/3 rd of in-hospital cardiac arrests. Myocardial stunning after resuscitation from cardiac arrest associated with spinal anaesthesia has probably not been reported earlier. Our case, an ASA physical status I lady, posted for tubal reanastomosis surgery developed bradycardia followed by asystole, approximately 5 minutes after givin...

  16. 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...

  17. Deli Bal Zehirlenmesi; Olgu Sunumu

    OpenAIRE

    AKSOY, Fatih; Baş, Hasan Aydin; Özaydın, Mehmet; Akif ARSLAN; Kapçı, Mücahit

    2014-01-01

    Mad honey poisoning; a case reportMad honey intoxication is the cause of a rare food poisoning which has been known from ancient times inthe Eastern Black Sea region of Turkey. The most frequent symptoms of the intoxication are hypotensionand bradycardia. The poisoning is due to the concentrated grayanotoxine (andromedotoxine) content of thehoney made by the bees from the wild flowers of the rhodendron species. In this case report, we presenteda case of a 72- year-old man showing life threati...

  18. Effect of prone sleeping on circulatory control in infants

    OpenAIRE

    Chong, A; N. Murphy; MATTHEWS, T

    2000-01-01

    BACKGROUND—The mechanism of death in sudden infant death syndrome (SIDS) remains unclear. Progressive bradycardia is the pre-eminent terminal event, suggesting that circulatory failure might be a crucial factor. Vasomotor tone regulates the circulatory system by controlling blood volume distribution while maintaining venous return and blood pressure.
AIM—To examine whether prone sleeping, the most consistently identified risk factor for SIDS, has a measurable influence on...

  19. Adult Medulloblastoma Associated with Syringomyelia: A Case Report

    OpenAIRE

    Wang, Ching-Chun

    2012-01-01

    The association between cerebellar medulloblastoma and syringomyelia is uncommon and only found in pediatric patients. To date, adult medulloblastoma associated with syringomyelia has not been reported in the literature. Paroxysmal bradycardia is an uncommon clinical manifestation in posterior fossa tumors and likely to be vagally mediated via brainstem preganglionic cardiac motor neurons. This report introduces the diagnosis and treatment of a case of adult medulloblastoma associated with sy...

  20. The cardiovascular and endocrine responses to voluntary and forced diving in trained and untrained rats

    OpenAIRE

    McCulloch, Paul F; DiNovo, Karyn M.; Connolly, Tiffanny M.

    2009-01-01

    The mammalian diving response, consisting of apnea, bradycardia, and increased total peripheral resistance, can be modified by conscious awareness, fear, and anticipation. We wondered whether swim and dive training in rats would 1) affect the magnitude of the cardiovascular responses during voluntary and forced diving, and 2) whether this training would reduce or eliminate any stress due to diving. Results indicate Sprague-Dawley rats have a substantial diving response. Immediately upon subme...

  1. Cardiovascular Complications in Ciguatera Fish Poisoning: A Wake-up Call

    Science.gov (United States)

    Senthilkumaran, Subramanian; Meenakshisundaram, Ramachandran; Michaels, Andrew D.; Suresh, Ponnuswamy; Thirumalaikolundusubramanian, Ponniah

    2011-01-01

    Ciguatera fish poisoning occurs with ingestion of fish containing ciguatoxin. It causes a clinical syndrome that comprises classic gastrointestinal, neurological and cardiovascular symptoms. Ciguatoxin is a sodium channel agonist with cholinergic and adrenergic activity. Although cardiovascular symptoms are rare with ciguatoxin, we report two cases with bradycardia and hypotension. Fatality and long-term sequelae are not uncommon with ciguatoxin poisoning and educating the general population is essential. PMID:22574244

  2. Of mice and men

    OpenAIRE

    D'Silva, Andrew; Akroyd, Rebecca; Brooks, Tim; Dashora, Umesh

    2014-01-01

    A case study of a patient returning from sub-Saharan Africa with a febrile illness and symptoms reminiscent of a previous malarial infection is discussed. The patient had a relative bradycardia with respect to febrile episodes, a transient macular rash and thrombocytopenia. The illness was conservatively managed for 1 month before positive Rickettsia serology and PCR results were reported. The patient was then treated with doxycycline with a complete resolution of symptoms.

  3. 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...

  4. 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.

  5. Surfactant use outside the tertiary care centre

    OpenAIRE

    Stuart, Shelagh; McMillan, Doug

    2005-01-01

    Early administration of surfactant to preterm babies with respiratory distress syndrome saves lives and decreases morbidity such as pneumothorax. Surfactant administration shortly after birth to intubated babies less than 30 weeks gestation decreases pulmonary air leak, chronic lung disease and mortality. Some preterm babies may be born in hospitals with a transport team hours away. Surfactant administration may cause transient bradycardia or hypoxemia and may rapidly improve lung function. A...

  6. Heart rate changes mediate the embryotoxic effect of antiarrhythmic drugs in the chick embryo

    Czech Academy of Sciences Publication Activity Database

    Kočková, Radka; Svatůňková, Jarmila; Novotný, J.; Hejnová, L.; Ošťádal, Bohuslav; Sedmera, David

    2013-01-01

    Roč. 304, č. 6 (2013), H895-H902. ISSN 0363-6135 R&D Projects: GA ČR(CZ) GAP302/11/1308; GA ČR(CZ) GA304/08/0615 Institutional research plan: CEZ:AV0Z50110509 Institutional support: RVO:67985823 Keywords : beta-blocking agents * embryonic heart * embryotoxicity * pregnancy * bradycardia Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 4.012, year: 2013

  7. Rhythm Disturbances in the Aerospace Medicine

    OpenAIRE

    Yıldız, Mustafa

    2013-01-01

    A number of rhythm disorders such as sinus arrhythmia, premature ventricular contractions, premature atrial contractions and sinus bradycardia and heart rate alterations may be seen under +Gz. The shift in autonomic balance may lead to alterations in cardiac rhythm and heart rate. The significance of these rhythm disturbances is not yet fully understood. In this manuscript the rhythm disturbances in the aerospace medicine were reviewed.Key Words: Aerospace medicine; rhythm disturbances; gravity

  8. Trigemino-cardiac reflex during skull-base neurosurgeries: a case report

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Khajavi

    2013-11-01

    Full Text Available Background: The Trigemino-cardiac reflex (TCR has been studied as a phenomenon including; bradycardia, arterial hypotension, apnea and gastric hypermotility during manipulation of the peripheral or central parts of the trigeminal nerve.Case presentation: We report a case of a 26-year-old man undergoing surgery for a skull base extra axial tumor in right petrous bone suspected to metastasis of a previous renal cell carcinoma which had been treated four years ago. The patient presented with continuous and unilateral headache and difficulty in swallowing, sensory neural hearing loss, nasal speech and tongue deviation to left side. He underwent general anesthesia with standard monitoring and total intravenous anesthetic technique. The first episode of sudden onset bradycardia and hypotension related to surgical manipulation was detected intraoperatively in which the heart rate spontaneously returned to normal level once the surgical manipulation stopped. However, it repeated several times by beginning of tumor resection and manipulation in the region of trigeminal nerve. The intensity of bradycardia in subsequent episodes of TCR was relatively crescendo and had no fatigability. Finally, it was treated by administration of a single dose of atropine (0.5mg/IV and did not happen again.Conclusion: The risk of TCR should be considered in any neurosurgical intervention involving trigeminal nerve and its branches, especially at the skull base surgeries. The vigilance of the medical team and continuous intraoperative hemodynamic monitoring alerts the surgeons to interrupt surgical maneuvers upon the TCR occurrence, immediately.

  9. The study of cardiovascular changes by intravascular injection of contrast media

    International Nuclear Information System (INIS)

    This investigation was aimed to study the effect of contrast media on the cardiovascular system. So in this study, pithed rats were used whether alteration in cardiovascular system by contrast media were controlled centrally. Furthermore, several hypertonic solutions were also used to clarify the effect of contrast media. The results are as follows: 1. Intravenous injection of contrast media in rats (2.5 ml/kg) caused hypotension and bradycardia. The effects were neither blocked by pretreatment of atropine nor pyribenzamine+atropine. 2. NaCI 4.7%, dextrose 24.8%, urea 9.0% and glycerol 10.1% (v/v) which were equiosmolar with contrast media, caused hypotension, but did not affect the heart rate. 3. In pithed rats, intravenous injection of Angiografin increased blood pressure in a dose-dependant manner, and caused decrease in heart rate compared with those of control rats. 4. In pithed rats, bradycardia by intravascular injection with Angiografin was partially blocked by atropine. 5. Metrizamide of which iodine content was adjusted to 280 mg/ml caused increased in blood pressure when was injected intravenously in pithed rats with little effect on heart rate. 6. When perfused with contrast media in rat hindlimb at 15 ml/min./kg speed both perfusion pressure and flow effluent increased, simultaneously. These results suggest that hypotension might be caused by the central effect due to hyperosmolarity of contrast media and bradycardia caused by both parasympathetic stimulation and direct inhibitory action on the cardiac conductive system.

  10. Cardiorespiratory reflexes and aquatic surface respiration in the neotropical fish tambaqui (Colossoma macropomum): acute responses to hypercarbia.

    Science.gov (United States)

    Florindo, Luiz H; Reid, Stephen G; Kalinin, Ana L; Milsom, William K; Rantin, Francisco T

    2004-05-01

    We examined the cardiorespiratory responses to 6 h of acute hypercarbia (1, 2.5, and 5% CO(2)) in intact and gill-denervated (bilateral denervation of branchial branches of cranial nerves IX and X) tambaqui, Colossoma macropomum. Intact fish exposed to 1 and 2.5% CO(2) increased respiratory frequency ( f(R)) and ventilation amplitude ( V(AMP)) slowly over a 1- to 3-h period. Denervated fish did not show this response, suggesting that tambaqui possess receptors in the gills that will produce excitatory responses to low levels of hypercarbia (1 and 2.5% CO(2)) if the exposure is prolonged. The cardiac response to stimulation of these receptors with this level of CO(2) was a tachycardia and not a bradycardia. During exposure to 5% CO(2), intact fish increased f(R) and V(AMP), and showed a pronounced bradycardia after 1 h. After 2 h, the heart rate ( f(H)) started to increase, but returned to control values after 6 h. In denervated fish, the increase in f(R) was abolished. The slow increase in V(AMP) and the bradycardia were not abolished, suggesting that these changes arose from extra-branchial receptors. Neither intact nor denervated fish developed the swelling of the lower lip or performed aquatic surface respiration, even after 6 h, suggesting that these are unique responses to hypoxia and not hypercarbia. PMID:14986045

  11. A retrospective study of cardio toxicities induced by 5-Fluouracil (5-FU) and 5-FU based chemotherapy regimens in Pakistani adult cancer patients at Shaukat Khanum Memorial Cancer Hospital and Research Center

    International Nuclear Information System (INIS)

    Objective: To study cardio toxicities, especially bradycardia in cancer patients treated with 5-Fluouracil and 5-Fluouracil based chemotherapy regimens in Pakistani population. Methods: Data was extracted from the medical records of all diagnosed cancer patients at Shaukat Khanum Memorial Cancer Hospital and Research Center registered between January 2002 and December 2004 receiving 5- Fluouracil based chemotherapy regimens. The data was analysed retrospectively, including electrocardiogram and cardiac markers. Pearson's Correlation coefficient was calculated to see any possible correlation between 5-Fluouracil alone and 5-Fluouracil based regimens and cardiotoxicity, and other variables. Results: Symptomatic cardiotoxicity was observed in 60 (19.93%) out of 301 patients whose cases were part of the study. Bradycardia was the most common cardiotoxicity and was observed in 36 (11.96%) patients. Nine (2.99%) mortalities were also observed. The incidence of cardiotoxicity was not significantly different between the patients with and without pre-existing cardiovascular disease (p = 0.095) and having negative correlation -0.305. Cardio toxicities were more common with Continuous Infusion (CI) of 5-Fluouracil, radiotherapy concurrent with 5-Fluouracil and when 5-Fluouracil was used in combination with Cisplatinum (CDDP). Conclusion: Cardio toxicities were more prevalent when 5-Fluouracil was used along with concurrent radiotherapy and with Cisplatinum and when administered in continuous infusion pattern. Hence, 5-Fluouracil and 5-Fluouracil based chemotherapy regimens cause cardio toxicities, especially bradycardia, in a significant number of cancer patients in Pakistani population. (author)

  12. Efficacy and safety of ondansetron in preventing postanesthesia shivering: a meta-analysis of randomized controlled trials

    Science.gov (United States)

    2014-01-01

    Background Shivering is a very common complication in the postanesthesia period. Increasing studies have reported ondansetron may be effective in prevention of postanesthesia shivering (PAS). However, the results remained controversial; hence we conducted a meta-analysis of randomized controlled trials to evaluate the efficacy and safety of ondansetron on the prevention of postanesthesia shivering. Methods PubMed and Embase databases were searched to identify the eligible randomized controlled trials assessing the effect of ondansetron on the prevention of PAS. Results were expressed as risk ratios (RRs) with accompanying 95% confidence intervals (CIs). The meta-analysis was performed with fixed-effect model or random-effect model according to the heterogeneity. Results Six trials including 533 subjects were included. Compared with placebo, ondansetron was associated with a significant reduction of PAS (RR 0.43, 95% CI, 0.27-0.70), without an increased risk of bradycardia (RR 0.37, 95% CI, 0.12-1.15). Compared with meperidine, no difference was observed in the incidence of PAS (RR 0.68, 95% CI, 0.39-1.19) and bradycardia (RR 2.0, 95% CI, 0.38-10.64). Conclusions Ondansetron has a preventive effect on PAS without a paralleled side effect of bradycardia. PMID:24588846

  13. Genetics and Sinus Node Dysfunction

    Directory of Open Access Journals (Sweden)

    Eyal Nof MD

    2009-04-01

    Full Text Available Sinus node dysfunction (SND is commonly encountered in the clinic. The clinical phenotype ranges from asymptomatic sinus bradycardia to complete atrial standstill. In some cases, sinus bradycardia is associated with other myocardial conditions such as congenital abnormalities, myocarditis, dystrophies, cardiomyopathies as well as fibrosis or other structural remodeling of the SA node.1-8 Although there are many etiologies for symptomatic slow heart rates, the only effective treatment available today is the implantation of a pacemaker. The predominant ion channel currents contributing to the pacemaker activity in the sinoatrial node (SAN include currents flowing through hyperpolarization-activated, cyclic nucleotide-gated (HCN channels,9 L- type Ca, T- type Ca,10 delayed rectifier K,1112 and acetylcholine (ACh-activated13,14 channels. However, their relative contribution remains a matter of debate and the cellular mechanisms contributing to abnormal sinus node function leading to bradycardia are not fully elucidated. Sodium channel current (INa, encoded by SCN5A, is responsible for the cardiac action potential (AP upstroke and therefore has an important role in initiation and propagation of the cardiac action potential. Although it is largely absent in the sinus node, it plays an important role at the periphery of the sinus node in transmitting electrical activity from the sinus node to the rest of the atria.

  14. 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.

  15. Biphasic cardiovascular and respiratory effects induced by β-citronellol.

    Science.gov (United States)

    Ribeiro-Filho, Helder Veras; de Souza Silva, Camila Meirelles; de Siqueira, Rodrigo JoséBezerra; Lahlou, Saad; Dos Santos, Armênio Aguiar; Magalhães, Pedro Jorge Caldas

    2016-03-15

    β-Citronellol is a monoterpene found in the essential oil of various plants with antihypertensive properties. In fact, β-citronellol possesses hypotensive actions due to its vasodilator abilities. Here we aimed to show that β-citronellol recruits airway sensory neural circuitry to evoke cardiorespiratory effects. In anesthetized rats, intravenous injection of β-citronellol caused biphasic hypotension, bradycardia and apnea. Bilateral vagotomy, perivagal capsaicin treatment or injection into the left ventricle abolished first rapid phase (named P1) but not delayed phase P2 of the β-citronellol effects. P1 persisted after pretreatment with capsazepine, ondansetron, HC-030031 or suramin. Suramin abolished P2 of apnea. In awake rats, β-citronellol induced biphasic hypotension and bradycardia being P1 abolished by methylatropine. In vitro, β-citronellol inhibited spontaneous or electrically-evoked contractions of rat isolated right or left atrium, respectively, and fully relaxed sustained contractions of phenylephrine in mesenteric artery rings. In conclusion, chemosensitive pulmonary vagal afferent fibers appear to mediate the cardiovascular and respiratory effects of β-citronellol. The transduction mechanism in P1 seems not to involve the activation of transient receptor potential vanilloid subtype 1 (TRPV1), transient receptor potential ankyrin subtype 1 (TRPA1), purinergic (P2X) or 5-HT3 receptors located on airways sensory nerves. P2 of hypotension and bradycardia seems resulting from a cardioinhibitory and vasodilatory effect of β-citronellol and the apnea from a purinergic signaling. PMID:26872991

  16. Asystole in young athletic women during breast augmentation: a report of three cases.

    Science.gov (United States)

    Schusterman, Asher; Schusterman, Mark

    2012-10-01

    Reported herein are three cases of spontaneous bradycardia progressing to asystole during routine breast augmentation in healthy, adult female patients with a history of endurance training and resting bradycardia (heart rate plastic surgery community of the possibility of these events occurring without warning in athletic patients, attempt to explain these findings, and provide a plan of action to minimize morbidity and mortality in these patients. The most severe case was that of a 38-year-old female who became severely bradycardic progressing to asystole during routine breast augmentation. She had no history of any medical problems, but did have a resting heart rate of surgery is not uncommon and routinely treated successfully with administration of atropine-like agents. Bradycardia progressing to frank asystole is rare and has not been reported in young, otherwise healthy, aesthetic surgery patients. This report should serve to alert the plastic surgeon to the possibility of this situation occurring and how to treat it successfully, especially in the outpatient or office-based surgery setting. Level of Evidence V This journal requires that authors assign a level of evidence to each article. PMID:22684612

  17. Acute effect of amiodarone on cardiovascular reflexes of normotensive and renal hypertensive rats

    Directory of Open Access Journals (Sweden)

    Oliveira P.F.

    2005-01-01

    Full Text Available The aim of the present study was to evaluate the effect of amiodarone on mean arterial pressure (MAP, heart rate (HR, baroreflex, Bezold-Jarisch, and peripheral chemoreflex in normotensive and chronic one-kidney, one-clip (1K1C hypertensive rats (N = 9 to 11 rats in each group. Amiodarone (50 mg/kg, iv elicited hypotension and bradycardia in normotensive (-10 ± 1 mmHg, -57 ± 6 bpm and hypertensive rats (-37 ± 7 mmHg, -39 ± 19 bpm. The baroreflex index (deltaHR/deltaMAP was significantly attenuated by amiodarone in both normotensive (-0.61 ± 0.12 vs -1.47 ± 0.14 bpm/mmHg for reflex bradycardia and -1.15 ± 0.19 vs -2.63 ± 0.26 bpm/mmHg for reflex tachycardia and hypertensive rats (-0.26 ± 0.05 vs -0.72 ± 0.16 bpm/mmHg for reflex bradycardia and -0.92 ± 0.19 vs -1.51 ± 0.19 bpm/mmHg for reflex tachycardia. The slope of linear regression from deltapulse interval/deltaMAP was attenuated for both reflex bradycardia and tachycardia in normotensive rats (-0.47 ± 0.13 vs -0.94 ± 0.19 ms/mmHg and -0.80 ± 0.13 vs -1.11 ± 0.13 ms/mmHg, but only for reflex bradycardia in hypertensive rats (-0.15 ± 0.02 vs -0.23 ± 0.3 ms/mmHg. In addition, the MAP and HR responses to the Bezold-Jarisch reflex were 20-30% smaller in amiodarone-treated normotensive or hypertensive rats. The bradycardic response to peripheral chemoreflex activation with intravenous potassium cyanide was also attenuated by amiodarone in both normotensive (-30 ± 6 vs -49 ± 8 bpm and hypertensive rats (-34 ± 13 vs -42 ± 10 bpm. On the basis of the well-known electrophysiological effects of amiodarone, the sinus node might be the responsible for the attenuation of the cardiovascular reflexes found in the present study.

  18. Use of lidocaine, propranolol, amiodarone, and verapamil in toad envenoming (genus bufo in dogs

    Directory of Open Access Journals (Sweden)

    M. SAKATE

    2001-12-01

    Full Text Available Toad envenoming in dogs can cause death by cardiac fibrilation (CVF. Traditional therapy consists mainly of atropine and propranolol, the last one used to prevent the CVF, that is preceded by negative ventricular deflections (NVDs in the QRS complex of the electrocardiogram. This study intended to verify, comparatively, the lidocaine, propranolol, amiodarone, and verapamil abilities to prevent CVF in experimentally envenomed dogs. Thirty-six dogs were divided into 6 groups (GL, GP, GA, GV, GST, and GSV with n=6; the dogs were submitted to volatile anaesthesia. The animals of the groups GL, GP, GA, and GV received 0.38g of toad venom through oro-gastric catheter and were treated with the following drugs respectively: lidocaine (4mg/Kg, propranolol (0.1mg/Kg, amiodarone (8mg/Kg, and verapamil (2mg/Kg. These drugs were repeated if NVDs reappeared with cardiac frequency >150, GST was not treated and GSV was just anaesthetized. The following results were obtained: GL, NVDs present in 4 animals, 100% recuperation with 3.66 doses/animal; GP, NVDs present in 2 animals, 100% recuperation with 1.66 dose/animal, with bradycardia at the anaesthetic return; GA, NVDs present in 3 animals, 33.33% recuperation with 1.5 dose/animal; GV, NVDs present in 4 animals, 100% recuperation with 2.16 doses/animal; GST, NVD present in 6 animals, 100% death and GSV, NVDs absent, 100% recuperation. As a conclusion, the anaesthetic proceedings used, did not cause NVDs, the envenoming that was not treated was lethal, and among the antiarrhythmics drugs used, verapamil was the most efficient, as it did not cause any serious bradycardia at the anaesthetic return and did not require repeated administrations. For lidocaine, it was efficient but required various administrations; amiodarone could not prevent the death of 4 animals; propranolol was efficient in relation to NVDs control, but caused serious bradycardia at the anaesthetic return.

  19. The role of branchial and orobranchial O2 chemoreceptors in the control of aquatic surface respiration in the neotropical fish tambaqui (Colossoma macropomum): progressive responses to prolonged hypoxia.

    Science.gov (United States)

    Florindo, Luiz H; Leite, Cléo A C; Kalinin, Ana L; Reid, Stephen G; Milsom, William K; Rantin, F Tadeu

    2006-05-01

    The present study examined the role of branchial and orobranchial O(2) chemoreceptors in the cardiorespiratory responses, aquatic surface respiration (ASR), and the development of inferior lip swelling in tambaqui during prolonged (6 h) exposure to hypoxia. Intact fish (control) and three groups of denervated fish (bilateral denervation of cranial nerves IX+X (to the gills), of cranial nerves V+VII (to the orobranchial cavity) or of cranial nerves V alone), were exposed to severe hypoxia (Pw(O)2=10 mmHg) for 360 min. Respiratory frequency (fr) and heart rate (fh) were recorded simultaneously with ASR. Intact (control) fish increased fr, ventilation amplitude (V(AMP)) and developed hypoxic bradycardia in the first 60 min of hypoxia. The bradycardia, however, abated progressively and had returned to normoxic levels by the last hour of exposure to hypoxia. The changes in respiratory frequency and the hypoxic bradycardia were eliminated by denervation of cranial nerves IX and X but were not affected by denervation of cranial nerves V or V+VII. The V(AMP) was not abolished by the various denervation protocols. The fh in fish with denervation of cranial nerves V or V+VII, however, did not recover to control values as in intact fish. After 360 min of exposure to hypoxia only the intact and IX+X denervated fish performed ASR. Denervation of cranial nerve V abolished the ASR behavior. However, all (control and denervated (IX+X, V and V+VII) fish developed inferior lip swelling. These results indicate that ASR is triggered by O(2) chemoreceptors innervated by cranial nerve V but that other mechanisms, such as a direct effect of hypoxia on the lip tissue, trigger lip swelling. PMID:16621951

  20. Vasovagal syncope as a manifestation of an evolutionary selected trait

    Directory of Open Access Journals (Sweden)

    Paolo Alboni; Marco Alboni

    2014-08-01

    Full Text Available Some observations suggest that typical (emotional or orthostatic vasovagal syncope (VVS is not a disease, but rather a manifestation of a non-pathological trait. We conducted an extensive bibliographic research on the vasovagal reactions in animals, including humans, in order to investigate the possible factors that may explain the origin and evolution of VVS. We found two processes which appear useful for the investigation of VVS evolution: fear/threat bradycardia (alarm bradycardia in animals, mainly during tonic immobility and vasovagal reflex during hemorrhagic shock (thoracic hypovolemia both in animals and humans. The available data suggest that VVS in humans, alarm bradycardia in animals and the vasovagal reflex during hemorrhagic shock share the same physiological mechanisms and that is indicative of a common evolutionary root. However, during the vasovagal reflex loss of consciousness occurs in humans, but is absent (or extremely rare in animals. That can be explained as a by-product due to the erect position and the large brain evolved in our species. If the vasovagal reflex persisted for millions of years along the vertebrates evolutionary history, we can reasonably assume that it has a function and it is not harmful. It could be neutral or beneficial, but the available data suggest it is beneficial: likely, it evolved as an advantageous response to stressful and possibly dangerous heart conditions. The transient inhibition of the sympathetic system, together with the activation of the vagal one, characterizes VVS. The consequent slowing of the heart rate induced by the vasovagal reflex may constitute a beneficial break of the cardiac pump, thereby reducing myocardial oxygen consumption. We suggest that typical VVS should be regarded as a selected response, which probably evolved in the ancient past as a defense mechanism of the organism within some ancestral group(s of vertebrates

  1. The bradycardic and hypotensive responses to serotonin are reduced by activation of GABAA receptors in the nucleus tractus solitarius of awake rats

    Directory of Open Access Journals (Sweden)

    Callera J.C.

    2005-01-01

    Full Text Available We investigated the effects of bilateral injections of the GABA receptor agonists muscimol (GABA A and baclofen (GABA B into the nucleus tractus solitarius (NTS on the bradycardia and hypotension induced by iv serotonin injections (5-HT, 2 µg/rat in awake male Holtzman rats. 5-HT was injected in rats with stainless steel cannulas implanted bilaterally in the NTS, before and 5, 15, and 60 min after bilateral injections of muscimol or baclofen into the NTS. The responses to 5-HT were tested before and after the injection of atropine methyl bromide. Muscimol (50 pmol/50 nl, N = 8 into the NTS increased basal mean arterial pressure (MAP from 115 ± 4 to 144 ± 6 mmHg, did not change basal heart rate (HR and reduced the bradycardia (-40 ± 14 and -73 ± 26 bpm at 5 and 15 min, respectively, vs -180 ± 20 bpm for the control and hypotension (-11 ± 4 and -14 ± 4 mmHg, vs -40 ± 9 mmHg for the control elicited by 5-HT. Baclofen (12.5 pmol/50 nl, N = 7 into the NTS also increased basal MAP, but did not change basal HR, bradycardia or hypotension in response to 5-HT injections. Atropine methyl bromide (1 mg/kg body weight injected iv reduced the bradycardic and hypotensive responses to 5-HT injections. The stimulation of GABA A receptors in the NTS of awake rats elicits a significant increase in basal MAP and decreases the cardiac Bezold-Jarisch reflex responses to iv 5-HT injections.

  2. 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.

  3. A video-polygraphic analysis of the cataplectic attack

    DEFF Research Database (Denmark)

    Rubboli, G; d'Orsi, G; Zaniboni, A;

    2000-01-01

    arrest of eye movements and phasic, massive, inhibitory muscular events; falling phase, characterized by a rhythmic pattern of suppressions and enhancements of muscular activity, leading to the fall; atonic phase, characterized by complete muscle atonia. Six episodes out of 11 were associated with...... bradycardia, that was maximal during the atonic phase. CONCLUSIONS: Analysis of the muscular phenomena that characterize cataplectic attacks in a standing patient suggests that the cataplectic fall occurs with a pattern that might result from the interaction between neuronal networks mediating muscular atonia...... of REM sleep and neural structures subserving postural control....

  4. Acute Hypotension After 50% Dextrose Injections.

    Science.gov (United States)

    Saites, Victoria; Laudanski, Krzysztof

    2016-05-15

    The hemodynamic effects of small-volume boluses of hyperosmotic solutions are often deemed negligible in the clinical setting. However, animal studies have reported decreases in systemic arterial blood pressure and bradycardia with the administration of hyperosmotic solutions. This is a report of a 60-year-old woman, intubated and sedated, who developed acute decreases in systemic arterial blood pressure with the administration of ≤50 mL of 50% dextrose. Animal studies suggest that hyperosmolar-induced hypotension may be avoided by administering the hyperosmotic solution slowly. This allows for admixture and therefore a decreased osmotic load at the proposed osmoreceptor involved in the neural reflex. PMID:26934608

  5. Role of the transient receptor potential vanilloid type 1 channel in renal inflammation induced by lipopolysaccharide in mice

    OpenAIRE

    Wang, Youping; Wang, Donna H.

    2012-01-01

    To determine the role of the transient receptor potential vanilloid type 1 (TRPV1) channel in the regulation of renal inflammation, lipopolysaccharide (LPS, 3 mg/kg) was intraperitoneally injected into wild-type (WT) and TRPV1-null mutant (TRPV1−/−) mice. The kidney and serum were collected 6 or 24 h after LPS injection for morphological analysis and proinflammatory cytokine assay. LPS injection led to a similar degree of transient hypotension and bradycardia in WT and TRPV1−/− mice determine...

  6. Trigeminocardiac Reflex during Maxillary Reconstruction Surgery: A Case Report

    Directory of Open Access Journals (Sweden)

    Mayank Kulshrestha

    2014-03-01

    Full Text Available Systemic hypotension, cardiac dysrhythmia especially bradycardia, apnoea, and gastric hypermotility occurring presumably after stimulation of any of the sensory branches of trigeminal nerve is coined as trigeminocardiac reflex (TCR. It has been described to occur in various surgeries like cerebello-pontine angle and pituitary fossa surgeries. Such bradycardic reflex responses have also been observed during maxillofacial surgeries. The TCR presents as a challenge to both the Anaesthesiologist and the Surgeon in view of its varied presentations, diagnosis, prevention and appropriate management.

  7. Arrhythmia management after device removal.

    Science.gov (United States)

    Nishii, Nobuhiro

    2016-08-01

    Arrhythmic management is needed after removal of cardiac implantable electronic devices (CIEDs). Patients completely dependent on CIEDs need temporary device back-up until new CIEDs are implanted. Various methods are available for device back-up, and the appropriate management varies among patients. The duration from CIED removal to implantation of a new CIED also differs among patients. Temporary pacing is needed for patients with bradycardia, a wearable cardioverter defibrillator (WCD) or catheter ablation is needed for patients with tachyarrhythmia, and sequential pacing is needed for patients dependent on cardiac resynchronization therapy. The present review focuses on arrhythmic management after CIED removal. PMID:27588151

  8. Adult human metapneumonovirus (hMPV) pneumonia mimicking Legionnaire's disease.

    Science.gov (United States)

    Cunha, Burke A; Irshad, Nadia; Connolly, James J

    2016-01-01

    In adults hospitalized with viral pneumonias the main differential diagnostic consideration is influenza pneumonia. The respiratory viruses causing viral influenza like illnesses (ILIs), e.g., RSV may closely resemble influenza. Rarely, extrapulmonary findings of some ILIs may resemble Legionnaire's disease (LD), e.g., adenovirus, human parainfluenza virus (HPIV-3). We present a most unusual case of human metapneumonovirus pneumonia (hMPV) with some characteristic extrapulmonary findings characteristic of LD, e.g., relative bradycardia, as well as mildly elevated serum transaminases and hyphosphatemia. We believe this is the first reported case of hMPV pneumonia in a hospitalized adult that had some features of LD. PMID:26988110

  9. Modulation of human sinus node function by systemic hypoxia

    Science.gov (United States)

    Eckberg, D. L.; Bastow, H., III; Scruby, A. E.

    1982-01-01

    The present study was conducted to determine whether bradycardia develops during systemic hypoxia in supine conscious human volunteers when respiratory frequency and tidal volume are maintained at constant levels. The obtained results suggest that mild hypoxia provokes cardioacceleration in humans, independent of changes of ventilation or baroreflex responsiveness. The earliest cardioacceleration is more prominent in the inspiratory than in the expiratory phase of respiration, and occurs with very small reductions of arterial oxygen saturation. Moderate systemic hypoxia dampens fluctuations of heart rate during the respiratory cycle.

  10. [Differential diagnosis and therapy of bradycardic arrhythmias].

    Science.gov (United States)

    Rausch, P; Jungmair, W; Kaliman, J F

    1994-01-01

    The most important symptoms in bradycardia are vertigo, dizziness and syncopy due to diminished cerebral blood sypply. Cardial symptoms are cardiac insufficiency and angina pectoris. By means of ECG, especially Holter-ECG, carotid sinus massage, atropin test and invasive methods (atrial stimulation, His-bundle ECG) sinu-nodal dysfunction, carotid sinus syndrome, bradyarrhythmia absoluta and AV-block can be diagnosed. Pharmacological treatment is only useful in acute situations. For symptomatic bradyarrhythmias the implantation of a Pacemaker is the therapy of choice. Individual treatment of the various types of bradyarrhythmia and the patients special needs is possible through the evolution of pacemaker technology. PMID:7825327

  11. THE ROLE OF BETA-BLOCKERS IN THE TREATMENT OF CARDIOVASCULAR DISEASES IN PREGNANT WOMEN

    Directory of Open Access Journals (Sweden)

    R. I. Striuk

    2015-12-01

    Full Text Available Highly selective β-adrenoblockers (β-AB are used in pregnant women with cardiovascular diseases (arterial hypertension, arrhythmia, Marfan syndrome, hypertrophic cardiomyopathy. β-AB fall into the category C according to safety classification of Food and Drug Administration (US FDA. Their prescription in different clinical situations meets the principle of "risk–benefit". Fetus and newborn status should be monitored because β-AB can cause bradycardia, hypoglycemia, apnea and metabolic disorders. The risk of these side effects is extremely low, while β-AB clinical efficacy is high.

  12. Comparison of landiolol and esmolol for treatment of intraoperative arrhythmia in dogs%兰地洛尔与艾司洛尔用于犬术中心律失常治疗效果的比较

    Institute of Scientific and Technical Information of China (English)

    李梅; 庄儒麟; 李华伟; 孙政; 马腾飞; 马行; 戴体俊

    2015-01-01

    (ED50) of landiolol and esmolol were determined using the sequential method.Treatment index (TI) was calculated.Experiment Ⅱ Eighteen dogs (9 males, 9 females), aged 8-12 months, weighing 7-10 kg, were equally and randomly divided into 3 groups: model group (group M) , landiolol group (group L) and esmolol group (group E).Intraoperative arrhythmia model was established by using gastrointestinal surgery combined with epinephrine.When sustained ventricular arrhythmias occurred, normal saline 0.5 ml/kg, landiolol 8.3 mg/kg and esmolol 10.0 mg/kg were given intravenously in C, L and E groups, respectively.The duration of arrhythmias was recorded.If bradycardia occurred (decrease in heart rate [HR] ≥ 25% of the baseline value) , isoprenaline 0.05 mg/kg and atropine 0.03 mg/kg were injected intravenously.The occurrence of bradycardia after the initial administration of landiolol and esmolol, and the accumulated dose of landiolol and esmolol consumed when bradycardia occurred were recorded.Isoprenaline and atropine-induced improvement in bradycardia was recorded.Results Compared with esmolol, the LD50 and TI of landiolol were significantly increased (P<0.01), and no significant change was found in ED50 of landiolol (P>0.05).The duration of arrhythmias was significantly shorter in L and E groups than in group C, and in group L than in group E (P<0.01).After the initial administration of landiolol and esmolol, the incidence of bradycardia was 0 and 100%, respectively, and the accumulated dose of landiolol and esmolol consumed when bradycardia occurred was (30± 13) mg/kg.Atropine could not effectively treat bradycardia, while isoprenaline could treat bradycardia.Compared with group L, the time for HR to rise and the duration for HR returning to the baseline value were significantly prolonged in group E (P<0.05).Conclusion Compared with esmolol, landiolol provides faster improvement in intraoperative arrhythmia, weaker negative chronotropic effect, and higher

  13. Complete recovery after severe myxoedema coma complicated by status epilepticus

    DEFF Research Database (Denmark)

    Fjølner, Jesper; Opstrup, Ulla Kampmann; Søndergaard, Esben;

    2015-01-01

    We report a case of life-threatening myxoedema presenting with hypothermia, hypotension, bradycardia, pericardial effusion and deep coma. The condition was complicated by prolonged status epilepticus. The optimal treatment strategy has been debated over the years and the literature is briefly...... reviewed. Treatment with l-thyroxine (LT4) monotherapy without initial loading dose and with no l-triiodothyronine (LT3) treatment was successful with full recovery after hospitalisation for more than a month. Myxoedema coma is a rare, reversible condition with a high mortality and should be considered as...

  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. Hypothyroidism complicates bradyarrhythmic episodes in a heart-transplanted patient: Can it be treated with low-dose dopamine?

    Science.gov (United States)

    2015-01-01

    Extracorporeal circulation decreases thyroid hormone levels in peripheral blood. This clinical entity may complicate the postoperative period after heart transplantation if the recipient has taken thyroid hormone replacement therapy. Cardiac transplantation was performed on a patient in whom thyroid hormone levels decreased after surgery. Sinus bradycardia was seen after surgery (30-40 bpm). Thyroid hormones were replaced in the patient. Due to the fact that temporary pacing decreased blood pressure, dopamine was safely given in very low doses. This case was discussed under the literature knowledge. PMID:26855660

  16. Hemichorea as a presentation of acute rheumatic fever: a case report

    Directory of Open Access Journals (Sweden)

    Khwaja Saifullah Zafar

    2014-08-01

    Full Text Available Chorea is a major manifestation of acute RF and is the only evidence of RF in approximately 20% of cases. We report on a 15-year-old boy who presented with transient right side involuntary jerky movements, apical systolic murmur, sinus bradycardia, arthralgia, elevated antistreptolysin O titer and ESR, who was diagnosed with acute rheumatic fever and improved with haloperidol, prednisolone, digoxin, aspirin and furosemide and was given benzathine penicillin prophylaxis for future RF. Patient is faring well in follow up visits. We present our case because of its rarity. [Int J Res Med Sci 2014; 2(4.000: 1788-1790

  17. 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.).

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

    DEFF Research Database (Denmark)

    Fox, Kim; Ford, Ian; Steg, Philippe Gabriel; Tardif, Jean-Claude; Tendera, Michal; Ferrari, Roberto; Jeppesen, Jørgen Lykke

    2014-01-01

    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...... those 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%, P<0.001). CONCLUSIONS: Among patients who had stable coronary artery disease without clinical heart failure, the addition of ivabradine to standard...

  19. Cardiovascular inhibition of salusin α within the nucleus tractus solitarii originated from suppressing the activities of presympathetic neurons in the rostral ventrolateral medulla%salusin α在孤束核内的心血管效应可能通过抑制头端延髓腹外侧区前交感神经元活动介导

    Institute of Scientific and Technical Information of China (English)

    李宏宝; 郭雅琼; 鲁彦; 伏晓琳; 刘颖璐; 郑天珍

    2011-01-01

    Aim Salusin a and salusin β are newly I-dentified bioactive peptides of 28 and 20 amino acid, respectively, which are reported to widely distribute in hematopoietic system, endocrine system and the central nervous system ( CNS ). They are responsible for causing hypotension, bradycardia and mitogenic activities. The cardiovascular functions of salusin a in the nucleus tractus solitarii ( NTS ) are not fully defined. The present study is to comparatively determine the cardiovascular functions of salusin a into the NTS in anesthetized rats. Methods Ninety-four anesthetic male SD rats were employed in present study. The dose-dependant responses of blood pressure and heart rate of salusin a ( 0. 04 ~ 4 pmol ) in the NTS were determined by bilateral or unilateral microinjection salusin a or artificial cerebrospinal fluid ( aCSF ) into the NTS in 50 rats. In 33 rats, aCSF, KYN, bilateral vagotomy or aCSF/ muscimol in RVLM were prior applied before salusin a ( 4 pmol ) was microinjected. The arterial baroreflex( ABR ) functions of rats of pre-post injection of salusin a into the NTS were defined in 11 rats. Results Bilateral or unilateral microinjection of salusin a into the NTS produced dose-dependent hypotension and bradycardia. Bilateral microinjection of salusin a did not alter baroreflex sensitivity functions. Prior application of KYN( 1 nmol ) or bilateral vagotomy into the NTS did not alter the hypotension and bradycardia induced by intra-NTS salusin a( P >0. 05 ). But pretreatment with muscimol ( 5 pmol )within the RVLM almost completely abolished the hypotension and bradycardia evoked by intra-NTS salusin a( P 0.05).RVLM预先注射muscimol (5 pmol)能有效阻断salusin α(4 pmol)在孤束核产生的降低血压、减缓心率的效应(P<0.05).结论 NTS注射salusin α产生的降低血压、减缓心率的效应可能通过激动RVLM内GABA受体,抑制前交感神经元兴奋性发挥作用.

  20. 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

  1. Medical image of the week: cervical fracture and dislocation

    Directory of Open Access Journals (Sweden)

    Evan Schmitz

    2014-04-01

    Full Text Available A 25 year old woman was a restrained driver in a rollover motor vehicle accident (MVA and suffered a C5-C6 fracture-dislocation with spinal cord injury (Figure 1. She developed neurogenic stunned myocardium, symptomatic bradycardia and neurogenic shock. Her cardiac ultrasound has been previously presented and can be viewed by clicking here. After developing the adult respiratory distress syndrome and multi-system organ failure she had multiple cardiac arrests and died after 5 days in the intensive care unit.

  2. Death Caused by Malignant Hyperthermia: Two Case Reports+

    OpenAIRE

    Erkol, Zerrin; Ertan, Ayşegül; Hüseyin ÖZ; ERKOL, Hayri; Şeker, Ali; Altınok, Ayfer; Süner, Çiğdem

    2012-01-01

    In this paper, we present two cases of death caused by malignant hyperthermia and discuss their properties according to the literature data. First case: a 24-year-old-male was taken to the operating room for lombar disc hernia operation. At the 30th minute of the operation, tachycardia (120/min) was observed followed by bradycardia and cardiac arrest occurred at the 45th minute of the operation. After resuscitation, his fever was 39.5°C (103.1°F), then the fever rised to 4...

  3. 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.

  4. 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.

  5. Life-threatening bradyarrhythmia with oral phenytoin overdose

    Directory of Open Access Journals (Sweden)

    Giridharan Srinivasan

    2015-01-01

    Full Text Available We report a case of a 41-year-old lady, who developed severe hypotension and sinus bradycardia, following oral consumption of 20 g of phenytoin and 500 mg of glibenclamide. She required high dose of inotropes and a temporary transvenous pacer for her hemodynamic instability. This life-threatening cardiotoxicity of phenytoin could have been due to its interaction with sulphonylurea. It is imperative to be aware of drug interactions, due to which, life-threatening cardiovascular manifestations following phenytoin toxicity can occur.

  6. Life-threatening bradyarrhythmia with oral phenytoin overdose.

    Science.gov (United States)

    Srinivasan, Giridharan; Wyawahare, Mukta; Mathen, Pratheesh George; Subrahmanyam, Dharanipragada K

    2015-01-01

    We report a case of a 41-year-old lady, who developed severe hypotension and sinus bradycardia, following oral consumption of 20 g of phenytoin and 500 mg of glibenclamide. She required high dose of inotropes and a temporary transvenous pacer for her hemodynamic instability. This life-threatening cardiotoxicity of phenytoin could have been due to its interaction with sulphonylurea. It is imperative to be aware of drug interactions, due to which, life-threatening cardiovascular manifestations following phenytoin toxicity can occur. PMID:26312007

  7. 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.

  8. Inadvertent intrathecal injection of large dose magnesium sulfate

    Directory of Open Access Journals (Sweden)

    Atabak Najafi

    2013-01-01

    Full Text Available The case is a 35-year-old man who underwent spinal anesthesia for emergency strangulated inguinal hernia repair. About five minutes after 3 ml intrathecal drug injection, the patient suffered respiratory distress, bradycardia, hypotension and loss of consciousness. The patient was rapidly intubated and crystalloid infusion and epinephrine drip were established. Thereafter, he was admitted in intensive care unit. Search for the cause revealed us that 3 ml of magnesium sulfate (50% was injected mistakenly for spinal anesthesia. Two days later, he was extubated and on the fifth day, he was discharged from the hospital without an obvious evidence of complication.

  9. Sick sinus syndrome associated with topical timolol maleate instillation

    Directory of Open Access Journals (Sweden)

    Harpreet S Walia

    2011-01-01

    Full Text Available A 70-year-old black woman presented with intermittent palpitations and dyspnea was found to be bradycardic with a normal sinus rhythm. She had instilled her topical timolol maleate approximately 30 minutes prior to each of these episodes. Topical timolol was discontinued and the conduction abnormality resolved. She was diagnosed as having intermittent sinus bradycardia with intermittent atrioventricular block, likely induced by topical beta-blocker therapy. Topical timolol maleate is an effective treatment for ocular hypertension, acting by reducing aqueous fluid production. However, it can induce systemic side effects and should be used with caution in patients with, or predisposed to, cardiac or respiratory depression.

  10. Sotalol.

    Science.gov (United States)

    Kpaeyeh, John Alvin; Wharton, John Marcus

    2016-06-01

    Sotalol is effective for treating atrial fibrillation (AF), ventricular tachycardia, premature ventricular contractions, and supraventricular tachycardia. Racemic (DL) sotalol inhibits the rapid component of the delayed rectifier potassium current. There is a near linear relationship between sotalol dosage and QT interval prolongation. However, in dose ranging trials in patients with AF, low-dose sotalol was not more effective than placebo. Orally administered sotalol has a bioavailability of nearly 100%. The only significant drug interactions are the need to avoid or limit use of concomitant drugs that cause QT prolongation, bradycardia, and/or hypotension. PMID:27261833

  11. Deletion of neurturin impairs development of cholinergic nerves and heart rate control in postnatal mouse hearts.

    Science.gov (United States)

    Downs, Anthony M; Jalloh, Hawa B; Prater, Kayla J; Fregoso, Santiago P; Bond, Cherie E; Hampton, Thomas G; Hoover, Donald B

    2016-05-01

    The neurotrophic factor neurturin is required for normal cholinergic innervation of adult mouse heart and bradycardic responses to vagal stimulation. Our goals were to determine effects of neurturin deletion on development of cardiac chronotropic and dromotropic functions, vagal baroreflex response, and cholinergic nerve density in nodal regions of postnatal mice. Experiments were performed on postnatal C57BL/6 wild-type (WT) and neurturin knockout (KO) mice. Serial electrocardiograms were recorded noninvasively from conscious pups using an ECGenie apparatus. Mice were treated with atenolol to evaluate and block sympathetic effects on heart rate (HR) and phenylephrine (PE) to stimulate the baroreflex. Immunohistochemistry was used to label cholinergic nerves in paraffin sections. WT and KO mice showed similar age-dependent increases in HR and decreases in PR interval between postnatal days (P) 2.5 and 21. Treatment with atenolol reduced HR significantly in WT and KO pups at P7.5. PE caused a reflex bradycardia that was significantly smaller in KO pups. Cholinergic nerve density was significantly less in nodal regions of P7.5 KO mice. We conclude that cholinergic nerves have minimal influence on developmental changes in HR and PR, QRS, and QTc intervals in mouse pups. However, cholinergic nerves mediate reflex bradycardia by 1 week postnatally. Deletion of neurturin impairs cholinergic innervation of the heart and the vagal efferent component of the baroreflex early during postnatal development. PMID:27162260

  12. 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.

  13. Detection of Heart Diseases by Mathematical Artificial Intelligence Algorithm Using Phonocardiogram Signals

    Directory of Open Access Journals (Sweden)

    D. Prakash

    2013-05-01

    Full Text Available An artificial intelligence (AI algorithm has been developed using Mathematical formula to diagnose heart disease from Phonocardiogram (PCG signals. Auscultation, the technique of listening to heart sounds with a stethoscope can be used as a primary detection technique for detecting heart disorders for the past years. But now the Phonocardiogram, the digital recording of heart sounds is becoming very popular technique as it is relatively inexpensive. Four amplitude parameters of the PCG signal are extracted by using filter technique and are used as input. PCG signals for three types of heart diseases such as Tachycardia, Bradycardia and Atrial fibrillation were used in this paper to test the accuracy. These disease types that affect the electrical system of heart are known as arrhythmias, cause the heart to beat very fast (Tachycardia or very slow (Bradycardia, or unexpectedly (Atrial fibrillation. After the signals are filtered and the parameters are extracted, the parameters are fed to the AI algorithm. Classifications of heart diseases are carried using the AI algorithm by comparing the extracted parameters. Here comparison is done using Min Max method. The developed mathematical artificial intelligence algorithm is implemented in MATLab using Simulink and the simulation results proved that the developed algorithm has been shown to be a powerful technique in detection of heart diseases using PCG signals.

  14. Ecg manifestations in dengue infection

    International Nuclear Information System (INIS)

    To determine the frequency of ECG changes in patients with dengue fever and dengue hemorrhagic fever. Place of study: Department of Medicine, Mayo Hospital Lahore Duration of study: September to November 201 Study design: Cross sectional analytical study Patient and methods: 116 patients with dengue infection were enrolled in the study. Their clinical presentation and examination was duly noted. Each patient had baseline and then regular monitoring of blood counts, metabolic profile and fluid status. Patients with Dengue Hemorrhagic fever underwent radiological examination in form of chest radiograph and ultrasound abdomen. ECG was carried out in all patients. Results: Out of 116 patients, 61(52.6%) suffered from Dengue Fever and 55(47.4%) had Dengue Hemorrhagic Fever. Overall 78 patients had normal ECG. Abnormal ECG findings like tachycardia, bradycardia, supraventricular tachycardia, left bundle branch block, ST depression, poor progression of R wave were noted. There was no significant relationship of ECG findings with the disease. Conclusion: ECG changes can occur in dengue infection with or without cardiac symptoms. Commonly noted findings were ST depression and bradycardia. (author)

  15. Thermoregulatory and Cardiovascular Consequences of a Transient Thyrotoxicosis and Recovery in Male Mice.

    Science.gov (United States)

    Hoefig, Carolin S; Harder, Lisbeth; Oelkrug, Rebecca; Meusel, Moritz; Vennström, Björn; Brabant, Georg; Mittag, Jens

    2016-07-01

    Thyroid hormones play a major role in body homeostasis, regulating energy expenditure and cardiovascular function. Given that obese people or athletes might consider rapid weight loss as beneficial, voluntary intoxication with T4 preparations is a growing cause for thyrotoxicosis. However, the long-lasting effects of transient thyrotoxicosis are poorly understood. Here we examined metabolic, thermoregulatory, and cardiovascular function upon induction and recovery from a 2-week thyrotoxicosis in male C57BL/6J mice. Our results showed that T4 treatment caused tachycardia, decreased hepatic glycogen stores, and higher body temperature as expected; however, we did not observe an increase in brown fat thermogenesis or decreased tail heat loss, suggesting that these tissues do not contribute to the hyperthermia induced by thyroid hormone. Most interestingly, when the T4 treatment was ended, a pronounced bradycardia was observed in the animals, which was likely caused by a rapid decline of T3 even below baseline levels. On the molecular level, this was accompanied by an overexpression of cardiac phospholamban and Serca2a mRNA, supporting the hypothesis that the heart depends more on T3 than T4. Our findings therefore demonstrate that a transient thyrotoxicosis can have pathological effects that even persist beyond the recovery of serum T4 levels, and in particular the observed bradycardia could be of clinical relevance when treating hyperthyroid patients. PMID:27145010

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

    Energy Technology Data Exchange (ETDEWEB)

    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. Large Outbreaks of Ciguatera after Consumption of Brown Marbled Grouper

    Directory of Open Access Journals (Sweden)

    Thomas Y. K. Chan

    2014-07-01

    Full Text Available Brown marbled grouper (Epinephelus fuscoguttatus is an apex predator from coral reefs of the Indo-Pacific region. All five published case series of ciguatera after consumption of brown marbled grouper were reviewed to characterize the types, severity and chronicity of ciguatera symptoms associated with its consumption. Three of these case series were from large outbreaks affecting over 100–200 subjects who had eaten this reef fish served at banquets. Affected subjects generally developed a combination of gastrointestinal, neurological and, less commonly, cardiovascular symptoms. Gastrointestinal symptoms occurred early and generally subsided in 1–2 days. Some neurological symptoms (e.g., paresthesia of four limbs could last for weeks or months. Sinus bradycardia and hypotension occurred early, but could be severe and prolonged, necessitating the timely use of intravenous fluids, atropine and dopamine. Other cardiovascular and neurological features included atrial ectopics, ventricular ectopics, dyspnea, chest tightness, PR interval >0.2 s, ST segment changes, polymyositis and coma. Concomitant alcohol consumption was associated with a much higher risk of developing bradycardia, hypotension and altered skin sensation. The public should realize that consumption of the high-risk fish (especially the ciguatoxin-rich parts and together with alcohol use and repeated ciguatoxin exposures will result in more severe and chronic illness.

  18. 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.

  19. Management of complications during percutaneous implementation of biliary stents

    International Nuclear Information System (INIS)

    Objective: To retrospectively analyze the complications and management of complications during percutaneous implementation of biliary stents in 17 patients. Methods: Percutaneous biliary drainage and implementation of biliary stents for malignant biliary obstruction under fluoroscopic guidance was performed in 64 patients. 17 cases developed complications. Bradycardia and hypotension was seen in 5 cases, slipping of the stent into the duodenum in 1, bile duct perforation in 2, the fine guidewire broken in the hepatic parenchyma in 2, malposition of the stent in 3, hepato-renal failure leading to hemorrhage in 2, exchanging guidewire broken in the duodenum in 1, and balloon broken leading to stent dislocation in 1, respectively. Results: Bradycardia and hypotension in the 5 cases was treated medically and the procedure was interrupted. Slipping of the stent into the duodenum was passed off spontaneously. Broken of the fine guidewire in the liver did not present any complaints until the death of the patients. Perforation of bile duct was treated conservatively with a clinical successful outcome. Malposition of the stent was treated by reimplementation of shorter stents. The broken exchanging guidewire in the duodenum during implementation was removed with the gastroscope. The hepato-renal failure leading to hemorrhage had poor prognosis. The broken balloon caused stent dislocation was treated by reimplementation of stent. Conclusion: Percutaneous implementation of stent is effective and safe for elderly patients with proximal stenosis of the biliary tract. However, one must be very careful to avoid the complications

  20. Congenital complete atrioventricular block. Report of one case and literature review

    International Nuclear Information System (INIS)

    Complete congenital atrioventricular block is a rare entity that has a high morbidity and mortality. Its real incidence remains unknown and a high suspicion index is needed for its diagnosis and consequently for its early intervention. It is observed in children of mothers having connective tissue autoimmune diseases, in particular systemic lupus erythematosus, when the condition is congenital. If it is post-natal, congenital cardiopathies are responsible in most cases. It may al so appear in. structurally normal hearts. The characteristic clinical finding is persistent bradycardia manifested since intrauterine life and affecting the circulatory fetal stability, going as far as to produce hydrops fetalis, a serious and lethal condition. After birth, it appears with bradycardia as well, that may or not unbalance the patient hemodynamics. Diagnosis is made upon clinical suspicion with fetal echocardiography and when post-natal, through electrocardiogram and maternal antibody type antiRo and antiLa. Pacemaker implantation is the definitive treatment that contributes to improve patient survival and prognosis. We present the case of a premature female patient with 31 weeks of gestation due to non-immune hydrops in who complete atrioventricuiar block secondary to maternal lupus erythematosus confirmed by frankly positive anti-nuclear antibodies and positive antiRo and antiLa antibodies was diagnosed, and that received inotropic support after pace maker implantation. She improved completely from her heart failure and was sent to other institution for conventional management of premature

  1. 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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. LIPID PROFILE AND ELECTROCARDIOGRAPHIC CHANGES IN THYROID DYSFUNCTION

    Directory of Open Access Journals (Sweden)

    Vandana

    2015-07-01

    Full Text Available BACKGROUND: The study was designed to explore lipid profile and electrocardiographic changes associated with thyroid dysfunctions. MATERIALS AND METHODS: A total of 50 patients of thyroid dysfunction having either hypothyroidism or hyperthyroidism were investigated wi th lipid profiles and electrocardiogram (ECG. RESULTS: Out of the 50 patients, 27(54% were suffering from hypothyroidism, while hyperthyroidism was present in 23(46%. Female: male ratio was 1.7:1. Mean cholesterol and LDL was higher in hypothyroid patie nts. Maximum number of hypothyroid patients (76% had either borderline high (27.92% or high (48.14% serum cholesterol. 91.3% of the 23 hyperthyroid patients had serum cholesterol levels <200 mg%. In hypothyroidism sinus bradycardia is the most common el ectrocardiographic findings and sinus tachycardia is most commonly seen in hyperthyroidism. CONCLUSION : Total and LDL cholesterol is significantly high in hypothyroid patients. Commonest electrocardiographic findings in hypothyroidism is sinus bradycardia whereas in hyperthyroid patients it is sinus tachycardia followed by atrial fibrillation

  4. Cardioprotective effects of gallic acid in diabetes-induced myocardial dysfunction in rats

    Directory of Open Access Journals (Sweden)

    Snehal S Patel

    2011-01-01

    Full Text Available Background: Normalization of hyperglycemia, hyperlipidemia, and oxidative stress is an important objective in preventing diabetes-induced cardiac dysfunction. Objective: This study was undertaken to examine the effects of gallic acid in myocardial dysfunctions associated with type-1 diabetes. Materials and Methods: Diabetes was induced by single intravenous injection of streptozotocin (STZ, 50 mg/kg i.v.. Gallic acid was administered daily at three different doses (100, 50, and 25 mg/kg p.o. for 8 weeks at the end of which blood samples were collected and analyzed for various biochemical parameters. Results: Injection of STZ produced significant loss of body weight (BW, polyphagia, polydypsia, hyperglycemia, hypoinsulinemia, hyperlipidemia, hypertension, bradycardia, and myocardial functional alterations. Treatment with gallic acid significantly lowered fasting glucose, the AUC glucose level in a dose-dependent manner; however, the insulin level was not increased significantly at same the dose and prevented loss of BW, polyphagia, and polydypsia in diabetic rats. It also prevented STZ-induced hyperlipidemia, hypertension, bradycardia, structural alterations in cardiac tissue such as increase in force of contraction, left ventricular weight to body weight ratio, collagen content, protein content, serum lactate dehydrogenase, and creatinine kinase levels in a dose-dependent manner. Further, treatment also produced reduction in lipid peroxidation and increase in antioxidant parameters in heart of diabetic rats. Conclusion: The results of this study suggest that gallic acid to be beneficial for the treatment of myocardial damage associated with type-1 diabetes.

  5. [The oculocardiac reflex in blepharoplasties].

    Science.gov (United States)

    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. PMID:18716987

  6. Perioperative and long-term operative outcomes after surgery for trigeminal neuralgia: microvascular decompression vs percutaneous balloon ablation

    Directory of Open Access Journals (Sweden)

    Anderson Douglas

    2008-07-01

    Full Text Available Abstract Objectives Numerous medical and surgical therapies have been utilized to treat the symptoms of trigeminal neuralgia (TN. This retrospective study compares patients undergoing either microvascular decompression or balloon ablation of the trigeminal ganglion and determines which produces the best long-term outcomes. Methods A 10-year retrospective chart review was performed on patients who underwent microvascular decompression (MVD or percutaneous balloon ablation (BA surgery for TN. Demographic data, intraoperative variables, length of hospitalization and symptom improvement were assessed along with complications and recurrences of symptoms after surgery. Appropriate statistical comparisons were utilized to assess differences between the two surgical techniques. Results MVD patients were younger but were otherwise similar to BA patients. Intraoperatively, twice as many BA patients developed bradycardia compared to MVD patients. 75% of BA patients with bradycardia had an improvement of symptoms. Hospital stay was shorter in BA patients but overall improvement of symptoms was better with MVD. Postoperative complication rates were similar (21% vs 26% between the BA and MVD groups. Discussion MVD produced better overall outcomes compared to BA and may be the procedure of choice for surgery to treat TN.

  7. Evidence for a direct action of Tityus serrulatus scorpion venom on the cardiac muscle.

    Science.gov (United States)

    Teixeira, A L; Fontoura, B F; Freire-Maia, L; Machado, C R; Camargos, E R; Teixeira, M M

    2001-05-01

    The ability of toxins to activate the cardiovascular system plays an important role in the morbidity and lethality of the Tityus serrulatus scorpion envenoming. Most of the actions of the scorpion toxins are indirect and due to the release of adrenergic and cholinergic neurotransmitters. Accordingly, treatment following envenoming is targeted towards inhibition of adrenergic and cholinergic receptors. Here, we have sought evidence for a direct action of T. serrulatus venom on the isolated rat heart (Langendorff's method). We show that the bradycardia induced by T. serrulatus venom was completely blocked by atropine, a muscarinic receptor antagonist. Similarly, the increase in heart rate that follows the venom-induced bradycardia was totally inhibited by a beta(1)-adrenoceptor antagonist or by chemical sympathetic denervation with 6-hydroxydopamine. In contrast to these findings, the venom-induced increase in contractile force was not modified by beta(1)-adrenoceptor blockade or by chemical sympathetic denervation. The results clearly demonstrate that the chronotropic effects of T. serrulatus are dependent on neurotransmitter release, but the inotropic effects are not. The neurotransmitter-independent increase in contractility seems to be a direct action of the venom on cardiomyocytes. We suggest that this direct effect on cardiac fibers may play a role in the development of cardiac arrhythmias and contractility defects following envenoming with T. serrulatus scorpion. PMID:11072050

  8. 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. PMID:26071949

  9. 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. PMID:26038597

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

    Directory of Open Access Journals (Sweden)

    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 

  11. Serious response during tilt-table test in elderly and its prophylactic management

    Institute of Scientific and Technical Information of China (English)

    HAN Yang; LI Xiao-xia; JLANG Wei-li; WANG Zhao-di; CHEN Tian-zhi

    2005-01-01

    Objective: To evaluate the serious response during tilt-table test (TTT) and its prophylactic management. Method:Seventy-six elderly patients were tested at a tilt angle of 70 degrees for a maximum of 45 min and then subjected to isoproterenol-provocative tilt testing. ECG and blood pressure were monitored during the test and patients were kept at normal saline condition through a peripheral intravenous duct. Results: Fifty-one of 76 patients were defined as positive including 23 having serious response; 6 of the 23 patients had arteriosclerosis involving intemal carotid arteries and 7 cases had bradycardia, two of which were associated with Ⅱ°-Ⅰ A-V block and the others with chronic atrial fibrillation. The serious response consisted of cardiac arrest for more than 5 s (6 cases), or serious bradycardia for more than 1 min (7 cases) or serious hypotension for more than 1 min (10 cases).Those with serious response were managed by returning to supine position, thus driving up legs and intravenous atropine, CPR (2cases with cardiac arrest) and needing oxygen supplementation (11 cases). Only 2 hypotension patients recovered gradually by 10min after emergency management, while others recovered rapidly with no complications. Conclusion: Although non-invasive,TTT may result in serious response, especially in elderly. Therefore proper patient selection, control of isoproterenol infusion and close observation of vital signs are decisive for a safe consequence.

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

    International Nuclear Information System (INIS)

    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

  13. Cardiac output and vasodilation in the vasovagal response: An analysis of the classic papers.

    Science.gov (United States)

    Wieling, Wouter; Jardine, David L; de Lange, Frederik J; Brignole, Michele; Nielsen, Henning B; Stewart, Julian; Sutton, Richard

    2016-03-01

    The simple faint is secondary to hypotension and bradycardia resulting in transient loss of consciousness. According to Ohm's law applied to the circulation, BP = SVR × CO, hypotension can result from a decrease in systemic vascular resistance (SVR), cardiac output (CO), or both. It is important to understand that when blood pressure (BP) is falling, SVR and CO do not change reciprocally as they do in the steady state. In 1932, Lewis, assuming that decreased SVR alone accounted for hypotension, defined "the vasovagal response" along pathophysiologic lines to denote the association of vasodilation 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. Plethysmographic measurements were intermittent and not frequent enough to capture rapid changes in blood flow during progressive hypotension. However, later investigations by Weissler, Murray, and Stevens performed between 1950 and 1970 used invasive beat-to-beat BP measurements and more frequent measurements of CO using the Fick principle. They demonstrated that CO significantly fell before syncope, and little vasodilation occurred until very late in the vasovagal reaction Thus, since the 1970s, decreasing cardiac output rather than vasodilation has been regarded as the principal mechanism for the hypotension of vasovagal syncope. PMID:26598322

  14. Anorexia nervosa in a pediatric renal transplant recipient and its reversal with cyclosporine.

    Science.gov (United States)

    Okechuku, Gyongyi; Boulos, Andrew K; Herman, Lettie; Upadhyay, Kiran

    2015-05-01

    We report a 16-yr-old female who developed AN within a month after renal transplantation and its resolution after switching from tacrolimus to cyclosporine. Her initial maintenance immunosuppressive regimen after renal transplantation consisted of tacrolimus, mycophenolate, and steroid. She had 7 kg weight loss within the first month of transplant with subsequent 10, 12, 17, and 19 kg loss after three, five, seven, and nine months of transplant, respectively. Besides weight loss and disturbances in body image, the patient developed alopecia, bradycardia, and persistent secondary amenorrhea. Upon switching to cyclosporine from tacrolimus nine months after transplant, she started regaining weight with 5 kg gain within two months and 10 kg after four months. She restarted her menstrual cycle, alopecia and bradycardia resolved, and her body image disturbance improved. Here, we describe a very unusual neuropsychiatric side effect of tacrolimus and its resolution with another calcineurin inhibitor, cyclosporine, in an adolescent renal transplant recipient. PMID:25661468

  15. Facing freeze: social threat induces bodily freeze in humans.

    Science.gov (United States)

    Roelofs, Karin; Hagenaars, Muriel A; Stins, John

    2010-11-01

    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 similar freeze-like responses in humans. We investigated body sway and heart rate in 50 female participants while they were standing on a stabilometric force platform and viewing cues that were socially threatening, socially neutral, and socially affiliative (angry, neutral, and happy faces, respectively). Posturographic analyses showed that angry faces (compared with neutral faces and happy faces) induced significant reductions in body sway. In addition, the reduced body sway for angry faces was accompanied by bradycardia and correlated significantly with subjective anxiety. Together, these findings indicate that spontaneous body responses to social threat cues involve freeze-like behavior in humans that mimics animal freeze responses. These findings open avenues for studying human freeze responses in relation to various sociobiological markers and social-affective disorders. PMID:20876881

  16. Swallowing-induced cardio-respiratory responses in man

    Directory of Open Access Journals (Sweden)

    Ballal Mansour

    1998-01-01

    Full Text Available Swallowing transiently increases heart rate. One of the authors developed pronounced bradycardia while breath holding, particularly after an expiration. The objective, therefore, was to study his cardiac responses during swallowing as pronounced bradycardia developed. When, after a maximum inspiration (supine, the heart rate slowly fell below 50 beats min′ well-defined P waves (lead II disappeared. By swallowing 6 times on command after the P waves disappeared his heart rate increased immediately (68 ± I beats min-′; n=6. P waves with similar morphology to those pre-swallowing were recorded 0.7 ± 0.1 s (n=6 after the first swallow. He continued breath holding after swallowing. P waves again disappeared, although at faster heart rates (57 ± I beats min′; n=6. Furthermore, well-defined P waves were observed after the second disappearance at heart rates within the range 30-40 beats min′. Small amplitude P waves continued to be recorded from lead I with P wave disappearance in lead II, suggesting a pacemaker shift, although not to the av node. Autonomic nerves can shift the dominant pacemaker within the sa node. The present report indicates that increased vagal tone may be rapidly reversed by swallowing.

  17. Large outbreaks of ciguatera after consumption of brown marbled grouper.

    Science.gov (United States)

    Chan, Thomas Y K

    2014-01-01

    Brown marbled grouper (Epinephelus fuscoguttatus) is an apex predator from coral reefs of the Indo-Pacific region. All five published case series of ciguatera after consumption of brown marbled grouper were reviewed to characterize the types, severity and chronicity of ciguatera symptoms associated with its consumption. Three of these case series were from large outbreaks affecting over 100-200 subjects who had eaten this reef fish served at banquets. Affected subjects generally developed a combination of gastrointestinal, neurological and, less commonly, cardiovascular symptoms. Gastrointestinal symptoms occurred early and generally subsided in 1-2 days. Some neurological symptoms (e.g., paresthesia of four limbs) could last for weeks or months. Sinus bradycardia and hypotension occurred early, but could be severe and prolonged, necessitating the timely use of intravenous fluids, atropine and dopamine. Other cardiovascular and neurological features included atrial ectopics, ventricular ectopics, dyspnea, chest tightness, PR interval >0.2 s, ST segment changes, polymyositis and coma. Concomitant alcohol consumption was associated with a much higher risk of developing bradycardia, hypotension and altered skin sensation. The public should realize that consumption of the high-risk fish (especially the ciguatoxin-rich parts and together with alcohol use) and repeated ciguatoxin exposures will result in more severe and chronic illness. PMID:25019942

  18. AANA journal course: update for nurse anesthetists-improving the safety of subarachnoid and epidural blocks--Part A.

    Science.gov (United States)

    Fiedler, M A

    1997-08-01

    Hypotension caused by reduced venous return to the heart is a common hazard during subarachnoid and epidural anesthesia. Reduced venous return can also cause severe bradycardia and even cardiac arrest. The infusion of a crystalloid intravenous preload prior to the injection of local anesthetic helps prevent these complications. Unfortunately, intravenous fluid preloading prior to subarachnoid or epidural block is neither appropriate for all patients nor is it always effective. Vasopressor infusions and lower extremity compression, though not completely studied, may allow for further decreases in the incidence of hypotension and bradycardia. When dosing an epidural catheter, making each dose a test dose and observing for signs of subarachnoid or intravascular injection decreases the incidence of hypotension, seizure, and cardiotoxicity. The pathophysiology of cardiac arrest and resuscitation is different during major conduction block due primarily to changes in peripheral vascular tone and venous return to the heart. Neural injury associated with regional anesthesia is due to needle trauma, hematoma, injectate toxicity, ischemia, and compression. Though neural injury is rare, it is more commonly associated with blocks performed in the lumbar region (spinals and epidurals) than in other types of blocks. PMID:9281920

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

    Directory of Open Access Journals (Sweden)

    G.L. Shimojo

    2015-06-01

    Full Text Available 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.

  20. Cardiovascular responses produced by central injection of hydrogen peroxide in conscious rats.

    Science.gov (United States)

    Máximo Cardoso, Leonardo; de Almeida Colombari, Débora Simões; Vanderlei Menani, José; Alves Chianca, Deoclécio; Colombari, Eduardo

    2006-12-11

    Reactive oxygen species (ROS) have been shown to modulate neuronal synaptic transmission and may play a role on the autonomic control of the cardiovascular system. In this study we investigated the effects produced by hydrogen peroxide (H(2)O(2)) injected alone or combined with the anti-oxidant agent N-acetil-l-cysteine (NAC) or catalase into the fourth brain ventricle (4th V) on mean arterial pressure and heart rate of conscious rats. Moreover the involvement of the autonomic nervous system on the cardiovascular responses to H(2)O(2) into the 4th V was also investigated. Male Holtzman rats (280-320 g) with a stainless steel cannula implanted into the 4th V and polyethylene cannulas inserted into the femoral artery and vein were used. Injections of H(2)O(2) (0.5, 1.0 and 1.5 micromol/0.2 microL, n=6) into the 4th V produced transient (for 10 min) dose-dependent pressor responses. The 1.0 and 1.5 micromol doses of H(2)O(2) also produced a long lasting bradycardia (at least 24 h with the high dose of H(2)O(2)). Prior injection of N-acetyl-l-cysteine (250 nmol/1 microL/rat) into the 4th V blockade the pressor response and attenuated the bradycardic response to H(2)O(2) (1 micromol/0.5 microL/rat, n=7) into the 4th V. Intravenous (i.v.) atropine methyl bromide (1.0 mg/kg, n=11) abolished the bradycardia but did not affect the pressor response to H(2)O(2). Prazosin hydrochloride (1.0 mg/kg, n=6) i.v. abolished the pressor response but did not affect the bradycardia. The increase in the catalase activity (500 UEA/1 microL/rat injected into the 4th V) also abolished both, pressor and bradycardic responses to H(2)O(2). The results suggest that increased ROS availability into 4th V simultaneously activate sympathetic and parasympathetic outflow inducing pressor and bradycardic responses. PMID:17113926

  1. Pharmacokinetics and pharmacodynamics of a nitric oxide-releasing derivative of enalapril in male beagles.

    Science.gov (United States)

    Okuyama, Cristina E; Mendes, Gustavo Duarte; Faro, Renato; Rezende, Vinicius M; Lagos, Rodolfo Monaco; Astigarraga, Rafael E B; Antunes, Edson; De Nucci, Gilberto

    2007-04-01

    1. Pharmacological compounds that release nitric oxide (NO) have been useful tools in the evaluation of the broad role of NO in physiopathology and therapeutics. The present study compared the pharmacokinetics and pharmacodynamics of enalapril and an NO-releasing enalapril molecule (NCX899) in conscious male beagles. The effects of both enalapril and NCX899 in the arterial hypertension and bradycardia induced by acute NO inhibition in anaesthetized dogs were also investigated. 2. Dogs received either NCX899 (4 micromol/kg, i.v.) or enalapril (4 micromol/kg, i.v.), after which plasma concentrations of the analytes and metabolites were quantified by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). 3. In the NCX899 group, the area under the time-course curve (AUC(0-24h)) was 29.18 +/- 4.72, 229.37 +/- 51.32 and 5159.23 +/- 514.88 microg.h/L for the analytes nitro-enalapril, enalapril and enalaprilat, respectively. In the enalapril group, the AUC(0-24h) was 704.53 +/- 158.86 and 4149.27 +/- 847.30 microg.h/L for the analytes enalapril and enalaprilat, respectively. Statistical analysis of data from both groups showed a significant difference for the analyte enalapril, but not for enalaprilat. Moreover, NCX899 and enalapril were equally effective in inhibiting the activity of serum angiotensin-converting enzyme. 4. In anaesthetized dogs, i.v. administration of the NO synthase (NOS) inhibitor N(G)-nitro-l-arginine methyl ester (l-NAME; 0.1-10 mg/kg) significantly elevated arterial blood pressure, with concomitant bradycardia. The compound NCX899 significantly attenuated both arterial hypertension and bradycardia, whereas enalapril had no significant effect. 5. In conclusion, the present results showed that the NO-releasing derivative of enalapril NCX899 presents a pharmacokinetic/pharmacodynamic relationship similar to its parent compound enalapril. Moreover, NCX899 (but not enalapril) was effective in protecting against the cardiovascular changes

  2. Fatal Envenomation of a Chilean Flamingo (Phoenicopterus chilensis) From Eastern Yellow Jacket Wasps (Vespula maculifrons).

    Science.gov (United States)

    Suedmeyer, Wm Kirk; Trupkiewicz, John G

    2014-12-01

    A 37-year-old, female Chilean flamingo (Phoenicopterus chilensis) presented with severe facial angioedema, bilateral corneal and palpebral edema, nictitating membrane paralysis, bradycardia, bradypnea, hypothermia, and numerous stingers and remnants of eastern yellow jacket wasps (Vespula maculifrons) attached to the feathers of the head, palpebrae, and conjunctiva. Evaluation of 2 complete blood cell counts and results of plasma chemical analysis and serum protein electrophoresis revealed severe increases in creatinine phosphokinase and aspartate aminotransferase activity, electrolyte disturbances, and moderate increases in levels of α1, α2, β1, and γ immunoglobulins when compared with reference interval values and conspecifics. Despite intensive treatment, the bird died 19 hours after presentation. Results of histologic evaluation of tissues were compatible with envenomation. Response to envenomation in avian species is not documented but should be considered in birds presenting with angioedema. PMID:25843472

  3. [Gallopamil and chlorthalidone versus atenolol and chlorthalidone in the treatment of obstructive hypertrophic cardiomyopathy in patients with arterial hypertension: polycardiographic evaluation of the systolic and diastolic function of the left ventricle].

    Science.gov (United States)

    Chieppa, S; Lobascio, C; Brandini, V; Iarussi, D; Giuliani, F; Langella, S; De Simone, R

    1989-08-01

    In 13 patients, affected by hypertrophic obstructive cardiomyopathy (HOCM) and essential hypertension, antihypertensive-efficacy and effects of a new calcium-channel blocker (gallopamil) associated with a diuretic agent (chlorthalidone) on left ventricular systolic and diastolic performance assessed by phonocardiographic methods. The results were compared to those obtained, in the same group of patients, with a selective beta-blocker (atenolol) associated with the same diuretic agent (chlorthalidone). With both therapeutic regimens a statistically significant reduction of systolic and diastolic arterial pressure was observed; both agents were able to reduce hemodynamic gradient in systole which characterize HOCM; however, the treatment with gallopamil plus chlorthalidone determined greater effects on left ventricular diastolic function as compared to the treatment with atenolol plus chlorthalidone; both treatments determined bradycardia. PMID:2605580

  4. Ogilvie′s syndrome in a case of myxedema coma

    Directory of Open Access Journals (Sweden)

    Uday Yanamandra

    2012-01-01

    Full Text Available Ogilvie′s syndrome [acute colonic pseudo-obstruction (ACPO] presents as massive colonic dilatation without a mechanical cause, usually in critically ill patients due to imbalanced sympathetic and parasympathetic activity. The initial therapy remains conservative with supportive measures (correction of metabolic, infectious or pharmacologic factors followed by neostigmine and decompressive colonoscopy. Surgery is reserved for patients with clinical deterioration or with evidence of colonic ischemia or perforation. A 60-year-old lady presented with fever, altered sensorium, obstipation, bradycardia and abdominal distension. Investigation revealed hyponatremia and acute colonic pseudo-obstruction. Supportive measures and decompressive colonoscopy were not of great benefit. Thyroid profile was suggestive of primary hypothyroidism. Colonic motility was restored only on starting thyroxin. The case is illustrative of the need to consider hypothyroidism, a common endocrine disorder, in the differential diagnosis of Ogilvie′s.

  5. Neonatal molecular pathologies induced by maternal anti-Ro and anti-La antibodies

    Directory of Open Access Journals (Sweden)

    Herrera-Esparza R

    2015-08-01

    Full Text Available Maternal antinuclear antibodies with anti-Ro or anti-La specificity might be pathogenic to the fetus and could induce molecular neonatal pathologies, such as neonatal lupus (NL with or without congenital heart block (CHB. The cutaneous manifestations of neonatal lupus appear at birth or a few weeks later, and skin lesions may persist for weeks. While CHB is characterized by intrauterine bradycardia or low heart rates at birth and may persist for months, depending on the degree of blockage. Clinical and experimental data demonstrated that anti-Ro and anti-La autoantibodies functionally inhibit L-type calcium channels and induce abnormalities in electrical conduction of the cardiac myocytes. It has been 38 years since the first clinical description of CHB. Presently, the pathophysiology of CHB has been clarified through clinical and basic research studies.

  6. Ultrasonographic findings of early abortion: suggested predictors

    International Nuclear Information System (INIS)

    To investigate predictable ultrasonographic findings of early abortion. To investigate objective rules for the screening of abortion. Ultrasonographic examination of 111 early pregnancies between the sixth and ninth week in women who had regular 28 day menstrual cycles was performed. Ultrasonographic measurements of the gestational sac, crown rump length and fetal heart rate were performed using a linear array real time transducer with doppler ultrasonogram. All measurements of 17 early abortions were compared to those of 94 normal pregnancies. Most of early aborted pregnancies were classified correctly by discriminant analysis with G-SAC and CRL (G-SAC=0.5 CRL + 15, sensitivity 76.5%, specificity 96.8%). With the addition of FHR, 94.1% of early abortions could be predicted. In conclusion, ultrasonographic findings of early intrauterine growth retardation, small gestational sac and bradycardia can be predictable signs suggestive of poor prognosis of early pregnancies

  7. AMLODIPINE INTOXICATION: A DIFFERENT PRESENTATION OF OVERDOSE OF A COMMONLY PRESCRIBED ANTI - HYPERTENSIVE

    Directory of Open Access Journals (Sweden)

    Shivakumar

    2013-12-01

    Full Text Available ABSTRACT : Calcium channel blockers (CCBs are one of the most commonly prescribed anti - hypertensive medications in India due to good efficacy and cost - effectiveness. Overdose of this wonderful dihydropyridine though common in the western world has been scarcely reported in the Indian literature. We report the case o f intoxication with Amlodipine , in a young female software technician. The patient came with a very different presentation of loose stools with severe hypotension , bradycardia , altered sensorium , hyperglycemia , respiratory distress and metabolic acidosis. With the patient on assisted mechanical ventilation and without any correlating history , there was a diagnostic dilemma. But with detailed history taking and from repeated conversations with the relatives , empty strips of Amlodipine tablets were found at t he patient’s bedside. The patient was treated with stomach wash , fluid resucsitation , calcium gluconate , Dopamine , hyperinsulinemia euglycemia therapy. The patient made a complete recovery and was discharged after a psychiatric consultation

  8. An Unusual Case of Asystole following Penetrating Neck Trauma and Anoxic Brain Injury

    Directory of Open Access Journals (Sweden)

    Matthew Nayor

    2011-01-01

    Full Text Available Bradycardia and transient asystole are well-described sequelae of a myriad of neurologic insults, ranging from focal to generalized injuries. Increased vagal tone also predisposes many individuals, particularly adolescents, to transient neurally mediated bradyarrhythmia. However, prolonged periods of sinus arrest without junctional or ventricular escape are quite rare, even after significant neurologic injury. We describe the case of a 17-year-old man who presented with anoxic brain injury secondary to hemorrhagic shock from a stab wound to the neck. His recovery was complicated by prolonged periods of sinus arrest and asystole, lasting over 60 seconds per episode. This case illustrates that sustained asystolic episodes may occur following significant neurologic injury, and may continue to recur even months after an initial insult. Pacemaker implantation for such patients should be strongly considered.

  9. 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.

  10. 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.

  11. Atenolol in the treatment of essential hypertension during pregnancy.

    Science.gov (United States)

    Rubin, P C; Butters, L; Low, R A; Reid, J L

    1982-08-01

    Atenolol has been studied prospectively in the management of ten patients with essential hypertension during pregnancy. Median supine BP fell significantly from 156/98 mmHg before treatment to 128/82 mmHg at term. Atenolol did not suppress cardiotocographic signs of foetal distress. Although there was one intrauterine death, the remaining nine babies had a median Apgar score at birth of 9 and a median weight which was 82% of the gestational mean. There were no cases of neonatal bradycardia or respiratory depression and the only case of hypoglycaemia was in a dysmature baby. These findings justify a formal study of beta-adrenoceptor blocker therapy in hypertensive diseases of pregnancy. PMID:7104179

  12. Intrauterine responses to nipple stimulation in late pregnancy.

    Science.gov (United States)

    Viegas, O A; Adaikan, P G; Singh, K; Arulkumaran, S; Kottegoda, S R; Ratnam, S S

    1986-01-01

    Characteristics of intrauterine activity in response to nipple stimulation were studied in 9 healthy pregnant subjects at term. All patients showed an increase in uterine activity varying from 10 to 730%. In 1 subject, marked uterine hypertonus was noted which resulted in profound fetal bradycardia. This response was transient, lasting 5.5 min, and fetal outcome unaffected. We believe that nipple stimulation is associated with a higher incidence of increased uterine activity in terms of frequency, intensity and basal tone, than has been previously recognized. This uterine hypertonus may affect the fetal heart rate adversely indicating the need to exercise caution when adopting this manoeuvre in late pregnancy, particularly when there is already evidence of fetal compromise. PMID:3781343

  13. Lethal neonatal rigidity and multifocal seizure syndrome--report of another family with a BRAT1 mutation.

    Science.gov (United States)

    Straussberg, Rachel; Ganelin-Cohen, Esther; Goldberg-Stern, Hadassah; Tzur, Shay; Behar, Doron M; Smirin-Yosef, Pola; Salmon-Divon, Mali; Basel-Vanagaite, Lina

    2015-03-01

    We describe two siblings born to consanguineous Arab-Muslim parents who presented in early infancy with myoclonic seizures, hypertonia and contractures, arrested head growth, inability to swallow, and bouts of apnea-bradycardia, culminating in cardiac arrest and death. Whole-genome sequencing yielded a c.1173delG mutation in the BRAT1 gene. Three recent reports identified mutations in the same gene in three infants from three Amish sibships, one Mexican neonate and two Japanese siblings with similar clinical manifestations. The authors speculated that the destabilization of the encoded protein may underlie the catastrophic epilepsy and corticobasal neuronal degeneration. We suggest that BRAT1 be added to the growing list of genes that are related to severe early infantile (neonatal) epileptic encephalopathy. PMID:25500575

  14. Rumenotomy for foreign bodies in a cow

    International Nuclear Information System (INIS)

    A five-year old Holstein cow presented with clinical signs of poor digestion and bradycardia, together with low blood potassium and chlorine concentrations and a high blood fibrinogen concentration. Traumatic reticuloperitonitis (TRP) was suspected, but it could not be confirmed using abdominal ultrasonography. Two foreign bodies were detected on radiography and the occurrence of two abscesses was suspected. There was no improvement with medical treatment, therefore a rumenotomy was performed. Three foreign bodies were removed, but the abscess was left in place. The animal rejoined herd after five days of hospitalisation. For TRP, exploratory laparotomy followed by rumenotomy is the treatment of choice, especially if medical treatment is ineffective. The decision to operate must be based on a sound diagnosis because of risk of infection

  15. Atypical Presentation of Massive Pulmonary Embolism, a Case Report

    Directory of Open Access Journals (Sweden)

    Alireza Majidi

    2014-03-01

    Full Text Available The lack of pathognomonic signs and symptoms makes the diagnosis of pulmonary embolism (PE difficult. Here, we report a case of a 42-year-old man presented to the emergency department with worsening epigastric pain, hypotension, frank bradycardia, and final diagnosis of PE. Although previous studies have indicated that abdominal pain was observed in 6.7% of patients with PE, the exact reason for abdominal pain in PE still remains unknown. Tension on the sensory nerve endings, hepatic congestion, and distention of Gilson’s capsule are some of the possible mechanisms of abdominal pain in PE. We conclude that emergency physicians should pay more attention to PE, which is an important differential diagnosis of shock state. In this context, rapid ultrasound in shock (RUSH should be considered as a vital sign that needs to be evaluated when recording the history of patients presented to the emergency department with signs and symptoms of shock.

  16. Unresponsive primipara after rupture of membranes.

    Science.gov (United States)

    Buechel, Johanna; Berset, Andreas; Lehmann, Michael A; Lapaire, Olav

    2015-01-01

    Amniotic fluid embolism, also called anaphylactoid syndrome of pregnancy, is a rare but severe problem in obstetrics. It occurs in 8/100,000 births and the maternal mortality is up to 90%. We report the case of a patient with amniotic fluid embolism who was transferred to our hospital. The initial presentation was an unresponsive patient after spontaneous rupture of the membranes. The massive hypotension and coagulopathy as well as fetal bradycardia of 60 bpm led, after stabilisation of the mother, to an emergency caesarean section. The neonate expired hours later, despite neonatological intensive care. During the operation, we had to deal with massive bleeding due to the coagulopathy. Through interdisciplinary teamwork including Bakri postpartum balloon insertion through the obstetrics team, uterine artery embolism by the interventional radiologists and transfusion of blood products, the maternal life was saved and the patient was discharged 9 days after admission. PMID:25883261

  17. Dental treatment in patients with cardiovascular disease

    Directory of Open Access Journals (Sweden)

    Cleonice da Silveira TEIXEIRA

    2008-04-01

    Full Text Available Introduction: The correct evaluation of patients with cardiovasculardisease is based on a careful anamnesis and on the previous knowledgeof the main coronary diseases and its sequels. Objective: This articlerevised the concepts and characteristics of diverse heart illnesses asthe ischemic cardiopathy, chest angina, congestive cardiac insufficiency,arrhythmia and bradycardia. Literature review and conclusion:Complications like myocardium infarct and bacterial endocarditis were described focusing the dental clinical procedures. The handling of this information is important during the determination of the cardiac risk of each patient, classifying as high, moderate, or minimum risk. Dental professionals must plan the clinical appointments according to pre-established patient’s risk. Short duration appointments and the limitation of the stress and anxiety levels with the use of anti-anxiolytic medicines and complementary sedation can be important for a transoperative and postoperative without complications. The urgent procedures that occurred during the clinical trial in patients with coronary disease were also discussed.

  18. Alpha-2 agonists as pain therapy in horses.

    Science.gov (United States)

    Valverde, Alexander

    2010-12-01

    Alpha-2 agonists, such as xylazine, clonidine, romifidine, detomidine, medetomidine, and dexmedetomidine, are potent analgesic drugs that also induce physiologic and behavioral changes, such as hypertension, bradycardia, atrioventricular block, excessive sedation and ataxia, all of which can potentially limit their systemic use as analgesics in some clinical cases. The use of medetomidine and dexmetomidine has been introduced for equine anesthesia/analgesia, and although not approved in this species, their increased specificity for alpha-2 receptors may offer some potential advantages over the traditional alpha-2 agonists. Similarly, other routes of administration and benefits of alpha-2 agonists are recognized in the human and laboratory animal literature, which may prove useful in the equine patient if validated in the near future. This review presents this relevant information. PMID:21056297

  19. Unusual Presentation of Dengue Fever: A child with acute myocarditis.

    Science.gov (United States)

    Aslam, Moaz; Aleem, Numra A; Zahid, Mohammad F; Rahman, Arshalooz J

    2016-02-01

    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. PMID:26909198

  20. 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.

  1. Prolonged QT interval in a man with anorexia nervosa.

    Science.gov (United States)

    Macías-Robles, María Dolores; Perez-Clemente, Ana María; Maciá-Bobes, Carmen; Alvarez-Rueda, María Asunción; Pozo-Nuevo, Sergio

    2009-01-01

    Anorexia nervosa is an eating disorder characterized by the avoidance of food intake, which usually leads to a weight loss. Cardiac co-morbility is common and we can find sometimes a mass loss from the left ventricle, which can be seen by echocardiography. But the commonest complications are rhythm variations, typically bradycardia with a prolonged QT interval in up to a 40% of the cases, which altogether elevates ventricular tachycardia and sudden death risk. We present the case of a male who was diagnosed with anorexia nervosa and developed asthenia, a long QT interval and also a severe both hypokalaemia and hypomagnesaemia. We intend to discuss the pathogenic paths as well as prophylactic and therapeutic measures to this potentially-lethal pathology. PMID:19646241

  2. [Anorexia nervosa and bulimia nervosa. II. Somatic complications of undernourishment].

    Science.gov (United States)

    van Rijn, C A

    1998-08-15

    In anorexia nervosa and bulimia nervosa, cachexia and deficient nourishment cause various physical abnormalities, especially of the endocrine and digestive systems and the heart. Disorders in the serotoninergic and dopaminergic systems contribute to development of an eating disorder, whereas an acquired deficiency of tryptophan impairs the serotoninergic system. Any problems of nutritional deficiencies, low blood sugar levels and gastrointestinal disorders disappear after normal nourishment is resumed. Hypotension and sinus bradycardia are manifestations of a physiological adjustment to a lower basal metabolism and need no treatment. Osteoporosis occurs from two years after the onset of weight loss; oestrogen supplementation may protect against this. In patients with infections, symptoms such as fever, leukocytosis and high BSE may be lacking. Hypoglycaemia incidentally leads to coma and death, and a lengthened QT interval to acute cardiac death. During restoration of the nutritional status, the intake of fluid and calories should initially be limited. During the first two weeks, the risk of cardiovascular complications is increased. PMID:9856167

  3. Preoperative cardiovascular investigations in liver transplant candidate: An update

    Science.gov (United States)

    Sehgal, Lalit; Srivastava, Piyush; Pandey, Chandra Kant; Jha, Amit

    2016-01-01

    Cardiovascular complications are a major cause of morbidity and mortality in patients with end-stage liver disease (ESLD) undergoing liver transplantation. Identifying candidates at the highest risk of postoperative cardiovascular complications is the cornerstone for optimizing the outcome. Ischaemic heart disease contributes to major portion of cardiovascular complications and therefore warrants evaluation in the preoperative period. Patients of ESLD usually demonstrate increased cardiac output, compromised ventricular response to stress, low systemic vascular resistance and occasionally bradycardia. Despite various recommendations for preoperative evaluation of cardiovascular disease in liver transplant candidates, a considerable controversy on screening methodology persists. This review critically focuses on the rapidly expanding body of evidence for diagnosis and risk stratification of cardiovascular disorder in liver transplant candidates. PMID:26962249

  4. Use of a Boari flap and renal descensus as treatment for proximal ureteral rupture in a cat.

    Science.gov (United States)

    Gordo, Inês; Mestrinho, Lisa A; Minderico, Maria M; Leal, Nuno M; Hamaide, Annick J

    2016-08-15

    CASE DESCRIPTION A 6-year-old neutered male domestic shorthair cat was evaluated because of signs of abdominal pain and anuria of 12 hours' duration after vehicular trauma. CLINICAL FINDINGS Lethargy, mydriasis, bradycardia, abdominal distension, and signs of pain on abdominal palpation were observed. Abdominal ultrasonography revealed moderate urinary bladder distension without evidence of free abdominal fluid; hematologic evaluation revealed leukocytosis with high BUN and serum creatinine concentrations. TREATMENT AND OUTCOME The patient was hospitalized, medical stabilization was attempted, and an indwelling urinary catheter was placed. Urinary output was cat was free of clinical signs, and results of ultrasonography, CBC, and serum biochemical analysis were unremarkable. CLINICAL RELEVANCE Results suggested that a Boari flap procedure with renal descensus could be a feasible alternative in the management of proximal ureteral rupture in cats, but research is needed in this area. PMID:27479285

  5. STUDY OF POLYSOMNO G RAPHY IN CURE POST - TUBERCULOSIS PATIENTS

    Directory of Open Access Journals (Sweden)

    Bhise Dhondiba

    2015-08-01

    Full Text Available Patients with obstructive sleep apnea (OSA have various Comorbidities like cardiovascular, cerebrovascular diseases and metabolic disorders. There is an association between pulmonary hypertension and obstructive sleep apnea. Obstructive sleep apnea is associated with nocturnal arterial oxygen desaturation. During apnea the increa sed vagal tone induces hypoxia and by mechanical effects of obstructive sleep apnea associated with intrathoracic pressure swings leads to bradycardia and acute increase in pulmonary artery pressure. Patients with coronary artery disease may develop myocar dial ischemia during apneas. Post - tuberculosis patients can lead to pulmonary sequelae that are characterized by impairments in the bronchial and parenchymal structure. The structural changes include bronchovascular distortions, bronchiectasis, emphysema a nd fibrosis. This leads to greater ventilation perfusion (V/Q mismatch and hypoxia.

  6. Kocher-debre-semelaigne syndrome with pericardial effusion

    Directory of Open Access Journals (Sweden)

    Dharaskar Praveen

    2007-09-01

    Full Text Available We report a 10-year-old female child with hypothyroidism and limb muscle pseudohypertrophy (i.e., Kocher-Debre-Semelaigne syndrome with pericardial effusion. The child presented with generalized swelling, breathlessness and difficulty in walking and in getting up from sitting position (of chronic duration. She had bradycardia, dull facies, marked hypertrophy of both calf muscles and nonpitting edema of legs. Pericardial effusion was detected clinically and confirmed on investigations. Muscle pseudohypertrophy was a striking feature, and hypothyroidism was confirmed on thyroid studies. The response to thyroxine replacement was excellent, with resolution of the pericardial effusion and clinical improvement. The unusual presence of pericardial effusion in Kocher-Debre-Semelaigne syndrome is discussed in the report.

  7. 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.

  8. 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; Chartier, Denis; Tsuji, Yukiomi; Hansen, Rie S; Olesen, Søren-Peter; Grunnet, Morten; Nattel, Stanley

    2008-01-01

    AIMS: Impaired repolarization in cardiac myocytes can lead to long QT syndrome (LQTS), with delayed repolarization and increased susceptibility to Torsades de Pointes (TdP) arrhythmias. Current pharmacological treatment of LQTS is often inadequate. This study sought to evaluate the antiarrhythmic...... 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...

  9. Recurrent antepartum compression of a single artery double nuchal cord necessitating emergency cesarean delivery.

    Science.gov (United States)

    Sherer, David M; Khoury-Collado, Fady; Dalloul, Mudar; Osho, Joseph A; Lamarque, Madelene D; Fomitcheva, Larissa; Abulafia, Ovadia

    2005-11-01

    Fetuses with a single umbilical artery are considered at increased risk for chromosomal and structural abnormalities, and increased adverse perinatal outcome. A young nulliparous patient was followed with weekly nonstress testing due to well-controlled gestational diabetes, a single umbilical artery, and a double nuchal cord. At 31 weeks gestation, following the occurrence of a severe prolonged variable deceleration of the fetal heart rate the patient was hospitalized for close fetal surveillance with consideration that the deceleration may represent recurring intermittent compression of the single umbilical artery. Continuous fetal monitoring depicted recurrent severe variable decelerations of the fetal heart rate. Thirty-six hours after admission, prolonged fetal bradycardia to 60 bpm necessitated emergency cesarean delivery of a nonhypoxic nonacidotic fetus, which subsequently did well. This case suggests that fetuses with a single umbilical artery nuchal cord(s) may be at increased risk of significant umbilical cord compression. PMID:16283603

  10. 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.

  11. 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.

  12. Cardiac syncope induced by glossopharyngeal "neuralgia": a rare presentation.

    Science.gov (United States)

    Korkes, Helio; de Oliveira, Eduardo Mesquita; Brollo, Luigi; Hachul, Denise Tessariol; Andrade, José Carlos da Silva; Peres, Mario Fernando Prieto; Schubsky, Victor

    2006-11-01

    The first description of severe pain in the distribution of the glossopharyngeal nerve is credited to Weisenberg, in 1910, in a patient with cerebellopontine angle tumor. However, it was Harris, in 1926, who coined the term glossopharyngeal neuralgia to describe this rare condition characterized by paroxysms of excruciating pain located laterally at the back of the tongue, soft palate, throat, and lateral and posterior pharynx, radiating to the ear. Swallowing, coughing, yawning or chewing may trigger pain, which usually lasts from seconds to minutes. The association between glossopharyngeal neuralgia and syncope is very rare, being identified by brief episodes of bradycardia, asystole, and hypotension. Such an association, with this same pathophysiology, was first described by Riley et al in 1942. PMID:17396191

  13. 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.

  14. Effects of nuclei ambiguus and dorsal motor nuclei of vagus on gastric H+ and HCO3- secretion in rats

    Institute of Scientific and Technical Information of China (English)

    Xue-Ying Zhang; Hong-Bin Ai; Xi-Yun Cui

    2006-01-01

    AIM: To determine the effects of electrical stimulation of nucleus ambiguus (NA) and dorsal motor nuclei of vagus (DMV) on gastric acid and bicarbonate secretion in rats.METHODS: NA and DMV in rats were electrically stimulated. Pylorus ligation or esophagus perfusion was used to collect the gastric secretion. The titratable H+ quantum, H+ concentration, HCO3- secretion quantum were measured.RESULTS: Electrical stimulation of NA had no effects on the volume of gastric juice, titratable acidity and acid concentration, but elicited a pronounced increase in the total bicarbonate. However, electrical stimulation of DMV significantly increased the titratable acidity, the volume of gastric juice and the acid concentration. Similarly,electrical stimulation of either NA or DMV decreased the respiratory frequency and sinus bradycardia.CONCLUSION: NA in rats can not control the secretion of gastric acid but the secretion of bicarbonate in gastric juice, while DMV controls the secretion of gastric acid.

  15. 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.

  16. The responses of Atlantic cod (Gadus morhua L.) to ultrasound-emitting predators: stress, behavioural changes or debilitation?

    DEFF Research Database (Denmark)

    Schack, H.B.; Malte, H.; Madsen, Peter Teglberg

    2008-01-01

    A previous study has reported that Atlantic cod can be conditioned to detect ultrasonic sound pulses of high intensity. This capability has been proposed as a mean for detection and avoidance of echolocating toothed whales that emit intense ultrasonic clicks. In this study, we use acoustic...... playbacks to test the hypotheses that unconditioned cod can detect and respond to intense ultrasound from toothed whales and from echosounders. Intense ultrasound exposure of 210 dB re. 1µPa (pp) did not cause a short-term stress response in the form of bradycardia in unconditioned cod. Free-swimming cod...... exposed to ultrasonic clicks and echosounder pulses with received levels of more than 204 dB re. 1 µPa (pp) did not elicit flight responses as seen in ultrasound detecting Alosinae. Furthermore, we tested the debilitating effects of high intensity ultrasound on swimming cod with no detected changes in...

  17. Ultrasonographic findings of early abortion: suggested predictors

    Energy Technology Data Exchange (ETDEWEB)

    Jun, Soon Ae; Ahn, Myoung Ock; Cha, Kwang Yul [Cha Women' s Hospital of Seoul, Seoul (Korea, Republic of); Lee, Young Doo [Yonsei University Medical College, Seoul (Korea, Republic of)

    1992-05-15

    To investigate predictable ultrasonographic findings of early abortion. To investigate objective rules for the screening of abortion. Ultrasonographic examination of 111 early pregnancies between the sixth and ninth week in women who had regular 28 day menstrual cycles was performed. Ultrasonographic measurements of the gestational sac, crown rump length and fetal heart rate were performed using a linear array real time transducer with doppler ultrasonogram. All measurements of 17 early abortions were compared to those of 94 normal pregnancies. Most of early aborted pregnancies were classified correctly by discriminant analysis with G-SAC and CRL (G-SAC=0.5 CRL + 15, sensitivity 76.5%, specificity 96.8%). With the addition of FHR, 94.1% of early abortions could be predicted. In conclusion, ultrasonographic findings of early intrauterine growth retardation, small gestational sac and bradycardia can be predictable signs suggestive of poor prognosis of early pregnancies.

  18. 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.

  19. Effect of yohimbine on xylazine-ketamine anesthesia in cats.

    Science.gov (United States)

    Hsu, W H; Lu, Z X

    1984-10-15

    Xylazine and ketamine are an anesthetic combination used in feline practice for routine surgical procedures. In a controlled study, we evaluated the effects of yohimbine, an antagonist of xylazine, on the anesthesia induced by this anesthetic combination in cats. Two intramuscular doses of xylazine and ketamine (2.2 mg of xylazine/kg plus 6.6 mg of ketamine/kg and 4.4 mg of xylazine/kg plus 6.6 mg of ketamine/kg) caused approximately 60 and 100 minutes of anesthesia, respectively, in control cats. When yohimbine (0.1 mg/kg) was given intravenously 45 minutes after ketamine administration, the cats regained consciousness within 3 minutes. They were ambulatory 1 to 2 minutes after regaining consciousness. Yohimbine also reversed the bradycardia and respiratory depression elicited by xylazine-ketamine. The results indicated that yohimbine may be useful for controlling the duration of xylazine-ketamine anesthesia in cats. PMID:6501048

  20. Pulmonary edema and lung injury after severe laryngospasm

    International Nuclear Information System (INIS)

    A young male with no pre-operative medical illness underwent corrective surgery for a deviated nasal septum under general anesthesia. At the end of surgery, patient was extubated but went into severe laryngospasm that did not improve with gentle Intermittent Positive Pressure Ventilation (IPPV) and small dose of Suxamethonium. As the situation worsened and patient developed severe bradycardia and de-saturation, re-intubation was done that revealed pink froth in the endotracheal tube. His portable chest X-ray was suggestive of non-cardiogenic pulmonary edema. With an overnight supportive treatment, using mechanical ventilation with Positive End- Expiratory Pressure (PEEP), morphine infusion and frusemide, patient improved and was subsequently weaned off from ventilator. (author)

  1. The role of training in the development of adaptive mechanisms in freedivers.

    Science.gov (United States)

    Ostrowski, Andrzej; Strzała, Marek; Stanula, Arkadiusz; Juszkiewicz, Mirosław; Pilch, Wanda; Maszczyk, Adam

    2012-05-01

    Freediving is a sport in which athletes aim to achieve the longest or the deepest breath-hold dive. Divers are at risk of gradually increasing hypoxia and hypercapnia due to a long time spent underwater and additionally of increasing hyperoxia while depth diving. Exceeding the limits of hypoxia endurance leads to loss of consciousness or even to death whithout immediate first aid. Often enhanced world records indicate the ability to shape specific to the discipline adaptive mechanisms of cardio-pulmonary system which are individually conditioned. During stay underwater heartbeats decelerating called bradycardia, increase in blood pressure, peripheral blood vessels narrowing and blood centralization in freediver's organism. These mechanisms enhance blood oxygen management as well as transporting it first of all to essential for survival organs, i.e. brain and heart. These mechanisms are supported by spleen and adrenal glands hormonal reactions. PMID:23487544

  2. 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.

  3. X-ray diagnosis and treatment for severe respiratory complications during cardiac catheterizations on pediatric congenital heart disease

    International Nuclear Information System (INIS)

    Objective: To study the radiological features of severe respiratory complications during cardiac catheterizations on pediatric congenital heart disease so as to make early diagnosis and treatment. We also intend to find the mechanism of these complications. Methods: A total of 9 pediatric cases with severe respiratory complications during cardiac catheterizations were included in the study. The clinical manifestations, radiological features, and corresponding treatments were reviewed. Results: Most of the cases had severe hypoxia, with 6 cases presenting with bradycardia. Opacification of two lung fields was found in 7 cases, pulmonary edema in 1 case, and atelectasis of the upper right lung in 1 case. With intubation, oxygen inhalation and administration of certain drugs, all cases were saved except 1 case with pulmonary edema. Conclusion: Severe respiratory complications during cardiac catheterizations on pediatric congenital heart disease are emergent and critical, and they often presented with various manifestations. Early diagnosis and correct treatment are the key to successful salvage. (authors)

  4. ALK-rearranged non-small cell lung cancers: how best to optimize the safety of crizotinib in clinical practice?

    Science.gov (United States)

    Girard, Nicolas; Audigier-Valette, Clarisse; Cortot, Alexis B; Mennecier, Bertrand; Debieuvre, Didier; Planchard, David; Zalcman, Gérard; Moro-Sibilot, Denis; Cadranel, Jacques; Barlési, Fabrice

    2015-02-01

    Crizotinib (XALKORI™, Pfizer) is a tyrosine kinase inhibitor targeting ALK, MET and ROS1, currently approved for the treatment of adults with ALK-rearranged non-small-cell lung cancer. Optimizing the management of frequent crizotinib-related adverse events is crucial to ensure its continuous administration and reproduce the response and survival rates reported in clinical trials. Here, we propose some practical measures, which are mostly derived from the recommendations given to the investigators of the PROFILE 1001, 1005, 1007 and 1014 trials and are based on experience and scientific findings regarding the management of these disorders. While visual disturbances or bradycardia are frequent but benign, the severity of the cardiac and hepatic adverse events requires special attention potential to QT interval prolongations and to the monitoring of electrolyte levels and liver function, taking into account potential drug-drug interactions. PMID:25413260

  5. A Case of Torsion of Gravid Uterus Caused by Leiomyoma

    Directory of Open Access Journals (Sweden)

    Gururaj Deshpande

    2011-01-01

    Full Text Available Uterine torsion during pregnancy is only sporadically reported in the literature. Here we present a case of leiomyoma causing uterine torsion in pregnancy and review the literature on etiology, diagnosis, and management. A 25-years-old primigravida with leiomyoma complicating pregnancy was admitted in our hospital with abdominal pain and uterine tenderness. She underwent emergency LSCS (lower segment cesarean section for fetal bradycardia. Intraoperatively, the uterus was rotated 180 degrees left to right. Inadvertent incision on the posterior wall was avoided by proper delineation of anatomy. Torsion was corrected by exteriorization of leiomyoma and uterus, and lower segment cesarean was carried out safely. Prompt recognition and management of this condition is necessary for better maternal and fetal outcome.

  6. Central anticholinergic syndrome vs. idiosyncratic reaction triggered by a small IV dose of atropine.

    Science.gov (United States)

    Cao, X; Cui, Y; White, P F; Tang, J; Ma, H

    2016-02-01

    A 58-year-old male was scheduled to undergo radical gastrectomy for cancer under general anesthesia. The patient developed agitation and irregular breathing after receiving a single dose of atropine (0.5 mg) to treat bradycardia immediately prior to induction of anesthesia. Within 5 min after the atropine injection, the patient became unresponsive with facial flushing and diaphoresis. When a drop in oxygen saturation was observed, a laryngeal mask airway was inserted after administering a small bolus dose of propofol (80 mg) and the patient was ventilated with 100% oxygen. Physostigmine was not administered because of the relatively low dose of atropine and the fact that his symptoms were not totally consistent with central anticholinergic syndrome (CAS). The differential diagnosis at the time also included an acute cardiovascular event and an idiosyncratic reaction to atropine. The patient fully recovered within 80 min from this highly unusual reaction to a single 0.5 mg IV dose of atropine. PMID:26471203

  7. Reuse of Explanted Pacemakers: An Option for Economically Underprivileged Patients in Developing Countries

    Directory of Open Access Journals (Sweden)

    Johnson Francis

    2007-10-01

    Full Text Available Permanent pacemaker implantation is an established mode of life saving therapy for patients with symptomatic bradycardia. As the human population is aging world-over, the need for pacemakers are also increasing. Reviewing the results of the 2001 World Survey on Cardiac Pacing and Implantable Cardioverter Defibrillators (Table 1, it is evident that not all patients who require pacemakers are receiving them, particularly in the Asia-Pacific region. The largest implanting country per head of population is Germany, although the largest numbers implanted are in the United States of America. In contrast, the countries of Asia have much smaller numbers with Myanmar having less than one implant per million population per year1.

  8. Development of an apnea detector for neonates using diaphragmatic surface electromyography.

    Science.gov (United States)

    Ochoa, J Mauricio; Osorio, Juan S; Torres, Robinson; McLeod, Chris N

    2009-01-01

    Respiratory diseases are among the most important and serious conditions that can affect the newborn baby. A cessation of breathing, longer than 15 seconds, or accompanied by hypoxia or bradycardia, is called apnea of prematurity (AOP) and has been found in more than 50% of premature infants. An apnea detector used in infant monitoring has been designed and constructed and is intended to be applied in a clinical environment. Diaphragmatic surface EMG has been used as the technique for detecting apnea episodes due to a direct relation with the respiratory drive. Both obstructive and central apnea can be determined as well as heart rate. Good performance and feasibility have been shown by the prototype. PMID:19963943

  9. Side effects of lohexol in arteriography

    International Nuclear Information System (INIS)

    Side effects of the contrast medium iohexol (300 mgI/ml) were evaluated in an open clinical multicenter study that included 2,118 patients. In one third of the examinations head and neck vessels were studied, in two thirds of examinations thoracic, abdominal, or femoral arteries were studied. Some 87% of the patients had no pain sensation, whereas only 64% did not have a heat feeling. The heat feeling was tolerable in 27% and untolerable in 9%. Cardiovascular disturbances such as a decrease in blood pressure or bradycardia were seen in 1.9%, cerebral manifestations such as transient ischemia in 1.5%. Allergy-like symptoms with a cutaneous manifestation or bronchospasm were seen in only 0.4% of all studies. Patients with a known history of allergic diathesis had three times the number of moderate side effects than patients with no history of allergy

  10. 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

    2016-01-01

    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. PMID:27190133

  11. 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.

  12. New device for dilatation of percutaneous biliary tract

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Sung-Gwon; Lim, Myung-Gwan; Cho, Young-Kook; Suh, Chang-Hae [Inha Univ. Hospital, Inchon (Korea, Republic of); Yoon, Hyun Ki; Song, Ho-Young; Sung, Kyu Bo [Asan Medical Center, Ulsan Univ. College of Medicine, Ulsan (Korea, Republic of); Shin, Joo-Won [Ulgi Hospital, Seoul (Korea, Republic of)

    1997-06-01

    To evaluate the usefulness of percutaneous transhepatic biliary drainage (PTBD) tract dilatation using a Nipro set. We dilated 28 percutaneous biliary drainage tracts up to 18F; 26 procedures involved PTBD, and two, cholecystostomy. A Nipro set was used for dilatation, the purposes of which were stone removal (n=18) and choledochoscopic biopsy (n=10). For dilatation, local anesthesia was used in all cases. In all patients, tract dilatation was successful. In 21 of 28 cases, dilatation of the right PTBD tract was involved, and in five of 28, dilatation of the left tract. In two cases, tract dilatation was done in cholecystostomy tracts. Complications encountered were pain (n=17), bradycardia (n=2), hemobilia (n=2), bleeding (n=1), and fever (n=1). In choledocoscopy, tract dilatation using a Nipro set is safe and simple.

  13. 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

  14. 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

  15. Electrical stimulation of the aortic depressor nerve in conscious rats overcomes the attenuation of the baroreflex in chronic heart failure.

    Science.gov (United States)

    Pinto, Tomás O C Teixeira; Lataro, Renata M; Castania, Jaci A; Durand, Marina T; Silva, Carlos A A; Patel, Kaushik P; Fazan, Rubens; Salgado, Helio C

    2016-04-01

    Chronic heart failure (CHF) is characterized by autonomic dysfunction combined with baroreflex attenuation. The hypotensive and bradycardic responses produced by electrical stimulation of the aortic depressor nerve (ADN) were examined in conscious CHF and control male Wistar rats (12-13 wk old). Furthermore, the role of parasympathetic and sympathetic nervous system in mediating the cardiovascular responses to baroreflex activation was evaluated by selective β1-adrenergic and muscarinic receptor antagonists. CHF was induced by myocardial infarction. After 6 wk, the subjects were implanted with electrodes for ADN stimulation. Twenty-four hours later, electrical stimulation of the ADN was applied for 20 s using five different frequencies (5, 15, 30, 60, and 90 Hz), while the arterial pressure was recorded by a catheter implanted into the femoral artery. Electrical stimulation of the ADN elicited progressive and similar hypotensive and bradycardic responses in control (n= 12) and CHF (n= 11) rats, while the hypotensive response was not affected by methylatropine. Nevertheless, the reflex bradycardia was attenuated by methylatropine in control, but not in CHF rats. Atenolol did not affect the hypotensive or bradycardic response in either group. The ADN function was examined under anesthesia through electroneurographic recordings. The arterial pressure-ADN activity relationship was attenuated in CHF rats. In conclusion, despite the attenuation of baroreceptor function in CHF rats, the electrical stimulation of the ADN elicited a stimulus-dependent hypotension and bradycardia of similar magnitude as observed in control rats. Therefore, electrical activation of the aortic baroreflex overcomes both the attenuation of parasympathetic function and the sympathetic overdrive. PMID:26843582

  16. Parasympathetic preganglionic cardiac motoneurons labeled after voluntary diving

    Directory of Open Access Journals (Sweden)

    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.

  17. Chemoreceptors and cardiovascular control in acute and chronic systemic hypoxia

    Directory of Open Access Journals (Sweden)

    J.M. Marshall

    1998-07-01

    Full Text Available This review describes the ways in which the primary bradycardia and peripheral vasoconstriction evoked by selective stimulation of peripheral chemoreceptors can be modified by the secondary effects of a chemoreceptor-induced increase in ventilation. The evidence that strong stimulation of peripheral chemoreceptors can evoke the behavioural and cardiovascular components of the alerting or defence response which is characteristically evoked by novel or noxious stimuli is considered. The functional significance of all these influences in systemic hypoxia is then discussed with emphasis on the fact that these reflex changes can be overcome by the local effects of hypoxia: central neural hypoxia depresses ventilation, hypoxia acting on the heart causes bradycardia and local hypoxia of skeletal muscle and brain induces vasodilatation. Further, it is proposed that these local influences can become interdependent, so generating a positive feedback loop that may explain sudden infant death syndrome (SIDS. It is also argued that a major contributor to these local influences is adenosine. The role of adenosine in determining the distribution of O2 in skeletal muscle microcirculation in hypoxia is discussed, together with its possible cellular mechanisms of action. Finally, evidence is presented that in chronic systemic hypoxia, the reflex vasoconstrictor influences of the sympathetic nervous system are reduced and/or the local dilator influences of hypoxia are enhanced. In vitro and in vivo findings suggest this is partly explained by upregulation of nitric oxide (NO synthesis by the vascular endothelium which facilitates vasodilatation induced by adenosine and other NO-dependent dilators and attenuates noradrenaline-evoked vasoconstriction.

  18. Stop or move: Defensive strategies in humans.

    Science.gov (United States)

    Bastos, Aline F; Vieira, Andre S; Oliveira, Jose M; Oliveira, Leticia; Pereira, Mirtes G; Figueira, Ivan; Erthal, Fatima S; Volchan, Eliane

    2016-04-01

    Threatening cues and surrounding contexts trigger specific defensive response patterns. Potential threat evokes attentive immobility; attack evokes flight when escape is available and immobility when escape is blocked. Tonic immobility installs when threat is overwhelming and life-risky. In humans, reduced body sway characterizes attentive and tonic immobility, the former with bradycardia, and the later with expressive tachycardia. Here, we investigate human defensive strategies in the presence or absence of an escape route. We employed pictures depicting a man carrying a gun and worked with participants exposed to urban violence. In pictures simulating more possibility of escape, the gun was directed away from the observer; in those simulating higher risk and less chance of escape, the gun was directed toward the observer. Matched control pictures depicted similar layouts, but a non-lethal object substituted the gun. Posturographic and electrocardiographic recordings were collected. Amplitude of sway and heart rate were higher for gun directed-away and lower for gun direct-toward. Compared to their respective matched controls, there was a general increase in the amplitude of sway for the gun directed-away pictures; and a reduction in back-and-forth sway and in heart rate for gun directed-toward pictures. Taken together, those measures suggest that, when exposed to threat invading their margin of safety in a context indicating possible escape route, humans, as non-human species, engage in active escape, resembling the flight stage of the defensive cascade. When facing threat indicating less possibility of escape, humans present an immobile response with bradycardia. PMID:26802729

  19. Accuracy of physical examination in the diagnosis of hypothyroidism: a cross-sectional, double-blind study

    Directory of Open Access Journals (Sweden)

    Indra R

    2004-01-01

    Full Text Available Background: Hypothyroidism is a common, potentially treatable endocrine disorder. Since hypothyroidism is not always associated with the signs and symptoms typically attributed to it, the diagnosis is often missed. Conversely, patients with typical signs and symptoms may not have the disease when laboratory tests are performed. Aims: We aimed to determine the accuracy of physical examination in the diagnosis of hypothyroidism. Setting and design: Prospective, hospital-based, cross-sectional diagnostic study. Material and Methods: Consecutive outpatients from the medicine department were screened and an independent comparison of physical signs (coarse skin, puffy face, slow movements, bradycardia, pretibial oedema and ankle reflex against thyroid hormone assay (TSH and FT4 was performed. Statistical analysis: Diagnostic accuracy was measured as sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and positive and negative predictive values. Results: Of the 1450 patients screened, 130 patients (102 women and 28 men underwent both clinical examination and thyroid function tests. Twenty-three patients (18% were diagnosed to have hypothyroidism by thyroid hormone assays. No single sign could easily discriminate a euthyroid from a hypothyroid patient (range of positive likelihood ratio (LR+ 1.0 to 3.88; range of negative likelihood ratio (LR-: 0.42 to 1.0. No physical sign generated a likelihood ratio large enough to increase the post-test probability significantly. The combination of signs that had the highest likelihood ratios (coarse skin, bradycardia and delayed ankle reflex was associated with modest accuracy (LR+ 3.75; LR- 0.48. Conclusion: Clinicians cannot rely exclusively on physical examination to confirm or rule out hypothyroidism. Patients with suspected hypothyroidism require a diagnostic workup that includes thyroid hormone assays.

  20. 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.

  1. Branchial receptors and cardiorespiratory reflexes in a neotropical fish, the tambaqui (Colossoma macropomum).

    Science.gov (United States)

    Sundin, L; Reid, S G; Rantin, F T; Milsom, W K

    2000-04-01

    This study examined the location and physiological roles of branchial chemoreceptors involved in the cardiorespiratory responses to hypoxia and hypercarbia in a neotropical fish that exhibits aquatic surface respiration, the tambaqui (Colossoma macropomum). Fish were exposed to abrupt progressive environmental hypoxia (18. 6-1.3 kPa water P(O2)) and hypercarbia (water equilibrated with 5 % CO(2) in air, which lowered the water pH from 7.0 to 5.0). They were also subjected to injections of NaCN into the ventral aorta (to stimulate receptors monitoring the blood) and buccal cavity (to stimulate receptors monitoring the respiratory water). All tests were performed before and after selective denervation of branchial branches of cranial nerves IX and X to the gill arches. The data suggest that the O(2) receptors eliciting reflex bradycardia and increases in breathing frequency are situated on all gill arches and sense changes in both the blood and respiratory water and that the O(2) receptors triggering the elevation in systemic vascular resistance, breathing amplitude, swelling of the inferior lip and that induce aquatic surface respiration during hypoxia are extrabranchial, although branchial receptors also contribute to the latter two responses. Hypercarbia also produced bradycardia and increases in breathing frequency, as well as hypertension, and, while the data suggest that there may be receptors uniquely sensitive to changes in CO(2)/pH involved in cardiorespiratory control, this is based on quantitative rather than qualitative differences in receptor responses. These data reveal yet another novel combination for the distribution of cardiorespiratory chemoreceptors in fish from which teleologically satisfying trends have yet to emerge. PMID:10708642

  2. Pharmacological Evidence that Histamine H3 Receptors Mediate Histamine-Induced Inhibition of the Vagal Bradycardic Out-flow in Pithed Rats.

    Science.gov (United States)

    García, Mónica; García-Pedraza, José Ángel; Villalón, Carlos M; Morán, Asunción

    2016-02-01

    In vivo stimulation of cardiac vagal neurons induces bradycardia by acetylcholine (ACh) release. As vagal release of ACh may be modulated by autoreceptors (muscarinic M2 ) and heteroreceptors (including serotonin 5-HT1 ), this study has analysed the pharmacological profile of the receptors involved in histamine-induced inhibition of the vagal bradycardic out-flow in pithed rats. For this purpose, 180 male Wistar rats were pithed, artificially ventilated and pre-treated (i.v.) with 1 mg/kg atenolol, followed by i.v. administration of physiological saline (1 ml/kg), histamine (10, 50, 100 and 200 μg/kg) or the selective histamine H1 (2-pyridylethylamine), H2 (dimaprit), H3 (methimepip) and H4 (VUF 8430) receptor agonists (1, 10, 50 and 100 μg/kg each). Under these conditions, electrical stimulation (3, 6 and 9 Hz; 15 ± 3 V and 1 ms) of the vagus nerve resulted in frequency-dependent bradycardic responses, which were (i) unchanged during the infusions of saline, 2-pyridylethylamine, dimaprit or VUF 8430; and (ii) dose-dependently inhibited by histamine or methimepip. Moreover, the inhibition of the bradycardia caused by 50 μg/kg of either histamine or methimepip (which failed to inhibit the bradycardic responses to i.v. bolus injections of acetylcholine; 1-10 μg/kg) was abolished by the H3 receptor antagonist JNJ 10181457 (1 mg/kg, i.v.). In conclusion, our results suggest that histamine-induced inhibition of the vagal bradycardic out-flow in pithed rats is mainly mediated by pre-junctional activation of histamine H3 receptors, as previously demonstrated for the vasopressor sympathetic out-flow and the vasodepressor sensory CGRPergic (calcitonin gene-related peptide) out-flow. PMID:26301462

  3. 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. PMID:23280584

  4. 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.

  5. 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

    Institute of Scientific and Technical Information of China (English)

    LIU Yan; ZHOU Lan; XU Hai-fei; YAN Li; DING Fan; HAO Wei; CAO Ji-min

    2013-01-01

    Background 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.Methods 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.Results 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.Conclusions 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.

  6. Acquired hemophilia as the cause of life-threatening hemorrhage in a 94-year-old man: a case report

    Directory of Open Access Journals (Sweden)

    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

  7. Effect of selective vagal nerve stimulation on blood pressure, heart rate and respiratory rate in rats under metoprolol medication.

    Science.gov (United States)

    Gierthmuehlen, Mortimer; Plachta, Dennis T T

    2016-02-01

    Selective vagal nerve stimulation (sVNS) has been shown to reduce blood pressure without major side effects in rats. This technology might be the key to non-medical antihypertensive treatment in patients with therapy-resistant hypertension. β-blockers are the first-line therapy of hypertension and have in general a bradycardic effect. As VNS itself can also promote bradycardia, it was the aim of this study to investigate the influence of the β1-selective blocker Metoprolol on the effect of sVNS especially with respect to the heart rate. In 10 male Wistar rats, a polyimide multichannel-cuff electrode was placed around the vagal nerve bundle to selectively stimulate the aortic depressor nerve fibers. The stimulation parameters were adapted to the thresholds of individual animals and were in the following ranges: frequency 30-50 Hz, amplitude 0.3-1.8 mA and pulse width 0.3-1.3 ms. Blood pressure responses were detected with a microtip transducer in the carotid artery, and electrocardiography was recorded with s.c. chest electrodes. After IV administration of Metoprolol (2 mg kg(-1) body weight), the animals' mean arterial blood pressure (MAP) and heart rate (HR) decreased significantly. Although the selective electrical stimulation of the baroreceptive fibers reduced MAP and HR, both effects were significantly alleviated by Metoprolol. As a side effect, the rate of stimulation-induced apnea significantly increased after Metoprolol administration. sVNS can lower the MAP under Metoprolol without causing severe bradycardia. PMID:26581776

  8. Metoclopramide-induced cardiac arrest

    Directory of Open Access Journals (Sweden)

    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

  9. Use of antiarrhythmic drugs in elderly patients

    Institute of Scientific and Technical Information of China (English)

    Hon-Chi Lee; Kristin TL Huang; Win-Kuang Shen

    2011-01-01

    Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability.Cardiac arrhythmias,including atrial fibrillation,sudden cardiac death,and bradycardia requiring pacemaker placement,all increase exponentially after the age of 60.It is important to distinguish between the normal,physiological consequences of aging on cardiacelectrophysiology and the abnormal,pathological alterations.The age-related cardiac changes include ventricular hypertrophy,senileamyloidosis,cardiac valvular degenerative changes and annular calcification,fibrous infiltration of the conduction system,and loss of naturalpacemaker cells and these changes could have a profound effect on the development of arrhythmias.The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intracellular Ca2+ overload which promote the development of cardiac an-hythmias.As ion channels are the substrates of antiarrhythmic drugs,it follows that the pharmacoldnetics and pharmacodynamics of these drugs will also change with age.Aging alters the absorption,distribution,metabolism,and elimination of antiarrhythmic drugs,so liver and kidney function must be monitored to avoid potential adverse drug effects,and antiarrhythmic dosing may need to be adjusted for age.Elderly patients are also more susceptible to the side effects of many antiarrhythmics,including bradycardia,orthostatic hypotension,urinary retention,and falls.Moreover,the choice of antiarrhythmic drugs in the elderly patient is frequently complicated by the presence of co-morbid conditions and by polyphanmacy,and the astute physician must pay careful attention to potential drug-drug interactions.Finally,it is important to remember that the use of antiarrhythmic drugs in elderly patients must be individualized and tailored to each patient's physiology,disease processes,and medication regimen.

  10. 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

  11. A semi-automatic computerized method to measure baroreflex-mediated heart rate responses that reduces interobserver variability

    Directory of Open Access Journals (Sweden)

    Soares P.P.S.

    2005-01-01

    Full Text Available Arterial baroreflex sensitivity estimated by pharmacological impulse stimuli depends on intrinsic signal variability and usually a subjective choice of blood pressure (BP and heart rate (HR values. We propose a semi-automatic method to estimate cardiovascular reflex sensitivity to bolus infusions of phenylephrine and nitroprusside. Beat-to-beat BP and HR time series for male Wistar rats (N = 13 were obtained from the digitized signal (sample frequency = 2 kHz and analyzed by the proposed method (PRM developed in Matlab language. In the PRM, time series were low-pass filtered with zero-phase distortion (3rd order Butterworth used in the forward and reverse direction and presented graphically, and parameters were selected interactively. Differences between basal mean values and peak BP (deltaBP and HR (deltaHR values after drug infusions were used to calculate baroreflex sensitivity indexes, defined as the deltaHR/deltaBP ratio. The PRM was compared to the method traditionally (TDM employed by seven independent observers using files for reflex bradycardia (N = 43 and tachycardia (N = 61. Agreement was assessed by Bland and Altman plots. Dispersion among users, measured as the standard deviation, was higher for TDM for reflex bradycardia (0.60 ± 0.46 vs 0.21 ± 0.26 bpm/mmHg for PRM, P < 0.001 and tachycardia (0.83 ± 0.62 vs 0.28 ± 0.28 bpm/mmHg for PRM, P < 0.001. The advantage of the present method is related to its objectivity, since the routine automatically calculates the desired parameters according to previous software instructions. This is an objective, robust and easy-to-use tool for cardiovascular reflex studies.

  12. Endogenous leptin contributes to baroreflex suppression within the solitary tract nucleus of aged rats.

    Science.gov (United States)

    Arnold, Amy C; Diz, Debra I

    2014-12-01

    The decline in cardiovagal baroreflex function that occurs with aging is accompanied by an increase in circulating leptin levels. Our previous studies showed that exogenous leptin impairs the baroreflex sensitivity for control of heart rate in younger rats, but the contribution of this hormone to baroreflex dysfunction during aging is unknown. Thus we assessed the effect of bilateral leptin microinjection (500 fmol/60 nl) within the solitary tract nucleus (NTS) on the baroreflex sensitivity in older (66 ± 2 wk of age) urethane/chloralose anesthetized Sprague-Dawley rats with elevated circulating leptin levels. In contrast to the 63% reduction observed in younger rats, leptin did not alter the baroreflex sensitivity for bradycardia evoked by phenylephrine in older rats (0.76 ± 0.19 baseline vs. 0.71 ± 0.15 ms/mmHg after leptin; P = 0.806). We hypothesized that this loss of sensitivity reflected endogenous suppression of the baroreflex by elevated leptin, rather than cardiovascular resistance to the peptide. Indeed, NTS administration of a leptin receptor antagonist (75 pmol/120 nl) improved the baroreflex sensitivity for bradycardia in older rats (0.73 ± 0.13 baseline vs. 1.19 ± 0.26 at 10 min vs. 1.87 ± 0.32 at 60 min vs. 1.22 ± 0.54 ms/mmHg at 120 min; P = 0.002), with no effect in younger rats. There was no effect of the leptin antagonist on the baroreflex sensitivity for tachycardia, responses to cardiac vagal chemosensitive fiber activation, or resting hemodynamics in older rats. These findings suggest that the actions of endogenous leptin within the NTS, either produced locally or derived from the circulation, contribute to baroreflex suppression during aging. PMID:25260611

  13. 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.

  14. The Safety of Autologous Peripheral Blood Stem Cell Transplantation by Intracoronory Infusion in Patients with Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    Zhang Ming; Li Zhanquan; Cui Lijie; Jin Yuanzhe; Yuan Long; Zhang Weiwei; Zhao Hongyuan

    2005-01-01

    Objectives Bone-marrow stem-cell transplantation has been shown to improve cardiac function in patients with acute myocardial infarction (AMI), but the safety of intracoronory infusion of autologous peripheral blood stem-cell (PBSCs) in patients with AMI is unknown. For this reason, we observe the feasibility and safety of PBSCs transplantation by intracoronory infusion in such patients. Methods 41 patients with AMI were allocated to receive granulocyte colony-stimulating factor (GCSF: Filgrastim, 300μg) with the dose of 300μg~600μg/day to mobilize the stem cell, and the duration of applying G-CSF was 5 days. On the sixth day, PBSCs were separated by Baxter CS 3000 blood cel 1 separator into suspend liquid 57 ml. Then the suspend liquid was infused into the infarct related artery (IRA)by occluding the over the wire balloon and infusing artery through balloon center lumen. In the process of the intracoronary infusion of PBSCs, the complications should be observed, which were arrhythmias including of bradycardia, sinus arrest or atrial ventricular block,premature ve. ntricular beats , ven~icular tachycardia,ventricular fibrillation; and hypotention, etc. Results There were total 10 cases with complications during the intracoronary infusion of PBSCs. The incidence of complications was 24.4% ( 10/41 ), including bradycardia was 2.4 % (1/41), sinus arrest or atrial ventricular block was 4.0% (2/41), ventricular fibrillation was 2.4 %(1/41), hypotentionwas 14.6 % (6/41).Conclusions In patients with AMI, intracoronary infusion of PBSCs is feasible and safe.

  15. COMPARATIVE STUDY OF INTRAVENOUS DEXMEDETOMIDINE PLUS INTRATHECAL BUPIVACAINE VS INTRATHECAL BUPIVACAINE ALONE FOR PROLONGATION OF SPINAL ANALGESIA

    Directory of Open Access Journals (Sweden)

    Rani

    2015-11-01

    Full Text Available : BACKGROUND: The prolongation of spinal anaesthesia by using clonidine through the oral, intravenous and spinal route has been known. The new alpha-2 agonist, dexmedetomidine has been proved to prolong the spinal anaesthesia through the intrathecal route. We hypothesized that dexmedetomidine when administered intravenously following spinal block also prolongs spinal analgesia. A placebo controlled randomized controlled trial study was done. METHODOLOGY: 50 Patients were randomly allocated into two equal groups group D and group C. Both group received spinal hyperbaric bupivacaine 15mg intrathecally. Patients in group D received intravenously a loading dose of 1mcg/kg dexmedetomidine over 10 min followed by C maintenance dose of 0.5mcg/kg/hr till the end of surgery. Patients in group C (The control group received normal saline. The regression times to reach S1 sensory level and bromage 0 motor scale, hemodynamic changes and the level of sedation were recorded. RESULTS: The duration of sensory block was longer in intravenous dexmedetomidine group compared with control group (264.32+15.3 min vs 164.2+13.12 min, p 0.001. The duration of motor block was longer in dexmedetomidine group than control group (198.8+16.9 min vs 135.8+12.38 min, p 0.001 CONCLUSION: Intravenous dexmedetomidine administration prolonged the sensory and motor blocks of bupivacaine spinal analgesia with good sedation effect and hemodynamic stability. The incidence of bradycardia is significantly high when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anaesthesia. Dexmedetomidine induced bradycardia and hypotension can be easily managed with atropine and mephentermine respectively. Dexmedetomidine provides excellent sedation and postoperative analgesia.

  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. 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.

  18. Safety of cardiac magnetic resonance and contrast angiography for neonates and small infants: a 10-year single-institution experience

    Energy Technology Data Exchange (ETDEWEB)

    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

  19. Safety of cardiac magnetic resonance and contrast angiography for neonates and small infants: a 10-year single-institution experience

    International Nuclear Information System (INIS)

    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 (SpO2) and cardiac rhythm were analyzed. Primary outcome measure was any AE during or 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 m2 (0.13-0.32 m2). 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 adverse events (AEs) - one major and 11 minor. Of those 12, nine children had GA (10%) and three had DS (6%). The single major AE was

  20. Ictal ECG changes in temporal lobe epilepsy Alterações eletrocardiográficas ictais em epilepsia do lobo temporal

    Directory of Open Access Journals (Sweden)

    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

  1. Angioplasty treatment and stent implant vs. surgical treatment in patients with stenosis of the cervical carotid artery

    International Nuclear Information System (INIS)

    Angioplasty with stent implant is a less invasive procedure than surgical intervention in the treatment of significant stenosis of the common cervical carotid artery (common and internal) (5). Currently the major published studies, in which angioplasty and surgical treatment are compared, show similar results in the major events, as cerebrovascular accidents and mortality, but a greater significant difference in the apparition of acute myocardial infarction, during surgical intervention (5,11). The objective of this study is to compare in both treatment methods the major and minor clinical events, like cerebrovascular accident, acute myocardial infarction, death, bradycardia, hypotension and encephalopathy during the intervention, the hospitalization and the follow-up year, as well as the re-intervention, the time of hospital stay and the complications of the surgical incision. Materials and methods: in this study of historical cohort, 46 patients with significant stenosis of the cervical carotid arteries, who were subjected to intervention from January 1st 2001 to December 31st 2003, were included. 21 patients were treated with angioplasty and stent implant and 25 with surgery (endarterectomy) Results: 1 (4.8%) major cerebrovascular accident occurred during angioplasty, whereas none occurred in the patients treated with surgery. 1 (4%) acute myocardial infarction occurred during intervention in the group of patients treated with surgery, and none in the patients treated with angioplasty. No deaths occurred in any of the groups during intervention, hospitalization and the follow-up year. After 8 months 1 (4%) patient treated with surgery was intervened again with angioplasty and stent implant. There were no statistically significant differences between both groups during hospitalization, and in the apparition of minor complications as bradycardia and hypotension. 2 (8%) complications related to the incision of the neck compromising cranial nerves, occurred in the

  2. Recognition of oculocardiac reflex%眼心反射的再认识

    Institute of Scientific and Technical Information of China (English)

    赵娟

    2011-01-01

    The oculocardiac reflex (OCR) occurs in up to 90% of ophthalmological surgeries,while most of the clinicians consider the performance of OCR is just bradycardia and arrhythmia and therefore ignore other system manifestation such as oculorespiratory reflex( ORR) and oculo-emetic reflex(OER),and so on.OCR appears not only in ophthalmological surgeries,and it also occurs during the endoscopic sinus surgery.A unstable bradycardia associated with stimulation of the mandibular division of cranial nerve V during trigeminal neuralgia pain treatment is also reported.This phenomenon is mostly introduced only as clinical manifestations.Therefore,it is helpful for us to understand the essential characteristic of OCR.The embryonic,anatomy,physiology and electrophysiology were reviewed in this article and thought to term it as oculovagal reflex is more comprehensive.%眼心反射(OCR)在眼科手术中的发生率高达90%,而大多数临床医师认为OCR的表现仅仅是心动过缓、心律失常,却忽略了其他系统的表现,如:"眼肺反射"(ORR)、"眼胃反射",也有人称之为"眼-呕吐反射(OER)"等.OCR并非仅仅为眼科手术的并发症,其在窦房结内镜手术过程中和治疗进行性三叉神经痛的过程中也可发生,但对此现象的描述以临床表现报道居多.目前的研究有助于提高临床医师对OCR的认识,对OCR的眼胚胎、解剖、生理、电生理、发生机制等研究进展进行综述,提出应重新认识OCR的本质特征,认为其名称为眼迷走神经反射(OVR)更为合理.

  3. The cardiopulmonary reflexes of spontaneously hypertensive rats are normalized after regression of left ventricular hypertrophy and hypertension

    Directory of Open Access Journals (Sweden)

    T.A. Uggere

    2000-05-01

    Full Text Available Cardiopulmonary reflexes are activated via changes in cardiac filling pressure (volume-sensitive reflex and chemical stimulation (chemosensitive reflex. The sensitivity of the cardiopulmonary reflexes to these stimuli is impaired in the spontaneously hypertensive rat (SHR and other models of hypertension and is thought to be associated with cardiac hypertrophy. The present study investigated whether the sensitivity of the cardiopulmonary reflexes in SHR is restored when cardiac hypertrophy and hypertension are reduced by enalapril treatment. Untreated SHR and WKY rats were fed a normal diet. Another groups of rats were treated with enalapril (10 mg kg-1 day-1, mixed in the diet; SHRE or WKYE for one month. After treatment, the volume-sensitive reflex was evaluated in each group by determining the decrease in magnitude of the efferent renal sympathetic nerve activity (RSNA produced by acute isotonic saline volume expansion. Chemoreflex sensitivity was evaluated by examining the bradycardia response elicited by phenyldiguanide administration. Cardiac hypertrophy was determined from the left ventricular/body weight (LV/BW ratio. Volume expansion produced an attenuated renal sympathoinhibitory response in SHR as compared to WKY rats. As compared to the levels observed in normotensive WKY rats, however, enalapril treatment restored the volume expansion-induced decrease in RSNA in SHRE. SHR with established hypertension had a higher LV/BW ratio (45% as compared to normotensive WKY rats. With enalapril treatment, the LV/BW ratio was reduced to 19% in SHRE. Finally, the reflex-induced bradycardia response produced by phenyldiguanide was significantly attenuated in SHR compared to WKY rats. Unlike the effects on the volume reflex, the sensitivity of the cardiac chemosensitive reflex to phenyldiguanide was not restored by enalapril treatment in SHRE. Taken together, these results indicate that the impairment of the volume-sensitive, but not the

  4. Aluminum Phosphide; the Most Fatal Rodenticide and Fungicide

    International Nuclear Information System (INIS)

    Introduction: Aluminum phosphide (AP) is a fumigate agent, which is also used to control rodents and pests in grain storage facilities. This agent is commonly used in low income and agricultural communities. AP is easily available, cheap and highly toxic. Ingestion of even half a fresh tablet invariably results in death. Its suicidal or accidental poisoning is a medical emergency, while in some low income countries it reaches to more than two third of poisoning deaths. Methods: PubMed was systematically searched (December 2006) for articles related to aluminium phosphide poisoning. 24 articles were finally included. Mechanism of action; AP on exposure to moisture, liberates highly toxic gas, phosphine. In animal and human models AP rapidly inhibits cytochrome-c oxidase leading to inhibition of mitochondrial oxidative phosphorylation and inhibits mitochondrial respiration and has cytotoxic action. Clinical Findings: Initial findings of intoxication may be nonspecific and transient. The symptoms may resolve within several hours after removal from exposure. It, however, produces phosphine gas, which is a mitochondrial poison. Its manufacturing and application pose risks of inhalation of phosphine. CNS; GCS is fine at the beginning. Biochemistry; Metabolic acidosis and liver dysfunction are reported. Shock is frequent. Respiratory Tract; Acute dyspnoea, hypotension, bradycardia and other signs of intoxication were also stated. Gastrointestinal; Reported short-segment esophageal strictures in the upper and mid esophagus, successfully managed by endoscopic dilatation. In sub-chronic use, degenerative changes in liver, heart and kidney of rabbits are reported. Cardiovascular; The ECG abnormalities are common and include hypotension, bradycardia, ST-T changes, Supraventricular tachycardia, ventricular ectopics, life threatening ventricular tachycardia, ventricular fibrillation, atrial flutter/fibrillation, variable degrees of heart block and toxic myocarditis. Haematologic

  5. 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

  6. [The best of cardiac pacing in 1999].

    Science.gov (United States)

    Deharo, J C

    2000-01-01

    Since the first clinical application to man forty years ago, for the treatment of bradycardia, cardiac pacing has been the object of continuous technological innovation in parallel with those in electronics and computerisation. However, independently of these expected advances, there has been a surprising widening of the field of application of pacing into those of haemodynamics and rhythmology. The recent publication of the long-term results of the Pacing in Cardiomyopathy (PIC) study confirmed the sustained decrease of intraventricular pressure gradient, of NYHA functional stage and improved quality of life of patients with hypertrophic obstructive cardiomyopathy paced in the DDD mode. The investigators also underlined the placebo effect of the pacemaker. The decrease in risk of sudden death and the reduction in ventricular remodelling have not been demonstrated yet. More recently, biventricular pacing has been proposed for the treatment of dilated cardiomyopathy and a French study showed a long-term improvement in NYHA stage and effort capacity. Several prospective randomised trials are under way to validate this indication. Acute haemodynamic evaluations have confirmed the efficacy of biventricular stimulation but also underline the value of left ventricular pacing alone. The effects on mortality, the selection of patients and the optimal configuration of pacing remain to be defined. In the field of prevention of atrial arrhythmias, the results of the multicenter SYNBIAPACE study, investigating biatrial pacing in patients with interatrial conduction defects, only showed a tendency to an increase in the delay before recurrence of atrial fibrillation. The value of the memory functions of pacemakers and the algorithms of prevention of atrial arrhythmias are still under investigation. Haemodynamic transducers have been introduced in some recent pacemakers to assess myocardial contractility and have applications in the evaluation of different pacing modes and in the

  7. Time-dependent effects of training on cardiovascular control in spontaneously hypertensive rats: role for brain oxidative stress and inflammation and baroreflex sensitivity.

    Directory of Open Access Journals (Sweden)

    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

  8. Co-localization of hypocretin-1 and leucine-enkephalin in hypothalamic neurons projecting to the nucleus of the solitary tract and their effect on arterial pressure.

    Science.gov (United States)

    Ciriello, J; Caverson, M M; McMurray, J C; Bruckschwaiger, E B

    2013-10-10

    Experiments were done to investigate whether hypothalamic hypocretin-1 (hcrt-1; orexin-A) neurons that sent axonal projections to cardiovascular responsive sites in the nucleus of the solitary tract (NTS) co-expressed leucine-enkephalin (L-Enk), and to determine the effects of co-administration of hcrt-1 and D-Ala2,D-Leu5-Enkephalin (DADL) into NTS on mean arterial pressure (MAP) and heart rate. In the first series, in the Wistar rat the retrograde tract-tracer fluorogold (FG) was microinjected (50nl) into caudal NTS sites at which L-glutamate (0.25 M; 10 nl) elicited decreases in MAP and where fibers hcrt-1 immunoreactive fibers were observed that also contained L-Enk immunoreactivity. Of the number of hypothalamic hcrt-1 immunoreactive neurons identified ipsilateral to the NTS injection site (1207 ± 78), 32.3 ± 2.3% co-expressed L-Enk immunoreactivity and of these, 2.6 ± 1.1% were retrogradely labeled with FG. Hcrt-1/L-Enk neurons projecting to NTS were found mainly within the perifornical region. In the second series, the region of caudal NTS found to contain axons that co-expressed hcrt-1 and L-Enk immunoreactivity was microinjected with a combination of hcrt-1 and DADL in α-chloralose anesthetized Wistar rats. Microinjection of DADL into NTS elicited depressor and bradycardia responses similar to those elicited by microinjection of hcrt-1. An hcrt-1 injection immediately after the DADL injection elicited an almost twofold increase in the magnitude of the depressor and bradycardia responses compared to those elicited by hcrt-1 alone. Prior injections of the non-specific opioid receptor antagonist naloxone or the specific opioid δ-receptor antagonist ICI 154,129 significantly attenuated the cardiovascular responses to the combined hcrt-1-DADL injections. Taken together, these data suggest that activation of hypothalamic-opioidergic neuronal systems contribute to the NTS hcrt-1 induced cardiovascular responses, and that this descending hypothalamo

  9. Nitric oxide as a target for the hypotensive and vasorelaxing effects induced by (Z)-ethyl 12-nitrooxy-octadec-9-enoate in rats.

    Science.gov (United States)

    Machado, Natália T; Maciel, Priscilla M P; Alustau, Maria C; Queiroz, Thyago M; Furtado, Fabíola F; Assis, Valéria L; Veras, Robson C; Araújo, Islânia G A; Athayde-Filho, Petrônio F; Medeiros, Isac A

    2014-10-01

    The cardiovascular effects induced by a new organic nitrate were investigated in rats. The (Z)-ethyl 12-nitrooxy-octadec-9-enoate (NCOE) was synthesized from ricinoleic acid, the major compound of the castor oil. NCOE induced significant and dose-dependent hypotension and bradycardia in normotensive rats. In rats pretreated with NCOE (60 mg/kg, i.v., once a day) for 4 consecutive days, hypotension induced by the nitrate was similar to that observed in rats that were not pretreated with the compound. The vasorelaxation induced by the compound was concentration-dependent (10(-10)-10(-3) M) in rat mesenteric artery rings, pre-contracted with phenylephrine (1 μM), with or without endothelium. Pre-incubation with PTIO (300 μM), a free radical form of NO (NO) scavenger, attenuated the NCOE vasorelaxation potency. However, in the presence of L-cysteine (3 mM), a reduced form of NO (NO-) scavenger, NCOE response was potentiated. NCOE effect was not changed in the presence of an inhibitor of cytochrome P450, proadifen (10 μM). On the other hand, the vasodilation was reduced in the presence of mitochondrial aldehyde dehydrogenase inhibitor (mtALDH), cyanamide (1 mM); soluble guanylyl cyclase inhibitor (sGC), ODQ (10 μM); and non-selective K+ channels blocker, TEA (3 mM). In addition the NCOE-induced vasorelaxation was reduced by BKCa (iberiotoxin, 100 nM) and KATP selective (glibenclamide, 10 μM) blockers, however the effect was not modified by a KV blocker (4-aminopyridine, 1 mM). Furthermore, NCOE increased NO levels in rat aortic smooth muscle cultured cells, detected by NO-sensitive probe DAF-2DA, by flow cytometry. These results together suggest that NCOE induces short-lasting hypotension and bradycardia, and promotes vasorelaxation due to NO release through the compound metabolism via mtALDH and consequent sGC, KATP and BKCa activation. Furthermore, the compound was not able to induce tolerance. PMID:24964291

  10. Intoxication due to Papaver rhoeas (Corn Poppy: Five Case Reports

    Directory of Open Access Journals (Sweden)

    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

  11. COMPARISION OF 3.5ML BUPIVACAINE HEAVY (17.5MG AND 3.5 ML ROPIVACAINE PLAIN (26.25 MG FOR SUBARACHNOID BLOCK

    Directory of Open Access Journals (Sweden)

    Neelesh

    2014-10-01

    Full Text Available OBJECTIVE: Ropivacaine, have been introduced into clinical practice because of their lower toxic effects for heart and central nervous system. Ropivacaine is nearly identical to Bupivacaine in onset of action, quality and duration of sensory block, but it produces lesser duration of motor blockade and has a better safety profile when used for the purpose of spinal anesthesia. This study was aimed to compare the intrathecal efficacy and safety between 3.5 ml, 0.5% heavy Bupivacaine (17.5 mg and 3.5 ml, 0.75% isobaric Ropivacaine (26.25 mg for lower limb orthopedic surgeries. MATERIALS AND METHODS: We enrolled 60 patients of ASA (American Society of Anesthesiologists grade I-II scheduled for elective lower limb orthopedic surgeries under spinal anesthesia for this prospective randomized double blind control trial. The patients were randomized to receive either 17.5 mg of 0.5% hyperbaric Bupivacaine or 26.25 mg of 0.75% isobaric Ropivacaine intrathecally. Intra-operative, characteristics of sensory and motor nerve block, and adverse effect (such as hypotension, bradycardia, nausea, vomiting, shivering or pruritis were evaluated. RESULTS: Baseline demographic variables were comparable between two groups. 1. Time taken to achieve sensory block to L3 (3.75 minutes with SD of 0.59 vs. 5.29 minutes with SD of 0.85. 2. Mean time for the onset of complete motor block in group A was 6.14 minute with SD of 0.708, where as in group B, it was 12.51 minutes with SD of 0.994. 3. Mean duration of sensory block in group A was 204.20 minutes with SD of 8.81, while in group B it lasted for 152.23 minutes with SD of 8.17. 4. Mean duration of motor block in group a patients was 212.67 minute with SD of 11.17 where as in group B patients, the motor block lasted for a mean duration of 135.13 minutes with SD of 11.68. P value for all above mentioned four observations were calculated to be <0.001, which means it is statistically significant 5. Side effects like

  12. Effects of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia: A randomized study

    Directory of Open Access Journals (Sweden)

    Chilkunda N Dinesh

    2014-01-01

    Full Text Available Background and Objectives: The present study was designed to evaluate the effect of intravenous dexmedetomidine on spinal anesthesia with 0.5% of hyperbaric bupivacaine. Materials and Methods: One hundred American Society of Anesthesiologists (ASA physical status I/II patients undergoing elective surgeries under spinal anesthesia were randomized into two groups of 50 each. Immediately after subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine, patients in group D received a loading dose of 1 μg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 μg/kg/h till the end of surgery, whereas patients in group C received an equivalent quantity of normal saline. Results: The time taken for regression of motor blockade to modified Bromage scale 0 was significantly prolonged in group D (220.7 ± 16.5 min compared to group C (131 ± 10.5 min (P < 0.001. The level of sensory block was higher in group D (T 6.88 ± 1.1 than group C (T 7.66 ± 0.8 (P < 0.001. The duration for two-dermatomal regression of sensory blockade (137.4 ± 10.9 min vs. 102.8 ± 14.8 min and the duration of sensory block (269.8 ± 20.7 min vs. 169.2 ± 12.1 min were significantly prolonged in group D compared to group C (P < 0.001. Intraoperative Ramsay sedation scores were higher in group D (4.4 ± 0.7 compared to group C (2 ± 0.1 (P < 0.001. Higher proportion of patients in group D had bradycardia (33% vs. 4% (P < 0.001, as compared to group C. The 24-h mean analgesic requirement was less and the time to first request for postoperative analgesic was prolonged in group D than in group C (P < 0.001. Conclusion: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anesthesia. The incidence of bradycardia is significantly higher when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anesthesia. Dexmedetomidine provides excellent intraoperative

  13. Response to low-dose intrathecal clonidine in septuagenarians undergoing sub-umbilical surgeries: A study

    Directory of Open Access Journals (Sweden)

    Jayashree Sen

    2015-01-01

    Full Text Available Clonidine, an alpha-2-adrenergic agonist, may have a clinically relevant analgesic action but also a hypotensive action, when administered spinally. Aim: To evaluate the analgesic and circulatory effects of low-dose intrathecal clonidine co-administered with hyperbaric bupivacaine in septuagenarian patients undergoing sub-umbilical surgeries. Materials and Methods: A total of 20 patients within the age group of 70-80 years of either sex, enrolled in this study, were randomly divided into groups of 10 each. Group I received clonidine 7.5 μg as an adjuvant to 15 mg of hyperbaric bupivacaine and Group II (control group received 15 mg of bupivacaine with saline to make volume in the two solutions equal. Result: The level of subarachnoid block was comparable in the two groups. Duration of motor blockade was longer in the clonidine group (221.4 ± 35.92 min compared with the control group (112.3 ± 12.45 min. Request for 1 st dose of analgesic was earlier in the control group (135.5 ± 28.52 min than the clonidine group (295 ± 18.85 min. Mean arterial pressure (clonidine 77.67 ± 6.47 vs. control 93.87 ± 3.03, P = 0.0002 and heart rate (clonidine 65.2 ± 5.20 vs. control 77.4 ± 6.06, P = 0.003 were significantly lower (P < 0.05 in the clonidine group compared with the control group from 20 mins after the block to the end of 3 h. In the clonidine group, 3 patients had postoperative headache, 4 had intra-operative shivering. 2 patients in the clonidine group also developed hypotension and 1 bradycardia and 1 of them developed bradyapnea along with acute hypotension 5 min after shifting to the postoperative ward and later recovered on resuscitation. In the control group 2 patients had bradycardia, 6 had intra-operative shivering and 3 had postoperative headache. Conclusion: We conclude that addition of clonidine in the dose of 7.5 μg to bupivacaine significantly increases the duration of spinal analgesia with clinically insignificant influence on

  14. Effects of Dexmedetomidine on Serum Interleukin-6, Hemodynamic Stability, and Postoperative Pain Relief in Elderly Patients under Spinal Anesthesia.

    Science.gov (United States)

    Yun, So Hui; Park, Jong Cook; Kim, Sang Rim; Choi, Yun Suk

    2016-02-01

    The beneficial effects of dexmedetomidine (DEX) have not been extensively investigated in elderly patients receiving spinal anesthesia. This study evaluated the effects of intravenous DEX infusion on stress and hemodynamic response, as well as on postoperative analgesia in elderly patients undergoing total knee arthroplasty (TKA). We randomly allocated 45 adult patients to 3 patient groups (n=15 each): uni-saline group patients underwent unilateral TKA with saline administration, uni-DEX group patients underwent unilateral TKA with DEX administration, and bilateral-DEX group patients underwent bilateral TKA with DEX administration. Serum interleukin︲6 (IL-6) levels were significantly lower in the bilateral-DEX group than in the uni-saline group 6 and 24h postoperatively, and were negatively correlated with total DEX dosage 24h postoperatively. Bradycardia occurred more frequently in the uni-DEX and bilateral-DEX groups than in the uni-saline group. The total dose of required supplementary analgesics was significantly higher in the uni-saline group than in the uni-DEX and bilateral-DEX groups 6h postoperatively. The results indicate that perioperative intravenous DEX administration decreases postoperative serum IL︲6 levels in patients undergoing bilateral TKA, and has a postoperative analgesic effect in patients undergoing unilateral or bilateral TKA. PMID:26899608

  15. The application of sacral block anesthesia in pediatric interventional therapy

    International Nuclear Information System (INIS)

    Objective: To discuss the management and feasibility of sacral block anesthesia in pediatric interventional therapy. Methods: A total of 80 pediatric patients were randomly and equally divided into two groups. Patients in group A received sacral block anesthesia together with basic anesthesia with propofol, while patients in group B received intravenous anesthesia with propofol. Small amount of ketamine as maintaining dose was used in both groups when needed. Results: The interventional management was successfully completed in all patients. A marked decrease in blood pressure occurred in three patients of group A receiving sacral block anesthesia. In group B receiving intravenous anesthesia, a decrease of SpO2 to below 90 percent was seen in 8 cases, and obvious bradycardia developed in 12 cases. All these patients were treated with intravenous medication or by reducing the dose of propofol. Additional small dose of ketamine was needed in 4 patients during the procedure. Conclusion: Sacral block anesthesia combined with intravenous anesthesia is one of the effective anesthesia management schemes for pediatric interventional therapy. (authors)

  16. Ketamine and midazolam sedation for pediatric gastroinntestinal endoscopy in the Arab world

    Institute of Scientific and Technical Information of China (English)

    Mohamad-Iqbal S Miqdady; Wail A Hayajneh; Ruba Abdelhadi; Mark A Gilger

    2011-01-01

    AIM: To evaluate the safety and effectiveness of intravenous ketamine-midazolam sedation during pediatric endoscopy in the Arab world. METHODS: A retrospective cohort study of all pediatric endoscopic procedures performed between 2002-2008 at the shared endoscopy suite of King Abdullah University Hospital, Jordan University of Science & Technology, Jordan was conducted. All children were > 1 year old and weighed > 10 kg with American Society of Anesthesiologists class 1 or 2. Analysis was performed in terms of sedation-related complications (desaturation, respiratory distress, apnea, bradycardia, cardiac arrest, emergence reactions), adequacy of sedation, need for sedation reversal, or failure to complete the procedure. RESULTS: A total of 301 patients (including 160 males) with a mean age of 9.26 years (range, 1-18 years) were included. All were premedicated with atropine; and 79.4% (239/301) had effective and uneventful sedation. And 248 (82.4%) of the 301 patients received a mean dose of 0.16 mg/kg (range, 0.07-0.39) midazolam and 1.06 mg/kg (range, 0.31-2.67) ketamine, respectively within the recommended dosage guidelines. Recommended maximum midazolam dose was exceeded in 17.6% patients [34 female (F):19 male (M), P = 0.003] and ketamine in 2.7% (3 M:5 F). Maximum midazolam dose was more likely to be exceeded than ketamine (P 1 year and weighing > 10 kg without co-morbidities.

  17. Induction of chagasic-like arrhythmias in the isolated beating hearts of healthy rats perfused with Trypanosoma cruzi-conditioned medium

    Directory of Open Access Journals (Sweden)

    H. Rodriguez-Angulo

    2013-01-01

    Full Text Available Chagas' myocardiopathy, caused by the intracellular protozoan Trypanosoma cruzi, is characterized by microvascular alterations, heart failure and arrhythmias. Ischemia and arrythmogenesis have been attributed to proteins shed by the parasite, although this has not been fully demonstrated. The aim of the present investigation was to study the effect of substances shed by T. cruzi on ischemia/reperfusion-induced arrhythmias. We performed a triple ischemia-reperfusion (I/R protocol whereby the isolated beating rat hearts were perfused with either Vero-control or Vero T. cruzi-infected conditioned medium during the different stages of ischemia and subsequently reperfused with Tyrode's solution. ECG and heart rate were recorded during the entire experiment. We observed that triple I/R-induced bradycardia was associated with the generation of auricular-ventricular blockade during ischemia and non-sustained nodal and ventricular tachycardia during reperfusion. Interestingly, perfusion with Vero-infected medium produced a delay in the reperfusion-induced recovery of heart rate, increased the frequency of tachycardic events and induced ventricular fibrillation. These results suggest that the presence of parasite-shed substances in conditioned media enhances the arrhythmogenic effects that occur during the I/R protocol.

  18. Directory of Open Access Journals (Sweden)

    H. Rodríguez-Angulo

    2013-11-01

    Full Text Available Chagas' myocardiopathy, caused by the intracellular protozoan Trypanosoma cruzi, is characterized by microvascular alterations, heart failure and arrhythmias. Ischemia and arrythmogenesis have been attributed to proteins shed by the parasite, although this has not been fully demonstrated. The aim of the present investigation was to study the effect of substances shed by T. cruzi on ischemia/reperfusion-induced arrhythmias. We performed a triple ischemia-reperfusion (I/R protocol whereby the isolated beating rat hearts were perfused with either Vero-control or Vero T. cruzi-infected conditioned medium during the different stages of ischemia and subsequently reperfused with Tyrode's solution. ECG and heart rate were recorded during the entire experiment. We observed that triple I/R-induced bradycardia was associated with the generation of auricular-ventricular blockade during ischemia and non-sustained nodal and ventricular tachycardia during reperfusion. Interestingly, perfusion with Vero-infected medium produced a delay in the reperfusion-induced recovery of heart rate, increased the frequency of tachycardic events and induced ventricular fibrillation. These results suggest that the presence of parasite-shed substances in conditioned media enhances the arrhythmogenic effects that occur during the I/R protocol.

  19. Primary hypoadrenocorticism in ten cats.

    Science.gov (United States)

    Peterson, M E; Greco, D S; Orth, D N

    1989-01-01

    Primary hypoadrenocorticism was diagnosed in ten young to middle-aged cats of mixed breeding. Five of the cats were male, and five were female. Historic signs included lethargy (n = 10), anorexia (n = 10), weight loss (n = 9), vomiting (n = 4), and polyuria (n = 3). Dehydration (n = 9), hypothermia (n = 8), prolonged capillary refill time (n = 5), weak pulse (n = 5), collapse (n = 3), and sinus bradycardia (n = 2) were found on physical examination. Results of initial laboratory tests revealed anemia (n = 3), absolute lymphocytosis (n = 2), absolute eosinophilia (n = 1), and azotemia and hyperphosphatemia (n = 10). Serum electrolyte changes included hyponatremia (n = 10), hyperkalemia (n = 9), hypochloremia (n = 9), and hypercalcemia (n = 1). The diagnosis of primary adrenocortical insufficiency was established on the basis of results of adrenocorticotropic hormone (ACTH) stimulation tests (n = 10) and endogenous plasma ACTH determinations (n = 7). Initial therapy for hypoadrenocorticism included intravenous administration of 0.9% saline and dexamethasone and intramuscular administration of desoxycorticosterone acetate in oil. Three cats were euthanatized shortly after diagnosis because of poor clinical response. Results of necropsy examination were unremarkable except for complete destruction of both adrenal cortices. Seven cats were treated chronically with oral prednisone or intramuscular methylprednisolone acetate for glucocorticoid supplementation and with oral fludrocortisone acetate or intramuscular injections of repository desoxycorticosterone pivalate for mineralocorticoid replacement. One cat died after 47 days of therapy from unknown causes; the other six cats are still alive and well after 3 to 70 months of treatment. PMID:2469793

  20. An association between anxiety and neurocardiogenic syncope during head-up tilt table testing.

    Science.gov (United States)

    Cohen, T J; Thayapran, N; Ibrahim, B; Quan, C; Quan, W; von zur Muhlen, F

    2000-05-01

    To study the association between anxiety and neurocardiogenic syncope as determined by head-up tilt table testing (HUT) in men and women with presyncope or syncope, patients with unexplained syncope or presyncope undergoing HUT were asked to complete the Burns Anxiety Inventory (BAI), a validated inventory of 33 questions with responses graded from 0 to 3. HUT consisted of a 30-minute tilt to 60 degrees, which if negative, was repeated with an isoproterenol infusion. A positive HUT was defined as symptomatic hypotension and/or bradycardia. Of the 66 patients who completed the BAI and underwent HUT, 33 were men and 33 were women. The mean age was 57 +/- 18 years (17-91 years). Patients with a positive HUT had a higher BAI score than those with a negative HUT (22 +/- 12 vs 14 +/- 13, P = 0.017). This association was stronger in women with a BAI score of 24 +/- 11 in those with a positive HUT versus 13 +/- 8 in those with a negative HUT (P = 0.005). In contrast, the mean BAI score for men with a positive HUT was 19 +/- 13, as compared to 15 +/- 16 for a negative HUT (P = 0.5). In conclusion, the present study demonstrates a statistical association between anxiety (as determined by BAI) and HUT result. Gender-based analysis revealed a more statistically significant relationship between anxiety and HUT outcome for women as compared to men. PMID:10833703

  1. EVALUATION OF THE RELATIVE INCIDENCE OF ADVERSE EFFECTS LEADING TO TREATMENT DISCONTINUATION OF RECOMMENDED ANTIHYPERTENSIVE DRUGS

    Directory of Open Access Journals (Sweden)

    Yakubu Sani Ibn

    2013-06-01

    Full Text Available This study aimed at evaluating the incidence of adverse effects leading to treatment discontinuation of antihypertensive drugs within the same therapeutic class. Individual medical records were searched to identify those hypertensive patients who had been commenced on antihypertensive therapy during a 24-month period and who had subsequently for a reason(s discontinued the therapy. The results showed variation in discontinuation rates for drugs within same class, and that might be related to the relative frequency of specific adverse effects. Cough was the reason cited for discontinuation of angiotensin converting enzyme inhibitors, with linosopril appearing to be better tolerated than captopril (39% vs 48% ; peripheral oedema with calcium channel blockers, with amlodipine appearing to be better tolerated than nifedipine (29% vs 38% and bradycardia with beta adrenergic receptor blockers, with propranolol better tolerated than atenolol (0% vs 48%. Diuretics showed the lowest discontinuation rate (3.3% mainly due to hypokalemia, with thiazide better tolerated than frusemide (11% vs 43%. Prescribers should verify their use of antihypertensive drugs to ensure that they prescribe drugs with lower adverse effect rates, in order that patients with hypertension continue using the medication in the long term, thereby reducing the risk of developing cardiovascular complications associated with uncontrolled blood pressure.

  2. Ontogenetic changes in skeletal muscle fiber type, fiber diameter and myoglobin concentration in the Northern elephant seal (Mirounga angustirostris

    Directory of Open Access Journals (Sweden)

    Colby eMoore

    2014-06-01

    Full Text Available Northern elephant seals (Mirounga angustirostris (NES are known to be deep, long-duration divers and to sustain long-repeated patterns of breath-hold, or apnea. Some phocid dives remain within the bounds of aerobic metabolism, accompanied by physiological responses inducing lung compression, bradycardia and peripheral vasoconstriction. Current data suggest an absence of type IIb fibers in pinniped locomotory musculature. To date, no fiber type data exist for NES, a consummate deep diver. In this study, NES were biopsied in the wild. Ontogenetic changes in skeletal muscle were revealed through succinate dehydrogenase (SDH based fiber typing. Results indicated a predominance of uniformly shaped, large type I fibers and elevated myoglobin (Mb concentrations in the longissimus dorsi (LD muscle of adults. No type II muscle fibers were detected in any adult sampled. This was in contrast to the juvenile animals that demonstrated type II myosin in Western Blot analysis, indicative of an ontogenetic change in skeletal muscle with maturation. These data support previous hypotheses that the absence of type II fibers indicates reliance on aerobic metabolism during dives, as well as a depressed metabolic rate and low energy locomotion. We also suggest that the lack of type IIb fibers (adults may provide a protection against ischemia reperfusion (IR injury in vasoconstricted peripheral skeletal muscle.

  3. Potential Additive Effects of Ticagrelor, Ivabradine, and Carvedilol on Sinus Node

    Directory of Open Access Journals (Sweden)

    Luigi Di Serafino

    2014-01-01

    Full Text Available A 51-year-old male patient presented to the emergency room with an anterior ST-elevation myocardial infarction. After a loading dose of both ticagrelor and aspirin, the patient underwent primary-PCI on the left anterior descending coronary artery with stent implantation. After successful revascularization, medical therapy included beta-blockers, statins, and angiotensin II receptor antagonists. Two days later, ivabradine was also administered in order to reduce heart rate at target, but the patient developed a severe symptomatic bradycardia and sinus arrest, even requiring administration of both atropine and adrenaline. Ivabradine and ticagrelor have been then suspended and this latter changed with prasugrel. Any other similar event was not reported during the following days. This clinical case raised concerns about the safety of the combination of beta-blockers and ivabradine in patients treated with ticagrelor, particularly during the acute phase of an acute coronary syndrome. These two latter drugs, in particular, might interact with the same receptor. In fact, ivabradine directly modulates the If-channel which is also modulated by the cyclic adenosine monophosphate levels. These latter have been shown to increase after ticagrelor assumption via inhibition of adenosine uptake by erythrocytes. Further studies are warrant to better clarify the safety of this association.

  4. Comparison of the Success of Two Techniques for the Endotracheal Intubation with C-MAC Video Laryngoscope Miller Blade in Children: A Prospective Randomized Study

    Directory of Open Access Journals (Sweden)

    Renu Sinha

    2016-01-01

    Full Text Available Background. Ease of endotracheal intubation with C-MAC video laryngoscope (VLS with Miller blades 0 and 1 has not been evaluated in children. Methods. Sixty children weighing 3–15 kg with normal airway were randomly divided into two groups. Intubation was done with C-MAC VLS Miller blade using either nonstyletted endotracheal tube (ETT (group WS or styletted ETT (group S. The time for intubation and total procedure, intubation attempts, failed intubation, blade repositioning or external laryngeal maneuver, and complications were recorded. Results. The median (minimum/maximum time for intubation in group WS and group S was 19.5 (9/48 seconds and 13.0 (18/55 seconds, respectively (p=0.03. The median (minimum/maximum time for procedure in group WS was 30.5 (18/72 seconds and in group S was 24.5 (14/67 seconds, respectively (p=0.02. Intubation in first attempt was done in 28 children in group WS and in 30 children in group S. Repositioning was required in 14 children in group WS and in 7 children in group S (p=0.06. There were no failure to intubate, desaturation, and bradycardia in both groups. Conclusion. Styletted ETT significantly reduces time for intubation and time for procedure in comparison to nonstyletted ETT.

  5. [Case of intrauterine retardation and fetal death during labor].

    Science.gov (United States)

    Frundeva, B; Dimitrova, V; Museva, A; Dimitrov, A; Zlatkov, V

    2014-01-01

    The case concerns to a 37 years old pregnant woman with a history of three miscarriages. Ultrasound biometry in early pregnancy corresponds to the term calculated according the last menstrual period (LMP). At 37 week of gestation was determined retardation of 5 weeks. Doppler velocimetry and quantity of amniotic fluid were in normal ranges and the pregnant refused hospitalization. She was admitted to the hospital three days after the appointed term without uterine contractions. The fetal ultrasound biometry meets 33 weeks and the Doppler examination of a. umbilicalis found resistance index (RI) of the upper limit of normal. The cardiotocography record shows: baseline fetal heart rate--143 beats/min, good variability and reactivity. There was one deceleration for 3 minutes, and then the recording returns to normal. Re-monitoring after 30 minutes establishes of a periodic decelerations and a tendency to bradycardia with reserved variability. At the start of the emergency Cesarean Section fetal heart beats are single. The delivered babe was with Apgar O. The reanimation was not successful and the fetus died. From the autopsy signs of severe asphyxia. In conclusion, it can be assumed that in strongly retarded fetuses, cardiotocography recording and Doppler velosimetry are not sufficiently reliable methods for continued monitoring. In late-onset and severe intrauterine growth retardation (IUGR) desirable delivery time is after reaching biological maturity at 36-37 week. PMID:25558672

  6. Resting tachycardia, a warning sign in anorexia nervosa: case report

    Directory of Open Access Journals (Sweden)

    Krantz Mori J

    2004-07-01

    Full Text Available Abstract Background Among psychiatric disorders, anorexia nervosa has the highest mortality rate. During an exacerbation of this illness, patients frequently present with nonspecific symptoms. Upon hospitalization, anorexia nervosa patients are often markedly bradycardic, which may be an adaptive response to progressive weight loss and negative energy balance. When anorexia nervosa patients manifest tachycardia, even heart rates in the 80–90 bpm range, a supervening acute illness should be suspected. Case presentation A 52-year old woman with longstanding anorexia nervosa was hospitalized due to progressive leg pain, weakness, and fatigue accompanied by marked weight loss. On physical examination she was cachectic but in no apparent distress. She had fine lanugo-type hair over her face and arms with an erythematous rash noted on her palms and left lower extremity. Her blood pressure was 96/50 mm Hg and resting heart rate was 106 bpm though she appeared euvolemic. Laboratory tests revealed anemia, mild leukocytosis, and hypoalbuminemia. She was initially treated with enteral feedings for an exacerbation of anorexia nervosa, but increasing leukocytosis without fever and worsening left leg pain prompted the diagnosis of an indolent left lower extremity cellulitis. With antibiotic therapy her heart rate decreased to 45 bpm despite minimal restoration of body weight. Conclusions Bradycardia is a characteristic feature of anorexia nervosa particularly with significant weight loss. When anorexia nervosa patients present with nonspecific symptoms, resting tachycardia should prompt a search for potentially life-threatening conditions.

  7. Silicon-containing nanocarriers for targeted drug delivery: synthesis, physicochemical properties and acute toxicity.

    Science.gov (United States)

    Sonin, Dmitry L; Korolev, Dmitry V; Postnov, Viktor N; Naumysheva, Elena B; Pochkaeva, Evgenia I; Vasyutina, Marina L; Galagudza, Michael M

    2016-06-01

    Silicon-containing nanoparticles (NPs) are considered promising drug carriers for targeted drug delivery. In this study, we investigated the physical and chemical properties of silicon-containing NPs, including silica and organomodified silica NPs (SiO2NPs and OrSiO2NPs, respectively), with different surface modifications, with the aim of increasing drug-loading efficiency. In addition, we described the original synthesis methods of different sizes of OrSiO2NPs, as well as new hybrid OrSiO2NPs with a silica core (SiO2 + OrSiO2NPs). Animal experiments revealed that the silicon-containing NPs investigated were non-toxic, as evidenced by a lack of hemodynamic response after intravenous administration. Bioelimination studies showed rapid renal excretion of OrSiO2NPs. In drug release kinetics studies, adenosine was immobilized on SiO2NPs using three different approaches: physical adsorption, ionic, and covalent bonding. We observed that the rate of adenosine desorption critically depended on the type of immobilization; therefore, adenosine release kinetics can be adjusted by SiO2NP surface modification technique. Adsorption of adenosine on SiO2 + OrSiO2NPs resulted in a significant attenuation of adenosine-induced hypotension and bradycardia. PMID:26203803

  8. Robust heart rate estimation from multiple asynchronous noisy sources using signal quality indices and a Kalman filter

    International Nuclear Information System (INIS)

    Physiological signals such as the electrocardiogram (ECG) and arterial blood pressure (ABP) in the intensive care unit (ICU) are often severely corrupted by noise, artifact and missing data, which lead to large errors in the estimation of the heart rate (HR) and ABP. A robust HR estimation method is described that compensates for these problems. The method is based upon the concept of fusing multiple signal quality indices (SQIs) and HR estimates derived from multiple electrocardiogram (ECG) leads and an invasive ABP waveform recorded from ICU patients. Physiological SQIs were obtained by analyzing the statistical characteristics of each waveform and their relationships to each other. HR estimates from the ECG and ABP are tracked with separate Kalman filters, using a modified update sequence based upon the individual SQIs. Data fusion of each HR estimate was then performed by weighting each estimate by the Kalman filters' SQI-modified innovations. This method was evaluated on over 6000 h of simultaneously acquired ECG and ABP from a 437 patient subset of ICU data by adding real ECG and realistic artificial ABP noise. The method provides an accurate HR estimate even in the presence of high levels of persistent noise and artifact, and during episodes of extreme bradycardia and tachycardia

  9. Cocaine, Marijuana, Hypertension and Cardiovascular Effects

    Directory of Open Access Journals (Sweden)

    Mohammad Hassan Ghadiani

    2015-07-01

    Full Text Available Cocaine is used by more than 14 million people worldwide, about 0.3 percent of the global population age is 15 to 64 years. After alcohol, cocaine is the most common cause of acute drug-related emergency department visits in the United States. Cocaine consumption is more frequently associated with acute cardiovascular illness.  Cocaine stimulates α1, α2, β1 and β2 adrenergic receptors through increased levels of norepinephrine and a lesser extent epinephrine. The cardiovascular effects of cocaine are thought to be similar and regardless to the route of consumption. An acute coronary syndrome is the most common cardiac problem including myocardial ischemia and infarction even in young persons without atherosclerosis, aortic dissection and rupture, arrhythmias, ventricular tachycardia and fibrillation, asystole and finally sudden death. Other cardiovascular effects that caused by cocaine include coronary artery aneurysm, palpitation, sinus tachycardia, increased systemic vascular resistance and hypertension crisis, left ventricular hypertrophy, myocarditis, cardiomyopathy, myocardial fibrosis, bundle branch block, heart block, supraventricular arrhythmia, accelerated atherosclerosis, hypotension, bradycardia and infective endocarditis  among intravenous users.Cocaine by three mechanisms cause ischemia: 1. increased myocardial oxygen demand, 2. decreased coronary blood flow due to coronary artery vasoconstriction and spasm and 3. Coronary artery thrombosis via activation of platelets, stimulation of platelet aggregation and potentiation of thromboxane production.

  10. Cardiomyopathy induced by artificial cardiac pacing: myth or reality sustained by evidence?

    Directory of Open Access Journals (Sweden)

    Andrés Di Leoni Ferrari

    2014-09-01

    Full Text Available Implantable cardiac pacing systems are a safe and effective treatment for symptomatic irreversible bradycardia. Under the proper indications, cardiac pacing might bring significant clinical benefit. Evidences from literature state that the action of the artificial pacing system, mainly when the ventricular lead is located at the apex of the right ventricle, produces negative effects to cardiac structure (remodeling, dilatation and function (dissinchrony. Patients with previously compromised left ventricular function would benefit the least with conventional right ventricle apical pacing, and are exposed to the risk of developing higher incidence of morbidity and mortality for heart failure. However, after almost 6 decades of cardiac pacing, just a reduced portion of patients in general would develop these alterations. In this context, there are not completely clear some issues related to cardiac pacing and the development of this cardiomyopathy. Causality relationships among QRS widening with a left bundle branch block morphology, contractility alterations within the left ventricle, and certain substrates or clinical (previous systolic dysfunction, structural heart disease, time from implant or electrical conditions (QRS duration, percentage of ventricular stimulation are still subjecte of debate. This review analyses contemporary data regarding this new entity, and discusses alternatives of how to use cardiac pacing in this context, emphasizing cardiac resynchronization therapy.

  11. Effect of adenosine cyclophosphate combined with vitamin C therapy on electrocardiogram and serum indexes of children with viral myocarditis

    Institute of Scientific and Technical Information of China (English)

    Jun Liao

    2016-01-01

    Objective:To study the effect of adenosine cyclophosphate combined with vitamin C therapy on electrocardiogram and serum indexes of children with viral myocarditis. Methods:A total of 110 cases of children with viral myocarditis treated in Pediatrics Department of our hospital from May 2012 to June 2914 were randomly divided into two groups, intervention group received adenosine cyclophosphate+vitamin C combined with conventional treatment, control group received conventional treatment, and then arrhythmia as well as serum myocardial enzymes, inflammatory mediators and signaling molecules of two groups were compared. Results: Cases with sinus tachycardia, premature beat, supraventricular tachycardia, atrioventricular block, sinus bradycardia, QT interval prolongation and ST-T segment change of intervention group were less than those of control group;serum aspartate transaminase, creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase, α-hydroxybutyrate dehydrogenase, MIF, TNF-α, IL-1β, IL-6 and MCP-1 contents as well as mRNA expression levels of Rho and Rock of intervention group were lower than those of control group, and mRNA expression levels of JAK2 and STAT1 were higher than those of control group. Conclusion:Adenosine cyclophosphate combined with vitamin C therapy can prevent the occurrence of arrhythmia in children with viral myocarditis, protect myocardial cells, inhibit inflammatory response and regulate JAK2-STAT1signaling pathway and Rho/Rock signaling pathway.

  12. Time course of the hemodynamic responses to aortic depressor nerve stimulation in conscious spontaneously hypertensive rats

    Directory of Open Access Journals (Sweden)

    M.T. Durand

    2012-05-01

    Full Text Available The time to reach the maximum response of arterial pressure, heart rate and vascular resistance (hindquarter and mesenteric was measured in conscious male spontaneously hypertensive (SHR and normotensive control rats (NCR; Wistar; 18-22 weeks subjected to electrical stimulation of the aortic depressor nerve (ADN under thiopental anesthesia. The parameters of stimulation were 1 mA intensity and 2 ms pulse length applied for 5 s, using frequencies of 10, 30, and 90 Hz. The time to reach the hemodynamic responses at different frequencies of ADN stimulation was similar for SHR (N = 15 and NCR (N = 14; hypotension = NCR (4194 ± 336 to 3695 ± 463 ms vs SHR (3475 ± 354 to 4494 ± 300 ms; bradycardia = NCR (1618 ± 152 to 1358 ± 185 ms vs SHR (1911 ± 323 to 1852 ± 431 ms, and the fall in hindquarter vascular resistance = NCR (6054 ± 486 to 6550 ± 847 ms vs SHR (4849 ± 918 to 4926 ± 646 ms; mesenteric = NCR (5574 ± 790 to 5752 ± 539 ms vs SHR (5638 ± 648 to 6777 ± 624 ms. In addition, ADN stimulation produced baroreflex responses characterized by a faster cardiac effect followed by a vascular effect, which together contributed to the decrease in arterial pressure. Therefore, the results indicate that there is no alteration in the conduction of the electrical impulse after the site of baroreceptor mechanical transduction in the baroreflex pathway (central and/or efferent in conscious SHR compared to NCR.

  13. 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.

  14. Selected physical characteristics of medical students

    Directory of Open Access Journals (Sweden)

    Dr. Lajos Ángyán

    2003-01-01

    Full Text Available The purpose of this study was to measure selected anthropometrical characteris-tics, motor abilities and cardiorespiratory functions of medical students. Eighty-seven students were involved in this investigation. The students were categorized into five groups: (1 recreational, doing sport activities irregularly, (2 basketball and (3 handball players, having training at least two times per week, as well as men (4 and women (5 students entering medical school. In all groups the mean body mass index and waist-to-hip ratio were at the upper level of the normal range, while body fat percentage was similar to standards for sedentary subjects. Better motor per-formances were obtained from the basketball and handball players than from the other groups. Static strength for the sample was somewhat above the normal sedentary level. The resting blood pressure and heart rate for most subjects were in the normal. Cardiovascular risk factors were found in six students. Their systolic blood pressure was above 140 mm Hg. There were no sub-jects identified with low blood pressure. The heart rate was elevated for three students from the recreational group, and in the women. Bradycardia did not occur. The vital capacity and the ability to hold one’s breath was at the upper level of the normal range. The present results emphasis the need to improve the students` prevention oriented life style through participation in exercising.

  15. FPGA Implementation of Heart Rate Monitoring System.

    Science.gov (United States)

    Panigrahy, D; Rakshit, M; Sahu, P K

    2016-03-01

    This paper describes a field programmable gate array (FPGA) implementation of a system that calculates the heart rate from Electrocardiogram (ECG) signal. After heart rate calculation, tachycardia, bradycardia or normal heart rate can easily be detected. ECG is a diagnosis tool routinely used to access the electrical activities and muscular function of the heart. Heart rate is calculated by detecting the R peaks from the ECG signal. To provide a portable and the continuous heart rate monitoring system for patients using ECG, needs a dedicated hardware. FPGA provides easy testability, allows faster implementation and verification option for implementing a new design. We have proposed a five-stage based methodology by using basic VHDL blocks like addition, multiplication and data conversion (real to the fixed point and vice-versa). Our proposed heart rate calculation (R-peak detection) method has been validated, using 48 first channel ECG records of the MIT-BIH arrhythmia database. It shows an accuracy of 99.84%, the sensitivity of 99.94% and the positive predictive value of 99.89%. Our proposed method outperforms other well-known methods in case of pathological ECG signals and successfully implemented in FPGA. PMID:26643079

  16. Reducing false arrhythmia alarms in the ICU using multimodal signals and robust QRS detection.

    Science.gov (United States)

    Sadr, Nadi; Huvanandana, Jacqueline; Nguyen, Doan Trang; Kalra, Chandan; McEwan, Alistair; de Chazal, Philip

    2016-08-01

    This study developed algorithms to decrease the arrhythmia false alarms in the ICU by processing multimodal signals of photoplethysmography (PPG), arterial blood pressure (ABP), and two ECG signals. The goal was to detect the five critical arrhythmias comprising asystole (ASY), extreme bradycardia (EBR), extreme tachycardia (ETC), ventricular tachycardia (VTA), and ventricular flutter or fibrillation (VFB). The different characteristics of the arrhythmias suggested the application of individual signal processing for each alarm and the combination of the algorithms to enhance false alarm detection. Thus, different features and signal processing techniques were used for each arrhythmia type. The ECG signals were first processed to reduce the signal interference. Then, a Hilbert-transform based QRS detector algorithm was utilized to identify the QRS complexes, which were then processed to determine the instantaneous heart rate. The pulsatile signals (PPG and ABP) were processed to discover the pulse onset of beats which were then employed to measure the heart rate. The signal quality index (SQI) of the signals was implemented to verify the integrity of the heart rate information. The overall score obtained by our algorithms in the 2015 Computing in Cardiology Challenge was a score of 74.03% for retrospective and 69.92% for real-time analysis. PMID:27455121

  17. Gill chemoreceptors and cardio-respiratory reflexes in the neotropical teleost pacu, Piaractus mesopotamicus.

    Science.gov (United States)

    Leite, C A C; Florindo, L H; Kalinin, A L; Milsom, W K; Rantin, F T

    2007-09-01

    This study examined the location and distribution of O(2) chemoreceptors involved in cardio-respiratory responses to hypoxia in the neotropical teleost, the pacu (Piaractus mesopotamicus). Intact fish and fish experiencing progressive gill denervation by selective transection of cranial nerves IX and X were exposed to gradual hypoxia and submitted to intrabuccal and intravenous injections of NaCN while their heart rate, ventilation rate and ventilation amplitude were measured. The chemoreceptors producing reflex bradycardia were confined to, but distributed along all gill arches, and were sensitive to O(2) levels in the water and the blood. Ventilatory responses to all stimuli, though modified, continued following gill denervation, however, indicating the presence of internally and externally oriented receptors along all gill arches and either in the pseudobranch or at extra-branchial sites. Chemoreceptors located on the first pair of gill arches and innervated by the glossopharyngeal nerve appeared to attenuate the cardiac and respiratory responses to hypoxia. The data indicate that the location and distribution of cardio-respiratory O(2) receptors are not identical to those in tambaqui (Colossoma macropomum) despite their similar habitats and close phylogenetic lineage, although the differences between the two species could reduce to nothing more than the presence or absence of the pseudobranch. PMID:17680247

  18. Muscle Energy Stores and Stroke Rates of Emperor Penguins: Implications for Muscle Metabolism and Dive Performance

    Science.gov (United States)

    Williams, Cassondra L.; Sato, Katsufumi; Shiomi, Kozue; Ponganis, Paul J.

    2016-01-01

    In diving birds and mammals, bradycardia and peripheral vasoconstriction potentially isolate muscle from the circulation. During complete ischemia, ATP production is dependent on the size of the myoglobin oxygen (O2) store and the concentrations of phosphocreatine (PCr) and glycogen (Gly). Therefore, we measured PCr and Gly concentrations in the primary underwater locomotory muscle of emperor penguin and modeled the depletion of muscle O2 and those energy stores under conditions of complete ischemia and a previously determined muscle metabolic rate. We also analyzed stroke rate to assess muscle workload variation during dives and evaluate potential limitations on the model. Measured PCr and Gly concentrations, 20.8 and 54.6 mmol kg−1, respectively, were similar to published values for non-diving animals. The model demonstrated that PCr and Gly provide a large anaerobic energy store, even for dives longer than 20 min. Stroke rate varied throughout the dive profile indicating muscle workload was not constant during dives as was assumed in the model. The stroke rate during the first 30 seconds of dives increased with increased dive depth. In extremely long dives, lower overall stroke rates were observed. Although O2 consumption and energy store depletion may vary during dives, the model demonstrated that PCr and Gly, even at concentrations typical of terrestrial birds and mammals, are a significant anaerobic energy store and can play an important role in the emperor penguin’s ability to perform long dives. PMID:22418705

  19. Epidemiology and Clinical Features of Ciguatera Fish Poisoning in Hong Kong

    Directory of Open Access Journals (Sweden)

    Thomas Y. K. Chan

    2014-10-01

    Full Text Available In the present review, the main objective was to describe the epidemiology and clinical features of ciguatera fish poisoning in Hong Kong. From 1989 to 2008, the annual incidence of ciguatera varied between 3.3 and 64.9 (median 10.2 per million people. The groupers have replaced the snappers as the most important cause of ciguatera. Pacific-ciguatoxins (CTX are most commonly present in reef fish samples implicated in ciguatera outbreaks. In affected subjects, the gastrointestinal symptoms often subside within days, whereas the neurological symptoms can persist for weeks or even months. Bradycardia and hypotension, which can be life-threatening, are common. Treatment of ciguatera is primarily supportive and symptomatic. Intravenous mannitol (1 g/kg has also been suggested. To prevent ciguatera outbreaks, the public should be educated to avoid eating large coral reef fishes, especially the CTX-rich parts. A Code of Practice on Import and Sale of Live Marine Fish for Human Consumption for Prevention and Control of Ciguatera Fish Poisoning was introduced from 2004 to 2013. The Food Safety Ordinance with a tracing mechanism came into full effect in February 2012. The Government would be able to trace the sources of the fishes more effectively and take prompt action when dealing with ciguatera incidents.

  20. Dentocardiac Reflex: an Allegedly New Subform of the Trigeminocardiac Reflex

    Directory of Open Access Journals (Sweden)

    Amr Abdulazim

    2011-05-01

    Full Text Available Trigeminocardiac reflex (TCR is currently defined as a sudden bradycardia and decrease in mean arterial blood pressure by 20% during the manipulation of the branches of trigeminal nerve. TCR, especially during the last decade has been mostly studied in the course of neurosurgical procedures which are supposed to elicit the central subtype of TCR. Previously the well-known oculocardiac reflex was also considered as a subtype of TCR. Recently, surgeons dealing with the other branches of the fifth cranial nerve have become more interested in this reflex. Some noteworthy points have been published discussing new aspects of the trigeminocardiac reflex (TCR in simple oral surgical procedures. Arakeri et al. have reviewed the similarities and differences between TCR, vasovagal response (VVR, and syncope. They have also explained a new possible pathway for the reflex during the simple extraction of upper first molars. The present paper aims to briefly discuss these recently presented points. Although the discussed concepts are noteworthy and consistent our preliminary results of our yet to be published studies, it seemed timely for us to discuss some possible shortcomings that may affect the results of such assessments.

  1. High-Resolution CT and Angiographic Evaluation of NexStent Wall Adaptation

    International Nuclear Information System (INIS)

    Carotid stenting is a minimally invasive treatment for extracranial carotid artery stenosis. Stent design may affect technical success and complications in a certain subgroup of patients. We examined the wall adaptability of a new closed-cell carotid stent (NexStent), which has a unique rolled sheet design. Forty-one patients had 42 carotid arteries treated with angioplasty and stenting for internal carotid artery stenosis. The mean patient age was 65 ± 10 years. All patients underwent high-resolution computed tomographic angiography after the stent implantation. Data analysis included pre- and postprocedural stenosis, procedure complications, plaque calcification, and stent apposition. We reviewed the angiographic and computed tomographic images for plaque coverage and stent expansion. All procedures were technically successful. Mean stenosis was reduced from 84 ± 8% before the procedure to 15.7 ± 7% after stenting. Two patients experienced transient ischemic attack; one patient had bradycardia and hypotension. Stent induced kinking was observed in one case. Good plaque coverage and proper overlapping of the rolled sheet was achieved in all cases. There was weak correlation between the residual stenosis and the amount of calcification. The stent provides adequate expansion and adaptation to the tapering anatomy of the bifurcation.

  2. Animal exposure during burn tests

    Science.gov (United States)

    Gaume, J. G.

    1976-01-01

    An animal exposure test system has been designed and fabricated for the purpose of collecting physiological and environmental (temperature) data from animal subjects exposed to combustion gases in large scale fire tests. The AETS consists of an open wire mesh, two-compartment cage, one containing an exercise wheel for small rodents, and the other containing one rat instrumented externally for electrocardiogram and respiration. The ECG and respiration sensors are located in a belt placed around the torso of the subject, electrode wires forming an umbilical to a connector in the top of the compartment. A cable extends from the connector to the power supply and signal conditioning electronics. These are connected to a dual-beam oscilloscope for real time monitoring and a magnetic tape recorder having three or more channels. Endpoints observed are bradycardia, cardiac arrhythmias, changes in respiratory pattern, respiratory arrest and cardiac arrest. The ECG record also appears to be a good method of monitoring animal activity as indicated by an increase in EMG noise superimposed on the record during increased activity of the torso musculature. Examples of the recordings are presented and discussed as to their significance regarding toxicity of fire gases.

  3. [Are the theoretical drawbacks of beta-blocker treatment in pregnancy being confirmed? A review of the literature].

    Science.gov (United States)

    Tcherdakoff, P; Goupil-Colliard, M

    1983-01-01

    The use of beta-blocking drugs in the treatment of hypertension during pregnancy has been the subject of controversies on the basis of theoretical hazards due to the pharmacology and pharmacokinetic characteristics of these drugs. A review of the literature on the subject shows that: The danger of premature contractions, abortion or premature delivery does not seem to increase with the use of beta-blockers. The blood supply is not more impaired with beta-blockers than with other antihypertensive drugs according to fetal growth, birth-weight, frequency of perinatal deaths or APGAR score. Although beta-blocking drugs pass into fetal circulation, neonatal bradycardia, respiratory distress or hypoglycemia do not seem more frequent with beta-blockers. Beta-blockers pass from maternal plasma into milk but the 24 hour dose brought to the newborn by maternal feeding is so slight as to be negligible. Thus, the cumulative data and the favorable opinions of many authors, the greater efficiency of beta-blockers authorizes the use of these drugs in the treatment of hypertension in pregnancy, where it seems to improve the outcome of the pregnancy and the state of the fetus at birth. PMID:6138464

  4. The Specific Characteristics in Children with Obstructive Sleep Apnea and Cor Pulmonale

    Directory of Open Access Journals (Sweden)

    Pi-Chang Lee

    2012-01-01

    Full Text Available Background. The prevalence of obstructive sleep apnea (OSA in the pediatric population is currently estimated at 1-2% of all children. The purpose of this study was to investigate the clinical and hemodynamic characteristics in pediatric patients with cor pulmonale and OSA. Methods. Thirty children with the diagnosis of OSA were included. These patients consisted of 26 male and 4 female children with a mean age of 7 ± 4 years old. Five of those children were found to be associated with cor pulmonale, and 25 had OSA but without cor pulmonale. Results. The arousal index was much higher in children with OSA and cor pulmonale. The children with OSA and cor pulmonale had much lower mean and minimal oxygen saturation and a higher incidence of bradycardia events. All 5 patients with OSA and cor pulmonale underwent an adenotonsillectomy, and the pulmonary arterial pressure dropped significantly after the surgery. Conclusion. This study demonstrated that the OSA pediatric patients with cor pulmonale had the different clinical manifestations and hemodynamic characteristics from those without cor pulmonale. The adenotonsillectomy had excellent results in both the OSA pediatric patients with and without cor pulmonale.

  5. Pentobarbital Toxicity after Self-Administration of Euthasol Veterinary Euthanasia Medication

    Directory of Open Access Journals (Sweden)

    Steven Jason Crellin

    2016-01-01

    Full Text Available Suicide attempt via sodium pentobarbital is uncommon. A 48-year-old woman with a history of depression and prior suicide attempt was found unresponsive by her veterinarian spouse near a syringe containing pink solution. Upon EMS’ arrival, the patient was experiencing apnea, hypoxemia, and miotic pupils; her blood glucose level measured 73 mg/dL. She was bradycardic and administered atropine with transient improvement in heart rate and transported to an emergency department; 2 mg of intravenous naloxone was administered without effect. She was endotracheally intubated via rapid sequence intubation. Rapid urine drug screening detected both benzodiazepines and barbiturates. The patient was transferred to an intensive care unit where she demonstrated a nearly absent radial pulse. Emergent fasciotomy to the left forearm and carpal tunnel was performed for acute compartment syndrome; “Euthasol” had been self-administered into the antecubital fossa. Expanded toxicological analysis via liquid chromatography/mass spectroscopy detected caffeine, atropine, 7-aminoclonazepam, phenytoin, citalopram, and naproxen. The patient’s coma resolved over 48 hours and she was successfully extubated without complication. Emergency physicians must closely monitor patients exposed to veterinary euthanasia agents who develop central nervous system and respiratory depression, hypothermia, bradycardia, hypotension, or skin injury. Consultation with a regional poison center and medical toxicologist is recommended.

  6. Cell and gene therapy for arrhythmias: Repair of cardiac conduction damage

    Institute of Scientific and Technical Information of China (English)

    Yong-Fu Xiao

    2011-01-01

    Action potentials generated in the sinoatrial node(SAN)dominate the rhythm and rate of a healthy human heart.Subsequently,these action potentials propagate to the whole heart via its conduction system .Abnormalities of impulse generation and/or propagation in a heart can cause arrhythmias.For example,SAN dysfunction or conduction block of the atrioventricular node can lead to serious bradycardia which is currently treated with an implanted electronic pacemaker.On the other hand conduction damage may cause reentrant tachyarrhythmias which are primarily treated pharmacologically or by medical device-based therapies,including defibrillation and tissue ablation.However,drug therapies sometimes may not be effective or are associated with serious side effects.Device-based therapies for cardiac arrhythmias,even with well developed technology,still face inadequacies,limitations,hardware complications,and other challenges.Therefore,scientists are actively seeking other alternatives for antiarrhythmic therapy.In particular,cells and genes used for repairing cardiac conduction damage/defect have been investigated in various studies both in vitro and in vivo.Despite the complexities of the excitation and conduction systems of the heart,cell and gene-based strategies provide novel alternatives for treatment or cure of cardiac anhythmias.This review summarizes some highlights of recent research progress in this field.

  7. Complete Congenital Heart Block in a Newborn Associated with Maternal Systemic Lupus Erythematosus: A Case Report

    Directory of Open Access Journals (Sweden)

    Mahmoud A. Kiblawi

    2013-12-01

    Full Text Available Background: Complete Congenital Heart Block (CCHB is a rare disease of the newborn that carries significant morbidity and mortality. CCHB can be diagnosed early or late in life. In newborns, it is usually associated with maternal autoantibodies or a congenital cardiac structural abnormality. The most common presentation of CCHB is bradycardia that can be diagnosed by an electrocardiogram. Results: This is a case report of a male infant born to a mother with an autoimmune disease, Systemic Lupus Erythematosus (SLE, who was found to have third degree heart block at birth. Conclusion: Early diagnosis and prompt management of the case is important for a better prognosis and prevention of associated complications. Neonates with CCHB should be managed at a tertiary care center and the only definite treatment is insertion of a pacemaker. Moreover, prenatal diagnosis and specific obstetric counseling of pregnant women with SLE along with careful monitoring with serial ultrasonography and echocardiography are of paramount importance in prevention of the disease in subsequent offspring.

  8. Intermittent hypoxia in childhood: the harmful consequences versus potential benefits of therapeutic uses.

    Science.gov (United States)

    Serebrovskaya, Tatiana V; Xi, Lei

    2015-01-01

    Intermittent hypoxia (IH) often occurs in early infancy in both preterm and term infants and especially at 36-44 weeks postmenstrual age. These episodes of IH could result from sleep-disordered breathing or may be temporally unrelated to apnea or bradycardia events. There are numerous reports indicating adverse effects of IH on development, behavior, academic achievement, and cognition in children with sleep apnea syndrome. It remains uncertain about the exact causative relationship between the neurocognitive and behavioral morbidities and IH and/or its associated sleep fragmentation. On the other hand, well-controlled and moderate IH conditioning/training has been used in sick children for treating their various forms of bronchial asthma, allergic dermatoses, autoimmune thyroiditis, cerebral palsy, and obesity. This review article provides an updated and impartial analysis on the currently available evidence in supporting either side of the seemingly contradictory scenarios. We wish to stimulate a comprehensive understanding of such a complex physiological phenomenon as intermittent hypoxia, which may be accompanied by other confounding factors (e.g., hypercapnia, polycythemia), in order to prevent or reduce its harmful consequences, while maximizing its potential utility as an effective therapeutic tool in pediatric patients. PMID:26042211

  9. Emergency PTCA and Brace Implantation in Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    Li Zhangquan; Guan Ruming; Zhang Ming

    2000-01-01

    Objective To further improve the rate of reperfusion of infarction related artery in AMI, remove the stricture, rescue ischemic myocardiurn, protect cardiac function and ameliorate the longterm prognosis. Method Among 73 patients with AMI, 50 underwent direct PTCA, 15 immediate PTCA,8 rescue PTCA and 20 braces were implanted. Result The proportion of recanalization is 94.5% (69/73) .The grade of blood flow (TIMI) improved to grade 3 in 20 patients with brace implantation, while 44 to grade 3 and 5 to grade 2 among 49 patients with simple PTCA. Residualstenosis in vessel was 1.8 ± 5.9(-10-10)% in patients with brace implantation versus 15.4 ± 11. (0 -30)% with simple PICA. The incidence of reperfusive cardiac arrythmia was 18.1%(10/62). There was mainly frequent ventricular premature beat and short paroxysmal ventricular tachycardia, if left anterior decending branch was reopened,while bradycardia and atrial ventricular block usually occurred after right coronary reperfused. Conclusion Emergency PTCA and brace implantation can apparently improve the proportion of reperfusioa of IRA in AMI. It is necessary to popularize and apply these treatment in medical units with available conditions.

  10. Control of respiration in fish, amphibians and reptiles

    Directory of Open Access Journals (Sweden)

    E.W. Taylor

    2010-05-01

    Full Text Available Fish and amphibians utilise a suction/force pump to ventilate gills or lungs, with the respiratory muscles innervated by cranial nerves, while reptiles have a thoracic, aspiratory pump innervated by spinal nerves. However, fish can recruit a hypobranchial pump for active jaw occlusion during hypoxia, using feeding muscles innervated by anterior spinal nerves. This same pump is used to ventilate the air-breathing organ in air-breathing fishes. Some reptiles retain a buccal force pump for use during hypoxia or exercise. All vertebrates have respiratory rhythm generators (RRG located in the brainstem. In cyclostomes and possibly jawed fishes, this may comprise elements of the trigeminal nucleus, though in the latter group RRG neurons have been located in the reticular formation. In air-breathing fishes and amphibians, there may be separate RRG for gill and lung ventilation. There is some evidence for multiple RRG in reptiles. Both amphibians and reptiles show episodic breathing patterns that may be centrally generated, though they do respond to changes in oxygen supply. Fish and larval amphibians have chemoreceptors sensitive to oxygen partial pressure located on the gills. Hypoxia induces increased ventilation and a reflex bradycardia and may trigger aquatic surface respiration or air-breathing, though these latter activities also respond to behavioural cues. Adult amphibians and reptiles have peripheral chemoreceptors located on the carotid arteries and central chemoreceptors sensitive to blood carbon dioxide levels. Lung perfusion may be regulated by cardiac shunting and lung ventilation stimulates lung stretch receptors.

  11. Power sources and electrical recharging strategies for implantable medical devices

    Institute of Scientific and Technical Information of China (English)

    Xiaojuan WEI; Jing LIU

    2008-01-01

    Implantable medical devices (IMDs) are crit-ically requested for the survival of patients subject to certain serious diseases such as bradycardia, fibrillation, diabetes, and disability, etc. Appropriate working of an active implantable medical device (IMD) heavily relies on the continuous supply of electricity. In this sense, long-term powering and recharging of an IMD via a highly safe, efficient and convenient way is, therefore, extremely important in clinics. Several conventional batteries, such as lithium cell, nuclear cell and bio-fuel cell, etc., have been developed to power IMDs. Meanwhile, the recharge of IMD from outside of the human body is also under investigation. In this paper, some of the most typical IMD batteries are reviewed. Their advantages and disadvantages are compared. In addition, several emer-ging innovations to recharge or directly drive the implanted batteries, including electromagnetic energy transmission, piezoelectric power generation, thermoelec-tric devices, ultrasonic power motors, radio frequency recharging and optical recharging methods, etc., are also discussed. Some fundamental and practical issues thus involved are summarized, and future prospects in this area are made.

  12. Effect of short-term physical exercise on foetal heart rate and uterine activity in normal and abnormal pregnancies.

    Science.gov (United States)

    Rauramo, I

    1987-01-01

    The response of a short-term submaximal bicycle ergometer test on foetal heart rate (FHR) and on uterine activity was studied in 61 pregnant women between pregnancy weeks 32 and 40. 28 of the women had uncomplicated pregnancies, 13 were hypertensive, 11 were diabetic, and 9 had intrahepatic cholestasis of pregnancy. After exercise, FHR declined in healthy subjects in pregnancy weeks past 35, whereas no significant change was found in such subjects before week 35 of pregnancy. Analysis of variance revealed a difference of FHR between subjects with umcomplicated and pre-eclamptic pregnancies in relation to time (p = 0.021). Exercise induced uterine contractions in hypertensive subjects. Foetal bradycardia was found in 2 healthy, in 2 pre-eclamptic, and in one cholestatic subject. In healthy pregnant women a non-reactive FHR with concomitant reduced FHR variability was found after exercise (P less than 0.01). The FHR variability of patients with pathologic pregnancies was less affected. These results suggest that, after a relatively strenuous short-term exercise, foetuses of mothers with uneventful pregnancies can be at risk of hypoxia in late pregnancy, but the clinical significance remains uncertain. PMID:3435001

  13. LMN Facial Palsy in Pregnancy: An Opportunity to Predict Preeclampsia—Report and Review

    Directory of Open Access Journals (Sweden)

    Vani Aditya

    2014-01-01

    Full Text Available Facial paralysis is the most frequent unilateral cranial nerve pathology affecting pregnant population 2 to 4 times more often than the nonpregnant population. There exists an association with preeclampsia but this has largely been overlooked. Clinicians often dismiss it for idiopathic palsy as seen in the present case. A 30-year-old woman, Gravida 4, Para 3, presented at 26 weeks pregnancy with complaints of facial weakness, blurring of vision, altered taste sensation, increased noise sensitivity for 1 month, headache since 18 days, and vomiting since 2­3 days. Her pulse was 90/min, BP was 170/120, and RR was 18/min. Uterus was 18 weeks size and proteinuria++ was present. Ultrasonography revealed a 26 weeks fetus, severe bradycardia, and absent liquor. HELLP syndrome was diagnosed after investigations. Six units of fresh frozen plasma were transfused. An informed decision for termination of pregnancy was made. She delivered a 450 gram stillborn. The third stage was complicated with postpartum hemorrhage but it was managed successfully. Women with Bell’s palsy during pregnancy should be evaluated critically as in some it may precede preeclampsia which has serious maternal and fetal implications. Therefore, these women should be in regular followup of the obstetrician.

  14. Phase I clinical trial for the effect of a radiosensitizer, PR-350 (Doranidazole), combined with intraoperative radiation therapy in the treatment of pancreatic carcinoma

    International Nuclear Information System (INIS)

    We tested the safety and efficacy of hypoxic cell sensitizer, PR-350 (Doranidazole), in conjunction with intraoperative electron beam radiation therapy (IORT) in patients with advanced adenocarcinoma of the pancreas. PR-350 was delivered intravenously at a dose of 400 to 2,000 mg/m2 in conjunction with IORT of 20 to 40 Gy applied to the pancreas. In 15 patients treated with PR-350, the blood concentration of PR-350 decreased rapidly and the mean half-time of 50% disappearance was 3.6∼5.0 hours. Eighty five percent of PR-350 was eliminated through the urine without any degradation. One patient showed a slight elevation of glutamic oxaloacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT) values and another patient showed a slight decrease of blood pressure with bradycardia. As both patients recovered without any clinical problems, the adequate dose of PR-350 was determined as 2,000 mg/m2. We will move to the next clinical trial in order to clarify the effect of PR-350 combined with IORT on patients with locally advanced pancreatic cancer without liver metastasis using a double-blind study design. (author)

  15. Leaky RyR2 channels unleash a brainstem spreading depolarization mechanism of sudden cardiac death.

    Science.gov (United States)

    Aiba, Isamu; Wehrens, Xander H T; Noebels, Jeffrey L

    2016-08-16

    Cardiorespiratory failure is the most common cause of sudden unexplained death in epilepsy (SUDEP). Genetic autopsies have detected "leaky" gain-of-function mutations in the ryanodine receptor-2 (RyR2) gene in both SUDEP and sudden cardiac death cases linked to catecholaminergic polymorphic ventricular tachycardia that feature lethal cardiac arrhythmias without structural abnormality. Here we find that a human leaky RyR2 mutation, R176Q (RQ), alters neurotransmitter release probability in mice and significantly lowers the threshold for spreading depolarization (SD) in dorsal medulla, leading to cardiorespiratory collapse. Rare episodes of sinus bradycardia, spontaneous seizure, and sudden death were detected in RQ/+ mutant mice in vivo; however, when provoked, cortical seizures frequently led to apneas, brainstem SD, cardiorespiratory failure, and death. In vitro studies revealed that the RQ mutation selectively strengthened excitatory, but not inhibitory, synapses and facilitated SD in both the neocortex as well as brainstem dorsal medulla autonomic microcircuits. These data link defects in neuronal intracellular calcium homeostasis to the vulnerability of central autonomic brainstem pathways to hypoxic stress and implicate brainstem SD as a previously unrecognized site and mechanism contributing to premature death in individuals with leaky RYR2 mutations. PMID:27482086

  16. Disfunção sinusal em paciente com isomerismo atrial esquerdo Sinus node dysfunction in a patient with left atrial isomerism

    Directory of Open Access Journals (Sweden)

    Sírio Hassem Sobrinho

    2006-10-01

    Full Text Available É relatado o caso de uma criança com seis anos de idade, assintomática, portadora de isomerismo atrial esquerdo e comunicação interatrial do tipo seio venoso. Ao exame físico, apresentava vários períodos de ritmo bradicárdico. Durante monitorização eletrocardiográfica de 24 horas, apresentou importante disfunção sinusal, com pausas sinusais de até 2,4 segundos. Foi implantado marcapasso definitivo com evolução satisfatória.We report the case of an asymptomatic six-year-old child with left atrial isomerism and sinus venosus atrial septal defect. The physical examination revealed several periods of bradycardia. During a 24-hour electrocardiographic monitoring the patient presented a significant sinus node dysfunction with sinus pauses of up to 2.4 seconds. A permanent pacemaker was implanted, with a satisfactory outcome.

  17. Polidocanol sclerotherapy for painful venous malformations: evaluation of safety and efficacy in pain relief

    Energy Technology Data Exchange (ETDEWEB)

    Mimura, Hidefumi; Fujiwara, Hiroyasu; Hiraki, Takao; Gobara, Hideo; Mukai, Takashi; Hyodo, Tsuyoshi; Iguchi, Toshihiro; Yasui, Kotaro; Kanazawa, Susumu [Okayama University Medical School, Department of Radiology, Okayama (Japan); Kimata, Yoshihiro [Okayama University Medical School, Plastic and Reconstructive Surgery, Okayama (Japan)

    2009-10-15

    The aim of this study was to retrospectively evaluate the safety and efficacy of polidocanol sclerotherapy in pain relief for painful venous malformations (VMs). Thirty-one patients with painful VMs underwent polidocanol sclerotherapy. Pain intensity was assessed with an 11-point verbal numerical rating scale. Sclerotherapy was technically successful in 58 (98.3%) of 59 sessions. Twenty-six (89.7%) out of 29 patients experienced an improvement in pain after sclerotherapy at follow-up, a mean of 46 months after treatment. The mean pain score improved from 6.6 {+-} 2.5 before treatment to 2.4{+-}2.9 after treatment (P<.001). The factors that significantly influenced the therapeutic effect were size of lesion (P=.008), margin of lesion (P=.006), and stasis of sclerosant (P=.032). Adverse events included hypotension and bradycardia during the procedure. No major complication occurred. Polidocanol sclerotherapy is safe and most efficacious in providing pain relief for patients with small VMs (equal to or less than 10 cm in diameter), VMs with a well-defined margin, and VMs with good stasis of sclerosant during sclerotherapy. (orig.)

  18. Standardization of resistance exercise training: effects in diabetic ovariectomized rats.

    Science.gov (United States)

    Sanches, I C; Conti, F F; Sartori, M; Irigoyen, M C; De Angelis, K

    2014-04-01

    This study was carried out with a 3-fold aim: 1) to standardize a maximal load test (MLT) on ladders for prescription of resistance exercise training (RET) in rats, 2) to prescribe moderate-intensity RET based on this MLT and 3) to test the effect of this RET in diabetic ovariectomized rats. Female Wistar rats were divided into control (C), diabetic ovariectomized sedentary (DOS) and trained (DOT) groups. The MLT was standardized with increased load applied to the rat tail for each climb, and blood lactate was measured to identify lactate threshold in C rats. MLT was applied in the 1st, 4th and 8th week of the protocol. After 8 weeks of RET, the arterial pressure was directly recorded. DOS group reduced performance in MLT, body weight, left ventricular, plantar and soleus muscles mass (vs. C). DOT rats showed an improvement in MLT associated with plantar muscle mass increased (vs. C and DOS), with attenuation of hypotension and bradycardia (vs. DOS). In conclusion, the results provide a useful method for determining the maximal load and applying RET in rats. Moreover, this study showed that moderate intensity RET improves hemodynamic status in diabetic ovariectomized rats, thereby reinforcing the role of RET in diabetes management. PMID:24022577

  19. Maxillary sporadic Burkitt′s lymphoma associated with neuro-orbital involvement in an Indian male

    Directory of Open Access Journals (Sweden)

    Rakesh Kumar Manne

    2014-01-01

    Full Text Available Burkitt′s lymphoma (BL is the fastest growing malignancy of the lymphoreticular system to affect humans and has a potential ability to double in size every day. A case of maxillary sporadic BL (sBL associated with neuro-orbital involvement in an Indian male is presented. sBL initially presented as maxillary swelling with no obvious dental and periodontal changes. Histological specimen from incisional biopsy revealed a round cell malignant tumor and immunohistochemistry reactions favored nonHodgkin′s lymphoma consistent with BL. Four weeks later, patient presented with orbital involvement as diplopia, sixth cranial nerve palsy, and medial rectus palsy. Chemotherapy regimen according to LMB 89 protocol was started. During chemotherapy regimen patient showed bradycardia and Babinski response, suggestive of central nervous system involvement. sBL associated with orbital involvement is extremely rare and only seven cases have been reported. Our case showed unusual presentation; despite the aggressive tumor did not show any common clinical, radiological, and hematological findings. We also discussed the role of oral medicine specialist, importance of early diagnosis, and prompt referral in management of maxillary sBL.

  20. [An elderly man with known heart failure admitted with cardiogenic shock].

    Science.gov (United States)

    Hovland, Anders; Fagerheim, Anne Kristine; Hardersen, Randolf; Nielsen, Erik Waage

    2010-07-01

    A 75-year-old man with post-MI heart failure and an ejection fraction of 15 % was treated with an ACE-inhibitor, spironolactone and a beta-blocker. He had reduced his intake of food and water due to an intercurrent illness the days before admission. He was admitted to our coronary care unit due to bradycardia and hypotension. On arrival his blood pressure was 60/40 mm Hg, and he was in a cardiogenic shock. The electrocardiogram showed broad QRS-complexes and large T waves. Serum-potassium was 9.1 mmol/L and he had acute renal failure with oliguria, probably caused by reduced cardiac output due to hypovolemia combined with taking an ACE inhibitor and spironolactone. Haemodialysis was started and during dialysis QRS complexes became more narrow and heart rate and blood pressure normalized. The patient was discharged 10 days later with normal potassium and creatinine levels. Patients treated with ACE-inhibitors and spironolactone should be monitored closely. During intercurrent illness dehydration may occur and this can lead to renal failure and hyperkalemia which can be life-threatening. The condition should be recognized and addressed promptly, and if indicated haemodialysis should be performed. PMID:20596117

  1. Effects of Intraoperative Hemodynamics on Incidence of Postoperative Delirium in Elderly Patients: A Retrospective Study.

    Science.gov (United States)

    Yang, Lin; Sun, De-Feng; Han, Jun; Liu, Ruochuan; Wang, Li-Jie; Zhang, Zhen-Zhen

    2016-01-01

    BACKGROUND Postoperative delirium (POD) is a common complication in the elderly. This retrospective study investigated the effect of intraoperative hemodynamics on the incidence of POD in elderly patients after major surgery to explore ways to reduce the incidence of POD. MATERIAL AND METHODS Based on the incidence of POD, elderly patients (81±6 y) were assigned to a POD (n=137) or non-POD group (n=343) after elective surgery with total intravenous anesthesia. POD was diagnosed based on the guidelines of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), using the confusion assessment method. The hemodynamic parameters, such as mean arterial pressure, were monitored 10 min before anesthesia (baseline) and intraoperatively. The incidence of intraoperative hypertension, hypotension, tachycardia, and bradycardia were calculated. RESULTS At 30 min and 60 min after the initiation of anesthesia and at the conclusion of surgery, the monitored hemodynamic parameter values of the POD group, but not those of the non-POD group, were significantly higher than at baseline. Multivariate logistic regression analysis showed that intraoperative hypertension and tachycardia were significantly associated with POD. CONCLUSIONS Intraoperative hypertension and tachycardia were significantly associated with POD. Maintaining intraoperative stable hemodynamics may reduce the incidence of POD in elderly patients undergoing surgery. PMID:27038856

  2. Parainfluenza Virus Infection.

    Science.gov (United States)

    Branche, Angela R; Falsey, Ann R

    2016-08-01

    Human parainfluenza viruses (HPIVs) are single-stranded, enveloped RNA viruses of the Paramyoviridaie family. There are four serotypes which cause respiratory illnesses in children and adults. HPIVs bind and replicate in the ciliated epithelial cells of the upper and lower respiratory tract and the extent of the infection correlates with the location involved. Seasonal HPIV epidemics result in a significant burden of disease in children and account for 40% of pediatric hospitalizations for lower respiratory tract illnesses (LRTIs) and 75% of croup cases. Parainfluenza viruses are associated with a wide spectrum of illnesses which include otitis media, pharyngitis, conjunctivitis, croup, tracheobronchitis, and pneumonia. Uncommon respiratory manifestations include apnea, bradycardia, parotitis, and respiratory distress syndrome and rarely disseminated infection. Immunity resulting from disease in childhood is incomplete and reinfection with HPIV accounts for 15% of respiratory illnesses in adults. Severe disease and fatal pneumonia may occur in elderly and immunocompromised adults. HPIV pneumonia in recipients of hematopoietic stem cell transplant (HSCT) is associated with 50% acute mortality and 75% mortality at 6 months. Though sensitive molecular diagnostics are available to rapidly diagnose HPIV infection, effective antiviral therapies are not available. Currently, treatment for HPIV infection is supportive with the exception of croup where the use of corticosteroids has been found to be beneficial. Several novel drugs including DAS181 appear promising in efforts to treat severe disease in immunocompromised patients, and vaccines to decrease the burden of disease in young children are in development. PMID:27486735

  3. [Neuro-autonomic inhibition and haemodynamics management optimization during cesarean section under spinal anaesthesia in pregnant women with gestosis].

    Science.gov (United States)

    Gur'ianov, V A; Shumov, I V

    2012-01-01

    Results showed that autonomic nervous system (ANS) and blood circulation system (BCS) dysfunction in 3rd trimester pregnant women with gestosis are more pronounced, than in healthy pregnant women, despite the prescribed treatment. The most significant disturbances were vagotonia and hypokinetic haemodynamics type (often iatrogenic). Spinal anaesthesia (SA) during Cesarean section in pregnant women is accompanied by blood pressure decrease to the level demanding on vasopressors use. Considering normal indicators of SI, CI, oxygen transportation and electrocardiogram vasopressor was not introduced Apgar score assessment of newborns was within normal. However, vagotonia and hypokinetic haemodynamics type during anaesthesia that certifies autoregulation reserves insufficiency. Atropine introduction in pregnant women with vagotonia and hypokinetic haemodynamics type (often iatrogenic, owing to irrational therapy) before SA beginning of promoted neurovegetative inhibition optimization and haemodynamics stabilization in eukinetic range. Vagus blockade (elimination of ANS dysfunction) was accompanied by more physiologic sympathicotonia development with smaller decrease of blood pressure (without stroke index reduction!), absence of bradycardia and vomiting. Research showed that the blood pressure cannot be the only objective criterion of vasopressors use. PMID:23662521

  4. Orai1 deficiency leads to heart failure and skeletal myopathy in zebrafish.

    Science.gov (United States)

    Völkers, Mirko; Dolatabadi, Nima; Gude, Natalie; Most, Patrick; Sussman, Mark A; Hassel, David

    2012-01-15

    Mutations in the store-operated Ca²⁺ entry pore protein ORAI1 have been reported to cause myopathies in human patients but the mechanism involved is not known. Cardiomyocytes express ORAI1 but its role in heart function is also unknown. Using reverse genetics in zebrafish, we demonstrated that inactivation of the highly conserved zebrafish orthologue of ORAI1 resulted in severe heart failure, reduced ventricular systolic function, bradycardia and skeletal muscle weakness. Electron microscopy of Orai1-deficient myocytes revealed progressive skeletal muscle instability with loss of myofiber integrity and ultrastructural abnormalities of the z-disc in both skeletal and cardiac muscle. Isolated Orai1-deficient cardiomyocytes showed loss of the calcineurin-associated protein calsarcin from the z-discs. Furthermore, we found mechanosignal transduction was affected in Orai1-depleted hearts, indicating an essential role for ORAI1 in establishing the cardiac signaling transduction machinery at the z-disc. Our findings identify ORAI1 as an important regulator of cardiac and skeletal muscle function and provide evidence linking ORAI1-mediated calcium signaling to sarcomere integrity and cardiomyocyte function. PMID:22302996

  5. Hydroxocobalamin as a Cyanide Antidote: Empirical use , Safety, Efficacy, and Considerations for Stockpiling

    International Nuclear Information System (INIS)

    Cyanide is a well-known toxic terrorism agent and is a major cause of mortality and morbidity in smoke inhalation victims. Terrorist attacks could start enclosed-space fires with cyanide-poisoned victims, even if cyanide itself was not utilized. Cyanide poisoning cannot be emergent confirmed by laboratory analysis and treatment with safe and efficacious antidotes must be administered empirically. Hydroxocobalamin has been recently approved by the US FDA and is a safe and efficacious antidote. Its efficacy is comparable to that of other, more toxic, cyanide antidotes. Its mechanism of action involves both direct cyanide chelation (forming non-toxic cyanocobalamin which is excreted in the urine) and nitric oxide scavenging. Adverse effects are usually limited to transient dark red-brown discoloration of urine, skin, sclera, and mucous membranes. Antidotal doses have not caused allergic reactions in cyanide-poisoned patients and only minor and easily-treated allergic reactions occurred in 2 of 136 normal volunteers. Transient, asymptomatic hypertension and reflex bradycardia have occurred in some normal volunteers, but not in seriously ill smoke inhalation victims not having significant cyanide poisoning. Hydroxocobalamin is a safe and efficacious antidote and can be empirically administered in pre-hospital or emergency department settings. It is therefore suitable for inclusion in national or multinational medication stockpiles and is already included in some national programs in the European Union.(author)

  6. Cardiovascular and behavioral responses of gray wolves to ketamine-xylazine immobilization and antagonism by yohimbine

    Science.gov (United States)

    Kreeger, T.J.; Faggella, A.M.; Seal, U.S.; Mech, L.D.; Callahan, M.; Hall, B.

    1987-01-01

    Adult wolves (Canis lupus) were immobilized with 6.6 mg/kg ketamine hydrochloride (KET) and 2.2 mg/kg xylazine hydrochloride (XYL) administered intramuscularly. Induction time was 4.6 +/- 0.3 min (mean +/- SE). Immobilization resulted in significant bradycardia and hypertension (P less than 0.05). Twenty min after induction, the wolves were given 0.05-0.60 mg/kg yohimbine hydrochloride (YOH). Yohimbine given intravenously produced dose-related increases in heart rate (HR) with doses greater than 0.15 mg/kg resulting in extreme tachycardia (greater than 300 bpm). All doses of YOH caused a temporary decrease in mean arterial blood pressure (MABP) with some individual animals manifesting profound hypotension (less than 30 torr) at doses greater than 0.15 mg/kg. Increasing the dose of YOH above 0.15 mg/kg did not significantly decrease either arousal or ambulation times. Administering YOH at 40 or 60 min after induction resulted in decreased arousal and ambulation times. Stimulation by weighing and taking repeated blood samples during anesthesia did not shorten arousal times. We recommend that wolves immobilized with XYL-KET be antagonized with doses of YOH less than 0.15 mg/kg.

  7. Smart Multi-Level Tool for Remote Patient Monitoring Based on a Wireless Sensor Network and Mobile Augmented Reality

    Directory of Open Access Journals (Sweden)

    Fernando Cornelio Jiménez González

    2014-09-01

    Full Text Available Technological innovations in the field of disease prevention and maintenance of patient health have enabled the evolution of fields such as monitoring systems. One of the main advances is the development of real-time monitors that use intelligent and wireless communication technology. In this paper, a system is presented for the remote monitoring of the body temperature and heart rate of a patient by means of a wireless sensor network (WSN and mobile augmented reality (MAR. The combination of a WSN and MAR provides a novel alternative to remotely measure body temperature and heart rate in real time during patient care. The system is composed of (1 hardware such as Arduino microcontrollers (in the patient nodes, personal computers (for the nurse server, smartphones (for the mobile nurse monitor and the virtual patient file and sensors (to measure body temperature and heart rate, (2 a network layer using WiFly technology, and (3 software such as LabView, Android SDK, and DroidAR. The results obtained from tests show that the system can perform effectively within a range of 20 m and requires ten minutes to stabilize the temperature sensor to detect hyperthermia, hypothermia or normal body temperature conditions. Additionally, the heart rate sensor can detect conditions of tachycardia and bradycardia.

  8. Smart multi-level tool for remote patient monitoring based on a wireless sensor network and mobile augmented reality.

    Science.gov (United States)

    González, Fernando Cornelio Jiménez; Villegas, Osslan Osiris Vergara; Ramírez, Dulce Esperanza Torres; Sánchez, Vianey Guadalupe Cruz; Domínguez, Humberto Ochoa

    2014-01-01

    Technological innovations in the field of disease prevention and maintenance of patient health have enabled the evolution of fields such as monitoring systems. One of the main advances is the development of real-time monitors that use intelligent and wireless communication technology. In this paper, a system is presented for the remote monitoring of the body temperature and heart rate of a patient by means of a wireless sensor network (WSN) and mobile augmented reality (MAR). The combination of a WSN and MAR provides a novel alternative to remotely measure body temperature and heart rate in real time during patient care. The system is composed of (1) hardware such as Arduino microcontrollers (in the patient nodes), personal computers (for the nurse server), smartphones (for the mobile nurse monitor and the virtual patient file) and sensors (to measure body temperature and heart rate), (2) a network layer using WiFly technology, and (3) software such as LabView, Android SDK, and DroidAR. The results obtained from tests show that the system can perform effectively within a range of 20 m and requires ten minutes to stabilize the temperature sensor to detect hyperthermia, hypothermia or normal body temperature conditions. Additionally, the heart rate sensor can detect conditions of tachycardia and bradycardia. PMID:25230306

  9. Cardiovascular activity of 14-deoxy-11,12-didehydroandrographolide in the anaesthetised rat and isolated right atria.

    Science.gov (United States)

    Zhang, C; Kuroyangi, M; Tan, B K

    1998-12-01

    The cardiovascular activity of 14-deoxy-11,12-didehydroandrographolide (DDA) from Andrographis paniculata (Burm.f.) Nees (Acanthaceae) was elucidated in anaesthetised Sprague-Dawley (SD) rats and isolated rat right atria. In anaesthetised rats, DDA produced significant falls in mean arterial blood pressure (MAP) and heart rate in a dose-dependent manner with the maximum decrease of 37.6 +/- 2.6% and 18.1 +/- 4.8%, respectively. The ED50 value for MAP was 3.43 mmol kg-1. Pharmacological antagonist studies were done using this dose. The hypotensive action of DDA was not mediated through effects on the alpha-adrenoceptor, muscarinic cholinergic and histaminergic receptors, for it was not affected by phentolamine, atropine as well as pyrilamine and cimetidine. However, it seems to work via adrenoceptors, autonomic ganglia receptor and angiotensin-converting enzyme, since the hypotensive effect of DDA was negated or attenuated in the presence of propranolol, hexamethonium and captopril. In the isolated right atria, DDA caused negative chronotropic action and antagonised isoproterenol-induced positive chronotropic actions in a non-competitive and dose-dependent manner. These results further supported the bradycardia-inducing and beta-adrenoceptor antagonistic properties of DDA in vivo. PMID:9990649

  10. Morbidity of Chagas heart disease in the microregion of Rio Negro, Amazonian Brazil: a case-control study

    Directory of Open Access Journals (Sweden)

    Jose Rodrigues Coura

    2013-12-01

    Full Text Available A case-control study on the morbidity of Chagas heart disease was carried out in the municipality of Barcelos in the microregion of the Rio Negro, state of Amazonas. One hundred and six individuals, who were serologically positive for Trypanosoma cruzi infection, as confirmed by at least two techniques with different principles, were matched according to age and sex with an equal number of seronegative individuals. The cases and controls were evaluated using an epidemiological questionnaire and clinical, electrocardiograph and echocardiograph examinations. In the seroepidemiological evaluation, 62% of the interviewees recognised triatomines and most of them confirmed that they had seen these insects in the piassava plantations of the riverside communities of the Negro River tributaries. Of the seropositive patients, 25.8% affirmed that they had been stung by the triatomines and 11.7% denied having been stung. The principal clinical manifestations of the seropositive individuals were palpitations, chest pain and dyspnoea upon effort. Cardiac auscultation revealed extrasystoles, bradycardia and systolic murmurs. The electrocardiographic alterations were ventricular extrasystoles, left and right bundle branch block, atrioventricular block and primary T wave alterations. The echocardiogram was altered in 22.6% of the seropositive individuals and in 8.5% of the seronegative individuals.

  11. [Severe Japanese Spotted Fever Complicated by Acute Respiratory Failure in Kobe City].

    Science.gov (United States)

    Takiguchi, Junji; Okimura, Kenjiro; Ishii, Mariko; Okamura, Kayoko; Sakamoto, Hirokazu; Inamoto, Shinya; Ando, Shuji

    2016-03-01

    We report herein on a case of severe Japanese spotted fever complicated by acute respiratory failure in Kobe City. A 70-year-old female presenting with general malaise and systematic erythema was admitted to our hospital in June, 2013. From her history and physical examination, she was found to be suffering from scleroderma and mild interstitial pneumonia. From admission, the patient was noted to have a fever of 39 degrees C accompanied by relative bradycardia. Physical examination revealed a black eschar on her right leg, making us suspect rickettsial infection since Kobe City is not an area predisposed to Japanese spotted fever. Three days after admission, her condition worsened and treatment with minocycline and levofloxacin was initiated in accordance with the treatment protocol for Japanese spotted fever. The following day, the patient developed acute respiratory distress syndrome (ARDS) and was put on a respirator. She gradually recovered with the antibiotic treatment and was discharged from the hospital 23 days after admission. The diagnosis of Japanese spotted fever was confirmed by conducting a polymerase chain reaction test on the eschar. Japanese spotted fever is noted to occur in any place other than Kobe City. Late diagnoses may result in aggravated cases of Japanese spotted fever, with the possibility of developing ARDS as a complication. PMID:27197438

  12. Clinical and Epidemiological Characteristics of Scrub Typhus and Murine Typhus among Hospitalized Patients with Acute Undifferentiated Fever in Northern Vietnam.

    Science.gov (United States)

    Hamaguchi, Sugihiro; Cuong, Ngo Chi; Tra, Doan Thu; Doan, Yen Hai; Shimizu, Kenta; Tuan, Nguyen Quang; Yoshida, Lay-Myint; Mai, Le Quynh; Duc-Anh, Dang; Ando, Shuji; Arikawa, Jiro; Parry, Christopher M; Ariyoshi, Koya; Thuy, Pham Thanh

    2015-05-01

    A descriptive study on rickettsiosis was conducted at the largest referral hospital in Hanoi, Vietnam, to identify epidemiological and clinical characteristics of specific rickettsiosis. Between March 2001 and February 2003, we enrolled 579 patients with acute undifferentiated fever (AUF), excluding patients with malaria, dengue fever, and typhoid fever, and serologically tested for Orientia tsutsugamushi and Rickettsia typhi. Of the patients, 237 (40.9%) and 193 (33.3%) had scrub and murine typhus, respectively, and 149 (25.7%) had neither of them (non-scrub and murine typhus [non-ST/MT]). The proportion of murine typhus was highest among patients living in Hanoi whereas that of scrub typhus was highest in national or regional border areas. The presence of an eschar, dyspnea, hypotension, and lymphadenopathy was significantly associated with a diagnosis of scrub typhus (OR = 46.56, 10.90, 9.01, and 7.92, respectively). Patients with murine typhus were less likely to have these findings but more likely to have myalgia, rash, and relative bradycardia (OR = 1.60, 1.56, and 1.45, respectively). Scrub typhus and murine typhus were shown to be common causes of AUF in northern Vietnam although the occurrence of spotted fever group rickettsiae was not determined. Clinical and epidemiological information may help local clinicians make clinical diagnosis of specific rickettsioses in a resource-limited setting. PMID:25778504

  13. Spontaneous Rupture of an Adrenal Artery in Pregnancy: A Case Report

    Directory of Open Access Journals (Sweden)

    D. Bolla

    2012-01-01

    Full Text Available A spontaneous rupture of an adrenal artery is a rare cause of abdominal pain in pregnancy. We present a case of a pregnant woman who needed to be operated on because of a rupture of the right adrenal artery associated with a fetal bradycardia. An immediate caesarean section was performed. The intra-abdominal palpation identified an extensive retroperitoneal mass near the right kidney and a postoperative computer tomography confirmed an active bleeding near the kidney. For this reason our interventional radiology team, using a right femoral artery approach, performed a flush aortogram and identified the source of bleeding in the right adrenal artery. After two attempts, a coiling of the artery stopped the haemorrhage. The pathogenesis of arterial haemorrhage is still poorly understood although a possible cause could be the excess of hormones during pregnancy, which can lead to a significant arterial wall degeneration. In case of a retroperitoneal bleeding and if the patient is still haemodynamically stable, a transcatheter embolization using microcoils must be considered. This technique is nowadays safe and effective and can be performed within a short time with a lower risk of complications.

  14. Spontaneous rupture of an adrenal artery in pregnancy: a case report.

    Science.gov (United States)

    Bolla, D; Schyrba, V; Drack, G; Dietler, S; Hornung, R

    2012-01-01

    A spontaneous rupture of an adrenal artery is a rare cause of abdominal pain in pregnancy. We present a case of a pregnant woman who needed to be operated on because of a rupture of the right adrenal artery associated with a fetal bradycardia. An immediate caesarean section was performed. The intra-abdominal palpation identified an extensive retroperitoneal mass near the right kidney and a postoperative computer tomography confirmed an active bleeding near the kidney. For this reason our interventional radiology team, using a right femoral artery approach, performed a flush aortogram and identified the source of bleeding in the right adrenal artery. After two attempts, a coiling of the artery stopped the haemorrhage. The pathogenesis of arterial haemorrhage is still poorly understood although a possible cause could be the excess of hormones during pregnancy, which can lead to a significant arterial wall degeneration. In case of a retroperitoneal bleeding and if the patient is still haemodynamically stable, a transcatheter embolization using microcoils must be considered. This technique is nowadays safe and effective and can be performed within a short time with a lower risk of complications. PMID:23346435

  15. ECG changes during cerebral angiography; A comparison of low osmolality contrast media

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Directory of Open Access Journals (Sweden)

    Ingo Voigt

    2013-01-01

    Full Text Available 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 after suffering from an oncological disease. During breaking up of her household, the patches were saved by the patient. Not knowing the risk of this drug, he mistook it as a heat plaster. Investigations. Laboratory test showed an impaired renal function and metabolic acidosis. Urine drug test was negative at admittance and 12 h later. CCT scan presented a global hypoxic brain disease. Treatment and Outcome. The patient was discharged 30 days after admittance in a hemodynamic stable condition but a vegetative state and transferred to a rehabilitation center. Learning Points. With the ongoing increase in fentanyl patch prescriptions for therapeutic reasons, it is likely that misuse cases will become more relevant. Conventional urine drug screening tests are not able to exclude the diagnosis fentanyl intoxication. History taking should include family member's drug prescriptions.

  17. Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam.

    Science.gov (United States)

    das Neves, Jose Francisco Nunes Pereira; das Neves Araújo, Mariana Moraes Pereira; de Paiva Araújo, Fernando; Ferreira, Clarice Martins; Duarte, Fabiana Baeta Neves; Pace, Fabio Heleno; Ornellas, Laura Cotta; Baron, Todd H; Ferreira, Lincoln Eduardo Villela Vieira de Castro

    2016-01-01

    Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction. PMID:27108817

  18. USE OF DEXMEDETOMIDINE ALONG WITH BUPIVACAINE FOR BRACHIAL PLEXUS BLOCK

    Directory of Open Access Journals (Sweden)

    Rachana Gandhi

    2012-02-01

    Full Text Available Introduction: Supraclavicular brachial plexus block provides safe, effective, low cost anaesthesia with good postoperative analgesia. This study was conducted to compare the postoperative analgesic efficacy and safety of dexmedetomidine for brachial plexus blockade along with bupivacaine. Methodology: This prospective double blind study was conducted on 70 patients of age 18 to 60 years posted for various upper limb surgeries and randomly allocated into two equal groups of 35 each. Control group-C received injection bupivacaine (0.25% 38 milliliter plus 2 milliliter normal saline, dexmedetomidine group-D received injection bupivacaine (0.25% 38 milliliter plus dexmedetomidine 30 microgram (2 milliliter. Assessment of motor and sensory blockade, pulse, systolic blood pressure, respiration and side effects were noted every 5 minutes for first 30 minute and every 10 minute till end of surgery. Duration of analgesia and incidence of various complications following the procedure were observed. Results: It was observed that in control group onset of motor and sensory blockade was faster. Where as, dexmedetomidine group have better hemodynamic stability and greater postoperative analgesia. Only two cases of bradycardia and two cases of hypotension were noticed in dexmedetomidine group-D. [National J of Med Res 2012; 2(1.000: 67-69

  19. Tako-Tsubo syndrome in an anaesthetised patient undergoing arthroscopic knee surgery

    Directory of Open Access Journals (Sweden)

    Artukoglu Feyzi

    2008-01-01

    Full Text Available We present a case of stress-induced myocardial stunning, also known as tako-Tsubo syndrome, in an anaesthetised patient undergoing arthroscopic replacement of the cruciate ligament. The patient′s (44 y male, ASA class II had a history of hypertension with no other known disease. He underwent a femoral nerve block with 20 ml of 0.5% ropivacaine before receiving a balanced general anaesthesia (propofol induction, sevoflurane maintenance, 10 µg/kg sufentanil. Ten min after the beginning of surgery during endoscopic intra-articular manipulation, the patient suffered from bradycardia and hypotension; following the administration of ephedrine and atropine, he developed tachycardia, hypertension and ST segment depression. Subsequently, his systemic blood pressure dropped necessitating inotropic drug support and - later - intraaortic balloon counterpulsation; a TEE revealed no evidence of hypovolemia, anterior and antero-septal hypokinesia with an ejection fraction of 25%. Surgery was finished whilst stabilising the patient haemodynamically. Postoperative cardiac enzymes showed little elevation, an emergency coronary angiogram apical akinesia with typical ballooning and basal hyperkinesias, compatible with Tako-tsubo syndrome. The patient′s postoperative course was uneventful. We theorize that stress caused by sudden surgical pain stimulus (introduction of the endoscope into the articulation, superficial anaesthesia and insufficient analgesia created a stressful event which probably might have caused a catecholamine surge as basis of Tako-tsubo syndrome.

  20. The accuracy and side effects of pharmacologic stress thallium myocardial scintigraphy with adenosine triphosphate disodium (ATP) infusion in the diagnosis of coronary artery disease

    International Nuclear Information System (INIS)

    The diagnostic accuracy and side effects of pharmacologic stress thallium myocardial scintigraphy with ATP infusion were studied in 172 patients with or without coronary artery disease. ATP was infused for five minutes at a rate of 0.16 mg/kg/min (group A) or 0.18 mg/kg/min (group B) via antecubital vein. One hundred and eleven (67 of group A, 44 of group B) of 172 patients underwent coronary arteriography (CAG). In 111 patients received CAG, overall sensitivity, specificity and accuracy of this method were 88%, 84% and 87%, respectively. In 67 patients of group A, these were 92%, 81% and 90%. In 44 patients of group B, 79%, 87% and 82% were documented (NS, between groups A and B). Chest pain, flushing, bradycardia and ST depression were included in side effects caused by ATP infusion. At least one of these side effects were observed in 84% of the all 172 patients, 89% of group A and 75% of group B (NS). But, all of the side effects were spontaneously alleviated within two minutes without any therapy. In conclusion, pharmacologic stress myocardial scintigraphy with ATP infusion is very accurate and safe, and infusion rate of 0.16 mg/kg/min is optimal for this purpose. (author)

  1. Ca2+-Clock-Dependent Pacemaking in the Sinus Node Is Impaired in Mice with a Cardiac Specific Reduction in SERCA2 Abundance

    Science.gov (United States)

    Logantha, Sunil Jit R. J.; Stokke, Mathis K.; Atkinson, Andrew J.; Kharche, Sanjay R.; Parveen, Sajida; Saeed, Yawer; Sjaastad, Ivar; Sejersted, Ole M.; Dobrzynski, Halina

    2016-01-01

    Background: The sarcoplasmic reticulum Ca2+-ATPase (SERCA2) pump is an important component of the Ca2+-clock pacemaker mechanism that provides robustness and flexibility to sinus node pacemaking. We have developed transgenic mice with reduced cardiac SERCA2 abundance (Serca2 KO) as a model for investigating SERCA2's role in sinus node pacemaking. Methods and Results: In Serca2 KO mice, ventricular SERCA2a protein content measured by Western blotting was 75% (P clock with 2 μM ryanodine induced bradycardia that was less pronounced in Serca2 KO preparations (9 ± 1% vs. 20 ± 3% in Serca2 FF; P clock. Mathematical modeling was used to dissect the effects of membrane- and Ca2+-clock components on Serca2 KO mouse heart rate and sinus node action potential. Computer modeling predicted a slowing of heart rate with SERCA2 downregulation and the heart rate slowing was pronounced at >70% reduction in SERCA2 activity. Conclusions: Serca2 KO mice show a disrupted Ca2+-clock-dependent pacemaker mechanism contributing to impaired sinus node and atrioventricular node function.

  2. A Thoracic Mechanism of Mild Traumatic Brain Injury Due to Blast Pressure Waves

    CERN Document Server

    Courtney, Amy; 10.1016/j.mehy.2008.08.015

    2008-01-01

    The mechanisms by which blast pressure waves cause mild to moderate traumatic brain injury (mTBI) are an open question. Possibilities include acceleration of the head, direct passage of the blast wave via the cranium, and propagation of the blast wave to the brain via a thoracic mechanism. The hypothesis that the blast pressure wave reaches the brain via a thoracic mechanism is considered in light of ballistic and blast pressure wave research. Ballistic pressure waves, caused by penetrating ballistic projectiles or ballistic impacts to body armor, can only reach the brain via an internal mechanism and have been shown to cause cerebral effects. Similar effects have been documented when a blast pressure wave has been applied to the whole body or focused on the thorax in animal models. While vagotomy reduces apnea and bradycardia due to ballistic or blast pressure waves, it does not eliminate neural damage in the brain, suggesting that the pressure wave directly affects the brain cells via a thoracic mechanism. ...

  3. Percutaneous transvenous packing of cavernous sinus with Onyx for cavernous dural arteriovenous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Lv Xianli [Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Chongwen, Beijing 100050 (China); Jiang Chuhan [Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Chongwen, Beijing 100050 (China)], E-mail: lvxianli000@163.com; Li Youxiang; Wu Zhongxue [Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Chongwen, Beijing 100050 (China)

    2009-08-15

    Objective: The aim of this study is to describe the technique and results of the transvenous approach for occlusion of cavernous dural arteriovenous fistulas (DAVFs) with Onyx. Methods: Eleven patients presenting with clinically symptomatic DAVFs, were treated between August 2005 and February 2007 at Beijing Tiantan Hospital. We were able to navigate small hydrophilic catheters and microguidwires through the facial vein or inferior petrosal sinus (IPS) into the ipsilateral cavernous sinus. After reaching the fistula site the cavernous sinus was packed with Onyx or combining with detachable platinum coils. Results: We were able to reach the fistula site and to achieve a good packing of Onyx or combining with coils within the arteriovenous shunting zone in 10 patients. The final angiogram showed complete occlusion of the arteriovenous fistula. Two (18.2%) patients developed a bradycardia during DMSO injection. No complications related to the approach were observed. Conclusions: Transvenous occlusion of cavernous DAVFs is a feasible approach, even via facial vein or via IPS. Onyx may be another option for cavernous packing other than detachable platinum coils.

  4. Percutaneous transvenous packing of cavernous sinus with Onyx for cavernous dural arteriovenous fistula

    International Nuclear Information System (INIS)

    Objective: The aim of this study is to describe the technique and results of the transvenous approach for occlusion of cavernous dural arteriovenous fistulas (DAVFs) with Onyx. Methods: Eleven patients presenting with clinically symptomatic DAVFs, were treated between August 2005 and February 2007 at Beijing Tiantan Hospital. We were able to navigate small hydrophilic catheters and microguidwires through the facial vein or inferior petrosal sinus (IPS) into the ipsilateral cavernous sinus. After reaching the fistula site the cavernous sinus was packed with Onyx or combining with detachable platinum coils. Results: We were able to reach the fistula site and to achieve a good packing of Onyx or combining with coils within the arteriovenous shunting zone in 10 patients. The final angiogram showed complete occlusion of the arteriovenous fistula. Two (18.2%) patients developed a bradycardia during DMSO injection. No complications related to the approach were observed. Conclusions: Transvenous occlusion of cavernous DAVFs is a feasible approach, even via facial vein or via IPS. Onyx may be another option for cavernous packing other than detachable platinum coils.

  5. An unusual case of loss of consciousness: when an epileptic brain let the heart slow down

    Directory of Open Access Journals (Sweden)

    Giovanni Assenza

    2012-03-01

    Full Text Available The differential diagnosis of an episode of transient loss of consciousness can be sometimes very tricking, in particular when symptoms peculiar of syncope are mixed with focal neurological symptoms. We report the case of a 54-year-old woman who suddenly claimed, during a polygraphic recording (electroencephalography/electrocardiogram, a feeling of fear and tachycardia followed by loss of consciousness and then a tonic posturing of the left limbs. Polygraphic recording showed a critical electroencephalographic pattern starting from left temporo-zygomatic channels followed after few seconds by a sudden slowing of cortical background activity associated with an episode of asystole, as witnessed simultaneously by electrocardiogram. Muscular activity covered electroencephalographic activity of following minutes. This case provides an opportunity to highlight the existence of rare conditions such as ictal arrhythmias which should be considered in the differential diagnosis of episodes of transient loss of consciousness in particular when dysautonomic and neurological symptoms are intermingled. Autonomic symptoms (vomiting, tachycardia, cyanosis, bradycardia and asystole may be also more frequent in idiopathic (more rarely symptomatic epilepsies of childhood (Panayiotopoulos syndrome.

  6. Increased cardiac sympathetic activity in patients with hypothyroidism as determined by iodine-123 metaiodobenzylguanidine scintigraphy

    International Nuclear Information System (INIS)

    Clinical manifestations of hypothyroidism, such as bradycardia, suggest decreased sympathetic tone. However, previous studies in patients with hypothyroidism have suggested that increased plasma noradrenaline (NA) levels represent enhanced general sympathetic activity. As yet, cardiac sympathetic activity (CSA) in hypothyroidism has not been clarified. To evaluate CSA in patients with hypothyroidism, iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy was performed in eight patients with hypothyroidism before therapy and in ten normal control patients. Planar images were obtained at 15 min and 4 h after injection of MIBG. The ratio of early myocardial uptake to the total injected dose (MU) and myocardial clearance of MIBG within 4 h p.i. (MC) were calculated. Plasma NA was also measured, and echocardiography was performed in all patients. Those patients with hypothyroidism in the euthyroid state after medical therapy were also evaluated in a similar manner. Left ventricular ejection fraction, measured by echocardiography, did not differ significantly between the groups. NA, MU and MC were significantly higher in patients with hypothyroidism than in controls, and all parameters were decreased after therapy. MC was well correlated with NA in hypothyroidism (r=0.86) before therapy. We conclude that CSA is increased in patients with hypothyroidism, in parallel with the enhanced general sympathetic activity. (orig.). With 4 figs., 2 tabs

  7. [Complications of low-dose amiodarone].

    Science.gov (United States)

    Feigl, D; Gilad, R; Katz, E

    1991-11-15

    Complications of low-dose amiodarone in 83 patients, in whom the drug was effective and who were followed for 1-13 years, are presented. Hypothyroidism was diagnosed in 11 (in 8 by the finding of elevated TSH). In 2 of the 3 in whom clinical signs of hypothyroidism were evident, amiodarone was continued, but thyroxine was also given. In 5 others thyrotoxicosis ensued. Propylthiouracil (PTU) was given and amiodarone was discontinued. PTU was then stopped within 4-8 months, without recurrence of the hyperthyroidism. In 1 patient pneumonitis resolved spontaneously a few weeks after stopping amiodarone. Because of gastrointestinal distress amiodarone was stopped in 1 patient. In none were liver enzymes elevated, nor was the nervous system affected clinically. Photosensitivity in 6 patients and skin discoloration in 2 did not necessitate discontinuation of the drug. Blurred vision was reported by 4, but its connection with amiodarone was not proven. There was sinus bradycardia in 2. There was no arrhythmic effect of amiodarone seen on ECG nor on Holter monitoring, nor was there any mortality. We conclude that amiodarone in low doses causes many complications, most of them mild and transient. However, in only a few cases is discontinuation of the drug indicated. PMID:1752553

  8. Comparison of three different formulations of local anaesthetics for cervical epidural anaesthesia during thyroid surgery

    Directory of Open Access Journals (Sweden)

    Gaurav Jain

    2012-01-01

    Full Text Available Background: To compare the efficacy and safety of local anaesthetics under cervical epidural anaesthesia (CEA using lignocaine (1%, bupivacaine (0.25% and ropivacaine (0.5% for thyroid surgery. Methods: In a prospective, randomized fashion, 81 patients were selected for thyroid surgery under CEA. They were assigned to one of three groups: Group L, B and R to receive 10 mL of 1% lignocaine, 0.25% bupivacaine and 0.5% ropivacaine, respectively. We compared their efficacy in terms of pulmonary and haemodynamic parameters, blockade quality and complications. Results: Of the total, 74 patients completed the study successfully. Sensory block attained the median dermatomal range of C2-T4/T5 in all the groups. Motor block was more pronounced in the ropivacaine group. Cardiorespiratory parameters decreased significantly in all the groups; however, none of the patients had any major complications except for bradycardia in two patients. Among the measured variables, the decrease in heart rate and peak expiratory force was more in the lignocaine group while forced vital capacity and forced expiratory volume at 1 sec declined to a greater extent in the ropivacaine group. The lignocaine group required significantly more epidural top-ups compared with the other two groups. Conclusion: We conclude that cervical epidural route can be safely used for surgery on thyroid gland in patients with normal cardiorespiratory reserve, using either of local anaesthetics chosen for our study. Under the selected dose and concentrations, the decrease in cardiorespiratory parameters was lesser with bupivacaine.

  9. The hemodynamic effects of spinal block with low dose of bupivacaine and sufentanil in patients with low myocardial ejection fraction.

    Directory of Open Access Journals (Sweden)

    Mehdi Sanatkar

    2013-07-01

    Full Text Available The aim of this study was to assess the effect of spinal block with low dose of bupivacaine and sufentanil on patients with low cardiac output who underwent lower limb surgery. Fifteen patients who had ejection fraction less than 40% (group 1 were compared with 65 cases with ejection fraction more than 40% (group 2 in our study. Our subjects underwent spinal block with 7.5 mg hyperbaric bupivacaine 0.5% and 5 µg sufentanil. We recorded early events such as hypotension, bradycardia, vasopressor need and ST segment change in our cases. The average mean arterial pressure decreased 13% (110 mmHg to 95.7 mmHg in group 1 and 20% (160 mmHg to 128 mmHg in group 2 (P<0.001. Hypotension due to spinal anesthesia was observed in none of our subjects in both groups and none of our cases need to vasopressor support. All patients remained alert, and no ST segment changes were observed in two groups. In our study none of subjects complained of pain intraoperatively. The subjects were without complaints during the spinal anesthetic in both groups. Spinal block with low dose local anesthetic and sufentanil was a safe and effective method for lower limb surgery in patients with low ejection fraction.

  10. Management of the trigeminocardiac reflex: Facts and own experience

    Directory of Open Access Journals (Sweden)

    Arasho Belachew

    2009-01-01

    Full Text Available The trigeminocardiac reflex (TCR is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hyper-motility during stimulation of any of the sensory branches of the trigeminal nerve. The proposed mechanism for the development of TCR is-the sensory nerve endings of the trigeminal nerve send neuronal signals via the Gasserian ganglion to the sensory nucleus of the trigeminal nerve, forming the afferent pathway of the reflex arc. It has been demonstrated that the TCR may occur with mechanical stimulation of all the branches of the trigeminal nerve anywhere along its course (central or peripheral. The reaction subsides with cessation of the stimulus. But, some patients may develop severe bradycardia, asystole, and arterial hypotension which require intervention. The risk factors already known to increase the incidence of TCR include: Hypercapnia; hypoxemia; light general anesthesia; age (more pronounced in children; the nature of the provoking stimulus (stimulus strength and duration; and drugs: Potent narcotic agents (sufentanil and alfentanil; beta-blockers; and calcium channel blockers. Because of the lack of full understanding of the TCR physiology, the current treatment options for patients with TCR include: (i risk factor identification and modification; (ii prophylactic measures; and (iii administration of vagolytic agents or sympathomimetics.

  11. Hemodynamic alterations in chronically conscious unrestrained diabetic rats

    International Nuclear Information System (INIS)

    Important cardiovascular dysfunctions have been described in streptozotocin (STZ)-diabetic rats. To determine the influence of these changes on the hemodynamic state and whether insulin treatment can avoid them, different hemodynamic parameters, obtained by the thermodilution method, were studied in STZ-induced (65 mg/kg) diabetic male Wistar rats, as well as in age-control, weight-control, and insulin-treated diabetic ones. Plasma volume was measured by dilution of radioiodinated (125I) human serum albumin. All rats were examined in the conscious, unrestrained state 12 wk after induction of diabetes or acidified saline (pH 4.5) injection. At 12 wk of diabetic state most important findings were normotension, high blood volume, bradycardia, increase in stroke volume, cardiac output, and cardiosomatic ratio, and decrease in total peripheral resistance and cardiac contractility and relaxation (dP/dt/sub max/ and dP/dt/sub min/ of left ventricular pressure curves). The insulin-treated diabetic rats did not show any hemodynamic differences when compared with the control animals. These results suggest that important hemodynamic alterations are present in the chronic diabetic states, possibly conditioning congestive heart failure. These alterations can be prevented by insulin treatment

  12. Non-invasive anesthesia for children undergoing proton radiation therapy

    International Nuclear Information System (INIS)

    Background: Proton therapy is a newer modality of radiotherapy during which anesthesiologists face specific challenges related to the setup and duration of treatment sessions. Purpose: Describe our anesthesia practice for children treated in a standalone proton therapy center, and report on complications encountered during anesthesia. Materials and methods: A retrospective review of anesthetic records for patients ⩽18 years of age treated with proton therapy at our institution between January 2006 and April 2013 was performed. Results: A total of 9328 anesthetics were administered to 340 children with a median age of 3.6 years (range, 0.4–14.2). The median daily anesthesia time was 47 min (range, 15–79). The average time between start of anesthesia to the start of radiotherapy was 7.2 min (range, 1–83 min). All patients received Total Intravenous Anesthesia (TIVA) with spontaneous ventilation, with 96.7% receiving supplemental oxygen by non-invasive methods. None required daily endotracheal intubation. Two episodes of bradycardia, and one episode each of; seizure, laryngospasm and bronchospasm were identified for a cumulative incidence of 0.05%. Conclusions: In this large series of children undergoing proton therapy at a freestanding center, TIVA without daily endotracheal intubation provided a safe, efficient, and less invasive option of anesthetic care

  13. Comparison of hemodynamic responses to dexmedetomidine versus esmolol in patients undergoing beating heart surgery

    Directory of Open Access Journals (Sweden)

    Mohamed Abdel Rahman Salem M.D,* Mostafa Elhamamsy M.D

    2001-09-01

    Full Text Available adrenergic agonists decrease sympathetic tone with ensuing attenuation of neuroendocrine and hemodynamic responses to anesthesia and surgery. Also, administration of beta -adrenergic antagonists contributes to prophylaxis against hypertension, tachycardia and myocardial ischemia and myocardial protection during cardiac surgery. The effects of dexmedetomidine (DEX, a highly specific alpha -adrenergic agonist, on these responses have not yet been fully reported in patients undergoing cardiac surgery. Esmolol (ESM is a cardioselective, short-acting -blocking agent. Previous studies have established the effectiveness of esmolol in the reduction of hemodynamic responses during anesthetic induction. Aim: The study of hemodynamic responses of dexmedetomidine and esmolol and their effects on the anesthetic requirements during anesthesia in beating heart surgery. Methods: Forty patients scheduled for elective beating heart surgery received a !thereaf"#$%!&'" end of surgery in the ESM group. Total intravenous anesthesia using fentanyl, cisatracurium a"( -* +of surgery. Hemodynamics measured included heart rate, mean arterial pressure, filling pressures, cardiac index, systemic and pulmonary vascular resistances. The incidence of hypotension, hypertension, tachycardia, bradycardia, dysrhythmias, ST segment changes, total anesthetics requirements, muscle rigidity and postoperative shivering were recorded. Results: #$%",-.&/ 0*! 0 ! l/min/m ( 1 ! + 2

  14. Role of the anterior region of the third ventricle in the cardiovascular responses produced by systemic injection of a nitric oxide synthase inhibitor

    Science.gov (United States)

    Lewis, S. J.; Whalen, E. J.; Beltz, T. G.; Johnson, A. K.

    1999-01-01

    This study examined whether a prior electrolytic lesion of the tissue surrounding the anteroventral third ventricle (AV3V) would affect the increase in mean arterial blood pressure (MAP) and the fall in heart rate (HR) produced by systemic injection of the nitric oxide synthesis (NOS) inhibitor, NG-nitro-L-arginine methyl ester (L-NAME; 25 micromol/kg, i.v.) in conscious rats. L-NAME produced a smaller increase in MAP in AV3V-lesion than in sham-lesion rats (+19+/-3 vs. +40+/-3 mmHg, respectively; P<0.05). In contrast, L-NAME produced similar falls in HR in the AV3V-lesion and sham-lesion rats (-103+/-15 vs. -97+/-8 bpm, respectively; P<0.05). These findings demonstrate that the L-NAME-induced pressor response is dependent upon the integrity of the AV3V region, whereas the L-NAME-induced bradycardia is not. Copyright 1999 Elsevier Science B. V.

  15. Melodic algorithms for pulse oximetry to allow audible discrimination of abnormal systolic blood pressures.

    Science.gov (United States)

    Chima, Ranjit S; Ortega, Rafael; Connor, Christopher W

    2014-12-01

    An anesthesiologist must remain vigilant of the patient's clinical status, incorporating many independent physiological measurements. Oxygen saturation and heart rate are represented by continuous audible tones generated by the pulse oximeter, a mandated monitoring device. Other important clinical parameters--notably blood pressure--lack any audible representation beyond arbitrarily-configured threshold alarms. Attempts to introduce further continuous audible tones have apparently foundered; the complexity and interaction of these tones have exceeded the ability of clinicians to interpret them. Instead, we manipulate the tonal and rhythmic structure of the accepted pulse oximeter tone pattern melodically. Three melodic algorithms were developed to apply tonal and rhythmic variations to the continuous pulse oximeter tone, dependent on the systolic blood pressure. The algorithms distort the original audible pattern minimally, to facilitate comprehension of both the underlying pattern and the applied variations. A panel of anesthesia practitioners (attending anesthesiologists, residents and nurse anesthetists) assessed these algorithms in characterizing perturbations in cardiopulmonary status. Twelve scenarios, incorporating combinations of oxygen desaturation, bradycardia, tachycardia, hypotension and hypertension, were tested. A rhythmic variation in which additional auditory information was conveyed only at halftime intervals, with every other "beat" of the pulse oximeter, was strongly favored. The respondents also strongly favored the use of musical chords over single tones. Given three algorithms of tones embedded in the pulse oximeter signal, anesthesiologists preferred a melodic tone to signal a significant change in blood pressure. PMID:24474369

  16. Ultrasound-Guided Transesophageal High-Intensity Focused Ultrasound Cardiac Ablation in a Beating Heart: A Pilot Feasibility Study in Pigs.

    Science.gov (United States)

    Bessiere, Francis; N'djin, W Apoutou; Colas, Elodie Constanciel; Chavrier, Françoise; Greillier, Paul; Chapelon, Jean Yves; Chevalier, Philippe; Lafon, Cyril

    2016-08-01

    Catheter ablation for the treatment of arrhythmia is associated with significant complications and often-repeated procedures. Consequently, a less invasive and more efficient technique is required. Because high-intensity focused ultrasound (HIFU) enables the generation of precise thermal ablations in deep-seated tissues without harming the tissues in the propagation path, it has the potential to be used as a new ablation technique. A system capable of delivering HIFU into the heart by a transesophageal route using ultrasound (US) imaging guidance was developed and tested in vivo in six male pigs. HIFU exposures were performed on atria and ventricles. At the time of autopsy, visual inspection identified thermal lesions in the targeted areas in three of the animals. These lesions were confirmed by histologic analysis (mean size: 5.5 mm(2) × 11 mm(2)). No esophageal thermal injury was observed. One animal presented with bradycardia due to an atrio-ventricular block, which provides real-time confirmation of an interaction between HIFU and the electrical circuits of the heart. Thus, US-guided HIFU has the potential to minimally invasively create myocardial lesions without an intra-cardiac device. PMID:27158083

  17. A case of Lassa fever: experience at St Thomas's Hospital.

    Science.gov (United States)

    Cooper, C B; Gransden, W R; Webster, M; King, M; O'Mahony, M; Young, S; Banatvala, J E

    1982-01-01

    An 18-year-old Nigerian girl, normally resident in Jos, was admitted to hospital for five days before she was diagnosed as having Lassa fever. There were several atypical features in the early stages of here illness, notably the absence of prostration, pharyngitis, or bradycardia and the development of appreciable leucocytosis. Consequent control and surveillance measures required checks for 21 days on 173 people who had had contact with as first line if they had handled her or specimens without taking precautions to avoid direct skin contact with her excretions, secretions, and blood; other contacts were categorised as second line. During her time in hospital she was managed in a single room on a general ward. She visited a number of investigative departments within the hospital, and her specimens were examined in five clinical laboratories. Despite this no secondary cases occurred among either first- or second-line contacts, and there was no serological evidence of subclinical infection among any of the contacts tested (159 people). PMID:6812717

  18. Heart risk associated with weight loss in anorexia nervosa and eating disorders: risk factors for QTc interval prolongation and dispersion.

    Science.gov (United States)

    Swenne, I; Larsson, P T

    1999-03-01

    Risk factors for QTc interval prolongation and dispersion, indicators of an increased risk for cardiac arrhythmia and sudden death, have been investigated in patients with eating disorders (ED) and ongoing weight loss. Patients were characterized with regard to weight, body mass index (BMI; weight/length2), duration of weight loss, rate of weight loss and rate of weight loss immediately preceding examination. At examination, a 12-lead electrocardiographic (ECG) registration and blood samples for analysis of serum electrolytes were obtained. In total, 92 examinations in 58 female patients aged 15.5+/-1.7 (mean +/- SD) y were analysed. Control ECG recordings were obtained from 38 normal-weight teenage girls with no known heart disease. Patients with ED weighed 40.7+/-7.8 kg, corresponding to BMI 15.2+/-2.4 kg/m2 following a weight loss of 11.8+/-6.5 kg. In ED patients, the ECG showed bradycardia, a shift to the right of the QRS axis, diminished amplitudes of the QRS complex and T wave, and prolongation and increased dispersion of the QTc interval. In multiple regression analyses low weight, low BMI and rapid weight loss immediately preceding the examination were the most important independent predictors of QTc interval prolongation and dispersion. It is concluded that an ECG examination is an important part of the assessment of patients with ED and ongoing weight loss, even in the absence of electrolyte disturbances, and especially if the patient is severely underweight or weight loss is rapid. PMID:10229042

  19. Intravenous but not perineural clonidine prolongs postoperative analgesia after psoas compartment block with 0.5% levobupivacaine for hip fracture surgery.

    LENUS (Irish Health Repository)

    Mannion, Stephen

    2012-02-03

    We evaluated the systemic and local effects of clonidine as an analgesic adjunct to psoas compartment block (PCB) with levobupivacaine. In a randomized, prospective, double-blind trial, 36 patients requiring hip fracture surgery received PCB and general anesthesia. Patients were randomized into three groups. Each patient received PCB with 0.4 mL\\/kg of levobupivacaine 0.5%. The control group (group L) received IV saline, the systemic clonidine group (group IC) received IV clonidine 1 mug\\/kg, and the peripheral clonidine group (group C) received IV saline and PCB with clonidine 1 microg\\/kg. The interval from time of completion of block injection to first supplementary analgesic administration was longer in group IC compared with group L (mean +\\/- sd, 13.4 +\\/- 6.1 versus 7.3 +\\/- 3.6 h; P = 0.03). There was no difference between group C and group L (10.3 +\\/- 5.9 versus 7.3 +\\/- 3.6 h; P > 0.05). The groups were similar in terms of 24 h cumulative morphine and acetaminophen consumption. There were no significant differences among groups regarding postoperative adverse effects (bradycardia, hypotension, sedation, and nausea). We conclude that IV but not perineural clonidine (1 microg\\/kg) prolongs analgesia after PCB without increasing the incidence of adverse effects.

  20. Nodular Regenerative Hyperplasia of Liver Mimicking Cirrhosis:a Case Report

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    A 34-year-old man with no history of any abdominal pain or fatigue was admitted to our hospital in June 2008 due to the cirrhosis found incidentally during a physical examination. Laboratory examination, electrocardiograph, abdominal ultrasonography and magnetic resonance imaging were carried out during his hospitalization. However, according to the results of the above measures, the diagnosis of nodular regenerative hyperplasia of the liver (NRHL) could not be made. The result of electrocardiograph showed there was no sinus bradycardia. The abdominal ultrasonography showed evidence of hepatosplenomegaly, and magnetic resonance imaging showed multiple non-enhancing hepatic nodules. Histologic conifrmation was available by means of liver biopsy and the deifnitive diagnosis of NRHL was conifrmed histologically by liver biopsy. NRHL always presents with signs of portal hypertension with little evidence of obvious liver disease, NRHL may mimick the cirrhosis of liver and be easily confused with cirrhosis of the liver nodules, so liver biopsy should be recommended for correct diagnosis. The clinical, radiological and pathologic features of this case with NRHL was reported in order to familiarize the physicians with its clinical manifestations.

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

    Science.gov (United States)

    Ayzenberg, Ilya; Hoepner, Robert; Kleiter, Ingo

    2016-01-01

    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. PMID:26929636

  2. Design of the Pacemaker REmote Follow-up Evaluation and Review (PREFER trial to assess the clinical value of the remote pacemaker interrogation in the management of pacemaker patients

    Directory of Open Access Journals (Sweden)

    Johnson W Ben

    2008-04-01

    Full Text Available Abstract Background Although pacemakers are primarily used for the treatment of bradycardia, diagnostic data available in current pacemakers allow them to be also used as sophisticated, continuous monitoring devices. Easy access to these stored data may assist clinicians in making diagnostic and therapeutic decisions sooner, thus avoiding potential long-term sequelae due to untreated clinical disorders. Internet-based remote device interrogation systems provide clinicians with frequent and complete access to stored data in pacemakers. In addition to monitoring device function, remote monitors may be a helpful tool in assisting physicians in the management of common arrhythmia disorders. Methods The Pacemaker REmote Follow-up Evaluation and Review (PREFER trial is a prospective, randomized, parallel, unblinded, multicenter, open label clinical trial to determine the utility of remote pacemaker interrogation in the earlier diagnosis of clinically actionable events compared to the existing practice of transtelephonic monitoring. There have been 980 patients enrolled and randomized to receive pacemaker follow up with either remote interrogation using the Medtronic CareLink® Network (CareLink versus the conventional method of transtelephonic monitoring (TTM in addition to periodic in-person interrogation and programming evaluations. The purpose of this manuscript is to describe the design of the PREFER trial. The results, to be presented separately, will characterize the number of clinically actionable events as a result of pacemaker follow-up using remote interrogation instead of TTM. Trial registration ClinicalTrials.gov: NCT00294645.

  3. Endogenous vasopressin and the central control of heart rate during dynamic exercise

    Directory of Open Access Journals (Sweden)

    L.C. Michelini

    1998-09-01

    Full Text Available The present article contains a brief review on the role of vasopressinergic projections to the nucleus tractus solitarii in the genesis of reflex bradycardia and in the modulation of heart rate control during exercise. The effects of vasopressin on exercise tachycardia are discussed on the basis of both the endogenous peptide content changes and the heart rate response changes observed during running in sedentary and trained rats. Dynamic exercise caused a specific vasopressin content increase in dorsal and ventral brainstem areas. In accordance, rats pretreated with the peptide or the V1 blocker into the nucleus tractus solitarii showed a significant potentiation or a marked blunting of the exercise tachycardia, respectively, without any change in the pressure response to exercise. It is proposed that the long-descending vasopressinergic pathway to the nucleus tractus solitarii serves as one link between the two main neural controllers of circulation, i.e., the central command and feedback control mechanisms driven by the peripheral receptors. Therefore, vasopressinergic input could contribute to the adjustment of heart rate response (and cardiac output to the circulatory demand during exercise.

  4. Gas chromatographic mass analysis and further pharmacological actions of Cymbopogon proximus essential oil.

    Science.gov (United States)

    Al-Taweel, A M; Fawzy, G A; Perveen, S; El Tahir, K E H

    2013-09-01

    The present study reports Gas chromatographic mass analysis (GC-MS) as well as important biological activities of Cymbopogon proximus essential oil. The chemical composition of the essential oil of Cymbopogon proximus was investigated by GC-MS. Furthermore, the effects of Cymbopogon proximus essential oil on the cardiac parasympathetic ganglia in rats, the intra-tracheal pressure in guinea-pigs and on carrageenan-induced inflammation in the rats paw, were studied. The GC-MS study led to the identification of 22 components with Piperitone representing (73.81%), Elemol (9.32%), alpha-Eudesmol (5.21%) and alpha-Terpineol (3.01%) of the oils composition. The percentage protective effect of the oil on the vagus-induced bradycardia in rats was 90.1±3.1%, which represents a significant protection. As for the effect of Cymbopogon oil on bronchoconstrictors-induced increase in intra-tracheal pressure in guinea-pigs, the oil antagonized the actions of 5-HT and histamine by 80±3.7 and 93±8.3%, respectively. Pharmacological investigations using Cymbopogon oil revealed its inherent ability to possess a bronchodilator activity mediated via blockade of both histamine and serotonin receptors. It possessed a significant ganglionic blocking action and a limited anti-inflammatory activity that seemed to involve blockade of histamine and serotonin receptors in the rats' paws. PMID:23780497

  5. Valsalva maneuver: shortest optimal expiratory strain duration

    Directory of Open Access Journals (Sweden)

    Ramesh K. Khurana, Md

    2011-07-01

    Full Text Available Purpose : To quantitate the level of difficulty and determine consistency of hemodynamic responses with various expiratory strain (ES durations. Methods : Thirty-four healthy subjects performed the Valsalva maneuver (VM with an ES duration of 10, 12, and 15 seconds in random order. Level of difficulty after each trial was rated 1 to 10, with 10 being the most difficult. Blood pressure and heart rate (HR were recorded continuously and non-invasively. Parameters studied were Valsalva ratio (VR, early phase II (IIE, late phase II (IIL, tachycardia latency (TL, bradycardia latency (BL, and overshoot latency (OV-L. Consistency of responses was calculated. Results : Difficulty increased significantly with increased ES duration: 5.1±0.1 (mean±SEM at 10 seconds, 5.9±0.1 at 12 seconds, and 6.8±0.1 at 15 seconds (p<0.001. Phase IIE, TL, BL, OV-L, and VR response did not differ statistically with increasing ES durations, and there were no differences in variability. Phase IIL response increased significantly with increasing ES duration. Phase IIL was poorly delineated in 14 of 102 trials with 10 seconds ES duration. Conclusions : ES duration of 10 seconds created a low level of difficulty in healthy individuals. This strain duration produced consistent hemodynamic response for all parameters tested except IIL phase. The absence of IIL phase with 10 seconds ES should not be interpreted as an indicator of sympathetic vasoconstrictor failure.

  6. SPINAL ANAESTHESIA VERSUS GENERAL ANAESTHESIA FOR LAPAROSCOPIC CHOLECYSTECTOMY - A PROSPECTIVE RANDOMIZED CONTROLLED STUDY

    Directory of Open Access Journals (Sweden)

    Prasad

    2014-02-01

    Full Text Available INTRODUCTION: Combining minimal invasive surgical and lesser invasive anesthesia technique reduces morbidity and mortality. The aim of the study is to compare spinal anesthesia with the gold standard general anesthesia for elective laparoscopic cholecystectomy. MATERIALS & METHODS: 60 healthy patients were randomized under spinal anesthesia (n=30 & General Anesthesia (n=30 . Hyperbaric 3ml bupivacaine plus 25mcg fenta nyl was administered for spinal group and conventional general anesthesia for GA group. Intraoperative parameters and post - operative pain and recovery were noted. Under spinal group any intraoperative discomfort were taken care by reassurance , drugs or con verted to GA. Questionnaire forms were provided for patients and surgeons to comment about the operation. RESULTS: None of the patients had significant hemodynamic and respiratory disturbance except for transient hypotension and bradycardia. Operative time was comparable. 6patients under spinal anesthesia had right shoulder pain , 2 patients were converted to GA and 4 patients were managed by injection midazolam and infiltration of lignocaine over the diaphragm. There was significant post - operative pain reli ef in spinal group. All the patients were comfortable and surgeons satisfied. CONCLUSION: Spinal anesthesia is adequate and safe for laparoscopic cholecystectomy in otherwise healthy patients and offers better postoperative pain control than general anesth esia without limiting recovery , but require cooperative patient , skilled surgeon , a gentle surgical technique and an enthusiastic anesthesiologist

  7. Pneumothorax and Pneumomediastinum in Pregnancy: A Case Report

    Directory of Open Access Journals (Sweden)

    S. Sathiyathasan

    2009-01-01

    Full Text Available Case Report. A 37 years old patient at 40 weeks gestation presented with acute severe hypoxia with a seizure followed by fetal bradycardia. Caesarean section was performed under GA and she was intubated and ventilated. History revealed longstanding right pleural endometriosis with multiple pneumothoraces and hydrothoraces. A CT chest showed extensive bilateral pnenumothoraces. Her clinical condition improved with a left-sided chest drain. Discussion. Severe hypoxia and seizures in a patient with previous history of pnenumothorax are highly suggestive of tension pneumothorax. Radiological investigations are vital for diagnosis. The traditional treatment approach to recurrent pneumothorax has been thorocotomy with bleb or bulla resection and pleurodeisis. The advantages of thorocoscopic surgical treatment over thorocotomy are decreased time of exposure to anaesthetic drugs, rapid lung expansion, decreased post operative pain, and a potentially shorter post operative recovery. In any future pregnancy due to the high risk of recurrence of pneumothorax Contemporary obstetric management should determine the method of delivery and continuous lumbar/epidural anesthesia should be used if at all feasible. Preconceptual counseling about this risk is vital, and women must be advised about potential serious adverse outcomes.

  8. Pacing the right ventricular outflow tract septum: time to embrace the future.

    Science.gov (United States)

    Hillock, Richard J; Mond, Harry G

    2012-01-01

    Transvenous pacing has revolutionized the management of patients with potentially life-threatening bradycardias and at its most basic level ensures rate support to maintain cardiac output. However, we have known for at least a decade that pacing from the right ventricle (RV) apex can induce left ventricle (LV) dysfunction, atrial fibrillation, heart failure, and maybe an increased mortality. Although pacemaker manufacturers have developed successful pacing algorithms designed to minimize unnecessary ventricular pacing, it cannot be avoided in a substantial proportion of pacemaker-dependent patients. Just as there is undoubted evidence that RV apical pacing is injurious, there is emerging evidence that pacing from the RV septum is associated with a shorter duration of activation, improved haemodynamics, and less LV remodelling. The move from traditional RV apical pacing to RV septal pacing requires a change in mindset for many practitioners. The anatomical landmarks and electrocardiograph features of RV septal pacing are well described and easily recognized. While active fixation is required to place the lead on the septum, shaped stylets are now available to assist the implanter. In addition, concerns about the stability and longevity of steroid-eluting active fixation leads have proven to be unfounded. We therefore encourage all implanters to adopt RV septal pacing to minimize the potential of harm to their patients. PMID:21846639

  9. [Pulmonary circulation in embolic pulmonary edema].

    Science.gov (United States)

    Sanotskaia, N V; Polikarpov, V V; Matsievskiĭ, D D

    1989-02-01

    The ultrasonic method was used in acute experiments on cats with open chest under artificial lung ventilation to obtain blood flow in low-lobar pulmonary artery and vein, the blood pressure in pulmonary artery, as well as the left atrial pressure in fat (olive oil) and mechanical (Lycopodium spores) pulmonary embolism. It is shown that pulmonary embolism produces the decrease in the blood flow in pulmonary artery and vein, the increase of the pressure in pulmonary artery and left atria, the increase of lung vessels resistance. The decrease is observed of systemic arterial pressure, bradycardia, and extrasystole. After 5-10 min the restoration of arterial pressure and heart rhythm occur and partial restoration of blood flow in pulmonary artery and vein. In many experiments the blood flow in vein outdoes that in the artery--it allows to suppose the increase of the blood flow in bronchial artery. After 60-90 min there occur sudden decrease of systemic arterial pressure, the decrease of the blood flow in pulmonary artery and vein. The pressure in pulmonary artery and resistance of pulmonary vessels remain high. Pulmonary edema developed in all animals. The death occurs in 60-100 min after the beginning of embolism. PMID:2923969

  10. Dronedarone For Atrial Fibrillation: Unbridled Enthusiasm Or Just Another Small Step Forward?

    Directory of Open Access Journals (Sweden)

    James A. Reiffel, M.D.

    2009-08-01

    Full Text Available In July 2009, the federal Food and Drug Administration (FDA approved the marketing of dronedarone (Multaq, sanofi-aventis for use in patients with atrial fibrillation (AF or flutter (AFL [with a requirement for a recent episode] that is paroxysmal or persistent – the latter having been converted to sinus rhythm or with conversion planned – who have, in addition to AF, certain “high-risk” markers for adverse outcomes that were derived from the enrollment criteria for the landmark ATHENA trial.1 These markers include one or more of: age >70 yrs, hypertension, diabetes mellitus, prior cerebrovascular accident, left atrial size of 50 mm or larger, or LVEF <40%. Contraindications include class IV heart failure or symptomatic heart failure with a recent decompensation; second or third degree AV block without a functioning pacemaker; bradycardia < 50 bpm; concomitant use of a strong CYP3A inhibitor or a QT prolonging agent that may induce torsades de pointes; QTc Bazett interval of 500 ms or longer; or severe hepatic impairment.

  11. Cardio-protective effects of carnitine in streptozotocin-induced diabetic rats

    Directory of Open Access Journals (Sweden)

    Malone Michael A

    2006-01-01

    Full Text Available Abstract Background Streptozotocin-induced diabetes (STZ-D in rats has been associated with carnitine deficiency, bradycardia and left ventricular enlargement. Aim The purpose of this study was to determine whether oral carnitine supplementation would normalize carnitine levels and cardiac function in STZ-D rats. Methods Wistar rats (48 were made hyperglycemic by STZ at 26 weeks of age. Same age normal Wistar rats (24 were used for comparison. Echocardiograms were performed at baseline 2, 6, 10, and 18 weeks after STZ administration in all animals. HbA1c, serum carnitine and free fatty acids (FFA were measured at the same times. Since STZ-D rats become carnitine deficient, 15 STZ-D rats received supplemental oral carnitine for 16 weeks. Results The heart rates for the STZ-D rats (290 ± 19 bpm were less than control rats (324 ± 20 bpm (p Conclusion Thus, supplemental oral carnitine in STZ-D rats normalized serum carnitine, heart rate regulation and left ventricular size. These findings suggest a metabolic mechanism for the cardiac dysfunction noted in this diabetic animal model.

  12. The use of diagnostic imaging for identifying abnormal gas accumulations in cetaceans and pinnipeds.

    Directory of Open Access Journals (Sweden)

    Sophie eDennison

    2012-06-01

    Full Text Available Recent dogma suggested that marine mammals are not at risk of decompression sickness (DCS due to a number of evolutionary adaptations. Several proposed adaptations exist. Lung compression and alveolar collapse that terminate gas exchange before a depth is reached where supersaturation is significant and bradycardia with peripheral vasoconstriction affecting the distribution, and dynamics of blood and tissue nitrogen levels. Published accounts of gas and fat emboli and dysbaric osteonecrosis in marine mammals and theoretical modeling have challenged this view-point, suggesting that decompression-like symptoms may occur under certain circumstances, contrary to common belief. Diagnostic imaging modalities are invaluable tools for the non-invasive examination of animals for evidence of gas and have been used to demonstrate the presence of incidental decompression-related renal gas accumulations in some stranded cetaceans. Diagnostic imaging has also contributed to the recognition of clinically significant gas accumulations in live and dead cetaceans and pinnipeds. Understanding the appropriate application and limitations of the available imaging modalities is important for accurate interpretation of results. The presence of gas may be incidental and must be interpreted cautiously alongside all other available data including clinical examination, clinical laboratory testing, gas analysis, necropsy examination and histology results.

  13. Sir Victor Horsley's contributions to the study and treatment of gunshot wounds of the head.

    Science.gov (United States)

    Cybulski, George R; Stone, James L; Patel, Ketan J

    2008-10-01

    Sir Victor Horsley'S many contributions to neurological surgery include experimental and clinical studies of gunshot wounds (GSW) of the head. Horsley's publications from 1894 to 1897 and 1914 to 1915 on GSWs were reviewed. Horsley described GSWs in animal and clay models, illustrating characteristics of the primary missile tract and secondary cavitation. A transcranial GSW model in 67 dogs related intracranial damage to the projectile's velocity and sectional area, producing a marked sudden increase in intracranial pressure that presumably "tunneled" to the medullary respiratory and cardiac centers. If the resultant sudden apnea was treated with artificial respiration and prompt surgical decompression, the animal often survived. In these animal experiments, Horsley clearly described increased intracranial pressure, hypertension, and bradycardia-later recognized as the Cushing response or triad. With the onset of World War I, Horsley again reviewed the ballistics of military weaponry, emphasizing projectile spin and velocity as the main wounding mechanisms. He was outspoken against the "wicked tradition" of neglecting cranial GSWs and personally treated cases with aggressive respiratory support and prompt decompression of devitalized tissue. Horsley's contributions to the experimental and clinical aspects of GSWs to the head are consistent with his other important contributions to neurosurgery and have largely stood the test of time. PMID:18981893

  14. Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention.

    Science.gov (United States)

    Devinsky, Orrin; Hesdorffer, Dale C; Thurman, David J; Lhatoo, Samden; Richerson, George

    2016-09-01

    Sudden unexpected death in epilepsy (SUDEP) can affect individuals of any age, but is most common in younger adults (aged 20-45 years). Generalised tonic-clonic seizures are the greatest risk factor for SUDEP; most often, SUDEP occurs after this type of seizure in bed during sleep hours and the person is found in a prone position. SUDEP excludes other forms of seizure-related sudden death that might be mechanistically related (eg, death after single febrile, unprovoked seizures, or status epilepticus). Typically, postictal apnoea and bradycardia progress to asystole and death. A crucial element of SUDEP is brainstem dysfunction, for which postictal generalised EEG suppression might be a biomarker. Dysfunction in serotonin and adenosine signalling systems, as well as genetic disorders affecting cardiac conduction and neuronal excitability, might also contribute. Because generalised tonic-clonic seizures precede most cases of SUDEP, patients must be better educated about prevention. The value of nocturnal monitoring to detect seizures and postictal stimulation is unproven but warrants further study. PMID:27571159

  15. Time course of the hemodynamic responses to aortic depressor nerve stimulation in conscious spontaneously hypertensive rats

    International Nuclear Information System (INIS)

    The time to reach the maximum response of arterial pressure, heart rate and vascular resistance (hindquarter and mesenteric) was measured in conscious male spontaneously hypertensive (SHR) and normotensive control rats (NCR; Wistar; 18-22 weeks) subjected to electrical stimulation of the aortic depressor nerve (ADN). The parameters of stimulation were 1 mA intensity and 2 ms pulse length applied for 5 s, using frequencies of 10, 30, and 90 Hz. The time to reach the hemodynamic responses at different frequencies of ADN stimulation was similar for SHR (N = 15) and NCR (N = 14); hypotension = NCR (4194 ± 336 to 3695 ± 463 ms) vs SHR (3475 ± 354 to 4494 ± 300 ms); bradycardia = NCR (1618 ± 152 to 1358 ± 185 ms) vs SHR (1911 ± 323 to 1852 ± 431 ms), and the fall in hindquarter vascular resistance = NCR (6054 ± 486 to 6550 ± 847 ms) vs SHR (4849 ± 918 to 4926 ± 646 ms); mesenteric = NCR (5574 ± 790 to 5752 ± 539 ms) vs SHR (5638 ± 648 to 6777 ± 624 ms). In addition, ADN stimulation produced baroreflex responses characterized by a faster cardiac effect followed by a vascular effect, which together contributed to the decrease in arterial pressure. Therefore, the results indicate that there is no alteration in the conduction of the electrical impulse after the site of baroreceptor mechanical transduction in the baroreflex pathway (central and/or efferent) in conscious SHR compared to NCR

  16. Arterial stiffness of lifelong Japanese female pearl divers.

    Science.gov (United States)

    Tanaka, Hirofumi; Tomoto, Tsubasa; Kosaki, Keisei; Sugawara, Jun

    2016-05-15

    Japanese female pearl divers called Ama specialize in free diving in the cold sea for collecting foods and pearls in oysters. Exercising in the water combined with marked bradycardia and pressor responses provides a circulatory challenge to properly buffer or cushion elevated cardiac pulsations. Because Ama perform repeated free dives throughout their lives, it is possible that they may have adapted similar arterial structure and function to those seen in diving mammals. We compared arterial stiffness of lifelong Japanese pearl divers with age-matched physically inactive adults living in the same fishing villages. A total of 115 Japanese female pearl divers were studied. Additionally, 50 physically inactive adults as well as 33 physically active adults (participating in community fitness programs) living in the same coastal villages were also studied. There were no differences in age (∼65 yr), body mass index, and brachial blood pressure between the groups. Measures of arterial stiffness, cardio-ankle vascular index and β-stiffness index were lower (P < 0.05) in pearl divers and physically active adults than in their physically inactive peers. Augmentation pressure and augmentation index adjusted for the heart rate of 75 beats/min were lower (P < 0.05) in pearl divers than in other groups. These results indicate that lifelong Japanese pearl divers demonstrate reduced arterial stiffness and arterial wave reflection compared with age-matched physically inactive peers living in the same fishing villages. PMID:26984889

  17. [Bilateral phrenic nerve paralysis, dysautonomia and restrictive cardiomyopathy in a case of POEMS syndrome].

    Science.gov (United States)

    Delalande, S; Stojkovic, T; Rose, C; Millaire, A; Hurtevent, J F; Vermersch, P

    2002-07-01

    We report a case of POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, M protein and Skin changes) with unusual clinical features. A 62-year-old woman presented a severe polyneuropathy with dysphonia and vegetative symptoms, including bradycardia and sphincterial disorders. The clinical examination showed facial hyperpigmentation, cachexia, anasarca and splenomegaly. She also presented restrictive cardiomyopathy and endocrine disturbances. Nerve conduction studies revealed a severe demyelinating sensorimotor neuropathy. Cerebrospinal fluid analysis showed an elevated protein level. We detected a biclonal gammapathy (Ig G and Ig A with lambda light chain) and lytic pelvic bone lesions. Later, she developed a severe ventilatory failure due to a bilateral phrenic nerve paralysis leading to a mechanical ventilation. Steroids followed by localized radiotherapy partially improved the respiratory status and stabilized the neuropathy. Phrenic nerve paralysis, restrictive cardiomyopathy, vegetative symptoms and cranial nerve palsy are exceptional in POEMS syndrome. Moreover, this case emphasizes the importance of radiological investigations since the discover of plasmocytoma may improve the prognosis of POEMS syndrome. PMID:12486906

  18. Household outbreak of Q-fever pneumonia related to a parturient cat.

    Science.gov (United States)

    Kosatsky, T

    1984-12-22

    An outbreak of febrile respiratory disease occurred over 11 days among thirteen adults in Nova Scotia, all members of an extended family and their friends. Signs of illness included bradycardia at the same time as fever, palatal petechiae, and rapidly enlarging bilateral pulmonary infiltrates. Ten of the patients had a four-fold rise in antibody to phase-2 Q-fever antigen as determined by complement fixation on acute and 4-week-convalescent serum samples. Six children of the extended family for whom a four-fold titre rise was shown had slight or no disease. Investigations showed that the illness related to having entered the home of four of the patients on 1 of 2 consecutive days. On the first day the family cat, subsequently found to have antibody to Q fever, gave birth to kittens which she nursed in a basket kept inside the entry way. Q fever has been associated with parturient cattle, sheep, and goats but family pets, particularly cats, have not previously been implicated in human illness. PMID:6151054

  19. [A case of X-linked myotubular myopathy with chylothorax].

    Science.gov (United States)

    Oishi, Taku; Sato, Tetsuya; Matsushita, Kenshi; Takechi, Tomoki; Murakami, Nobuyuki; Fujieda, Mikiya

    2016-01-01

    We report a case of X-linked myotubular myopathy with chylothorax. A male infant weighing 2,114 g was born to a mother whose pregnancy was complicated with polyhydramnios from gestational week 32. At gestational week 37, emergent caesarian section was performed due to membrane rupture followed by fetal bradycardia. Ventilatory support was necessary because the neonate showed severe birth asphyxia accompanied by hypotonia and dyspnea. He also showed a respiratory complication of chylothorax at 10 days old; therefore, thoracic drainage was performed. Congenital chylothorax associated with congenital myotonic dystrophy (CMD) has been described in a number of past reports. Specific findings of congenital myotubular myopathy and partial CMD, such as peripheral halo of muscle fibers, were demonstrated in biopsied muscle, and mutation of the myotubularin (MTM1) gene was identified. Tracheostomy was performed at 5 months old because of prolonged ventilatory support and severe dysphagia. The infant was able to be discharged at 17 months old. Congenital chylothorax might be associated with congenital myotubular myopathies such as CMD. PMID:27012108

  20. [The Use of Arginine Vasopressin and PhosphodiesteraseIII Inhibitor for Circulatory Shock after the Resection of a Massive Adrenal Pheochromocytoma].

    Science.gov (United States)

    Nagamine, Yusuke; Nishinarita, Reiko; Mizutani, Kenji; Goto, Takahisa

    2016-06-01

    A 72-year-old man developed hypertensive crisis five month previously, and was diagnosed with massive adrenal pheochromocytoma, with a diameter of 14.5 cm. Preoperative echocardiography revealed normal cardiac function. The open abdominal surgery was performed under general anesthesia. During manipulation of the tumor he developed hypertension and tachycardia. Severe hypotension (50/25 mmHg) and mild bradycardia (70 beats x min(-1)) followed the resection of the tumor. In addition to volume replacement noradrenaline and adrenaline were administered, but the systolic blood pressure rose only to 60-70 mmHg. In order to treat vasodilatory shock, we started to administer arginine vasopressin infusion at 0.03 units x min(-1). His systolic blood pressure rose to 90 mmHg. The patient was transferred to the intensive care unit (ICU) postoperatively. The echocardiography revealed diffuse hypokinetic cardiac function. In order to treat cardiogenic shock, we started to administer olprinone (phosphodiesteraseIII inhibitor, infusion of 0.1 μg x kg(-1) x min(-1)). On postoperative day 2, circulatory shock improved and the patient was discharged from the ICU. In conclusion, circulatory shock after the resection of a massive pheochromocytoma was due to the down regulation of α and β adrenergic receptors. The non-adrenergic vasoconstrictor and inotrope were useful for this situation. PMID:27483661

  1. Time course of the hemodynamic responses to aortic depressor nerve stimulation in conscious spontaneously hypertensive rats

    Energy Technology Data Exchange (ETDEWEB)

    Durand, M.T.; Mota, A.L. [Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Barale, A.R. [Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Castania, J.A.; Fazan, R. Jr.; Salgado, H.C. [Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil)

    2012-03-16

    The time to reach the maximum response of arterial pressure, heart rate and vascular resistance (hindquarter and mesenteric) was measured in conscious male spontaneously hypertensive (SHR) and normotensive control rats (NCR; Wistar; 18-22 weeks) subjected to electrical stimulation of the aortic depressor nerve (ADN). The parameters of stimulation were 1 mA intensity and 2 ms pulse length applied for 5 s, using frequencies of 10, 30, and 90 Hz. The time to reach the hemodynamic responses at different frequencies of ADN stimulation was similar for SHR (N = 15) and NCR (N = 14); hypotension = NCR (4194 ± 336 to 3695 ± 463 ms) vs SHR (3475 ± 354 to 4494 ± 300 ms); bradycardia = NCR (1618 ± 152 to 1358 ± 185 ms) vs SHR (1911 ± 323 to 1852 ± 431 ms), and the fall in hindquarter vascular resistance = NCR (6054 ± 486 to 6550 ± 847 ms) vs SHR (4849 ± 918 to 4926 ± 646 ms); mesenteric = NCR (5574 ± 790 to 5752 ± 539 ms) vs SHR (5638 ± 648 to 6777 ± 624 ms). In addition, ADN stimulation produced baroreflex responses characterized by a faster cardiac effect followed by a vascular effect, which together contributed to the decrease in arterial pressure. Therefore, the results indicate that there is no alteration in the conduction of the electrical impulse after the site of baroreceptor mechanical transduction in the baroreflex pathway (central and/or efferent) in conscious SHR compared to NCR.

  2. Polidocanol sclerotherapy for painful venous malformations: evaluation of safety and efficacy in pain relief

    International Nuclear Information System (INIS)

    The aim of this study was to retrospectively evaluate the safety and efficacy of polidocanol sclerotherapy in pain relief for painful venous malformations (VMs). Thirty-one patients with painful VMs underwent polidocanol sclerotherapy. Pain intensity was assessed with an 11-point verbal numerical rating scale. Sclerotherapy was technically successful in 58 (98.3%) of 59 sessions. Twenty-six (89.7%) out of 29 patients experienced an improvement in pain after sclerotherapy at follow-up, a mean of 46 months after treatment. The mean pain score improved from 6.6 ± 2.5 before treatment to 2.4±2.9 after treatment (P<.001). The factors that significantly influenced the therapeutic effect were size of lesion (P=.008), margin of lesion (P=.006), and stasis of sclerosant (P=.032). Adverse events included hypotension and bradycardia during the procedure. No major complication occurred. Polidocanol sclerotherapy is safe and most efficacious in providing pain relief for patients with small VMs (equal to or less than 10 cm in diameter), VMs with a well-defined margin, and VMs with good stasis of sclerosant during sclerotherapy. (orig.)

  3. Prevention of diabetes-induced myocardial dysfunction in rats using the juice of the Emblica officinalis fruit

    Science.gov (United States)

    Patel, Snehal S; Goyal, Ramesh K

    2011-01-01

    Normalization of hyperglycemia, hyperlipidemia and oxidative stress is an important objective in preventing diabetes-induced cardiac dysfunction. The present study investigated the effects of the fruit juice obtained from Emblica officinalis on myocardial dysfunction in diabetic rats. Diabetes was induced by streptozotocin (STZ), and the rats were treated with E officinalis fruit juice for eight weeks. Injection of STZ produced loss of body weight, polydypsia, polyphagia, hyperglycemia, hypoinsulinemia and dyslipidemia. It also produced hypertension, bradycardia, hypertrophy and myocardial functional alterations associated with an increase in serum lactate dehydrogenase and creatinine kinase-MB levels. Treatment with the fruit juice not only prevented STZ-induced loss of body weight, increases in water and food intake, increases in serum glucose levels and disturbed lipid profile, but also an increase in serum lactate dehydrogenase and creatinine kinase-MB levels, and increased myocardial hypertrophy and cardiomyopathy. There was an increase in the area under the curve (AUC) for glucose, and a decrease in AUCinsulin was observed in diabetic rats; treatment decreased AUCglucose but not AUCinsulin or hyperinsulinemia. There was a decrease in antioxidant enzyme levels (in superoxide dismutase, reduced glutathione and catalase) in diabetic hearts, which could be improved by treatment with fruit juice. The present data suggest that fruit juice may be beneficial for the treatment of myocardial damage associated with type 1 diabetes mellitus. The activity of E officinalis fruit juice can be attributed to the concentration of polyphenol present. PMID:22065939

  4. Antagonistic effects of atipamezole, flumazenil and 4-aminopyridine against anaesthesia with medetomidine, midazolam and ketamine combination in cats.

    Science.gov (United States)

    Ueoka, Naotami; Hikasa, Yoshiaki

    2008-02-01

    Antagonistic effects of atipamezole (ATI), flumazenil (FLU) and 4-aminopyridine (4AP) alone and in various combinations after administration of medetomidine-midazolam-ketamine (MED-MID-KET) were evaluated in cats. Animals were anaesthetised with MED (50 microg/kg), MID (0.5 mg/kg) and KET (10 mg/kg) given intramuscularly. Twenty minutes later, physiological saline, ATI (200 microg/kg), FLU (0.1 mg/kg), 4AP (0.5 mg/kg), ATI-FLU, FLU-4AP, ATI-4AP or ATI-FLU-4AP was administered intravenously. FLU, 4AP alone, or FLU-4AP did not effectively antagonise the anaesthesia, hypothermia, bradycardia, and bradypnoea induced by MED-MID-KET. ATI alone was effective. ATI-FLU, ATI-4AP and ATI-FLU-4AP combinations produced an immediate and effective recovery from anaesthesia. The combination of ATI-FLU-4AP was the most effective in antagonising the anaesthetic effects, but was associated with tachycardia, tachypnoea, excitement, and muscle tremors. Combinations with ATI are more effective for antagonising anaesthesia, but ATI-FLU-4AP is not suitable. PMID:17766159

  5. [An experimental study of the effects of ketamine on the central sympathetic system, respiration and circulation (author's transl)].

    Science.gov (United States)

    Pfeifer, G; Tauberger, G; Schulte am Esch, J

    1981-06-01

    Cats were given basal anaesthesia (nitrous oxide-oxygen) with artificial ventilation. They were then injected intravenously with 5 mg/kilogram bodyweight of ketamine. The injection was followed by a marked ketamine. The injection was followed by a marked reduction in both the tone of the central sympathetic system and the activity of the phrenic nerve which lasted for 10 minutes and 30 minutes respectively. Doses of 10 mg/kilogram bodyweight caused a longer lasting and more pronounced lowering of sympathetic activity while phrenic activity was approximately the same as with the smaller dosage. Injection of 2.5 mg/kilogram bodyweight reduced the sympathetic tone only if it was accompanied by asphyxia (central stimulation). Administration of 5 mg and of 10 mg/kilogram bodyweight was followed by a fall in blood pressure by 15-45 per cent up to 2 minutes after the injection. The heart rate at rest was unaffected but in the presence of asphyxia there was a dose-dependent reduction in the expected bradycardia. Ketamine also induced definite central inhibition thereby preventing the circulatory activation which occurs when the drug is used for anaesthetic purposes. The observation that the bradycardic effect arising from central stimulation was weakened suggests a reduction of central vagal activity. PMID:7258572

  6. Medetomidine sedation in dogs and cats: a review of its pharmacology, antagonism and dose.

    Science.gov (United States)

    Cullen, L K

    1996-09-01

    Medetomidine is a relatively new sedative analgesic in dogs and cats but some precautions are required when using it. It is a potent alpha 2-adrenoceptor agonist and stimulates receptors centrally to produce dose-dependent sedation and analgesia and receptors centrally and peripherally to cause marked bradycardia and decrease the cardiac output. While hypotension occurs frequently, higher doses of the sedative can raise the blood pressure due to an affect on peripheral receptors. Slowing of the respiratory rate is a frequent effect of medetomidine with some dogs showing signs of cyanosis. Other actions that follow medetomidine use are slowing of gastrointestinal motility, hypothermia, changes to endocrine function and, occasionally, vomiting and muscle twitching. The clinical use of medetomidine in dogs and cats is discussed. Recommended dose rates are presented along with precautions that should be taken when it is used alone for sedation, as an anaesthetic premedicant or in combination with ketamine, propofol or opioids. Hypoxaemia occurs frequently in dogs given medetomidine and propofol. The actions of medetomidine can be rapidly reversed with the specific alpha 2-adrenoceptor antagonist, atipamezole, which is an advantage because undesirable and sedative actions of medetomidine can be terminated. PMID:8885463

  7. Introduction to the clinical pharmacology of medetomidine.

    Science.gov (United States)

    Vainio, O

    1989-01-01

    Medetomidine is a sedative and analgesic drug intended for use in dogs and cats but it can also be successfully used in many other species. The effect of medetomidine is dose dependent at the recommended dose range (10-80 micrograms/kg for dogs and 50-150 micrograms/kg for cats). At doses higher than the recommended ones the strength of sedation does not increase, only the duration of the effect. From the cardiovascular changes induced with medetomidine, the profound bradycardia is most prominent. It can be transiently prevented with atropine or glycopyrrolate medication. An initial increase in arterial blood pressure followed by a longer lasting slightly hypotensive or normotensive period can be observed. Respiratory frequency tends to decrease but the changes stay within normal limits for resting animals. Vomiting may occur during the induction period of sedation. Occasional muscle jerks can be observed. Hypothermia has been reported in every animal sedated with medetomidine. Medetomidine can be used as preanaesthetic prior to ketamine, barbiturate and halothane anaesthesia. PMID:2571283

  8. Fungal endocarditis with right ventricular candidal mycetoma in a premature neonate

    Directory of Open Access Journals (Sweden)

    Jayashree Purkayastha

    2015-09-01

    Full Text Available Fungal mycetoma or endocarditis is rare in premature neonates and it is often associated with high mortality. In the majority of the cases diagnosis is made postmortem. Here we report a 0-week-old preterm neonate who developed Candida albicans blood stream infection complicated by endocarditis and subsequent mycetoma. Initially, this neonate had Klebsiella sepsis requiring multiple antibiotic courses. A peripherally inserted central venous catheter was used to give total parenteral nutrition. On day 24 of life, he developed candidemia, treated with 14 day course of fluconazole and shown improvement. Further, on day 60 of life he developed cholestasis, deranged liver function tests and persistent thrombocytopenia along with apnea, bradycardia and desaturations. Blood culture again grew again C. albicansEchocardiography showed large fungal vegetation on tricuspid valve with a mycetoma filling the right ventricle. He was treated with intravenous amphotericin B, fluconazole and upportive measures, but he deteriorated and succumbed after two weeks. J Microbiol Infect Dis 2015;5(3: 142-145

  9. Aldosterone antagonists in monotherapy are protective against streptozotocin-induced diabetic nephropathy in rats.

    Science.gov (United States)

    Banki, Nora F; Ver, Agota; Wagner, Laszlo J; Vannay, Adam; Degrell, Peter; Prokai, Agnes; Gellai, Renata; Lenart, Lilla; Szakal, Dorottya-Nagy; Kenesei, Eva; Rosta, Klara; Reusz, Gyorgy; Szabo, Attila J; Tulassay, Tivadar; Baylis, Chris; Fekete, Andrea

    2012-01-01

    Angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) are the standard clinical therapy of diabetic nephropathy (DN), while aldosterone antagonists are only used as adjuncts. Previously in experimental DN we showed that Na/K ATPase (NKA) is mislocated and angiotensin II leads to superimposed renal progression. Here we investigated the monotherapeutic effect of aldosterone blockers on the progression of DN and renal NKA alteration in comparison to ACEi and ARBs. Streptozotocin-diabetic rats developing DN were treated with aldosterone antagonists; ACEi and ARB. Renal function, morphology, protein level and tubular localization of NKA were analyzed. To evaluate the effect of high glucose per se; HK-2 proximal tubular cells were cultured in normal or high concentration of glucose and treated with the same agents. Aldosterone antagonists were the most effective in ameliorating functional and structural kidney damage and they normalized diabetes induced bradycardia and weight loss. Aldosterone blockers also prevented hyperglycemia and diabetes induced increase in NKA protein level and enzyme mislocation. A monotherapy with aldosterone antagonists might be as, or more effective than ACEi or ARBs in the prevention of STZ-induced DN. Furthermore the alteration of the NKA could represent a novel pathophysiological feature of DN and might serve as an additional target of aldosterone blockers. PMID:22761931

  10. Aldosterone antagonists in monotherapy are protective against streptozotocin-induced diabetic nephropathy in rats.

    Directory of Open Access Journals (Sweden)

    Nora F Banki

    Full Text Available Angiotensin converting enzyme inhibitors (ACEi and angiotensin II receptor blockers (ARB are the standard clinical therapy of diabetic nephropathy (DN, while aldosterone antagonists are only used as adjuncts. Previously in experimental DN we showed that Na/K ATPase (NKA is mislocated and angiotensin II leads to superimposed renal progression. Here we investigated the monotherapeutic effect of aldosterone blockers on the progression of DN and renal NKA alteration in comparison to ACEi and ARBs. Streptozotocin-diabetic rats developing DN were treated with aldosterone antagonists; ACEi and ARB. Renal function, morphology, protein level and tubular localization of NKA were analyzed. To evaluate the effect of high glucose per se; HK-2 proximal tubular cells were cultured in normal or high concentration of glucose and treated with the same agents. Aldosterone antagonists were the most effective in ameliorating functional and structural kidney damage and they normalized diabetes induced bradycardia and weight loss. Aldosterone blockers also prevented hyperglycemia and diabetes induced increase in NKA protein level and enzyme mislocation. A monotherapy with aldosterone antagonists might be as, or more effective than ACEi or ARBs in the prevention of STZ-induced DN. Furthermore the alteration of the NKA could represent a novel pathophysiological feature of DN and might serve as an additional target of aldosterone blockers.

  11. Circulatory responses to asphyxia differ if the asphyxia occurs in utero or ex utero in near-term lambs.

    Directory of Open Access Journals (Sweden)

    Kristina S Sobotka

    Full Text Available A cornerstone of neonatal resuscitation teaching suggests that a rapid vagal-mediated bradycardia is one of the first signs of perinatal compromise. As this understanding is based primarily on fetal studies, we investigated whether the heart rate and blood pressure response to total asphyxia is influenced by whether the animal is in utero or ex utero.Fetal sheep were instrumented at ∼ 139 days of gestation and then asphyxiated by umbilical cord occlusion until mean arterial blood pressure decreased to ∼ 20 mmHg. Lambs were either completely submerged in amniotic fluid (in utero; n = 8 throughout the asphyxia or were delivered and then remained ex utero (ex utero; n = 8 throughout the asphyxia. Heart rate and arterial blood pressure were continuously recorded.Heart rate was higher in ex utero lambs than in utero lambs. Heart rates in in utero lambs rapidly decreased, while heart rates in ex utero lambs initially increased following cord occlusion (for ∼ 1.5 min before they started to decrease. Mean arterial pressure initially increased then decreased in both groups.Heart rate response to asphyxia was markedly different depending upon whether the lamb was in utero or ex utero. This indicates that the cardiovascular responses to perinatal asphyxia are significantly influenced by the newborn's local environment. As such, based solely on heart rate, the stage and severity of a perinatal asphyxic event may not be as accurate as previously assumed.

  12. Problems associated with the apnea test in the diagnosis of brain death

    Directory of Open Access Journals (Sweden)

    Saposnik Gustavo

    2004-07-01

    Full Text Available Background: Brain death is the absence of all cortical functions, including the brainstem. The apnea test (AT is a necessary requisite to complete this diagnosis. Anecdotal reports describing hypotension and acidosis due to apnea test have been reported. However, there are few studies that evaluate complications or difficulties related to this procedure. Objective: To analyze medical problems associated with the apnea test. Methods and Patients: We analyzed clinical features, potential risk conditions, and problems in 129 brain dead patients during the apnea test. The diagnosis of brain death was made according to the American Academy of Neurology recommendations. Results: Clinical problems during the apnea test were detected in more than two thirds of patients, including: arterial hypotension (12%, acidosis (68%, and hypoxemia (23%. Four patients developed major complications, including: pneumothorax, cardiac arrest, bradycardia, atrial fibrillation and myocardial infarction. Conclusion: The apnea test is not an innocuous procedure. Complications during the AT are more common than reported and limit organ procurement for transplantation. Guidelines for performing the AT should be followed in order to avoid clinical complications.

  13. Case of a sigmoid colon cancer with metachronous metastases to the mesorectum and the abdominal wall

    Directory of Open Access Journals (Sweden)

    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.

  14. Parametric evaluation of methotrimeprazine-midazolam-ketamine and methotrimeprazine-midazolam-ketamine-xylazine combination in dogs

    Directory of Open Access Journals (Sweden)

    Santos Gustavo José Von Glehn dos

    2006-01-01

    Full Text Available PURPOSE: To evaluate the parameters of dogs anesthetized by different dissociative drugs protocols through continuous intravenous infusion. METHODS: Thirty healthy dogs of both sexes were assigned randomly to three groups (G1, G2, and G3. G1 was administered with methotrimeprazine as a pre-anesthetic medication, intravenously midazolam-ketamine as bolus for induction and midazolam-ketamine by continuous intravenous infusion for a 60 minute-period of maintenance. G2: the same as for G1. plus an increase in the midazolam dose during maintenance. G3: the same treatment as for G2, plus the addition of xylazine during maintenance. Immediately after induction the anesthetic maintenance started, and measures were taken 15 minutes after pre-medication, at 10 minutes intervals, during maintenance (M0 to M7. RESULTS: Bradycardia, atrioventricular blockage, bradypnea and hypoxemia were shown in G3. G1 and G2 showed a slight hypotension only. CONCLUSION: There were some advantages by using the continuous intravenous via: no parameters oscillation and reduction in the anesthetic recovery period. The increase in midazolam dose brought about little parametric variations which were greater when xylazine was used, with a consequent hypoxemia, bradyarrhytmia, and decrease in respiratory frequency and minute volume.

  15. Differences of promethazine and terfenadine on ion channels in guinea pig ventricular myocytes

    Institute of Scientific and Technical Information of China (English)

    LI Xue-wen; NIU Shuan-cheng; ZHANG Xuan-ping; L(U) Ji-yuan; BAI Feng; ZHANG Ling; WU Bo-wei

    2006-01-01

    @@ Promethazine, a first generation antihistamine,has an antiarrhythmic effect on ischemia-reperfusion inducing arrhythmias1 and experimental arrhythmias.2 However, terfenadine as a second generation of antihistamine, has been reported to elicit hypotension, bradycardia, prolongation of the QTc interval and torsades de pointes (TdP) like ventricular arrhythmia.3 This may be due to the blockage on rectifier postassium current (Ik) of terfenadine, resulting in the prolongation of the action potential duration (APD) and dispersion of the repolarization duration, which might provoke a specific form of polymorphic ventricular tachydysrhythmia, i.e. TdP.4 In clinical practice,however, the class Ⅲ antiarrhythmic agents, which target on the Ik and prolong the action potential duration and QTc interval, rarely lead to arrhythmias.Other actions must be considered to underlie the arrhythmogenic tendency of terfenadine besides its inhibition on Ik. Though both promethazine and terfenadine block the H1 receptor, there must be a different pharmacology profile between the two compounds on ion channels of cardiac myocytes.Whole-cell patch clamp technique was used to investigate the effects of these two antagonists of the H1 receptor on the main ion currents in cardiac electrical activities.

  16. Fibrosis: a structural modulator of Sinoatrial Node physiology and dysfunction

    Directory of Open Access Journals (Sweden)

    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.

  17. Ready and waiting: Freezing as active action preparation under threat.

    Science.gov (United States)

    Gladwin, Thomas E; Hashemi, Mahur M; van Ast, Vanessa; Roelofs, Karin

    2016-04-21

    Freezing is a defensive response characterized by rigidity and bradycardia, but it is unclear whether it is a passive versus active preparatory state. We developed a shooting task in which preparation and threat were manipulated independently: Participants were either helpless or able to respond to a possible upcoming attack, and attacks were either associated with an electric shock or not. Essentially, a purely anticipatory preparatory period was used during which no stimuli occurred. Freezing was assessed during this period. In addition to heart rate, body sway was measured, using a stabilometric force platform. The efficacy of the threat manipulation was confirmed via self-report. The ability to prepare led to decreases in heart rate and postural sway, while threat led to decreased heart rate. Further, exploratory analyses suggested that aggressive participants showed reduced initial freezing for threatening opponents, but increased postural freezing when armed. The results suggest that freezing may involve active preparation. Relations to results in passive viewing tasks are discussed. PMID:26994781

  18. Autonomic Nervous System Mediates the Hypotensive Effects of Aqueous and Residual Methanolic Extracts of Syzygium polyanthum (Wight) Walp. var. polyanthum Leaves in Anaesthetized Rats.

    Science.gov (United States)

    Ismail, A; Mohamed, M; Sulaiman, S A; Wan Ahmad, W A N

    2013-01-01

    Syzygium polyanthum (Wight) Walp. var. polyanthum leaves are consumed as a traditional Malay treatment of hypertension. This study investigates hypotensive potential of aqueous (AESP) and residual methanolic (met-AESP) extracts of S. polyanthum leaves and possible involvement of autonomic receptors. AESP and met-AESP (20 to 100 mg/kg) were intravenously administered into anaesthetized Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats. Blood pressure and heart were monitored for 20 min. AESP and met-AESP induced significant dose-dependent hypotension, but only 100 mg/kg AESP caused mild bradycardia (n = 5). AESP-induced hypotension was more potent than that of met-AESP in WKY. AESP has a faster onset time than that of met-AESP in both WKY and SHR. However, met-AESP-induced hypotension was more sustained than that of AESP in SHR. Blockages of autonomic ganglion and α -adrenergic receptors using hexamethonium and phentolamine (n = 5 for each group) partially attenuated AESP-induced hypotension, suggesting involvement of α -adrenergic receptors. Blockages of autonomic ganglion, β -adrenergic, cholinergic receptors, and nitric oxide production using hexamethonium, propranolol, atropine, and N- ω -nitro-l arginine methyl ester (L-NAME) (n = 5 for each group) partially attenuated met-AESP-induced hypotension, suggesting involvement of β -adrenergic and cholinergic receptors via nitric oxide production. PMID:24454508

  19. Autonomic Nervous System Mediates the Hypotensive Effects of Aqueous and Residual Methanolic Extracts of Syzygium polyanthum (Wight Walp. var. polyanthum Leaves in Anaesthetized Rats

    Directory of Open Access Journals (Sweden)

    A. Ismail

    2013-01-01

    Full Text Available Syzygium polyanthum (Wight Walp. var. polyanthum leaves are consumed as a traditional Malay treatment of hypertension. This study investigates hypotensive potential of aqueous (AESP and residual methanolic (met-AESP extracts of S. polyanthum leaves and possible involvement of autonomic receptors. AESP and met-AESP (20 to 100 mg/kg were intravenously administered into anaesthetized Wistar-Kyoto (WKY and spontaneously hypertensive (SHR rats. Blood pressure and heart were monitored for 20 min. AESP and met-AESP induced significant dose-dependent hypotension, but only 100 mg/kg AESP caused mild bradycardia (n=5. AESP-induced hypotension was more potent than that of met-AESP in WKY. AESP has a faster onset time than that of met-AESP in both WKY and SHR. However, met-AESP-induced hypotension was more sustained than that of AESP in SHR. Blockages of autonomic ganglion and α-adrenergic receptors using hexamethonium and phentolamine (n=5 for each group partially attenuated AESP-induced hypotension, suggesting involvement of α-adrenergic receptors. Blockages of autonomic ganglion, β-adrenergic, cholinergic receptors, and nitric oxide production using hexamethonium, propranolol, atropine, and N-ω-nitro-l arginine methyl ester (L-NAME (n=5 for each group partially attenuated met-AESP-induced hypotension, suggesting involvement of β-adrenergic and cholinergic receptors via nitric oxide production.

  20. John Call Dalton, Jr., MD: America's first neurophysiologist.

    Science.gov (United States)

    Fine, E J; Manteghi, T; Sobel, S H; Lohr, L A

    2000-09-26

    Before the discoveries of John Call Dalton, Jr., MD (1824-1889), innervation of laryngeal muscles, long-term effects of cerebellar lesions, and consequences of raised intracranial pressure were poorly understood. Dalton discovered that the posterior cricoarytenoid muscles adducted the vocal cords during inspiration. He confirmed Flourens' observations that acute ablation of the cerebellum of pigeons caused loss of coordination. Dalton observed that properly cared for pigeons gradually recovered "coordinating power." Dalton observed that prolonged raised intracranial pressure caused tachycardia and then fatal bradycardia in dogs. Before Dalton published his photographic atlas of the human brain, neuroanatomy atlases were sketched by Europeans and imported into the United States. Dalton's atlas of the human brain contained precise photographs of vertical and horizontal sections that equal modern works. Before Dalton introduced live demonstrations of animals, physiology was taught by recitation of texts only. Dalton was the first American-born professor to teach physiology employing demonstrations of live animals operated on under ether anesthesia. He wrote an essay advocating experimentation on animals as the proper method of acquiring knowledge of function and that humane animal experimentation would ultimately improve the health of man and animals. His eloquent advocacy for humane experimental physiology quelled attacks by contemporaneous antivivisectionists. Dalton was America's first experimental neurophysiologist. PMID:10994009

  1. Amniotic fluid embolism.

    Science.gov (United States)

    Kaur, Kiranpreet; Bhardwaj, Mamta; Kumar, Prashant; Singhal, Suresh; Singh, Tarandeep; Hooda, Sarla

    2016-01-01

    Amniotic fluid embolism (AFE) is one of the catastrophic complications of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse. Etiology largely remains unknown, but may occur in healthy women during labour, during cesarean section, after abnormal vaginal delivery, or during the second trimester of pregnancy. It may also occur up to 48 hours post-delivery. It can also occur during abortion, after abdominal trauma, and during amnio-infusion. The pathophysiology of AFE is not completely understood. Possible historical cause is that any breach of the barrier between maternal blood and amniotic fluid forces the entry of amniotic fluid into the systemic circulation and results in a physical obstruction of the pulmonary circulation. The presenting signs and symptoms of AFE involve many organ systems. Clinical signs and symptoms are acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy etc. Besides basic investigations lung scan, serum tryptase levels, serum levels of C3 and C4 complements, zinc coproporphyrin, serum sialyl Tn etc are helpful in establishing the diagnosis. Treatment is mainly supportive, but exchange transfusion, extracorporeal membrane oxygenation, and uterine artery embolization have been tried from time to time. The maternal prognosis after amniotic fluid embolism is very poor though infant survival rate is around 70%. PMID:27275041

  2. Management of patient with necrotizing fasciitis: a challenge for anaesthesiologist

    Directory of Open Access Journals (Sweden)

    Reena Mahajan

    2015-06-01

    Full Text Available Necrotising fasciitis, a highly lethal infection of deep seated subcutaneous tissue and fascia, is associated with high mortality and long term morbidity. A five year old child of necrotizing fasciitis with poor general condition, deranged investigations and unstable vitals was posted for debridement. After initial resuscitation, TIVA was given, intraoperative period was uneventful and post operatively patient was shifted to recovery room as fully conscious with O2 by face mask. After 1 and frac12; hours, patient became drowsy, hypotensive with bradycardia and urine output was nil. Immediate resuscitation started and vasopressors added. Despite all aggressive interventions, the patient died due to sepsis induced multiorgan failure. Blood samples and wound aspirate culture showed group A beta hemolytic Streptococcous. In this case report we discuss the best possible management of such patients and tried to minimize several barriers like lack of early recognition of severe sepsis and septic shock, treatment delay, lack of several investigations and drugs, shortage of health care providers, absence of locally written protocol, remote area and tried to give the massage that adherence to published guidelines for the management of severe sepsis patients lowers mortality. [Int J Res Med Sci 2015; 3(3.000: 763-766

  3. Female alcoholics: electrocardiographic changes and associated metabolic and electrolytic disorders

    Directory of Open Access Journals (Sweden)

    Borini Paulo

    2003-01-01

    Full Text Available OBJECTIVE: To identify the electrocardiographic changes and their associations with metabolic and electrolytic changes in female alcoholics. METHODS: The study comprised 44 female alcoholics with no apparent physical disorder. They underwent the following examinations: conventional electrocardiography; serologic tests for syphilis, Chagas' disease, and hepatitis B and C viruses; urinary pregnancy testing; hematimetric analysis; biochemical measurements of albumin, fibrinogen, fasting and postprandial glycemias, lipids, hepatic enzymes, and markers for tissue necrosis and inflammation. RESULTS: Some type of electrocardiographic change was identified in 33 (75% patients. In 17 (38.6% patients, more than one of the following changes were present: prolonged QTc interval in 24 (54.5%, change in ventricular repolarization in 11(25%, left ventricular hypertrophy in 6 (13.6%, sinus bradycardia in 4 (9.1%, sinus tachycardia in 3 (6.8%, and conduction disorder in 3 (6.8%. The patients had elevated mean serum levels of creatine phosphokinase, aspartate aminotransferases, and gamma glutamyl transferase, as well as hypocalcemia and low levels of total cholesterol and LDL-cholesterol. The patients with altered electrocardiograms had a more elevated age, a lower alcohol consumption, hypopotassemia, and significantly elevated levels of triglycerides, postprandial glucose, sodium and gamma glutamyl transferase than those with normal electrocardiograms. The opposite occurred with fasting glycemia, magnesium, and alanine aminotransferase. CONCLUSION: The electrocardiographic changes found were prolonged QTc interval, change in ventricular repolarization, and left ventricular hypertrophy. Patients with normal and abnormal electrocardiograms had different metabolic and electrolytic changes.

  4. Radioprotective and hemodynamic effects of WR-2721 and cystamine in rats: Time course studies

    International Nuclear Information System (INIS)

    In experiments on rats a radioprotective dose of WR-2721 (200 mg/kg) and cystamine (50 mg/kg) exhibited significant protective effects against radiation death during the first hour after i.m. administration. Gamma rays were delivered at a dose rate of 0.35 to 0.31 Gy/min in gradually increased doses for the calculation of LD values and relative efficacy of whole body irradiation. WR-2721 afforded protection with the highest dose reduction factor (DRF) of 1.51, while the best DRF value with cystamine was 1.36. No protection was found when the interval between injection of both radioprotectives and the beginning of irradiation was longer than 60 min. WR-2721 as well as cystamine in pentobarbital anesthetized rats induced a significant depression in cardiac output, hypotension and bradycardia immediately after i.m. injection. The manifestations of depression in hemodynamics persisted throughout the 4-hour observation period. The results indicate that the hemodynamic effects of WR-2721 and of cystamine are not important for their radioprotective actions in rats. (author)

  5. Sleep in Wilson′s disease: A polysomnography-based study

    Directory of Open Access Journals (Sweden)

    Netto Archana

    2010-01-01

    Full Text Available Wilson′s disease (WD has neuro-anatomical, pathophysiological and neurochemical basis for sleep disturbances. The aim of the study was objective evaluation of the frequency and nature of sleep abnormalities using polysomnography (PSG in patients with WD. The study included 25 subjects with WD (males, 18; age , 24.4 ± 9.25 years and 25 healthy controls (all males; age, 33.1 ± 9.7 years. After phenotypic assessment and magnetic resonance imaging (MRI, sleep-related questionnaires were administered, and PSG was performed. Patients had significantly reduced total sleep-time (P=.001, sleep-efficiency (P=.001, percentage of deep sleep (P=.01, and REM-sleep (P=.04 with prolonged sleep-onset latency (P=.05 and latency to stage 2 (P=.02. Subgroup analyses of patients based on demographic and clinical parameters were done. Men had significantly more bradycardia both during awake (P=.002 and sleep (P=.03 states. Younger patients (<20 years had frequent tachycardia (P=.01, higher Periodic Limb Movement (PLM Index (P=.01 and lesser REM% sleep (P=.05. Patients on de-coppering therapy had prolonged REM-sleep-onset latency (P=.03 and mixed apnea events (P=.04. The isolated limb movements were more in the severe form of disease (P=.05 and in patients taking anticonvulsants (P=.03. This study, the first of its kind in literature, revealed significant sleep disturbances in patients with Wilson′s disease.

  6. Scorpion (Buthus tamulus venom toxicity on cardiopulmonary reflexes involves kinins via 5-HT3 receptor subtypes

    Directory of Open Access Journals (Sweden)

    S. BAGCHI

    2001-01-01

    Full Text Available The mechanisms underlying the action of Indian red scorpion Buthus tamulus (BT venom-induced augmentation of cardiopulmonary reflexes elicited by intravenous injection of 5-HT were examined in urethane anaesthetized rats. The 5-HT produced a concentration-dependent increase in time-response area of bradycardiac response, with the responses at submaximal concentrations shifted to the left after exposure to BT venom (20 µg/kg, IV. Aprotinin (6000 kallikrein inactivating unit, IV as such had no effect on 5-HT reflex responses (bradycardia, hypotension, and apnea, but blocked the venom-induced reflex augmentation. While ondansetron (10 µg/kg, IV completely blocked the 5-HT reflex responses, these reappeared partially after venom exposure (20 µg/kg. Exposure to bradykinin (50 µg/kg, IV for 30 min also augmented the 5-HT-induced reflex responses similar to venom. The bradykinin-induced augmentation was also blocked by ondansetron. Results indicate that the venom-induced augmentation of cardiopulmonary reflexes is mediated through kinins sensitizing 5-HT3 receptor subtypes.

  7. Facial immersion in cold water enhances cerebral blood velocity during breath-hold exercise in humans

    DEFF Research Database (Denmark)

    Kjeld, Thomas; Pott, Frank C; Secher, Niels H

    2009-01-01

    The diving response is initiated by apnea and facial immersion in cold water and includes, besides bradycardia, peripheral vasoconstriction, while cerebral perfusion may be enhanced. This study evaluated whether facial immersion in 10 degrees C water has an independent influence on cerebral...... <0.001). Similarly, during 100-W exercise, a breath hold increased Pa(CO(2)) from 5.9 to 8.2 kPa (P <0.001) and MCA V(mean) from 55 to 113 cm/s ( approximately 105%), and facial immersion further increased MCA V(mean) to 122 cm/s ( approximately 88%; both P <0.001). MCA V(mean) also increased during...... 180-W exercise (from 47 to 53 cm/s), and this increment became larger with facial immersion (76 cm/s, approximately 62%; P <0.001), although Pa(CO(2)) did not significantly change. These results indicate that a breath hold diverts blood toward the brain with a >100% increase in MCA V(mean), largely...

  8. The effect of water temperature on the human body and the swimming effort

    Directory of Open Access Journals (Sweden)

    SERAFEIM ALEXIOU

    2014-10-01

    Full Text Available Although many research papers have dealt with the influence of environmental temperature on the various Human body functions during exercise in land, a few only informations exist for the equivalent alterations in water temperatures during immersion and swimming. The present preview research paper is referred on this subject. During swimming in the normal water temperature 26° ± 1° C (63, the functions of the human body respond regularly and the performance of swimmers tends to be improved. However, during swimming in cold water critical differences appear in human functions, such as bradycardia, angiospasm, hyperventilation and adaptations of thermoregulatory mechanism which influence the swimming performance and the life itself. Especially in very cold water temperature the disturbances of the cardiovascular system may lead in critical arrhythmia or sudden death. The cold water temperature, however, influences the kinetic and energy behavior related to the reduction of swimmers performance because of its possible influence on the neuromuscular function. In the increased water temperature up to 28° C appears tachycardia, vasodilation and other alternations which aim to better thermoregulation. The swimmers records are possibly equivalent with a tendency to be improved, to the records in normal temperature of championships 26° C and the increased temperature mainly in the speed events (3. Therefore, there is a differentiation on swimmers performances due to water temperature declination from normal. Also, body functions change during water immersion.

  9. Local thermodilution: a reliable technique for estimating renal blood flow in the rabbit

    Energy Technology Data Exchange (ETDEWEB)

    Baker, D.G.; Lin, Y.C.

    1982-01-01

    1. A thermistor probe designed for determination of renal blood flow in rabbits, consisted of a fast-responding bead thermistor and an injection port which was also used to measure renal venous pressure between injections. 2. By an in vitro calibration system, actual measured flow (Qa) correlates well with the thermodilution calculated flow (Qc), where Qc . 0.99 Qa + 4.9 (r . 0.97, n . 42). 3. The renal blood flow (RBF) as determined by the thermodilution technique in 3 control groups was 53 +/- 3 (8), 60 +/- 6 (8), and 62 +/- 3 (3) ml/min/kidney or about 9% of the cardiac output. 4. Hypovolemia (-10%) reduced RBF by 19% from the control value, whereas, hypervolemia (+10%) did not alter RBF. 5. Smoke-induced apnea resulted in hypertension (+30%) and bradycardia (-39%), and was associated with changes in RBF (-55%) and renal vascular resistance (+183%). 6. We conclude that the local thermodilution technique is a relatively easy and reliable method for estimating RBF in rabbits.

  10. Hemodynamic alterations in chronically conscious unrestrained diabetic rats

    Energy Technology Data Exchange (ETDEWEB)

    Carbonell, L.F.; Salmon, M.G.; Garcia-Estan, J.; Salazar, F.J.; Ubeda, M.; Quesada, T.

    1987-05-01

    Important cardiovascular dysfunctions have been described in streptozotocin (STZ)-diabetic rats. To determine the influence of these changes on the hemodynamic state and whether insulin treatment can avoid them, different hemodynamic parameters, obtained by the thermodilution method, were studied in STZ-induced (65 mg/kg) diabetic male Wistar rats, as well as in age-control, weight-control, and insulin-treated diabetic ones. Plasma volume was measured by dilution of radioiodinated (/sup 125/I) human serum albumin. All rats were examined in the conscious, unrestrained state 12 wk after induction of diabetes or acidified saline (pH 4.5) injection. At 12 wk of diabetic state most important findings were normotension, high blood volume, bradycardia, increase in stroke volume, cardiac output, and cardiosomatic ratio, and decrease in total peripheral resistance and cardiac contractility and relaxation (dP/dt/sub max/ and dP/dt/sub min/ of left ventricular pressure curves). The insulin-treated diabetic rats did not show any hemodynamic differences when compared with the control animals. These results suggest that important hemodynamic alterations are present in the chronic diabetic states, possibly conditioning congestive heart failure. These alterations can be prevented by insulin treatment.

  11. Cerebral Hemispheric Lateralization Associated with Hippocampal Sclerosis May Affect Interictal Cardiovascular Autonomic Functions in Temporal Lobe Epilepsy

    Directory of Open Access Journals (Sweden)

    Rokia Ghchime

    2016-01-01

    Full Text Available It is well established that the temporal lobe epilepsy (TLE is linked to the autonomic nervous system dysfunctions. Seizures alter the function of different systems such as the respiratory, cardiovascular, gastrointestinal, and urogenital systems. The aim of this work was to evaluate the possible factors which may be involved in interictal cardiovascular autonomic function in temporal lobe epilepsy with complex partial seizures, and with particular attention to hippocampal sclerosis. The study was conducted in 30 patients with intractable temporal lobe epilepsy (19 with left hippocampal sclerosis, 11 with right hippocampal sclerosis. All subjects underwent four tests of cardiac autonomic function: heart rate changes in response to deep breathing, heart rate, and blood pressure variations throughout resting activity and during hand grip, mental stress, and orthostatic tests. Our results show that the right cerebral hemisphere predominantly modulates sympathetic activity, while the left cerebral hemisphere mainly modulates parasympathetic activity, which mediated tachycardia and excessive bradycardia counterregulation, both of which might be involved as a mechanism of sudden unexpected death in epilepsy patients (SUDEP.

  12. Ectopia Cordis and Pentalogy of Cantrell: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Murat Bakacak

    2014-07-01

    Full Text Available Ectopia cordis (EC is the presence of a live, beating heart outside the thorax and is one of the most unique congenital anomalies. EC has been a weak association noted with trisomy 18 and a few cases have been associated with other chromosomal abnormalities. Pentalogy of cantrell (PC is a rare congenital syndrome of abdominal wall defect, lower sternal defect, diaphragmatic pericardial defect, anterior diaphragmatic defect, and intracardiac abnormalities. It has a rare frequency of about 1/100,000 births. The hallmark of this syndrome is an omphalocele associated with EC. Only a few patients with the full spectrum of the pentalogy have been described. Only very few patients survive attempts at surgical repair, the main causes of death being tachyarrhythmias, bradycardia, low blood pressure, rupture of the diverticulum, and heart failure. Early diagnosis is important about discuss the option of elective termination with the parents if intracardiac anomalies of incompatible with life are noted. We report two cases of PC diagnosed in early second trimester.

  13. Pharmacological treatment of cardiac glycoside poisoning.

    Science.gov (United States)

    Roberts, Darren M; Gallapatthy, Gamini; Dunuwille, Asunga; Chan, Betty S

    2016-03-01

    Cardiac glycosides are an important cause of poisoning, reflecting their widespread clinical usage and presence in natural sources. Poisoning can manifest as varying degrees of toxicity. Predominant clinical features include gastrointestinal signs, bradycardia and heart block. Death occurs from ventricular fibrillation or tachycardia. A wide range of treatments have been used, the more common including activated charcoal, atropine, β-adrenoceptor agonists, temporary pacing, anti-digoxin Fab and magnesium, and more novel agents include fructose-1,6-diphosphate (clinical trial in progress) and anticalin. However, even in the case of those treatments that have been in use for decades, there is debate regarding their efficacy, the indications and dosage that optimizes outcomes. This contributes to variability in use across the world. Another factor influencing usage is access. Barriers to access include the requirement for transfer to a specialized centre (for example, to receive temporary pacing) or financial resources (for example, anti-digoxin Fab in resource poor countries). Recent data suggest that existing methods for calculating the dose of anti-digoxin Fab in digoxin poisoning overstate the dose required, and that its efficacy may be minimal in patients with chronic digoxin poisoning. Cheaper and effective medicines are required, in particular for the treatment of yellow oleander poisoning which is problematic in resource poor countries. PMID:26505271

  14. Incidence of hemodynamic depression after carotid artery stenting using different self-expandable stent types

    International Nuclear Information System (INIS)

    The rates of hemodynamic depression (HD) and thromboembolism were compared in 95 carotid artery stenting (CAS) procedures performed in 87 patients with severe carotid artery stenosis using self-expandable braided Elgiloy stents (Wallstent) in 52 and slotted-tube Nitinol stents (Precise) in 43 procedures. The blood pressure, pulse rate, and neurological signs were recorded at short intervals during and after CAS. All patients underwent diffusion-weighted magnetic resonance imaging within 5 days after the procedure. The incidences of hypotension, bradycardia, and both were 17.9%, 3.2%, and 11.6%, respectively. The rate of postprocedural HD was 23.1% with Wallstent and 44.2% with Precise; the difference was significant (p=0.025). No patient manifested major cardiovascular disease after CAS. Diffusion-weighted magnetic resonance imaging revealed thromboembolism after 26.9% and 34.9% of Wallstent and Precise stent placement procedures, respectively; the difference was not significant. The type of self-expandable stent placed may affect the risk of procedural HD in patients undergoing CAS. Postprocedural HD was resolved successfully by the administration of vasopressors and by withholding antihypertensive agents. (author)

  15. Autoimmune autonomic ganglionopathy in a pediatric patient presenting with acute encephalitis.

    Science.gov (United States)

    Kuki, Ichiro; Kawawaki, Hisashi; Okazaki, Shin; Hattori, Yuka; Horino, Asako; Higuchi, Osamu; Nakane, Shunya

    2016-06-01

    Autoimmune autonomic ganglionopathy (AAG) is an acquired immune-mediated disorder that leads to systemic autonomic failure. Autoantibodies to the ganglionic nicotinic acetylcholine receptor (gAChR) are detected in 50% of AAG patients. We report the first pediatric case of AAG presenting with acute encephalitis. The patient was a 13-year-old boy who presented with orthostatic hypotension, followed by rapidly progressing disturbance of consciousness. Cerebrospinal fluid analysis revealed significant pleocytosis and increased neopterin concentration. Head MRI showed hyperintensities in bilateral caudate nuclei, putamen, hippocampus, and insula cortex. Severe autonomic dysfunctions such as severe orthostatic hypotension, bradycardia, dysuria, prolonged constipation and vomiting appeared. These symptoms were successfully controlled by repeated immunomodulating therapy with intravenous methylprednisolone pulse therapy and intravenous immunoglobulin. Autoantibodies to the α3 subunit of gAChR were detected at neurological onset, but were undetectable five months later. This observation indicates that AAG should be suspected in patients manifesting acute encephalitis characterized by preceding and prolonged autonomic symptoms, and immunomodulating therapy from an early stage can be effective. PMID:26740077

  16. The safety of dipyridamole myocardial perfusion scintigraphy (MPS) in patients with end-stage chronic airways limitations (CAL)

    International Nuclear Information System (INIS)

    Full text: Dipyridamole MPS is a well-established investigative technique in the diagnosis and pre-operative risk stratification of patients with possible coronary artery disease. However, there remains a concern of its use in patients with end-stage chronic airways limitations (CAL). Lung volume reduction surgery (LVRS) is a recent therapeutic option for such patients. The options for non-invasive pre-operative cardiac assessment in such patients are limited. This study reviewed the safety of dipyridamole use in such a clinical setting. 20 patients (10M, 10F, mean age 64.8 yrs) were evaluated. None had any history of ischaemic heart disease. Dipyridamole was administered intravenously at a dose of 0.05 mg/kg. Six patients remained asymptomatic throughout the procedure, while none experienced any chest pain. Two patients experienced moderate dyspnoea, which was rapidly relieved with aminophylline (100mg IV) during the recovery phase of the study. Two others developed mild dyspnoea; one settled spontaneously, while the other responded promptly to aminophylline. Aminophylline was administered to nine other patients to reverse minor symptoms (headache, flushing sensation). One other patient developed marked hypotension (SBP fell >20mmHg) and bradycardia, but no ECG changes for myocardial ischaemia. He responded well to aminophylline. His myocardial perfusion scan demonstrated extensive reversible myocardial ischaemia. Although the population size was small, dipyridamole appears safe to use in patients with end-stage CAL. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  17. Ciguatera caused by consumption of humphead wrasse.

    Science.gov (United States)

    Chan, Thomas Y K

    2013-12-15

    Humphead wrasse (Cheilinus undulatus) is an apex predator from coral reefs of the Indo-Pacific region. A food surveillance project using a validated mouse bioassay revealed the presence of ciguatoxins in significantly greater amounts in its flesh than in groupers and other coral reef fishes commonly available in Hong Kong wholesale market. Humphead wrasse has long been known to cause ciguatera, but there was a lack of clinical reports. A 45-year-old woman developed ciguatera after eating humphead wrasse. She required ICU care and infusions of intravenous fluids and dopamine for management of severe hypotension. All 5 published case series are also reviewed to characterise the types, severity and chronicity of ciguatera symptoms after its consumption. In addition to the gastrointestinal, neurological and other features that were typical of ciguatera, some subjects developed sinus bradycardia, hypotension, shock, neuropsychiatric features (e.g. mental exhaustion, depression, insomnia and memory loss), other central nervous system symptoms (e.g. coma, convulsions and ataxia) and myocardial ischaemia. Other subjects still experienced residual symptoms 6 months later; these were mainly neurological or neuropsychiatric complaints and skin pruritus. To prevent ciguatera, the public should avoid eating humphead wrasse and other large coral reef fishes. They should realise that consumption of the high-risk fish may result in more severe and chronic illness, including life-threatening complications and neuropsychiatric features. PMID:24141055

  18. Epidemiology and clinical features of ciguatera fish poisoning in Hong Kong.

    Science.gov (United States)

    Chan, Thomas Y K

    2014-10-01

    In the present review, the main objective was to describe the epidemiology and clinical features of ciguatera fish poisoning in Hong Kong. From 1989 to 2008, the annual incidence of ciguatera varied between 3.3 and 64.9 (median 10.2) per million people. The groupers have replaced the snappers as the most important cause of ciguatera. Pacific-ciguatoxins (CTX) are most commonly present in reef fish samples implicated in ciguatera outbreaks. In affected subjects, the gastrointestinal symptoms often subside within days, whereas the neurological symptoms can persist for weeks or even months. Bradycardia and hypotension, which can be life-threatening, are common. Treatment of ciguatera is primarily supportive and symptomatic. Intravenous mannitol (1 g/kg) has also been suggested. To prevent ciguatera outbreaks, the public should be educated to avoid eating large coral reef fishes, especially the CTX-rich parts. A Code of Practice on Import and Sale of Live Marine Fish for Human Consumption for Prevention and Control of Ciguatera Fish Poisoning was introduced from 2004 to 2013. The Food Safety Ordinance with a tracing mechanism came into full effect in February 2012. The Government would be able to trace the sources of the fishes more effectively and take prompt action when dealing with ciguatera incidents. PMID:25333356

  19. Thirty years of blackouts: a case report of swallow syncope

    Directory of Open Access Journals (Sweden)

    Irene Lambiris

    2013-04-01

    Full Text Available Deglutition syncope has been demonstrated in isolated case reports, the first being described over 50 years ago. It is thought to be caused by a hypersensitive vagotonic reflex in response to esophageal dilation after swallowing. It can cause syncope due to complete atrioventricular (AV block and acute reduction of cardiac output. Although rare, its lethality is worthy of discussion, as early recognition can offer complete treatment with placement of a pacemaker. A 54-year-old man presented with 30 years of lightheadedness and syncope, followed by disorientation and tremors, after eating sandwiches or drinking carbonated beverages. He initially was evaluated by a neurologist. Work-up included cardiac 2D transthoracic echocardiogram, electroencephalogram, swallow stud, pulmonary function tests, electrocardiogram, and cardiac stress testing. All tests were within normal limits, and it was determined that he was suffering from convulsive syncope and deglutition syncope. Referral to the cardiac electrophysiology department with tilt-table testing accompanied by swallow evaluation was then recommended. The tests demonstrated marked vagal response resulting in sinus bradycardia with second-degree AV block and pauses up to 3.5 seconds. Patient experienced near syncope. A rate-responsive, dual-chamber Boston Scientific pacemaker with DDDR programming was implanted. Patient has remained asymptomatic at follow-up.

  20. Short and middle term outcome of radiofrequency catheter ablation for paroxysmal and sustained atrial fibrillation

    International Nuclear Information System (INIS)

    The aim of this study was to assess short and middle term outcome of radiofrequency catheter ablation for drug-refractory paroxysmal and sustained atrial fibrillation. Subjects were 30 patients of atrial fibrillation (19 paroxysmal, 11 sustained) who underwent extensive pulmonary vein isolation from January 2007 to August 2009 in our department. Twenty three men and seven women, aged from 44 to 76 years, were enrolled. Follow-up period was one to 32 months. Drug free success was 33%, but symptoms and electrocardiogram (EGG) findings were improved in 93 % of the patients by administration of anti-arrhythmic agents. Five of the six patients with bradycardia-tachycardia syndrome was free from pacemaker implantation. Left ventricular ejection fraction was improved in two patients with dilated cardiomyopathy (DCM)-like left ventricular dysfunction. One case had cardiac tamponade and transient ST elevation due to right coronary air embolism were observed in two cases. There were no death and no cerebrovascular events during the procedures and follow-up periods. In conclusion, radiofrequency catheter ablation for paroxysmal and sustained atrial fibrillation in our department may be highly acceptable new method for improving the symptoms and clinical signs of the patients. (author)