Frequencies and patterns of arrythmias in anterior and inferior myocardial infarction

The objective of this study was to identify the frequency and clinical patterns of arrhythmias in anterior and inferior myocardial infarction [MI]. A descriptive study. This study was conducted at critical care unit of Combined Military Hospital Kharian cantonment from January 2006 to December 2006. Hundred patients were included in the study that fulfilled the required criteria. They underwent detailed history taking and systemic examination. Patients were monitored through cardiac monitors and serial ECG recordings were taken especially if any rhythm disturbances were observed or if the patient suffered any symptom, till the time of discharge from the hospital. The relevant information was entered into a specially designed pro forma. All the data collected through the pro forma was analyzed through SPSS version 11 in terms of frequency, percentages and proportions. Premature ventricular contractions [PVCs] were the most common rhythm disturbance followed by ventricular tachycardia [VT]. Both were more common in anterior myocardial infarction [MI] than inferior MI. Bradyarrhythmias were more common with inferior MI. PVCs usually manifested with chest pain, VT was accompanied by palpitations and dyspnoea. Atrioventricular [AV] blocks clinically presented as syncope. PVCs are the most common rhythm disturbance after anterior and inferior MI. VT and ventricular fibrillation [VF] are frequent in anterior while bradyarrhythmias are common with inferior MI

Estudio descriptivo sobre bloqueos Atrio-ventriculares en infartos posteriores en el Hospital de Caldas ese, 1999-2002 / Descriptive study on Vestibule-ventricular blockades in later infarcts in the Hospital of Caldas that, 1999-2002

El infarto agudo de miocardio (IAM) es un problema de salud pública a escala mundial y nacional, que merece una prevención, diagnóstico y tratamiento oportunos. La persona que sufre un IAM de la cara inferior tiene entre sus posibles complicaciones el bloqueo atrio-ventricular(bloqueo AV) en sus diversas manifestaciones. Materiales y métodos: El presente es un estudio de tipo descriptivo, retrospectivo realizado en el Hospital Universitario de Caldas ESE, por medio de la revisión de historias clínicascorrespondientes a los años 1999 a 2002, de los pacientes que presentaron infarto agudo de miocardio de cara inferior. Se tomaron de las historias variables como edad, sexo, consumo de alcohol, tabaco, sedentarismo yla presencia o ausencia de enfermedades previas tales como hipertensión arterial, diabetes mellitus, dislipidemias e infarto agudo de miocardio previo y el tiempo de aparición del bloqueo (menor o mayor de 24 horas). Resultados: Se encontró una asociaciónsignificativa entre la incidencia de bloqueos AVcon la edad (p=0.017) y el IAM previo (p=0.001).igualmente se encontró una asociación significativaentre mortalidad y tipo de bloqueo (p=0.028). No se presentó asociación entre los factores de riesgo asociados para IAM, y la presentación de bloqueo, excepto una posible relación con la hipertensión arterial (p=0.176), no del todo clara, por lo cual se recomiendaque sea explorada por estudios posteriores. El 32.7 por ciento de personas con infarto de cara inferior presentó algún tipo de bloqueo, y el 77.1 por ciento de los bloqueos se presentó en las primeras 24 horas. Conclusiones: Los pacientes que presenten un IAM de cara inferior con una edad >65 años, se deben someter a seguimiento con monitoría continua por electrocardiograma durante las primeras 24 horas; lo mismo todo paciente con IAM de cara inferior, se debe incluir dentro del grupo de seguimiento clínico, electrocardiográfico y de monitoreo estricto.

Bloqueios de ramo e bloqueios atrioventriculares como complicaçöes do infarto agudo do miocárdio na era trombolítica / Bundle branch and atrioventricular block as complications of acute myocardial infarction in the thrombolytic era

OBJECTIVE: To analyze the incidence of intraventricular and atrioventricular conduction defects associated with acute myocardial infarction and the degree of in hospital mortality resulting from this condition during the era of thrombolytic therapy. METHODS: Observational study of a cohort of 929 consecutive patients with acute myocardial infarction. Multivariate analysis by logistic regression. Was used. RESULTS: Logistic regression showed a greater incidence of bundle branch block in male sex (odds ratio = 1.87, 95 per cent CI = 1.02-3.42), age over 70 years (odds ratio = 2.31, 95 per cent CI = 1.68-5.00), anterior localization of the infarction (odds ratio = 1.93, 95 per cent CI = 1.03-3.65). There was a greater incidence of complete atrioventricular block in inferior infarcts (odds ratio = 2.59, 95 per cent CI 1.30-5.18) and the presence of cardiogenic shock (odds ratio = 3.90, 95 per cent CI = 1.43-10.65). Use of a thrombolytic agent was associated with a tendency toward a lower occurrence of bundle branch block (odds ratio = 0.68) and a greater occurrence of complete atrioventricular block (odds ratio = 1.44). The presence of bundle branch block (odds ratio = 2.45 95 per cent , CI = 1.14-5.28) and of complete atrioventricular block (odds ratio = 13.59, 95 per cent CI = 5.43-33.98) was associated with a high and independent probability of inhospital death. CONCLUSION: During the current era of thrombolytic therapy and in this population, intraventricular disturbances of electrical conduction and complete atrioventricular block were associated with a high and independent risk of inhospital death during acute myocardial infarction.

Complete heart block complicating acute myocardial infarction [pattern, management and in-hospital outcome]

852 consecutive patients admitted to the CCU in Matareia Teaching Hospital [MTH] were studied to assess the incidence of complete heart block [CHB] in acute myocardial infarction [AMI], and evaluate its outcome and the type of therapy applied. Out of 605 patients with AMI, 24 developed CHB. Inferior wall infarction was present in 18, anterior AMI in 4, and subendocardial in 2 cases. The onset of block in all cases was in the first 2 days. Fifteen patients were treated medically and 9 required temporary pacing. Only 3 cases had persistent block and required permanent pacing. The overall outcome was good, whatever the therapeutic modality adopted

Electrocardiographic manifestations of healthy residents of a tribal Himalayan village.

Electrocardiograms of 984 healthy subjects residing in village Kalpa at the height of 9000 feet above sea level were studied. Right ventricular hypertrophy (RVH) was observed in 9 (0.914%) subjects. Electrocardiographic evidence of ischaemic heart disease was found in 6 (0.609%) subjects.

Bloqueio atrioventricular fetal / Fetal atrioventricular block

Objetivo - Estudar a etiopatogenia e evolução clínica dos fetos portadores de bloqueio átrioventricular (BAY) com o objetivo de identificar fatores que afetam a história natural dessa entidade. Métodos - Ecocardiografia fetal associada ao modo M e doppler foi realizada em 600 gestantes entre 18 a 40 semanas por diversas indicações. Em 13 fetos (2,1%) diagnosticou-se BAV. Foram analisados o tipo de bloqueio, presença de cardiopatia congênita associada à síndrome de isomerismo atrial esquerdo, assim como a positividade para doença materna do tecido conectivo, clínica ou laboratorial. Resultados - BAV isolado foi encontrado em 6 fetos (5 casos de BAV total e 1 caso de BAV 2° grau 2:1). Neste grupo, 5 gestantes apresentaram positividade para anticorpos antinúcleo. Bloqueio associado à cardiopatia foi encontrado em 7 casos, sendo em 6 associados à síndrome de isomor fismo atrial esquerdo (5 casos de BAV total e 1 caso de BAV 2° grau 2:1). Conclusão - Os achados deste estudo concordam com dados de literatura sobre a possível relação causa-efeito entre anticorpos maternos, característicos da doença do tecido conectivo e o bloqueio cardíaco fetal isolado. Da mesma forma, concordam com a literatura a péssima evolução dos fetos portadores de bloqueio e anormalidade cardíaca estrutural, associada à síndrome do isomor fismo atrial esquerdo. Formas efetivas de terapia fetal não estão estabelecidas

Purpose - To study the pathogenesis, evolution and prognosis of the complete heart block of the fetus. Methods - Bidimensional echo cardiography associated to M-mode and doppler was performed in 600 patients. All cases of congenital heart block were referred because the fetuses presented hydrops, bradycardia and/or cardiac malformation suspected by routine ultrasound.Results - Isolated heart block was found in 6 fetuses (5 cases of complete type and 1 case of 2nd degree type 2:1). Heart block associated with complex cardiac disease and left atrial isomerism was found in 6 fetuses with no survivors (5 cases of complete type and 1 case of 2nd degree type 2:1). Heart block associated with átrioventricular discordante wasfound in 1 case. Conlusion - The findings of this study agree the literatura about the relation between maternal anti-RO antibodies and isolated complete heart block. We also found a poor prognosis in the group with heart block and complex cardiac malformations

Bloqueio átrio-ventricular congênito: características neonatais e evoluçäo / Congenital complete heart block

Säo apresentados 9 casos de RN portadores de bloqueio átrio-ventricular congênito (BAVC) com detecçäo da anomalia no terceiro trimestre de gestaçäo através de ecocardiografia fetal. Todos os RNs foram de termo ou limítrofes e a maioria nasceu de parto cesáreo, em boas condiçöes. Imediatamente após o nascimento, foi realizado avaliaçäo cardiológica completa, através de exame clínico, ECG, Rx de tórax, ecocardiografia e monitorizaçäo de FC pelo Holter contínuo de 24 horas. Cinco RNs apresentaram BAVC com FC basal ao redor de 60 bat/min e, em destes, a sorologia para LES (anti SS-AA/Rô) foi positiva. Os 5 evoluiram bem, tendo recebido alta antes do primeiro mês de vida sem medicaçäo e com acompanhamento ambulatorial. Um RN apresentou BAVC com FC basal ao redor de 50 bat/min, tendo evoluido para ICC ao final do primeiro mês, compensada com o uso de digitálico e diurético. Três casos eram associados com cardiopatia congênita complexa, sendo 2 do tipo átrio-ventricular communis (AVC) e um do tipo transposiçäo corrigida dos grandes vasos da base. Os 2 casos com AVC foram os únicos que descompensaram precocemente (primeira semana de vida). Estes casos mostram que a detecçäo precoce de alteraçöes de ritmo cardíaco no pré-natal, um preparo adequado para a recepçäo do RN ao nascimento, avaliaçäo cardiológica completa, säo fatores decisivos para uma boa evoluçäo pós-natal

Estudios electrofisiológicos en la miocarditis chagásica crónica / Electrophysiological studies in the chronic Chagasic myocarditis

Los estudios electrofisiológicos sond e utilidad en el diagnóstico y reconocimiento de las arritmias en general y de la miocarditis chagásica crónica, permitiendo conocer el origen de aquellas, el modo de activación intracardíaca del estímulo ectópico y su capacidad de generar taquiarritmias severas, la vulnerabilidad de los ventrículos a los estímulos ectrópicos, los trastornos en la conducción, su significación pronóstica, y el comportamiento frente a distintas drogas antiarritmicas para el tratamiento de pacientes; possibilitando la selección del tratamiento adecuado, evaluación de su efectividad, y, decisión de la eventual implantación de marcapasos definitivo. Se describen el equipamiento y métodos de los estudios electrofisiológicos, detallándose los registros que pueden obtenerse en ellos: recorrido de estímulos auriculares ectópicos y su origen; registrados de Haz de His y de potencial de acción monofásico -para establecer las variaciones presentadas en la administración de drogas antiarrítmicas-. También se consideran útiles, en pacientes con arritmias, los métodos de estimulación ventricular programada