ABSTRACT
The authors review the history of atrial fibrillation, the most frequent clinically observed cardiac arrhythmia. A French "clinicopathologist", Jean Baptist de Sénac (1693-1770), was the first who assumed a correlation between "rebellious palpitation" and a stenosis of the mitral valve. From an analysis of simultaneously recorded arterial and venous pressure curves, the Scottish Sir James Mackenzie (1853-1925) demonstrated that a presystolic a wave cannot be seen on the jugular phlebogram during "pulsus irregularis perpetuus". The first human ECG depicting atrial fibrillation was published by Willem Einthoven (1860-1927) in 1906. The proof of a direct connection between absolute arrhythmia and auricular fibrillation was established by two Viennese physicians, Rothberger and Winterberg. The major discoveries relating to the pathomechanism and the clinical features of atrial fibrillation in the 20(th) century stemmed from the scientific activities of Karel Frederik Wenckebach, Sir Thomas Lewis, Gordon Moe, and Maurits Allessie.
Subject(s)
Atrial Fibrillation/history , Electrocardiography/history , Mitral Valve Stenosis/history , Atrial Fibrillation/diagnosis , Europe , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , HumansABSTRACT
The authors report the first Hungarian case of electrocardiographic Osborn wave with accidental hypothermia (core temperature 32 degrees C). The cellular and ionic mechanisms of the development of J-wave-elevation and the cardiac electrophysiological and ECG changes caused by hypothermia are briefly reviewed. An account is presented of those conditions in which, in a few or in all ECG leads, an Osborn wave or distinct J-point-elevation may be observed.
Subject(s)
Electrocardiography , Heart Conduction System/physiopathology , Hypothermia/physiopathology , Aged , Humans , MaleABSTRACT
Elective versus therapeutic lymph node dissection has been a controversial field of the surgical treatment of cutaneous malignant melanoma for more than two decades. The identification and biopsy of the sentinel lymph node in different solid malignancies has become feasible by the method described by Morton in 1992. The sentinel lymph node is the first tumor draining lymph node in the regional lymph node basin. If metastasis is not proven in the sentinel node by detailed histological study those are unlikely in other regional lymph nodes and formal lymph node dissection can be omitted. Patients undergoing surgery for primary cutaneous (intermediate or high risk) melanoma have been initiated in this feasibility study. Of the 40 patients the sentinel lymph node biopsy was unsuccessful in two and at least one positive sentinel lymph node was found in nine patients. The duration of the procedure is between five and 15 minutes. After this feasibility study further prospective and randomized studies are projected.
Subject(s)
Lymphatic Metastasis/diagnosis , Melanoma/pathology , Melanoma/surgery , Sentinel Lymph Node Biopsy/methods , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Adult , Aged , Feasibility Studies , Female , Humans , Lymphatic Metastasis/diagnostic imaging , Male , Melanoma/diagnostic imaging , Middle Aged , Radionuclide Imaging , Skin Neoplasms/diagnostic imagingABSTRACT
A review is provided of the present state of knowledge relating to the cardiac electrophysiological effects of adenosine at ion channel and clinical levels. It is emphasized that intravenous adenosine is highly effective in terminating sinus node, atrioventricular (AV) nodal and AV-reciprocating reentrant tachycardias. In the course of an account of the antiarrhythmic indications of adenosine therapy, the main aspects of the diagnostic use of the nucleoside are briefly discussed. It is pointed out that adenosine treatment may possibly be accompanied by the occurrence of atrial and ventricular proarrhythmias, for at pharmacological dose of 6-12 mg this endogenous cardioprotective and antiarrhythmic agent is not devoid of side-effects.
Subject(s)
Adenosine/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Heart/drug effects , Tachycardia, Sinoatrial Nodal Reentry/drug therapy , Adenosine/administration & dosage , Anti-Arrhythmia Agents/pharmacology , Dose-Response Relationship, Drug , Humans , Injections, IntravenousABSTRACT
A review is presented at the main causes of the change in paradigm that has occurred in the past 10 years in antiarrhythmic pharmacotherapy. The new attitude is ascribed to (1) the advances made in the application of non-pharmacological therapeutic modalities (radiofrequency catheter ablation, implantable antiarrhythmic devices), (2) the modification of therapeutic practice in response to the results of large-scale prospective randomized clinical trials, and (3) the proper recognition and appropriate appreciation of the frequently life-threatening proarrhythmic action of antiarrhythmic drugs. The current state of knowledge is discussed as concerns the anti- and proarrhythmic effects of the drugs available at present, and also their safe clinical use.
Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac/drug therapy , Anti-Arrhythmia Agents/adverse effects , Arrhythmias, Cardiac/chemically induced , Arrhythmias, Cardiac/diagnosis , Catheter Ablation , Electrocardiography , Humans , Tachycardia, Atrioventricular Nodal ReentryABSTRACT
A case of quinidine-induced syncope with prevailing neurological symptoms is reported in which the transient right-sided hemiparesis and fluctuating soporific state was induced by recurrent torsades de pointes ventricular tachycardias. In connection with this case, attention is paid to the difficulties of differential diagnosis and to the consideration of cardiac and metabolic disorders mimicking TIA or ischaemic stroke.
