ABSTRACT
To distinguish supraventricular tachycardia with aberrancy from ventricular tachycardia is sometimes difficult. It seems to be easy to distinguish the two forms in patients with preexisting bundle branch block: if the QRS morphology during tachycardia is identical to those during at rest the tachycardia is supraventricular, if different, ventricular. We present two cases with preexisting bundle branch block and wide complex tachycardia whose QRS morphologies were almost same to those during normal rest rhythm. The atrioventricular dissociation and the response to adenosine and lidocaine strongly suggests ventricular tachycardia. In these cases ventricular tachycardia masqueraded as supraventricular tachycardia and the identical QRS morphology with the preexisting bundle branch block may suggest a misdiagnosis of supraventricular tachycardia.
Subject(s)
Heart Conduction System/physiopathology , Tachycardia, Ventricular/diagnosis , Aged , Aged, 80 and over , Diagnosis, Differential , Electrocardiography , Humans , Male , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/physiopathology , Tachycardia, Ventricular/physiopathologyABSTRACT
The authors report two cases where headaches was the only manifestation of severe myocardial ischemia. They had high degree coronaria sclerosis which was demonstrated by angiocardiography in one patient and at autopsy in the second patient. These findings suggest that in the mechanism of headache angina rather the pain perception than generalized vasospasm plays an important role.
Subject(s)
Angina Pectoris/complications , Headache/etiology , Myocardial Ischemia/complications , Adult , Aged , Aged, 80 and over , Angina Pectoris/etiology , Angiocardiography , Angioplasty, Balloon, Coronary , Coronary Angiography , Echocardiography , Electrocardiography , Humans , Male , Myocardial Ischemia/diagnostic imaging , Myocardial Ischemia/pathology , Myocardial Ischemia/surgeryABSTRACT
The authors investigated the effect of adenosine or ATP on narrow QRS tachycardia in 56 pts, 3 pts with wide QRS tachycardia 9 pts with suspected latent preexcitation and 10 pts with PVC suspected to be ventricular parasystole. After the bolus iv. administration of adenosine or ATP every SVT was stopped related to AV node (44 pts), but in the rest twelve related to atrial origin of SVT only one automatic atrial tachycardia could be stopped. From the 9 patient suspected to have concealed WPW 2 pts had delta wave during the effect of adenosine, and in four pts parasystole was demonstrated among the pts had varying coupling interval PVC. None of the pts who had wide QRS tachycardia was the tachycardia stopped, but in two cases the supraventricular origin--atrial flutter and tachycardia--was discovered. The authors emphasize the favourable effect of adenosine in narrow complex tachycardia and suggest that it can given safely in wide QRS tachycardia of unknown origin either. The diagnostic effect of adenosine can be used in sinus rhythm too if latent preexcitation or ventricular parasystole is suspected.
Subject(s)
Adenosine Triphosphate/therapeutic use , Arrhythmia, Sinus/drug therapy , Arrhythmias, Cardiac/drug therapy , Tachycardia, Sinoatrial Nodal Reentry/drug therapy , Tachycardia/drug therapy , Adolescent , Adult , Aged , Arrhythmia, Sinus/diagnosis , Arrhythmias, Cardiac/diagnosis , Electrocardiography , Female , Humans , Male , Middle Aged , Parasystole/diagnosis , Parasystole/drug therapy , Tachycardia/classification , Tachycardia/diagnosis , Tachycardia, Sinoatrial Nodal Reentry/diagnosisABSTRACT
The authors describe a case of a 71 year old man who suffered from chronic lung disease and had atrial tachycardias. 18 mg adenosine terminated his paroxysmal supraventricular tachycardia. The Holter monitoring showed that the tachycardia began at the late diastole with normal PQ interval, suggesting that an ectopic atrial tachycardia was terminated. They propose that adenosine is a "new" drug for termination of some form of atrial tachycardia.
