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1.
J Geriatr Cardiol ; 21(6): 686-688, 2024 Jun 28.
Article in English | MEDLINE | ID: mdl-38973821
3.
Oxf Med Case Reports ; 2024(1): omad143, 2024 Jan.
Article in English | MEDLINE | ID: mdl-38292154

ABSTRACT

Vagal maneuvers are techniques used to increase parasympathetic tone, particularly useful in the management of hemodynamically stable supraventricular tachycardias. If ineffective, adenosine can be attempted. We present a patient with atrioventricular nodal re-entrant tachycardia (AVNRT), who could not effectively perform Valsalva maneuvers and had contraindications for carotid massage and adenosine administration, that converted into sinus rhythm by using a rectal thermometer. This maneuver was reproduced on various occasions. We suggest that rectal vagal maneuver may provide an additional therapeutic modality for selected patients with AVNRT.

5.
Cureus ; 15(7): e41442, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37546043

ABSTRACT

A variety of noncardiac conditions mimic the electrocardiographic changes of ST-elevation myocardial infarction (STEMI). Therefore, a physician must maintain a high index of suspicion when evaluating ST-segment elevation (STE). We present a case of epigastric pain secondary to ileus and gastric dilatation masquerading as anterolateral STEMI on an electrocardiogram (ECG). The STE promptly resolved following laparotomy. To the best of our knowledge, this is the first case of anterolateral STE secondary to gastric dilatation.

6.
Cureus ; 15(7): e42163, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37602013

ABSTRACT

We report the case of a 51-year-old male with pectus excavatum (PEX) who presented with stress-related chest pain as a symptom of acute non-ST elevation myocardial infarction. Coronary angiography (CAG) revealed a suspected single coronary artery (SCA) anatomy with diffuse atherosclerotic narrowing, without evidence of other coronary ostia in the aortic root. The diagnosis was confirmed on cardiac computed tomography (CCTA) as the SCA of the R-I type by Lipton classification. The percutaneous coronary intervention was performed with good angiographic results and resolution of symptoms.

7.
J Cardiopulm Rehabil Prev ; 42(3): E34-E41, 2022 05 01.
Article in English | MEDLINE | ID: mdl-35383665

ABSTRACT

PURPOSE: Heart rate response during exercise testing (ET) provides valuable prognostic information. Limited data are available regarding the prognostic interplay of heart rate (HR) measured at rest, exercise and recovery phases of ET, and its ability to predict risk beyond exercise capacity. METHODS: Retrospective analysis of treadmill ETs was performed by the Bruce protocol in patients aged 35-75 yr without known cardiovascular disease (CVD; n = 13 887; 47% women). Heart rate recovery at 2 min (HRR2; defined abnormal <42 beats) and chronotropic index (CI; defined abnormal <80%, determined as age-predicted HR reserve) were analyzed in association with the risk of developing myocardial infarction, stroke, or death (major adverse cardiovascular event [MACE]) during median follow-up of 6.5 yr. RESULTS: The HRR2 <42 beats and CI <80% were each associated with increased risk of MACE: adjusted hazard ratios with 95% confidence interval 1.47: 1.27-1.72 and 1.66: 1.42-1.93, P < .001, respectively, evident also when analyzed as continuous variables. Strength of association of HRR2 and CI with outcome was attenuated but remained significant with further adjustment for exercise duration and metabolic equivalents. Having both HRR2 and CI abnormal compared with only one measure abnormal was associated with hazard ratios with 95% confidence interval of 1.66: 1.38-2.00 and 1.48: 1.22-1.79 for MACE, before and after adjustment for cardiorespiratory fitness (CRF). The degree of CRF (low vs mid/high) did not modify the prognostic effect of HRR2 and CI (P-for-interaction nonsignificant). CONCLUSIONS: Both HRR2 and CI provide independent prognostic information beyond CRF in patients without CVD referred for ET. The predictive ability is more pronounced when both abnormal HR measures coexist.


Subject(s)
Cardiovascular Diseases , Exercise Test , Heart Rate , Cardiovascular Diseases/complications , Female , Heart Rate/physiology , Humans , Male , Prognosis , Retrospective Studies , Risk Factors
8.
Cureus ; 13(4): e14255, 2021 Apr 02.
Article in English | MEDLINE | ID: mdl-33954068

ABSTRACT

BACKGROUND: Myocardial ischemia may lead to lethal arrhythmias. Treatment of these arrhythmias without addressing the cause of ischemia may be futile. The length of resuscitation is an important parameter for determining when to stop resuscitation but with shockable rhythms and reversible cause of the cardiac arrest, the decision to terminate resuscitation is complex.  Case Summary: A patient with a three-month history of shortness of breath with effort developed pulseless ventricular tachycardia (VT) at the early stages of a stress test. In coronary angiography, a critical lesion in the right coronary artery (RCA) was observed and treated with two stents. During the procedure and for a total of five hours, the patient had more than 100 separate episodes of VT and ventricular fibrillation (VF) that were treated by 150 defibrillations, artificial ventilation, intra-aortic counter-pulsation balloon insertion, and multiple drugs. One hour after the initial stenting procedure, thrombosis of the RCA was demonstrated and treated successfully with angioplasty. Use of procainamide resolved the arrhythmias and the patient recovered completely without neurological deficit, ejection fraction of 45%, and is asymptomatic at one year following the event. DISCUSSION: Our case shows that with a revisable cause of cardiac arrest, resuscitation should be directed at maintaining perfusion of essential organs and treating the reversible cause. Without re-opening the RCA, we could not have saved the patient's life. The use of an extracorporeal membrane oxygenator, if available, should be considered in similar cases. Finally, the quality of cardiopulmonary resuscitation determines the neurological outcome regardless of the length of resuscitation, as was evident in our patient who recovered completely.

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