Supraventricular tachycardia in children.

The mechanisms causing different supraventricular tachycardias can be identified with the aid of the 12-lead ECG using Tipple's approach. The main aims of this retrospective study were to use the 12-lead ECG to determine the underlying mechanisms of supraventricular arrhythmias and to evaluate the effectiveness of the treatment modalities used. Forty-one patients were included in the study. The main findings were: nine of the 41 patients had atrial tachycardias while junctional tachycardia occurred in 32/41 of our patients. The underlying mechanisms causing the junctional tachycardias were: AVNRT (n = 21), AVRT (n = 10) and JET (n = 1). Of the 10 patients presenting with AVRT, eight were less than one year old. AVNRT occurred more often in the older age group (>1 year of age). Fifteen of the 41 patients had spontaneous cessation of their supraventricular tachycardia. The drug most commonly used during the acute and long-term phases was digoxin. Amiodarone was used in six patients with an 80% success rate. In the early 80s verapamil was used in five patients with a 100% success rate. It is important to note that verapamil is no longer used in children due to its side effects. Lately, adenosine phosphate is the drug of choice in most supraventricular tachycardias. The management of supraventricular tachycardias in paediatric practice is mainly based on clinical studies and individual experience. Care must therefore be taken to choose medication regimens that are likely to be effective with the minimum risk of potentiating abnormal haemodynamics or conduction.

Subjective pulsatile tinnitus cured by carotid endarterectomy. A case report.

A 70-year-old woman with unilateral pulsatile tinnitus was relieved of the complaint after carotid endarterectomy. Internal carotid artery stenosis presenting with pulsatile tinnitus is rare. Endarterectomy can relieve symptoms if the correct diagnosis is made.

Subclavian vein stenosis and axillary vein 'effort thrombosis'. Age and the first rib bypass collateral, thrombolytic therapy and first rib resection.

Three patients presented with axillary vein 'effort thrombosis'. Intravenous streptokinase for 3 days followed by heparin for 10 days restored patency and relieved symptoms. Pretreatment diagnosis and the effect of streptokinase were confirmed venographically and an abnormality in the subclavian vein just medial to the first rib was demonstrated. This stenosis was most severe and had a prominent bypass collateral in the oldest patient. It is proposed that, in the absence of superimposed thrombosis, the damage to the vein in predisposed patients is progressive with age, with establishment of permanent collaterals. Transaxillary first rib resection is advised to prevent compression of the veins in the thoracic outlet.

High-output cardiac failure associated with an iliac artery aneurysm and arteriovenous fistula. A case report.

Rupture of an aneurysm into a major vein is an uncommon complication, and the resulting arteriovenous fistula frequently causes high-output cardiac failure as a presenting symptom. A patient with high-output cardiac failure refractory to conservative treatment and an aortic and left iliac artery aneurysm and associated arteriovenous fistula between the left common iliac artery and vein is presented. The fistula was confirmed by transfemoral arteriography. Successful resection of the aneurysm and closure of the fistula resulted in dramatic clinical improvement. Careful monitoring of cardiovascular function with a Swan-Ganz catheter, before, during and after operation contributed to a satisfactory result.