BACKGROUND Bradycardia,renal failure,atrioventricular nodal blockade,shock,and hyper-kalemia(BRASH)syndrome is an acronym used to describe a constellation of BRASH.It is an underrecognized phenomenon that can be deadl...BACKGROUND Bradycardia,renal failure,atrioventricular nodal blockade,shock,and hyper-kalemia(BRASH)syndrome is an acronym used to describe a constellation of BRASH.It is an underrecognized phenomenon that can be deadly if not appro-priately managed in a timely manner.This case highlights the importance of rapid diagnosis and reviews a multitude of treatment options in a uniquely severe case of BRASH syndrome.CASE SUMMARY We present a case of a 54-year-old male on a beta-blocker and angiotensin-con-verting enzyme inhibitor who presented with one day history of nausea,vomi-ting,and shortness of breath.Upon presentation,he was bradycardic and hypotensive,requiring transcutaneous pacing.Initial electrocardiogram showed atrial fibrillation with ventricular rate in 30’s.He was found to have acute kidney injury,hyperkalemia,and metabolic acidosis.He was successfully treated with multiple potassium lowering agents,continuous renal replacement therapy,four pressors,mechanical ventilation,and transvenous pacing with complete recovery prior to discharge.CONCLUSION Increased awareness of BRASH syndrome may improve outcomes through timely diagnosis and aggressive intervention.展开更多
Rationale:Cholera is an acute diarrheal disease caused by the ingestion of food or water contaminated by Vibrio cholerae.It threatens global health and signifies a lack of proper access to clean water and sanitation.I...Rationale:Cholera is an acute diarrheal disease caused by the ingestion of food or water contaminated by Vibrio cholerae.It threatens global health and signifies a lack of proper access to clean water and sanitation.If not treated properly,cholera causes severe watery diarrhea that can lead to hypovolemic shock.Patient’s Concern:A 23-year-old male patient was admitted with severe diarrhea with a frequency of fifteen to twenty loose,watery stools and was severely dehydrated.The patient developed severe bradycardia with a positive serum troponin level and no chest pain.Initial electrocardiogram on the day of admission was sinus tachycardia with a heart rate of 120 beats/min on the third day of admission,the patient developed bradycardia with a heart rate of 45 beats/min with a prolonged QT interval of 550 msec(corrected QT interval 476 msec).Diagnosis:Cholera with sinus bradycardia with prolonged QT interval.Interventions:Based on the clinical situation and the inferior vena cava status determined by ultrasound,a thorough fluid resuscitation using crystalloids was performed.The patient was then administered antibiotics:oral doxycycline 300 mg STAT and intravenous ciprofloxacin 15 mg/kg twice daily for three days.Outcomes:After 5 days of adequate hydration and antimicrobial treatment,diarrhea was resolved and heart rate improved with no electrocardiogram abnormalities.Lessons:This case report highlights the importance of timely diagnosis and managing severe diarrhea in cholera patients to prevent morbidity and mortality.Public awareness regarding cholera and its complications is necessary for the betterment of the community.展开更多
Objective Castleman disease, also known as giant lymph node hyperplasia, involves lesions in the lymph nodes usually located in the chest_ENREF_1, particularly in the mediastinum. Meanwhile, sinus bradycardia is a sin...Objective Castleman disease, also known as giant lymph node hyperplasia, involves lesions in the lymph nodes usually located in the chest_ENREF_1, particularly in the mediastinum. Meanwhile, sinus bradycardia is a sinus rhythm slower than 60 beats per min, and it can occur in both healthy and sick individuals. However, the comorbidity of these two disorders has not been previously reported. In this paper, we report a case of a 46-year-old woman who presented with persistent sinus bradycardia and irondeficiency anemia. Diagnostic work-up revealed hepatosplenomegaly and a giant mass near the splenic hilum. The mass was removed surgically; after which, the patient's bradycardia resolved immediately, while her anemia was corrected after subsequent chemotherapy. Pathological examination revealed lymph nodes with benign lesions, and the patient was diagnosed with hyaline-vascular variant of Castleman disease. This is the first documented case of sinus bradycardia associated with Castleman disease. In this paper, we describe the case characteristics, discuss the possible pathogenesis, and consider the appropriate treatment of symptomatic sinus bradycardia accompanying Castleman disease.展开更多
Rationale:Vanishing lung syndrome is rare and can be associated with a history of smoking and marijuana use.The occurrence of giant bullae can also be linked to infections,particularly tuberculosis in tropical countri...Rationale:Vanishing lung syndrome is rare and can be associated with a history of smoking and marijuana use.The occurrence of giant bullae can also be linked to infections,particularly tuberculosis in tropical countries.Patient concerns:A 26-year-old male complained of weakness,severe vomiting,and reduced breathlessness when lying on the left side.He had a history of pulmonary tuberculosis two years ago.Diagnosis:Symptomatic bradycardia in tuberculosis-related giant bullae.Interventions:The patient was recommended to undergo an elective bullectomy,but he decided not to proceed with the procedure.Atropine sulfate was administered to alleviate symptoms of bradycardia,while a standardized anti-tuberculosis regimen were started for the next six months.Outcomes:Following 7 days of intensive care treatment involving antituberculosis medications and atropine sulfate,the patient achieved hemodynamic stability,opting against bullectomy despite residual symptoms of dyspnea.Subsequent six months of antituberculosis therapy notably alleviated symptoms without requiring bullectomy.Lessons:Increasing intrathoracic pressure can also be caused mechanically by giant bullae.Cardiac symptoms in vanishing lung syndrome are reversible and can be alleviated once the underlying cause is addressed.In this case,symptomatic bradycardia was reduced only with tuberculosis treatment without bullectomy intervention。展开更多
BACKGROUND Hyperthyroidism often leads to tachycardia,but there are also sporadic reports of hyperthyroidism with severe bradycardia,such as sick sinus syndrome(SSS)and atrioventricular block.These disorders are a cha...BACKGROUND Hyperthyroidism often leads to tachycardia,but there are also sporadic reports of hyperthyroidism with severe bradycardia,such as sick sinus syndrome(SSS)and atrioventricular block.These disorders are a challenge for clinicians.CASE SUMMARY We describe three cases of hyperthyroidism with SSS and found 31 similar cases in a PubMed literature search.Through the analysis of these 34 cases,we found 21 cases of atrioventricular block and 13 cases of SSS,with 67.6%of the patients experiencing bradycardia symptoms.After drug treatment,temporary pacemaker implantation,or anti-hyperthyroidism treatment,the bradycardia of 27 patients(79.4%)was relieved,and the median recovery time was 5.5(2-8)d.Only 7 cases(20.6%)needed permanent pacemaker implantation.CONCLUSION Patients with hyperthyroidism should be aware of the risk of severe bradycardia.In most cases,drug treatment or temporary pacemaker placement is recommended for initial treatment.If the bradycardia does not improve after 1 wk,a permanent pacemaker should be implanted.展开更多
BACKGROUND Cardiac arrhythmias,including bradyarrhythmias,have been described as manifestations of coronavirus disease 2019(COVID-19).Herein,we present a case of junctional bradycardia secondary to possible sinus node...BACKGROUND Cardiac arrhythmias,including bradyarrhythmias,have been described as manifestations of coronavirus disease 2019(COVID-19).Herein,we present a case of junctional bradycardia secondary to possible sinus node dysfunction in a patient with COVID-19.CASE SUMMARY The patient was a 32-year-old woman with no significant medical history.On the third day of hospitalization,she developed junctional bradycardia while being hemodynamically stable.The episodes of nodal dysrhythmia with a low heart rate persisted for the next few days and were associated with elevated levels of systemic inflammatory markers.The patient received antiviral and anti-inflammatory treatments for the viral infection but no antiarrhythmic medications.She had a normal sinus rhythm on day 12.CONCLUSION Cardiac rhythm monitoring,focusing on the association between cardiac arrhythmias and the systemic inflammatory response,is important in COVID-19 patients.展开更多
After cervical spinal cord injury (SCI), the autonomic nervous system (ANS) becomes impaired and then, bradycardia can develop. In view of this, we performed to prescribe aminophylline as pharmacotherapy for bradycard...After cervical spinal cord injury (SCI), the autonomic nervous system (ANS) becomes impaired and then, bradycardia can develop. In view of this, we performed to prescribe aminophylline as pharmacotherapy for bradycardia. The study population consisted of 36 patients with cervical SCI. Bradycardia developed in 20 patients (55.6%), of these patients, 8 showed spontaneous recovery. Twelve patients had persistent bradycardia, therefore, aminophylline was administered at 0.5 mg/kg/hr by intravenous infusion. Their average heart rate increased within 24 hours after the start of infusion. In heart rate variability analysis for 7 preliminarily selected patients, the spectral waveforms of “oligowave type” indicating ANS impairment tended to appear in relatively early phase after injury (i.e., 2 days to 2 weeks after injury), whereas “normal type” was observed in the late phase (i.e., at 4 weeks). “Sympathetic block type” was observed throughout the follow-up period (2 days to 4 weeks). “Sympathetic block type” was also observed in a non-bradycardic patient on day 2. These results underscore the importance of treating ANS impairment with aminophylline while keeping in mind that bradycardia can occur even in post-SCI patients without clinical manifestations.展开更多
BACKGROUND Intravenous steroid pulse therapy is the treatment of choice for acute exacerbation of multiple sclerosis(MS).Although steroid administration is generally welltolerated,cases of cardiac arrhythmia have been...BACKGROUND Intravenous steroid pulse therapy is the treatment of choice for acute exacerbation of multiple sclerosis(MS).Although steroid administration is generally welltolerated,cases of cardiac arrhythmia have been reported.Herein,we describe a young woman who developed marked sinus bradycardia and T-wave abnormalities after corticosteroid administration.We also present plausible explanations for the abnormalities observed in this patient.CASE SUMMARY An 18-year-old woman experienced vertiginous dizziness and binocular diplopia 1 wk prior to admission.Neurological examination revealed left internuclear ophthalmoplegia with left peripheral-type facial palsy.The initial laboratory results were consistent with those of type 2 diabetes.Brain magnetic resonance imaging revealed multifocal,non-enhancing,symptomatic lesions and multiple enhancing lesions.She was diagnosed with MS and maturity-onset diabetes of the young.Intravenous methylprednisolone was administered.On day 5 after methylprednisolone infusion,marked bradycardia with T-wave abnormalities were observed.Genetic evaluation to elucidate the underlying conditions revealed a hepatocyte nuclear factor 4-alpha(HNF4A)gene mutation.Steroid treatment was discontinued under suspicion of corticosteroid-induced bradycardia.Her electrocardiogram changes returned to normal without complications two days after steroid discontinuation.CONCLUSION Corticosteroid-induced bradycardia may have a significant clinical impact,especially in patients with comorbidities,such as HNF4A mutations.展开更多
Background: Beflex is an active fixation atrial and ventricular lead with a retractable screw;X-Fine is a passive fixation ventricular lead. These two bradycardia lead models were evaluated in the FINE study, an obser...Background: Beflex is an active fixation atrial and ventricular lead with a retractable screw;X-Fine is a passive fixation ventricular lead. These two bradycardia lead models were evaluated in the FINE study, an observational prospective trial conducted in France and Spain. Methods: Patients enlisted for pacemaker or defibrillator implants were enrolled. The primary objective was to assess acute dislodgement rates at the 3-month follow-up visit. Safety and electrical performances of the leads were assessed in acute conditions at implant and at the follow-up visit up to three months later. A handling questionnaire was submitted to implanting investigators immediately after implant. Results: A total of 2254 patients were enrolled in 95 centers;investigators implanted 1153 active atrial leads, mainly in the right atrium;1021 active right ventricular leads, mainly in the septum and 712 passive right ventricular leads, mainly in the apex. After a mean follow-up of 54.9 ± 37.6 days, dislodgement rates were 1.0% and 1.6% for atrial and ventricular active, and 3.2% for ventricular passive leads. No unexpected adverse reactions were observed during the course of the study and the electrical performances at implant and follow-up visits remained within normal ranges. Overall, most investigators (84%) rated leads’ handling as superior (better or best) to what observed with other bradycardia leads. Conclusion: Different bradycardia leads showed a dislodgement rate of 1.0% and 1.6% for atrial and ventricular active leads, and 3.2% for ventricular passive leads, at 3-month follow-up. Acute safety and electrical performances were within expected ranges and very good handling performances were observed.展开更多
BACKGROUND Bradycardia-induced cardiomyopathy(BIC),which is a disease resulting from bradycardia,is characterized by cardiac chamber enlargement and diminished cardiac function.The correction of bradycardia can allow ...BACKGROUND Bradycardia-induced cardiomyopathy(BIC),which is a disease resulting from bradycardia,is characterized by cardiac chamber enlargement and diminished cardiac function.The correction of bradycardia can allow for significant improvements in both cardiac function and structure;however,this disease has been infrequently documented.In this case,we conducted a longitudinal followup of a patient who had been enduring BIC for more than 40 years to heighten awareness and prompt timely diagnosis and rational intervention.CASE SUMMARY A woman who presented with postactivity fatigue and dyspnea was diagnosed with bradycardia at the age of 7.Since she had no obvious symptoms,she did not receive any treatment to improve her bradycardia during the 42-year follow-up,except for the implantation of a temporary pacemaker during labor induction surgery.As time progressed,the patient's heart gradually expanded due to her low ventricular rate,and she was diagnosed with BIC.In 2014,the patient developed atrial fibrillation,her ventricular rate gradually increased,and her heart shape gradually returned to normal.This report describes the cardiac morphological changes caused by the heart rate changes in BIC patients older than 40 years,introduces another possible outcome of BIC,and emphasizes the importance of early intervention in treating BIC.CONCLUSION BIC can induce atrial fibrillation,causing an increased ventricular rate and leading to positive cardiac remodeling.展开更多
Positive pressure generated in peritoneal cavity by gas insufflation during laparoscopic procedures can cause hemodynamic instability. There are a few case reports suggesting similar occurrences during thoracoscopic p...Positive pressure generated in peritoneal cavity by gas insufflation during laparoscopic procedures can cause hemodynamic instability. There are a few case reports suggesting similar occurrences during thoracoscopic procedures as well. The mechanism behind the conditions above is explained to be due to stretch force applied to peritoneum and pleura which causes vagal stimulation. We wish to present a case where a high negative pressure applied to pleural cavity lead to treatment-resistant bradycardia. The possible mechanism behind this occurrence was traction pressure on pleura which triggered vagal activity. The bradycardia subsided on reducing or discontinuing negative suction pressure. To best of our knowledge this the first case report on bradycardia associated with high negative suction pressure applied to inter costal drain.展开更多
Cardiovascular disease is defined as a heart rate that is less than 60 bpm. Implantable cardiac devices such as pacemakers are widely used nowadays. In this paper, design and implementation of the heart model can be c...Cardiovascular disease is defined as a heart rate that is less than 60 bpm. Implantable cardiac devices such as pacemakers are widely used nowadays. In this paper, design and implementation of the heart model can be controlled to be the heart of a patient suffering from a decrease in heart rate (Bradycardia). A system is designed to sense and calculate the heart rate per minute and it is considered as an input to the controller. The design and implementation of Mamdani fuzzy controller to generate electric pulses that mimic the natural pacing system of the heart maintains an adequate heart rate by delivering controlled, rhythmic electrical stimuli to the chambers of the patient heart. The proposed controller is tested by using Matlab/Simulink program.展开更多
Weight gain, Osteoporosis, Glucose intolerance, Hypertension, and Cataract are the common complications associated with Dexamethasone. However, here we report a case of Multiple Myeloma who received chemotherapy invol...Weight gain, Osteoporosis, Glucose intolerance, Hypertension, and Cataract are the common complications associated with Dexamethasone. However, here we report a case of Multiple Myeloma who received chemotherapy involving Dexamethasone. Although this patient has no previous comorbid cardiac condition, he developed Sinus Bradycardia during the latter part of chemo regimen. Ironically Sinus Bradycardia was asymptomatic in these cases. The exact mechanism of how Dexamethasone causes Sinus Bradycardia is yet not properly understood, and some of the possible mechanisms of Dexamethasone causing Sinus Bradycardia have been postulated below.展开更多
Background Management of premature ventricular contractions （PVCs） and bradycardia is difficult, because most antiarrhythmic drugs may lead to more severe bradycardia, so other effective drugs with less side effects...Background Management of premature ventricular contractions （PVCs） and bradycardia is difficult, because most antiarrhythmic drugs may lead to more severe bradycardia, so other effective drugs with less side effects are alternatives for treating those patients. To evaluate the efficacy and safety of the traditional Chinese medicine Shensong Yangxin capsule （SYC） in patients with bradycardia and PVCs, a pilot study was conducted. Methods One hundred and sixty-eight patients with bradycardia and PVCs were randomly assigned to receive either SYC （trial group, = 86） or placebo （control group, = 82） for 4 weeks. ECG, 24-hour continuous ECG recording, echocardiography, quality of life, hepatic function and renal were evaluated at baseline and after 4-week treatment. Results The average heart rate, the fastest heart rate, and the lowest heart rate in the trial group were all significantly higher than those in the baseline and the control group after 4-week follow-up （ 〈 0.01, 0.05, 0.05, respectively.）. Compared with pretreatment, the PVCs in the trial group decreased significantly after treatment （1911.7 ±402.6 vs. 5550.1 ± 973.7, 〈 0.01）. Both the quality of life and the symptom scores in the trial group were significantly better than those in the control group. No severe adverse effects were reported. Conclusion SYC is effective and safe for the treatment of PVCs and bradycardia and improves the symptoms and quality of life.展开更多
Background The study was to access the feasibility and effectiveness of permanent left bundle branch pacing(LBBP)in patients with bradycardia after cardiac surgery,in comparison with conventional right ventricular out...Background The study was to access the feasibility and effectiveness of permanent left bundle branch pacing(LBBP)in patients with bradycardia after cardiac surgery,in comparison with conventional right ventricular outflow tract septal pacing(RVOSP).Methods A total of 50 patients with cardiac surgery who underwent permanent pacemaker implantation(PPI)were enrolled,21 patients underwent LBBP(LBBP group)and 29 patients underwent RVOSP(RVOSP group).Pacing electrical parameters,QRS duration(QRSd),echocardiographic measurements,lead and device related complications were obtained at procedure and during follow-ups.Results There were no statistically significant differences between the LBBP group and the RVOSP group at procedure and at the twelfth month’s follow-up in pacing thresholds(0.64±0.16 V vs.0.63±0.22 V)and(0.91±0.28 V vs.0.85±0.20 V),R-wave amplitude(16.68±4.52 mV vs.15.09±4.53 mV)and(14.41±8.65 mV vs.12.65±6.17 mV),pacing impedances(719.24±152.65Ωvs.639.13±177.04Ω)and(534.01±96.92Ωvs.499.18±77.87Ω).But the average ventricular pacing percentage(VP%)at the first month’s follow-up(81.96±32.06%vs.58.37±42.96%)and at the twelfth month’s follow-up(84.65±35.84%vs.53.57±38.47%)showed significant difference between two groups(P<0.05);The LBBP group produced narrower QRSd(121.13±23.91 ms)than the RVOSP group(158.00±9.69 ms)(P=0.011).There were no significant differences between the LBBP group and the RVOSP group at pre-procedure and at the twelfth month’s follow-up in echocardiographic parameters,which included left ventricular end-diastolic dimension(LVEDD)(48.76±7.08 mm vs.47.34±6.91 mm)and(50.58±10.33 mm vs.45.97±7.11 mm),left ventricular ejection fraction(LVEF)(58.33±12.64%vs.61.50±8.40%)and(55.85±16.35%vs.61.50±10.52%),and area of tricuspid regurgitation(TR)(2.79±3.65 cm2 vs.2.85±2.26 cm2)and(3.09±2.34 cm2 vs.2.95±1.92 cm2).No lead and device related complication was observed during follow-ups.Conclusions LBBP is feasible and effective in patients with bradycardia after cardiac surgery.LBBP produces narrow QRSd,which may be a preferred pacing strategy for patients after cardiac surgery.[S Chin J Cardiol 2021;22(1):13-20]展开更多
With the increasing use of nirmatrelvir-ritonavir in older COVID-19 patients,adverse drug reactions due to drug-drug interactions have become more frequent.This report describes a patient who experienced severe bradyc...With the increasing use of nirmatrelvir-ritonavir in older COVID-19 patients,adverse drug reactions due to drug-drug interactions have become more frequent.This report describes a patient who experienced severe bradycardia and hypotension following the concurrent use of heart rate-control medications and nirmatrelvir-ritonavir during an active COVID-19 infection.This suggests that clinicians should be cautious when dealing with nirmatrelvir-ritonavir and try their best to avoid serious adverse reactions.展开更多
Anemia in pregnancy is a significant event that often requires treatment to prevent long term effects in the mother and the fetus.Many factors determine which iron preparation to use,including route and ease of admini...Anemia in pregnancy is a significant event that often requires treatment to prevent long term effects in the mother and the fetus.Many factors determine which iron preparation to use,including route and ease of administration,patient tolerability,safety,and cost.This case report summarizes two separate patient cases where sodium ferric gluconate complex was administered intravenously to pregnant women,resulting in fetal bradycardia and emergent cesarean procedures.展开更多
Severe coronavirus 2019 (COVID-19) infection is associated with myocardial injury and arrhythmia. Bradycardia is a newly recognized consequence of COVID-19. Relative bradycardia and its effects in 4 critically ill pat...Severe coronavirus 2019 (COVID-19) infection is associated with myocardial injury and arrhythmia. Bradycardia is a newly recognized consequence of COVID-19. Relative bradycardia and its effects in 4 critically ill patients with COVID-19 was described in this case series. The 4 cases showed the same clinical phenomenon: sinus bradycardia without a compensatory increase in heart rate in response to elevation of body temperature. Typically, heart rate decreases as body temperature rises. The 4 patients were all men with an average age of 67 years. Patient 1 was a 78-year-old man with no major medical history who died from COVID-19 pneumonia. The other 3 patients recovered.展开更多
文摘BACKGROUND Bradycardia,renal failure,atrioventricular nodal blockade,shock,and hyper-kalemia(BRASH)syndrome is an acronym used to describe a constellation of BRASH.It is an underrecognized phenomenon that can be deadly if not appro-priately managed in a timely manner.This case highlights the importance of rapid diagnosis and reviews a multitude of treatment options in a uniquely severe case of BRASH syndrome.CASE SUMMARY We present a case of a 54-year-old male on a beta-blocker and angiotensin-con-verting enzyme inhibitor who presented with one day history of nausea,vomi-ting,and shortness of breath.Upon presentation,he was bradycardic and hypotensive,requiring transcutaneous pacing.Initial electrocardiogram showed atrial fibrillation with ventricular rate in 30’s.He was found to have acute kidney injury,hyperkalemia,and metabolic acidosis.He was successfully treated with multiple potassium lowering agents,continuous renal replacement therapy,four pressors,mechanical ventilation,and transvenous pacing with complete recovery prior to discharge.CONCLUSION Increased awareness of BRASH syndrome may improve outcomes through timely diagnosis and aggressive intervention.
文摘Rationale:Cholera is an acute diarrheal disease caused by the ingestion of food or water contaminated by Vibrio cholerae.It threatens global health and signifies a lack of proper access to clean water and sanitation.If not treated properly,cholera causes severe watery diarrhea that can lead to hypovolemic shock.Patient’s Concern:A 23-year-old male patient was admitted with severe diarrhea with a frequency of fifteen to twenty loose,watery stools and was severely dehydrated.The patient developed severe bradycardia with a positive serum troponin level and no chest pain.Initial electrocardiogram on the day of admission was sinus tachycardia with a heart rate of 120 beats/min on the third day of admission,the patient developed bradycardia with a heart rate of 45 beats/min with a prolonged QT interval of 550 msec(corrected QT interval 476 msec).Diagnosis:Cholera with sinus bradycardia with prolonged QT interval.Interventions:Based on the clinical situation and the inferior vena cava status determined by ultrasound,a thorough fluid resuscitation using crystalloids was performed.The patient was then administered antibiotics:oral doxycycline 300 mg STAT and intravenous ciprofloxacin 15 mg/kg twice daily for three days.Outcomes:After 5 days of adequate hydration and antimicrobial treatment,diarrhea was resolved and heart rate improved with no electrocardiogram abnormalities.Lessons:This case report highlights the importance of timely diagnosis and managing severe diarrhea in cholera patients to prevent morbidity and mortality.Public awareness regarding cholera and its complications is necessary for the betterment of the community.
文摘Objective Castleman disease, also known as giant lymph node hyperplasia, involves lesions in the lymph nodes usually located in the chest_ENREF_1, particularly in the mediastinum. Meanwhile, sinus bradycardia is a sinus rhythm slower than 60 beats per min, and it can occur in both healthy and sick individuals. However, the comorbidity of these two disorders has not been previously reported. In this paper, we report a case of a 46-year-old woman who presented with persistent sinus bradycardia and irondeficiency anemia. Diagnostic work-up revealed hepatosplenomegaly and a giant mass near the splenic hilum. The mass was removed surgically; after which, the patient's bradycardia resolved immediately, while her anemia was corrected after subsequent chemotherapy. Pathological examination revealed lymph nodes with benign lesions, and the patient was diagnosed with hyaline-vascular variant of Castleman disease. This is the first documented case of sinus bradycardia associated with Castleman disease. In this paper, we describe the case characteristics, discuss the possible pathogenesis, and consider the appropriate treatment of symptomatic sinus bradycardia accompanying Castleman disease.
文摘Rationale:Vanishing lung syndrome is rare and can be associated with a history of smoking and marijuana use.The occurrence of giant bullae can also be linked to infections,particularly tuberculosis in tropical countries.Patient concerns:A 26-year-old male complained of weakness,severe vomiting,and reduced breathlessness when lying on the left side.He had a history of pulmonary tuberculosis two years ago.Diagnosis:Symptomatic bradycardia in tuberculosis-related giant bullae.Interventions:The patient was recommended to undergo an elective bullectomy,but he decided not to proceed with the procedure.Atropine sulfate was administered to alleviate symptoms of bradycardia,while a standardized anti-tuberculosis regimen were started for the next six months.Outcomes:Following 7 days of intensive care treatment involving antituberculosis medications and atropine sulfate,the patient achieved hemodynamic stability,opting against bullectomy despite residual symptoms of dyspnea.Subsequent six months of antituberculosis therapy notably alleviated symptoms without requiring bullectomy.Lessons:Increasing intrathoracic pressure can also be caused mechanically by giant bullae.Cardiac symptoms in vanishing lung syndrome are reversible and can be alleviated once the underlying cause is addressed.In this case,symptomatic bradycardia was reduced only with tuberculosis treatment without bullectomy intervention。
基金the Clinical Medical Research Center Project of Hainan Province,China,No.LCYX202207Key R&D Plan Project of Hainan Province,China,No.ZDYF2020118.
文摘BACKGROUND Hyperthyroidism often leads to tachycardia,but there are also sporadic reports of hyperthyroidism with severe bradycardia,such as sick sinus syndrome(SSS)and atrioventricular block.These disorders are a challenge for clinicians.CASE SUMMARY We describe three cases of hyperthyroidism with SSS and found 31 similar cases in a PubMed literature search.Through the analysis of these 34 cases,we found 21 cases of atrioventricular block and 13 cases of SSS,with 67.6%of the patients experiencing bradycardia symptoms.After drug treatment,temporary pacemaker implantation,or anti-hyperthyroidism treatment,the bradycardia of 27 patients(79.4%)was relieved,and the median recovery time was 5.5(2-8)d.Only 7 cases(20.6%)needed permanent pacemaker implantation.CONCLUSION Patients with hyperthyroidism should be aware of the risk of severe bradycardia.In most cases,drug treatment or temporary pacemaker placement is recommended for initial treatment.If the bradycardia does not improve after 1 wk,a permanent pacemaker should be implanted.
文摘BACKGROUND Cardiac arrhythmias,including bradyarrhythmias,have been described as manifestations of coronavirus disease 2019(COVID-19).Herein,we present a case of junctional bradycardia secondary to possible sinus node dysfunction in a patient with COVID-19.CASE SUMMARY The patient was a 32-year-old woman with no significant medical history.On the third day of hospitalization,she developed junctional bradycardia while being hemodynamically stable.The episodes of nodal dysrhythmia with a low heart rate persisted for the next few days and were associated with elevated levels of systemic inflammatory markers.The patient received antiviral and anti-inflammatory treatments for the viral infection but no antiarrhythmic medications.She had a normal sinus rhythm on day 12.CONCLUSION Cardiac rhythm monitoring,focusing on the association between cardiac arrhythmias and the systemic inflammatory response,is important in COVID-19 patients.
文摘After cervical spinal cord injury (SCI), the autonomic nervous system (ANS) becomes impaired and then, bradycardia can develop. In view of this, we performed to prescribe aminophylline as pharmacotherapy for bradycardia. The study population consisted of 36 patients with cervical SCI. Bradycardia developed in 20 patients (55.6%), of these patients, 8 showed spontaneous recovery. Twelve patients had persistent bradycardia, therefore, aminophylline was administered at 0.5 mg/kg/hr by intravenous infusion. Their average heart rate increased within 24 hours after the start of infusion. In heart rate variability analysis for 7 preliminarily selected patients, the spectral waveforms of “oligowave type” indicating ANS impairment tended to appear in relatively early phase after injury (i.e., 2 days to 2 weeks after injury), whereas “normal type” was observed in the late phase (i.e., at 4 weeks). “Sympathetic block type” was observed throughout the follow-up period (2 days to 4 weeks). “Sympathetic block type” was also observed in a non-bradycardic patient on day 2. These results underscore the importance of treating ANS impairment with aminophylline while keeping in mind that bradycardia can occur even in post-SCI patients without clinical manifestations.
文摘BACKGROUND Intravenous steroid pulse therapy is the treatment of choice for acute exacerbation of multiple sclerosis(MS).Although steroid administration is generally welltolerated,cases of cardiac arrhythmia have been reported.Herein,we describe a young woman who developed marked sinus bradycardia and T-wave abnormalities after corticosteroid administration.We also present plausible explanations for the abnormalities observed in this patient.CASE SUMMARY An 18-year-old woman experienced vertiginous dizziness and binocular diplopia 1 wk prior to admission.Neurological examination revealed left internuclear ophthalmoplegia with left peripheral-type facial palsy.The initial laboratory results were consistent with those of type 2 diabetes.Brain magnetic resonance imaging revealed multifocal,non-enhancing,symptomatic lesions and multiple enhancing lesions.She was diagnosed with MS and maturity-onset diabetes of the young.Intravenous methylprednisolone was administered.On day 5 after methylprednisolone infusion,marked bradycardia with T-wave abnormalities were observed.Genetic evaluation to elucidate the underlying conditions revealed a hepatocyte nuclear factor 4-alpha(HNF4A)gene mutation.Steroid treatment was discontinued under suspicion of corticosteroid-induced bradycardia.Her electrocardiogram changes returned to normal without complications two days after steroid discontinuation.CONCLUSION Corticosteroid-induced bradycardia may have a significant clinical impact,especially in patients with comorbidities,such as HNF4A mutations.
文摘Background: Beflex is an active fixation atrial and ventricular lead with a retractable screw;X-Fine is a passive fixation ventricular lead. These two bradycardia lead models were evaluated in the FINE study, an observational prospective trial conducted in France and Spain. Methods: Patients enlisted for pacemaker or defibrillator implants were enrolled. The primary objective was to assess acute dislodgement rates at the 3-month follow-up visit. Safety and electrical performances of the leads were assessed in acute conditions at implant and at the follow-up visit up to three months later. A handling questionnaire was submitted to implanting investigators immediately after implant. Results: A total of 2254 patients were enrolled in 95 centers;investigators implanted 1153 active atrial leads, mainly in the right atrium;1021 active right ventricular leads, mainly in the septum and 712 passive right ventricular leads, mainly in the apex. After a mean follow-up of 54.9 ± 37.6 days, dislodgement rates were 1.0% and 1.6% for atrial and ventricular active, and 3.2% for ventricular passive leads. No unexpected adverse reactions were observed during the course of the study and the electrical performances at implant and follow-up visits remained within normal ranges. Overall, most investigators (84%) rated leads’ handling as superior (better or best) to what observed with other bradycardia leads. Conclusion: Different bradycardia leads showed a dislodgement rate of 1.0% and 1.6% for atrial and ventricular active leads, and 3.2% for ventricular passive leads, at 3-month follow-up. Acute safety and electrical performances were within expected ranges and very good handling performances were observed.
基金Supported by National Natural Science Foundation of China,No.81970241Tianfu Qingcheng Project-Tianfu Science and Technology Elite,No.1358.
文摘BACKGROUND Bradycardia-induced cardiomyopathy(BIC),which is a disease resulting from bradycardia,is characterized by cardiac chamber enlargement and diminished cardiac function.The correction of bradycardia can allow for significant improvements in both cardiac function and structure;however,this disease has been infrequently documented.In this case,we conducted a longitudinal followup of a patient who had been enduring BIC for more than 40 years to heighten awareness and prompt timely diagnosis and rational intervention.CASE SUMMARY A woman who presented with postactivity fatigue and dyspnea was diagnosed with bradycardia at the age of 7.Since she had no obvious symptoms,she did not receive any treatment to improve her bradycardia during the 42-year follow-up,except for the implantation of a temporary pacemaker during labor induction surgery.As time progressed,the patient's heart gradually expanded due to her low ventricular rate,and she was diagnosed with BIC.In 2014,the patient developed atrial fibrillation,her ventricular rate gradually increased,and her heart shape gradually returned to normal.This report describes the cardiac morphological changes caused by the heart rate changes in BIC patients older than 40 years,introduces another possible outcome of BIC,and emphasizes the importance of early intervention in treating BIC.CONCLUSION BIC can induce atrial fibrillation,causing an increased ventricular rate and leading to positive cardiac remodeling.
文摘Positive pressure generated in peritoneal cavity by gas insufflation during laparoscopic procedures can cause hemodynamic instability. There are a few case reports suggesting similar occurrences during thoracoscopic procedures as well. The mechanism behind the conditions above is explained to be due to stretch force applied to peritoneum and pleura which causes vagal stimulation. We wish to present a case where a high negative pressure applied to pleural cavity lead to treatment-resistant bradycardia. The possible mechanism behind this occurrence was traction pressure on pleura which triggered vagal activity. The bradycardia subsided on reducing or discontinuing negative suction pressure. To best of our knowledge this the first case report on bradycardia associated with high negative suction pressure applied to inter costal drain.
文摘Cardiovascular disease is defined as a heart rate that is less than 60 bpm. Implantable cardiac devices such as pacemakers are widely used nowadays. In this paper, design and implementation of the heart model can be controlled to be the heart of a patient suffering from a decrease in heart rate (Bradycardia). A system is designed to sense and calculate the heart rate per minute and it is considered as an input to the controller. The design and implementation of Mamdani fuzzy controller to generate electric pulses that mimic the natural pacing system of the heart maintains an adequate heart rate by delivering controlled, rhythmic electrical stimuli to the chambers of the patient heart. The proposed controller is tested by using Matlab/Simulink program.
文摘Weight gain, Osteoporosis, Glucose intolerance, Hypertension, and Cataract are the common complications associated with Dexamethasone. However, here we report a case of Multiple Myeloma who received chemotherapy involving Dexamethasone. Although this patient has no previous comorbid cardiac condition, he developed Sinus Bradycardia during the latter part of chemo regimen. Ironically Sinus Bradycardia was asymptomatic in these cases. The exact mechanism of how Dexamethasone causes Sinus Bradycardia is yet not properly understood, and some of the possible mechanisms of Dexamethasone causing Sinus Bradycardia have been postulated below.
基金supported by Science and Technology Key Foundation of Guangdong Province(No.2010B031600166)the Science and Technology Foundation of Guangdong Province(No.2011B061300072)the Medical Scientific Research Foundation of Guangdong Province(No.A2014005)
文摘Background Management of premature ventricular contractions （PVCs） and bradycardia is difficult, because most antiarrhythmic drugs may lead to more severe bradycardia, so other effective drugs with less side effects are alternatives for treating those patients. To evaluate the efficacy and safety of the traditional Chinese medicine Shensong Yangxin capsule （SYC） in patients with bradycardia and PVCs, a pilot study was conducted. Methods One hundred and sixty-eight patients with bradycardia and PVCs were randomly assigned to receive either SYC （trial group, = 86） or placebo （control group, = 82） for 4 weeks. ECG, 24-hour continuous ECG recording, echocardiography, quality of life, hepatic function and renal were evaluated at baseline and after 4-week treatment. Results The average heart rate, the fastest heart rate, and the lowest heart rate in the trial group were all significantly higher than those in the baseline and the control group after 4-week follow-up （ 〈 0.01, 0.05, 0.05, respectively.）. Compared with pretreatment, the PVCs in the trial group decreased significantly after treatment （1911.7 ±402.6 vs. 5550.1 ± 973.7, 〈 0.01）. Both the quality of life and the symptom scores in the trial group were significantly better than those in the control group. No severe adverse effects were reported. Conclusion SYC is effective and safe for the treatment of PVCs and bradycardia and improves the symptoms and quality of life.
文摘Background The study was to access the feasibility and effectiveness of permanent left bundle branch pacing(LBBP)in patients with bradycardia after cardiac surgery,in comparison with conventional right ventricular outflow tract septal pacing(RVOSP).Methods A total of 50 patients with cardiac surgery who underwent permanent pacemaker implantation(PPI)were enrolled,21 patients underwent LBBP(LBBP group)and 29 patients underwent RVOSP(RVOSP group).Pacing electrical parameters,QRS duration(QRSd),echocardiographic measurements,lead and device related complications were obtained at procedure and during follow-ups.Results There were no statistically significant differences between the LBBP group and the RVOSP group at procedure and at the twelfth month’s follow-up in pacing thresholds(0.64±0.16 V vs.0.63±0.22 V)and(0.91±0.28 V vs.0.85±0.20 V),R-wave amplitude(16.68±4.52 mV vs.15.09±4.53 mV)and(14.41±8.65 mV vs.12.65±6.17 mV),pacing impedances(719.24±152.65Ωvs.639.13±177.04Ω)and(534.01±96.92Ωvs.499.18±77.87Ω).But the average ventricular pacing percentage(VP%)at the first month’s follow-up(81.96±32.06%vs.58.37±42.96%)and at the twelfth month’s follow-up(84.65±35.84%vs.53.57±38.47%)showed significant difference between two groups(P<0.05);The LBBP group produced narrower QRSd(121.13±23.91 ms)than the RVOSP group(158.00±9.69 ms)(P=0.011).There were no significant differences between the LBBP group and the RVOSP group at pre-procedure and at the twelfth month’s follow-up in echocardiographic parameters,which included left ventricular end-diastolic dimension(LVEDD)(48.76±7.08 mm vs.47.34±6.91 mm)and(50.58±10.33 mm vs.45.97±7.11 mm),left ventricular ejection fraction(LVEF)(58.33±12.64%vs.61.50±8.40%)and(55.85±16.35%vs.61.50±10.52%),and area of tricuspid regurgitation(TR)(2.79±3.65 cm2 vs.2.85±2.26 cm2)and(3.09±2.34 cm2 vs.2.95±1.92 cm2).No lead and device related complication was observed during follow-ups.Conclusions LBBP is feasible and effective in patients with bradycardia after cardiac surgery.LBBP produces narrow QRSd,which may be a preferred pacing strategy for patients after cardiac surgery.[S Chin J Cardiol 2021;22(1):13-20]
文摘With the increasing use of nirmatrelvir-ritonavir in older COVID-19 patients,adverse drug reactions due to drug-drug interactions have become more frequent.This report describes a patient who experienced severe bradycardia and hypotension following the concurrent use of heart rate-control medications and nirmatrelvir-ritonavir during an active COVID-19 infection.This suggests that clinicians should be cautious when dealing with nirmatrelvir-ritonavir and try their best to avoid serious adverse reactions.
文摘Anemia in pregnancy is a significant event that often requires treatment to prevent long term effects in the mother and the fetus.Many factors determine which iron preparation to use,including route and ease of administration,patient tolerability,safety,and cost.This case report summarizes two separate patient cases where sodium ferric gluconate complex was administered intravenously to pregnant women,resulting in fetal bradycardia and emergent cesarean procedures.
文摘Severe coronavirus 2019 (COVID-19) infection is associated with myocardial injury and arrhythmia. Bradycardia is a newly recognized consequence of COVID-19. Relative bradycardia and its effects in 4 critically ill patients with COVID-19 was described in this case series. The 4 cases showed the same clinical phenomenon: sinus bradycardia without a compensatory increase in heart rate in response to elevation of body temperature. Typically, heart rate decreases as body temperature rises. The 4 patients were all men with an average age of 67 years. Patient 1 was a 78-year-old man with no major medical history who died from COVID-19 pneumonia. The other 3 patients recovered.
