Rationale: Cope's sign is reflex bradycardia seen in the patient presenting with symptoms of acute cholecystitis. This bradycardia may be due to vagally mediated cardio-biliary reflex. Many of these reflexes due t...Rationale: Cope's sign is reflex bradycardia seen in the patient presenting with symptoms of acute cholecystitis. This bradycardia may be due to vagally mediated cardio-biliary reflex. Many of these reflexes due to acute cholecystitis have similar clinical features (some electrocardiographic changes like bradycardia, complete heart block, and asystole) mimicking that of acute coronary syndrome. Patient's concern: A 60-year old male presented with symptoms of acute cholecystitis and referred to the emergency department with complete heart block and abdominal pain with hypotension requiring an emergency temporary pacemaker. Diagnosis: Cope's sign and complete heart block. Intervention: Emergency temporary cardiac pacemaker insertion. Outcomes: The patient was discharged after three days with regular follow-up and advice for laparoscopic cholecystectomy. Lessons: Complete heart block or any symptomatic bradycardia associated with abdominal pain should be under consideration of cholecystitis that may be associated with either presence or absence of gall stones due to cardio biliary reflex.展开更多
Rationale:COVID-19 has a wide range of clinical presentations requiring a high index of suspicion for diagnosing patients presenting with extrapulmonary manifestations.Among them,patients with cardiovascular involveme...Rationale:COVID-19 has a wide range of clinical presentations requiring a high index of suspicion for diagnosing patients presenting with extrapulmonary manifestations.Among them,patients with cardiovascular involvement have a high mortality.Patient’s concerns:A 50-year-old male patient with COVID-19 infection presented with multiple syncopal episodes,myalgia,and mild respiratory symptoms.Diagnosis:Mild COVID-19 infection with complete heart block.Interventions:Temporary pacing followed by permanent pacemaker insertion 10 days after the onset.Outcomes:The patient was managed as per COVID-19 protocol in an isolation ward,and his condition improved but remained pacemaker dependent until a repeat RT-PCR for COVID-19 tested negative,after which he was shifted back to the cardiac care unit for permanent pacemaker insertion.The patient was discharged after inflammatory markers were normal and clinical condition was completely stable.Lessons:COVID-19 has a wide range of clinical presentations,and extrapulmonary manifestations,especially,cardiovascular involvement can not be ignored.展开更多
BACKGROUND Congenital complete heart block(CCHB)with normal cardiac structure and negativity for anti-Ro/La antibody is rare.Additionally,CCHB is much less frequently diagnosed in adults,and its natural history in adu...BACKGROUND Congenital complete heart block(CCHB)with normal cardiac structure and negativity for anti-Ro/La antibody is rare.Additionally,CCHB is much less frequently diagnosed in adults,and its natural history in adults is less well known.CASE SUMMARY A 23-year-old woman was admitted to our hospital for frequent syncopal episodes.She had bradycardia at the age of 1 year but had never had impaired exercise capacity or a syncopal episode before admission.The possible diagnosis of acquired complete atrioventricular block was carefully ruled out,and then the diagnosis of CCHB was made.According to existing guidelines,permanent pacemaker implantation was recommended,but the patient declined.With regular follow-up for 28 years,the patient had an unusually good outcome without any invasive intervention or medicine.She had an uneventful pregnancy and led a normally active life without any symptoms of low cardiac output or syncopal recurrence.CONCLUSION This case implies that CCHB in adulthood may have good clinical outcomes and does not always require permanent pacemaker implantation.展开更多
We are reporting a case of acquired complete heart block and long QT interval (a dispersion of repolarization that leads to polymorphic ventricular tachycardia) that has presented with loss of conscious and proved to ...We are reporting a case of acquired complete heart block and long QT interval (a dispersion of repolarization that leads to polymorphic ventricular tachycardia) that has presented with loss of conscious and proved to be due to torsade de pointes. The patient responded well to cardiac pacing and beta blocker therapy. The association of complete acquired heart block and long QT interval is quite rare.展开更多
A sinus of Valsalva aneurysm (SOVA) is abnormal dilatation of the either aortic sinuses, area of the aortic root between the aortic valve annulus and the sinotubular junction. Their clinical presentation may range fro...A sinus of Valsalva aneurysm (SOVA) is abnormal dilatation of the either aortic sinuses, area of the aortic root between the aortic valve annulus and the sinotubular junction. Their clinical presentation may range from being asymptomatic as an incidental finding on cardiac imaging to symptomatic presentations related to the compression of adjoining structures or intracardiac shunting caused by rupture of the SOVA mostly into the right side of the heart. The compression leads to findings of tricuspid valve regurgitation, right ventricular outflow tract (RVOT) obstruction and rarely complete heart block (CHB). Dissection or erosion into interventricular septum is one of the rarest complications of SOVA. The symptomatic presentation is almost always a surgical emergency. Here we present a case report of a patient with unruptured sinus of valsalva originating from right sinus dissecting into interventricular septum causing complete heart bock. In this case after surgical correction the complete heart block reverted to sinus rhythm.展开更多
The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertio...The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertion is associated with well-defined risks, and less invasive techniques exist to treat transient, hemodynamically significant intraoperative brady-arrhythmias. The present case report details the performance of general anesthesia for arthroscopic knee surgery in an adult patient with this condition without a pacemaker. Documentation of preoperative chronotropic competence with isoproterenol may be of value in deciding whether to proceed without temporary pacing capability in this setting.展开更多
Objective： Congenital heart block （CHB） is a rare but life-threatening disorder. More than half of CHB cases are associated with maternal autoimmune, which are termed as autoimmune-associated CHB. This review summa...Objective： Congenital heart block （CHB） is a rare but life-threatening disorder. More than half of CHB cases are associated with maternal autoimmune, which are termed as autoimmune-associated CHB. This review summarized the recent research findings in understanding autoimmune-associated CHB, discussed the current diagnostic approaches and management strategies, and summarized the problems and future directions for this disorder. Data Sources： We retrieved the articles published in English from the PubMed database up to January 2017, using the keywords including＂Autoimmune-associated＂, ＂Autoimmune-mediated＂, and ＂Congenital heart block＂. Study Selection： Articles about autoimmune-associated CHB were obtained and reviewed. Results： Observational studies consistently reported that transplacental maternal antibodies might recognize fetal or neonatal antigens in various tissues and result in immunological damages, but the molecular mechanisms underlying CHB pathogenesis still need illuminated. Multiple factors were involved in the process of atrioventricular block development and progression. While several susceptibility genes had been successfully defined, how these genes and their protein interact and impact each other remains to be explored. With currently available diagnostic tools, fetal ultrasound cardiography, and fetal magnetocardiography, most of CHB could be successfully diagnosed and comprehensively evaluated prenatally. The efficacy of current approaches for preventing the progression and recurrence of CHB and other autoimmune-mediated damages was still controversial. Conclusions： This review highlighted the relationships between autoimmune injuries and CHB and strengthened the importance of perinatal management and therapy for autoimmune-associated CHB.展开更多
Purpose: Whether or not right and left stellate ganglion blocks (SGB) affect blood pressure (BP) and heart rate (HR) differently has been controversial. The aim of this study was to analyze BP and HR changes after lar...Purpose: Whether or not right and left stellate ganglion blocks (SGB) affect blood pressure (BP) and heart rate (HR) differently has been controversial. The aim of this study was to analyze BP and HR changes after large numbers of right or left SGBs. Methods: A total of 16,404 right SGBs and 13,766 left SGBs were performed with 6 ml of 1% mepivacaine using the anterior paratracheal approach at C6. Changes in systolic BP and HR 30 min after SGBs were compared to the baseline values. Results: Systolic BP decreased by 25 to 49 mmHg in 10.93% and more than 50 mmHg in 0.67% of 16,404 right SGBs. Those percentages were significantly higher than corresponding percentages;8.43% and 0.49% of 13,766 left SGBs (P < 0.0001 and P < 0.05, respectively). On the other hand, systolic BP increased by 25-49 mmHg in 5.74% and more than 50 mmHg in 0.52% of left SGBs, and in 4.15% and 0.18% of right SGBs (P < 0.0001and P < 0.0001 between left and right SGBs, respectively). Right SGB caused marked reduction in HR (greater than 30 beats/min), more than left SGB (4.22% versus 2.70%, P Conclusions: Both right and left SGBs could produce clinically significant hypertension and hypotension, and also severe bradycardia. However, right SGB produces a higher incidence of significant reductions in systolic BP and HR, compared to left SGB. On the other hand, left SGB produces a significant increase in systolic BP compared to right SGB. Those differences likely stem from the hemispheric asymmetry in autonomic cardiovascular control.展开更多
In this paper, an index for evaluating Distance of a healthy heart from Sino-Atrial Blocking Arrhythmia (SABA) is presented. After definition of the main pacemakers' model of heart, Sino-Atrial (SA) and Atrio-Vent...In this paper, an index for evaluating Distance of a healthy heart from Sino-Atrial Blocking Arrhythmia (SABA) is presented. After definition of the main pacemakers' model of heart, Sino-Atrial (SA) and Atrio-Ventricular nodes (AV), the boundary of synchronization, which demonstrates the boundary of blocking arrhythmia, is obtained using perturbation method. In order to estimate of healthy heart characteristics, a parameter estimator is introduced. The distance from SABA is calculated using Lagrange method and Kohn-Tucker conditions. In addition, the maximum admissible decrease in the coupling intensity and the maximum admissible increase in the discrepancy between the natural frequencies of two pacemakers are determined in order to maintain the synchronization between the two pacemakers.展开更多
Objective:To investigate the clinical nursing intervention effect of moxibustion on abdominal distension symptoms in heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome).Metho...Objective:To investigate the clinical nursing intervention effect of moxibustion on abdominal distension symptoms in heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome).Methods:62 patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)admitted to our hospital from February 2023 to February 2024 were selected and divided into the observation group(n=31)and the control group(n=31)by using the random numerical table method.The control group adopted conventional nursing interventions,and the observation group received the nursing program of the control group with the addition of moxibustion nursing interventions.The nursing effectiveness,quality of life scores,and nursing satisfaction were compared between the two groups.Results:The nursing effectiveness of the observation group was significantly higher than the control group(P<0.05);the quality of life score of the observation group was significantly higher than the control group(P<0.05);the nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:The use of moxibustion nursing intervention in patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)can effectively relieve the symptoms of abdominal distension,improve patients'quality of life,and increase nursing satisfaction,which has promotion and application values.展开更多
A number of publications have claimed that Mobitz type Ⅱ atrioventricular block(AVB)may occur during sleep.None of the reports defined type Ⅱ AVB and representative electrocardiograms were either misinterpreted or m...A number of publications have claimed that Mobitz type Ⅱ atrioventricular block(AVB)may occur during sleep.None of the reports defined type Ⅱ AVB and representative electrocardiograms were either misinterpreted or missing.Relatively benign Wenckebach type Ⅰ AVB is often misdiagnosed as Mobitz type Ⅱ which is an indication for a pacemaker.Review of the published reports indicates that Mobitz type II AVB does not occur during sleep when it is absent in the awake state.Conclusion:There is no proof that sleep is associated with Mobitz type Ⅱ AVB.展开更多
Although Lyme carditis is relatively rare within 4-6 wk of exposure, it can uncommonly present as the first sign of disseminated Lyme disease. Here we present 17 year old boy who presented to the emergency department ...Although Lyme carditis is relatively rare within 4-6 wk of exposure, it can uncommonly present as the first sign of disseminated Lyme disease. Here we present 17 year old boy who presented to the emergency department with chest discomfort and was later found to have complete atrioventricular block due to lyme carditis. He had uneventful recovery after empiric treatment with ceftriaxone. Our case highlights the importance of considering reversible causes of complete AV block since appropriate therapy can avoid the need for permanent pacemaker insertion.展开更多
Introduction: Post-operative (post-op) complete atrio-ventricular heart block (CAVB) occurs after 1% - 4% of pediatric cardiac operations. Current practice dictates implantation of permanent pacemaker (PPM) when post-...Introduction: Post-operative (post-op) complete atrio-ventricular heart block (CAVB) occurs after 1% - 4% of pediatric cardiac operations. Current practice dictates implantation of permanent pacemaker (PPM) when post-op CAVB persists >9 days. We propose that earlier PPM implantation may be the most cost-effective methodology since patient costs increase with extended length of stay (LOS). Methods: Data on the probabilities of persistent post-op CAVB were extracted from published reports. No individual patient data were utilized during this study. This was utilized to create a decision-making model and a total cost analysis on post-op day 0 - 10 to determine the most cost-efficient day to implant a PPM. Cost variables included estimates of daily cardiac ICU care, cost of PPM implantation, LOS, cost related to possible superficial or deep infection based on published prevalence rates (2.3% and 4.9%, respectively) and need for explant due to deep infection or recovery of native conduction. The model assumes 5-day minimum LOS and 1 day increase in LOS with PPM implantation. Cost data were obtained from relevant billing codes and manufacturer list prices for PPM and leads. A secondary analysis evaluated probability of unnecessary PPMs implanted and excess costs. Results: Post-op day (POD) 4 is the lowest total cost of PPM implantation for post-op CAVB, even when accounting for possible risk of either superficial or deep infection. A one-way sensitivity analysis accounting for variability of cardiac ICU care costs between centers ranging from $3000 - $9000 per day consistently replicates POD 4 as the most cost-effective day for PPM implantation. Implant on POD 4 results in a 26% chance of unnecessary implantation. Conclusions: The most cost-efficient day for PPM implantation for post-op CAVB is post-op day 4, which results in a minimum total cost savings of $17,422 per patient. Added costs due to risk of superficial or deep infection are marginal due to low prevalence of post-operative infection in this population.展开更多
We report a case of an 11-year-old boy with diagnosed but uncorrected tetralogy of Fallot presented to us for brain abscess drainage. The child was managed successfully with scalp block with sedation.
BACKGROUND Cardiac resynchronization therapy(CRT) can be used as an escalated therapy to improve heart function in patients with cardiac dysfunction due to long-term right ventricular pacing. However, guidelines are o...BACKGROUND Cardiac resynchronization therapy(CRT) can be used as an escalated therapy to improve heart function in patients with cardiac dysfunction due to long-term right ventricular pacing. However, guidelines are only targeted at adults. CRT is rarely used in children.CASE SUMMARY This case aimed to implement biventricular pacing in one child with heart failure who had a left ventricular ejection fraction < 35% at 4 years after implantation of an atrioventricular sequential pacemaker due to atrioventricular block.Postoperatively, echocardiography showed atrial sensing ventricular pacing and QRS wave duration of 120-130 ms, and cardiac function significantly improved after upgrading pacemaker.CONCLUSION Patients whose cardiac function is deteriorated to a level to upgrade to CRT should be upgraded to reverse myocardial remodeling as soon as possible.展开更多
Cardiac Sarcoidosis (CS) is a rare and deceptive disease affecting young adults with catastrophic results including life threatening arrhythmia, congestive heart failure and even sudden death as the initial presentati...Cardiac Sarcoidosis (CS) is a rare and deceptive disease affecting young adults with catastrophic results including life threatening arrhythmia, congestive heart failure and even sudden death as the initial presentation. CS has been linked to a significant high morbidity & mortality. We present two patients: The first patient with an initial cardiac event that led us to a diagnosis of Pulmonary and Cardiac Sarcoidosis. A second patient, who was diagnosed initially with pulmonary Sarcoidosis, presented with a severe heart conduction abnormality. Both patients were successfully treated with permanent pacemakers. The dual purpose of our study is first to emphasize the importance of follow up on patients with Non-Cardiac Sarcoidosis for cardiac involvement and secondly to increase awareness of CS as part of a differential diagnosis among young adults with unexplained arrhythmia.展开更多
Background The effects of trimetazidine on patients with dilated cardiomyopathy（DCM） and left bundle branch block（LBBB） are not clear. Methods Sixty consecutive patients with DCM, LBBB and heart dysfunction（35% ...Background The effects of trimetazidine on patients with dilated cardiomyopathy（DCM） and left bundle branch block（LBBB） are not clear. Methods Sixty consecutive patients with DCM, LBBB and heart dysfunction（35% ≤ LVEF ≤ 45%） were randomly allocated to heart failure therapy plus trimetazidine group（20 mg three times a day; 30 patients） or heart failure therapy alone group（30 patients）. During follow-up of 6months, QRS morphology, plasma NT-proBNP, 6-minute walk test（6MWT） and echocardiographic indexes were measured. Results At the 6th month, a significant functional improvement was noted in patients receiving trimetazidine added to heart failure treatment. In patients from the trimetazidine group, an increase of left ventricular ejection fraction（LVEF） was noted（from 38 ± 5.5% to 47 ± 7.1%, P = 0.020）. The increase of LVEF in the trimetazidine group was associated with a more significant reduction of the left ventricular endsystolic diameter（LVESD） compared with the control group at 6-month follow-up. The NT-pro BNP levels decreased significantly in the trimetazidine group（3.11 ± 0.47 at baseline and 2.77 ± 0.45 at 6-month followup, P 〈 0.01） and the 6MWT increased significantly in the trimetazidine group（325 ± 44 m at baseline and419 ± 56 m at 6-month follow-up, P 〈 0.01）. The differences in NT-pro BNP levels（2.77 ± 0.45 vs 2.96 ±0.46, P = 0.036） and 6MWT（419 ± 56 m vs 366 ± 54 m, P = 0.032） between the two groups were significant at 6-month follow-up. Conclusions Trimetazidine can improve LV function caused by DCM and LBBB. The positive effects of trimetazidine on LV function are especially evident in patients with optimization of drug therapy for heart failure, which strongly suggests an additive effect of these therapy modalities.展开更多
Cardiac sarcoidosis(CS)is a rare but serious manifestation of sarcoidosis that can lead to significant morbidity and mortality due to arrhythmias and heart failure.The inflammatory process in CS is characterized by th...Cardiac sarcoidosis(CS)is a rare but serious manifestation of sarcoidosis that can lead to significant morbidity and mortality due to arrhythmias and heart failure.The inflammatory process in CS is characterized by the formation of noncaseating granulomas in the myocardium,which can disrupt normal cardiac function and conduction.Corticosteroids are the primary therapeutic agents used to manage CS,particularly during the acute inflammatory phase,as they help reduce inflammation and improve cardiac function.However,the long-term use of steroids poses risks,including opportunistic infections and metabolic complications.Advanced imaging techniques,such as cardiac magnetic resonance imaging and positron emission tomography,play a crucial role in diagnosing CS and assessing myocardial involvement.These imaging modalities also aid in risk stratification for arrhythmic events,guiding therapeutic decisions such as the initiation of steroid therapy and the potential placement of implantable cardioverterdefibrillators.This review synthesizes current evidence regarding the role of steroid therapy in managing CS and its implications for cardiac arrhythmias,emphasizing the need for individualized treatment strategies to optimize patient outcomes.展开更多
Persistent left superior vena cava(PLSVC)is a rare congenital anomaly that may complicate cardiac procedures when associated with a dilated coronary sinus(CS)and conduction disturbances.We report the case of a 27-year...Persistent left superior vena cava(PLSVC)is a rare congenital anomaly that may complicate cardiac procedures when associated with a dilated coronary sinus(CS)and conduction disturbances.We report the case of a 27-year-old male with Wilson’s disease who presented with complete heart block.Echocardiography showed biatrial enlargement and severe CS dilation,while contrast-enhanced computed tomography(CT)confirmed PLSVC draining into the CS without a bridging vein.Anatomical constraints prevented cardiac resynchronization therapy,and dual-chamber pacemaker implantation proved technically challenging due to lead placement difficulties.This case highlights the importance of thorough preoperative assessment and individualized pacing strategies in patients with PLSVC,in order to anticipate anatomical challenges and optimize outcomes.展开更多
文摘Rationale: Cope's sign is reflex bradycardia seen in the patient presenting with symptoms of acute cholecystitis. This bradycardia may be due to vagally mediated cardio-biliary reflex. Many of these reflexes due to acute cholecystitis have similar clinical features (some electrocardiographic changes like bradycardia, complete heart block, and asystole) mimicking that of acute coronary syndrome. Patient's concern: A 60-year old male presented with symptoms of acute cholecystitis and referred to the emergency department with complete heart block and abdominal pain with hypotension requiring an emergency temporary pacemaker. Diagnosis: Cope's sign and complete heart block. Intervention: Emergency temporary cardiac pacemaker insertion. Outcomes: The patient was discharged after three days with regular follow-up and advice for laparoscopic cholecystectomy. Lessons: Complete heart block or any symptomatic bradycardia associated with abdominal pain should be under consideration of cholecystitis that may be associated with either presence or absence of gall stones due to cardio biliary reflex.
文摘Rationale:COVID-19 has a wide range of clinical presentations requiring a high index of suspicion for diagnosing patients presenting with extrapulmonary manifestations.Among them,patients with cardiovascular involvement have a high mortality.Patient’s concerns:A 50-year-old male patient with COVID-19 infection presented with multiple syncopal episodes,myalgia,and mild respiratory symptoms.Diagnosis:Mild COVID-19 infection with complete heart block.Interventions:Temporary pacing followed by permanent pacemaker insertion 10 days after the onset.Outcomes:The patient was managed as per COVID-19 protocol in an isolation ward,and his condition improved but remained pacemaker dependent until a repeat RT-PCR for COVID-19 tested negative,after which he was shifted back to the cardiac care unit for permanent pacemaker insertion.The patient was discharged after inflammatory markers were normal and clinical condition was completely stable.Lessons:COVID-19 has a wide range of clinical presentations,and extrapulmonary manifestations,especially,cardiovascular involvement can not be ignored.
文摘BACKGROUND Congenital complete heart block(CCHB)with normal cardiac structure and negativity for anti-Ro/La antibody is rare.Additionally,CCHB is much less frequently diagnosed in adults,and its natural history in adults is less well known.CASE SUMMARY A 23-year-old woman was admitted to our hospital for frequent syncopal episodes.She had bradycardia at the age of 1 year but had never had impaired exercise capacity or a syncopal episode before admission.The possible diagnosis of acquired complete atrioventricular block was carefully ruled out,and then the diagnosis of CCHB was made.According to existing guidelines,permanent pacemaker implantation was recommended,but the patient declined.With regular follow-up for 28 years,the patient had an unusually good outcome without any invasive intervention or medicine.She had an uneventful pregnancy and led a normally active life without any symptoms of low cardiac output or syncopal recurrence.CONCLUSION This case implies that CCHB in adulthood may have good clinical outcomes and does not always require permanent pacemaker implantation.
文摘We are reporting a case of acquired complete heart block and long QT interval (a dispersion of repolarization that leads to polymorphic ventricular tachycardia) that has presented with loss of conscious and proved to be due to torsade de pointes. The patient responded well to cardiac pacing and beta blocker therapy. The association of complete acquired heart block and long QT interval is quite rare.
文摘A sinus of Valsalva aneurysm (SOVA) is abnormal dilatation of the either aortic sinuses, area of the aortic root between the aortic valve annulus and the sinotubular junction. Their clinical presentation may range from being asymptomatic as an incidental finding on cardiac imaging to symptomatic presentations related to the compression of adjoining structures or intracardiac shunting caused by rupture of the SOVA mostly into the right side of the heart. The compression leads to findings of tricuspid valve regurgitation, right ventricular outflow tract (RVOT) obstruction and rarely complete heart block (CHB). Dissection or erosion into interventricular septum is one of the rarest complications of SOVA. The symptomatic presentation is almost always a surgical emergency. Here we present a case report of a patient with unruptured sinus of valsalva originating from right sinus dissecting into interventricular septum causing complete heart bock. In this case after surgical correction the complete heart block reverted to sinus rhythm.
文摘The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertion is associated with well-defined risks, and less invasive techniques exist to treat transient, hemodynamically significant intraoperative brady-arrhythmias. The present case report details the performance of general anesthesia for arthroscopic knee surgery in an adult patient with this condition without a pacemaker. Documentation of preoperative chronotropic competence with isoproterenol may be of value in deciding whether to proceed without temporary pacing capability in this setting.
基金o This study was supported by grants from the National Natural Science Foundation of China （No. 81570369, and No. 81571515） and the Program for Changjiang Scholars and Innovative Research Team in University （PCSIRT No. IRT0935）.
文摘Objective： Congenital heart block （CHB） is a rare but life-threatening disorder. More than half of CHB cases are associated with maternal autoimmune, which are termed as autoimmune-associated CHB. This review summarized the recent research findings in understanding autoimmune-associated CHB, discussed the current diagnostic approaches and management strategies, and summarized the problems and future directions for this disorder. Data Sources： We retrieved the articles published in English from the PubMed database up to January 2017, using the keywords including＂Autoimmune-associated＂, ＂Autoimmune-mediated＂, and ＂Congenital heart block＂. Study Selection： Articles about autoimmune-associated CHB were obtained and reviewed. Results： Observational studies consistently reported that transplacental maternal antibodies might recognize fetal or neonatal antigens in various tissues and result in immunological damages, but the molecular mechanisms underlying CHB pathogenesis still need illuminated. Multiple factors were involved in the process of atrioventricular block development and progression. While several susceptibility genes had been successfully defined, how these genes and their protein interact and impact each other remains to be explored. With currently available diagnostic tools, fetal ultrasound cardiography, and fetal magnetocardiography, most of CHB could be successfully diagnosed and comprehensively evaluated prenatally. The efficacy of current approaches for preventing the progression and recurrence of CHB and other autoimmune-mediated damages was still controversial. Conclusions： This review highlighted the relationships between autoimmune injuries and CHB and strengthened the importance of perinatal management and therapy for autoimmune-associated CHB.
文摘Purpose: Whether or not right and left stellate ganglion blocks (SGB) affect blood pressure (BP) and heart rate (HR) differently has been controversial. The aim of this study was to analyze BP and HR changes after large numbers of right or left SGBs. Methods: A total of 16,404 right SGBs and 13,766 left SGBs were performed with 6 ml of 1% mepivacaine using the anterior paratracheal approach at C6. Changes in systolic BP and HR 30 min after SGBs were compared to the baseline values. Results: Systolic BP decreased by 25 to 49 mmHg in 10.93% and more than 50 mmHg in 0.67% of 16,404 right SGBs. Those percentages were significantly higher than corresponding percentages;8.43% and 0.49% of 13,766 left SGBs (P < 0.0001 and P < 0.05, respectively). On the other hand, systolic BP increased by 25-49 mmHg in 5.74% and more than 50 mmHg in 0.52% of left SGBs, and in 4.15% and 0.18% of right SGBs (P < 0.0001and P < 0.0001 between left and right SGBs, respectively). Right SGB caused marked reduction in HR (greater than 30 beats/min), more than left SGB (4.22% versus 2.70%, P Conclusions: Both right and left SGBs could produce clinically significant hypertension and hypotension, and also severe bradycardia. However, right SGB produces a higher incidence of significant reductions in systolic BP and HR, compared to left SGB. On the other hand, left SGB produces a significant increase in systolic BP compared to right SGB. Those differences likely stem from the hemispheric asymmetry in autonomic cardiovascular control.
文摘In this paper, an index for evaluating Distance of a healthy heart from Sino-Atrial Blocking Arrhythmia (SABA) is presented. After definition of the main pacemakers' model of heart, Sino-Atrial (SA) and Atrio-Ventricular nodes (AV), the boundary of synchronization, which demonstrates the boundary of blocking arrhythmia, is obtained using perturbation method. In order to estimate of healthy heart characteristics, a parameter estimator is introduced. The distance from SABA is calculated using Lagrange method and Kohn-Tucker conditions. In addition, the maximum admissible decrease in the coupling intensity and the maximum admissible increase in the discrepancy between the natural frequencies of two pacemakers are determined in order to maintain the synchronization between the two pacemakers.
文摘Objective:To investigate the clinical nursing intervention effect of moxibustion on abdominal distension symptoms in heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome).Methods:62 patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)admitted to our hospital from February 2023 to February 2024 were selected and divided into the observation group(n=31)and the control group(n=31)by using the random numerical table method.The control group adopted conventional nursing interventions,and the observation group received the nursing program of the control group with the addition of moxibustion nursing interventions.The nursing effectiveness,quality of life scores,and nursing satisfaction were compared between the two groups.Results:The nursing effectiveness of the observation group was significantly higher than the control group(P<0.05);the quality of life score of the observation group was significantly higher than the control group(P<0.05);the nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:The use of moxibustion nursing intervention in patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)can effectively relieve the symptoms of abdominal distension,improve patients'quality of life,and increase nursing satisfaction,which has promotion and application values.
文摘A number of publications have claimed that Mobitz type Ⅱ atrioventricular block(AVB)may occur during sleep.None of the reports defined type Ⅱ AVB and representative electrocardiograms were either misinterpreted or missing.Relatively benign Wenckebach type Ⅰ AVB is often misdiagnosed as Mobitz type Ⅱ which is an indication for a pacemaker.Review of the published reports indicates that Mobitz type II AVB does not occur during sleep when it is absent in the awake state.Conclusion:There is no proof that sleep is associated with Mobitz type Ⅱ AVB.
文摘Although Lyme carditis is relatively rare within 4-6 wk of exposure, it can uncommonly present as the first sign of disseminated Lyme disease. Here we present 17 year old boy who presented to the emergency department with chest discomfort and was later found to have complete atrioventricular block due to lyme carditis. He had uneventful recovery after empiric treatment with ceftriaxone. Our case highlights the importance of considering reversible causes of complete AV block since appropriate therapy can avoid the need for permanent pacemaker insertion.
文摘Introduction: Post-operative (post-op) complete atrio-ventricular heart block (CAVB) occurs after 1% - 4% of pediatric cardiac operations. Current practice dictates implantation of permanent pacemaker (PPM) when post-op CAVB persists >9 days. We propose that earlier PPM implantation may be the most cost-effective methodology since patient costs increase with extended length of stay (LOS). Methods: Data on the probabilities of persistent post-op CAVB were extracted from published reports. No individual patient data were utilized during this study. This was utilized to create a decision-making model and a total cost analysis on post-op day 0 - 10 to determine the most cost-efficient day to implant a PPM. Cost variables included estimates of daily cardiac ICU care, cost of PPM implantation, LOS, cost related to possible superficial or deep infection based on published prevalence rates (2.3% and 4.9%, respectively) and need for explant due to deep infection or recovery of native conduction. The model assumes 5-day minimum LOS and 1 day increase in LOS with PPM implantation. Cost data were obtained from relevant billing codes and manufacturer list prices for PPM and leads. A secondary analysis evaluated probability of unnecessary PPMs implanted and excess costs. Results: Post-op day (POD) 4 is the lowest total cost of PPM implantation for post-op CAVB, even when accounting for possible risk of either superficial or deep infection. A one-way sensitivity analysis accounting for variability of cardiac ICU care costs between centers ranging from $3000 - $9000 per day consistently replicates POD 4 as the most cost-effective day for PPM implantation. Implant on POD 4 results in a 26% chance of unnecessary implantation. Conclusions: The most cost-efficient day for PPM implantation for post-op CAVB is post-op day 4, which results in a minimum total cost savings of $17,422 per patient. Added costs due to risk of superficial or deep infection are marginal due to low prevalence of post-operative infection in this population.
文摘We report a case of an 11-year-old boy with diagnosed but uncorrected tetralogy of Fallot presented to us for brain abscess drainage. The child was managed successfully with scalp block with sedation.
基金Supported by The Clinical Research Center Project of Department of Science and Technology of Guizhou Province,No.(2016)410 and No.(2017)5405
文摘BACKGROUND Cardiac resynchronization therapy(CRT) can be used as an escalated therapy to improve heart function in patients with cardiac dysfunction due to long-term right ventricular pacing. However, guidelines are only targeted at adults. CRT is rarely used in children.CASE SUMMARY This case aimed to implement biventricular pacing in one child with heart failure who had a left ventricular ejection fraction < 35% at 4 years after implantation of an atrioventricular sequential pacemaker due to atrioventricular block.Postoperatively, echocardiography showed atrial sensing ventricular pacing and QRS wave duration of 120-130 ms, and cardiac function significantly improved after upgrading pacemaker.CONCLUSION Patients whose cardiac function is deteriorated to a level to upgrade to CRT should be upgraded to reverse myocardial remodeling as soon as possible.
文摘Cardiac Sarcoidosis (CS) is a rare and deceptive disease affecting young adults with catastrophic results including life threatening arrhythmia, congestive heart failure and even sudden death as the initial presentation. CS has been linked to a significant high morbidity & mortality. We present two patients: The first patient with an initial cardiac event that led us to a diagnosis of Pulmonary and Cardiac Sarcoidosis. A second patient, who was diagnosed initially with pulmonary Sarcoidosis, presented with a severe heart conduction abnormality. Both patients were successfully treated with permanent pacemakers. The dual purpose of our study is first to emphasize the importance of follow up on patients with Non-Cardiac Sarcoidosis for cardiac involvement and secondly to increase awareness of CS as part of a differential diagnosis among young adults with unexplained arrhythmia.
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 Natural Science Foundation of Guangdong Province(No.7001020)
文摘Background The effects of trimetazidine on patients with dilated cardiomyopathy（DCM） and left bundle branch block（LBBB） are not clear. Methods Sixty consecutive patients with DCM, LBBB and heart dysfunction（35% ≤ LVEF ≤ 45%） were randomly allocated to heart failure therapy plus trimetazidine group（20 mg three times a day; 30 patients） or heart failure therapy alone group（30 patients）. During follow-up of 6months, QRS morphology, plasma NT-proBNP, 6-minute walk test（6MWT） and echocardiographic indexes were measured. Results At the 6th month, a significant functional improvement was noted in patients receiving trimetazidine added to heart failure treatment. In patients from the trimetazidine group, an increase of left ventricular ejection fraction（LVEF） was noted（from 38 ± 5.5% to 47 ± 7.1%, P = 0.020）. The increase of LVEF in the trimetazidine group was associated with a more significant reduction of the left ventricular endsystolic diameter（LVESD） compared with the control group at 6-month follow-up. The NT-pro BNP levels decreased significantly in the trimetazidine group（3.11 ± 0.47 at baseline and 2.77 ± 0.45 at 6-month followup, P 〈 0.01） and the 6MWT increased significantly in the trimetazidine group（325 ± 44 m at baseline and419 ± 56 m at 6-month follow-up, P 〈 0.01）. The differences in NT-pro BNP levels（2.77 ± 0.45 vs 2.96 ±0.46, P = 0.036） and 6MWT（419 ± 56 m vs 366 ± 54 m, P = 0.032） between the two groups were significant at 6-month follow-up. Conclusions Trimetazidine can improve LV function caused by DCM and LBBB. The positive effects of trimetazidine on LV function are especially evident in patients with optimization of drug therapy for heart failure, which strongly suggests an additive effect of these therapy modalities.
文摘Cardiac sarcoidosis(CS)is a rare but serious manifestation of sarcoidosis that can lead to significant morbidity and mortality due to arrhythmias and heart failure.The inflammatory process in CS is characterized by the formation of noncaseating granulomas in the myocardium,which can disrupt normal cardiac function and conduction.Corticosteroids are the primary therapeutic agents used to manage CS,particularly during the acute inflammatory phase,as they help reduce inflammation and improve cardiac function.However,the long-term use of steroids poses risks,including opportunistic infections and metabolic complications.Advanced imaging techniques,such as cardiac magnetic resonance imaging and positron emission tomography,play a crucial role in diagnosing CS and assessing myocardial involvement.These imaging modalities also aid in risk stratification for arrhythmic events,guiding therapeutic decisions such as the initiation of steroid therapy and the potential placement of implantable cardioverterdefibrillators.This review synthesizes current evidence regarding the role of steroid therapy in managing CS and its implications for cardiac arrhythmias,emphasizing the need for individualized treatment strategies to optimize patient outcomes.
文摘Persistent left superior vena cava(PLSVC)is a rare congenital anomaly that may complicate cardiac procedures when associated with a dilated coronary sinus(CS)and conduction disturbances.We report the case of a 27-year-old male with Wilson’s disease who presented with complete heart block.Echocardiography showed biatrial enlargement and severe CS dilation,while contrast-enhanced computed tomography(CT)confirmed PLSVC draining into the CS without a bridging vein.Anatomical constraints prevented cardiac resynchronization therapy,and dual-chamber pacemaker implantation proved technically challenging due to lead placement difficulties.This case highlights the importance of thorough preoperative assessment and individualized pacing strategies in patients with PLSVC,in order to anticipate anatomical challenges and optimize outcomes.
