Delayed and spontaneous coronary artery rupture following nonpenetrating chest trauma.
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Aneurysm, Ruptured↗
Biomedical subjects
D A Rubin
Publications and source records attributed to D A Rubin.
Autosomal dominant inherited ventricular tachycardia.
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Chromosome Aberrations↗
In vitro effects of homologous prolactins on testosterone production by testes of tilapia (Oreochromis mossambicus).
The tilapia, Oreochromis mossambicus, produces two prolactins designated tPRL177 and tPRL188 to indicate the number of amino acid residues in each. The direct in vitro actions of tPRL177 and tPRL188 on basal and ovine luteinizing hormone (LH)-induced testosterone production in minced testes of courting and noncourting (bachelor) tilapia were examined. Courting males were housed with females and were used as soon as they built a spawning pit; noncourting males were housed with other males and were used when they appeared female-like in coloration. The in vitro culture system consisted of two phases. In phase 1 (0-10 hr), testicular tissue was incubated without (control) or with the tPRLs--both alone and together and in doses ranging from 0.5 to 32 microM. In phase 2 (10-16 hr), the culture medium was replaced with medium containing 6.25 microM (0.25 micrograms/ml) ovine LH. Testosterone production during both phases was determined by radioimmunoassay of the medium. The tPRLs stimulated testosterone production during phase 1 in courting males (by 25%) but not in noncourting males. Exposure to either or both tPRLs in phase 1 enhanced the response of testicular tissue from courting males to ovine LH (by 10%) and inhibited the response of minced testes taken from noncourting males (by 12%). This is the first evidence to demonstrate direct gonadal activity of homologous PRL in a teleost.
Animals↗
Reversible late potentials due to ischemia.
The role of ischemia in the development of reversible late potentials was assessed in 19 patients undergoing percutaneous transluminal coronary angioplasty. Signal-averaged electrocardiograms were performed before angioplasty, during ischemia caused by balloon inflation and after angioplasty. Five of 19 patients developed late potentials that reverted to normal after angioplasty. Age, sex, ejection fraction, left ventricular end diastolic pressure, vessels involved, and extent of myocardium in jeopardy did not predict the development of late potentials. Patients with a prior history of myocardial infarction were more likely to develop late potentials. Therefore, patients with prior myocardial infarction appear more likely to develop the substrate for reentrant ventricular tachycardia during periods of ischemia.
Angioplasty, Balloon, Coronary↗
Prospective evaluation of heart block complicating early Lyme disease.
Lyme disease is a recognized cause of heart block/carditis. The incidence of heart block complicating early Lyme disease has not been prospectively evaluated. In this study, 61 patients with early Lyme disease documented by the rash of erythema migrans were prospectively evaluated for carditis. Fifty five of 61 patients had a repeat examination 3 to 4 weeks after initiation of antibiotic therapy. Only one of 61 patients (1.6%) presented with heart block, which resolved with antibiotics. None of the 54 patients without heart block on initial presentation had a change in any measured electrocardiographic parameter or progressed to heart block after antibiotics. Therefore, early Lyme disease appears to be infrequently complicated by heart block. Early administration of antibiotics may prevent the development of heart block/carditis.
Adult↗
Subacute pulmonary toxicity from amiodarone.
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Aged↗
Interhemispheric fissure width in neonates on ECMO.
The neurosonograms of fifty-eight patients treated over a four-year period with ECMO support were retrospectively reviewed for analysis of changes in interhemispheric (IHF) width while on ECMO. To correlate these measurements with patterns of development of total body edema as reflected by chest wall thickening on portable chest radiographs, patients were divided into three categories based on the pattern and severity of body edema development. Patterns of IHF widening were compared between these categories, and to the pattern of development of chest wall edema within each category. Results indicate that IHF width tends to progressively increase during ECMO and that the pattern of IHF widening tends to parallel development of overall body edema. Additionally, IHF widening was found to resolve following termination of ECMO support, as demonstrated on follow-up cranial CT examinations. Our results suggest that IHF widening in infants on ECMO is an intracranial manifestation of the generalized edema accumulation that frequently occurs during ECMO.
Analysis of Variance↗
Acute reversible diffuse conduction system disease due to Lyme disease.
During the acute phase of Lyme disease, a 56-year-old man without previous heart disease developed complete heart block with alternating left and right bundle branch block pattern QRS complexes. Electrophysiological study performed in the acute phase revealed marked HV prolongation, although the level of heart block was at the atrioventricular node. The heart block was mildly symptomatic and resolved (as did the bundle branch block) with antibiotic therapy. Lyme disease may cause reversible His-Purkinje disease.
Acute Disease↗
Polymorphic ventricular tachycardia.
The case of a patient with torsade de pointes in the setting of congenital complete heart block is described. Lack of recognition of this polymorphic ventricular tachycardia resulted in therapy that potentiated the dysrhythmia. After correct recognition, and directed therapy, the patient responded appropriately. The clinical settings, recognition, and management options available for torsade de pointes are discussed to familiarize the emergency physician with this important and unique dysrhythmia.
Adult↗
Selective hypervagotonia isolated to the atrioventricular node.
Thirteen patients with recurrent unexplained syncope or presyncope underwent electrophysiological evaluation. A prolonged effective refractory period and functional refractory period of the atrioventricular node as well as slow paced rate to atrioventricular block were the only abnormalities found. Ventricular tachycardia could not be induced. All electrophysiological abnormalities reverted to normal following atropine administration. These patients have selective hypervagotonia isolated to the atrioventricular node. Three of thirteen patients required permanent pacing, and one required propantheline to control recurrent symptoms. Selective hypervagotonia may be a distinct clinical entity that can cause symptoms and require therapy.
Adult↗
Predictors, prevention, and long-term prognosis of atrial fibrillation after coronary artery bypass graft operations.
Multiple trials have suggested the use of digoxin, digoxin and propranolol, or timolol to prevent atrial fibrillation after coronary artery bypass grafting. No trial has evaluated the efficacy of digoxin verus propranolol. Furthermore, the predictors of postoperative atrial fibrillation and the long-term consequence of atrial fibrillation that reverts to sinus rhythm have not been established. One hundred fifty patients were randomized to receive no drug, propranolol (20 mg every 6 hours), or digoxin (0.5 mg followed by 0.25 mg daily). Twenty-seven patients were excluded from data analysis. In the remaining 123 patients, no preoperative parameter (age, sex, diabetes, hypertension, smoking, electrocardiographic p wave morphology, or preoperative digoxin or propranolol therapy), intraoperative parameter (bypass time, aortic cross-clamp time, or number of vessels bypassed), or postoperative parameter (peak creatinine kinase, congestive heart failure, or pericarditis) by univariate or multivariate analysis predicted patients at risk for atrial fibrillation. Sustained atrial fibrillation developed in 37.5% of control and 32.6% of digoxin-treated patients. Only 16.2% of propranolol-treated patients had sustained atrial fibrillation (p less than 0.03). There were no in-hospital complications in those patients with atrial fibrillation. After 26 +/- 7 months follow-up, those patients with postoperative atrial fibrillation had no increased incidence of angina, cerebral vascular accident, myocardial infarction, or sudden death. Therefore, in this select population, propranolol prophylaxis is effective but discretionary.
Atrial Fibrillation↗
Ventricular arrhythmias after coronary artery bypass graft surgery: incidence, risk factors and long-term prognosis.
The incidence, risk factors and long-term prognosis of complex ventricular arrhythmias after coronary artery bypass graft surgery are not known. Complex ventricular arrhythmias are defined as Lown grades 4a (couplets), 4b (ventricular tachycardia) and 5 (R on T phenomenon). Ninety-two patients with normal left ventricular function who underwent elective coronary artery bypass graft surgery were prospectively evaluated. Ventricular arrhythmias were documented by predischarge 24 hour ambulatory electrocardiographic monitoring; 43% of patients had no or simple ventricular arrhythmias (Lown grades 1 to 3) and 57% had complex ventricular arrhythmias. Risk factors analyzed included age, sex, diabetes, hypertension, smoking, preoperative digoxin or propranolol therapy, cardiopulmonary bypass time, aortic cross-clamp time, number of vessels bypassed, peak creatine kinase (CK) elevation and pericarditis. No risk factor identified patients at higher risk for complex ventricular arrhythmias. Patients were followed up for 6 to 24 months (mean 16). Patients with complex ventricular arrhythmias did not have a higher incidence of sudden death, cardiac death, syncope, angina, myocardial infarction or cerebrovascular accident. It was concluded that: Complex ventricular arrhythmias are common after coronary artery bypass graft surgery. None of the risk factors considered identify high risk patients. Complex ventricular arrhythmias after coronary artery bypass graft surgery do not indicate a poor prognosis in patients with normal left ventricular function.
Ambulatory Care↗
Visualization of coronary artery fistula with transesophageal echocardiography.
Coronary artery fistulas are relatively uncommon and are usually initially suspected on auscultation of a continuous murmur. Long-term complications include congestive heart failure, endocarditis, ischemia, and atrial arrhythmias. The role of echocardiography in visualization and diagnosis of these fistulas is expanding. We report two cases in which transesophageal echocardiography was used to visualize and better define proximal coronary arteries and coronary artery fistulas.
Adult↗