Forty-nine consecutive patients (44 with atrial fibrillation and five with atrial flutter) received 10 mg of verapamil five to seven minutes before elective electroversion, to evaluate the feasibility of the latter while verapamil effects were present. Excluded were patients with moderate-to-severe heart failure, acute myocardial infarction, mean ventricular rate lower than 70 beats/minute, those receiving any antiarrhythmic drug other than digoxin, and those in whom sinus node dysfunction was suspected. In six patients, eight complications took place: four instances of hypotension (systolic blood pressure below 80 mm Hg), two instances of junctional escape rhythm (47 and 63 beats/minute) and two instances of junctional tachycardia. In all four instances of hypotension, return to normal values of blood pressure was spontaneous (within five minutes in three patients). Rhythm disturbances were transient, without clinical relevance. This study suggests that electroversion can be safely carried out during clinical action of verapamil in properly selected patients, and that occasional, self-limited hypotension is the only complication of clinical significance to be expected.

Adolescent↗

PubMedDate not supplied

Cardiac tamponade as the initial manifestation of acute leukemia: report of a case and review of the literature.

An 18-year-old woman with acute monoblastic leukemia presenting with cardiac tamponade is reported. Subxiphoid pericardiotomy was performed, and blast cells were observed in the pericardial fluid. The leukemia was refractory to chemotherapy and the patient died at three months from diagnosis, without recurrence of the pericardial effusion. In the review of the literature, only ten cases of cardiac tamponade as the first manifestation of acute leukemia have been found.

Adolescent↗

PubMedDate not supplied

[Prognostic value of a symptom-limited exertion test in the early phase of myocardial infarct].

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Adult↗