Biomedical subjects
Publications and source records attributed to N García Hernández.
Idiopathic is a nonspecific term applied to cases of ventricular tachycardia occurring in patients without overt heart disease or obvious precipitating circumstances. This arrhythmia should always be considered a diagnosis of exclusion. Periodic re-evaluation of patients with idiopathic arrhythmias should be performed to be certain that abnormalities do not develop.
We present a case of a psychiatric patient treated with Amitriptyline who developed Stokes-Adams attacks with EKG manifestations of prolonged Q-T and "torsade de pointes".
Two patients who had sudden unexpected death while being monitored by a Holter electrocardiograph apparatus are reported. The first patient with heart disease of unknown etiology initially developed first degree A-V block, progressive left bundle branch block and finally asystole. The second patient with previous coronary artery disease and recent myocardial infarction revealed multifocal ventricular extrasystoles with frequent bigeminism and trigeminism which ended in ventricular tachycardia and fibrillation. Emphasis is made on the necessity of detecting those high risk patients and establishing preventive post-hospitalization care to modify the evolution and prognosis in this group of patients.
The history of a 12 year old male, who developed a bidirectional tachycardia and sudden death without evidence of neurological or cardiac disease is described. The role of bidirectional tachycardia related to sudden death is discussed, as well as its possible origin and mechanisms, based on the case described.
Two well documented cases of permanent atrial standstill are reported. Both fulfilled the diagnostic criteria of absence of electrical and mechanical atrial activity. The importance of response to electrical stimuli and escape rhythm is discussed within the context of a severe, irreversible and evolutive disease.
We describe the case of a 11 year old male who developed a bidirectional tachycardia associated to mitral valve prolapse as the only evident anatomical anomaly. Simultaneous recordings of surface ECG readings and intracavitary tracings showed left ventricular origin of such tachycardia. In the present study we confirm the site of origin of the arrhythmia and the association between bidirectional tachycardia and mitral valve prolapse.
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The case report is a woman 45 years old from a rural zone of the Federal District (Mexico City) with subvalvular mitral aneurysm of probable chagasic origin. Its main clinic manifestation was caused by the presence of recurrent ventricular arrhythmias refractory to medical treatment. The diagnosis was made by means of the serology, echocardiography, cineangiography and endocardial biopsy. The treatment consisted in the surgical resection of the aneurysm with successful evolution.
The ablation of cardiac arrhythmias by radiofrequency has changed radically the treatment of arrhythmias. We present the case of a woman with cirrhosis and no structural heart disease, who was severely limited in her activities because of drug-refractory paroxysmal supraventricular tachyarrhythmias. She underwent an atrio-ventricular node ablation by radiofrequency. She was discharged with no antiarrhythmic drugs and on a permanent cardiac pacing. She showed obvious improvement in her quality of life.
A premature 3 days-old female with AV block Möbitz type II and structurally normal heart is presented. Progressive atrial abnormal repolarization was observed. Besides, transient total electrical alternans that included P wave, QRS complex, ST segment and T wave was evident. Retrospective analysis on ECG findings showed multiple metabolic and electrolytic disturbances related with this phenomenon. Hypoxia, hypothermia and long QT interval around an immature heart are particularly discussed as triggering factors.
Two patients with ischemic heart disease had sudden death detected by means of ambulatory electrocardiography; the first patient had ventricular tachycardia-asystole and the second bradycardia-asystole without mediating a ventricular tachyarrhythmia. In both cases the autonomic function of the heart was determined, by means of the heart rate variability for spectral analysis and for time domain analysis. An important decrease in heart rate variability in the patient with tachyarrhythmia was appreciated, more pronounced in the hour previous to his death. On the other hand, in the patient with bradycardia-asystole there was increased heart rate variability. This suggests different neural influences in both patients for the development of sudden death: an alteration in the autonomic function of the heart in the patient with ventricular tachyarrhythmias, related to a depressed parasympathetic tone. In the patient with bradycardia-asystole, the parasympathetic tone was accentuated.
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Two patients with the congenital form of the long QT syndrome and polymorphous ventricular tachycardias unresponsive to adrenergic beta-blockade, were successfully treated with permanent pacemaker. We discuss the role of cardiac stimulation with pacemakers in the context of all the therapeutic modalities, taking into account the recent knowledge of chromosomal alterations and also in ionic channels.