Biomedical subjects
Publications and source records attributed to V S Wayne.
The supraventricular tachyarrhythmias (SVT) encompass a variety of rhythm disturbances in which the rate exceeds 100 beats per minute (in adults). Such disturbances originate from sinus, atrial, or atrio-ventricular junctional pacemakers located above the bundle of histidine (His). The treatment depends on the type of arrhythmia, its mechanism and the clinical situation or consequences.
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Five patients, all women in their 50s and all with a documented history of migraine headaches, had ischemic chest pains investigated. Four patients had angina primarily occurring at rest, with documented ischemic electrocardiographic changes during pain in all five. Three subjects sustained myocardial infarction, one shortly after taking ergotamine tartrate for an acute attack of migraine. Subsequent coronary angiography in all five subjects revealed no evidence of atherosclerotic coronary artery disease, suggestive of spasm as the cause of ischemia. In subjects with known migraine, the occurrence of chest pain may represent coronary artery spasm, and should be investigated with concurrent electrocardiographs, as these two clinical entities may be related as part of a generalised vasospastic disorder. The use of ergot preparations should be contraindicated in such patients, as exacerbation of chest pain and frank myocardial infarction may result. These chest pains responded favourably to calcium channel blockers.
A 16 year old girl with the rare syndrome characterised by hypertension, hyperkalemia, and acidosis was treated with a range of drugs, including thiazides, frusemide, and beta-adrenoceptor antagonists. None of the agents normalised the hypertension and biochemical abnormalities. Best results were obtained with methyclothiazide in full dosage, which normalised the blood pressure, serum potassium level, and bicarbonate level in the face of increased plasma renin activity. Empirical treatment with thiazides is the most satisfactory method for long term management.
Following exercise testing, a 71-year-old man developed atrial tachycardia with a unusual form of conduction disturbance: 4:2 atrioventricular (A-V) block. This pattern of A-V block is explainable by two different mechanisms of concealed conduction: two different levels of block in the A-V nodal region and dual A-V nodal pathways with concealed retrograde conduction of P waves. These concepts can also explain a variety of other unusual conduction disturbances.
Over a five-year period, 2267 patients attended a cardiac rehabilitation programme. Fourteen patients developed serious ventricular arrhythmias, and most of these had severe coronary artery disease with left ventricular dysfunction. Patients with known coronary artery disease should have medically supervised exercise programmes with an immediate access to resuscitation equipment.
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Fourteen patients with pericardial effusions without clinical signs of tamponade (pulsus paradoxus or other cardiac and circulatory abnormalities) showed inspiratory reductions in echocardiographic left ventricular internal diastolic diameter which correlated directly with the exaggerated respiratory changes in systolic time intervals (both pre-ejection period and left ventricular ejection time). Excessive pericardial fluid affects left ventricular function even in the absence of clinical manifestations.
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We report a rare electrocardiographic finding occurring in previously undescribed circumstances in which a 61-year-old man undergoing exercise testing developed striking ST segment elevation on the ECG characterized by electrical alternans of the ST segments. The significance of electrical alternans is briefly discussed in the light of this event.
Three patients with ischaemic heart disease developed profound cardiac failure, hypotension and bradycardia during combined therapy with verapamil and beta-adrenergic blocking drugs. This clinical picture resolved completely with cessation of the combined therapy. Baseline left ventricular function, assessed by cardiac catheterisation or nuclear angiography, was normal in two patients and only mildly reduced in the other. Simultaneously administration of beta-adrenergic blocking drugs and verapamil may result in profound adverse interactions and should only be administered with great caution.