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2 examples of severe tricuspid incompetence presenting in the newborn period are described. Both recovered with medical treatment alone, with subsequent decrease in tricuspid incompetence. Postnatal course is attributed to normal decrease in pulmonary vascular resistance. Some infants may be at considerable risk until this decrease occurs.
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The authors, having studied a case of Meadows syndrome, confirm that this cardiomyopathy is a specific entity in pregnancy and the puerperium. They point out the difficulties in diagnosis, as Meadows syndrome seems to be diagnosis of elimination. They point out that a paraclinical balance has to be drawn up very fully on the biological and haemodynamic planes to confirm this condition. Finally, after a short discussion about the therapy, they tackle the problem of the prognosis for life and for future childbearing in these patients, which is determined by the persistence or absence of cardiac enlargement.
To obtain information on endocardial activation-sequence, unipolar recordings at seven left ventricular and six right ventricular points were performed in a 37-year-old man suffering from cardiomyopathy and tachycardia-dependent left bundle branch block (LBBB). Results were as follows: 1) the recovery time was longer in anterior than in posterior portion of left bundle branch fibers; 2) an high posterior left ventricular point was directly activated via posterior left bundle branch fibers; 3) the directly activated left ventricular zone was too small and relatively too late excited in respect of the right interventricular septum, from which the stimulus reached the left septum, to mask the LBBB electrocardiographic pattern; 4) in the presence of tachycardia-dependent LBBB the duration of left ventricular endocardial activation was about twice (62 msec) that found in the absence of tachycardia-dependent LBBB (28 msec).
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A review and discussion of the incidence and clinical importance of various cardiac arrhythmias in patients with inflammatory diseases of the heart is presented in this paper.
The authors report on 4 Intensive Care Unit cases, hospitalized for syncopes due to serious ventricular arrhythmias. They all presented long Q-T and were receiving treatment with prenylamine. Improvements were observed on suspension of the drug, suggesting therefore that during this treatment, frequent electrocardiographic checks, especially for elderly patients, should be carried out. Caution should also be exercised in associations with other chinidinosimiles and hypokaliemic drugs
2 patients with symptoms of paroxysmal AV block showed widening, splitting, slurring and decreasing amplitude of the His potential. Concomitantly, this was followed by different patterns of bundle branch block. In one of the patients it was obvious that a left bundle branch block was related to a Wenckebach phenomenon in the His bundle, and in the other patient different bundle branch block patterns were related to the occurrence of the intra-His bundle conduction delay. It is suggested that the present electrophysiological findings reflect asynchronous conduction in the His bundle causing a critical conduction delay in parts of the bundle branches leading to bundle branch block.
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It was established that the presence of Samoilov-Wenckebach's periods and prolongation of the H--V interval at low frequency of the imposed rhythm as well as periods of asystolia of more than 1,200 msec are most typical for these patients. An attempt was made to determine the type of cardiac stimulation indicated for such patients from the character of the disorders of rhythm observed in them and the initial frequency of their own cardiac contractions.
The overdrive pacing method is widely used now in clinical practice for prevention and treatment of severe ventricular disorders of the cardiac rhythm. The mechanisms of arrhythmia suppression by means of this stimulation is analysed. Indications are determined for the choice of the site of stimulation and optimal impulce frequency in ischemic heart disease, and overdosage with digitalis drugs, as well as in myocardiopathy.