Coronary artery spasm with sinus node dysfunction and syncope

In a 55-year-old man, attacks of spontaneous angina were associated with dizziness and syncope. Holter ECG monitoring disclosed evidence of sinus node dysfunction. Dizziness and syncope were corrected by a permanent ventricular demand pacemaker. Coronary cineangiography showed spontaneous, severe, diffuse spasm in a dominant left coronary artery and localized spasm in a nondominant right coronary artery. The patient died of pump failure shortly after cardiac catheterization. An autopsy disclosed only minimal coronary atherosclerosis. This patient's condition shows that (1) coronary spasm may cause sinus node dysfunction, dizziness, and syncope, (2) severe spasm that involves all the coronary artery branches may be fatal, and (3) severe spasm occur in minimally diseased coronary arteries confirmed by pathologic examination.

Striking electrocardiographic changes associated with pheochromocytoma. Masquerading as ischemic heart disease

A patient with pheochromocytoma presented striking electrocardiographic changes mimicking ischemic heart disease at one time and acute pulmonary embolism at other times. Diffuse left ventricular hypokinesia was demonstrated in the presence of normal coronary arteries. Following removal of the pheochromocytoma, the electrocardiographic abnormalities disappeared.

Multifascicular block in cardiomyopathy. Incidence, localization by His bundle study and prognosis

Of 70 patients with cardiomyopathy, nine (13%) had bifascicular block: right bundle branch block with left anterior hemiblock in four, right bundle branch block with left posterior hemiblock in two, and left bundle branch block with left anterior hemiblock in three. Isolated left bundle branch block was present in four, isolated left anterior hemiblock in 13, and isolated left posterior hemiblock in one. No isolated right bundle branch block was found. Five of the patients with bifascicular block were evaluated by His bundle electrocardiography and atrial pacing. Block in the His-Purkinje system (prolonged HV interval) was present in four and atrioventricular conduction (AH interval) was normal in all five. Despite a common prolongation in intraventricular conduction, short term prognosis seems to be favorable since: (1) none had spontaneous progression to more advanced block or experienced Stokes-Adams attacks for an average follow-up period of at least 42 months, and (2) with atrial pacing, one-to-one atrioventricular conduction persisted to rates up to 150/min in all patients with no further prolongation of HV interval.

His bundle electrogram in congenitally corrected transposition of the great vessels

His bundle electrogram was recorded in a young adult male with corrected transposition of the great vessels and single ventricle. Prolonged PA and AH intervals, wide diphasic His spike, and normal HV intervals were found. These findings are suggestive of the diffuse nature of conduction delay in this congenital lesion involving intra-atrial, AV nodal, and intra-His regions.

Electrocardiographic abnormalities in alcoholic cardiomyopathy. A study of 65 patients

Electrocardiograms of 65 patients with alcoholic cardiomyopathy seen over a five-year period were reviewed. ST segment and T wave abnormalities, left ventricular hypertrophy, biatrial enlargement, left atrial enlargement, premature ventricular contractions, prolonged PR interval, and left anterior hemiblock are the most frequently encountered abnormalities. A combination of left ventricular hypertrophy and biatrial enlargement with or without left anterior hemiblock is most specific, Atrial flutter or fibrillation, pathologic Q waves, and bifascicular block are not uncommon findings, while isolated right atrial or right ventricular abnormalities, and isolated posterior hemiblock or right bundle branch block are rare. Electrocardiographic changes are in general similar to those seen in any diffuse cardiomyopathy and reflect biventricular involvement.

Hemoglobin S-C disease presenting as acute pneumonitis with pulmonary angiographic findings in two patients

Acute illness characterized by fever, cough, chest pain and pulmonary infiltrates on chest film is characteristic of patients witb sickle cell anemia and with sickle-C disease. The underlying hemoglobinopathy is usually recognized in the former, but because patients with sickle-C disease as a rule have less severe anemia and fewer, less severe crises their abnormal hemoglobin may not be detected until adolescence or adulthood. Acute pulmonary illness in such patients may therefore present a diagnostic dilemma for the unwary. Two cases are presented to highlight this point. Pulmonary angiographic findings in patients with sickle cell states might add information about the pathogenesis of this disorder since vascular occlusion appears to play a major role. Pulmonary angiograms in the two patients we describe documented the presence of localized abnormalities of perfusion. In one, the presence of filling defects in medium-sized arteries suggests intravascular thromboembolism.

Evidence for specialized atrioventricular conduction in hyperkalemia

A patient who had chronic coarse atrial fibrillation developed severe hyperkalemia accompanied by total loss of fibrillatory waves while an irregularly irregular ventricular rhythm persisted. Correction of hyperkalemia resulted in prompt return of coarse atrial fibrillation. This sequence of events renders strong support to direct atrioventricular conduction through the specialized internodal tracts.

Complete heart block with normal QRS duration occurring distal to the his bundle in acute inferior myocardial infarction

A patient with acute inferior myocardial infarction developed on the second day complete heart block with normal QRS duration, and the block was found to be distal to the His bundle. To our knowledge, this is the first such documented case in the English literature. Failure of the preceding Wenckebach periods and of complete heart block to respond to intravenous atropine may be a clinical clue to the nature of this type of heart block. The implications and possible explanations are discussed in the light of recent knowledge concerning the nature of heart block in inferior wall myocardial infarction.