Atrioventricular nodal reentrant tachycardia

Atrial fibrillation induced by atrioventricular nodal reentrant tachycardia

In 4 patients with recurrent episodes of paroxysmal atrial fibrillation as the only documented arrhythmia, electrophysiologic study showed that atrial fibrillation originated after a very fast transition from atrioventricular nodal reentrant tachycardia. Recognition of atrioventricular nodal reentrant tachycardia as the triggering factor for atrial fibrillation has important therapeutic consequences.

Electrophysiological study of young patients with exercise related paroxysms of palpitation: role of atropine and isoprenaline for initiation of supraventricular tachycardia

Electrophysiological studies were performed in eight patients (four men and four women, mean (SD) age 24 (5) years with paroxysmal attacks of palpitation during or immediately after exercise. Five patients were competitive athletes at college. In two patients spontaneous supraventricular tachycardia during exercise was recorded by ambulatory electrocardiographic monitoring and in another it was induced by treadmill exercise testing. Two had dual atrioventricular nodal pathways, three had manifest atrioventricular accessory pathways, and three had concealed atrioventricular pathways. Programmed stimulation induced sustained supraventricular tachycardia in six patients--in two after intravenous injection of atropine sulphate (1 mg) and in four during infusion of isoprenaline (0.01 microgram/kg/min). In one patient, non-sustained atrioventricular nodal reentrant tachycardia was induced during isoprenaline infusion. In the remaining patient, who had dual atrioventricular nodal pathways, tachycardia was not inducible. AH block prevented maintenance of reentry in five patients. In five patients shortening of the effective refractory period of the atrioventricular node with atropine (one patient) and isoprenaline (four patients) caused sustained supraventricular tachycardia. The present study indicates that treatment with atropine and isoprenaline may be an important factor in the initiation of supraventricular tachycardia in patients with exercise related paroxysms of palpitation.

Common complications in critically ill patients

Patients in intensive care units (ICUs) are subject to many complications connected with the advanced therapy required for their serious illnesses. Complications of ventilatory support include problems associated with short-term and long-term intubation, barotrauma, gastrointestinal tract bleeding, and weaning errors. Cardiac tachyarrhythmias can arise from a patient's intrinsic cardiac disease, as well as from drug therapy itself. Hemodynamic monitoring is crucial to careful patient management, but it is associated with technical complications during insertion such as pneumothorax, as well as interpretive errors such as those caused by positive end-inspiratory pressure. Acute renal failure can develop as a result both of therapy with drugs such as aminoglycosides and hypotension of many etiologies, as well as the use of contrast media. Nosocomial infection, which is a dreaded complication in ICU patients, usually arises from sources in the urinary tract, bloodstream, or lung. Complications frequently can arise if the interactions of drugs commonly used in the ICU are not recognized. Further, the ICU patient is subject to nutritional complications, acid base problems, and psychological disturbances. This monograph deals with the frequency, etiology, and prevention of these common ICU complications.

MAST application in the treatment of paroxysmal supraventricular tachycardia in a child

A case of paroxysmal supraventricular tachycardia (PSVT) in a child with successful termination of the arrhythmia by military antishock trouser (MAST) application is described. The use of MAST application in terminating PSVT in adults has been previously reported. Ours is the first such case reported using this method in the therapy of PSVT in children. Our report suggests that MAST application may be another maneuver to add to those vagal maneuvers known to be of benefit in the termination of PSVT in children as well as in adults.

Termination of paroxysmal supraventricular tachycardia by digital rectal massage

A 71-year-old woman with an episode of paroxysmal supraventricular tachycardia (PSVT) complicated by angina pectoris and hypotension had her arrhythmia abruptly terminated by digital rectal massage (DRM) after other vagotonic maneuvers had failed. DRM termination of PSVT has not been heretofore reported. In treating PSVT by physical vagotonic maneuvers, DRM may be preferable to other techniques because of the decreased likelihood of complications noted with other such maneuvers.

Emergency treatment of tachyarrhythmias

The diagnosis, clinical aspects, and emergency treatment of the most common cardiac arrhythmias, including atrial flutter and fibrillation, paroxysmal supraventricular tachycardia, the Wolff-Parkinson-White syndrome, ventricular tachycardia, and torsades de pointes, are discussed. The use of the antiarrhythmic drugs most frequently utilized in clinical practice is described.