1
|
Dilsizian V, Gewirtz H, Paivanas N, Kitsiou AN, Hage FG, Crone NE, Schwartz RG. Serious and potentially life threatening complications of cardiac stress testing: Physiological mechanisms and management strategies. J Nucl Cardiol 2015; 22:1198-213; quiz 1195-7. [PMID: 25975944 DOI: 10.1007/s12350-015-0141-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Henry Gewirtz
- Department of Medicine (Cardiology Division), Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicholas Paivanas
- Department of Medicine (Division of Cardiology), University of Rochester Medical Center, Rochester, NY, USA
| | | | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ronald G Schwartz
- Departments of Medicine (Division of Cardiology) and Imaging Sciences (Nuclear Medicine), University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
2
|
Kossaify A, Refaat M. Programmed ventricular stimulation--indications and limitations: a comprehensive update and review. Hellenic J Cardiol 2013; 54:39-46. [PMID: 23340128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- Antoine Kossaify
- Cardiology Division, Electrophysiology Unit, USEK-NDS University Hospital, Byblos, Lebanon.
| | | |
Collapse
|
3
|
|
4
|
Laskey WK, Feinendegen LE, Neumann RD, Dilsizian V. Low-level ionizing radiation from noninvasive cardiac imaging: can we extrapolate estimated risks from epidemiologic data to the clinical setting? JACC Cardiovasc Imaging 2010; 3:517-24. [PMID: 20466348 DOI: 10.1016/j.jcmg.2009.11.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 11/03/2009] [Accepted: 11/06/2009] [Indexed: 11/17/2022]
Abstract
Clinical decision-making regarding the use of low-level ionizing radiation for diagnostic and/or therapeutic purposes in patients with cardiovascular disease must, as in all other clinical scenarios, encompass the broad range of the risk-benefit ratio. Concerns regarding the late carcinogenic effects of exposure to low levels, i.e., <100 mSv, of ionizing radiation stem from extrapolation of exposure-outcome data in survivors of World War II atomic bomb explosions. However, ongoing debate regarding the true incremental risk to subjects exposed to doses currently administered in cardiovascular procedures fails to take into account the uncertainty of the dose-response relationship in this lower range, as well as tissue-specific reparative responses, also manifest at lower levels of exposure. The present discussion draws attention to both of these aspects as they relate to clinical decision-making.
Collapse
Affiliation(s)
- Warren K Laskey
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, USA.
| | | | | | | |
Collapse
|
5
|
Ackerman MJ, Khositseth A, Tester DJ, Hejlik JB, Shen WK, Porter CBJ. Epinephrine-induced QT interval prolongation: a gene-specific paradoxical response in congenital long QT syndrome. Mayo Clin Proc 2002; 77:413-21. [PMID: 12004990 DOI: 10.4065/77.5.413] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the effect of epinephrine on the QT interval in patients with genotyped long QT syndrome (LQTS). PATIENTS AND METHODS Between May 1999 and April 2001, 37 patients (24 females) with genotyped LQTS (19 LQT1, 15 LQT2, 3 LQT3, mean age, 27 years; range, 10-53 years) from 21 different kindreds and 27 (16 females) controls (mean age, 31 years; range, 13-45 years) were studied at baseline and during gradually increasing doses of intravenous epinephrine infusion (0.05, 0.1, 0.2, and 0.3 microg x k(-1) x min(-1)). The 12-lead electrocardiogram was monitored continuously, and heart rate, QT, and corrected QT interval (QTc) were measured during each study stage. RESULTS There was no significant difference in resting heart rate or chronotropic response to epinephrine between LQTS patients and controls. The mean +/- SD baseline QTc was greater in LQTS patients (500+/-68 ms) than in controls (436+/-19 ms, P<.001). However, 9 (47%) of 19 KVLQT1-genotyped LQT1 patients had a nondiagnostic resting QTc (<460 milliseconds), whereas 11 (41%) of 27 controls had a resting QTc higher than 440 milliseconds. During epinephrine infusion, every LQT1 patient manifested prolongation of the QT interval (paradoxical response), whereas healthy controls and patients with either LQT2 or LQT3 tended to have shortened QT intervals (P<.001). The maximum mean +/- SD change in QT (AQT [epinephrine QT minus baseline QT]) was -5+/-47 ms (controls), +94+/-31 ms (LQT1), and -87+/-67 ms (LQT2 and LQT3 patients). Of 27 controls, 6 had lengthening of their QT intervals (AQT >30 milliseconds) during high-dose epinephrine. Low-dose epinephrine (0.05 microg x kg(-1) x min(-1)) completely discriminated LQT1 patients (AQT, +82+/-34 ms) from controls (AQT, -7+/-13 ms; P<.001). Epinephrine-triggered nonsustained ventricular tachycardia occurred in 2 patients with LQTS and in 1 control. CONCLUSIONS Epinephrine-induced prolongation of the QT interval appears pathognomonic for LQT1. Low-dose epinephrine infusion distinguishes controls from patients with concealed LQT1 manifesting an equivocal QTc at rest. Thus, epinephrine provocation may help unmask some patients with concealed LQTS and strategically direct molecular genetic testing.
Collapse
Affiliation(s)
- Michael J Ackerman
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | | | | | | | |
Collapse
|
6
|
Stein RA, Chaitman BR, Balady GJ, Fleg JL, Limacher MC, Pina IL, Williams MA, Bazzarre T. Safety and utility of exercise testing in emergency room chest pain centers: An advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association. Circulation 2000; 102:1463-7. [PMID: 10993869 DOI: 10.1161/01.cir.102.12.1463] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
7
|
Abstract
The optimal preoperative evaluation of cardiac risk in patients with peripheral vascular disease is controversial. In developing a paradigm for preoperative cardiac workup, potential adverse effects of evaluation and cardiac intervention must be considered. This study analyzed the deleterious outcomes of extensive, comprehensive cardiac evaluation and intervention before planned vascular surgery in patients treated at the Denver Department of Veterans Affairs Medical Center. Over a 12-month period between 1994 and 1995, 161 patients were scheduled to undergo major vascular operations; 153 patients came to operation. The decision to pursue a cardiac evaluation was variously made by a combination of surgeons, cardiologists, and anesthesiologists. No defined protocol was followed. Cardiac history, chest X-rays and ECGs were obtained for all patients. Extended cardiac evaluation included these studies plus special tests, including echocardiography (echo), radionuclide ventriculography (RNVG), dipyridamole thallium scintigraphy (DTS), and cardiac catheterization (CC). Extended cardiac evaluations were undertaken in 42 patients. Complications related to percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) were also recorded. Cardiac mortality and morbidity after vascular interventions were itemized in all 153 patients. Forty-two male patients, aged 68 +/- 9 years, underwent extended cardiac evaluations before planned vascular operations. The median elapsed time for cardiac workup was 14 days (mean 30 +/- 59 days). The median and mean times from cardiac workup to vascular surgery were 25 days and 76 +/- 142 days, respectively. Eighteen (43%) patients had echo or RNVG; 22 (52%) patients had DTS; 27 (64%) had CC; 9 (21%) had PTCA; 7 (17%) had CABG. Sixteen (38%) patients had untoward events related to cardiac evaluation. Eight patients (19%: one with cerebrovascular disease, and seven with aortic aneurysms) refused vascular surgery after extended cardiac workup. Complications attributable to CC, PTCA, and CABG included prosthetic graft infection, pseudoaneurysms (two), sternal wound infections (two), renal failure and brain anoxia. Two patients with severe limb ischemia who were candidates for revascularization ultimately required amputations because of delay due to cardiac evaluations. Extensive cardiac evaluation prior to vascular operations can result in morbidity, delays, and refusal to undergo vascular surgery. The underlying indication for vascular operations and the local iatrogenic cardiac complication rates must be considered before ordering special studies.
Collapse
Affiliation(s)
- W C Krupski
- Section of Vascular Surgery, University of Colorado Health Sciences Center, Denver 80262, USA
| | | | | | | | | | | |
Collapse
|
8
|
[Information of patients preceding electrophysiologic diagnostic procedures]. Arch Mal Coeur Vaiss 1999; 92:79-80. [PMID: 10065289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
9
|
Metz LC, Whitford K. Fluid delivery by pressure monitoring systems in the pediatric intensive care unit: a retrospective comparative analysis of two systems. Am J Crit Care 1996; 5:66-7. [PMID: 8680495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- L C Metz
- Rainbow Babies and Childrens Hospital, Cleveland, Ohio, USA.
| | | |
Collapse
|
10
|
Freitas J, Puig J, Campos J, Garcia JM, Cunha DL, Carvalho MJ, Costa O, Gomes MC, Freitas AF. [Malignant vasovagal syncope: a case of prolonged asystole induced by the "tilt" test and aggravated by therapy with a beta blocker (a clinical case and diagnostic, physiopathologic and therapeutic review)]. Rev Port Cardiol 1993; 12:745-51, 702. [PMID: 8217251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The authors describe a case of a middle-age male with recurrent syncope, in whom the tilt test was useful in the diagnosis and therapeutic evaluation. Malignant criteria of vasovagal syncope were established and the beta blocking worsening effect was documented, in spite of the general agreement of the first choice drug.
Collapse
Affiliation(s)
- J Freitas
- Serviço de Cardiologia, Hospital de São João
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Pfisterer M. [Risk of cardiological interventions]. Schweiz Med Wochenschr 1993; 123:261-7. [PMID: 8446859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The risk of cardiac interventions has to be assessed in relation to the possible benefit and in comparison to the natural history and to alternative interventions. The relationship between complications (mortality, morbidity) and age, severity of the disease, gender and technique on one hand, and between risk of the intervention versus risk of uninfluenced natural history on the other, are discussed. Diagnostic, therapeutic and prophylactic interventions are presented separately; the benefit needs to be defined differently for each: diagnostic accuracy or symptom relief, improved quality of life and survival, and prolonged life respectively. Finally, it is stressed that the choice of an intervention is not only dependent on the determinants of risk, but also on the availability of a certain method, operator experience, cost and, last but not least, patient preference.
Collapse
Affiliation(s)
- M Pfisterer
- Kardiologische Abteilung, Departement Innere Medizin, Kantonsspital Basel
| |
Collapse
|
12
|
Abstract
We report a case of acute myocardial infarction following a hyperventilation test performed at coronary angiography. The potential pathophysiological mechanisms and clinical implications are discussed.
Collapse
Affiliation(s)
- G Fragasso
- Divisione di Cardiologia, Istituto Scientifico San Raffaele, Milan, Italy
| | | | | | | |
Collapse
|
13
|
Meijler FL. [Testing for HIV infection in cardiology]. Ned Tijdschr Geneeskd 1988; 132:1445-6. [PMID: 3412524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
14
|
Elbaz-Rostykus C, Baylac-Domengetroy F, Coisne D, Gallimard JF, Allal J, Barraine R. [Prinzmetal's syncopal angina during an electroencephalogram. Triggering role of the hyperpnea test]. Ann Cardiol Angeiol (Paris) 1987; 36:473-6. [PMID: 3426120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We are reporting a cardiac arrest occurring during an electroencephalogram with hyperventilation. The diagnosis is made on the Holter recording which shows a Prinzmetal's angor tracing followed with ventricular arrhythmias, leading to asystoly. The physiopathology of the spasm is not clear and we are discussing the possible mechanisms. We stress again the harmful role of beta-blockers in this pathology. In addition, we insist on electrocardiographic manifestations surrounding sudden death. As for the hyperventilation test, its potential risks call for caution during its performance.
Collapse
|
15
|
Ianovskiĭ GV, Stepanenko AP, Belonozhko AG, Mkhitarian LS, Tretiak ED. [Various features of the preparation of patients with chronic ischemic heart disease for roentgenosurgical examinations]. Vrach Delo 1985:57-60. [PMID: 4082556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
16
|
Arata L, Penco M, Agati L, Fedele F, Dagianti A. [Effects of other provoking tests on cardiovascular function]. Cardiologia 1985; 30:655-69. [PMID: 3915223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
17
|
Galvani M, Bugiardini R, Ferrini D, Gridelli C, Mari L, Pozzati A, Puddu P. [Myocardial ischemia induced by the cold pressor test in patients with exertion angina. Case contribution]. G Ital Cardiol 1985; 15:567-70. [PMID: 4065472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The aim of the present study was to assess the incidence of myocardial ischemia during cold pressor test in patients with stable exertional angina pectoris. Thirty-seven patients with proven coronary artery disease were submitted to cold pressor and exercise stress testing; computer assisted electrocardiographic recordings were obtained throughout the examinations. Cold stimulation provoked electrocardiographic signs of subendocardial ischemia only in 3 patients. They had suffered of a previous myocardial infarction and showed low exercise tolerance and severe coronary lesions (one with triple vessel and 2 with left main disease). Interestingly, only one of these patients gave an history of angina during cold exposure. Thus these data indicate that chest pain and electrocardiographic signs of ischemia are an uncommon event during cold pressor stimulation which occurs more likely in patients with fairly severe coronary narrowings. More sensitive markers of ischemia and/or different modalities of cold application are required for studies concerning the relationship between cold exposure and angina pectoris.
Collapse
|
18
|
Grolleau R. [Invasive procedures in cardiology. Materials, catheterization, incidents and accidents, role of the nurse]. Soins Cardiol 1984:3-6. [PMID: 6570336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
19
|
Malkin VB, Plakhatniuk VI. [Rare cases of severe heart rhythm disturbances during the hypoxic function test]. Kardiologiia 1982; 22:92-5. [PMID: 7077938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Cases of severe rhythm disorders of cardiac activity--the syncope developing lasting up to 34 seconds, are described in practically healthy individuals undergoing the hypoxic functional test. It is concluded that the hypoxic functional tests require a specially trained physician who must not only stop the test, but also give the patient immediate aid.
Collapse
|
20
|
Atterhög JH, Jonsson B, Samuelsson R. [Complications in clinical effort tests in Sweden]. Lakartidningen 1980; 77:2689-91. [PMID: 7453287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
21
|
Abstract
Most of the statistics on complications of ergometric exercise tests come from the United States and are largely related to treadmill ergometry. A questionnaire was sent in the summer of 1978 to 198 investigative units in the German-speaking regions. The results of 1065 923 person-tests were made available. Exercise testing of 353 638 sports-persons revealed no serious complications. On the other hand, testing of 712 285 patients, predominantly with coronary heart disease, lead to 17 deaths and a total of 96 life-threatening complications. The result of this survey indicates that one must expect one such complication for every 7500 ergometry tests. The danger of pulmonary oedema on exercise in recumbency is about five times higher than that on sitting or standing. The most frequent complication was ventricular fibrillation. A defibrillator should therefore always be immediately available during exercise tests.
Collapse
|
22
|
Klempt HW, Euler R, Oschkinat F, Schmelzer M. [Complication during the dipyridamole-test (author's transl)]. Med Klin 1979; 74:631-4. [PMID: 460027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Performing the dipyridamole-test for evaluating coronary artery disease a man at the age of 57 years developed after application of 15 mg dipyridamole intravenously angina pectoris. For removal of angina pectoris 240 mg aminophylline were injected, after what bradycardia and finally cardiac arrest occurred. Resuscitation was successful. Possible reasons and some precautions were discussed.
Collapse
|
23
|
Kimbiris D, Linhart JW. Sequential atrioventricular pacing as a stress test. Evaluation of left ventricular function in second-degree AV heart block developing during atrial pacing. Chest 1975; 67:540-3. [PMID: 1126190 DOI: 10.1378/chest.67.5.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Advanced or second-degree atrioventricular (AV) heart block pre-existing or developing during atrial pacing (AP) at low heart rates of smaller than 130 per minute, limits the value of AP to stress the left ventricle. When Wenkebach type AV block is present, the heart rate can be increased by administration of atropine before atrial pacing or by right ventricular pacing. Atropine, however, occasionally may cause serious supraventricular or ventricular arrhythmias, and high rate right ventricular pacing is not tolerated by many patients with left ventricular dysfunction because of the absence of the atrial contribution. Twenty-eight out of 101 patients with angina pectoris (27.7 percent) developed second degree AV heart block during atrial pacing studies performed for evaluation of left ventricular function. In 8 of the 28 patients, sequential AV pacing (SP) was performed successfully, with the heart rate being increased to 150-167 per minute. In 4 of the 8 patients, left ventricular dysnfunction was demonstrated during and immediately after SP. Typical angina pectoris developed in two of the four patients during SP, one of whom proved to have normal coronary arteriogram. Sequential AV pacing is an alternative method to increase the heart rate for the purpose of stressing the left ventricle when advanced degree or second-degree AV heart block pre-exists or develops during right atrial pacing. In some patients the method of SP might be preferable to administration of atropine or to ventricular pacing.
Collapse
|
24
|
Kindermann G. [Carotid sinus pressure test for diagnosis of unexplained syncopal attacks and indication for pacemaker treatment]. Med Klin 1974; 69:477-80. [PMID: 4598561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
25
|
|
26
|
|