News (Page 5)

Treatment of Chronic Symptomatic Supraventricular Bradyarrhythmias with Transdermal Scopolamine

Treatment of Chronic Symptomatic Supraventricular Bradyarrhythmias with Transdermal Scopolamine

Chronic persistent or intermittent symptomatic bradyar-rhythmias of sinus, atrial or atrioventricular (AV) junctional origin are customarily treated by implantation of a permanent cardiac pacemaker. The management of such arrhythmias can present a challenge in patients in whom permanent pacemaker implantation may not be indicated, such as in the demented or terminally ill. Repeated oral administration of atropine or sublingual administration of isoproterenol may reduce frequency or magnitude of supraventricular bradyarrhythmias, but these therapeutic modalities commonly produce unacceptable side effects and are not without risk. This report describes a demented patient whose supraventricular bradyarrhythmias substantially improved […]

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Myocardial Sarcoidosis Unresponsive to Steroids: Discussion

This patient displayed several unusual features of sarcoidosis, namely: the large, bilateral pleural effusions, myocardial and pericardial involvement, lack of systemic “markers” for the disease process, and lack of response to steroids. It is estimated that approximately 1 percent of patients with sarcoidosis have pleural involvement. The presence of either bilateral or massive pleural effusions are usually the subjects of case reports. Sarcoidosis may affect any area of the heart—pericardium, myocardium, or endocardium. Of these, the myocardium is most frequently involved. The exact incidence of cardiac involvement, however, is difficult to ascertain. Autopsy series suggest […]

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Myocardial Sarcoidosis Unresponsive to Steroids

Figure 1. Myocardial surface at surgery. Note the whitish areas (as opposed to the flash reflection) indicating gross involvement with sarcoidosis.

Treatment with Cyclophosphamide Corticosteroids are the mainstay in the treatment of chronic sarcoidosis. Only recently have immune-alter-ing medications been used, usually in patients who have been shown to have disease unresponsive to steroid therapy. The following case exemplifies this unusual aspect of sarcoidosis. alphagan-eye-drops.com Case Report A 37-year-old black woman presented in January, 1979 with shortness of breath and bilateral hilar lymphodenopathy. Sarcoidosis was diagnosed by mediastinoscopy and biopsy. Prednisone was prescribed, but she discontinued its use after two months due to Cushingoid side effects. In August, 1979, she presented with a massive left pleural […]

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Asymptomatic Ventricular Arrhythmias in Patients with Obstructive Lung Disease: Outcome

The two patient populations best characterized for the purpose of comparing 24-hour arrhythmia prevalence are those patients postmyocardial infarction and patients with idiopathic dilated cardiomyopathy. In the postinfarction group, 15 to 25 percent have VPBs (^3/hour) and 10 to 15 percent have one or more runs of nonsustained ventricular tachycardia; whereas comparative prevalence rates in patients with symptomatic heart failure due to idiopathic dilated cardiomyopathy are higher (60 to 80 percent and 35 to 50 percent respectively). The prevalence of repetitive ventricular arrhythmias increases with more severe left ventricular dysfunction. In the present study, there […]

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Asymptomatic Ventricular Arrhythmias in Patients with Obstructive Lung Disease

Asymptomatic Ventricular Arrhythmias in Patients with Obstructive Lung Disease

Should They Be IVeated? In this issue of Chest (see page 44) Shih and colleagues make important observations on the frequency and significance of cardiac arrhythmias during a 24-hour electrocardiographic (ECG) recording in a well-defined patient population with chronic obstructive lung disease. Previous studies have reported variable types, as well as a wide disparity of arrhythmia prevalence figures, in patients with obstructive lung disease. These discrepancies are partially explained by the differences in recording ECG duration, (12-lead ECG vs continuous ECG recording) severity of respiratory failure, (inpatient vs outpatient) and the frequency of concomitant organic […]

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Broncho-aortic Fistula Secondary to Pulmonary Tuberculosis: Discussion

Postmortem examination showed marked pleural thickening and adhesion, especially on the left side. On the left side, there were dense adhesions between the aorta, pericardium, and mediastinal structures. A portion of the aorta and pericardium were excised with both lungs. Dissection showed a hole just beneath the brown vegetation on the lateral wall of the left main bronchus that opened into the aorta (Fig 1 and 2). A probe demonstrated a fistula between the left main bronchus and the aorta (Fig 3). Serial cuts through the fistula showed granulomas with caseous necrosis. Auramine-rhodamine stain of […]

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Broncho-aortic Fistula Secondary to Pulmonary Tuberculosis

Figure 1. Bronchial side of fistula, showing brown appearance of mucosa with visible orifice.

Massive hemoptysis, defined as expectoration of more than 500 ml of blood within 24 hours, is usually due to tuberculosis, bronchiectasis, or pulmonary abscess. Investigation of these cases include a routine chest x-ray film, bronchoscopy, bronchography, sputum cytology, angiographic techniques, and, recently, computerized axial tomographic scanning. Fistulous connection between the tracheobronchial tree and the aorta occurs very rarely and has been reported secondary to aortic aneurysmal or graft erosion of the tracheobronchial wall. We report a case of broncho-aortic fistula secondary to pulmonary tuberculosis without primary involvement of the aorta. www.patanol-eyedrops.com

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Rapid Hemodynamic Improvement in Right Ventricular Infarction After Coronary Angioplasty: Discussion

Although right ventricular infarction has been described for many years at autopsy, the hemodynamic impact was not well recognized until the report of Cohn et al in 1974. Since it is essential to recognize early signs of predominant right ventricular infarction because it may require a unique form of therapy, several clinical and electrocardiographic studies have attempted to detect right ventricular involvement in acute myocardial infarction. Necrosis of a large proportion of the right ventricle causes a hemodynamic derangement characterized by systemic hypotension and disproportionate elevation of right ventricular filling pressure compared to left ventricular […]

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