Auriculoventricular Block Research Articles

Advantages of Electrocardiographic Monitoring in Top Level Athletes

We used continuous electrocardiographic monitoring according to Holter's method for a tentative evaluation of the prognostic value of the main electrocardiographic peculiarities of the "athlete's heart". Five hundred and eighty-seven Holter recordings were performed in 164 top athletes divided into three groups: dynamic, static and mixed. Selection criteria were either clinical or electrical (resting-ECG). The prognostic value of arrhythmia is variable: unworrying junctional rhythm (JR) and auriculo-ventricular blocks (AVB) that disappeared under strain, which in our study interested mostly the dynamic group. No pejorative prognostic criteria were found related to supraventricular premature beats (SVPB). Ventricular premature beats (VPB) of recent occurrence were predominantly found, in our study, in the static athletes; their occurrence was not always accounted for and their prognosis, at least as regards sports, was uncertain. Holters repeated throughout the sports season made it possible to establish a relationship between some peculiarities and the training intensiveness: auriculo-ventricular block and junction rhythm culminated during intensive periods. Unusual sinus tachycardia would be indicative of over-training.

THE EFFECT OF INTRAVENOUS LIGNOCAINE ON CARDIAC ARRHYTHMIAS DURING ELECTROCONVULSIVE THERAPY

The effects of intravenous lignocaine and atropine in preventing cardiac arrhythmias were evaluated in forty-five psychiatric patients undergoing electroconvulsive therapy. During the electrical shock a more prolonged asystole was observed in the lignocaine than in the atropine group. During the tonic-clonic seizure ventricular extrasystoles appeared in six atropinized patients. During the postconvulsive period fourteen patients premedicated with atropine exhibited ventricular extrasystole and tachycardia, whereas in five pretreated with lignocaine auriculoventricular block was noted. Lignocaine pretreatment significantly reduced the duration of the somatic convulsion. It is concluded that lignocaine is a valuable premedicant for electroconvulsive therapy in patients with ventricular arrhythmias or when atropine administration is contraindicated.

“Paradoxic” re-establishment of normal conduction by digitalis in A-V block

Faintness and syncopal attacks for five months compelled this 57 year-old woman to enter our hospital for treatment. Some attacks were severe and were followed by complete unconsciousness and urinary incontinence. Bradycardia was evident in the first episode. At this time a 2: 1 auriculoventricular block was recorded. She had no history of hypertension, coronary insufficiency or myocardial infarction. She did not smoke. On admission, the blood pressure was 120/65 mm. Hg, the radial pulse rate, 42/min., and the jugular pulse rate, 84/min. The heart was not enlarged on physical or x-ray examination. She had no congestive heart failure. The laboratory tests showed stigma of thalassemia, hemoglobin 11.9 gm.%, red blood cells 5,350,OOO per cu. mm., hematocrit 39 per cent, marked increase of AZ hemoglobin and blood serum iron 179.3 pg. per cent. The electrolytes, liver function tests, serum oxalacetic transaminase, serologic tests, urinalysis, x-ray studies of cervical ribs and gallbladder were normal. Although the esophagram revealed a saccular expansion of the esophagus below the aortic arch, the patient never experienced any syncopal episode during swallowing. The electrocardiogram (Fig. 1) revealed a 2: 1 A-V block and ST-T changes suggesting ischemia. The low R waves in VI, Vp and Va and the inverted T waves in V? and VB suggested damage in the anterior myocardial wall. Therefore, scarring in the A-V node was considered the cause of the impaired conduction. The effects of sympathomimetic agents (isoproterenol and ephedrine) and atropinization were only temporary; they were slowly discontinued within three days, and digitalis was given to produce complete A-V block. The patient received oral digoxin 0.25 mg. twice a day. Six days later, normal A-V conduction proved by esophageal leads was reestablished and maintained thereafter by digoxin. The second electrocardiogram (Fig. 2) showed improvement of the anterior wall ischemia and ST-T changes suggesting digitalis effect. Although the electrocardiogram suggested left ventricular hypertrophy, there was no history of hypertension or any clinical or radiologic evidence to substantiate this diagnosis.

DIGITALIS CARDIOTONICS IN RECENT MYOCARDIAL INFARCT

SummaryCardiotonic glucosides are indicated in recent myocardial infarction complicated by paroxystic auricular tachycardia, by auricular flutter or fibrillation, by intense sinusal tachycardia and by heart failure, i.e. in 15 to 50 % of all cases. These drugs are of no use in the common forms of recent myocardial infarct, and definitely contra-indicated in infarcts complicated by auriculo-ventricular block. Although they should be managed cautiously, premature beats and ventricular tachycardia are not absolute contra-indications to digitalis.More than slight differences in action or absorption, it is the physician’s own experience which determines the type of glucoside to be used. The oral route should be preferred if a compound with regular intestinal absorption, such as digitoxin, is administered. Initial doses are adjusted to heart rate and severity of heart failure. Moderate doses (0.2 to 0,3 mg Digitaline daily) arc generally sufficient, but recent myocardial infarction should not preclude larger dosage if this is necessary.The effectiveness of cardiotonic glucosides in recent coronary thrombosis is demonstrated by decrease in ventricular rate (and frequent restoration of sinusal rhythm in cases with ectopic rhythm) in 90 % of the cases, and by improvement or disappearance of signs of heart failure in 75 % of the cases. Failures of digitalis therapy are related to the type and grade of heart failure, for as heart failure itself, they parallel the magnitude of the myocardial injuries.The frequent severity of myocardial lesions thus explains most of the accidents observed during therapy. For the same degree of heart failure, the accidents observed during digitalization after coronary thrombosis are not more frequent or more severe than in heart failure of other aetiologies. To decrease the occurrence and severity of these accidents, anticoagulants should be added to digitalis treatment, as well as diuretic drugs, with addition of K if necessary. Such patients should be submitted to careful clinical and electrical supervision. If nausea, vomiting, bigeminal or polymorphous ventricular premature beats, or any disturbance in auriculo-ventricular conduction supervene, digitalis administration should be immediately interrupted, and appropriate measures should be eventually instituted.

A cured case of Adams-Stokes syndrome occurring frequently within 5 days

Authors recorded a clinical details of Adams-Stokes syndrome in 76 aged man, occurring frequently and disappearing with recovery after some 5 days from the onset. Electrocardiogram showed complete auriculoventricular block. During this time, ventricular asystole was observed and the patient was recovered from faintness soon after the reaction of ventricular systole. Judging from his anamnesis, complete auriculoventricular block in this case may be associated with the hypertensive cardiovascular disturbances.

Apropos of 2 cases of myocardial infarct with various disorders of auriculo-ventricular conduction

SummaryTwo cases of myocardial infarct complicated with variable defect of auriculo-ventricular conduction are presented. In these two cases, the lesion involved the posterior aspect of the left ventricle and a portion of the interventricular septum. There was a recent thrombus in the right coronary artery and the anterior descending artery was also obstructed by atheroma.The appearance of a complete auriculo-ventricular block in cardiac infarct can be related with obstructive lesion in both coronary arteries. Severe and bilateral insufficiency in coronary arteries can partly explain the very high rate of mortality in cardiac infarct complicated by complete auriculo-ventricular block.In these two cases, spontaneous regression of conduction troubles did not prevent a fatal outcome.

実験的減圧症に関する研究 : とくに心音図を中心として

Phonocardiograms and electrocardiograms of rabbits in an experimental high barometric pressure tank were studied in normal, compressed and decompressed states. Provoking conditions of the decompression sickness, dissection findings of the lethal cases, and the recovery of the animal from ckokes were also observed. Furthermore, heartsounds of the animal were observed under normal pressure, inhaling air rich in oxygen. The results obtained are as follows. 1) Under high pressure, the amplitude of the first and the second heartsounds decreased. But after the decompression they both increased, and the increase of the amplitude of the first was especially remarkable. 2) The heart rates were reduced after the compression and showed an increasing tendency after the decompression. 3) Under high pressure, the electrocardiogram changed only a little. In lethal cases by serious decompression sickness auriculo ventricular block and auricular fibrillation were observed; while in recovered cases from chokes, negative T was observed. 4) It seems that the lowest limit of the onset conditions determined by K. Ueda is higher than that deduced by the author's results. 5) Dissection findings showed that there were bubbles in all blood vessels. 6) Recompressing to the previous high pressure, the choked rabbit lay in ventral position some 20 minutes after the commencement, and after one hour it stood up and began to walk. 7) Inhaling air added with aboundant oxygen under normal pressure, the amplitude of the animal's first and second heartsounds decreased. Restoring to the inhalation of the normal air, the amplitude showed a tendency of increase. It seems that the decrease of the amplitude of the heartsounds under high pressure is due to the increase of the partial pressure of oxygen in the air.

Second degree heart block with Wenckebach phenomenon: Its occurrence over a period of several years in a young healthy adult

1. 1. Intermittent second degree auriculoventricular block with the Wenckebach phenomenon has been demonstrated in a patient who does not have organic heart disease. The duration of this phenomenon has been at least 6 years. 2. 2. The effects of atropine and vagal stimulation have been discussed.

Two cases of aneurysms of the sinus of Valsalva with interesting roentgen changes.

Aneurysms of the sinuses of Valsalva are rare and when uncomplicated produce few clinical, roentgenographic, and electrocardiographic findings. Associated congenital lesions are frequently of interest, but the complications of these aneurysms, which produce a wide variety of changes, make them of medical interest. This paper reports 2 cases with roentgen changes which are seen much more frequently in other types of heart disease. Case I: A 54-year-old colored male was admitted to Duke University Hospital on May 1, 1955, because of severe, oppressive, nonradiating substernal pain. He had had a similar attack in March 1955, which was treated at another hospital as an acute coronary occlusion. He gave a two-year history of exertional dyspnea and angina, mild orthopnea, and occasional nocturnal dyspnea. More recently he had suffered mild pitting ankle edema and wheezing, and had coughed up foamy, pink sputum. The past medical history and systemic review were noncontributory. The patient specifically denied ever having syphilis. Physical examination was within normal limits except for clinical evidence of congestive heart failure and a Grade II systolic and Grade III diastolic murmur in the aortic area, with a blood pressure of 120/40. The electrocardiogram showed a first-degree auriculoventricular block with delayed intraventricular conduction, which was compatible with an anteroseptal infarct of unknown age. A serologic test for syphilis was negative. Urinalysis showed a 2 plus proteinuria and innumerable erythrocytes. Roentgenograms of the chest (Fig. 1) revealed the aorta to be tortuous, with the heart slightly enlarged in the transverse diameter. The pulmonary vasculature was somewhat increased in prominence, although the more peripheral vessels appeared to be decreased in caliber, suggesting some degree of pulmonary hypertension. The patient responded satisfactorily to therapy for congestive heart failure and was discharged on May 6, 1955, to be followed as an outpatient on digitoxin, diuretics, sedatives, and a low-salt diet. Under this regime, ambulation was slowly restored, but the patient was seen at frequent intervals because of increasing dyspnea on exertion and chest pain. It was for these symptoms that he was readmitted on Oct. 10, 1955. Two cardiac consultants thought the history and clinical findings were those of a reactivated rheumatic heart disease with involvement of the mitral and aortic valves and requested a cardiac fluoroscopy and barium swallow. This study (Fig. 1) revealed the esophagus displaced posteriorly and to the right and a double density along the right side of the heart, all compatible with left atrial enlargement. There was also evidence of left ventricular enlargement. Chest films, when compared with those of an earlier date, showed the heart to have increased in size and the pulmonary vasculature to be more prominent medially, whereas the peripheral vessels were definitely decreased in caliber.

Electrocardiographic Patterns Evoked by Venom of the Stingray.

SummaryIntravenous injection of stingray venom produced various changes in the ECG patterns of cats. The extent of the change depends, for the most part, on the amount of venom injected. Small amounts of the venom produce bradycardia with an increase in the PR interval giving a first, second or third degree auriculo-ventricular block. The second degree block is usually followed by sinus arrest. Reversal of the small dose effects occurs within 30 seconds following the end of the injection. Cats receiving larger amounts of the venom show, in addition to the PR interval change, almost immediate ST, T wave change indicative of ischemia and in some animals true muscle injury. These changes often persist for 10 minutes before reverting to normal. When fatal amounts of the venom are injected the pattern is abnormal and unpredictable. All degrees of auriculo-ventricular block, sinus arrest, inter-ventricular block, decreased amplitude of QRS complex, and various degrees of ischemia and injury are seen. The rapid ...

Electrocardiographic patterns of normal and thiamine-deficient baby pigs.

SummaryElectrocardiograms were made weekly from birth through 5 weeks of age on 35 baby pigs receiving various subminimal and adequate levels of thiamine in the diet. Typical ECG patterns of normal and thiamine-deficient baby pigs are presented and described. Statistically significant increases in PR time, QT time and cycle length occurred in deficient animals. Thiamine-deficient pigs consistently exhibited sinus arrhythmia. First and second degree auriculoventricular block were manifested. Evidence of cardiac hypertrophy occurred in deficient animals.

Effect of molar sodium lactate in increasing cardiac rhythmicity; clinical and experimental study of its use in the treatment of patients with slow heart rates, Stokes-Adams syndrome, and episodes of cardiac arrest.

• Sodium lactate, in concentrations of one mol per liter of water, can be given by intravenous infusion or by intracardiac injection without toxic effects. In sinus bradycardia a significant acceleration of heart rate follows, and in complete auriculoventricular block and ventricular standstill the effects have in some instances been lifesaving. The action of molar sodium lactate has been studied in 46 human subjects, including 5 healthy volunteers. In the latter, 100 to 200 cc. produced a slight alkalosis lasting one or two hours. During that time the lactate is metabolized, probably being used directly as fuel by the myocardium. It did not raise the blood pressure above normal in any case. It was effective in restoring the heartbeat when given within two minutes after terminal cardiac arrest. Intracardiac injection succeeded in one instance after intravenous injection had failed, and in another instance the lactate was effective after epinephrine and phenylephrine had been ineffective.

The Electrocardiogram in Myocardial Infarction : PART V. INFARCTION OF THE INTERVENTRICULAR SEPTUM

In this study, infarction of the interventricular septum was demonstrated pathologically in 24 of all 35 cases. The author had studied the correlation between electrocardiographic and post-mortem findings concerning the septal infarction in these 24 cases. Of 24 cases, 8 were men and 16 were women and their age ranged from 52 to 86, except in 2 cases. Among these 24 cases, 3 had recent and 21 had healed infarctions at autopsy, but it was considered that in at least 5 cases with healed infarctions, the electrocardiogram was obtained when the infarction was in the acute stage. These cases were classified into four groups, according to the distribution of the lesion at autopsy: (1) coexistent septal extension of anterior infarction in 5 cases; (2) septal extension of anteroposterior infarction in 13 cases; (3) extension of posterior infarction into the posterior portion of the interventricular septum in 5 cases; (4) infarction limited to the interventricular septum in 1 case. On the other hand, the cases were classified into three groups, according to the extent of the lesion in the interventricular septum at autopsy: (〓) large, massive infarction involving at least half or more of the inverventricular septum in 7 cases; (〓) minimal infarction confined to only small portion of the interventricular septum or distributed in patchy fashion in the septum in 10 cases; (〓) moderate infarction corresponded to the middle of both above-mentioned groups in 7 cases. The electrocardiographic patterns in these septal infarction were summarized as follows: 1. Interventricular conduction defects, in which QRS interval was 0.12 second or more, were obtained in 3 cases with right bundle branch block, in one case with the so-called arborization block in the form of left bundle branch block, and in one case with prolonged QRS interval, uncomplicated by a bundle branch block. a) In 2 of 3 cases with right bundle branch block, autopsy revealed the anteroposterior infarction accompanied by a three-plus or two-plus infarction in the interventricular septum, and the electrocardiogram showed an abnormal Q wave and a late (delayed) R wave from Lead V_1 to V_4. In a remaining case of right bundle branch block, in which posterior infarct extended into the posterior portion of the interventricular septum, the electrocardiogram showed an abnormal Q wave in Leads _aV_F III and II, but the right precordial leads showed the similar pattern of uncomplicated right bundle branch block. b) In a case with left bundle branch block, an acute infarction limited to the basal portion of the interventricular septum was found at autopsy, and the electrocardiogram showed the pattern of arborization block characterized by the high grade prolongation of QRS interval and low voltage in the standard and unipolar limb leads, without appearance of an abnormal Q wave in any lead. c) In another case of intraventricular conduction defect, which showed QRS interval of 0.12 second, the damage in the free wall of the left ventricle was extensive, but the septal involvement was very small at autopsy, and a diagnostic pattern of septal infarction could not be found in the electrocardiogram. 2. Auriculoventricular block was observed in only one case of incomplete auriculoventricular block which was probably caused by digitalis intoxication in the course of infarction. 3. The cases without intraventricular conduction defect. a) The cases with septal extension of anterior or anteroposterior infarction: When the extent of infarct in the interventricular septum was moderate (〓) or massive (〓), in 10 of 12 cases, an abnormal Q wave was observed in Leads V_1 and V_2 or Lead V_2, and most of them were accompanied by RS-T variations. In the remaining 2 cases, the amplitude of the initial R wave in the right precordial leads decreased abnormally as the electrode was moved from right to left, and finally an abnormal Q wave was recorded in Lead

A case of double auriculoventricular block with an idioventricular rate of 14 per minute and “chaotic” auricular activity

A case is described, of a man of 70 years with hypertensive-arteriosclerotic heart disease, showing complete heart block with 2 to 1 idioventricular block, a ventricular rate of 14 per minute, and complete auricular arrhythmia with wandering of the cardiac pacemaker.

Myocardial infarction with aneurysm of interventricular septum and perforation.

Myocardial infarction followed by perforation of the interventricular septum is a syndrome more commonly recognized now in view of the increasing number of reports of its occurrence appearing in the literature. However, it is uncommon to find portrayed in one case, the case reported below, the variations of pathology, anatomy, and physiology. It is for this purpose that the following report is made. It is noted below that diagnosis was made antemortem, immediately consequent to the acute onset of Bernheim's syndrome; that the patient subsequently survived for more than two months; that he developed a complete auriculoventricular block within a matter of hours after the perforation; that during the course of his illness he showed in succession the electrocardiogram pattern of an acute posterior myocardial infarction, five days later a two-to-one auriculoventricular block, two days later left ventricular hypertrophy pattern, and two months later a bigeminous rhythm; that the disease

Atrial flutter: 1 to 1 conduction during treatment with quinidine and digitalis

A TRIAL flutter is an uncommon cardiac arrhythmia found in less than 0.2 per cent of patients clinically suspected of having heart disease.lJ Its manifestations are, in large part, dep-ndent on the accompanying ventricular rate. Usually some degree of auriculoventricular block is present, resulting in a ventricular rate slower than the atria1 rate. Occasionally, however, the ventricular rate rises to the level of the atria1 rate. Persistence of such rapid ventricular rates, particularly in the presence of heart disease, is almost invariably associated with syncope, circulatory collapse, or pulmonary congestion.

Stokes-Adams attacks with simultaneous auricular and ventricular standstill.

This is a report of a case of Stokes-Adams seizures in a patient with partial auriculoventricular block. Simultaneous auricular and ventricular standstill in about half the seizures of which we have electrocardiographic record, and complete relief after atropine, leads us to think the seizures were due to vagal effect.

Adams-Stokes' syndrome caused by ventricular tachycardia in two cases of complete auriculoventricular block.

Acta Medica ScandinavicaVolume 147, Issue 5-6 p. 379-385 Adams-Stokes' Syndrome Caused by Ventricular Tachycardia in two Cases of Complete Auriculoventricular Block JON R. MYHRE, JON R. MYHRE Department of Medicine, University Clinic, Bergen, NorwaySearch for more papers by this author JON R. MYHRE, JON R. MYHRE Department of Medicine, University Clinic, Bergen, NorwaySearch for more papers by this author First published: January/December 1954 https://doi.org/10.1111/j.0954-6820.1954.tb11395.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume147, Issue5-6January/December 1954Pages 379-385 RelatedInformation

The diagnosis of posterior myocardial infarction

An anatomico-pathologic basis for the vectorcardiographic diagnosis of high posterior infarct has been demonstrated. Autopsy findings and vectorcardiographic diagnosis indicate that almost one tenth of all infarcts involving the posterior wall of the left ventricle are small and are limited to its upper portion. Even more common are infarcts so situated but extending to other portions of the left ventricle. The importance of these observations lies in the fact that the high posterior infarcts do not, as a rule, produce diagnostic signs in the electrocardiogram. Consequently, many posterior wall infarcts are overlooked, and in an even larger number of cases the extent of the lesion is minimized. Our preliminary studies in vectorcardiography have directly or indirectly confirmed some generally accepted explanations for the diagnostic failure of the electrocardiogram in cases of infarct and have revealed some new ones. The observations herein reported demonstrate some of the limitations of the electrocardiogram in relation to the diagnosis of posterior infarction. Diagnostic failure is witnessed when the electrocardiogram discloses left bundle branch block, when the posterior infarct is small, located high on the posterior wall, is old, or is associated with acute anterior wall infarction. Old anterior wall infarction and left ventricular hypertrophy do not interfere with the development of the electrocardiographic signs of posterior infarction. It is noteworthy that not a single electrocardiogram in this series of cases was interpreted as normal. An abnormal electrocardiogram, then, obtained in a patient with a clinical picture of acute coronary heart disease, should be considered consistent with, but not diagnostic of, acute infarction. The electrocardiogram was interpreted as abnormal in nineteen of the eighty cases, and in twelve of them anterior infarction was also present. Since acute anterior infarction commonly conceals the electrocardiographic signs of posterior infarct, the latter should be suspected in some cases in which the electrocardiogram shows only acute anterior infarction, especially when changes reciprocal to the anterior infarct are poorly developed or absent and when bundle branch block or high-grade auriculoventricular block appears during the course of the illness. The electrocardiographic changes in high posterior infarct may consist solely of S-T segment depression or tall R and T waves in the precordial leads.

Ventricular standstill during the intravenous procaine amide treatment of ventricular tachycardia

1. 1. The literature on the treatment of ventricular tachycardia with quinidine and with procaine amide is briefly reviewed. 2. 2. Three cases of serious cardiac depression occurring with procaine amide properly administered intravenously are reported. One of these patients died immediately after the injection. 3. 3. The possible mechanism of this reaction is discussed. 4. 4. Recommendations are made regarding the use of intravenous procaine amide. The drug should probably not be given by this route in septal infarction, bundle branch block, and auriculoventricular block.