Complaints Of Palpitations Research Articles

Extra Anatomic Repair of Interrupted Aortic Arch

Interrupted Aortic Arch is a rare congenital anomaly with an incidence of 2 per 100,000 live births. It is almost always (95-97%) associated with structural abnormality like VSD. Interrupted Aortic Arch is usually diagnosed soon after birth, and when left untreated results in 90% mortality at a median age of 4 days. Isolated IAA is a very rare entity. Substantial collateral circulation must be present to maintain flow and enable survival. Conventional surgical repair is a challenge due to extensive collateral circulation in patients who have survived to adulthood. Here, we report a patient with an isolated IAA without any associated defect who survived into third decade. The patient presented with complaints of palpitations, uncontrolled hypertension, and weakness in lower limbs and on evaluation, he had isolated Interrupted Aortic Arch. We managed to do an Extra anatomical Bypass graft from ascending aorta to descending aorta on a beating heart with minimal risk. The procedure was done through median sternotomy to avoid the damage to collaterals when approached through thoracotomy.

Диагностические возможности фрагментарного мониторирования электрокардиограммы у пациентов с сердечными аритмиями

The data about the use of external ECG event recorders are few and contradictory, which makes it relevant to the present study. We evaluated the clinical efficacy of fragmentary ECG monitoring in patients with palpitation and/or dizziness. The study involved 83 patients, mean age 46,5±13,6 years, with complaints of palpitation (group 1, n=65) and dizziness/syncope (group 2, n=18). All patients underwent 24-h holter monitoring and event recording. Comparative analysis showed that the diagnostic value of event recording was higher: 50,6% versus 24.1%. Therefore, the fragmentary ECG monitoring is an effective method to detect arrhythmic events and its diagnostic value 2 times higher than the traditional Holter monitoring.

Modern Possibilities of Metabolic Therapy in Improving the Quality of Life in Patients with Postinfarction Cardiosclerosis

95 patients with postinfarction cardiosclerosis and angina pectoris II and III functional classes were examined. The study included patients who refused intervention revascularization. The main group included 48 patients who were added taurine (Dibikor 750 mg / day) to enhance the effect of basic therapy, and the comparison group included 47 patients who received standard therapy and placebo. The duration of treatment was 3 months. The study demonstrated positive effects of taurine that was confirmed by significant improvements in the following indicators: subjective status, indicators of the Seattle questionnaire, echocardiographic parameters, cardiac arrhythmias. There was a decrease in the severity of fatigue by 2 times, a decrease in the intensity of complaints of palpitations by 72.3%, a decrease in the severity of dyspnea by 30.0% and a severity of pain in the heart area by 50%. Indicators of most scales of the Seattle questionnaire in patients of the main group at the end of the study significantly exceeded (p <0.05) the corresponding values in patients of the comparison group. In patients whose treatment was used taurine, a significant improvement in inotropic function was noted (the ejection fraction is significantly higher than in the comparison group, respectively 56.0 ± 1.8 and 53.5 ± 1.1%, p <0,05), the bathmotropic and chronotropic myocardial functions improved, which was shown by a 45% decrease in the number of ventricular extrasystoles, a 57% decrease in the frequency of supraventricular heart rhythm disturbances, a decrease in the incidence rate of ST segment depression (in the main group the number of episodes was significantly lower than p <0,05 than in the comparison group). The use of taurine in the complex treatment of patients with exertional angina, after suffering a myocardial infarction, is safe and not accompanied by side effects. Taurine is advisable to include in the complex treatment of patients with exertional angina pectoris, who have had a myocardial infarction in order to improve the myocardial inotropic function, enhance the antiarrhythmic and lipid-lowering effects of the basic therapy. The recommended dose of Taurine is 750 mg per day as a supplement to standard therapy with a duration of therapy of at least 3 months.

Fibromuscular Dysplasia of Coronary and Brachial Artery

Summary A 72-year-old woman with a chief complaint of palpitation and shortness of breath showed “string of beads” appearance in the right coronary artery and right brachial artery. The 3-D optical frequency domain imaging showed “haustra coli” like appearance in the right coronary artery, and she was diagnosed as fibromuscular dysplasia.

IVABRADINE AND INAPPROPRIATE SINUS TACHYCARDIA: A FUNNY TARGET FOR AN INAPPROPRIATE DISEASE

Inappropriate sinus tachycardia (IST) refractory to standard medical therapy and sinus nodal modification can be treated successfully with ivabradine. A 43-year-old female presented with complaint of palpitations and fatigue for 4 months. Her symptoms occurred with household chores. Her medical

Hidden details in cases with palpitation complaints: Type D personality depression and anxiety

Amac: Carpinti sikâyeti olan ve organik bir neden tespit edilemeyen hastalarda, D tipi kisiligin orani ve depresyon, anksiyete puanlari bilinmemektedir. Bunlarin bilinmesi carpintinin etiyolojisini anlamada ve tedavisinde katki saglayabilir. Yontemler: Kardiyoloji Poliklinigine carpinti sikayeti ile basvuran, carpintinin olasi organik etiyolojileri ekarte edilmis olan ve 18 yasindan buyuk hastalar arastirmaya dâhil edilmistir. Calismada sosyodemografik veri formu, D Tipi Kisilik Olcegi, Hastane Ansiyete ve Depresyon Olcegi kullanildi. Bulgular: Depresyon puanlari hasta grubunda yuksek bulundu (p<0.05). Hasta grubundakilerin %60’inda, kontrol grubunun %22’sinde D tipi kisilik tespit edildi. Hasta ve kontrol grubu olgularin D tipi varligi ile yas, cinsiyet, medeni durum, depresyon ve anksiyete puanlari iliskisi icin yapilan Spearman korelasyon analizi sonuclari incelendiginde D tipi varligi ile; Hasta grubunda egitim durumu arasinda negatif yonde, zayif ve anlamli iliski bulundu (p<0,05). Hasta ve kontrol grubu olgularda D tipi varligi ile depresyon ve anksiyete puanlari arasinda guclu, pozitif yonde ve anlamli iliski bulundu (p<0,05). Sonuc: Bircok kardiyolojik hastalikta etkili oldugu bilinen D tipi kisiligin ve depresyonun, carpintida da fazla oldugunun bilinmesi palpitasyonun etiyolojisini anlamada ve tedavisini yapmada katki saglayabilir.

Coexistence of Brugada and Wolff Parkinson White Syndrome: A Case Report and Review of the Literature

A 31-year-old male patient presented with complaints of palpitations, dizziness, and recurrent episodes of syncope. A 12-lead electrocardiogram (ECG) revealed manifest ventricular preexcitation, which suggested Wolff Parkinson White syndrome. In addition, an incomplete right bundle branch block and a 3-mm ST segment elevation ending with inverted T-waves in V2 were consistent with coved-type (type 1) Brugada pattern. An electrophysiological study was performed, and during the mapping, the earliest ventricular activation with the shortest A-V interval was found on the mitral annulus posterolateral site. After successful radiofrequency catheter ablation of the accessory pathway, the Brugada pattern on the ECG changed, which prompted an ajmaline provocation test. A type 1 Brugada ECG pattern occurred following the administration of ajmaline. Considering the probable symptom combinations of these 2 coexisting syndromes and the presence of recurrent episodes of syncope, programmed ventricular stimulation was performed and subsequently, ventricular fibrillation was induced. An implantable cardioverter-defibrillator was implanted soon after.

A floating heart: A case of congenital pericardial agenesis associated with atrial septal defect

Congenital absence of the pericardium is a rare condition. Diagnosis and management of this condition remain a dilemma for clinicians. Here, we report a case of 15-year-old boy who had complaint of palpitation. Considering the echocardiographic features, pericardial agenesis associated with atrial septal defect (ASD) was suspected and multimodality imaging was performed for subsequent confirmation. Mal-aligned septum leads to failure in ASD device closure; therefore, the defect was repaired surgically by using a Dacron patch. Physicians need to be aware of this disorder and its associated congenital abnormalities, to enable them to make a correct diagnosis and treatment plan.

A Brief Interview to Detect Panic Attacks and Panic Disorder in Emergency Department Patients with Cardiopulmonary Complaints.

Patients with panic-related anxiety often initially present to the emergency department (ED) complaining of respiratory or cardiac symptoms, but rates of detection of panic symptoms by ED physicians remain low. This study was undertaken to evaluate the relevance of panic attacks and panic disorder in ED patients who present with cardiopulmonary symptoms and to determine whether a brief symptom-based tool could be constructed to assist in rapid recognition of panic-related anxiety in the ED setting. English-speaking adult ED patients with a chief complaint of palpitations, chest pain, dizziness, or difficulty breathing were evaluated for the presence of panic attacks and panic disorder with the Structured Clinical Interview for DSM-IV Axis I Disorders. Participants completed self-report measures to assess panic-related symptoms, comorbid psychiatric conditions, health-related disability, and health service use. In this sample (N=200), 23.5% had panic attacks and 23.0% had panic disorder. Both groups reported higher rates of panic attack symptoms, greater psychiatric comorbidity, greater health-related disability, and higher rates of ED and mental health service use compared with those without either condition. A brief 7-item tool consisting of panic symptoms identified patients with panic attacks or panic disorder with 85% accuracy (area under the curve=0.90, sensitivity=82%, specificity=88%). Patients with panic attacks or panic disorder commonly present to the ED, but often go unrecognized. A brief 7-item clinician rating scale accurately identifies these patients among those ED patients presenting with cardiopulmonary complaints.

Intermittent Wolff-Parkinson-White.

A 16-year-old female presented to the emergency department with complaints of palpitations of two hours duration. She had similar episodes in the past brought on by stress, anger, chocolate, or coffee. The ECG obtained in the course of her medical work-up led to the diagnosis of Wolff-Parkinson-White (WPW) syndrome. The characteristic short PR segment and delta wave are best seen in the lead I rhythm strip. In this rare example, the electrocardiographic morphology alternates between multiple beats of WPW and beats of normal sinus rhythm (A). It is important to recognize the characteristic features of pre-excitation syndromes such as WPW as patients may require treatment with antiarrhythmic drugs and/or radiofrequency ablation. Furthermore, emergency management of tachyarrhythmias in patients with a known history of WPW may differ from those without. However, as demonstrated in this example, such findings may be intermittent thus making an accurate and timely diagnosis challenging. Once it is apparent, proper documentation with copies of the ECG or rhythm strip in the patient record is imperative. In this case, the patient was also provided with a copy of her ECG to show the cardiologist which proved to be important since a repeat ECG at the cardiology clinic later the same day was unremarkable (B).

Radiofrequency Ablation of Focal Atrial Tachycardia from Coronary Sinus

Focal atrial tachycardia (AT) is defined as atrial activation originating from a discrete focus with centrifugal spread. Available information suggests that focal activity can be caused by automaticity, triggered activity, or microreentry. Generally, AT response poorly to medication but can be treated by radiofrequency ablation with high long-term success. Focal AT represents approximately 3% to 17% of the patients referred for supraventricular tachycardia (SVT) radiofrequency ablation (RFA). Electrophysiology study is important to correctly diagnose the mechanism of the SVT before RFA is performed. Observation and several pacing maneuver could be done to identify the mechanism of SVT.A 54 year old female came with chief complaint of palpitation. During palpitation her ECG showed narrow complex regular tachycardia with the P-wave that was difficult to ascertain clearly. Electrophysiology study showed VA interval 130 ms, differences between VA interval during tachycardia and VA interval during RV pacing was 55 ms, no advanced in atrial activation, difference between ventricular post pacing interval (PPI) and tachycardia cycle length (TCL) was 130 ms, ventricular pacing during tachycardia results in V-A-A-V response before tachycardia resumes, and showed concentric atrial activation with earliest point at CS 9-10, indicating an AT from coronary sinus origin. AT was terminated during the RFA.Electrophysiology study is important to correctly diagnose AT, especially when P-wave during tachycardia in the surface ECG is uncertain. Several pacing maneuver during electrophysiology study can be very helpful to verify the diagnosis of AT.

POSSIBILITIES OF IVABRADINE, A SELECTIVE INHIBITOR OF ION F-CHANNELS OF SINUS NODE, IN PREVENTION OF ANTHRACYCLINE CARDIOTOXICITY IN PATIENTS WITH BREAST CANCER

Aim. To study the efficacy of ivabradine in the prevention of cardiotoxic effects due to chemotherapeutic drugs in patients with breast cancer. Material and methods. The open randomized uncontrolled study included 55 patients with breast cancer who had to undergo chemotherapy by anthracyclines. The inclusion criterion was a heart rate >70 beats/min. Collection of complaints and anamnesis, ECG, echocardiography, routine laboratory tests were performed in all patients initially and after 1, 3, 6 and 12 months. All patients were treated with polychemotherapy with anthracyclines in combination with cyclophosphamide and fluorouracil. The patients included into the study were randomized into two groups. Patients of the main group (n=23) were additionally prescribed ivabradine in a daily dose of 10 mg followed by a dose titration. Patients of the control group (n=32) received only polychemotherapy. Results. In the main group a decrease in heart rate was observed already by the first month (from 83.6±9.5 to 67.1±7.5 beats/min, p 0.05). A significant change in the LV ejection fraction was not found in both groups. Significant differences in LV global longitudinal strain were found between groups in 1, 3 and 6 months of observation (p 70 beats/min was safe and did not cause bradycardia. Ivabradine use was accompanied by a significant reduction in a number of patients with complaints of palpitation, contributed to the preservation of normalLV global longitudinal deformation in chemotherapy, while the control group had negative changes with a maximum by the 6th month of follow-up.

Gestational Outcomes of Beta Blocker Therapy as a Treatment of Palpitations

Introduction: Beta blocker therapy is considered the primary treatment for palpitations caused by supraventricular or ventricular ectopy. The safety of beta blocker therapy during pregnancy is somewhat controversial and not well studied. Objective: Examine the outcomes of beta blocker therapy for heart palpitations in pregnant women. Methods: We conducted a retrospective review of 3778 pregnant patients between January 2014 and January 2016. The patients’ ages ranged between 18 to 40 years old. 227 patients had complaints of palpitation. 52 patients were eligible for inclusion and were dichotomized into two groups based on their treatment status, Eight patients received treatment with a non-selective beta blocker. The second group did not receive beta blocker therapy. Primary and secondary outcomes based on data collected from the patients’ electronic medical records were compared between the two groups. Results: Beta-blocker exposure during pregnancy was found to be associated with increased risk of small for gestational age (SGA) (OR 7.663, p-value 0.033) as well as a tendency towards increased risk of pregnancy induced hypertension (PIH) (OR 10.87, p-value 0.052). There was no statistical difference in the rates of preterm birth, stillbirth, postpartum haemorrhage, gestational diabetes, need for blood transfusion or the method of delivery between the two groups. Conclusion: The data indicates that exposure to beta-blockers during pregnancy was associated with a significant increase in the risk of both SGA and PIH. This Finding should be explored further with a large randomized controlled trial.

Prevalence of Fibromyalgia Syndrome and Its Correlations with Arrhythmia in Patients with Palpitations.

It is aimed to determine the prevalence of fibromyalgia syndrome (FMS) and its correlations with arrhythmia in patients with palpitations. Sixty-two patients who underwent electrophysiological study (EPS) due to palpitation complaints in Cardiology department and 40 healthy controls were included in the study. The precise diagnosis of arrhythmia was established using EPS. All participants were screened for FMS using American College of Rheumatology 2010 Fibromyalgia diagnostic criteria. Clinical assessments included measurement of severity of pain, fatigue and morning fatigue with visual analog scale (VAS), functional status with Fibromyalgia Impact Questionnaire (FIQ), and anxiety/depression with Hospital Anxiety and Depression Scale (HAD). FMS was diagnosed in 22 of the 62 patients (36%), and 4 of the 40 healthy controls (10%) (p 0.05). EPS+ patients with FMS had higher fatigue levels, HAD and FIQ scores than EPS- patients, although statistically insignificant. HV durations were statistically longer in the EPS- subgroup (p < 0.05) but other EPS data were similar. FMS frequency and HAD anxiety scores were found to be higher in patients with palpitation complaints. However, we found no association between arrhythmia, EPS parameters and FMS. In our clinical practice we should keep in mind to carry out assessments in terms of FMS in patients with palpitation.

Efficacy And Safety Of Implantable Loop Recorder: Experience Of A Center.

Introduction: Symptoms like syncope or palpitations frequently present a diagnostic challenge. An implantable loop recorder (ILR) is an important aid in the management of these patients. Methods: A retrospective study of patients that underwent ILR implantation from November 2007 to 2014. For each patient the indication for implantation, baseline characteristics, previous study, complications, recorded tracing and interventions were evaluated. Results: A total of 62 patients were included, 50% men, with a mean age of 62.5±18.8 years old. Previously to ILR implantation 88.7% of patients had performed Holter, 17.7% external events recorder, 33.9% Tilt test and 29% an electrophysiological study. The implantation indications were recurrent syncope in 90.3%, palpitations 8.1% and ischemic stroke in one patient. Mean follow-up time was 17.1±16.3 months. Symptoms were reported in 66.1% of the patients, 46.8% of those yielding a diagnostic finding. In all cases of palpitation complaints with diagnosis we found atrial fibrillation (AF). In patients with syncope atrioventricular conduction disturbance was demonstrated in 19.6%, sinus node dysfunction in 16.1%, paroxysmal supra-ventricular tachycardia 7.1% and AF in 1.8%. These finding resulted in 19 pacemaker and one CRT-D implantation, introduction of anticoagulation in five patients and one ablation of accessory pathway. There were no major complications. Conclusion: ILR proved to be safe and efficient. It has enabled the identification or exclusion of serious rhythm disturbances in more than half of patients and provided a targeted therapeutic intervention.

Large Coronary-Cameral Fistulas in an Adult Patient: A Rare Coronary Anomaly with Concealed Clinical Findings (Case Report and Literature Review)

Coronary-cameral fistulas (CCFs) constitute a rare anomaly that can be incidentally detected during angiography. CCFs are solitary, large or small assemblies that originate from coronary arteries and enter one of the cardiac chambers. We describe a 29-year-old woman, who referred to our clinic with the chief complaints of palpitation, atypical chest pain, and dyspnea on exertion (functional class II). Multimodality imaging confirmed the diagnosis of a CCF from the left main with extension to the right atrium and drainage therein. The CCF was closed percutaneously with a patent ductus arteriosus occluder successfully.

Ruptured aneurysm of sinus of Valsalva – an unexpected cause of tachycardia and severe dyspnea in a young patient (RCD code: I-1B.0)

The presented case report illustrates a rare and unexpected cause of tachycardia and exercise tolerance reduction in a young patient with noncoronary sinus of Valsalva aneurysm rupture. The patient was referred to our hospital due to complaints of palpitation, dyspnoea and severe reduction of exercise tolerance of acute onset. Transthoracic echocardiography revealed a shunt between aorta and right atrium, moderate aortic and tricuspid regurgitation and signs of hyperkinetic circulation. Transesophageal echocardiogram confirmed the presence of ruptured aneurysm. The patient was consulted by a local multidisciplinary Heart Team and referred for cardiac surgery, after which he recovered without any complications. JRCD 2016; 3 (1): 17–19

Surgical Resection of Giant Lipoma of Interventricular Septum Presenting as RVOTO: A Case Report

Primary cardiac tumors are rare and lipoma at interventricular septum is rarer. Most of the cardiac tumors are diagnosed incidentally on noninvasive imaging. The clinical manifestations of them depend on its anatomic location. Here we are discussing about a 35-year-old female, who presented with complaints of palpitation, dyspnoea and occasional dizziness for 6 months. On transthoracic echocardiography and Magnetic Resonance imaging (MRI) evaluation, a large mass of 5.4x5.9x 6.5 cm in size at interventricular septum was detected. The mass was partially obstructing right ventricular outflow tract (RVOT). As the mass was large, the surgical resection had to be performed via both transtricuspid valve and transpulmonary artery (PA) approach to avoid residual outflow tract obstruction. Aorta was opened to rule out extension of the mass to left of septum. Histology confirmed the diagnosis of lipoma. Key words: Cardiac neoplasms, Echocardiography, Interventricular septum, Lipoma, Myocardial.

Abstract 17956: Stratification of Cardiac Electrophysiologic Phenotypes via Systematic Auditory Electrophysiology Evaluation

It is well appreciated that overlap exists between cardiac and auditory electrophysiology, notably the classic example of Jervell Lange Neilson syndrome. We aimed to investigate if further insights into cardiac electrophysiology could be derived via auditory electrophysiology evaluation. We performed a retrospective chart review in the Partners Healthcare system from January 2001- May 2015 for patients who underwent at least 23 hours of a Holter recording as well as an auditory hearing evaluation. 55 patients were identified. Indications for auditory evaluation included patient complaint of hearing loss, symptomatic tinnitus and pre-neurosurgical evaluation. Indications for Holter recordings included complaint of palpitations and heart rate monitoring. Of the 55 patients, 26 (47%) had at least mild sensorineural defect in at least one ear while 28 (51%) had at least mild conductive defect in at least one ear. All auditory evaluations were interpreted by a clinical audiologist. Patients with sensorineural hearing defects had an increased percentage of total (summed atrial and ventricular) ectopic beats when compared to those without any hearing defects as well as those with conductive hearing defects (3.7% versus 0.3% versus 0.5% respectively, p&lt;0.05). The 9 patients (16%) with bilateral sensorineural loss had significant increase in atrial ectopy as a percent of total beats when compared to the 46 patients without bilateral sensorineural hearing loss (6.1% versus 1.1%, p&lt;0.05). Patients with bilateral sensorineural hearing defects had an increased prevalence of atrial fibrillation when compared to those without sensorineural hearing loss (44% vs 14%). In conclusion, a retrospective analysis of a small population of patients having undergone clinical auditory evaluation and Holter monitoring suggests that patients with bilateral sensorineural defects have increased atrial arrhythmias over controls. This finding serves as a hypothesis generating observation regarding the ability of non-cardiac electrophysiologic findings to characterize arrhythmic propensity. These observations further suggest that extracardiac electrophysiologic determinants exist that may be leveraged to better stratify arrhythmic risk.

Giant cardiac hydatid cyst: case presentation with radiologic survey and review of literature

Hydatid disease is mostly localised to liver and lungs. Cardiac involvement is a rare but potentially very serious complication of echinococcosis, constituting only 0.5–2% of all cases of hydatidosis. Cardiac hydatid cyst is a diagnostic and therapeutic challenge on account of highly variable clinical presentations and non-specifi c symptoms and often numerous unpredictable complications. We present a case report of 20-year-old man who was admitted to our hospital with chief complaint of palpitations and shortness of breath. Using baseline investigations like ECG, transthoracic echocardiography, ultrasonography, non-contrast computed tomography and magnetic resonance imaging, a giant multiloculated cystic lesion (58.4 mm × 43.3 mm) was diagnosed in the apex of left ventricle. Serologic tests (hydatid cyst antibody) confi rmed Echinococcus infection. Thoracic computed tomography with intravenous contrast was not performed because patient reported history of allergy to contrast. This case report is unusual as it is concerned with the description of a rare disease entity (large cardiac hydatid cyst). Its radiological appearances are discussed for early diagnosis and better understanding of the disease, together with a review of the literature.Journal of Kathmandu Medical CollegeVol. 3, No. 4, Oct.-Dec., 2014Page: