EKG Abnormalities Research Articles

Postmortem findings in morbidly obese individuals dying after gastric bypass procedures

Mortality has been reported to complicate gastric bypass, with common causes of death attributable to anastomotic leaks, sepsis, hemorrhage, and bowel obstruction. We evaluated autopsy reports from 10 patients having undergone gastric bypass. Medical records were reviewed to identify comorbidities. Data of interest included preoperative electrocardiogram (EKG) abnormalities, cause of death, body weight, anastamosis appearance, heart weight, extent of coronary artery disease, ventricular size, liver weight, and gall bladder status. A total of 7 men and 3 women were autopsied. Average age was 40 years (range, 30-49 years), and mean body mass index at autopsy was 60.3 kg/m(2) (range, 33.2-80.9 kg/m(2)). Evidence of anastomotic leaks was present in 7 cases, resulting in 4 deaths. Death was attributed to pulmonary embolism in one case. There were 5 cardiac-related deaths, all attributed to arrhythmias. Microscopic evidence of coronary artery disease was observed in 6. Cardiomegaly was seen in all patients, left ventricular hypertrophy in 8, right ventricular hypertrophy in 3, and hepatomegaly in all 10. Nine patients were status post cholecystectomy. Of the 8 preoperative EKG available, abnormalities were identified in 5. After gastric bypass, death was attributed to cardiac-related causes, pulmonary embolism, and operative complications. A significant proportion of cardiac-related deaths occured in the absence of atherosclerosis. Most patients had preoperative EKG abnormalities. As a high incidence of cardiomegaly was observed, operative stress associated with the procedure may increase the risk of arrhythmia in morbid obesity. Consequently, in morbidly obese patients, a detailed preoperative cardiovascular evaluation is warranted to reduce postoperative mortality.

Cardiovascular disease and Alzheimer's disease: common links

Growing evidence supports a strong and likely causal association between cardiovascular disease (CVD), and its risk factors, with incidence of cognitive decline and Alzheimer's disease. Individuals with subclinical CVD are at higher risk for dementia and Alzheimer's. Several cardiovascular risk factors are also risk factors for dementia, including hypertension, high LDL cholesterol, low HDL cholesterol and especially diabetes. Moderate alcohol appears to be protective for both CVD and dementia. In contrast, inflammatory markers predict cardiovascular risk, but not dementia, despite biological plausibility for such a link. The substantial overlap in risk factors points to new avenues for research and prevention.

Electrocardiographic Abnormalities in Patients With Acute Pancreatitis

Electrocardiographic abnormalities may be associated with acute pancreatitis (AP). To describe the electrocardiographic disturbances present in patients with AP and to assess differences in electrolyte and pancreatic enzyme levels among patients with and without these abnormalities. Fifty-one consecutive patients with AP and without preexisting heart disease underwent a standard 12-lead electrocardiogram (EKG) and a serum electrolyte profile. EKG abnormalities were summarized in terms of frequencies, means, and standard deviations. Electrolyte and enzyme levels were summarized as medians. Differences were analyzed using the Mann-Whitney U test. Twenty-eight patients (55%) had an abnormal EKG. Nonspecific changes of repolarization (20%), sinus tachycardia (12%), and left anterior hemiblock (10%) were the most frequent disturbances. Patients with sinus tachycardia had lower levels of phosphorus (2.3 vs. 3.4 mEq/L, P < 0.004) and calcium (8.4 vs. 9.1 mg/dL, P < 0.02). A tendency to higher levels of potassium and lower levels of phosphorus was found in patients with sinus tachycardia and nonspecific changes of repolarization, respectively. No differences were found in amylase, pancreatic amylase, or lipase among patients with normal and abnormal EKG. More than 50% of the patients with AP had EKG abnormalities, and these changes could be related to electrolyte alterations.

EKG abnormalities in children and adolescents with symptomatic temporal lobe epilepsy.

Changes in cardiac rate and rhythm are often found in adult patients with temporal lobe epilepsy (TLE) and could be involved in the pathogenesis of sudden unexplained death (SUDEP). However, little is known about heart rate (HR) variability in pediatric patients with TLE. To investigate ictal and peri-ictal HR abnormalities in children and adolescents with medically refractory symptomatic TLE and to determine the influence of focus localization and laterality. Patients younger than 18 years, with drug-resistant unilateral symptomatic TLE and presenting with at least one habitual complex partial seizure (CPS) during presurgical noninvasive video-EEG monitoring, were enrolled. Synchronous single-channel EKG recordings were analyzed during the preictal, ictal, and postictal stages. Twenty patients fulfilled the inclusion criteria. Seventy-two temporal lobe seizures (TLSs) were analyzed. Ictal tachycardia was found in 71 TLSs (98%), whereas ictal bradycardia was not observed. During preictal stages, tachycardia occurred in 20 seizures and mild bradycardia in 3. In 44 seizures (62%), tachycardia was still present >60 seconds after EEG seizure termination. Cluster analysis revealed significant differences in HR evolution depending on location and side of seizure onset: Early and high HR increase was primarily associated with right mesial TLSs. Cardiovascular dysregulation is common during temporal lobe CPSs in children. These results confirm a right hemispheric lateralization of sympathetic cardiac control.

Prognostic significance of normal myocardial perfusion imaging among blacks and hispanics in an inner-city population

Background: Previous studies have shown that the risk of death/MI at 1 year is less than 1% in patients with normal stress myocardial perfusion imaging. However, the racial distribution of patients enrolled in these studies is not known or very few Blacks and Hispanics were included. Hence, the prognostic value of normal stress perfusion imaging in Blacks and Hispanic patients is not well established. Our objective was to determine the incidence of all cause mortality in Blacks and Hispanics with normal myocardial stress perfusion scan and EF. Methods and Results: Retrospective review of 657 patients who had normal SPECT Tc99m sestamibi stress perfusion study utilizing attenuation and scatter correction, with gated SPECT EF ≥45 in year 2000. Blacks 34%, Hispanics 55%. All cause mortality from Social Security Death Index was 22 (3.3%) over at least 36 months period, thus an annual mortality rate of approximately 1.1%. Study population was divided in two groups those alive and those dead. Analysis showed that following characteristics were predictor for increased mortality, older age, diabetes mellitus, High resting heart rate, resting EKG abnormalities, low end point systolic and diastolic pressure. There was no significant difference amongst the two groups in gender, smoking h/o hypertension, resting systolic or diastolic blood pressure, EF by gated SPECT and transient Ischemic dilatation. Characters Alive (N = 635) Dead (N = 22) P value Age 58.3 ± 11.9 65.9 ± 12.8 0.003 Diabetes Mellitus 27% 77% 0.0000003 Resting EKG abn 44% 82% 0.0004 Resting HR 70 ± 14 82 ± 18 0.0004 Endpoint SBP 159 ± 36 137 ± 41 0.007 Endpoint DBP 75 ± 12 67 ± 11 0.002 Conclusions: This study is first of its kind study in an inner city population. The overall mortality in Black and Hispanic patients with normal stress perfusion study with EF≥45 is very low and similar to other Non-Black and Non-Hispanic population.

Asymtomatic diabetics do not have a higher prevalence of abnormal myocardial perfusion scans as compared to non-diabetics in Blacks and Hispanics

Background: Diabetes is a CAD equivalent. Performing MPI SPECT Tc99m-MIBI in asymptomatic diabetics would identify higher proportions of silent CAD earlier and may translate into better prevention, healthcare and lower healthcare cost. Methods: Retrospective review of 231 MPIs of patients asymptomatic for CAD. Patients with H/O CAD, PAD, MI, angina pectoris, revascularization were excluded. MPIs interpreted by two independent cardiologists blinded to histories. Two groups, non-diabetics (156) and diabetics (75). Results: Blacks & Hispanics 95%.Diabetics were significantly older (66±11vs 62.5±13, p=0.045), more hypertensives (92% vs 67%, p=<0.00005)and less likely to be smokers (12% vs 23%, p=0.04)but there were no differences in gender, postmenopausal status, hyperlipedimia, obesity,F/H/O premature CAD,occurrence of chest pain at peak stress, stress EKG abnormalities and proportion of abnormal scans. However, SPECT gated EF% was significantly lower among diabetics. See table. Conclusions: First of its kind study in Blacks and Hispanics. Asymtomatic diabetics, despite having significantly lower EF and being older and more hypertensives had similar prevalence of abnormal stress EKG and MPIs as compared to non-diabetics. Routine screening of asymptomatic diabetics does not detect more CAD than among non-diabetics and may not be cost effective. A large scale, prospective, randomized study is warranted. MPI Findings Non-Diabetics N = 156 Diabetics N = 75 p value Normal 80% 80% 0.98 Ischemia only 10% 5% 0.14 Scar only 4% 7% 0.35 Scar and Ischemia 6% 8% 0.52 Gated EF% 53.8 ± 14.4 47.5 ± 18.4 0.009

Prolongation of the corrected QT interval in adult patients with anti-Ro/SSA-positive connective tissue diseases.

Newborns of mothers positive for anti-Ro/SSA autoantibodies may develop a series of electrocardiographic (EKG) disturbances. Prolongation of the corrected QT (QTc) interval was recently reported in a significant proportion of children with maternally acquired anti-Ro/SSA antibodies, with a concomitant disappearance of EKG abnormalities and acquired maternal autoantibodies during the first year, suggesting a direct, reversible electrophysiologic effect of anti-Ro/SSA antibodies on the ventricular repolarization. On this basis, we investigated whether these antibodies may also affect cardiac repolarization in anti-Ro/SSA-positive adult patients with connective tissue diseases. Fifty-seven patients with connective tissue diseases were selected: 31 had anti-Ro/SSA antibodies and 26 did not (controls). In all subjects, we analyzed the QTc interval, heart rate variability, and signal-averaged high-resolution EKG recording. Anti-Ro/SSA-positive patients showed a significant prolongation of the mean QTc interval compared with the controls (mean +/- SD 445 +/- 21 versus 419 +/- 17 msec; P = 0.000005). Eighteen of the 31 anti-Ro/SSA-positive patients (58%) and none of the 26 anti-Ro/SSA-negative patients had QTc values above the upper limit of normal (440 msec). Both groups had a reduction in heart rate variability, with a prevalence for the sympathetic nervous system and a high incidence of ventricular late potentials; these values were not significantly different between the 2 groups. Adult patients with anti-Ro/SSA-positive connective tissue diseases showed a high prevalence of QTc interval prolongation. This feature, with the concomitant abnormalities in the autonomic tone and ventricular late excitability observed in all patients studied, suggests that anti-Ro/SSA-positive patients may have a particularly high risk of developing life-threatening arrhythmias.

Myocardial Injury in Acute Stroke: A Troponin I Study

Acute cerebrovascular insults can induce a variety of cardiac changes. We sought to describe the findings in a cohort of patients who had an acute stroke in whom Troponin I (TI) was sampled to determine the presence of associated myocardial damage. This is a retrospective case series study. The investigators identified all patients who had an acute stroke in whom TI had been sampled. Demographics, stroke severity as determined by National Institutes of Health Stroke Scale (NIHSS), stroke location, electrocardiogram (EKG) results, echocardiography results, and cardiology evaluation were obtained from the stroke database or the medical records. Logistic regression analysis was performed to determine the clinical and paraclinical variables associated with TI elevation. During a 14-month period, 191 patients were studied, but TI levels were available in only 160 (84%) of the 191 patients. The sample was composed of 89 (55%) men and 71 (45%) women, with a median age of 76 years. Elevated TI occurred in 10 (6%) of the 160 patients. EKG changes suggestive of cardiac ischemia occurred in 2 of the 10 patients with high TI who had a stroke. In the remainder patients' TI elevations occurred in the absence of EKG or echocardiographic abnormalities. High NIHSS but no other variable was associated with TI elevation (p=.02). Ventricular arrhythmias, congestive heart failure, post-infarct pericarditis, and sudden death did not occur. In this limited sample, elevated TI occurred in 6% of the patients with acute stroke and was associated with severe stroke. Although in some patients who have acute stroke, TI elevation may represent coronary ischemia, in others it may reflect neurogenic-induced cardiac injury.

Cardiotoxicity and late onset seizures with citalopram overdose

A 31-year-old man ingested 400 mg of citalopram (Celexa®) after an argument with his parents and girlfriend 13 h before presentation. Paramedics witnessed the patient having a generalized clonic seizure. The electrocardiogram (EKG) revealed a wide QRS complex, prolongation of the QTc interval, and left bundle branch pattern. He was treated with sodium bicarbonate with resolution of these changes. The patient was continued on a sodium bicarbonate infusion and demonstrated no further EKG abnormalities. Sodium bicarbonate should be considered as a treatment modality in patients with EKG abnormalities of prolongation of QRS or QTc interval after citalopram overdose.

Heart rate and EKG changes in 102 seizures: analysis of influencing factors

Purpose: Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality in patients with epilepsy. Since cardiac arrhythmia may be a responsible factor, we sought to determine the prevalence of significant EKG abnormalities during and immediately after epileptic seizures, and to identify risk factors for these changes. Methods: We retrospectively assessed changes in heart rate (HR) and the occurrence of EKG abnormalities in 102 seizures (71 non-generalized, 31 generalized) from 41 patients using video-EKG-EEG recordings. Results: The majority of seizures (101/102; 99%) led to an increase in HR. EKG abnormalities (other than sinus tachycardia) were noted in 22/102 (21.5%) seizures overall. Most EKG changes were benign, but potentially serious changes occurred in 6/102 (6%) seizures and 4/41 (10%) patients. These included ST-depression (5 seizures in 3 patients) and T-wave inversion (1 seizure). Ictal HR was higher ( P<0.03) and EKG-abnormalities were more common ( P<0.05) in generalized compared to non-generalized seizures. Ictal EKG abnormalities were seen in 35% of generalized seizures, including potentially serious changes in 13%. There was a trend towards higher risk of ictal EKG abnormalities when seizures arose from sleep or from the left hemisphere, when MRI showed evidence of hippocampal sclerosis, and when ictal HR was higher. Age and seizure duration had no effect on the occurrence of EKG abnormalities. Conclusion: We conclude that ictal EKG abnormalities other than sinus tachycardia are not unusual, especially in generalized seizures. These findings may be relevant to the phenomenon of SUDEP.

Torsades de Pointes Associated with High Dose Levomethadyl Acetate (ORLAAM®)

A patient undergoing management of heroin dependency with high dosages of the long-acting methadone derivative, levomethadyl acetate HCl (LAAM; ORLAAM®) developed a prolonged QTc interval and polymorphic QRS complexes on EKG consistent with torsades de pointes(TdP). The patient was taking other drugs known to prolong the QTc interval (fluoxetine and IV cocaine), and those known to antagonize the activity of the P450 enzymes responsible for the metabolism of LAAM and its active metabolite (fluoxetine, cocaine and marijuana). No previous reports have appeared in the literature attributing this adverse event to LAAM therapy; however, five similar cases have been reported to the manufacturer. Animal studies indicate that LAAM and metabolites prolong the action potential duration of myocardial cells. We propose that predisposed patients on high doses of LAAM may be at risk for developing TdP. Patients being treated with LAAM should receive dosages consistent with guidelines and be evaluated for concomitant diseases, interacting drug therapies, and EKG abnormalities.

Natural history of cardiac involvement in myotonic dystrophy: correlation with CTG repeats.

The authors prospectively studied the natural course of cardiac involvement and its relationship to cytosine-thymine-guanine (CTG) expansion in 50 patients with myotonic dystrophy who were submitted to periodic cardiovascular EKG and EKG-Holter monitoring during a median follow-up of 56 months. Nineteen patients (38%) developed major EKG changes. CTG length was not correlated with the frequency of EKG abnormalities, but was inversely correlated with the age at onset of EKG abnormalities (p < 0.0001). CTG length influences the timing of cardiac complications in myotonic dystrophy.

EKG abnormalities during partial seizures in refractory epilepsy.

This study assessed the frequency and character of ictal cardiac rhythm and conduction abnormalities in intractable epilepsy. Sudden unexpected death in epilepsy (SUDEP) is a major cause of excess mortality in people with refractory epilepsy, and cardiac arrhythmias during seizures may be responsible. The frequency of cardiac abnormalities during seizures in patients with refractory epilepsy must be determined. Fifty-one seizures in 43 patients with intractable partial epilepsy were analyzed prospectively from CCTV-EEG monitoring with one ECG channel. Arrhythmias, repolarization abnormalities, and PR and QTc intervals were determined for preictal (3 min), ictal, and postictal (3 min) periods for one or more seizures per patient. Parametric statistics were used for continuous variables, and nonparametric statistics were used for categoric variables. Of the patients, 39% had one or more abnormalities of rhythm and/or repolarization during or immediately after seizures. Abnormalities included asystole (one), atrial fibrillation (one), marked or moderate sinus arrhythmia (six), supraventricular tachycardia (one), atrial premature depolarizations (APDs; eight), ventricular premature depolarizations (VPDs; two), and bundle-branch block (three). Mean seizure duration was longer in patients with abnormalities than in those without (204 vs. 71 s; p < 0.001). Generalized tonic-clonic seizures were also associated with increased occurrence of ictal ECG abnormalities (p = 0.006) as compared with complex partial seizures. There were no clinically significant differences in mean preictal and ictal/postictal PR and QTc intervals. Cardiac rhythm and conduction abnormalities are common during seizures, particularly if they are prolonged or generalized, in intractable epilepsy. These abnormalities may contribute to SUDEP.

Wolff-Parkinson-White Syndrome Simulating Inferior Myocardial Infarction in a Cocaine Abuser for Urgent Dilation and Evacuation of the Uterus

Wolff-Parkinson-White Syndrome Simulating Inferior Myocardial Infarction in a Cocaine Abuser for Urgent Dilation and Evacuation of the Uterus

Avaliação inicial de homoenxertos em posição pulmonar em crianças e adolescentes

Objective: Heart valve homografts - fresh or cryopreserved - are a good valvular substitute in infants and teenagers as they need no anticoagulation, have a higher resistance to infection and present a good hemodynamic performance. The objective of this report was to evaluate the initial postoperative results on pediatric subjects after homograft implant in pulmonary position. Methods: Fourteen homografts were implanted in pulmonary position from September, 1995 to December, 1997. Four of them were fresh (28.6%) and ten were cryopreserved (71.4%). Subjects ranged in age from 10 months to 17 years with 9 (64%) males and 5 (36%) females . The subjects were divided into two groups, as follows: A - aortic valve disease (Ross operation) and B - congenital heart disease. The diameter of the homografts ranged from 16 to 26 mm. The cardiopulmonary-bypass time ranged from 74 to 303 minutes and the aortic-occlusion time between 49 to 160 minutos. Results: A hospital death occurred. All the survivors were clinically, radiologically, electrocardiographycally and echocardiographycally monitored. There were 13 NYHA I patients and one NYHA II patients. The most common complications were low output syndrome, pericardial effusion and EKG abnormalities. All these ocurred in two patient but with a favorable outcome. Stenosis of the right ventricular outflow track was observed early on in two subjects with gradients of 44 and 23 mmHg. One of the pulmonary homografts was submitted to a successful balloon valvuloplasty due to a severe stenosis. The rheumatic patients are still receiving antibiotic therapy and without recurrence of the disease. Conclusion: Evaluation of the hemodynamics of the homografts, in pulmonary position, was satisfactory. One of the subjects has presented marked stenosis but, after a balloon valvuloplasty, his gradient decreased. Another patient has kept his preoperative NYHA classification. We believe was not correlated with the homograft (coagulation disorder). It's our belief that fresh and cryopreserved homografts are a satisfactory solution for the correction of congenital or acquired valve disease in infants and adolescents.

Pharmacokinetics of hydroxychloroquine and chloroquine during treatment of rheumatic diseases

Hydroxychloroquine (HCQ) and chloroquine (CQ) are well absorbed (0.7-0.8 bioavailability) when given orally. Severe malnutrition (such as kwashiorkor) effects absorption but diahrrea does not. Both HCQ and CQ have prolonged half-lives, between 40 and 50 days, and low blood clearance (e.g. hydroxychloroquine's blood clearance is 96 ml/min). There is great variability of blood concentrations with an eleven-fold range of drug concentrations found after similar doses in RA patients. Protein binding ranges between 30 and 40% with binding to both albumin and alpha, glycoprotein. There is differential binding and metabolism of the (R) and (S) stereoisomers. Both drugs bind strongly to pigmented tissues but also bind to mononuclear cells, muscles, etc. There is stereo-selective excretion of both drugs and 40-50% of the drug is excreted renally. Between 21 and 47% is excreted unchanged. There is a suggestion of concentration response and concentration toxicity relationships with decreased morning stiffness as HCQ concentrations increase and increased EKG abnormalities as CQ concentrations become higher, but further testing is required. Pharmacokinetic interaction studies are limited. Potentially important kinetic interactions have been documented for d-penicillamine and cimetidine but have not been found for aspirin, ranitidine or imipramine.

Morbidity of Chagas disease in areas of Sertão da Paraiba and Caatinga do Piauí

A clinical and electrocardiographic case control study was carried out with 186 pairs of persons with positive and negative serology for T. cruzi infection from the Sertão Paraíba and in 200 seropositive cases from the region of Caatinga in the State of Piauí, North-eastern Brazil. The predominant clinical manifestations in seropositive cases in both areas were: palpitations, dyspnea on effort, precordial pain, dysphagia, odynophagia, pyrosis and intestinal constipation. The EKG abnormalities rates suggestive of chronic chagasic cardiopathy were respectively in Paraíba and Piauí: AV block 3.8% and 2%, RBBB III 6.4% and 7%, RBBB III+ LAB 10.7% and 10.5%, and multifocal extrasystoles 2.7% and 3%. Xenodiagnosis in a sample of 54 seropositive individuals in the Sert-ao of Para-iba and in 120 in the Caatinga of Piauí was revealed 13% and 34% positive; PCR tests in a sample of 47 seropositives in Paraíba and 101 in Piauí revealed positives in 44.6% and 59.5% respectively. Blood culture in LIT media of 101 seropositive cases from the Caatinga of Piauí was positive for T. cruzi in 25.7%. A triatomine survey carried out in a sample of 132 domiciles and peridomiciles in the Sertão of Paraíba and in a sample of 159 in the Caatinga of Piauí showed the following results: In Paraíba, 16 specimens of T. brasiliensis, not infected with T. cruzi, were captured. In Piauí, 750 triatomines were captured, of these 625 were examined: 49 were T. pseudomaculata, not infected with T. cruzi (19 in peridomiciles and 30 in the domiciles), and 576 were T. brasiliensis (371 in the domiciles and 205 in the peridomiciles) and of this latter specie 32 (5.5%) were infected with T. cruzi (31 in the domiciles and one in the peridomicile).

EKG abnormalities in pediatric patients with myotonic dystrophy

Electrocardiographic (EKG) abnormalities are frequent in patients with myotonic dystrophy; cardiac complications may lead to significant morbidity and mortality. The charts of 17 pediatric patients with myotonic dystrophy were reviewed to ascertain the frequency of EKG abnormalities and cardiovascular symptoms. Fifteen of 17 patients had abnormal EKGs with sinus bradycardia being the most common abnormality. Only 1 of 17 patients had cardiovascular symptoms. Four patients had moderate to severe weakness and 3 of them had a conduction disturbance (i.e., first-degree AV block or intraventricular conduction delay). Two of the remaining 13 patients with mild weakness had conduction disturbances. No pediatric patients had progressive EKG abnormalities during follow-up. Baseline EKG study of pediatric patients with myotonic dystrophy is recommended because abnormalities are frequent and usually asymptomatic. Frequent follow-up EKGs are probably unnecessary unless the patient is symptomatic or has heart block.

Symptomatic cardiotoxicity with high-dose 5-fluorouracil infusion: a prospective study.

Cardiotoxicity with 5-fluorouracil (5-FU) therapy has been reported to range from asymptomatic EKG abnormalities to fatal myocardial infarction. We report a prospective study in 100 consecutive patients receiving 5-FU infusion in combination with other chemotherapeutic agents or alone for the treatment of different malignancies with the aim of identifying patients who develop symptomatic cardiotoxicity. Patients with a history of cardiac illness, abnormal EKG or cardiac enzyme levels were excluded. Patients were observed during the total period of infusion, daily EKG was performed on asymptomatic patients, those who developed cardiotoxicity were monitored till symptom-free for 24 h. Eight patients developed symptoms suggestive of cardiotoxicity. Pain was the commonest symptom (5/8), followed by palpitation and sweating. Three patients developed EKG abnormalities and 1 went into cardiogenic shock. Time to toxicity ranged from 18 to 30 h (mean 24 +/- 3.7 h) and serial cardiac enzyme levels remained normal in all patients. The symptoms reversed immediately on cessation of the treatment in most of the patients (7/8). Time to recovery ranged from 5 to 60 min (mean 19.28 +/- 19.6 min). There was no recorded death due to toxicity. We conclude that 5-Fu infusion is associated with a significant risk of symptomatic cardiotoxicity. Concomitant chemotherapeutic agents, received by all the affected patients, may have a contributory effect too. Cardiotoxicity seems to be completely reversible, particularly in patients without underlying cardiac disease. The patients should be informed about the symptoms and the condition recognised and managed immediately.

Evolution of the electrocardiographic changes in patients with hypertrophic cardiomyopathy

In 75 patients with hypertrophic cardiomopathy (HCM) followed for a mean period of 5.5 years (range 2-20 years), evolution of the electrocardiographic (EKG) changes was assessed. Progression of EKG abnormalities occurred in 35 patients (47%). It was manifested by an increase in precordial QRS voltage in 33 patients, development of new P-wave mitral in 11 patients, and development or disappearance of pathologic Q waves in 14 patients. With follow-up times greater than 5 years, 5-8 years, and greater than 8 years, EKG progression was present in 27, 41, and 80% of patients, respectively. Age less than 30 years at the beginning of study and left ventricular outflow obstruction predisposed to EKG progression within 5-8 years. Patients with progressive EKG changes were more prone to experience clinical deterioration than those without EKG progression (63 vs. 15%, p less than 0.001). With chronic verapamil administration, progression of EKG abnormalities occurred insignificantly less often than with propranolol treatment (35 vs. 64%, p = 0.20). It is concluded that with long-term follow-up, HCM tends to progress in a significant proportion of adult patients.