Episodes Of Palpitations Research Articles

Young Adult With Multivisceral Lesions and Hypoglycemia

Gastroe A 28-year-old male patient presented with complaints of episodic sweating, palpitation and restlessness for 1 year. He had documented recurrent hypoglycemia which was relieved by consumption of sugars. There was a past history of craniotomy for cerebellar hemangioblastoma in 2009 and 2011. There was no significant family history. A general physical examination did not reveal any abnormality except for well healed craniotomy scars. The evocative testing for hypoglycemia revealed fasting blood sugar 40mg%, serum insulin levels 37 (range 1.9–23) mU/mL, C-peptide -6.68 (range 1.1-4.4) ng/mL. The patient was further investigated with contrast enhanced abdominal magnetic resonance imaging (MRI scan) (Figures A and B). The MRI scan depicts multiple simple cysts and/or serous cystadenomas of varying size in the pancreas. The left kidney has Bosniak 3 cystic lesions. There is a 3.1 2.8 cm heterogeneous solid tumor in the distal body pancreatic tail region.

Disabling Palpitations in an Adolescent.

A teenage girl presented with recurrent episodes of palpitations for 6 consecutive years. The resting 12-lead electrocardiogram showed sinus rhythm with no preexcitation or repolarization abnormalities. Therewere incessantmultiple runsof nonsustainedventricular tachycardiawith right bundle branch block morphologic features.QRS complexeswere negative in the rest of theprecordial leads (V2-V6) and in leads I andavL, butpositive in III, avR, andavF, suggesting a left (lateral) ventricular apical origin (Figure 1). The echocardiogram showed no structural abnormalities. The patientwas prescribed sotalol but her symptomsdidnot improve. Invasive electrophysiological mapping of the left ventricle endocardium demonstrated that the ventricular tachycardia probably originated from the epicardial surface of left ventricular apex. Quiz at jamacardiology.com Figure 1. Twelve-lead surface electrocardiogram during tachycardia. QRS complexes are positive in V1, negative in the rest of the precordial leads (V2-V6), and negative in leads I and avL but positive in III, avR, and avF.

Breaking It Gently: A Rare Case of Arrhythmogenic Right Ventricular Cardiomyopathy Presenting as Sustained Ventricular Tachycardia

We report a case of a 42-year-old female with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) who presented with recurrent episodes of palpitations, dizziness and lightheadedness. On evaluation, she developed a new onset sustained ventricular tachycardia (VT) and the diagnosis was confirmed through genetic testing, cardiac imaging, and electrophysiological study. Insertion of automatic implantable cardioverter defibrillator (AICD), antiarrhythmic medication, and ventricular ectopy radiofrequency ablation afforded improvement of symptoms. In conclusion, combination of these treatment modalities abated ventricular tachycardia from ARVC.

A young female with recurrent syncope.

A 23-year-old woman presented with multiple episodes of palpitations and loss of consciousness within a 48 h period. She gave a history of similar episodes since childhood and had been previously diagnosed as suffering from epilepsy. While being monitored in the hospital, she was found to have rapid polymorphic ventricular tachycardia (PVT) during the episodes. She required repeated cardioversion as the arrhythmia recurred despite administration of intravenous amiodarone and lignocaine. Prolonged monitoring showed frequent premature ventricular complexes (PVC) (figure 1A), couplets and short runs of ventricular tachycardia (figure 1B) and longer runs of ventricular tachycardia, which were associated with her clinical symptoms (figure 1C). Echocardiography showed no structural …

Effects of Smoking on Pilots of Bangladesh Air Force in Dhaka Area

Introduction: Smokers have a high morbidity and mortality rate and the causes of excess morbidity and mortality include lung cancer, COPD (Chronic Obstructive Pulmonary Disease) and cor pulmonale. An estimated 100 million people died in the 20th century from tobacco-associated diseases. Smoking also affects the performance and cause physical deterioration of pilots.
 Objectives: To evaluate the effects of smoking on pilots of Bangladesh Air Force (BAF), Dhaka area.
 Materials and Methods: This cross sectional study was conducted during the period of January to June 2014 among the available pilots of different age and ranks of 6 flying squadrons of BAF Dhaka area. Data were collected by using a pre-tested semistructured questionnaire distributed among the pilots. Information were also collected from Central Medical Board (CMB), BAF about total number of pilots placed in low medical category and nature of their sickness. Finally chest X-ray and ECG of the pilots were done to find out any respiratory and cardiovascular abnormalities. Data obtained were entered into SPSS version 21.0 for analysis.
 Results: Total 190 pilots were interviewed and among them, 80(42%) were smokers and 110(58%) were non-smokers. Most of the pilots were within the age group of 26-30 years (30%). Out of 80 smoker, 37(46%) smoked for more than 10 years, rest smoked for 10 years and less. Stress was the most common cause of starting smoking (96.3%). Fifty eight (72.5%) pilots agreed that their stamina and physical efficiency decreased due to smoking, 21 (26.3%) experienced breathlessness at high altitude, 26(32.5%) experienced visual disturbance during night flying. Fifty three (66.3%) pilots complained of occasional episode of palpitation along with increase in pulse rate. Thirty one (39%) experienced occasional headache during high altitude flight, 58(72.5%) had heart burn related to smoking. Thirty eight (47.5%) had occasional bouts of cough with sputum and 40(50%) complained of occasional gum bleeding. These pilots also informed that they reported sick several times for headache, heart burn, cough and URTI (Upper Respiratory Tract Infection) and were unfit for flying duties. During January-June 2014, a total of 10 pilots of BAF Dhaka area were placed in low medical category out of them 6 (60%) pilots had smoking habits and suffered from IHD-4 (Ischemic Heart Disease) and HTN-2 (Hypertension). There was statistically significant association between number of the cigarette smoked, period of smoking and physical deterioration of smoker pilots (P<0.05). Those who smoked more than 10 sticks/day and more than 10 years had moderate to severe physical deterioration.
 Conclusion: Smoking adversely affects all systems of human body. It impairs altitude tolerance, early induction of hypoxia, impairment of night vision. It affects autonomic systems and thus impairs all compensatory mechanism needed at higher altitudes. Morbidity and mortality related to smoking have linear relation. Pilots must be indoctrinated not to smoke for the sake of their safety flight, own life, their families and the nation.
 Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 22-27

Phaeochromocytoma and Paraganglioma.

Phaeochromocytomas and paragangliomas are relatively uncommon tumours which may be manifest in many ways, specifically as sustained or paroxysmal hypertension, episodes of palpitations, sweating, headache and anxiety, or increasingly as an incidental finding. Recent studies have shown that an increasing number are due to germline mutations. This review concentrates on the diagnosis, biochemistry and treatment of these fascinating tumours.

The Case of a Heartfelt Swallow

Deglutition tachycardia is a rare disorder. There have been less sixty cases reported since it was first described in 1925 by Kasai et al. Here we present a case of deglutition tachycardia. The patient is a 56 year old man who presents with 2 weeks of palpitations associated with swallowing solids. He has no prior cardiac history. He reports transient (5-10 seconds) episodes of palpitations that would occur while swallowing solid food. He denied having symptoms when not eating, or swallowing liquids alone. His other past medical history includes hypothyroidism and myopia requiring retinal detachment 3 weeks prior to presentation. He reports only taking levothyroxine daily for hypothyroidism. On the day of presentation, while eating he began having palpitations that did not resolve and after 30 minutes he sought medical attention at the emergency department. In the emergency department he was found to have atrial fibrillation with rapid ventricular rate of 176 beats per minute. He was treated with diltiazem drip and metoprolol which converted his rhythm to normal sinus. Laboratory results were normal including hemoglobin and TSH. While admitted on continual telemetry he had short, 6-10 beats, bursts of atrial fibrillation with aberrant ventricular conduction (AVR) that occurred only during meal time. Echocardiogram and stress test during admission were normal. Gastroenterology recommended a barium esophagogram which showed no structural abnormalities but found that on 4 consecutive swallows a rhythm strip taken simultaneously revealed atrial fibrillation with AVR when the bolus passed the left atrium. He was discharged on metoprolol and had no further episodes. He later revealed that he was taking an anticholinergic eye drop for his retinal repair that he had started 3 weeks prior to presentation, and stopped shortly after discharge.Figure 1This patient experienced deglutition tachycardia from a combined effect of mechanical stimulation of the left atrial focus by the food bolus and the increased automaticity of the focus from the anticholinergic eye drop. Deglutition tachycardia though rare is important to recognize in a patient presenting with tachycardia associated with swallowing.

Onda J, predictor de muerte súbita

It used to be believed that the syndrome of early repolarization, which is determined by the point J and ST segment on the electrocardiogram, was a benign pattern. In recent decades its malign character has been shown when presented in the inferior leads and/or side given its potential to trigger lethal arrhythmias (occurs 1-13% of the general population and in 15-70% of cases of idiopathic ventricular fibrillation), as in the case of idiopathic polymorphic ventricular tachycardia that can degenerate into ventricular fibrillation and sudden death. A case of a 41 year-old patient who initially presented episodes of palpitations, syncope and sudden death is presented, in whom subsequently early repolarization type 2 disorder is evidenced.

Left Atrial Appendage Aneurysm

A 57-year-old woman presented to our emergency department with intermittent episodes of palpitations, which began abruptly without significant precipitants and resolved spontaneously. Physical examinations showed a rapid heart rate of 130 beats per minute approximately, with irregular pattern; the remainder was unremarkable. She was otherwise healthy, without history of panic disorders or cardiovascular diseases. No remarkable family history was reported. She did not take medicine and did not use illicit drugs, alcohol or tobacco. No emotional stress was noted recently. An electrocardiogram showed atrial fibrillation with rapid ventricular responses. The patient received transthoracic echocardiography initially in our emergency department, and the preliminary findings showed no significant structural abnormalities. Surprisingly, the chest x-ray revealed a bulky mass, obliterating the left cardiac border (Figure 1A, arrow). Under the impression of possible structural heart disease, advanced computed tomography of the chest confirmed a large aneurysm (Figure 1B, arrow), arising from the left aspect of atrium (Figure 1B, asterisk). Blood testing showed normal serum thyroid-stimulating hormone and electrolyte levels. The patient underwent an aneurysmectomy. After surgery, the patient recovered and was discharged uneventfully, with a regular sinus rhythm and resolution of symptoms.

Pheochromocytoma: Cath lab opening up the pandora's box

Pheochromocytoma is a catecholamine secreting neuroendocrine tumor arising from chromaffin cells in the adrenal medulla or extraadrenal paraganglia. The classic triad of symptoms consists of episodic headache, palpitations and diaphoresis. Pheochromocytomas can result in various cardiac manifestations including systemic hypertension, ventricular hypertrophy and congestive heart failure due to prolonged hypertension. They can also manifest with arrhythmias, myocarditis and dilated cardiomyopathy due to toxic exposure to catecholamines, or occasionally as acute coronary syndrome. Here, we describe a case who presented very similar to acute coronary syndrome with elevated cardiac biomarkers and was taken into catheterization lab. His coronaries were normal but he was incidentally detected to have suprarenal mass during angiography. He was finally diagnosed as having pheochromocytoma. Subsequently he was surgically treated and cured.

Heart palpitation relief with Melissa officinalis leaf extract: Double blind, randomized, placebo controlled trial of efficacy and safety

Ethnopharmacological relevanceIn Traditional Iranian Medicine (TIM), Melissa officinalis L. is commonly regarded as an effective therapy for heart palpitations. ObjectiveHeart palpitation is a common complaint that is often benign and associated with a marked distress that makes the condition difficult to treat. Herbal medicines provide an alternative to conventional drugs for treating various kinds of diseases. This study was done as a double blind randomized placebo-controlled clinical trial to evaluate the efficacy and safety of the dried extract of M. officinalis on adults suffering from benign palpitations. Materials and methodsEligible volunteers were randomly assigned as outpatients to a 14 day treatment with 500mg twice a day of lyophilized aqueous extract of M. officinalis leaves (or placebo). Participants in the tests, physicians and researchers were blind to group assignments. Both primary and secondary outcomes were patient-reported. Primary outcomes were obtained from two measures: mean frequency of palpitation episodes per week, derived from patients׳ diaries, and mean intensity of palpitation estimated through Visual Analogue Scale (VAS) in a self-report questionnaire. Psychiatric symptoms (somatization, anxiety and insomnia, social dysfunction and severe depression) were evaluated as secondary outcomes by General Health Questionnaire-28 (GHQ-28), before and after intervention. ResultsFifty-five volunteers out of 71 recruited study subjects completed the trial. Results showed that 14-day of treatment with lyophilized aqueous extract of M. officinalis leaves reduced frequency of palpitation episodes and significantly reduced the number of anxious patients in comparison to the placebo (P=0.0001, P=0.004 resp.). Also, M. officinalis extract showed no indication of any serious side effects. ConclusionLyophilized aqueous extract of M. officinalis leaves may be a proper and safe herbal drug for the treatment of benign palpitations.

Choice of Management in a Rare Case of Symptomatic Wolff-Parkinson-White (WPW) Syndrome Type B

Introduction: Wolff-Parkinson-White (WPW) syndrome type B is a congenital condition involving abnormal electrical conduction between the atria and the ventricles that provide an accessory pathway (AP) for a re-entrant tachycardia circuit. Background: This case report illustrates a 28-year-old male who presented with multiple episodes of rapid, regular palpitations associated with dizziness and nausea. These episodes of palpitations often resolve spontaneously. Physical examination revealed normal first and second heart sounds with no audible murmurs. Other systemic examinations were unremarkable. A 12 lead electrocardiogram showed an atrioventricular re-entrant tachycardia (AVRT) of 210 beats per minute. Intravenous amiodarone was given to which he responded. Post pharmacological cardioversion, the repeated ECG showed shortened PR interval and broad QRS complexes associated with negative delta waves in lead V1, T-wave inversion in inferior leads and precordial leads of V5-V6 which represented a Type B pattern. He was then referred to the electrophysiology unit at the National Heart Institute for radiofrequency ablation (RFA) and Holter monitoring. Conclusion: Wolff-Parkinson-White (WPW) Type B should be considered as a differential diagnosis for a young individual who presents with frequent palpitations. RFA is well known as a permanent solution to the prevention of tachyarrhythmia.

Spontaneous All Three Electrocardiographic Patterns in Same patient with Brugada Syndrome

Brugada Syndrome (BS) was described as a clinical entity in 1992. The diagnosis is made by ECG and is defined by the presence of an atypical right bundle branch block pattern with a characteristic cove-shaped ST elevation in leads V1 to V3, in the absence of obvious structural heart disease, electrolyte disturbances or ischaemia [1]. This condition is genetically transmitted as an autosomal dominant syndrome with incomplete penetrance. The ECG changes of BS are dynamic, transient [2] and can vary spontaneously which also makes it difficult to assess its exact incidence. Three subtypes have been recognised, based on different ECG features. A 59-year-old male presented to the ED after an episode of palpitations that began 60 minutes earlier. He was resuscitated outside for ventricular tachycardia, referred to our hospital in view of Electrocardiographic changes. He had no prior medical problems and was not on any medications. The electrocardiogram (ECG) showed subtle downsloping ST-segment elevation in leads V1,to V3 suggestive diagnostic of Brugada syndrome (Figure 1). Results of laboratory investigations and chest x-ray were normal. Later next day patients ECG showed type II pattern of BS (Figure 2) followed by type III ECG pattern (Figure 3) spontaneously .This case is an example demonstrating the dynamic ECG changes of all three subtypes in a single individual spontaneously.

Paraganglioma: A rare retroperitoneal tumor

Paraganglioma is a rare catecholamine-secreting tumor, that is, found anywhere in the line of the sympathetic chain and that of the parasympathetic ganglia. They usually present with severe hypertension which can be challenging to the surgeon during the management. We successfully managed a 28-year-old lady who presented with a 6 year history of episodic hypertension, palpitation, insomnia, excessive sweating, and weight loss. An abdominal ultrasonography and computed tomography scan showed a retroperitoneal mass in front of the left kidney. She subsequently had exploratory laparotomy and excision of the tumor with resolution of symptoms. Histology of the mass revealed features consistent with a paraganglioma. She is presently being followed up in our surgical out-patient clinic.

A patient with palpitations

A 52 year old woman presented to the Acute Medical Unit with her 4th episode of palpitations in the past four weeks. Each episode was similar in nature and described as being acute in onset, fast and regular, associated with pre-syncope but never syncope or chest pain. The episodes lasted for 30 – 45 minutes and would self terminate. Of particular note, the episodes were not associated with exertion and she had a normal exercise tolerance.

Three is a crowd.

QuestionA 40-year-old woman was seen at our outpatient clinicbecause of episodes of palpitations that lasted severalhours. She reported no syncopal episodes or familyhistory of sudden cardiac death and was not on anymedication. The resting ECG and ECG recorded duringthe palpitations are shown in Fig. 1a and b.Whatisthe(differential) diagnosis?AnswerYou will find the answer elsewhere in this issue.

Three is a crowd.

QuestionA 40-year-old woman was seen at our outpatient clinicbecause of episodes of palpitations that lasted severalhours. She reported no syncopal episodes or familyhistory of sudden cardiac death and was not on anymedication. The resting ECG and ECG recorded duringthe palpitations are shown in Fig. 1a and b.Whatisthe(differential) diagnosis?AnswerYou will find the answer elsewhere in this issue.

Inducible Focal Atrial Tachycardia of Coronary Sinus Origin Masquerading as Ventricular Tachycardia

CASE: This is the case of a 35-year old male physician presenting with a 12-year history of palpitations despite oral metoprolol. He had reversible left hemiparesis with right hemispheric lacunar infarctions on computerized tomography scan. The 12-lead electrocardiogram (ECG) recorded during an episode of palpitations revealed wide QRS (0.16 s) tachycardia (heart rate=214 beats per minute) with left bundle branch block (LBBB) QRS morphology; no identifiable P waves; QS pattern in leads V1 to V4; RS pattern in leads V5 and V6; and a QRS axis at -1300. There were no AV dissociation; fusion and captured beats; and precordial QRS concordance. Electrophysiology studies (EPS) were performed. During programmed electrical stimulation (PES) at the right ventricular apex, sustained narrow QRS (0.10 s) tachycardia (168 bpm) was induced. Examination of the intracardiac atrial (A) and ventricular (V) electrograms during the tachycardia revealed a 1:1 AV relationship; closer A electrogram to the preceding A electrogram than the following V electrogram producing a short RP tachycardia (<70 ms); variable VA intervals; VAAV response during ventricular overdrive maneuver, and termination of the tachycardia at the V electrogram. The above EP parameters favored a diagnosis of focal atrial tachycardia (FAT) over re-entrant supraventricular tachycardia (SVT). The earliest activation site of the induced SVT was recorded near the ostium of the coronary sinus (CS 9 and 10) which coincided with the findings on 3D mapping. DIAGNOSIS: FAT with acceleration-dependent functional LBBB based on a mechanism of triggered automaticity arising from the coronary sinus ostium. TREATMENT AND OUTCOME: Radiofrequency ablation was applied on the identified arrhythymogenic atrial focus and effectively restored sinus rhythm and rendered the FAT non-inducible.

Catheter Ablation of an Anteroseptal Accessory Pathway Guided by Three-dimensional Electroanatomical Mapping in Symptomatic Wolff-Parkinson-White Syndrome

OBJECTIVE: To report a case of a successful anteroseptal accessory pathway ablation in a 32-year old male with symptomatic Wolf-Parkinson-White (WPW) syndrome with the guidance of three-dimensional (3D) electroanatomical mapping. CLINICAL PRESENTATION: This is the case of a 32-year old male with symptomatic WPW syndrome presenting as frequent episodes of palpitations since 2002 despite being maintained on flecainide 100 mg twice daily. He was initially admitted in another institution for electrophysiological study (EPS), which showed orthodromic tachycardia using an anteroseptal pathway. Due to the proximity of the accessory pathway to the bundle of His, ablation was not attempted. He was referred to our institution and eventually underwent successful radiofrequency (RF) ablation of the anteroseptal accessory pathway with the guidance of 3D electroanatomical mapping. At baseline, the His proximal electrodes appeared to have the earliest ventricular activation in sinus rhythm, and the earliest His bundle activation with ventricular pacing as well. During tachycardia, there was concentric ventriculo-atrial (VA) conduction via the accessory pathway, with the earliest VA conduction at the His electrode essentially fused. The accessory pathway was mapped to the anteroseptal region of the tricuspid annulus that was 2 to 3 mm from the Bundle of His. RF application in this area during sinus rhythm with 3D electroanatomical guidance resulted in loss of the delta wave after 2 seconds of energy application of 30 watts at 35° (right antero-oblique), which persisted after the ablation. SIGNIFICANCE: EPS with RF ablation is the first-line treatment for symptomatic WPW syndrome. However, due to the potential for atrioventricular block especially in the anteroseptal accessory pathway ablation because of its close proximity to the His bundle, precise mapping of the tract is essential and can be accomplished using 3D electroanatomical mapping. KEYWORDS: Wolff-Parkinson-White syndrome, electroanatomical mapping, anteroseptal accessory pathway, septal ablation, radiofrequency ablation complications, atrioventricular block.

ECG Challenge: June 10, 2014

HomeCirculationVol. 129, No. 23ECG Challenge: June 10, 2014 Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBECG Challenge: June 10, 2014 Originally published10 Jun 2014https://doi.org/10.1161/CIRCULATIONAHA.114.011012Circulation. 2014;129:2436IntroductionA 28-year-old man with no known heart disease, but a history of occasional palpitations which he states he is able to terminate by performing a valsalva maneuver, presents to the emergency room with an episode of palpitations that did not terminate as usual. By the time he arrived he stated that the palpitations had resolved, but while an ECG was recorded the symptoms recurred.Download figureDownload PowerPointWhat is the diagnosis?To submit your diagnosis, go to http://circ.ahajournals.org/letters/submit/circulationaha;129/23/2436. The diagnosis will follow in next week’s issue (June 17).Please go to the journal’s Facebook page for more ECG Challenges: http://goo.gl/cm4K7. Challenges are posted on Tuesdays and Responses on Wednesdays.FootnotesCorrespondence to Philip J. Podrid, MD, West Roxbury VA Hospital, Section of Cardiology, 1400 VFW Parkway, West Roxbury, MA 02132. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetails June 10, 2014Vol 129, Issue 23 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.114.011012 Originally publishedJune 10, 2014 PDF download Advertisement SubjectsElectrocardiology (ECG)