Increase In Premature Ventricular Contractions Research Articles

Adverse events in clinical treatments with serotonergic psychedelics and MDMA: A mixed-methods systematic review

Introduction:Small-scale clinical studies with psychedelic drugs have shown promising results for the treatment of several mental disorders. Before psychedelics become registered medicines, it is important to know the full range of adverse events (AEs) for making balanced treatment decisions.Objective:To systematically review the presence of AEs during and after administration of serotonergic psychedelics and 3,4-methyenedioxymethamphetamine (MDMA) in clinical studies.Methods:We systematically searched PubMed, PsycINFO, Embase, and ClinicalTrials.gov for clinical trials with psychedelics since 2000 describing the results of quantitative and qualitative studies.Results:We included 44 articles (34 quantitative + 10 qualitative), describing treatments with MDMA and serotonergic psychedelics (psilocybin, lysergic acid diethylamide, and ayahuasca) in 598 unique patients. In many studies, AEs were not systematically assessed. Despite this limitation, treatments seemed to be overall well tolerated. Nausea, headaches, and anxiety were commonly reported acute AEs across diagnoses and compounds. Late AEs included headaches (psilocybin, MDMA), fatigue, low mood, and anxiety (MDMA). One serious AE occurred during MDMA administration (increase in premature ventricular contractions requiring brief hospitalization); no other AEs required medical intervention. Qualitative studies suggested that psychologically challenging experiences may also be therapeutically beneficial. Except for ayahuasca, a large proportion of patients had prior experience with psychedelic drugs before entering studies.Conclusions:AEs are poorly defined in the context of psychedelic treatments and are probably underreported in the literature due to study design (lack of systematic assessment of AEs) and sample selection. Acute challenging experiences may be therapeutically meaningful, but a better understanding of AEs in the context of psychedelic treatments requires systematic and detailed reporting.

Limb Girdle Muscular Dystrophy Type 2L (Anoctamin 5 Deficiency): Cardiac Involvement and Characterization of the Skeletal Muscle Phenotype (S15.006)

Objective: To test the prevalence of the newly discovered limb girdle muscular dystrophy type 2L (LGMD2L) in Denmark, and further characterize the phenotype. Background Mutations in the anoctamin 5 gene causes LGMD2L, which was first described in 2010. Two existing reports on small LGMD2L cohorts, suggest that LGMD2L may be a relatively common cause of LGMD2. Less than 30 patients have been reported so far. It appears that the disease, like LGMD2B (dysferlinopathy) may present as either classical LGMD2 or as a distal myopathy (MMD3), primarily involving the posterior calf musculature. In this study, we determined the prevalence of anoctamin 5 deficiency in a cohort of patients with unclassified LGMD2, hyperCKemia or distal myopathy. Design/Methods: All unclassified LGMD2 patients (26 out of 161), unexplained hyperCKemia (15 patients) and distal myopathies (5 patients) were tested for mutations in ANO5. All mutation-positive patients underwent a clinical exam, echocardiography and 48-h Holter monitoring. Results: Ten of 26 unclassified LGMD2 patients, 2 of the 15 hyperCKemia patients and 4 of 5 distal myopathy patients had LGMD2L. All patients carried the common c.191dupA mutation on at least one allele. Echocardiograhies were unremarkable, but Holter monitoring showed a 2.5-fold increase in premature ventricular contractions, which predicts an increased risk of cardiovascular disease. Only 2 of the 16 patients were women. In distal forms, the medial gastrocnemius muscle was the preferentially affected muscle, but the phenotype converges into a LGMD2 phenotype in all patients with time. Calpain 3 expression on Western blots was decreased in about half the patients. Conclusions: This study suggests that LGMD2L (16 patients) is the third commonest LGMD2 type in Denmark, only surpassed by LGMD2I (64 patients) and LGMD2A (22 patients). The study demonstrates for the first time that cardiac involvement may occur in this disease, and suggests a regular electrocardiographic follow-up of these patients. Disclosure: Dr. Vissing has received personal compensation for activities with Genzyme Corporation. Dr. Witting has nothing to disclose. Dr. Lauritsen has nothing to disclose. Dr. Duno has nothing to disclose.

Heart rate dependency of premature ventricular contractions. Correlation between electrocardiographic monitoring and exercise-related patterns.

The identification of the response of ventricular arrhythmias to exercise testing could provide important information in the clinical setting but is difficult to obtain as no definite criteria are available. The aim of this study was to evaluate whether analysis of spontaneous heart rate dependency of premature ventricular contractions evaluated by means of 24 h electrocardiographic monitoring is capable of predicting their behaviour during exercise. One hundred and twenty-six patients (49 +/- 16 years) with frequent (> 30 h) premature ventricular contractions underwent 24 h electrocardiographic monitoring in order to evaluate the relationship between arrhythmias and heart rate, and an exercise test in order to evaluate the behaviour of the arrhythmias. On the basis of the incidence of premature ventricular contractions at different cardiac cycle lengths found at electrocardiographic monitoring, three groups of patients were identified: 34 with a tachycardia-enhanced pattern (the shorter the cycle length the higher the incidence of arrhythmias); 32 with a bradycardia-enhanced pattern (the longer the cycle length the higher the incidence of arrhythmias); and 60 patients with an indifferent pattern (no relationship). During the exercise test, the number of premature ventricular contractions/min at maximal effort in comparison with baseline increased in patients with a tachycardia-enhanced pattern (couplets or runs appeared in 10), decreased in those with a bradycardia-enhanced pattern and did not change in those with an indifferent pattern. The positive predictive accuracy of the tachycardia-enhanced pattern in predicting an increase in premature ventricular contractions > 100% at maximal effort was 78%. Identification of spontaneous behaviour between the incidence of premature ventricular contractions and the length of the preceding cardiac cycle may predict the behaviour of arrhythmias during exercise.

Shock Wave Lithoripsy with the Dornier MFL 5000 Lithotriptor Using an External Fixed Rate Signal

Purpose We examine the effects of fixed rate shock wave administration on the cardiac rhythm and treatment efficacy of a tubless lithotriptor (Dornier MFL 5000 * * Dornier Medical Systems, Marietta, Georgia. ). A secondary goal was to examine the treatment efficacy of fixed shock were administration compared to R wave triggered lithotripsy. Materials and Methods In this prospective study Holter monitoring was used before, during and after nonR wave triggered shock wave lithotripsy. Results An increase in premature ventricular contractions was noted during shock wave lithotripsy. However, there were no episodes of significant ventricular ectopia, ventricular tachycardia, asystole or heart block as a result of nonR wave triggered shock wave administration. NonR wave gated shock wave lithotripsy expedited patient treatment (mean treatment time 46 plus/minus 21 minutes), minimized the use of sedation during treatment and produced results similar to R wave gated shock wave lithotripsy with the MFL 5000 lithotriptor. Conclusions With adequate precautions, fixed rate shock wave administration would appear to be a reasonable option to treat urolithiasis with the MFL 5000 lithotriptor as with other newer lithotriptors.

Effects of Long-Term Therapy with Oral Piroximone on Resting Hemodynamics, Peak Aerobic Capacity, and the Anaerobic Threshold in Patients with Heart Failure

Piroximone (MDL 19205), a new imidazole derivative with positive inotropic and vasodilating properties, was administered to 10 patients with congestive heart failure. After acute intravenous (0.90 +/- 0.12 mg/kg, mean +/- SEM) and oral (1.41 +/- 0.18 mg/kg) administration, cardiac index and stroke volume index increased and were accompanied by a decline in systemic vascular resistance, pulmonary capillary wedge pressure, and right atrial pressure. Mean arterial pressure was unchanged, but heart rate increased modestly after intravenous piroximone. An increase in premature ventricular contractions was documented in four patients after drug administration. Seven of the 10 patients completed 12 weeks of therapy with piroximone; one patient withdrew after 8 weeks because of deterioration in clinical status; one developed severe ventricular arrhythmias and died after 5 days of treatment; and a drug-induced hepatitis was documented in one subject at 4 weeks. No significant improvement in oxygen uptake at peak exercise and the anaerobic threshold was observed after long-term treatment (assessed at 6 and 12 weeks). Hemodynamic responsiveness to piroximone was sustained in five patients who underwent repeat evaluation at 12 weeks. Thus, long-term treatment with piroximone was not associated with an improvement in maximal and submaximal exercise capacity in patients with congestive heart failure. Serious adverse effects were observed with the administration of this drug.

Submaximal Treadmill Exercise Evaluation in Patients with Symptoms of Cardiovascular Disease: An Aid to Rehabilitation and Re-Employment

The potential benefits of submaximal treadmill exercise testing were evaluated in 250 patients. The exercise endpoint was angina pectoris with a positive test for ischemic heart disease in 27 of 250 (10.8 percent) and paroxysmal atrial tachycardia in two patients. An increase in premature ventricular contractions developed in 32 of 250 patients (12.8 percent) and 18 of 250 patients (7.2 percent) developed more supraventricular ectopic contractions. In 152 patients referred for undiagnosed chest pain, having been considered physically disabled, 100 (65 percent) returned to active work. Of 52 patients with arrhythmias either detected or increased in frequency by testing all but three returned to more activity. It is concluded that submaximal treadmill exercise testing is useful in detecting ischemia and arrhythmias in patients with cardiovascular symptoms and aids in returning many patients to more physical activity. The potential benefits of submaximal treadmill exercise testing were evaluated in 250 patients. The exercise endpoint was angina pectoris with a positive test for ischemic heart disease in 27 of 250 (10.8 percent) and paroxysmal atrial tachycardia in two patients. An increase in premature ventricular contractions developed in 32 of 250 patients (12.8 percent) and 18 of 250 patients (7.2 percent) developed more supraventricular ectopic contractions. In 152 patients referred for undiagnosed chest pain, having been considered physically disabled, 100 (65 percent) returned to active work. Of 52 patients with arrhythmias either detected or increased in frequency by testing all but three returned to more activity. It is concluded that submaximal treadmill exercise testing is useful in detecting ischemia and arrhythmias in patients with cardiovascular symptoms and aids in returning many patients to more physical activity.