Stokes-Adams Attacks Research Articles

A Rare Case of Ventricular Standstill and High-Grade AV Block in Patient with Thyrotoxicosis

Background Stokes-Adams Syndrome can be caused by high-grade AV Block, ventricular tachycardia, and one of the uncommon cause, ventricular standstill. Although thyrotoxicosis is commonly presented as tachycardia, it’s unusual for AV blocks to occur, especially a high-grade one.Case Illustration A 45-year-old female was admitted with fatigue, dizziness, and recurrent episodes of unconsciousness. She had a history of hyperthyroid, routinely managed with Propylthiouracil and Propranolol. Physical examination showed HR: 30 x/min, and other unremarkable systemic examinations. Initial ECG showed 3:1 AV Block. Patient was managed with Dopamin and moved to ICU for further observation. In the ICU, suddenly she had a Stokes-Adam episode presented as a seizure, her monitor showing P waves with an absence of ventricular activity lasting for few seconds. Due to the condition of ventricular standstill, a Temporary Pacemaker (TPM) was installed urgently, and so patient’s vital sign was stable with pacing rhythm. We found Free Thyroxine (T4) level of 46.85 pmol/l, TSH of 0.005 ulU/ml, and unremarkable echocardiographic findings. Considering these results, we suspect that the cause of the ventricular standstill was due to thyrotoxicosis. Propylthiouracil and dexamethasone were given to manage the disease. After 7 days of treatment, she was discharged with sinus rhythm on her ECG. Conclusion Ventricular standstill is frequently associated with conduction blockages, but it can sometimes occur without them. Ventricular standstill treatment often necessitates the use of temporary pacing wires or a pacemaker. In thyroid crises, high-degree AV-block is uncommon, but when the euthyroid condition is restored, clinical status and conduction problems can be reversible.

Chatterjee phenomenon in a patient with heart failure with preserved ejection fraction: a case report

The article presents a case report of the Chatterjee phenomenon after implantation of a pacemaker in a patient with heart failure with preserved ejection fraction. During hospitalization in a specialized cardiology hospital, the patient's electrocardiogram (ECG) showed atrial fibrillation (AF) with a ventricular rate of 49 bpm, ST segment depression of 1 mm in I, II, V4-V6 leads. Taking into account the data of 24-hour ECG monitoring (pauses up to 5,2 seconds with AF) and Stokes-Adams syndrome equivalents, a decision was made to implant a single-chamber pacemaker. Immediately after the pacemaker implantation, AF was registered on the ECG with a pacemaker VVI mode of 60 pulses/min. On the second day after intervention, the pacemaker was reprogrammed in the form of reducing the minimum pacing rate from 60 to 45 pulses/min. On the third day after pacemaker implantation, altered terminal ventricular complex part was detected in the form of negative T waves in I, II, III, aVF, V2-V6 leads, as well as ST segment depression in V3-V6 to 1,5 mm. Differential diagnosis of the identified abnormalities with other clinical conditions accompanied by impaired repolarization processes according to ECG data was carried out. In dynamics, normalization of the ECG picture after 2,5 months was demonstrated.

Robert James Graves (1796-1853), The Irish School of Medicine, and Graves' Disease.

Robert James Graves, a native of Dublin, Ireland, was a physician rather than a surgeon; however, his name is well-known to all general and endocrine surgeons. He was born in Dublin, Ireland, and received his BA and MB degrees from Trinity College (formerly, Dublin University). After further studies throughout Europe, he received his "licentiate" from the Royal College of Physicians of Ireland in 1820 and was appointed Physician to the Meath Hospital in Dublin in 1821. Graves received many honors during his career including the following: King's Professor in the Institute of Medicine (1824); President of the Royal College of Physicians of Ireland (1843-44); and a Fellow of the Royal Society (FRS, 1849). In addition, he was a prominent member of the Irish School of Medicine which also included William Stokes (1804-1878) (Cheyne-Stokes breathing, Stokes-Adams attacks) and Dominic Corrigan (1802-1880) (Corrigan's pulse). Graves' description of exophthalmic goiter was in 1835, some 49 years after that of Caleb Hillier Parry (1755-1822) of Bath, England; however, Bath's report was not published till 1825 or 3 years after his death. Graves' disease is still the eponym applied to this form of hyperthyroidism in the United States.

Clinical analysis of temporary pacemaker implantation in 13 children.

BackgroundAt present, temporary pacemaker implantation is very common in the treatment of cardiovascular diseases in adults. However, the number of pediatric pacemakers implanted is still relatively small, and relevant research is also far less than that of adults. This study aimed to explore the application of temporary pacemakers in children with acute and critical cardiovascular diseases.MethodsThe clinical data of children with cardiovascular diseases who were treated with temporary pacemakers in Tianjin Children’s Hospital from October 2017 to February 2021 were analyzed retrospectively.ResultsA total of 13 children with cardiovascular diseases were included in this study, including 4 males and 9 females, mean age of 71.2±56.3 months, and median body weight of 15.5 kg. There were 9 children with endocardial pacing and 4 children with epicardial pacing. The types of diseases included fulminant myocarditis (n=8), complete atrioventricular block (CAVB; n=1), and arrhythmias after open heart surgery (n=4). The median time from onset to admission was 1.0 days in children with endocardial pacing and there was cardiac arrest in 2 children, heart failure in 9 children, cardiogenic shock in 8 children, and Adams-Stokes attack in 7 children. The median time from admission to implantation of temporary pacemakers was 3.0 h and the operation time was 55.0±19.4 min. All 4 children with epicardial pacing had pacemakers implanted during operation because of CAVB. The pacing mode was VVI mode. The initial perceptual voltage was 1–2 mv, the output voltage was 5v, and the pacing frequency was 70–145 bpm. A total of 11 children reverted to sinus rhythm within 5.0 (1.8–34.0) h and the working time of temporary pacemakers was 134.0 (15.0–191.0) h. There was poor pacing in 2 children and catheter displacement in 1 child during pacing. A total of 12 children were followed up for 20.0±12.5 months and 1 was lost to follow-up. During the follow-up period, the cardiac functions were basically normal and no new arrhythmia appeared.ConclusionsTemporary pacemakers have the advantage of simple operation, definite effect, and safety which has a remarkable effect in the treatment of acute and critical cardiovascular diseases in children.

Impact of bedrest on cardiovascular events and complications associated with temporary pacemakers in patients waiting for permanent pacemaker implantation.

BackgroundPatients with a temporary pacemaker (TPM) for bradycardias are required to maintain bedrest until permanent pacemakers (PPMs) are implanted because of the development of Adams–Stokes syndrome, worsening heart failure, or complications associated with TPMs is anticipated. However, bedrest may be detrimental in patients because it leads to disuse syndrome. This study examined whether bedrest could decrease the incidence of cardiovascular events or complications associated with TPMs in patients waiting for PPM implantation.MethodsWe conducted a retrospective cohort study on 88 patients who had emergency hospitalization for the treatment of bradycardias, and a TPM was inserted during the waiting period before PPM implantation. We divided patients into two groups according to whether they underwent bedrest (Bedrest Group) or not (Ambulation Group) during the period that patients were supported with TPM. We evaluated whether bedrest was a predictor of adverse events using a logistic regression analysis.ResultsAdverse events occurred in 31 patients (35%). In the univariate analysis, there was no significant difference in the incidence of adverse events between the Bedrest and Ambulation Groups (39% vs. 29%). In the logistic regression analysis, bedrest was not a predictor of adverse events (odds ratio, 1.40; 95% confidence interval, 0.53‐3.68, P = .497).ConclusionsIn patients with TPMs for bradyarrhythmias during the waiting period for PPM implantations, bedrest might not prevent adverse events, such as cardiovascular events and complications associated with TPMs.

P898Association of acroparesthesias and angiokeratomas with the alpha-galactosidase A gene polymorphisms in females with hypertrophic cardiomyopathy

Abstract Introduction Clinical implications of different single nucleotide polymorphisms (SNPs) in the alpha-galactosidase A gene (α-GLA) as potential cause of symptoms and organ manifestations similarly to those seen in Fabry disease (FD) remain unclear. Purpose To study the prevalence of FD among patients with hypertrophic cardiomyopathy (HCM), as well as to evaluate the impact of polymorphic variants of the α-GLA gene on extracardiac manifestations in females with HCM. Methods The study included 321 patients with left ventricular hypertrophy ≥15 mm. 24 of the 321 patients (males (n=15) and females (n=9)) presented with HCM phenotype and extracardiac features suggestive of FD: acroparesthesias and pain in hands and feet, stroke at a young age, angiokeratomas, kidney damage (microalbuminuria, proteinuria, decreased glomerular filtration rate), suspicion for X-linked inheritance. This patients carried out screening for FD. A combined enzymatic and genetic strategy was used, measuring the activity of α-D-galactosidase A by tandem mass spectrometry (ESI-MS/MS) and genotyping the α-GLA (in females) in dried filter-paper blood spot samples. Results We haven't identified any pathogenic genetic variants in the α-GLA gene. However, in three patients with HCM, the two intronic SNPs within the α-GAL gene (c.640–16A>G [rs2071397] and c.1000–22C>T [rs2071228]) were identified. Patient no. 1, a 64-year-old female, was admitted to our clinic for the diagnosis of obstructive HCM. She also had a transient 2:1 second degree atrioventricular block, an Adams-Stokes attack, angiokeratomas and left median cerebral artery lacunar stroke in middle age. In case no. 2, a 75-year-old female, were verified obstructive HCM, a 1st degree atrioventricular block, paroxysms of nonsustained ventricular tachycardia, acroparesthesia, pain in hands and angiokeratomas. In patient no. 3, a 41-year-old female, were established combined phenotypes (nonobstructive hypertrophic + restrictive), acroparesthesia, pain in hands and angiokeratomas. Conclusions In females with HCM, the intronic SNPs (rs2071397 and rs2071228) in the α-GLA gene can be associated with angiokeratomas and acroparesthesias.

Heart transplantation in a patient with primary malignant tumor

The article looks at a clinical case of a 31-year-old female with signs of paroxysmal ventricular tachycardia and Morgagni–Adams–Stokes syndrome. In April 2014, electrophysiological examination revealed a source of ventricular tachycardia localized in the apices of the right and left ventricles of the patient. The sources were then subjected to RF ablation followed by cardioverter-defibrillator implantation. Subsequent antiarrhythmic therapy failed to improve her state. In September 2016 the patient was re-examined and underwent RF ablation of the apical region of the right ventricle. Later on, taking into account continuously recurrent life-threatening cardiac rhythm disorders, as well as unpromising strategies for further conservative treatment, she was put on the waiting list and then underwent orthotopic cardiac transplantation. Histological examination and immunohistochemistry assay showed leiomyosarcoma in the source of ventricular tachycardia previously found in the apex of the right ventricle. This clinical case demonstrates a diversity of clinical manifestations of primary malignant tumors of the heart that pose a challenge for intravital diagnostics and interpretation of a clinical picture.

Hereditary Long Q-T Without Congenital Deafness (Romano-Ward) Syndrome

We report a case o fhereditary long Q-T syndrome without congenital deafness (Romano-Ward syndrome). In four members of a family, a father and his daughters, the Q-T intervals on the EKG were found to be prolonged. There were no other accompanying familial anomalies such as deafness or a tendency to extracellular hypokalemia The youngest daughter which had the longest. Q-T interval had several Adams-Stokes attacks, and died in the last attack at the age of 23 months. Her two older siblings died at the age of 15 and 10 months with the same typical clinical histories. The eldest daughter, a 12-year old girl, has no clinical symptoms at all, while the fourth child, 5-yeltr old girl has several occasions of near fainting attacks. The EKG of the father showed several runs of supraventricular premature contractions that ceased spontaneously, besides evidence of the prolongation of Q-T interval. The beta-adrenergic blocking drug (propranalol) given in a relatively small maintenance dose, proved to be effective in preventing attacks of the father and the fourth child, despite the unchanged prolongation of the Q-T interval.

P4-5 - A Case Report of Left Ventricular Noncompaction With Syncope Due to Adams-Stokes Syndrome, Requiring ICD Implantation

Objective: I reported a case diagnosed as left ventricular noncompaction (LVNC) after Adams-Stokes syndrome complicated with traumatic subarachnoid hemorrhage and acute subdural hematoma. Case Presentation: A 78-year-old man with family history of sudden death was diagnosed as atrial fibrillation and suspected as dilated cardiomyopathy by home doctor. After he fell down and had head trauma because of syncope during walking without symptom, he got seizure at home, transferred to our hospital by helicopter emergency medical service. Head CT showed traumatic subarachnoid hemorrhage and acute subdural hematoma, and Adams-Stokes syndrome was suspected. His echocardiography showed left ventricular ejection fraction about 30% with diffuse hypokinesis, and remarkable trabeculations at lateral wall with blood flow confirmed by color Doppler. Cardiac magnetic resonance showed trabeculations at lateral wall with late gadlinium enhancement and noncompaction to compaction ratio above 2. Considering these findings, we diagnosed as LVNC. Holter electrocardiography showed non-sustained ventricular tachycardia, and electrophysiological study resulted in induction of ventricular tachycardia and ventricular fibrillation. We decided ICD implantation with judgement as class I. He was discharged with carvedilol 10 mg, perindopril 6 mg, spironolactone 25 mg. Conclusion: I experienced a rare case of LVNC after syncope due to Adams-Stokes syndome, requiring ICD implantation.

Non-Hodgkin's Lymphoma Complicated with Marked Hypercalcemia Caused by Parathyroid Hormone Related Protein, Presenting with Adams-Stokes Attack

A rare case of non-Hodgkin's lymphoma (NHL) complicated with marked hypercalcemia caused by parathyroid hormone related protein (PTHrP) and presenting with Adams-Stokes attack is reported. A 72-year-old woman was involved in a traffic accident, and was transferred to our hospital. Blood examination revealed marked hypercalcemia (5.3 mmol/l (21.3 mg/dl)). A diagnosis of NHL (B-cell lymphoma, clinical stage IVA) was made by the results of the bone marrow biopsy, CT features showing multiple masses, and the gallium scintigraphy showing strong accumulation. Because of high blood level of PTHrP, hypercalcemia was considered to be due to PTHrP as a mediator acting on calcium metabolism. Hypercalcemia complicated with malignancy has a risk resulting in a fatal outcome. In the cases of malignant lymphoma complicated with hypercalcemia, we should pay attention to PTHrP as a mediator.

Unusual electrocardiographic presentation of conduction disturbances from acute use of Chloroquine: rare case report

23-year-old man presented with Stokes-Adams attacks due to sinus node dysfunction. He was being treated for malaria with chloroquine for the last two days. Temporary pacemaker was implanted. Subsequently he developed all spectrum of atrioventricular block following recovery of sinus node dysfunction which also recovered on the fi fteenth day and was discharged. Cardiac damage, such as cardiomyopathy and conduction system disturbances, is regarded as uncommon consequences of acute chloroquines’s toxicity. Here we present a case in which chloroquine used as acute therapy for malaria resulted in conduction disorder beginning from sinus node dysfunction to Mobitz I atrioventricular block to complete heart block with recovery to normal sinus rhythm in single patient.

Clinical analysis of 73 pediatric patients with completely atrioventricular conduction block

Objective To explore the causes, clinical characteristics and prognosis of children's completely atrioventricular block(CAVB). Methods The clinical data of 73 patients with CAVB were analyzed retrospectively from January 2004 to December 2013 at the Cardiology Department, Nanjing Children's Hospital Affiliated to Nanjing Medical University.Within those 73 patients, 34 patients were male and the others were female, from 3 months old to 12.5 years old, the mean age of 6 years. Results There were 21 congenital CAVB patients and 52 acquired CAVB patients with myocarditis undergoing ventricular septal defect (VSD) closure operation.All congenital CAVB patients were refractory to drug therapy.Electrocardiogram and echocardiogram were performed in 19 cases without clinical symptoms during follow-up, but 2 cases had permanent pacemaker implanted.Among 27 fulminant myocarditis, Adams-Stokes attacks were found in 15 cases, 3 cases had Adams-Stokes attack in 15 cases with sequelae of myocarditis, and 2 out of 6 cases undergoing VSD closure operation had Adams-Stokes attack, and other 4 cases without clinical symptoms were followed up periodically.The acquired CAVB patients were given energy composition and intravenous megavitamin C. The cases with fulminant myocarditis were given adrenal cortical hormone and intravenous gamma globulins simulta-neously.A total of 27 acquired CAVB patients were implanted temporary pacemaker and 5 with permanent pacemaker.Among 52 acquired CAVB patients, 31 cases were cured, 9 cases were improved, 11 cases were ineffective, and 1 case died. Conclusions Most congenital CAVB children without clinical symptoms need clinical follow-ups.Myocarditis is a major cause of acquired CAVB.The CAVB prognosis caused by fulminant myocarditis may be related to antimely implanting the temporary pacemaker timely.Permanent pacemaker should be implanted in patients who have no response to drug therapy with frequent Adams - Stokes or heart failure. Key words: Complete atrioventricular block; Pacemaker; Prognosis; Child

Acute cholecystitis mimicking or accompanying cardiovascular disease among Japanese patients hospitalized in a Cardiology Department.

BackgroundAcute cholecystitis sometimes displays symptoms and electrocardiographic changes mimicking cardiovascular problems. It may also coexist with cardiovascular disorders. We analyzed the clinical characteristic of the cardiac patients who were diagnosed with acute cholecystitis during hospitalization in the cardiology department.MethodsUsing the department database, we identified 16 patients who were diagnosed with acute cholecystitis during the hospitalization in the cardiology department between June 2010 and June 2014.ResultsFive patients who were initially suspected to have cardiac problems (acute coronary syndrome, four patients; Adams-Stokes syndrome, one patient) owing to their symptoms were subsequently diagnosed with acute cholecystitis. Two of these patients showed electrocardiographic changes mimicking myocardial ischemia, and three tested positive for a biomarker (heart-type fatty acid binding protein) of acute myocardial injury. The 11 remaining cardiac patients were diagnosed with acute cholecystitis during their hospitalization or at the time of admission. Prolonged fasting and/or staying in an intensive care unit (ICU) may have contributed to their condition. Among these 11 patients, aortic dissection was the most prevalent underlying cardiac condition, affecting 5 patients.ConclusionsAlthough it is a rare condition, acute cholecystitis may coexist with or be misdiagnosed as a cardiovascular disorder. This possibility should not be overlooked in cardiac patients because a delay in treatment may result in critical complications.

A prospective multicenter clinical study of Xuebijing injection in the treatment of sepsis and multiple organ dysfunction syndrome

To evaluate the clinical efficacy and safety of Xuebijing injection in treatment of sepsis and multiple organ dysfunction syndrome (MODS). A prospective multicenter clinical study was conducted. The patients with sepsis, severe sepsis, or MODS admitted to Department of Emergency and Critical Care Medicine of 70 hospitals across the country during 2006 to 2008 were enrolled. All of the patients received the basis treatment of conventional therapy, plus Xuebijing injection of 50-100 mL, 2-3 times a day for 5-7 days, and the dose might be increased in serious cases. The vital signs, 24-hour urine output, Glasgow coma score (GCS), white blood cell count (WBC), platelet count (PLT), Marshall score, gastrointestinal function score, syndrome of traditional Chinese medicine (TCM), blood lactate (Lac), blood glucose, serum creatinine (SCr), and total bilirubin (TBil) were observed before treatment, 1, 3, and 5 days after treatment, and at the end of the treatment. The results of above mentioned parameters after the treatment were compared with that before treatment in each patient. At the same time, the occurrence and the degree of adverse reactions were recorded to evaluate the safety of Xuebijing injection. A total of 2,574 patients were enrolled, and in 2,509 cases the treatment was completed in, with a drop of 65 cases. 704 cases were diagnosed to have sepsis, 768 with severe sepsis, and 1,037 with MODS. According to TCM, in 1,951 cases syndrome of stasis-toxin in the interior, and in 558 syndrome of excessive exuberance of heat-toxic in the interior were diagnosed. After the treatment of Xuebijing injection combined with conventional therapy, the temperature, heart rate, respiration rate, blood pressure, WBC, PLT, GCS, 24-hour urine output, blood glucose, Lac, SCr, TBil, Marshall score, gastrointestinal function score, as well as the symptoms, signs and TCM tongue condition and pulse condition, and TCM scores were significantly improved in all patients as well as the patients with sepsis, severe sepsis, or MODS (P<0.05 or P<0.01). The effective rate of all patients and the patients with sepsis, severe sepsis, or MODS was 89.20% (2,238/2,509), 92.76% (653/704), 91.54% (703/768), 85.05% (882/1,037), respectively, and the 28-day survival rate was 93.90% (2,356/2,509), 98.01% (690/704), 96.35% (740/768), 89.30% (926/1,037), respectively. In 3 patients with MODS adverse events (0.12%) occurred, including 2 cases of stress ulcer and 1 case of Adams-Stokes syndrome. After clinical evaluation, the adverse events were found to be unrelated with the study medication, and Xuebijing injection was continued till the end of treatment. Xuebijing injection combined with conventional therapy may effectively ameliorate systemic inflammatory response, protect organ function, alleviate the symptoms, improve organ functions, and elevate the clinical cure rate. Adverse events occur occasionally. Xuebijing injection is found to be safe.

Clinical features of the fulminant myocarditis

Objective To review the clinical features of fulminant myocartitis, in order to provide assistance to the clinical management. Methods The clinic data of 183 patients with viral myocarditis, including 153 cases of acute myocarditis and 30 cases of fulminant myocarditis admitted in our hospital during January 2008 and Dec 2012 were retrospectively analyzed. The age of onset, interval after virus infect, initial symptoms, auxiliary examination, treatment, and turnover were compared in the study. Results The average onset age of fulminant myocartitis and acute myocarditis were similar[(22.3±7.6) vs. (26.2±12.6) years, P=0.105 5]. There was a significant difference between the two gourps in the rate of patients with a explicit history of virus infection[30.0%(9/30) vs. 78.4%(120/153), χ2=28.3, P<0.001], the average interval after virus infect [(3.1±2.2) vs. (7.0±3.80) d, P<0.001] and the length of hospital stay[(12.1±6.9) vs. (6.9±4.50) d, P<0.001].Chest congestion (101/153, 66.0%), feebleness(76/153, 49.7%), fluster(74/153, 48.4%) are the most onset symptoms of acute myocarditis, while chest congestion (24/30, 80.0%), shortness of breath(14/30, 46.7%), feebleness(13/30, 43.3%) in flunimant myocarditis.Advanced A-V block(19/30, 63.3%), cardiogenic shock (18/30, 60.0%), ventricular arrhythmia(16/30, 53.3%), Adams-Stokes syndrome(8/30, 26.67%) and acute renal failure(8/30, 26.7%) were the most complications of flunimant myocarditis.Temporary pacemaker(11 cases), extracorporeal memberane exygenator(7 cases) and intra-aortic balloon pump(7 cases) were applied in critical patients.In acute phase, 21 cases were cured, 9 cases was dead of cardiogenic shock and ventricular(27, 30.0%). Two dead cases applied with ECMO because of delay.After leaving hospital, 1 case was implanted permanent pacemaker, 2 cases became chronic myocarditis and required hospitalization repeatedly. Conclusions The fulminant myocarditis has a rapid onset, most of which has no prodrome of virus infection or a shorter interval than acute myocarditis. Timely and effective mechanical circulatory support is critical for fulminant myocarditis. Key words: Myocarditis; Clinical feature; Diagnosis

Evaluation of the effect of transdermal nitroglycerin and intravenous neostigmine added to lignocaine for intravenous regional anesthesia

Objective This study aimed to determine the advantage of a combination of transdermal nitroglycerine and neostigmine in intravenous regional anesthesia (IVRA). Background The aim of this study was to evaluate the effect of transdermal nitroglycerine, neostigmine, or both when added to lidocaine compared with lidocaine alone in the IVRA technique. Patients and methods Eighty patients (ASA grade I and II, aged 18-60 years) of both sexes were enrolled. The patients were divided randomly into groups as follows: group 1: the neostigmine group: a dose of 2.5 mg/kg lidocaine 0.5% (0.5 ml/kg) with the addition of 0.5 mg neostigmine was administered ( n = 20). Group 2: nitroglycerine group: a dose of 2.5 mg/kg lidocaine 0.5% (0.5 ml/kg) with the addition of 5 mg of transdermal nitroglycerine (a nitroglycerine patch was applied 2 h before the start of IVRA) was administered ( n = 20). Group 3: nitroglycerine-neostigmine group: a dose of 2.5 mg/kg lidocaine 0.5% (0.5 ml/kg) with the addition of 5 mg of transdermal nitroglycerine (a nitroglycerine patch was applied 2 h before the start of IVRA) and 0.5 mg neostigmine was administered ( n = 20). Group 4: lidocaine only (control group): participants received IVRA with 2 ml saline added to lidocaine (0.5 ml/kg) ( n = 20). Exclusion criteria Patients with ischemic heart disease, heart block, second or third degree, severe sinoatrial block, serious adverse drug reaction to lidocaine or amide local anesthetics, concurrent treatment with quinidine, flecainide, disopyramide, procainamide, Adams-Stokes syndrome, Wolff-Parkinson-White syndrome, allergic reactions to organic nitrates, allergy to nitroglycerin, allergy to the adhesive patches, hypersensitivity to neostigmine, myasthenia graves, a history of reaction to bromides, peritonitis, mechanical gastrointestinal, or urinary tract obstruction were excluded. Results Sensory and motor block onset times were shorter in the neostigmine-nitroglycerine group compared with all the other groups ( P P Conclusion We found that the addition of 0.5 mg neostigmine to a dose of 2.5 mg/kg of 0.5% lidocaine for IVRA with a 5 mg transdermal nitroglycerine patch improved the operating conditions and the quality of anesthesia and prolonged postoperative relief, with no adverse effects.

Swallow syncope after cardiac surgery in a sheep

Swallow syncope after cardiac surgery in a sheep

症例 アダムス・ストークス発作を呈したコクサッキーB群ウイルス感染による心膜心筋炎の1例

症例 アダムス・ストークス発作を呈したコクサッキーB群ウイルス感染による心膜心筋炎の1例

症例 向精神薬服用中に失神発作をきたした1症例:Phenothiazine系薬剤によるQT延長とAdams-Stokes 症候群

症例 向精神薬服用中に失神発作をきたした1症例:Phenothiazine系薬剤によるQT延長とAdams-Stokes 症候群

症例 心室瘤を伴う原発性アルドステロン症に合併したアダムス-ストークス症候群の1例

症例 心室瘤を伴う原発性アルドステロン症に合併したアダムス-ストークス症候群の1例