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Sick sinus syndrome in chronic chagas heart disease
ABSTRACTS
SICK SINUS SYNDROME IN CHRONIC CHAGAS’ HEART DISEASE. MD, FACC; Jos6 R. LosanoOtto Hern&ndez-Pieretti, Wilson, MD; Adalberto Urbina-Quintana, MD; Guillermo Villoria, MD; Maria I. de Herndndes, MD; Enrique y Escuela de Medicina G6mes-Amundarain, MD. “Hospital Vargas” and “Hospital Central de las Fuerzas Armadas” Caracas. Venezuela. Sick Sinus Syndrome (SSS) had not been reported as such in Chronic Chagas’ Heart Disease (CCHD). The following study was conducted to evaluate the incidence and clinical picture of SSS in CCHD. The clinical rewith CCHD were reviewed. The mean cords of 700 pts. age, the absence of angina and the other clinical fea tures did not suggest coronary artery disease. The were consistent with SSS and divided ECG of 15 pts. into two groups. Group I (5 pts.) did not reveal asso ciated A-V conduction disturbances; the mean age was and there was no evidence of congestive 73.6 yrs. heart failure (CHF). Group II included 10 pts. in whom SSS was associated to A-V conduction disturbances; the mean age was 45.9 yrs. CHF was present in 30 $. Dizziness and Stokes Adams Syndrome (SAS) were observed in both groups: 40% in group I and 20% in group II. Permanent pacemakers could be implanted in The analysis revealed that SSS is only 73% of pts. not a common isolated finding in CCHD. However, this disorder was associated with severe symptoms, including SAS. The ECG abnormalities associated to SSS further indicate severe damage to atrial, junctional and ventricular tissue (P wave abnormalities, intermittent slow junctional and ventricular rhythms, A-V block, BBB, hemiblocks, PACs, PVCs, etc.) with involvement of pacemakers and conducting system. Relatively long periods of atria1 and ventricular asystole were recorded by Dynamic ECG, indicating severe depression of sinus node and subsidiary pacemakers.
EVALUATION OF ACUTE MYOCARDIAL INFARCTION WITH TECHNETIUM-99m-TETRACYCLINE INFARCT IMAGING B. Leonard Holman, MD; Michael Lesch, MD, FACC; Franklin Zweiman, MD; John Temte, MD, PhD; Mrinal K. Dewangee,PhD; Bernard Lown, MD, FACC; Richard Gorlin, MD, FACC, Peter Bent Brigham Hospital, Boston, Mass.
PRODROMA OF VENTRICULAR FIBRILLATION IN ACUTE ISCHEMIA: EFFECT OF HEART RATE AND ANTI-ARRHYTHMIC DRUGS Ronald R. Hope, MB, MPACP: Benjamin J. Scherlag, PhD; Philip Samet, MD, FACC, Mount Sinai Medical Center, Miami Beach, Florida The efficacy of antiarrhythmic drugs in the prehospitalisation phase of acute myocardial infarction has not been established. In 25 open chest dogs with the anterior descending coronary artery (ADCA) temporarily occluded (2-6 min), ischemic zone subepicardial electrograms (IZE) were recorded. Ventricular arrhythmias (including premature contractions, tachycardia and fibrillation) occurred in all and followed increasing delay in IZE onset up to 320 msec whereas the average QT interval was 280 msec. The effect of heart rate (HR), lidocaine and propranolol on IZE delay was examined. With atria1 pacing CAP), an average increase in HR of 32% in 6 normal and 3 denervated dogs during ADCA occlusion resulted in severe IZE delays and ventricular arrhythmias whose average onset was 1.4 min earlier than at control HR (2.8 min with AP; 4.2 min control HR). The effect of lidocaine (lo-15 mg/kg) during 14 temporary occlusions of the ADCA in 10 dogs was compared with 19 occlusions without lidocaine in the same dogs. At the same period of ischemia there was no difference in IZE delay with or without lidocaine (70*20 msec and 69f20 msec, respectively. Propranolol slowed the average HR from 140/min to 109/min. Average IZE delay at the same period of ADCA occlusion was 42+8 and 4956 msec with and without propranolol, respectively. ADCA occlusion for the same period with AP at 170-200/min resulted in IZE delays of 66+5 msec without, and 76+2 msec with propranolol. IZE delay and ventricular arrhythmias after ADCA occlusion occurred earlier if HR was increased. Propranolol inhibited the onset of IZE delay by slowing HR. Lidocaine had no effect on HR and did not influence IZE delay or the onset of early ventricular arrhythmias.
HEMODYNAMIC
AIan J. Hordof,M.D., Jr., MD., University
Tetracycline binds to necrotic tissue; its fluorescence has been used to identify experimental acute myocardial infarction (AMI). When Tetracycline is labeled with Technetium-99m ( ggmTc-TC), its concentration in the infarcted tissue can be imaged by noninvasive external means, permitting detection, localization and sizing of the lesion. The thorax was imaged in anterior, LAO and BAO projections in 13 CCU and 8 control patients 4, 8 and 24 hours after injection of 2OmCi of ggmTc-TC. Abnormal activity was localized with a radionuclide angiocardiogram (ggmTCO,-) performed issaediately after vvmTc-TC imaging. All controls had negative scans. By clinical criteria, 9 CCU patients sustained AMI, (7 transmural, 2 nontransmural), in 3 the diagnosis was equivocal and in 1 AM1 was ruled out. The scan was positive in 9/9, l/3 and O/l patients, respectively. Positive scans returned to normal within l-2 weeks in 819 patients. A negative scan became
positive in 1 patient who developed AM1 in-hospital. The technique differs from K' analogue scanning for infarct detection because: a) ggmTc-TC produces a positive image which can be analyzed for intensity and size, b) vvmTc-TC binds to acutely necrotic tissue and therefore does not image areas of old infarction or fibrosis, and c) sequential daily imaging permits temporal analysis of the infarct. In conclusion, vvmTc-TC permits localization and accurate detection of acutely infarcted myocardium.
144
January 1974
The American Journal of CARDIOLOGY
ASSESSMENT
OF TOTAL
MONARY VENOUS CONNECTION CORRECTION DURING INFANCY
Constance J. Hayes,M.D.,
James R Malm, MD.,
ANOMALOUS
(TAPVC)
PUL-
FOLLOWING Frederick 0. Bowman,
Wel ton M Gersony,M.D.,
Columbia
College of Physicians 8 Surgeons, New York,
N.Y.
Nine patients with TAPVC and pulmonary artery hypertension (PAH) who survived open heart correction prior to 6 months of age, have been followed
for one to 6 years after surgery. Five of the in-
fants hod supracardiac TAPVC; 3 had drainage into the coronary sinus and one had a mixed type of venous connection. Postoperatively, all of the children were asymptomatic and displayed normal growthand development. Chest x-mys revealed normal heart size ond pulmonary vascular pattern in 8patients,whereas megoly wos noted in one instance.EIectrocardiograms
mild cordioshowed fron-
tal QRS axes ranging from 80° to 105O with mild right ventricular conduction delayr Regression of preoperative right ventricular hypertrophy was apparent in each case.Ectopic atria1 pacemakers with heart rates in the range of 85 to 120 were present in2patientr Seven patients
underwent ,oost-operative
cardiac cotheterizo-
tion 10 months to5 years (mea-1=3 years) after surgery. Pulmonary attery pressures ranged from 16/8 to 32/12 (mean=23/10, f;5). One patient had on elevated pulmonary artery wedge pressure (14 mm Hg). Two infants had small L*Rshunts (I .3/l; 1.4/l),in the area of the coronorysinus,and one had a catheter potent interatriol communication. None had R+L shunts. In each patient,angicgrophy revealed the site of the commcn pulmonary vein-left atria1 (C&LA) junction to be widely potent with a normal sized left atrium and left ventricle.This study indicates that successful corrective surgery for TAPVC with PAH by open CPV-LA onastomosis performed in infancy, results in on excellent long term prognosis.
Volume 33
SICK SINUS SYNDROME IN CHRONIC CHAGAS’ HEART DISEASE. MD, FACC; Jos6 R. LosanoOtto Hern&ndez-Pieretti, Wilson, MD; Adalberto Urbina-Quintana, MD; Guillermo Villoria, MD; Maria I. de Herndndes, MD; Enrique y Escuela de Medicina G6mes-Amundarain, MD. “Hospital Vargas” and “Hospital Central de las Fuerzas Armadas” Caracas. Venezuela. Sick Sinus Syndrome (SSS) had not been reported as such in Chronic Chagas’ Heart Disease (CCHD). The following study was conducted to evaluate the incidence and clinical picture of SSS in CCHD. The clinical rewith CCHD were reviewed. The mean cords of 700 pts. age, the absence of angina and the other clinical fea tures did not suggest coronary artery disease. The were consistent with SSS and divided ECG of 15 pts. into two groups. Group I (5 pts.) did not reveal asso ciated A-V conduction disturbances; the mean age was and there was no evidence of congestive 73.6 yrs. heart failure (CHF). Group II included 10 pts. in whom SSS was associated to A-V conduction disturbances; the mean age was 45.9 yrs. CHF was present in 30 $. Dizziness and Stokes Adams Syndrome (SAS) were observed in both groups: 40% in group I and 20% in group II. Permanent pacemakers could be implanted in The analysis revealed that SSS is only 73% of pts. not a common isolated finding in CCHD. However, this disorder was associated with severe symptoms, including SAS. The ECG abnormalities associated to SSS further indicate severe damage to atrial, junctional and ventricular tissue (P wave abnormalities, intermittent slow junctional and ventricular rhythms, A-V block, BBB, hemiblocks, PACs, PVCs, etc.) with involvement of pacemakers and conducting system. Relatively long periods of atria1 and ventricular asystole were recorded by Dynamic ECG, indicating severe depression of sinus node and subsidiary pacemakers.
EVALUATION OF ACUTE MYOCARDIAL INFARCTION WITH TECHNETIUM-99m-TETRACYCLINE INFARCT IMAGING B. Leonard Holman, MD; Michael Lesch, MD, FACC; Franklin Zweiman, MD; John Temte, MD, PhD; Mrinal K. Dewangee,PhD; Bernard Lown, MD, FACC; Richard Gorlin, MD, FACC, Peter Bent Brigham Hospital, Boston, Mass.
PRODROMA OF VENTRICULAR FIBRILLATION IN ACUTE ISCHEMIA: EFFECT OF HEART RATE AND ANTI-ARRHYTHMIC DRUGS Ronald R. Hope, MB, MPACP: Benjamin J. Scherlag, PhD; Philip Samet, MD, FACC, Mount Sinai Medical Center, Miami Beach, Florida The efficacy of antiarrhythmic drugs in the prehospitalisation phase of acute myocardial infarction has not been established. In 25 open chest dogs with the anterior descending coronary artery (ADCA) temporarily occluded (2-6 min), ischemic zone subepicardial electrograms (IZE) were recorded. Ventricular arrhythmias (including premature contractions, tachycardia and fibrillation) occurred in all and followed increasing delay in IZE onset up to 320 msec whereas the average QT interval was 280 msec. The effect of heart rate (HR), lidocaine and propranolol on IZE delay was examined. With atria1 pacing CAP), an average increase in HR of 32% in 6 normal and 3 denervated dogs during ADCA occlusion resulted in severe IZE delays and ventricular arrhythmias whose average onset was 1.4 min earlier than at control HR (2.8 min with AP; 4.2 min control HR). The effect of lidocaine (lo-15 mg/kg) during 14 temporary occlusions of the ADCA in 10 dogs was compared with 19 occlusions without lidocaine in the same dogs. At the same period of ischemia there was no difference in IZE delay with or without lidocaine (70*20 msec and 69f20 msec, respectively. Propranolol slowed the average HR from 140/min to 109/min. Average IZE delay at the same period of ADCA occlusion was 42+8 and 4956 msec with and without propranolol, respectively. ADCA occlusion for the same period with AP at 170-200/min resulted in IZE delays of 66+5 msec without, and 76+2 msec with propranolol. IZE delay and ventricular arrhythmias after ADCA occlusion occurred earlier if HR was increased. Propranolol inhibited the onset of IZE delay by slowing HR. Lidocaine had no effect on HR and did not influence IZE delay or the onset of early ventricular arrhythmias.
HEMODYNAMIC
AIan J. Hordof,M.D., Jr., MD., University
Tetracycline binds to necrotic tissue; its fluorescence has been used to identify experimental acute myocardial infarction (AMI). When Tetracycline is labeled with Technetium-99m ( ggmTc-TC), its concentration in the infarcted tissue can be imaged by noninvasive external means, permitting detection, localization and sizing of the lesion. The thorax was imaged in anterior, LAO and BAO projections in 13 CCU and 8 control patients 4, 8 and 24 hours after injection of 2OmCi of ggmTc-TC. Abnormal activity was localized with a radionuclide angiocardiogram (ggmTCO,-) performed issaediately after vvmTc-TC imaging. All controls had negative scans. By clinical criteria, 9 CCU patients sustained AMI, (7 transmural, 2 nontransmural), in 3 the diagnosis was equivocal and in 1 AM1 was ruled out. The scan was positive in 9/9, l/3 and O/l patients, respectively. Positive scans returned to normal within l-2 weeks in 819 patients. A negative scan became
positive in 1 patient who developed AM1 in-hospital. The technique differs from K' analogue scanning for infarct detection because: a) ggmTc-TC produces a positive image which can be analyzed for intensity and size, b) vvmTc-TC binds to acutely necrotic tissue and therefore does not image areas of old infarction or fibrosis, and c) sequential daily imaging permits temporal analysis of the infarct. In conclusion, vvmTc-TC permits localization and accurate detection of acutely infarcted myocardium.
144
January 1974
The American Journal of CARDIOLOGY
ASSESSMENT
OF TOTAL
MONARY VENOUS CONNECTION CORRECTION DURING INFANCY
Constance J. Hayes,M.D.,
James R Malm, MD.,
ANOMALOUS
(TAPVC)
PUL-
FOLLOWING Frederick 0. Bowman,
Wel ton M Gersony,M.D.,
Columbia
College of Physicians 8 Surgeons, New York,
N.Y.
Nine patients with TAPVC and pulmonary artery hypertension (PAH) who survived open heart correction prior to 6 months of age, have been followed
for one to 6 years after surgery. Five of the in-
fants hod supracardiac TAPVC; 3 had drainage into the coronary sinus and one had a mixed type of venous connection. Postoperatively, all of the children were asymptomatic and displayed normal growthand development. Chest x-mys revealed normal heart size ond pulmonary vascular pattern in 8patients,whereas megoly wos noted in one instance.EIectrocardiograms
mild cordioshowed fron-
tal QRS axes ranging from 80° to 105O with mild right ventricular conduction delayr Regression of preoperative right ventricular hypertrophy was apparent in each case.Ectopic atria1 pacemakers with heart rates in the range of 85 to 120 were present in2patientr Seven patients
underwent ,oost-operative
cardiac cotheterizo-
tion 10 months to5 years (mea-1=3 years) after surgery. Pulmonary attery pressures ranged from 16/8 to 32/12 (mean=23/10, f;5). One patient had on elevated pulmonary artery wedge pressure (14 mm Hg). Two infants had small L*Rshunts (I .3/l; 1.4/l),in the area of the coronorysinus,and one had a catheter potent interatriol communication. None had R+L shunts. In each patient,angicgrophy revealed the site of the commcn pulmonary vein-left atria1 (C&LA) junction to be widely potent with a normal sized left atrium and left ventricle.This study indicates that successful corrective surgery for TAPVC with PAH by open CPV-LA onastomosis performed in infancy, results in on excellent long term prognosis.
Volume 33