Electrocardiography ; Humans ; Tachycardia, Sinus/diagnosis*

Adolescent ; Atrial Appendage ; Diagnostic Errors ; Female ; Humans ; Tachycardia, Ectopic Atrial ; diagnosis ; Tachycardia, Sinus ; diagnosis

Supraventricular tachycardia (SVT) refers to a heterogeneous group of arrhythmias localized within the upper part of the heart (the His bundle or above). In general, the term SVT does not include atrial fibrillation. Common forms of SVT include atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, focal atrial tachycardia, and atrial flutter. Other, less common arrhythmias also fall under the category of SVT, including inappropriate sinus tachycardia and junctional reentrant/ectopic tachycardia. Paroxysmal supraventricular tachycardia refers to AVNRT and AVRT. SVTs can be identified and classified by clinical manifestation/physical examination, ECG, and/or electrophysiologic analysis.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrial Flutter ; Bundle of His ; Diagnosis, Differential* ; Electrocardiography ; Heart ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Sinus ; Tachycardia, Supraventricular*

BACKGROUND: Coronary sinus catheterization is important in electrophysiological studies. However the mor-phologic feature of the coronary sinus and its significance in patients with supraventricular tachycardia (SVT) have not been determined. During diagnostic electrophysiological studies, coronary sinus catheterization was easier in patients with atrioventricular nodal reentry tachycardia (AVNRT) than in patients with atrioventricular reentry tachycardia (AVRT). Therefore, we studied coronary sinus morphology in patients with SVT and compared AVNRT and AVRT patients. METHODS: The size and shape of the coronary sinus were measured in 13 patients who underwent retrograde coronary sinus venogram during electrophysiologic study between May and June 1996. The diagnosis was 7 cases of AVNRT, 2 of Wolff-Parkinson-White syndrome and 4 of concealed bypass tracts (mean age, 40 years : male vs female, 1 : 1.2). RESULTS: The mean coronary sinus ostial diameter was 10.4+/-2.0 mm:for AVNRT, it was 11.4+/-2.2 mm, and for AVRT it was 9.3+/-1.0 mm in left anterior oblique projection (p=0.031). The mean coronary sinus-to-spine angle was 82.6+/-17.4degrees : AVNRT 95.4+/-24.4degrees and AVRT 67.7+/-15.2degrees in anterior posterior projection (p=0.035). CONCLUSION: The coronary sinus ostial diameter of AVNRT patients was significantly larger than that of AVRT patients. This finding may have important implications for arrythmia pathogenesis in such patients.
Arrhythmias, Cardiac ; Catheterization ; Catheters ; Coronary Sinus* ; Diagnosis ; Female ; Humans ; Male ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Supraventricular* ; Wolff-Parkinson-White Syndrome

Arrhythmias in the neonatal period are not uncommon, and may occur in neonates with a normal heart or in those with structural heart disease. Neonatal arrhythmias are classified as either benign or nonbenign. Benign arrhythmias include sinus arrhythmia, premature atrial contraction, premature ventricular contraction, and junctional rhythm; these arrhythmias have no clinical significance and do not need therapy. Supraventricular tachycardia, ventricular tachycardia, atrioventricular conduction abnormalities, and genetic arrhythmia such as congenital long-QT syndrome are classified as nonbenign arrhythmias. Although most neonatal arrhythmias are asymptomatic and rarely life-threatening, the prognosis depends on the early recognition and proper management of the condition in some serious cases. Precise diagnosis with risk stratification of patients with nonbenign neonatal arrhythmia is needed to reduce morbidity and mortality. In this article, I review the current understanding of the common clinical presentation, etiology, natural history, and management of neonatal arrhythmias in the absence of an underlying congenital heart disease.
Arrhythmia, Sinus ; Arrhythmias, Cardiac* ; Atrial Premature Complexes ; Diagnosis* ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Infant, Newborn ; Mortality ; Natural History ; Prognosis ; Tachycardia, Supraventricular ; Tachycardia, Ventricular ; Ventricular Premature Complexes

PURPOSE: For tachycardic patients not in need of immediate cardioversion, the International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care emphasize specific rhythm diagnosis and avoidance of simplistic overuse of adenosine. The purpose of this study was to identify the rhythms for which adenosine was inappropriately prescribed at the emergency department after the International Guidelines 2000 had been adopted. METHODS: We retrospectively investigated 128 tachycardic patients who had been prescribed adenosine at the emergency department from September 2000 to March 2003. Patients were divided into two groups. The Appropriate Use Group was comprised of patients for whom had been prescribed for narrow QRS-complex tachycardia on the initial ECG. The Inappropriate Use Group was comprised of patients for whom adenosine had been prescribed for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin on the initial ECG. RESULTS: Of the 128 patients, 31 (24.2%) were in the Inappropriate Use Group. Among them, atrial fibrillation was involved in 15, atrial flutter in 3, atrial tachycardia in 2, sinus tachycardia in 8, and wide QRS-complex tachycardia of unknown origin in 3. CONCLUSION: Approximately 24% of the emergency department patients who were treated with adenosine received the medication unnecessarily for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin. Additional education on electrocardiographic recognition of tachyarrhythmias, and the Tachycardia Algorithms of Guidelines 2000 may be necessary for residents of emergency department.
Adenosine* ; Atrial Fibrillation ; Atrial Flutter ; Cardiopulmonary Resuscitation ; Diagnosis ; Education ; Electric Countershock ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Retrospective Studies ; Tachycardia ; Tachycardia, Sinus

We present the case of a patient who developed new-onset asymptomatic sinus tachycardia after undergoing treatment for a right ventricular myocardial infarction. Even after excluding heart failure, infection and bleeding, the sinus tachycardia persisted. Computed tomography pulmonary angiography showed multiple bilateral pulmonary emboli. The vital sign abnormality resolved after treatment with an anticoagulant. We postulate that the pulmonary emboli originated from thrombi that were formed in the infarcted and dysfunctional right ventricle. Pulmonary embolism is a very rare complication of right ventricular myocardial infarction, and patients usually present with pleuritic chest pain. Our case highlights that asymptomatic sinus tachycardia could be a presenting feature of pulmonary embolism after the occurrence of a right ventricular myocardial infarction. A high index of suspicion is warranted in order to detect this potentially lethal complication.
Adult ; Echocardiography ; Electrocardiography ; Heart Ventricles ; diagnostic imaging ; Humans ; Male ; Myocardial Infarction ; complications ; diagnosis ; Pulmonary Embolism ; complications ; diagnosis ; Tachycardia, Sinus ; diagnosis ; etiology

Pulmonary hypertension has variable causes. Reported causes are autoimmune diseases, liver cirrhosis with portal hypertension, HIV infection, use of anorectic drugs or oral contraceptives, sleep apnea syndrome and endocrinopathies. Primary pulmonary hypertension is a rare, progressive, and often fatal disease of unknown cause. The disease is most common in women (ratio 1.7:1) and the mean age at the time of diagnosis is the mid-30s. Variable cardiovascular manifestations are frequent in hyperthyroidism. These include sinus tachycardia, atrial dysrhythmias, decreased exercise tolerance, cardiomegaly, increased cardiac output and congestive heart failure. Herein, we report a case with hyperthyroidism and coincidental pulmonary hypertension. After successful therapy of the thyrotoxic state, the pulmonary pressure decreased markedly, indicating a possible pathogenetic link.
Autoimmune Diseases ; Cardiac Output ; Cardiomegaly ; Contraceptives, Oral ; Diagnosis ; Exercise Tolerance ; Female ; Heart Failure ; HIV Infections ; Humans ; Hypertension ; Hypertension, Portal ; Hypertension, Pulmonary* ; Hyperthyroidism* ; Liver Cirrhosis ; Sleep Apnea Syndromes ; Tachycardia, Sinus

Pulmonary hypertension has variable causes. Reported causes are autoimmune diseases, liver cirrhosis with portal hypertension, HIV infection, use of anorectic drugs or oral contraceptives, sleep apnea syndrome and endocrinopathies. Primary pulmonary hypertension is a rare, progressive, and often fatal disease of unknown cause. The disease is most common in women (ratio 1.7:1) and the mean age at the time of diagnosis is the mid-30s. Variable cardiovascular manifestations are frequent in hyperthyroidism. These include sinus tachycardia, atrial dysrhythmias, decreased exercise tolerance, cardiomegaly, increased cardiac output and congestive heart failure. Herein, we report a case with hyperthyroidism and coincidental pulmonary hypertension. After successful therapy of the thyrotoxic state, the pulmonary pressure decreased markedly, indicating a possible pathogenetic link.
Autoimmune Diseases ; Cardiac Output ; Cardiomegaly ; Contraceptives, Oral ; Diagnosis ; Exercise Tolerance ; Female ; Heart Failure ; HIV Infections ; Humans ; Hypertension ; Hypertension, Portal ; Hypertension, Pulmonary* ; Hyperthyroidism* ; Liver Cirrhosis ; Sleep Apnea Syndromes ; Tachycardia, Sinus

We reported a case of postoperative pulmonary embolism associated with pelvic lymphadenectomy for staging prostatic carcinoma. A 66-year-old man was admitted to our hospital complaining of dysuria. Transperineal prostatic biopsy under transrectal ultrasonographic guidance revealed evidence of malignancy. Abdominal CT and whole body scan demonstrated no abnormal findings. Staging pelvic lymphadenectomy was performed safely under general anesthesia. On the 6th postoperative day, the patient had sudden dyspnea and chest pain. EKG showed sinus tachycardia. Chest A-P showed some elevation of left diaphragm. Pulmonary perfusion scan revealed multiple cold area throughout both lung fields. A diagnosis of pulmonary embolism was made. Shock treatment and anticoagulant therapy were successfully performed. This case suggests that attention should be directed to pulmonary embolism as one of the postoperative complication of staging pelvic lymphadenectomy.
Aged ; Anesthesia, General ; Biopsy ; Chest Pain ; Diagnosis ; Diaphragm ; Dyspnea ; Dysuria ; Electrocardiography ; Humans ; Lung ; Lymph Node Excision* ; Perfusion ; Postoperative Complications ; Prostatic Neoplasms ; Pulmonary Embolism* ; Shock ; Tachycardia, Sinus ; Thorax ; Tomography, X-Ray Computed ; Whole Body Imaging