scholarly journals Management of adolescent anorexia with symptomatic bradycardia and frequent premature ventricular contractions: a case report

2021 ◽  
Vol 49 (10) ◽  
pp. 030006052110501
Author(s):  
Fuxu Chen ◽  
Chao Feng ◽  
Jie Song ◽  
Shudong Xia
Keyword(s):  
Heart Rate ◽  
Anorexia Nervosa ◽  
Pacemaker Implantation ◽  
Premature Ventricular Contractions ◽  
Cardiac Intervention ◽  
The Past ◽  
Electrocardiographic Monitoring ◽  
Symptomatic Bradycardia ◽  
Mean Heart Rate

Syncope associated with bradycardia and ventricular arrhythmia is an indication of cardiac intervention. However, in adolescent patients with anorexia nervosa, the management of syncope and arrhythmia can be different. We present a case of a 17-year-old boy who was admitted to the hospital because of syncope during exercise. Electrocardiographic monitoring showed that his mean heart rate was 41 beats/minute, with many long pauses and frequent premature ventricular contractions. These results suggested that the syncope was probably caused by arrythmia. He had been on a diet and had lost 20 kg in the past 6 months, with a body mass index of only 15.3 kg/m2. He was diagnosed with anorexia nervosa. Pacemaker implantation or ablation was not performed. Refeeding therapy was performed with mirtazapine. A follow-up showed a stepwise increase in his heart rate and a stepwise decrease in premature ventricular contractions, with an increase in his body weight. The findings from this case show that vagal hyperactivity associated with anorexia nervosa might lead to multiple premature ventricular contractions and bradycardia.

Bradycardia in athletes: clinical evaluation and management

ESC CardioMed ◽  
2018 ◽  
pp. 1971-1973
Author(s):  
Hein Heidbuchel
Keyword(s):  
Sinus Bradycardia ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Ionic Channel ◽  
Physiological Adaptation ◽  
Infiltrative Cardiomyopathy ◽  
Former Athletes ◽  
Underlying Causes ◽  
Symptomatic Bradycardia

Sinus bradycardia is very common in athletes. Recent evidence has shown that vagal hypertonia is not so much the mechanism behind this physiological adaptation, but rather intrinsic structural and ionic channel remodelling of the sinus node. Some athletes may present with extreme forms of bradycardia, such as a resting sinus rhythm of less than 30 beats per minute or sinus pauses of longer than 3 s. Even if asymptomatic, one may wonder how far this can still be considered ‘physiological’, since it is known that former athletes have a higher likelihood for the development of symptomatic bradycardia and the need for pacemaker implantation. Whereas asymptomatic athletes can participate in all sports, temporary cessation in those with symptoms is warranted to gauge resolution of bradycardia. If persistently symptomatic, pacemaker implantation needs to be considered. In those with extreme bradycardia but who are asymptomatic, a more intensified follow-up is recommended after exclusion of underlying causes (e.g. infiltrative cardiomyopathy, Lyme disease, or sarcoidosis).

P1096Cardioneuroablation changes the type of vaso-vagal response in patients with asystolic reflex syncope

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R Piotrowski ◽  
A Zuk ◽  
J Baran ◽  
A Sikorska ◽  
T Krynski ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Postgraduate Medical Education ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Heart Rate Variability Parameter ◽  
History Of ◽  
The Right ◽  
The Impact

Abstract Funding Acknowledgements Centre of Postgraduate Medical Education No. 501-1-10-14-19 Background. Cardioneuroablation (CNA) - ablation of ganglionated plexi (GP) to eliminate or reduce parasympathetic overactivity, has been recently proposed as a new therapeutic method in patients with vaso-vagal syncope (VVS) due to cardioinhibitory or mixed mechanism. Purpose. To assess the impact of CNA on the type of VV response during tilt testing (TT). Methods. The study group consisted of the first 20 patients (7 males, mean age 38 ± 9 – year – old) enrolled in the ongoing prospective Roman study (NCT 03903744). All patients had a history of ECG documented syncope due to asystole and confirmed asystolic form of VVS at baseline TT. CNA was performed using electroanatomical system Carto 3 and radiofrequency applications delivered in the right and left atrium at the right anterior GP and right inferior GP sites. The second TT was performed three months later. Resting heart rate (HR) and heart rate variability parameter (SDDN) were also assessed. Results. At baseline TT, nineteen patients had cardioinhibitory syncope (asystole ranging from 3 to 60 s)  (sinus node arrest – 17 patients, A-V block – 2 patients) and 1 had mixed form of VVS (asystole lasting 3 s preceded by hypotension). During three-month follow-up no syncopal episodes were noted. At the 3-month TT, 6 (30 %) patients had no syncope whereas the remaining 13 (65 %)  had syncope – twelve (60 %) due to vasodepressor mechanism and only one (5 %) due to asystole - as before CNA. One patient did not have TT because of pregnancy. Mean resting HR after CNA was significantly faster and SDNN significantly lower than before the procedure (82 ± 9 vs 69 ± 11 beats/min, p = 0.0004 and 74 ± 22 vs 143 ± 40 ms, p = 0.00003, respectively) and these changes were was similar in those who fainted during second TT and those who did not (82 ± 11 vs 81 ± 4 beats/min, p = NS and (75 ± 2 vs 77 ± 18 ms, p = NS, respectively). Conclusions. CNA profoundly affects the type of VV reaction causing normalization of the response to tilting or changing cardiodepression to vasodepression. These effects are also depicted by changes in HR and heart rate variability. Elimination of TT-induced reflex asystole may prevent clinical recurrences of syncope during short-term follow-up. These findings encourage to conduct further studies involving CNA since this method appears to be effective and obviates the need for pacemaker implantation in young people with reflex asystolic syncope.

Abstract 2036: Severe Autonomic Failure in Diabetic Postinfarction-Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Georg Schmidt ◽  
Petra Barthel ◽  
Raphael Schneider ◽  
Axel Bauer ◽  
Elisabeth Arnoldi ◽  
...  
Keyword(s):  
Heart Rate ◽  
Proportional Hazards ◽  
Autonomic Failure ◽  
Multivariable Analysis ◽  
Total Mortality ◽  
Holter Monitoring ◽  
Mortality Rates ◽  
Cox Proportional Hazards ◽  
Mean Heart Rate

Background: Diabetic post-infarction patients are at high risk of subsequent death. Deceleration Capacity (DC) and Heart Rate Turbulence (HRT) are a risk predictors that quantify different aspects of autonomic performance (tone and reflex function). Sever Autonomic Failure (SAF) was assumed if DC and HRT were compromised. This study investigates the predictive value SAF in diabetic post-infarction patients. Patients: 416 consecutive diabetic post-infarction patients, age < <26> 75 years, in sinus rhythm were enrolled. Primary endpoint was total mortality at 5 years. Mean follow-up period was 4.4 years. Methods: DC and HRT were determined according to the published methodology. Severe autonomic failure (SAF) was defined as DC < <26> 4.5 ms and HRT category 2. Cox-proportional hazards analyses were performed with respect to age, history of previous myocardial infarction, mean heart rate, HRV index and arrhythmia count during 24-h Holter monitoring, QRS duration and LVEF, all with prospectively defined dichotomies. Results: During follow-up, 61 patients died. There were 36 cardiac deaths, out of which 23 occurred suddenly. 24 patients presented with SAF, 13 patients with LVEF < <26> 30%. Five-year all-cause mortality rates of patients with and without SAF were 63% and 11%, respectively (Figure , left panel). For LVEF 30%, these figures were 51% and 15% (Figure , right panel). Similar figures were observed for cardiac mortality. In multivariable analysis, presence of SAF indicated a hazard ratio of 5.1 (LVEF 4.2; age 3.5, mean heart rate 1.9). Conclusion: Diabetic post-infarction patients with SAF have a poor outcome, whereas mortality rates of patients without SAF were low.

Pharmacological treatment of young children with permanent junctional reciprocating tachycardia

2003 ◽  
Vol 13 (5) ◽  
pp. 408-412 ◽  
Author(s):  
Margriet van Stuijvenberg ◽  
Gertie C. M. Beaufort-Krol ◽  
Jaap Haaksma ◽  
Margreet Th. E. Bink-Boelkens
Keyword(s):  
Heart Rate ◽  
Young Children ◽  
Cardiac Function ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Pharmacological Treatment ◽  
Left Ventricular ◽  
The Mean ◽  
Mean Heart Rate

Our objective was to assess the efficacy of pharmacological treatment in reducing the incidence of permanent junctional reciprocating tachycardia in young children, or to bring the mean heart rate over 24 h to a normal level.We included 21 children with a median age of 0.05 year seen with permanent junctional reciprocating tachycardia over the period 1990 through 2001. Of these children, two had abnormal left ventricular function. Follow-up visits were made at least every 6 months. We registered the presence of the tachycardia over 24 h, the mean heart rate over 24 h, and cardiac function. Treatment was started with propafenone alone, or in combination with digoxin as the first choice. Treatment was effective in 14 cases (67%), with either complete disappearance of the tachycardia after discontinuation of medication, or continuation in sinus rhythm with medication; partially effective in 4 cases (20%) when the mean heart rate over 24 h on the last Holter recording was less than 1 standard deviation above the normal for age; but was not effective in the remaining 3 cases (14%). In 3 patients treated with propafenone, or 13 given propafenone and digoxin, treatment was effective in 12 (75%), partially effective in 2 (13%), and ineffective in the other 2 (13%).All 21 children had a normal left ventricular function at the end of follow-up. The median duration of follow-up was 2.4 years. Permanent junctional reciprocating tachycardia had disappeared spontaneously in one-third of the children, 5 being less than 1 year old. Adverse effects, seen in 5 cases, were mild or asymptomatic. No signs of proarrhythmia were registered.Pharmacological treatment, either with propafenone alone, or in combination with digoxin, is safe and effective in young children with permanent junctional reciprocating tachycardia. The mean heart rate is normalized, and cardiac function is restored and preserved. Radiofrequency ablation may be delayed to a safer age, with the arrhythmia disappearing spontaneously in one-third.

scholarly journals A case report of cardiac toxicity from barracuda ingestion in Mexico

2020 ◽  
Author(s):  
Alice Haouzi ◽  
Haitham Khraishah ◽  
Jamie Diamond ◽  
Duane S Pinto
Keyword(s):  
Heart Rate ◽  
Gastrointestinal Symptoms ◽  
Neurological Symptoms ◽  
Cardiac Complications ◽  
Permanent Pacing ◽  
Temporary Treatment ◽  
Symptomatic Bradycardia ◽  
Cardiac Manifestations ◽  
Electrocardiogram Ecg

Abstract Background Ciguatera toxicity is a fish-borne illness that initially manifests with gastrointestinal symptoms, followed by bizarre neurological symptoms including heat-cold sensation alteration, peculiar feeling of loose teeth, and peripheral neuropathy. However, cardiac manifestations are rare and underreported in the literature. Case summary A 73-year-old man presented with symptomatic bradycardia and hypotension after ingestion of barracuda fish in Mexico. He received atropine and dopamine with subsequent improvement in his symptoms, but continued to experience peripheral neuropathic and other odd sensations. Four of his family members ingested the same fish and had similar symptoms. He was managed conservatively and did not require temporary or permanent pacing. Within 1 week from toxin exposure, bradycardia had improved. Heart rate was 40–50 b.p.m. at rest, and he was discharged with an ambulatory monitor. Heart rate had increased to 77 b.p.m. at 1-month follow-up on repeat electrocardiogram (ECG). Discussion Although the predominant manifestations of ciguatera toxicity are neurological, cardiac complications tend to be more acute and require attention. Unlike neurological symptoms, bradycardia and hypotension are short-lived, often resolving within a week. Treatment continues to be largely supportive, and patients may require temporary treatment with positive chronotropic agents such as atropine or dopamine.

scholarly journals Follow-up studies of anorexia nervosa: a review of four decades of outcome research

1991 ◽  
Vol 21 (2) ◽  
pp. 447-454 ◽  
Author(s):  
H.-Ch. Steinhausen ◽  
C. Rauss-Mason ◽  
R. Seidel
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Outcome Research ◽  
German Language ◽  
Systematic Analysis ◽  
Striking Increase ◽  
The Past ◽  
Language Studies ◽  
Follow Up Studies

SYNOPSISIn 1983 we presented a systematic analysis of the available literature on the course of anorexia nervosa (Steinhausen & Glanville, 1983a). The survey was based on 45 English and German language studies published between 1953 and 1981. During the past decade there has been a striking increase of publications related to eating disorders in general. This pertains as well to follow-up studies on anorexia nervosa. In addition to studies compiled in our previous report, we were able to locate another 22 follow-up studies published in major English and German language journals between 1981 and 1989.

Evaluation of Normal Heart Rate in Early Pregnancy Corresponding to Gestational Age between Six to Eight Weeks

Med Phoenix ◽  
2017 ◽  
Vol 2 (1) ◽  
pp. 34-37
Author(s):  
Akhilesh Kumar Jha ◽  
Bikranta Rimal ◽  
Tarannum Khatun
Keyword(s):  
Heart Rate ◽  
Early Pregnancy ◽  
Well Being ◽  
Clinical Decision ◽  
First Trimester ◽  
Normal Heart ◽  
Normal Heart Rate ◽  
First Trimester Of Pregnancy ◽  
Singleton Pregnancies

Background: Ultrasonography is the reliable and safe way for the evaluation of pregnancy. Heart rate can be detected more confidently from the Ultrasonography. Heart rate is an important parameter for the evaluation of early pregnancy. The purpose of this study was to evaluate the normal heart rate in embryos/fetuses between 6 and 8 weeks of gestation.Method: In our region people are poor and most of them do not know the benefit of regular follow up examination during pregnancy. So most of pregnant women come to our centre at late stage of pregnancy. The number of pregnancy cases is good in our centre but the number of early pregnancy cases coming to regular follow up examination is low. Thus the study was conducted in 51 normal singleton pregnancies undergoing routine ultrasound examination during the first trimester of pregnancy. The duration of study was 6 weeks.Result: Out of 51 singleton pregnancies, 20 cases (39.2%) heart rate were between 131-150 beat per minute and 25 cases (49.0 %) heart rate were between 151-170 beat per minute. However 4 cases (7.8%) were between 110-120 beat per minute and 2 cases (3.9%) were more than 171 beat per minute. There were zero cases above the 180 beat per minute.Conclusion: The result of this study will help to evaluate abnormal and normal fetal heart rate so that early clinical decision whether to continue the pregnancy or terminate it can be taken, as Ultrasonography is only the method used in screening fetal well being in most of the region of our country.Med Phoenix Vol.2(1) July 2017, 34-37

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