Arthur Bernstein

Clinical and electrophysiologic effects of chronic lorcainide therapy in refractory ventricular tachycardia

The clinical, electrophysiologic and pharmacologic effects of chronic lorcainide therapy in patients with refractory ventricular tachycardia were evaluated using programmed electrical stimulation. Twelve patients with recurrent refractory ventricular tachycardia and organic heart disease, 10 men and 2 women aged 41 to 76 years, with no evidence of prior high degree atrioventricular or bifascicular block were studied. Programmed electrical stimulation was performed in the control, drug-free state and after chronic administration of lorcainide (dose range 200 to 600 mg/day, duration 48 to 240 hours, mean 106 hours) in 11 patients. One patient developed intolerable drug side effects and treatment was discontinued after 36 hours. In the 11 other patients, there was a significant increase in PR interval (187 ± 55 to 219 ± 56 ms; p 0.2). The ventricular effective refractory period increased from 234 ± 21 to 266 ± 15 ms (p Long-term lorcainide therapy was continued in the four responders. During a 2 to 12 month follow-up period, two patients have remained arrhythmia-free, one patient developed intolerable side effects requiring discontinuation of the drug and one patient with advanced renal failure died. It is concluded that chronic lorcainide therapy has significant electrocardiographic and electrophysiologic effects, but has a limited role in the long-term treatment of patients with refractory sustained ventricular tachycardia.

The Evolution of the vectorcardiogram and electrocardiogram of the normal infant: I. The normal newborn∗☆

Abstract 1. 1. Vectorcardiograms and electrocardiograms were obtained in fifty normal newborn infants. 2. 2. Typically, the vectorcardiographic findings were similar to those found in cases of pathologic right ventricular hypertrophy in older children and adults with two possible exceptions: (1) T sE loops were almost always concordant with the QRS sE loops in all planes in the normal newborn; and (2) the QRS sE loop was usually inscribed in a clock-wise direction in the sagittal plane in the normal newborn. 3. 3. Variations from the typical vectorcardiographic findings were seen including: (1) QRS sE loops oriented predominantly to the left in some, superiorly in others and posteriorly in still another group; (2) counterclockwise direction of inscription of the QRS sE loop in the frontal and horizontal planes. 4. 4. In general, the electrocardiograms showed varying degrees of right axis deviation and evidence of “right ventricular preponderance” in the precordial leads. 5. 5. Deviations from typical electrocardiographic findings were also encountered including: (1) precordial lead patterns suggestive of “left ventricular preponderance”; and (2) T wave changes heretofore described as indicative of pathologic ventricular hypertrophy. These included upright T waves in right precordial leads of infants more than one day old and inverted T waves in left precordial leads of the same age group. 6. 6. Arrhythmias were present as follows: five infants with ventricular premature systoles, one with nodal premature systoles, one with atrial premature systoles and one with a wandering pacemaker. 7. 7. Because of the wide range of normal, conservatism is urged in the interpretation of the vectorcardiogram and electrocardiogram of the newborn infant.

The vectorcardiogram in direct posterior wall myocardial infarction

Abstract 1. 1. Employing the cube reference system, vectorcardiograms were obtained in six cases of myocardial infarction involving the posterior wall of the left ventricle. 2. 2. In these vectorcardiograms, the early forces of the QRS loop were abnormally displaced anteriorly and to the right. This finding accounts for the increased R wave amplitude in right precordial leads of the scalar electro-cardiogram that is seen in posterior wall infarction. 3. 3. The vectorcardiogram is of particular diagnostic value when infarction is localized to the posterior surface since the classic pattern of myocardial infarction is not evident in the routine electrocardiogram. 4. 4. Vectorcardiography serves to differentiate posterior infarct from other causes of prominent R waves in right precordial leads such as right bundle branch block and right ventricular hypertrophy.

ACUTE GOUT SECONDARY TO MULTIPLE MYELOMA: A CASE REPORT

Excerpt Gout has been reported as occurring concurrently with the hyperuricemia found in leukemia1and in polycythemia vera.2In multiple myeloma, a condition resembling leukemia, there is also a hyp...

Bigeminy: An electrocardiographic study of bigeminal rhythms

Abstract 1. 1. Electrocardiographic bigeminy is defined as that phenomenon in which there is a constantly repeated pairing of impulses with respect to time, which involves either the auricles or ventricles alone, or both sets of chambers together. 2. 2. A comprehensive classification of electrocardiographic bigeminy is presented. 3. 3. The various types of electrocardiographic bigeminy are described, and interesting examples which we have observed are shown.

Telemetric monitoring of arrhythmias in acute myocardial infarction

Abstract A relay telemetric system has been developed for the continuous monitoring and recording of the electrocardiogram in patients with acute myocardial infarction. The results in the first 6 cases are described. The monitor demonstrated arrhythmias in all the cases, with episodes of ventricular tachycardia in 4 of the 6. Most of the disturbances in rhythm were not detected on frequent clinical examinations and conventional electrocardiograms. Continuous electrocardiographic monitoring provides for immediate recognition of arrhythmias and also serves as an important investigative tool for study of the electrogenesis of these potentially fatal complications of myocardial infarction.

Paired pacing after coronary artery ligation

Abstract Experiments were designed to test the hazards and physiologic effects of paired pacing of the heart before and after coronary ligation. Sustained paired pacing was performed in 13 of 14 “normal” animals in which the left anterior descending coronary artery was identified but not ligated. The technique produced increased myocardial contractility, as manifested by augmented left ventricular dp/dt. Pacer-induced ventricular fibrillation occurred in 7 of 9 other dogs in which paired pacing was attempted after coronary artery ligation. In a third group of 14 dogs pretreated with propranolol, paired pacing was safely accomplished in 11 after coronary artery ligation. Propranolol did not interfere with the inotropic effects of paired pacing. Application of these data to the problem of the “power failure” syndrome associated with myocardial infarction is discussed.

UNUSUAL PHYSICAL FINDINGS IN PLEURAL EFFUSION: INTRATHORACIC MANOMETRIC STUDIES

Excerpt The diagnosis of pleural effusion on physical examination has been based on the classic findings of absent tactile fremitus, dullness or flatness to percussion, and absent breath sounds. Th...

A new multipurpose cardiac catheter

Abstract A new cardiac catheter has been developed that obviates the need for the reintroduction of special catheters to perform different functions. The catheter measures all cardiovascular pressures, provides for blood oximetry sampling, permits the injection of contrast substances and indicator dyes, records intracardiac electrocardiograms, and provides a dipolar electrode for cardiac pacing.

Ventricular fibrillation, a late complication of direct-current countershock

Abstract A case of ventricular fibrillation that occurred 8 hours after direct-current countershock for chronic atrial fibrillation is reported. A plea is made for constant electrocardiographic monitoring in the post-conversion period.