Harry R. Gibbs

Infective endocarditis of a bicuspid aortic valve caused by hansenula anomala

Infective endocarditis due to Hansenula anomala developed on a bicuspid aortic valve in a 40-year-old man. H. anomala, an ascomycetous yeast, may be a member of the normal flora of the throat and alimentary tract in humans but has not been previously known to be pathogenic in humans. A past history of intravenous drug use may have contributed to the development of disease in this patient.

Haloperidol and Torsades de Pointes

Excerpt To the editor: Haloperidol, a butyrophenone, is widely used in the treatment of acute and chronic psychoses as well as in the management of agitated patients. It has been considered extreme...

Toluene sniffing and severe sinus bradycardia.

Excerpt To the editor: The exact cause of sudden death from toluene vapor inhalation remains unknown. Most evidence suggests a cardiac cause. One postulated mechanism is the development of fatal ve...

Isolated tricuspid valve prolapse diagnosed by echocardiography

Isolated tricuspid valve prolapse in the absence of mitral valve prolapse or other cardiac defects has not been previously noted. This report describes a patient who on both M-mode and two-dimensional echocardiography demonstrated tricuspid prolapse without other associated abnormalities. The implications of this finding are discussed.

Pure vasodepressor carotid sinus hypersensitivity. Unusual cause of recurrent syncope

Recurrent syncope in a 53-year-old man was found to be due to vasodepressor carotid sinus hypersensitivity. Establishment of the diagnosis required monitoring of both the electrocardiographic changes and the blood pressure during carotid sinus massage. Current therapeutic approaches to patients with symptomatic vasodepressor hypersensitivity are discussed.

Slowing of Ventricular Tachycardia as a Possible Endpoint for Serial Drug Testing at Electrophysiological Study

Certain patients who cannot be rendered noninducible by serial drug testing during electrophysiology study demonstrate significant slowing of their ventricular tachycardia rate with selected agents. We evaluated the characteristics and outcome of 19 such patients to assess whether this slowing could be considered an acceptable endpoint for treatment. This group consisted of 14 males and 5 females (mean age 63 ± 9) with a mean ejection fraction of 28 ± 13% and inducible sustained ventricular tachycardia. Sixteen patients had known coronary artery disease and 13 had prior myocardial infarction. The other three patients had idiopathic cardiomyopathy. Serial drug testing during an electrophysiology protocol that used up to three extrastimuli at two or three cycle lengths at two right ventricular sites was used to select a medication regimen that provided optimal ventricular tachycardia slowing without limiting side effects. Five patients were treated with amiodarone, three with Ic agents fall with ejection fraction > 30%), and the remainder with la and Ib agents alone or in combination. Mean initial ventricular tachycardia rate was 219 ± 26 beats/mm with posttreafment ventricular tachycardia rate 137 ±17 fmean initial cycle length 278 ± 35 msec, posttreatment 443 ± 53 msec). Two groups were identified, those who had recurrent (although well‐tolerated) ventricular tachycardia (group 1, n = 6, mean time to recurrence = 15 months), and those who did not (group II, n = 11, mean follow‐up 22 months). Overall sudden death rate was 5%, while total mortality was 11% (all mortality in group I). No factor such as sex, age, drug type, ejection fraction, presence of coronary artery disease or aneurysm, or ventricular tachycardia morphology was significantly different between the groups. Conclusions: Significant ventricular tachycardia slowing by selected drug therapy at electrophysiology study is an acceptable therapeutic endpoint for certain patients, with a low rate of subsequent sudden death. However, recurrence, even if well tolerated, may be a marker for need for nonmedical therapy such as a device or surgery.