John V. Temte

Basis for recurring ventricular fibrillation in the absence of coronary heart disease and its management.

A 39-year-old man twice experienced ventricular fibrillation and exhibited numerous ventricular premature beats. Coronary arteries were normal, and no impaired cardiac function was found upon catheterization. Evidence was adduced that the ventricular premature beats were related to higher nervous activity. The patient had serious psychiatric problems; the ventricular premature beats were provoked by psychophysiologic stress, increased during REM sleep, were reduced by meditation, and were controlled by beta-adrenergic blockade, phenytoin and digitalization. We conclude that psychologic and neurophysiologic factors may predispose to life-threatening cardiac arrhythmia in the absence of organic heart disease. Effective management of the recurrent ventricular arrhythmia involved; acute drug testing for assessing antiarrhythmic efficacy; use of programmed trendscription to provide on-line information on drug action; a treatment program involving more than one agent; and use of measures to reduce sympathetic nervous activity.

Detection and sizing of acute myocardial infarcts with 99mTc (Sn) tetracycline.

Abstract Myocardial scintigraphy was performed in 28 patients with the technetium chelate, 99mTc (Sn) tetracycline. Acutely infarcted myocardium was visualized as an area of increased radioactivity. All 14 patients with definite clinical evidence of acute myocardial infarction and two of five patients in whom the evidence of infarction was equivocal had abnormal scintigrams. Scintigraphy gave normal results in nine patients in whom an acute lesion failed to evolve. Peak activity occurred one to three days after the clinical onset of chest pain. Old infarcts did not concentrate 99mTc (Sn) tetracycline. (N Engl J Med 291:159–163, 1974)