Yoriaki Mineda

Cardiac hemangioma: a report of two cases and review of the literature

Cardiac hemangioma is extremely rare. We encountered two patients with cardiac hemangioma detected by thoracic echocardiography during a medical checkup. In the first case, transthoracic echocardiography revealed a pedunculated tumor in the left ventricle. Selective left coronary angiography demonstrated that the main feeding artery of the tumor arose from the third diagonal branch of the left anterior descending coronary artery. In the second case, thoracic and transesophageal echocardiography showed an oval tumor arising from the right atrium. Both tumors were successfully resected. Histopathological examination revealed that one of the tumors was a capillary hemangioma and the other was a mixed capillary and cavernous hemangioma. After operation, both patients had an uneventful recovery without any complications.

Response to head-up tilt testing in patients with situational syncope.

The results of head-up tilt testing were compared between 24 patients with situational syncope and 44 age-matched patients with typical vasovagal syncope. Patients with situational syncope showed poor positive responses, especially in the passive tilt results (8.3% vs. 39%, p = 0.0078).

Does an Early Increase in Heart Rate During Tilting Predict the Results of Passive Tilt Testing

Head‐up tilt testing is a useful but time‐consuming procedure. If we could accurately predict the tilt testing results; we would be able to substantially shorten the duration of tilt protocol. To clarify the hypothesis that an early increase in heart rate (HR) during tilting can predict the passive tilt results in our protocol (80‐degree angle for 30 minutes), we studied 115 consecutive patients (72 men, 43 women, mean age 46 ± 19 years) who were clinically diagnosed with neurally mediated syncope. Twentynine (25%) patients had a positive tilt test (P group), whereas 86 (75%) patients had a negative test (N group). The early HR increase was defined as the maximum HR during the first 5 minutes of tilting minus the resting HR before tilting. The early HR increase was significantly higher in the P group (23.8 ± 9.5 beats/min) than in the N group (17.5 ± 8.2 beats/min, P = 0.0008), but it was negatively correlated with the tilt duration to positive response (r =−0.52, P = 0.0032) and the patient age in the entire study population (r = 0.62, P < 0.0001). Results of multiple regression analysis indicated that age, tilt result, and tilt duration were independently associated with the early HR increase. As a result, an early HR increase ± 18 beats/min, the best apparent cut‐off point obtained in our study, was a sensitive (100%) marker for prediction of a positive response at ± 15 minutes of tilting, but it showed a low specificity (61 %). In conclusion, an early HR increase during 80‐degree tilting may be only predictive for a positive result ± 15 minutes because it depends on the tilt duration to a positive response and patient age.

Paroxysmal Atrioventricular Block Induced During Head‐Up Tilt Testing in an Apparently Healthy Man

Paroxysmal AV Block During HUT Testing. Introduction: Prolonged asystole during head‐up tilt testing has been reported, but the occurrence of paroxysmal AV block appears to he rare.

Dislodgment of an Atrial Screw‐In Pacing Lead 10 Years After Implantation

Dislodgment of an atrial screw‐in pacing lead is quite rare. This report describes a rare case of an atrial screw‐in lead dislodgment 10 years after implantation. Although it is an uncommon complication, very late dislodgment can occur postoperatively, and careful follow‐up is necessary. (PACE 2004; 27:264–265)

What is the optimal increase in resting heart rate with low dose isoproterenol infusion for tilt-induced vasovagal response?

Summary: Isoproterenol is widely used as a provocative medium for vasovagal responses during tilt testing. Dose of isoproterenol infusion is generally titrated empirically by increase in resting heart rate before tilt up. To determine the optimal increase in resting heart rate with isoproterenol for tilt‐induced vasovagal responses, we studied 97 consecutive patients with unexplained syncope. After the end of a negative baseline tilt (80° for 30 min), the isoproterenol tilt was performed using one of two protocols: two‐stage isoproterenol‐tilt protocol, with doses of 0.01 and 0.02 μg/kg per min for 10 min each, or one‐stage isoproterenol‐tilt protocol, with a dose of 1 or 2 μg/min for 10 min. The resting heart rate increase was defined as a percentage increase in the resting heart rate after isoproterenol infusion, compared to the baseline heart rate before the tilt test. In 117 tilt procedures, 28 (93%) of the 30 positive responses occurred with a resting heart rate increase of ≥21%. With the resting heart rate increase of 60 and 100%, 18 (60%) and 27 (90%) positive responses were observed, respectively. In conclusion, the minimum resting heart rate increase of ≥21% was required to provoke a vasovagal response during subsequent isoproterenol‐tilt (80° for 10 min). Preferably, heart rate should be increased to 60‐100% by isoproterenol titration before tilting.