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Dexmedetomidine is an a2-adrenergic agonist that promotes deep sedation and analgesia. Ketamine is a dissociative anesthetic that exerts a negative inotropic effect, resulting in increased heart rate. Methadone, a full opioid agonist, causes mild respiratory depression and bradycardia. This study aimed to demonstrate the cardiovascular effects of the combination of dexmedetomidine, ketamine, and methadone in sedating a healthy dog undergoing echocardiographic and electrocardiographic examinations. The patient was sedated, and one hour after the sedative effects had subsided, the mentioned examinations were performed. Six months later, the examinations were repeated without the use of sedatives. The dog received 2 µg/kg of dexmedetomidine, 1 mg/kg of ketamine, and 0.3 mg/kg of methadone intramuscularly. The electrocardiogram showed sinus bradycardia, first-degree atrioventricular block, second-degree atrioventricular block Mobitz type II, and an increase in QRS duration, suggesting left ventricular overload. When performed without sedation, only sinus arrhythmia was observed. The echocardiogram showed normal parameters for the species in both evaluation periods. It can be concluded that the cardiovascular effects observed are attributable to dexmedetomidine, given that the dose of ketamine used was analgesic, and the sedative effect of dexmedetomidine was enhanced by methadone. [ABSTRACT FROM AUTHOR]

Introducción: los tumores cardiacos presentan una baja incidencia en la población general y su presentación clínica es muy variada. Su hallazgo suele ser incidental. El objetivo de este reporte de caso clínico es resaltar la utilidad del ultrasonido y la ecocardiografía en urgencias como herramienta para procedimientos diagnósticos y terapéuticos. Caso clínico: paciente del sexo masculino de 60 años, quien acudió a urgencias por referir disnea, mareos y debilidad generalizada. Presentó bradicardia 35 lpm y se corroboró bradiarritmia tipo ritmo de la unión. Se decidió implantar un marcapasos temporal transvenoso guiado por ultrasonido y se le hizo ecocardiografía, gracias a la cual se encontró una tumoración en aurícula izquierda, compatible con mixoma auricular. La arritmia mencionada persistió, por lo cual se le hizo resección quirúrgica del mixoma al paciente y se le implantó un marcapasos permanente epicárdico DDDR. El paciente fue egresado a domicilio sin complicaciones, con adecuada evolución a los 30 días. Conclusiones: el diagnóstico de tumoraciones cardiacas en ocasiones se realiza de manera incidental con estudios de imagen. En nuestro caso, la utilización del ultrasonido en urgencias como método diagnóstico y guía para colocación de marcapasos transvenoso permitió la documentación de la masa cardiaca desde el ingreso hospitalario del paciente. Background: Cardiac tumors have a low incidence in general population, and its clinical presentation varies so much. The aim of this clinical case report is to highlight the importance and utility of ultrasound and echocardiogram in the emergency department as a tool for diagnostic and therapeutic procedures. Clinical case: 60-year-old male patient who presented to the emergency department because of dyspnea, dizziness, and weakness. At his arrival he was found with 35 bpm, and a junctional bradycardia was confirmed. We decided to implant a temporary transvenous pacemaker with the aid of ultrasound and echocardiogram guidance, finding an intracardiac left atrium mass compatible with a myxoma. The patient was admitted to the cardiology ward, with no remission of the bradycardia. The arrhythmia persisted, which is why the patient underwent the resection of the cardiac tumor along with an implant of a permanent epicardial DDDR pacemaker. The patient was discharged home after a few days with no complications, and he was doing well after a 30-day follow-up. Conclusions: Diagnosis of cardiac tumors is sometimes obtained as an incidental finding with image diagnostic tests. In our case, the use of ultrasound in our emergency department as a diagnostic and therapeutic tool led us to document the cardiac tumor of our patient since his arrival to the hospital. [ABSTRACT FROM AUTHOR]

Objective: The benefit of atropine in pediatric tracheal intubation is not well established. The objective of this study was to evaluate the effect of atropine on the incidence of hypoxemia and bradycardia during tracheal intubations in the pediatric emergency department. Methods: This is a single-center observational study in a tertiary pediatric emergency department. Data were collected on all tracheal intubations in patients from 31 days to incomplete 20 years old, performed between January 2016 and September 2020. Procedures were divided into two groups according to the use or not of atropine as a premedication during intubation. Records with missing data, patients with cardiorespiratory arrest, cyanotic congenital heart diseases, and those with chronic lung diseases with baseline hypoxemia were excluded. The primary outcome was hypoxemia (peripheral oxygen saturation ≤88%), while the secondary outcomes were bradycardia (decrease in heart rate >20% between the maximum and minimum values) and critical bradycardia (heart rate <60 bpm) during intubation procedure. Results: A total of 151 tracheal intubations were identified during the study period, of which 126 were eligible. Of those, 77% had complex, chronic underlying diseases. Atropine was administered to 43 (34.1%) patients and was associated with greater odds of hypoxemia in univariable analysis (OR: 2.62; 95%CI 1.15–6.16; p=0.027) but not in multivariable analysis (OR: 2.07; 95%CI 0.42–10.32; p=0.37). Critical bradycardia occurred in only three patients, being two in the atropine group (p=0.26). Bradycardia was analyzed in only 42 procedures. Atropine use was associated with higher odds of bradycardia in multivariable analysis (OR: 11.00; 95%CI 1.3–92.8; p=0.028). Conclusions: Atropine as a premedication in tracheal intubation did not prevent the occurrence of hypoxemia or bradycardia during intubation procedures in pediatric emergency. [ABSTRACT FROM AUTHOR]

Background/purpose: Inferior vena cava (IVC) interruption is rare and can be detected through prenatal or postnatal imaging. It usually occurs in patients with heterotaxy syndrome with bilateral left-sidedness (left isomerism or polysplenia syndrome), indicating a laterality defect. However, its long-term outcomes remain unclear. Methods: This retrospective study included a patient cohort with evidence of IVC interruption based on imagining data (1980–2019) selected from our institutional database. Results: We included 34 (male/female = 14/20) patients with IVC interruption. Most of the patients had left isomerism of the bronchopulmonary situs (96.4%) and cardiac atrial situs (90.3%). Splenic anomalies, including polysplenia (35.7%), lobulated spleen (39.3%), inversus solitary spleen (10.7%), and asplenia (3.6%), were common. Normal cardiac structure was noted in four (11.8%) patients. Congenital heart disease (CHD) was noted in 30 patients: 7 with simple CHD and 23 with severe CHD. Bradycardia occurred in 47.1% of the patients and was not associated with CHD. Splenic variations were not associated with CHD or bradycardia. The survival rates for the 10-, 20-, and 40-year age groups were 0.880, 0.792, and 0.441, respectively; severe CHD was the only risk factor. Conclusion: IVC interruption can present as an isolated lesion and be associated with CHD. Although bradycardia was common among the patients, CHD severity was the only risk factor for survival. Patients with IVC interruption commonly have left isomerism at the atrial and bronchopulmonary situs, but the spectrum of splenic abnormalities is wide, including polysplenia, lobulated spleen, solitary inversus spleen, and, rarely, asplenia.

Se estudian los casos de dos pacientes que demandan nuestro servicio de indicación farmacéutica porque presentan sintomatología digestiva inespecífica. Ambos están siendo tratados con fármacos de estrecho margen terapéutico (carbonato de litio y digoxina, respectivamente). Durante la indicación, el análisis de la medicación revela la posibilidad de que la clínica que ambos manifiestan guarde relación con estos tratamientos en distinta medida: en el caso del carbonato de litio, por tratarse de una reacción adversa frecuente en tratamientos prolongados, y en el de la digoxina, porque la sintomatología va acompañada de bradicardia. En consecuencia, se proponen dos intervenciones, siendo una de ellas la derivación urgente al médico de atención primaria. El análisis de los tratamientos farmacológicos crónicos prescritos a los pacientes, especialmente aquellos de estrecho margen terapéutico, durante el proceso de indicación, es un punto clave para discriminar entre clínica debida exclusivamente a síntomas menores y otras situaciones que pueden incluso comprometer la vida.

Introducción: El síndrome de Hellp y rotura hepática es una complicación poco frecuente especialmente en casos de embarazo gemelar, presentamos el caso de un hematoma subcapsular hepático roto por síndrome de HELLP que complicó un embarazo gemelar que requirió cesárea de emergencia y para el manejo de la hipovolemia el empaquetamiento hepático.Presentación del caso: Femenina, 41 años, gestación gemelar de 35 semanas, acude a emergencia por contracciones uterina y ausencia de movimientos fetales. Ante bradicardia severa de ambos fetos, se decide cesárea de urgencia. Al abrir la cavidad abdominal se encuentra hemoperitoneo, se logra extraer ambos fetos vivos. Se realiza laparotomía media, supra e infraumbilical exploradora (postcesárea) y se halla rotura hepática del lóbulo derecho. Se procede a empaquetamiento hepático con 11 compresas de gasas, colocación de 4 drenes Penrose laminares y cierre temporal abdominal, el manejo del shock hipovolémico y la preeclampsia se continuó en la Unidad de Cuidados Intensivos la paciente se fue de alta en buenas condiciones a los 21 días. Conclusión: El síndrome de HELLP produce complicaciones graves como rotura hepática que si no es tratada correctamente en forma temprana y multidisciplinaria puede llevar a producir mortalidad materno perinatal.

Copyright of Revista Ciencias de la Salud is the property of Colegio Mayor de Nuestra Senora del Rosario and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Salud, Ciencia y Tecnología is the property of Fundacion Salud, Ciencia y Tecnologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/purpose: Inferior vena cava (IVC) interruption is rare and can be detected through prenatal or postnatal imaging. It usually occurs in patients with heterotaxy syndrome with bilateral left-sidedness (left isomerism or polysplenia syndrome), indicating a laterality defect. However, its long-term outcomes remain unclear.Methods: This retrospective study included a patient cohort with evidence of IVC interruption based on imagining data (1980-2019) selected from our institutional database.Results: We included 34 (male/female = 14/20) patients with IVC interruption. Most of the patients had left isomerism of the bronchopulmonary situs (96.4%) and cardiac atrial situs (90.3%). Splenic anomalies, including polysplenia (35.7%), lobulated spleen (39.3%), inversus solitary spleen (10.7%), and asplenia (3.6%), were common. Normal cardiac structure was noted in four (11.8%) patients. Congenital heart disease (CHD) was noted in 30 patients: 7 with simple CHD and 23 with severe CHD. Bradycardia occurred in 47.1% of the patients and was not associated with CHD. Splenic variations were not associated with CHD or bradycardia. The survival rates for the 10-, 20-, and 40-year age groups were 0.880, 0.792, and 0.441, respectively; severe CHD was the only risk factor.Conclusion: IVC interruption can present as an isolated lesion and be associated with CHD. Although bradycardia was common among the patients, CHD severity was the only risk factor for survival. Patients with IVC interruption commonly have left isomerism at the atrial and bronchopulmonary situs, but the spectrum of splenic abnormalities is wide, including polysplenia, lobulated spleen, solitary inversus spleen, and, rarely, asplenia. [ABSTRACT FROM AUTHOR]

Vasovagal syncope (VVS) can occur in every third of human population. Clinical symptoms of VVS areas a result of arterial hypotension with critical global cerebral hypoperfusion due to vasodilatation and bradicardia. Bradicardia is manifested as sinus node dysfunction and atrioventricular conduction disturbances due to activation of nervus vagus. Asystole can take place in some cases. Lack of efficacy of permanent pacemaker founds in patients to prevent of VVS. The results of double blind placebo controlled studies, European and American expert's opinions, probable causes of lack of efficacy of pacemakers in such category of patients and way of solution of this problem are discussed in the review. Syncope recurrences in spite of pacemaker implantation, risk of surgery complications and good life prognosis are arguments for therapeutic approach, now suitable for the most of patients with VVS. Case report (VVS with asystole but without of pacemaker implantation) with successful follow-up is analyzed in the article.

BRASH syndrome results as a consequence of a chain of pathophysiological events that generally occurs in elderly patients, with underlying cardiac disease, treated with beta-blockers or calcium channel blockers, and who present hyperkalemia. This combination of events potentiates the adverse effects of these drugs, thus, bradycardia, hypoperfusion and shock may develop. We present the case of a 78-year-old male patient with a history of high blood pressure, diabetes mellitus and stage II chronic kidney disease, who was being treated with carvedilol and who attended the emergency department presenting the clinical features that characterize the syndrome. Despite the implantation of a temporary transvenous pacemaker, he died a few hours later. In this report is highlighted the importance of recognizing the factors that lead to the appearance of this syndrome, and the multimodal treatment that these patients need as part of the therapeutic protocol. [ABSTRACT FROM AUTHOR]

Fundamento: La creación en Cienfuegos de una consulta destinada exclusivamente a las bradiarritmias, desde 2017, ha hecho posible el tratamiento y seguimiento más particularizado a los pacientes afectados. Por ello, resulta relevante el estudio de sus características clínicas y paraclínicas.Objetivo: caracterizar desde el punto de vista clínico a los pacientes con bradiarritmias no reversibles.Métodos: se realizó un estudio observacional, descriptivo, de corte transversal. Se trabajó con todos los pacientes atendidos por el Servicio de Cardiología con diagnóstico de bradiarritmia no reversible (N=214). Se estudiaron variables clínicas, electrocardiográficas, ergométricas y ecocardiográficas. A cada una se le dio el tratamiento estadístico de acuerdo a su distribución, escala y tipo.Resultados: predominó el sexo masculino. La media de edad fue de 74 años. La hipertensión fue la comorbilidad más frecuente. El estudio ecocardigráfico demostró algún tipo de alteración estructural en el 80 % de los pacientes. La etiología más frecuente fue la fibrosis del sistema excito-conductor (77 %), así como el bloqueo auriculoventricular de tercer grado fue el diagnóstico electrocardiográfico más habitual entre los que recibieron implante de marcapasos transitorios y permanentes. Predominó el implante de marcapasos permanentes VVI-VVIR. Existió un bajo índice de complicaciones.Conclusión: la población estudiada se caracterizó como envejecida; con presencia de comorbilidades; con algún tipo de alteración estructural en la mayoría, demostrado a través del estudio ecocardiográfico. Fueron causas principales de la bradiarritmia no reversible, la fibrosis del sistema excito-conductor y la isquémica.

Copyright of Farmacéuticos Comunitarios is the property of Sociedad Espanola de Farmacia Familiar y Comunitaria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background: Considering the potential deleterious effects of right ventricular (RV) pacing, the hypothesis of this study is that isolated left ventricular (LV) pacing through the coronary sinus is safe and may provide better clinical and echocardiographic benefits to patients with bradyarrhythmias and normal ventricular function requiring heart rate correction alone. Objective: To assess the safety, efficacy, and effects of LV pacing using an active-fixation coronary sinus lead in comparison with RV pacing, in patients eligible for conventional pacemaker (PM) implantation. Methods: Randomized, controlled, and single-blinded clinical trial in adult patients submitted to PM implantation due to bradyarrhythmias and systolic ventricular function ≥ 0.40. Randomization (RV vs. LV) occurred before PM implantation. The main results of the study were procedural success, safety, and efficacy. Secondary results were clinical and echocardiographic changes. Chi-squared test, Fisher's exact test and Student's t-test were used, considering a significance level of 5%. Results: From June 2012 to January 2014, 91 patients were included, 36 in the RV Group and 55 in the LV Group. Baseline characteristics of patients in both groups were similar. PM implantation was performed successfully and without any complications in all patients in the RV group. Of the 55 patients initially allocated into the LV group, active-fixation coronary sinus lead implantation was not possible in 20 (36.4%) patients. The most frequent complication was phrenic nerve stimulation, detected in 9 (25.7%) patients in the LV group. During the follow-up period, there were no hospitalizations due to heart failure. Reductions of more than 10% in left ventricular ejection fraction were observed in 23.5% of patients in the RV group and 20.6% of those in the LV group (p = 0.767). Tissue Doppler analysis showed that 91.2% of subjects in the RV group and 68.8% of those in the LV group had interventricular dyssynchrony (p = 0.022). Conclusion: The procedural success rate of LV implant was low, and the safety of the procedure was influenced mainly by the high rate of phrenic nerve stimulation in the postoperative period.

Objective: The objective of this study was to describe the case of a 19-year-old male presenting with bradycardia and hypotension after a honeybee sting making a review of the literature and pathophysiology of the cardiovascular and electrocardiogram (EKG) changes after a bee sting. Methods: The patient's airway was inspected and secured. Electrocardiogram with an idioventricular rhythm at 41' bpm. Oxygen was administered, an intravenous access was established, and the transcutaneous pacemaker leads were placed on the chest of the patient, then published guidelines management was induced. Results: The EKG showed idioventricular rhythm at a rate of 41 beats/min that resolved to a normal sinus rhythm after treatment. Conclusions: A full and prompt cardiovascular evaluation should be performed in all patients presenting to the emergency department after a bee sting, and published guidelines regarding the management of bradycardia and anaphylaxis should be followed to achieve successful outcomes. [ABSTRACT FROM AUTHOR]

Introduction: hypotension and bradycardia are two underlying and almost common complications caused by spinal anesthesia in cases of elective cesarean section (CS). Suitable treatment of the complications is particularly important to improve the conditions of patients. Hence, the aim of this study is to compare the effect of intravenous administration of epinephrine and ephedrine in the management of hypotension and bradycardia caused by CS spinal anesthesia. Method: the study was done as a random clinical trial on 126 women under spinal anesthesia for elective CS, hospitalized in Kamali Hospital, Karaj in 2020-21. The statistical samples were classified into two ephedrine and epinephrine. Patients systolic blood pressure, diastolic blood pressure, heart rate and Apgar and VBG of the newborn were analyzed in two study groups. Results: The results showed that the mean value of diastolic blood pressure, which was the same in the two groups at the beginning, was significantly increased in the ephedrine group compared to the epinephrine group from minute eight. Mean systolic blood pressure, which was the same in the two groups at the beginning, was significantly increased in the ephedrine group compared to the epinephrine group in minutes 8-16. However, they showed no significant difference in the rest of the evaluations. The mean value of heart rate that was the same between the two groups at the beginning was significantly increased in the ephedrine group in minutes 10, 25, 35, and 45; although the two groups showed no significant difference in other times assessed. The mean value of PCO2 and HCO3 showed a significant difference between the two groups, and both were higher in the ephedrine group. Conclusion: Our results indicate that intravenous ephedrine compared to intravenous epinephrine produces a higher increasing the values blood pressure and heart rate in the management of hypotension and bradycardia caused by spinal anesthesia in the cases of elective cesarean section. [ABSTRACT FROM AUTHOR]

Introducción: el reflejo trigémino cardíaco es una respuesta fisiológica parasimpática repentina, que ocasiona alteraciones cardiovasculares importantes durante la estimulación nerviosa en el trayecto del V par craneal, generalmente ocurre al realizar procedimientos quirúrgicos en cirugía oral y maxilofacial, neurocirugía, oftalmología y dermatología. La artroscopia de la articulación temporomandibular ha sido tradicionalmente considerada un procedimiento quirúrgico seguro, mínimamente invasivo, aun así, esta técnica no está exenta de complicaciones neuro y cardiovasculares. Objetivo: presentar un caso clínico que durante una artroscopia de la articulación temporomandibular en la fase de instrumentación del espacio articular superior, y que, bajo monitoreo continuo del anestesiólogo, reportó una bradicardia súbita. Conclusión: el diagnóstico intraoperatorio de reflejo trigémino cardíaco, fue descrito por el servicio de anestesiología recibiendo un tratamiento farmacológico temprano para esta condición, lo que permitió obtener una adecuada evolución trans y postoperatoria. La artroscopia de la articulación temporomandibular ha sido tradicionalmente considerada un procedimiento quirúrgico seguro, mínimamente invasivo, aun así, esta técnica no está exenta de complicaciones. El objetivo de este artículo es presentar un caso clínico que durante una artroscopia de la articulación temporomandibular en la fase de instrumentación del espacio articular superior sufrió una bradicardia súbita, con un diagnóstico intraoperatorio de reflejo trigémino cardíaco, recibiendo un tratamiento temprano por parte del servicio de anestesiología de esta condición, obteniendo una adecuada evolución trans y postoperatoria.

Introducción: como es sabido, las arritmias son una causa importante de las palpitaciones, siendo este un problema común en los individuos que se encuentran dentro del rango de la edad pediátrica. El objetivo de esta investigación es informar al público en general sobre la importancia de la correcta investigación del origen de las palpitaciones, mediante una correcta anamnesis, examen físico y un EKG de 12 derivaciones, ya que esto puede provocar una gran preocupación entre los padres y/o tutores de los escolares. Los pacientes pediátricos suelen buscar atención médica para los síntomas asociados con las arritmias. Las arritmias cardíacas son consideradas como las alteraciones de la secuencia de contracciones y relajación del corazón. Sin embargo, no todas las alteraciones del ritmo son sintomáticas, pero sí requieren una cuidadosa evaluación para su correcto diagnóstico. Los pacientes pueden presentar síntomas como palpitaciones, síncope, sudor o cefalea, mientras que otros pueden no presentar síntomas y ser detectado ante un examen físico de rutina, o una evaluación por alguna otra causa.1,2,3,4 La evaluación inicial de un paciente que presenta arritmia consiste en realizar una historia clínica completa, abordando los síntomas, el momento de la arritmia, y las posibles enfermedades subyacentes; un examen físico y un electrocardiograma de 12 derivaciones, si es posible durante la arritmia o sin ella.3 Por otro lado, la etiología de las palpitaciones puede ser de tipo cardíacas, o no cardíacas, por tal razón, es primordial definir si existe trastorno metabólico y electrolítico, o antecedentes tiroideos y psicosomáticos, ya que estos pueden desencadenar alteraciones del ritmo cardíaco.5 Material y Métodos: para el desarrollo de la siguiente investigación se ha realizado una revisión sistemática de artículos científicos consultando en bases de datos bibliográficas Pub Med/MED LINE, Up to date, Scielo y El Sevier, con restricción de fechas desde el 2015 hasta la actualidad, en los idiomas español e inglés. Con los datos obtenidos de los artículos científicos se pudo analizar el concepto y origen de las arritmias, y así afirmar las causas más frecuentes de estas, y la importancia de la cuidadosa evaluación del paciente junto con su correcto diagnóstico. Resultados: en la presente investigación encontramos que las causas más frecuentes de arritmias de origen no cardíaco en pacientes pediátricos fueron, en primer lugar, los trastornos metabólicos, incluyendo los trastornos electrolíticos como hiper/hipopotasemia e hipercalcemia, hipoglucemia, inestabilidad hemodinámica e hipotermia. Del mismo modo, pacientes con trastornos tiroideos, psicosomáticos y por exposición a medicamentos, especialmente los simpaticomiméticos contenidos en bebidas de altos niveles de cafeína. Y medicamentos para la tos/resfriado pueden desencadenar una alteración del ritmo cardíaco. Conclusiones: no siempre la presencia de palpitaciones es causada por enfermedades cardíacas, sino que existen palpitaciones de origen no cardíacos, provenientes de otros sistemas, las cuales no representa ningún peligro para el individuo. No obstante, todas las palpitaciones deben ser estudiadas para su correcto diagnóstico y tratamiento.

Background: The creation of a bradyarrhythmias consultation in Cienfuegos, since 2017, has made possible the treatment and more specific follow-up of affected patients. Therefore, the study of its clinical and paraclinical characteristics is relevant. Objective: to characterize patients with non-reversible bradyarrhythmias from the clinical point of view. Methods: an observational, descriptive, cross-sectional study was carried out. All the patients seen by the Cardiology Service with a diagnosis of non-reversible bradyarrhythmia (N = 214) were taken into account to this work. Clinical, electrocardiographic, ergometric and echocardiographic variables were studied. Each one was given the statistical treatment according to its distribution, scale and type. Results: Male sex predominated. The median age was 74 years. Hypertension was the most frequent comorbidity. The echocardigraphic study showed some type of structural alteration in the 80% of the patients. The most common etiology was fibrosis of the excito-conductor system (77%), as well as third degree atrioventricular block was the most common electrocardiographic diagnosis among those who received temporary and permanent pacemaker implantation. There was a low rate of complications. Conclusion: the studied population was characterized as aged; with the presence of comorbidities; with some type of structural alteration in the majority, demonstrated through echocardiographic study. Fibrosis of the excito-conductive system and ischemic were the main causes of non-reversible bradyarrhythmia. [ABSTRACT FROM AUTHOR]

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Introduction: Patients with Down syndrome without structural heart disease may present with a dysfunction of the cardiac autonomic regulation, which is manifested by a reduced response of the heart rate (HR) to stimuli. Based on the hemodynamic responses, it has been postulated that individuals with Down syndrome have a reduced vagal tone and sympathetic activation. This review explains the role of the autonomic system in the control of HR and the attenuated chronotropic response observed in this population. Objective: To describe, through a clinical case presentation, the autonomic dysfunction observed in patients with Down syndrome, in order to identify the causes attributed by scientific evidence. Materials and methods: A clinical case was described and a search was made in PubMed of the terms: “Down Syndrome” AND “Bradycardia”, “VO2peak”, “Heart Rate Variability”, “Vagal Tone”, “Sympathetic Activation”. Results: The findings suggest that physical exercise may be an effective intervention to improve autonomic cardiac function in patients with Down syndrome. Furthermore, training-induced improvements were achieved by participants with lower levels of vagal modulation at the start of the study, in both patients with and without disabilities. In consequence, training may be effective to improve cardiorespiratory fitness in those who have a greater degree of autonomic dysfunction. Conclusion: A clinical case of Down syndrome with sinus dysfunction was presented in this study. This condition could be related to a dysfunction of autonomic cardiac function regulation caused by reduced HR response to stimuli.

Copyright of Arquivo Brasileiro de Medicina Veterinaria e Zootecnia is the property of Universidade Federal de Minas Gerais, Escola de Veterinaria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of CES Medicina is the property of Universidad CES and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A fibrilaçao atrial é a arritmia sustentada mais frequente na prática clínica. Uma significativa parcela de pacientes portadores dessa afecçao evolui com períodos de bradiarritmias, necessitando implante de marcapasso. Dessa forma, nos portadores de dispositivos cardíacos implantáveis, pode ser necessária a indicaçao de ablaçoes complexas, como a da fibrilaçao atrial, com acesso transeptal e manipulaçao de cateteres próximo aos cabos-eletrodos definitivos. Relatamos o caso de um paciente portador de marcapasso bicameral com síndrome bradi-taquicardia e fibrilaçao atrial de alta frequência ventricular, refratária à medicaçao, no qual foi possível realizar a ablaçao da fibrilaçao atrial com sucesso a longo prazo, demonstrado pela telemetria do marcapasso, permitindo suspender a anticoagulaçao e sem necessidade de indicar bloqueio atrioventricular.

Hiperparatireoidismo associado a hipercalcemia causando bradicardia significativa é uma combinaçao rara. Relatamos o caso de uma paciente de 62 anos de idade em pré-operatório de paratireoidectomia total decorrente de hiperparatireoidismo primário sintomático, que evoluiu com bloqueio atrioventricular avançado percebido durante a internaçao. A paciente necessitou de implante de marcapasso definitivo, pois permaneceu com bloqueio cardíaco avançado mesmo após correçao da hipercalcemia.

Una paciente habitual de nuestra farmacia comunitaria nos consulta acerca de un cuadro de astenia, debilidad y fatiga de varias semanas de evolución. Tras realizar el estado de situación inicial y estudiar el caso detectamos varios problemas relacionados con medicamentos, siendo una marcada bradicardia el más acuciante. El estudio en detalle de la farmacoterapia de la paciente revela que la fracción de timolol absorbida tras su instilación ocular, que emplea para tratar su hipertensión ocular, podría ser responsable de una acusada disminución de su frecuencia cardiaca. Dicha bradicardia puede ser especialmente significativa en personas de edad avanzada y en individuos que, como consecuencia del polimorfismo de la enzima responsable del metabolismo de timolol, expresan un determinado genotipo con menor capacidad de biotransformación. Intervenimos indicando a la paciente la conveniencia de que su médico valorase otras opciones para el tratamiento de la hipertensión ocular. Tras una visita a urgencias por el agravamiento de los síntomas, se constata la bradicardia severa y el betabloqueante es sustituido por un tratamiento alternativo (latanoprost). La intervención farmacéutica resulta en la retirada de timolol, la remisión de los síntomas y en la resolución de dos problemas relacionados con medicamentos.

ABSTRACTBACKGROUND AND OBJECTIVES: the "shortness of breath" or "breathing interruption" crisis can be considered a cause of hypoxia in childhood. It is characterized by the presence of a triggering factor followed by weeping and apnea in expiration accompanied by cyanosis or pallor. The sequence of events may include bradycardia, loss of consciousness, abnormal postural tone and even asystole. A review of the literature revealed only two reports of postoperative apnea caused by "shortness of breath".CASE REPORT: this article describes the case of a child with a history of "shortness of breath" undiagnosed before the adenotonsillectomy, but that represented the cause of episodes of hypoxemia and bradycardia in the postoperative period.CONCLUSIONS: the "shortness of breath" crisis should be considered as a possible cause of perioperative hypoxia in children, especially when there is a history suggestive of this problem. As some events may be accompanied by bradycardia, loss of consciousness, abnormal postural tone and even asystole, observation in a hospital setting should be considered.

Nicotine is a dangerous substance extracted from tobacco leaves. When nicotine is absorbed in excessive amounts, it can lead to respiratory failure and cardiac arrest. The commercialization of electronic cigarettes (e-cigarettes) has allowed users to directly handle e-cigarette liquid. Consequently, the risk of liquid nicotine exposure has increased. We describe our experience of managing the case of a patient who orally ingested a high concentration of liquid nicotine from e-cigarette liquid. The patient presented with bradycardia and hypotension, which are symptoms of parasympathetic stimulation, together with impaired consciousness. He recovered following treatment with atropine and a vasopressor. [ABSTRACT FROM AUTHOR]

Copyright of Ciberrevista Enfermeriadeurgencias.com is the property of Sociedad Espanola de Enfermeria de Urgencias y Emergencias and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Intraoperative critical events are rare situations and their management in some occasions may be inaccurate or not done in time. Objective: To translate and update checklists for the management of critical events in the operating room developed by Adriadne Labs, based on secondary clinical evidence. Materials and methods: For the translation and update of checklists, we followed the recommendations of Adriadne Labs for the modification of the checklists according to a systematic methodology divided in steps: 1) translation of the original checklists; 2) systematic research of the literature; 3) evaluation and selection of the evidence; 4) adaptation of the checklist for the management of local anesthetic toxicity; 5) changes, subtractions, and additions to the translated lists, and 6) diagramming of the checklists. Results: We translated to Spanish the 12 original checklists and adapted a new checklist for the management of local anesthetic systemic toxicity. As a result of the systematic research of the literature, we retrieved 1.407 references and selected 7 papers that were used to update the new checklists based on evidence. The new checklists were diagrammed according to the recommendations of design of the original lists. Conclusion: Twelve checklists were translated and updated and a new one for the management of local anesthetic systemic toxicity was adapted based on a systematic review of the literature [ABSTRACT FROM AUTHOR]

Granulomatosis with polyangiitis is a rare systemic inflammatory disorder characterized by vasculitis of the small arteries, the arterioles and the capillaries together with necrotizing granulomatous lesions. This case reports on a young female patient, previously diagnosed with granulomatosis with polyangiitis, who was admitted to the intensive care unit with seizures and hemodynamic instability due to a complete atrioventricular heart block. Te event was associated with multiple episodes of sustained ventricular tachycardia without any structural heart changes or electrolyte disturbances. In the intensive care unit, the patient was fitted with a provisory pacemaker, followed by immunosuppression with corticosteroids and immunobiological therapy, resulting in a total hemodynamic improvement. Severe conduction disorders in patients presenting granulomatosis with polyangiitis are rare but can contribute to increased morbidity. Early detection and specific intervention can prevent unfavorable outcomes, specifically in the intensive care unit. [ABSTRACT FROM AUTHOR]

Copyright of Colombian Journal of Anesthesiology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Facultad de Medicina de la Universidad Nacional de Colombia is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The neonate must make a transition after birth from intrauterine continuous transplacental supply of oxygen and glucose to different extra uterine conditions. In healthy neonate the period of adaptation almost finished in the perinatal period and newborn can be safely discharged after this time. Retrospective study in the NICU, Clinical Hospital Osijek, during the year 2016 was done. Almost 26% of neonates were admitted in NICU because of the prolonged adaptation to extra uterine life. It was their main diagnosis. The majority of them have been polycytemic, had early jaundice and a part of them had bradycardia. Mother's illnesses as a possible cause of prolonged neonatal adaptation were found in 21.7%. About 58.3% of newborns with prolonged adaptation have had problems during mother's pregnancy and delivery. Hypertrophic as well as hypotrophic neonates were risk neonates for prolonged postnatal adaptation, as well as newborns gender. Mode of delivery takes a big role in the neonatal adaptation. Induction and augmentation of the labor acts as a possibly stress factor. Main symptoms among those newborns were: plethora, cyanotic crises, bradicardia, dystonia, irritability, jaundice and respiratory distress. Most of the investigated newborns need oxygen 6-10 days. The majority of them stay in the hospital up to 10 days. Prolonged adaptation has almost equally been found in the first, second and third pregnancy. [ABSTRACT FROM AUTHOR]

Copyright of Revista Facultad de Medicina de la Universidad Nacional de Colombia is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La apena del prematuro es un importante problema clínico, manifestado por un ritmo respiratorio inestable, reflejo de una inmadurez de los sistemas de control respiratorio. Esta revisión aborda definiciones, patogénesis y alternativas terapéuticas. Aún están en estudio y/o no son bien conocidos, los mecanismos neuronales que provocan apnea en el prematuro. En la reciente década, se ha conocido mejor la generación del ritmo respiratorio y su modulación en el neonato. Estos episodios de pérdida de respiración efectiva pueden conducir a cuadros de hipoxemia y bradicardia, que pueden ser lo suficientemente severos como para necesitar resucitación y el uso de ventilación asistida. La cafeína sigue siendo el principal tratamiento farmacológico. La Apnea del prematuro se resuelve típicamente con la maduración.

Alteraciones autonómicas agudas por infartos cerebrales se han descrito con frecuencia comprometiendo la región insular, dentro de las anormalidades se han documentado alteraciones de severidad variable del ritmo cardíaco, incluyendo la bradicardia extrema sintomática; en la literatura solo hay un reporte de caso de bradi-cardia extrema asociado a un infarto talámico paramediano bilateral, a continuación, describimos un segundo caso de un infarto talámico con la misma presentación.

FUNDAMENTO: A estimulação endocárdica convencional do ventrículo direito (VD) ocasiona alargamento do QRS e dessincronização do miocárdio, comprometendo a função ventricular. Com a necessidade de estimulação menos deletéria, a estimulação septal do VD tem sido mais utilizada. Eventualmente têm sido relatados limiares mais altos e ondas R menores na estimulação septal. OBJETIVO: Comparar os parâmetros das estimulações apical e septal, intrapaciente, para verificar se existem diferenças que possam interferir na escolha do ponto de estimulação. MÉTODOS: Estudo prospectivo controlado. Foram incluídos 25 pacientes, com 67,2 ± 9 anos, 10 (40%) mulheres, com indicações de marca-passo por bradiarritmias. Etiologias foram degenerativa em nove (36%), coronariopatia em oito (32%), doença de Chagas em sete (28%), e valvopatia em um (4%) pacientes. Foram utilizados eletrodos de fixação ativa e avaliados os limiares de comando, impedância e onda R uni e bipolares no implante e após seis meses. RESULTADOS: A média aguda dos limiares de comando, ondas R e impedâncias unipolares/bipolares septais x apicais foram, respectivamente, 0,73x0,74V e 0,73x0,78V; 10x9,9 mV e 12,3x12,4 mV; 579x621 Ω e 611x629 Ω. Comparações entre parâmetros septais e apicais com teste t-pareado bicaudal demonstraram um P > 0,1. Após seis meses, a média dos limiares de comando, ondas R e Impedâncias unipolares/ bipolares septais x apicais foram, respectivamente, 0,5 x 0,72 V e 0,71 x 0,87 V; 11,4x9,5 mV e 12x11,2 mV; 423x426Ω e 578x550Ω, com P > 0,05, exceto comparando-se limiar de estimulação unipolar septal com apical unipolar p de 0,02. CONCLUSÃO: Utilizando comparações intrapaciente, não existem diferenças expressivas entre parâmetros eletrofisiológicos de estimulação septal e apical sendo que não há restrições para a escolha da estimulação septal em ventrículo direito.BACKGROUND: The conventional right ventricle (RV) endocardial pacing leads QRS widening and desynchronization myocardial compromising ventricular function. With the need for stimulation less deleterious, RV septal pacing has been used more. Eventually have been reported higher thresholds and smaller R waves in the septal stimulation. OBJECTIVE: To compare the parameters of the septal and apical stimulation, intra-patient, if there are any differences that may affect the choice of the point of stimulation. METHODS: A prospective controlled study. We included 25 patients, 67.2±9 years, 10 (40%) women with indications for pacemaker for bradyarrhythmias. Etiologies were degenerative in nine (36%), Coronary disease in eight (32%), Chagas disease in seven (28%), and valve disease in one (4%) patient. Electrodes were active fixation and assessed the thresholds of command, impedance and R wave in uniand bipolar implant and after six months. RESULTS: The average acute threshold command, R wave and impedance unipolar / bipolar septais x apicais were respectively 0.73 x 0.73V and 0,74V x 0,78V; 10 x 9,9mV and 12,3 x 12,4mV; 579 x 621Ω and 611 x 629Ω. Comparisons between parameters with septal and apical two-tailed paired t-test showed a P > 0.1. After six months, the mean control thresholds, R wave impedances and unipolar/bipolar septais x apicais were respectively 0.5V x 0 72V and 0.71V x 0,87V; 11.4 x 9,5mV and 12x11,2mV; 423x426 Ω and 578x550 Ω, with P > 0.05, except compared to unipolar pacing threshold septal apical unipolar P 0.02. CONCLUSION: Using intra-patient comparisons, no significant differences between electrophysiological parameters septal and apical pacing and there are no restrictions for choosing the right ventricular septal pacing.

Se efectuó un estudio analítico observacional, de tipo caso-control, de los pacientes atendidos en el cuerpo de guardia y posteriormente ingresados en el Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba desde enero de 2009 hasta diciembre de 2010, con el diagnóstico de traumatismo craneoencefálico grave, a fin de determinar los principales factores de pronóstico relacionados con la mortalidad por esa causa; para ello se realizaron pruebas estadísticas como Ji al cuadrado, razón de productos cruzados y modelo de regresión logística. Entre los factores de pronóstico que influyeron en la mortalidad por ese tipo de traumatismo, sobresalieron: edad por encima de los 60 años, bradipnea, bradicardia e hipotensión arterial. En el análisis bivariante de regresión logística, la bradipnea y la hipotensión arterial fueron las variables pronósticas independientes.An analytical and observational case-control study of patients with severe cranioencephalic trauma attended at the emergency room and subsequently hospitalized at "Saturnino Lora" Provincial Teaching Hospital in Santiago de Cuba was carried out from January, 2009 to December, 2010 in order to determine the main prognosis factors related to mortality due to that cause. That is why some statistical tests, such as chi square test, odds ratio, and logistical regression model, were performed. Age over 60 years, bradypnea, bradycardia, and hypotension prevailed among prognosis factors which influenced in mortality due to this kind of trauma. In the bivariate logistic regression analysis, bradypnea and hypotension were the independent prognostic variables.

Fingolimod is a new and efficient treatment for multiple sclerosis (MS). The drug administration requires special attention to the first dose, since cardiovascular adverse events can be observed during the initial six hours of fingolimod ingestion. The present study consisted of a review of cardiovascular data on 180 patients with MS receiving the first dose of fingolimod. The rate of bradycardia in these patients was higher than that observed in clinical trials with very strict inclusion criteria for patients. There were less than 10% of cases requiring special attention, but no fatal cases. All but one patient continued the treatment after this initial dose. This is the first report on real-life administration of fingolimod to Brazilian patients with MS, and one of the few studies with these characteristics in the world.

Neste estudo, investigaram-se as modificações fisiológicas em Spilotes pullatus, como determinantes das respostas ao medo, obtidas pela exposição ao eletrocardiograma. Foram utilizadas quatro serpentes com média de peso de 0,5±0,06kg. Dois minutos após a fixação dos eletrodos, as serpentes apresentavam-se imóveis, com redução significativa na freqüência cardíaca e aumento nos intervalos PQ, QRS, RR e RT (PThis study investigated electrocardiographic changes in Spilotes pullatus using four snakes weighing 0.5±0.06kg. Two minutes after that electrocardiogram apparatus had been fixed in Spilotes pullatus, snakes were immobile and there was a significant reduction of the heart rate and an increase in PQ, QRS, RR, and RT intervals (P