The high diagnostic rate of implantable loop recorder in the everyday clinical practice is in accordance with the findings in prospective clinical studies. This observation supports the early application of loop recorder in the diagnostic algorithm of syncope.
A 52-year-old woman is presented with repetitive transient loss of consciousness. Implantable loop recorder (ILR) recorded muscle artifacts during the generalized tonic-clonic seizures. Seizure was diagnosed and antiepileptic drug was started. The patient has been asymptomatic for 9 months. Orv Hetil. 2019; 160(29): 1143–1145.
Összefoglaló. Egy 78 éves férfi széles-QRS-tachycardiás esetét
mutatjuk be. A betegnél a pitvar-kamrai disszociáció igazolta a ritmuszavar
kamrai eredetét, amelyet a Valsalva-manőverrel több alkalommal is átmenetileg
meg lehetett szüntetni. A szerzők ismertetik a manőver lehetséges
patomechanizmusait, illetve felhívják a figyelmet arra, hogy a vagusmanőverre
megszűnő reguláris tachycardia nem jelent feltétlenül supraventricularis
eredetet. Orv Hetil. 2021; 162(12): 468–470.
Summary. A 78-year-old man is presented with wide QRS tachycardia
(WQRST). The ventricular origin of WQRST was confirmed by atrioventricular
dissociation. The Valsalva maneuver terminated the tachycardia repeatedly. The
authors discuss the possible mechanisms of Valsalva maneuver in the arrhythmia
termination. This case highlights that Valsalva maneuver or carotid massage
terminated tachycardia are not necessarily supraventricular tachycardia. Orv
Hetil. 2021; 162(12): 468–470.
ST-segment elevation is the hallmark of acute transmural myocardial ischemia caused by acute occlusion of a coronary artery. ST-segment elevation is the major criterion for the patients with chest pain to immediate reperfusion therapy. Despite its clinical importance, the mechanism of ST-elevation remains unclear. Two patients are reported with proximal left anterior descending coronary occlusion but without ST-segment elevation. The distinct ECG patterns were tall, with symmetrical T-waves and upsloping and digoxin-like ST-segment depression. Patients with these ECG patterns need immediate coronary intervention.
A 77-year-old female patient was admitted to our emergency department with syncope and suspected pacemaker dysfunction. An AAI pacemaker implantation () is mentioned in her medical history due to tachycardiabradycardia syndrome 3 years earlier with the prescription of 300-mg propafenone orally to be taken twice a day. The patient was free of complaints for over 2 years and had no documented or long-lasting arrhythmias since then. The pacemaker interrogation 1 week before recent admission showed good device function; with battery voltage at 2.77 V, battery impedance at 0.7 kOhm, lead impedance at 593 Ohm, as well as pacing thresholds at 0.8 V/0.75 ms and 1.2 V/0.40 ms. The atrial sensing was measured to be between 1.7 mV and 2.2 mV at a spontaneous sinus rate of 47 beats/min. The initial programmed parameters were atrial pulse amplitude at 2.4 V, pulse width 0.40 ms, and sensitivity at 0.8 mV. On the morning of the admission our patient felt palpitations again and therefore took another 300-mg propafenone as advised by the "pill in the pocket" concept (900-mg propafenone within 13 hours). Four hours later, she first felt dizziness with nausea, then lost consciousness for a few moments shortly afterwards. The emergency electrocardiogram performed on-site revealed normal regular, but ineffective, atrial pacemaker stimuli with 800 ms as well as a narrow QRS ventricular escape rhythm with cycle lengths of 1,920 ms (Fig. 1). The emergency therapy given from the medical staff at her home was 3-mg atropine given intravenously as well as 500-mL saline infusion. On admission to our Coronary Care Unit, the cycle length of the escape rhythm was already shorter at 550 ms Address for reprints: János Tomcsányi, M.D., Budai Irgalmasrendi Kórház Kardiológia,Árpád fejedelem u.7,
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