Sudden death in aortic stenosis monitored by ear densitographic pulse and ECG

Nikolić, George; Haffty, Bruce G.; Bishop, Richard L.; Singh, Jang Bahadur; Flessas, Athanasios; Spodick, David H.

doi:10.1016/0002-8703(82)90210-1

Cited by 18 publications

(2 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Approximately 40% of these patients die suddenly due to sudden cardiac death syndrome [1 -6]. Ventricular tachycardia and fibrillation were documented in 80% of patients with HF in whom electrocardiogram (ECG) Holter recordings were being obtained at the time of sudden death [7][8][9]. Cellular mechanisms that could generate abnormal rhythmic activity in HF include afterpotentials, reentry and enhanced automaticity (see for review [10]).…”

mentioning

confidence: 99%

Repolarization abnormalities in cardiomyocytes of dogs with chronic heart failure: role of sustained inward current

Undrovinas¹,

Maltsev²,

Sabbah³

1999

Cellular and Molecular Life Sciences (CMLS)

188

166

View full text Add to dashboard Cite

We previously showed that a canine model of chronic heart failure (HF) produced by multiple coronary microembolizations manifests ventricular arrhythmias similar to those observed in patients with chronic HF. In the present study, we used single canine cardiomyocytes isolated from the left ventricle (LV) of normal dogs (n = 13) and dogs with HF (n = 15) to examine the cellular substrate of these arrhythmias. Action potentials (APs) and ion currents were measured by perforated and whole cell patch clamp, respectively. We found prolonged APs and alterations of AP duration resulting in early afterdepolarizations (EADs) at the low pacing rates of 0.5 Hz and 0.2 Hz. Na+ channel blockers saxitoxin (STX, 100 nM) and lidocaine (90 microM) reduced AP duration dispersion and abolished EADs in HF cardiomyocytes. The steady-state current (Iss)-voltage relation, in the voltage range from -25 mV to 25 mV analogous to the AP plateau level, was significantly shifted inward in HF cardiomyocytes. STX and lidocaine shifted the Iss-voltage relationship in an outward direction. The shifts produced by both drugs was significantly greater in cardiomyocytes of dogs with HF, indicating an increase in inward current. In the experimental configuration in which K+ currents were blocked, the density of the steady-state Ca2+ current (ICa) was found to decrease in HF cardiomyocytes by approximately 33%. In contrast, the density of the steady-state Na+ current (INa) significantly (P < 0.01) increased in HF cardiomyocytes (0.17 +/- 0.06 pA/pF) compared with normal cells (0.08 +/- 0.02 pA/pF). The relative contribution of INa to the net inward current was greater in HF cardiomyocytes, as evident from the increased ratio of INa/ICa (from 0.22 to 0.68). These observation support a hypothesis that anomalous repolarization of HF cardiomyocytes is due, at least in part, to an increased steady-state inward Na+ current.

show abstract

mentioning

confidence: 99%

Repolarization abnormalities in cardiomyocytes of dogs with chronic heart failure: role of sustained inward current

Undrovinas¹,

Maltsev²,

Sabbah³

1999

Cellular and Molecular Life Sciences (CMLS)

188

166

View full text Add to dashboard Cite

show abstract

“…The mechanism of sudden death in aortic stenosis has not been fully explained until now, although a considerable amount of data suggest the possible role of malignant tachyarrhythmias or abnormal Bezold-Jarisch reflex accompanied by bradyarrhythmias and hypotension. 23,24 The prolongation of the QTc intervallong-QT syndromeis associated with a potentially fatal form of polymorphic ventricular tachycardiatorsades de pointes. Acquired forms of QTc prolongation and arrhythmia are often related to drug effects, not only caused by the particular drug's property or dosage but also by drug-drug interactions, as well as specific characteristics of the patientsuch as age, gender, the presence and severity of the primary heart disease, and genetic predisposition.…”

Section: Discussionmentioning

confidence: 99%

The association between pro-arrhythmic agents and aortic stenosis in young adults: is it sufficient to clarify the sudden unexpected deaths?

et al. 2016

View full text Add to dashboard Cite

Most young patients with mild-to-moderate aortic stenosis show no symptoms, and sudden death appears only occasionally. We hypothesised that malignant ventricular arrhythmias could be responsible for the high incidence of sudden death in such patients. If multiple factors such as asymptomatic aortic stenosis in association with arrhythmia-provoking agents are involved, could it be sufficient to account for sudden unexpected death? In this study, eight cases of sudden death in young adults, with ages ranging from 22 to 36 years, who had never reported any symptoms that could be related to aortic stenosis, were investigated. Full autopsies were performed, and congenital aortic stenosis in all eight cases was confirmed. DNA testing for channelopathies was negative. Comprehensive toxicological analyses found an electrolyte imbalance, or non-toxic concentrations of amitriptyline, terfenadine, caffeine, and ethanol. Collectively, these results suggest that congenital asymptomatic aortic stenosis without cardiac hypertrophy in young adults is not sufficient to cause sudden death merely on its own; rather, an additional provoking factor is necessary. According to our findings, the provoking factor may be a state of physical or emotional stress, a state of electrolyte imbalance, or even taking a therapeutic dose of a particular drug.

show abstract

Klinischer Teil

Bethge

Gonska

1996

Langzeit-Elektrokardiographie

View full text Add to dashboard Cite

Sudden death in aortic stenosis monitored by ear densitographic pulse and ECG

Cited by 18 publications

References 8 publications

Repolarization abnormalities in cardiomyocytes of dogs with chronic heart failure: role of sustained inward current

Repolarization abnormalities in cardiomyocytes of dogs with chronic heart failure: role of sustained inward current

The association between pro-arrhythmic agents and aortic stenosis in young adults: is it sufficient to clarify the sudden unexpected deaths?

Klinischer Teil

Contact Info

Product

Resources

About