scholarly journals Accelerated Idioventricular Rhythm and Hypokalemia, Atypical Presentation in the Midst of a Pandemic

2021 ◽  
Vol 34 (1) ◽  
pp. 23-27
Author(s):  
Carlos Rodríguez-Artuza ◽  
Mayela Labarca Torres ◽  
José Meza
Keyword(s):  
Sinus Rhythm ◽  
Rural Population ◽  
Serum Magnesium ◽  
Electrolyte Imbalance ◽  
Atypical Presentation ◽  
Diagnostic Investigation ◽  
Exertional Dyspnea ◽  
Idioventricular Rhythm ◽  
Private Center ◽  
Surface Electrocardiogram

A 34-year-old female patient was referred to a private center from a rural population due to exertional dyspnea and palpitations for 15 days being previously asymptomatic, a surface electrocardiogram diagnoses sinus rhythm alternating with accelerated idioventricular rhythm with episodes of short-coupling intervals. When conducting a diagnostic investigation, hypokalemia and decreased serum magnesium were evidenced and, after correction of the water-electrolyte imbalance, the electrocardiographic disorders disappeared.

scholarly journals Study of effect of serum magnesium concentration on clinical outcome of critically sick patients in medical intensive care unit

2021 ◽  
Vol 8 (12) ◽  
pp. 1812
Author(s):  
Ganedi S. Kumari
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Serum Magnesium ◽  
Ventilatory Support ◽  
Magnesium Level ◽  
Cardiac Insufficiency ◽  
Electrolyte Imbalance ◽  
Magnesium Concentration ◽  
Ventilator Support ◽  
Male Predominance

Background: Deficiency of magnesium is common and often ignored. It is associated with cardiac irregularity, cardiac insufficiency, seizure and electrolyte imbalance. As this element has multiple functions in our body it is important in the pathophysiology of several critical illnesses in intensive care unit (ICU). Hence the present study was undertaken to determine the usefulness of admission serum magnesium levels with regards to patient outcome considering mortality, need and duration of ventilator support, and acute physiologic assessment and chronic health evaluation 2 (APACHE 2) score.Methods: Demographic data such as age and sex were recorded. Patients were assessed for presenting complaints, history of other diseases and habits through an interview with the patients or care giver. These findings were recorded on a predesigned proforma patients was followed up for the outcomes such as mortality, need of ventilator support, duration of ICU stay and APACHE 2 score.Results: Regarding comparison between outcome of patients between two groups, 44% patients with magnesium level <1.7 mg/dl have improved and 72% patient didn’t improve. 44% patients with magnesium level >1.7 mg/dl have improved and 28% patient didn’t improve.Conclusions: From present observational study we can conclude that hypomagnesaemia is more common in patients more than 50 years of age and with male predominance. Pneumonia with septicaemia and cerebrovascular accident (CVA) was commonly associated with hypomagnesaemia. In present study we have observed that hypomagnesaemia is associated with high APACHE 2 score, poor outcome and more requirement of ventilatory support.

Select Opportunistic Infections in Adult Patients With HIV

2012 ◽  
Author(s):  
John W. Wilson ◽  
Lynn L. Estes
Keyword(s):  
Risk Factors ◽  
Drug Therapy ◽  
Opportunistic Infections ◽  
Immunosuppressive Drug ◽  
Atypical Presentation ◽  
Chest Discomfort ◽  
Exertional Dyspnea ◽  
Interstitial Infiltrate ◽  
Immunosuppressive Drug Therapy ◽  
Chronic Corticosteroid

•Risk factors: Ubiquitous organism; CD4 count <200/mcL; chronic corticosteroid or other immunosuppressive drug therapy•Clinical disease• Exertional dyspnea, fever, nonproductive cough, and chest discomfort that gets worse over days to weeks• Hypoxemia; chest radiographs vary (most commonly show diffuse bilateral, symmetrical interstitial infiltrate but may be relatively normal early in course and can have atypical presentation)...

Hypercoagulability Promotes Atrial Fibrosis and Fibrillation

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4246-4246
Author(s):  
Henri M.H. Spronk ◽  
Anne-Margreet de Jong ◽  
Hetty C. de Boer ◽  
Alexander Maas ◽  
Sander Verheule ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Cardiac Fibroblasts ◽  
Normal Sinus Rhythm ◽  
Factor Xa ◽  
P Wave ◽  
Wild Type ◽  
Normal Sinus ◽  
Episode Duration ◽  
Surface Electrocardiogram

Abstract Background: It is well known that atrial fibrillation (AF) induces a hypercoagulable state, which significantly increases stroke risk in patients with AF contributing to morbidity and mortality in these patients. Active coagulation factors can also provoke diverse cellular responses through stimulation of protease-activated receptors (PARs). In the heart and vessels, coagulation factor mediated PAR activation may provoke and mediate pro-inflammatory and tissue remodeling responses, potentially contributing to organ damage. We hypothesized that the onset and progression of AF, may be affected by hypercoagulability-mediated cell signaling responses, in the heart. Methods and results: To study the potential role of PARs in the structural remodeling process that renders the atria more prone to AF we first investigated whether thrombin or factor Xa could induce atrial fibroblast remodeling. In isolated rat cardiac fibroblasts, thrombin enhanced the phosphorylation of the pro-fibrotic signaling molecules Akt and Erk, and increased expression of TGFβ1 (2.7 fold) and the pro-inflammatory factor monocyte chemo-attractant protein-1 (6.1 fold). Thrombin also increased the incorporation of 3H-proline suggesting enhanced collagen synthesis by cardiac fibroblasts (2.5 fold). Differentiation towards myofibroblasts was indicated by increased expression of smooth muscle actin (2 fold). All effects could be prevented by the direct thrombin inhibitor dabigatran and comparable results were obtained for stimulation with factor Xa and inhibition with rivaroxaban, respectively. Next we studied whether enhanced stimulation of PARs
by chronic elevation of thrombin levels would lead to an enhanced vulnerability to AF in transgenic mice. In mice with enhanced thrombin activity due to a mutation in the thrombomodulin gene resulting in impaired thrombin inhibition (TMpro/pro), inducibility of AF episodes provoked by burst pacing was higher (6 out of 10 versus 1 out of 10 in wild type) and the duration of AF episodes was longer (episodes >2s in 6 out of 10 versus 0 out of 10 in wild type). Finally, we showed that inhibition of the coagulation cascade attenuated the development of AF in a goat model of AF. In 6 goats with persistent AF and treated with the anticoagulant nadroparine (4 weeks, 150 IU/kg twice daily) the complexity of the AF substrate was less pronounced compared to control animals. The conduction heterogeneity and block were 33% shorter in the nadroparine treated animals (maximal conduction time 23.3±3.1ms in control versus 15.7±2.1ms in nadroparine, p<0.05) and AF-induced a-SMA expression and endomysial fibrosis were less pronounced. Conclusion: The hypercoagulable state during AF provokes pro-fibrotic and pro-inflammatory responses in cardiac fibroblasts, as well as promotes the development of a substrate for AF in transgenic mice and in goats with persistent AF. Together, these results strongly support the role of hypercoagulability and PAR activation in the development of a substrate for AF. In addition, direct anticoagulant treatment may protect against AF-related cellular atrial remodelling. Figure 1: Enhanced AF inducibility and prolonged AF duration in TMpro/pro mice. Transesophageal stimulation was used to test AF inducibility. A surface electrocardiogram (lead I, sampled at 2.5 kHz) was recorded to detect AF. A) Traces show an example of a Wt mouse, returning to normal sinus rhythm immediately after the burst (upper panel) and a TMpro/pro mouse, showing a 3s episode of AF before returning to sinus rhythm (lower panel). In both cases, the first P wave observed after the burst is indicated. B) AF was inducible in 1 out of 10 Wt mice and 6 out of 10 TMpro/pro mice. C) Distribution of the longest AF episode duration observed in each Wt and TMpro/pro mouse. Figure 1:. Enhanced AF inducibility and prolonged AF duration in TMpro/pro mice. Transesophageal stimulation was used to test AF inducibility. A surface electrocardiogram (lead I, sampled at 2.5 kHz) was recorded to detect AF. A) Traces show an example of a Wt mouse, returning to normal sinus rhythm immediately after the burst (upper panel) and a TMpro/pro mouse, showing a 3s episode of AF before returning to sinus rhythm (lower panel). In both cases, the first P wave observed after the burst is indicated. B) AF was inducible in 1 out of 10 Wt mice and 6 out of 10 TMpro/pro mice. C) Distribution of the longest AF episode duration observed in each Wt and TMpro/pro mouse. Disclosures No relevant conflicts of interest to declare.

scholarly journals A Study on the Effects of Hypomagnesaemia among Critically Ill Patients at a Tertiary Care Hospital of Southern Bihar

2020 ◽  
Vol 7 (43) ◽  
pp. 2458-2462
Author(s):  
Harjot Singh ◽  
Amit Kumar Ranjan ◽  
Ranjan Kumar
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Serum Magnesium ◽  
Chronic Health Evaluation ◽  
Apache Ii ◽  
Electrolyte Imbalance ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Ventilator Support ◽  
Chronic Health

BACKGROUND Hypomagnesaemia is associated with other electrolyte abnormalities like hypokalaemia, hyponatremia, and hypophosphatemia. We wanted to study the serum magnesium levels in critically ill patients, and correlate the serum magnesium levels with patient outcome and other parameters like duration of stay in ICU, ventilator support and APACHE-II (Acute Physiology and Chronic Health Evaluation-II) score. METHODS The study included all the cases admitted in the ICU of Narayan Medical College & Hospital, with variable medical conditions within 6 months fulfilling the inclusion criteria. Demographic data (age and sex), medical history, surgical history, medications administrated and length of ICU stay were recorded for each patient. The severity scoring system used was Acute Physiology and Chronic Health Evaluation-II (APACHE-II). RESULTS Prevalence of Hypomagnesaemia in the present study was 60.2 %. Mortality and mechanical ventilator support (2.7 % and 28.4 %) in normomagnesemia subjects were significantly lesser than hypomagnesaemia subjects (33.9 % and 54.5 % respectively). CONCLUSIONS Hypomagnesaemia is a common electrolyte imbalance in critically ill patients. It is associated with higher mortality and morbidity in critically ill patients and is also associated with more frequent and more prolonged ventilatory support. KEYWORDS Critically Ill, Hypomagnesaemia, APACHE-II Score, Mortality, Ventilator Support

scholarly journals Experience with Serum Magnesium Estimations in Critically Ill Patients Admitted in High Dependency Unit of A Tertiary Care Hospital

2018 ◽  
Vol 29 (2) ◽  
pp. 69-74
Author(s):  
Tasnuva Saiful ◽  
Mamun Mostafi ◽  
Md Abdul Ali Mia ◽  
Md Robed Amin ◽  
Syeda Marzana ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Magnesium Deficiency ◽  
Serum Magnesium ◽  
Tertiary Care ◽  
Electrolyte Imbalance ◽  
Care Hospital ◽  
High Dependency Unit ◽  
Hospital Outcome ◽  
High Dependency

Background: Magnesium deficiency has been a common, but easily ignored, electrolyte abnormality. Studies on magnesium in our country are lacking. Here, we have estimated and correlated serum magnesium levels with outcomes and other electrolyte imbalance in critically ill patients with respect to the mortality, in hospital outcome and length of high dependency unit (HDU) stay.Methods: A prospective, observational study was conducted in patients who had been admitted to the HDU. Patient’s demographic profile, medical history, serum magnesium, calcium and electrolytes were enrolled on admission. Patients were divided into normomagnesemic, hypomagnesemic hypermagnesemic groups and compared for various parameters.Results: Out of 60 critically ill-patients, 32 patients (53.33%) were hypomagnesemic, 20 patients (33.33%) were normomagnesemic and 8 patients (13.33%) were hypermagnesemic. The duration of stay of the patients in HDU, in hospital outcome and mortality showed significant variation between these groups. Associated electrolyte abnormalities in hypomagnesemic patients were hypokalemia (56.25%) and hypocalcemia (62.50%). Most of the hypomagnesemic patients were hypertensive (62.50% vs 40%) and was presented in drowsy state (50% vs 40%) compared to normomagnesemic group. Mortality of hypomagnesemic group was 37.50% while that of hypermagnesemic group was 25%. In hospital, arrythmia (18.75%) and convulsion (12.50%) developed in hypomagnesemic groups. Mean duration of length of stay in HDU was 7.45 days in hypomagnesemic, 6.83 days normomagnesemic, and 8.67 days in hypermagnesemic group.Conclusion: Development of magnesium imbalance in critically ill patients is associated with bad prognosis. Monitoring of serum magnesium levels may have prognostic, perhaps therapeutic implication.Bangladesh J Medicine Jul 2018; 29(2) : 69-74

scholarly journals HYPOMAGNESAEMIA AND HYPOCALCAEMIA THE MAJOR MISSED OUT CLINICAL CONDITION IN THE MANAGEMENT OF DIABETES

2021 ◽  
pp. 16-22
Author(s):  
Divya S ◽  
Fahima Sheerin SMH ◽  
Chindhiha S ◽  
Suganthi M ◽  
Sherafin Vincy ◽  
...  
Keyword(s):  
Insulin Secretion ◽  
Gold Standard ◽  
Hba1c Level ◽  
Serum Magnesium ◽  
Vital Role ◽  
Electrolyte Imbalance ◽  
Serum Electrolytes ◽  
Pancreatic Cell ◽  
Insulin Synthesis ◽  
Hypoglycaemic Agents

Magnesium (Mg) and Calcium (Ca) is one of the essential factors for the insulin to get released from the pancreatic cell. To evaluate the relation of hypomagnesemia and hypocalcaemia in the glycaemic control and to analyse the importance of both Mg and Ca in the insulin secretion mechanism. The study was conducted in the laboratory department, Billroth hospitals. A total of 239 individuals were selected for this study, HbA1c level, serum magnesium and calcium were assessed for all the individuals and in addition to this serum electrolytes were also checked. Out of 239 individuals, 79 were found out as uncontrolled diabetic by calculating HbA1c as a gold standard, males are higher in ratio compared to female. By studying serum magnesium and calcium level, hypocalcaemia is present in more individuals and females (31%) are much prone to both than males (20%). The different correlation was also analysed for hypomagnesemia and hypocalcaemia. The electrolytes like sodium (Na) and potassium (K) was analysed, females are highly affected by electrolyte imbalance but in hypomagnesemia diabetic individuals the males are high in electrolyte imbalance. Since Mg and Ca plays a vital role in insulin synthesis, secretion, repair, and the alteration, along with the hypoglycaemic agents the supplementation of magnesium or calcium could be suggested via, dietary or drug supplements. In addition to this, regular monitoring of electrolytes is essential to maintain fluid balance.

Abstract 14912: Sotalol-induced Wide Complex Rhythm: What is the Mechanism?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Albert J Rogers ◽  
Paul J Wang ◽  
Nitish Badhwar
Keyword(s):  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Conduction Time ◽  
Autonomic Tone ◽  
Normal Sinus ◽  
Typical Atrial Flutter ◽  
Atrial Conduction Time ◽  
Idioventricular Rhythm ◽  
History Of

Introduction: Delta waves associated with atrioventricular accessory pathways (APs) may manifest with autonomic tone, heart rate, and rhythm changes. Rarely, drugs like sotalol can block AV nodal conduction, revealing latent WPW, one treatable cause of sudden death. Case report: A 38-year-old man was admitted for sotalol loading due to frequent typical atrial flutter and SVT and a desire to avoid catheter ablation. He had a history of cardiac arrest with adenosine and tachycardia-induced cardiomyopathy. After recovery, cardiac MRI showed a normal heart without scar. Admission 12-lead ECG ( Figure A ) revealed normal sinus rhythm without other abnormality. With administration of sotalol, the patient developed a wide complex rhythm ( Figure B ). Interpretation of the rhythm indicated presence of a latent AP and a repeat ECG ( Figure C ) confirmed manifest preexcitation. After consenting to electrophysiology study, the patient developed a short RP tachycardia ( Figure D ) which terminated with Valsalva. The patient underwent successful catheter ablation of the pathway located at the anterior floor of the coronary sinus body and the cavotricuspid isthmus. Discussion: The differential diagnosis for a wide complex rhythm in this setting includes rate-related aberrancy, idioventricular rhythm, phase 4 aberrancy, and preexcitation from an AP. Shortened and consistent PR intervals in the tracing lead to preexcitation as the only possible mechanism. APs that are capable of anterograde conduction but are not manifest in sinus rhythm are termed latent APs. Conditions that may cause this phenomenon include opposite autonomic effects on the AP and the AV node, increased atrial conduction time, or concealed retrograde conduction into the AP. Sotalol typically increases the retrograde effective refractory period of the AP but has variable anterograde effect. Sotalol has not previously been reported to reveal a latent AP but may have acted through one of the stated mechanisms.

Use of Procainamide for Conversion of Acute Onset AF Following Pericardiocentesis in a Dog

2012 ◽  
Vol 48 (6) ◽  
pp. 429-433 ◽  
Author(s):  
Ryan Fries ◽  
Ashley B. Saunders
Keyword(s):  
Atrial Fibrillation ◽  
Pericardial Effusion ◽  
Sinus Rhythm ◽  
Systemic Blood Pressure ◽  
Acute Onset ◽  
Potential Treatment ◽  
Golden Retriever ◽  
Systemic Blood ◽  
Antiarrhythmic Medications ◽  
Surface Electrocardiogram

A 9 yr old spayed female golden retriever was evaluated for anorexia and suspected gastric dilatation. Subsequent evaluation the following day determined the dog to have pericardial effusion. Muffled heart sounds and jugular pulses were noted on physical exam, and the dog was diagnosed with pleural and pericardial effusion. A sinus rhythm with a rate of 142 beats/min was documented on a surface electrocardiogram (EKG). Following pericardiocentesis, the heart rate increased to 260 beats/min, the rhythm became irregular, and the systemic blood pressure decreased. Atrial fibrillation (AF) was confirmed by EKG. Procainamide was administered IV over 15 min, resulting in successful conversion of AF to sinus rhythm and clinical improvement. Procainamide is one of several antiarrhythmic medications that are used for the conversion of acute AF in humans; however, its utility and efficacy in dogs in the setting of AF has not previously been reported. This case highlights a unique complication of performing a pericardiocentesis that requires immediate treatment and describes a potential treatment option for the conversion of acute AF in dogs.

scholarly journals Severe Bradycardia Increases the Incidence and Severity of Torsade de Pointes Arrhythmias by Augmenting Preexistent Spatial Dispersion of Repolarization in the CAVB Dog Model

2021 ◽  
Vol 12 ◽  
Author(s):  
Valerie Y. H. van Weperen ◽  
Albert Dunnink ◽  
Alexandre Bossu ◽  
Jet D. M. Beekman ◽  
Veronique M. F. Meijborg ◽  
...  
Keyword(s):  
Spatial Dispersion ◽  
Torsade De Pointes ◽  
Left Ventricular ◽  
Dispersion Of Repolarization ◽  
Dog Model ◽  
Severe Bradycardia ◽  
Idioventricular Rhythm ◽  
Surface Electrocardiogram ◽  
Temporal Dispersion ◽  
Unipolar Electrograms

IntroductionTorsade de pointes arrhythmias (TdP) in the chronic atrioventricular block (CAVB) dog model result from proarrhythmic factors, which trigger TdP and/or reinforce the arrhythmic substrate. This study investigated electrophysiological and arrhythmogenic consequences of severe bradycardia for TdP.MethodsDofetilide (25 μg/kg per 5 min) was administered to eight anesthetized, idioventricular rhythm (IVR) remodeled CAVB dogs in two serial experiments: once under 60 beats per minute (bpm), right ventricular apex paced (RVA60) conditions, once under more bradycardic IVR conditions. Recordings included surface electrocardiogram and short-term variability (STV) of repolarization from endocardial unipolar electrograms. TdP inducibility (three or more episodes within 10 min after start of dofetilide) and arrhythmic activity scores (AS) were established. Mapping experiments in 10 additional dogs determined the effect of lowering rate on STV and spatial dispersion of repolarization (SDR) in baseline.ResultsIVR-tested animals had longer baseline RR-interval (1,403 ± 271 ms) and repolarization intervals than RVA60 animals. Dofetilide increased STV similarly under both rhythm strategies. Nevertheless, TdP inducibility and AS were higher under IVR conditions (6/8 and 37 ± 27 vs. 1/8 and 8 ± 12 in RVA60, respectively, both p &lt; 0.05). Mapping: Pacing from high (128 ± 10 bpm) to middle (88 ± 10 bpm) to experimental rate (61 ± 3 bpm) increased all electrophysiological parameters, including interventricular dispersion, due to steeper left ventricular restitution curves, and intraventricular SDR: maximal cubic dispersion from 60 ± 14 (high) to 69 ± 17 (middle) to 84 ± 22 ms (p &lt; 0.05 vs. high and middle rate).ConclusionIn CAVB dogs, severe bradycardia increases the probability and severity of arrhythmic events by heterogeneously causing electrophysiological instability, which is mainly reflected in an increased spatial, and to a lesser extent temporal, dispersion of repolarization.

Sign in / Sign up

Export Citation Format

Share Document