Clinical case of non-immune hydrops in a preterm infant with paroxismal tachycardia

Non-immune hydrops of the fetus is a heterogeneous pathology, which is usually the final stage in the development of intrauterine diseases, manifested by clinically pronounced hydration in the absence of signs of immune sensitization. This pathology is characterized by relatively high mortality in both antenatal and postnatal periods. The causes of non-immune hydrops of the fetus are very diverse, arrhythmias being one of common causes of non-immune hydrops. As are a starting factor for the development of non-immune hydrops in utero they are more often observed in the period from 29 to 32 weeks of gestational age. The reasons for a fetus to be prone to develop arrhythmias in the later stages of pregnancy are unknown. However, they may be due to changes velocity of impulse propagation along the aberrant pathways of the cardiac conducting system. Nevertheless, it is this factor that further leads to the accumulation of fluid in serous cavities and tissues, the most common form of arrhythmia in the fetus being supraventricular tachycardia. The article describes a clinical case of non-immune hydrops in a preterm infant with supraventricular paroxysmal tachycardia is presented. The close relationship between rhythm disturbance in the fetus as well as the emergency and further increasing of non-immune hydrops is noted. The symptoms of this pathology are discussed, the data of functional and laboratory diagnostic methods. Attention is paid to parameters of mechanical ventilation of the lungs; scheme of cardiotonic support in the treatment of this case of non-immune hydrops is given.

Iatrogenic Transient Complete Heart Block in a Preexisting LBBB

Catheter induced cardiac arrhythmia is a well-known complication encountered during pulmonary artery or cardiac catheterization. Injury to the cardiac conducting system often involves the right bundle branch which in a patient with preexisting left bundle branch block can lead to fatal arrhythmia including asystole. Such a complication during central venous cannulation is rare as it usually does not enter the heart. The guide wire or the cannula itself can cause such an injury during central venous cannulation. The length of the guide wire, its rigidity, and lack of set guidelines for its insertion make it theoretically more prone to cause such an injury. We report a case of LBBB that went into transient complete heart block following guide wire insertion during a central venous cannulation procedure.

Atrioventricular Conduction Delay in Fetuses Exposed to Anti-SSA/Ro and Anti-SSB/La Antibodies: A Magnetocardiography Study

Background. The presence of anti-SSA/Ro and anti-SSB/La antibodies during pregnancy is associated with fetal congenital heart block (CHB), which is primarily diagnosed through fetal echocardiography. Conclusive information about the complete electrophysiology of the fetal cardiac conducting system is still lacking. In addition to echocardiography, fetal magnetocardiography (fMCG) can be used. fMCG is the magnetic analogue of the fetal electrocardiogram (ECG).Patients and Methods. Forty-eight pregnant women were enrolled in an observational study; 16 of them tested positive for anti-SSA/Ro and anti-SSB/La antibodies. In addition to routine fetal echocardiography, fMCG was used. Fetal cardiac time intervals (fCTIs) were extracted from the magnetic recordings by predefined procedures. ECGs in the neonates of the study group were performed within the first month after delivery.Results. The PQ segment of the fCTI was significantly prolonged in the study group (P=0.007), representing a delay of the electrical impulse in the atrioventricular (AV) node. Other fCTIs were within normal range. None of the anti-SSA/Ro and/or anti-SSB/La fetuses progressed to a more advanced heart block during pregnancy or after birth.Conclusion. The study identified a low-risk population within antibody positive mothers, where PQ segment prolongation is associated with a lack of progression of the disease.

Metastatic Carcinoid to the Conducting System—Is It a Rare or Merely Unrecognized Manifestation of Carcinoid Cardiopathy?

We report a unique case of carcinoid cardiopathy. The patient, a 59-year-old white woman with a known carcinoid tumor of the terminal ileum, presented with complete heart block and subsequently died. Because of her clinical presentation, we examined the conducting system at autopsy. The atrioventricular node was heavily infiltrated by metastatic carcinoid. The tumor was also seen in the surrounding atrial myocardium. No other metastatic lesions were seen in the heart. Carcinoid cardiopathy in the form of right-sided endocardial and valvular thickening has been well documented in the literature, and we found these features in our case as well. To our knowledge, carcinoid has never been documented in the cardiac conducting system until now. We found 2 cases of possible involvement of the conducting system reported in the literature. Unfortunately, the conducting system was not examined postmortem in either of these cases. If conducting system involvement is not unique to the present case, patients with metastatic carcinoid and cardiac problems may require different management. We hope that this case will stimulate further postmortem study of the conducting system in patients with metastatic carcinoid tumor.

Using the 12-lead ECG to detect ischemia, injury, and infarction

The 12-lead ECG is extremely valuable in helping the critical care nurse detect the presence of myocardial ischemia, injury, and infarction. With an understanding of the 12-lead ECG, the nurse can relate the ECG findings to the patient's coronary artery disease and can anticipate the clinical consequences both for the functioning of the cardiac muscle and for the cardiac conducting system.