pyrophosphate and Arrhythmias--Cardiac

Topics: Adolescent; Arrhythmias, Cardiac; Cardiac Catheterization; Coronary Angiography; Coronary Disease; Diphosphates; Electrocardiography; Exercise Test; Female; Heart; Heart Diseases; Heart Failure; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, X-Ray Computed; Ultrasonography

The possible myocardial injury induced by electrical cardioversion in the treatment of supraventricular arrhythmias was analyzed after 45 countershocks of 200 joules and after 6 of 600 joules (total accumulated energy). In all patients myocardial injury was evaluated by serial CK, CK-Mb, and myoglobin determinations and in 48 cases a cardiac gammagraphy with technetium pyrophosphate was also performed. Significant increases in total CK and myoglobin were observed in 2 (4%) patients treated with 200 joules and in 3 (50%) patients receiving 600 joules. CK-Mb was also increased in one patient receiving 200 joules (13.5 U/I) and in one patient treated with 600 joules (27.8 U/I). In all cases technetium gammagraphy was negative.

Topics: Adult; Arrhythmias, Cardiac; Cardiomyopathies; Clinical Enzyme Tests; Creatine Kinase; Diphosphates; Electric Countershock; Female; Heart; Humans; Isoenzymes; Male; Middle Aged; Myoglobin; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

Studies of pathology have shown that involvement of the right ventricle (RV) in acute myocardial infarction (AMI) is relatively common. Our experience in the noninvasive diagnosis of RVAMI and its early prognosis is presented. Sixty patients with AMI were prospectively studied: 40 patients with inferior AMI and 20 patients with anterior AMI. The evaluation was made by: (1) CLINICAL FINDINGS: hypotension, congestive heart failure, sinus bradycardia less than 40/min, dysrhythmia, and conduction disturbances; (2) ECG record including precordial lead (V4R); (3) Radioisotope heart scintigraphy: 99mTc-PYP infarct scintigraphy and multigated acquisition MUGA blood pool scanning. Of the 40 patients diagnosed as having inferior AMI, 20 cases (50%) were found to be associated with RVAMI. All of them were diagnosed by positive radionuclide studies, and 17 (85%) also demonstrated a ST segment elevation of 0.1 mV, and pathological Q waves in the V4R lead. The ejection fraction (EF) of RV was found to be significantly decreased in patients with RVAMI compared with the other group (mean, 27% versus 57%). Among the 20 patients with RVAMI, 16 (80%) showed various complications during the hospitalization period, versus 9 patients (45%) from the group with inferior AMI. The most common complication in RVAMI patients was conduction disturbances (7 of 20 versus 2 of 20 patients). The clinical and prognostic importance of the early diagnosis of RVAMI is stressed.

Topics: Arrhythmias, Cardiac; Diphosphates; Electrocardiography; Heart Ventricles; Humans; Myocardial Infarction; Prognosis; Prospective Studies; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate

Perfusion scintigraphy with thallium-201, infarct scintigraphy with technetium-99m pyrophosphate (TcPYP), and equilibrium blood pool scintigraphy were performed during the initial hospitalization for acute myocardial infarction (MI) in 25 patients without evidence of heart failure who presented with advanced electrocardiographic rhythm and conduction disturbances requiring treatment. Scintigraphic findings during short-term hospitalization were related to the late clinical follow-up performed an average of 14 months later, where patients were grouped as asymptomatic, 8 patients; symptomatic, 9 patients; and deceased, 8 patients. Quantitation of perfusion abnormalities, TcPYP image abnormalities, and left ventricular ejection fraction (EF) revealed that the deceased group had significantly larger TcPYP abnormalities (36 +/- 20 cm2), absolute perfusion abnormalities (32 +/- 16 cm2), and perfusion abnormalities expressed as a percentage of the projected left ventricular area (42 +/- 8%) than the asymptomatic group (13 +/- 8 cm2, 14 +/- 6 cm2, and 20 +/- 9%; p less than 0.05, p greater than 0.05, and p less than 0.01, respectively). The percent perfusion abnormality was significantly larger in the deceased group (42 +/- 8%, p less than 0.01) than in either the symptomatic group (35 +/- 13%, p less than 0.01) or the asymptomatic group (20 +/- 9%), and this parameter in the symptomatic group also differed from that in the asymptomatic group (p less than 0.01). The study indicates that patients with rhythm and conduction disturbances and without congestive heart failure during acute MI may follow an uncomplicated or a complicated late clinical course. Early scintigraphic measurements of MI and perfusion correlate well with this outcome; however, EF could not differentiate among prognostic subgroups.

Topics: Adult; Aged; Arrhythmias, Cardiac; Diphosphates; Electrocardiography; Female; Follow-Up Studies; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Time Factors

Topics: Adult; Aged; Arrhythmias, Cardiac; Diphosphates; Electric Countershock; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Pectoralis Muscles; Radionuclide Imaging; Resuscitation; Technetium

Thirty survivors of acute myocardial infarction with 3+ or 4+ positive technetium-99m pyrophosphate myocardial scintigrams were followed up for 28 +/- 3.1 months (mean +/- standard deviation). Three patient groups were identified from the pattern of radioactive uptake in the scintigram: Group I, 16 patients with focal uptake (anterior in 7, lateral in 2, posterior in 3 and inferior in 4); Group II, 6 patients with anterior myocardial infarction and a doughnut pattern of uptake; Group III, 8 patients with nontransmural myocardial infarction and a diffuse pattern of uptake. Late complications developed in all patients with the doughnut pattern of uptake compared with 43 percent of patients with the focal pattern and 12 percent of patients with the diffuse pattern. After discharge from the hospital, five of six patients with a doughnut pattern of uptake died (mean survival time 9.8 months after the initial myocardial infarction). This mortality rate (83 percent) was significantly greater than that of patients with a focal (mortality rate 6 percent) or diffuse (no mortality) pattern of uptake. The doughnut pattern of technetium-99m pyrophosphate myocardial uptake in patients with acute myocardial infarction appears to identify a subgroup of patients with a very poor long-term prognosis.

Topics: Angina Pectoris; Arrhythmias, Cardiac; Diphosphates; Follow-Up Studies; Heart; Heart Block; Heart Failure; Humans; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Recurrence; Technetium

Topics: Adult; Allopurinol; Arrhythmias, Cardiac; Blood Glucose; Cardiomegaly; Cholesterol; Diphosphates; Electrocardiography; Heart Defects, Congenital; Humans; Lipids; Male; Orotic Acid; Phosphates; Phospholipids; Ribose; Triglycerides; Uric Acid; Uricosuric Agents

Topics: Acetylcholine; Arrhythmias, Cardiac; Arsenic; Azides; Brugada Syndrome; Cardiac Conduction System Disease; Cyanides; Diphosphates; Enzyme Inhibitors; Fluorides; Fluoroacetates; Heart Conduction System; Iodoacetates; Malonates; Pharmacology; Rabbits; Research; Toxicology