ramipril and Tachycardia--Ventricular

A 47-year-old recreational sportsman showed in a routine ergometry polymorphic ventricular extrasystoles with good physical performance.. In resting ECG impressed ventricular extrasystoles (VES) predominantly right-hand-block-like with superior axis, a long-term ECG yielded up to 100 VES per hour. Echocardiographically imposing 4 - 5 trabeculae, feathered, reticular structures apically in the left and lower in the right ventricle. The cardio-MRT revealed a wall dilation laterally and apically with increased trabecularization, no late enhancement.. mild form of NCCM, currently asymptomatic THERAPY:  Cardiac insufficiency treatment is based on the guidelines, including ICD-CRT therapy. We recommended ramipril and decided against transvenous ICD implantation. At the time of the presentation, subcutaneous ICD systems were not available. Family screening and genotyping of affected persons are recommended.. Most patients have cardiac insufficiency, rhythmic symptoms, or thrombi formation in the noncompact portions of the left ventricular wall. Ventricular tachycardias are frequent and sudden cardiac death is the leading cause of death. Arrythmias are accessible to medication or ablation treatment. Endurance sports lead to favorable adaptations of the cardiovascular system in spite of increased risk of sudden cardiac death. The example shows that asymptomatic boundary findings also exist. Whether a sporting activity has a protective influence must be further investigated.. Ein 47-jähriger Freizeitsportler zeigte in einer Routineergometrie polymorphe ventrikuläre Extrasystolen bei guter körperlicher Leistungsfähigkeit.. Im Ruhe-EKG imponierten ventrikuläre Extrasystolen (VES) überwiegend rechtsschenkelblockartig mit superiorer Achse, ein Langzeit-EKG ergab bis 100 VES pro Stunde. Echokardiografisch imponierten 4 – 5 Trabekel, gefiederte, netzartige Strukturen apikal im linken und geringer im rechten Ventrikel. Das Kardio-MRT ergab eine Wandverdünnung lateral und apikal mit vermehrter Trabekularisierung, kein Late-Enhancement.. milde Form einer NCCM, aktuell asymptomatisch.. Die Herzinsuffizienzbehandlung orientiert sich an den Leitlinien einschließlich ICD-CRT-Therapie. Wir empfahlen Ramipril und entschieden uns gegen eine transvenöse ICD-Implantation. Zum Zeitpunkt der Vorstellung waren subkutane ICD-Systeme noch nicht erhältlich. Ein Familienscreening und eine Genotypisierung Betroffener werden empfohlen.. Die meisten Patienten weisen bei Vorstellung eine Herzinsuffizienz, Rhythmussymptomatik oder Thrombenbildung in den nichtkompakten Anteilen der linksventrikulären Wand auf. Ventrikuläre Tachykardien sind häufig und der plötzliche Herztod die häufigste Todesursache. Arrythmien sind einer medikamentösen oder Ablationsbehandlung zugänglich. Ausdauersport führt zu günstigen Anpassungen des Herz-Kreislaufsystems trotz erhöhtem Risiko für den plötzlichen Herztod. Das Beispiel zeigt, dass auch asymptomatische Grenzbefunde existieren. Ob eine sportliche Betätigung einen protektiven Einfluss hat, muss weiter untersucht werden.

Topics: Cardiovascular Agents; Diagnostic Tests, Routine; Electrocardiography; Humans; Male; Middle Aged; Ramipril; Tachycardia, Ventricular

The current study aims to explore the effect of ramipril on the occurrence of ventricular arrhythmias and its possible mechanism after myocardial infarction (MI) in rabbits.. A total of 24 rabbits were divided into three groups: the sham operation group (SHAM), the MI group, and the ramipril group (RAM). All groups were subjected to thoracotomy under sterile conditions; the MI and RAM groups underwent ligation of the left anterior descending coronary artery. On the second day after surgery, the RAM group was given ramipril (1 mg/kg per day). The rabbits in each group were fed for 12 weeks. The monophasic action potentials of the epicardium, mid-myocardium and endocardium in each group were, respectively, recorded before the MI and at 12 weeks after the MI. Meanwhile, the episodes of ventricular tachycardia or fibrillation (VT/VF) induced by procedure stimulations were counted, and the changes in L-type Ca flux (Ica-L) were recorded by means of the whole-cell patch-clamp technique.. The episodes of VT/VF were decreased in the RAM group after MI. At 12 weeks after MI, the transmural dispersion of repolarization (TDR) in the MI group was prolonged significantly compared with the SHAM and RAM groups. The density of Ica-L in the MI group was significantly lower than that any other group.. Ramipril manifestly decreases the incidence of VT/VF after MI in rabbits, and the mechanism may be associated with its inhibitory effect on electrical remodeling after MI.

Topics: Action Potentials; Angiotensin-Converting Enzyme Inhibitors; Animals; Calcium Channels, L-Type; Calcium Signaling; Cardiac Pacing, Artificial; Disease Models, Animal; Electrocardiography; Heart Ventricles; Myocardial Infarction; Myocardium; Patch-Clamp Techniques; Rabbits; Ramipril; Tachycardia, Ventricular; Time Factors; Ventricular Fibrillation

A 32-year-old competitive soccer player presented with palpitations he had felt for 4 weeks during maximal activity (soccer training and match). The physical examination and an exercise electrocardiogram were carried out by his general practitioner up to 19 s at 350 W and a heart rate of 147/min without showing any abnormalities.. All blood parameters revealed no signs of illness. During treadmill exercise at a heart rate of 181/min, a non-sustained ventricular tachycardia was induced. Echocardiography showed a dilated left ventricle with an enddiastolic diameter of 70 mm and low fractional shortening (28 %). Cardiac catheterization demonstrated a diminished left ventricular ejection fraction (38 %) and an enlarged enddiastolic volume (199 ml) without signs of coronary artery disease. Electrophysiologic testing induced a non-sustained ventricular tachycardia.. The echocardiographic and angiographic results indicated a dilated cardiomyopathy. Competitive sports activities were stopped and treatment with a beta-blocker (metoprolol) and an ACE-antagonist (ramipril) was started.. In young male and female athletes, the possibility of severe cardiac abnormalities have to be considered even in the presence of good physical fitness and performance. To reach a high sensitivity for diagnostic ergometry, the work-load must reach the maximal capacity of the cardio-pulmonary system. Differences in the exercise performance of athletes and untrained subjects have to be considered.

Topics: Adrenergic beta-Antagonists; Adult; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Antihypertensive Agents; Cardiac Catheterization; Cardiomyopathy, Dilated; Echocardiography, Doppler, Color; Electrocardiography; Exercise Test; Heart Rate; Humans; Male; Metoprolol; Ramipril; Sensitivity and Specificity; Soccer; Stroke Volume; Tachycardia, Ventricular