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Cureus Oct 2021While bradyarrhythmia is the most common arrhythmia during deglutition, tachycardias are considered to be a very rare condition with approximately 50 cases documented...
While bradyarrhythmia is the most common arrhythmia during deglutition, tachycardias are considered to be a very rare condition with approximately 50 cases documented worldwide. The subjects are usually men with no structural heart disease or gastrointestinal pathology, and symptoms may vary from palpitations to lightheadedness or syncope. Management is based on adapting alimentary habits in combination with agents such as beta-blockers, calcium channel blockers, and class IA, IC, and III drugs. Radiofrequency catheter ablation offers a permanent cure in the majority of the reported cases. We report the case of a 51-year-old male with swallowing-induced palpitations, corresponding to brief episodes of atrial tachycardia. Beta-blockers and calcium channel blockers were interrupted because of intolerance. Lifestyle measures with fractionated meals allowing small boluses significantly reduced symptoms. The patient was reticent to invasive measures.
PubMed: 34745774
DOI: 10.7759/cureus.18448 -
Frontiers in Endocrinology 2023Pheochromocytomas (PCC)/paragangliomas (PGL) are catecholamine (CA) -secreting neuroendocrine tumors, which are known as PPGL due to their histological and... (Review)
Review
Pheochromocytomas (PCC)/paragangliomas (PGL) are catecholamine (CA) -secreting neuroendocrine tumors, which are known as PPGL due to their histological and pathophysiological similarities. In addition to the typical triad of paroxysmal headache, palpitation, and sweating, PPGL may also be accompanied by symptoms and signs involving multiple organs and systems such as the cardiovascular system, digestive system, endocrine system, and nervous system. Currently, surgical resection is the first choice for PPGL. Safe and effective surgical management of complicated PPGL is the goal of clinical work. In this paper, we discuss this hot issue based on complicated PPGL cases, aiming to share our experience of the surgical management strategy of PPGL.
Topics: Humans; Pheochromocytoma; Paraganglioma; Adrenal Gland Neoplasms; Neuroendocrine Tumors; Catecholamines
PubMed: 37152961
DOI: 10.3389/fendo.2023.1129622 -
World Journal of Cardiology Nov 2021Palpitations are one of the most common reasons for medical consultation. They tend to worry patients and can affect their quality of life. They are often a symptom... (Review)
Review
Palpitations are one of the most common reasons for medical consultation. They tend to worry patients and can affect their quality of life. They are often a symptom associated with cardiac rhythm disorders, although there are other etiologies. For diagnosis, it is essential to be able to reliably correlate the symptoms with an electrocardiographic record allowing the identification or ruling out of a possible rhythm disorder. However, reaching a diagnosis is not always simple, given that they tend to be transitory symptoms and the patient is frequently asymptomatic at the time of assessment. In recent years, electrocardiographic monitoring systems have incorporated many technical improvements that solve several of the 24-h Holter monitor limitations. The objective of this review is to provide an update on the different monitoring methods currently available, remarking their indications and limitations, to help healthcare professionals to appropriately select and use them in the work-up of patients with palpitations.
PubMed: 34909127
DOI: 10.4330/wjc.v13.i11.608 -
Journal of General Internal Medicine Jan 2022Palpitations are a common symptom managed by general practitioners and cardiologists; atrial fibrillation (AF) is the most common arrhythmia in adults. The recent... (Review)
Review
Palpitations are a common symptom managed by general practitioners and cardiologists; atrial fibrillation (AF) is the most common arrhythmia in adults. The recent commercial availability of smartphone-based devices and wearable technologies with arrhythmia detection capabilities has revolutionized the diagnosis and management of these common medical issues, as it has placed the power of arrhythmia detection into the hands of the patient. Numerous mobile health (mHealth) devices that can detect, record, and automatically interpret irregularities in heart rhythm and abrupt changes in heart rate using photoplethysmography (PPG)- and electrocardiogram-based technologies are now commercially available. As opposed to prescription-based external rhythm monitoring approaches, these devices are more inexpensive and allow for longer-term monitoring, thus increasing sensitivity for arrhythmia detection, particularly for patients with infrequent symptoms possibly due to cardiac arrhythmias. These devices can be used to correlate symptoms with cardiac arrhythmias, assess efficacy and toxicities of arrhythmia therapies, and screen the population for serious rhythm disturbances such as AF. Although several devices have received clearance for AF detection from the United States Food & Drug Administration, limitations include the need for ECG confirmation for arrhythmias detected by PPG alone, false positives, false negatives, charging requirements for the battery, and financial cost. In summary, the growth of commercially available devices for remote, patient-facing rhythm monitoring represents an exciting new opportunity in the care of patients with palpitations and known or suspected dysrhythmias. Physicians should be familiar with the evidence that underlies their added value to patient care and, importantly, their current limitations.
Topics: Adult; Atrial Fibrillation; Electrocardiography; Humans; Photoplethysmography; Smartphone; Telemedicine
PubMed: 34282532
DOI: 10.1007/s11606-021-07007-w -
Annals of Noninvasive Electrocardiology... Mar 2021A 66-year-old man, implanted Abbott dual-chamber pacemaker, was admitted to our hospital due to recurrent palpitation. ECG was recorded on admission, which created a...
A 66-year-old man, implanted Abbott dual-chamber pacemaker, was admitted to our hospital due to recurrent palpitation. ECG was recorded on admission, which created a diagnostic confusion: What accounts for the appearance of the VP in the setting of a stable intrinsic atrioventricular (AV) conduction? In this case, we will focus on the logical reasoning in the analysis of Pacing ECG.
Topics: Aged; Cardiac Pacing, Artificial; Electrocardiography; Equipment Design; Heart Conduction System; Heart Ventricles; Humans; Male
PubMed: 32822069
DOI: 10.1111/anec.12793 -
International Journal of Environmental... May 2023A likely mechanism of Long COVID (LC) is dysautonomia, manifesting as orthostatic intolerance (OI). In our LC service, all patients underwent a National Aeronautics and...
INTRODUCTION
A likely mechanism of Long COVID (LC) is dysautonomia, manifesting as orthostatic intolerance (OI). In our LC service, all patients underwent a National Aeronautics and Space Administration (NASA) Lean Test (NLT), which can detect OI syndromes of Postural Tachycardia Syndrome (PoTS) or Orthostatic Hypotension (OH) in a clinic setting. Patients also completed the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), a validated LC outcome measure. Our objectives in this retrospective study were (1) to report on the findings of the NLT; and (2) to compare findings from the NLT with LC symptoms reported on the C19-YRS.
METHODS
NLT data, including maximum heart rate increase, blood pressure decrease, number of minutes completed and symptoms experienced during the NLT were extracted retrospectively, together with palpitation and dizziness scores from the C19-YRS. Mann-Witney U tests were used to examine for statistical difference in palpitation or dizziness scores between patients with normal NLT and those with abnormal NLT. Spearman's rank was used to examine the correlation between the degree of postural HR and BP change with C19-YRS symptom severity score.
RESULTS
Of the 100 patients with LC recruited, 38 experienced symptoms of OI during the NLT; 13 met the haemodynamic screening criteria for PoTS and 9 for OH. On the C19-YRS, 81 reported dizziness as at least a mild problem, and 68 for palpitations being at least a mild problem. There was no significant statistical difference between reported dizziness or palpitation scores in those with normal NLT and those with abnormal NLT. The correlation between symptom severity score and NLT findings was <0.16 (poor).
CONCLUSIONS
We have found evidence of OI, both symptomatically and haemodynamically in patients with LC. The severity of palpitations and dizziness reported on the C19-YRS does not appear to correlate with NLT findings. We would recommend using the NLT in all LC patients in a clinic setting, regardless of presenting LC symptoms, due to this inconsistency.
Topics: Humans; Orthostatic Intolerance; Retrospective Studies; Post-Acute COVID-19 Syndrome; Dizziness; COVID-19; Postural Orthostatic Tachycardia Syndrome; Hypotension, Orthostatic
PubMed: 37239531
DOI: 10.3390/ijerph20105804 -
International Journal of Yoga 2021Evidence suggests that yoga is safe and effective in improving various risk factors, quality of life (QoL), and psychological burden that is related to arrhythmia.... (Review)
Review
Evidence suggests that yoga is safe and effective in improving various risk factors, quality of life (QoL), and psychological burden that is related to arrhythmia. However, this is the first-ever systematic review performed to report the role of yoga in arrhythmia. We have performed a literature search using Cochrane Library, Medline/PubMed, Web of Science Core Collection, and IndMED electronic databases up to 3, January 2018. Of 240 articles, 6 potentially eligible articles were identified and included in the review. Results showed that yoga could be considered an efficient adjuvant in reducing arrhythmia (paroxysmal atrial fibrillation, ventricular tachyarrhythmia, and palpitation) related health problems; blood pressure, heart rate, depression and anxiety scores; and in improving health-related QoL of arrhythmia patients. However, there is a lack of randomized controlled trials and a clear mechanism behind the effect of yoga; studies had relatively a small sample size and different yoga protocols.
PubMed: 33840974
DOI: 10.4103/ijoy.IJOY_7_20 -
Frontiers in Endocrinology 2022Although pediatric pheochromocytomas and paragangliomas (PPGLs) are rare, they have important differences compared to those in adults. Unfortunately, without timely... (Review)
Review
Although pediatric pheochromocytomas and paragangliomas (PPGLs) are rare, they have important differences compared to those in adults. Unfortunately, without timely diagnosis and management, these tumors have a potentially devastating impact on pediatric patients. Pediatric PPGLs are more often extra-adrenal, multifocal/metastatic, and recurrent, likely due to these tumors being more commonly due to a genetic predisposition than in adults. This genetic risk results in disease manifestations at an earlier age giving these tumors time to advance before detection. In spite of these problematic features, advances in the molecular and biochemical characterization of PPGLs have heralded an age of increasingly personalized medicine. An understanding of the genetic basis for an individual patient's tumor provides insight into its natural history and can guide clinicians in management of this challenging disease. In pediatric PPGLs, mutations in genes related to pseudohypoxia are most commonly seen, including the von Hippel-Lindau gene () and succinate dehydrogenase subunit () genes, with the highest risk for metastatic disease associated with variants in and . Such pathogenic variants are associated with a noradrenergic biochemical phenotype with resultant sustained catecholamine release and therefore persistent symptoms. This is in contrast to paroxysmal symptoms (e.g., episodic hypertension, palpitations, and diaphoresis/flushing) as seen in the adrenergic, or epinephrine-predominant, biochemical phenotype (due to episodic catecholamine release) that is commonly observed in adults. Additionally, PPGLs in children more often present with signs and symptoms of catecholamine excess. Therefore, children, adolescents, and young adults present differently from older adults (e.g., the prototypical presentation of palpitations, perspiration, and pounding headaches in the setting of an isolated adrenal mass). These presentations are a direct result of genetic determinants and highlight the need for pediatricians to recognize these differences in order to expedite appropriate evaluations, including genetic testing. Identification and familiarity with causative genes inform surveillance and treatment strategies to improve outcomes in pediatric patients with PPGL.
Topics: Adrenal Gland Neoplasms; Catecholamines; Genetic Testing; Humans; Paraganglioma; Pheochromocytoma
PubMed: 35903274
DOI: 10.3389/fendo.2022.936178