No abstract

Cardiac angiography produces one of the highest radiation exposures of any commonly used diagnostic x ray procedure. Recently, serious radiation induced skin injuries have been reported after repeated therapeutic interventional procedures using prolonged fluoroscopic imaging. Two male patients, aged 62 and 71 years, in whom chronic radiodermatitis developed one to two years after two consecutive cardiac catheterisation procedures are reported. Both patients had undergone lengthy procedures using prolonged fluoroscopic guidance in a limited number of projections. The resulting skin lesions were preceded, in one case, by an acute erythema and took the form of a delayed pigmented telangiectatic, indurated, or ulcerated plaque in the upper back or below the axilla whose site corresponded to the location of the x ray tube during cardiac catheterisation. Cutaneous side eVects of radiation exposure result from direct damage to the irradiated tissue and have known thresholds. The diagnosis of radiation induced skin injury relies essentially on clinical and histopathological findings, location of skin lesions, and careful medical history. Interventional cardiologists should be aware of this complication, because chronic radiodermatitis may result in painful and resistant ulceration and eventually in squamous cell carcinoma. (Heart 1999;81:308-312)

Head up tilt is an established test for assessing patients with vasovagal syncope. Prolonged asystole during the test has previously been reported in patients suffering from the malignant form of this syndrome. Little is known about the prognostic significance of this response and there is no consensus about the optimum treatment. Four such patients are reported who were treated pharmacologically. During follow up they remained free from major events and their symptoms were welil controiled. Conservative management is the initial method of choice and only if this fails should implantation of a dual chamber permanent pacemaker be considered. (Heart 1997;77:273-275 A 72 year old woman presented with a five year history of recurrent syncope occurring about once a week. The episodes were preceded by lightheadedness and once resulted in head injury. Physical examination was normal. The ECG, echocardiogram, and x ray of the cervical spine were normal. A 48 hour tape showed asymptomatic episodes of bradycardia at 41 beats/min. She underwent a tilt test and at four minutes she developed abrupt syncope. The ECG showed asystole for 30 seconds, followed by complete atrioventricular block. She was returned to supine position and 0-6 mg of atropine was given, after which she recovered completely. Metoprolol, 25 mg three times a day, was prescribed and she remained asymptomatic for the following 15 months. CASE 4 A 20 year old woman gave a 10 year history of recurrent syncope occurring almost daily, preceded by nausea and vertigo and associated with occasional incontinence. Physical examination was normal apart from a soft systolic murmur. Her electrocardiogram showed nonspecific T changes; a 24 hour tape was normal and an echocardiogram showed mild mitral regurgitation. The tilt table test was positive, producing a 48 second asystolic pause at 40 minutes of head upright position, associated with incontinence. Cardiopulmonary resuscitation was started and the patient resumed sinus rhythm a few seconds later and regained consciousness. She was started on disopyramide, 250 mg twice a day, and after 13 months she still suffers infrequent presyncopal episodes but she has not had any further syncope. DiscussionThere is limited knowledge about the natural history of recurrent syncope although a documented non-cardiac cause as well as a normal 273 on 9 May 2018 by guest. Protected by copyright.

No abstract

The results demonstrate that the in-hospital acute graft failure rate is 3.4% (6.8% of patients). Multi-slice computed tomography is a robust technique to assess novel therapies to reduce the rate of graft attrition further, and might be clinically useful in patients with persistent or early recurrence of symptoms after CABG.