Response to Exercise in Congenital Complete Atrioventricular Block

Ikkos, D; Hanson, John S.

doi:10.1161/01.cir.22.4.583

Cited by 49 publications

(13 citation statements)

References 26 publications

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“…When tested 34 years before, she had shown a greater increase than the other cases, from 46 at rest, to a rate of 76 a minute during the first quarter minute, though only to 59 during the whole of the first minute. Ikkos and Hanson (1960) found similar fast rates at rest, from 41 to 60 a minute in 11 patients, aged 7 to 23 years. With moderate exercise the average rate increased from 51 to 71 a minute and with more strenuous exercise to 95 a minute.…”

Section: General Picture Of These Patientssupporting

confidence: 61%

“…He more than doubled his heart rate but because his stroke volume at rest was already 1 75 times the normal (to balance his slow heart rate) he could increase this only another 1 4 times (making in all 2 45 times). More recently, Ikkos and Hanson (1960) found that two girls roughly doubled their cardiac _man 582 *; zi *: output with moderate exercise. One increased the stroke volume by 54 per cent and the ventricular rate by 42 per cent, while the other doubled the rate with little change in the stroke volume.…”

Section: Discussion Of Circulation In Completementioning

confidence: 98%

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Six cases of congenital complete heart block followed for 34-40 years.

Campbell¹,

Emanuel²

1967

Heart

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Section: General Picture Of These Patientssupporting

confidence: 61%

Section: Discussion Of Circulation In Completementioning

confidence: 98%

Six cases of congenital complete heart block followed for 34-40 years.

Campbell¹,

Emanuel²

1967

Heart

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“…It has often been shown that adaptation to heart-block occurs so that the working capacity becomes virtually normal (Gilchrist, 1934;Campbell, 1943;Ikkos and Hanson, 1960), but there is no time for adaptation with the transient changes in rate described here. Summary This paper describes the cases of four patients with a syndrome in which chest pain, dyspnoea, palpitations, faintness, weakness of the limbs, and alarm are associated with a transient or increasing heart-block occurring usually on exertion.…”

Section: B)mentioning

confidence: 88%

A Syndrome Due to Transient or Changing Heart-block

Fowler¹

1962

BMJ

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EPIDURAL ANALGESIA BRrIISH event 40 minutes or even longer after epidural injection of what might have seemed a not too excessiv_e dose in a patient of normal biological age. SummaryInjection of local anaesthetic solutions into the spinal extradural space results in a segmental type of analgesia.In normal subjects the number of analgesic dermatomos can be predicted with an accuracy of 15 to 30(,%b in terms of age and the concentration and volume of local anaesthetic used. The amount of local anaesthetic required to block a given area declines steadily after the second decade, in a manner reminiscent of some other curves relating biological phenomena to age. Fifty-three patients with occlusive vascular disease reacted abnormally to epidural analgesia. They behaved as if they were 25 to 50 years older than their chronological age, or as if the injected solution had been twice the concentration actually used. In these patients segmental analgesia spread one and a half to three times further than in normal subjects of the same age. This tendency to increased spread can be hazardous if the anaesthetist is not aware of the necessity for reduced dosage in arteriosclerotic patients.The timen taken for epidural analgesia to reach its farthest limits varies quite widely in normal subjects, and does not appear to be dependent on age. This time interval is prolonged in arteriosclerotic patients.The significance of these findings is discussed in relation to the effects of ageing processes, and to the site of action of epidural analgesia. Rec., 68, 63. C-escitelli, F. (1951). Amer. J. Physiol., 166, 229. de Saram, M. (1956). Anaesthzesia, 11, 77. Downie, A. W., and Newell, D. J. (1961). Neuraology (AMinntzeap.), 11, 876. Dyrbye, M. 0. (1959 PhYsician to Charing Cross Hospital, LondonzIt is well recognized that angina pectoris can occur with the paroxysmal tachycardias. Pain can also be a direct result of heart-block, the pain and the block starting and ending at the same time. Four cases of transient or changing heart-block are reported. Two of the patients had normal cardiograms at rest and had severe pain only when exertion was associated with a 2: 1 heart-block. The pain was described as bursting, relieved by a varying period of rest but not by trinitroglycerin, and radiating to the neck and down the arms. The pain was associated with the sudden onset of severe dyspnoea, palpitations, a feeling of marked faintness, weakness of the limbs, and alarm. In the other two cases symptoms were associated with a change from 2: 1 to a complete heart-block.Froment et al. (1959) report three cases of anginal pain associated with heart-block but without evidence of coronary artery disease. They believe that myocardial anoxia results from the decrease in coronary blood flow with the abrupt slowing of the heart rate. This is discussed later.Exercise has an important effect on the ventricular rate in both complete and partial heart-block. It was once thought that the bradycardia of complete heart-block was quite unaltered during exe...

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“…Congenital complete heart block is compatible with normal development and survival (Yater, 1929;Campbell and Thorne, 1956;Donoso, Braunwald, Jick, and Grushman, 1956;Ikkos and Hanson, 1960;Hill, 1963;Nakamura and Nadas, 1964), but there is no doubt that Stokes-Adams attacks, though rare, can occur, and probably reflect a poor prognosis (Smithells and Outon, 1959;Molthan, Miller, Hastreiter, and Paul, 1962;Nakamura and Nadas, 1964).…”

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confidence: 99%