• The Korean Nurse
• /
• v.33 no.4
• /
• pp.62-85
• /
• 1994

The data were analyzed by using an S. P. S. S. computerized program for mean, standard deviation, percentage and paired t-test. The results of this study were as follows: 1. The increase in $PaO_2$ after hyperoxygenation and hyperinflation was highly statistically significant(p=0.041), and the increase in $PaO_2$ immediately after suctioning was not significant (p=0.752). The time of lowest $PaO_2$ was 30 seconds after the endotracheal suction. 2. The occurrance of cardiac arrhythmia after the endotracheal suction included sinus tachycardia, sinus arrhythmia, sinus bradycardia, premature atrial contraction (PAC), and premature ventricular contraction (PVC). The most frequent cardiac arrhythmia was sinus tachycardia (a subjects). Sinus arrhythmia was observed in 5 subjects and continued till 10 minutes after suctioning in two of these. Sinus bradycardia occurred in only 3 subjects and among them, 1 subjects shows sinus arrythmia till 10 minutes after suctioning along. PAC was observed in only one subject and continued till five minutes after suctining along with sinus arrhythmia. PVC was observed in three subjects: it lasted for only 30 seconds after suctioning in two subjects. but continued for 10 minutes after suctioning in the third. 6 subjects manifested two kinds of Cardiac arrhythmia Three of them showed sinus tachycardia with PVC, another 2 showed sinus bradycardia with sinus arrhythmia, and the other subject showed sinus arrhythmia with PAC. 3. The increases in heart rate during the endotracheal suction immediately after and at 30 seconds after suctioning were statistically significant (p=0.005). The increase in heart rate at one minute after suctioning was also significant (p=0.023). The increase in heart rate continued until 10 minutes after the endotracheal suction, but was not statistically significant In this study, endotracheal suctioning with hyperoxygenation and hyperinflation was effective in preventing a decrease in $PaO_2$ after suctioning, but not in preventing cardiac arrhythmias. Nurses should be aware of the complications of endotracheal suctioning and do effective hyperoxygenation and hyperinflation before and after suctioning. Further research is needed to develop a efficient endotracheal suction method which will minimize complications. This study needs to be replicated with different population of patients intubatted or having a tracheostomy, specifically, patients who cardiac or pulmonary desease. The data were analyzed by using an S. P. S. S. computerized program for mean, standard deviation, percentage and paired t-test. The results of this study were as follows: 1. The increase in $PaO_2$ after hyperoxygenation and hyperinflation was highly statistically significant(p=0.041), and the increase in $PaO_2$ immediately after suctioning was not significant (p=0.752). The time of lowest $PaO_2$ was 30 seconds after the endotracheal suction. 2. The occurrance of cardiac arrhythmia after the endotracheal suction included sinus tachycardia, sinus arrhythmia, sinus bradycardia, premature atrial contraction (PAC), and premature ventricular contraction (PVC). The most frequent cardiac arrhythmia was sinus tachycardia (a subjects). Sinus arrhythmia was observed in 5 subjects and continued till 10 minutes after suctioning in two of these. Sinus bradycardia occurred in only 3 subjects and among them, 1 subjects shows sinus arrythmia till 10 minutes after suctioning along. PAC was observed in only one subject and continued till five minutes after suctining along with sinus arrhythmia. PVC was observed in three subjects: it lasted for only 30 seconds after suctioning in two subjects. but continued for 10 minutes after suctioning in the third. 6 subjects manifested two kinds of Cardiac arrhythmia Three of them showed sinus tachycardia with PVC, another 2 showed sinus bradycardia with sinus arrhythmia, and the other subject showed sinus arrhythmia with PAC. 3. The increases in heart rate during the endotracheal suction immediately after and at 30 seconds after suctioning were statistically significant (p=0.005). The increase in heart rate at one minute after suctioning was also significant (p=0.023). The increase in heart rate continued until 10 minutes after the endotracheal suction, but was not statistically significant In this study, endotracheal suctioning with hyperoxygenation and hyperinflation was effective in preventing a decrease in $PaO_2$ after suctioning, but not in preventing cardiac arrhythmias. Nurses should be aware of the complications of endotracheal suctioning and do effective hyperoxygenation and hyperinflation before and after suctioning. Further research is needed to develop a efficient endotracheal suction method which will minimize complications. This study needs to be replicated with different population of patients intubatted or having a tracheostomy, specifically, patients who cardiac or pulmonary desease.

• Journal of Chest Surgery
• /
• v.27 no.5
• /
• pp.339-344
• /
• 1994

Sinus node dysfunction is common after orthotopic heart transplantation.Electrophysiologic studies have documented a high incidence [46% to 50%] of impaired sinus node automaticity and sinoatrial conduction in the early posttransplantation period. Sinus node dysfunction persists in over 20 % of patients and leads to prolonged bradyarrythmias, including sinus or nodal bradycardia and sinus arrest.The purpose of this paper was to observe sinus node dysfunction after orthotopic heart transplantation. Ten cardiac recipient dogs were monitored continuously after orthotopic transplantations between unrelated adult mongrel dogs. Crystalloid cardioplegic solution [Choongwoi Cardioplegia

• Journal of The Korean Society of Clinical Toxicology
• /
• v.11 no.2
• /
• pp.119-126
• /
• 2013

Purpose: The aim of this study was to evaluate the clinical characteristics and outcome of patients who presented to the emergency department (ED) with cardiotoxicity caused by ingestion of Himalayan mad honey. Methods: Medical records of 12 patients who presented to the ED from January 1, 2005 to December 31, 2012 with cardiotoxicity caused by ingestion of Himalayan mad honey were retrospectively reviewed. Results: The mean age of patients was 54.5 years and 58.3% were men. The median amount of mad honey ingested was 30.0 cc, and the mean time from ingestion to onset of symptoms was 39.4 minutes. All patients had hypotension and bradycardia upon arrival in the ED. The initial electrocardiogram showed sinus bradycardia in seven patients, junctional bradycardia in four patients, and atrial fibrillation with slow ventricular response in one patient. Four patients were treated with intravenous normal saline solution only. Eight patients were treated with intravenous normal saline solution and atropine sulfate in a dose ranging from 0.5 to 2.0 mg. Blood pressure and pulse rate returned to normal limits within 24 hours in all patients. Conclusion: Our study showed that all patients with cardiotoxicity caused by ingestion of Himalayan mad honey had severe hypotension, bradycardia, and bradyarrythmias, including sinus bradycardia and junctional bradycardia and all patients responded well to conservative treatment, including intravenous normal saline solution and intravenous atropine sulfate.

• Korean Journal of Clinical Laboratory Science
• /
• v.44 no.3
• /
• pp.136-141
• /
• 2012

The hearts of highly trained athletes show morphologic and electrocardiographic (ECG) changes that suggest the presence of cardiovascular disease, including sinus bradycardia, a striking increase in precordial R-wave or S-wave voltages, ST segment depression, and T-wave inversions. Despite a number of previous observational surveys, the determinants of abnormal ECG patterns in trained athletes remain largely unresolved. In this study, we compared the electrocardiographic characteristics of athletes to determine any sensitive indicators. Comparison between ECG patterns and cardiac physiology was performed in 21 junior athletes and 25 untrained subjects with no signs of cardiac disease. Sinus bradycardia was detected in a subset of athletes but not statistically significant between the athletes ($69.9{\pm}11.1bpm$) and the control ($72.7{\pm}9.9bpm$) group. The mean values of the PR and QTc intervals in the athletes' group were $149.2{\pm}15.4ms$ and $402.3{\pm}28.8ms$, respectively. Also, there were no significantly differences between control group and the athletes' group. In addition, the athletes demonstrated a spectrum of alterations in the 12-lead ECG pattern, including marked increase in precordial R-wave or S-wave voltages ($$SV_1+RV_5{\geq_-}35mm$$, 23.8%), QRS duration ($${\geq_-}90ms$$, 90.5%), suggestive of left ventricular hypertrophy. However, left axis deviation, ST segment depression, and T-wave changes in V5, V6 were not observed in either the athletes or control group. Our findings suggest that sinus bradycardia, precordial R-wave or S-wave voltages, and QRS duration seem to be more sensitively detected in athletes than in control group. Further researches on the electrocardiographic patterns of athletes should be carried out to improve the sensitivity and specificity of diagnostic criteria.

• Journal of Preventive Medicine and Public Health
• /
• v.31 no.2 s.61
• /
• pp.183-198
• /
• 1998

In order to determine the prevalence rate and find out the sexual difference of abnormal electrocardiographic findings manifested by computerized EKG, which is equipped with auto-analyzing function, a total of 2,083 electrocardiograms that were taken from population over 20 years-old from October 1996 to February 1997 were studied according to their age, gender and blood pressure. 1. Using the electrocardiography with auto-analyzing function, 33 kinds of abnormal findings were manifested. The prevalence rate of abnormal findings was 52.8% in male and 43.7% in female. Among them, the most common finding was sinus brady-cardia found in 17.6% of male and 15.4% of female. Left ventricular hypertrophy by voltage criteria, minimal voltage of left ventricular hypertrophy, left axis deviation and atrial fibrillation were more common in male than in female statistically. Both of nospecific T wave and ST segment abnormality were more common in female than in male statistically. 2. Thirty-three kinds of abnormal findings were manifested. They revealed one abnormal finding alone or combined with some other ones making 128 kinds of abnormal finding. The most common abnormal finiding that manifested alone was right axis deviation (100%), then myocardial ischemia (95.7%) the next. The most common abnormal finding that complexed with other abnormal findings were left anterior fascicular block(percentage of single manifestation, 26.2%) and nonspecific T wave abnormality(percentage of single manifestation; 32.9%). Also, combination of sinus bradycardia and minimal voltage of left ventricular hypertrophy, and combination of sinus bradycardia and left ventricular hypertrophy were included in 25th sequences of abnormal findings. 3. The prevalence rate of abnormal electrocardiographic findings were higher in older group, hypertensive group, and the group of higher systolic or diastolic pressure in both sexes. 4. Abnormal findings that commonly manifested with sinus bradycardia were voltage criteria or minimal voltage of left ventricular hypertrophy(38.6%): sinus arrhythmia(10.5%): nonspecific T wave or ST segment abnormality(18.4%) and first degree AV block(7.2%) in descending order. 5. The most common site which manifested myocardial ischemia was posterior and inferior wall with equal percentage of 23.4%. And then anterior wall(19.1%), and antero-lateral wall and septum with equal percentage of 10.6% was noted in descending order.

• Journal of Chest Surgery
• /
• v.16 no.2
• /
• pp.190-198
• /
• 1983

The management of cardiac arrhythmias by cardiac pacing has increased greatly since the treatment of complete heart block with an external transcutaneous pacemaker in 1952, followed by the use of myocardial wires connected to an external pulse generation, by external transvenous pacing, and then by transvenous pacing with implantable components in thoracic wall.By now, the three bases of modern cardiac pacing for bradyarrhythmias had been established [1] an implantable device [2] the transvenous approach [3] the ability of the pacemaker to sense cardiac activity and modify its own function accordingly. In transvenous implantation of a pacemaker, any one of four vessels at the root of the neck is suitable for passage of the electrode - cephalic vein, external jugular vein, internal jugular vein, costo-axillary branch of the axillary vein. The new technique of direct puncture of the subclavian vein, either percutaneously or after skin incision only has been made, is invaluable & is used routinely. We have experienced one 25 years old patient who had rheumatic mitral stenosis & minimum aortic regurgitation with sinus bradycardia associated with premature atrial tachycardia & another 54 years old female patient who was suffered from sick sinus syndrome with sinus bradycardia & sinus arrest. The 1st patient was taken open mitral commissurotomy & aortic valvuloplasty and then was taken atrlal pace-maker implantation through If subclavian puncture method in post-op 14 days, and the second patient was taken atrial pacemaker implantation through If subclavian puncture method. Their postop course was in uneventful & were discharged, without complication. Their condition have been good to now.

• Clinical and Experimental Pediatrics
• /
• v.46 no.2
• /
• pp.195-197
• /
• 2003

Sick sinus syndrome(SSS) constitutes a spectrum of cardiac arrhythmia, including sinus bradycardia, sinus pause-arrest, sinoatrial block, slow escape rhythm, bradyarrhythmia and tachyarrhythmia. SSS is relatively uncommon in children but its exact incidence is unknown because diagnostic criteria are not uniform and most children with SSS, in general are asymptomatic. SSS may be primary(organic sinus node disease) or secondary(cardiac surgery comprises much of SSS in children and adolescents), but it can hardly be caused by familial relations as well. We reports an occurrence of familial sick sinus syndrome. Mother was diagnosed as SSS, which was presented by symptoms of dizziness and treated by permanent pacemaker(DDD). Also, two daughters revealed SSS with non-compacted cardiomyopathy on neonatal screening and fetal echocardiography respectively. We concluded that familial SSS may occur, so familial screening should be suggested.

• Clinical and Experimental Pediatrics
• /
• v.59 no.sup1
• /
• pp.129-132
• /
• 2016

Ictal tachycardia and bradycardia are common arrhythmias; however, ictal sinus pause and asystole are rare. Ictal arrhythmia is mostly reported in adults with temporal lobe epilepsy. Recently, ictal arrhythmia was recognized as a major warning sign of sudden unexpected death in epilepsy. We present an interesting case of a child with ictal sinus pause and asystole. A 27-month-old girl was hospitalized due to 5 episodes of convulsions during the past 2 days. Results of routine electroencephalography (EEG) were normal, but she experienced brief generalized tonic seizure for 3 days. During video-monitored EEG and echocardiography (ECG), she showed multiple myoclonic seizures simultaneously or independently, as well as frequent sinus pauses. After treatment with valproic acid, myoclonus and generalized tonic seizures were well controlled and only 2 sinus pauses were seen on 24-hour Holter ECG monitoring. Sinus dysfunction should be recognized on EEG, and it can sometimes be treated successfully with only antiepileptic medication.

• Journal of Chest Surgery
• /
• v.24 no.9
• /
• pp.843-852
• /
• 1991

We prospectively studied postoperative cardiac arrhythmia after open heart surgery to analyze the types and incidence of cardiac arrhythmia and to predict preoperative risk factors. And also we evaluated the effectiveness of atrial and ventricular epicardial electrodes which were placed during operation Between March 1990 and August 1990, We had operated on in 211 patients and we studied 201 consecutive patients excluding 10 patients. The study group included 99 males and 102 female patients, ages 1 month to 75 years[Mean$\pm$SD=28.0$\pm$21.7 years]. Postoperatively, all patients were regularly seen by the cardiac surgeon and cardiologist, They had continuous electrocardiographic monitoring for the first 3 days, initially in the intensive care unit and were checked routine electrocardiography on the postoperative 7 days, The postoperative cardiac arrhythmia were analyzed and possible associations of this arrhythmia with various pre, intra, and postoperative factors were studied by univariate and multivariate discriminant analysis, The overall incidence of postoperative cardiac arrhythmia except relative sinus bradycardia was 36.8%;[74/201], The incidence of postoperative cardiac arrhythmia in acyanotic congenital heart disease: 19.4%, cyanotic congenital heart disease: 20.8%, cardiac arrhythmia surgery: 33.3%, acquired valvular heart disease: 60.9% and coronary artery occlusive disease: 38.9%. Both univariate and multivariate studies indicated the pre operative symptom duration[p = 0013], the duration of medication[p=0.003], presence of preoperative arrhythmia[p<0.001] and pre-operative left atrial dimension in echocardiography to be the factor promoting postoperative cardiac arrhythmia. Multivariate discriminant analysis showed that the presence of preoperative cardiac arrhythmia, bypass time and the duration of preoperative symptom duration conveyed considerable risk factor on post-operative arrhythmia. The atrial wire electrodes were used diagnostically in 36 and were used therapeutically in 89 among 201 patients. Atrial pacing were used to treat relative sinus bradycardia, accelerated junctional tachycardia or premature atrial or ventricular contractions in 51 patients. Atrioventricular sequential pacing were used in 16 patients and ventricular pacing were used in 20 patients. Hemodynamics were evaluated in 2 patients of relative sinus bradycardia before and after atrial pacing. The atrial pacing increased the amount of cardiac output to 15% more. Because of their great utility in the diagnosis and treatment of arrhythmias, we conclude that routine placement of atrial and ventricular electrodes at the time of operation is indicated regardless of the nature of the open-heart procedure.

• The Journal of Internal Korean Medicine
• /
• v.23 no.2
• /
• pp.274-279
• /
• 2002

The sick sinus syndrome refers to a combination of symptoms (dizziness, confusion, fatigue, syncope, and congestive heart failure) caused by sinus node dysfunction and marked sinus bradycardia, sinoarterial block, or sinus arrest. 'Abdominal pulsation' means a disagreeable symptom that is defined as sensation of beating at the abdomen. We experienced a 84 year-old female patient who had dizziness, fatigue, abdominal pulsation and frequent voiding. These symptoms were related to previous episodes and presumed sick sinus syndrome by symptoms, ECGs and 24 hrs of holter monitoring. In the point of Differentiation of Syndrome (辨證), this patient was diagnosed as 'Water retention(水氣)' and was administered with Yeonggyechulgam-tang(岺桂朮甘湯). After the treatment, abdominal pulsation (frequency) and dizziness (VAS) were improved. Futhermore, the interval of voiding was longer and each volume of urination increased.