Browse
Submit Data
Databases
API
Help

Dataset Information

27 Views

0 Connections

0 Citations

0 Reanalyses

0 Downloads

Omics score: 0

Bezold-Jarisch reflex-mediated asystole during dobutamine stress testing: a case report.

ABSTRACT:

Background

The Bezold-Jarisch reflex (BJR) is a cardioinhibitory parasympathetic response to activation of ventricular mechanoreceptors, which can result in bradycardia, atrioventricular block, or asystole. This phenomenon has been triggered by acute myocardial ischaemia, intra-arterial nitroglycerine use, natriuretic peptides, and with exceptional rarity, in middle-aged women only, by dobutamine infusion during stress echocardiography.

Case summary

We present the case of a 61-year-old woman who suffered a 5.1-s sinus pause during her 20??g/kg/min infusion of dobutamine. Recovery was immediate following termination of dobutamine infusion. Concurrent echocardiography was normal, and subsequent cardiac catheterization and electrophysiologic study were normal.

Discussion

This is the fifth documented case of a severe BJR causing asystole during dobutamine infusion, which adds to the accumulating evidence supporting the benign nature of the condition.

SUBMITTER: Hossain N

PROVIDER: S-EPMC7837248 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Json Xml

Publications

Bezold-Jarisch reflex-mediated asystole during dobutamine stress testing: a case report.

Hossain Nimrah N Hossain Naseem N Al-Sadawi Mohammed M Haq Salman S

European heart journal. Case reports 20201115 6

<h4>Background</h4>The Bezold-Jarisch reflex (BJR) is a cardioinhibitory parasympathetic response to activation of ventricular mechanoreceptors, which can result in bradycardia, atrioventricular block, or asystole. This phenomenon has been triggered by acute myocardial ischaemia, intra-arterial nitroglycerine use, natriuretic peptides, and with exceptional rarity, in middle-aged women only, by dobutamine infusion during stress echocardiography.<h4>Case summary</h4>We present the case of a 61-yea ...[more]

PMID: 33532694

Similar Datasets

Vagally mediated atrioventricular block with ventricular asystole immediately after assuming prone position under spinal anestheisa: a case report.

Project description:Vagally mediated atrioventricular (AV) block is a condition which a paroxysmal AV block occurs with the slowing of the sinus rate. Owing to its unpredictability and benign nature, it often goes unrecognized in clinical practice. We present the case of a 49-year-old man who suddenly lost consciousness when he assumed a prone position for hemorrohoidectomy under spinal anesthesia; continuous electrocardiographic recording revealed AV block with ventricular asystole. He was completely recovered after returning to a supine position. This case calls our attention to fatal manifestation of vagally mediated AV block leading to syncope.

| S-EPMC4754269 | biostudies-literature

Cardiac pacing in severe recurrent reflex syncope and tilt-induced asystole.

Project description:AimThe benefit of cardiac pacing in patients with severe recurrent reflex syncope and asystole induced by tilt testing has not been established. The usefulness of tilt-table test to select candidates for cardiac pacing is controversial.Methods and resultsWe randomly assigned patients aged 40 years or older who had at least two episodes of unpredictable severe reflex syncope during the last year and a tilt-induced syncope with an asystolic pause longer than 3 s, to receive either an active (pacing ON; 63 patients) or an inactive (pacing OFF; 64 patients) dual-chamber pacemaker with closed loop stimulation (CLS). The primary endpoint was the time to first recurrence of syncope. Patients and independent outcome assessors were blinded to the assigned treatment. After a median follow-up of 11.2 months, syncope occurred in significantly fewer patients in the pacing group than in the control group [10 (16%) vs. 34 (53%); hazard ratio, 0.23; P = 0.00005]. The estimated syncope recurrence rate at 1 year was 19% (pacing) and 53% (control) and at 2 years, 22% (pacing) and 68% (control). A combined endpoint of syncope or presyncope occurred in significantly fewer patients in the pacing group [23 (37%) vs. 40 (63%); hazard ratio, 0.44; P = 0.002]. Minor device-related adverse events were reported in five patients (4%).ConclusionIn patients aged 40 years or older, affected by severe recurrent reflex syncope and tilt-induced asystole, dual-chamber pacemaker with CLS is highly effective in reducing the recurrences of syncope. Our findings support the inclusion of tilt testing as a useful method to select candidates for cardiac pacing.Study registrationClinicalTrials.gov identifier NCT02324920, Eudamed number CIV-05-013546.

| S-EPMC7857694 | biostudies-literature

Lazarus in asystole: a case report of autoresuscitation after prolonged cardiac arrest.

Project description:BackgroundThird-degree atrioventricular (AV) block can result in sudden cardiac death if no reliable escape rhythm is present. Here, we report a case of an 86-year-old female patient who developed a third-degree AV block leading to cardiac arrest. Surprisingly, sinus rhythm returned after 4?min of asystole, and she showed complete neurological recovery.Case summaryEmergency services were contacted by the husband of an 86-year-old woman after she was found unconscious. Ambulance personnel diagnosed a third-degree AV block without an escape rhythm and transcutaneous pacing was started. At arrival on the emergency ward, pacing was inadequate, resulting in absence of circulation for ?10 min. After consultation with the family, the patient turned out to have signed a 'do not resuscitate' order. Given the impression that the considerable delay deemed favourable neurological recovery unlikely, it was decided together with the family to stop the resuscitation. Subsequently, she had an intermittent junctional escape rhythm but eventually developed a documented asystole of more than 4?min. Against all expectations, she regained sinus rhythm and fully recovered. Eventually, a pacemaker was implanted and she was discharged home without neurological sequalae of the cardiac arrest.DiscussionAutoresuscitation, also known as the Lazarus syndrome, is the spontaneous return of circulation after cardiac arrest and is incidentally seen after failed cardiopulmonary resuscitation (CPR). Autoresuscitation in the absence of CPR is highly unusual, but could, in this case, be due to the total AV block as the cause of the cardiac arrest.

| S-EPMC6764576 | biostudies-literature

A case report of a coronary myocardial bridge with impaired full-cycle ratio during dobutamine challenge.

Project description:Background:A myocardial bridge (MB) is a coronary variant in which an epicardial coronary artery tunnels through the myocardial band. Although MBs have been reported to cause ischaemia, physiological assessment of an MB has not been fully established. Case summary:We encountered a case with exertional chest pain who underwent coronary angiography showing an MB at the mid-left anterior descending artery with systolic compression. Optical coherence tomography showed an MB defined as a homogeneous intermediate intensity surrounding the epicardial artery. The full-cycle ratio, defined as the lowest ratio of distal coronary pressure (Pd ) to aortic pressure (Pa ) during the entire cardiac cycle, measured 0.89 at rest and 0.73 with intravenous dobutamine of 20?µg/kg/min with a distinctive waveform pattern (early diastolic Pd drop) during a dobutamine challenge. Metoprolol succinate dosage was increased. The patient has been free from chest pain for 7?months after the discharge. Discussion:Optical coherence tomography may contribute to anatomical detections of MBs. Because a systolic compression of the MB and release of the vascular lumen during early diastole leads to an early steep pressure loss, early diastolic Pd drop should be one of the specific haemodynamic characteristics of MBs. On the other hand, in a severe atherosclerotic stenosis, Pd drop is typically observed in late diastole, which could be differentiated from that of MBs. Because full-cycle ratio reflects the whole cardiac cycle including early diastole, this might be more useful than other physiological indices for detection of MB-related ischaemia induced by a dobutamine challenge.

| S-EPMC7319821 | biostudies-literature

Paradoxical cardiac conduction during exercise stress testing in myotonic dystrophy type 1: a case report.

Project description:BackgroundExercise stress testing (EST) identifies functional abnormalities that may manifest only during physiologic stress to the heart. This may have significant prognostic value in identifying latent conduction abnormalities in asymptomatic patients with myotonic dystrophy type 1 (MD1), who may benefit from prophylactic permanent pacemaker (PPM) implantation.Case reportWe report the case of a patient with MD1 with a 5-month history of atypical left-sided chest pain. Her baseline electrocardiogram (ECG) showed sinus rhythm and variable PR interval prolongation (206-220 ms) without symptoms of cardiac conduction disease. Routine blood tests and cardiac investigations including a 24-h ECG monitoring, echocardiogram, and a cardiac magnetic resonance imaging scan, revealed no abnormalities. To investigate her chest pain and to determine the need for prophylactic PPM implantation, EST and an electrophysiological study were performed. Exercise testing revealed minimal PR shortening (PR = 200 ms) at peak exercise and paradoxical PR prolongation (PR = 280 ms) during the early recovery period. A prophylactic DDDR PPM was implanted following an electrophysiological study that revealed a prolonged His-ventricle (HV) interval of 84 ms.DiscussionThe current use of annual ECG and 24 Holter monitoring may not adequately detect abnormal cardiac conduction in asymptomatic patients with MD1. The invasive nature of electrophysiology studies limits its use as a screening tool for conduction abnormalities in asymptomatic patients. Thus, EST could be used to identify underlying conduction abnormalities in MD1 patients without any specific symptoms of bradycardia, which warrant further invasive electrophysiological studies (EPS).

| S-EPMC8567071 | biostudies-literature

Spasm of the near reflex: A case report.

Project description:Purpose:Spasm of the near reflex (SNR) is a triad of miosis, excess accommodation and excess convergence. Primary SNR is most often functional in origin We aim to highlight the clinical features which distinguish primary convergence from other conditions with a similar presentation but more sinister underlying aetiology, for example bilateral abducens nerve palsy. Observations:There is a paucity of published data on SNR, in particular diagnostic criteria and treatment. We report a case of SNR of functional origin in an otherwise healthy young female and discuss the clinical features that differentiate this condition from similar conditions with underlying neurological origin. Conclusions and importance:SNR is predominantly a clinical diagnosis, and often leads to patients undergoing unnecessary investigations and sometimes treatment. Recognising the salient features that differentiate it could potentially avoid this.

| S-EPMC5722181 | biostudies-literature

Dobutamine stress testing in patients with Fontan circulation augmented by biomechanical modeling.

Project description:Understanding (patho)physiological phenomena and mechanisms of failure in patients with Fontan circulation-a surgically established circulation for patients born with a functionally single ventricle-remains challenging due to the complex hemodynamics and high inter-patient variations in anatomy and function. In this work, we present a biomechanical model of the heart and circulation to augment the diagnostic evaluation of Fontan patients with early-stage heart failure. The proposed framework employs a reduced-order model of heart coupled with a simplified circulation including venous return, creating a closed-loop system. We deploy this framework to augment the information from data obtained during combined cardiac catheterization and magnetic resonance exams (XMR), performed at rest and during dobutamine stress in 9 children with Fontan circulation and 2 biventricular controls. We demonstrate that our modeling framework enables patient-specific investigation of myocardial stiffness, contractility at rest, contractile reserve during stress and changes in vascular resistance. Hereby, the model allows to identify key factors underlying the pathophysiological response to stress in these patients. In addition, the rapid personalization of the model to patient data and fast simulation of cardiac cycles make our framework directly applicable in a clinical workflow. We conclude that the proposed modeling framework is a valuable addition to the current clinical diagnostic XMR exam that helps to explain patient-specific stress hemodynamics and can identify potential mechanisms of failure in patients with Fontan circulation.

| S-EPMC7034893 | biostudies-literature

Dobutamine stress echocardiography in low-flow, low-gradient aortic stenosis with concomitant severe functional mitral regurgitation: a case report.

Project description:BackgroundDobutamine stress echocardiography (DSE) in classical low-flow, low-gradient (LFLG) aortic stenosis (AS) is recommended in recent guidelines to differentiate true-severe AS from pseudo-severe AS. However, DSE for patients with concomitant significant mitral regurgitation (MR) is often inaccurate or inconclusive.Case summaryA 73-year-old man with a history of coronary artery bypass grafting was referred to our institution with congestive heart failure. Transthoracic echocardiogram showed severe functional MR and LFLG AS. The results of DSE to determine the severity of AS were inconclusive owing to the absence of flow reserve, usually defined as stroke volume increase of ≥20%. In addition, calcium score by computed tomography scan was also inconclusive. Our heart team decided to reassess the severity of AS after percutaneous edge-to-edge mitral valve repair (PMVR), considering the patient's high surgical risk. Percutaneous edge-to-edge mitral valve repair was uneventful, resulting in marked reduction of MR from severe to trivial. Dobutamine stress echocardiography after PMVR revealed true-severe AS with the presence of flow reserve. Transcatheter aortic valve implantation (TAVI) was performed, and the patient ambulatorily discharged.DiscussionThe coexistence of significant AS may lead to overestimation of the severity of MR, and reportedly, concomitant MR improves in the majority of patients after TAVI, especially MR of functional aetiology. However, the coexistence of significant MR often leads to inconclusive DSE results because dobutamine stress may worsen MR and fail to increase the stroke volume. In our case, DSE after PMVR was useful to diagnose the true-severe AS for the patient with LFLG AS and severe functional MR.

| S-EPMC8189303 | biostudies-literature

Aspergillus case report

Project description:Aspergillary rhinopharyngitis in an equine patient

| PRJEB46193 | ENA

Dobutamine Stress Echocardiography for the Bedside Assessment of Viability Following a Motor Vehicle Accident and Subsequent Myocardial Infarction: A Case Report.

Project description:The authors describe a case of a critically ill patient presenting after motor vehicle trauma complicated by anterior myocardial infarction and cardiogenic shock. Assessment of myocardial viability in the territory of a critically stenosed left anterior descending artery (LAD) was necessary to determine the optimal management strategy. Bedside dobutamine stress echocardiography (DSE) demonstrated viability in the LAD territory and the patient underwent uncomplicated single-vessel bypass surgery with subsequent improvement in left-ventricular function. This case illustrates the utility of bedside DSE to assess myocardial viability in patients for whom other non-invasive modalities are not feasible.

| S-EPMC4767133 | biostudies-literature

OmicsDI is part of the ELIXIR infrastructure

OmicsDI is an Elixir interoperability service. Learn more ›

Tweets

OmicsDI Databases

PRIDE
PeptideAtlas
MassIVE
JPOST Repository
Physiome Model Repository

EGA
EVA
ENA
LINCS
PAXDB
Cell Collective

MetaboLights
Metabolomics Workbench
MetabolomeExpress
GNPS
BioModels
FAIRDOMHub

ArrayExpress
dbGaP
ExpressionAtlas
GEO
NODE

Information

Databases
Help
API
Contact us
Code on GitHub
Terms of use
Submit Data