QRS complex

Hydatid pericardial tamponade: a grape soup.

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A 35-year-old Libyan woman was referred to us from another institution with the diagnosis of massive pericardial effusion and pericardial tamponade.

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On admission to us, she was hypotensive, tachycardic and tachypnoeic. Electrocardiography showed unspecific low QRS voltage and ST-T segment flattening. Chest x-ray showed cardiomegaly. We did an emergency pericardial aspiration which yielded 1500 ml of yellow coloured fluid. A transthoracic echocardiogrm showed multiple cystic formations approximately 1·5—2 cm within the pericardial cavity), and confirmed the need for surgery. We did a standard median sternotomy and thoroughly irrigated the pericardium with hypertonic saline; multiple cysts were removed from the pericardium (figures B and C). Our patient was diagnosed with a ruptured intrapericardial hydatid cyst and pericardial tamponade. We established the diagnosis based on the gross appearance of the removed cysts, the echocardiogram results, and a high ESR. Hydatid disease is endemic in Libya, a southern Mediterranean country. Serological tests were not available. After surgery she was treated with oral albendazole for 12 days. She recovered well and was discharged 12 days after surgery. Pericardial tamponade due to hydatid disease is a rare condition that has been seldom reported in the literature.

Source: Lancet

 

 

If You Need to Pace the Right Ventricle, Pace the Left as Well.

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In patients with atrioventricular block and LVEFs 50%, outcomes were better with biventricular pacing than with right ventricular pacing.

 

Cardiac resynchronization therapy (CRT), or biventricular pacing, is beneficial in patients with wide QRS complexes and left ventricular ejection fractions (LVEFs) less than 35%. However, the benefits of CRT have rarely been tested in patients with LVEFs greater than 35%. In the BLOCK HF trial, investigators enrolled individuals with LVEFs 50% who had an indication for a pacemaker because of atrioventricular (AV) block or markedly prolonged PR interval on AV-node conduction testing.

In all, 691 patients in the U.S. and Canada received a biventricular pacemaker or, if indicated, a biventricular implantable cardioverter-defibrillator. Patients were randomized to right ventricular (RV) or biventricular pacing. During a mean follow-up of 37 months, a primary endpoint — death, urgent visit for heart failure, or an increase in LV end-systolic volume index of 15% — occurred in 45.8% of patients in the biventricular-pacing group compared with 55.6% in the RV-pacing group (hazard ratio, 0.75; 95% credible interval, 0.60–0.90; see figure).

Comment: BLOCK HF extends the patient population that benefits from cardiac resynchronization therapy to those with left ventricular ejection fractions greater than 35% who are likely to require pacing a high percentage of the time. These findings are consistent with those from PACE and from a trial conducted by Yu and colleagues (JW Cardiol 2009 Nov 15). The body of evidence is thus approaching critical mass to render future trials comparing right ventricular pacing and CRT unethical, perhaps even in patients with preserved LVEF.

Source: Journal Watch Cardiology