Value of physical signs in the diagnosis of ventricular tachycardia.


BACKGROUND:Although the use of physical signs for the diagnosis of ventricular tachycardia (VT) was described in the early 1900s, their value in this role has never been systematically assessed. METHODS AND RESULTS:Using a blinded, randomized protocol, we examined the ability of 26 clinicians to detect ventriculoatrial (VA) dissociation during cardiac pacing in 21 patients with both atrial and ventricular pacing wires in situ after successful ablation of accessory pathways. In protocol 1 (10 patients), pacing was randomized to either ventricular pacing alone (simulating VT) or to atrioventricular sequential pacing (simulating supraventricular tachycardia or VT with intact VA conduction) at rates of 150 or 180 beats per minute. Each patients was examined by four clinicians blinded to the pacing mode. Clinicians were asked to make a diagnosis of "VA association" or "VA dissociation" after examining the patient for variability of the arterial pulse, jugular venous pulse (JVP), and first heart sound. In protocol 2 (11 patients), randomization of pacing mode was performed between examination of each of the three physical signs so that the value of each sign was assessed individually. In protocol 1, a diagnosis of VA dissociation (VT) was made in 21 of 40 observations, with a specificity of 75%, sensitivity of 70%, and a positive predictive value (PPV) of 71%. In protocol 2, from a total of 132 observations (44 for each sign), the sensitivity, specificity, and PPV for a diagnosis of VT were as follows: arterial pulse, 61%, 71%, 70%; JVP, 96%, 75%, 82%; and first heart sound, 58%, 100%, 100%. CONCLUSIONS:It is concluded that, in patients with a regular tachycardia of uncertain origin, clinically detectable variations in the first heart sound and JVP are highly specific and sensitive indicators, respectively, of a diagnosis of VT. Assessment of the arterial pulse is of little value in this role.






Garratt CJ,Griffith MJ,Young G,Curzen N,Brecker S,Rickards AF,Camm AJ




Has Abstract


1994-12-01 00:00:00












  • Rheumatic and nonrheumatic valvular heart disease: epidemiology, management, and prevention in Africa.

    abstract:BACKGROUND:Unlike the Western world, valvular disease ranks among the major cardiovascular afflictions in Africa. Acute rheumatic fever and chronic rheumatic valvular disease in their most virulent form are still commonly encountered and impose a huge burden on limited healthcare resources. METHODS AND RESULTS:We perf...


    pub_type: 杂志文章,评审


    authors: Essop MR,Nkomo VT

    更新日期:2005-12-06 00:00:00

  • Significance of ventricular arrhythmias initiated by programmed ventricular stimulation: the importance of the type of ventricular arrhythmia induced and the number of premature stimuli required.

    abstract::An increasing number of premature ventricular stimuli are being used during programmed stimulation of the heart in the investigation of patients with documented or suspected ventricular arrhythmias. To analyze the significance of the different types of ventricular arrhythmias that are initiated, we evaluated in a pros...


    pub_type: 杂志文章


    authors: Brugada P,Green M,Abdollah H,Wellens HJ

    更新日期:1984-01-01 00:00:00

  • Effect of surgical reduction of left ventricular outflow obstruction on hemodynamics, coronary flow, and myocardial metabolism in hypertrophic cardiomyopathy.

    abstract::To assess the impact of operative reduction of left ventricular outflow obstruction in hypertrophic cardiomyopathy, measurements of great cardiac vein flow, oxygen and lactate content, left ventricular pressures, and cardiac index were measured at rest and during pacing stress in 20 consecutive patients (13, myotomy-m...


    pub_type: 杂志文章


    authors: Cannon RO 3rd,McIntosh CL,Schenke WH,Maron BJ,Bonow RO,Epstein SE

    更新日期:1989-04-01 00:00:00

  • Angiotensin II increases plasminogen activator inhibitor type 1 and tissue-type plasminogen activator messenger RNA in cultured rat aortic smooth muscle cells.

    abstract:BACKGROUND:The role of angiotensin as a vasoconstrictor is well established. Lately, several other actions of this hormone on vascular smooth muscle (VSM) cells have been recognized including the induction of hypertrophy and/or DNA synthesis. Platelet-derived growth factor (PDGF), a mitogen recently shown to increase p...


    pub_type: 杂志文章


    authors: van Leeuwen RT,Kol A,Andreotti F,Kluft C,Maseri A,Sperti G

    更新日期:1994-07-01 00:00:00

  • Cytomegalovirus infection impairs the nitric oxide synthase pathway: role of asymmetric dimethylarginine in transplant arteriosclerosis.

    abstract:BACKGROUND:We hypothesized that cytomegalovirus (CMV) may contribute to the vasculopathy observed in cardiac allograft recipients by impairing the endothelial nitric oxide synthase pathway. We focused on asymmetric dimethylarginine (ADMA, the endogenous inhibitor of nitric oxide synthase) as a potential mediator of the...


    pub_type: 杂志文章


    authors: Weis M,Kledal TN,Lin KY,Panchal SN,Gao SZ,Valantine HA,Mocarski ES,Cooke JP

    更新日期:2004-02-03 00:00:00

  • Vascular injury, repair, and restenosis after percutaneous transluminal angioplasty in the atherosclerotic rabbit.

    abstract:BACKGROUND:Several nonatherosclerotic animal models of restenosis exist and are used for the evaluation of the vascular response to angioplasty-induced injury. However, few studies have evaluated the response of an atherosclerotic vessel to angioplasty. The present study examined the radiographic, histological, immunoh...


    pub_type: 杂志文章


    authors: Wilensky RL,March KL,Gradus-Pizlo I,Sandusky G,Fineberg N,Hathaway DR

    更新日期:1995-11-15 00:00:00

  • Exercise training stimulates ischemia-induced neovascularization via phosphatidylinositol 3-kinase/Akt-dependent hypoxia-induced factor-1 alpha reactivation in mice of advanced age.

    abstract:BACKGROUND:Exercise stimulates the vascular response in pathological conditions, including ischemia; however, the molecular mechanisms by which exercise improves the impaired hypoxia-induced factor (HIF)-1 alpha-mediated response to hypoxia associated with aging are poorly understood. Here, we report that swimming trai...


    pub_type: 杂志文章


    authors: Cheng XW,Kuzuya M,Kim W,Song H,Hu L,Inoue A,Nakamura K,Di Q,Sasaki T,Tsuzuki M,Shi GP,Okumura K,Murohara T

    更新日期:2010-08-17 00:00:00

  • Clinical, genetic, and biophysical characterization of SCN5A mutations associated with atrioventricular conduction block.

    abstract:BACKGROUND:Three distinct cardiac arrhythmia disorders, the long-QT syndrome, Brugada syndrome, and conduction system disease, have been associated with heterozygous mutations in the cardiac voltage-gated sodium channel alpha-subunit gene (SCN5A). We present clinical, genetic, and biophysical features of 2 new SCN5A mu...


    pub_type: 杂志文章


    authors: Wang DW,Viswanathan PC,Balser JR,George AL Jr,Benson DW

    更新日期:2002-01-22 00:00:00

  • Pulselessness After Initiation of Cardiopulmonary Resuscitation for Bradycardia in Hospitalized Children.

    abstract:BACKGROUND:Cardiopulmonary resuscitation (CPR) is initiated in hospitalized children with bradycardia and poor perfusion. However, their rate of progression to pulseless cardiac arrest despite CPR and the differences in survival compared with initially pulseless arrest are unknown. We examined the prevalence and predic...


    pub_type: 杂志文章


    authors: Khera R,Tang Y,Girotra S,Nadkarni VM,Link MS,Raymond TT,Guerguerian AM,Berg RA,Chan PS,American Heart Association’s Get With the Guidelines-Resuscitation Investigators.

    更新日期:2019-07-30 00:00:00

  • Sex differences in hospital mortality after coronary artery bypass surgery: evidence for a higher mortality in younger women.

    abstract:BACKGROUND:Data are conflicting over whether women have higher mortality than men after coronary artery bypass graft (CABG) surgery. Younger but not older women hospitalized for acute myocardial infarction have higher in-hospital mortality rates than men. We hypothesized that younger women also have higher in-hospital ...


    pub_type: 杂志文章


    authors: Vaccarino V,Abramson JL,Veledar E,Weintraub WS

    更新日期:2002-03-12 00:00:00

  • C-Myc expression and its role in patients with chronic aortic regurgitation.

    abstract:BACKGROUND:Proto-oncogenes have been implicated in the pathogenesis of gene-mediated myocardial remodeling. In the human heart, however, it has not been clarified whether these proto-oncogenes are related to contractile impairment and structural alteration of the myocardium. The present study is designed to investigate...


    pub_type: 杂志文章


    authors: Taketani S,Sawa Y,Taniguchi K,Mitsuno M,Kawaguchi N,Onishi S,Matsuda H

    更新日期:1997-11-04 00:00:00

  • Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Ger

    abstract:BACKGROUND:Age is an important determinant of outcomes for patients with acute coronary syndromes (ACS); however, community practice reveals a disproportionately lower use of cardiovascular medications and invasive treatment even among elderly patients with ACS who would stand to benefit. Reasons include limited trial ...


    pub_type: 杂志文章,评审


    authors: Alexander KP,Newby LK,Cannon CP,Armstrong PW,Gibler WB,Rich MW,Van de Werf F,White HD,Weaver WD,Naylor MD,Gore JM,Krumholz HM,Ohman EM,American Heart Association Council on Clinical Cardiology.,Society of Geriatric Cardiology

    更新日期:2007-05-15 00:00:00

  • Locus for atrial fibrillation maps to chromosome 6q14-16.

    abstract:BACKGROUND:Atrial fibrillation (AF), the most common clinical arrhythmia, is a major cause of morbidity and mortality. Although AF is often associated with other cardiovascular conditions, many patients present without an obvious etiology. Inherited forms of AF exist, but the causative gene has been defined only in a s...


    pub_type: 杂志文章


    authors: Ellinor PT,Shin JT,Moore RK,Yoerger DM,MacRae CA

    更新日期:2003-06-17 00:00:00

  • Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium.

    abstract::We have previously shown that a brief episode of ischemia slows the rate of ATP depletion during subsequent ischemic episodes. Additionally, intermittent reperfusion may be beneficial to the myocardium by washing out catabolites that have accumulated during ischemia. Thus, we proposed that multiple brief ischemic epis...


    pub_type: 杂志文章


    authors: Murry CE,Jennings RB,Reimer KA

    更新日期:1986-11-01 00:00:00

  • Fish-rich diet, leptin, and body mass.

    abstract:BACKGROUND:Leptin has been implicated in cardiovascular disease. A diet rich in fish has been associated with decreased cardiac and vascular risk. METHODS AND RESULTS:We examined the relationship between diet and leptin in 2 related homogeneous African tribal populations of Tanzania. One tribe consumes freshwater fish...


    pub_type: 杂志文章


    authors: Winnicki M,Somers VK,Accurso V,Phillips BG,Puato M,Palatini P,Pauletto P

    更新日期:2002-07-16 00:00:00

  • Characterization of plaque components with intravascular ultrasound elastography in human femoral and coronary arteries in vitro.

    abstract:BACKGROUND:The composition of plaque is a major determinant of coronary-related clinical syndromes. Intravascular ultrasound (IVUS) elastography has proven to be a technique capable of reflecting the mechanical properties of phantom material and the femoral arterial wall. The aim of this study was to investigate the ca...


    pub_type: 杂志文章


    authors: de Korte CL,Pasterkamp G,van der Steen AF,Woutman HA,Bom N

    更新日期:2000-08-08 00:00:00

  • Antiinflammatory effects of angiotensin II subtype 1 receptor blockade in hypertensive patients with microinflammation.

    abstract:BACKGROUND:Experimental studies revealed proinflammatory properties of angiotensin II. We evaluated antiinflammatory effects of the angiotensin II subtype 1 receptor antagonist olmesartan medoxomil alone and in cotherapy with the HMG-CoA reductase inhibitor pravastatin in patients with essential hypertension and microi...


    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Fliser D,Buchholz K,Haller H,EUropean Trial on Olmesartan and Pravastatin in Inflammation and Atherosclerosis (EUTOPIA) Investigators.

    更新日期:2004-08-31 00:00:00

  • Late vascular response to repeat stenting for in-stent restenosis with and without radiation: an intravascular ultrasound volumetric analysis.

    abstract:BACKGROUND:Re-stenting of in-stent restenosis (ISR) improves acute angiographic results. Methods and Results- Volumetric intravascular ultrasound analysis was performed in 70 ISR lesions that received either placebo (n=36) or (192)Ir radiation (n=34). ISR lesions treated by re-stenting were divided into 3 groups: old s...


    pub_type: 临床试验,杂志文章


    authors: Morino Y,Limpijankit T,Honda Y,Lansky AJ,Waksman R,Bonneau HN,Yock PG,Mintz GS,Fitzgerald PJ

    更新日期:2002-05-28 00:00:00

  • Defibrillator Versus beta-Blockers for Unexplained Death in Thailand (DEBUT): a randomized clinical trial.

    abstract:BACKGROUND:Sudden Unexplained Death Syndrome (SUDS) is the leading cause of death in young, healthy, Southeast Asian men. The role of an implantable cardioverter defibrillator (ICD) for mortality reduction in these patients remains unclear. METHODS AND RESULTS:The Defibrillator Versus beta-Blockers for Unexplained Dea...


    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Nademanee K,Veerakul G,Mower M,Likittanasombat K,Krittayapong R,Bhuripanyo K,Sitthisook S,Chaothawee L,Lai MY,Azen SP

    更新日期:2003-05-06 00:00:00

  • Predictors of first discharge and subsequent survival in patients with automatic implantable cardioverter-defibrillators.

    abstract:BACKGROUND:Two hundred eighteen patients were evaluated in a two-phase approach (time to first appropriate discharge, survival after discharge) to identify factors that may be related to maximal benefit derived from use of an automatic implantable cardioverter-defibrillator (AICD). METHODS AND RESULTS:One hundred nine...


    pub_type: 杂志文章


    authors: Levine JH,Mellits ED,Baumgardner RA,Veltri EP,Mower M,Grunwald L,Guarnieri T,Aarons D,Griffith LS

    更新日期:1991-08-01 00:00:00

  • Intracellular calcium and vulnerability to fibrillation and defibrillation in Langendorff-perfused rabbit ventricles.

    abstract:BACKGROUND:The role of intracellular calcium (Ca(i)) in defibrillation and vulnerability is unclear. METHODS AND RESULTS:We simultaneously mapped epicardial membrane potential and Ca(i) during shock on T-wave episodes (n=104) and attempted defibrillation episodes (n=173) in 17 Langendorff-perfused rabbit ventricles. U...


    pub_type: 杂志文章


    authors: Hwang GS,Hayashi H,Tang L,Ogawa M,Hernandez H,Tan AY,Li H,Karagueuzian HS,Weiss JN,Lin SF,Chen PS

    更新日期:2006-12-12 00:00:00

  • Impact of nonoperative therapy on the clinical management of peripheral arterial disease.

    abstract::Nonoperative therapy includes conservative noninterventional modalities and the endovascular interventional modalities of percutaneous transluminal angioplasty and a variety of laser systems and atherectomy devices. The role and impact of all nonoperative treatments are considered in the perspectives of the natural hi...


    pub_type: 杂志文章,评审


    authors: Veith FJ,Gupta SK,Wengerter KR,Rivers SP,Bakal CW

    更新日期:1991-02-01 00:00:00

  • Targeting patients undergoing angioplasty for thrombus inhibition: a cost-effectiveness and decision support model.

    abstract:BACKGROUND:In recent clinical trials, glycoprotein IIb/IIIa blockers have demonstrated effectiveness in preventing adverse events after angioplasty in high-risk patients. However, uncertainty exists regarding the cost-effective selection of patients to receive antiplatelet therapy. METHODS AND RESULTS:All 4962 patient...


    pub_type: 杂志文章


    authors: Weintraub WS,Thompson TD,Culler S,Boccuzzi SJ,Becker ER,Kosinski AS,Mahoney E

    更新日期:2000-07-25 00:00:00

  • Lack of Ability to Present Antigens on Major Histocompatibility Complex Class II Molecules Aggravates Atherosclerosis in ApoE-/- Mice.

    abstract:BACKGROUND:Hypercholesterolemic mice lacking factors required for activation of CD4+ T cells are characterized by reduced development of atherosclerosis. Consequently, it has been assumed that atherosclerosis involves loss of tolerance against modified self-antigens generated in response to hypercholesterolemia and tha...


    pub_type: 杂志文章


    authors: Wigren M,Rattik S,Yao Mattisson I,Tomas L,Grönberg C,Söderberg I,Alm R,Sundius L,Ljungcrantz I,Björkbacka H,Fredrikson GN,Nilsson J

    更新日期:2019-05-28 00:00:00

  • Acute cardiovascular effects of fetal surgery in the human.

    abstract:BACKGROUND:Prenatal surgery for congenital anomalies can prevent fetal demise or alter the course of organ development, resulting in a more favorable condition at birth. The indications for fetal surgery continue to expand, yet little is known about the acute sequelae of fetal surgery on the human cardiovascular system...


    pub_type: 杂志文章,评审


    authors: Rychik J,Tian Z,Cohen MS,Ewing SG,Cohen D,Howell LJ,Wilson RD,Johnson MP,Hedrick HL,Flake AW,Crombleholme TM,Adzick NS

    更新日期:2004-09-21 00:00:00

  • Association of fibrinogen with cardiovascular risk factors and cardiovascular disease in the Framingham Offspring Population.

    abstract:BACKGROUND:Fibrinogen has been identified as an independent risk factor for cardiovascular disease and associated with traditional cardiovascular risk factors. Also, the role of elevated fibrinogen in thrombosis suggests that it may be on the causal pathway for certain risk factors to exert their effect. These associat...


    pub_type: 杂志文章


    authors: Stec JJ,Silbershatz H,Tofler GH,Matheney TH,Sutherland P,Lipinska I,Massaro JM,Wilson PF,Muller JE,D'Agostino RB Sr

    更新日期:2000-10-03 00:00:00

  • Upregulation of angiotensin II type 1 receptor, inflammatory mediators, and enzymes of arachidonate metabolism in obese Zucker rat kidney: reversal by angiotensin II type 1 receptor blockade.

    abstract:BACKGROUND:Severe obesity can result in proteinuria and progressive glomerulosclerosis in humans and experimental animals. The associated renal disease is ameliorated by weight reduction and/or blockade of the renin-angiotensin system. Various growth factors, cytokines, and lipid mediators are implicated in the pathoge...


    pub_type: 杂志文章


    authors: Xu ZG,Lanting L,Vaziri ND,Li Z,Sepassi L,Rodriguez-Iturbe B,Natarajan R

    更新日期:2005-04-19 00:00:00

  • Immunoglobulin M type of autoantibodies to oxidized low-density lipoprotein has an inverse relation to carotid artery atherosclerosis.

    abstract:BACKGROUND:Lipoprotein oxidation plays an important part in atherogenesis. Autoantibodies to oxidation-specific epitopes of LDL occur in plasma and atherosclerotic lesions of humans and animals. The potential role of these autoantibodies in atherogenesis still remains unsolved. We studied the relationship between diffe...


    pub_type: 杂志文章


    authors: Karvonen J,Päivänsalo M,Kesäniemi YA,Hörkkö S

    更新日期:2003-10-28 00:00:00

  • Coronary arteriographic findings in acute transmural myocardial infarction.

    abstract::To describe the coronary arteriographic findings during early transmural myocardial infarction and to define the prevalence of coronary thrombosis by arteriography, we performed coronary arteriography and left ventriculography within 24 hours from symptom onset of transmural myocardial infarction in 517 patients. The ...


    pub_type: 杂志文章


    authors: DeWood MA,Spores J,Hensley GR,Simpson CS,Eugster GS,Sutherland KI,Grunwald RP,Shields JP

    更新日期:1983-08-01 00:00:00

  • Glucose-insulin-potassium and tri-iodothyronine individually improve hemodynamic performance and are associated with reduced troponin I release after on-pump coronary artery bypass grafting.

    abstract:BACKGROUND:Both glucose-insulin-potassium (GIK) and tri-iodothyronine (T3) may improve cardiovascular performance after coronary artery surgery (CABG) but their effects have not been directly compared and the effects of combined treatment are unknown. METHODS AND RESULTS:In 2 consecutive randomized double-blind placeb...


    pub_type: 杂志文章,随机对照试验


    authors: Ranasinghe AM,Quinn DW,Pagano D,Edwards N,Faroqui M,Graham TR,Keogh BE,Mascaro J,Riddington DW,Rooney SJ,Townend JN,Wilson IC,Bonser RS

    更新日期:2006-07-04 00:00:00