Complete heart block after mediastinal irradiation in a patient with the Wolff-Parkinson-White syndrome

Radiation therapy is the current standard therapy for several malignant disorders, including Hodgkin’s disease. Cardiac complications, pericardial disease in particular, may develop long after the treatment. However, conduction disorders have rarely been described. We report a patient with the Wolff-Parkinson-White syndrome who developed complete heart block 16 years after mediastinal radiation therapy. (c) 2005 Elsevier Ireland Ltd. All rights reserved

Out-patient management of chronic heart failure

Chronic heart failure is a clinical syndrome associated with an ominous long-term prognosis and major economic consequences for Western societies. In recent years, considerable progress has been made in the pharmacological management of heart failure, and several treatments have been confirmed to confer survival and symptomatic benefits. However, pharmaceuticals remain underutilised, and the combination of several different drugs present challenges for their optimal prescription, requiring a thorough knowledge of potential side effects and complex interactions. This article reviews in detail the evidence pertaining to the out-patient pharmacological management of chronic heart failure, and offers recommendations on the use of various drugs in complex clinical conditions, or in areas of ongoing controversy

Suppression by propranolol and amiodarone of an electrical storm refractory to metoprolol and amiodarone

A 60-year-old male patient with ischemic cardiomyopathy experienced an electrical storm, I month after implantation of an internal cardioverter-defibrillator. Recurrent life-threatening episodes of ventricular tachycardia persisted despite maximal antiarrhythmic theraphy with amiodarone, metoprolol and mexiletine. After a total of more than 500 cardioversions, all antiarrhythmic medications were withdrawn, and the nonselective beta-blocker propranolol was initiated. Electrical stability was achieved and the patient was discharged on propranolol 400 mg/day. Two months later, a second arrhythmia cluster occurred that was controlled by the addition of amiodarone. The patient remains free of arrhythmia 15 months after the event with the combination of propranolol and amiodarone. (c) 2004 Elsevier Ireland Ltd. All rights reserved

Hemophagocytic lymphohistiocytosis after chemotherapy for multiple myeloma

Secondary hemophagocytic lymphohistiocytosis has been reported after infections in immunocompromised hosts or in association with several malignancies. We report a case of secondary hemophagocytic syndrome after chemotherapy for multiple myeloma, which responded dramatically to dexamethasone, etoposide, and cyclosporin A

Effectiveness of amiodarone therapy in patients with severe congestive heart failure and intolerance to metoprolol

The clinical and hemodynamic effects of amiodarone were examined in patients with severe congestive heart failure who were unable to tolerate metoprolol therapy. Amiodarone improved left ventricular ejection fraction and stabilized their clinical and hemodynamic condition to a level comparable with metoprolol

Long-term intermittent dobutamine infusion combined with oral amiodarone improves the survival of patients with severe congestive heart failure

Study objective: To evaluate the effects of long-term intermittent dobutamine infusion (IDI) with concomitant administration of low-dose amiodarone in patients with congestive heart failure (CHF) refractory to standard medical treatment. Design: Prospective, interventional clinical trial. Setting: Inpatient and outpatient heart failure clinic in a university teaching hospital. Patients and interventions: Twenty-two patients with CHF refractory to standard treatment who could be weaned from dobutamine therapy after an initial 72-h infusion were included in this study. The first 11 patients (group 1) were treated with IDI, 10 mug/kg/min, as needed (mean, once every 16 days, lasting for 12 to 48 h); the next 11 patients (group 2) received oral amiodarone, 480 mg/d, and IDI, 10 mug/kg/min, for 8 h every 7 days. Measurement and results: There were no differences in baseline clinical, hemodynamic, and five biochemical characteristics between the two groups. The left ventricular ejection fraction was 13.5 +/- 4.5% in group 1 vs 15.5 +/- 4.9% in group 2 (mean +/- SD; p = 0.451); mean pulmonary capillary wedge pressure was 31.3 +/- 4.4 mm Hg vs 29.4 +/- 3.3 mm Hg (p = 0.316); serum creatinine was 1.9 +/- 0.4 mg/dL vs 1.6 +/- 0.5 mg/dL (p = 0.19); and serum Na was 139.6 +/- 6.2 mEq/L vs 138.4 +/- 3.1 mEq/L (p = 0.569). At 12 months of follow-up, 1 of 11 patients (9%) was alive in group 1 vs 6 of 11 patients (55%) in group 2 (p = 0.011). Furthermore, in group 2, the functional status improved significantly within the first 3 months of treatment, from New York Heart Association functional class IV to 2.63 +/- 0.5 (p = 0.0001). Conclusion: Long-term IDI in conjunction,vith amiodarone, added to conventional drugs, improved clinical status and survival of patients with severe CHF

Long-term intermittent dobutamine infusion, combined with oral amiodarone for end-stage heart failure - A randomized double-blind study

Study objectives: To examine the effects of long-term intermittent dobutamine infusion, combined with oral amiodarone in patients with congestive heart failure (CHF) refractory to standard medical treatment. Design: Prospective, randomized, double-blind, placebo-controlled clinical trial. Setting: Inpatient and outpatient heart failure clinic in a university teaching hospital. Patients and interventions: Thirty patients with end-stage CHF refractory to standard medical treatment who could be weaned from dobutamine therapy after a first 72-h infusion were randomized in a double-blind manner to receive IV infusions of placebo (group 1; 14 patients) vs dobutamine in a dose of 10 mug/kg/min (group 2; 16 patients) for 8 h every 14 days. All patients received standard medical therapy and also were treated with oral amiodarone, 400 mg/d, which was started at least 2 weeks before randomization. Measurements and results: Kaplan-Meier survival analysis showed a 60% reduction in the risk of death from any cause in the group treated with the combination of dobutamine and amiodarone, compared with the group treated with placebo and amiodarone (hazard ratio, 0.403; 95% confidence interval, 0.164 to 0.992; p = 0.048). The 1-year and 2-year survival rates were 69% and 44%, respectively, in the dobutamine-treated group, vs 28% and 21%, respectively, in the placebo-treated group (p < 0.05 for both comparisons). Median survival times were 574 and 144 days, respectively, for groups 2 and 1. At 6 months, the New York Heart Association functional class was significantly improved in the patients who survived from both groups. Conclusions: Long-term intermittent dobutamine infusion combined with amiodarone added to the conventional drugs improved the survival of patients with advanced CHF that was refractory to conventional treatment