Adenosine and supraventricular tachycardia

Article Abstract:

Tachycardia is excessively fast beating of the heart. A variety of different physiological dysfunctions may lead to tachycardia, and proper diagnosis of the underlying cause is critical to selecting the proper treatment. When the source of the tachycardia is not within the thick muscular ventricles of the heart, the condition is called supraventricular tachycardia. Quite often, the abnormality lies in the electrically excitable tissues that regulate the beating of the heart, the sino-atrial node and the atrioventricular node. The drug verapamil is frequently used to terminate paroxysmal supraventricular tachycardia. Curiously, however, a drug recently approved to treat this condition is actually one of the oldest. Less than two years ago, adenosine was approved for the treatment of supraventricular tachycardia. This naturally occurring substance plays an important role in many of a cell's regulatory processes; it is also converted into one of the nucleotides that make up DNA. Adenosine was first used in the treatment of supraventricular tachycardia in 1933, but only recently has the attention of researchers again focussed on this potentially useful substance. The authors provide a detailed review of the current state of knowledge about adenosine and its use in the treatment of tachycardias. While adenosine may be directly useful in the treatment of some forms of tachycardia, its effectiveness may prove to be useful for diagnostic purposes as well. For example, when ventricular tachycardia is erroneously diagnosed as supraventricular tachycardia, treatment with verapamil may actually worsen the condition. However, the failure of the condition to respond immediately to adenosine may demonstrate that the diagnosis was incorrect and lead to proper treatment for the patient. This review describes how the combination of electrocardiography and adenosine administration can be used in the management of tachycardias. (Consumer Summary produced by Reliance Medical Information, Inc.)

Tachycardia, Adenosine, Supraventricular tachycardia

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A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction

Article Abstract:

The angiotensin-converting-enzyme (ACE) inhibitor trandolapril may reduce the mortality and risk of heart failure in people who have heart attacks followed by poor left ventricular function. Among 1749 people who had poor left ventricular function following a heart attack, 876 received 1 milligram to 4 milligrams of trandolapril a day, and 873 received a placebo. Treatment lasted for 24 months. After one year, the percentage of people who died from any cause was 35% in the trandolapril group and 42% in the placebo group. The risk of any death, of death from cardiac causes, and of heart failure was approximately 25% lower in the trandolapril group than in the placebo group. However, the risk of subsequent heart attack was not significantly lower in the trandolapril group. Side effects occurred in both groups and included chest pain, cough, hypotension, and poor kidney function. These results suggest that ACE inhibitors are most appropriate for those heart attack patients with left ventricular dysfunction.

Evaluation, ACE inhibitors, Angiotensin converting enzyme inhibitors, Heart attack

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Dangerous ventricular arrhythmias - can we predict drug efficacy?

Article Abstract:

A research study compared electrocardiographic monitoring to electrophysiologic testing for the evaluation of antiarrhythmic drugs in patients with ventricular tachycardia. Ventricular tachycardia is a rapid heart beat that originates in the upper chambers of the heart. Electrocardiographic monitoring is a non-invasive approach that involves ambulatory monitoring and exercise testing. Electrophysiologic testing is an invasive approach. The two approaches were evaluated in a select group of patients who were not typical of heart disease patients. Interpretation of the data may also have had certain types of limitations. The scientists who carried out the study recommended treatment with sotalol evaluated by ambulatory testing. This recommendation may not be supported by their data. Further studies may be needed before a recommendation can be made.

Editorial, Electrocardiography, Ventricular fibrillation, Ventricular tachycardia, Anti-arrhythmia drugs, Antiarrhythmia agents, Ambulatory electrocardiography

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