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Re: [ekg_club] Procainamide

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  • Jcbartus@aol.com
    And you are 100% right Nick! I wish I had some calipers to give ya. :) Actually I saw this case and the QTC was (believe it or not) relatively normal...or at
    Message 1 of 20 , Jul 1, 2005
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      And you are 100% right Nick!  I wish I had some calipers to give ya.  :) Actually I saw this case and the QTC was (believe it or not) relatively normal...or at least not long and I so wish I had the strip.  However on research what we found was procainamide was recomended from several sources (on Marriot's it's somewhere in the high fifties or low sixties in terms of pages) for reentrant circuits due to several things.  One is because it blocks reverse conduction and the other reasons are like 7 pages worth of that book.  (Wow, I feel like an advertisement my apologies to the gang).  Remember your question was could you ever think a case where you would use procainamide.   Had we not mucked around for an hour and a half (when I mean marathon runner with a healthy cardiovascular system I'm really not kidding)  while the guy had a heartrate in the 330's with absolutely no symptoms other than the crankin' heart rate apparantly one of the first drugs we should have turned to was procainamide.  Special case...sure!  But a neat one.  As an aside from that case I also learned what happens when you give a calcium channel blocker to WPW with rapid afib.  If you haven't done it, I don't recomend it, but it's all sorts of exciting! 

      A very punchy Chris
    • Nick Nudell
      I am in the middle of a CME from Epocrates on SCD and Athletes... very interesting figures they present. Those who are healthy and athletic may not be all
      Message 2 of 20 , Jul 1, 2005
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        I am in the middle of a CME from Epocrates on SCD and Athletes... very interesting figures they present.

        Those who are "healthy" and athletic may not be all that healthy after all.

        Think about how many arrests you have seen in people who should be healthy. I think they also compensate a bit longer than a non-athlete which gives us more time to do something before arrest, so perhaps they have a longer peri-arrest period.

        Nick


        Jcbartus@... wrote:

        And you are 100% right Nick!  I wish I had some calipers to give ya.  :) Actually I saw this case and the QTC was (believe it or not) relatively normal...or at least not long and I so wish I had the strip.  However on research what we found was procainamide was recomended from several sources (on Marriot's it's somewhere in the high fifties or low sixties in terms of pages) for reentrant circuits due to several things.  One is because it blocks reverse conduction and the other reasons are like 7 pages worth of that book.  (Wow, I feel like an advertisement my apologies to the gang).  Remember your question was could you ever think a case where you would use procainamide.   Had we not mucked around for an hour and a half (when I mean marathon runner with a healthy cardiovascular system I'm really not kidding)  while the guy had a heartrate in the 330's with absolutely no symptoms other than the crankin' heart rate apparantly one of the first drugs we should have turned to was procainamide.  Special case...sure!  But a neat one.  As an aside from that case I also learned what happens when you give a calcium channel blocker to WPW with rapid afib.  If you haven't done it, I don't recomend it, but it's all sorts of exciting! 

        A very punchy Chris


      • htaed_rd@123mail.org
        Dr. Kenneth H. Cooper, the doctor who has pushed aerobics more than just about anyone else, wrote a book called Running Without Fear, How to reduce the risk
        Message 3 of 20 , Jul 1, 2005
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          Dr. Kenneth H. Cooper, the doctor who has pushed aerobics more than just
          about anyone else, wrote a book called "Running Without Fear, How to
          reduce the risk of heart attack and sudden death during aerobic
          exercise." 1985

          A catchy title.

          This was written after the 1984 death of Jim Fixx, one of the gurus of
          running back then.

          Jim Fixx died while running, this scared a lot of people.

          The theory in the book is that he had an episode of VT, fell to the
          ground, but on a slope where his head was elevated above his feet, and
          the rhythm and its inability to work against gravity (to circulate blood
          to the heart and brain) led to his death.

          On another topic, Jim Fixx wrote a lot about the problems he, and other
          athletes, had in obtaining life or health insurance due to ventricular
          hypertrophy secondary to exercise. As with any muscle, exercise leads to
          hypertrophy (growth). When does that become significant?

          Tim Noonan.


          On Fri, 01 Jul 2005 11:22:26 -0700, "Nick Nudell" <medicnick@...>
          said:
          > I am in the middle of a CME from Epocrates on SCD and Athletes... very
          > interesting figures they present.
          >
          > Those who are "healthy" and athletic may not be all that healthy after
          > all.
          >
          > Think about how many arrests you have seen in people who should be
          > healthy. I think they also compensate a bit longer than a non-athlete
          > which gives us more time to do something before arrest, so perhaps they
          > have a longer peri-arrest period.
          >
          > Nick
          >
          >
          > Jcbartus@... wrote:
          >
          > > And you are 100% right Nick! I wish I had some calipers to give ya.
          > > :) Actually I saw this case and the QTC was (believe it or not)
          > > relatively normal...or at least not long and I so wish I had the
          > > strip. However on research what we found was procainamide was
          > > recomended from several sources (on Marriot's it's somewhere in the
          > > high fifties or low sixties in terms of pages) for reentrant circuits
          > > due to several things. One is because it blocks reverse conduction
          > > and the other reasons are like 7 pages worth of that book. (Wow, I
          > > feel like an advertisement my apologies to the gang). Remember your
          > > question was could you ever think a case where you would use
          > > procainamide. Had we not mucked around for an hour and a half (when
          > > I mean marathon runner with a healthy cardiovascular system I'm really
          > > not kidding) while the guy had a heartrate in the 330's with
          > > absolutely no symptoms other than the crankin' heart rate apparantly
          > > one of the first drugs we should have turned to was procainamide.
          > > Special case...sure! But a neat one. As an aside from that case I
          > > also learned what happens when you give a calcium channel blocker to
          > > WPW with rapid afib. If you haven't done it, I don't recomend it, but
          > > it's all sorts of exciting!
          > >
          > > A very punchy Chris
          > >
        • Jcbartus@aol.com
          The compensation period for this guy was absolutely AMAZING! Otherwise I agree with you. He had made it to 40 and his WPW had never been picked up. By the
          Message 4 of 20 , Jul 1, 2005
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            The compensation period for this guy was absolutely AMAZING!  Otherwise I agree with you.   He had made it to 40 and his WPW had never been picked up.  By the time he was cardioverted he had spent literally 3 hours with a heart rate of 300-350 averaging in the 330's.  And for roughly 2 hours and 57 minutes of that time period he had no chest pain, shortness of breath or any other clinical signs barring a cranking pulse rate.  He had counted it after a late night work out session and noticed that his heart was going really fast and had kept track of it, and after an hour and a bit of that he called 911. 

            Chris


            Chris
          • htaed_rd@123mail.org
            Do you know what his blood pressure was. I remember watching a bit of the Tour de France one year, they were taking resting vital signs on the racers, the
            Message 5 of 20 , Jul 1, 2005
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              Do you know what his blood pressure was.

              I remember watching a bit of the Tour de France one year, they were
              taking resting vital signs on the racers, the lowest HR and BP were 37
              and 70 systolic, so maybe this patient is able to tolerate a lower BP
              than the rest of us and still perfuse adequately.

              Tim Noonan.


              On Fri, 1 Jul 2005 15:15:18 EDT, Jcbartus@... said:
              > The compensation period for this guy was absolutely AMAZING! Otherwise I
              > agree with you. He had made it to 40 and his WPW had never been picked
              > up. By
              > the time he was cardioverted he had spent literally 3 hours with a heart
              > rate
              > of 300-350 averaging in the 330's. And for roughly 2 hours and 57
              > minutes of
              > that time period he had no chest pain, shortness of breath or any other
              > clinical signs barring a cranking pulse rate. He had counted it after a
              > late night
              > work out session and noticed that his heart was going really fast and had
              > kept
              > track of it, and after an hour and a bit of that he called 911.
              >
              > Chris
              >
              >
              > Chris
            • Nick Nudell
              Can you imagine the size of the cannon wave in someone who has this as a normal? I have seen quite a few Lance Armstrong wannabes who had heart rates under
              Message 6 of 20 , Jul 1, 2005
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                Can you imagine the size of the cannon wave in someone who has this as a normal?

                I have seen quite a few Lance Armstrong wannabes who had heart rates under 50.... but they do not often have "normal" EKGs. The strength of their vagal tone reduces R-R variability which has been proven to be indicative of a higher risk for sudden cardiac arrest.

                Their cardiomyopathy is not something to be proud of...

                Nick


                htaed_rd@... wrote:
                Do you know what his blood pressure was.
                
                I remember watching a bit of the Tour de France one year, they were
                taking resting vital signs on the racers, the lowest HR and BP were 37
                and 70 systolic, so maybe this patient is able to tolerate a lower BP
                than the rest of us and still perfuse adequately.
                
                Tim Noonan.
                
                  
                  
              • htaed_rd@123mail.org
                Don t anaerobic exercise and increased vagal tone increase R-R variability? Tim Noonan. On Fri, 01 Jul 2005 16:41:14 -0700, Nick Nudell
                Message 7 of 20 , Jul 1, 2005
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                  Don't anaerobic exercise and increased vagal tone increase R-R
                  variability?

                  Tim Noonan.


                  On Fri, 01 Jul 2005 16:41:14 -0700, "Nick Nudell" <medicnick@...>
                  said:
                  > Can you imagine the size of the cannon wave in someone who has this as a
                  > normal?
                  >
                  > I have seen quite a few Lance Armstrong wannabes who had heart rates
                  > under 50.... but they do not often have "normal" EKGs. The strength of
                  > their vagal tone reduces R-R variability which has been proven to be
                  > indicative of a higher risk for sudden cardiac arrest.
                  >
                  > Their cardiomyopathy is not something to be proud of...
                  >
                  > Nick
                  >
                  >
                  > htaed_rd@... wrote:
                  >
                  > >Do you know what his blood pressure was.
                  > >
                  > >I remember watching a bit of the Tour de France one year, they were
                  > >taking resting vital signs on the racers, the lowest HR and BP were 37
                  > >and 70 systolic, so maybe this patient is able to tolerate a lower BP
                  > >than the rest of us and still perfuse adequately.
                  > >
                  > >Tim Noonan.
                  > >
                  > >
                  > >
                  > >
                  > >
                • Jcbartus@aol.com
                  I don t remember what his BP was, unfortunately my clear memories (this case was 2 years ago) were of reading the 12 lead. I suspect it was relatively
                  Message 8 of 20 , Jul 2, 2005
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                    I don't remember what his BP was, unfortunately my clear memories (this case was 2 years ago) were of reading the 12 lead.   I suspect it was relatively normal.  The reason I suspect it was that the second we came up with something to justify cardioversion by ACLS guidelines (cp, sob, etc.) we did it.  So I suspect that if the BP had been really low, we would have cardioverted earlier.  Also we tried cardiazem which also we would not have done with a normal BP.  I really wish I hadn't lost my copy of the 12 leads.  It was impressive!  Let me see if I can't hunt them down at all. 

                    Chris
                  • Jcbartus@aol.com
                    Hey did anyone watch on the discovery channel a special called The Science of Lance Armstrong . I figured it was bike related and so didn t watch it, no
                    Message 9 of 20 , Jul 2, 2005
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                      Hey did anyone watch on the discovery channel a special called "The Science of Lance Armstrong".  I figured it was bike related and so didn't watch it, no however I wonder if maybe there wasn't some exercise physiology/cardiology thrown in that might have touched on this?

                      Chris
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