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Atrial Tachyarrhythmia with Short PR Interval

Lown-Ganong-Levine Syndrome


Presentation

  • Presentation History The history is of bouts of tachycardia that may present as rapid palpitations. It most often starts in early adulthood but can present in childhood. It tends to get less frequent with passing years.[patient.co.uk]
  • When the "concertina" effect was present, the direction of the terminal vectors remained unchanged. In four patients with the Lown-Ganong-Levine syndrome, the PSE loop closed, and in three patients, a small opening was present.[ncbi.nlm.nih.gov]
  • Diagnosis of Lown-Ganong-Levine syndrome is primarily by excluding other arrhythmias by an ECG [1] Rate: 100 to 250 bpm (atrial); ventricular varies Rhythm: regular, narrow QRS complex usually; irregular (ectopic foci) may have wide QRS complex if aberrancy present[explainmedicine.com]
Euthyroid
  • She was euthyroid; ECG revealed regular rhythm with inverted P waves, short PR interval, absent delta waves with normal QRS morphology ( Figure 1 ). Diagnosed as a case of LGL syndrome and put on tab atenolol 50 mg OD.[ncbi.nlm.nih.gov]
Renal Artery Stenosis
  • artery stenosis ) - Aortic dissection / Aortic aneurysm ( Abdominal aortic aneurysm ) - Aneurysm - Raynaud's phenomenon / Raynaud's disease - Buerger's disease - Vasculitis / Arteritis ( Aortitis ) - Intermittent claudication - Arteriovenous fistula[wikidoc.org]
Lymphedema
  • Budd-Chiari syndrome , Renal vein thrombosis , Paget-Schroetter disease ) - Varicose veins / Portacaval anastomosis ( Hemorrhoid , Esophageal varices , Varicocele , Gastric varices , Caput medusae ) - Superior vena cava syndrome - Lymph ( Lymphadenitis , Lymphedema[wikidoc.org]
Intracranial Hemorrhage
  • hemorrhage / cerebral hemorrhage : Extra-axial hemorrhage ( Epidural hemorrhage , Subdural hemorrhage , Subarachnoid hemorrhage ) Intra-axial hematoma ( Intraventricular hemorrhages , Intraparenchymal hemorrhage ) - Anterior spinal artery syndrome -[wikidoc.org]
Cesarean Section
  • Post by: 3:35PM Dec 22, 2018 Comments off CASE REPORT Med-Science . 2018; 7(4): 951-2 doi: 10.5455/medscience.2018.07.8875 Anesthesia management in cesarean section with lown ganong levine syndrome Duygu Demiroz Aslan; Fusun Adam; Neslihan Altunkaya.[medicinescience.org]

Workup

  • Workup Laboratory Studies Workup is directed at determining the cause of tachycardia. Lown-Ganong-Levine syndrome (LGL) is an outdated diagnosis, and as such no workup is directed at making this diagnosis.[emedicine.medscape.com]
  • In the acute setting, a standard workup for tachycardia is indicated i.e. ECG, lytes, TSH. In patients who have dyspnea, a chest X-ray should be obtained.[emdocs.net]
  • WORKUP Lab Studies: The extent of the workup is determined by the acuity of the patient’s illness.[rjmatthewsmd.com]
  • Table 4 lists items to include in a focused examination and diagnostic workup. Enlarge Print Table 4.[aafp.org]
Gastric Varices
  • varices , Caput medusae ) - Superior vena cava syndrome - Lymph ( Lymphadenitis , Lymphedema , Lymphangitis ) Other Hypotension ( Orthostatic hypotension ) - Rheumatic fever See also congenital ( Q20-Q28 , 745-747 )[wikidoc.org]

Treatment

  • This era was followed by improved environmental factors which operate to produce methods of medical treatment, introduction congenital cardiac malformations.[books.google.com]
  • Click here for example ECG and further information Links: treatment prophylaxis[gpnotebook.co.uk]
  • However, verapamil and digoxin are contraindicated for treatment of atrial fibrillation or flutter in these patients because they might accelerate conduction through the bypass tract and induce ventricular fibrillation.[accessanesthesiology.mhmedical.com]

Prognosis

  • Prognosis The syndrome can produce ventricular fibrillation and sudden death [ 7 ]. However, this is unusual, and it is normally far more benign and can be controlled by pharmacological means.[patient.co.uk]
  • Prognosis The syndrome can produce ventricular fibrillation and sudden death [ 7 ] . However, this is unusual, and it is normally far more benign and can be controlled by pharmacological means.[patient.info]
  • Long-term prognosis of pre-excitation and WPW syndrome The majority of all patients with pre-excitation will experience AVRT.[ecgwaves.com]
  • Prognosis is usually extremely poor despite resuscitative efforts D. Criteria: 1. Rhythm: none 2. Heart rate: none 3. QRS: none 4. P wave: may be present or have none 5. PR interval: none 6.[andrews.edu]

Etiology

  • Their etiology is not precisely century with the first clinical recognition of known, so we have included chapters that dis symptoms and patterns for diagnosis of car cuss many aspects of congenital cardiac mal diovascular diseases.[books.google.com]
  • In Western countries, myocarditis or pericarditis (most commonly of viral etiology) are occasionally associated with arrhythmias.[guwsmedical.info]
  • This type of tachycardia may be caused by hypomagnesemia (among other etiologies), and is important to recognize because its treatment may differ from standard ventricular tachycardia.[madsci.com]
  • Etiology: This is a conduction defect in either the right or left branches of the bundle of HIS. Usually, the cause is tissue damage. Clinical Implications: The arrhythmia itself is not dangerous.[nurseslearning.com]
  • There are no visible T waves There is no PR interval and no ST segment The causes for atrial flutter can be : Premature atrial contractions (PAC's) Ischemic heart disease Re-Entry Phenomenon Pulmonary emboli Unknown etiology Atrial flutter is a serious[jan.ucc.nau.edu]

Epidemiology

  • Epidemiology Lown suggested that 17% of people with a PR interval of less than 120 ms would have the condition [ 3 ]. It is however very rare, with prevalence estimated to be less than one in a million [ 4 ].[patient.co.uk]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • Epidemiology Lown suggested that 17% of people with a PR interval of less than 120 ms would have the condition [ 3 ] . It is however very rare, with prevalence estimated to be less than one in a million [ 4 ] .[patient.info]
  • “Lown-Ganong-Levine Syndrome: Background, Pathophysiology, Epidemiology.” Medscape. Web. 5 Nov. 2015. MacKenzie, MD, Ross. “Short PR Interval.” Journal of Insurance Medicine 37 (2005): 145-52. Web. 5 Nov. 2015. Lown B, Ganong WF, Levine SA.[emdocs.net]
Sex distribution
Age distribution

Pathophysiology

  • Unlike WPW syndrome, the pathophysiology underlying LGL syndrome is poorly understood. The syndrome was once thought to involve an accessory pathway (bundle of James) that connects the atria directly to the bundle of His.[en.wikipedia.org]
  • Whatever the pathophysiology, conduction is passed from the atria to the bundle of His without the delay usually incurred at the AV node.[patient.co.uk]
  • ....Cijan A. 1983 12 The Lown-Ganong-Levine syndrome. ( 6182544 ) Castellanos A....Myerburg R.J. 1982 13 Analysis of anterograde and retrograde fast pathway properties in patients with dual atrioventricular nodal pathways: observations regarding the pathophysiology[malacards.org]
  • Levine . [ 1 ] [ 2 ] A short PR is seen. [ 3 ] Pathophysiology In normal individuals, electrical activity in the heart is initiated in the sinoatrial (SA) node (located in the right atrium ), propagates to the atrioventricular (AV) node, and then through[dictionnaire.sensagent.leparisien.fr]

Prevention

  • Bernard Lown was a founder of International Physicians for the Prevention of Nuclear War and, in 1985, the group was awarded the Nobel Prize for Peace. He developed the direct current defibrillator.[patient.co.uk]
  • Hypoxia, hypercarbia, or acidosis must be prevented because all these complications render cardiac muscle membranes unstable and ectopic depolarization more likely. Same as for Wolff-Parkinson-White syndrome.[accessanesthesiology.mhmedical.com]
  • The key to successful management is in avoiding precipitating factors, vigilant pre-operative monitoring of dysrhythmias, and prevention and aggressive management of complications on occurrence.[ncbi.nlm.nih.gov]
  • Although disappointed by the inability to ablate the tachycardia, the decision was made to begin a home medication regimen to help with prevention and breakthrough. Propranolol 10 mg by mouth daily was prescribed for initial treatment.[eplabdigest.com]

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