Elimination of Ventricular Arrhythmia in Catecholaminergic Polymorphic Ventricular Tachycardia by Targeting “Catecholamine‐Sensitive Area”: A Dominant‐Subordinate Relationship between Origin Sites of Bidirectional Ventricular Premature Contractions

We report on a patient diagnosed with catechoaminergic polymorphic ventricular tachycardia (CPVT) who underwent catheter ablation of ventricular premature contractions (VPCs) induced by epinephrine. VPCs were classified roughly into three types. Type 1 and Type 2 VPCs (right bundle branch block [RBBB] configuration and inferior axis) were eliminated by radiofrequency applications at the left aortic sinus of Valsalva and the anterolateral papillary muscle (APM), respectively. Although no spontaneous VPCs were seen after the elimination of Type 1 and 2 VPCs, pacing resulting in capture at the APM induced Type 3 VPC (RBBB configuration and superior axis) reproducibly. The electrophysiological findings observed in our representative case have important implications both for understanding the pathophysiology of CPVT and for considering therapeutic strategies.     

Orthostatic changes in normovolemic children: An analysis of the “tilt test”

Orthostatic changes in pulse rate and blood pressure were assessed on 455 normovolemic children between 4 and 17 years of age who visited emergency departments with a variety of complaints. Blood pressures and pulse rates were measured in the upper extremity with the patient supine, sitting, and standing. The postural changes in pulse rate and blood pressure for age groups 4 to 9 years, 10 to 13 years, and 14 to 18 years were computed, and statistical analyses were performed to identify factors predisposing to changes in pulse rate and blood pressure. In all categories of chief complaint, comparable numbers (average 25.4%) of patients had an increase in pulse rate of >20 beats/min. An average of 10.7% of children in each category had a fall in systolic blood pressure >20 torr. Only increasing body temperature, especially in the youngest children, and diarrhea, particularly if more than 12 hours in duration, predisposed to having a “positive tilt test” using these criteria. The “tilt test” for assessing orthostatic hypotension is of little value in assessing normovolemic children presenting for acute care. A positive test result is very nonspecific.     

Terminology Matters: Patient Understanding of “Opioids” and “Narcotics”

Background: The terms “opioid” and “narcotic” are often used interchangeably by healthcare providers. The purpose of this study was to compare understanding “narcotics” vs. “opioids.” Methods: A convenience sample of English‐speaking women (n = 188), aged 21–45 years, seeking care at a primary care clinic were asked (1) “What is an opioid/narcotic?” (2) “Give an example of an opioid/narcotic?” (3) “Why does someone take an opioid/narcotic?” and (4) “What happens when someone takes an opioid/narcotic for a long time?” Responses were recorded verbatim by a research assistant and then coded independently by two investigators. Results: More than half of respondents (55.9%) responded “don’t know” to all 4 opioid questions, while just 3.2% responded “don’t know” to all 4 narcotic questions (P < 0.01). Most women were unfamiliar with the term opioid (76.3%) and did not know why someone would take an opioid (68.8%). About two‐thirds of respondents were able to give an example of a narcotic (64.2%) and knew the consequences of long‐term narcotic use (63.2%). Conclusions: While more women were more familiar with narcotic, many identified negative connotations with this term. Future research should explore how to improve patient understanding and attitudes regarding both the terms opioids and narcotics.     

“Burnt out” dilated hypertrophic cardiomyopathy causing acute LVAD thrombosis

Case report illustrates obstruction encountered in a patient with end‐stage dilated hypertrophic cardiomyopathy (HCM) who underwent LVAD implantation. The morphology reversed in early postoperative period to HCM. Pump replacement required coring of the ventricular muscle. Dilated end‐stage hypertrophic cardiomyopathy can revert back to the original morphology on decompression.     

“Aloha”: An In-House Nursing Home Vacation

This article describes a weeklong in-house “vacation” that was held at a Department of Veterans Affairs nursing home. The author provides the guidelines used to plan, implement, and evaluate the project. The in-house nursing home vacation was successful, as measured by the number of residents in attendance, their positive evaluations, and their desire to repeat the experience. The primary reason for the success of this program was the number and strength of the interactive partnerships.