FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Volume 294:623-629 March 18, 1976 Number 12 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Abstract

A 39-year-old man twice experienced ventricular fibrillation and exhibited numerous ventricular premature beats. Coronary arteries were normal, and no impaired cardiac function was found upon catheterization. Evidence was adduced that the ventricular premature beats were related to higher nervous activity. The patient had serious psychiatric problems; the ventricular premature beats were provoked by psychophysiologic stress, increased during REM sleep, were reduced by meditation, and were controlled by beta-adrenergic blockade, phenytoin and digitalization. We conclude that psychologic and neurophysiologic factors may predispose to life-threatening cardiac arrhythmia in the absence of organic heart disease. Effective management of the recurrent ventricular arrhythmia involved; acute drug testing for assessing antiarrhythmic efficacy; use of programmed trendscription to provide on-line information on drug action; a treatment program involving more than one agent; and use of measures to reduce sympathetic nervous activity.

This article has been cited by other articles:

• Ziegelstein, R. C. (2007). Acute Emotional Stress and Cardiac Arrhythmias. JAMA 298: 324-329 [Abstract] [Full Text]  
• Kornfeld, D. S. (2002). Consultation-Liaison Psychiatry: Contributions to Medical Practice. Am. J. Psychiatry 159: 1964-1972 [Abstract] [Full Text]  
• Hemingway, H., Malik, M., Marmot, M. (2001). Social and psychosocial influences on sudden cardiac death, ventricular arrhythmia and cardiac autonomic function. Eur Heart J 22: 1082-1101  
• Merz, C. N. B., Pardo, Y. (2000). Mental Versus Physical Stress, QT Prolongation, and the Autonomic Nervous System. Circulation 101 : e213-e214 [Full Text]  
• McLeod, K A, Hillis, W S, Houston, A B, Wilson, N, Trainer, A, Neilson, J, Doig, W B (1999). Reduced heart rate variability following repair of tetralogy of Fallot. Heart 81: 656-660 [Abstract] [Full Text]  
• Coronel, R., Opthof, T., Taggart, P., Tytgat, J., Veldkamp, M. (1997). Differential electrophysiology of repolarisation from clone to clinic. Cardiovasc Res 33: 503-517  
• Hlatky, M. A., Lam, L. C., Lee, K. L., Clapp-Channing, N. E., Williams, R. B., Pryor, D. B., Califf, R. M., Mark, D. B. (1995). Job Strain and the Prevalence and Outcome of Coronary Artery Disease. Circulation 92: 327-333 [Abstract] [Full Text]  
• Dossey, B. (1983). Holistic nursing: what is it?. J Holist Nurs 1: 37-38  
• Strassman, R. J., Galanter, M. (1980). The Abhidharma: a Cross-Cultural Model for the Psychiatric Application of Medication. International Journal of Social Psychiatry 26: 293-299  
• Comerford, T. J., Propert, D. B. (1979). Accelerated Idioventricular Rhythm in Patients Without Acute Myocardial Infarction. ANGIOLOGY 30: 768-775 [Abstract]