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Abolished Vagal Tone Associated with Thyrotoxicosis Triggers Prinzmetal Variant Angina and Paroxysmal Atrial Fibrillation

Michele Emdin, MD; Lorenza Pratali, MD; and Giorgio Iervasi, MD
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CNR Institute of Clinical Physiology; Pisa, Italy 56100 (Emdin) CNR Institute of Clinical Physiology; Pisa, Italy 56100 (Pratali) CNR Institute of Clinical Physiology; Pisa, Italy 56100 (Iervasi)

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Ann Intern Med. 2000;132(8):679. doi:10.7326/0003-4819-132-8-200004180-00024
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Case findings. Top left.Middle left.Bottom left.Top right.Middle right.Bottom right.

Highly irregular R-R intervals during atrial fibrillation lasting more than 3 hours (before sinus rhythm restoration), characterized by tachycardia and lack of beat-to-beat and circadian heart rate variability. Electrocardiogram samples during atrial fibrillation, sinus rhythm, and myocardial ischemia. Three bursts of ischemic episodes, represented by transient ST-segment elevation. Heart rate variability was restored 48 hours after initiation of diltiazem treatment. Electrocardiogram sample documenting basal normofrequent sinus rhythm. ST segments indicating that treatment prevented ischemia.

Grahic Jump Location




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