Ventricular fibrillation causes: Difference between revisions

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__NOTOC__
__NOTOC__
{{Ventricular fibrillation}}
{{Ventricular fibrillation}}
{{CMG}}; {{AE}} {{Ochuko}}
{{CMG}}; {{AE}} {{Ochuko}} {{Sahar}}


==Overview==
==Overview==
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==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include [[conditions]] that may result in death or permanent disability within 24 hours if left untreated.
*[[Myocardial infarction]]
*Acute coronary ischemia<ref name="pmid19252119">{{cite journal |vauthors=Koplan BA, Stevenson WG |title=Ventricular tachycardia and sudden cardiac death |journal=Mayo Clin. Proc. |volume=84 |issue=3 |pages=289–97 |date=March 2009 |pmid=19252119 |pmc=2664600 |doi=10.1016/S0025-6196(11)61149-X |url=}}</ref>
*[[Pericardial tamponade]]
*[[Pulmonary embolism]]
*[[Pulmonary embolism]]
*[[Unstable angina]]
*[[Tension pneumothorax]]


===Common Causes===
===Common Causes===
Common [[causes]] of ventricular fibrillation include:<ref name="pmid27250216">{{cite journal |vauthors=Khairy P |title=Ventricular arrhythmias and sudden cardiac death in adults with congenital heart disease |journal=Heart |volume=102 |issue=21 |pages=1703–1709 |date=November 2016 |pmid=27250216 |doi=10.1136/heartjnl-2015-309069 |url=}}</ref><ref name="pmid28222965">{{cite journal |vauthors=Maury P, Sacher F, Rollin A, Mondoly P, Duparc A, Zeppenfeld K, Hascoet S |title=Ventricular arrhythmias and sudden death in tetralogy of Fallot |journal=Arch Cardiovasc Dis |volume=110 |issue=5 |pages=354–362 |date=May 2017 |pmid=28222965 |doi=10.1016/j.acvd.2016.12.006 |url=}}</ref><ref name="pmid1638716">{{cite journal |vauthors=Saumarez RC, Camm AJ, Panagos A, Gill JS, Stewart JT, de Belder MA, Simpson IA, McKenna WJ |title=Ventricular fibrillation in hypertrophic cardiomyopathy is associated with increased fractionation of paced right ventricular electrograms |journal=Circulation |volume=86 |issue=2 |pages=467–74 |date=August 1992 |pmid=1638716 |doi=10.1161/01.cir.86.2.467 |url=}}</ref><ref name="BektasSoyuncu2012">{{cite journal|last1=Bektas|first1=Firat|last2=Soyuncu|first2=Secgin|title=Hypokalemia-induced Ventricular Fibrillation|journal=The Journal of Emergency Medicine|volume=42|issue=2|year=2012|pages=184–185|issn=07364679|doi=10.1016/j.jemermed.2010.05.079}}</ref><ref name="KlasnerScalzo1996">{{cite journal|last1=Klasner|first1=Ann E|last2=Scalzo|first2=Anthony J|last3=Blume|first3=Carolyn|last4=Johnson|first4=Paul|last5=Thompson|first5=Michael W|title=Marked Hypocalcemia and Ventricular Fibrillation in Two Pediatric Patients Exposed to a Fluoride-Containing Wheel Cleaner|journal=Annals of Emergency Medicine|volume=28|issue=6|year=1996|pages=713–718|issn=01960644|doi=10.1016/S0196-0644(96)70097-5}}</ref><ref name="pmid3181653">{{cite journal |vauthors=Billman GE, Hoskins RS |title=Cocaine-induced ventricular fibrillation: protection afforded by the calcium antagonist verapamil |journal=FASEB J. |volume=2 |issue=14 |pages=2990–5 |date=November 1988 |pmid=3181653 |doi=10.1096/fasebj.2.14.3181653 |url=}}</ref><ref name="HeistRuskin2010">{{cite journal|last1=Heist|first1=E. Kevin|last2=Ruskin|first2=Jeremy N.|title=Drug-Induced Arrhythmia|journal=Circulation|volume=122|issue=14|year=2010|pages=1426–1435|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.109.894725}}</ref>
*[[cardiomyopathy|Cardiomyopathies]]
*[[cardiomyopathy|Cardiomyopathies]]
*[[Commotio cordis]]
*[[Commotio cordis]]
*[[Congenital heart disease]]
*[[Congenital heart disease]]
*[[Electrocution]]  
*[[Electrocution]]  
*[[Heart attack]]
*[[Myocardial infarction]]
*[[Heart surgery]]
*[[Heart surgery]]
*Narrowed coronary arteries
*Electrolyte abnormalities
*[[Sudden cardiac death]]
**[[Hypokalemia]]
 
**[[Hypocalcemia]]
===Causes by Organ System===
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[automaticity|Abnormal automaticity]], [[myocardial rupture|acute myocardial rupture]], [[aortic dissection]], [[aortic stenosis]], [[arrhythmogenic right ventricular dysplasia]], [[Brugada syndrome]], [[cardiomyopathies]], [[commotio cordis]], [[complete heart block]], [[congenital heart disease]], [[coronary artery spasm]], [[dilated cardiomyopathy]], [[heart attack]], [[heart block]], [[heart surgery]], [[hypertrophic cardiomyopathy]], [[hypokalemia]], [[hypoxia]], [[ischemic stroke]], [[myocardial infarction]], [[myocardial ischemia]], [[myocarditis]], [[pericardial tamponade]], [[preexcitation syndrome]], [[prolonged QT syndrome]], [[pulmonary embolism]], [[pulmonary hypertension]], re-entry or circus motion, [[short QT syndrome]], [[sudden cardiac death]], [[sudden infant death syndrome]], [[Sumatriptan]], [[torsade de pointes]], [[unstable angina]], [[valvular heart disease]], [[Wolff-Parkinson-White syndrome]]
|-
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Belladonna]], [[poisoning|environmental poisoning]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Amiodarone]], [[calcium chloride]], [[calcium gluconate]], [[Eletriptan]], [[ergotamine tartrate]], [[Fosphenytoin sodium]], [[ibutilide]], [[catecholamine|increased catecholamine levels]], [[medications]], [[Naratriptan]], [[phenobarbital]], [[pramipexole]], proarrhythmic drugs
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[catecholamine|Increased catecholamine levels]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[poisoning|Environmental poisoning]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Brugada syndrome]], [[congenital heart disease]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Pulmonary embolism]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 74: Line 75:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Myocarditis]], [[sepsis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Intracranial hemorrhage]], [[ischemic stroke]], [[Pickwickian syndrome]], [[sleep apnea]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Acid-base disturbances]], [[electrolyte imbalance]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 110: Line 111:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Aspiration]], [[bronchospasm]], [[hypoxia]], [[Pickwickian syndrome]], [[pulmonary embolism]], [[pulmonary hypertension]], [[sudden infant death syndrome]], [[tension pneumothorax]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Electrolyte imbalance]], [[hypokalemia]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 126: Line 127:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Electric shock]], [[electrocution]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 134: Line 135:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Drowning]], [[hyperthermia]], [[hypothermia]], [[idiopathic]],
|-
|-
|}
|}


 
===Causes in Alphabetical Order<ref name="HeistRuskin2010">{{cite journal|last1=Heist|first1=E. Kevin|last2=Ruskin|first2=Jeremy N.|title=Drug-Induced Arrhythmia|journal=Circulation|volume=122|issue=14|year=2010|pages=1426–1435|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.109.894725}}</ref><ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref><ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
 
{{col-begin|width=80%}}
===Causes in Alphabetical Order<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref><ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
{{col-break|width=33%}}
 
*[[automaticity|Abnormal automaticity]]
*[[Myocarditis]]<ref name="pmid24772701">{{cite journal| author=Jain PK, Sharma AK, Agarwal N, Jain PK, Sengar NS, Agarwal N et al.| title=A prospective clinical study of myocarditis in cases of acute ingestion of paraphenylene diamine (hair dye) poisoning in northern India. | journal=J Assoc Physicians India | year= 2013 | volume= 61 | issue= 9 | pages= 633-6, 644 | pmid=24772701 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24772701  }} </ref>
*[[Acid-base disturbances]]
*[[myocardial rupture|Acute myocardial rupture]]
*[[Amiodarone]]
*[[Aortic dissection]]
*[[Aortic stenosis]]
*[[Arrhythmogenic right ventricular dysplasia]]
*[[Aspiration]]
*[[Belladonna]]
*[[Bronchospasm]]
*[[Brugada syndrome]]<ref name="AlingsWilde1999">{{cite journal|last1=Alings|first1=Marco|last2=Wilde|first2=Arthur|title=“Brugada” Syndrome|journal=Circulation|volume=99|issue=5|year=1999|pages=666–673|issn=0009-7322|doi=10.1161/01.CIR.99.5.666}}</ref>
*[[Calcium chloride]]
*[[Calcium gluconate]]
*[[cardiomyopathy|Cardiomyopathies]]
*[[Commotio cordis]]
*[[Complete heart block]]
*[[Congenital heart disease]]
*[[Coronary artery spasm]]
*[[Dilated cardiomyopathy]]
*[[Drowning]]
*[[Electric shock]]
*[[Electrocution]]
*[[Electrolyte imbalance]]
*[[poisoning|Environmental poisoning]]
*[[Ergotamine tartrate]]
*[[Heart attack]]
*[[Heart block]]
*[[Heart surgery]]
*[[Hyperthermia]]
*[[Hypertrophic cardiomyopathy]]
*[[Hypokalemia]]
{{col-break|width=33%}}
*[[Hypothermia]]<ref name="pmid24429494">{{cite journal |vauthors=Gurabi Z, Koncz I, Patocskai B, Nesterenko VV, Antzelevitch C |title=Cellular mechanism underlying hypothermia-induced ventricular tachycardia/ventricular fibrillation in the setting of early repolarization and the protective effect of quinidine, cilostazol, and milrinone |journal=Circ Arrhythm Electrophysiol |volume=7 |issue=1 |pages=134–42 |date=February 2014 |pmid=24429494 |pmc=3951442 |doi=10.1161/CIRCEP.113.000919 |url=}}</ref>
*[[Hypoxia]]
*[[Ibutilide]]
*[[Idiopathic]]
*[[catecholamine|Increased catecholamine levels]]
*[[Intracranial hemorrhage]]
*[[Ischemic stroke]]
*[[Medications]]
*[[Myocardial infarction]]
*[[Myocardial ischemia]]
*[[Myocarditis]] <ref name="pmid24772701">{{cite journal| author=Jain PK, Sharma AK, Agarwal N, Jain PK, Sengar NS, Agarwal N et al.| title=A prospective clinical study of myocarditis in cases of acute ingestion of paraphenylene diamine (hair dye) poisoning in northern India. | journal=J Assoc Physicians India | year= 2013 | volume= 61 | issue= 9 | pages= 633-6, 644 | pmid=24772701 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24772701  }} </ref>
*[[Naratriptan]]
*[[Pericardial tamponade]]
*[[Phenobarbital]]
*[[Pickwickian syndrome]]
*[[Pramipexole]]
*[[Preexcitation syndrome]]
*Proarrhythmic drugs
*[[Prolonged QT syndrome]]
*[[Pulmonary embolism]]
*[[Pulmonary hypertension]]
*Re-entry or circus motion
*[[Sepsis]]
*[[Short QT syndrome]]
*[[Sleep apnea]]
*[[Sudden cardiac death]]
*[[Sudden infant death syndrome]]
*[[Sumatriptan]]
*[[Tension pneumothorax]]
*[[Torsade de pointes]]
*[[Unstable angina]]
*[[Valvular heart disease]]
*[[Wolff-Parkinson-White syndrome]]
{{col-end}}


==References==
==References==

Latest revision as of 18:18, 14 January 2020

Ventricular fibrillation Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2] Sahar Memar Montazerin, M.D.[3]

Overview

The heart pumps blood to the lungs, brain, and other organs. Interruption of the heartbeat for only a few seconds can lead to fainting (syncope) or cardiac arrest. Fibrillation is an uncontrolled twitching or quivering of muscle fibers (fibrils). When it occurs in the lower chambers of the heart, it is called ventricular fibrillation. During ventricular fibrillation, blood is not pumped from the heart. Sudden cardiac death results. The most common cause of VF is a heart attack. However, VF can occur whenever the heart muscle does not get enough oxygen.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Common causes of ventricular fibrillation include:[2][3][4][5][6][7][8]

Causes by Organ System

Cardiovascular Abnormal automaticity, acute myocardial rupture, aortic dissection, aortic stenosis, arrhythmogenic right ventricular dysplasia, Brugada syndrome, cardiomyopathies, commotio cordis, complete heart block, congenital heart disease, coronary artery spasm, dilated cardiomyopathy, heart attack, heart block, heart surgery, hypertrophic cardiomyopathy, hypokalemia, hypoxia, ischemic stroke, myocardial infarction, myocardial ischemia, myocarditis, pericardial tamponade, preexcitation syndrome, prolonged QT syndrome, pulmonary embolism, pulmonary hypertension, re-entry or circus motion, short QT syndrome, sudden cardiac death, sudden infant death syndrome, Sumatriptan, torsade de pointes, unstable angina, valvular heart disease, Wolff-Parkinson-White syndrome
Chemical/Poisoning Belladonna, environmental poisoning
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Amiodarone, calcium chloride, calcium gluconate, Eletriptan, ergotamine tartrate, Fosphenytoin sodium, ibutilide, increased catecholamine levels, medications, Naratriptan, phenobarbital, pramipexole, proarrhythmic drugs
Ear Nose Throat No underlying causes
Endocrine Increased catecholamine levels
Environmental Environmental poisoning
Gastroenterologic No underlying causes
Genetic Brugada syndrome, congenital heart disease
Hematologic Pulmonary embolism
Iatrogenic No underlying causes
Infectious Disease Myocarditis, sepsis
Musculoskeletal/Orthopedic No underlying causes
Neurologic Intracranial hemorrhage, ischemic stroke, Pickwickian syndrome, sleep apnea
Nutritional/Metabolic Acid-base disturbances, electrolyte imbalance
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Aspiration, bronchospasm, hypoxia, Pickwickian syndrome, pulmonary embolism, pulmonary hypertension, sudden infant death syndrome, tension pneumothorax
Renal/Electrolyte Electrolyte imbalance, hypokalemia
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma Electric shock, electrocution
Urologic No underlying causes
Miscellaneous Drowning, hyperthermia, hypothermia, idiopathic,

Causes in Alphabetical Order[8][9][10]

References

  1. ↑ Koplan BA, Stevenson WG (March 2009). "Ventricular tachycardia and sudden cardiac death". Mayo Clin. Proc. 84 (3): 289–97. doi:10.1016/S0025-6196(11)61149-X. PMC 2664600. PMID 19252119.
  2. ↑ Khairy P (November 2016). "Ventricular arrhythmias and sudden cardiac death in adults with congenital heart disease". Heart. 102 (21): 1703–1709. doi:10.1136/heartjnl-2015-309069. PMID 27250216.
  3. ↑ Maury P, Sacher F, Rollin A, Mondoly P, Duparc A, Zeppenfeld K, Hascoet S (May 2017). "Ventricular arrhythmias and sudden death in tetralogy of Fallot". Arch Cardiovasc Dis. 110 (5): 354–362. doi:10.1016/j.acvd.2016.12.006. PMID 28222965.
  4. ↑ Saumarez RC, Camm AJ, Panagos A, Gill JS, Stewart JT, de Belder MA, Simpson IA, McKenna WJ (August 1992). "Ventricular fibrillation in hypertrophic cardiomyopathy is associated with increased fractionation of paced right ventricular electrograms". Circulation. 86 (2): 467–74. doi:10.1161/01.cir.86.2.467. PMID 1638716.
  5. ↑ Bektas, Firat; Soyuncu, Secgin (2012). "Hypokalemia-induced Ventricular Fibrillation". The Journal of Emergency Medicine. 42 (2): 184–185. doi:10.1016/j.jemermed.2010.05.079. ISSN 0736-4679.
  6. ↑ Klasner, Ann E; Scalzo, Anthony J; Blume, Carolyn; Johnson, Paul; Thompson, Michael W (1996). "Marked Hypocalcemia and Ventricular Fibrillation in Two Pediatric Patients Exposed to a Fluoride-Containing Wheel Cleaner". Annals of Emergency Medicine. 28 (6): 713–718. doi:10.1016/S0196-0644(96)70097-5. ISSN 0196-0644.
  7. ↑ Billman GE, Hoskins RS (November 1988). "Cocaine-induced ventricular fibrillation: protection afforded by the calcium antagonist verapamil". FASEB J. 2 (14): 2990–5. doi:10.1096/fasebj.2.14.3181653. PMID 3181653.
  8. ↑ 8.0 8.1 Heist, E. Kevin; Ruskin, Jeremy N. (2010). "Drug-Induced Arrhythmia". Circulation. 122 (14): 1426–1435. doi:10.1161/CIRCULATIONAHA.109.894725. ISSN 0009-7322.
  9. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  10. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  11. ↑ Alings, Marco; Wilde, Arthur (1999). ""Brugada" Syndrome". Circulation. 99 (5): 666–673. doi:10.1161/01.CIR.99.5.666. ISSN 0009-7322.
  12. ↑ Gurabi Z, Koncz I, Patocskai B, Nesterenko VV, Antzelevitch C (February 2014). "Cellular mechanism underlying hypothermia-induced ventricular tachycardia/ventricular fibrillation in the setting of early repolarization and the protective effect of quinidine, cilostazol, and milrinone". Circ Arrhythm Electrophysiol. 7 (1): 134–42. doi:10.1161/CIRCEP.113.000919. PMC 3951442. PMID 24429494.
  13. ↑ Jain PK, Sharma AK, Agarwal N, Jain PK, Sengar NS, Agarwal N; et al. (2013). "A prospective clinical study of myocarditis in cases of acute ingestion of paraphenylene diamine (hair dye) poisoning in northern India". J Assoc Physicians India. 61 (9): 633–6, 644. PMID 24772701.

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