Ventricular fibrillation causes: Difference between revisions

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__NOTOC__
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{{Ventricular fibrillation}}
{{Ventricular fibrillation}}
{{CMG}}
{{CMG}}; {{AE}} {{Ochuko}} {{Sahar}}
 
==Overview==
==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 fiber]]s (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==
==Causes==
===Abnormal automaticity===
===Life Threatening Causes===
Automaticity is a measure of the propensity of a fiber to initiate an impulse spontaneously. The product of a [[Hypoxia (medical)|hypoxic]] myocardium can be hyperirritable myocardial cells. These may then act as pacemakers. The ventricles are then being stimulated by more than one [[pacemaker]]. Scar and dying tissue is inexcitable, but around these areas usually lies a penumbra of hypoxic tissue that is excitable. Ventricular excitability may generate re-entry arrhythmias.
Life-threatening causes include [[conditions]] that may result in death or permanent disability within 24 hours if left untreated.
*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]]
*[[Tension pneumothorax]]


It is interesting to note that most cardiac myocardial cells with an associated increased propensity to arrhythmia development have an associated loss of [[membrane potential]]. That is, the maximum diastolic potential is less negative and therefore exists closer to the [[threshold potential]]. Cellular depolarisation can be due to a raised external concentration of [[potassium]] ions K<sup>+</sup>, a decreased intracellular concentration of [[sodium]] ions Na<sup>+</sup>, increased permeability to Na<sup>+</sup>, or a decreased permeability to K<sup>+</sup>. The ionic basic automaticity is the net gain of an intracellular positive charge during diastole in the presence of a voltage-dependent channel activated by potentials negative to &ndash;50 to &ndash;60&nbsp;mV.
===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]]
*[[Commotio cordis]]
*[[Congenital heart disease]]
*[[Electrocution]]
*[[Myocardial infarction]]
*[[Heart surgery]]
*Electrolyte abnormalities
**[[Hypokalemia]]
**[[Hypocalcemia]]
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|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="Beige"| [[Belladonna]], [[poisoning|environmental poisoning]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|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"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[catecholamine|Increased catecholamine levels]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[poisoning|Environmental poisoning]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Brugada syndrome]], [[congenital heart disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Pulmonary embolism]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Myocarditis]], [[sepsis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Intracranial hemorrhage]], [[ischemic stroke]], [[Pickwickian syndrome]], [[sleep apnea]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Acid-base disturbances]], [[electrolyte imbalance]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Aspiration]], [[bronchospasm]], [[hypoxia]], [[Pickwickian syndrome]], [[pulmonary embolism]], [[pulmonary hypertension]], [[sudden infant death syndrome]], [[tension pneumothorax]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[Electrolyte imbalance]], [[hypokalemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Electric shock]], [[electrocution]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Drowning]], [[hyperthermia]], [[hypothermia]], [[idiopathic]],
|-
|}


Myocardial cells are exposed to different environments. Normal cells may be exposed to hyperkalaemia; abnormal cells may be perfused by normal environment. For example, with a healed myocardial infarction, abnormal cells can be exposed to an abnormal environment such as with a myocardial infarction with myocardial ischaemia. In conditions such as myocardial ischaemia, possible mechanism of arrhythmia generation include the resulting decreased internal K<sup>+</sup> concentration, the increased external K<sup>+</sup> concentration, norepinephrine release and acidosis.<ref>Ho K 1993</ref> When myocardial cell are exposed to hyperkaliemia, the maximum diastolic potential is depolarized as a result of the alteration of Ik1 potassium current, whose intensity and direction is strictly dependant on intracellular and extracellular potassium concentrations. With Ik1 suppressed, an hyperpolarizing effect is lost and therefore there can be activation of [[funny current]] even in myocardial cells (which is normally suppressed by the hyperpolarizing effect of coexisting potassium currents). This can lead to the instauration of automaticity in ischemic tissue.
===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%}}
{{col-break|width=33%}}
*[[automaticity|Abnormal automaticity]]
*[[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}}


===Re-entry===<!-- This section is linked from [[Ventricular fibrillation]] -->
==References==
The role of re-entry or '''circus motion''' was demonstrated separately by Mines and Garrey.<ref>Mines GR 1913, Garrey WE 1914</ref> Mines created a ring of excitable tissue by cutting the atria out of the [[ray fish]]. Garrey cut out a similar ring from the [[turtle]] ventricle. They were both able to show that, if a ring of excitable tissue was stimulated at a single point, the subsequent waves of depolarisation would pass around the ring. The waves eventually meet and cancel each other out, but, if an area of transient block occurred with a [[refractory period (physiology)|refractory period]] that blocked one wavefront and subsequently allowed the other to proceed retrogradely over the other path, then a self-sustaining circus movement phenomenon would result. For this to happen, however, it is necessary that there be some form of non-uniformity. In practice, this may be an area of [[ischaemic]] or [[infarct]]ed myocardium, or underlying [[Myocardial scarring|scar tissue]].
{{Reflist|2}}
 
It is possible to think of the advancing wave of depolarisation as a dipole with a head and a tail. The length of the refractory period and the time taken for the dipole to travel a certain distance—the propagation velocity—will determine whether such a circumstance will arise for re-entry to occur. Factors that promote re-entry would include a slow-propagation velocity, a short refractory period with a sufficient size of ring of conduction tissue. These would enable a dipole to reach an area that had been refractory and is now able to be depolarised with continuation of the [[wavefront]].


In clinical practice, therefore, factors that would lead to the right conditions to favour such re-entry mechanisms include increased heart size through [[hypertrophy]] or dilatation, drugs which alter the length of the refractory period and areas of cardiac disease. Therefore, the substrate of ventricular fibrillation is transient or permanent conduction block. Block due either to areas of damaged or refractory tissue leads to areas of myocardium for initiation and perpetuation of fibrillation through the phenomenon of re-entry.
[[Category:Cardiology]]
 
[[Category:Up-To-Date cardiology]]
===Causes in Alphabetical Order===
[[Category:Up-To-Date]]
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>
[[Category:Electrophysiology]]
 
[[Category:Emergency medicine]]
* Acid-base disturbances
[[Category:Intensive care medicine]]
* Electrolyte imbalances
[[Category:Causes of death]]
* [[Hyperthermia]]
[[Category:Crowdiagnosis]]
* [[Ddx:Hypothermia|Hypothermia]]
* Hypoxia
* Improper sympathetic stimulation
* Increased catecholamine levels
* Prolonged QT syndromes
* Proarrhythmic drugs
 
==References==
{{reflist|2}}


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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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