one of my empoylee  applied for leave of 20 days for going out for some tourism
with his family, which was rejected for some official reason. after a
week his wife came to office carrying a ecg report showing some
disorder in it along with family doctor's letter of one month complete
rest. coincidently i came to know from a booking agent of him booking
tickets for a tourist center for next week. i sent one of my officer
to his house regarding his health concern with request for an another
ecg test from a reailable hospital to avoid any false alarm. he agreed
for that and the montoring of the ecg again reported some disorder. my
question is that a ecg montoring can be manipulated by a person
without the help of radiologist, and how it can be done. thanks

---

Request for Question Clarification by pinkfreud-ga on 25 Oct 2004 11:07 PDT

It would be very helpful to know precisely what kind of disorder was
indicated by the electrocardiogram.

---

Clarification of Question by where4-ga on 25 Oct 2004 19:49 PDT

the disorder shown was abnormal heart rythem. thanks

---

Request for Question Clarification by pinkfreud-ga on 25 Oct 2004 21:00 PDT

Certain kinds of drugs can cause temporary heart rhythm abnormalities.
If a person were to take such drugs with the intent of appearing to
have a heart problem, it is possible that an electrocardiogram could
give misleading results. However, there's no way that I (or any
Researcher) can prove that such a thing was done in this case. If
you'd like a list of some of the drugs that might produce temporary
arrhythmias, I'd be glad to compile such a list. Would that be a
satisfactory answer to your question?

---

Clarification of Question by where4-ga on 26 Oct 2004 02:40 PDT

thanks. it does not seems to me that any drug might have taken,
because my officer took him almost instantly from his home for the
monitoring, which took place almost one week after the first one. even
you can give me all the possibilities,either medicine or some other if
it is there.

---

Clarification of Question by where4-ga on 26 Oct 2004 22:50 PDT

hello pinkfreud-ga i am awating for the answer. thanks

---

Request for Question Clarification by pinkfreud-ga on 27 Oct 2004 08:15 PDT

I had left your question open for other Researchers, since you said
"it does not seems to me that any drug might have taken," and the only
possibilities that occurred to me involve the taking of drugs. If
you'd like a list of some of the drugs that might cause temporary
abnormalities in heart rhythms, I'll be pleased to compile such a list
for you. I just want to be sure that this will be fully satisfactory.

---

Clarification of Question by where4-ga on 27 Oct 2004 20:23 PDT

please give me detials of drugs, it may be helpfull. please try to
find out any other possibilties also. thanks.

As I mentioned earlier, it is possible to temporarily alter the
heart's rhythm by taking certain drugs. I have gathered some material
for you on this subject. Please keep in mind that this is not medical
advice, and has no probative value in relationship to the possible
fraud that you suspect.

======================================================================

"An arrhythmia is an irregular heartbeat - either too fast, too slow
(bradycardia), or irregular. Most arrhythmias are not dangerous, but
some do require monitoring and treatment...
 
Arrhythmia can be caused by a variety of factors, including:

Congenital defect. Some people are born with an irregular heartbeat. 

Lifestyle. Consuming alcohol or caffeine, or using tobacco or illegal
drugs can induce an arrhythmia.

Medication. Some cold medicines and diet pills have been known to
cause arrhythmia.

Heart disease. History of heart attack or high blood pressure can
cause arrhythmia."

Strong Heart and Vascular Center
http://www.stronghealth.com/services/cardiology/Conditions/arrhythmia.cfm

"Bradycardia is a type of arrhythmia where the heart beats at a slower
than normal rate. A normal heart will beat anywhere from 60-100 times
per minute. At times, like during sleep, or in certain athletes, the
heart may beat less than 60 times per minutes, and be completely
normal, but often a slow heart beat is a medical treatment that
requires treatment...

Bradycardia can be caused by a variety of factors, including:

Congenital defect - born with an irregular heartbeat 

Aging - degenerative process of age can cause the heart to slow down 

Medication -some cold medicines and diet pills have been known to cause arrhythmia 

Heart disease - dysfunction of the electrical pathways of the heart
can cause bradycardia."

Strong Heart and Vascular Center
http://www.stronghealth.com/services/cardiology/Conditions/bradycardia.cfm

======================================================================

"The weight-loss supplement Metabolife 356 causes subtle changes in
heartbeat in test subjects."

Science News (Nov. 22, 2003)
http://www.sciencenews.org/articles/20031122/note15ref.asp

[NOTE: the article referenced above concerns a formula of the
weight-loss supplement Metabolife which contained ephedra. Ephedra,
which can cause heart rhythm abnormalities, is now banned from such
products in the United States.]

======================================================================

"Can antiarrhythmic drugs cause arrhythmia?

The recognition that certain types of ventricular premature beats,
specifically repetitive forms, may be forerunners of more serious
tachyarrhythmias has led to the practice of prophylactic therapy with
antiarrhythmic drugs to suppress these forms in patients who have
underlying cardiac disease. Several antiarrhythmic drugs are available
for oral therapy, and many others are undergoing investigation. The
usefulness of these agents is often limited by frequent side effects,
which include idiosyncratic and unpredictable reactions that are not
related to drug level. One such effect is the aggravation of the
arrhythmia being treated. Noninvasive drug testing in 245 patients for
a total of 1024 single drug tests showed 113 studies (11 per cent) to
have been aggravated by the antiarrhythmic drug. At least one drug was
proarrhythmic in 78 patients (32 per cent). Aggravation of arrhythmia
is a potentially serious drug complication that occurs with all
antiarrhythmic agents."

Journal of Clinical Pharmacology, 1984; 24:313-319
http://www.jclinpharm.org/cgi/content/abstract/24/7/313

======================================================================

"Proarrhythmic agents 
 
Most antiarrhythmic agents can provoke serious arrhythmias, including
ventricular tachycardia and ventricular fibrillation. The class I
drugs can cause sustained ventricular tachycardia. By slowing the
atrial flutter rate, propafenone and flecainide may increase the
ventricular response with one-to-one conduction through the AV node.
And the class III drugs, by prolonging action potential duration, may
cause torsades de pointes."

Treatment Options
http://www.treatment-options.com/article.cfm?PubID=CM06-5-1-02&Type=Article&KeyWords=
"Drugs can cause arrhythmia

======================================================================

 Some cases of arrhythmia can be traced to certain drugs, including:
 Appetite suppressants
 Beta blockers
 Caffeine
 Cocaine
 Amphetamines
 Nicotine in cigarettes
 Some asthma medications
 Thyroid medications."

Better Health Channel
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Heart_arrhythmia_and_palpitations?OpenDocument

======================================================================

"Certain stimulants such as coffee, alcohol and some over-the-counter
cold remedies can cause arrhythmia in some people. Relief may be
achieved by avoiding these substances."

National Heart Foundation, New Zealand
http://www.nhf.org.nz/index.asp?PageID=2145828254 

======================================================================

"Sniffing... Aerosols (like lighter fuel) can cause arrhythmia
(irregular heartbeat)."

Young Peoples Drug Project
http://www.base10drugs.plus.com/solvents.htm

======================================================================

"Gross deficiency of dietary selenium may cause many heart problems,
including arrhythmia."

NETrition.com
http://www11.netrition.com/cgi/healthnotes.cgi?ContentID=1182007

======================================================================

"White Horehound preparations may antagonize hydroxytryptamine
(antidepressant). Large doses may antagonize antidiarrheal drugs.
Cardioactives may potentiate cardiac glycosides, interfere or
antagonize antiarrhythmic drugs, increase the risk of hypokalemia,
antagonize beta-adrenoceptor blocking drugs, interact with
depolarizing muscle relaxants and increase the risk of arrhythmias,
interfere with nitrates and calcium-channel blockers, and
cardioactives may increase the arrhythmogenic potential of
terfenadine... Very large doses can cause arrhythmia."

Nutrition Focus
http://www.nutritionfocus.com/nutrition_supplementation/herbs/horehound_herb.html

======================================================================

"One-fourth of patients use drugs that cause arrhythmia; Their doctors
are unaware... According to a report in the American Journal of
Medicine, 23% of patients receive prescriptions for drugs that prolong
QT Interval, and one tenth of these receive more than one drug
affecting QT interval, according to a recently released study. 'QT
Interval' refers to the time during which the heart gathers its energy
for its next contraction - the 'backswing' of the heart, as it were.
Disturbing this part of the heart's cycle can cause Arrhythmias...
Half of the drugs known to prolong QT interval prescribed in this
study were antidepressants, e.g. Prozac (fluoxetine) and Zoloft
(sertraline). Antibiotics were often common, e.g., Clarithromycin,
Levofloxacin, and Erythromycin."

Press World: Pharmeceuticals
http://pharmaceuticals.press-world.com/v/26518.html

======================================================================

"Medications, drugs, or substance causes of Palpitations: 

The following drugs, medications, substances or toxins are some of the
possible causes of Palpitations as a symptom. This list is incomplete
and various other drugs or substances may cause your symptoms. Always
advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or
alternative treatments...
 
Caffeine 
Stimulants 
Tobacco 
Snuff 
Alcohol 
Illicit drugs 
Amphetamines 
Cocaine 
Digitalis glycosides 
Digoxin 
Psychotropic drugs 
Thyroid hormone 
Certain OTC weight-loss medications 
Anti-arrhythmic drugs - can sometimes actually cause an arrhythmia 
Quinidine 
Procainamide 
Lidocaine 
Dispyramide 
Phenytoin 
Drugs causing ventricular arrhythmia 
Cocaine 
Phenothiazines 
Diphenhydramine 
Propranolol 
Propoxyphene 
Tricyclic antidepressants 
Amiodarone 
Drugs causing bradycardia 
Beta blockers 
Lithium 
Antihypertensive agents 
Reserpine 
Methyldopa 
Clonidine 
Calcium channel blockers 
Drugs causing sinus tachycardia 
Hydralazine 
Minoxidil" 

WrongDiagnosis.com
http://www.wrongdiagnosis.com/causes/palpitations.htm

======================================================================

"List of Potentially Proarrhythmic Agents 

(N.B. All prolong QT interval to varying degrees with or without documented TdP) 

(* = withdrawn or suspended) 

Antiarrhythmics: 

 Class 1: quinidine, procainamide, disopyramide, ajmaline, encainide*,
flecainide, propafenone
 Class 3: amiodarone, sotalol, d,l-sotalol*, bretylium, dofetilide,
almokalant*, azimilide, ibutilide

Anti-anginals/vasodilators: 

 prenylamine*, terodiline*,    bepridil 

Anti-hypertensives: 

 nicardipine, isradipine 
 moexipril/hydrochlorthiazide, indapamide 

Antihistamines: 

 terfenadine*, astemizole*, ebastine, diphenhydramine, hydroxyzine, azelastine 

Serotonin agonists & antagonists: 

 cisapride*, ketanserin* 
 ondansetron, granisetron, dolasetron 

Antimicrobials: 

 erythromycin, clarithromycin, spiramycin
 cotrimoxazole
 ketoconazole
 trimethoprim sulfa (bactrim), pentamidine
 sparfloxacin, gatifloxacin, grepafloxacin*, levofloxacin, moxifloxacin
 antiviral: foscarnet (HIV) 

Antimalarials: 

 quinine, chloroquine, halofantrine, amantidine 

Psychiatric drugs: 

 tricyclic antidepressants: amitriptyline, nortriptyline, desipramine,
clomipramine, imipramine, doxepin
 phenothiazines: thioridazine*, chlorpromazine, trifluoperazine,
prochlorperazine, fluphenazine
 others: haloperidol, droperidol*, pericycline, sertindole, pimozide,
fluoxetine, venlafaxaine, trazodone,
 mesoridazine,   quetiapine, risperidone   

Anticonvulsant: 

 felbamate, fosphenytoin (prodrug of phenytoin) 

Anti-migraine: 

 naratriptan, sumatriptan, zolmitriptan 

Anti-cancer: 

 arsenic trioxide, tacrolimus, tamoxifen, 

Others:

 organophosphates, probucol, vasopressin, domperidone, levomethadyl,
octreotide, salmeterol, tizanidine

Derived from: Yap YG, Camm J.  Risk of torsades de pointes with
non-cardiac drugs. Doctors need to be aware that many drugs can cause
qt prolongation [editorial]."

CRY (Cardiac Risk in the Young)
http://www.c-r-y.org.uk/lqtsdrugs.htm

======================================================================

Google search strategy:

Google Web Search: "cause arrhythmia"
://www.google.com/search?hl=en&q=%22cause+arrhythmia%22

Google Web Search: proarrhythmic drugs
://www.google.com/search?hl=en&q=proarrhythmic+drugs

======================================================================

I hope this is helpful. If anything is unclear or incomplete, or if a
link doesn't work for you, please request clarification.

Best regards,
pinkfreud

so nice of you for taking so much trouble.i wish you all the
prosperity,good health and peace of mind with full of pleasure.
thanks.

I'm no medical expert on these matter, but maybe he's had the problem
all along and is using it to his advantage now. My personal
recommendation is be sure and check with a lawyer before ruining his
vacation, it would be a bummer if he really developed the condition
and got to tell a jury how awful you were after all his loyal years of
service. Good luck.

Thank you very much for the kind words, the five stars, and the generous tip!

~pinkfreud

It is also necessary to know the exact type of arrhythmia diagnosed on
ECG.  There are many different types of arrhythmias, and some of them
are totally harmless, and don't mean much in terms of cardiac disease.

Good luck
~JR