ABSTRACT
Aims: Evidence is increasing to indicate that individuals with mental illness may be at risk of premature death. We studied the prevalence of QTc prolongation, QT dispersion (QTd) and cardiac arrhythmias in patients on psychotropic drugs. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medicine and Department of Behavioral Sciences, University of Ilorin Teaching Hospital, Nigeria Between Januaryand June 2010. Methodology: One hundred and ninety-one consecutive patients on psychotropic medications with 121 controls were studied. All the subjects had detailed clinical examination and resting electrocardiogram (ECG) at 25mm/sec. QTc was determined using Bazett formula and QTd by subtracting shortest from longest QTc in 12-lead ECG. Results: Mean QTc of the patients (450±46msc) was longer (p=0.0001) than that of the controls (390±27msc) but mean QTd was similar (p=0.13) in both groups. QTc was prolonged in 68(35.6%) patients compared to 11(9.1%) controls, p=0.0001. LVH, arrhythmias and abnormal T-wave morphology occurred more (p=0.01, 0.01 and 0.001 respectively) in the patients than controls. Age, duration of treatment and total daily doses of antipsychotics were independent predictors of QTc. Cardiac arrhythmias were seen in 24.1% of the patients but none had ventricular arrhythmias. Conclusion: Psychotropic drug use is a risk factor for QTc prolongation and cardiac arrhythmias. We suggest periodic electrocardiography, discourage polypharmacy and recommend drug holiday in stable patients.
ABSTRACT
Background: Chronic kidney disease (CKD) has an increased risk of not only end-stage renal disease (ESRD); but majority of moderate CKD patients do die from cardiovascular disease (CVD) before reaching ESRD. The prognosis of these patients is very poor in most developing countries because of late presentation; inadequate diagnostic facilities; and inability to pay for treatment. Knowledge about CVD in CKD is crucial because of unpredictable progressive nature of the disease and increased risk of premature death from cardiovascular events. We sought to determine prevalence and pattern of electrocardiographic abnormalities in dialysis naive CKD patients. Materials and Methods: This is a 10-year prospective cross-sectional study carried out at the University of Ilorin Teaching Hospital; Ilorin. Patients were recruited from the nephrology clinic and renal wards and all who met diagnostic criteria for stages 4 and 5 CKD were included. All had their standard 12-lead electrocardiogram (ECG) recorded and various findings were critically studied and interpreted independently by two consultant physician including a cardiologist. Data analysis was done using SPSS version 16. Results: Overall; 86of the patients had at least one form of ECG abnormality; with hypertension (HTN) and anemia being the main contributory factors. These include left ventricular hypertrophy (LVH) (27.6); left atrial enlargement (LAE) (21.6); combination of LVH and LAE (17.2); and ventricular premature contractions (6). Etiology of CKD appears to have influence on ECG changes as prevalence of LVH and LAE were high among hypertensive renal disease; chronic glomerulonephritis (CGN); and diabetic nephropathy patients. Conclusion: LVH and LAE were very common ECG abnormalities in our dialysis naive CKD patients. HTN; CGN; anemia; late presentation; and male gender appear to be the main risk factors for the ECG abnormalities. There is need for gender-specific intervention strategies directed at early detection and treatment of HTN; anemia; and underlying kidney disease; especially in resource poor nations where the burden of CKD is assuming epidemic proportion
Subject(s)
Dialysis , Electrocardiography , Renal InsufficiencyABSTRACT
Background: Relationship between type 2 DM and cardiovascular disease (CVD) is well known, with CVD being the most common cause of mortality in diabetics. Significant myocardial injury before overt CVD in DM can be identified early using echocardiography. This study therefore aimed at evaluating left ventricular structure and function of patients with type 2 DM. Materials and Methods: One hundred and fifty adult type 2 DM patients were recruited with 150 age- and sexmatched controls. Patients and subjects with systemic hypertension, pregnancy, sickle cell disease and structural heart disease were excluded from the study. Participants were evaluated clinically; had anthropometric parameters and electrocardiogram taken. Echocardiograms were obtained according to the American Society of Echocardiography (ASE) recommendations. Results: Mean age of the patients (55.4±11.6 years) was similar to that of the control (54.2±9.6 years) (P=0.348) and the duration of DM was 4.53 years. Left ventricular (LV) systolic function was normal in both groups but was higher in patients than controls (ejection fraction=70.3±10.7% and 64.4 ± 9.4%, P =0.001 respectively). The prevalence of LV diastolic dysfunction (LVDD) was 72% in the patients compared with 6% in controls (P=0.001). Patients' age, body weight, duration of DM, LV mass index and left atrial dimension were positive correlates of LVDD while patients' age, weight and left atrial dimension were independent predictors of LVDD. Conclusion: There is high prevalence of alterations in LV structure and function in normotensive type 2 DM; and there is a need for early intervention to prevent overt LV dysfunction
Subject(s)
Cardiovascular Diseases , Ventricular Function, LeftABSTRACT
BACKGROUND: Echocardiography is increasingly being used as a screening test to identify sources of cardiogenic embolism in patients with ischemic stroke or transient ischaemic attack (TIA). However; no consensus exists presently on the utilization of this imaging facility in individuals with stroke. OBJECTIVE: To evaluate the yield of transthoracic echocardiography in patients with ischaemic stroke with a view to providing guidance in its use in clinical management of stroke. METHODS: One hundred and twenty-six consecutive stroke patients with 90 controls were recruited prospectively. Patients were examined echocardiographically for evidence of intramural thrombus; congenital defects; valvular heart disease; wall motion abnormalities and intra-cardiac masses using twodimensional; m-Mode and Doppler facilities. RESULTS: Potential cardiac source of emboli (CSE) was identified in 23.0of the stroke patients. Those who had CSE identified aged 53.0(20.8) years were younger (p=0.0001) than those who did not have CSE; 57.2 (13.5) years. Five (4.0) patients had rheumatic valvular heart disease with demonstrable clots in the left atrium. On the other hand; four(3.2) patients had RHD without thrombi seen. Two patients had biventricular thrombi. One of these patients had giant clots within the ventricles and multiple freely mobile thrombi in right ventricle without obvious cardiac structural defect. CONCLUSION: Young stroke or transient ischaemic attacks patients who have clinical signs suggesting the heart as the potential CSE should have low threshold for echocardiography. However; there is a need for rationalisation of request for echocardiography where such clinical signs are absent