ABSTRACT
Background: There are no data on electrocardiographic (ECG) findings from general population of Indian subcontinent. We analyzed ECG abnormalities of in adults as part of a community survey of prevalence of coronary artery disease and risk factors from South India. Methods and results: In this cross-sectional study of men and women between the ages 20 to 79 years, ECGs recorded digitally were analyzed using the Minnesota code. Electrocardiograms were analyzed for abnormalities in 4630 participants (women 59.6%). The overall prevalence of ECG abnormalities (39.9%) was higher in men (47.24% vs. 34.9% p <0.0001). QRS axis deviation, first degree AV block, fascicular blocks, incomplete right bundle branch block, sinus bradycardia and ST elevation in the anterior chest leads were markedly higher in men. Sinus tachycardia and low voltage QRS occurred more often in women. The overall prevalence of atrial fibrillation was 0.32% which was markedly lower than the western data. Brugada and early repolarisation patterns occurred in 1.06% and 1.56% respectively, equal in both age groups, but markedly higher in men. Brugada pattern occurred more often than in the west, but much less than the Far East population. Early repolarisation pattern was similar to rest of Asian population, but significantly less than the Caucasian population Conclusion: In this community-based study, prevalence of major electrocardiographic abnormalities was high. Overall, men had significantly higher ECG abnormalities
ABSTRACT
Background Carotid sinus syndrome accounts for one third of patients who presents with unexplained syncope. Prevalence of carotid sinus hypersensitivity (CSH) in Indians has not been studied till now. Objectives To assess the prevalence and associations of CSH in symptomatic patients above 50 years and to study its prognostic significance pertaining to sudden cardiac death, syncope, recurrent pre syncope and falls on 1 year follow up. Methods Patients above 50 years who presented with unexplained syncope, recurrent syncope or falls were considered cases and those without these symptoms were considered as controls. All the patients underwent carotid sinus massage and their responses noted. All symptomatic patients were followed up and observed for events like sudden cardiac death, syncope, recurrent pre syncope and falls during 1 year follow up. Patients with recurrent syncope and predominant cardioinhibitory syncope were advised permanent pacemaker implantation. Results A total of 252 patients were screened, 130 patients constituted cases and 49 patients constituted controls. CSH was demonstrable in 32% (n = 42) of cases as compared to 8% (n = 4) in controls (p < 0.001). Cardioinhibitory response was the predominant response (88%, n = 38) followed by mixed response (12%, n = 4). CSH was associated with advancing age, male gender (93%, n = 39, p < 0.001) and history of smoking (63%, n = 27, p = 0.009). Composite outcomes of sudden cardiac death, syncope, recurrent pre syncope and falls were significantly higher in patients with symptomatic CSH than in those without it (45%, n = 16 vs. 6.8%, n = 6; p < 0.001). Conclusions In conclusion, the prevalence of CSH in patients above 50 yrs with unexplained syncope was high in our population. Patients with CSH and baseline symptoms developed recurrent syncope during follow up. Carotid sinus massage should be a part of routine examination protocol for unexplained syncope.
ABSTRACT
Background and objective There are no data on the prevalence of peripheral artery disease (PAD) and risk factors in Indians. This study was aimed at studying the prevalence of PAD and risk factors in elderly population of northern parts of Kerala, South India. Methods In a prospective observational survey we evaluated men and women of age between 60 and 79 years from Kerala. Anthropometric measurements, biochemical investigations and electrocardiogram were done. The diagnosis of PAD was made by ABI < 0.9. Assessment of coronary artery disease CAD was performed using historical, angina questionnaire and electrocardiographic criteria. Results Of the total sample of 1330, we could evaluate 1148 respondents (86.3%). Overall mean (SD) ABI was 0.97 (0.19). Age-adjusted prevalence of PAD was 26.7% (95% CI (24.3, 29.4)) with no difference between urban and rural population. Prevalence of symptomatic PAD was low. Diabetes, hypertension, high cholesterol, low high-density lipoprotein cholesterol, sedentary life style and smoking was observed in 25.5%, 62.9%, 61.6%, 35.9% 38.1% and 30.7%, respectively. On multivariate analysis age, smoking and physical inactivity were strong predictors of PAD. There was independent association of PAD with definite CAD. Conclusions There was high prevalence of PAD in Kerala, driven by high prevalence of risk factors. The prevalence was equal in rural and urban population. Intermittent claudication was uncommon. Age, female gender, smoking, physical inactivity, diabetes were independent predictors for presence of PAD.