Teachable moments in ECG: The physiology behind the pattern

@#The electrocardiographic analysis of heart blocks provides great opportunities for the discussion of mechanisms of electrical cardiac conduction, serving as “teachable moments” in medicine. Recognition of heart blocks can sometimes be a challenge as they can present in many forms, different severities and levels of blocks that present as varied patterns on electrocardiographic tracing. The ultimate key to correct diagnosis rests on adequate understanding of normal electrophysiology of the electrical system of the heart. While it is vital to recognize the pattern, we should always know and understand the physiology behind the pattern. This article presents a detailed analysis of a case of heart block which can easily be misinterpreted on first look. The case is featured not for its rarity but for the interesting concepts in cardiac electrophysiology that are highlighted. Navigation of the different elements of tracing can be an adventure and a great learning experience enjoyed by both students and experts.

The typology of physicians according to perspectives on telemedicine during and beyond the COVID-19 pandemic

Introduction@#The coronavirus (CoVid-19) pandemic brought about a massive impact to the healthcare system, including disruption of patient follow-ups and consultations. Subsequently, an increase in physicians’ use of telemedicine was seen. While this technology has been documented to improve delivery of care, it has encountered varied acceptance among physicians. Gaps in specific national legislation, lack of established rules and accreditation standards, and ethical/legal implications add to the concerns. Anchored on the Unified Theory of Acceptance and Use of Technology model, this study aimed to segment physicians according to their perspectives regarding telemedicine during the pandemic. @*Methods@#A mixed methods sequential explanatory design using Q-methodology was applied to identify distinct patterns and perceptions of physicians on the use of telemedicine during the pandemic. A Q-sample of 25 statements on perceptions of telemedicine was developed through literature review, and 24 physicians were purposively selected. Participants were instructed to sort statements into a distribution grid according to their degree of agreement/disagreement. Post-sorting interview was conducted to expound on their response. Data were analyzed using by-person factor analysis through the PQMethod software version 2.35.

Health-related quality of life in patients with permanent pacemaker at the University of Santo Tomas Hospital: A cross-sectional correlational study

Introduction@#The evolution of cardiac pacing is expected to decrease the cardiovascular morbidity and mortality but this type of intervention might affect the health-related quality of life (HRQOL) and eventually the overall prognosis of the patient. This study assessed the HRQOL in patients with permanent pacemaker using Philippines (Tagalog) Short Form (SF)-36v2 health survey.Introduction:The evolution of cardiac pacing is expected to decrease the cardiovascular morbidity and mortality but this type of intervention might affect the health-related quality of life (HRQOL) and eventually the overall prognosis of the patient. This study assessed the HRQOL in patients with permanent pacemaker using Philippines (Tagalog) Short Form (SF)-36v2 health survey.@*Methods@#A cross-sectional correlation study was conducted. Philippines (Tagalog) SF-36v2 health survey was administered among patients with permanent pacemaker who had their pacemaker analysis at the University of Santo Tomas Hospital from October to December 2015. The higher the score the better HRQOL and many studies used a cut-off point of 50. Pearson Correlation and Non-Parametric Mann-Whitney Tests were used in this study. @*Results@#Forty-two patients were enrolled in this study. There were 24 male and 18 females with mean interval of age 71.48+12.3. Most of the HRQOL scores were lower than 50. The highest HRQOL scores were vitality and mental health aspect while the worst were role emotional and physical functional aspect. Age, educational attainment, type of permanent pacemaker, pacemaker dependency, NYHA (New York Heart Association) functional capacity and presence of co-morbidities particularly diabetes mellitus type 2 were significant factors for poor HRQOL. @*Conclusion@#This study showed that overall the HRQOL in patients with permanent pacemaker was below average. A comprehensive management in order to improve the HRQOL should be considered among patients with permanent pacemaker.

Incidence of Contrast-induced Nephropathy in Patients Undergoing Coronary Angiography: An Annual Review in A University Hospital

Introduction@#The rapidly growing number of percutaneous coronary interventions has led to a considerable improvement in the outcome of patients with acute coronary syndromes, yet concurrently exposing patients to enormous volumes of contrast media with the inherent risk of renal function impairment.@*Objective@#To determine the incidence of contrast induced nephropathy of patients admitted at University of Santo Tomas Hospital (USTH) who underwent coronary angiography with or without Percutaneous Transluminal Coronary Angioplasty (PTCA).@*Methodology@#This is a retrospective, descriptive study including patients aged 18 years and above, of any gender, admitted at the USTH from January 1, 2016 to December 31, 2016, who underwent coronary angiography with or without PTCA with baseline and follow up creatinine levels 48-72 hours after the procedure. Data were retrieved by review of medical records of these patients. @*Results@#Three out of 78 patients (3.8%) had elevated creatinine but all three patients also underwent major surgery within 48 hours after coronary angiography which could explain the renal impairment.@*Conclusion@#Although contrast induced nephropathy was described as the third most common cause of new Acute Kidney Injury in hospitalized patients, it was accordingly nil among those who underwent coronary angiography at USTH from January to December 2016. Benefi ts and risks of undergoing coronary angiography should always be weighed individually. Risk stratifi cation scores should only serve as a guide in managing patients and proper preventive measures should be applied.