ABSTRACT
Background: ACS represents a global epidemic. Arrhythmia in ACS is common. Careful investigation may lead to further improvement of prognosis. Retrospectively analyzed the year- round data of our center. Study was undertaken to analyze the incidence, frequency and type of arrhythmias in ACS. This is to aid timely intervention and to modify the outcome. Identification of the type of arrhythmia is of therapeutic and prognostic importance.Methods: This cross sectional analytical study was conducted in the Department of Cardiology, Apollo Hospitals Dhaka, from January 2019 to January 2020 with ACS patients. Enrolled consecutively and data analyzed.Results: There were 500 patients enrolled considering inclusion and exclusion criteria. Sample was subdivided into 3 groups on the type of ACS. Group-I with UA, Group-II with NSTE - ACS and Group-III with STE - ACS. Different types of arrhythmia noted. Types of arrhythmia were correlated with type of ACS. 500 patients included. Mean age 55.53±12.70, 71.6% male and 28.4% female. 60.4% hypertensive, 46.2% diabetic, 20.2% positive family history of CAD, 32.2% current smoker, 56.4% dyslipidaemic and 9.6% asthmatic. 31.2% UA, 39.2% NSTE-ACS and 29.6% STE-ACS. Type of arrhythmias noted. 22% sinus tachycardia, 20.2% sinus bradycardia, 9% atrial fibrillation, 5.2% ventricular ectopic, 4.8% supra ventricular ectopic, 2.8% bundle branch block, 2.2% atrio-ventricular block, 1% broad complex tachycardia, 0.4% narrow complex tachycardia, 0.2% sinus node dysfunction and 32.2% without any arrhythmia. Significant incidences of arrhythmia detected - respectively 29.8%, 39.2% and 31%, p<0.001.Conclusions: In conclusion, arrhythmias in ACS are common. More attention should be paid to improve their treatment and prognosis.
ABSTRACT
Brugada syndrome is a potentially lethal and eminently treatable entity that may present with palpitations or syncope. This article presents the case of a young patient with Brugada syndrome and reviews key features in the epidemiology, pathophysiology, diagnosis, treatment and prognosis of this condition.
ABSTRACT
Background: ST-segment depression in ECG is a common finding during paroxysmal supraventricular tachycardia. The exact mechanism and etiology of this ST-segment depression is not always evident. In this study we have tried to evaluate the significance of ST-segment depression during supraventricular tachycardia. Methods: Hospitalized patients for elective electrophysiological study with previous (EPS) history of supraventricular tachycardia with or without ST-segment depression were evaluated clinically, by coronary angiogram and EPS. Data were analyzed by appropriate statistical methods and comparison made between groups with ST-segment depression (Group A) and without ST-segment depression (Group B). Results: Total number of patients was 66. Equal number of patients (33) was in each group. The mean age of patients was 43.8 years. There was female predominance (M:F ratio 2:3). The mean heart rate during supraventricular tachycardia was 161 beats/min. Age, sex, coronary artery disease risk factors and heart rate during an episode of supraventricular tachycardia did not have any significant influence on ST-segment depression. Significant coronary artery disease was found in two patients in Group A and one patient in Group B. Electrophysiological study revealed that Atrio ventricular reentry tachycardia (AVRT) and AV nodal reentry tachycardia (AVNRT) were present in 28 (42.4%) and 38 (57.6%) cases respectively. Patients of group A exhibit AVRT significantly more than patients of group B.The sensitivity of ST-segment depression in correctly diagnosing coronary artery disease (CAD) was 66.7% while the specificity was 50.8%. The sensitivity of ST-segment depression in correctly differentiating AVRT was 83.3% while the specificity was 66.7%. The positive predictive value (PPV) and Negative predictive value (NPV) of the test were 75% and 76.9% respectively. Conclusion: ST-segment depression during episode of supraventricular tachycardia is a poor indicator of coronary artery disease. Presence of ST-segment depression can differentiate AVRT from AVNRT. However, >2 mm ST-segment depression was proved to be an excellent predictor of AVRT.