The changes of amplitude of T wave and ST segment between the supine and orthostatic electrocardio-gram in children and adolescents with postural tachycardia syndrome / 中国小儿急救医学

Objective To investigate the changes of amplitude of T wave and ST segment between the supine and orthostatic electrocardiogram in children and adolescents with postural tachycardia syndrome (POTS). Methods A total of 74 children and adolescents diagnosed as POTS by head-up tilt test (HUTT),who complained of unexplained dizziness,headache,syncope or other symptoms,were chosen as POTS group. A total of 64 children and adolescents who did the health check in our child health clinic were selected as control group by age and sex in the same period. All the cases in this study came from the syncope specialized clinic or inpatient department of the Second Xiangya Hospital,Central South University,from August 2013 to January 2016. The heart rate and the 12-lead T-wave and ST-segment amplitude of the supine and orthostatic electrocardiogram were measured by software and manual intervention. Results (1) Com-pared with supine electrocardiogram,the heart rate of orthostatic electrocardiogram of POTS group increased [(105. 2 ± 16. 3) times/ min vs. (83. 8 ± 18. 0) times/ min,t = - 7. 598,P < 0. 01],the T-wave amplitude decreased in lead Ⅰ[(0. 28 ± 0. 14) mV vs. (0. 33 ± 0. 11) mV,t = 2. 598,P < 0. 05],Ⅱ[(0. 28 ± 0. 12) mV vs. (0. 39 ± 0. 13) mV,t = 5. 340,P < 0. 01],Ⅲ[(0. 00 ± 0. 19) mV vs. (0. 07 ± 0. 11) mV,t = 3. 041, P < 0. 01],aVF[(0. 14 ± 0. 13) mV vs. (0. 23 ± 0. 11) mV,t = 4. 505,P < 0. 01],V4 [(0. 33 ± 0. 21) mV vs. (0. 51 ± 0. 23) mV,t = 4. 938,P < 0. 01],V5 [(0. 37 ± 0. 10) mV vs. (0. 50 ± 0. 15) mV,t = 7. 764,P <0. 01] and V6 [(0. 25 ± 0. 10) mV vs. (0. 37 ± 0. 10) mV,t = 7. 538,P < 0. 01],the T-wave amplitude in-creased in lead aVR[( - 0. 27 ± 0. 11) mV vs. ( - 0. 36 ± 0. 10) mV,t = - 5. 023,P < 0. 01],and the ST-segment amplitude increased in lead V 5 [(0. 07 ± 0. 04) mV vs. (0. 06 ± 0. 04) mV,t = - 2. 309,P < 0. 05]. (2) Compared with control group,the difference of heart rate of POTS group increased [( - 21. 4 ± 14. 0) times/ min vs. ( - 10. 7 ± 11. 4)times/ min,t = 4. 875,P < 0. 01],and the difference of T-wave amplitude in-creased in lead Ⅰ[(0. 05 ± 0. 10) mV vs. ( - 0. 01 ± 0. 15) mV,t = - 3. 161,P < 0. 01],Ⅱ[(0. 11 ± 0. 12) mV vs. (0. 07 ± 0. 12) mV,t = - 2. 243,P < 0. 05],V4 [(0. 18 ± 0. 18) mV vs. (0. 07 ± 0. 20) mV,t =- 3. 282,P < 0. 01],V5 [(0. 18 ± 0. 11) mV vs. (0. 14 ± 0. 13) mV,t = - 2. 013,P < 0. 05] and V6 [(0. 13 ± 0. 08) mV vs. (0. 08 ± 0. 10) mV,t = - 3. 364,P < 0. 01],and the difference of T-wave amplitude in-creased significant in lead aVR[( - 0. 09 ± 0. 08) mV vs. ( - 0. 03 ± 0. 08) mV,t = 4. 109,P < 0. 01]. (3) Logistic regression analysis:the difference of heart rate and T-wave amplitude in lead V5 and V6 on supine and orthostatic electrocardiogram was statistically valuable for the diagnosis of POTS (P < 0. 05). (4) Diag-nostic test evaluation:when the difference of heart rate ≥15 times/ min,of T-wave amplitude in lead V5 and lead V 6≥ 0. 10 mV separately,on supine and orthostatic electrocardiogram at the same time,the sensitivity of the diagnosis of POTS was 37. 8％ and the specificity was 81. 3％ . (5)The follow-up of children and adoles-cents with POTS showed no significant difference of T-wave amplitude and ST-segment amplitude on ortho-static and supine ECG comparing to the initial diagnosis,regardless of the type of HUTT reaction remained or turned negative (P >0. 05). Conclusion The difference of heart rate and of T-wave amplitude in lead V5 and V6 are valuable for the diagnosis of POTS in children and adolescents.

Etiology and prognosis of children and adolescents with situational syncope / 中华实用儿科临床杂志

Objective To retrospectively analyze the etiology and prognosis of the children and adolescents with situational syncope in a single center.Methods There were 4 274 cases of children and adolescents [aged from 2 to 18 years old,the average age being (10.82 ± 3.13)years old],male 2 208 cases,female 2 066 cases with ortho-static intolerance syndromes,such as unexplained syncope or symptoms of presyncope,etc,who were treated at Children's Syncope Outpatient Department or Inpatient Department in the Second Xiangya Hospital,Central South University from January 2000 to November 2017.All subjects underwent detailed history investigation,careful physical examinations, routine 12-lead electrocardiogram,Holter electrocardiogram(ECG),chest X-ray,echocardiography,electroencephalo-gram(EEG)and head computerized tomography(CT)or magnetic resonance imaging(MRI),blood biochemical exami-nation (including fasting glucose,myocardial enzymes)and organic diseases in the heart,brain,blood vessels were ex-cluded,but the cause of syncope was still not clear.The head-up tilt table test (HUTT)was performed after the pa-tients or/and the families wrote the informed consent agreement.Results A total of 177 (4.14%)patients with situa-tional syncope were diagnosed among 4 274 cases.Etiology included the abdominal musecle exercise (35.59%,63/177 cases),urination (24.29%,43/177 cases),bathing (9.60%,17/177 cases),defecation (7.34%,13/177 cases), singing (5. 08%,9/177 cases),rides (4.52%,8/177 cases),blood-injection-injury phobia (3.95%,7/177 ca-ses),swallowing (3.39%,6/177 cases),and hair-grooming (2. 82%,5/177 cases),syncope during acupuncture treatment (2. 26%,4/177 cases),and cough (1.13%,2/177 cases). The common positions were upright position (84.18%,149/177 cases),squatting to standing position (8.47%,15/177 cases),sitting position (5.08%,9/177 cases),and squatting position (2.26%,4/177 cases).HUTT positive rate was 69.49%(123/177 cases),common type of hemodynamic were the vasodepressive type of vasovagal syncope (45.20%,80/177 cases),mixed type of vaso-vagal syncope (19.77%,35/177 cases),postural orthostatic tachycardia syndrome (3.39%,6/177 cases)and the cardiac suppressive type of vasovagal syncope (1.13%,2/177 cases).In 35 cases of situational syncope,the number of children and adolescents with syncope was significantly reduced by health education and upstanding training.By the first follow-up review,the cases were reduced from (2.69 ± 1.81)times to (0.59 ± 0.96)times after healthy edu-cation of 2-16 weeks [(4.97 ± 3.16)weeks].By the second follow-up review,3 out of 8 cases did not faint,3 cases fainted 1 time,1 case fainted 2 times,and 1 case fainted 4 times.The outcomes of the first reexamination of HUTT in 16 cases were negative,and other 3 cases were negative by twice visit.Conclusions The etiology of children and adoles-cents are flag-raising(abdominal muscle exercise),urination,bathing,defecation,singing,riding,blood-injection-injury phobia,swallowing,hair -grooming,syncope during acupuncture treatment and coughing. Healthy education is good for situational syncope.

Incidence of long (short) PR interval in electrocardiogram among healthy people in Changsha and its clinical significance / 中南大学学报(医学版)

OBJECTIVE@#To analyze the incidence of long (short) PR interval in electrocardiogram among healthy people in Changsha and the clinical significance.
@*METHODS@#Twelve-lead body surface electrocardiogram was taken to measure the heart rates and PR intervals from 4 025 healthy individuals (age range from 6 min after birth to 83 years old) who performed physical examination from Jan, 1993 to Dec, 2012 in the Second Xiangya Hospital, Central South University. Statistics were analyzed by SPSS 16.0.
@*RESULTS@#The total incidence of short PR interval was 19.65% (791/4 025). The age group from birth to 13 years old had a higher incidence than the other age groups (χ2=432, P0.05).
@*CONCLUSION@#The incidence of long (short) PR intervals varies in different age groups of healthy people. The incidences of long (short) PR intervals in children before 10 years old are higher than those in adults, especially the short PR intervals, as a result of the heart rate affected by childhood autonomic nervous function and the change in atrial volume with age. Adults have long (short) PR interval should be regularly followed-up to prevent cardiovascular events.

Clinical characteristics and treatment of 89 patients with head-up tilt table test induced syncope with convulsion / 中南大学学报(医学版)

OBJECTIVE@#To study the clinical features and intervention strategies of head-up tilt table test (HUTT) induced syncope triggering convulsion.@*METHODS@#HUTT was performed in 2377 cases (male 1116 cases and female 1261 cases) with syncope, dizziness, headache, chest tightness at Second Xiangya Hospital of Central South University from September 2000 to August 2011. They were 2.00-78.00 (18.57±14.36) years old, 1719 cases were younger than 18 years (the children group) [(2.00-17.92 (10.88±3.02) years] and 658 were older than 18 years (the adult group) [(18.00-78.00 (38.66±12.87) years]. We analyzed the related factors for inducing syncope triggering convulsion symptom and other serious side effects in HUTT.@*RESULTS@#1) Eighty-nine patients (3.74%) induced syncope with convulsion symptoms during HUTT, with more adults (62.92%) than children (37.08%) (χ(2)=87.842, P<0.01). 2) Sinus cardiac arrest and heart rate recovery time: 25 (28.09%) out of the 89 patients had sinus cardiac arrest. The sinus cardiac arrest time was 3.00-14.60 (7.90±3.44) s. After the HUTT, the heart rate recovery time was 0.50-37.00 (3.05±4.11) min, 70 of which (78.65%) resumed 3 min. 3) INTERVENTIONS: when all patients completed the HUTT, they would take oxygen and drink milk and other measures to relieve convulsions and recover heart rate and blood pressure. No one died, and the vital signs of 2 patients returned to normal after intravenous administration.@*CONCLUSION@#Induced syncope triggering convulsion symptom in HUTT is more common in adult patients. Convulsions disappear and heart rate and blood pressure return to normal after taking oxygen and milk and other measures. HUTT in clinical practice is safe, and can be used in patients of all ages.

Differences between age and gender in patients with micturition syncope / 中南大学学报(医学版)

OBJECTIVE@#To study the difference between age and gender in patients with micturition syncope (MS).@*METHODS@#A total of 56 patients with MS were diagnosed from 1 542(3-72 years old) cases with unexplained syncope or symptoms of presyncope during micturition in our hospital. The age, onset age, positive rate of head up tilt table test (HUTT) and their correlation with age and gender were analyzed.@*RESULTS@#The average age of patients with MS was older than that of patients with nonmicturition syncope (NMS)[5-67(35.5)years old vs. 3-72(12)years old,Z=-7.587,P18 years old) were more than children (≤ 18 years old) (9.4% vs. 1.0%,χ2=65.689,P<0.01). There was gender difference in the onset rate of MS (male 5.0% vs. female 2.5%,χ 2=6.858,P<0.01). There was no difference in the positive rate of HUTT between the MS and NMS groups, and between the males and females with MS. There was no difference in age and onset age between the HUTT positive and negative group, and between the males and females.@*CONCLUSION@#MS occurs more often in adults and males. Bezold Jazisch reflex may play a role in the mechanism of MS.