STUDY OF CLINICAL OUTCOME AND CARDIOVASCULAR SEQUELAE IN COVID-19 PATIENTS

Cardiovascular complications in COVID-19 include deep vein thrombosis, stroke, angina, myocardial infarction, heart failure and cardiogenic shock.ECG changes including sinus tachycardia, sinus bradycardia and atrial ?brillation . Incidence of cardiovascular complications is directly linked to severity of disease which in turn correlate with in?ammatory markers including CRP, LDH, Ferritin, D Dimer and IL-6. Raised In?ammatory markers also suggest poor outcome of patients. Therefore it is advisable to do in?ammatory markers in admitted patients for management. Followup study at 3 and 6 months revealed new onset cardiovascular complications while no new complications were documented at 12months follow up.Thus regular health checkup is recommended post COVID infections for atleast 6months.

A study on the clinical spectrum and electrocardiographic changes in scorpion sting envenomation

Background: Scorpion stings, though not a big problem in many developed countries, it is a major public health problem in underdeveloped and in some developing countries all over the world. Objectives was to study on the clinical spectrum and electrocardiographic changes in scorpion sting envenomation.Methods: This study was conducted in a tertiary care institute after obtaining the IEC clearance and informed consent from the patients for a period of 6 months from January 2018 to June 2018. All the patients admitted to the toxicology ward and general ward with scorpion envenomation during the study period were included in the study. A total number of 53 cases of scorpion envenomation and 20 healthy patients from the outpatient department of General medicine, were taken as controls.Results: Fifty-nine percent of the patients presented with Grade 1 envenomation, seven percent with Grade 2 and thirty four percent with Grade 3 envenomation. Local pain (83%) and tachycardia (19%) were the commonest presenting symptom and sign respectively. Sinus tachycardia (6%) was the commonest ECG abnormality seen in the study. There was statistical significance in the relationship between ECG change and biochemical marker CK-MB.Conclusions: Scorpion envenomation in adults needs to be studied to identify the high-risk groups and to assess the morbidity caused it. There was no mortality due to scorpion sting in the study period and significant correlation between the time delay and severity of envenomation was found which indicates a need for immediate medical care following scorpion sting.

A prospective study on cardiac changes (electrocardiographic, enzymatic and echocardiographic) in birth asphyxiated neonates admitted in tertiary care centre

Background: Reduced myocardial performance and cardiac output following perinatal asphyxia may significantly complicate perinatal management and may contribute to increased end-organ damage and mortality. Hence the present study was done with the aim to assess the usefulness of echocardiography, electrocardiography (ECG), and cardiac enzymes in evaluating myocardial damage in perinatal asphyxia neonates and to assess their correlation with different stages of hypoxic-ischemic encephalopathy (HIE) and outcome.Methods: The study was conducted in the NICU, Department of Pediatrics, Government Chengalpattu Medical college hospital between August 2017 and August 2018 using 70 birth asphyxiated term babies. The asphyxiated babies were resuscitated as per NRP guidelines and were stratified into HIE stages as per Levene system of classification and were managed as per clinical condition. ECG grading, echo changes were noted. Creatinine kinase-MB (CKMB) levels were measured and documented after 12 hours of life among these babies and were analysed.Results: Of 70 cases, 36 (51.4%) had mild, 26 (37.1%) moderate and 8 (11.4%) severe HIE. Abnormal ECG was observed in 63 cases. Raised CKMB levels were found in 67 (95.7%) and abnormal echo findings were noted in 46 (65.7%) babies. ECG, echo changes and CKMB levels showed increasing abnormalities with increasing severity of HIE (p=0.000, 0.030 and 0.001 respectively). 8 babies in present study expired.Conclusions: Cardiac abnormalities among asphyxiated neonates requires high index of suspicion. ECG abnormalities, echo changes, elevated CK-MB levels in babies with HIE can help us identify neonates at risk of complications and guide in timely intervention that can prevent mortality of these babies and help us achieve better neurological outcome in these babies.

A study of cardiac changes in asymptomatic diabetic patients in comparison with normal population

Background: India is predicted to bear the greatest Coronary artery disease (CAD) burden, according to the estimates from the global burden of disease study. Majority of the time the patient of diabetes presents with complications like Myocardial infarction (MI), heart failure, being end stages of cardiovascular disease associated with other macro and micro-vascular complications.Methods: This study was done in view of screening the asymptomatic diabetic individuals presenting to our hospital for any evidence of early cardio-vascular manifestations. With the aid of non-invasive testing such as electrocardiography (ECG) and 2D echo the early changes were noted and compared with the normal population and the cardiac status thus evaluated. A total of 106 patients (53 were diabetic and 53 non-diabetic controls) were included in the study in order to compare the ECG and 2D echo findings among the population. The main aim of the present study was to observe the ECG manifestations in diabetic patients without overt symptoms of any cardiac disease and to evaluate the ECG changes along with 2D echocardiogram in asymptomatic diabetic patients and compare with normal population.Results: From the study, it was observed that majority among the diabetic population were found to have statistically significant changes in the ECG like PR interval prolongation, T wave inversions and QT interval prolongation. 2D ECHO studied showed the presence of Left ventricular diastolic dysfunction and Regional wall motion abnormalities to be evident among the diabetic population.Conclusions: It was concluded from the study that diabetic patients have a higher risk of cardiovascular morbidities compared to the general population and ECG changes are observed even when they are clinically asymptomatic. This observation has been confirmed by the 2D echo findings. It is essential to screen diabetic patients at an early stage to prevent cardiovascular complications. ECG being a relatively cheap and non-invasive investigation should be utilized to screen diabetics for the same.

A study of the ECG changes associated with Organophosphorous compound poisoning

Introduction: Estimates from the World Health Organisation (WHO) indicate that 1 million accidental poisoning and 2 million suicide attempts involving pesticides occur the world over. Large proportion present to the ICU with an acute suicidal attempt with male predominance. The case mortality in the developing world is more than 20%. The cardiac manifestations are hypotension, bradycardia, and varied Electrocardiogram (ECG) changes manifested by prolonged QTc interval, inverted T waves, prolonged PR interval, and ST-segment elevation. There is also a high incidence of respiratory failure which has a high mortality. Aim of the study: ECG changes and systemic manifestations with organophosphorous compounds and its relationship to the nature of the compound and its outcome. Materials and methods: The study was conducted at Rajiv Gandhi Government General Hospital and Madras Medical College during a month period from June 2010 and October 2010. The study was conducted on a total of 102 patients admitted to the toxicology unit of Rajiv Gandhi Government General Hospital. A detailed history and physical examination and biochemical and ECG monitoring were done. Results: Most of the patients were in the age group 21-30. The mortality rate was 17%. The percentage of death was noted to be increased in the extremes of age groups less than 20 and more than 60 years. Of the patients who expired mortality was highest in monocrotophos consumption and a majority of them had ECG changes and renal (16%)/respiratory failures (58%). The ECG abnormality was seen in 64% of individuals. Conclusion: We concluded from this study that Electrocardiographic changes correlated independently with the prognosis of the OP poisoning cases and the identification of them, particularly QTc prolongation and timely shifting of cases to ICU and CCU where adequate N. Jayaprakash, S. Geetha. A study of the ECG changes associated with Organophosphorous compound poisoning. IAIM, 2019; 6(2): 69-73. Page 70 resuscitative measures, ventricular pacing facilities available can prevent such sudden cardiac deaths. Blood transfusion is said to have a role in severe poisoning in rapidly replenishing acetylcholinesterase enzyme.

Study of ECG changes in patients with acute stroke: a hospital based cross sectional study

Background: Physicians are confronted on having ECG in patients with acute stroke as it can mimic that of myocardial infarction/ischemia. They should be aware of these changes taking place in patients with acute stroke and not due to myocardial infarction/ischemia. The objective of the present study was to study ECG changes in patients with acute stroke.Methods: A hospital based cross sectional study was carried out for a period of six months at Malla Reddy Hospital. A total of 100 patients were included who were eligible for the presents study as per the inclusion and exclusion criteria. Detailed clinical examination, history, lipid profile, blood pressure, BMI, addictions, RBS and ECG were done for all selected patients. Data was analysed using means, proportions. Statistical tests like chi square test and t test were used.Results: Majority of patients with acute stroke were above 60 years of age, males, urban residents, professional and skilled persons, and alcoholics. Based on the study of ECG among patients with acute stroke it was found that T wave inversion was the most common ECG change found in 33% and this was more in females (36.1%) compared to 31.3% in males. LVH was next common condition found on ECG of acute stroke patients but this time its incidence was more in males (25%) compared to females with only 13.9%. Factors like age, BMI, SBP, DBP, TC, TG, LDL, VLDL, HDL, addictions, residence, sex, family history were not found to be associated with ECG changes.Conclusions: T wave inversion and left axis deviation along with left ventricular hypertrophy were common ECG changes in patients with acute stroke. No studied factor was found to be associated with ECG changes in patients with acute stroke.

Hiperpotasemia severa en emergencia: Manifestaciones clínicas y manejo terapéutico a propósito de tres casos / Severe hyperkalemia in the emergency: Clinical manifestations and therapeutic management on three cases

La hiperpotasemia se define como la elevación del potasio plasmático por encima de 5,5 mEq/L. Es una alteración electrolítica que puede determinar complicaciones clínicas fatales, siendo las más graves las cardiovasculares y musculares. Es consecuencia de una disminución en la eliminación renal del potasio, distribución corporal desde el espacio intracelular al extracelular, o aumento del aporte del ion. Entre los factores que se vinculan a la presencia de repercusiones clínicas está el nivel de hiperpotasemia, la velocidad de su instalación y la coexistencia con otras disionías. Se presentan tres casos de hiperpotasemia severa asistidos en el departamento de emergencia. Presentan como elementos comunes la presencia de alteraciones electrocardiográficas y la necesidad de hemodiálisis para su corrección. La estrategia terapéutica consiste en antagonizar los efectos a nivel de la membrana celular, facilitar el ingreso del potasio al espacio intracelular y remover el exceso corporal del ion. Se destaca la importancia del reconocimiento y diagnóstico precoz de las repercusiones clínicas de la hiperpotasemia en los pacientes con riesgo de presentarla.

ABSTRACT:: Arch Med Interna 2012 - 34(3):91-94 Hyperkalemia is defined as the elevation of serum potassium levels over 5.5 mEq/L. It is an electrolytic disorder that may lead to lethal clinical complications, with cardiovascular and muscular events being the worst. It results from a reduction of potassium excretion by the kidney, body distribution from the intracellular to the extracellular space, or an increased intake or administration of the ion. The clinical impact depends on a number of factors, including the severity of the hyperkalemia, its rate of onset and the co-existence with other ionic imbalances. The paper discusses two patients that sought care at the emergency department with severe hyperkalemia. They both presented with electrocardiographic disorders, and they both required hemodialysis. The therapeutic strategy consists of antagonizing the effects at the level of the cell membrane, facilitating the transfer of potassium into the cell and removing the excessive ion from the body. The authors emphasize the importance of an early detection and diagnosis of the clinical impact of hyperkalemia in the patients at risk of developing the disorder.

Relationship between ECG Abnormalities and Prognosisin in Patients with Cerebrovascular Accident / 医学研究杂志

Objective To investigate the relationship between cerebrovascular accident and abnormal electrocardiogram. Methods The ECG abnormalities and clinical data of 314 patients with cerebrovascular accident were analyzed. Results 56.7% patients developed arrhythmia. Among them, the morbility of arrhythmia in patients with cerebral hemorrhage was higher than that of cerebral infarction ( P

Eletrocardiographic changes in chronic Trypanosoma cruzi infected Cebus apella monkeys / Alterações eletrocardiográficas em macacos cebus apella com infecção chagásica crônica

Objetivo - Avaliar aspectos eletrocardiográficos da doença de Chagas em macacos Cebus aspella. Casuística e Métodos - 53 macacos Cebus apella (jovens e adultos de ambos os sexos): 35 como grupo controle e 18 inoculados 4 ou 5 anos atrás com três cepas diferentes de Trypanosoma cruzi (CA1, n = 10; Colombian, n = 4, Tulahuen, n = 4). Resultados - O eletrocardiograma basal mostrou-se diferente do ser humano, com alta freqüência cardíaca e ondas "p pulmonale" sem patologia pulmonar. Alteraçöes em ECG entre 11 e 58 meses depois da primeira inculaçäo foram: bloqueio do ramo direito; bloqueio intermitente direito; sobrecarga ventricular esquerda; alteraçöes de repolarizaçäo; hemibloqueio anterior esqurdo; extra-sístoles. Estas alteraçöes se assemelham às encontradas nos humanos, assim como também as alteraçöes clínicas, parasitológicas e imunológicas. Sua incidência e o tempo de apariçäo parecem variar segundo a cepa, o inóculo e a freqüência de inoculaçäo. Três dos macacos morreram espontaneamente 46, 48 e 52 meses depois da infecçäo, por causa de evoluçäo natrual da doença. Seis sacrificados durante o seguimento tinham lesöes histopatológicas cujas intensidades se relacionavam diretamente com o tempo e se assemelhavam à doença humana. Conclusäo 0 O Cebus apella é modelo aproppriado para o estudo dos diferentes aspectos da doença de Chagas, particularmente aqueles relacionados com as fases indeterminada e crônica, já que reproduz alteraçöes eletrocardiográficas encontradas no ser humano