Prognostic Value of T-wave Positivity in Lead aVR in COVID-19 Pneumonia

SUMMARY OBJECTIVE: T-wave positivity in the lead aVR is a marker of ventricular repolarization abnormality and provides information on short- and long-term cardiovascular mortality in heart failure patients, those with anterior myocardial infarction, and patients who underwent hemodialysis for various reasons. The aim of this study was to investigate the relationship between T-wave positivity in the lead aVR on superficial electrocardiogram and mortality from COVID-19 pneumonia. METHODS: This study retrospectively included 130 patients who were diagnosed with COVID-19 and treated as an outpatient or in the thoracic diseases ward in a single center between January 2021 and June 2021. All patients included in the study had clinical and radiological features and signs of COVID-19 pneumonia. The COVID-19 diagnosis of all patients was confirmed by polymerase chain reaction detected from an oropharyngeal swab. RESULTS: A total of 130 patients were included in this study. Patients were divided into two groups: survived and deceased. There were 55 patients (mean age: 64.76-14.93 years, 58.18 male, 41.12% female) in the survived group and 75 patients (mean age: 65-15 years, 58.67 male, 41.33% female) in the deceased group. The univariate and multivariate regression analyses showed that positive transcatheter aortic valve replacement (OR 5.151; 95%CI 1.001-26.504; p=0.0012), lactate dehydrogenase (OR 1.006; 95%CI 1.001-1.010; p=0.012), and d-dimer (OR 1.436; 95%CI 1.115-1.848; p=0.005) were independent risk factors for mortality. CONCLUSION: A positive transcatheter aortic valve replacement is useful in risk stratification for mortality from COVID-19 pneumonia.

Investigation and analysis on the current situation and demand of intracavity electrocardiographic positioning technique training for PICC specialist nurses in Shandong Province / 中国实用护理杂志

Objective:To understand the current situation and demand of intracavity electrocardiographic positioning technique training for PICC specialist nurses in Shandong Province, and provide a reference for further improving and improving the training of PICC specialist nurses.Methods:From July 7-23, 2019, a total of 903 PICC specialist nurses in Shandong Province were selected by the convenience sampling method. The nurses were investigated by the self-made general information questionnaire of PICC specialist nurses in Shandong Province and the training demand questionnaire of intracavity electrocardiographic positioning technique.Results:40.75% (368/903) PICC specialist nurses had participated in intracavity electrocardiographic positioning technique training; 84.27% (761/903) PICC specialist nurses thought it necessary to conduct intracavity electrocardiographic positioning technique training. PICC specialist nurses had various training on intracavity electrocardiographic positioning technique, the average content requirements were all above 4.67 points. The highest score of theoretical training content was the judgment of the relationship between catheter tip position and electrocardiogram P wave (4.80 ± 0.47), and the highest score of operation training content was the intracavitary electrocardiography guided PICC catheterization (4.74 ± 0.55). 94.24%(851/903) PICC specialist nurses hoped to achieve the goal of improving clinical nursing practice ability through intracavity electrocardiographic positioning technique training. Intravenous therapy specialist academic conference was the main hoped training form(76.85%, 694/903). Multiple regression analysis showed that the number of years of catheterization, job position and understanding of the technology were the influencing factors of PICC specialist nurses′ training needs for intracavity electrocardiographic positioning technique ( t = -3.73,3.12, -3.63, all P<0.05). Conclusions:The training rate of intracavity electrocardiographic positioning technique was low, but PICC specialist nurses had higher training requirements for intracavity electrocardiographic positioning technique. Managers should pay attention to the training of intracavity electrocardiographic positioning technique, and develop targeted training programs to further improve the clinical practice capabilities of the PICC specialist nursing team.

The numerous denominations of the Brugada syndrome and proposal about how to put an end to an old controversy - a historical-critical perspective

BACKGROUNG: The eponymous Brugada Syndrome (BrS) in honor of its discovery as an independent entity by the Spanish/Catalan Brugada brothers, Pedro and Josep, has deserved numerous denominations derived mainly from the clinical genotype/phenotype correlation. The purpose of this manuscript is to present and analyze the nomenclatures that this intriguing and challenging syndrome has received over the past 28 years. We also compared the main features between cases from the first report of the Brugada brothers and an article by Martini et al. The nomenclatures used by these authors are closely linked to the BrS, but the cases (except one) presented in the article by Martini et al do not present the type 1 Brugada ECG pattern, which is mandatory for the diagnosis of BrS

INTRODUÇÃO: A Síndrome de Brugada (SB), em homenagem à sua descoberta como entidade independente pelos irmãos espanhóis / catalães Pedro e Josep Brugada, tem merecido inúmeras denominações derivadas principalmente da correlação genótipo /fenótipo clínico. O objetivo deste manuscrito é apresentar e analisar as nomenclaturas que esta intrigante e desafiadora síndrome recebeu nos últimos 28 anos. Também comparamos as principais características entre os casos do primeiro relato dos irmãos Brugada e um artigo de Martini e col. As nomenclaturas utilizadas por esses autores estão intimamente ligadas à SB, mas os casos (exceto um) apresentados no artigo de Martini e cols. não apresentam o padrão eletrocardiográfico de Brugada tipo 1, obrigatório para o diagnóstico da SB

Ortogonalización de derivaciones de electrocardiograma / Orthogonalization of electrocardiographic derivations

Introducción: El delineador de señales electrocardiográficas (ECG) multiderivación basado en la transformada wavelet posee alta resolución espacial y permite eliminar las diferencias interderivación que aparecen tradicionalmente en los métodos uniderivación. Para esto necesita de derivaciones de señales electrocardiográficas ortogonales entre sí para la obtención de un bucle espacial. Objetivo: Desarrollar métodos de ortogonalización de dos o tres derivaciones de señales electrocardiográficas que permitan la generalización del delineador multiderivación basado en la transformada wavelet en cualquier base de datos señales electrocardiográficas con más de una derivación. Métodos: Se implementaron tres métodos de ortogonalización de derivaciones de señales electrocardiográficas: ortogonalización de dos derivaciones a partir de la proyección de vectores, ortogonalización a partir de componentes principales y ortogonalización a partir del método clásico de Gram-Schmidt. Resultados: Se comparó el funcionamiento del delineador multiderivación de ECG cuando es usado cada método de ortogonalización, mediante el cálculo de la media aritmética y la desviación estándar teniendo en cuenta diferentes combinaciones de derivaciones de ambas bases de datos para cada una de las marcas analizadas. Los mejores resultados se obtuvieron con el método análisis de componentes principales y el peor comportamiento con el método de ortogonalización de dos derivaciones. Conclusiones: Los algoritmos de ortogonalización que obtuvieron los mejores resultados fueron los basados en tres derivaciones ortogonales, en la que fue ligeramente superior la descomposición en componentes principales y, por tanto, se considera el método más adecuado para la generalización del delineador multiderivación(AU)

Introduction: The wavelet transform-based multiderivation electrocardiographic (ECG) signal delineator has high spatial resolution and makes it possible to eliminate interderivation differences traditionally appearing in uniderivation methods. But this requires electrocardiographic signal derivations orthogonal to one another to obtain a spatial loop. Objective: Develop orthogonalization methods of two or three electrographic signal derivations allowing generalization of the wavelet transform-based multiderivation delineator in any electrographic signal database with more than one derivation. Methods: Three orthogonalization methods were implemented for electrocardiographic signal derivations: vector projection-based two-derivation orthogonalization, principal component-based orthogonalization, and orthogonalization based on the Gram-Schmidt classic method. Results: A comparison was performed between the operation of the ECG multiderivation delineator when used with each orthogonalization method. The comparison was based on estimation of the arithmetic mean and standard deviation bearing in mind different combinations of derivations from both databases for each of the marks analyzed. The best results were obtained with the principal component analysis method and the worst ones with the two-derivation orthogonalization method. Conclusions: The orthogonalization algorithms obtaining the best results were those based on three orthogonal derivations, in which decomposition into principal components was slightly higher. This is therefore considered to be the most appropriate method for generalization of the multiderivation delineator(AU)

Análisis de parámetros en señales electrocardiográficas de pacientes con Chagas y de variables del dominio del tiempo de la HRV usando polígrafo de alta resolución / Analysis of parameters in electrocardiographic signals of patients with Chagas and time domain variables of the HRV using high resolution polygraph / Análise de parâmetros em sinais eletrocardiográficos de pacientes com variáveis Chagas e de domínio do tempo da VFC utilizando polígrafo de alta resolução

Resumen Este trabajo presenta los resultados obtenidos de un estudio sobre el análisis de parámetros electrocardiográficos en registros de pacientes seropositivos a la enfermedad de Chagas del Departamento del Meta y medición de las variables en el dominio de tiempo de la variabilidad de la frecuencia cardiaca (HRV) y su comparación con registros de población de control. Se obtuvieron un total de 38 registros de 10 minutos en su gran mayoría (57,9%) con un polígrafo de alta resolución entre ambas poblaciones, creándose una base de datos anotada de éstos registros. El presente estudio, permitió encontrar diferencias significativas de parámetros electrocardiográficos para el intervalo QTc entre los grupos, que podría ser consecuencia de alteración de la condución cardiaca que se traduce en un mayor incremento del QTc, así como de afectación de las variables del dominio de tiempo de la Variabilidad de la Frecuencia Cardiaca (HRV), como la SDRR y SEHR, que resultan en valores más bajos para los pacientes seropositivos a enfermedad de Chagas. Se concluye que variables de los registros ECG y de la HRV, presentan alteración en pacientes con enfermedad de Chagas , que podrían ser utilizados como alertas tempranas de la enfermedad no diagnosticada serológicamente.

Abstract This paper presents the results obtained from a study on the analysis of electrocardiographic parameters in records of patients seropositive to Chagas disease of the Department of Meta and measurement of the variables in the time domain of heart rate variability (HRV) and its comparison with population control records. A total of 38 10-minute records were obtained in the vast majority (57,9%) with a high resolution polygraph between both populations, creating an annotated database of these records. The present study allowed us to find significant differences in electrocardiographic parameters for the QTc interval between the groups, which could be a consequence of an alteration of the cardiac conduction that translates into a greater increase in the QTc, as well as the affectation of the time domain variables of Heart Rate Variability (HRV), such as the SDRR and SEHR, which result in lower values ​​for HRV-positive patients with Chagas disease. It is concluded that variables from the ECG and HRV registries present an alteration in patients with Chagas disease, which could be used as early warnings of the serologically undiagnosed disease.

Resumo Este artigo apresenta os resultados obtidos em um estudo sobre a análise de parâmetros eletrocardiográficos em prontuários de pacientes soropositivos para a doença de Chagas do Departamento de Meta e mensuração das variáveis ​​no domínio do tempo da variabilidade da freqüência cardíaca (VFC) e sua comparação com os registros de controle populacional. Um total de 38 registros de 10 minutos foi obtido na grande maioria (57,9%) com um polígrafo de alta resolução entre as duas populações, criando um banco de dados anotado desses registros. O presente estudo permitiu encontrar diferenças significativas nos parâmetros eletrocardiográficos para o intervalo QTc entre os grupos, o que pode ser consequência de uma alteração da condução cardíaca que se traduz em maior aumento no QTc, bem como no comprometimento das variáveis ​​no domínio do tempo Variabilidade da Frequência Cardíaca (VFC), como o SDRR e o SEHR, que resultam em valores mais baixos para pacientes HIV positivos com doença de Chagas. Concluise que as variáveis ​​dos registros de ECG e HRV apresentam alteração nos pacientes com doença de Chagas, que pode ser utilizada como alerta precoce da doença sorologicamente não diagnosticada.

Serial Electrocardiographic Changes in a Young Female with Acute Myocarditis

Electrocardiographic changes in myocarditis mimic a wide range of ECG diagnoses ranging from ST-elevation myocardial infarction to complete heart block. We report a case of acute myocarditis in a young female with a wide range of ECG changes that mimic ST-elevation myocardial infarction and atrioventricular block.

Importancia de las arritmias cardiacas inducidas por tioridazina en las edades geriátricas / Importance of the heart arrhythmias induced by thioridazine in geriatric ages

RESUMEN Introducción: la discapacidad mental, íntimamente relacionada con el incremento de la expectativa de vida, se considera uno de los problemas más graves que hay que enfrentar en la centuria recién iniciada. Esto trae consigo el aumento de la prescripción de agentes anti psicóticos, como la tioridazina, lo que tiende a convertirse en un problema de salud al causar arritmias y en ocasiones fatales. Aún no se conoce en qué grado estas alteraciones son responsables de algunas muertes súbitas ocurridas en personas que tomaban estos medicamentos. Objetivo: identificar cuáles son las alteraciones clínicas y electrocardiográficas en los pacientes que usan la tioridazina, como droga de elección en los trastornos psiquiátricos. Materiales y métodos: se realizó un estudio descriptivo, a los ancianos atendidos en el Servicio de Geriatría que ingieran tioridazina, en cualquier dosis. Durante al período de marzo del año 2017 hasta marzo del 2018. Resultados: predominaron los ancianos del sexo femenino y comprendido en las edades 60 y 74 años, con nivel de escolaridad secundario, lo que se correlacionó con la doble función de la mujer en la sociedad actual, y el elevado nivel de escolaridad de la ciudadanía cubana. Predominaron antecedentes de hipertensión arterial y diabetes, al igual las palpitaciones en relación a un aumento de los bloqueos del has de his, observados en los electrocardiogramas. No se presentaron fallecidos. Conclusiones: deben utilizarse dosis bajas del medicamento, por corto tiempo y bajo supervisión electrocardiográfica (AU).

ABSTRACT Introduction: mental incapacity, tightly related to the life expectancy increase, is considered one of the most serious problems to afford in the current century. It brings about the increase of the prescription of anti-psychotic agents, like thioridazine, tending to become a health problem because of causing arrhythmias that are occasionally life-threatening. It is still unknown in what level these alterations are responsible for several sudden deaths in persons who took these drugs. Objective: to identify which are the clinical and electrocardiographic alterations in patients using thioridazine as drug of choice in psychiatric disorders. Materials and methods: a descriptive study was carried out in all patients who attended the Geriatric Service taking thioridazine in any doses during the period from March 2017 to March 2018. Results: female elder people aged 60-74 years predominated, with secondary school scholarship, finding a relationship with the double function of women in the current society, and the high level of scholarship among Cuban citizen. Arterial hypertension and diabetes antecedents predominated, and also palpitations related to the increase of His bundle blockade observed in electrocardiograms. There were no deaths. Conclusions: low doses of the drug should be used for a short time and under electrocardiographic supervision (AU).

Cardiovascular abnormalities in severe scrub typhus

Background: Himachal Pradesh is an endemic area for scrub typhus. If not treated early, it can lead to life threatening complications, affecting various systems of the body. Hence, this study was done with an objective to study the cardiovascular abnormalities in patients of severe scrub typhus.Methods: Authors conducted a hospital-based study in Departments of Medicine and Cardiology, of a tertiary care hospital in Sub-himalayan region in patients of severe scrub typhus from June 2016 to May 2017.Results: Thirty-two (55%) patients were aged <60 years with female preponderance (72%).   Electrocardiographic changes included sinus tachycardia in 56 (97%), axis deviation in 5(9%), ST-T changes in 3(5%) and atrial fibrillation in 1(2%). Echocardiographic changes included tricuspid regurgitation in 14(24%), pericardial effusion in 4(7%), myocarditis in 1(2%) and Regional wall motion abnormality in 1(2%). Left ventricular ejection fraction >45% in 47 (81%) and <45% in 11(19%).  Fifty-one patients had hypotension at presentation and 49 (90%) of them improved. Interestingly, 10 of 11 patients with reduced EF (<45%) survived whereas 6 of total 7 patients, who died, had preserved EF (>45 %).Conclusions: Severe scrub typhus manifested with ST/T changes, myocarditis, pericardial effusion, arrhythmias, shock and patients with reduced EF on Echocardiography had better outcome.

Electrocardiography changes in localizing the culprit vessel in acute myocardial infarction with angiographic correlations

Background: The electrocardiogram is the primary diagnostic tool to evaluate a patient with chest pain and suspected myocardial infarction. Anterior wall infarction due to occlusion of proximal LAD has worse prognosis compared to distal or branch vessel lesions. Diagnosis of anterior/inferior/posterior or lateral MI is based on patterns of ST deviation and risk assessment based on absolute magnitude of ST segment deviation or the width of QRS complexes. Although coronary angiography is the gold standard for determining the infarct related artery in acute myocardial infarction, ECG can be useful tool in identifying the culprit artery involved at the primary care.Methods: A prospective cross-sectional study was conducted in Aarupadai Veedu Medical College and Hospital. Standard 12 lead electrocardiograph were recorded for 50 patients at a speed of 25 mm/s and voltage of 10mm/mv. Patients who had acute inferior wall MI additional right pericardial leads were recorded (V3R and V4R). The recorded ECG was interpreted using the electrocardiographic algorithms of Zimet-baum PJ et al. An ST elevation or depression was considered significant only if it was >1mm.Results: The study result showed maximum specificity for LCx (100%) followed by RCA (92.67) and LAD (89.91). The sensitivity for identifying the culprit artery by ECG in acute myocardial infarction was 100% for both LAD and RCA coronary artery but 0% for LCx coronary artery. In case of LAD occlusion, the sensitivity is 100% for proximal LAD occlusion and 92.86%for distal LAD occlusion. The sensitivity and specificity for proximal and distal RCA is 100% and 80.43% respectively.Conclusions: ECG is an easily, widely available and non-invasive tool to localize the site of culprit artery in acute myocardial infarction.

Alteraciones electrofisiológicas y/o bioquímicas del trauma cardíaco / Electrophysiological and/or biochemical alterations of cardiac trauma

Resumen El trauma cardíaco constituye una de las primeras causas de mortalidad en la población general. La gran mayoría son causados por accidentes automovilísticos. Su diagnóstico es difícil y requiere alto índice de sospecha en trauma cerrado. Posee un índice de mortalidad muy elevado, cercano al 76%. Existen varios métodos diagnósticos disponibles para facilitar su detección pero ninguno logra alcanzar una sensibilidad cercana al 100%. El trauma cardíaco contuso puede variar desde lesión cardíaca asintomática hasta ruptura cardíaca y muerte. Actualmente se utilizan marcadores bioquímicos como enzimas cardíacas, siendo la Troponina I la más específica; y electrofisiológicos como hallazgos en el electrocardiograma sugestivos de bloqueo de rama y taquicardia sinusal, siendo estos los más frecuentemente encontrados.

Abstract Heart trauma is one of the leading causes of mortality in the general population. The vast majority are caused by automobile accidents. Its diagnosis is difficult and requires a high index of suspicion in closed trauma. It has a very high mortality rate, close to 76%. There are several diagnostic methods available to facilitate its detection, but none can reach a sensitivity close to 100%. Contusive heart trauma can range from asymptomatic cardiac injury to cardiac rupture and death. Currently, biochemical markers are used as cardiac enzymes, with Troponin I being the most specific; and electrophysiological findings in the electrocardiogram suggestive of branch block and sinus tachycardia, these being the most frequently found.

Sedative and electrocardiographic effects of low dose dexmedetomidine in healthy cats / Efeitos sedativos e eletrocardiográficos da baixa dose de dexmedetomidina em gatos saudáveis

In feline veterinary practice sedation is often needed to perform diagnostic or minimally invasive procedures, minimize stress, and facilitate handling. The mortality rate of cats undergoing sedation is significantly higher than dogs, so it is fundamental that the sedatives provide good cardiovascular stability. Dexmedetomidine (DEX) is an α2-adrenergic receptor agonist utilized in cats to provide sedation and analgesia, although studies have been utilized high doses, and markedly hemodynamic impairments were reported. The aim of this study was to prospectively investigate how the sedative and electrocardiographic effects of a low dose of DEX performing in cats. Eleven healthy cats were recruited; baseline sedative score, systolic arterial pressure, electrocardiography, and vasovagal tonus index (VVTI) were assessed, and repeated after ten minutes of DEX 5μg/kg intramuscularly (IM). A smooth sedation was noticed, and emesis and sialorrhea were common adverse effects, observed on average seven minutes after IM injection. Furthermore, electrocardiographic effects of a low dose of DEX mainly include decreases on heart rate, and increases on T-wave amplitude. The augmentation on VVTI and appearance of respiratory sinus arrhythmia, as well as sinus bradycardia in some cats, suggesting that DEX enhances parasympathetic tonus in healthy cats, and therefore will be best avoid in patients at risk for bradycardia.(AU)

Na rotina clínica da medicina veterinária felina a sedação é frequentemente requerida para realização de procedimentos diagnósticos ou minimamente invasivos, para minimizar o estresse e facilitar o manuseio dos pacientes. A taxa de mortalidade de gatos submetidos à sedação é mais elevada do que em cães, por esse motivo, é fundamental que os sedativos confiram estabilidade hemodinâmica. A dexmedetomidina (DEX) é um α2-agonista utilizado em felinos para promover sedação e analgesia, porém os estudos têm utilizado doses elevadas, e com isso prejuízos hemodinâmicos importantes foram relatados. O objetivo desta investigação foi avaliar os efeitos sedativos e eletrocardiográficos da baixa dose de DEX em gatos. Para tal, onze felinos saudáveis foram recrutados, foram obtidos valores basais para escore de sedação, pressão arterial sistólica e eletrocardiografia, além do índice de tônus vaso vagal (ITVV). Após dez minutos da aplicação intramuscular (IM) de DEX 5μg/kg todos os exames foram repetidos. Após a DEX, sedação suave foi detectada, e a êmese e sialorreia foram efeitos adversos comuns, observados em média 7 minutos após a injeção IM. Ademais, os principais efeitos eletrocardiográficos foram redução na frequência cardíaca e aumento na amplitude da onda T. O ITVV mais elevado e surgimento de arritmia sinusal respiratória, bem como bradicardia sinusal em alguns gatos, sugerem que a DEX eleva o tônus parassimpático, e por esse motivo deve ser utilizada com cautela em pacientes com predisposição à bradicardia.(AU)

Clinical Characteristics Associated with Electrocardiographic Left Ventricular Hypertrophy in Clinical Normotensives without a History of Hypertension: a Cross-Sectional Study / 가정의학회지

BACKGROUND: This study evaluated factors independently associated with electrocardiographic left ventricular hypertrophy (ECG-LVH) in subjects who were normotensive on clinical measurement and had no prior history of hypertension. METHODS: This cross-sectional study analyzed cases and controls in the Comprehensive Medical Examination Center of Hallym University Sacred Heart Hospital. Eligible case participants presented ECG-LVH according to the Sokolow- Lyon or Cornell criteria, were normotensive on clinical measurement, and had never received a diagnosis of hypertension. The control group comprised subjects with normal sinus rhythm who were normotensive on clinical measurement with no history of hypertension. RESULTS: A multiple logistic regression model showed male sex, age and systolic blood pressure to be positively related to the presence of ECG-LVH. A positive relation of smoking and regular exercise; an inverse relation of pulse rate to the presence of ECG-LVH were found only in men. An inverse relation of uric acid level was found only in women. Detailed analyses of relatively healthy and young men according to whether or not to exercise regularly showed that positive relations of age and systolic blood pressure; an inverse relation of obesity to the presence of ECG-LVH were apparent in the non-regular exercise group but not in the regular exercise group. In the regular exercise group, only pulse rate showed significant (inverse) association with the presence of ECG-LVH. CONCLUSION: The varying risk factor profiles associated with ECG-LVH according to sex and the participation in regular exercise may help to elucidate the ECG-LVH in clinical normotensives with no prior history of hypertension.

Concentración sanguínea de troponina I en pacientes embarazadas sin y con preeclampsia severa / Troponin I blood concentration in pregnant patients without and with severe preeclampsia

Resumen OBJETIVO: Comparar la concentración sanguínea de troponina I en pacientes embarazadas sin y con preeclampsia severa. MATERIALES Y MÉTODOS: Estudio prospectivo y transversal efectuado en pacientes de una unidad médica de alta especialidad en Ginecología y Obstetricia de la Ciudad de México admitidas entre los meses de enero a mayo de 2019. Criterio de inclusión: pacientes de cualquier edad y paridad con más de 20 semanas de embarazo. Criterio de exclusión: mujeres con enfermedades previas que pudieran condicionar daño miocárdico. Para cuantificar la troponina I a todas se les tomó sangre venosa. El valor normal de la troponina I está entre 0 y 0.4 ng/mL. Se les tomó un electrocardiograma y una radiografía de tórax. Los reportes de ambos grupos se compararon. Se utilizó estadística descriptiva y prueba t de Student pareada. RESULTADOS: 71 mujeres reunieron los criterios de inclusión y se dividieron en dos grupos: 37 pacientes sin preeclampsia (grupo A) y 34 con preeclampsia (grupo B). La concentración sanguínea de la troponina I del grupo A fue 0.05 ± 0.008 ng/mL y del grupo B: 0.05 ± 0.02 ng/mL (p = 0.30). En el grupo B se encontraron alteraciones electrocardiográficas en 14.7% (n = 5) cuyos valores de troponina I fueron normales. La radiografía del tórax fue normal en 100%. CONCLUSIONES: La concentración sanguínea de troponina I en pacientes embarazadas sin y con preeclampsia severa resultó normal, incluidas las 5 mujeres con preeclampsia y alteraciones electrocardiográficas.

Abstract OBJECTIVE: To compare the blood concentration of Troponin I (TI) in pregnant patients without and with severe preeclampsia (SP). MATERIALS AND METHODS: Prospective, cross-sectional study, conducted in patients of a medical unit of high specialty of gynecology and obstetrics of Mexico City admitted in the period from January to May of the year 2019. Patients of any age and parity with pregnancy > 20 weeks were selected. Those with previous diseases that may condition myocardial damage were excluded. Venous blood was taken to quantify TI using the "Triage Cardiac Panel"® device of the Biosite® brand that runs an indirect immunofluorescence program coupled to a reader called "Triage Meter"®. For this test the normal value of TI is 0 to 0.4 ng/mL. An electrocardiogram and a chest X-ray were also performed. The results of both groups were compared. Descriptive statistics and the paired Student's T test were used. RESULTS: 71 women met the selection criteria. Two groups were formed: 37 patients without preeclampsia (group A) and 34 women with PS (group B). The blood concentration of TI in group A was 0.05 ± 0.008 ng / ml and in group B 0.05 ± 0.02 ng/mL (p = 0.30). In group B electrocardiographic abnormalities were found in 14.70% (5 cases) whose TI values were normal. Chest x-ray was normal in 100%. CONCLUSIONS: the blood concentration of TI in pregnant patients without and with PS was normal, including 5 preeclamptic women with electrocardiographic abnormalities.

Influence of body position on the measurement of electrocardiographic waves in healthy dogs / Influência do posicionamento corporal na mensuração das ondas eletrocardiográficas em cães sadios

The agreement between the electrocardiographic waves measured from tracings recorded in right lateral recumbency and several other unusual body positions was assessed. Electrocardiograms were recorded in 160 healthy dogs in right lateral, left lateral, dorsal and sternal recumbencies, as well as in standing position. Considering the right lateral recordings as the gold standard, the lowest biases for the majority of ECG parameters were calculated from left lateral recordings, whereas the highest biases were documented from dorsal and standing positions. For the mean electrical axis, the dorsal recumbency produced the lowest bias, while the greatest one was identified in sternal position. An analysis of variance indicated differences when the means of P wave duration and amplitude, duration of QRS and QT, and mean electrical axis obtained in unusual positions were compared with right lateral. In conclusion, left lateral recumbency produced the most similar measurements as compared to right lateral, but the wide limits of agreement preclude the use and interpretation of these positions interchangeably.(AU)

A concordância entre a mensuração das ondas eletrocardiográficas a partir de traçados registrados em cães mantidos em decúbito lateral direito e em vários outros posicionamentos corporais foi avaliada nesta pesquisa. Para tanto, traçados eletrocardiográficos de 160 cães saudáveis foram registrados com os pacientes posicionados nos decúbitos lateral direito, lateral esquerdo, dorsal e esternal, assim como em posição quadrupedal. Tomando como padrão ouro os registros obtidos em decúbito lateral direito, as menores diferenças médias para a maioria dos parâmetros eletrocardiográficos foram obtidas a partir dos traçados registrados com o cão mantido em decúbito lateral esquerdo, enquanto as maiores diferenças médias foram documentadas nos registros obtidos nos decúbitos dorsal e quadrupedal. Para o eixo elétrico médio, o decúbito dorsal produziu a menor diferença média, enquanto a maior foi identificada no registro em posição esternal. A análise de variância mostrou diferenças entre as médias da duração e amplitude da onda P, duração do QRS e do intervalo QT e o eixo elétrico médico quando as posições não usuais foram comparadas com o decúbito lateral direito. Esta pesquisa mostrou que o decúbito lateral esquerdo produziu as medidas mais semelhantes quando comparado àquelas obtidas em decúbito lateral direito. No entanto, os limites de concordância amplos impedem que essas posições sejam utilizadas e interpretadas de maneira intercambiável.(AU)

Onset detection of surface diaphragmatic electromyography based on sample entropy and individualized threshold / 生物医学工程学杂志

The diaphragm is the main respiratory muscle in the body. The onset detection of the surface diaphragmatic electromyography (sEMGdi) can be used in the respiratory rehabilitation training of the hemiparetic stroke patients, but the existence of electrocardiography (ECG) increases the difficulty of onset detection. Therefore, a method based on sample entropy (SampEn) and individualized threshold, referred to as SampEn method, was proposed to detect onset of muscle activity in this paper, which involved the extraction of SampEn features, the optimization of the SampEn parameters and , the selection of individualized threshold and the establishment of the judgment conditions. In this paper, three methods were used to compare onset detection accuracy with the SampEn method, which contained root mean square (RMS) with wavelet transform (WT), Teager-Kaiser energy operator (TKE) with wavelet transform and TKE without wavelet transform, respectively. sEMGdi signals of 12 healthy subjects in 2 different breathing ways were collected for signal synthesis and methods detection. The cumulative sum of the absolute value of error was used as an judgement value to evaluate the accuracy of the four methods. The results show that SampEn method can achieve higher and more stable detection precision than the other three methods, which is an onset detection method that can adapt to individual differences and achieve high detection accuracy without ECG denoising, providing a basis for sEMGdi based respiratory rehabilitation training and real time interaction.

Alteraciones electrocardiográficas en un paciente con hemorragia intracerebral talámica / Electrocardiographical changes in a patient with intracerebral thalamic hemorrhage

Se presenta el caso clínico de un paciente de 67 años de edad, quien ingresó en el Servicio de Neurología del Hospital General Docente Dr Juan Bruno Zayas Alfonso, Santiago de Cuba, con manifestaciones clínicas neurológicas y cifras elevadas de tensión arterial, además de alteraciones electrocardiográficas que semejaban isquemia miocárdica. Ante la ausencia de dolor precordial u otros signos clínicos de isquemia miocárdica fue imposible diagnosticar un síndrome coronario agudo, por lo cual se le realizó una tomografía axial computarizada simple de cráneo, cuyo resultado confirmó que se trataba de una hemorragia intracerebral talámica. Finalmente, los biomarcadores de necrosis miocárdica resultaron negativos.

The case report of a 67 year-old patient is presented who was admitted in the Neurology Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital, Santiago de Cuba, with neurological clinical manifestations and high values of blood pressure, besides electrocardiographical changes similar to myocardial ischemia. As there was absence of precordial pain or other clinical signs of myocardial ischemia, it was impossible to diagnose an acute coronary syndrome, reason why a simple skull on-line axial tomography was carried out which result confirmed that it was an intracerebralthalamic hemorrhage. Finally, the biomarkers of myocardial necrosis were negative.

Primeros estudios sobre la variabilidad de la frecuencia cardiaca con métodos cibernéticos en Cuba / First studies about the heart frequency variability with cybernetic methods in Cuba

La introducción y aplicación de métodos matemáticos y cibernéticos para el estudio de la variabilidad del ritmo cardiaco, así como su regulación se inició en la Unión Soviética; su desarrollo estuvo vinculado principalmente a los estudios y análisis evaluativos realizados a los cosmonautas en la década del 60 del siglo pasado. Se expone la experiencia sobre el tema realizada por primera vez en el país, a inicios de la década siguiente, en la Facultad de Ciencias Médicas de Santiago de Cuba. De igual manera, se señalan las distintas etapas y facetas que tuvieron tales estudios y su significación. A través de este trabajo se puede constatar que aquellos enfoques y resultados abrieron las posibilidades para continuar dichos estudios en otros campos, estados y condiciones en los años posteriores hasta el presente

The introduction and implementation of mathematical and cybernetic methods for the study of the heart rhythm variability, as well as their regulation began in the Soviet Union; their development was linked mainly to the evaluative studies and analysis carried out to the cosmonauts last century during the 60s. The experience on the topic carried out for the first time in the country is exposed, at the beginnings of the following decade, in the Medical Sciences Faculty in Santiago de Cuba. In a same way, the different stages and sides that had such studies and their significance are pointed out. Through this work you can verify that those approaches and results opened the possibilities to continue these studies in other fields, states and conditions in the following years until the present time.

Patrones electrocardiográficos en pacientes con enfermedad de Chagas en zona sur de la ciudad de Salta / Electrocardiographic patterns in patients with Chagas disease in south of Salta city / Padrões eletrocardiográficos em pacientes com doença de Chagas no sul da cidade de Salta

Introducción. Los pacientes con serología positiva para enfermedad de Chagas pueden presentar en su evolución diferentes lesiones eléctricas que difieren de acuerdo a la distribución geográfica del Trypanosoma cruzi. Objetivos. Determinar qué lesiones electrocardiográficas se observan en pacientes que residen en zona sur de la ciudad de Salta (Salta, Argentina). Materiales y métodos. Se realizó un estudio prospectivo y observacional desde el 10/11/2013 hasta 29/02/2016, en el servicio de cardiología del Hospital Papa Francisco localizado en zona sur de la ciudad de Salta (Salta, Argentina). A todos los pacientes se les realizó historia clínica, electrocardiograma de 12 derivaciones y se les diagnosticó enfermedad de Chagas con dos reacciones serológicas positivas HAI y Elisa. Se utilizó el Consenso Internacional de Chagas del año 2010. Variable estadística: porcentaje. Resultados. Fueron evaluados 400 pacientes con epidemiología positiva para enfermedad de Chagas de los cuales 110 tuvieron diagnóstico de enfermedad de Chagas: 59 (54%) pacientes de sexo femenino con promedio de edad para ambos sexos de 47 años. La enfermedad de Chagas crónica sin patología demostrada se presentó en 60 (55%) pacientes, edad promedio de 45 años, la enfermedad de Chagas crónica con patología demostrada en 50 (45%) pacientes, con edad promedio de 59 años. El patrón electrocardiográfico más frecuente en la población analizada fue el HBAI+BRD. Conclusión. El patrón electrocardiográfico más frecuente en la población analizada fue HBAI+BRD, predominando en la consulta el sexo femenino.

Introduction. In patients with positive serology for Chagas disease, different electrical injuries can occur during their evolution, and they differ according to the geographical distribution of Trypanosoma cruzi. Objectives. To determine which electrocardiographic lesions have seen in patients living in south of Salta city (Salta, Argentine). Materials and methods. A prospective observational study was conducted from 11/10/2013 to 02/29/2016, at the cardiology department of Pope Francisco Hospital located in southern part of Salta city. All patients underwent a complete clinical history, 12-lead electrocardiogram and diagnosed with Chagas disease by two positive serological reactions: HAI and Elisa. The International Consensus of Chagas disease 2010 was used. Statistical variable: the percentage was used. Results. We evaluated 400 patients with positive epidemiology for Chagas disease, 110 were finally diagnosed with Chagas disease; 59 (54%) female patients, the average age for both sexes was 47 years. Chronic Chagas disease without proven structural pathology occurred in 60 (55%) patients, average age 45 years. Chronic Chagas disease with structural damage 50 (45%) average age of 59 years, the most frequent electrocardiographic pattern in the analyzed population was LAHB + RBB. Conclusion. The most frequent electrocardiographic pattern in the analyzed population was LAHB + RBB, predominating in our consultation females patients.

Antecedentes. Os pacientes com sorologia positiva para doença de Chagas pode ocorrer em sua evolução diferente lesões elétricas diferem de acordo com a distribuição geográfica das Trypanosoma cruzi. Objetivos. Determinar quais lesões eletrocardiogramas são vistas em pacientes residentes no sul da cidade de Salta (Salta, Argentina). Materiais e métodos. Um estudo observacional prospectivo foi realizado de 10/11/2013 a 29/02/2016, no departamento de cardiologia do Hospital Papa Francisco localizado na parte sul da cidade de Salta (Salta, Argentina). Todos os pacientes foram submetidos à história clínica, eletrocardiograma de 12 derivações e foram diagnosticados com a doença de Chagas com duas reações sorológicas positivas: HAI e Elisa. Consenso Internacional Chagas 2010. Estatísticas de variáveis: a percentagem foi usada. Resultados. Foram avaliados 400 pacientes com epidemiologia positiva para doença de Chagas dos quais 110 foram diagnosticados com Chagas: 59 (54%) pacientes do sexo feminino, com idade média para ambos os sexos de 47 anos. Doença de Chagas crônicas sem patologia comprovada ocorreu em 60 (55%) pacientes, com idade média de 45 anos. Doença de Chagas crônica demonstrada em 50 (45%) pacientes com idade média de 59 anos. O padrão eletrocardiográfico mais frequente na população analisada foi HBAE + BRD. Conclusão. O padrão eletrocardiográfico mais frequente na população analisada foi HBAE + BRD, predominando no sexo feminino de consulta.