Alterações eletrocardiográficas em pacientes com Leishmaniose Tegumentar Americana tratados com antimoniato de meglumina: revisão integrativa / Electrocardiographic changes in patients with American tegumentary leishmaniasis treated with meglumine antimoniate: integrative review

Introdução: a Leishmaniose Tegumentar Americana (LTA) é uma infecção zoonótica cujo tratamento é realizado com a droga antimoniato de meglumina (AM). Objetivo: Relatar as alterações eletrocardiográficas decorrentes do uso de AM em pacientes com LTA. Metodologia: foi realizada uma revisão integrativa da literatura por meio das bases de dados BIREME, PUBMED, COCHRANE, SCIELO e literatura cinzenta, usando como estratégia de busca o cruzamento dos seguintes descritores, nos idiomas português e inglês: leishmaniose cutânea, eletrocardiografia, meglumina e toxicidade. Não foi estipulado um intervalo temporal para que um maior número de publicações fosse obtido. Resultados: foram encontrados 134 artigos, desses apenas 09 atenderam aos critérios de inclusão. As principais alterações eletrocardiográficas encontradas durante a terapêutica foram as alterações de repolarização ventricular, com destaque para o prolongamento do intervalo QT corrigido pela frequência cardíaca. Já entre as alterações mais graves em termos de morbimortalidade, destacam-se as arritmias ventriculares complexas, principalmente a Torsade de pointes. Discussão: em todos os artigos selecionados foram encontradas alterações ao eletrocardiograma (ECG) durante o tratamento com AM, sendo recomendado em todos os pacientes, o acompanhamento eletrocardiográfico. Apenas um estudo excluiu as alterações do ECG basal, presença de comorbidades e uso de drogas cardiotóxicas sendo esses possíveis vieses para avaliação da toxicidade cardíaca diretamente provocada pelo antimonial. Conclusão: considerando as alterações na repolarização ventricular e as possíveis arritmias ventriculares em pacientes em tratamento para LTA em uso de AM, o acompanhamento eletrocardiográfico é recomendado durante a terapêutica de todos esses pacientes, sendo útil para prevenção de complicações cardiovasculares importantes.

Introduction: American Tegumentary Leishmaniasis (ATL) is a zoonotic infection whose treatment is carried out with the meglumine antimoniate drug (AM). Objective: To report the electrocardiographic changes resulting from the use of AM in patients with ATL. Methodology: an integrative literature review was carried out using the BIREME, PUBMED, COCHRANE, SCIELO and gray literature databases, using as a search strategy the crossing of the following descriptors, in Portuguese and English: cutaneous leishmaniasis, electrocardiography, meglumine and toxicity. A time interval was not stipulated in order to obtain a greater number of publications. Results: we found 134 articles, of which only 9 met the inclusion criteria. The main electrocardiographic changes found during therapy were changes in ventricular repolarization, with emphasis on the prolongation of the QT interval corrected by heart rate. Already the most serious changes in terms of morbidity and mortality, complex ventricular arrhythmias, especially Torsade de pointes, stand out. Discussion: changes in the electrocardiogram (ECG) were found in all selected articles during treatment with AM, with electrocardiographic monitoring being recommended in all patients. Only one study excluded: changes in the baseline ECG, the presence of comorbidities and / or use of cardiotoxic drugs, these being possible biases to assess cardiac toxicity directly caused by the antimonial. Conclusion: considering the changes in ventricular repolarization and possible ventricular arrhythmias in patients undergoing treatment for ATL using AM, electrocardiographic monitoring is recommended during the therapy of all these patients, being useful for the prevention of important cardiovascular complications.

Electrocardiografía en chequeo médico precompetitivo: subanálisis de un registro unicéntrico prospectivo / Electrocardiography in pre-competitive medical fit: Subanalysis of a prospective single-center registry

Resumen Introducción: La interpretación del electrocardiograma del deportista muchas veces se ve complicada por los cambios producidos por el entrenamiento prolongado. Objetivos: Comparar la aplicación de los criterios de Seattle para valoración electrocardiográfica en deportistas en un grupo de cardiólogos del instituto de Cardiología y medicina del deporte, contra un profesional especializado en electrocardiografía del deportista, bajo los mismos criterios. Material y métodos: Sobre una base de datos prospectiva de pacientes que concurrieron al centro de medicina del deporte entre junio de 2017 y enero de 2018 para realización de apto físico, se incluyeron para el análisis 499 electrocardiogramas. Siete cardiólogos del Instituto de deportes (IW) valoraron los electrocardiogramas como "normales"; "alteraciones normales" o "alteraciones dudosas o anormales" (que requirieron más estudios en el seguimiento) conociendo los antecedentes del paciente al igual que los estudios realizados y la valoración cruzada de los electrocardiogramas dentro del instituto. Un cardiólogo del cuerpo médico de Boca Juniors especializado en electrocardiografía del deportista (FR) valoró los 499 electrocardiogramas de manera ciega (sin conocer los datos demográficos de los pacientes o los antecedentes patológicos) utilizando los mismos criterios. Resultados: De un total de 499 electrocardiogramas, 448 (89%) fueron interpretados como normales por el especialista en electrocardiografía del deporte vs. 459 (91%) por los cardiólogos del instituto de deporte. Respecto a alteraciones normales, 21 (4%) electrocardiogramas fueron considerados como alteraciones normales para el especialista en electrocardiografía vs. 23 (4%) por el instituto de deportes. 30 (6%) electrocardiogramas presentaron alteraciones dudosas o anormales para el especialista vs. 17 (3%) para el instituto de deporte. Conclusiones: La interpretación electrocardiográfica puede presentar variaciones de un centro a otro a pesar de utilizar criterios estandarizados. Es probable que la evaluación clínica influencie los resultados.

Abstract Introduction: The interpretation of the athlete's electrocardiogram is often complicated by the changes produced by prolonged training. Objective: To compare the application of Seattle criteria for electrocardiographic assessment in a group of cardiologists against a professional specialized in electrocardiography of the athlete under the same criteria. Material and methods: On a prospective database of recreational athletes who attended between June 2017 and January 2018 to perform physical fitness, 499 electrocardiograms were included for the analysis. Seven cardiologists from the Sports Institute (IW) rated the electrocardiograms as "normal"; "Normal alterations" or "dubious or abnormal alterations" knowing the patient's background as well as the studies performed. A cardiologist from the Boca Juniors medical team specialized in sportsman's electrocardiography (RF) assessed the 499 electrocardiograms blindly (without knowing the demographic data of the patients or the pathological background) using the same criteria. Results: Out of a total of 499 electrocardiograms, 448 (89%) were interpreted as normal by the sports electrocardiography specialist vs 459 (91%) by the cardiologists of the sports institute. Regarding normal alterations, 21 (4%) electrocardiograms were considered normal alterations for the electrocardiography specialist vs 23 (4%) by the sports institute. 30 (6%) electrocardiograms showed doubtful or abnormal alterations for the specialist vs 17 (3%) for the sports institute. Conclusions: The electrocardiographic interpretation can present variations from one center to another despite using standardized criteria. It is likely that the clinical evaluation.

Dinámica cardiaca del adulto evaluada mediante las proporciones de la entropía / Adult dynamic heart evaluated by the proportions of entropy

Resumen Introducción: A partir de la teoría de los sistemas dinámicos, junto con la teoría de la probabilidad y el concepto de entropía se ha desarrollado una nueva metodología matemática de aplicación clínica. Objetivo: Aplicar la metodología previamente desarrollada para evaluar la dinámica cardíaca de adulto utilizando para ello la probabilidad y proporciones de la entropía del atractor. Materiales y métodos: Se desarrolló un estudio ciego tomando como Gold Standard el diagnóstico convencional emitido por un experto con 480 holter, 30 dinámicas normales y 450 con diferentes patologías; para cada holter se generó un atractor numérico cuantificando la probabilidad de aparición de parejas ordenadas de frecuencias cardiacas consecutivas, evaluando posteriormente la entropía, relación S/k y proporciones para cada dinámica durante mínimo 18 horas. Fueron hallados los valores de sensibilidad, especificidad y coeficiente Kappa. Resultados: La metodología aplicada permitió diferenciar cuantitativamente normalidad de enfermedad, encontrando los valores de las proporciones en los rangos establecidos. Los valores de sensibilidad y especificidad fueron de 100%, y el coeficiente Kappa fue de 1. Conclusión: A partir de las distribuciones de probabilidad de la aparición de parejas ordenadas de frecuencias cardiacas consecutivas y de su entropía es posible diagnosticar la dinámica cardiaca durante mínimo 18 horas.

Abstract Introduction: A new mathematical methodology of clinical application has been developed from the theory of dynamic systems, together with the theory of probability and the concept of entropy. Objective: To apply the methodology previously developed to evaluate the heart dynamics of adult through the probability and proportions of entropy of the attractor. Materials and methods: A blind study was developed taking as Gold Standard the conventional diagnosis issued by an expert with 480 Holter, 30 normal dynamics and 450 with different pathologies. For each Holter, a numerical attractor was generated by quantifying the probability of appearance of consecutive pairs of cardiac frequencies, subsequently evaluating entropy, S/K ratio and proportions for each dynamic for at least 18 hours. The values of sensitivity, specificity and Kappa coefficient were found. Results: The applied methodology allowed to differentiate quantitatively normality of disease, finding the values of the proportions in the established ranges. The sensitivity and specificity values were 100%, and Kappa coefficient was 1. Conclusion: It is possible to diagnose cardiac dynamics for at least 18 hours based on the probability distributions of the appearance of consecutive pairs of cardiac frequencies and their entropy.

Sistemas dinámicos aplicados a la dinámica cardiaca en 18 horas mediante una ley matemática exponencial / Dynamical systems applied to cardiac dynamics in 18 hours by an exponential mathematical law

Objetivo: confirmar la capacidad diagnostica de una ley exponencial de ayuda diagnostica, desarrollada para 21 horas con base en la teoría de sistemas dinámicos junto con la geometría fractal, en evaluaciones realizadas en 18 horas, mediante un estudio de concordancia diagnóstica con respecto al Gold estándar. Materiales y métodos:se realizó un estudio de 60 dinámicas cardiacas evaluadas en Holter y registros electrocardiográficos continuos, de los cuales 15 provienen de sujetos normales y 45 de pacientes con diferentes tipos de patologías cardiacas. Se desarrollaron simulaciones teóricas de la secuencia de las frecuencias cardiacas durante 18 horas, y se construyeron atractores. Se calculó la dimensión fractal de cada atractor y su ocupación espacial en el espacio generalizado de Box-Counting. Se determinó el diagnóstico matemático a partir de la ley y se calculó sensibilidad, especificidad y coeficiente Kappa. Resultados: se encontraron valores para normalidad entre 219 y 373 en la rejilla Kp y entre 49 y 70 para enfermedad aguda, evidenciando que el método permite diferenciar normalidad de enfermedad aguda mediante la ocupación espacial de los atractores valorados desde la ley matemática en 18 horas. Se encontraron valores de sensibilidad y especificidad del 100% y un coeficiente Kappa de 1 al comparar el diagnóstico físico-matemático con el Gold estándar. Conclusión: la ley exponencial de los sistemas dinámicos cardiacos aplicada en 18 horas es útil como herramientade ayuda diagnóstica, permitiendo cuantificar casos normales, en evolución hacia la enfermedad y en estados agudos...(AU)

Objective: to confirm the diagnostic capacity of an exponential diagnostic aid law, developed for 21 hours, based on the theory of dynamic systems along with the fractal geometry, in evaluations carried out in 18 hours, through a diagnostic concordance study with respect to the gold standard. Materials and methods: a study of 60 cardiac dynamics evaluated in Holter and continuous electrocardiographic recordings was performed, of which 15 come from normal subjects and 45 from patients with different types of heart diseases. Theoretical simulations of the sequence of heart rates were developed for 18 hours, and were built attractors. The fractal dimension of each attractor and its spatial occupation in the generalized Box-Counting space was calculated.Mathematical diagnosis is determined from the law and sensitivity, specificity and Kappa coefficient was calculated. Results: values normally found between 219 and 373 in the Kp grid and between 49 and 70 for acute disease, showing that the method can differentiate normal acute disease by spatial occupation of attractors assessed from the mathematical law in 18 hours. Sensitivity and specificity of 100% and a Kappa coefficient of 1 were found by comparing the physical-mathematical diagnosis with the Gold standard. Conclusion: the exponential mathematical law of cardiac dynamic systems applied in 18 hours is useful as a diagnostic aid tool, allowing quantifying normal cases, evolving towards disease and acute conditions...(AU)

Parámetros clínicos y electrocardiográficos por décadas de vida. Análisis por el Holter de 24 horas / Clinical and electrocardiographics parameters, for decades of life. Analysis for the Holter of 24 hours

INTRODUCCIÓN: el electrocardiograma, tiene variaciones normales, de acuerdo con las edades, existiendo alteraciones del ritmo cardiaco, conforme avanza la edad; asi mismo los síntomas y su correlación con las arritmias, varían con la edad y con el sexo de los pacientes. Estas variaciones, pueden registrarse mejor con el Holter de 24 horas. OBJETIVOS: utilizar el Holter de 24 horas, para indagar variaciones, por décadas de vida de: síntomas, arritmias, correlacion síntomas- arritmias y la diferencia de estas variables según el sexo de los pacientes. METODOS: Se efectuaron 1220 estudios a 662 mujeres y a 558 hombres con un rango de edad entre 1 y 93 años. Las variables fueron: edad, sexo, síntomas (disnea, síncope, palpitaciones, lipotimia y dolor precordial); arritmias ventriculares y supraventriculares; correlación positiva, cuándo la arritmia coincidió con el síntoma, correlación negativa, si la arritmia no concidió con el síntoma o el mismo estuvo ausente; si no se registraron arritmias, el estudio fue calificado como normal, Los pacientes fueron clasificados por décadas de vida, correlacionandose las distintas variables con los grupos etareos. RESULTADOS: pacientes sintomáticos 42%. Arritmias 82%. Correlación positiva 23%. Estudios normales 18%. Los hombres predominaron en las edades extremas. Las palpitaciones fueron el síntoma más frecuente, predominando en la década de los 30. Las lipotimias, fueron más frecuentes conforme aumentaba la edad. Las extrasístoles aumentaron en frecuencia conforme la edad avanzaba. La Taquicardia Supraventricular, aumentó progresivamente desde los 30 años. La Fibrilación y Aleteo Auriculares, empezaron a presentarse a los 40 años, haciendose más frecuentes en cada década. Paro Sinusal, se presentó a los 60 años. El Bloqueo A-V Completo, fue mayor al final de las edades. La correlación positiva, fue frecuente en las edades medias. Los estudios normales fueron frecuentes solamente en las primeras edades. Las arritmias, fueron incrementándose, según avanzaba la edad. CONCLUSIÓN: en cada grupo etario, los parámetros clínicos y electrocardiográficos, son diferentes; los pacientes sintomáticos, así como la correlación positiva, son menos frecuentes en las edades extremas; determinadas arritmias se registran cada vez más frecuente, según la edad avanza, debido al progresivo envejecimiento del sistema excitoconductor.

INTRODUCTION: the electrocardiogram , has normal variations in accordance with the ages, existing alterations of the heart rhythm as the age advances , likewise the symptoms and its correlation with the arrhythmias, the vary with the age and the sex of the patients, these variations can register better with the 24 hours Holter monitoring. OBJETIVES: to use the 24 hour Holter monitoring, to investigate variations, for decades oflife of: symptoms, arrhythmias, correlation symptoms-arrhythmias, and the difference of these variables, according to the sex of patients. METHODS: the made studies were 1220, to 662 women and 558 man, with an age range between 1 and 93 years. The variables were: age, sex, symptoms (dyspnea, syncope, presyncope, palpitations and chest pain); ventricular and supraventricular arrhythmias; positive correlation, when the arrhythmia coincide with the symptom; negative correlation, if the arrhythmia didn't coincide with the symptom, or the same on was absent; if they didn't register arrhythmias, the study qualified as normal. The patients were classified by decades of life, being correlated the different variables with the age groups. RESULTS: symptomatic patients 42%, Arrhythmias 81%; positive correlation 23%; normal studies 18%. The men prevailed in the aged extremes. The palpitations, were the most frequent symptom, prevalent in the years 30. The presyncope were most frequent, as the age increased. The premature beats increased in the frequency, as the age advanced. The Supraventricular Tachycardia, increased progressively, from the 30 years. The Atrial Fibrillations and Flutter, the began to be presented, to the 40 years, being made but you frequent in every decade. The Sinus Arrrested, was presented to the 60 years. The Complete Heart Block, were most frequent at the end of the ages. The positive correlation, were frequent in the middle ages. The normal studies, were frequent, only in the first ages. The arrhythmias, were being increased, as the age advanced. CONCLUSION: in each age group, the clinical, and electrocardiográphics parameters, the are different; the symptomatic patients, as well as the positive correlation, the are less frequent in the extreme ages; determined arrhythmias, the register more frequent according to the age it advances, due to progressive aging of the excitoconductor systems.

Correlación de síntomas con arritmias cardiacas, por el holter de 2 horas / Correation of caardiac arrhythmias with symptoms for the 24 hours holter

Introducción.- El Holter de 24 horas, es utiizado como un exámen no invasivo, para detectar arritmias cardíacas y correlacionar con los síntomas que refiere el paciente. Objetivos.- Correlacionar la arritmia y el síntoma, determinar: la capacidad de la arritmia, para provocar síntomas, sensibilidad del síntoma, para detectar arritmias y posibilidades de tratamiento con los resultados. Método.- Se efectuaron 1146 estudios, los pacientes llevaron un diario, donde anotaron los síntomas y la hora del mismo, pulsándo el boton de eventos de la grabadora. Se definió como correlación positiva, cuándo la arritmia coincidió con el síntoma, correlación negativa, si la arritmia no coincidió con el síntoma, o el mismo estuvo ausente; si no se registraron arritmias, se calificó como estudio indeterminado. Se correlacionaron las medias de los valores, para obtener diferencia estadística y se calcularon los índices de sensibilidad y especificidad. Resultados.- Durante el estudio, 42%, tuvieron síntomas: palpitaciones 81%, lipotimias 15%, disnea 3% y dolor precordial 7%. En 82% se registraron arritmias: Extrasistolia Supraventricular 71%, Extrasistolia Ventricular 68%, Taquicardia Supraventricular 17%, Fibrilación Auricular 8%, Taquicardia Sinusal 7%, Bloqueo Auriculoventricular 4%, Taquicardia Ventricular 2%, Aleteo Auricular 2%, Paro Sinusal 0,5%. Correlación positiva, se encontró en un 22%; la cual fue mayor para las palpitaciones en un 58%, siguiendo el dolor predordial 26%, lipotimias 25 % y disnea 20%. La Taquicardia Sinusal, el Paro Sinusal y el Aleteo Auricular produjeron síntomas más frecuentemente, las Extrasístoles produjeron menos síntomas. La sensibilidad del síntoma para detectar arritmias fue 43% y la especificidad 66 %. Estudios normales fueron 18%. Conclusión.- La correlación síntoma-arritmia del Holter de 24 horas, fue baja, así como la sensibilidad del síntoma, para detectar arritmias. Debiéndo tomar en cuenta la frecuencia de los síntomas para indicar el estudio, siendo preferible utilizar el Registrador de Eventos, en caso de que los síntomas no sean cotidianos.

Introduction.- The 24 hours Holter monitoring is used as an exam noninvasive, to detect cardiac arrhythmias and to correlate with the symptoms that the patient refers. Objetives.- To correlate the arrhythmia and the symptom. To determinate: the capacity of the arrhythmia to cause symptoms, sensibility of the symptom to detect arrhythmias and treatment possibilities with the results. Methods.- Thousand hundred forty six studies were made, the patients took a diary, whey they wrote the symptoms, and the hour the same ones, pressing the button of the events of the recorder. It was defined: as positive correlation, when the arrhythmia coincided with the symptom, negative correlation, if the arrhythmia didn't coincide with the symptom, or the same one was absent; if they didn't register arrhythmias, it was qualified like uncertain study. The mean of the values were correlated, to obtain difference statistic and the index of sensibility and specificity were calculated. Results.- During the study 42% they had symptoms: palpitations 81%, presyncope 15%, dyspnoea 3%, chest pain 7%. In 82%, they were registered arrhythmias: Supraventricular premature beats 71%, Ventricular premature beats 68%, Supraventricular Tachycardia 17%, Atrial Fibrillation 8%, Sinus Tachycardia 7%, A-V Heart Block 4%, Ventricular Tachycardia 2%, Atrial Flutter 2%, Sinus Arrest 0,5%. Correlation positive was in 22%, being bigger for the palpitations in 58%, then the chest pain 26%, presyncope 25% and dyspnea 20%. The Sinus Tachycardia, the Sinus Arrest, and the Atrial Flutter, produced more symptoms, the premature beats, produced less symptoms. The sensibility of the symptom to detected arrhythmias, it was 43% and the specificity 66% . Normal studies were 18%. Conclusion.- There was a low correlation betwen symptoms and arrhythmias, as well as the sensibility of the symptom to detected arrhythmias. Should take in account the frecuency of the symptoms to indicate the study, being preferable to use the Cardiac Events recorders, when the symptoms are not daily.

Infarto agudo do miocárdio e injeção intramiocárdica experimental em cães: estudos clínico, enzimático, eletrocardiográfico e ecocardiográfico / Experimental acute myocardial infarction in dogs: clinic, enzymatic, electrocardiographic and echocardiographic studies

Os eventos isquêmicos em cães são incomuns, porém podem estar sendo subnotificados. Avaliou-se o infarto agudo do miocárdio (IAM) clinicamente, por meio de eletrocardiografia (ECG), eletrocardiografia contínua (EC), ecocardiografia (ECO), enzima creatina quinase (CK), enzima creatina quinase fração MB (CK-MB) e anátomo-histologicamente em cães sem raça definida, e observou-se a ocorrência de arritmias após injeção intramiocárdia por EC. O IAM foi obtido após a ligadura da coronária descendente anterior. Os animais apresentaram ao ECO dilatação da câmara esquerda e aumento do índice de desempenho miocárdico. Ao ECG houve desnivelamento de ST nas derivações pré-cordiais V1 e V2. No EC observaram-se arritmias ventriculares graves e supradesnivelamento de ST. As enzimas CK e CK-MB aumentaram significativamente, sendo que os picos de CK-MB e de CK ocorreram seis horas e 12 horas, respectivamente, após o IAM. Na análise histológica constatou-se infarto da parede inferior do ventrículo esquerdo e substituição do tecido muscular por tecido fibroso. Avaliou-se a injeção intramiocárdica por EC que pode servir como via terapêutica cardíaca, não sendo observado aumento das arritmias ventriculares após a injeção no miocárdio infartado. O infarto em cães pode ser detectado pelos exames cardíacos disponíveis, e a injeção intramiocárdica é uma via terapêutica cardíaca possível.

Ischemic events in dogs are uncommon; however, this may be under-reported. The myocardial infarction was created by left anterior descending coronary ligation in healthy mongrel dogs in clinical and laboratorial exams. These dogs were evaluated clinically, electrocardiography (ECG), through ambulatory electrocardiography (AE), echocardiography (ECO), creatine kinase enzyme (CK), creatine kinase MB fraction enzyme (CK-MB) and histopathologically. Even in these animals we observed the occurrence of arrhythmia after intramyocardial injection by AE. The animals exhibited left ventricular chamber enlargement and increase in myocardial performance index at ECO. In ECG, there were deviations in ST segment in the precordial leads V1 and V2. CK and CK-MB showed high increase, CK and CK-MB peaks occurred six and 12 hours after infarction, respectively. Histopathology of the infarction in the inferior wall of the left ventricle and replacement of muscle tissue by fibrous tissue were seen. Furthermore, intramyocardial injection that may be used for therapeutic purposes was evaluated by AE, which demonstrated no increase in the ventricular arrhythmias. Therefore, myocardial infarction in dogs can be detected with the tests available and intramyocardial injection can be used as a therapeutic way.

Desarrollo de un holter digital con grabación de eventos y software de visualización / Develoment of a digital holter with events recording and software display

El monitoreo ambulatorio de las señales electrocardiográficas (ECG), “Holter”, representa una herramienta esencial, en la evaluación diagnóstica de pacientes con arritmias cardiacas involucradas en procesos patológicos como miocardiopatías, estadios post-infarto, lesiones del sistema autónomo cardíaco, entre otros, así como en el seguimiento del funcionamiento de marcapasos implantados. Los equipos disponibles en Colombia para realizar este tipo de funciones, son muy especializados, por lo que resultan costosos y poco asequibles para muchos pacientes. En este proyecto, se desarrolló un prototipo de un sistema de monitoreo y registro de eventos cardiacos, que acondiciona las señales ECG a través de la amplificación, filtración y elevación del nivel DC, y almacena la información adquirida de las tres derivadas principales (DI, DII y DIII), en una memoria SD (Security Digital), usando el estándar de archivos FAT (File Allocation Table), permitiendo que la información pueda ser leída en cualquier computador. Además, se desarrolló un software que permite visualizar los registros previamente almacenados en la memoria, para su revisión y análisis. Con la ayuda de un simulador de ondas ECG, se calibraron las frecuencias de 30 BPM, 120 BPM y 300 BPM las amplitudes 0,5 mV, 1 mV y 2 mV. Se encontró que los errores del prototipo son del 1% para frecuencia y del 6% para amplitud.

The ambulatory monitoring of electrocardiographic signals, “Holter”, represents a decisive tool in the diagnostic evaluation of patients with cardiac arrhythmias involved in pathological processes like cardiomyopathies, post-infarct stages, injuries of the cardiac autonomous system, among others, as well as in the monitoring of implanted pacemakers. There are few devices of this kind available in Colombia and most of them are very specialized and expensive for the majority of patients. We built a cardiac monitoring and cardiac events registering system prototype that processes the ECG signals (amplification, filtration and DC elevation), and stores the data acquired from the three main derivations DI, DII and DIII in an SD (Security Digital) memory using the FAT (File Allocation Table) standard, which allows the reading of this information in any computer. Moreover, we developed a software program that allows for the visualization of the registries previously stored in the SD memory for their review and analysis. Using an ECG simulator, the frequencies 30 BPM, 120 BPM and 300 BPM and the amplitudes 0,5 mV, 1 mV and 2 mV were calibrated. It was found that the prototype errors were smaller than 1% for frequency and 6% for amplitude.

Comparison of heart rate variability between ESRD patients on peritoneal dialysis and hypertensive patients / 대한내과학회지

BACKGROUND/AIMS: Heart rate variability (HRV) is regulated by the balance between the sympathetic and parasympathetic tones. HRV can be used to assess the effects of drugs and other interventions on cardiac autonomic tone, including exercise, respiration, metabolic change, and psychological or physical stress. As few studies have examined HRV in end-stage renal disease (ESRD) patients in Korea, we investigated autonomic nervous system activity reflected in HRV in patients on peritoneal dialysis for ESRD. METHODS: We compared the pattern of cardiac sympathetic and parasympathetic activity through time-and frequency-domain analysis of HRV in 20 ESRD patients and 65 hypertensive control subjects using 24-hour Holter monitoring. The patients had been undergoing peritoneal dialysis at the Bongseng Hospital between January 2006 and December 2008. RESULTS: The mean age of the patients and controls was 53.8+/-13.1 and 55.1+/-13.7 years, respectively. In the patient group, all of the time- and frequency-domain HRV measures were reduced compared with the control group, including the HRV index, normalized unit of low-frequency (LF norm), and ratio of low-frequency power to high-frequency power (LF/HF), whereas the normalized unit of high frequency (HF norm) was increased. CONCLUSIONS: Autonomic tone in ESRD patients on peritoneal dialysis is decreased compared with patients with hypertension. The parasympathetic tone in ESRD patients on peritoneal dialysis dominates over the sympathetic tone.

Comparison of heart rate variability between end stage renal disease patients on hemodialysis and hypertensive patients / 대한내과학회지

BACKGROUND/AIMS: Heart rate variability (HRV) can be used to assess the effects of drugs and other interventions, including exercise, respiration, metabolic changes, and psychological or physical stressors, on cardiac autonomic tone. HRV is regulated by the balance of sympathetic and parasympathetic tone. Few studies pertaining to HRV in end stage renal disease (ESRD) patients have been performed in Korea. Thus, autonomic nervous system activity as indicated by HRV was investigated in patients on hemodialysis due to ESRD. METHODS: We compared the pattern of cardiac sympathetic and parasympathetic activity through time- and frequency- domain analyses of HRV with 24-hour Holter monitoring in 30 ESRD patients and 64 hypertensive control subjects. The ESRD patients had undergone hemodialysis therapy at the Bongseng Hospital between January 2006 and June 2007. RESULTS: The mean age of ESRD patients and hypertensive controls was 51.17+/-11.91 and 55.02+/-13.72 years, respectively. In the ESRD group, all time- and frequency-domain HRV measures, including the standard deviation of all normal sinus R-R intervals over 24 hours (SDNN), the HRV index, the very low-frequency (VLF) normalized unit of low-frequency (LFnorm), and the ratio of low-frequency power to high-frequency power (LF/HF), were reduced; the normalized unit of high frequency (HFnorm) was increased in the ESRD patients compared with the control group. CONCLUSION: The autonomic tone in ESRD patients on hemodiaysis was decreased compared with hypertensive patients. The parasympathetic tone in ESRD patients on hemodyalysis was dominant over the sympathetic tone.

24 hr Ambulatory ECG and Schellong Test for the Diagnosis of Cardiovascular Origin Dizziness

BACKGROUND AND OBJECTIVES:Dizziness is a vague symptom of disease. Dizziness of cardiovascular origin is associated with decreased cardiac output and usually presented as light-headed sensation of an impending faint. This study aims to provide the clinician with a logical approach to identifying the cardiovascular causes of dizziness. MATERIALS AND METHOD:From February 2002 to June 2004, we sampled the 30 dizzy patients who complained light-headed sensation of an impending faint with underlying disease of arrhythmia or abnormal blood pressure. The 11 patients with arrhythmia were monitored by 24 hr ambulatory ECG monitoring and all were examined with Schellong test. RESULTS:Among the 11 patients with arrhythmia, 7 patients were diagnosed as cardiovascular origin dizziness by 24hr ambulatory ECG monitoring and 10 patients as orthostatic hypotension by Schellong test. CONCLUSION:The results of this study indicated that 24hr ambulatory ECG monitoring and Schellong test had efficacy for the diagnosis of dizzy patients who complained light-headed sensation of an impending faint with underlying disease of arrhythmia or abnormal blood pressure

The study of 24-hour holter monitoring in patients with coronary artery disease

BACKGROUND: Patients with ischemic heart disease have many episodes of ischemic attack which is presented as ST-T change in electrocardiogram during ordinary daily life. The purpose of this study was to confirm the presence of a significant circardian variation in transient myocardial ischemia and the difference of the incidence of ischemia according to involved vessel. METHODS: Twenty two patients with angiographically significant coronary stenosis were evaluated. The ambulatory electrocardiography(Holter monitoring) was performed in each patients. RESULTS: One hundred twenty-eight episodes of ischemic ST-T changes occured in 18(82%) of 22 patients and 65(51%) episodes of ischemic ST-T changes occured between 6 A.M. and 12 noon(p<0.005). The mean frequency per patient according to involved vessel was 9 in double vessel disease, 4.5 in diffuse sclerosis with old myocardial infarction, 2.9 in single left anterior descending, 2.3 in single right coronary and 1 in single left main coronary artery disease. The only one episode of T wave change was observed in patients with lesion of left circumflex artery. The mean frequency of ST changes per patient according to type of angina was 4.8 in postinfartion angina, 3.5 in unstable angina and 2.1 in stable angina and the mean frequency of T change was 4.7 in stable angina, 2 in unstable angina and 0.3 in postinfarction angina. CONCLUSIONS: The significant circardian variation of ischemic activity was found in patients with ischemic heart disease. The mean frequency of ST change was higher in double vessel disease and diffuse sclerosis with old myocardial infarction than in other coronary artery lesion. And the episode of ST change was more frequent in postinfarction angina and unstable angina pectoris and the episodes of T change in stable angina pectoris. Also this study suggest 24-hour Holter monitoring has a low detectability of ischemic episodes in patient with lesion of left circumflex artery.

Reproducibility of Ambulatory Electrocardiography

To evaluate the reproducibility of the Ambulatory Electrocardiography (AECG), we examined the consistency rates of premature beats between the baseline AECG's and the repeat AECG's in 23 patients who underwent AECG's times within 1 year. 12 patients were male and 11 patients were female. Their mean age was 48 years. (Range ; 20 years-75 years) The time interval between both AECG's was 1 month 20 days. (Range ; 1 day-9months) They did not take any antiarrhythmic druge during the observation period except 4 patients who were taking calcium channel blockers or beta receptor blockers for hypertensive heart disease or ischemic heart disease. The consistency rate of both frequency and complexity of ventricular premature beats was 52%. The consisency rate of both frequency and complexity of supraventicular premature beats was 35%. These consistency rates seemed to vary as the time interval between both AECG's differed. In the case of ventricular premature beats, the consistency rates of 1 day, 8 days and 5 months as the time interval were 100%, 38% and 14% respectively. In the case of supraventricular premature beats, the consistency rates were 50%, 25% and 29%. We concluded that the reproducility of the AECG was low and this reproducibility became lower as the time interval between both AECG's became longer and that hese facts had to be considered when the effect of the antiarrhythmic drugs was evaluated.