Relationship of the T-wave Tpeak-Tend interval with conduction system disorders in arterial hypertension / Relación del intervalo Tpico-Tfinal de la onda T con trastornos del sistema de conducción en hipertensión arterial

Abstract Purpose: The Tpeak-Tend interval of the T wave has emerged as a new electrocardiographic marker of increased transmural dispersion of ventricular repolarization. We aimed to determine the presence of cardiac conduction system disorders in patients with systemic arterial hypertension (SAH) who have altered Tpeak-Tend interval of the T wave. Methods: The 67 patients with SAH were divided into two groups. Those with prolonged (≥ 77 ms) Tpeak-Tend intervals, 21 (31%) patients were in the study group. Those with normal (< 77 ms) Tpeak-Tend intervals, 46 (69%) patients were in the control group. Alteration of ventricular repolarization manifested as a prolongation of the Tpeak-Tend interval was detected by computerized electrocardiographic analysis tools. Results: The median value of QRS complex duration was significantly wider in the study group as compared to the control group (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). There was a significantly greater incidence of left anterior hemiblock in the study group (14% vs. 0% p < 0.04). The median value of the QTc interval was significantly greater in the study group (440 ± 26 vs. 422 ± 15 p < 0.01). There was a significantly greater incidence of patients with prolonged QTc interval in the study group (33% vs. 11% p < 0.02). The median value of the Tpeak-Tend interval was significantly greater in the study group (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), as well as, the Tpeak-Tend/QTc ratio in the study group (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). Conclusion: There is a significantly greater ventricular repolarization disorders and abnormalities of the cardiac conduction system in SAH patients who possess altered Tpeak-Tend interval of the T wave.

Resumen Objetivo: El intervalo Tpico-Tfinal de la onda T es un marcador electrocardiográfico de la dispersión transmural aumentada de la repolarización ventricular. Investigamos la presencia de trastornos del sistema de conducción cardíaca en pacientes con hipertensión arterial sistémica (HA) que poseen alterado el intervalo Tpico-Tfinal de la onda T. Métodos: Los 67 pacientes con HA fueron divididos en dos grupos. Aquellos con intervalos de Tpico-Tfinal prolongados (≥ 77 ms), 21 (31%) pacientes (grupo de estudio). Aquellos con intervalos normales (< 77 ms) Tpico-Tfinal, 46 (69%) pacientes (grupo control). Los intervalos Tpico-Tfinal fueron medidos por herramientas de análisis electrocardiográfico computarizado. Resultados: El valor mediano de la duración del complejo QRS fue significativamente más amplio en el grupo de estudio (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). Hubo una incidencia significativamente mayor de hemibloqueo anterior izquierdo en el grupo de estudio (14% vs. 0% p < 0.04). El valor mediano del intervalo QTc fue significativamente mayor en el grupo de estudio (440 ± 26 vs. 422 ± 15 p < 0.01). Hubo una incidencia significativamente mayor de pacientes con intervalo QTc prolongado en el grupo de estudio (33% vs. 11% p < 0.02). El valor mediano del intervalo Tpico-Tfinal fue significativamente mayor en el grupo de estudio (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), así como el cociente Tpico-Tfinal/QTc (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). Conclusión: Existe una alteración de la repolarización ventricular significativamente mayor y anomalías del sistema de conducción cardíaca en pacientes con HA que poseen alteración del intervalo Tpico-Tfinal de la onda T.

Prevalence of QTc prolongation among hypertensive patients and its association with other co-morbidities

Background:Hypertension, an iceberg disease contributes significantly to the global health burden. This pan-endemic disease is a harbinger for cardiovascular events, especially life-threatening arrhythmias. A simple and cost-effective electrocardiogram serves as an effective tool to identifyand evaluate hypertensives with high cardiovascular risk.QTc interval which indicates repolarization abnormality is one such effective tool.The study aimed at describing the prevalence of QTc prolongation among hypertensive individuals and also to assess the association of QTc prolongation with various co-morbidities.Methods:One hundred and fifty-nine hypertensive patients were evaluated in this cross-sectional study for six months. Demographic variables, biochemical parameters, blood pressure and electrocardiogram were recorded for all the patients. Data obtained were statistically evaluated.Results:The mean age of participants was 55.6 years (SD�76). There were 103 males (64.4%) and 43 females (35.6%). QTc prolongation was noted in 52.5% of the population studied.Statistically significant QTc prolongation among poorly controlled hypertensive was 59% when compared to that of controlled hypertensive at 37.5% was noted. About 26% of the participants were smokers, 27% were alcoholics and 60% had co-existing diabetes mellitus. Diabetes and gender were found to have a statistically significant association with QTc prolongation.Conclusions:The study found a positive correlation between prolonged QTc and hypertensives and hypertensives with coexisting diabetes. To mitigate the consequences of hypertension, the study recommends early diagnosis, stringent blood pressure control, efficient and effective use of QTc measurement, and preventive pharmacotherapy.

Association of endemic arsenic poisoning and abnormal electrocardiogram: Meta-analysis / 中华地方病学杂志

Objective:To evaluate the correlation between endemic arsenic poisoning and abnormal electrocardiogram (ECG).Methods:PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Wanfang data, VIP and other databases were used for literature retrieval, and epidemiological literatures related to abnormal ECG of endemic arsenic poisoning published in domestic and abroad were included in the study. The time limit was from the establishment of the database to December 1, 2020. RevMan 5.3 was used for Meta-analysis of binary variables. Random effect model was selected according to the results of heterogeneity, and odds ratio ( OR) was used as the effect index. Characteristic changes were found by subgroup analysis. Bias was published by funnel plot. Results:Nine articles were included in this Meta-analysis, with 6 articles in Chinese and 3 articles in English, respectively. The abnormal ECG changes included QTc prolongation, ST-T segment change, left axis deviation and arrhythmia. Finally, 1 975 cases were included in the exposure group, including 575 cases of abnormal ECG; 750 cases of control group, including 145 cases of abnormal ECG. Meta-analysis showed that the combined OR value [95% confidence interval ( CI)] of abnormal ECG changes was 4.41 (2.83 - 6.87), with statistical significance between the two groups ( Z = 6.56, P < 0.05); the results of subgroup analysis showed that the combined OR values (95% CI) of QTc prolongation, ST-T segment change, left axis deviation and arrhythmia were 12.30 (5.91 - 25.59), 2.74 (1.39 - 5.41), 2.93 (0.89 - 9.62) and 4.13 (2.38 - 7.17), respectively. Conclusions:Endemic arsenic poisoning may cause abnormal ECG. Prolongation of QTc caused by arsenic exposure may be the characteristic change of abnormal ECG.

Effects of different psychotropic drugs on the QTc interval in the elderly population / 中华老年医学杂志

Medications are the main means for the treatment of mental illness, and it is of great significance to be familiar with the adverse reactions of psychotropic drugs for the formulation and optimization of treatment plans.The prolongation of the QT interval corrected by heart rate(QTc interval)is one of the most common cardiotoxic reactions after taking psychotropic drugs and may lead to torsade de pointes and increase the risk of sudden cardiac death.The elderly population is more prone to QTc interval prolongation.In this review, we focus on the relationship between common psychotropic drugs and QTc interval prolongation and influencing factors in the elderly population, so as to help clinicians avoid risk in drug selection.

QTc, Tp-e Interval and Tp-e/QTc Ratio in Patients with Hypocalcemia-case Control Study

Abstract Background: To the best of our knowledge, there are studies related to QT and QTc interval in patients with hypocalcemia, but there are no studies evaluating T wave peak and end interval (Tp-e interval), Tp-e/QT and Tp-e/QTc ratios used to evaluate cardiac arrhythmia risk and ventricular repolarization changes rates. Objectives: Therefore, we aimed to investigate whether there is a change in Tp-e interval, Tp-e/QT and Tp-e/QTc ratios in patients with hypocalcemia. Methods: Retrospectively, 29 patients with hypocalcemia in the emergency department were included in the study. Twenty-nine patients with similar age and sex distribution were included in the study as the control group. All patients underwent 12-lead electrocardiography (ECG). In addition to routine measurements, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were measured on ECG. The study data were grouped as patients with and without hypocalcemia. Results: The mean age of the patients was 66.24 ± 4.95 years. QTc interval, Tp-e interval and Tp-e/QTc values were found to be significantly higher in patients with hypocalcemia (p <0.001 for each). QTc interval, Tp-e interval and Tp-e/QTc ratio showed a significant negative correlation with calcium levels. Conclusion: Tp-e interval and Tp-e/QTc ratios are significantly increased in patients with hypocalcemia compared to those without hypocalcemia and this can be used more effectively in the follow-up of cardiac fatal arrhythmias.

Lopinavir/ritonavir: is early administration better in Covid-19?

Background: To share the data of coronavirus 2019 (Covid-19) patients started on lopinavir-ritonavir (lopi/r) in relation to time period from the onset of symptoms.Method: Observational descriptive study of 23 Covid-19 patients admitted in a tertiary care center in India from March 2020 to May 2020. Patients categorized into 2 groups based on the timing of initiation of lopi/r from the onset of symptoms. Group 1 were given the drug early (≤7 days) and group 2 late (>7 days). The clinical events (oxygen requirement days and ICU stay) and outcomes of hospital stay between the two groups were evaluated.Results: Patients were started on lopi/r for a period of 14 days on admission, out of which 12 patients were in group 1 and 11 patients in group 2. Underlying co-morbidities were present in 15 patients (65.21%). The mean duration from onset of symptoms to lopi/r initiation was 4 days and 11.1 days in Group 1 and 2 respectively. Requirement for oxygen support (2.16 versus 6.54 days), mean duration of hospitalization (8.58 versus 11.54 days) and mean duration of obtaining first Covid-19 negative report from the onset of symptoms (10.5 versus 19.57 days) were all significantly lesser in group 1 (p<0.05). All patients belonging to Group 1 and eight patients of group 2 recovered completely and were discharged whereas 3 patients of group 2 expired. Diarrhea was the most commonly observed adverse effect of lopi/r in our patients.Conclusion: With no approved weapon to tackle the Covid-19 pandemic, we should keep lopi/r in our armamentarium of drugs and use it at the earliest. More clinical trials are needed in future to ascertain if lopi/r can reduce hospital stay, prompt faster recovery and result in better clinical outcome.

Detailed ECG analysis in type 2 diabetes mellitus: a predictor of multitude of complications

Background: Type 2 diabetes mellitus is a systemic disease with life-threatening complications and morbidity. The 12 lead ECG, an easily available investigation, when studied in detail can give a lot of information and predict various microvascular and macrovascular complications apart from coronary artery disease.Methods: A random cross sectional study involving 100 patients of type 2 diabetes mellitus, in the age group of 18-80 years were included in study after applying various inclusion and exclusion criteria. They were subjected to ECG, 2D echocardiography and laboratory tests. Data were collected and analysed.Results: Arrythmia was not detected in any patient. A resting tachycardia (HR >100) in 30 patients correlated with Prolonged QTc (>440 miliseconds) (p=0.04). QRS amplitude was reduced in 26 patients. Prolonged QTc also correlated with presence of diabetic complications, retinopathy of NPDR type and nephropathy (p=0.004). Hence about 30% of the study group did show signs of early diabetic cardiac autonomic neuropathy and cardiomyopathy.Conclusions: The statistically significant utility of electrocardiogram in predicting various complications of diabetes apart from coronary artery disease.

Cardiovascular dysfunction in patients of cirrhosis of liver

Background: Cirrhosis of liver refers to a progressive condition that disrupts the normal architecture of the liver. It is increasingly recognized that cirrhosis per se can cause cardiac dysfunction. The aim was to assess cardiovascular dysfunction electrocardiographically and echocardiographically in patients with cirrhosis of liver and to find the correlation between cardiovascular dysfunction and severity of liver cirrhosis as per child-PUGH score.Methods: Total 90 patients of cirrhosis of liver of both sexes were included in this cross-sectional study conducted from January 2018 to August 2019 in SGRDIMSR, Sri Amritsar. The severity of liver cirrhosis was assessed as per Child Pugh Score. QTc interval was calculated by Bazett抯 formula. Systolic and Diastolic dysfunction was seen on 2D-echocardiography.Results: QTc interval increased linearly with the severity of liver cirrhosis. Mean values of QTc in Child Pugh Class A=425.00(�.97), Class B=437.35(�.60), Class C=479.71(�.48) with p value of 0.04 which is significant. Diastolic dysfunction was also related with the severity of liver cirrhosis. In Child Pugh Class A= 2(33%) patients had grade 1 diastolic dysfunction, Class B=23(59%) patients had grade 1 diastolic dysfunction while in Child Pugh Class C=3(7%) had grade 1 diastolic dysfunction, 33(73%) patients had grade 2 diastolic dysfunction and 1(2%) patients had grade 3 diastolic dysfunction with p value of 0.04 which is significant. Systolic function was found normal in all the patients.Conclusions: Diastolic dysfunction and QTc interval prolongation are both related with the severity of liver cirrhosis and are major criteria of cirrhotic cardiomyopathy.

The evaluation of QTc prolongation and QT dispersion in type 2 diabetes mellitus as an indicator of cardiac autonomic neuropathy

Background: Diabetes mellitus refers to group of metabolic disorders characterized by hyperglycemia due to an absolute or relative deficit in insulin production or action. Diabetes mellitus produces pathological changes in most organs of the body including heart, blood vessels, kidneys, nerves and eyes. Cardiovascular autonomic neuropathy (CAN) is a severely debilitating yet underdiagnosed complication of diabetes. Diabetes-associated cardiovascular autonomic neuropathy damages autonomic nerve fibers that innervate the heart and blood vessels causing abnormalities in heart rate and vascular dynamics.Methods: Total 80 cases of diabetes mellitus were selected. Cardiac autonomic neuropathy in them was diagnosed by a series of tests recommended by Ewing et al, which include - Valsalva ratio, Deep Breath Test, Heart rate response to standing, Postural Hypotension, SHGT Increase in diastolic BP on sustained hand grip. They were divided into 2 groups A and B depending on presence or absence of cardiac autonomic neuropathy. ECG was done to calculate QTc and QTd.Results: In group A mean QTc was 0.344 sec and in group B in patients with mild CAN mean QTc was 0.432, moderate CAN mean QTc was 0.444, and in patients of severe CAN mean QTc was 0.481. p value was 0.001 that it is highly significant. Means more was degree of CAN more was prolongation of QT and similarly more the degree of CAN more was QTd.Conclusions: Diagnosis of cardiac autonomic neuropathy by battery of cardiac autonomic function tests is a comlex procedure. The prolongation of QTc interval and more specifically QTd interval on ECG is a marker in diagnosis of cardiac autonomic neuropathy which can be easily evaluated.

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.

Evaluation of the QTc internal and QT dispersion in patients with newly detected clinical hypothyroidism

Background: Thyroid hormones play an important role in the orchestration of various metabolic functions in the body and thus thyroid dysfunction can produce dramatic cardiovascular effects. Electrocardiographic changes such as bradycardia, low voltage complexes, and varying degrees of heart block are commonly recognized in hypothyroid patients. Hypothyroidism has been found to be associated with increased cardiovascular morbidity and mortality. Hence, it is important to investigate the ECG profile in these patients. The present study was aimed at evaluating the QTc interval and QT dispersion, an indicator of inhomogeneity of ventricular repolarisation and cardiac autonomic modulation in patients with newly detected clinical hypothyroidism.Methods: 50 patients with newly detected clinical hypothyroidism and 50 healthy controls were included in the study. The ECG was recorded and the heart-rate, QTc interval and QT dispersion were calculated.Results: The mean heart-rate was found to be significantly (p <0.05) reduced in hypothyroid patients when compared to healthy controls. The mean QTc interval and QT dispersion were significantly increased in hypothyroid patients when compared to controls. QTmin and QTmax of cases and controls also showed a statistically significant difference.Conclusion: Thus, the present study confirms the role of thyroid hormones on the cardiovascular system, particularly on ventricular repolarisation and cardiac autonomic modulation. Hence, early and prompt therapy with levothyroxine may help to prevent the adverse events resulting from cardiovascular dysfunction.

Effect Of Various Phases Of Menstrual Cycle On Electrocardiogram In 18-22 Years Healthy Females

During the menstrual cycle phases changes in the levels of female sex hormones mainly estrogens and progesterone, have some possible influence over the clotting and fiinolytic activity of the blood, rhythmicity and conductivity of the electrical impulse of heart. Aim: Main objective of the study is to find out the effects of different phases of menstruation on ECG intervals. Methodology: This was a cross sectional descriptive study conducted in female nursing students aging18 to22 years were considered Sample size was decided to be 140 female nursing students from LN Nursing College, Bhopal. Inclusion criteria were normal healthy female aged 18 to 22 years with regular menstrual cycle (30 days +- 3 days) in previous six cycles. There Electrocardiographic changes were accessed in different phases of menstrual cycle. Results- In our study we found longest RR interval in secreatory phase in comparison to proliferative and menstrual phase. Shortest Bleeding Time was found in menstrual phase. The results related to QT and QTc intervals shows that longest clotting time measures in proliferative phase as comparison to Menstrual and secreatory phase. Shortest QT and QTc intervals were found in secreatory phase

Alteration of cardiovascular autonomic activity in type 2 diabetes mellitus

Background: Diabetes mellitus (DM) is a clinical syndrome characterized by hyperglycaemia due to absolute or relative insulin deficiency. Cardiovascular autonomic neuropathy (CAN) invokes potentially life-threatening outcomes especially in poorly controlled diabetic patients. This study was to evaluate the prevalence of CAN in diabetic patients and its relationship with QTc interval.Methods: This observational study of two year duration was included total 123 patients of more than 30 (thirty) years and up to 60 (sixty) years of age who were presented with diabetic mellitus (DM) those were evaluated for CAN using four distinct clinical tests-Resting heart rate (RHR), test for orthostatic hypotension (OH), hand gripping test (HGT) and QTc interval on ECG. Data were analyzed with statistical package for social sciences (SPSS), version 23.Results: The mean age of all 103 studied patients was 48.94±8.69 years; Mostly patients belong to 50-60 years of age and the majority was males (69.0%). Out of 103 72.8% patients were reported with CAN (51 males and 24 females) and without CAN were 27.2.0% (20 males and 8 females), 36% of patients of Definite Parasympathetic neuropathy, 25% Normal and 20% of Sympathetic neuropathic patients. HbA1c level increases the danger of CAN also. QTc interval is a reliable indicator for the presence of CAN.Conclusions: Duration of diabetes is directly proportional to the prevalence of CAN. Various cardiac autonomic function tests detect CAN.

To Study the Prevalence of QTc Interval Prolongation in Cirrhosis of Liver And Its Relationship with the Severity of Disease

Background: Cirrhosis of liver is considered as chronicdisease of liver characterised by the triad of parenchymalinflammation, necrosis and regeneration with diffuse increasein fibrosis and formation of nodules around regenerating liverparenchyma. A retrospective study of 90 patients of livercirrhosis visiting OPD/Indoor of SGRDIMSR, Vallah, SriAmritsar were included in the study conducted from Jan 2017to Aug 2018 to assess QTc interval in patients with cirrhosis ofliver due to any etiology and to find the correlation betweenQTc interval and severity of liver cirrhosis as per Child-PughScore.Methods: The severity of liver cirrhosis was assessed andaccording to the Child Pugh Score, divided into Class A, ClassB and Class C of 30 patients each. QT interval was noted in allthe patients. QTc was calculated by Bazett’s formula. Fromabove parameters we try to find out whether there is anycorrelation between QTc and severity of disease.Results: The mean value of calculated QTc interval in: ClassA=0.474; Class B=0.490 and Class C=0.583. The QTc intervalincreased linearly with the severity of the disease and the pvalue was less than 0.001 which is highly significant.Conclusion: In our study we concluded that the prolongationof QTc interval is co-related with liver function and itsprevalence increases with the severity of liver dysfunction.Prolongation of the QTc interval was statistically confirmed inChild-Pugh C and B. The prolonged Q-T interval predictssevere arrhythmias and sudden death, and they are the idealcandidates for liver transplantation.

Relationship Of Blood Pressure With Qtc Interval And C-Reactive Protein

Background: C-reactive protein (CRP) is a systemic inflammatory marker used extensively. QTc interval representsboth ventricular depolarization and repolarization. Hypertension is one of the foremost leading causes ofmorbidity and mortality globally.Objectives: To explore the relationship of systolic blood pressure with QTc interval and CRP levels. Likewise toinvestigate the association of diastolic blood pressure with QTc interval and CRP levels.Materials and Methods: The study was carried out on 100 randomly selected subjects in the age group of 20-45years. Both genders were included. Hypertensive subjects on treatment were also included. Three records ofblood pressure in the supine position were obtained with 2 minute interval between each and average wasconsidered. QT interval and RR interval were measured from standard 12 lead electrocardiogram (ECG). Tangentmethod was used for QT interval and later it was corrected for heart rate to arrive at QTc interval using Bazett’sformula. CRP levels were obtained using high sensitivity (hs-CRP) assay kits.Results: There was a positive and significant association for systolic blood pressure with both QTc and CRP.Likewise we also found a positive and significant association for diastolic blood pressure with both QTc andCRP.Discussion: The inflammatory modulatory processes are altered in hypertension, thereby increasing CRP levels.CRP increases endothelin-1 and reduces nitric oxide leading to vasoconstriction and hypertension. Further CRPcauses autonomic imbalances by increasing sympathetic activity that lead to hypertension and indirectlyprolonging QTc interval. QTc interval is also lengthened by left ventricular hypertrophy as a complication ofhypertension.Conclusion: Hypertension with left ventricular hypertrophy can cause cardiac arrhythmias and sudden cardiacdeath. This may be prevented by early detection of high risk hypertensive subjects or even those prone todevelop hypertension using QTc and CRP indicators. Further these markers are cheap and widely used and theyprovide valuable diagnostic and prognostic features especially in developing countries like India.

A Study Of Prognosis Of Stroke With Special Reference To Electrocardiographic Changes And 2d-Echo.

Introduction: Stroke is the second most common cause of death and major cause of disability worldwide. Approximately 20 million people each year suffer from stroke of which 5 million do not survive. Cerebral infarction is responsible for about 80% of all rst ever in a lifetime strokes. There are many risk factors for cerebrovascular accidents like hypertension, diabetes, aneurysm & coagulopathy . This study was undertaken to determine ECG changes in stroke with diabetic and its prognostic signicance. Aims & Objectives: The present study aims to determine the 2D ECHO and ST-T changes among stroke patients and its implication in assessing prognosis. Material and Methods: The present study was carried out in100 patients admitted in department of medicine, S.S. medical college and associated S.G.M.H hospital, Rewa (M.P.) from july 2014 to Jun. 2015. Inclusion Criteria: The stroke patients of both sexes aged >16 years admitted to SGMH, Rewa. Neurodecit lasting >24 hours. Detailed neurological examination including fundoscopy and cardiovascular examination was carried out in all the cases. A12 lead ECG was done within 24 hours of admission. Result: th th Stroke was most common in 5 and 6 decade (55%). Males had higher preponderance among stroke patients (Male-female ratio 1.5:1). Hypertension was the most common risk factor in 45% of patients. In infarct the most common presenting complaints were headache(25%), Vomiting(19.11%) & Convulsion(8.82%). Such complaints were signicantly higher in hemorrhage Headache(65.62%), vomiting(78.12%) & convulsion(12.50%). Abnormal ECG changes were more common among hemorrhagic patients (78.12%) compared to infarct patients (67.64%). LVdysfunction was the most common abnormality noted in both groups i.e., infarct (23.53%) and hemorrhage (56.26%). Conclusion: ST segment depression in infarct(30%),hemorrhage(53.33%), QTc prolongation infarct(35.71),hemorrhage(46.66%) and prominent U wave infarct(50%),hemorrhage(53.33%) are the common ECG abnormalities in strokes. ECG abnormalities in stroke patients do not have any prognostic signicance. 2D echo abnormalities were more common among hemorrhage group (75%) than in infarct (44.12%). LV dysfunction showed signicant mortality in stroke patients and was statistically signicant (p<0.001).

The Advance of Escitalopram's Drug-induced QTc Prolongation / 中国药学杂志

Escitalopram, a selective serotonin re-uptake inhibitor (SSRI) antidepressant which is the (S)-enantiomer of citalopram, is worldwide used for the treatment of depressive and anxious disorders in clinical practice, however, recent data have indicated that high therapeutic escitalopram doses may cause the potential of QTc prolongation effect, which is a predisposing factor for arrhythmia. Nevertheless, in March 2012, the Food and Drug Administration (FDA) issued a safety bulletin advising the daily dosage of escitalopram should be restricted to a maximum of 20 mg daily in healthy adults and 10 mg maximum in high risk patients (eg>60 years of age). In this review, we aimed to investigate what factors can affect and how escitalopram gives rise to QTc prolongation.

Comparison of manual and automated measurement of QT interval on ECG at rest for males / 国际药学研究杂志

In order to perform the correct interpretation of corrected QT interval length (QTc), correct QT measurement (QT) is required. Inadequate QTc and QT measurements and calculations can lead to overdiagnosing, unjustified treatment for unaffected individuals, and underestimation of disease severity. This study investigates differences in length between manual and automated QT (QTc) on the ECG at rest and determines the causes of these differences. Analysis included 3925 ECG recordings of random men (age range 15+). QTc and QT intervals are measured with manual methods and automated algorithms. QTc and QT numeral values in 2 measurement methods matched in 4.3% of ECGs only. Most automated measurements (83.8%) were overestimated. Fraction of underdiagnosis of QTc prolongation cases over 440 msec for male for automated measurement and calculation was 20.4%, overdiagnosis share – 17.4%. Questionable automatic measurements of prolonged QT and QTc intervals should be supplemented by manual reevaluation and calculation of this interval. Most common differences in detecting QTc above 440 msec between manual and automated measurements involve the T wave (undetected T wave offset, T wave low amplitude, T wave alternation), altogether conditionated 53.3% of differences. 35% of those cases were connected with vague Q (R) wave. In 8.3% of cases, the cause of difference in QTc detection over 440 msec for manual and automated methods was not revealed.

Cambios electrocardiográficos en pacientes con VIH con y sin inhibidores de proteasa vs NNRTI / Differences in electrocardiographic changes in HIV patients with and without treatment with protease inhibitors vs NNRTI

Resumen ANTECEDENTES La infección por el virus de inmunodeficiencia humana (VIH) incrementa la prevalencia de prolongación del intervalo QT corregido (QTc), lo que es un factor independiente de eventos de enfermedad cardiovascular en esta población. En la bibliografía mundial se asocia este cambio con la administración de los antirretrovirales inhibidores de proteasa y efavirenz. Sin embargo, no se conocen datos de estos cambios en la población mexicana. MATERIAL Y MÉTODO Estudio prospectivo observacional en el que se seleccionaron expedientes de marzo de 2015 a mayo de 2016 de la consulta externa del Instituto Nacional de Enfermedades Respiratorias (INER); se dividieron en dos grupos: sin tratamiento, por reciente diagnóstico, y con tratamiento antirretroviral. Se registraron datos clínicos, tratamiento farmacológico, electrocardiograma y química sanguínea. RESULTADOS No se encontraron diferencias entre ambos grupos respecto a edad ni electrólitos séricos. Tampoco se encontró relación entre la prolongación del QTc con efavirenz o los inhibidores de proteasa. Raltegravir disminuyó la duración del QTc (p = 0.001) mientras que la coinfección por molusco contagioso se asoció con prolongación del QTc (p = 0.02). CONCLUSIÓN En nuestro estudio no logramos demostrar en población mexicana relación de la prolongación del QTc con los antirretrovirales de primera ni segunda línea. Se requieren más estudios para determinar la importancia clínica del efecto de raltegravir y molusco contagioso en el QTc.

Abstract BACKGROUND Human immunodeficiency virus (HIV) infection increases the prevalence of QTc prolongation (QTc), which is an independent factor of cardiovascular disease events in this population. In the world literature this change is associated with the use of the protease inhibitors and efavirenz antiretrovirals. However, no data are available on these changes in the Mexican population. MATERIAL AND METHOD A prospective observational study was done selecting records from March 2015 to May 2016 of the external consultation of the National Institute of Respiratory Diseases (INER), Mexico City; they were divided into two groups, those without treatment, because recent diagnosis, and with antiretroviral treatment. We recorded clinical data, pharmacological treatment, electrocardiogram and blood chemistry. RESULTS We found no differences between the two groups regarding age or serum electrolytes. We found no association between QTc prolongation and efavirenz or protease inhibitors. Raltegravir decreased QTc duration (p = 0.001) while molluscum contagiosum coinfection was associated with QTc prolongation (p = 0.02). CONCLUSION In our study, we failed to demonstrate in Mexican population association of QTc prolongation with first- and second-line antiretrovirals. More studies are needed to determine the clinical significance of the effect of raltegravir and molluscum contagiosum on QTc.

Study of clinical profile of organophosphorus poisoning with special reference to electrocardiographic changes and electrolyte derangement

Background: Organophosphorus Compounds (OPC) are main cause of accidental and suicidal poisoning in agrarian countries like India. Aim was to study the clinical profile of OPC-Poisoning and correlate it with the electrocardiographic (ECG) changes and electrolyte abnormalities.Methods: Hundred consecutive cases admitted to Medicine Department underwent clinical examination, ECG, electrolytes, Acetyl Choline Esterase (AChE) estimation from time to time and Paradeniya Organophosphorus Poisoning (POP) score at the time of admission. All these parameter with duration of hospital stay and outcome were statistically analysed using X2 test, Fisher exact test, and inference was drawn.Results: In hundred OPC-Poisoning patients [Male (n=48), Female (n=52), M: F ratio 0.92:1] with mean age of 37.78�.95 years, commonest poison was cholropyrifos+cypermethrin and was mostly suicidal (96%). Common symptoms were sweating (48%), salivation, blurring of vision, breathlessness and signs were smell of poison (90%), tachypnea, altered sensorium, miosis and fasciculation. POP scoring found 41% of patients in mild, 26% in moderate and 33% in sever grade of poisoning. Hospital stay ranged from 4-18 days. Complications were pulmonary Edema (PE) in 28%, Respiratory Failure (RF) 18%, Aspiration Pneumonia (AP) 15% and Intermediate Syndrome (IS) 4%. 10 died out of 42 patients who had complications and the cause of death was RF in 4, Ventricular Fibrillation (VF) 2 and IS in 2. ECG finding showed sinus tachycardia (31%), prolonged corrected QT (QTc) interval (28%), sinus bradycardia (25%), ST-T changes (17%) and Premature Ventricular Contraction (PVC) in 4% which degenerated to VF in 2%. 24 patients were Hypokalemic from which 16 developed complications.Conclusions: Similar to earlier studies we observed poisoning which was suicidal. QTc prolongation and Hypokalemia are associated with high morbidity and mortality in OPC-Poisoning.