RESUMO
Resumo Fundamento A associação entre o status de saúde cardiovascular ideal ( ideal cardiovascular health ( ICVH) e diagnóstico de fibrilação ou flutter atrial (FFA) foi menos estudado em comparação a outras doenças cardiovasculares. Objetivos Analisar a associação entre o diagnóstico de FFA e métricas e escores de ICVH no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Métodos Este estudo analisou dados de 13141 participantes com dados completos. Os traçados eletrocardiográficos foram codificados de acordo com o Sistema de Minnesota, em um centro de leitura centralizado. As métricas do ICVH (dieta, atividade física, índice de massa corporal, tabagismo, glicemia de jeju, e colesterol total) e escores do ICVH foram calculados conforme proposto pela American Heart Association . Modelos de regressão logística bruta e ajustada foram construídos para analisar associações de métricas e escores do ICVH com diagnóstico de FFA. O nível de significância foi estabelecido em 0,05. Resultados A idade mediana da amostra foi de 55 anos, e 54,4% eram mulheres. Nos modelos ajustados, os escores de ICVH não apresentaram associação significativa com diagnóstico de FFA prevalente [odds ratio (OR):0,96; intervalo de confiança de 95% (IC95%):0,80-1,16; p=0,70). Perfis de pressão arterial ideal (OR:0,33; IC95%:0,1-0,74; p=0,007) e colesterol total ideal (OR:1,88; IC95%:1,19-2,98; p=0,007) foram significativamente associados com o diagnóstico de FFA. Conclusões Não foram identificadas associações significativas entre escores de ICVH global e diagnóstico de FFA após ajuste multivariado em nossas análises, devido, ao menos em parte, às associações antagônicas da FFA com métricas de pressão arterial e de colesterol total do ICVH. Nossos resultados sugerem que estimar a prevenção da FFA por meio de escore de ICVH global pode não ser adequado, e as métricas do ICVH devem ser consideradas separadamente.
Abstract Background The association between ideal cardiovascular health (ICVH) status and atrial fibrillation or flutter (AFF) diagnosis has been less studied compared to other cardiovascular diseases. Objective To analyze the association between AFF diagnosis and ICVH metrics and scores in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods This study analyzed data from 13,141 participants with complete data. Electrocardiographic tracings were coded according to the Minnesota Coding System, in a centralized reading center. ICVH metrics (diet, physical activity, body mass index, smoking, blood pressure, fasting plasma glucose, and total cholesterol) and scores were calculated as proposed by the American Heart Association. Crude and adjusted binary logistic regression models were built to analyze the association of ICVH metrics and scores with AFF diagnosis. Significance level was set at 0.05. Results The sample had a median age of 55 years and 54.4% were women. In adjusted models, ICVH scores were not significantly associated with prevalent AFF diagnosis (odds ratio [OR]:0.96; 95% confidence interval [95% CI]:0.80-1.16; p=0.70). Ideal blood pressure (OR:0.33; 95% CI:0.15-0.74; p=0.007) and total cholesterol (OR:1.88; 95% CI:1.19-2.98; p=0.007) profiles were significantly associated with AFF diagnosis. Conclusions No significant associations were identified between global ICVH scores and AFF diagnosis after multivariable adjustment in our analyses, at least partially due to the antagonistic associations of AFF with blood pressure and total cholesterol ICVH metrics. Our results suggest that estimating the prevention of AFF burden using global ICVH scores may not be adequate, and ICVH metrics should be considered in separate.
RESUMO
Background: Poisoning with Thevetia peruviana (yellow oleander) is commonly observed in Northern and Eastern provinces of Sri Lanka causing significant morbidity and mortality. It contains cardiac glycosides which are toxic to cardiac muscle that results in cardiovascular dysrhythmias. Objective: To determine the pattern of cardiac dysrhythmias and outcome of yellow oleander poisoning at a tertiary care center of Northern Sri Lanka. Methods: A descriptive, cross sectional, prospective study was carried among patients with yellow oleander poisoning admitted to Teaching hospital, Jaffna, Sri Lanka over a period of two years. Twelve lead standard electrocardiography and 2‑lead ECG monitoring were performed in all patients during the hospital stay at the cardiology unit. Data were entered in Microsoft Excel sheet and was analyzed using SPSS [version 21] analytical package. Results were presented as counts, percentages and mean ± SD for continuous variables. Results: 23 out of 44 patients were females. Mean age of the patients was 24.84 [SD ± 0.43] years. Most of the patients were symptomatic and presented with gastro intestinal symptoms like vomiting, abdominal pain and diarrhea. Bradycardia was the most commonly observed cardiac rhythm abnormality within the first 24 hrs of ingestion of yellow oleander seeds. Sinus bradycardia [75%] was the commonest cause for bradycardia. All patients were treated with multiple doses of activated charcoal irrespective of the time of presentation. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and 12 of them needed temporary pacing. Conclusion: Most of the victims of Yellow oleander poisoning were young adults. The cardiac toxicity developed within 24 hours of ingestion of the seeds. The risk of toxicity has not related to the number of seeds consumed. Most patients have nonspecific symptoms. AV conduction abnormalities are common. Activated charcoal is useful in most cases.