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)

Alteraciones electrocardiográficas en una cohorte de pacientes con miocardiopatía hipertrófica septal asimétrica / Electrocardiographic changes in patients with septal asymmetric hypertrophic cardiomyopathy

Introducción: ciertos hallazgos del electrocardiograma (ECG) de superficie sugieren el diagnóstico de miocardiopatía hipertrófica (MCH) y se correlacionan directamente con su expresión fenotípica. Sin embargo, las modificaciones ECG han sido escasamente descritas en series locales y regionales. El objetivo de este estudio fue caracterizar los cambios ECG en la MCH, correlacionándolos con variables clínicas y estructurales. Método: se interpretaron los ECG en una cohorte de 26 pacientes con MCH septal asimétrica referidos a la policlínica especializada del Centro Cardiovascular Universitario del Uruguay. Todos los pacientes fueron estudiados con ecocardiograma Doppler y 13 de ellos, además, con resonancia nuclear magnética cardíaca (RNMC) para evaluar la presencia, extensión y distribución del realce tardío de gadolinio (RTG) como marcador de fibrosis intramiocárdica. La correlación de los hallazgos ECG con los síntomas, severidad de la hipertrofia y presencia y extensión de la fibrosis intramiocárdica se analizó mediante la prueba exacta de Fisher o el test no paramétrico de Mann-Whitney. Resultados: el hallazgo de un ECG normal fue muy infrecuente en nuestra serie (8,0%). Las alteraciones ECG más comunes se observaron en la repolarización ventricular (76,9%) bajo forma de sobrecarga sistólica (42,3%) e inversión de la onda T (30,7%). Los signos de sobrecarga auricular izquierda (53,8%), hipertrofia ventricular izquierda (61,5%), fragmentación del QRS (46,2%) y ondas Q anormales (30,7%) fueron menos frecuentes. Los criterios de hipertrofia no se correlacionaron con los síntomas, el espesor parietal, la obstrucción al tracto de salida del ventrículo izquierdo ni la presencia de RTG en la RNMC. No encontramos asociación significativa entre la fragmentación del QRS o la presencia de ondas Q y el hallazgo de RTG en la RNMC. Aunque los pacientes con hipertrofia septal más severa presentaban extensas áreas de fibrosis, esta relación no alcanzó significación estadística. Conclusión: el trazado ECG es anormal en la gran mayoría (92,0%) de los pacientes con MCH septal asimétrica, y se caracteriza por alteraciones diversas, lo que confirma su utilidad como herramienta de tamizaje. Sin embargo, en nuestra serie los hallazgos ECG no se correlacionan con los síntomas, el espesor parietal ni la presencia de fibrosis intramiocárdica. La contribución diagnóstica de signos ECG combinados y su potencial valor pronóstico en diferentes variantes fenotípicas de MCH merecen ser evaluados en series locales más amplias.

Introduction: in many cases, surface ECG suggests the diagnosis of hypertrophic cardiomyopathy (HCM) and is directly related to phenotypic expression. However, ECG changes have been not fully described in regional and local case series. Our study was aimed to characterize the ECG abnormalities in patients with HCM, correlating these findings with clinical and structural variables. Method: ECG recordings were interpreted in a cohort of 26 subjects with asymmetric septal HCM. All patients were studied by echocardiogram, adding MRI in 13 cases to evaluate the presence, extension and distribution of late gadolinium enhancement (LGE) as a marker of myocardial fibrosis. The correlation of ECG findings with symptoms, severity of hypertrophy and presence and extension of myocardial fibrosis was analyzed using Fisher's exact test or non-parametric Mann-Whitney test. Results: the presence of a normal ECG was very infrequent in our sample (8,0%). The most common ECG abnormalities were observed in ventricular repolarization (76,9%) as systolic overload (42,3%) and T wave inversion (30,7%). ECG signs suggesting left atrium dilation (53,8%), left ventricle hypertrophy (LVH) criteria (61,5%), QRS fragmentation (46,2%) and abnormal Q waves (30,7%) were less frequently found. LVH was not correlated with symptoms, wall thickness, left ventricular outflow tract obstruction or presence of LGE. We found no significant relationship between LGE and fragmented QRS or abnormal Q waves. While patients with more severe septal hypertrophy exhibited large areas of LGE, this relationship did not reach statistical significance. Conclusion: in our cohort, the ECG is abnormal in 92,0% of patients with asymmetric septal HCM and is characterized by various alterations, confirming its usefulness as a screening tool. However, the findings in the ECG did not correlate closely with symptoms, amount of hypertrophy or presence of myocardial fibrosis. Larger local series must evaluate diagnostic contribution of combined ECG findings and its potential prognostic value in different phenotypic variants of HCM.

Importância da eletrocardiografia como um exame pré-cirúrgico em cães / Importance of electrocardiography as a pre-operative examination in dogs

Foi analisado o perfil eletrocardiográfico pré-cirúrgico de 124 cães submetidos a diferentes intervenções cirúrgicas com objetivo de relacionar as variáveis idade, sexo, porte, ausência ou presença de alterações cardiovasculares detectadas durante o exame físico e afecção cirúrgica com os achados eletrocardiográficos. Não foi observada associação entre essas variáveis e as alterações eletrocardiográficas. Um total de 79 animais (63,7%) apresentou algum tipo de alteração no eletrocardiograma. Assim, este estudo sugere que o exame eletrocardiográfico pré-cirúrgico é de grande valia, independente do sexo, idade, peso, histórico ou sinais clínicos associados a doença cardíaca.(AU)

An analysis of the pre-surgical electrocardiographic profile was made of 124 dogs submitted to different surgical interventions to correlate the variables age, sex, size, absence or presence of cardiovascular abnormalities detected during physical examination and of the surgical cases with electrocardiographic findings. No association between these variables and electrocardiographic changes were observed. A total of 79 cães (63.7%) showed some type of change in the electrocardiogram. The study suggests that pre-surgical electrocardiographic examination is of great importance, regardless of sex, age, weight, historic or clinical signs associated with heart disease.(AU)

Prevalence of oral anticoagulation in atrial fibrillation

OBJECTIVES: Atrial fibrillation is the most common sustained arrhythmia and is associated with poor outcomes, including stroke. The ability of anticoagulation therapy to reduce the risk of stroke has been well established; however, the prevalence of anticoagulation therapy use in the Public Health System is unknown. The aim of this study is to evaluate both the prevalence of anticoagulation therapy among patients with atrial fibrillation and the indications for the treatment. METHODS: In this cross-sectional study, we included consecutive patients who had atrial fibrillation documented by an electrocardiogram performed between September 2011 and March 2012 at a university hospital of the Public Health System. The variables analyzed included the risk of a thromboembolic event and/or bleeding, the use of antiplatelet or anticoagulation therapy, the location where the electrocardiogram report was initially reviewed and the specialty of the physician who initially reviewed it. RESULTS: We included 162 patients (mean age 68.9 years, 56% men). Hypertension (90.1%), heart failure (53.4%) and stroke (38.9%) were the most prevalent diseases found. Only 50.6% of the patients knew that they had atrial fibrillation. Regarding the use of therapy, only 37.6% of patients classified as high risk according to the CHADS2 scores and 35.5% according to the CHA2DS2VASc used oral anticoagulation. A presumptive diagnosis of heart failure and the fact that the electrocardiogram was evaluated by a cardiologist were the only independent predictors of the use of anticoagulants. CONCLUSIONS: Our study found a low prevalence of oral anticoagulation therapy among patients with atrial fibrillation and an indication for stroke prophylaxis for the use of this therapy, including among those with high CHADS2 and CHA2DS2VASc scores. .

Prevalence of normal electrocardiograms in primary care patients / Prevalência de eletrocardiogramas normais em pacientes da atenção primária

Objective: Knowing the proportion the proportion of normal and abnormal electrocardiograms (ECGs) in primary care patients allows us to estimate the proportion of exams that can be analyzed by the general practitioner with minimal training in ECG interpretation, in addition to being epidemiologically relevant. The objective of this study is to assess the prevalence of normal ECGs in primary care patients. Methods: all digital ECGs analyzed by the cardiologists of Telehealth Network of Minas Gerais (TNMG) in 2011 were evaluated. TNMG is a public telehealth service that provides support to primary care professionals in 662 municipalities in the state of Minas Gerais, Brazil. Results: during the study period, 290,795 ECGs were analyzed (mean age 51 ± 19 years), 57.6% were normal. This proportion was higher in women (60.1 vs 57.6%, p <0.001) and lower in patients with hypertension (45.8% vs 63.2%, p <0.001) or diabetes (43.3% vs 63.2%, p <0.001). A progressive reduction in the prevalence of normal ECG with increasing age was observed. Among the ECGs of patients under investigation for chest pain, 58.7% showed no abnormalities. Conclusion: the prevalence of normal ECGs in primary care patients is higher than 50% and this proportion decreases with age and comorbidities. Most ECGs performed for investigation of chest pain in primary care shows no abnormality. .

Objetivo: o conhecimento da proporção de eletrocardiogramas (ECG) normais e alterados em pacientes atendidos na atenção primária permite estimar a proporção de exames que pode ser analisada pelo médico generalista com formação mínima na interpretação do ECG, além de ter relevância epidemiológica. O objetivo deste estudo é avaliar a prevalência de ECG sem alterações em pacientes atendidos na Atenção Primária. Métodos: todos os ECG digitais analisados pelos cardiologistas da Rede de Teleassistência de Minas Gerais (RTMG) no ano de 2011 foram avaliados. A RTMG é um serviço público de telessaúde, que atende a atenção primária em 662 municípios em Minas Gerais, Brasil. Resultados: no período do estudo, 290.795 ECG foram analisados (idade média 51±19 anos) e 57,6% deles eram normais. Essa proporção foi maior em mulheres (60,1 vs. 57,6%, p < 0,001) e menor em pacientes com hipertensão (45,8% vs. 63,2%, p < 0,001) ou diabetes (43,3% vs. 63,2%, p < 0,001). Foi observada redução progressiva na prevalência de ECG normal com o aumento da idade. Entre os ECG de pacientes em investigação para dor torácica, 58,7% não apresentaram alterações. Conclusão: a prevalência de ECG normais em pacientes da atenção primária é superior a 50% e essa proporção diminui com a idade e a presença de comorbidades. A maioria dos ECG realizados para investigação de dor torácica na atenção primária não tem alterações. .

P wave dispersion and severity of obstructive sleep apnea syndrome

OSA is associated with an increased prevalence of coronary artery disease heart failure and rhythm disturbance. Also, P-wave dispersion [Pd] reflects inhomogeneous atrial depolarization secondary to insults such as chronically elevated atrial pressure, ischemia, or metabolic stress that promote atrial structure remodeling and provide a substrate for atrial fibrillation. We aimed to investigate Pd in patients with OSA and to determine if there is any relationship with severity of the disease. This study was conducted in Chest and Cardiology Departments, Assuit University Hospital, Egypt on 40 OSA patients [29 males and 11 females], and 20 healthy controls. We excluded patients with COPD and any diagnosed cardiac disease. For every patient, we did a polysomnography and ECG. Pd was significantly more in OSA [98.50 +/- 4.77 m/s] than controls [72.00 +/- 3.37 m/s] Rvalue <0.05]. Pd in severe, moderate and mild OSA were 111.43 +/- 5.62 m/s, 95.00 +/- 7.83 m/s ando5.71 +/- 8.41 m/s, respectively with a significant positive correlation with severity of OSA. Multiple linear regression shows that systolic blood pressure and BMI are independently associated with Pd [beta = 0.56, p = 0.00] [beta = 0.27, p = 0.05]. Pd is increased and correlated with severity of OSA. Systolic blood pressure and BMI are independent risk factors for Pd. Follow up of patients to detect clinical implications is recommended

Value of cardiac biomarkers in patients with acute pulmonary embolism

Prognostic stratification of patients with PE is important in management and potentially improve clinical outcome. Cardiac biomarkers are used as an adjunct to clinical and echocardiographic risk stratification in a variety of circumstances, [Creatine-kinase-MB [CK-MB]] and cardiac troponin I [cTnl] are most widely used because of their high sensitivities, and very high specificity of troponin for heart muscle injury. Evidence is mounting that myoglobin's sensitivity for myocardial necrosis combined with its unique release and clearance properties may render it particularly attractive as a risk marker either alone or in combination with other markers. The aim of the current study is to assess the levels of cardiac specific biomarkers in relation to different clinical, ECG and echocardiogrphic findings in patients with acute PE, as well as evaluating the prognostic value of these biomarkers for inhospital mortality and adverse clinical events. This study comprised 40 patients with proved PE [22 males and 18 females], their mean age was 50.05 +/- 13.09 years [range 22-70 years]. The following investigations were performed for all patients; 12-leads ECG, Full echo Doppler study, spiral CT of the chest, and laboratory testing: arterial blood gas, serum myoglobin, serum troponin, total CK and CK-MB, kidney and liver function tests. Significant elevation of CK-MB [> 10 micro/L] was noted only in 7.5% of patients, while cardiac cTnl was elevated [>/= 0.07 ng/ml] in 45% of patients and elevated serum myoglobin was found very early after symptoms [<4 h] in 55% of patients. Elevated serum cTnl and myoglobin were significantly associated with ECG signs of right ventricular strain and echocardiographic evidence of right ventricular dysfunction. The results of the present study demonstrate the prognostic value of cardiac specific biomarkers, cardiac troponin I and myoglobin in acute pulmonary embolism. Thus, the current data combined with the results of previous studies strongly support the integration of troponin and myoglobin testing into the risk stratification and management of patients with established acute PE

Quantification of non-calcified and calcified coronary plaques using 64-slice MDCT in patients with acute coronary syndrome

To investigate the accuracy of 64-row MDCT to analyze and quantify coronary arterial plaques in patients presented with acute coronary syndrome [ACS]. Between April 2010 and December 2013, 50 patients presented with acute cardiac chest pain were categorized into 2 groups according to their diagnosis based on clinical evaluation, ECG findings and cardiac biomarkers; group A including patients with ACS and group B including patients with stable angina [SA]. Both groups underwent 64-row multidetector CT [MDCT] coronary arterial imaging. For each plaque, stenosis percentage was evaluated and the plaque was quantified using software [Sureplaque[registered]] based on the density [HU] and percentage of its individual components including lipid, soft tissue, and calcium density. Of the 50 patients; 24 and 26 were grouped into groups A and B respectively. The mean value of stenosis percent of the proximal and middle coronary segments of group A patients = 77.2% +/- 10.2% - 90.5% +/- 58.4% and 79.5% +/- 9.1% - 85.25% +/- 11% respectively, while in group B = 54.1% +/- 12.1% - 65.2% +/- 18.4% and 53.3% +/- 1.5% - 68.6% +/- 11.7% respectively [p=0.00-0.001]. Quantification showed a mean value of lipid content percentage of group A = 15.4% +/- 0.8% - 47.7% +/- 19.2%, while in group B = 7.2% +/- 5.5% - 10.3% +/- 8.2% [p=0.008-0.001]. The mean value of soft tissue content percentage in group A = 15.4% +/- 0.8% - 47.7% +/- 19.2%, while in group B = 7.2% +/- 5.5% - 10.3% +/- 8.2%. The calcification content percentage in group A = 18% +/- 8.7% - 35.1% +/- 16%, while in group B = 66.4% +/- 13.8% - 76.7% +/- 16.5%. 64-row MDCT angiographic quantification software provides a good basis for the future attempts of proper risk stratification of patients with coronary artery disease especially those liable for developing ACS

Emissão de laudos eletrocardiográficos a distância: experiência da rede catarinense de telemedicina / Issuing electrocardiographic reports remotely: experience of the telemedicine network of Santa Catarina

FUNDAMENTO: Cresce o uso da Telemedicina, especialmente no envio e na avaliação de eletrocardiograma (ECG). É um procedimento de baixo custo, com alto potencial de salvar vidas. OBJETIVO: Descrever a forma de análise sistemática e o perfil do usuário da Rede Catarinense de Telemedicina quando o laudo era emitido de forma livre. MÉTODOS: Estudo observacional, transversal, determinando as associações entre características dos pacientes e diagnósticos eletrocardiográficos emitidos, dentre os usuários da Rede Catarinense de Telemedicina quando o laudo era fornecido de forma livre. Esse sistema estava conectado a 287 cidades de Santa Catarina, os exames eram feitos nos locais de origem e emitidos os laudos em três hospitais terciários. Entre 2005 e 2010, os laudos eram emitidos de forma livre e foi criado um método probabilístico para análise dos dados. Um cardiologista experiente avaliou todos os ECG para aferir a chance de anormalidade. RESULTADOS: Foram avaliados 243.363 ECG. A maioria (58%) foi realizada em pacientes com mais de 50 anos e proveniente da atenção primária (72%). Houve diferenças de frequência por região, parcialmente relacionado com número de cardiologistas/região (r = -0,551), com a distância dos centros terciários e com possíveis diferenças de aceitação do método. Cerca de 53% do ECG foram anormais, com maior frequência quanto maior a idade (r2 = 0,8166), e com diferenças regionais também significantes (p < 0,0001). CONCLUSÃO: Foi construído um sistema de análise dos dados integrando termos prevalentes, análise probabilística e dicionários especializados. O sistema tem atendido uma parcela significativa da população catarinense, principalmente idosos, da rede básica e de regiões remotas do estado.

BACKGROUND: A growing use of telemedicine has been observed, especially as regards the sending and evaluation of electrocardiograms (ECG); this is a low-cost procedure with a high potential to save lives. OBJECTIVES: To describe the form of systematic analysis and user profile of the Telemedicine Network of Santa Catarina during the time when the report was issued freely. METHODS: Observational cross-sectional study determining the associations between patient characteristics and electrocardiographic diagnoses issued among users of the Telemedicine Network of Santa Catarina during the time when the report was issued freely. This system was connected to 287 cities in Santa Catarina; the tests were done in the places of origin and the reports were issued in three tertiary-care hospitals. From 2005 to 2010 the reports were issued freely and a probabilistic method for data analysis was created. An experienced cardiologist evaluated all ECGs to assess the chances of abnormality. RESULTS: 243,363 ECGs were evaluated. The majority (58%) was performed on patients older than 50 years from primary care services (72%). There were differences in the frequency per region; this was partly related to the number of cardiologists/region (r = -0.551), to the distance from tertiary-care centers and potential differences of acceptance of the method. Approximately 53% of the ECGs were abnormal with greater frequency with increasing age (r² = 0.8166) and with significant regional differences (p < 0.0001). CONCLUSIONS: We built a data analysis system integrating prevalent terms, probabilistic analysis and specialized dictionaries. The system has covered a significant portion of the population of Santa Catarina, mainly elderly patients from the network of primary healthcare centers and remote regions of the State.

Nocturnal heart rate variability analysis as a screening tool for obstructive sleep apnea syndrome

Recurrent intermittent hypoxia and subsequent increased sympathetic nervous system activity have been adopted as possible mechanisms underlying cardiac rhythm disturbances in obstructive sleep apnea syndrome [OSAS]. We analyzed nocturnal heart rate variability [HRV] in 80 patients [74 males, 6 females, mean age 47.01 +/- 10 yrs] with polysomnographically verified OSAS to assess the changes in nocturnal HRV indices, and to investigate the correlation between these changes to the severity of OSAS. The 80 patients were subdivided into 2 subgroups based upon the severity of OSAS; the first subgroup consisted of 27 patients with mild-to-moderate OSAS, while the second subgroup consisted of 53 patients with severe OSAS. For control group, 25 healthy individuals were included in the study. In time-domain analysis, the mean of the standard deviation of all RR intervals for all 5-min segments [SDNN index] was significantly different between patients with OSAS and control as well as among different stages of severity of OSAS [p = 0.02, and p = 0.046, respectively]. The standard deviation of all RR intervals [SDNN] was significantly different between patients with OSAS and control [p = 0.039]. HRV triangular index was significantly different among different stages of severity of OSAS [p = 0.023]. Frequency-domain variables namely total power, very low frequency [VLF] power, and low frequency [LF] power were significantly increased in patients with OSAS in comparison to control [p = 0.01, p = 0.024, and p = 0.018, respectively], as well as among OSAS subgroups [p = 0.01, p = 0.02, and p = 0.04, respectively]. Stepwise multiple logistic regression analysis revealed that AHI correlated positively with SDNN [r = 0.247, p = 0.036], SDNN index [r = 0.306, p = 0.009], total power [r = 0.323, p = 0.006], VLF power [r = 0.248, p = 0.037], LF power [r = 0.384, p = 0.001], and LF/HF ratio [r = 0.342, p = 0.004], but correlated negatively with RR interval [r = - 0.247, p = 0.036]. OSAS predisposes to clinically significant nocturnal impairment of the cardiac autonomic function as evidenced by nocturnal HRV analysis and this impairment was correlated to the severity of OSAS. Accordingly, HRV can serve as a simple, powerful screening tool for cases with suspected OSAS

Pulmonary arterial hypertension: literature review

Pulmonary arterial hypertension [PAH] is a fatal disease as it results in a very bad damage to the pulmonary vasculature which progress gradually to cause right ventricular failure. In idiopathic PAH there is hypertrophy and hyperplasia of the pulmonary arteries which eventually obliterate the vessel, and in more advanced stages thrombosis The classification of PAH has undergone several revisions, the latest was during the 4[th] World Symposium held in 2008, few modifications were adopted concerning Group 1 and Group 4. Many pathways are involved in the abnormal proliferation and contraction of the smooth muscle cells of the pulmonary arteries in patients with PAH. Three of these pathways are important: endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, and prostacyclin derivatives. The aim of medical treatment is to dilate the pulmonary vasculature and reverse the abnormal remodeling characteristic of pulmonary vascular disease. The practical difficulties encountered in treating children influence management and include their age, level of understanding, size, and in some, and the presence of other anomalies.Monitoring patients are normally monitored through commonly available tests such as pulse oxymetery, arterial blood gas tests, CXR, serial ECG's, serial echocardiograms, and spirometry or more advanced lung function tests. The prognosis of pulmonary hypertension varies in between different diagnostic groups. In general, the prognosis is poor with no definitive cure for it. Patients whose disease progresses and is unresponsive to medical treatments either undergo transplantation or die of progressive right-sided heart failure. Certain types of pulmonary venous hypertension has poorer prognosis especially in pediatric patients. Although the disease is * fatal, trials to get more effective treatments are being held in many centers, and great efforts should be done to clarify the complete patho-physiological process

Interferon Induced Myocardial Disorders mhepatitis C Virus Patients

Hepatitis C virus [HCV] infection is the most common cause of newly diagnosed chronic liver disease. Prevention of HCV complications can be achieved by antiviral therapy. Cardiovascular complications occurred in clinical trials of interferon. The most common presentations of cardio toxicity were cardiac arrhythmias, dilated cardiomyopathy, symptoms of IHD, and low-level conduction impairment or reversible hypertension. This study aimed to investigate the left ventricular systolic and diastolic functions in hepatitis c virus patients treated by interferon alfa. The study included 50 Egyptian cases infected by Hepatitis C virus and was candidate for treatment by Interferon alpha. After initial cardiac evaluation, IFN-alpha 2b was administered once weekly for 6 months, and cardiac evaluation [medical history, physical examination, ECG, systolic and diastolic function parameters by echocardiography] was performed on the 6th month of therapy. In this study, abnormal findings were detected in some patients: dilated cardiomyopathy, early diastolic dysfunctions, mild thickening of the left ventricle, atrial extra systole, and ST segment depression. All of our results were statistically non significant [p-value >0.05]. There was no significant change or adverse effects due to the virus C itself or Interferon alpha therapy. Findings support the tolerability of human leukocyte Interferon alpha for treatment of patients with chronic hepatitis C

Evaluación del conocimiento del patrón electrocardiográfico en estudiantes de Medicina de la universidad de Manizales de octavo a décimo semestre: año 2008 / Evaluation of the electrocardiographic pattern knowledge in medicine students of the university de Manizales of eighth to tenth semester in 2008

Introducción. Las estadísticas de morbi-mortalidad del departamento de Caldas(Colombia) muestran el infarto de miocardio en los primeros lugares, por ello surge el interés de investigar el grado de conocimiento en la interpretación del patrón electrocardiográfico en los estudiantes de Medicina de la Universidad de Manizales. Materiales y Métodos. Un estudio descriptivo correlacional, en el cual se evalúa el conocimiento del patrón electrocardiográfico en 99 estudiantes de Medicina de la Universidad de Manizales. Se diseñó un cuestionario para evaluar el conocimiento del patrón electrocardiográfico que consta de preguntas de selección múltiple con única respuesta, preguntas falso-verdadero y una evaluación práctica. Resultados. Se observa que los semestres noveno y décimo muestran una calificación promedio significativamente mayor que octavo; y una tendencia a que los estudiantes con promedios más altos logren mejores puntuaciones en el cuestionario. La calificación promedio fue de 1,82. No se encontraron otras diferencias significativas. Conclusiones. Se recomienda implementar estrategias de educación continuada o actualizaciones periódicas que garanticen la adecuada retención del conocimiento. La mayoría de los estudiantes incluidos en el estudio consideran que el método de enseñanza es inadecuado, aunque se reconoce la clase de electrocardiografía interesante, recomiendan mejorar la metodología. La principal falencia identificada es la falta de práctica clínica electrocardiográfica. Los casos clínicos y pacientes virtuales podrían ser la estrategias que motiven al estudiante y satisfaga el enfoque teórico practico que se reclama.

Prevalence of coronary heart disease among Tehran adults: Tehran Lipid and Glucose Study

This study is the first report on the prevalence of coronary heart disease [CHD] and its associated risk factors in adult residents of Tehran. Standard supine ECG data were collected for 5984 men and women aged > /= 30 years and coded by Minnesota criteria. All major cardiovascular risk factors were also measured. Based on Rose angina, self-reported history of CHD or ECG-defined CHD, the aged-adjusted prevalence of CHD was 21.8% [22.3% in women and 18.8% in men]. Variables independently associated with CHD were female sex, age, systolic blood pressure, 2-hour postprandial glucose, body mass index, waist-to-hip ratio and LDL/HDL cholesterol ratio

Fator prognóstico do infarto agudo do miocárdio com supradesnível de ST / Prognosis factor of acute myocardial infarction with ST elevation

Objetivos: Conhecer a relação entre a área cardíaca infartada observada no eletrocardiograma e os níveis séricos dos marcadores isquêmicos CPK e CK-MB com o desfecho dos pacientes.Métodos: Estudo transversal, documental, observacional e retrospectivo abrangendo 96 pacientes infartados atendidos no Hospital São José, em Criciúma, SC, no período de 2003 a 2005. As variáveis estudadas foram sexo, idade, área cardíaca infartada, nível de enzimas e desfecho dos pacientes. Resultados: Dos pacientes estudados, 73 (76,04%)eram do sexo masculino e 23 (23,96%) feminino com média de idade de 60,1 anos. Observou-se maior prevalênciada mortalidade no sexo feminino (p=0,033) e em idades mais avançadas (p=0,02). Houve maior freqüênciade infarto agudo do miocárdio na parede inferior, e maior mortalidade naqueles com lesão da parede ântero- lateral. Os níveis dos marcadores isquêmicos forammaiores no sexo feminino e nos pacientes que evoluíram para óbito, não mostrando relação com a mortalidadeem uma parede infartada específica.Conclusão: Das variáveis estudadas, sexo e idade foram estatisticamente significativas quando relacionadas com o desfecho dos pacientes. Na análise dos níveis enzimáticos em uma parede cardíaca específica, não se observou associação significativa com óbito.

Objectives: To know the relation between the infarct cardiac area detected in electrocardiogram andserum levels of the ischemic markers CPK and CKMB with outcome of the patients. Methods: Transversal, document, observational and retrospective study ranging 96 infarcted patients checked in São José Hospital in Criciúma City, SC, from 2003 to 2005. The variables studied were sex, age, infarct cardiac area, enzymes level and outcome of the patients. Results: From the studied patients, 73 (76,04%) weremale and 23 (23,96%) female, with median age of 60,05 years. It was observed more prevalence of the mortality in women (p=0,33) and in advanced ages (p=0,02). There were most frequency of acute myocardial infarction in the inferior wall and more mortality on those with ântero-lateral lesion. The ischemic markers levels werehigher in females and in patients who died, not showing relation with mortality in a specific infarcted wall. Conclusion: From the studied variables, sex and age were statistically significant when related with the outcome of the patients. In the enzymes level analysis of aspecific cardiac wall it wasn’t observed significant relation with death.

Incidence of ventricular arrhythmias, brady-arrhythmias and sudden cardiac death in Sudanese patients with acute myocardial infarction

Ventricular arrhythmias [VAS], including ventricular tachycardia [VT], ventricular fibrillation [VF] and Brady-arrhythmias, are life-threatening complications of acute myocardial infarction [MI]. To study the incidence of ventricular arrhythmias, brady-arrhythmias and Sudden Cardiac Death [SCD] in Sudanese patients with acute MI. This is a prospective cross sectional, hospital based study, conducted at Elshaab Teaching Hospital Khartoum Sudan. One Hundred Sudanese patients with acute MI were enrolled in the study in the period between August 2006 and December 2006. A questionnaire was constructed in sections to address the different aspect of the study group. ECG Monitor was used to confirm the complication in every patient. Of the study group forty seven [47%] patients were 55-65 years old, twenty eight [28%] were more than 65 years old and twenty five [25%] were less than 55 years old. Sixty nine [69%] were males. Twenty patients [20%] developed complications [ventricular arrhythmias [VAS], Brady-arrhythmias and SCD]. The incidence of ventricular arrhythmias, brady-arrhythmias and sudden cardiac death following acute myocardial infarction were significantly high in Sudanese patients. The increased incidence is even in all age groups. DM, smoking and past history of IHD are the commonest associated risk factors. Thrombolysis is under used and had no significant impact

Estudo comparativo entre a avaliaçao livre, dirigida e automatizada na assistência ao diagnóstico eletrocardiográfico em crianças e adolescentes / Comparative study among the free evaluation, guided and automatized in the assistance to the electrocardiographic diagnosis in children and adolescents

Para avaliar a precisão da análise segmentar em eletrocardiografia pediátrica por cardiologistas, três diferentes métodos foram confrontados. No primeiro, avaliação livre, a normalidade segmentar é questionada e o entrevistado tem liberdade para aferição métrica, caso necessário. No segundo, avaliação dirigida, a mesma pergunta é formulada, porém com a imposição de uma aferição prévia do segmento No terceiro, avaliação automatizada, apenas a aferição é solicitada e submetida a um software de interpretação segmentar para ECG pediátrico com uma tabela de normalidade. As respostas foram comparadas às análises de dois cardiologistas (controle). O viés interpretativo foi significativamente menor na avaliação automatizada e a aferição precedente não modificou as interpretações não automatizadas...

To establish the precision of segmental analyses in pediatric electrocardiography by cardiologists, three different methods were confronted. In the first one, free assessment, the segment normality is questioned and the practitioner is allowed to quantitatively check the ECG, if needed. In the second, guided assessment, the same question is formulated, but the preliminary inspection of the segment is mandatory. In the third, automated assessment, only the inspection is requested and submitted to segmental interpretation software for pediatric ECG with an embedded table of normality. All answers were compared to the analysis of two cardiologists (control). Interpretative bias was significantly lower in the automated assessment and preceding inspection has not modified the non automated interpretations...

Electrocardiographs diagnosis of left ventricular hypertrophy: comparison with echocardiography

The present study was conducted to determine the sensitivity and specificity of electrocardiographic criteria for the assessment of left ventricular hypertrophy by comparing it with the gold standard of echocardiography. Fifty clinically diagnosed patients of LVH were included in this collaborative study of Dept. of Physiology, Army Medical College, Rawalpindi and Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi. ECG of the patients were recorded and Romhilt-Estes point score calculated. This was followed by echocardiography and left ventricular mass and left ventricular mass index was calculated. It was found that Romhilt-Estes point score system of ECG had a sensitivity of 35% and specificity 90%. It is concluded that the sensitivity of ECG is low in detecting LVH, however, sensitivity can be increased by combining Sokolow Lyons voltage criteria and Cornell voltage criteria with Romhilt-Estes point score. ECG is however still recommended as a routine investigation because of its cost effectiveness and easy availability

Case report: a 14 days old neonate with intracardiac mass

Amjad was a 14 days old neonate, presented with progressive bluish coloration. He initially started on breast feeding but later on was noticed by mother to stop frequently during feeds, cry excessively and developed bluish disceleration of mucosa and lips. On examination, the baby was blue, cold and dehydrated. He had pulse of 150/min, respiratory rate of 60/ min, blood pressure of 80/50 mm of Hg, oxygen saturation of 78% and afebrile. The neonate had a severe perianal rash extending into groins. On cardiovascular examination, apex beat was in left 4th intercostal space lateral to midclavicular line. He had a 3/6 pansystolic murmur at lower left sternal edge with normal heart sound. An S3 gallop was noticed as well as prominent neck veins were seen and liver was tender on palpation. The relevant investigations were carried out revealing Hb of 21g/dl. The 12 lead ECG revealed heart rate of 140/min, PR interval of 80 msec, RSR` in V1 QT interval of 0.2 sec. On chest X-ray cardiomegaly was noticed along with plethoric lung fields. Two dimensional echocardiogram revealed situ solitus, levocardia, AV and VA concordance, systemic venous return to LA, pulmonary venous return to RA, and huge mass was noticed in right atrium extending to right ventricle causing obstruction to pulmonary venous return. On the basis of history, examination and investigations a diagnosis of cardiac tumor was made and diagnostic procedure was preformed. The child was put on intravenous antibiotics, cefitraxone and vitamin K. A big growth from right ventricle was removed adherent to RV cavity and tricuspid valve. It was extending to right atrium. Mass excision was done resulting in a small RV cavity and small pulmonary arteries were seen. The tricuspid valve was dilated. After the tumor resection, RVOT reconstruction was done and RA was closed. Multiple attempts to wean off from bypass were not successful as the right ventricle cavity was not able to cope with systemic venous return and the child expired. The specimen was sent for histopathology which revealed a right sided rhabdomyoma