ABSTRACT
AIMS: Sudden cardiac death (SCD) in young individuals is often unexpected, provoking substantial emotional stress for family and friends of the deceased. Cardiac screening may identify individuals who harbour disorders linked to SCD. The feasibility and diagnostic yield of a nationwide cardiac screening programme in adolescents has never been explored. METHODS: All individuals eligible for cardiac screening (students aged 15 years) were systematically invited to enrol. Students were provided with a health questionnaire. ECGs were acquired at school. A physician led consultation was carried out on site. Participants with an abnormal screen were then referred for secondary evaluation to the nation's tertiary centre. Feasibility criteria included a) participation rate >60%, b) adherence to secondary evaluation >80%, and c) cost per individual screened equating to <100. The diagnostic yield was also evaluated. RESULTS: At the end of enrolment, 2708 students gave consent (mean 15 years, 50.4% male), equating to 67.9% of the eligible cohort. Overall, 109 participants (4.0%) were referred for further evaluation. An abnormal electrocardiogram (ECG) was the most common reason for referral (3.7%). Fifteen individuals (0.6%) were diagnosed with a cardiac condition. Nine (0.3%) had a condition linked to SCD (n = 1 Long-QT syndrome, n = 1 Hypertrophic Cardiomyopathy, n = 5 Wolff-Parkinson White, n = 2 coronary anomalies). The yield was similar in athletes and non-athletes (p = 0.324). The cost per cardiac individual screened equated to 51.15. CONCLUSION: A nationwide systematic cardiac screening programme for adolescent athletes and non-athletes is feasible and cost-efficient, provided that responsible centres have the appropriate infrastructure.
ABSTRACT
BACKGROUND: Anterior T wave inversion (TWI) is frequent in healthy adolescent individuals (juvenile ECG pattern), normalising after puberty. Its clinical implications are uncertain. AIM: This study assessed a) national prevalence of anterior TWI, b) ST segment morphology, c) proportion of individuals with a juvenile ECG pattern whose ECG normalises and d) factors predicting TWI persistence >16 years. METHODS: Adolescents (mean 15y) in Malta were systematically invited to enrol in a cardiac screening program. Subjects completed a health questionnaire and an ECG at their school. Participants with TWI were labelled as TWI in V1-V2 or extended TWI (V1-V3/4). The latter were followed at 1 year with a repeat ECG. Those with persistent extended anterior TWI were offered evaluation and surveillance. RESULTS: The prevalence of isolated anterior TWI was 5.0%, commoner in females (6.3%) independent of athletic ability. Extended TWI was commoner in female athletes (4.2%, non-athletes 2.1%). Females often had shallow TWI without overt ST segment abnormalities. Deep TWI and ST segment changes were more frequent in males. Only 0.2% of cases persisted ≥16 years of age. ST segment characteristics were not able to predict T wave normalisation. No events took place during follow up (40 ± 9 months). CONCLUSION: Anterior TWI is a frequent phenomenon in adolescents, especially in females. Female athletes are also more likely to have extended anterior TWI. Only 0.2% of cases have persistent anterior TWI at 16 years of age. Chest wall anatomy may explain this phenomenon in females. It is uncommon in males, hence why surveillance is more prudent.
Subject(s)
Electrocardiography , Sports , Male , Adolescent , Humans , Female , Athletes , Arrhythmias, Cardiac/diagnosis , HeartABSTRACT
BACKGROUND: Myocarditis is caused by inflammation affecting the heart muscle. The usual aetiological factor is viral, especially in immunocompetent hosts and developed countries. Campylobacter jejuni is a common cause of bacterial gastroenteritis but has rarely been associated with myocarditis. CASE SUMMARY: We report a case of a 22-year-old male admitted with pleuritic chest pain and a diarrhoeal illness. Thorough evaluation of the patient history did not reveal any sources for contracting the diarrhoea. Stool cultures confirmed that the patient had C. jejuni infection as well as myopericarditis confirmed on cardiac magnetic resonance imaging (cardiac MRI). Treatment with colchicine 0.5 mg BD, ibuprofen 600 mg TDS, and ciprofloxacin 500 mg BD orally for 5 days was started, together with an intravenous infusion of 0.9% normal saline 1 L TDS. The patient showed signs of improvement over a span of three days and the ST changes on electrocardiogram resolved. DISCUSSION: Although C. jejuni-associated myopericarditis is uncommon, it can be potentially life-threatening if not considered in the differential. Its diagnosis involves good history taking, examination, and investigation with electrocardiography, troponins and inflammatory markers, echocardiography, and cardiac MRI. Several mechanisms of infection have been suggested, including direct insult by toxin or bacterium as well as an immune-mediated response. Both supportive and causative treatments are important to ensure recovery while reducing the risk of complications. It is therefore crucial to ensure that the patient receives adequate follow-up to ascertain patient progress and to mitigate any complications that may arise as well as tackle patient concerns. The patient had a rapid recovery.
