ABSTRACT
Apparent life-threatening event (ALTE) is a term used to define an event of unknown cause after an infant is found limp, cyanotic, bradycardic, and/or requires resuscitation. Eight to 15% of children with ALTE die of sudden infant death syndrome. Obstructive sleep apnea, bradycardia, gastroesophageal reflux, and laryngotracheal abnormalities are frequently associated with ALTE. Wide QT dispersion is associated with sudden death in heart failure and increased risk of ventricular fibrillation in acute myocardial infarction. Here, we assess QT dispersion in infants with ALTE and its correlation to clinical and electrocardiographic indices. The study included eighty nine infants (age 2.14 +/- 1.8 months, 46 males and 43 females) referred with ALTE to the pediatric emergency room and 18 controls (age 2.77 +/- 2.2 months) who underwent electrocardiogram assessment of QTmin, QTmax, QT dispersion (QT-D), and as well as QTmin, QTmax, and QT-D corrected for heart rate (QTcmin, QTcmax, QTC-D, respectively). All infants were referred at the usual diagnostic tests-the gastroesophageal reflux test, apnea monitoring, Holter ECG monitoring, electroencephalogram, and Doppler echocardiography. QT-D, QTc-D, and QTc-min were significantly greater in the ALTE group (p < 0.01). Greater QTc-D was found in males compared to females (p < 0.001). QT-D and QTc-D showed little or no correlation with age of infant or positivity of diagnostic tests. QTc has been found by multiple regression analysis to be the independent variable with the greatest impact on QTc-D (beta = -0.68, p < 0.001).
Subject(s)
Electrocardiography, Ambulatory , Long QT Syndrome/diagnosis , Sudden Infant Death/etiology , Cause of Death , Echocardiography, Doppler , Female , Heart Rate/physiology , Humans , Infant , Infant Welfare , Infant, Newborn , Israel , Long QT Syndrome/physiopathology , Male , Severity of Illness Index , Sex Factors , Statistics as Topic , SyndromeABSTRACT
Early reperfusion in acute myocardial infarction (AMI) has been shown to reduce the extent of myocardial necrosis and to improve short and long term prognosis. Gender, smoking, age and site of infarct location may be regarded as prognostic factors for the outcome of AMI and of thrombolytic therapy with streptokinase (STK). The aim of this study was to identify factors, which are related to the results of thrombolytic therapy by STK in AMI. 156 patients (122 males and 34 females) treated with STK were retrospectively analyzed: they were subdivided into 3 groups according to the presumed success of thrombolytic therapy based on the accepted clinical and angiographic TIMI flow criteria. Group 1 = successful (88 patients), group 2 = probably successful (20 patients) and group 3 = failed thrombolysis (48 patients). Multiple regression analysis showed that Killip class (p = 0.0005), time from pain onset to thrombolysis initiation (p = 0.02) and the time of the day in which thrombolysis began (p = 0.037) are independent major predictive factors for successful thrombolytic therapy by STK in AMI. Gender, age, smoking and some risk factors are not of similar predictive power. These results may guide us in the optimization of thrombolytic therapy by STK in AMI, different dose regimens for different times of day and probably preference for primary PTCA in the early morning hours.
Subject(s)
Fibrinolytic Agents/therapeutic use , Myocardial Infarction/drug therapy , Streptokinase/therapeutic use , Thrombolytic Therapy , Aged , Coronary Angiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Infarction/diagnostic imaging , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
Cardiac rhabdomyoma diagnosed prenatally by cross-sectional echocardiography was confirmed after birth by Doppler echocardiography and cardiac catheterization in a baby with tuberous sclerosis. Doppler echocardiographic follow-up after 2 years revealed regression of tumour masses and concomitant disappearance of pulmonary regurgitation which was caused by the large tumour mass in the right ventricular outflow tract. In spite of a sizeable mass protruding into the left ventricular outflow tract, repeated Doppler examination failed to demonstrate any significant obstruction, thus avoiding repeated catheterizations and unnecessary surgery. Doppler examination of ventricular inflow revealed normal filling characteristics. Doppler and cross-sectional echocardiography was of great value in the management of this patient.
