Prevalence of electrocardiographic abnormalities in elite and sub-elite professional athletes / Prevalencia de alteraciones electrocardiográficas en deportistas élite y sub-élite

Objective: The objective of this study is to determine the prevalence of electrocardiographic abnormalities that could endanger the lives of elite and sub-elite professional athletes based on normal, borderline, and abnormal findings described in international recommendations. Material and method: This retrospective observational study was performed only on men elite football players, men elite baseball players, men elite basketball players, and men sub-elite football players (second division, third division, U-15, U-17, and U-20). Data were collected from pre-competition ECGs performed by team-affiliated physicians in the 2012 – 2019 preseasons of active-roster athletes and sub-elite players. The qualitative characteristics of each ECG were analyzed using the international recommendations for electrocardiographic interpretation in athletes to detect accepted training-related ECG findings and findings classified as borderline and abnormal. Results: A total of 716 ECGs were included. Common training-related ECG changes were found in 63.1%; sinus bradycardia was the most prevalent training-related ECG change (47.2%). The prevalence of borderline ECG readings among all the participants was 3.9%; the most frequent change was right axis deviation. The prevalence of abnormal ECG findings overall was 4.2%. Conclusion: Electrocardiographic changes in athletes are frequently seen; however, a constant review of changes within abnormal or borderline parameters is recommended. It is suggested that further research studies should study the electrocardiographic changes in elite and sub-elite athletes and compare these changes considering the biological sex of the athletes to see if there are any differences.(AU)

Objetivo: El objetivo del presente estudio es evaluar la prevalencia de anormalidades electrocardiográficas que puedan poner en peligro la vida de deportistas profesionales élite y sub-élite, a partir de hallazgos normales, limítrofes y anormales en el ECG descritas en consensos internacionales. Material y método: Estudio retrospectivo y observacional donde se analizaron los ECGs de 12 derivaciones en reposo de jugadores de élite de fútbol, béisbol y baloncesto y jugadores sub-élite de fútbol, solamente del género masculino. Los datos se recopilaron de ECGs previos a la competencia realizados por médicos afiliados al equipo en las pretemporadas 2012-2019 en deportistas de la lista activa y jugadores sub-élite. Se utilizaron las recomendaciones internacionales para la interpretación electrocardiográfica de deportistas en las variables cuantitativas para conocer las alteraciones electrocardiográficas aceptadas y evaluar la detección de anormalidades en el trazo para clasificarlas en anormal o en el límite.Resultados: Un total de 716 ECGs fueron incluidos. Se encontraron cambios comunes en el ECG relacionados con el entrenamiento en el 63,1%; la bradicardia sinusal fue el cambio en el ECG relacionado con el entrenamiento más frecuente (47,2%). La prevalencia de lecturas limítrofes de ECG entre todos los participantes fue del 3,9%; el cambio más frecuente fue la desviación del eje a la derecha. La prevalencia de hallazgos ECG anormales en general fue del 4,2%. Conclusiones: Los cambios electrocardiográficos en los deportistas se ven con frecuencia, sin embargo, se recomienda constante revisión de cambios dentro de parámetros anormales o en limitrófes. Se sugiere que estudios de investigación estudien los cambios electrocardiográficos en deportistas élite y sub-élite y que se comparen estos cambios teniendo en cuenta el sexo biológico de los deportistas para ver si existen diferencias.(AU)

Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery.

BACKGROUND: The electrocardiogram is the most widely used test to assess cardiovascular risk during the preoperative period. The objective of the present study is to evaluate the incidence of electrocardiographic alterations in the general population scheduled for non-cardiac surgery and to determine if the age greater than or equal to 65 years or the revised cardiac risk index ≥1 represent a risk factor for presenting these alterations. MATERIAL AND METHODS: Over a period of one month, all preoperative electrocardiograms (ECG) from the anesthesia clinic were analyzed. Various epidemiological data were collected and the revised cardiac risk index was calculated. Major alterations were defined as those requiring Cardiology follow-up. RESULTS: 476 patients were recruited, of whom 40.8% were ≥65 years, 32.6% had HTN, 14.4% DM and 27.9% dyslipidemia. 16.16% of the patients had a Lee Index ≥1. Of the entire sample, 80.5% had a normal ECG, 6.5% minor alterations and 13.0% major alterations. In the multivariate analysis, age ≥65 years and the presence of HTN were shown as independent risk factors for presenting alterations in the total and major ECG. The Lee index ≥1 was not associated with an increased risk of electrocardiographic abnormalities. CONCLUSIONS: Patients ≥65 years old and those with HTN are at greater risk of presenting major electrocardiographic abnormalities, so we recommend including the ECG as a routine diagnostic test in the preoperative period of non-cardiac surgery.

Incidencia de alteraciones electrocardiográficas en el preoperatorio de cirugía no cardiaca / Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery

Antecedentes: El electrocardiograma es la prueba más utilizada para evaluar el riesgo cardiovascular durante el periodo preoperatorio. El objetivo del presente estudio es evaluar la incidencia de alteraciones electrocardiográficas en la población general programada para cirugía no cardiaca y determinar si la edad ≥ 65 años o el índice de riesgo cardiaco revisado ≥ 1 suponen un factor de riesgo para presentar dichas alteraciones. Material y métodos: Durante un periodo de un mes se analizaron todos los electrocardiogramas (ECG) preoperatorios de la consulta de anestesia. Se recogieron datos epidemiológicos y se calculó el índice de riesgo cardiaco revisado. Se definieron como alteraciones electrocardiográficas mayores aquellas que precisaban seguimiento por Cardiología. Resultados: Se reclutaron 476 pacientes, de los cuales 40,8% eran ≥ 65 años, 32,6% tenían HTA, 14,4% DM y 27,9% dislipemia. Un 16,16% de los pacientes tuvieron un índice de Lee ≥ 1.El 80,5% de los pacientes presentaban un ECG normal, el 6,5% alteraciones menores y el 13%, alteraciones mayores. En el análisis multivariante, la edad ≥ 65 años y la presencia de HTA se mostraron como factores de riesgo independiente para presentar alteraciones en el ECG totales y mayores.El índice de Lee ≥ 1 no se asoció con un mayor riesgo de alteraciones electrocardiográficas.ConclusiónLos pacientes ≥ 65 años o aquellos con HTA tienen mayor riesgo de presentar alteraciones electrocardiográficas mayores, por lo que recomendamos incluir en estos el ECG como prueba diagnóstica preoperatoria de rutina en cirugía no cardiaca.(AU)

BackgroundThe electrocardiogram is the most widely used test to assess cardiovascular risk during the preoperative period.The objective of the present study is to evaluate the incidence of electrocardiographic alterations in the general population scheduled for non-cardiac surgery and to determine if the age greater than or equal to 65 years or the revised cardiac risk index ≥ 1 represent a risk factor for presenting these alterations.Material and methods: Over a period of one month, all preoperative electrocardiograms (ECG) from the anesthesia clinic were analyzed. Various epidemiological data were collected and the revised cardiac risk index was calculated. Major alterations were defined as those requiring Cardiology follow-up.Results: 476 patients were recruited, of whom 40.8% were ≥ 65 years, 32.6% had HTN, 14.4% DM and 27.9% dyslipidemia. 16.16% of the patients had a Lee Index ≥ 1.Of the entire sample, 80.5% had a normal ECG, 6.5% minor alterations and 13.0% major alterations. In the multivariate analysis, age ≥ 65 years and the presence of HTN were shown as independent risk factors for presenting alterations in the total and major ECG.The Lee index ≥ 1 was not associated with an increased risk of electrocardiographic abnormalities.Conclusions: Patients ≥ 65 years old and those with HTN are at greater risk of presenting major electrocardiographic abnormalities, so we recommend including the ECG as a routine diagnostic test in the preoperative period of non-cardiac surgery.(AU)

Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery. / Incidencia de alteraciones electrocardiográficas en el preoperatorio de cirugía no cardiaca.

BACKGROUND: The electrocardiogram is the most widely used test to assess cardiovascular risk during the preoperative period. The objective of the present study is to evaluate the incidence of electrocardiographic alterations in the general population scheduled for non-cardiac surgery and to determine if the age greater than or equal to 65 years or the revised cardiac risk index ≥ 1 represent a risk factor for presenting these alterations. MATERIAL AND METHODS: Over a period of one month, all preoperative electrocardiograms (ECG) from the anesthesia clinic were analyzed. Various epidemiological data were collected and the revised cardiac risk index was calculated. Major alterations were defined as those requiring Cardiology follow-up. RESULTS: 476 patients were recruited, of whom 40.8% were ≥ 65 years, 32.6% had HTN, 14.4% DM and 27.9% dyslipidemia. 16.16% of the patients had a Lee Index ≥ 1. Of the entire sample, 80.5% had a normal ECG, 6.5% minor alterations and 13.0% major alterations. In the multivariate analysis, age ≥ 65 years and the presence of HTN were shown as independent risk factors for presenting alterations in the total and major ECG. The Lee index ≥ 1 was not associated with an increased risk of electrocardiographic abnormalities. CONCLUSIONS: Patients ≥ 65 years old and those with HTN are at greater risk of presenting major electrocardiographic abnormalities, so we recommend including the ECG as a routine diagnostic test in the preoperative period of non-cardiac surgery.

Ortogonalización de derivaciones de electrocardiograma / Orthogonalization of electrocardiographic derivations

Introducción: El delineador de señales electrocardiográficas (ECG) multiderivación basado en la transformada wavelet posee alta resolución espacial y permite eliminar las diferencias interderivación que aparecen tradicionalmente en los métodos uniderivación. Para esto necesita de derivaciones de señales electrocardiográficas ortogonales entre sí para la obtención de un bucle espacial. Objetivo: Desarrollar métodos de ortogonalización de dos o tres derivaciones de señales electrocardiográficas que permitan la generalización del delineador multiderivación basado en la transformada wavelet en cualquier base de datos señales electrocardiográficas con más de una derivación. Métodos: Se implementaron tres métodos de ortogonalización de derivaciones de señales electrocardiográficas: ortogonalización de dos derivaciones a partir de la proyección de vectores, ortogonalización a partir de componentes principales y ortogonalización a partir del método clásico de Gram-Schmidt. Resultados: Se comparó el funcionamiento del delineador multiderivación de ECG cuando es usado cada método de ortogonalización, mediante el cálculo de la media aritmética y la desviación estándar teniendo en cuenta diferentes combinaciones de derivaciones de ambas bases de datos para cada una de las marcas analizadas. Los mejores resultados se obtuvieron con el método análisis de componentes principales y el peor comportamiento con el método de ortogonalización de dos derivaciones. Conclusiones: Los algoritmos de ortogonalización que obtuvieron los mejores resultados fueron los basados en tres derivaciones ortogonales, en la que fue ligeramente superior la descomposición en componentes principales y, por tanto, se considera el método más adecuado para la generalización del delineador multiderivación(AU)

Introduction: The wavelet transform-based multiderivation electrocardiographic (ECG) signal delineator has high spatial resolution and makes it possible to eliminate interderivation differences traditionally appearing in uniderivation methods. But this requires electrocardiographic signal derivations orthogonal to one another to obtain a spatial loop. Objective: Develop orthogonalization methods of two or three electrographic signal derivations allowing generalization of the wavelet transform-based multiderivation delineator in any electrographic signal database with more than one derivation. Methods: Three orthogonalization methods were implemented for electrocardiographic signal derivations: vector projection-based two-derivation orthogonalization, principal component-based orthogonalization, and orthogonalization based on the Gram-Schmidt classic method. Results: A comparison was performed between the operation of the ECG multiderivation delineator when used with each orthogonalization method. The comparison was based on estimation of the arithmetic mean and standard deviation bearing in mind different combinations of derivations from both databases for each of the marks analyzed. The best results were obtained with the principal component analysis method and the worst ones with the two-derivation orthogonalization method. Conclusions: The orthogonalization algorithms obtaining the best results were those based on three orthogonal derivations, in which decomposition into principal components was slightly higher. This is therefore considered to be the most appropriate method for generalization of the multiderivation delineator(AU)

Abnormal Electrocardiographic Findings in the Population Older Than 40 Years. Prevalence and Clinical Significance. Results of the OFRECE Study.

INTRODUCTION AND OBJECTIVES: Abnormal electrocardiographic findings are highly common. The aim of this study was to analyze the prevalence of abnormal electrocardiographic patterns in the general Spanish population aged 40 years or older. METHODS: This subanalysis of the OFRECE study selected a representative sample of the Spanish population aged 40 years or older. Clinical data and electrocardiograms were available in all participants. The electrocardiograms were read centrally. Each electrocardiogram was independently assessed by 2 trained cardiologists and, if there was disagreement, a third was consulted to reach a consensus-based diagnosis. Prior to reading the electrocardiograms, diagnostic criteria were strictly defined for each of the abnormalities analyzed. We analyzed the prevalence and clinical factors associated with cavity enlargement, conduction disorders, repolarization abnormalities, pathological Q waves, atrial and ventricular premature beats, and pre-excitation. RESULTS: A total of 8343 individuals were evaluated, (mean age, 59.2 years; 52.4% women). Only 4074 (51.2%) participants had a completely normal electrocardiogram. The most frequent abnormalities were nonspecific repolarization abnormalities (16%) associated with coronary heart disease and atrial fibrillation; right bundle-branch block (8.1%) associated with chronic pulmonary obstructive disease; left anterior hemiblock (6.5%) related to hypertension and congestive heart failure; and long PR interval (3.7%), which was associated with coronary heart disease. CONCLUSIONS: Electrocardiographic abnormalities are very common in the general population aged 40 years or older. Only about half of the population had a completely normal electrocardiogram.

Concentración sanguínea de troponina I en pacientes embarazadas sin y con preeclampsia severa / Troponin I blood concentration in pregnant patients without and with severe preeclampsia

Resumen OBJETIVO: Comparar la concentración sanguínea de troponina I en pacientes embarazadas sin y con preeclampsia severa. MATERIALES Y MÉTODOS: Estudio prospectivo y transversal efectuado en pacientes de una unidad médica de alta especialidad en Ginecología y Obstetricia de la Ciudad de México admitidas entre los meses de enero a mayo de 2019. Criterio de inclusión: pacientes de cualquier edad y paridad con más de 20 semanas de embarazo. Criterio de exclusión: mujeres con enfermedades previas que pudieran condicionar daño miocárdico. Para cuantificar la troponina I a todas se les tomó sangre venosa. El valor normal de la troponina I está entre 0 y 0.4 ng/mL. Se les tomó un electrocardiograma y una radiografía de tórax. Los reportes de ambos grupos se compararon. Se utilizó estadística descriptiva y prueba t de Student pareada. RESULTADOS: 71 mujeres reunieron los criterios de inclusión y se dividieron en dos grupos: 37 pacientes sin preeclampsia (grupo A) y 34 con preeclampsia (grupo B). La concentración sanguínea de la troponina I del grupo A fue 0.05 ± 0.008 ng/mL y del grupo B: 0.05 ± 0.02 ng/mL (p = 0.30). En el grupo B se encontraron alteraciones electrocardiográficas en 14.7% (n = 5) cuyos valores de troponina I fueron normales. La radiografía del tórax fue normal en 100%. CONCLUSIONES: La concentración sanguínea de troponina I en pacientes embarazadas sin y con preeclampsia severa resultó normal, incluidas las 5 mujeres con preeclampsia y alteraciones electrocardiográficas.

Abstract OBJECTIVE: To compare the blood concentration of Troponin I (TI) in pregnant patients without and with severe preeclampsia (SP). MATERIALS AND METHODS: Prospective, cross-sectional study, conducted in patients of a medical unit of high specialty of gynecology and obstetrics of Mexico City admitted in the period from January to May of the year 2019. Patients of any age and parity with pregnancy > 20 weeks were selected. Those with previous diseases that may condition myocardial damage were excluded. Venous blood was taken to quantify TI using the "Triage Cardiac Panel"® device of the Biosite® brand that runs an indirect immunofluorescence program coupled to a reader called "Triage Meter"®. For this test the normal value of TI is 0 to 0.4 ng/mL. An electrocardiogram and a chest X-ray were also performed. The results of both groups were compared. Descriptive statistics and the paired Student's T test were used. RESULTS: 71 women met the selection criteria. Two groups were formed: 37 patients without preeclampsia (group A) and 34 women with PS (group B). The blood concentration of TI in group A was 0.05 ± 0.008 ng / ml and in group B 0.05 ± 0.02 ng/mL (p = 0.30). In group B electrocardiographic abnormalities were found in 14.70% (5 cases) whose TI values were normal. Chest x-ray was normal in 100%. CONCLUSIONS: the blood concentration of TI in pregnant patients without and with PS was normal, including 5 preeclamptic women with electrocardiographic abnormalities.

Alteraciones electrocardiográficas en pacientes con hemorragia intracerebral espontánea / Electrocardiographic changes in patients with spontaneous intracerebral hemorrhage

Introducción: desde la última centuria se estudia la asociación entre eventos cerebrovasculares hemorrágicos y alteraciones electrocardiográficas, así como el valor de estas como factor pronóstico de mortalidad. Objetivo: caracterizar las alteraciones electrocardiográficas en pacientes con hemorragia intracerebral espontánea a su llegada al Servicio de Urgencias. Material y Método: se realizó un estudio observacional descriptivo de corte transversal de las alteraciones electrocardiográficas agudas en pacientes con hemorragia cerebral durante el período de enero del 2010 hasta diciembre del 2011 en el Hospital Comandante Manuel Fajardo de La Habana. Resultados: se observó un predominio del sexo femenino y la media de edad fue de 70 años, las alteraciones electrocardiográficas más frecuentes fueron la taquicardia sinusal, el aplanamiento o inversión de la onda T y la bradicardia sinusal. Las dos terceras partes de los pacientes que presentaron dichas alteraciones fallecieron. Conclusiones: cerca de 50 por ciento de los pacientes presentó cambios electrocardiográficos. Estos predominaron en pacientes femeninos, y se observó una relación estadísticamente significativa con los egresados fallecidos(AU)

Introduction: for the last hundred years the relationship between hemorrhagic cerebrovascular events and electrocardiographic alterations has been studied, as well as their significance as a prognostic factor for mortality. Objective: to characterize the electrocardiographic alterations in patients with spontaneous intracerebral hemorrhage at their arrival to the Emergency Room. Material and Method: an observational descriptive and transverse study was carried out between January 2010 and December 2011 in Comandante Manuel Fajardo University Hospital. Results: it was found a predominance of females, with an average age of 70 years. The most frequent electrocardiographic alterations were sinus tachycardia, sinus bradycardia, and flat or inverted T waves. Around two thirds of the patients with these changes died in the hospital. Conclusions: nearly 50 percent of patients presented with electrocardiographic anomalies on admittance. They prevailed in female patients and a statistically significant difference was found between them and adverse outcomes(AU)

Hiperpotasemia severa en emergencia: Manifestaciones clínicas y manejo terapéutico a propósito de tres casos / Severe hyperkalemia in the emergency: Clinical manifestations and therapeutic management on three cases

La hiperpotasemia se define como la elevación del potasio plasmático por encima de 5,5 mEq/L. Es una alteración electrolítica que puede determinar complicaciones clínicas fatales, siendo las más graves las cardiovasculares y musculares. Es consecuencia de una disminución en la eliminación renal del potasio, distribución corporal desde el espacio intracelular al extracelular, o aumento del aporte del ion. Entre los factores que se vinculan a la presencia de repercusiones clínicas está el nivel de hiperpotasemia, la velocidad de su instalación y la coexistencia con otras disionías. Se presentan tres casos de hiperpotasemia severa asistidos en el departamento de emergencia. Presentan como elementos comunes la presencia de alteraciones electrocardiográficas y la necesidad de hemodiálisis para su corrección. La estrategia terapéutica consiste en antagonizar los efectos a nivel de la membrana celular, facilitar el ingreso del potasio al espacio intracelular y remover el exceso corporal del ion. Se destaca la importancia del reconocimiento y diagnóstico precoz de las repercusiones clínicas de la hiperpotasemia en los pacientes con riesgo de presentarla.

ABSTRACT:: Arch Med Interna 2012 - 34(3):91-94 Hyperkalemia is defined as the elevation of serum potassium levels over 5.5 mEq/L. It is an electrolytic disorder that may lead to lethal clinical complications, with cardiovascular and muscular events being the worst. It results from a reduction of potassium excretion by the kidney, body distribution from the intracellular to the extracellular space, or an increased intake or administration of the ion. The clinical impact depends on a number of factors, including the severity of the hyperkalemia, its rate of onset and the co-existence with other ionic imbalances. The paper discusses two patients that sought care at the emergency department with severe hyperkalemia. They both presented with electrocardiographic disorders, and they both required hemodialysis. The therapeutic strategy consists of antagonizing the effects at the level of the cell membrane, facilitating the transfer of potassium into the cell and removing the excessive ion from the body. The authors emphasize the importance of an early detection and diagnosis of the clinical impact of hyperkalemia in the patients at risk of developing the disorder.

Alteraciones electrocardiográficas en hemorragia subaracnoidea / Electrocardiographic alterations in subarachnoid hemorrhage

Los enfermos con hemorragia subaracnoidea (HSA) presentan con frecuencia alteraciones electrocardiográficas (ECG), las más frecuentes son alargamiento del segmento QT, ondas T negativas, elevación o inversión del segmento ST y ondas U. La inversión de las ondas T asociada a la prolongación del QT se correlaciona con alteraciones de la contractilidad ventricular y es una indicación para practicar ecocardiograma. Se reporta el caso de un paciente con HSA secundaria a ruptura de aneurisma intracraneal que presentó cambios electrocardiográficos, enfatizando en la patogénesis de éstos y el impacto que tienen en el comportamiento clínico y la evolución.

Electrocardiographic (EGC) changes have been frequently observed in patients with subarachnoid hemorrhage (SAH). The most frequent anomalies reported are prolonged of the QT interval, negative T waves, elevation or inversion of the ST segment and U wave. T wave inversion associated to QT interval prolongation is related to alterations in ventricular contraction indicating that echocardiographic screening is required. We report the case of a patient with SAH secondary to intracranial aneurism rupture who showed electrocardiographic changes, emphasizing the pathogenesis of the latter and the impact they have in both clinical manifestations and evolution.

Estudio transversal clínico y epidemiológico de la enfermedad de Chagas en una área rural del Nordeste Argentino / Clinical cross-sectional and epidemiologic study of Chagas disease in a rural area of the Argentinian northeast

Esta investigación tiene por objeto analizar las características epidemiológicas, clínicas, electrocardiográficas y radiológicas de una población de seropositivos y seronegativos al Trypanosoma cruzi en una área rural del Departamento San Miguel, provincia de Corrientes, Argentina. Se seleccionaron 132 pobladores (58 hombres y 74 mujeres) de todos los grupos etareos para la realización de un examen clínico y cardiovascular. Se registraron síntomas y signos compatibles con afección cardíaca, tensión arterial, electrocardiograma de 12 derivaciones y radiografía anteroposterior de tórax. En la signo-sintomatología, anomalías electrocardiográficas y en las alteraciones radiográficas detectadas, no se observaron diferencias estadísticamente significativas entre seropositivos y seronegativos. Se concluye que si bien en la población objeto de estudio la infección chagásica no se asoció a mayor prevalencia de cardiopatía, cabe destacar que los pacientes chagásicos pertenecían a un grupo etareo muy joven con un 54,0% de ellos menores de 20 años y que el 45,0% de los pacientes mayores de 41 años tenían alteraciones electrocardiográficas.

The main goal was to know the epidemiologic, clinical, electrocardiographic and radiologic characteristics among a population of seropositives and seronegatives to Trypanosoma cruzi in a rural area of the Department of San Miguel, province of Corrientes, Argentina. One hundred and thirty-two patients of different ages: 2-79 years old were researched (58 males, 74 females). In order to make a thorough assessment clinical evaluation and cardiologic testing were carried out. Signs and symptoms consistent with heart disease, blood pressure, 12-lead ECG registry and chest x-ray (PA view) were registered. In signs and symptoms, abnormal ECG patterns and radiologic abnormalities, non-significant statistic difference were observed. Although we were unable to find a significant relationship between chagasic infection and a higher prevalence for heart disease, it is important to stress the fact that 54.0% of the studied population was largely composed of very young patients whose ages were less than 20 years old, and 45.0% of those older than 41 years showed ECG abnormalities.