Early Repolarization Syndrome Leading to Recurrent Cardiac Arrest in a Young Active Duty Patient.

A previously healthy, active duty 37-year-old male experienced recurrent cardiac arrests because of ventricular fibrillation and polymorphic ventricular tachycardia. Initial evaluation did not reveal a clear ischemic, structural, toxic, or metabolic cause. Close monitoring of telemetry before his third cardiac arrest revealed the cause to be early repolarization syndrome (ERS). In this case, we review the diagnosis, epidemiology, and prognostic significance of early repolarization pattern as it relates to ERS. We also discuss acute and long-term treatment strategies for patients with ERS.

Presence of Spontaneous Echo Contrast on Point-of-Care Vascular Ultrasound and the Development of Major Clotting Events in Coronavirus Disease 2019 Patients.

The presence of spontaneous echo contrast on ultrasonography is a predisposition to increased thromboembolic risk. The purpose of this study was to assess for the prevalence and consequences of spontaneous echo contrast on point-of-care vascular ultrasound in coronavirus disease 2019. DESIGN SETTING AND PATIENTS: This was a retrospective cohort study of 39 adult patients admitted to the ICU with a confirmed coronavirus disease 2019 diagnosis at a large tertiary-care academic medical center. Patients were included if they had undergone a vascular ultrasound examination during their ICU admission. Overall, 48 venous ultrasound studies among the 39 patients were reviewed in blinded fashion by two reviewers for the presence of venous spontaneous echo contrast, and charts were analyzed for laboratory data and outcomes. MEASUREMENTS AND MAIN RESULTS S: pontaneous echo contrast correlated with serum viscosity (mean values of 2.64, 2.54, and 2.04 cP for dense spontaneous echo contrast, spontaneous echo contrast , and no spontaneous echo contrast, respectively, with a p value of 0.0056 for spontaneous echo contrast compared with negative spontaneous echo contrast) and hyperfibrinogenemia (mean values of 726.6, 668.5, and 566.6 mg/dL for dense spontaneous echo contrast, positive spontaneous echo contrast, and negative spontaneous echo contrast, respectively, with a p value of 0.0045 for dense spontaneous echo contrast compared with negative spontaneous echo contrast). About 36% of patients with dense spontaneous echo contrast and 33% of individuals with positive spontaneous echo contrast experienced significant clotting events compared with 17% of those with negative spontaneous echo contrast. A total of 19% of patients with spontaneous echo contrast suffered a cardiac arrest following a major clotting event, and there were no cardiac arrests from clotting events in the negative spontaneous echo contrast group. There was no association with the presence of spontaneous echo contrast and right or left cardiac function or other laboratory values such as d-dimer, external thromboelastometry - maximum lysis, platelet counts, C-reactive protein, or interleukin-6. CONCLUSIONS: Point-of-care venous ultrasonography is easily performed and reliably interpreted for visualization of spontaneous echo contrast. The presence of spontaneous echo contrast in patients with coronavirus disease 2019 is associated with hyperviscosity and increased rates of thrombotic events and complications.

Functional Movement Screen (FMS™) Scores and Demographics of US Army Pre-Ranger Candidates.

INTRODUCTION: The United States Army Rangers are a unique population whose training requirements are intensive, and physically and mentally demanding. The Functional Movement Screen (FMS) is a movement screening tool designed to assess movement quality and asymmetries in movement with the potential to identify injury risk. This study was a descriptive, cross-sectional investigation examining associations between FMS scores and the various measures of health and performance of active duty soldiers in light infantry units who were involved in the U.S. Army Pre-Ranger Course (PRC). MATERIALS AND METHODS: Before the PRC, 491 male soldiers (mean age = 24.0 ± 3.8 years; mean height = 176.6 ± 7.2 cm; mean body mass = 80.2 ± 9.8 kg) completed a questionnaire which included items on self-assessed physical fitness, last Army physical fitness test (APFT) score, tobacco use, and injury history. The soldiers then completed the FMS, which consisted of seven movements and three clearing tests. From the FMS results, a determination of asymmetries (i.e., differences in FMS scores between the right and left side of the body) was made. Differences between groups were analyzed via an independent sample t-test, a one-way analysis of variance, or a chi-square as appropriate. Significance was set at 0.05 a priori. RESULTS: The average composite FMS score was 16.4 (±1.9) points. Soldiers reporting ≥290 APFT points achieved a higher FMS score than those reporting lower APFT scores (16.5 ± 2.0 vs 16.1 ± 2.0 points, P = 0.03). Soldiers reporting either tobacco use or a previous musculoskeletal injury had lower FMS scores than those not reporting these (tobacco: 16.1 ± 2.1 vs 16.5 ± 1.8 points, P = 0.02; injury: 16.0 ± 2.2 vs 16.6 ± 1.8 points, P < 0.01). FMS asymmetries were not related to APFT scores, tobacco use, or self-rated fitness. As self-rated fitness increased so did APFT scores. CONCLUSIONS: Active duty soldiers of a light infantry division achieved FMS scores similar to other military populations tested, and the composite FMS score was related to higher APFT scores, absence of tobacco use, and absence of previous musculoskeletal injuries. Improving PRC candidate healthy habits through highlighting the negative associations between poorer fitness, cigarette tobacco use and movement quality, may reduce injury risk and increase PRC completion potential.

The reliability of rehabilitative ultrasound imaging in the measurement of infraspinatus muscle function in the symptomatic and asymptomatic shoulders of patients with unilateral shoulder impingement syndrome.

BACKGROUND: Rehabilitative ultrasound Imaging (RUSI) is increasingly used in the management of musculoskeletal conditions as it provides an objective measure of muscle function while being less invasive than needle electromyography. While research has documented the ability to reliably measure trunk muscles in patients with back pain, no study to date has used RUSI to quantify infraspinatus muscle function in patients with shoulder impingement syndrome (SIS). HYPOTHESIS/PURPOSE: The purpose of this study was to examine the intra-rater and inter-rater reliability of measuring infraspinatus muscle thickness with RUSI and to compare such measures during resting versus contracted muscle states and in the symptomatic versus asymptomatic shoulders in patients with SIS. STUDY DESIGN: Cross-sectional, measurement study. METHODS: Fifty-two participants with unilateral SIS underwent a standard baseline examination to include RUSI of the infraspinatus muscle bilaterally. Images were acquired at rest and during a submaximal isometric contraction, by two novice examiners. The isometric contraction was elicited by having prone participants externally rotate their shoulder from a position of 90° abduction into a dynamometer and hold a static force of 20 mmHg (approximately 20-30% maximal voluntary contraction). Images were captured using a standardized placement of the transducer placed just inferior to the spine of the scapula along the medial scapular border and measured off-line using Image J software (V1.38t, National Institutes of Health, Bethesda, Maryland). RESULTS: Estimates (ICCs) for thickness measurements ranged between 0.96 and 0.98 for intra-rater reliability and between 0.87 and 0.92 for inter-rater reliability. Reliability was substantially lower (ICC = 0.43 to 0.79) for calculations of percent thickness change. The infraspinatus muscle was significantly thicker when contracted (19.1mm) than during rest (16.2mm) in both shoulders (p < 0.001). There was also a statistically significant interaction between contraction state and shoulder (p = 0.026), indicating that the change in thickness that occurred during contraction was significantly smaller in the symptomatic shoulder than in the asymptomatic shoulder. CONCLUSION: RUSI measurements of infraspinatus muscle thickness appear to be highly reliable, both within the same examiner and between different examiners, in patients with SIS. Moreover, such measurements were different in rested and contracted states of the infraspinatus, as well as, between the symptomatic and asymptomatic shoulders of patients with unilateral SIS. LEVEL OF EVIDENCE: Level 2.