Elaboração de algoritmo para interpretação rápidadas principais arritmias cardíacas no eletrocardiograma / Algorithm Elaboration For Quick Interpretation Of The Main Heart Arrythmias In The Electrocardiogram

Objetivo: relatar a elaboração de um algoritmo para facilitar a interpretação rápida das principais arritmias cardíacas no eletrocardiograma. Método: estudo descritivo, exploratório, com abordagem qualitativa, do tipo relato de experiência, realizado mediante um projeto de intervenção em educação em saúde durante o ano de 2021. Resultados: a elaboração do algoritmo denominado Scaritmo contribuiu para sistematizar as etapas de identificação de arritmias cardíacas, favorecendo o processo didático e aprendizado dos estudantes e otimizando a interpretação rápida do eletrocardiograma. Conclusão: o uso do algoritmo Scaritmo permite a sistematização teórico-prática das etapas necessárias para a interpretação do eletrocardiograma tornando sua avaliação mais didática e assertiva pelo examinador em treinamento.(AU)

Objective: to report the development of an algorithm to facilitate the rapid interpretation of the main cardiac arrhythmias in electrocardiogram. Method: a descriptive, exploratory study with qualitative approach, of experience report type, conducted through an intervention project in health education during the year 2021. Results: The development of the algorithm called Scaritmo contributed to systematize the steps of cardiac arrhythmia identification, favoring the didactic process and student learning, and optimizing the rapid interpretation of the electrocardiogram. Conclusion: The use of the Scaritm algorithm allows the theoretical and practical systematization of the steps necessary for the interpretation of electrocardiograms, making its evaluation more didactic and assertive by the examiner in training.(AU)

Objetivo: relatar el desarrollo de un algoritmo para facilitar la interpretación rápida de las principales arritmias cardíacas en electrocardiograma. Método: estudio descriptivo, exploratorio, con abordaje cualitativo, de tipo relato de experiencia, realizado a través de un proyecto de intervención en educación para la salud durante el año 2021. Resultados: el desarrollo del algoritmo denominado Scaritmo contribuyó para sistematizar los pasos de identificación de arritmias cardíacas, favoreciendo el proceso didáctico y el aprendizaje de los alumnos y optimizando la rápida interpretación del electrocardiograma. Conclusión: El uso del algoritmo Scaritmo permite la sistematización teórica y práctica de los pasos necesarios para la interpretación del electrocardiograma, tornando su evaluación más didáctica y asertiva por el examinador en formación.(AU)

Electrocardiogram abnormalities detected during a routine medical examination of healthy members of the armed forces: An observational study

Background and objective: Only few studies addressed ECG findings in healthy members of the Indian armed forces or the general population of India. The study was conducted to assess the prevalence of abnormal electrocardiogram (ECG) detected during a routine medical examination of healthy members of the Indian armed forces. Method: The ECG of all the healthy members performed during a routine medical examination was initially reported by physicians at various armed forces service hospitals in the Eastern Command (EC) and later perused by the cardiologist at Command Hospital Eastern Command (CHEC). Individuals with abnormal ECG underwent relevant cardiac evaluation at CHEC to determine the underlying pathology. Results: A total of 1,045 members of the Indian armed forces were included in the study and were categorised as follows: 244 in Group-1 (aged < 25years), 478 in Group-2 (aged between 25 to 40 years) and 323 in Group-3 (aged > 40years). Abnormal ECG was found in 108 (10.3%) individuals. Left axis deviation was the most common abnormality detected in 18 (1.2%) individuals, followed by incomplete RBBB and T wave inversion which were each found in 15 subjects (1.43% of all individuals and 13.9% of the subjects with abnormal ECG). The prevalence of ECG abnormalities detected in our study was similar to that reported in previous studies. Only five (0.47%) of the 108 individuals with abnormal ECG were found to have underlying cardiovascular disease. Conclusion: Morphological ECG abnormalities were common in the subjects but did not vary significantly from the general population, and only a minority had underlying pathology. While most of the abnormalities may only represent normal variations and their occurrence in healthy individuals during routine health check-ups should not be alarming. Evaluation of structural heart disease should be done for ECG abnormalities with prognostic significance that has been well-characterised.

Intelligent Electrocardiogram Analysis in Medicine: Data, Methods, and Applications / 中国医学科学杂志(英文版)

Electrocardiogram (ECG) is a low-cost, simple, fast, and non-invasive test. It can reflect the heart's electrical activity and provide valuable diagnostic clues about the health of the entire body. Therefore, ECG has been widely used in various biomedical applications such as arrhythmia detection, disease-specific detection, mortality prediction, and biometric recognition. In recent years, ECG-related studies have been carried out using a variety of publicly available datasets, with many differences in the datasets used, data preprocessing methods, targeted challenges, and modeling and analysis techniques. Here we systematically summarize and analyze the ECG-based automatic analysis methods and applications. Specifically, we first reviewed 22 commonly used ECG public datasets and provided an overview of data preprocessing processes. Then we described some of the most widely used applications of ECG signals and analyzed the advanced methods involved in these applications. Finally, we elucidated some of the challenges in ECG analysis and provided suggestions for further research.

Electrocardiogram signal classification based on fusion method of residual network and self-attention mechanism / 生物医学工程学杂志

In the diagnosis of cardiovascular diseases, the analysis of electrocardiogram (ECG) signals has always played a crucial role. At present, how to effectively identify abnormal heart beats by algorithms is still a difficult task in the field of ECG signal analysis. Based on this, a classification model that automatically identifies abnormal heartbeats based on deep residual network (ResNet) and self-attention mechanism was proposed. Firstly, this paper designed an 18-layer convolutional neural network (CNN) based on the residual structure, which helped model fully extract the local features. Then, the bi-directional gated recurrent unit (BiGRU) was used to explore the temporal correlation for further obtaining the temporal features. Finally, the self-attention mechanism was built to weight important information and enhance model's ability to extract important features, which helped model achieve higher classification accuracy. In addition, in order to mitigate the interference on classification performance due to data imbalance, the study utilized multiple approaches for data augmentation. The experimental data in this study came from the arrhythmia database constructed by MIT and Beth Israel Hospital (MIT-BIH), and the final results showed that the proposed model achieved an overall accuracy of 98.33% on the original dataset and 99.12% on the optimized dataset, which demonstrated that the proposed model can achieve good performance in ECG signal classification, and possessed potential value for application to portable ECG detection devices.

Fetal electrocardiogram signal extraction and analysis method combining fast independent component analysis algorithm and convolutional neural network / 生物医学工程学杂志

Fetal electrocardiogram (ECG) signals provide important clinical information for early diagnosis and intervention of fetal abnormalities. In this paper, we propose a new method for fetal ECG signal extraction and analysis. Firstly, an improved fast independent component analysis method and singular value decomposition algorithm are combined to extract high-quality fetal ECG signals and solve the waveform missing problem. Secondly, a novel convolutional neural network model is applied to identify the QRS complex waves of fetal ECG signals and effectively solve the waveform overlap problem. Finally, high quality extraction of fetal ECG signals and intelligent recognition of fetal QRS complex waves are achieved. The method proposed in this paper was validated with the data from the PhysioNet computing in cardiology challenge 2013 database of the Complex Physiological Signals Research Resource Network. The results show that the average sensitivity and positive prediction values of the extraction algorithm are 98.21% and 99.52%, respectively, and the average sensitivity and positive prediction values of the QRS complex waves recognition algorithm are 94.14% and 95.80%, respectively, which are better than those of other research results. In conclusion, the algorithm and model proposed in this paper have some practical significance and may provide a theoretical basis for clinical medical decision making in the future.

Eletrocardiograma padrão de 12 derivações para diagnóstico da oclusão coronariana aguda: nova abordagem eletrocardiográfica das síndromes coronarianas / Preservation of anatomical specimens in sodium chloride: a study with fertilization product / Conservación de especímenes anatómicos en cloruro sódico: un estudio con producto de fertilización

Introdução: As síndromes coronarianas agudas decorrem de ruptura de placa coronariana com formação de trombos, embolização e obstrução, dependendo do nível de obstrução, podemos ter infartos e anginas e a nível eletrocardiográfico podemos ter ou não o supra desnivelamento do segmento ST. Para o correto diagnóstico e melhor prognóstico é importante acompanhar suas manifestações clínicas e avaliar as alterações eletrocardiográficas. Objetivo: Estudar uso do eletrocardiograma padrão de 12 derivações, para diagnóstico da oclusão coronariana aguda: uma nova abordagem eletrocardiográfica das síndromes coronarianas. Método: Estudo de revisão integrativa, com dados secundários da Biblioteca Virtual em Saúde (BVS), base eletrônica de dados da Literatura Latino ­ Americana e do Caribe em Ciências da Saúde (Lilacs) e da biblioteca digital Scientific Electronic Library Online (Scielo). Resultados: Descreveu-se 7 achados eletrocardiográficos sugestivos de oclusão coronariana aguda: padrões como os De Winter, Wellens, IAM posterior, distorção final do QRS, Critérios de Sgarbossa- Smith para IAM associado a BRE ou ritmo de marca-passo ventricular, ondas T's hiperagudas e fórmulas matemáticas para diagnóstico da oclusão da descendente anterior. Conclusão: Embora a abordagem que se vale de tais achados no ECG seja mais acurada na detecção da oclusão coronariana aguda do que os critérios milimétricos do segmento ST, essa nova abordagem precisa de mais estudos para avaliação de seu real poder diagnóstico.

Introduction: As acute coronary syndromes due to coronary plaque rupture, with thrombus formation, embolization and obstruction, depending on the degree of obstruction, we may have infarction and angina at the electrocardiographic level, we may have an unevenness or overdevelopment of the ST interval. For a correct diagnosis and prognosis, it is important to monitor its clinical manifestations and assess electrocardiographic changes. Objective: To study the use of a standard 12- lead electrocardiogram for the diagnosis of acute coronary occlusion: a new electrocardiographic approach to coronary syndromes. Method: Integrative review study, secondary data from the Virtual Health Library (VHL), electronic database of the Latin American and Caribbean Literature on Health Sciences (Lilacs) and the Scientific Electronic Library Online (Scielo) digital library. Results: Seven electrocardiographic findings suggestive of acute coronary occlusion were described: patterns such as De Winter, Wellen, posterior AMI, terminal QRS distortion, Sgarbossa-Smith criteria for AMI associated with LBBB or ventricular paced rhythm, hyperacute T waves, and mathematical formulas for diagnosing anterior descending occlusion. Conclusion: Although the approach that makes use of such ECG findings is more accurate in detecting acute coronary occlusion than the millimeter ST-segment criteria, this new approach needs further studies to assess its real diagnostic power.

Introducción: Como síndromes coronarios agudos debidos a rotura de placa coronaria, con formación de trombo, embolización y obstrucción, dependiendo del grado de obstrucción, podemos tener infarto y angina a nivel electrocardiográfico, podemos tener un desnivel o sobredesarrollo del intervalo ST. Para un correcto diagnóstico y pronóstico es importante monitorizar sus manifestaciones clínicas y valorar los cambios electrocardiográficos. Objetivo: Estudiar el uso de un electrocardiograma estándar de 12 derivaciones para el diagnóstico de la oclusión coronaria aguda: una nueva aproximación electrocardiográfica a los síndromes coronarios. Método: Estudio de revisión integradora, datos secundarios de la Biblioteca Virtual en Salud (BVS), base de datos electrónica de la Literatura Latinoamericana y del Caribe en Ciencias de la Salud (Lilacs) y de la biblioteca digital Scientific Electronic Library Online (Scielo). Resultados: Se describieron siete hallazgos electrocardiográficos sugestivos de oclusión coronaria aguda: patrones como De Winter, Wellen, IAM posterior, distorsión terminal del QRS, criterios de Sgarbossa-Smith para IAM asociado a BRIHH o ritmo ventricular estimulado, ondas T hiperagudas y fórmulas matemáticas para el diagnóstico de oclusión de la descendente anterior. Conclusiones: Aunque el enfoque que hace uso de dichos hallazgos ECG es más preciso en la detección de la oclusión coronaria aguda que los criterios milimétricos del segmento ST, este nuevo enfoque necesita más estudios para evaluar su poder diagnóstico real.

El electrocardiograma en la amiloidosis cardíaca: un arma para la sospecha diagnóstica de esta enfermedad / The electrocardiogram in cardiac amyloidosis: a weapon for the diagnosis suspect of this disease / O electrocardiograma na amiloidose cardíaca: uma arma para a suspeita diagnóstica desta doença

La amiloidosis cardíaca (AC) es una enfermedad con mal pronóstico si el tratamiento no se inicia de forma temprana, por lo que una de las asignaturas pendientes en esta enfermedad consiste en realizar un diagnóstico precoz. El electrocardiograma (ECG) es una prueba diagnóstica de bajo costo y amplia disponibilidad que nos permite sospechar esta enfermedad, dado que resulta normal en < 5% de los pacientes. El hallazgo clásico es la presencia de bajos voltajes en relación con la gran hipertrofia que se observa en las pruebas de imagen, así como el conocido patrón de pseudoinfarto. Ambos hallazgos son más frecuentes en el subtipo de amiloidosis por cadenas ligeras, que era el más frecuentemente diagnosticado en el pasado. Sin embargo, con la expansión del diagnóstico no invasivo del subtipo a transtiretina, su identificación ha crecido de forma exponencial y se convirtió en el más diagnosticado con más frecuencia en nuestro medio. Se debe prestar especial atención a todos estos hallazgos electrocardiográficos, con el fin de que esta prueba diagnóstica de sencilla obtención pueda contribuir de forma importante a la sospecha y al diagnóstico precoz de la AC.

Cardiac amyloidosis (CA) is a serious disease with a poor prognosis if treatment is not started early, so one of the pending issues in this condition is to make an early diagnosis. The electrocardiogram (EKG) is an inexpensive and widely available diagnostic test that can offer differential data when suspecting this disease, being normal in < 5% of these patients. The classic EKG finding is the presence of low voltages in relation to the large hypertrophy seen on imaging tests, as well as the well-known pseudoinfarct pattern. Both findings are more frequent in the light chain subtype of CA, which was the most frequently diagnosed in the past. However, with the growth of noninvasive diagnostic tests, the identification of the transtyretin subtype has grown exponentially, becoming the most frequently diagnosed in our setting. Special attention should be paid to all these electrocardiographic findings, so that this simple diagnostic test can make an important contribution to the early suspicion and diagnosis of CA.

A amiloidose cardíaca (AC) é uma doença grave com um mau prognóstico no caso de não se iniciar tratamento de forma precoce, pelo que a necessidade de um pronto diagnóstico é imperiosa. Quando se suspeita desta doença, o eletrocardiograma (ECG) é um teste de diagnóstico pouco dispendioso e disponível em todo o mundo, que pode fornecer dados discriminativos importantes, sendo normal em menos de 5% dos casos. O achado clássico do ECG é a presença de baixas voltagens em relação à grande hipertrofia vista na imagem, bem como o conhecido padrão de pseudoinfarte. Ambos os resultados são mais frequentes no subtipo a cadenas ligeras, o mais frequentemente diagnosticado no passado. No entanto, com o aumento dos testes de diagnóstico não-invasivos, o diagnóstico ddo subtipo a transtirretina, o mais cresceu de forma exponencial, tornando-se o mais frequentemente diagnosticado no nosso meio. Deve ser dada especial atenção a todos estes achados eletrocardiográficos já que esta prova de diagnóstico de fácil obtenção pode contribuir de forma importante para a suspeição de diagnóstico precoce de AC.

Exploring the Historical Background and Clinical Implications of Electrocardiogram in the Context of Chagas Disease Research

ABSTRACT Chagas disease (CD) remains one of the most significant endemic diseases in Latin America. Approximately 30% of individuals with CD develop the cardiac form, the main determinant of morbidity and mortality, which is characterized by typical electrocardiogram (ECG) changes caused by chronic chagasic cardiopathy (CCC). This review accentuates to how crucial it is for research teams and reference centers that treat patients with CD to standardize ECG in CCC. This was a non-systematic review of the literature. ECG is the most widely used examination in the diagnosis and evaluation of CCC, and it is also employed in epidemiological surveys, risk stratification for cardiovascular events and death, and monitoring the clinical progression of the disease. Carlos Chagas and Eurico Villela published the first work addressing CCC in 1922. Other works followed, including the study by Evandro Chagas' which was the first to perform ECG in CD, culminating in Francisco Laranja's seminal work in 1956. Since the 1980s, standardizations and ECG reading codes for CD have been established. This standardization aimed to code complex arrhythmias and characteristic ventricular conduction disorders and standardize ECG readings for clinical and epidemiological studies in CD. Nearly all existing electrocardiographic abnormalities can be found in CD, with a predominance of abnormalities in the formation and conduction of cardiac stimuli. The complex and heterogeneous substrate of CD with varied electrocardiographic manifestations poses a significant challenge when comparing studies involving patients with CCC, emphasizing the need for ECG standardization in CD.

Anomalies électrocardiographiques chez les patients hospitalisés pour COVID-19 à Fianarantsoa, Madagascar

Les anomalies électrocardiographiques sont l'expression d'une atteinte cardiovasculaire lors de la COVID-19. Les troubles du rythme et de la conduction cardiaque peuvent mettre en jeu le pronostic vital à court terme au cours de la COVID -19. Notre objectif principal est de décrire les anomalies électrocardiographiques et leurs fréquences chez les patients atteints de la COVID -19. L'objectif secondaire est de déterminer l'association entre ces anomalies électrocardiographiques et la gravité de la maladie. Méthodes : Il s'agit d'une étude rétrospective à visée descriptive des patients hospitalisés pour COVID-19 dans les centres de traitement COVID -19 de Fianarantsoa sur une période de 14 mois. Résultats : Nous avons retenu 101 patients. Le sex-ratio était de 1,06. La moyenne d'âge était de 59,81ans +/- 11,9. Tous les patients retenus avaient un électrocardiogramme à 12 dérivations et un test positif à la COVID-19. L'électrocardiogramme (ECG) était anormal chez 87 (86,1%) patients. Dans les formes graves et modérées de la maladie nous avons enregistré à l'ECG: 51 (50,5%) tachycardies sinusales, 13 (12,8%) blocs de branche incomplets droits, 13 (12,8%) profil S1Q3T3, 24 (23,7%) ondes Q pathologiques, 19 (18,8%) anomalies du segment ST. Dans les formes graves de la maladie nous avons enregistré à l'ECG: 2 (3,8%) bloc auriculoventriculaire complet (BAV complet), 7 (13,4%) blocs de branche gauche complet (BBG), 5 (9,6%) blocs de branche droit complet (BBD). La tachycardie sinusale avait une association significative avec la gravité de la maladie (p=0,002). Conclusion : Des anomalies électrocardiographiques ont été observées dans notre étude. La tachycardie sinusale était associée à la gravité de la maladie. Une surveillance rythmique, des explorations cardiaques plus pertinentes sont nécessaires pour une meilleure prise charge de la COVID-19

Diagnostic utility of 31 ECG criteria for predicting echocardiographic left ventricular geometry / Utilidad diagnóstica del ECG para predecir la geometría del ventrículo izquierdo por ecocardiograma

Abstract Objective: To explore the diagnostic utility of 31 electrocardiogram (ECG) criteria for detecting echocardiographic (Echo) left ventricular geometry using accuracy. Methods: This cross-sectional study included consecutive adults (> 18 years) that were classified by Echo left ventricular geometry as normal (NL), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Thirty-one state-of-the-art ECG criteria for Echo left ventricular hypertrophy were calculated. AUC 95%CI, accuracy, sensitivity, specificity, and positive and negative predictive value for detecting Echo left ventricular geometries were compared. Multivariable linear regression models were produced using the ECG criteria as the dependent variable. Results: A total of 672 adults were included in the study. From 31 ECG criteria, Cornell (ECG21, SV3 + RaVL) and modified Cornell (ECG 31, RaVL + deepest S in all leads) criteria have the best overall AUC in differentiating NL versus CH (0.666 and 0.646), NL versus EH (0.686 and 0.656), CR versus CH (0.687 and 0.661), and CR versus EH (0.718 and 0.676). In multivariable linear regression models, CH and EH had the strongest effect on the final voltage in Cor- nell (ECG21) and modified Cornell (ECG31). Conclusions: From 31 state-of-the-art criteria, Cornell and modified Cornell criteria have the best AUC and accuracy for predicting most left ventricular geometries. CH and EH had the strongest effect on the voltage of Cornell and modified Cornell criteria compared to body mass index, age, diabetes, hypertension, and chronic heart disease. The ECG criteria poorly differentiate NL from CR and CH from EH.

Resumen Objetivo: Explorar la utilidad diagnóstica de 31 criterios de ECG para detectar la geometría ecocardiográfica del ventrículo izquierdo usando la exactitud, área bajo la curva, sensibilidad, especificidad, y valor predictivo positivo y negativo. Métodos: Este estudio transversal incluyó adultos (> 18 años) que se sometieron a ECG y ecocardiograma transtorácico. Los pacientes fueron clasificados según la geometría del ventrículo izquierdo: normal (NL), remodelado concéntrico (RC), hipertrofia concéntrica (HC) e hipertrofia excéntrica (HE). Se calcularon 31 criterios clásicos de ECG para detectar hipertrofia ventricular izquierda y se comparó el rendimiento diagnóstico en cada geometría. Creamos un modelo de regresión lineal múltiple usando los criterios de ECG como variable dependiente. Resultados: Se incluyeron 672 adultos. Los criterios de Cornell (ECG 21, SV3 + RaVL) y Cornell modificado (ECG31, RaVL + S mas profunda de las 12 derivaciones) tienen el mejor AUC para diferenciar NL versus HC (0.666 y 0.646), NL versus HE (0.686 y 0.656), RC versus HC (0.687 y 0.661) y RC versus HE (0.718 y 0.676). En el análisis multivariado la geometría del ventrículo izquierdo (HC e HE) fue la variable que mas influyó en el resultado final del criterio de Cornell y de Cornell modificado. Conclusión: De los 31 criterios clásicos explorados, los criterios de Cornell y Cornell modificado tienen el mejor AUC y exactitud para predecir la mayoría de las geometrías del ventrículo izquierdo. Los criterios del ECG no diferencian bien la geometría NL del RC ni HC de la HE.

The Challenges And Pitfalls Of Limb-Leads And Heart-Axis Calculations - The Differences Between the Overall Magnitudes of Bipolar and Augmented Unipolar Leads cannot be Explained with the Ohm's Law

Summary Our paper analyses the interdependence between the overall magnitudes and resistances of bipolar and augmented unipolar limb leads of electrocardiograms. The findings strongly indicate that the overall ratio of magnitude of the bipolar and augmented unipolar limb leads is not a constant value, whereas the overall ratio of resistance is a constant value. These results expand but partially contradict a previous study. The ratio of the magnitude of bipolar leads to augmented unipolar leads is between 1 and 4/3 with a mean value of 2/?3, and this ratio is a function of the electrical axis of the heart. Our results also show that the overall ratio of resistance between bipolar and augmented unipolar limb leads approaches the value of 4/3. Conclusively, the ratio of magnitudes between limb leads is not a constant value, the ratio of resistances can be assumed as a constant value and therefore the difference of magnitudes between limb leads cannot be explained with the Ohm's law.

Síndrome de Wellens: un patrón electrocardiográfico de alto riesgo / Wellens syndrome: A high-risk electrocardiographic pattern

Resumen Se presenta el caso de un varón de 40 años sin antecedentes cardiovasculares, que ingresó a nuestro centro por dolor precordial. En el electrocardiograma se evidenció un patrón típico, ya des crito, conocido como síndrome de Wellens tipo 1 o A, caracterizado por supradesnivel del ST < 1 mm y onda T bifásica en la derivación V3. Se diagnosticó infarto agudo de miocardio sin elevación del ST, TIMI 3 y GRACE score 66 puntos. Este patrón electrocardiográfico es de alto riesgo, más allá de los puntajes estratificadores, dado que se correlaciona con lesión grave en la arteria descendente an terior a nivel proximal y requiere intervención percutánea sin demoras. En la coronariografía se eviden ciaron 3 lesiones graves: tercio proximal y medio de la arteria descendente anterior y primera diagonal. Destacamos la vigencia de este patrón electrocardiográfico, descrito hace más de 40 años, para identificar y estratificar a pacientes con síndrome coronario agudo.

Abstract We present the case of a 40-year-old male without cardiovascular risk factors, who was admit ted to our hospital due to chest pain. The electrocardiogram showed a typical pattern, already described, known as Wellens syndrome type 1 or A, characterized by ST segment elevation <1 mm and biphasic T wave in lead V3. Was diagnosed of acute myocardial infarction without ST elevation, TIMI 3 and GRACE score 66 points. This electrocardiographic pattern is of high risk, beyond the stratifying scores, since it correlates with severe injury to the anterior descending artery at the proximal level and requires percutaneous interven tion without delay. The coronary angiography revealed 3 severe lesions: the proximal and middle thirds of the left anterior descending artery and the first diagonal. We highlight the validity of this electrocardiographic pattern, described more than 40 years ago, to identify and stratify patients with acute coronary syndrome.

Risk of cardiovascular disease in soccer referees: a cross sectional study

Introducrion: although the mortality rate among soccer players is low, it causes much impact on the entire community and is a fascinating conundrum. Objetive: to evaluate the cardiovascular risk of soccer referees, to describe the frequency of cardiovascular risk considering age groups younger and older than 35 years old and to relate the Framingham and PROCAM indices for the comparison of cardiovascular risk in soccer referees. Methods: We analyzed 50 referees of Paulista Soccer Federation subjected to clinical and laboratory based evaluations at the Center for Sports Health at the Faculty of Medicine of ABC, and were divided into two groups: lower and higher than 35 years of age. For analysis involving all variables of the study it was initially carried out as a descriptive evaluation of the entire group, and then the Framingham and PROCAM methods were applied in a two-dimensional way. Finally, the logistic regression analysis was applied. Anthropometric statistics, blood pressure, laboratory tests and ergospirometric values were within normal limits. Results: referees older than 35 years old presented significant increased values of waist circumference, body mass index, glucose blood levels, lower VO2max and higher cardiovascular risk according to Framingham and PROCAM. Conclusion: the risk for coronary heart disease was higher in referees older than 35 years old.

Introdução: embora a taxa de mortalidade entre os jogadores de futebol seja baixa, ela causa muito impacto em toda a comunidade e é um enigma fascinante.Objetivo: avaliar o risco cardiovascular de árbitros de futebol, descrever a frequência de risco cardiovascular considerando faixas etárias menores e maiores de 35 anos e relacionar os índices de Framingham e PROCAM para comparação de risco cardiovascular em árbitros de futebol.Métodos: foram analisados 50 árbitros da Federação Paulista de Futebol submetidos a avaliações clínicas e laboratoriais no Centro de Saúde Esportiva da Faculdade de Medicina do ABC, divididos em dois grupos: menores e maiores de 35 anos. Para a análise envolvendo todas as variáveis do estudo foi realizada inicialmente como uma avaliação descritiva de todo o grupo e, em seguida, foram aplicados os métodos de Framingham e PROCAM de forma bidimensional. Por fim, foi aplicada a análise de regressão logística. Estatísticas antropométricas, pressão arterial, exames laboratoriais e valores ergoespirométricos estavam dentro da normalidade.Resultados: os árbitros com mais de 35 anos apresentaram valores significantemente aumentados de circunferência da cintura, índice de massa corporal, glicemia, menor VO2máx e maior risco cardiovascular segundo Framingham e PROCAM.Conclusão: o risco de doença coronariana foi maior em árbitros com mais de 35 anos.

Síndrome de takotsubo secundario a trastorno emocional adaptativo / Takotsubo syndrome secondary to adaptative emotional disorder

Introducción: El síndrome de takotsubo o cardiomiopatía por stress, se caracteriza por una disfunción sistólica regional transitoria, principalmente del ventrículo izquierdo que simula un infarto agudo de miocardio, pero en ausencia de evidencia angiográfica de enfermedad arterial coronaria obstructiva o rotura aguda de placa. Es la causa del 1-2 % de todos los síndromes coronarios agudos, se requiere de un diagnóstico oportuno y un tratamiento adecuado para evitar la morbimortalidad por esta patología. Objetivo: destacar la importancia de tener en cuenta el síndrome de takotsubo o cardiomiopatía por estrés como diagnóstico diferencial de los pacientes con dolor torácico según la historia clínica y los desencadenantes del dolor. Presentación de caso: Paciente de 50 años de edad con dolor torácico de características típicas posterior a episodio emocional; reporte de electrocardiograma inicial isquemia anterolateral con troponina positiva y falla cardiaca sistólica, angiografía sin alteración en los vasos coronarios, se diagnosticó síndrome de takotsubo. Conclusión: Es importante considerar el síndrome de takotsubo en el diagnóstico diferencial de los pacientes con dolor torácico, evaluando las circunstancias por las cuales se origina el dolor, ya que requiere un manejo médico multidisciplinario.

Introduction: Takotsubo syndrome or stress cardiomyopathy is characterized by a transient regional systolic dysfunction, mainly of the left ventricle that simulates an acute myocardial infarction, but in the absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture. It is the cause of 1-2 % of all acute coronary syndromes, which requires a timely diagnosis and an adequate treatment to avoid morbidity and mortality from this pathology. Objective: to highlight the importance of taking into account takotsubo syndrome or stress cardiomyopathy as a differential diagnosis in patients with chest pain according to the clinical history and pain triggers. Case presentation: Fifty-year-old patient with typical chest pain after an emotional episode; the initial electrocardiogram reported anterolateral ischemia with positive troponin and systolic heart failure, and the angiography showed no alteration in the coronary vessels, concluding with the diagnosis of Takotsubo syndrome. Conclusion: It is important to consider takotsubo syndrome in the differential diagnosis of patients with chest pain, evaluating the circumstances by which the pain originates since it requires multidisciplinary medical management.

Peculiar association of pulmonary embolism with evolved inferior wall myocardial infarction

Inferior wall myocardial infarction (MI) is one of the common straightforward cardiac conditions in the emergency department (ED) but inferior wall MI masquerading pulmonary embolism (PE) is extremely rare and can be missed if not evaluated promptly in ED. Misdiagnosis of PE is associated with high mortality. Here, we report a case of a 67-year-old male who was admitted to the ED and has been diagnosed with evolved inferior wall MI based on his clinical presentation and electrocardiogram. Later, he developed syncope following which he was reassessed and evaluated for the other possible conditions. Bedside echocardiography findings raised suspicion for PE, which was further confirmed by computed tomography pulmonary angiogram (CTPA). The patient underwent successful thrombolysis and was scheduled for an elective coronary angiogram. This case report highlights the importance of clinical presentation and the benefits of bedside echocardiography that helped in suspecting the association of PE with evolved inferior wall MI

Prevalence of QTc prolongation among hypertensive patients and its association with other co-morbidities

Background:Hypertension, an iceberg disease contributes significantly to the global health burden. This pan-endemic disease is a harbinger for cardiovascular events, especially life-threatening arrhythmias. A simple and cost-effective electrocardiogram serves as an effective tool to identifyand evaluate hypertensives with high cardiovascular risk.QTc interval which indicates repolarization abnormality is one such effective tool.The study aimed at describing the prevalence of QTc prolongation among hypertensive individuals and also to assess the association of QTc prolongation with various co-morbidities.Methods:One hundred and fifty-nine hypertensive patients were evaluated in this cross-sectional study for six months. Demographic variables, biochemical parameters, blood pressure and electrocardiogram were recorded for all the patients. Data obtained were statistically evaluated.Results:The mean age of participants was 55.6 years (SD�76). There were 103 males (64.4%) and 43 females (35.6%). QTc prolongation was noted in 52.5% of the population studied.Statistically significant QTc prolongation among poorly controlled hypertensive was 59% when compared to that of controlled hypertensive at 37.5% was noted. About 26% of the participants were smokers, 27% were alcoholics and 60% had co-existing diabetes mellitus. Diabetes and gender were found to have a statistically significant association with QTc prolongation.Conclusions:The study found a positive correlation between prolonged QTc and hypertensives and hypertensives with coexisting diabetes. To mitigate the consequences of hypertension, the study recommends early diagnosis, stringent blood pressure control, efficient and effective use of QTc measurement, and preventive pharmacotherapy.

An observational study to find out changes in arterial oxygen tension during fiberoptic bronchoscopy

Background:Arterialhypoxaemiaisthecommonestcomplication,sincerespiratory depressantdrugsareusedforpremedication,andtheairwayisalsopartially occludedbythebronchoscope.Thestudyisthereforedesignedtofindoutthechangesinarterialoxygen tensionduring (FOB)alongwitheffectoncentral hemodynamics, pre andpost procedure ECGand PFT.Objectives were tofind out thechanges in arterial oxygentension during FOB, to study the effects of FOBon central hemodynamics, electrocardiographicallyand pulmonaryfunction tests.Methods:One hundred patients aged above 20 years undergoing FOB were evaluated for the arterial oxygen tension and cardiac rhythm changes at KNCH, Jodhpur during 12 months study period from 2019 to 2020.Results:All patients developed a fall in PaO2following FOB but hypoxaemia was noted only in 18 cases. Bronchial washing, punch biopsy and brush biopsy did contribute to hypoxaemia significantly. There was a uniform rise in heart rate in all the patients after FOB which was statistically significant. There was slight sinus tachycardia inmostofthecases although ECG indicated no major arrhythmias.ThepulmonaryfunctionswhichincludechangeinVC,FVC, FEV1andPEFR after FOB, on statisticallycomparisonnostatistical difference could be observed. Therewasnosignificantchangein PaCO2level and pH level.MeanofSBP andmeanofDBPwasstatistically significant.Conclusions:All patients showed a decline in arterial PaO2after FOB which was highly significant. There was slight sinus tachycardia in most of cases. FOB itself does not endanger the patients with any significant or serious complications.

Wearable technology for electrocardiogram and vectocardiogram using the Dower Transformation / Tecnologia vestível para exames de eletrocardiograma e vetocardiograma utilizando a transformada de Dower / Tecnología vestible para exámenes de electrocardiograma y vetocardiograma utilizando de la transformada de Dower

Objectives: Thousands of people suffer from cardiovascular diseases. Even though the electrocardiogram is an exam consolidated. The lack of methodological observation in the placement of sensors can compromise the results. This article proposes a wearable vest capable of conditioning cardiac signals from three simultaneous channels, reducing the chance of failures in the exam due to the smaller number of electrodes attached to the patient's body. Methods: It adds the vectorcardiogram technique to the electrocardiogram wearable, which consists of three orthonormal derivations Vx, Vy, and Vz, measuring dynamic components of the heart vector. Results: The display of the cardiac biopotential in the web-mobile application represents the visualization of the twelve derivations synthesized from the Dower transform and the spatial projections of the cardiac loop under a three-dimensional view. Conclusion: Feasibility of integrating the vectorcardiogram with the electrocardiogram exam.

Objetivos: Milhares de pessoas sofrem com doenças cardiovasculares, apesar do Eletrocardiograma ser um exame consolidado, a falta de observação metodológica na colocação dos sensores pode comprometer os resultados. O presente artigo propõe um colete vestível capaz de condicionar sinais cardíacos de três canais simultâneos, reduzindo a chance de falhas na execução do exame em função da menor quantidade de eletrodos fixados ao corpo do paciente. Métodos: Acrescenta a técnica do vetocardiograma ao vestível de eletrocardiograma, que consiste em três derivações ortonormais Vx, Vy e Vz, medindo componentes dinâmicos do vetor coração. Resultados: Exibição do biopotencial cardíaco na aplicação web-mobile representa de forma satisfatória a visualização das doze derivações sintetizadas a partir da transformada de Dower, bem como, as projeções espaciais do loop cardíaco sob uma visão tridimensional. Conclusão: Viabilidade de integração do vetocardiograma ao exame de eletrocardiograma.

Objetivos: Miles de personas padecen enfermedades cardiovasculares, a pesar de que el electrocardiograma es un examen consolidado, la falta de observación metodológica en la colocación de sensores puede comprometer los resultados. Este artículo propone una tecnología vestible capaz de acondicionar las señales cardíacas de tres canales simultáneos, reduciendo la posibilidad de fallas en el examen por la menor cantidad de electrodos adheridos al cuerpo del paciente. Métodos: Agrega la técnica del vetocardiograma al electrocardiograma vestible, que consta de tres derivaciones ortonormales Vx, Vy y Vz, midiendo los componentes dinámicos del vector cardíaco. Resultados: La visualización del biopotencial cardíaco en la aplicación web-móvil representa satisfactoriamente la visualización de las doce derivaciones sintetizadas a partir de la transformada de Dower, así como las proyecciones espaciales del bucle cardíaco bajo una vista tridimensional. Conclusión: Viabilidad de integrar el vetocardiograma con el examen electrocardiográfico.

Analysis of monitoring results of Keshan disease in Shaanxi Province in 2020 / 中华地方病学杂志

Objective:To grasp the current situation of Keshan disease in Shaanxi Province, and to provide scientific basis for evaluation of local Keshan disease control and elimination.Methods:From May to November 2020, Keshan disease surveillance was carried out in all the diseased townships (towns) of 29 diseased counties (districts, cities) in Shaanxi Province. The diseased village was used as the unit to collect the demographic data of the diseased areas, and the village doctor's clues were used to investigate suspected myocardial cases, and recent outpatient or inpatient clinical examination data of Keshan disease cases were collected; suspected cases were organized for clinical physical examination, electrocardiography (ECG), chest X-ray and echocardiography examination. According to "Notice of the National Health Commission on Printing and Distributing the Evaluation Measures for the Control and Elimination of Key Endemic Diseases (2019 Edition)", the diseased compliance status was assessed.Results:There were 174 diseased townships (towns) and 2 653 diseased villages in the whole province, with a permanent population of 2 819 342 people. A total of 87 suspected cases and 29 confirmed cases of Keshan disease were found, including 27 cases of chronic Keshan disease and 2 cases of latent Keshan disease. The acute and subacute Keshan disease and new cases with disease duration less than 1 year were not detected. The ST-T changes, premature ventricular contractions, complete right bundle branch block, left ventricular hypertrophy, and atrial fibrillation were the most common ECG changes in 29 cases of Keshan disease, and the single ECG change accounted for 6.90% (2/29), two changes accounted for 44.83% (13/29), and three or more changes accounted for 48.28% (14/29). There were 1 case with normal cardiothoracic ratio in chest X-ray examination, 10, 13, and 4 cases with mild, moderate and severe enlargement, respectively; 13 cases with enlarged left atrium in echocardiography, 15 cases with enlarged left ventricle, and 6 cases with enlarged heart.Conclusions:All the diseased areas in Shaanxi Province have reached the national standard for elimination of Keshan disease. Keshan disease monitoring should be continued, self-management of patients with chronic Keshan disease and follow-up observation of patients with latent Keshan disease should be strengthened, and treatment programs for patients with Keshan disease should be actively carried out to improve the quality of life of the patients.