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2.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 9-18, feb. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-ET2-3431

RESUMEN

Objetivos. Analizar qué características clínicas y del ECG de la primera valoración de pacientes con dolor torácico no traumático (DNT) se asocian con una clasificación inicial de sospecha de síndrome coronario agudo (SCA) y con el diagnóstico final de SCA, e identificar cuáles resultan sobre o infravaloradas durante la clasificación inicial. Método. Se incluyeron las consultas consecutivas por DTNT en una unidad de dolor torácico durante 10 años (2008-2017) en las que se disponía de los diagnósticos inicial de sospecha (SCA/no SCA) y final de alta de urgencias (SCA/no SCA). Se incluyeron 33 variables independientes (2 demográficas, 5 comorbilidad cardiovascular, 22 dolor torácico, 4 datos ECG). Se calcularon las odds ratio (OR) para la clasificación (inicial y final) como SCA para cada variable independiente, crudas y ajustadas en modelos globales que incluían todas ellas. En estos modelos ajustados se comparó si las OR para la clasificación inicial y final como SCA eran significativamente diferentes. Resultados. Se incluyeron 34.552 visitas. Las 33 variables analizadas mostraron asociación significativa para la clasificación inicial y final del DTNT como SCA, y en muchos casos esta asociación se mantuvo en el modelo ajustado. Diecinueve variables mostraron OR significativamente diferentes para la sospecha inicial de SCA que para el diagnóstico final de SCA: 10 sobrestimaban la asociación final y 9 la subestimaban. Conclusión. Los datos clínicos iniciales clásicamente utilizados para sospechar SCA pacientes con DTNT en urgencias identifican todos ellos individualmente a pacientes con riesgo incrementado de ser clasificado inicial y finalmente como SCA; sin embargo, algunos de ellos sobreestiman y otros subestiman inicialmente el riesgo final. Los urgenciólogos debieran sensibilizarse más con estos datos subestimados


Objectives. To analyze clinical data and electrocardiographic (ECG) findings obtained during the initial evaluation of patients with nontraumatic chest pain (NTCP). To explore associations between these findings and the initial and final diagnoses of acute coronary syndrome (ACS). To assess which variables initially over- or underestimate risk ACS. Methods. Consecutive patients with NTCP attended in a chest pain unit during the 10-year period of 2008–2017 were included if the suspected and discharge diagnoses of interest (ACS or non-ACS) had been recorded. Thirtythree independent variables (demographic, 2; cardiovascular, 5; chest pain, 22; ECG, 4). We included all variables in models to calculate crude and adjusted odds ratios (ORs) between each independent variable and the initial and final diagnoses. The adjusted ORs were compared to determine whether the initial and final diagnoses of ACS differed significantly in relation to the variables. Results. A total of 34 552 patient visits were attended. The ORs for the 33 variables were significantly associated with initial and final NTCP classification as ACS or non-ACS, and in many cases the association was confirmed by the adjusted ORs. The adjusted ORs for 19 variables were significantly different in their relation to the initial and final diagnoses of ACS: 10 overpredicted the probability of the diagnosis and 9 underpredicted it. Conclusions. The variables traditionally used to warn of ACS in emergency patients with NTCP identify individuals likely to be initially and finally diagnosed with ACS. However, some of these variables overestimate or underestimate the risk of a final ACS diagnosis. Emergency medicine physicians should be aware of variables associated with underestimation of risk


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Análisis de Datos , Ficha Clínica , Electrocardiografía/estadística & datos numéricos , Dolor en el Pecho/epidemiología , Síndrome Coronario Agudo/diagnóstico , Indicadores de Salud , Oportunidad Relativa , Modelos Logísticos , Análisis Multivariante
4.
Medicine (Baltimore) ; 99(5): e18656, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000371

RESUMEN

RATIONALE: The De Winter electrocardiogram (ECG) pattern is considered as a ST elevated myocardial infarction (STEMI)-equivalent pattern. Due to its rare nature, it is unclear whether this ECG pattern suggests the presence of some other condition. PATIENT CONCERNS: We reported a 47-year-old man with new-onset chest discomfort several hours after the second-stage percutaneous coronary intervention (PCI). DIAGNOSES: An emergency coronary angiogram (CAG) did not show any abnormality. However, the dynamic changes in the ECG and myocardial biomarkers indicated perioperative myocardial infarction. INTERVENTION: The patient was monitored in the cardiac care unite (CCU), and was administered an intravenous infusion of diltiazem and subcutaneous injection of low molecular weight heparin. OUTCOMES: After a few hours, his symptoms were alleviated. The patient was discharged after 6 days of hospitalization without any complications. LESSONS: The De Winter ECG pattern can be observed in patients without significantly coronary arteries occlusion. The newly onset De Winter ECG pattern after PCI procedure may indicate perioperative myocardial infarction caused by impaired microvascular perfusion.


Asunto(s)
Electrocardiografía , Infarto del Miocardio/diagnóstico , Intervención Coronaria Percutánea/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Complicaciones Posoperatorias/etiología
5.
Medicine (Baltimore) ; 99(4): e18961, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977913

RESUMEN

This study explored whether sympathovagal modulation assessed through frequency domains of heart rate variability (HRV) can indicate sepsis in patients with suspected infection.In total, 370 consecutive adult patients with suspected infection admitted to the emergency department were enrolled in this single-center cohort study. A continuous 10-minute electrocardiography for HRV analysis was recorded immediately for these patients after inclusion. Patients were stratified into non-sepsis and sepsis groups based on a sepsis-related organ failure assessment score of ≥2 that met the Third International Consensus Definitions for Sepsis. Seven frequency domains of HRV were compared between these 2 groups.Compared with the non-sepsis group (n = 98), the sepsis group (n = 272) had a significantly lower incidence of respiratory tract infection, higher total power, higher very-low-frequency component, higher high-frequency (HF) component, higher normalized HF component, lower normalized low-frequency (LF) component, and lower LF component/HF component ratio (LF/HF). Multiple logistic regression model identified HF component (odds ratio [OR] = 0.994; 95% confidence interval [CI], 0.990-0.999) and LF/HF (OR = 0.494; 95% CI, 0.423-0.578) as significant variables associated with sepsis. The area under receiver operating characteristic curves of HF component and LF/HF was 0.741 (95% CI, 0.685-0.797) and 0.930 (95% CI, 0.900-0.960), respectively, in identifying sepsis in patients with suspected infection.Tilted sympathovagal balance toward increased vagal activity and depressed sympathetic modulation, assessed by the HF component and LF/HF, may indicate sepsis in patients with suspected infection.


Asunto(s)
Frecuencia Cardíaca , Sepsis/diagnóstico , Nervio Vago/fisiopatología , Anciano , Estudios de Casos y Controles , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Estudios Prospectivos , Sensibilidad y Especificidad , Sepsis/fisiopatología
6.
Lancet ; 395(10219): e9, 2020 01 18.
Artículo en Inglés | MEDLINE | ID: mdl-31954472
8.
Adv Exp Med Biol ; 1232: 315-322, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893426

RESUMEN

We present an unobtrusive cuff-less sphygmomanometer based on contact-type and optical pulse sensors for continuous and minimally invasive monitoring of blood pressure (BP). We developed a cuff-less sphygmomanometer that utilizes the pulse arrival time (PAT) to estimate continuous BP. To assess its accuracy, we recruited 10 healthy subjects in whom we carried out BP studies using the cuff-less sphygmomanometer compared with a standard cuff-type device in a stationary sitting patient. Preliminary results showed that the mean difference (MD) of estimated systolic blood pressure and diastolic blood pressure were 0.96 ± 9.6 (mean ± SD) mmHg and 1.14 ± 7.5 mmHg, respectively, compared to the control. The corresponding correlation between the estimated BP values and controls were 0.78 for systolic blood pressure (p < 0.01) and 0.69 for diastolic blood pressure (p < 0.01); thus, there were significant correlations. These results suggest that the developed cuff-less sphygmomanometer has the potential for continuous BP monitoring. Finally, we conducted a preliminary study of simultaneous monitoring of cuff-less BP and near-infrared spectroscopy to evaluate the potential for assessment of autonomic nervous system functions during mental stress tasks.


Asunto(s)
Determinación de la Presión Sanguínea , Esfigmomanometros , Adulto , Sistema Nervioso Autónomo/fisiología , Presión Sanguínea , Determinación de la Presión Sanguínea/instrumentación , Electrocardiografía , Frecuencia Cardíaca , Humanos , Masculino , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/normas , Esfigmomanometros/normas , Adulto Joven
13.
Artículo en Inglés | MEDLINE | ID: mdl-31936779

RESUMEN

Lecca et al., in a recent publication in the Int. J. Environ. Res. Public Health had made some mistakes in the statistical analysis and interpretation of the results. Age was not a clear contributing factor in the prolongation of QT interval in the electrocardiogram (ECG), as there were strong confounders in their study. The effects of age were mainly faded out because of the age range of the participants. The use of Pearson's correlation is questionable because of the normality assumptions was not met on the studied variables. They also made some conclusions about the effects of long and night shifts on the QT prolongation that were not appropriate based on their study type. All of these mentioned issues might completely change the validity of the conclusions they made.


Asunto(s)
Estrés Laboral , Salud Pública , Electrocardiografía , Humanos , Masculino
16.
Artículo en Japonés | MEDLINE | ID: mdl-31956185

RESUMEN

PURPOSE: In triggered acquisition noncontrast enhancement magnetic resonance angiography using ECG-gated with short-term inversion recovery (STIR-TRANCE), signal intensity and contrast fluctuate according to the value of refocus flip angle (RFA). We believe that we can visualize the pulmonary vascular excellently by optimized RFA which improves the signal intensity of pulmonary vascular and the contrast between pulmonary vascular and lung parenchyma. The purpose of this study is to optimize RFA in pulmonary vascular magnetic resonance angiography (MRA) imaging using STIR-TRANCE. METHOD: Pulmonary vascular MRA was performed in five normal volunteers. The department's ethics committee approved the study, and informed consent was obtained from all subjects. Before the STIR-TRANCE study, an ECG-gated single shot TSE (SS TSE) scan was performed to determine the timing of diastole. Later, the diastolic STIR-TRANCE imaging using both ECG and respiratory gating was performed with three different RFA (140 degree, 160 degree, and 180 degree). For physical evaluation, we used the signal to noise ratio (SNR) and contrast and for visual evaluation, so we used the Scheffe's method. RESULTS: SNR increases with increasing RFA. The contrast of 160 degree was significantly higher than the contrast of 180 degree. There was no significant difference in visual evaluation. CONCLUSION: From the perspective of specific absorption rate (SAR) reduction, we concluded that the optimal RFA for pulmonary vascular MRA in this study was 160 degree.


Asunto(s)
Electrocardiografía , Imagen Tridimensional , Pulmón , Angiografía por Resonancia Magnética , Diástole , Humanos , Pulmón/irrigación sanguínea , Pulmón/diagnóstico por imagen , Relación Señal-Ruido
18.
Medicine (Baltimore) ; 99(1): e18371, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895771

RESUMEN

INTRODUCTION: Kawasaki disease (KD) is an acute vasculitis syndrome that mainly affects children and is the first cause of acquired heart disease. Coronary artery lesion is the most serious complication of KD. Only two previous studies have reported similar cases, but we reported patient was younger and had a longer follow-up. PATIENT CONCERNS: We reported a case of coronary sequelae of KD treated with rotational atherectomy and drug coated balloon (DCB). During the week after surgery, the patient complained of a slight chest pain intermittently, but no longer appeared after that. DIAGNOSIS: We diagnosed by electrocardiogram and angiography. Angiography showed that the anterior descending branch (LAD) proximal stenosis was 95%, the right coronary artery (RCA) middle stenosis was 99%, and the calcification was severe. INTERVENTIONS: We treat the patient with rotational atherectomy using a 1.25 mm burr, pre-dilatation of the stenosis lesion with a 3.5 mm × 15 mm non-compliant balloon was achieved. Then 3.5 mm × 15 mm drug eluting balloon was inflated at 10 atm for 60 seconds. OUTCOMES: After the 6-month follow-up (from October 2018 to March 2019), the symptom of angina disappeared. Coronary angiography 6 months later showed no apparent progression of vessel narrowing. CONCLUSION: The present case suggests that rotational atherectomy followed by DCB dilation could be an alternative revascularization therapy of choice in coronary KD sequelae complicated with atherosclerosis.


Asunto(s)
Aterectomía Coronaria/métodos , Aneurisma Coronario/cirugía , Síndrome Mucocutáneo Linfonodular/complicaciones , Adulto , Angioplastia Coronaria con Balón/métodos , Calcinosis/patología , Aneurisma Coronario/diagnóstico por imagen , Aneurisma Coronario/etiología , Vasos Coronarios/patología , Electrocardiografía , Humanos , Masculino
19.
Medicine (Baltimore) ; 99(2): e18548, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914030

RESUMEN

BACKGROUND: Coronary heart disease angina pectoris is a common clinical symptom in patients with coronary heart disease, due to coronary atherosclerotic stenosis or sputum leading to coronary insufficiency, myocardial transient ischemia, hypoxia caused by precordial pain as the main clinical manifestations Group syndrome. Coronary heart disease angina causes coronary blood flow insufficiency, cannot meet the normal activities of myocardial cells, leading to myocardial ischemia or necrosis. When the disease occurs, there is paroxysmal and crushing pain in the precordial area of the patient. Therefore, we recognize the importance of the disease and have paid enough attention. Clinical studies in recent years have found that the use of acupuncture in the treatment of angina pectoris has a good clinical application prospect. This study was conducted to study the effect of using acupuncture to treat angina pectoris. METHODS AND ANALYSIS: We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet, Nature, Science online and China Journal Full-text Database, China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of angina pectoris. ETHICS AND DISSEMINATION: This systematic review will evaluate the efficacy and safety of acupuncture for angina pectoris. Because all of the data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial. REGISTRATION NUMBER: PROSPERO CRD42019138003.


Asunto(s)
Terapia por Acupuntura/métodos , Angina de Pecho/terapia , Terapia por Acupuntura/efectos adversos , Electrocardiografía , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación
20.
Medicine (Baltimore) ; 99(2): e18684, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914066

RESUMEN

BACKGROUND: Numerous studies have illustrated the association of QRS width with the incidence of echocardiographic response to cardiac resynchronization therapy (CRT). This study aimed to summarize the observational studies regarding the magnitude of change in QRS width between responders and nonresponders to CRT. METHODS: The PubMed, Embase, and the Cochrane Library were systematically searched for relevant studies investigating the changes of QRS width with the incidence of echocardiographic response to CRT from inception till May 2019. The pooled weighted mean difference (WMD) with 95% confidence interval (CI) was calculated through random-effects model. RESULTS: Five prospective and 6 retrospective studies with a total of 1524 patients were selected for final analysis. The reduction of QRS width in responders was significantly greater than nonresponders (WMD: -20.54 ms; 95% CI: -26.78 to -14.29; P < .001). Moreover, responders were associated with greater percentage reduction in QRS width when compared with nonresponders (WMD: -8.80%; 95% CI: -13.08 to -4.52; P < .001). Finally, the mean change in QRS width between responders and nonresponders differed when stratified by country, study design, mean age, percentage male, ejection fraction, measuring time of postimplanted QRS, ischemic cardiomyopathy, atrial fibrillation, and study quality. CONCLUSIONS: These findings indicated that shortening QRS width after CRT device implantation showed association with greater incidence of echocardiographic responses to CRT. Further prospective studies should be conducted to evaluate the prognostic values of QRS width on the incidence of echocardiographic response to CRT.


Asunto(s)
Terapia de Resincronización Cardíaca , Ecocardiografía , Electrocardiografía , Humanos , Masculino , Estudios Observacionales como Asunto
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