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1.
Praxis (Bern 1994) ; 110(1): 19-21, 2021 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-33406936

RESUMEN

CME ECG 67/Answers: Arrhythmia on Exertion Abstract. Ventricular tachycardias are potentially life-threatening cardiac arrhythmias with a heart rate >100 beats/min, originating from the specific conduction system below the His or the ventricular myocardium. The morphology of the surface ECG can provide valid information about the underlying mechanism and the associated cardiac disorder. The according pathomechanism is of paramount importance for further management. This article is intended to provide an insight into the various causes and treatment options as well as the differential diagnosis of ventricular tachycardias.


Asunto(s)
Esfuerzo Físico , Taquicardia Ventricular , Arritmias Cardíacas/diagnóstico , Electrocardiografía , Sistema de Conducción Cardíaco , Humanos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiología
2.
Br J Sports Med ; 55(1): 54-61, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33020140

RESUMEN

OBJECTIVE: During the COVID-19 pandemic, it is essential to understand if and how to screen SARS-CoV-2-positive athletes to safely resume training and competitions. The aim of this study is to understand which investigations are useful in a screening protocol aimed at protecting health but also avoiding inappropriate examinations. METHODS: We conducted a cohort study of a professional soccer team that is based on an extensive screening protocol for resuming training during the COVID-19 pandemic. It included personal history, antigen swabs, blood tests, spirometry, resting/stress-test ECG with oxygen saturation monitoring, echocardiogram, Holter and chest CT. We also compared the findings with prior data from the same subjects before infection and with data from SARS-CoV-2-negative players. RESULTS: None of the players had positive swab and/or anti-SARS-CoV-2 IgM class antibodies. Out of 30 players, 18 (60%) had IgG class antibodies. None had suffered severe SARS-CoV-2-related disease, 12 (66.7%) had complained of mild COVID-19-related symptoms and 6 (33.3%) were asymptomatic. None of the players we examined revealed significant cardiovascular abnormalities after clinical recovery. A mild reduction in spirometry parameters versus pre-COVID-19 values was observed in all athletes, but it was statistically significant (p<0.05) only in SARS-CoV-2-positive athletes. One SARS-CoV-2-positive player showed increased troponin I level, but extensive investigation did not show signs of myocardial damage. CONCLUSION: In this small cohort of athletes with previous asymptomatic/mild SARS-CoV-2 infection, a comprehensive screening protocol including blood tests, spirometry, resting ECG, stress-test ECG with oxygen saturation monitoring and echocardiogram did not identify relevant anomalies. While larger studies are needed, extensive cardiorespiratory and haematological screening in athletes with asymptomatic/mild SARS-CoV-2 infection appears unnecessary.


Asunto(s)
/métodos , Fútbol , Adulto , Anticuerpos Antivirales/sangre , Infecciones Asintomáticas , Atletas/clasificación , /clasificación , Estudios de Cohortes , Electrocardiografía/métodos , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Italia/epidemiología , Masculino , Anamnesis , Espirometría , Adulto Joven
7.
Med Clin North Am ; 105(1): 93-106, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33246525

RESUMEN

Palpitations are a common presenting symptom in primary care, yet their cause can be difficult to diagnose due to their intermittent and sometimes infrequent nature. All patients presenting with a chief complaint of palpitations should undergo a detailed history, physical examination, and electrocardiogram (ECG). This alone can yield a probable diagnosis. Limited laboratory testing, ambulatory ECG monitoring, and cardiology referral are sometimes indicated. This article reviews current data and guidelines on how to evaluate palpitations in the primary care setting.


Asunto(s)
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiología , Arritmias Cardíacas/economía , Diagnóstico Diferencial , Electrocardiografía , Electrocardiografía Ambulatoria , Medicina Basada en la Evidencia , Costos de la Atención en Salud , Humanos , Anamnesis , Examen Físico , Atención Primaria de Salud
8.
Ter Arkh ; 92(9): 8-14, 2020 Oct 14.
Artículo en Ruso | MEDLINE | ID: mdl-33346425

RESUMEN

AIM: to evaluate the effectiveness of cardiac contractility modulation (MSS) in patients with chronic heart failure (CHF) and atrial fibrillation (AF). MATERIALS AND METHODS: The following studies were performed in 40 patients with CHF and AF before implantation of the MSS device and after 2 and 6 months of follow-up: 12-channel ECG, transthoracic EchoCG, 6-minute walk test, determination of the level of Pro-natriuretic N-terminal peptide (NT-proBNP), daily ECG monitoring, and a questionnaire based on the Minnesota quality of life questionnaire for patients with CHF (MHFLQ). All patients received long-term optimal drug therapy for CHF before surgery. RESULTS: The results obtained indicate a statistically significant positive effect of the use of MSS in patients with CHF and AF on LV FV, the functional class of CHF, and levels of NT-proBNP regardless of the etiology of CHF. CONCLUSION: The use of MSS may be promising for the treatment of heart failure in patients with CHF and AF.


Asunto(s)
Fibrilación Atrial , Insuficiencia Cardíaca , Fibrilación Atrial/tratamiento farmacológico , Enfermedad Crónica , Electrocardiografía , Humanos , Péptido Natriurético Encefálico , Fragmentos de Péptidos , Calidad de Vida
9.
Ter Arkh ; 92(9): 85-93, 2020 Oct 14.
Artículo en Ruso | MEDLINE | ID: mdl-33346436

RESUMEN

The angle between theQRSandTvectors reflects the consistency or inconsistency of the processes of de- and repolarization of the ventricles of the heart and is considered one of the indicators of global electrical heterogeneity of myocardium. In recent years, the prognostic value of theQRS-Tangle has been demonstrated in relation to total and cardiovascular mortality, both in the population and in various groups of patients. The mechanisms of this phenomenon are not completely clear. The review analyses studies published over the past five years on the relationship between theQRS-Tangle and mortality, as well as coronary heart disease and heart failure. Possible mechanisms for increasing theQRS-Tangle are discussed. Data are given on the use of theQRS-Tangle in diagnostic and prognostic scales, including in combination with other indicators of global electrical heterogeneity of myocardium.


Asunto(s)
Electrocardiografía , Insuficiencia Cardíaca , Corazón , Insuficiencia Cardíaca/diagnóstico , Ventrículos Cardíacos , Humanos , Pronóstico , Factores de Riesgo
10.
J Korean Med Sci ; 35(47): e399, 2020 Dec 07.
Artículo en Inglés | MEDLINE | ID: mdl-33289367

RESUMEN

BACKGROUND: This paper proposes a novel method for automatically identifying sleep apnea (SA) severity based on deep learning from a short-term normal electrocardiography (ECG) signal. METHODS: A convolutional neural network (CNN) was used as an identification model and implemented using a one-dimensional convolutional, pooling, and fully connected layer. An optimal architecture is incorporated into the CNN model for the precise identification of SA severity. A total of 144 subjects were studied. The nocturnal single-lead ECG signal was collected, and the short-term normal ECG was extracted from them. The short-term normal ECG was segmented for a duration of 30 seconds and divided into two datasets for training and evaluation. The training set consists of 82,952 segments (66,360 training set, 16,592 validation set) from 117 subjects, while the test set has 20,738 segments from 27 subjects. RESULTS: F1-score of 98.0% was obtained from the test set. Mild and moderate SA can be identified with an accuracy of 99.0%. CONCLUSION: The results showed the possibility of automatically identifying SA severity based on a short-term normal ECG signal.


Asunto(s)
Aprendizaje Profundo , Electrocardiografía , Síndromes de la Apnea del Sueño/patología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Procesamiento de Señales Asistido por Computador , Síndromes de la Apnea del Sueño/diagnóstico
11.
J Coll Physicians Surg Pak ; 30(10): 153-157, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33291194

RESUMEN

OBJECTIVE: To assess and identify the risk of prolonged QT about hydroxychloroquine (HQ) and azithromycin (AZ) used in the treatment of patients with COVID-19. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Turkey, from March to May 2020. METHODOLOGY: One hundred and forty-four patients with the diagnosis of COVID-19, confirmed by Rt-PCR (reverse transcription-polymerase chain reaction), were restrospectively reviewed. Patients who were hospitalised, received HQ or HQ plus AZ treatment, had a baseline electrocardiogram (ECG), and had at least one ECG after treatment were included in the study. Patients with missing data were excluded. RESULTS: Fifty-one (35.4%) patients were given hydroxychloroquine monoterapy (HQ), 93 (64.6%) were given hydroxychloroquine plus azithromycin (HA), and 70 (48.6%) were women. Pre-treatment mean QTc measurements were calculated as 410.61 ± 29.44 milliseconds (ms) for HQ group and 412.02 ± 25.37 ms for HA group, while the mean values of post-treatment QTc measurements were calculated as 432.31 ± 33.97 ms for HQ group and 432.03 ± 27.0 ms for the HA group. Post-treatment QTc measurements of both HA group and HQ group were prolonged compared to pre-treatment measurements. Ventricular arrhythmia was not observed in any patient. CONCLUSION: For COVID-19, no globally accepted definite treatment has yet been found. Both of hydroxychloroquine monotherapy and hydroxychloroquine plus azithromycin treatment regimens cause QTc measurement to increase at a statistically significant level. We concluded that this increase in QTc did not cause ventricular arrhythmia. Key Words: COVID-19, QTc interval, Hydroxychloroquine, Azithromycin.


Asunto(s)
Azitromicina/efectos adversos , Electrocardiografía/efectos de los fármacos , Hidroxicloroquina/efectos adversos , Síndrome de QT Prolongado/inducido químicamente , Pandemias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Antimaláricos/efectos adversos , Antimaláricos/uso terapéutico , Azitromicina/uso terapéutico , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Hidroxicloroquina/uso terapéutico , Síndrome de QT Prolongado/fisiopatología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Adulto Joven
13.
Med Hypotheses ; 144: 110177, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33254499

RESUMEN

The mandatory use of facemasks is a public health measure implemented by various countries in response to the novel coronavirus disease 19 (COVID-19) pandemic. However, there have been case reports of sudden cardiac death (SCD) with the wearing of facemasks during exercise. In this paper, we hypothesize that exercise with facemasks may increase the risk of ventricular tachycardia/ventricular fibrillation (VT/VF) leading to SCD via the development of acute and/or intermittent hypoxia and hypercapnia. We discuss the potential underlying mechanisms including increases in adrenergic stimulation and oxidative stress leading to electrophysiological abnormalities that promote arrhythmias via non-reentrant and reentrant mechanisms. Given the interplay of multiple variables contributing to the increased arrhythmic risk, we advise avoidance of a facemask during high intensity exercise, or if wearing of a mask is mandatory, exercise intensity should remain low to avoid precipitation of lethal arrhythmias. However, we cannot exclude the possibility of an arrhythmic substrate even with low intensity exercise especially in those with established chronic cardiovascular disease in whom baseline electrophysiological abnormalities may be found.


Asunto(s)
/complicaciones , Muerte Súbita Cardíaca , Fenómenos Electrofisiológicos , Ejercicio Físico , Máscaras , Arritmias Cardíacas/fisiopatología , Electrocardiografía , Humanos , Hipercapnia , Hipoxia , Modelos Teóricos , Estrés Oxidativo , Especies Reactivas de Oxígeno/metabolismo , Riesgo , Taquicardia Ventricular/fisiopatología , Fibrilación Ventricular/fisiopatología
14.
Pan Afr Med J ; 37(Suppl 1): 13, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33343792

RESUMEN

Klinefelter syndrome is the most common congenital abnormality causing primary hypogonadism and predisposing to a state of hypercoagulability. We report the case of a 37-year-old man, of Algerian nationality, diagnosed with Klinefelter syndrome admitted to the hospital via the emergency room for acute chest pain and dyspnea. The patient arrived in Tunisia 36 hours ago. On admission, body temperature was 38.2°C, blood pressure, pulse and respiratory rate were 130/70 mmHg, 120/minute and 26/minute, respectively. He had an oxygen saturation of 87% in room air. His electrocardiography revealed a complete right bundle-branch block, chest X-Ray was normal. In front of the clinical presentation and the origin of the patient coming from an endemic country, COVID-19 infection was suspected but ruled out by pharyngeal swabs testing negative by real-time reverse-transcription polymerase chain reaction test and massive pulmonary embolism was diagnosed from his chest computed tomography images. The symptoms improved with anticoagulation treatment.


Asunto(s)
/diagnóstico , Síndrome de Klinefelter/fisiopatología , Embolia Pulmonar/diagnóstico , /diagnóstico , Adulto , Bloqueo de Rama/diagnóstico , Dolor en el Pecho/etiología , Disnea/etiología , Electrocardiografía , Servicio de Urgencia en Hospital , Humanos , Masculino , Tomografía Computarizada por Rayos X
15.
J Med Case Rep ; 14(1): 246, 2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33339534

RESUMEN

BACKGROUND: In December 2019, a new coronavirus (named severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) spread from China, causing a pandemic in a very short time. The main clinical presentation of SARS-CoV-2 infection (COVID-19, coronavirus disease-2019) is pneumonia, but several cardiovascular complications may also occur (e.g., acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure and cardiogenic shock). Direct or indirect mechanisms induced by SARS-CoV-2 could be implicated in the pathogenesis of these events. CASE PRESENTATION: We report herein the third case of COVID-19 autoimmune haemolytic anaemia (AIHA) reported so far, which occurredwithout any other possible explanations in a Caucasian patient. The patient also suffered from ST-elevation myocardial injury. CONCLUSIONS: Both complications occurred quite late after COVID-19 diagnosis and were probably precipitated by systemic inflammation, as indicated by a significant delayed increase in inflammatory markers, including interleukin-6 (IL-6).


Asunto(s)
Anemia Hemolítica Autoinmune/sangre , Infecciones Asintomáticas , Proteína C-Reactiva/inmunología , Interleucina-6/inmunología , Infarto del Miocardio con Elevación del ST/diagnóstico , Anciano de 80 o más Años , Anemia Hemolítica Autoinmune/tratamiento farmacológico , Anemia Hemolítica Autoinmune/etiología , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , /tratamiento farmacológico , Prueba de Coombs , Electrocardiografía , Inhibidores Enzimáticos/uso terapéutico , Femenino , Glucocorticoides/uso terapéutico , Humanos , Hidroxicloroquina/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Prednisolona/uso terapéutico , Infarto del Miocardio con Elevación del ST/tratamiento farmacológico , Infarto del Miocardio con Elevación del ST/etiología
16.
BMJ Case Rep ; 13(12)2020 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-33323422

RESUMEN

Myocardial infarction in a nonagenarian is a morbid cardiac illness that can lead to significant mortality unless properly dealt with management aspects. Many comorbid or family-related issues might be part of holdbacks in management of such a group of patients. Hence, myocardial infarction in a nonagenarian where intervention is better treatment option forms an uncommon combination and has many preprocedural, periprocedural and postprocedural difficulties related to multiple issues. Here, we present a case of nonagenarian who presented with extensive anterior wall MI and was successfully dealt with primary percutaneous coronary intervention despite periprocedural and intraprocedural difficulties.


Asunto(s)
Infarto del Miocardio/diagnóstico , Infarto del Miocardio/cirugía , Intervención Coronaria Percutánea/métodos , Anciano de 80 o más Años , Diagnóstico Diferencial , Ecocardiografía/métodos , Electrocardiografía/métodos , Humanos , Masculino , Infarto del Miocardio/diagnóstico por imagen , Resultado del Tratamiento
17.
Indian Heart J ; 72(6): 500-507, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33357637

RESUMEN

INTRODUCTION: Since the epidemic of COVID-19 attracted the attention, reports were surrounding electrocardiographic changes in the infected individuals. We aimed at pinpointing different observed ECG findings and discussing their clinical significance. METHODS: We conducted a systematic search in PubMed, Embase, and Scopus databases. We included eligible original papers, reports, letters to the editors, and case reports published from December 2019 to May 10, 2020. RESULTS: The team identified 20 articles related to this topic. We divided them into articles discussing drug-induced and non-drug-induced changes. Studies reported an increased risk of QTc interval prolongations influenced by different therapies based on chloroquine, hydroxychloroquine, and azithromycin. Although these medications increased risks of severe QTc prolongations, they induced no arrhythmia-related deaths. In the non-drug-induced group, ST-T abnormalities, notably ST elevation, accounted for the most observed ECG finding in the patients with COVID-19, but their relation with myocardial injuries was under dispute. CONCLUSION: This systematic review suggests that identifying ECG patterns that might be related to COVID-19 is vital. Provided that physicians do not recognize these patterns, they might erroneously risk the lives of their patients. Furthermore, important drug-induced ECG changes provide awareness to the health-care workers on the risks of possible therapies.


Asunto(s)
Arritmias Cardíacas/diagnóstico , Electrocardiografía , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/fisiopatología , Comorbilidad , Humanos , Pandemias
18.
Indian Heart J ; 72(6): 593-598, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33357651

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) has led to a widespread morbidity and mortality. Limited data exists regarding the involvement of cardiovascular system in COVID-19 patients. We sought to evaluate the cardiovascular (CV) complications and its impact on outcomes in symptomatic COVID-19 patients. METHODS: This was a single center observational study among symptomatic COVID-19 patients. Data regarding clinical profile, laboratory investigations, CV complications, treatment and outcomes were collected. Cardiac biomarkers and 12 lead electrocardiograms were done in all while echocardiography was done in those with clinical indications for the same. Corrected QT-interval (QTc) at baseline and maximum value during hospitalization were computed. RESULTS: Of the 108 patients, majority of them were males with a mean age of 51.2 ± 17.7 years. Hypertension (38%) and diabetes (32.4%) were most prevalent co-morbidities. ECG findings included sinus tachycardia in 18 (16.9%), first degree AV block in 5 (4.6%), VT/VF in 2 (1.8%) and sinus bradycardia in one (0.9%). QTc prolongation was observed in 17.6% subjects. CV complications included acute cardiac injury in 25.9%, heart failure, cardiogenic shock and acute coronary syndrome in 3.7% each, "probable" myocarditis in 2.8% patients. Patients with acute cardiac injury had higher mortality than those without (16/28 [57.1%] vs 14/78 [17.5%]; P < 0.0001). Multivariate logistic regression analysis showed that acute cardiac injury (OR: 11.3), lymphopenia (OR: 4.91), use of inotropic agents (OR: 2.46) and neutrophil-lymphocyte ratio (OR:1.1) were independent predictors of mortality. CONCLUSIONS: CV complications such as acute cardiac injury is common in COVID-19 patients and is associated with worse prognosis.


Asunto(s)
/complicaciones , Enfermedades Cardiovasculares/etiología , Hospitalización/tendencias , /epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/terapia , Comorbilidad , Electrocardiografía , Femenino , Humanos , Incidencia , India/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Pronóstico , Estudios Retrospectivos
19.
J Cardiovasc Magn Reson ; 22(1): 78, 2020 11 30.
Artículo en Inglés | MEDLINE | ID: mdl-33256791

RESUMEN

BACKGROUND: Computed tomography angiography (CTA) or contrast-enhanced (CE) cardiovascular magnetic resonance angiography (CMRA) is often obtained in patients with atrial fibrillation undergoing evaluation prior to pulmonary vein (PV) isolation. Drawbacks of CTA include radiation exposure and potential risks from iodinated contrast agent administration. Free-breathing 3D balanced steady-state free precession (bSSFP) Non-contrast CMRA is a potential imaging option, but vascular detail can be suboptimal due to ghost artifacts and blurring that tend to occur with a Cartesian k-space trajectory or, in some cases, inconsistent respiratory gating. We therefore explored the potential utility of both breath-holding and free-breathing non-contrast CMRA, using radial k-space trajectories that are known to be less sensitive to flow and motion artifacts than Cartesian. MAIN BODY: Free-breathing 3D Cartesian and radial stack-of-stars acquisitions were compared in 6 healthy subjects. In addition, 27 patients underwent CTA and non-contrast CMRA for PV mapping. Three radial CMR acquisition strategies were tested: (1) breath-hold (BH) 2D radial bSSFP (BH-2D); (2) breath-hold, multiple thin-slab 3D stack-of-stars bSSFP (BH-SOS); and (3) navigator-gated free-breathing (FB) 3D stack-of-star bSSFP using a spatially non-selective RF excitation (FB-NS-SOS). A non-rigid registration algorithm was used to compensate for variations in breath-hold depth. In healthy subjects, image quality and vessel sharpness using a free-breathing 3D SOS acquisition was significantly better than free-breathing (FB) Cartesian 3D. In patients, diagnostic image quality was obtained using all three radial CMRA techniques, with BH-SOS and FB-NS-SOS outperforming BH-2D. There was overall good correlation for PV maximal diameter between BH-2D and CTA (ICC = 0.87/0.83 for the two readers), excellent correlation between BH-SOS and CTA (ICC = 0.90/0.91), and good to excellent correlation between FB-NS-SOS and CTA (ICC = 0.87/0.94). For PV area, there was overall good correlation between BH-2D and CTA (ICC = 0.79/0.83), good to excellent correlation between BH-SOS and CTA (ICC = 0.88/0.91) and excellent correlation between FB-NS-SOS and CTA (ICC = 0.90/0.95). CNR was significantly higher with BH-SOS (mean = 11.04) by comparison to BH-2D (mean = 6.02; P = 0.007) and FB-NS-SOS (mean = 5.29; P = 0.002). CONCLUSION: Our results suggest that a free-breathing stack-of-stars bSSFP technique is advantageous in providing accurate depiction of PV anatomy and ostial measurements without significant degradation from off-resonance artifacts, and with better image quality than Cartesian 3D. For patients in whom respiratory gating is unsuccessful, a breath-hold thin-slab stack-of-stars technique with retrospective motion correction may be a useful alternative.


Asunto(s)
Fibrilación Atrial/diagnóstico por imagen , Imagenología Tridimensional , Angiografía por Resonancia Magnética , Flebografía , Venas Pulmonares/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Fibrilación Atrial/cirugía , Técnicas de Imagen Sincronizada Cardíacas , Estudios de Casos y Controles , Angiografía por Tomografía Computarizada , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Venas Pulmonares/cirugía , Reproducibilidad de los Resultados
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