Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 41.898
Filtrar
1.
BMJ ; 373: n379, 2021 04 12.
Artículo en Inglés | MEDLINE | ID: mdl-33846159

RESUMEN

Atrial fibrillation is a common chronic disease seen in primary care offices, emergency departments, inpatient hospital services, and many subspecialty practices. Atrial fibrillation care is complicated and multifaceted, and, at various points, clinicians may see it as a consequence and cause of multi-morbidity, as a silent driver of stroke risk, as a bellwether of an acute medical illness, or as a primary rhythm disturbance that requires targeted treatment. Primary care physicians in particular must navigate these priorities, perspectives, and resources to meet the needs of individual patients. This includes judicious use of diagnostic testing, thoughtful use of novel therapeutic agents and procedures, and providing access to subspecialty expertise. This review explores the epidemiology, screening, and risk assessment of atrial fibrillation, as well as management of its symptoms (rate and various rhythm control options) and stroke risk (anticoagulation and other treatments), and offers a model for the integration of the components of atrial fibrillation care.


Asunto(s)
Fibrilación Atrial/diagnóstico , Tamizaje Masivo/normas , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/normas , Accidente Cerebrovascular/prevención & control , Antiarrítmicos/administración & dosificación , Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/epidemiología , Fibrilación Atrial/terapia , Cateterismo Cardíaco , Electrocardiografía , Carga Global de Enfermedades , Estilo de Vida Saludable , Frecuencia Cardíaca/efectos de los fármacos , Frecuencia Cardíaca/fisiología , Humanos , Incidencia , Tamizaje Masivo/métodos , Prevalencia , Atención Primaria de Salud/métodos , Medición de Riesgo/métodos , Factores de Riesgo , Accidente Cerebrovascular/etiología
2.
Medicine (Baltimore) ; 100(16): e25425, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33879672

RESUMEN

BACKGROUND: The American Heart Association guidelines recommend switching chest compression providers at least every 2 min depending on their fatigue during cardiopulmonary resuscitation (CPR). Although the provider's heart rate is widely used as an objective indicator for detecting fatigue, the accuracy of this measure is debatable. OBJECTIVES: This study was designed to determine whether real-time heart rate is a measure of fatigue in compression providers. STUDY DESIGN: A simulation-based prospective interventional study including 110 participants. METHODS: Participants performed chest compressions in pairs for four cycles using advanced cardiovascular life support simulation. Each participant's heart rate was measured using wearable healthcare devices, and qualitative variables regarding individual compressions were obtained from computerized devices. The primary outcome was correct depth of chest compressions. The main exposure was the change in heart rate, defined as the difference between the participant's heart rate during individual compressions and that before the simulation was initiated. RESULTS: With a constant compression duration for one cycle, the overall accuracy of compression depth significantly decreased with increasing heart rate. Female participants displayed significantly decreased accuracy of compression depth with increasing heart rate (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.95-0.98; P < .001). Conversely, male participants displayed significantly improved accuracy with increasing heart rate (OR: 1.03; 95% CI: 1.02-1.04; P < .001). CONCLUSION: Increasing heart rate could reflect fatigue in providers performing chest compressions with a constant duration for one cycle. Thus, provider rotation should be considered according to objectively measured fatigue during CPR.


Asunto(s)
Reanimación Cardiopulmonar/métodos , Auxiliares de Urgencia/estadística & datos numéricos , Fatiga/fisiopatología , Frecuencia Cardíaca/fisiología , Enfermedades Profesionales/fisiopatología , Adulto , Reanimación Cardiopulmonar/educación , Auxiliares de Urgencia/educación , Fatiga/diagnóstico , Femenino , Humanos , Masculino , Maniquíes , Enfermedades Profesionales/diagnóstico , Estudios Prospectivos , Entrenamiento Simulado , Trabajo/fisiología , Adulto Joven
3.
Medicine (Baltimore) ; 100(8): e24753, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663090

RESUMEN

BACKGROUND: Archery has existed in human history for millenniums. Being a unique exercise and precision sport, the keys to performance are emotional control, attention, and concentration rather than explosive force, muscle power, and endurance. During the execution of archery, attention is the key to performance in elite players, especially in the initial period while drawing the bow. Auricular acupoint stimulation is one of the therapeutic methods of traditional Chinese medicine and has been reported for its use in amplifying the anesthesia effect, weight reduction, cessation of substance abuse, and autonomic nervous modulation. METHODS: The study will recruit archery players in school teams among junior and senior high schools and colleges. The subjects will be randomly assigned to the ear and sham acupressure groups. This is a randomized controlled trial with crossover design. The outcome measures will be obtained, including the meridian activities and balance index with Ryodoraku device, the movement stability with WIMU tracking system, the continuous heart rate record, and the scores of the 2 sections as the performance. The subjects will rate their attention and fatigue levels through self-reported questionnaires. OBJECTIVES: This study aims to investigate the immediate effect of non-invasive auricular acupoint stimulation on the performance and meridian activities of archery athletes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04637607.


Asunto(s)
Acupresión/métodos , Atletas , Oído/fisiología , Puntos de Acupuntura , Adolescente , Atención/fisiología , Estudios Cruzados , Fatiga/terapia , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Meridianos
4.
J Vis Exp ; (168)2021 02 14.
Artículo en Inglés | MEDLINE | ID: mdl-33645573

RESUMEN

Blood pressure (BP) and heart rate (HR) are both controlled by the autonomic nervous system (ANS) and are closely intertwined due to reflex mechanisms. The baroreflex is a key homeostatic mechanism to counteract acute, short-term changes in arterial BP and to maintain BP in a relatively narrow physiological range. BP is sensed by baroreceptors located in the aortic arch and carotid sinus. When BP changes, signals are transmitted to the central nervous system and are then communicated to the parasympathetic and sympathetic branches of the autonomic nervous system to adjust HR. A rise in BP causes a reflex decrease in HR, a drop in BP causes a reflex increase in HR. Baroreflex sensitivity (BRS) is the quantitative relationship between changes in arterial BP and corresponding changes in HR. Cardiovascular diseases are often associated with impaired baroreflex function. In various studies reduced BRS has been reported in e.g., heart failure, myocardial infarction, or coronary artery disease. Determination of BRS requires information from both BP and HR, which can be recorded simultaneously using telemetric devices. The surgical procedure is described beginning with the insertion of the pressure sensor into the left carotid artery and positioning of its tip in the aortic arch to monitor arterial pressure followed by the subcutaneous placement of the transmitter and ECG electrodes. We also describe postoperative intensive care and analgesic management. After a two-week period of post-surgery recovery long-term ECG and BP recordings are performed in conscious and unrestrained mice. Finally, we include examples of high-quality recordings and the analysis of spontaneous baroreceptor sensitivity using the sequence method.


Asunto(s)
Barorreflejo/fisiología , Presión Sanguínea/fisiología , Estado de Conciencia/fisiología , Electrocardiografía , Telemetría , Animales , Arterias Carótidas/fisiología , Ritmo Circadiano/fisiología , Electrodos Implantados , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Ratones Endogámicos C57BL , Procesamiento de Señales Asistido por Computador , Programas Informáticos
5.
J Med Life ; 14(1): 105-110, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33767794

RESUMEN

According to the definition adopted by the international biological program, physical performance is characterized by maximum oxygen consumption (MOC). Profession, lifestyle, and sport affect the value of the MOC. For anatomy and physiology, oxygen delivery to muscle tissue depends on the state of the respiratory and cardiovascular system, the amount and composition of blood. In this case, the leading role belongs to the cardiac activity, namely to the magnitude of the shock and minute volumes of blood in working conditions. High values of MOC and, consequently, a large work capacity are characteristic of athletes specializing in cyclic sports with moderate and high power. The purpose of the research was to evaluate the adaptive response of the cardiovascular system of girls involved in cyclic and acyclic sports as well as those not involved in sports. The study was conducted in 2018. During the research, we used pulse oximetry and determination of blood pressure according to N.S. Korotkov, as well as an assessment of the adaptation of the cardiovascular system according to the Ruffier Index. Studies have shown differences in the level of performance of girls involved in cyclic sports (athletics) and acyclic sports (karate and taekwondo), as well as non-sports. During the experiments, heart rate and blood pressure indicators were recorded at rest and after exercise, and the Ruffier Index, which reflects the level of performance of the participants, was calculated.


Asunto(s)
Rendimiento Atlético/fisiología , Deportes , Presión Sanguínea/fisiología , Ejercicio Físico/fisiología , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Estilo de Vida , Consumo de Oxígeno/fisiología
6.
Int Heart J ; 62(2): 312-319, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33678799

RESUMEN

This study aims to evaluate the incidence of ischemic stroke or transient ischemic attack (TIA) based on CHA2DS2-VASc scores in non-AF Chinese patients with sinus rhythm.We used health check-up data of 101,510 participants from the Kailuan Cohort Study. Participants' risk levels were defined by their CHA2DS2-VASc scores (range 0-3): Men with scores of 0, 1, or ≥ 2 and women with scores of 1, 2, or ≥ 3 were considered at low, intermediate, or high risk, respectively. Cox proportional hazards model was used to assess the association between the CHA2DS2-VASc-determined risk and the incidence of ischemic stroke/TIA.The mean 7.5 year follow-up examination revealed 2968 ischemic strokes/TIA events. The incidence rates for ischemic stroke/TIA events in men and women were 3.8% and 1.5%, respectively. The incidence of ischemic stroke/TIA increased with elevated predicted risks based on CHA2DS2-VASc scores in men: 2.2% for low-risk, 4.1% for intermediate-risk, and 7.8% for high-risk groups (P < 0.001 for trend). The incidences of ischemic stroke/TIA also increased with elevated predicted risks in women: 0.8% for low-risk, 2.1% for intermediate-risk, and 5.0% for high-risk groups (P < 0.001 for trend). Compared with low-risk group, the crude hazard ratio (95% confidence interval) of ischemic stroke/TIA for men in moderate- and high-risk groups were 1.96 (1.79-2.14; P < 0.001) and 4.18 (3.81-4.57; P < 0.001). Similar findings were observed in women.Risks of ischemic stroke/TIA events was high, particularly among those with high CHA2DS2-VASc scores.


Asunto(s)
Fibrilación Atrial/complicaciones , Isquemia Encefálica/epidemiología , Frecuencia Cardíaca/fisiología , Ataque Isquémico Transitorio/epidemiología , Medición de Riesgo/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/etiología , China/epidemiología , Femenino , Humanos , Incidencia , Ataque Isquémico Transitorio/etiología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
7.
Int Heart J ; 62(2): 344-349, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33731516

RESUMEN

Cardiovascular event rates of patients with a dipper blood pressure (BP) and dipper heart rate (HR) pattern are lower than those of patients with nondipper BP and HR patterns. However, how the pacemaker mode affects the diurnal BP and HR patterns remains unclear.We enrolled nine patients (average age 74.4 ± 6.6 years, 4 males and 5 females) with sick sinus syndrome who required atrial pacing. We investigated sequential 6-month pacing regimens (DDD mode at 60 bpm and sleep rate mode). We set the lower rate of sleep rate mode as follows: 60 bpm during the daytime and 50 bpm during the nighttime. The order of pacing mode was randomized, with crossover design. Ambulatory BP monitoring was performed at baseline, 6 months, and 12 months, BP category was classified into four groups (extreme dipper, dipper, nondipper, and riser pattern), and HR was classified into dipper and nondipper patterns.Nighttime HR during the sleep rate mode was significantly lower than that at DDD (57.1 ± 6.2 versus 63.5 ± 3.8 bpm, P = 0.001). The dipper HR pattern was increased in the sleep rate mode compared with those at baseline or DDD mode (versus baseline: 89% versus 44%, P = 0.035; versus DDD: 89% versus 22%, P = 0.004). The dipper BP pattern significantly increased in the sleep rate mode compared with the baseline (56% versus 11%, P = 0.035), but the difference between the sleep rate mode and DDD mode was statistically marginal (56% versus 22%, P = 0.081).The pacemaker settings in the sleep rate mode increased the dipper HR and BP patterns in pacemaker-dependent patients with sick sinus syndrome.


Asunto(s)
Sistema Nervioso Autónomo/fisiopatología , Presión Sanguínea/fisiología , Ritmo Circadiano/fisiología , Atrios Cardíacos/fisiopatología , Frecuencia Cardíaca/fisiología , Marcapaso Artificial , Síndrome del Seno Enfermo/fisiopatología , Sueño/fisiología , Anciano , Monitoreo Ambulatorio de la Presión Arterial , Femenino , Humanos , Masculino , Síndrome del Seno Enfermo/terapia
8.
Int Heart J ; 62(2): 329-336, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33731518

RESUMEN

The reasons of residual left ventricular outflow tract (LVOT) obstruction following alcohol septal ablation (ASA) remain unclear, and outcomes of myectomy following failed ASA remain underreported.Thirteen symptomatic patients (10 women, a median age of 60.0 years) who underwent septal myectomy following failed ASA were reviewed. The patients were followed up for a median of 6 months. The clinical characteristics and outcomes of these patients were analyzed and were compared with those of 178 patients who underwent isolated myectomy without previous ASA at our institution during the same period.In the first ASA procedure, the median number of septal perforator arteries injected was 1.0 with the median value of peak creatine kinase following ablation of 978.5 U/L.Uncontrollable extent and location of infarcted myocardium caused by ablation and mitral subvalvular anomalies were found in four (30.8%) and seven (53.8%) patients, respectively. No operative or follow-up deaths occurred. The median maximum LVOT gradients fell from preoperative 112.0 to 8.5 mmHg at follow-up (P < 0.001). Compared with controls, patients with failed ASA had a higher proportion of mitral subvalvular anomalies (53.8% versus 13.5%, P = 0.001) and developed a higher incidence of complete atrioventricular block following myectomy (15.4% versus 1.7%, P = 0.038).Low institutional or operator experience with ablation, uncontrollable extent and location of infarcted myocardium caused by ablation, and mitral subvalvular anomalies may be reasons for failed ASA. Surgical myectomy for the treatment of residual LVOT obstruction after unsuccessful ASA may be associated with favorable results.


Asunto(s)
Técnicas de Ablación/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Etanol/farmacología , Tabiques Cardíacos/cirugía , Obstrucción del Flujo Ventricular Externo/terapia , Adulto , Anciano , Femenino , Estudios de Seguimiento , Frecuencia Cardíaca/fisiología , Tabiques Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Insuficiencia del Tratamiento , Obstrucción del Flujo Ventricular Externo/diagnóstico , Obstrucción del Flujo Ventricular Externo/fisiopatología
9.
Int Heart J ; 62(2): 298-304, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33731524

RESUMEN

Radiofrequency and cryoballoon applications around the pulmonary veins (PVs) could provoke a vagal reflex (VR) by modulating the intrinsic cardiac autonomic nervous system (ICANS).This study aimed to investigate the incidence, timing, and clinical impact of a VR provoked by a laser balloon application for a PV isolation (PVI).A total of 92 consecutive paroxysmal atrial fibrillation (PAF) patients underwent a laser balloon PVI of PAF. Acute changes in the heart rate and blood pressure were recorded. The heart rate variability (HRV) was tested by Holter ECGs before and at three months following the ablation. Three hundred forty-five out of 363 PVs were successfully isolated (97%) with laser balloon applications. A VR such as sinus bradycardia (26.1%), transient sinus arrest (9.8%), transient atrioventricular block (1.1%), or a blood pressure reduction (8.7%) was observed during the laser balloon applications for the PVI. The follow-up ended at 12 months. The HRV attenuation was comparable before and at three months after the ablation procedure between that with and without a VR (P = 0.14). The PAF recurrence rate was also comparable between the two groups (P = 0.882).The laser balloon PVI often provoked a VR, however, the modulation of the ICANS was temporary and for up to three months as measured by the HRV changes after the ablation, and the freedom from any atrial fibrillation recurrence was comparable regardless of the occurrence of a VR.


Asunto(s)
Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Frecuencia Cardíaca/fisiología , Terapia por Láser/métodos , Taquicardia Paroxística/cirugía , Nervio Vago/fisiopatología , Anciano , Fibrilación Atrial/fisiopatología , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Taquicardia Paroxística/fisiopatología , Factores de Tiempo
10.
PLoS One ; 16(3): e0249128, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33760875

RESUMEN

INTRODUCTION: The analysis of heart rate variability (HRV) has proven to be an important tool for the management of autonomous nerve system in both surgical and critically ill patients. We conducted this study to show the different spectral frequency and time domain parameters of HRV as a prospective predictor for critically ill patients, and in particular for COVID-19 patients who are on mechanical ventilation. The hypothesis is that most severely ill COVID-19 patients have a depletion of the sympathetic nervous system and a predominance of parasympathetic activity reflecting the remaining compensatory anti-inflammatory response. MATERIALS AND METHODS: A single-center, prospective, observational pilot study which included COVID-19 patients admitted to the Surgical Intensive Care Unit was conducted. The normalized high-frequency component (HFnu), i.e. ANIm, and the standard deviation of RR intervals (SDNN), i.e. Energy, were recorded using the analgesia nociception index monitor (ANI). To estimate the severity and mortality we used the SOFA score and the date of discharge or date of death. RESULTS: A total of fourteen patients were finally included in the study. ANIm were higher in the non-survivor group (p = 0.003) and were correlated with higher IL-6 levels (p = 0.020). Energy was inversely correlated with SOFA (p = 0.039) and fewer survival days (p = 0.046). A limit value at 80 of ANIm, predicted mortalities with a sensitivity of 100% and specificity of 85.7%. In the case of Energy, a limit value of 0.41 ms predicted mortality with all predictive values of 71.4%. CONCLUSION: A low autonomic nervous system activity, i.e. low SDNN or Energy, and a predominance of the parasympathetic system, i.e. low HFnu or ANIm, due to the sympathetic depletion in COVID-19 patients are associated with a worse prognosis, higher mortality, and higher IL-6 levels.


Asunto(s)
/complicaciones , Frecuencia Cardíaca/fisiología , Adulto , Sistema Nervioso Autónomo , Enfermedad Crítica , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Nocicepción/fisiología , Dolor , Manejo del Dolor , Dimensión del Dolor/métodos , Proyectos Piloto , Pronóstico , Estudios Prospectivos , Índice de Severidad de la Enfermedad
11.
Medicine (Baltimore) ; 100(13): e25333, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33787630

RESUMEN

ABSTRACT: Deceleration capacitiy for rapid risk stratification in stroke patientsCerebral ischemia is a major cause of neurologic deficit and patients suffering from ischemic stroke bear a relevant risk of mortality. Identifying stroke patients at high mortality risk is of crucial clinical relevance. Deceleration capacity of heart rate (DC) as a parameter of cardiac autonomic function is an excellent predictor of mortality in myocardial infarction and heart failure patients.The aim of our study was to evaluate whether DC provides prognostic information regarding mortality risk in patients with acute ischemic stroke.From September 2015 to March 2018 we prospectively enrolled consecutive patients presenting at the Stroke Unit of our university hospital with acute ischemic stroke who were in sinus rhythm. In these patients 24 hours-Holter-ECG recordings and evaluation of National Institute of Health Stroke Scale (NIHSS) were performed. DC was calculated according to a previously published algorithm. Primary endpoint was intrahospital mortality.Eight hundred seventy eight stroke patients were included in the study. Intrahospital mortality was 2.8% (25 patients). Both DC and NIHSS were significantly different between non-survivors and survivors (Mean ±â€ŠSD: DC: 4.1 ±â€Š2.8 ms vs 6.3 ±â€Š3.3 ms, P < .001) (NIHSS: 7.6 ±â€Š7.1 vs 4.3 ±â€Š5.5, P = .02). DC achieved an area under the curve value (AUC) of 0.708 for predicting intrahospital mortality, while the AUC value of NIHSS was 0.641. In a binary logistic regression analysis, DC, NIHSS and age were independent predictors for intrahospital mortality (DC: HR CI 95%: 0.88 (0.79-0.97); P = .01; NIHSS: HR CI 95%: 1.08 (1.02-1.15); P = .01; Age: HR CI 95%: 1.07 (1.02-1.11); P = .004. The combination of NIHSS, age and DC in a prediction model led to a significant improvement of the AUC, which was 0.757 (P < .001, incremental development index [IDI] 95% CI: 0.037 (0.018-0.057)), compared to the individual risk parameters.Our study demonstrated that DC is suitable for both objective and independent risk stratification in patients suffering from ischemic stroke. The application of a prediction model combining NIHSS, age and DC is superior to the single markers in identifying patients at high mortality risk.


Asunto(s)
Frecuencia Cardíaca/fisiología , Modelos Cardiovasculares , Anciano , Anciano de 80 o más Años , Desaceleración , Electrocardiografía Ambulatoria/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Mortalidad Hospitalaria , Humanos , /fisiopatología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Pronóstico , Estudios Prospectivos , Curva ROC , Medición de Riesgo/métodos , Factores de Tiempo
12.
Arch. prev. riesgos labor. (Ed. impr.) ; 24(1): 34-46, ene.-mar. 2021. ilus, tab, graf
Artículo en Español | IBECS | ID: ibc-197119

RESUMEN

OBJETIVO: Analizar los efectos de las variables altura vertical y la frecuencia de levantamiento sobre la frecuencia cardiaca en trabajadores en la tarea de levantamiento de cargas. MÉTODO: Diseño experimental factorial con bloques, considerando como variables independientes la altura vertical y la frecuencia de levantamiento y la dependiente la frecuencia cardiaca. El experimento se desarrolló con 20 trabajadores entre 18 y 40 años con al menos seis meses de experiencia en tareas de almacén y empaque en una empresa de productos lácteos. Se calculó el coeficiente FRIMAT para determinar la carga fisiológica de la tarea. RESULTADOS: Existe un efecto significativo sobre la respuesta de la frecuencia cardiaca debido a la interacción de la frecuencia y la altura vertical del levantamiento. Además, basados en el coeficiente FRIMAT, se obtuvo una calificación de "carga de trabajo mínima" para el 85% de los tratamientos, y en un tratamiento, se presentó una calificación de "algo difícil". CONCLUSIONES: La altura y frecuencia de levantamiento no actúan de manera independiente y tienen un efecto sobre la carga fisiológica del trabajador en el levantamiento manual de cargas manifestada en la frecuencia cardiaca


OBJECTIVE: To analyze the effects of vertical height and lifting frequency on the physiological response in workers during lifting of loads. METHODS: Factorial experimental design with blocks, considering vertical height and lifting frequency as independent variables; the dependent variable was defined as the heart rate. The experiment was conducted in 20 workers between the ages of 18 and 40 years with at least six months of experience in warehouse and packaging tasks at a dairy products company. We calculated the FRIMAT coefficient to determine the physiological load of the task. RESULTS: We found a significant effect on the heart rate response due to the interaction of the rate and the vertical height of the lift. Based on the FRIMAT coefficient, we obtained a rating of "minimal workload" for 85% of the treatments; for one treatment there was a rating of "somewhat difficult". CONCLUSIONS: Height and frequency of lift do not act separately and have an effect on the physiological load of the worker during manual lifting, reflected by changes in the heart rate


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Esfuerzo Físico/fisiología , Frecuencia Cardíaca/fisiología , Salud Laboral , Elevación , Análisis de Varianza , Epidemiología Experimental
13.
Circulation ; 143(13): 1274-1286, 2021 03 30.
Artículo en Inglés | MEDLINE | ID: mdl-33517677

RESUMEN

BACKGROUND: Heart rate-corrected QT interval (QTc) prolongation, whether secondary to drugs, genetics including congenital long QT syndrome, and/or systemic diseases including SARS-CoV-2-mediated coronavirus disease 2019 (COVID-19), can predispose to ventricular arrhythmias and sudden cardiac death. Currently, QTc assessment and monitoring relies largely on 12-lead electrocardiography. As such, we sought to train and validate an artificial intelligence (AI)-enabled 12-lead ECG algorithm to determine the QTc, and then prospectively test this algorithm on tracings acquired from a mobile ECG (mECG) device in a population enriched for repolarization abnormalities. METHODS: Using >1.6 million 12-lead ECGs from 538 200 patients, a deep neural network (DNN) was derived (patients for training, n = 250 767; patients for testing, n = 107 920) and validated (n = 179 513 patients) to predict the QTc using cardiologist-overread QTc values as the "gold standard". The ability of this DNN to detect clinically-relevant QTc prolongation (eg, QTc ≥500 ms) was then tested prospectively on 686 patients with genetic heart disease (50% with long QT syndrome) with QTc values obtained from both a 12-lead ECG and a prototype mECG device equivalent to the commercially-available AliveCor KardiaMobile 6L. RESULTS: In the validation sample, strong agreement was observed between human over-read and DNN-predicted QTc values (-1.76±23.14 ms). Similarly, within the prospective, genetic heart disease-enriched dataset, the difference between DNN-predicted QTc values derived from mECG tracings and those annotated from 12-lead ECGs by a QT expert (-0.45±24.73 ms) and a commercial core ECG laboratory [10.52±25.64 ms] was nominal. When applied to mECG tracings, the DNN's ability to detect a QTc value ≥500 ms yielded an area under the curve, sensitivity, and specificity of 0.97, 80.0%, and 94.4%, respectively. CONCLUSIONS: Using smartphone-enabled electrodes, an AI DNN can predict accurately the QTc of a standard 12-lead ECG. QTc estimation from an AI-enabled mECG device may provide a cost-effective means of screening for both acquired and congenital long QT syndrome in a variety of clinical settings where standard 12-lead electrocardiography is not accessible or cost-effective.


Asunto(s)
Inteligencia Artificial , Electrocardiografía/métodos , Cardiopatías/diagnóstico , Frecuencia Cardíaca/fisiología , Adulto , Anciano , Área Bajo la Curva , /virología , Electrocardiografía/instrumentación , Femenino , Cardiopatías/fisiopatología , Humanos , Síndrome de QT Prolongado/diagnóstico , Síndrome de QT Prolongado/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad , Teléfono Inteligente
14.
Cochrane Database Syst Rev ; 2: CD008823, 2021 02 24.
Artículo en Inglés | MEDLINE | ID: mdl-33630309

RESUMEN

BACKGROUND: Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. Walking is a low-cost form of physical activity and one which most people can do. Studies testing the effect of walking on blood pressure have revealed inconsistent findings. OBJECTIVES: To determine the effect of walking as a physical activity intervention on blood pressure and heart rate. SEARCH METHODS: We searched the following databases up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 2), Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO, SPORTDiscus, PEDro, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the following Chinese databases up to May 2020: Index to Taiwan Periodical Literature System; National Digital Library of Theses and Dissertation in Taiwan; China National Knowledge Infrastructure (CNKI) Journals, Theses & Dissertations; and Wanfang Medical Online. We contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA: Randomised controlled trials of participants, aged 16 years and over, which evaluated the effects of a walking intervention compared to non-intervention control on blood pressure and heart rate were included. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Where data were not available in the published reports, we contacted authors. Pooled results for blood pressure and heart rate were presented as mean differences (MDs) between groups with 95% confidence intervals (CIs). We undertook subgroup analyses for age and sex. We undertook sensitivity analyses to assess the effect of sample size on our findings. MAIN RESULTS: A total of 73 trials met our inclusion criteria. These 73 trials included 5763 participants and were undertaken in 22 countries. Participants were aged from 16 to 84 years and there were approximately 1.5 times as many females as males. The characteristics of walking interventions in the included studies were as follows: the majority of walking interventions was at home/community (n = 50) but supervised (n = 36 out of 47 reported the information of supervision); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate. Many studies were at risk of selection bias and performance bias. Primary outcome We found moderate-certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD -4.11 mmHg, 95% CI -5.22 to -3.01; 73 studies, n = 5060). We found moderate-certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD -4.41 mmHg, 95% CI -6.17 to -2.65; 14 studies, n = 491), and low-certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD -3.79 mmHg, 95% CI -5.64 to -1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD -4.30 mmHg, 95% CI -6.17 to -2.44, 24 studies, n = 2610). We also found low certainty-evidence suggesting that walking reduces SBP in both females (MD -5.65 mmHg, 95% CI -7.89 to -3.41; 22 studies, n = 1149) and males (MD -4.64 mmHg, 95% CI -8.69 to -0.59; 6 studies, n = 203). Secondary outcomes We found low-certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD -1.79 mmHg, 95% CI -2.51 to -1.07; 69 studies, n = 4711) and heart rate (MD -2.76 beats per minute (bpm), 95% CI -4.57 to -0.95; 26 studies, n = 1747). We found moderate-certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD -3.01 mmHg, 95% CI -4.44 to -1.58; 14 studies, n = 491) and low-certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD -1.74 mmHg, 95% CI -2.95 to -0.52; 32 studies, n = 1730) and those aged 60 years and over (MD -1.33 mmHg, 95% CI -2.40 to -0.26; 23 studies, n = 2490). We found moderate-certainty evidence that suggests walking reduces DBP for males (MD -2.54 mmHg, 95% CI -4.84 to -0.24; 6 studies, n = 203) and low-certainty evidence that walking reduces DBP for females (MD -2.69 mmHg, 95% CI -4.16 to -1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times. AUTHORS' CONCLUSIONS: Moderate-certainty evidence suggests that walking probably reduces SBP. Moderate- or low-certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low-certainty evidence suggests that walking may reduce DBP and heart rate. Moderate- and low-certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes.


Asunto(s)
Presión Sanguínea/fisiología , Frecuencia Cardíaca/fisiología , Hipertensión/terapia , Caminata/fisiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Sesgo , Diástole , Femenino , Humanos , Traumatismos de la Rodilla/etiología , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Sístole , Factores de Tiempo , Caminata/clasificación , Adulto Joven
15.
J Med Internet Res ; 23(2): e26107, 2021 02 22.
Artículo en Inglés | MEDLINE | ID: mdl-33529156

RESUMEN

BACKGROUND: Changes in autonomic nervous system function, characterized by heart rate variability (HRV), have been associated with infection and observed prior to its clinical identification. OBJECTIVE: We performed an evaluation of HRV collected by a wearable device to identify and predict COVID-19 and its related symptoms. METHODS: Health care workers in the Mount Sinai Health System were prospectively followed in an ongoing observational study using the custom Warrior Watch Study app, which was downloaded to their smartphones. Participants wore an Apple Watch for the duration of the study, measuring HRV throughout the follow-up period. Surveys assessing infection and symptom-related questions were obtained daily. RESULTS: Using a mixed-effect cosinor model, the mean amplitude of the circadian pattern of the standard deviation of the interbeat interval of normal sinus beats (SDNN), an HRV metric, differed between subjects with and without COVID-19 (P=.006). The mean amplitude of this circadian pattern differed between individuals during the 7 days before and the 7 days after a COVID-19 diagnosis compared to this metric during uninfected time periods (P=.01). Significant changes in the mean and amplitude of the circadian pattern of the SDNN was observed between the first day of reporting a COVID-19-related symptom compared to all other symptom-free days (P=.01). CONCLUSIONS: Longitudinally collected HRV metrics from a commonly worn commercial wearable device (Apple Watch) can predict the diagnosis of COVID-19 and identify COVID-19-related symptoms. Prior to the diagnosis of COVID-19 by nasal swab polymerase chain reaction testing, significant changes in HRV were observed, demonstrating the predictive ability of this metric to identify COVID-19 infection.


Asunto(s)
/métodos , /fisiopatología , Frecuencia Cardíaca/fisiología , Dispositivos Electrónicos Vestibles , Adulto , Ritmo Circadiano/fisiología , Femenino , Personal de Salud , Humanos , Masculino , /aislamiento & purificación
16.
PLoS One ; 16(2): e0247414, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33626065

RESUMEN

BACKGROUND: Facemasks are recommended to reduce the spread of SARS-CoV-2, but concern about inadequate gas exchange is an often cited reason for non-compliance. RESEARCH QUESTION: Among adult volunteers, do either cloth masks or surgical masks impair oxygenation or ventilation either at rest or during physical activity? STUDY DESIGN AND METHODS: With IRB approval and informed consent, we measured heart rate (HR), transcutaneous carbon dioxide (CO2) tension and oxygen levels (SpO2) at the conclusion of six 10-minute phases: sitting quietly and walking briskly without a mask, sitting quietly and walking briskly while wearing a cloth mask, and sitting quietly and walking briskly while wearing a surgical mask. Brisk walking required at least a 10bpm increase in heart rate. Occurrences of hypoxemia (decrease in SpO2 of ≥3% from baseline to a value of ≤94%) and hypercarbia (increase in CO2 tension of ≥5 mmHg from baseline to a value of ≥46 mmHg) in individual subjects were collected. Wilcoxon signed-rank was used for pairwise comparisons among values for the whole cohort (e.g. walking without a mask versus walking with a cloth mask). RESULTS: Among 50 adult volunteers (median age 33 years; 32% with a co-morbidity), there were no episodes of hypoxemia or hypercarbia (0%; 95% confidence interval 0-1.9%). In paired comparisons, there were no statistically significant differences in either CO2 or SpO2 between baseline measurements without a mask and those while wearing either kind of mask mask, both at rest and after walking briskly for ten minutes. INTERPRETATION: The risk of pathologic gas exchange impairment with cloth masks and surgical masks is near-zero in the general adult population.


Asunto(s)
/prevención & control , Máscaras , Oxígeno/metabolismo , Ventilación Pulmonar/fisiología , Adulto , /transmisión , Dióxido de Carbono/metabolismo , Ejercicio Físico/fisiología , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Hipoxia/etiología , Hipoxia/metabolismo , Masculino , Máscaras/efectos adversos , Descanso/fisiología , Caminata/fisiología
17.
JAMA Netw Open ; 4(2): e2037209, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33576818

RESUMEN

Importance: Conducted electrical weapons (CEWs) are used broadly as a less-lethal force option for police officers. However, there is no clear picture of the possible health risks in humans on the basis of rigorously assessed scientific evidence from the international peer-reviewed literature. Objective: To synthesize and systematically evaluate the strength of published evidence for an association between exposure to different models of CEWs and adverse acute as well as chronic conditions. Evidence Review: Following a preregistered review protocol, the literature search strategy was based on a search of reviews published between January 1, 2000, and April 24, 2020, of PubMed, MEDLINE, EMBASE, Web of Science, PsycINFO, and Cochrane Library, as well as relevant online databases and bibliographic sources, such as reference sections of recent publications. The identified studies were independently assessed in terms of scope, relevance, methodologic bias, and quality. Peer-reviewed publications of human studies were included, using original data and with a focus on the use of taser CEWs in the context of law enforcement. Eligible studies examined clearly defined health outcomes as dependent variables following exposure to a CEW. The review followed the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. A meta-analysis could not be conducted. Findings: Of the 1081 unique records screened, 33 relevant studies were identified, all of them of experimental design and conducted in the US. Eleven studies had a low risk of bias and 22 had a higher bias risk. Studies focused on outcomes such as physiologic stress responses, heart rate, blood pressure, arrhythmias, or cognitive performance. Independently of bias risk, the studies reported few or no acute health problems, apart from the wounds caused by the darts. Furthermore, no long-term outcomes were studied. Most of the studies were performed on healthy, physically fit individuals (eg, police officers) in a controlled setting, with short exposure duration (5 seconds). Half of the studies, mainly those with a higher risk of bias, were at least partly funded by the manufacturer. Conclusions and Relevance: Based on the findings of the reviewed studies, the risk for adverse health outcomes due to CEW exposure can be currently estimated as low. However, most of the reviewed studies had methodologic limitations. Considering that recruited participants were not representative of the population that usually encounters a CEW deployment, it is not possible to draw conclusions regarding exposure outcomes in potentially vulnerable populations or high-risk groups, such as those under the influence of substances.


Asunto(s)
Presión Sanguínea/fisiología , Cognición/fisiología , Lesiones por Armas Conductoras de Energía/fisiopatología , Frecuencia Cardíaca/fisiología , Armas , Acidosis Láctica/epidemiología , Acidosis Láctica/etiología , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/etiología , Enfermedad Crónica , Lesiones por Armas Conductoras de Energía/complicaciones , Voluntarios Sanos , Humanos , Hipertensión/epidemiología , Hipertensión/etiología , Policia , Apoyo a la Investigación como Asunto , Medición de Riesgo , Factores de Tiempo
18.
Life Sci ; 271: 119190, 2021 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-33571518

RESUMEN

AIMS: This study aimed to investigate the relationship between ischemia- and reperfusion-induced arrhythmia and blood serum estrogen levels, myocardial estrogen receptor levels, antioxidant enzyme activities, and the effects of the estrogen receptor blocker, fulvestrant (ICI 182 780). MAIN METHODS: A total of 102 female Sprague-Dawley rats of different ages (2-3, 6-7, 14-15, and 20-21 months) were used in this study. Myocardial ischemia was produced by ligation of the descending branch of the left anterior descending coronary artery, and reperfusion was produced by releasing this artery. An electrocardiogram (ECG) and blood pressure were recorded for 6 min of ischemia and 6 min of reperfusion. The levels of superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT), estrogen receptor α (ERα), and estrogen receptor ß (ERß) in myocardial tissue and 17 beta-estradiol (E2) in blood serum were measured via enzyme-linked immunosorbent assay (ELISA). The results were compared using a Mann-Whitney U test, one-way analysis of variance (ANOVA), and a student's t-test. KEY FINDINGS: It is not the changes in serum estrogen levels but the decreasing myocardial estrogen receptors and antioxidant activities that could be responsible for the occurrence of more severe arrhythmia in response to reperfusion in older female rats. SIGNIFICANCE: The death rate due to a heart attack in younger men is higher than in women. However, it equalizes after the menopausal stage in women. In this study, the reason for the increasing sudden post-menopausal death rate in women was investigated experimentally.


Asunto(s)
Envejecimiento/metabolismo , Antioxidantes/metabolismo , Daño por Reperfusión Miocárdica/metabolismo , Miocardio/metabolismo , Receptores Estrogénicos/metabolismo , Fibrilación Ventricular/metabolismo , Envejecimiento/patología , Animales , Electrocardiografía/métodos , Femenino , Frecuencia Cardíaca/fisiología , Daño por Reperfusión Miocárdica/fisiopatología , Ratas , Ratas Sprague-Dawley , Fibrilación Ventricular/fisiopatología
19.
BMC Infect Dis ; 21(1): 208, 2021 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-33632141

RESUMEN

BACKGROUND: Hand, foot, and mouth disease (HFMD) is an acute infectious disease caused by human enterovirus 71 (EV71), coxsackievirus, or echovirus, which is particularly common in preschool children. Severe HFMD is prone to cause pulmonary edema before progressing to respiratory and circulatory failure; thus hemodynamic monitoring and fluid management are important to the treatment process. METHODS: We did a review of young patients who had been successfully treated in our department for severe HFMD, which had been caused by EV71. A total of 20 patients met the inclusion criteria. Eight cases were monitored by the pulse indicator continuous cardiac output (PiCCO) technique, and fluid management was administered according to its parameters. With regard to the treatment with PiCCO monitoring, patients were divided into two groups: the PiCCO group (8 patients) and the control group (12 patients). The groups were then compared comprehensively to evaluate whether PiCCO monitoring could improve patients' clinical outcomes. RESULTS: After analysis, the findings informed that although PiCCO failed to shorten the length of ICU stay, reduce the days of vasoactive drug usage, or lower the number of cases which required mechanical ventilation, PiCCO did reduce the incidence of fluid overload (p = 0.085) and shorten the days of mechanical ventilation (p = 0.028). After effective treatment, PiCCO monitoring indicated that the cardiac index (CI) increased gradually(p < 0.0001), in contrast to their pulse (P, p < 0.0001), the extra vascular lung water index (EVLWI, p < 0.0001), the global end diastolic volume index (GEDVI, p = 0.0043), and the systemic vascular resistance index (SVRI, p < 0.0001), all of which decreased gradually. CONCLUSION: Our study discovered that PiCCO hemodynamic monitoring in young children with severe HFMD has some potential benefits, such as reducing fluid overload and the duration of mechanical ventilation. However, whether it can ameliorate the severity of the disease, reduce mortality, or prevent multiple organ dysfunction remain to be further investigated.


Asunto(s)
Fluidoterapia , Enfermedad de Boca, Mano y Pie/fisiopatología , Enfermedad de Boca, Mano y Pie/terapia , Hemodinámica/fisiología , Monitoreo Fisiológico/métodos , Gasto Cardíaco/fisiología , Preescolar , Enterovirus Humano A/aislamiento & purificación , Femenino , Enfermedad de Boca, Mano y Pie/diagnóstico , Frecuencia Cardíaca/fisiología , Humanos , Lactante , Masculino , Edema Pulmonar/diagnóstico , Edema Pulmonar/fisiopatología , Edema Pulmonar/terapia , Estudios Retrospectivos , Resultado del Tratamiento
20.
Isr Med Assoc J ; 23(2): 107-110, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33595216

RESUMEN

BACKGROUND: Takotsubo syndrome (TTS) is a non-ischemic cardiomyopathy characterized by an acute reversible left ventricular dysfunction with typical apical ballooning, usually with subsequent complete spontaneous recovery. TTS shares several features with acute coronary syndrome (ACS), including clinical presentation, ECG changes, and elevated troponin. OBJECTIVES: To identify different features that may help differentiate between TTS and ACS with presentation based on presenting symptoms and physical examination. METHODS: We compared 35 patients who TTS had been diagnosed with 60 age- and sex- matched patients with ACS (both ST and non-ST segment elevation myocardial infarction) who were hospitalized in Galilee Medical Center through 2011-2015.Basic characteristics and clinical features of the two groups were compared using appropriate statistical tests. RESULTS: Of the patients with TTS, 21 (60%) reported an emotional trigger (60%) before admission, although they did not have increased prevalence of psychiatric disease compared to ACS patients (5.7% vs. 5%, P = 0.611). There was no difference in the type of chest pain or accompanied symptoms between the groups. Of notice, ECG changes in the TTS group were prominent in the anterior leads, and the patients presented with higher heart rate (86 ± 17 vs. 79 ± 15, P = 0.029) and lower systolic blood pressure (129 ± 26 vs. 142 ± 30, P = 0.034) on admission compared to the ACS group. CONCLUSIONS: There was no reliable feature that could distinguish TTS from ACS based on clinical presentation. TTS should always be in the differential diagnosis in patients with acute chest pain, especially in elderly women.


Asunto(s)
Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/fisiopatología , Electrocardiografía , Cardiomiopatía de Takotsubo/fisiopatología , Anciano , Anciano de 80 o más Años , Presión Sanguínea/fisiología , Dolor en el Pecho/epidemiología , Dolor en el Pecho/etiología , Diagnóstico Diferencial , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Cardiomiopatía de Takotsubo/diagnóstico , Troponina/metabolismo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...