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1.
Eur Heart J Acute Cardiovasc Care ; : 2048872619883619, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31657616

RESUMO

BACKGROUND: The European Society of Cardiology's 0/1-hour algorithm improves the early triage of patients towards "rule-out" or "rule-in" of non-ST-segment elevation myocardial infarction. The HEART score is a risk stratification tool for patients with undifferentiated chest pain. We sought to evaluate the performance of the European Society of Cardiology 0/1-hour algorithm and the HEART score to evaluate chest pain patients in the emergency department. METHODS: In this prospective study, we applied the European Society of Cardiology 0/1-hour algorithm and the HEART score in 1355 consecutive patients who presented to the emergency department with symptoms suggestive of acute coronary syndrome without ST-segment elevation. Patients were followed for non-ST-segment elevation myocardial infarctions and major adverse cardiac events at 30 days: death, non-ST-segment elevation myocardial infarction, or unplanned coronary revascularization. RESULTS: The European Society of Cardiology 0/1-hour algorithm classified 921 (68.0%) patients as "rule-out" and the HEART score classified 686 (50.6%) patients as "low-risk". The 30-day incidence of non-ST-segment elevation myocardial infarctions was 0.32% in the European Society of Cardiology 0/1-hour algorithm "rule-out" patients versus 0.29% in the HEART score "low-risk" patients (p=0.75). The rate of major adverse cardiac events was 7.7% in the European Society of Cardiology 0/1-hour algorithm "rule-out" patients versus 1.1% in the HEART score "low-risk" patients (p<0.001). CONCLUSION: The European Society of Cardiology 0/1-hour algorithm identified more patients with low risk of non-ST-segment elevation myocardial infarctions at 30 days whereas for major adverse cardiac events, the HEART score had a greater capacity to detect low-risk patients.

3.
J Electrocardiol ; 55: 102-106, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31152990

RESUMO

BACKGROUND: Brugada syndrome (BrS) is an inherited ion channelopathy that may predispose affected individuals to atrial cardiomyopathy. We tested the hypothesis that BrS patients have higher degrees of atrial electrophysiological abnormalities compared to controls, and these can be reflected by changes in P-wave parameters determined on the electrocardiogram (ECG). METHODS: This was a single-center retrospective study comparing BrS patients to age- and gender-matched control subjects. Mean P-wave duration (PWDmean), maximum PWD (PWDmax) and minimum PWD (PWDmin), P-wave dispersion (PWDmax - PWDmin), and P-wave terminal force in V1 (PTFV1) were measured. PWDmax ≥ 120 ms, in the presence and absence of biphasic P-waves in the inferior leads, were termed advanced and partial inter-atrial block (IAB), respectively. RESULTS: The proportion of IAB was significantly higher in BrS patients (28/51; 55%) than in control subjects (14/51; 27%; Fisher's Exact test; P < 0.01). Advanced IAB was observed in two BrS patients but none of the control subjects (P = 0.50). Compared to controls, BrS patients showed higher PWDmean (107 [98-113] vs. 97 [90-108] ms; KWANOVA, P < 0.01), PWDmax (123 [110-132] vs. 113 [107-121] ms; P < 0.001) but statistically indistinguishable PWDmin (82 [72-92] vs. 77 [69-85]; P = 0.09), and P-wave dispersion (38 [26-52] vs. 37 [23-45] ms; P = 0.14). PTFV1 was significantly higher in BrS patients than in control subjects (24 [0-40] vs. 0 [0-27] mm.ms; P < 0.05). CONCLUSION: Atrial conduction abnormalities are frequently observed in BrS. These patients may require monitoring for future development of atrial fibrillation and stroke.

4.
Ann Noninvasive Electrocardiol ; 24(6): e12669, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31184409

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and has significant morbidity. A score composed of easily measured electrocardiographic variables to identify patients at risk of AF would be of great value in order to stratify patients for increased monitoring and surveillance. The purpose of this study was to develop an electrocardiographic risk score for new-onset AF. METHODS: A total of 676 patients without previous AF undergoing coronary angiography were retrospectively studied. Points were allocated based on P-wave morphology in inferior leads, voltage in lead 1, and P-wave duration (MVP). Patients were divided into three risk groups and followed until development of AF or last available clinical appointment. RESULTS: Mean age was 65 years, and 68% were male. The high- and intermediate-risk groups were more likely to develop AF than the low-risk group (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3-4.4; p = 0.006 and OR 2.1, 95% CI 1.4-3.27; p = 0.009, respectively). The high-risk group had a significantly shorter mean time to development of AF (258 weeks; 95% CI 205-310 weeks) compared to the intermediate- (278 weeks; 95% CI 252-303 weeks) and low-risk groups (322 weeks 95% CI 307-338 weeks), p = 0.005. CONCLUSIONS: A simple risk score composed of easy-to-measure electrocardiographic variables can help to predict new-onset AF. Further validation studies will be needed to assess the ability of this risk score to predict AF in other populations.

6.
Expert Rev Cardiovasc Ther ; 17(5): 335-343, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30987471

RESUMO

Introduction: With greater social acceptance and the evolution of transgender medicine as a specialty, more trans women are seeking hormone therapy (HT). Several studies have identified an increase in cardiovascular disease in trans women, however no studies have investigated the incidence of arrhythmias. Using two cases from the authors' clinic as examples, we propose that hormone therapy in trans women may increase the risk of cardiac arrhythmias. Areas covered: A literature search of sex hormones and cardiac arrhythmias was conducted. Using sex hormone studies completed in cis individuals and animal models we identified several similarities to trans women on HT. In cis men, low levels of testosterone are associated with increased rates of atrial fibrillation and right ventricular outflow tract arrhythmias. The role of estradiol remains less clear but there is evidence to suggest that the administration of exogenous estrogen may increase the rates of cardiac arrhythmias in cis women. Expert opinion: Research in the field of transgender medicine is expanding. As more trans women initiate HT, we will have a larger database from which to collect information regarding the benefits and risks of treatment, including the potential side effect of arrhythmias.


Assuntos
Arritmias Cardíacas/epidemiologia , Fibrilação Atrial/epidemiologia , Pessoas Transgênero , Arritmias Cardíacas/etiologia , Estradiol/sangue , Estrogênios/administração & dosagem , Estrogênios/efeitos adversos , Feminino , Hormônios Esteroides Gonadais/sangue , Humanos , Masculino , Testosterona/sangue
11.
Alcohol ; 79: 163-169, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30769023

RESUMO

BACKGROUND AND AIMS: Heavy alcohol use is a risk factor for disease and mortality; however, epidemiological findings have demonstrated protective effects of a light-to-moderate intake of alcohol on cardiovascular health. There are many misconceptions regarding appropriate levels of alcohol intake and the risks and benefits of consumption. We sought to examine physician attitudes and recommendations regarding alcohol intake in a cohort of Uruguayan cardiologists. METHODS: A cross-sectional survey of 25 questions was distributed through the Uruguayan Society of Cardiology to attending cardiologists and advanced cardiology trainees. RESULTS: There were 298 respondents; 237 were attending cardiologists and 61 were advanced cardiology trainees. In total, 34% of cardiologists viewed moderate alcohol intake to be beneficial for cardiovascular health, 27% believed only wine offered such benefits, 36% viewed any intake to be harmful, and 3% had other opinions. More than half (57%) self-reported their perceived knowledge to come from academic sources. Regarding knowledge of guidelines, only 42% were aware of the concept of 'standard drink' (SD). Cardiologists were not comfortable (on a Likert scale) converting SD into other metric units (1.92 ± 2.77). Cardiologists were not satisfied with their knowledge of drinking guidelines (2.42 ± 2.63); however, men were more comfortable than women (p = 0.003). Cardiologists were generally comfortable in counseling patients regarding safe limits of consumption (5.46 ± 3.08, on a 0-10 scale). CONCLUSIONS: Uruguayan cardiologists were not satisfied with their knowledge of drinking guidelines or understanding of the alcohol metric units. This study suggests a necessity to optimize educational resources for physicians.

14.
Trends Cardiovasc Med ; 29(8): 476-480, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30482482

RESUMO

Medical devices have become increasingly connected in recent years. While this added interconnectivity has provided capabilities for wireless communication and remote monitoring, it has also introduced possible risks for cybersecurity vulnerabilities. Lately, there has been an increased awareness of the potential for cybersecurity breaches in implanted cardiac devices (pacemakers and defibrillators) among patients, healthcare providers, and the media. In this article, we review the current perspective on cybersecurity in implanted medical devices, including a recent high-profile case example of a cybersecurity threat. We outline the actions taken by all the involved stakeholders in response to the disclosure of potential vulnerabilities in medical devices and summarize the positions of major societies in response to these events.

15.
Indian Pacing Electrophysiol J ; 19(1): 27-29, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30367925

RESUMO

Venous revascularization is an approach used in patients with total venous occlusion requiring venous access for cardiac device lead placement. Several percutaneous approaches to venous revascularization have been proposed. For the first time, we describe the case of a 69-year-old male with total venous occlusion who was successfully revascularized using a 'diathermy' technique.

16.
Clin Cardiol ; 42(2): 222-226, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30536892

RESUMO

BACKGROUND: A large percentage of patients with non-ST-segment acute coronary syndrome (NSTE-ACS) present with acute total occlusion (TO) of some major epicardial vessel that does not generate electrocardiographic changes. Ongoing research into the methods of accurately predicting acute TO have not yielded great success. HYPOTHESIS: High-sensitivity cardiac troponin T (hs-cTnT) has a good predictive value for the presence of acute TO of the culprit artery in patients with NSTE-ACS. METHODS: A single-center retrospective study of 1011 patients diagnosed with NSTE-ACS who underwent coronary angiography and hs-cTnT measured on admission. The predictive value of hs-cTnT in the presence of acute TO was assessed by the area under the ROC curve. RESULTS: The mean age of the population was 67.12 ± 13.18 and 74.1% were male. 7.3% of the patients presented with acute TO. The AUC for hs-cTnT to predict acute TO was 0.95. A hs-cTnT value of 1006 ng/L (71.8 fold of the URL) best predicted the presence of acute TO, with a sensitivity of 86% and specificity of 95% positive predictive value (PPV): 86% and negative predictive value (NPV): 94%. CONCLUSIONS: Hs-cTnT was a good predictor of acute TO in patients with NSTE-ACS. Hs-cTnT values greater than 1006 ng/L were highly predictive of acute TO of a major coronary vessel.


Assuntos
Síndrome Coronariana Aguda/sangue , Oclusão Coronária/sangue , Eletrocardiografia , Troponina T/sangue , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Idoso , Biomarcadores/sangue , Angiografia Coronária , Oclusão Coronária/complicações , Oclusão Coronária/diagnóstico , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos
17.
Trends Cardiovasc Med ; 29(2): 97-106, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30104174

RESUMO

Alcoholic beverages, specifically wine, have been consumed for many years. Wine is postulated to play an important role in the improvement of cardiovascular risk factors. Most epidemiological studies have found sustained consumption at light-to-moderate amounts to increase HDL cholesterol, reduce platelet aggregation, and promote fibrinolysis. Wine consumption has been inversely associated with ischemic heart disease, and the alcohol-blood pressure association, in most studies, follows a J-shaped curve. These outcomes have been attributed to the molecular constituents of wine, namely ethanol and polyphenols. Due to the continued interest in wine as a biological beverage, we review the chemistry of wine as clinicians, including its chemical composition, viticulture and enological practices, and other chemical factors that influence the bioactive components of wine. We also outline the biological effects of wine components and directions for future research.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Valor Nutritivo , Vinho/análise , Consumo de Bebidas Alcoólicas/efeitos adversos , Animais , Doenças Cardiovasculares/diagnóstico , Humanos , Prognóstico , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Vinho/efeitos adversos
20.
J Electrocardiol ; 51(6): 963-965, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30497756

RESUMO

Brugada phenocopies (BrP) are clinical entities that are characterized by ECG patterns identical to those of Brugada syndrome, but are the result of various clinical conditions. We describe the case of a 41-year-old male who exhibited BrP due to a left ventricular aneurysm in the context of chronic coronary artery disease.


Assuntos
Síndrome de Brugada/diagnóstico , Síndrome de Brugada/fisiopatologia , Ecocardiografia , Eletrocardiografia , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Fenótipo
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