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1.
Medicine (Baltimore) ; 100(22): e25978, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087840

RESUMO

BACKGROUND: The early repolarization pattern (ERP) has recently been associated with cardiac events such as ventricular arrhythmias and sudden cardiac death. However, estimates of the prevalence of ERP vary widely, especially between the general population and physically active individuals. We performed this systematic review and meta-analysis to quantitatively evaluate the worldwide prevalence of ERP in the general population and physically active individuals. METHODS: We thoroughly searched the PubMed, EMBASE, Web of science, the Cochrane Library, and Scopus databases for relevant studies published until December 20, 2020. Studies in which prevalence was presented or could be estimated from eligible data were included. The pooled prevalence was analyzed using a random-effect model. RESULTS: Finally, we included 29 studies (182,135 subjects) in the general population and 14 studies (8087 subjects) in the physically active individuals. The worldwide pooled prevalence of ERP in the general population was 11.6% (95% confidence interval [CI]: 10.0%-13.3%). The incidence of ERP was 17.0% and 6.2% in men and women, respectively. The prevalence was 20.9% in blacks, 13.4% in Asians, and 10.1% in Caucasians. Additionally, the prevalence of ERP in physically active individuals was 33.9% (95% CI: 25.3%-42.6%). CONCLUSION: A significant difference in the worldwide prevalence of ERP is revealed in this study. The ERP is highly prevalent in men, blacks, and physically active individuals.


Assuntos
Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Exercício Físico/fisiologia , Fatores Etários , Grupos de Populações Continentais , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Características de Residência , Fatores Sexuais
2.
Arch Cardiovasc Dis ; 114(5): 407-414, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34088625

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been a fast-growing worldwide pandemic. AIMS: We aimed to investigate the incidence of cardiac arrhythmias among a large French cohort of implantable cardioverter defibrillator recipients over the first 5 months of 2020. METHODS: Five thousand nine hundred and fifty-four implantable cardioverter defibrillator recipients were followed by remote monitoring during the COVID-19 period (from 01 January to 31 May 2020). Data were obtained from automated remote follow-up of implantable cardioverter defibrillators utilizing the Implicity® platform. For all patients, the type of arrhythmia (atrial fibrillation, ventricular tachycardia or ventricular fibrillation), the number of ventricular arrhythmia episodes and the type of implantable cardioverter defibrillator-delivered therapy were recorded. RESULTS: A total of 472 (7.9%) patients presented 4917 ventricular arrhythmia events. An increase in ventricular arrhythmia incidence was observed after the first COVID-19 case in France, and especially during weeks #10 and #11, at the time of major governmental measures, with an increase in the incidence of antitachycardia pacing delivered therapy. During the 11 weeks before the lockdown order, the curve of the percentage of live-stream television coverage of COVID-19 information matched the ventricular arrhythmia incidence. During the lockdown, the incidence of ventricular arrhythmia decreased significantly compared with baseline (0.05±0.7 vs. 0.09±1.2 episodes per patient per week, respectively; P<0.001). Importantly, no correlation was observed between ventricular arrhythmia incidence and the curve of COVID-19 incidence. No changes were observed regarding atrial fibrillation/atrial tachycardia episodes over time. CONCLUSIONS: An increase in ventricular arrhythmia incidence was observed in the 2 weeks before the lockdown order, at the time of major governmental measures. Ventricular arrhythmia incidence decreased dramatically during the lockdown.


Assuntos
Arritmias Cardíacas/epidemiologia , COVID-19/epidemiologia , Desfibriladores Implantáveis , Monitorização Ambulatorial/métodos , Tecnologia de Sensoriamento Remoto/métodos , SARS-CoV-2 , Idoso , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Feminino , Seguimentos , França/epidemiologia , Frequência Cardíaca , Ventrículos do Coração/fisiopatologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/estatística & dados numéricos , Estudos Prospectivos , Quarentena , Tecnologia de Sensoriamento Remoto/instrumentação , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/epidemiologia
3.
Nat Commun ; 12(1): 2472, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33931651

RESUMO

Electrical activity in the heart exhibits 24-hour rhythmicity, and potentially fatal arrhythmias are more likely to occur at specific times of day. Here, we demonstrate that circadian clocks within the brain and heart set daily rhythms in sinoatrial (SA) and atrioventricular (AV) node activity, and impose a time-of-day dependent susceptibility to ventricular arrhythmia. Critically, the balance of circadian inputs from the autonomic nervous system and cardiomyocyte clock to the SA and AV nodes differ, and this renders the cardiac conduction system sensitive to decoupling during abrupt shifts in behavioural routine and sleep-wake timing. Our findings reveal a functional segregation of circadian control across the heart's conduction system and inherent susceptibility to arrhythmia.


Assuntos
Arritmias Cardíacas/fisiopatologia , Nó Atrioventricular/fisiologia , Ritmo Circadiano/fisiologia , Frequência Cardíaca/fisiologia , Miócitos Cardíacos/fisiologia , Nó Sinoatrial/fisiologia , Fatores de Transcrição ARNTL/genética , Fatores de Transcrição ARNTL/metabolismo , Adulto , Animais , Arritmias Cardíacas/genética , Arritmias Cardíacas/metabolismo , Nó Atrioventricular/metabolismo , Sistema Nervoso Autônomo/fisiologia , Relógios Circadianos/fisiologia , Eletrocardiografia , Feminino , Regulação da Expressão Gênica/genética , Regulação da Expressão Gênica/fisiologia , Humanos , Masculino , Camundongos , Camundongos Transgênicos , Pessoa de Meia-Idade , Miócitos Cardíacos/metabolismo , Nó Sinoatrial/metabolismo , Sono/fisiologia
4.
Am J Med Sci ; 361(6): 690-701, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33941367

RESUMO

Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus. Hyperglycemia, acidosis, and electrolyte imbalances can directly affect the heart by inducing toxicity, impairing myocardial blood flow, autonomic dysfunction, and altering activation and conduction of electrical impulses throughout the heart, increasing the risk of arrhythmias and ischemia. The electrocardiogram is useful in monitoring patients during and after an episode of DKA, as it allows the detection of arrhythmias and guides metabolic correction. Unfortunately, reports on electrocardiographic abnormalities in patients with DKA are lacking. We found two electrocardiographic patterns that are frequently reported in the literature: a pseudo-myocardial infarction and a Brugada Phenocopy. Both are associated with DKA metabolic anomalies and they resolve after treatment. Because of their clinical relevance and the challenge they represent for clinicians, we analyzed the clinical characteristics of these patients and the mechanisms involved in these electrocardiographic findings.


Assuntos
Arritmias Cardíacas/fisiopatologia , Cetoacidose Diabética/fisiopatologia , Eletrocardiografia/métodos , Frequência Cardíaca/fisiologia , Doença Aguda , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Cetoacidose Diabética/complicações , Cetoacidose Diabética/diagnóstico , Humanos
5.
Expert Rev Med Devices ; 18(5): 493-498, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33970735

RESUMO

OBJECTIVES: The aim of this study is to demonstrate how Electrophysiology activity has been impacted by the pandemic Coronavirus disease 2019 (COVID-19). METHODS: In this multicenter retrospective study, we analyze all consecutive patients admitted for electrophysiological procedures during the COVID-19 lockdown in the Tuscany region of Italy, comparing them to patients hospitalized in the corresponding period of the previous year. RESULTS: The impact of COVID-19 on cardiac arrhythmia management was impressive, with a reduction of more than 50% in all kinds of procedures. A gender gap was observed, with a more relevant reduction for female patients. Arrhythmic urgencies requiring a device implant showed a reduced time from symptoms to first medical contact but the time from first medical contact to procedure was significantly prolonged. CONCLUSION: Hospitals need to consider how outbreaks may affect health systems beyond the immediate infection. Routine activity should be based on a risk assessment between the prompt performance of procedure and its postponement. Retrospective observational analysis such as this study could be decisive in evidence-based medicine of any future pathogen outbreak.Nonstandard Abbreviations and Acronyms PM= pacemakerICD= implantable cardioverter defibrillatorECV= electrical cardioversionEPS= electrophysiological studyAP= ablations proceduresCIED= cardiac implantable electronic devicesWCD= wearable cardioverter defibrillatorEP Lab= Electrophysiology LaboratoriesAVNRT =atrioventricular nodal reentry tachycardiaAVRT= atrioventricular reentry tachycardiaAFL= atrial flutterAF= atrial fibrillationVT= ventricular tachycardiaAT= atrial tachycardia.


Assuntos
COVID-19/epidemiologia , Atenção à Saúde , Surtos de Doenças , Técnicas Eletrofisiológicas Cardíacas , Idoso , Arritmias Cardíacas/fisiopatologia , Desfibriladores Implantáveis , Feminino , Humanos , Itália/epidemiologia , Masculino , Marca-Passo Artificial , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Fatores de Tempo
6.
J Med Ultrason (2001) ; 48(2): 137-144, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33837866

RESUMO

PURPOSE: We previously reported that acoustic radiation force impulse (ARFI) with concomitant administration of perfluorobutane as an ultrasound contrast agent (UCA)-induced arrhythmias at a mechanical index (MI) of 1.8 or 4.0 in a rabbit model. The present study identified the location of arrhythmias with a MI < 1.8 using a new system that can transmit ARFI with B-mode imaging. METHODS: Under general anesthesia, six male Japanese white rabbits were placed in a supine position. Using this system, we targeted ARFI to the exact site of the heart. ARFI exposure with MI 0.9-1.2 was performed to the right or left ventricle of the heart 2 min after UCA injection. RESULTS: ARFI with a MI lower than previously reported to rabbit heart evoked extrasystolic waves with single UCA infusion. Arrhythmias were not observed using ARFI without UCA. Extrasystolic waves were observed significantly more frequently in the right ventricle group than in the left ventricle group, with arrhythmias showing reversed shapes. No fatal arrhythmias were observed. CONCLUSION: ARFI applied to simulate clinical conditions in rabbit heart evoked extrasystolic waves with single UCA infusion. The right ventricle group was significantly more sensitive to ARFI exposure, resulting in arrhythmias, than the left ventricle group. The shapes of PVCs that occurred in the right ventricle group and the left ventricle group were reversed. Ultrasound practitioners who use ARFI should be aware of this adverse reaction, even if the MI is below the previously determined value of 1.9.


Assuntos
Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/diagnóstico por imagem , Meios de Contraste/efeitos adversos , Técnicas de Imagem por Elasticidade/métodos , Fluorcarbonetos/efeitos adversos , Aumento da Imagem/métodos , Animais , Arritmias Cardíacas/fisiopatologia , Meios de Contraste/administração & dosagem , Modelos Animais de Doenças , Fluorcarbonetos/administração & dosagem , Coração/diagnóstico por imagem , Coração/fisiopatologia , Masculino , Coelhos
7.
Glob Heart ; 16(1): 18, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: covidwho-1175699

RESUMO

The current pandemic of SARS-COV 2 infection (Covid-19) is challenging health systems and communities worldwide. At the individual level, the main biological system involved in Covid-19 is the respiratory system. Respiratory complications range from mild flu-like illness symptoms to a fatal respiratory distress syndrome or a severe and fulminant pneumonia. Critically, the presence of a pre-existing cardiovascular disease or its risk factors, such as hypertension or type II diabetes mellitus, increases the chance of having severe complications (including death) if infected by the virus. In addition, the infection can worsen an existing cardiovascular disease or precipitate new ones. This paper presents a contemporary review of cardiovascular complications of Covid-19. It also specifically examines the impact of the disease on those already vulnerable and on the poorly resourced health systems of Africa as well as the potential broader consequences on the socio-economic health of this region.


Assuntos
COVID-19/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/fisiopatologia , África , Antimaláricos/efeitos adversos , Arritmias Cardíacas/economia , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , COVID-19/complicações , COVID-19/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/etiologia , Cloroquina/efeitos adversos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Atenção à Saúde/economia , Fatores Econômicos , Recessão Econômica , Produto Interno Bruto , Recursos em Saúde/economia , Recursos em Saúde/provisão & distribuição , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Hidroxicloroquina/efeitos adversos , Inflamação , Isquemia Miocárdica/economia , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/fisiopatologia , Miocardite/economia , Miocardite/etiologia , Miocardite/fisiopatologia , SARS-CoV-2 , Síndrome Respiratória Aguda Grave/complicações , Síndrome Respiratória Aguda Grave/fisiopatologia , Fatores Socioeconômicos , Cardiomiopatia de Takotsubo/economia , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/fisiopatologia
8.
Glob Heart ; 16(1): 14, 2021 02 12.
Artigo em Inglês | MEDLINE | ID: covidwho-1143732

RESUMO

Background: Infection caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) exhibits a strong infectivity but less virulence compared to severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). In terms of cardiovascular morbidity, susceptible population include elderly and patients with certain cardiovascular conditions. This infection has been associated with cardiac injury, cardiovascular complications and higher mortality. Objectives: The main objective of the CARDIO COVID 19-20 Registry is to determine the presence of cardiovascular comorbidities and cardiovascular complications in COVID-19 infected patients that required in-hospital treatment in different Latin American institutions. Methods: The CARDIO COVID 19-20 Registry is an observational, multicenter, ambispective, and hospital-based registry of patients with confirmed COVID-19 infection who required in-hospital treatment in Latin America. Enrollment of patients started on May 01, 2020 and was initially planned to last three months; based on the progression of pandemic in Latin America, enrollment was extended until December 2020, and could be extended once again based on the pandemic course in our continent at that moment. Conclusions: The CARDIO COVID 19-20 Registry will characterize the in-hospital population diagnosed with COVID-19 in Latin America in order to identify risk factors for worsening of cardiovascular comorbidities or for the appearance of cardiovascular complications during hospitalization and during the 30-day follow up period.


Assuntos
COVID-19/epidemiologia , Doenças Cardiovasculares/epidemiologia , Sistema de Registros , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , COVID-19/complicações , COVID-19/fisiopatologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Comorbidade , Doença das Coronárias/epidemiologia , Doença das Coronárias/etiologia , Doença das Coronárias/fisiopatologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , América Latina , Miocardite/epidemiologia , Miocardite/etiologia , Miocardite/fisiopatologia , SARS-CoV-2 , Trombose/epidemiologia , Trombose/etiologia , Trombose/fisiopatologia
9.
J Stroke Cerebrovasc Dis ; 30(6): 105776, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33839377

RESUMO

INTRODUCTION: Cardiac dysfunction directly caused by spontaneous intracerebral hemorrhage (ICH) is a poorly understood phenomenon, and its impact on outcome is still uncertain. The aim of this study is to investigate the relationship between electrocardiographic (EKG) abnormalities and mortality in ICH. METHODS: This is a retrospective study analyzing EKG patterns on admission in patients admitted with ICH at a tertiary care center over an eight-year period. For each patient, demographics, medical history, clinical presentation, EKG on admission and during hospitalization, and head CT at presentation were reviewed. Mortality was noted. RESULTS: A total of 301 ICH patients were included in the study. The most prevalent EKG abnormalities were QTc prolongation in 56% of patients (n = 168) followed by inversion of T waves (TWI) in 37% of patients (n = 110). QTc prolongation was associated with ganglionic location (p = 0.03) and intraventricular hemorrhage (IVH) (p = 0.01), TWIs were associated with ganglionic location (p = 0.02), and PR prolongation was associated with IVH (p = 0.01), while QRS prolongation was associated with lobar location (p < 0.01). Volume of ICH, hemispheric laterality, and involvement of insular cortex were not correlated with specific EKG patterns. In a logistic regression model, after correcting for ICH severity and prior cardiac history, presence of TWI was independently associated with mortality (OR: 3.04, CI:1.6-5.8, p < 0.01). Adding TWI to ICH score improved its prognostic accuracy (AUC 0.81, p = 0.04). Disappearance of TWI during hospitalization did not translate into improvement of survival (p = 0.5). CONCLUSION: Presence of TWI on admission is an independent and unmodifiable factor associated with mortality in ICH. Further research is needed to elucidate the pathophysiologic mechanisms underlying electrocardiographic changes after primary intracerebral hemorrhage.


Assuntos
Potenciais de Ação , Arritmias Cardíacas/diagnóstico , Hemorragia Cerebral/diagnóstico , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Idoso , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
10.
Biomed Res Int ; 2021: 6624298, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33816620

RESUMO

To explore a method to predict ECG signals in body area networks (BANs), we propose a hybrid prediction method for ECG signals in this paper. The proposed method combines variational mode decomposition (VMD), phase space reconstruction (PSR), and a radial basis function (RBF) neural network to predict an ECG signal. To reduce the nonstationarity and randomness of the ECG signal, we use VMD to decompose the ECG signal into several intrinsic mode functions (IMFs) with finite bandwidth, which is helpful to improve the prediction accuracy. The input parameters of the RBF neural network affect the prediction accuracy and computational burden. We employ PSR to optimize input parameters of the RBF neural network. To evaluate the prediction performance of the proposed method, we carry out many simulation experiments on ECG data from the MIT-BIH Arrhythmia Database. The experimental results show that the root mean square error (RMSE) and mean absolute error (MAE) of the proposed method are of 10-3 magnitude, while the RMSE and MAE of some competitive prediction methods are of 10-2 magnitude. Compared with other several prediction methods, our method obviously improves the prediction accuracy of ECG signals.


Assuntos
Arritmias Cardíacas/fisiopatologia , Bases de Dados Factuais , Eletrocardiografia , Redes Neurais de Computação , Processamento de Sinais Assistido por Computador , Humanos
11.
Int J Mol Sci ; 22(8)2021 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-33920294

RESUMO

Most causal genes for inherited arrhythmia syndromes (IASs) encode cardiac ion channel-related proteins. Genotype-phenotype studies and functional analyses of mutant genes, using heterologous expression systems and animal models, have revealed the pathophysiology of IASs and enabled, in part, the establishment of causal gene-specific precision medicine. Additionally, the utilization of induced pluripotent stem cell (iPSC) technology have provided further insights into the pathophysiology of IASs and novel promising therapeutic strategies, especially in long QT syndrome. It is now known that there are atypical clinical phenotypes of IASs associated with specific mutations that have unique electrophysiological properties, which raises a possibility of mutation-specific precision medicine. In particular, patients with Brugada syndrome harboring an SCN5A R1632C mutation exhibit exercise-induced cardiac events, which may be caused by a marked activity-dependent loss of R1632C-Nav1.5 availability due to a marked delay of recovery from inactivation. This suggests that the use of isoproterenol should be avoided. Conversely, the efficacy of ß-blocker needs to be examined. Patients harboring a KCND3 V392I mutation exhibit both cardiac (early repolarization syndrome and paroxysmal atrial fibrillation) and cerebral (epilepsy) phenotypes, which may be associated with a unique mixed electrophysiological property of V392I-Kv4.3. Since the epileptic phenotype appears to manifest prior to cardiac events in this mutation carrier, identifying KCND3 mutations in patients with epilepsy and providing optimal therapy will help prevent sudden unexpected death in epilepsy. Further studies using the iPSC technology may provide novel insights into the pathophysiology of atypical clinical phenotypes of IASs and the development of mutation-specific precision medicine.


Assuntos
Arritmias Cardíacas/diagnóstico , Fibrilação Atrial/diagnóstico , Síndrome de Brugada/diagnóstico , Síndrome do QT Longo/diagnóstico , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/genética , Arritmias Cardíacas/fisiopatologia , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/genética , Fibrilação Atrial/fisiopatologia , Síndrome de Brugada/diagnóstico por imagem , Síndrome de Brugada/genética , Síndrome de Brugada/fisiopatologia , Eletrofisiologia Cardíaca , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Humanos , Síndrome do QT Longo/diagnóstico por imagem , Síndrome do QT Longo/genética , Síndrome do QT Longo/fisiopatologia , Fenótipo , Medicina de Precisão
12.
Eur Rev Med Pharmacol Sci ; 25(8): 3272-3278, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33928614

RESUMO

OBJECTIVE: Ventricular arrhythmias were the most frequent manifestations in patients with COVID-19. Both the natural course of the disease and the treatment drugs used have effects on ventricular repolarization. The objective of this study was to evaluate the effects of repolarization parameters obtained from surface electrocardiography (ECG) on prognosis. PATIENTS AND METHODS: Participants were 205 consecutive patients hospitalized with COVID-19 diagnosis. The 12-lead surface ECG was obtained from each patient on admission. The ECG results were evaluated against the patients' clinical characteristics and outcomes by experienced cardiology specialists. RESULTS: The mean age was higher in the non-survivor group compared to the survivor group (57.4 ± 15.7 vs. 65.6 ± 16.6; p = 0.001). The demographical characteristics were similar between the survivor and non-survivor groups. Multivariate analyses demonstrated that age (OR: 1.041; p = 0.009), D-dimer (OR: 1.002; p = 0.031), high-sensitivity troponin I (hs-TnI) (OR: 1.010; p = 0.041), pneumonia on computed tomography (CT) (OR: 4.985; p < 0.001), the peak-to-end interval of the T wave (Tp-e) (OR: 3.421; p < 0.001), and Tp-e/QTc ratio (OR: 1.978; p = 0.013) were statistically significant independent predictors in terms of determining mortality. CONCLUSIONS: Prolonged Tp-e interval and increased Tp-e/QTc ratio on admission are decent predictors and linked with mortality. ECG is a practical study to evaluate prognosis and potential arrhythmias, as well as initiating suitable treatment.


Assuntos
Arritmias Cardíacas/fisiopatologia , COVID-19/fisiopatologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/epidemiologia , COVID-19/epidemiologia , COVID-19/metabolismo , COVID-19/mortalidade , Eletrocardiografia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prognóstico , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Troponina I/metabolismo
13.
Int J Mol Sci ; 22(6)2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33809145

RESUMO

Acute myocardial infarction (MI) is one of the most common causes of death worldwide. Pituitary adenylate cyclase activating polypeptide (PACAP) is a cardioprotective neuropeptide expressing its receptors in the cardiovascular system. The aim of our study was to examine tissue PACAP-38 in a translational porcine MI model and plasma PACAP-38 levels in patients with ST-segment elevation myocardial infarction (STEMI). Significantly lower PACAP-38 levels were detected in the non-ischemic region of the left ventricle (LV) in MI heart compared to the ischemic region of MI-LV and also to the Sham-operated LV in porcine MI model. In STEMI patients, plasma PACAP-38 level was significantly higher before percutaneous coronary intervention (PCI) compared to controls, and decreased after PCI. Significant negative correlation was found between plasma PACAP-38 and troponin levels. Furthermore, a significant effect was revealed between plasma PACAP-38, hypertension and HbA1c levels. This was the first study showing significant changes in cardiac tissue PACAP levels in a porcine MI model and plasma PACAP levels in STEMI patients. These results suggest that PACAP, due to its cardioprotective effects, may play a regulatory role in MI and could be a potential biomarker or drug target in MI.


Assuntos
Arritmias Cardíacas/sangue , Infarto do Miocárdio/sangue , Polipeptídeo Hipofisário Ativador de Adenilato Ciclase/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/genética , Idoso , Animais , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/cirurgia , Feminino , Hemoglobina A Glicada/genética , Ventrículos do Coração/metabolismo , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/genética , Infarto do Miocárdio/patologia , Infarto do Miocárdio/cirurgia , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/genética , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Polipeptídeo Hipofisário Ativador de Adenilato Ciclase/genética , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/patologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Suínos , Resultado do Tratamento , Troponina/sangue
14.
Pan Afr Med J ; 38: 140, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33912310

RESUMO

Hypertrophic cardiomyopathy (HCM) is a common inherited cardiomyopathy, with an estimated prevalence of 1 in 500 people. Despite overall favorable outcomes with modern treatment and early diagnosis of disease, adverse complications could occur during times of physiological stress like pregnancy. Complications of HCM include sudden cardiac death, heart failure, and arrhythmia. We report the case of a 32-year-old pregnant woman with obstructive HCM, presenting with recurrent episodes of ventricular arrhythmia despite medical therapy. This case exhibits how close monitoring and proper management during pregnancy according to the latest recommendations, resulted in a successful and uneventful delivery.


Assuntos
Arritmias Cardíacas/diagnóstico , Cardiomiopatia Hipertrófica/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico , Adulto , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/terapia , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/terapia , Resultado da Gravidez , Recidiva
15.
Glob Heart ; 16(1): 14, 2021 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-33833938

RESUMO

Background: Infection caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) exhibits a strong infectivity but less virulence compared to severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). In terms of cardiovascular morbidity, susceptible population include elderly and patients with certain cardiovascular conditions. This infection has been associated with cardiac injury, cardiovascular complications and higher mortality. Objectives: The main objective of the CARDIO COVID 19-20 Registry is to determine the presence of cardiovascular comorbidities and cardiovascular complications in COVID-19 infected patients that required in-hospital treatment in different Latin American institutions. Methods: The CARDIO COVID 19-20 Registry is an observational, multicenter, ambispective, and hospital-based registry of patients with confirmed COVID-19 infection who required in-hospital treatment in Latin America. Enrollment of patients started on May 01, 2020 and was initially planned to last three months; based on the progression of pandemic in Latin America, enrollment was extended until December 2020, and could be extended once again based on the pandemic course in our continent at that moment. Conclusions: The CARDIO COVID 19-20 Registry will characterize the in-hospital population diagnosed with COVID-19 in Latin America in order to identify risk factors for worsening of cardiovascular comorbidities or for the appearance of cardiovascular complications during hospitalization and during the 30-day follow up period.


Assuntos
COVID-19/epidemiologia , Doenças Cardiovasculares/epidemiologia , Sistema de Registros , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , COVID-19/complicações , COVID-19/fisiopatologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Comorbidade , Doença das Coronárias/epidemiologia , Doença das Coronárias/etiologia , Doença das Coronárias/fisiopatologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , América Latina , Miocardite/epidemiologia , Miocardite/etiologia , Miocardite/fisiopatologia , SARS-CoV-2 , Trombose/epidemiologia , Trombose/etiologia , Trombose/fisiopatologia
16.
Glob Heart ; 16(1): 18, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33833942

RESUMO

The current pandemic of SARS-COV 2 infection (Covid-19) is challenging health systems and communities worldwide. At the individual level, the main biological system involved in Covid-19 is the respiratory system. Respiratory complications range from mild flu-like illness symptoms to a fatal respiratory distress syndrome or a severe and fulminant pneumonia. Critically, the presence of a pre-existing cardiovascular disease or its risk factors, such as hypertension or type II diabetes mellitus, increases the chance of having severe complications (including death) if infected by the virus. In addition, the infection can worsen an existing cardiovascular disease or precipitate new ones. This paper presents a contemporary review of cardiovascular complications of Covid-19. It also specifically examines the impact of the disease on those already vulnerable and on the poorly resourced health systems of Africa as well as the potential broader consequences on the socio-economic health of this region.


Assuntos
COVID-19/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/fisiopatologia , África , Antimaláricos/efeitos adversos , Arritmias Cardíacas/economia , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , COVID-19/complicações , COVID-19/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/etiologia , Cloroquina/efeitos adversos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Atenção à Saúde/economia , Fatores Econômicos , Recessão Econômica , Produto Interno Bruto , Recursos em Saúde/economia , Recursos em Saúde/provisão & distribuição , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Hidroxicloroquina/efeitos adversos , Inflamação , Isquemia Miocárdica/economia , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/fisiopatologia , Miocardite/economia , Miocardite/etiologia , Miocardite/fisiopatologia , SARS-CoV-2 , Síndrome Respiratória Aguda Grave/complicações , Síndrome Respiratória Aguda Grave/fisiopatologia , Fatores Socioeconômicos , Cardiomiopatia de Takotsubo/economia , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/fisiopatologia
17.
Med Sci Monit ; 27: e928637, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33711006

RESUMO

BACKGROUND Concerns have been raised among clinicians and patients about the cardiovascular risks of bisphosphonates used in the treatment of osteoporosis. The goal of this study was to investigate the acute effect of zoledronic acid (ZA) infusion on arrhythmia development using an electrocardiograph (ECG). MATERIAL AND METHODS This prospective study was a self-controlled case series study that recruited 116 female patients with osteoporosis. The patients underwent standard 12-lead electrocardiography before and 1 day after zoledronic acid intravenous infusion to evaluate cardiac adverse effects and the change in ECG parameters after the infusion. Heart rhythm, atrial and ventricular premature contractions, atrial fibrillation, P wave, and QTc parameters were measured using an ECG. A blood biochemical examination was performed for all patients before the ZA infusion. Body temperature was measured twice per day. RESULTS Before ZA administration, ECG findings were normal in 47 patients and abnormal in 69 patients. After ZA administration, ECG findings were normal in 35 patients and abnormal in 81 patients. New onsets of premature atrial contractions and atrial fibrillation were observed in 1 patient each, and new onsets of premature ventricular contractions were observed in 2 patients. The heart rate was obviously higher, and the QT interval was obviously shorter after ZA administration, compared with before administration. No significant differences in P wave and QTc parameters were found between the 2 ECG measurements. CONCLUSIONS During the acute phase, 116 women with osteoporosis who were treated with zoledronic acid infusion did not develop significantly abnormal ECG changes.


Assuntos
Arritmias Cardíacas/etiologia , Ácido Zoledrônico/efeitos adversos , Ácido Zoledrônico/uso terapêutico , Doença Aguda , Idoso , Arritmias Cardíacas/fisiopatologia , Grupo com Ancestrais do Continente Asiático , Fibrilação Atrial/fisiopatologia , Difosfonatos/efeitos adversos , Eletrocardiografia/métodos , Feminino , Átrios do Coração/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Pessoa de Meia-Idade , Monitorização Fisiológica , Osteoporose/tratamento farmacológico , Estudos Prospectivos , Ácido Zoledrônico/metabolismo
18.
Vet J ; 270: 105624, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33641808

RESUMO

Pacemakers use heart rate histograms (% beats) and sensor indicated rate histograms (% time) to illustrate rate distributions. When programmed to the rate adaptive modes, these data are used to determine the appropriateness of rate response to activity. These histograms are generated from instantaneous heart rate calculations. In humans, such data are compared to known histographic rate profiles. Such rate profiles during 24 h in the dog are not available. Moreover, data representation differ between Holter monitoring and pacemakers making comparisons challenging. The rate distribution in dogs >7-years of age was determined over 24 h using instantaneous and rolling average heart rate. Such data could serve as a guide to programming pacing rates for dogs. Sinus arrhythmia resulted in dissimilar heart rate profiles depending on the method of determining rate. The long intervals of sinus arrhythmia resulted in median values for the percent of time with an instantaneous heart rate of <50 beats/min (bpm) of 15%, whereas a rolling average heart rate of <50 bpm was 0.2%. Based on the cumulative time of the rolling average rate, dogs spent 26.3% of the day between 70-90 bpm with rates <65 bpm and >90 bpm approximating 30% for each. Rates >160 bpm were uncommon (<1%). However, high variability existed between dogs. This study demonstrated the shortcomings of both instantaneous and averaging methods to evaluate heart rate profiles in the dog and that both methods should be incorporated when making pacing rate decisions during programming.


Assuntos
Arritmias Cardíacas/veterinária , Doenças do Cão/fisiopatologia , Determinação da Frequência Cardíaca/veterinária , Frequência Cardíaca/fisiologia , Marca-Passo Artificial/veterinária , Software , Fatores Etários , Animais , Arritmia Sinusal/fisiopatologia , Arritmia Sinusal/veterinária , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Doenças do Cão/terapia , Cães , Eletrocardiografia Ambulatorial/veterinária , Feminino , Determinação da Frequência Cardíaca/métodos , Humanos , Masculino , Valores de Referência , Síndrome do Nó Sinusal/fisiopatologia , Síndrome do Nó Sinusal/terapia , Síndrome do Nó Sinusal/veterinária , Software/estatística & dados numéricos
19.
Toxicol Appl Pharmacol ; 418: 115480, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33689843

RESUMO

Drug-induced cardiotoxicity is a major barrier to drug development and a main cause of withdrawal of marketed drugs. Drugs can strongly alter the spontaneous functioning of the heart by interacting with the cardiac membrane ion channels. If these effects only surface during in vivo preclinical tests, clinical trials or worse after commercialization, the societal and economic burden will be significant and seriously hinder the efficient drug development process. Hence, cardiac safety pharmacology requires in vitro electrophysiological screening assays of all drug candidates to predict cardiotoxic effects before clinical trials. In the past 10 years, microelectrode array (MEA) technology began to be considered a valuable approach in pharmaceutical applications. However, an effective tool for high-throughput intracellular measurements, compatible with pharmaceutical standards, is not yet available. Here, we propose laser-induced optoacoustic poration combined with CMOS-MEA technology as a reliable and effective platform to detect cardiotoxicity. This approach enables the acquisition of high-quality action potential recordings from large numbers of cardiomyocytes within the same culture well, providing reliable data using single-well MEA devices and single cardiac syncytia per each drug. Thus, this technology could be applied in drug safety screening platforms reducing times and costs of cardiotoxicity assessments, while simultaneously improving the data reliability.


Assuntos
Potenciais de Ação/efeitos dos fármacos , Arritmias Cardíacas/induzido quimicamente , Células-Tronco Pluripotentes Induzidas/efeitos dos fármacos , Lasers , Microeletrodos , Miócitos Cardíacos/efeitos dos fármacos , Técnicas Fotoacústicas/instrumentação , Testes de Toxicidade/instrumentação , Arritmias Cardíacas/metabolismo , Arritmias Cardíacas/fisiopatologia , Cardiotoxicidade , Redução de Custos , Análise Custo-Benefício , Frequência Cardíaca/efeitos dos fármacos , Humanos , Células-Tronco Pluripotentes Induzidas/metabolismo , Microeletrodos/economia , Miócitos Cardíacos/metabolismo , Técnicas Fotoacústicas/economia , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Tempo , Testes de Toxicidade/economia , Fluxo de Trabalho
20.
Am J Kidney Dis ; 77(5): 796-809, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33771393

RESUMO

Since maintenance hemodialysis (HD) first became available in the United States in 1962, there has been tremendous growth in the population of patients with kidney failure. HD has become a routine treatment carried out in outpatient clinics, hospitals, nursing facilities, and in patients' homes. Although it is a complex procedure, HD is quite safe. Serious complications are uncommon due to the use of modern HD machines and water treatment systems as well as the development of strict protocols to monitor various aspects of the HD treatment. The practicing nephrologist must be knowledgeable about life-threatening complications that can occur during HD and be able to recognize, manage, and prevent them. This installment in the AJKD Core Curriculum in Nephrology reviews the pathogenesis, management, and prevention of 9 HD emergencies. The HD emergencies covered include dialyzer reactions, dialysis disequilibrium syndrome, uremic/dialysis-associated pericarditis, air embolism, venous needle dislodgement, vascular access hemorrhage, hemolysis, dialysis water contamination, and arrhythmia episodes.


Assuntos
Emergências , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Edema Encefálico , Descontaminação , Soluções para Diálise/normas , Embolia Aérea/etiologia , Embolia Aérea/fisiopatologia , Embolia Aérea/terapia , Deslocamentos de Líquidos Corporais , Hemólise , Hemorragia/etiologia , Hemorragia/fisiopatologia , Hemorragia/terapia , Humanos , Hipersensibilidade/etiologia , Hipersensibilidade/fisiopatologia , Hipersensibilidade/terapia , Rins Artificiais/efeitos adversos , Agulhas , Nefrologia , Pericardite/etiologia , Pericardite/fisiopatologia , Pericardite/terapia , Falha de Prótese , Esterilização , Uremia/complicações , Purificação da Água/normas
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