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1.
High Blood Press Cardiovasc Prev ; 26(4): 339-344, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385256

RESUMO

INTRODUCTION: Opportunistic screening of atrial fibrillation is a valuable approach to the identification of subjects with unknown or non-symptomatic atrial fibrillation (AF) with the potential of reducing the burden of ischemic stroke in the population. AIM: To evaluate the feasibility of a large-scale screening for atrial fibrillation using a blood pressure monitor (MicrolifeAFIB) endowed with a validated algorithm able to detect AF calculating the irregularity of interval times between heartbeats. METHODS: In this cross-sectional study conducted in 74 pharmacies in Verona participated 3071 people aged 50 years or more. In 6 months, information about drugs, previous diagnoses of cardiovascular diseases, anthropometric and demographic data was recorded, together with the measurement of blood pressure and cardiac rhythm by using the MicrolifeAFIB device. Pharmacists also collected anthropometric and demographic data of the participants, along with information concerning their personal history of cardiovascular disease and the use of antihypertensive and antithrombotic agents. All those who were positive at the screening for atrial fibrillation were referred to their family doctor. RESULTS: The screening revealed 98 subjects (3.2%) positive for AF; 44 of these reported a previous diagnosis of AF and were treated with anticoagulants (77%) or with antiplatelet agents (7%). By logistic regression analysis, age, male sex and heart failure were independently associated with positivity for AF. Association between positive test and previous stroke/TIA was found in the 54 subjects without a previous diagnosis of AF (9% had a previous stroke/TIA). CONCLUSIONS: Opportunistic screening for atrial fibrillation in the pharmacies is feasible and allows to identify a number of subjects with silent, non-previously diagnosed AF, therefore is potentially useful in large-scale projects aimed at the prevention of cardiovascular morbidity and mortality.


Assuntos
Fibrilação Atrial/diagnóstico , Determinação da Pressão Arterial/instrumentação , Serviços Comunitários de Farmácia , Frequência Cardíaca , Programas de Rastreamento/instrumentação , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Pressão Sanguínea , Estudos Transversais , Eletrocardiografia , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico
2.
Medicine (Baltimore) ; 98(32): e16642, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393361

RESUMO

RATIONALE: Tachycardia-induced cardiomyopathy (TIC) is defined as systolic and/or diastolic dysfunction of the left ventricle resulting from prolonged elevated heart rates, completely reversible upon control of the arrhythmia. Atrioventricular reentrant tachycardia (AVRT) is one of the most frequent causes of TIC. In its incessant form, it is unlikely to be controlled by pharmacological treatment, catheter ablation being the principal therapeutic option. The coexistence of left bundle branch block (LBBB) in patients with AVRT may cause difficulties in the early diagnosis and management of tachycardia because of the wide complex morphology, making it harder to localize the accessory pathway (AP). PATIENT CONCERNS: A 60-year-old woman, presented incessant episodes of palpitations and shortness of breath due to a LBBB tachycardia leading to hemodynamic instability. DIAGNOSIS: The patient had a wide QRS tachycardia, with LBBB morphology and a heart rate of 160/minute. Echocardiography showed global hypokinesia with 25% left ventricular ejection fraction (LVEF). Considering the patient's clinical picture, TIC was suspected. INTERVENTIONS: The electrophysiological study revealed a left lateral accessory pathway. Catheter ablation was successfully performed at the level of the lateral mitral ring. OUTCOMES: One week after the ablation the patient had no signs of heart failure and the LVEF normalized to 55%. During 6-months follow-up the patient presented no more episodes of tachycardia or heart failure and the LVEF remained normal. LESSONS: AVRT is rarely associated with intrinsic LBBB, being a potential cause of TIC. In these patients, it is unlikely to control the arrhythmia pharmacologically, catheter ablation being the best therapeutic option. The variation of QRS complex duration between LBBB pattern in SR and AVRT could be useful for early diagnosis of an ipsilateral AP on surface ECG.


Assuntos
Bloqueio de Ramo/cirurgia , Ablação por Cateter/métodos , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Bloqueio de Ramo/complicações , Bloqueio de Ramo/diagnóstico , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Ecocardiografia , Eletrocardiografia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Taquicardia por Reentrada no Nó Atrioventricular/complicações
3.
Med Clin North Am ; 103(5): 767-774, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378323

RESUMO

This article represents an overview of the basic concepts of cardiac electrophysiology. This relatively new field became a subspecialty of cardiology in the mid-1990s due to the rapid development of equipment that allowed the study and cure of cardiac arrhythmias percutaneously. Simultaneously, technology provided the field with percutaneous cardiac implantable electronic devices designed to protect patients from life-threatening bradyarrhythmias and tachyarrhythmias. Recently, the field has focused on the ablative treatment of atrial fibrillation, the most common arrhythmia facing an aging population, and the diagnosis and management of many inherited arrhythmias through advances in understanding of their genetic cause.


Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Eletrocardiografia , Fenômenos Eletrofisiológicos , Humanos , Marca-Passo Artificial , Ablação por Radiofrequência
4.
Med Clin North Am ; 103(5): 775-784, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378324

RESUMO

A 12-lead electrocardiogram (ECG) is the most commonly ordered cardiac test. Although data are not robust, guidelines recommend against performing an ECG in patients who are asymptomatic, even if they have a higher risk of developing cardiovascular disease in the long term. Conversely, patients with cardiac symptoms, including chest pain, dyspnea, palpitation, and syncope, should have an ECG performed in the office. Computerized algorithms exist ubiquitously to guide interpretation, but they can be the source of erroneous information. A stepwise approach is given to guide the primary care physician's approach to the systematic interpretation of ECG tracings.


Assuntos
Dor no Peito/etiologia , Eletrocardiografia/estatística & dados numéricos , Cardiopatias/diagnóstico , Atenção Primária à Saúde/métodos , Algoritmos , Atletas , Diagnóstico por Computador/normas , Humanos
5.
Med Clin North Am ; 103(5): 785-791, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378325

RESUMO

Palpitation is common. It is often accompanied by dizziness, lightheadedness, near syncope, and even syncope. It may be difficult to confirm a diagnosis in patients with infrequent symptoms. Several tools are available to document arrhythmias in the workup of a patient with palpitation, including 24-hour Holter monitoring, 30-day external continuous monitoring, and implantable loop recorders. A number of private companies are now able to empower patients to monitor heart rates and even give accurate rhythm strips. This article reviews the current data on how to make the diagnosis and which tools to use in the primary care setting.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Eletrocardiografia Ambulatorial , Humanos , Avaliação de Sintomas , Fatores de Tempo
6.
Med Clin North Am ; 103(5): 793-807, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378326

RESUMO

Cardiac arrhythmia is a common cause of syncope. The prompt identification of arrhythmic syncope has diagnostic and prognostic implications. In this article, an approach to identifying and managing arrhythmic syncope is discussed, including key findings from the history, physical examination, electrocardiogram, role of risk stratification, use of supplemental investigations, and treatment.


Assuntos
Arritmias Cardíacas/diagnóstico , Síncope/etiologia , Arritmias Cardíacas/complicações , Eletrocardiografia , Humanos , Exame Físico , Prognóstico , Síncope/epidemiologia
7.
Med Clin North Am ; 103(5): 863-879, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378331

RESUMO

The term paroxysmal supraventricular tachycardia encompasses a heterogeneous group of arrhythmias with different electrophysiologic characteristics. Knowledge of the mechanism of each supraventricular tachycardia is important in determining management in the office, at the bedside, and in the electrophysiology laboratory. Paroxysmal supraventricular tachycardias have an abrupt onset and offset, typically initiating and terminating with premature atrial ectopic beats. In the acute setting, both vagal maneuvers and pharmacologic therapy can be effective in arrhythmia termination. Catheter ablation has revolutionized therapy for many supraventricular tachycardias, and newer techniques have significantly improved ablation efficacy and decreased periprocedural complications and procedure times.


Assuntos
Antiarrítmicos/administração & dosagem , Ablação por Cateter/métodos , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/terapia , Eletrocardiografia , Humanos , Taquicardia Supraventricular/fisiopatologia , Resultado do Tratamento
8.
Med Clin North Am ; 103(5): 881-895, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378332

RESUMO

Ventricular tachycardia is commonly seen in medical practice. It may be completely benign or portend high risk for sudden cardiac death. Therefore, it is important that clinicians be familiar with and able to promptly recognize and manage ventricular tachycardia when confronted with it clinically. In many cases, curative therapy for a given ventricular arrhythmia may be provided after a thorough understanding of the underlying substrate and mechanism. In this article, the authors broadly review the current classification of the different ventricular arrhythmias encountered in medical practice, provide brief background regarding the different mechanisms, and discuss practical diagnosis and management scenarios.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapia , Antiarrítmicos/uso terapêutico , Gerenciamento Clínico , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ablação por Radiofrequência/métodos , Taquicardia Ventricular/complicações , Taquicardia Ventricular/diagnóstico
9.
Biochem Med (Zagreb) ; 29(3): 031001, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31379463

RESUMO

Introduction: Phlebotomy is an error-prone process in which mistakes are difficult to reveal. This case report describes the effect on laboratory results originating from a blood sample collected in close proximity to an intravenous catheter. Materials and methods: A 69-year-old male patient was referred to the Emergency department where pneumonia was suspected. Phlebotomy was performed to collect blood samples to assess electrolytes, renal function, liver function, infection and haematological parameters. Results: The laboratory analysis showed reduced potassium and calcium concentrations. To prevent life-threatening cardiac failure the clinician decided to correct those electrolytes. Remarkably, the electrocardiogram showed no abnormalities corresponding to hypokalaemia and hypocalcaemia. This observation, in combination with an overall increase in laboratory parameters with the exception of sodium and chloride, led to the suspicion of a preanalytical error. Retrospectively, an intravenous catheter was inserted in close proximity of the puncture place but no continuous infusion was started prior to phlebotomy. However, the intravenous catheter was flushed with sodium chloride. Since potential other causes were excluded, the flushing of the intravenous catheter with sodium chloride prior to phlebotomy was the most probable cause for the deviating laboratory results and subsequently for the unnecessary potassium and calcium suppletion. Conclusion: This case underlines the importance of caution in the interpretation of laboratory results obtained from specimens that are collected in the proximity of an intravenous catheter, even in the absence of continuous infusion.


Assuntos
Cateteres , Flebotomia/métodos , Idoso , Cálcio/sangue , Eletrocardiografia , Serviço Hospitalar de Emergência , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Potássio/sangue , Fase Pré-Analítica , Cloreto de Sódio/química
10.
Int. j. cardiovasc. sci. (Impr.) ; 32(4): 368-373, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1012344

RESUMO

Cardiopulmonary exercise testing is widely used in the evaluation of patients with left ventricular dysfunction, and some of these patients have an implantable cardioverter-defibrillator (ICD). However, this test presents specific challenges because of the susceptibility to ventricular arrhythmias during maximal levels of exercise. Objective: To evaluate the safety of cardiopulmonary exercise testing in patients with ICD. Methods: The study included patients with ICD who underwent cardiopulmonary exercise testing between 2007 and 2015. The tests were completed once the electronic devices were programmed. The maximum allowed heart rate reached during exercise was 10 beats below the first therapy zone programmed. Results: The study included 69 patients with mean age 53.7 ± 10.8 years, including 68% men. Exercise time was 8.7±2.3 minutes, with peak oxygen consumption of 13.3 ± 4.3 ml.kg-1.min-1. Peak heart rate was 62.9 ± 13.4% of the maximum rate predicted, with all patients taking specific medication. Ventricular arrhythmia was observed in 29% of the patients, and paired ventricular extrasystoles, ventricular bigeminism or non-sustained ventricular tachycardia were observed in only 14.5% of the patients. There was no sustained ventricular arrhythmia resulting in ICD therapy or other complications, such as inappropriate therapies. The frequency of severe events was 0%, 95% CI (0 - 5.2%). Conclusion: In the sample of patients evaluated, the cardiopulmonary exercise testing was shown to be safe during its performance in a hospital setting, following the safety standards


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Desfibriladores Implantáveis , Teste de Esforço/métodos , Consumo de Oxigênio , Arritmias Cardíacas , Doenças Cardiovasculares , Índice de Massa Corporal , Morte Súbita Cardíaca , Eletrocardiografia/métodos , Frequência Cardíaca
11.
Int. j. cardiovasc. sci. (Impr.) ; 32(4): 374-383, July-Aug. 2019. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-1012347

RESUMO

Maximal oxygen uptake (VO2max) and both first (VT1) and second (VT2) thresholds have been used as reference points for exercise prescription in different populations. Objective: We aimed to test the hypothesis that exercise prescription, based on VTs determined by treadmill cardiopulmonary exercise testing (CPET), is influenced by the rate of increase in treadmill workload. Methods: Nine healthy individuals underwent two CPETs, followed by two sessions of submaximal exercise, both in randomized order. For the "speed" protocol, there was an increment of 0.1 to 0.3 km.h-1 every 15s. The "grade" incremental protocol increased 1% every 30s and 0.1 km.h-1 every 45s. This was followed by submaximal exercise sessions lasting 40min at an intensity corresponding to heart rate (HR) between the VT1 and VT2. Results: The "speed" protocol resulted in higher VT1 (p = 0.01) and VT2 (p = 0.02) when compared to the "grade" incremental protocol, but there was no effect on VO2max. The target HR for the submaximal exercise sessions was higher in the "speed" protocol compared to the "grade" incremental protocol (p < 0.01) and remained stable during the two steady-state exercise sessions. Blood lactate remained stable during the submaximal exercise sessions, with higher values observed during the "speed" protocol than those "grade" incremental protocol (p < 0.01). Conclusions: Compared to a grade-based protocol, a speed-based protocol resulted in higher VT1 and VT2, which significantly affected cardiorespiratory and metabolic responses to prescribed exercise intensity in healthy young adults


Assuntos
Humanos , Masculino , Feminino , Adulto , Tolerância ao Exercício , Teste de Esforço/métodos , Consumo de Oxigênio , Prognóstico , Doenças Cardiovasculares/diagnóstico , Exercício , Protocolos/métodos , Eletrocardiografia/métodos , /métodos , Frequência Cardíaca
12.
Int. j. cardiovasc. sci. (Impr.) ; 32(4): 391-395, July-Aug. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1012351

RESUMO

Prior statements have recommended restriction from competitive sports participation for all athletes with ICDs. Recent data, however, suggests that many athletes can participate in sports without adverse events. In the ICD Sports Registry, 440 athletes, aged 8-60 years, 77 of which were high-level interscholastic athletes, who had continued to practice sports, were prospectively followed for 4 years, with no deaths or failures to defibrillate during practice, and no injuries related to arrhythmia or shock during sports. Shocks did occur, for ventricular and supraventricular arrhythmias. While more athletes received shocks during physical activity than at rest, there were no differences between competition or practice, versus other physical activity. Programming with higher rate cut-offs and longer durations was associated with fewer inappropriate shocks, with no increase in syncope. Based on this study, current recommendations now state that returning to competition may be considered for an athlete with an ICD. In considering this decision, the underlying disease and type of sport should be discussed, and shared decision-making between doctor, patient, and often family, is critical


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Esportes , Desfibriladores Implantáveis , Atletas , Qualidade de Vida , Esportes , Síncope , Doenças Cardiovasculares/mortalidade , Exercício , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia/métodos
14.
Stud Health Technol Inform ; 264: 55-59, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437884

RESUMO

When dealing with electrocardiography (ECG) the main focus relies on the classification of the heart's electric activity and deep learning has been proving its value over the years classifying the heartbeats, exhibiting great performance when doing so. Following these assumptions, we propose a deep learning model based on a ResNet architecture with convolutional 1D layers to classify the beats into one of the 4 classes: normal, atrial premature contraction, premature ventricular contraction and others. Experimental results with MIT-BIH Arrhythmia Database confirmed that the model is able to perform well, obtaining an accuracy of 96% when using stochastic gradient descent (SGD) and 83% when using adaptive moment estimation (Adam), SGD also obtained F1-scores over 90% for the four classes proposed. A larger dataset was created and tested as unforeseen data for the trained model, proving that new tests should be done to improve the accuracy of it.


Assuntos
Eletrocardiografia , Processamento de Sinais Assistido por Computador , Algoritmos , Arritmias Cardíacas , Bases de Dados Factuais , Frequência Cardíaca , Humanos
16.
Medicine (Baltimore) ; 98(34): e16938, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441885

RESUMO

We aimed to investigate heart rate recovery (HRR) in patients with transient ischemic attack (TIA) and the relationship between HRR and health-related quality of life (HRQOL).All available patients were enrolled during the enrollment period. A total of 120 patients with TIA and 120 healthy controls were included in this study. A treadmill stress test was performed to calculate the HRR. The HRR were calculated as follows: HRR 1, 2, 3, and 5 minutes = heart rate at peak during exercise - heart rate at 1, 2, 3, and 5 minutes at rest. All patients enrolled were asked to fill in the Short Form 36 Health Survey to calculate HRQOL.We found that the maximum heart rate of TIA patients was significantly higher than that of healthy controls (166 ±â€Š11 vs. 162 ±â€Š14 beats/min, P = .015). Similarly, maximum systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in TIA group compared with healthy control group (SBP: 172 ±â€Š15 vs. 165 ±â€Š14 mm Hg, P < .001; DBP: 102 ±â€Š12 vs. 93 ±â€Š16 mm Hg, P < .001). The HRR were significantly lower in TIA group compared with control group (TIA vs. controls, HRR1: 17 ±â€Š7 vs. 30 ±â€Š8 beats/min, HRR2: 32 ±â€Š11 vs. 49 ±â€Š9 beats/min, HRR3: 43 ±â€Š13 vs. 63 ±â€Š12 beats/min, HRR5: 54 ±â€Š16 vs. 73 ±â€Š15 beats/min, all P < .001). Multivariate analysis showed that older age (P = .03) and high BMI (P = .04) were risk factors associated with abnormal HRR in patients with TIA. With regard to HRQOL, we found that role limitations due to physical problems, general health, vitality, and role limitations due to emotional problems were significantly lower in patients with abnormal HRR compared with patients with normal HRR. Multivariate analysis showed that older age (P = .04) and abnormal HRR (P = .03) were predictors for poor HRQOL in TIA patients.HRR was impaired in patients with TIA. In addition, TIA patients with abnormal HRR suffered from a significantly poorer HRQOL. Hence, given the prognostic value of HRR, patients with TIA should be monitored to prevent cardiovascular events and to improve HRQOL.


Assuntos
Frequência Cardíaca/fisiologia , Ataque Isquêmico Transitório/fisiopatologia , Qualidade de Vida , Adulto , Fatores Etários , Pressão Sanguínea , Índice de Massa Corporal , Estudos de Casos e Controles , Eletrocardiografia , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica/fisiologia , Inquéritos e Questionários
17.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(7): 534-538, 2019 Jul 24.
Artigo em Chinês | MEDLINE | ID: mdl-31365993

RESUMO

Objective: To evaluate the clinical and cardiac magnetic resonance (CMR) features of apical hypertrophic cardiomyopathy (ApHCM) patients complicating with left ventricular apical aneurysm (LVAA). Methods: CMR confirmed 25 ApHCM patients complicating with LVAA from January 2010 to December 2017 in Fuwai hospital were included in this study, and the baseline clinical data and CMR characteristics were retrospectively analyzed. There were 14 pure ApHCM (hypertrophy limited at the apical segments) complicating with LVAA patients and 11 mixed ApHCM (predominantly apical hypertrophy along with thickening of contiguous non-apical left ventricular region) with LVAA patients. Results: In this patient cohort,age of 84% (21/25) patients ranged between 20-70 years old, and 68% (17/25) were male. There were 68% (17/25) patients with complaint of chest distress symptom, 56% (14/25) with complaint of chest pain, 32% (8/25) with complaint of palpitation,16% (4/25) with complaint of dyspnea, and 12% (3/25) presented as syncope. ST-T segment changes of electrocardiogram were observed in all patients, and giant negative T waves were detected in 80% patients (20/25). The rate of missed diagnosis by echocardiography for detecting ApHCM and LVAA was 16% (4/25) and 68% (17/25), respectively. CMR showed discrete thin-walled dyskinetic or akinetic segment of the most distal portion of the left ventricular chamber in ApHCM patients with LVAA. Transmural late gadolinium enhancement of the aneurysmal rim was detected in 76% (19/25) patients, and the maximum transverse dimension of aneurysm was bigger in patients with transmural late gadolinium enhancement than in patients without transmural late gadolinium enhancement ((22.0±10.8)mm vs. (11.7±4.0) mm, P=0.033). Conclusion: ApHCM with LVAA patients have distinct cardiac clinical features, and CMR is the most useful tool for the accurate and objective evaluation of this disease.


Assuntos
Cardiomiopatia Hipertrófica , Meios de Contraste , Adulto , Idoso , Eletrocardiografia , Feminino , Gadolínio , Humanos , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
18.
Medicine (Baltimore) ; 98(32): e16370, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393346

RESUMO

Validated risk scoring systems in African American (AA) population are under studied. We utilized history, electrocardiogram, age, risk factors, and initial troponin (HEART) and thrombolysis in myocardial infarction (TIMI) scores to predict major adverse cardiovascular events (MACE) in non-high cardiovascular (CV) risk predominantly AA patient population.A retrospective emergency department (ED) charts review of 1266 chest pain patients where HEART and TIMI scores were calculated for each patient. Logistic regression model was computed to predict 6-week and 1-year MACE and 90-day cardiac readmission. Decision curve analysis (DCA) was constructed to differentiate between clinical strategies in non-high CV risk patients.Of the 817 patients included, 500 patients had low HEART score vs. 317 patients who had moderate HEART score. Six hundred sixty-three patients had low TIMI score vs. 154 patients had high TIMI score. The univariate logistic regression model shows odds ratio of predicting 6-week MACE using HEART score was 3.11 (95% confidence interval [CI] 1.43-6.76, P = .004) with increase in risk category from low to moderate vs. 2.07 (95% CI 1.18-3.63, P = .011) using TIMI score with increase in risk category from low to high and c-statistic of 0.86 vs. 0.79, respectively. DCA showed net benefit of using HEART score is equally predictive of 6-week MACE when compared to TIMI.In non-high CV risk AA patients, HEART score is better predictive tool for 6-week MACE when compared to TIMI score. Furthermore, patients presenting to ED with chest pain, the optimal strategy for a 2% to 4% miss rate threshold probability should be to discharge these patients from the ED.


Assuntos
Afro-Americanos , Doenças Cardiovasculares/etnologia , Dor no Peito/etnologia , Indicadores Básicos de Saúde , Hospitais Comunitários/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Doenças Cardiovasculares/mortalidade , Dor no Peito/etiologia , Dor no Peito/mortalidade , Eletrocardiografia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Readmissão do Paciente , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Terapia Trombolítica/estatística & dados numéricos , Troponina/sangue
19.
Int Heart J ; 60(4): 979-982, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257342

RESUMO

Congenital long QT syndrome (LQTS) is a cardiac channelopathy that leads to the prolongation of the QT interval. This prolongation can lead to ventricular tachyarrhythmia, syncope, and sudden cardiac death. There are various types of LQTS. Treatment of LQT1 and LQT2 is mainly based on antiadrenergic therapy. LQT3, on the other hand, is a result of a mutation of the SCN5A gene, which encodes the sodium channels. In this type, patients are sensitive to vagal stimuli and episodes tend to occur at rest. Sodium channel blocking compounds, such as ranolazine, mexiletine, and flecainide, have been found to be effective in selective mutations.In this case report, we report the case of a child with congenital LQT3 (V411M) who presented first with sudden cardiac death and three weeks later with an implantable cardioverter defibrillator storm. Knowing the specific mutation and understanding the mechanism at the molecular level through an in vitro study yielded a clinically meaningful result. The patient's arrhythmia burden was totally eliminated following successful treatment with flecainide.


Assuntos
DNA/genética , Eletrocardiografia , Flecainida/uso terapêutico , Síndrome do QT Longo/tratamento farmacológico , Mutação , Canal de Sódio Disparado por Voltagem NAV1.5/genética , Criança , Análise Mutacional de DNA , Feminino , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/genética , Canal de Sódio Disparado por Voltagem NAV1.5/metabolismo , Bloqueadores do Canal de Sódio Disparado por Voltagem/uso terapêutico
20.
Int Heart J ; 60(4): 812-821, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308323

RESUMO

Pulmonary vein isolation (PVI) of atrial fibrillation (AF) can reduce the AF burden and, potentially, reduce the long-term risk of strokes and death. However, it remains unclear whether anticoagulants can be stopped after PVI because of post-ablation AF recurrence in some patients. This study aimed to investigate the discontinuation rate of anticoagulants and long-term incidence of strokes after PVI.We enrolled 512 consecutive Japanese patients with AF (mean age, 63.4 ± 10.4 years; 123 women; 234 with non-paroxysmal AF; CHADS2 score/CHA2DS2-VASC score, 1.32 ± 1.12/2.21 ± 1.54) who underwent PVI between 2012 and 2015. During a 28.0 ± 17.1 -month follow-up, anticoagulants were terminated in 230 (44.9%) of the 512 patients, AF recurred in 200 (39.1%), and 10 (1.95%) suffered from a stroke. Death occurred in 5 (0.98%) patients. Although the incidence of strokes, by a Kaplan-Meier analysis, was similar, the incidence of death was lower (Hazard ratio 0.37, 95% confidence interval 0.12-0.93, P = 0.041) in the AF ablation group than the control group without ablation after 1:1 propensity score matching (the control data was derived from 2,986 patients in the SAKURA AF Registry, a large-cohort AF registry).Anticoagulants were discontinued in nearly half the patients who underwent AF ablation; of these, 39.1% experienced AF recurrences, 1.95% suffered from strokes, and 0.98% died, but the risk of death after AF ablation appeared to be lower than that in a propensity score-matched control group without ablation during long-term follow-up.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Eletrocardiografia , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , Idoso , Fibrilação Atrial/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Recidiva , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
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