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1.
Medicine (Baltimore) ; 100(31): e26787, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397829

RESUMO

BACKGROUND: Lopinavir, ritonavir, atazanavir, and saquinavir had been reportedly used or suggested for coronavirus disease 2019 (COVID-19) treatment. They may cause electrocardiography changes. We aim to evaluate risk of PR prolongation, QRS widening, and QT prolongation from lopinavir, ritonavir, atazanavir, and saquinavir. METHODS: In accordance with preferred reporting items for systematic reviews and meta-analyses guidelines, our search was conducted in PubMed Central, PubMed, EBSCOhost, and ProQuest from inception to June 25, 2020. Titles and abstracts were reviewed for relevance. Cochrane Risk of Bias Tool 2.0 and Downs and Black criteria was used to evaluate quality of studies. RESULTS: We retrieved 9 articles. Most randomized controlled trials have low risk of biases while all quasi-experimental studies have a positive rating. Four studies reporting PR prolongation however only 2 studies with PR interval >200 ms. One of which, reported its association after treatment with ritonavir-boosted saquinavir treatment while another, during treatment with ritonavir-boosted atazanavir. No study reported QRS widening >120 ms with treatment. Four studies reporting QT prolongation, with only one study reaching QT interval >450 ms after ritonavir-boosted saquinavir treatment on healthy patients. There is only one study on COVID-19 patients reporting QT prolongation in 1 out of 95 patients after ritonavir-boosted lopinavir treatment. CONCLUSION: Limited evidence suggests that lopinavir, ritonavir, atazanavir, and saquinavir could cause PR prolongation, QRS widening, and QT prolongation. Further trials with closer monitoring and assessment of electrocardiography are needed to ascertain usage safety of antivirals in COVID-19 era.


Assuntos
Sulfato de Atazanavir/efeitos adversos , Síndrome do QT Longo/etiologia , Lopinavir/efeitos adversos , Ritonavir/efeitos adversos , Saquinavir/efeitos adversos , Adulto , Sulfato de Atazanavir/uso terapêutico , Inibidores do Citocromo P-450 CYP3A/efeitos adversos , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Eletrocardiografia/métodos , Humanos , Lopinavir/uso terapêutico , Ritonavir/uso terapêutico , Saquinavir/uso terapêutico
2.
Cardiovasc Ultrasound ; 19(1): 31, 2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429107

RESUMO

BACKGROUND: Cardiovascular complications of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV2) are known to be associated with poor outcome. A small number of case series and reports have described cases of myocarditis and ischaemic events, however, knowledge on the aetiology of acute cardiac failure in SARS-CoV2 remains limited. We describe the occurrence and risk stratification imaging correlates of 'takotsubo' stress cardiomyopathy presenting in a patient with Coronavirus Disease 2019 (COVID-19) in the intensive care unit. An intubated 53-year old patient with COVID19 suffered acute haemodynamic collapse in the intensive care unit, and was thus investigated with transthoracic echocardiography (TTE), 12-lead electrocardiograms (ECG) and serial troponins and blood tests, and eventually coronary angiography due to clinical suspicion of ischaemic aetiology. Echocardiography revealed a reduced ejection fraction, with evident extensive apical akinesia spanning multiple coronary territories. Troponins and NT-proBNP were elevated, and ECG revealed ST elevation: coronary angiography was thus performed. This revealed no significant coronary stenosis. Repeat echocardiography performed within the following week revealed a substantial recovery of ejection fraction and wall motion abnormalities. Despite requirement of a prolonged ICU stay, the patient now remains clinically stable, and is on spontaneous breathing. CONCLUSION: This case report presents a case of takotsubo stress cardiomyopathy occurring in a critically unwell patient with COVID19 in the intensive care setting. Stress cardiomyopathy may be an acute cardiovascular complication of COVID-19 infection. In the COVID19 critical care setting, urgent bedside echocardiography is an important tool for initial clinical assessment of patients suffering haemodynamic compromise.


Assuntos
COVID-19/epidemiologia , Angiografia Coronária/métodos , Ecocardiografia/métodos , Eletrocardiografia/métodos , Cardiomiopatia de Takotsubo/diagnóstico , Comorbidade , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Cardiomiopatia de Takotsubo/epidemiologia
3.
Medicine (Baltimore) ; 100(29): e26269, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398001

RESUMO

ABSTRACT: Variables derived from the cardiopulmonary exercise test (CPX) provide objective information regarding the exercise capacity of children with cerebral palsy (CP), which can be used as the basis for exercise recommendations. Performing maximal CPX might not be appropriate, safe, or practical for children with CP. In the present study, the safety and feasibility of symptom-limited CPX using the modified Naughton protocol, a submaximal protocol, were investigated in children with CP, Gross Motor Function Classification System (GMFCS) level I or II. The present study included 40 children aged 6 to 12 years with CP who underwent symptom-limited CPX. CPX was performed to measure cardiopulmonary fitness using a treadmill with a modified Naughton protocol. Motor capacity was assessed using the Gross Motor Function Measure (GMFM), Pediatric Balance Scale (PBS), Timed Up and Go (TUG) test, and 6-minute walk test. Thirty-seven children with CP successfully completed testing without any adverse events during or immediately after CPX (dropout rate 7.5%). The reason for test termination was dyspnea (51.4%) or leg fatigue (48.6%). Based on the respiratory exchange ratio (RER), 21 of 37 (56.8%) children chose premature termination. The relationship between the reason for test termination and RER was not statistically significant (Spearman rho = 0.082, P = .631). CPX exercise time was strongly correlated with GMFM (Spearman rho = 0.714) and moderate correlation with PBS (Spearman rho = 0.690) and TUG (Spearman rho = 0.537). Peak oxygen uptake during CPX showed a weak correlation with GMFM and a moderate correlation with PBS. This study revealed that symptom-limited CPX using the modified Naughton protocol was safe and feasible for children with CP and GMFCS level I or II.


Assuntos
Paralisia Cerebral/classificação , Teste de Esforço/normas , Paralisia Cerebral/epidemiologia , Distribuição de Qui-Quadrado , Criança , Eletrocardiografia/métodos , Teste de Esforço/métodos , Teste de Esforço/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Segurança do Paciente , República da Coreia/epidemiologia
4.
Tex Heart Inst J ; 48(3)2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34383957

RESUMO

During the coronavirus disease 2019 (COVID-19) pandmic, more patients are presenting with complications late after acute myocardial infarction. We report the case of a 71-year-old man who delayed seeking medical care for 2 weeks, despite progressive shortness of breath, cough, and tactile fever, for fear of contracting COVID-19 in the hospital. Clinical and echocardiographic evaluation revealed a ventricular septal rupture secondary to acute myocardial infarction. The patient underwent urgent cardiac catheterization, followed by successful saphenous vein grafting to the left anterior descending coronary artery and open surgical repair of the ventricular septal rupture with a bovine pericardial patch. This case highlights a potential long-lasting negative effect that the COVID-19 pandemic will have on the care-seeking behavior and health of patients with acute cardiovascular disease.


Assuntos
COVID-19 , Cateterismo Cardíaco/métodos , Ponte de Artéria Coronária/métodos , Medo , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST , Ruptura do Septo Ventricular , Idoso , COVID-19/epidemiologia , COVID-19/psicologia , Angiografia Coronária/métodos , Ecocardiografia/métodos , Eletrocardiografia/métodos , Humanos , Masculino , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Tempo para o Tratamento/tendências , Resultado do Tratamento , Ruptura do Septo Ventricular/diagnóstico , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/fisiopatologia , Ruptura do Septo Ventricular/cirurgia
5.
Am J Cardiol ; 152: 146-149, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34237610

RESUMO

The optimal screening strategy to prevent sudden cardiac death (SCD) in athletes remains unknown. Pre-participation screening with electrocardiogram (ECG) remains controversial. The utility and accuracy of limb-lead (LL) ECG alone in identifying cardiac abnormalities associated with SCD has not been studied. This study was a comparative secondary data analysis, comparing the interpretation accuracy of 4 physicians evaluating publicly available ECGs of the most common cardiac conditions associated with SCD in athletes. Each physician interpreted a total of 100 ECGs: 50 normal ECGs (25 LL and 25 standard 12L) and 50 abnormal ECGs (25 LL and 25 standard 12L). The agreement between LL ECGs and 12L ECGs was assessed by Cohen's kappa coefficient and the accuracy of identifying an abnormal ECG was compared across LL and 12L ECGs using a chi-squared test. Inter-rater reliability was assessed by estimating the Fleiss's kappa coefficient. The sensitivity of LL ECG and 12L ECG was identical at 86%. The specificity of LL ECG was 75% (95% CI = 65% to 83%) and 12L ECG was 82% (95% CI = 73% to 89%). Substantial agreement was seen between LL ECG and 12L ECG interpretation across all readers (k = 0.63; 95% CI = 0.49 to 0.77). Interpretation accuracy was 81% (95% CI = 74% to 86%) and 84% (95% CI 78% to 89%) using LL ECG and 12L ECG, respectively (p = 0.43). In conclusion, the accuracy, sensitivity, and specificity were high and comparable for both LL ECG and 12L ECG in identifying cardiovascular conditions associated with SCD. Agreement between LL ECG and 12L ECG was substantial.


Assuntos
Atletas , Doenças Cardiovasculares/diagnóstico , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia/métodos , Displasia Arritmogênica Ventricular Direita/complicações , Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Síndrome de Brugada/complicações , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/fisiopatologia , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/fisiopatologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/fisiopatologia , Morte Súbita Cardíaca/etiologia , Humanos , Síndrome do QT Longo/complicações , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/fisiopatologia , Programas de Rastreamento , Miocardite/complicações , Miocardite/diagnóstico , Miocardite/fisiopatologia , Síndrome de Wolff-Parkinson-White/complicações , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/fisiopatologia
6.
Glob Heart ; 16(1): 42, 2021 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-34211828

RESUMO

Background: QTc prolongation is an adverse effect of COVID-19 therapies. The use of a handheld device in this scenario has not been addressed. Objectives: To evaluate the feasibility of QTc monitoring with a smart device in COVID-19 patients receiving QTc-interfering therapies. Methods: Prospective study of consecutive COVID-19 patients treated with hydroxychloroquine ± azithromycin ± lopinavir-ritonavir. ECG monitoring was performed with 12-lead ECG or with KardiaMobile-6L. Both registries were also sequentially obtained in a cohort of healthy patients. We evaluated differences in QTc in COVID-19 patients between three different monitoring strategies: 12-lead ECG at baseline and follow-up (A), 12-lead ECG at baseline and follow-up with the smart device (B), and fully monitored with handheld 6-lead ECG (group C). Time needed to obtain an ECG registry was also documented. Results: One hundred and eighty-two COVID-19 patients were included (A: 119(65.4%); B: 50(27.5%); C: 13(7.1%). QTc peak during hospitalization did significantly increase in all groups. No differences were observed between the three monitoring strategies in QTc prolongation (p = 0.864). In the control group, all but one ECG registry with the smart device allowed QTc measurement and mean QTc did not differ between both techniques (p = 0.612), displaying a moderate reliability (ICC 0.56 [0.19-0.76]). Time of ECG registry was significantly longer for the 12-lead ECG than for handheld device in both cohorts (p < 0.001). Conclusion: QTc monitoring with KardiaMobile-6L in COVID-19 patients was feasible. Time of ECG registration was significantly lower with the smart device, which may offer an important advantage for prevention of virus dissemination among healthcare providers.


Assuntos
COVID-19/tratamento farmacológico , Eletrocardiografia/métodos , Síndrome do QT Longo/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Antivirais/efeitos adversos , Azitromicina/efeitos adversos , Combinação de Medicamentos , Eletrocardiografia/instrumentação , Inibidores Enzimáticos/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Hidroxicloroquina/efeitos adversos , Síndrome do QT Longo/induzido quimicamente , Lopinavir/efeitos adversos , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Prospectivos , Reprodutibilidade dos Testes , Ritonavir/efeitos adversos , SARS-CoV-2
8.
Circ Cardiovasc Imaging ; 14(6): e012281, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34126762

RESUMO

BACKGROUND: Classical methods for detecting left ventricular (LV) hypertrophy (LVH) using 12-lead ECGs are insensitive. Deep learning models using ECG to infer cardiac magnetic resonance (CMR)-derived LV mass may improve LVH detection. METHODS: Within 32 239 individuals of the UK Biobank prospective cohort who underwent CMR and 12-lead ECG, we trained a convolutional neural network to predict CMR-derived LV mass using 12-lead ECGs (left ventricular mass-artificial intelligence [LVM-AI]). In independent test sets (UK Biobank [n=4903] and Mass General Brigham [MGB, n=1371]), we assessed correlation between LVM-AI predicted and CMR-derived LV mass and compared LVH discrimination using LVM-AI versus traditional ECG-based rules (ie, Sokolow-Lyon, Cornell, lead aVL rule, or any ECG rule). In the UK Biobank and an ambulatory MGB cohort (MGB outcomes, n=28 612), we assessed associations between LVM-AI predicted LVH and incident cardiovascular outcomes using age- and sex-adjusted Cox regression. RESULTS: LVM-AI predicted LV mass correlated with CMR-derived LV mass in both test sets, although correlation was greater in the UK Biobank (r=0.79) versus MGB (r=0.60, P<0.001 for both). When compared with any ECG rule, LVM-AI demonstrated similar LVH discrimination in the UK Biobank (LVM-AI c-statistic 0.653 [95% CI, 0.608 -0.698] versus any ECG rule c-statistic 0.618 [95% CI, 0.574 -0.663], P=0.11) and superior discrimination in MGB (0.621; 95% CI, 0.592 -0.649 versus 0.588; 95% CI, 0.564 -0.611, P=0.02). LVM-AI-predicted LVH was associated with incident atrial fibrillation, myocardial infarction, heart failure, and ventricular arrhythmias. CONCLUSIONS: Deep learning-inferred LV mass estimates from 12-lead ECGs correlate with CMR-derived LV mass, associate with incident cardiovascular disease, and may improve LVH discrimination compared to traditional ECG rules.


Assuntos
Inteligência Artificial , Aprendizado Profundo , Eletrocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
Clin Interv Aging ; 16: 1139-1149, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34168437

RESUMO

Background: Silent myocardial infarction (SMI) accounts for more than half of all MIs, and common risk factors and pathophysiological pathways coexist between SMI and frailty. The risk of frailty among patients with SMI is not well established. This study aimed to examine the association between SMI and frailty. Methods and Results: This analysis included data from the Atherosclerosis Risk in Communities study. Patients without MI at baseline were eligible for inclusion. SMI was defined as electrocardiographic evidence of MI without clinical MI (CMI) after the baseline and until the fourth visit. Frailty was assessed during the fifth visit. A total of 4953 participants were included with an average age of 52.2±5.1 years. Among these participants, 2.7% (n=135) developed SMI, and 2.9% (n=146) developed CMI. After a median follow-up time of 14.7 (14.0-15.3) years, 6.7% (n=336) of the participants developed frailty. Patients with SMI and CMI were significantly more likely to become frail than those without MI (15.6% vs 6.2%, P<0.001 and 16.4% vs 6.2%, P<0.001, respectively). After adjusting for confounders, SMI and CMI were found to be independent predictors of frailty (odds ratio [OR]=2.243, 95% confidence interval [CI]=1.307-3.850, P=0.003 and OR=2.164, 95% CI=1.259-3.721, P=0.005, respectively). The association was consistent among the subgroups of age, sex, race, diabetes, and hypertension. Conclusion: In conclusion, both SMI and CMI were found to be associated with a higher risk of frailty. Future studies are needed to confirm the beneficial effects of screening for SMI as well as to implement standardized preventive treatment to reduce the risk of frailty. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005131.


Assuntos
Aterosclerose/epidemiologia , Fragilidade/epidemiologia , Infarto do Miocárdio/epidemiologia , Idoso , Aterosclerose/fisiopatologia , Eletrocardiografia/métodos , Fragilidade/fisiopatologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Prognóstico , Medição de Risco , Fatores de Risco
10.
Medicine (Baltimore) ; 100(26): e26498, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190179

RESUMO

ABSTRACT: There was a controversy for the electrocardiogram (ECG) changes and their relationship with disease severity in old patients with acute cerebral ischemic stroke (CIS). This study was aim to provide referential data for this topic.Totally 200 old patients with acute CIS in our hospital from January 2017 to December 2019 were included into this study. According to the ST-T segment changes in ECG, these patients were divided into 3 groups: persistent ischemic group (n = 38), transient ischemic group (n = 106) and non-ischemic group (n = 56). The characteristics and incidence of abnormal ECG and their relationship with disease severity, infarct size and prognosis were respectively analyzed under the severe, moderate and mild type of disease.The ECG changes of patients were mainly characterized by myocardial ischemic ST-T segment changes with a abnormal ECG incidence of 72.00%, the arrhythmia with a abnormal ECG incidence of 9.50%, which were the second most common in clinical features. There were statistically significant differences of myocardial ischemic ST-T segment changes among different disease severity, infarct size and prognosis of acute CIS patients (P < .05). The ischemic ST-T segment changes of ECG reflected that the disease severity, and more ECG abnormalities indicated more severe pathological conditions in CIS patients.The characteristics of ischemic ST-T segment changes have important reference value in the evaluation of severity and prognosis of acute CIS in old patients.


Assuntos
Encéfalo , Eletrocardiografia , AVC Isquêmico , Isquemia Miocárdica , Acidente Vascular Cerebral , Idoso , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/etiologia , China/epidemiologia , Correlação de Dados , Eletrocardiografia/métodos , Eletrocardiografia/estatística & dados numéricos , Feminino , Humanos , AVC Isquêmico/diagnóstico , AVC Isquêmico/epidemiologia , AVC Isquêmico/fisiopatologia , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/etiologia , Masculino , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/fisiopatologia , Prognóstico , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia
11.
Medicine (Baltimore) ; 100(26): e26558, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190194

RESUMO

ABSTRACT: A warning system included directly faxing electrocardiography information to the mobile phone immediately after an ST-segment elevation myocardial infarction (STEMI) diagnosis was made at a non-percutaneous coronary intervention (PCI) capable hospital. This study aimed to explore the outcomes after using a warning system in transfer STEMI patients.From October 2013 to December 2016, 667 patients experienced a STEMI event and received primary PCI at our institution. 274 patients who were divided into transfer group were transferred from non-PCI capable hospitals and connected to a first-line cardiovascular doctor by the warning system. Other 393 patients were divided into the non-transfer group.The transfer group still had a longer pain-to-reperfusion time and presented higher troponin-I level when compared with non-transfer group. There was no significant difference in the use of drug-eluting stent and procedural devices between non-transfer and transfer groups. The prevalence of different anti-platelet agents loading did not differ between non-transfer and transfer groups. Non-significant trend about higher prevalence of statin use was noted in transfer group (78.9% vs 86.1%, P = .058). The transfer group presented similar clinical short-term results regarding both cardiovascular and all-cause mortality when comparing with non-transfer group. The transfer group provided non-significant trend about lower one-year cardiovascular mortality (10.7% vs 6.2%, P = .052) and lower all-cause mortality (12.2% vs 6.9%, P = .026) when compared with non-transfer group. There was a significant difference in the Kaplan-Meier curve of 1-year cardiovascular mortality between the transfer group and the non-transfer group (P = .049).After using the warning system, the inter-facility transfer group had comparable outcomes even though a longer pain-to-reperfusion time and a higher peak troponin-I level when comparing with non-transfer group.


Assuntos
Dor no Peito , Sistemas de Informação Hospitalar , Transferência de Pacientes , Infarto do Miocárdio com Supradesnível do Segmento ST , Tempo para o Tratamento/normas , Dor no Peito/sangue , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Eletrocardiografia/métodos , Feminino , Sistemas de Informação Hospitalar/organização & administração , Sistemas de Informação Hospitalar/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Transferência de Pacientes/métodos , Transferência de Pacientes/organização & administração , Transferência de Pacientes/normas , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , Melhoria de Qualidade , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Taiwan/epidemiologia , Troponina I/sangue
12.
Medicine (Baltimore) ; 100(23): e26318, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115044

RESUMO

RATIONALE: Acute organophosphorus pesticide poisoning (AOPP) is a common critical illness observed in clinical practice, and severe AOPP can cause serious cardiac toxicity. PATIENT CONCERNS: This patient was a 43-year-old woman who was admitted to the emergency department with acute respiratory failure and hypotension 13 hours after oral consumption of 300 mL of phoxim pesticide. DIAGNOSES: Acute organophosphorus pesticide poisoning, cardiogenic shock. INTERVENTIONS: We conducted veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy as the patient did not respond to conventional measures. OUTCOMES: This patient was successfully rescued with VA-ECMO therapy and discharged. LESSONS: We suggest that for patients with severe myocardial injury complicated with cardiogenic shock caused by AOPP, the use of VA-ECMO therapy can improve the prognosis.


Assuntos
Cardiotoxicidade , Oxigenação por Membrana Extracorpórea/métodos , Intoxicação por Organofosfatos/complicações , Praguicidas/toxicidade , Choque Cardiogênico , Adulto , Cardiotoxicidade/complicações , Cardiotoxicidade/etiologia , Cardiotoxicidade/fisiopatologia , Eletrocardiografia/métodos , Feminino , Humanos , Organofosfatos/toxicidade , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/terapia , Resultado do Tratamento
13.
Mayo Clin Proc ; 96(7): 1835-1844, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34116837

RESUMO

OBJECTIVE: To evaluate the cost-effectiveness of an artificial intelligence electrocardiogram (AI-ECG) algorithm under various clinical and cost scenarios when used for universal screening at age 65. PATIENTS AND METHODS: We used decision analytic modeling to perform a cost-effectiveness analysis of the use of AI-ECG to screen for asymptomatic left ventricular dysfunction (ALVD) once at age 65 compared with no screening. This screening consisted of an initial screening decision tree and subsequent construction of a Markov model. One-way sensitivity analysis on various disease and cost parameters to evaluate cost-effectiveness at both $50,000 per quality-adjusted life year (QALY) and $100,000 per QALY willingness-to-pay threshold. RESULTS: We found that for universal screening at age 65, the novel AI-ECG algorithm would cost $43,351 per QALY gained, test performance, disease characteristics, and testing cost parameters significantly affect cost-effectiveness, and screening at ages 55 and 75 would cost $48,649 and $52,072 per QALY gained, respectively. Overall, under most of the clinical scenarios modeled, coupled with its robust test performance in both testing and validation cohorts, screening with the novel AI-ECG algorithm appears to be cost-effective at a willingness-to-pay threshold of $50,000. CONCLUSION: Universal screening for ALVD with the novel AI-ECG appears to be cost-effective under most clinical scenarios with a cost of <$50,000 per QALY. Cost-effectiveness is particularly sensitive to both the probability of disease progression and the cost of screening and downstream testing. To improve cost-effectiveness modeling, further study of the natural progression and treatment of ALVD and external validation of AI-ECG should be undertaken.


Assuntos
Inteligência Artificial/economia , Eletrocardiografia/métodos , Programas de Rastreamento , Disfunção Ventricular Esquerda , Idoso , Algoritmos , Doenças Assintomáticas , Análise Custo-Benefício , Aprendizado Profundo , Feminino , Humanos , Masculino , Cadeias de Markov , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/economia , Disfunção Ventricular Esquerda/fisiopatologia
14.
Rural Remote Health ; 21(2): 6166, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34107219

RESUMO

In 2020, a girl aged 5 years presented to the coronavirus assessment centre on a remote Scottish island with symptoms consistent with novel coronavirus 2019 (COVID-19). Her mother was concerned as she had noted the patient to have an irregular pulse. COVID-19 has been shown to cause cardiac arrhythmia, and so after discussion with tertiary paediatric cardiology services an ECG was recommended. In order to minimise potential spread of coronavirus in the healthcare setting a portable ECG device was immediately delivered to the patient, with the ECG tracing being sent electronically to a cardiologist. A formal diagnosis was then communicated to the parents within 2 hours of the initial contact.


Assuntos
Arritmias Cardíacas/etiologia , Eletrocardiografia/métodos , Infecções Respiratórias/diagnóstico , População Rural , Telemedicina/métodos , COVID-19/diagnóstico , COVID-19/prevenção & controle , Pré-Escolar , Tosse/etiologia , Diagnóstico Diferencial , Feminino , Febre/etiologia , Humanos , SARS-CoV-2
15.
Nat Med ; 27(5): 815-819, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33958795

RESUMO

We have conducted a pragmatic clinical trial aimed to assess whether an electrocardiogram (ECG)-based, artificial intelligence (AI)-powered clinical decision support tool enables early diagnosis of low ejection fraction (EF), a condition that is underdiagnosed but treatable. In this trial ( NCT04000087 ), 120 primary care teams from 45 clinics or hospitals were cluster-randomized to either the intervention arm (access to AI results; 181 clinicians) or the control arm (usual care; 177 clinicians). ECGs were obtained as part of routine care from a total of 22,641 adults (N = 11,573 intervention; N = 11,068 control) without prior heart failure. The primary outcome was a new diagnosis of low EF (≤50%) within 90 days of the ECG. The trial met the prespecified primary endpoint, demonstrating that the intervention increased the diagnosis of low EF in the overall cohort (1.6% in the control arm versus 2.1% in the intervention arm, odds ratio (OR) 1.32 (1.01-1.61), P = 0.007) and among those who were identified as having a high likelihood of low EF (that is, positive AI-ECG, 6% of the overall cohort) (14.5% in the control arm versus 19.5% in the intervention arm, OR 1.43 (1.08-1.91), P = 0.01). In the overall cohort, echocardiogram utilization was similar between the two arms (18.2% control versus 19.2% intervention, P = 0.17); for patients with positive AI-ECGs, more echocardiograms were obtained in the intervention compared to the control arm (38.1% control versus 49.6% intervention, P < 0.001). These results indicate that use of an AI algorithm based on ECGs can enable the early diagnosis of low EF in patients in the setting of routine primary care.


Assuntos
Inteligência Artificial , Sistemas de Apoio a Decisões Clínicas/instrumentação , Ecocardiografia/métodos , Insuficiência Cardíaca/diagnóstico , Volume Sistólico/fisiologia , Adolescente , Adulto , Idoso , Algoritmos , Diagnóstico Precoce , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
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
19.
Am J Nurs ; 121(6): 61-64, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34009167

RESUMO

Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.


Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/enfermagem , Dispneia/diagnóstico , Dispneia/enfermagem , Eletrocardiografia/enfermagem , Enfermagem em Emergência/métodos , Eletrocardiografia/métodos , Humanos
20.
Lancet Neurol ; 20(6): 426-436, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34022169

RESUMO

BACKGROUND: Systematic electrocardiogram (ECG) monitoring improves detection of covert atrial fibrillation in stroke survivors but the effect on secondary prevention is unknown. We aimed to assess the effect of systematic ECG monitoring of patients in hospital on the rate of oral anticoagulant use after 12 months. METHODS: In this investigator-initiated, randomised, open-label, parallel-group multicentre study with masked endpoint adjudication, we recruited patients aged at least 18 years with acute ischaemic stroke or transient ischaemic attack without known atrial fibrillation in 38 certified stroke units in Germany. Patients were randomly assigned (1:1) to usual diagnostic procedures for atrial fibrillation detection (control group) or additional Holter-ECG recording for up to 7 days in hospital (intervention group). Patients were stratified by centre using a random permuted block design. The primary outcome was the proportion of patients on oral anticoagulants at 12 months after the index event in the intention-to-treat population. Secondary outcomes included the number of patients with newly diagnosed atrial fibrillation in hospital and the composite of recurrent stroke, major bleeding, myocardial infarction, or death after 6 months, 12 months, and 24 months. This trial was registered with ClinicalTrials.gov, NCT02204267, and is completed and closed for participants. FINDINGS: Between Dec 9, 2014, and Sept 11, 2017, 3465 patients were randomly assigned, 1735 (50·1%) to the intervention group and 1730 (49·9%) to the control group. Oral anticoagulation status was available in 2920 (84·3%) patients at 12 months (1484 [50·8%] in the intervention group and 1436 [49·2%] in the control group). For the primary outcome, at 12 months, 203 (13·7%) of 1484 patients in the intervention group versus 169 (11·8%) of 1436 in the control group were on oral anticoagulants (odds ratio [OR] 1·2 [95% CI 0·9-1·5]; p=0·13). Atrial fibrillation was newly detected in patients in hospital in 97 (5·8%) of 1714 in the intervention group versus 68 (4·0%) of 1717 in the control group (hazard ratio [HR] 1·4 [95% CI 1·0-2·0]; p=0·024). The composite of cardiovascular outcomes and death did not differ between patients randomly assigned to the intervention group versus the control group at 24 months (232 [13·5%] of 1714 vs 249 [14·5%] of 1717; HR 0·9 [0·8-1·1]; p=0·43). Skin reactions due to study ECG electrodes were reported in 56 (3·3%) patients in the intervention group. All-cause death occured in 73 (4·3%) patients in the intervention group and in 103 (6·0%) patients in the control group (OR 0·7 [0·5-0·9]). INTERPRETATION: Systematic core centrally reviewed ECG monitoring is feasible and increases the detection rate of atrial fibrillation in unselected patients hospitalised with acute ischaemic stroke or transient ischaemic attack, if added to usual diagnostic care in certified German stroke units. However, we found no effect of systematic ECG monitoring on the rate of oral anticoagulant use after 12 months and further efforts are needed to improve secondary stroke prevention. FUNDING: Bayer Vital. TRANSLATION: For the German translation of the abstract see Supplementary Materials section.


Assuntos
Fibrilação Atrial/fisiopatologia , Isquemia Encefálica/fisiopatologia , AVC Isquêmico/fisiopatologia , Monitorização Fisiológica/métodos , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Eletrocardiografia/métodos , Feminino , Humanos , AVC Isquêmico/diagnóstico , AVC Isquêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
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