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1.
Presse Med ; 48(12): 1393-1400, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31471091

RESUMO

An ECG is recommended by the French Society of Cardiology in the screening of a competitive athlete. An intense and prolonged physical activity (>4 hours of intense sport/week) can lead to a physiological electric remodeling. In addition to physical activity (type, intensity, duration), the ECG should be interpreted according to the athlete's ethnicity and age. It is necessary to know the physiological modifications related to sport practice to avoid either false reassurances or the realization of unjustified additional examinations because of a wrong interpretation. The latest athlete ECG classification published in 2017 can be used to identify in which athlete additional tests are recommended (figure 1).


Assuntos
Atletas , Eletrocardiografia , Cardiopatias/diagnóstico , Esportes , Cardiologia/métodos , Cardiologia/normas , Diagnóstico Diferencial , Técnicas de Diagnóstico Cardiovascular/normas , Eletrocardiografia/métodos , Eletrocardiografia/normas , Exercício/fisiologia , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Padrões de Referência , Esportes/normas
2.
Rev Bras Enferm ; 72(3): 609-616, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269123

RESUMO

OBJECTIVE: To measure the magnitude of the effect of an individualized parameterization protocol for hemodynamic alarms in patients with acute myocardial infarction. METHOD: Pragmatic clinical trial, open label and single arm, whose intervention was performed through a protocol validated and tested in 32 patients using multiparametric monitors. The heart rate, blood pressure, respiratory rate, oxygen saturation and ST segment-monitoring were measured and classified for clinical consistency one hour before and after the intervention, for 64 hours. RESULTS: The protocol obtained Content Validity Index of 0.92. Of the 460 registered alarms, 261 were considered inconsistent before the intervention and 47 after it. The Relative Risk of inconsistent alarms after the protocol was 0.32 (95% CI 0.23-0.43, p <0.0001). CONCLUSION: The protocol proved to be a protective factor to the appearance of inconsistent clinical alarms of multiparametric monitors.


Assuntos
Monitorização Fisiológica/enfermagem , Infarto do Miocárdio/enfermagem , Idoso , Pressão Sanguínea/fisiologia , Alarmes Clínicos , Eletrocardiografia/enfermagem , Eletrocardiografia/normas , Feminino , Frequência Cardíaca/fisiologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas
3.
PLoS One ; 14(5): e0217097, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150418

RESUMO

INTRODUCTION: Cardiac resynchronization therapy (CRT) is an effective treatment that reduces mortality and improves cardiac function in patients with left bundle branch block (LBBB). However, about 30% of patients passing the current criteria do not benefit or benefit only a little from CRT. Three predictors of benefit based on different ECG properties were compared: 1) "strict" left bundle branch block classification (SLBBB); 2) QRS area; 3) ventricular electrical delay (VED) which defines the septal-lateral conduction delay. These predictors have never been analyzed concurrently. We analyzed the relationship between them on a subset of 602 records from the MADIT-CRT trial. METHODS & RESULTS: SLBBB classification was performed by two experts; QRS area and VED were computed fully automatically. High-frequency QRS (HFQRS) maps were used to inspect conduction abnormalities. The correlation between SLBBB and other predictors was R = 0.613, 0.523 and 0.390 for VED, QRS area in Z lead, and QRS duration, respectively. Scatter plots were used to pick up disagreement between the predictors. The majority of SLBBB subjects- 295 of 330 (89%)-are supposed to respond positively to CRT according to the VED and QRS area, though 93 of 272 (34%) non-SLBBB should also benefit from CRT according to the VED and QRS area. CONCLUSION: SLBBB classification is limited by the proper setting of cut-off values. In addition, it is too "strict" and excludes patients that may benefit from CRT therapy. QRS area and VED are clearly defined parameters. They may be used to optimize biventricular stimulation. Detailed analysis of conduction irregularities with CRT optimization should be based on HFQRS maps.


Assuntos
Bloqueio de Ramo/terapia , Dispositivos de Terapia de Ressincronização Cardíaca/normas , Terapia de Ressincronização Cardíaca/métodos , Eletrocardiografia/métodos , Eletrocardiografia/normas , Potenciais de Ação , Bloqueio de Ramo/fisiopatologia , Cardioversão Elétrica , Frequência Cardíaca , Humanos , Valor Preditivo dos Testes , Resultado do Tratamento , Função Ventricular Esquerda
4.
PLoS One ; 14(5): e0217288, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31120968

RESUMO

BACKGROUND: Optical measurement techniques and recent advances in wearable technology have made heart rate (HR) sensing simpler and more affordable. OBJECTIVES: The Polar OH1 is an arm worn optical heart rate monitor. The objectives of this study are two-fold; 1) to validate the OH1 optical HR sensor with the gold standard of HR measurement, electrocardiography (ECG), over a range of moderate to high intensity physical activities, 2) to validate wearing the OH1 at the temple as an alternative location to its recommended wearing location around the forearm and upper arm. METHODS: Twenty-four individuals participated in a physical exercise protocol, by walking on a treadmill and riding a stationary spin bike at different speeds while the criterion measure, ECG and Polar OH1 HR were recorded simultaneously at three different body locations; forearm, upper arm and the temple. Time synchronised HR data points were compared using Bland-Altman analyses and intraclass correlation. RESULTS: The intraclass correlation between the ECG and Polar OH1, for the aggregated data, was 0.99 and the estimated mean bias ranged 0.27-0.33 bpm for the sensor locations. The three sensors exhibited a 95% limit of agreement (LoA: forearm 5.22, -4.68 bpm; upper arm 5.15, -4.49; temple 5.22, -4.66). The mean of the ECG HR for the aggregated data was 112.15 ± 24.52 bpm. The intraclass correlation of HR values below and above this mean were 0.98 and 0.99 respectively. The reported mean bias ranged 0.38-0.47 bpm (95% LoA: forearm 6.14, -5.38 bpm; upper arm 6.07, -5.13 bpm; temple 6.09, -5.31 bpm), and 0.15-0.16 bpm (95% LoA: forearm 3.99, -3.69 bpm; upper arm 3.90, -3.58 bpm; temple 4.06, -3.76 bpm) respectively. During different exercise intensities, the intraclass correlation ranged 0.95-0.99 for the three sensor locations. During the entire protocol, the estimated mean bias was in the range -0.15-0.55 bpm, 0.01-0.53 bpm and -0.37-0.48 bpm, for the forearm, upper arm and temple locations respectively. The corresponding upper limits of 95% LoA were 3.22-7.03 bpm, 3.25-6.82 bpm and 3.18-7.04 bpm while the lower limits of 95% LoA were -6.36-(-2.35) bpm, -6.46-(-2.30) bpm and -7.42-(-2.41) bpm. CONCLUSION: Polar OH1 demonstrates high level of agreement with the criterion measure ECG HR, thus can be used as a valid measure of HR in lab and field settings during moderate and high intensity physical activities.


Assuntos
Exercício/fisiologia , Monitores de Aptidão Física/normas , Determinação da Frequência Cardíaca/instrumentação , Frequência Cardíaca/fisiologia , Dispositivos Eletrônicos Vestíveis , Adulto , Braço , Eletrocardiografia/normas , Eletrocardiografia/estatística & dados numéricos , Teste de Esforço/instrumentação , Teste de Esforço/normas , Teste de Esforço/estatística & dados numéricos , Feminino , Monitores de Aptidão Física/estatística & dados numéricos , Testa , Determinação da Frequência Cardíaca/normas , Determinação da Frequência Cardíaca/estatística & dados numéricos , Humanos , Masculino , Dispositivos Ópticos/normas , Dispositivos Ópticos/estatística & dados numéricos , Fotopletismografia/instrumentação , Fotopletismografia/normas , Fotopletismografia/estatística & dados numéricos , Dispositivos Eletrônicos Vestíveis/normas , Dispositivos Eletrônicos Vestíveis/estatística & dados numéricos , Adulto Jovem
6.
Clin Chim Acta ; 493: 156-161, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30826369

RESUMO

BACKGROUND: The Italian Society of Clinical Biochemistry (SIBioC) and the Italian Section of the European Ligand Assay Society (ELAS) have recently promoted a multicenter study (Italian hs-cTnI Study) with the aim to accurately evaluate analytical performances and reference values of the most popular cTnI methods commercially available in Italy. The aim of this article is to report the results of the Italian hs-cTnI Study concerning the evaluation of the 99th percentile URL and reference change (RCV) values around the 99th URL of the Access cTnI method. MATERIALS AND METHODS: Heparinized plasma samples were collected from 1306 healthy adult volunteers by 8 Italian clinical centers. Every center collected from 50 to 150 plasma samples from healthy adult subjects. All volunteers denied the presence of chronic or acute diseases and had normal values of routine laboratory tests (including creatinine, electrolytes, glucose and blood counts). An older cohort of 457 adult subjects (mean age 63.0 years; SD 8.1 years, minimum 47 years, maximum 86 years) underwent also ECG and cardiac imaging analysis in order to exclude the presence of asymptomatic cardiac disease. RESULTS AND CONCLUSIONS: The results of the present study confirm that the Access hsTnI method using the DxI platform satisfies the two criteria required by international guidelines for high-sensitivity methods for cTn assay. Furthermore, the results of this study confirm that the calculation of the 99th percentile URL values are greatly affected not only by age and sex of the reference population, but also by the statistical approach used for calculation of cTnI distribution parameters.


Assuntos
Técnicas de Imagem de Sincronização Cardíaca/normas , Eletrocardiografia/normas , Troponina I/sangue , Troponina T/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Voluntários Saudáveis , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Valores de Referência , Adulto Jovem
7.
JMIR Mhealth Uhealth ; 7(3): e11437, 2019 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-30835243

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The asymptomatic nature and paroxysmal frequency of AF lead to suboptimal early detection. A novel technology, photoplethysmography (PPG), has been developed for AF screening. However, there has been limited validation of mobile phone and smart band apps with PPG compared to 12-lead electrocardiograms (ECG). OBJECTIVE: We investigated the feasibility and accuracy of a mobile phone and smart band for AF detection using pulse data measured by PPG. METHODS: A total of 112 consecutive inpatients were recruited from the Chinese PLA General Hospital from March 15 to April 1, 2018. Participants were simultaneously tested with mobile phones (HUAWEI Mate 9, HUAWEI Honor 7X), smart bands (HUAWEI Band 2), and 12-lead ECG for 3 minutes. RESULTS: In all, 108 patients (56 with normal sinus rhythm, 52 with persistent AF) were enrolled in the final analysis after excluding four patients with unclear cardiac rhythms. The corresponding sensitivity and specificity of the smart band PPG were 95.36% (95% CI 92.00%-97.40%) and 99.70% (95% CI 98.08%-99.98%), respectively. The positive predictive value of the smart band PPG was 99.63% (95% CI 97.61%-99.98%), the negative predictive value was 96.24% (95% CI 93.50%-97.90%), and the accuracy was 97.72% (95% CI 96.11%-98.70%). Moreover, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of mobile phones with PPG for AF detection were over 94%. There was no significant difference after further statistical analysis of the results from the different smart devices compared with the gold-standard ECG (P>.99). CONCLUSIONS: The algorithm based on mobile phones and smart bands with PPG demonstrated good performance in detecting AF and may represent a convenient tool for AF detection in at-risk individuals, allowing widespread screening of AF in the population. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-OOC-17014138; http://www.chictr.org.cn/showproj.aspx?proj=24191 (Archived by WebCite at http://www.webcitation/76WXknvE6).


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia/instrumentação , Fotopletismografia/normas , Adulto , Idoso , Telefone Celular/instrumentação , Telefone Celular/estatística & dados numéricos , Distribuição de Qui-Quadrado , Eletrocardiografia/métodos , Eletrocardiografia/normas , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Fotopletismografia/instrumentação , Fotopletismografia/métodos , Projetos Piloto , Sensibilidade e Especificidade , Estatísticas não Paramétricas
8.
J Physiol Anthropol ; 38(1): 3, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30867063

RESUMO

Although analysis of heart rate variability is widely used for the assessment of autonomic function, its fundamental framework linking low-frequency and high-frequency components of heart rate variability with sympathetic and parasympathetic autonomic divisions has developed in the 1980s. This simplified framework is no longer able to deal with much evidence about heart rate variability accumulated over the past half-century. This review addresses the pitfalls caused by the old framework and discusses the points that need attention in autonomic assessment by heart rate variability.


Assuntos
Sistema Nervoso Autônomo/fisiologia , Frequência Cardíaca/fisiologia , Monitorização Fisiológica/normas , Acelerometria/normas , Eletrocardiografia/normas , Feminino , Humanos , Masculino , Postura/fisiologia , Arritmia Sinusal Respiratória/fisiologia , Processamento de Sinais Assistido por Computador , Análise Espectral
9.
Arch Dis Child Fetal Neonatal Ed ; 104(6): F572-F574, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30796058

RESUMO

The 2015 neonatal resuscitation guidelines added ECG to assess an infant's heart rate when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room. We report four cases of pulseless electrical activity during neonatal cardiopulmonary resuscitation in levels II-III neonatal intensive care units in Canada (Edmonton [n=3] and Winnipeg [n=1]).Healthcare providers should be aware that pulseless electrical activity can occur in newborn infants during cardiopulmonary resuscitation. We propose an adapted neonatal resuscitation algorithm to include pulseless electrical activity. Furthermore, in compromised newborns, heart rate should be assessed using a combination of methods/techniques to ensure accurate heart rate assessment. When ECG displays a heart rate but the infant is unresponsive, pulseless electrical activity should be suspected and chest compression should be started.


Assuntos
Eletrocardiografia/normas , Parada Cardíaca/diagnóstico , Parada Cardíaca/fisiopatologia , Reanimação Cardiopulmonar/métodos , Frequência Cardíaca , Humanos , Recém-Nascido
12.
Med Educ Online ; 24(1): 1549923, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30481149

RESUMO

BACKGROUND: There is limited information on whether the orderly display of limb lead ECGs (electrocardiograms) can facilitate students to determine frontal plane QRS complex wave electrical axis. OBJECTIVES: The study investigated whether the orderly display of limb lead ECGs can raise Chinese undergraduate intern's diagnostic accuracy when determining frontal plane axis. DESIGN: A total of 147 fifth-year undergraduate interns aged between 21 and 25 years were randomly arranged into 2 groups: one group was given classically displayed ECGs of limb leads while the other group was given orderly displayed ECGs of limb leads. They were then taught to determine frontal plane axis with one of the above displays. The intern's diagnostic accuracy and time used were measured. RESULTS: After teaching, the orderly display can more effectively raise diagnostic accuracy when determining axis as compared to the classical display (76.65 ± 23.16% vs. 68.88 ± 23.21%, P < 0.05), although diagnostic accuracy in axis determination was improved in both groups as compared to the axis determination at baseline (all P < 0.05). CONCLUSIONS: Orderly display of limb lead ECGs may raise Chinese intern's diagnostic accuracy when determining frontal plane axis.


Assuntos
Estágio Clínico , Eletrocardiografia/métodos , Eletrocardiografia/normas , Adulto , China , Feminino , Humanos , Masculino , Adulto Jovem
13.
Int J Cardiol ; 282: 7-15, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30527992

RESUMO

OBJECTIVE: While >20% of patients presenting to the cardiac catheterization laboratory with angina have no obstructive coronary artery disease (CAD), a majority (77%) have an occult coronary abnormality (endothelial dysfunction, microvascular dysfunction (MVD), and/or a myocardial bridge (MB)). There are little data regarding the ability of noninvasive stress testing to identify these occult abnormalities in patients with angina in the absence of obstructive CAD. METHODS: We retrospectively evaluated 155 patients (76.7% women) with angina and no obstructive CAD who underwent stress echocardiography and/or electrocardiography before angiography. We evaluated Duke treadmill score, heart rate recovery (HRR), metabolic equivalents, and blood pressure response. During angiography, patients underwent invasive testing for endothelial dysfunction (decrease in epicardial coronary artery diameter >20% after intracoronary acetylcholine), MVD (index of microcirculatory resistance ≥25), and intravascular ultrasound for the presence of an MB. RESULTS: Stress echocardiography and electrocardiography were positive in 58 (43.6%) and 57 (36.7%) patients, respectively. Endothelial dysfunction was present in 96 (64%), MVD in 32 (20.6%), and an MB in 83 (53.9%). On multivariable logistic regression, stress echo was not associated with any abnormality, while stress ECG was associated with endothelial dysfunction. An abnormal HRR was associated with endothelial dysfunction and MVD, but not an MB. CONCLUSION: Conventional stress testing is insufficient for identifying occult coronary abnormalities that are frequently present in patients with angina in the absence of obstructive CAD. A normal stress test does not rule out a non-obstructive coronary etiology of angina, nor does it negate the need for comprehensive invasive testing.


Assuntos
Angina Pectoris/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia sob Estresse/normas , Teste de Esforço/normas , Adulto , Idoso , Angina Pectoris/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Eletrocardiografia/normas , Feminino , Humanos , Masculino , Microcirculação/fisiologia , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Int J Cardiovasc Imaging ; 35(3): 491-498, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30377894

RESUMO

Speckle tracking analysis (STE) of the left ventricle offers a new method to assess left ventricular (LV) diastolic function. LV diastolic strain measurements offer a non-invasive, global and direct measure of LV diastolic function. However, there is little data on normal values and the influence of anthropomorphic factors which is crucial in clinical practice for new techniques. The aims of this study were to formulate reference values for LV diastolic strain rate, elucidate effects of age and sex on LV diastolic strain analysis and compare STE measurements with conventional LV diastolic measurements. One-hundred-forty-seven healthy subjects aged 20-72 years (≥ 28 subjects per age decade) were prospectively included (Mean age 44 ± 13.7 years, 50% female) and examined with electrocardiography and 2D-echocardiography, including speckle tracking. Left ventricular peak early diastolic strain rate (Sre) was measured in the apical windows, using STE. Men had significantly lower LV Sre values than women (1.02 ± 0.22 vs. 1.18 ± 0.23, p value < 0.001). Left ventricular Sre was inversely associated with age, with values decreasing with ageing. An inverse relation was also found with blood pressure and body surface area. Linear regression analysis showed that LV Sre was independently associated with both age and sex. A multivariable linear regression analysis for LV Sre with conventional LV diastolic variables accounted for 70.9% of the variation of LV Sre, showing good model performance. Reference values for LV Sre are reported and found to be both age- and sex-dependent. Therefore we recommend age- and sex-specific references values to be used in daily clinical practice.


Assuntos
Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Função Ventricular Esquerda , Adulto , Fatores Etários , Idoso , Fenômenos Biomecânicos , Estudos Transversais , Diástole , Ecocardiografia/normas , Eletrocardiografia/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Padrões de Referência , Fatores Sexuais , Estresse Mecânico , Adulto Jovem
16.
Telemed J E Health ; 25(3): 199-204, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29975583

RESUMO

BACKGROUND: Tele-electrocardiography (tele-ECG) is a powerful ally in the screening of acute ischemic lesions. INTRODUCTION: Evidence that confirms the correlation between the diagnosis of acute coronary syndrome (ACS) determined in the prehospital setting and the confirmation of the diagnosis in the hospital setting is scarce. This study compares the presumed diagnosis of ACS in the prehospital setting based on electrocardiographic changes, such as ST-segment deviation, with the diagnosis confirmed in a hospital setting. MATERIALS AND METHODS: Retrospective, cross-sectional analysis of medical records of patients who sought emergency ambulance services of a distinguished public healthcare service in the city of Porto Alegre from September 2013 to August 2014. Data were collected from tele-ECG recordings and medical records available at the database of the Secretary of Health. The study was based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS: Among the 1,338 prehospital examinations performed, a total of 250 admissions in tertiary hospitals were registered. There was a significant agreement (p < 0.01) of 71% of the electrocardiographic changes identified in the prehospital setting with the diagnosis of ACS confirmed in the hospital setting. These changes were more prevalent in men (p = 0.048) and in patients aged 60 years or older (p = 0.006). DISCUSSION: The tele-ECG allows the early diagnosis of ACS, reducing the delay to definitive treatment, be it reperfusion, chemical, or mechanical therapy. CONCLUSIONS: Seventy-two percent of the prehospital diagnosis of ACS based on electrocardiographic changes was later confirmed in the hospital setting.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Eletrocardiografia/normas , Serviços Médicos de Emergência/normas , Reprodutibilidade dos Testes , Telemedicina/normas , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Adv Health Sci Educ Theory Pract ; 24(1): 45-63, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30171512

RESUMO

Learning curves can support a competency-based approach to assessment for learning. When interpreting repeated assessment data displayed as learning curves, a key assessment question is: "How well is each learner learning?" We outline the validity argument and investigation relevant to this question, for a computer-based repeated assessment of competence in electrocardiogram (ECG) interpretation. We developed an on-line ECG learning program based on 292 anonymized ECGs collected from an electronic patient database. After diagnosing each ECG, participants received feedback including the computer interpretation, cardiologist's annotation, and correct diagnosis. In 2015, participants from a single institution, across a range of ECG skill levels, diagnosed at least 60 ECGs. We planned, collected and evaluated validity evidence under each inference of Kane's validity framework. For Scoring, three cardiologists' kappa for agreement on correct diagnosis was 0.92. There was a range of ECG difficulty across and within each diagnostic category. For Generalization, appropriate sampling was reflected in the inclusion of a typical clinical base rate of 39% normal ECGs. Applying generalizability theory presented unique challenges. Under the Extrapolation inference, group learning curves demonstrated expert-novice differences, performance increased with practice and the incremental phase of the learning curve reflected ongoing, effortful learning. A minority of learners had atypical learning curves. We did not collect Implications evidence. Our results support a preliminary validity argument for a learning curve assessment approach for repeated ECG interpretation with deliberate and mixed practice. This approach holds promise for providing educators and researchers, in collaboration with their learners, with deeper insights into how well each learner is learning.


Assuntos
Educação de Graduação em Medicina/métodos , Avaliação Educacional/métodos , Eletrocardiografia/métodos , Curva de Aprendizado , Competência Clínica , Educação Baseada em Competências , Educação a Distância , Educação de Graduação em Medicina/normas , Avaliação Educacional/normas , Eletrocardiografia/normas , Feedback Formativo , Humanos , Internet , Reprodutibilidade dos Testes
18.
Arch Dis Child Fetal Neonatal Ed ; 104(2): F215-F217, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29895572

RESUMO

BACKGROUND: The 2015 neonatal resuscitation guidelines added ECG as a recommended method of assessment of an infant's heart rate (HR) when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room. OBJECTIVES: To compare accuracy of ECG with auscultation to assess asystole in asphyxiated piglets. METHODS: Neonatal piglets had the right common carotid artery exposed and enclosed with a real-time ultrasonic flow probe and HR was continuously measured and recorded using ECG. This set-up allowed simultaneous monitoring of HR via ECG and carotid blood flow (CBF). The piglets were exposed to 30 min normocapnic alveolar hypoxia followed by asphyxia until asystole, achieved by disconnecting the ventilator and clamping the endotracheal tube. Asystole was defined as zero carotid blood flow and was compared with ECG traces and auscultation for heart sounds using a neonatal/infant stethoscope. RESULTS: Overall, 54 piglets were studied with a median (IQR) duration of asphyxia of 325 (200-491) s. In 14 (26%) piglets, CBF, ECG and auscultation identified asystole. In 23 (43%) piglets, we observed no CBF and no audible heart sounds, while ECG displayed an HR ranging from 15 to 80/min. Sixteen (30%) piglets remained bradycardic (defined as HR of <100/min) after 10 min of asphyxia, identified by CBF, ECG and auscultation. CONCLUSION: Clinicians should be aware of the potential inaccuracy of ECG assessment during asphyxia in newborn infants and should rather rely on assessment using a combination of auscultation, palpation, pulse oximetry and ECG.


Assuntos
Asfixia/fisiopatologia , Eletrocardiografia/normas , Parada Cardíaca/diagnóstico , Auscultação Cardíaca/normas , Frequência Cardíaca/fisiologia , Animais , Modelos Animais de Doenças , Parada Cardíaca/fisiopatologia , Suínos
19.
Ann Cardiol Angeiol (Paris) ; 68(3): 139-143, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-30290918

RESUMO

INTRODUCTION: In obese patients, standard recording of electrocardiogram seems to have specific electrical modifications related to obesity. These modifications could be minimized by the use of alternative recording techniques. The aim of this study is to evaluate the effect of the recording technique (standard versus Lund) on the electrocardiogram quality in healthy obese patients. METHOD: This is an observational and descriptive study carried out in emergency medical services during a two years period. Healthy subjects with an age over 18 years and a body mass index (BMI)≥30kg/m2 were included. Each participant had an electrocardiogram according to Lund's technique immediately followed by a standard recording. Deflections amplitude and their respective axes were compared between the two techniques. The primary endpoint was the frequency of microvoltage. The secondary endpoints were the flat T wave at the inferior and the left axial deviations. RESULTS: Fifty obese patients were included. The average BMI was 36.8±6.6kg/m2. The average age was 45±13 years with a sex ratio of 0.52. The standard technique was associated with a higher incidence of microvoltage (40% versus 20%, P=0.029) and flattening of the T wave (40% versus 18%, P=0.015). Analysis of the variance of the P, QRS and T wave axes did not find any difference between the two techniques. CONCLUSION: The Lund technique reduces the incidence of electrical abnormalities in the electrocardiogram of healthy obese patients.


Assuntos
Índice de Massa Corporal , Eletrocardiografia/métodos , Eletrodos , Obesidade/fisiopatologia , Adulto , Análise de Variância , Tornozelo , Braço , Eletrocardiografia/instrumentação , Eletrocardiografia/normas , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Coxa da Perna , Punho
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