METHODS AND RESULTS: Baseline ECGs were collected in 153 152 middle-aged participants (ages 35-70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270-360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30-60 cases per 100 000 persons) (P
Case presentation: 50-year-old male had his chemoport inserted for adjuvant chemotherapy 3 years ago. During the removal, remaining half of the distal catheter was not found. There was no difficulties during the removal. Chest xray revealed that the fractured catheter had embolized to the right ventricle. Further history taking, he did experienced occasional palpitation and chest discomfort for the past six months. Electrocardiogram and cardiac enzymes were normal. Urgent removal of the fractured catheter via the percutaneous endovascular approach, under fluoroscopic guidance by an experience interventional radiologist was done. The procedure was successful without any complication. Patient made an uneventful recovery. He was discharged the following day, and was well during his 3rd month follow up.
Conclusion: Early detection and preventive measures can be done to prevent pinch-off syndrome. Unrecognized POS can result in fatal complications such as cardiac arrhythmia and septic embolization. Retrieval via the percutaneous endovascular approach provide excellent outcome in the case of embolized fractured catheter.
METHOD: For 293 consecutive patients admitted to our hospital via the emergency department for COVID-19 between 01/03/20 -18/05/20, demographic data, laboratory findings, admission electrocardiograph and clinical observations were compared in those who survived and those who died within 6 weeks. Hospital records were reviewed for prior electrocardiograms for comparison with those recorded on presentation with COVID-19.
RESULTS: Patients who died were older than survivors (82 vs 69.8 years, p 455 ms (males) and >465 ms (females) (p = 0.028, HR 1.49 [1.04-2.13]), as predictors of mortality. QTc prolongation beyond these dichotomy limits was associated with increased mortality risk (p = 0.0027, HR 1.78 [1.2-2.6]).
CONCLUSION: QTc prolongation occurs in COVID-19 illness and is associated with poor outcome.
MATERIALS AND METHODS: Between 16-April-2020 to 30-April- 2020, patients with suspected or confirmed for COVID-19 indicated for in-patient treatment with hydroxychloroquine with or without lopinavir-ritonavir to the Sarawak General Hospital were monitored with KardiaMobile smartphone electrocardiogram (AliveCor®, Mountain View, CA) or standard 12-lead electrocardiogram. The baseline and serial QTc intervals were monitored till the last dose of medications or until the normalization of the QTc interval.
RESULTS: Thirty patients were treated with hydroxychloroquine, and 20 (66.7%) patients received a combination of hydroxychloroquine and lopinavir-ritonavir therapy. The maximum QTc interval was significantly prolonged compared to baseline (434.6±28.2msec vs. 458.6±47.1msec, p=0.001). The maximum QTc interval (456.1±45.7msec vs. 464.6±45.2msec, p=0.635) and the delta QTc (32.6±38.5msec vs. 26.3±35.8msec, p=0.658) were not significantly different between patients on hydroxychloroquine or a combination of hydroxychloroquine and lopinavir-ritonavir. Five (16.7%) patients had QTc of 500msec or more. Four (13.3%) patients required discontinuation of hydroxychloroquine and 3 (10.0%) patients required discontinuation of lopinavirritonavir due to QTc prolongation. However, no torsade de pointes was observed.
CONCLUSIONS: QTc monitoring using smartphone electrocardiogram was feasible in COVID-19 patients treated with hydroxychloroquine with or without lopinavir-ritonavir. The usage of hydroxychloroquine and lopinavir-ritonavir resulted in QTc prolongation, but no torsade de pointes or arrhythmogenic death was observed.
MATERIAL AND METHODS: A prospective, quasi-experimental physiological study. Selected healthy subjects were observed electrocardiographically for 60 s continuously in three equal phases of 20 s each - baseline phase, nasoendoscopic phase, and recovery phase (post-nasoendoscopy). Heart rate fluctuations were charted, followed by identification of a positive nasocardiac reflex group of subjects and a negative group. Analyses against multiple variables were done.
RESULTS: A total of 53 subjects were analysed. Heart rate during the baseline phase was 81.0 ± 9.9, nasoendoscopic phase was 72.7 ± 10.1, and recovery phase was 75.2 ± 9.6. Sixteen subjects (30.2%) had a positive nasocardiac reflex, and they remained in sinus rhythm with no occurrences of skipped beats, atrioventricular blocks or asystoles. One subject (1.9%) developed temporary ectopic premature ventricular contractions after nasoendoscopy. No variables were found affecting the incidence of a nasocardiac reflex in our study.
CONCLUSIONS: The pattern of heart rate dynamics was consistent as heart rates drop rapidly upon endoscope insertion and recover in some measure after its withdrawal. Although all our subjects remained asymptomatic, clinicians should not overlook the risks of a severe nasocardiac reflex when performing nasoendoscopy. We recommend that electrical cardiac monitoring be part of the management of vasovagal responses during in-office endonasal procedures.
OBJECTIVE: The purpose of this study was to identify predictors of A4 amplitude and high AVS.
METHODS: We analyzed 64 patients enrolled in MARVEL 2 who had visible P waves on electrocardiogram for assessing A4 amplitude and 40 patients with third-degree AV block for assessing AVS at rest. High AVS was defined as >90% correct atrial-triggered ventricular pacing. The association between clinical factors and echocardiographic parameters with A4 amplitude was investigated using a multivariable model with lasso variable selection. Variables associated with A4 amplitude together with premature ventricular contraction burden, sinus rate, and sinus rate variability (standard deviation of successive differences of P-P intervals [SDSD]) were assessed for association with AVS.
RESULTS: In univariate analysis, low A4 amplitude was inversely related to atrial function assessed by E/A ratio and e'/a' ratio, and was directly related to atrial contraction excursion (ACE) and atrial strain (Ɛa) on echocardiography (all P ≤.05). The multivariable lasso regression model found coronary artery bypass graft history, E/A ratio, ACE, and Ɛa were associated with low A4 amplitude. E/A ratio and SDSD were multivariable predictors of high AVS, with >90% probability if E/A <0.94 and SDSD <5 bpm.
CONCLUSION: Clinical parameters and echocardiographic markers of atrial function are associated with A4 signal amplitude. High AVS can be predicted by E/A ratio <0.94 and low sinus rate variability at rest.
Materials and methods: This prospective study that screened 59 healthy cats and the status of the heart were evaluated based on a combination of findings from physical examination, electrocardiography, blood pressure measurement, routine blood test, urinalysis, and total thyroid level.
Results: Approximately 40.7% (n = 24/59) of the apparently healthy cats were diagnosed with heart disease hypertrophic cardiomyopathy (62.5%) remains to be the most commonly diagnosed. The mean age was 4.9-year old (age range, 7-month-old to 19-year-old). The prevalence was higher in males (45.0%; n = 17/38) cats, especially the domestic shorthairs (46.0%; n = 11/24). Among the healthy cats with vertebral heart scale (VHS) > 8.0, only 52% (n = 12/23) of them were diagnosed with cardiomyopathy. However, 33% (n = 12/36) of the cats with normal VHS ≤ 7.9 were diagnosed with heart disease. Consistently, all healthy cats with abnormal heart sounds were diagnosed with heart disease. About 31.4% (n = 16/51) of these cats with typical heart sound had cardiomyopathy too.
Conclusion: The occurrence of cardiomyopathy in apparently healthy cats has no association with the patient's age, sex, and VHS, except for the heart sound. Echocardiography remains the best diagnostic tool, as normal heart size and normal heart sound do not exclude cardiomyopathy in this group of apparently healthy cats.
Materials and Methods: A total of 324 undergraduate preclinical (year 2) and clinical (year 3-5) medical students participated in this study. The research design used thematic analysis of an open-ended questionnaire to analyze the qualitative data.
Results: The thematic analysis detected five major emergent themes: lack of remembering (18.2%), lack of understanding (28.4%), difficulty in applying (3.6%), difficulty in analysis (15.1%), and difficulty in interpretation (17.8%), of which addressing these challenges could be taken as a foundation step upon which medical educators put an emphasis on in order to improve ECG teaching and learning.
Conclusion: Negative attitude toward ECG learning poses a serious threat to acquire competency in ECG interpretation skill. The concept of student's memorizing ECG is not a correct approach; instead, understanding the concept and vector analysis is an elementary key for mastering ECG interpretation skill. The finding of this study sheds light into a better understanding of medical students' deficient points of ECG learning in parallel with taxonomy of cognitive domain and enables the medical teachers to come up with effective and innovative strategies for innovative ECG learning in an undergraduate medical curriculum.