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Fulltext A rare case of Riamet induced prolonged corrected QT interval

Neesha Sundramoorthy, Khaiteri R., Jer Ming Low, Chan Soon Thim Darren

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):70-70.
MyJurnal

Introduction: Artemether and lumefantrine was registered as Riamet in Switzerland in 1999 and is commonly used in Keningau Hospital for managing uncomplicated malaria. Riamet works at the food vacoule of the malarial parasite, where they interfere with the conversion of heme into haemozoin. Case description: We report a case of Riamet induced prolonged corrected QT interval (QTc) in a 37 year old gentleman admitted for severe malaria (hypotension) with normal QTc of 420msc on presentation. Upon starting Riamet, he developed bradycardia and ECG showed sinus bradycardia with prolonged QTc of 551msec and no arrythmias. Echocardiography showed no structural heart abnormalities. All electrolytes were within normal range. He was monitored in cardiac care unit with decision to complete 6 doses of Riamet. Patient was started on Dopamine infusion which maintained his blood pressure and heart rate within normal range. 5 days post Riamet completion, his heart rate improved and dopamine infusion was tapered off and QTc normalized to 407msc. Discussion: The most common mechanism of drugs causing QT inter-val prolongation is by blocking the human ether-à-go-go related gene (hERG) potassium channel. Blockage of the hEGR channel lengthens ventricular re-polarization and duration of ventricular action potential which is reflected in ECG as prolonged QT interval. In the in-vitro whole cell patch clamp study, lumefantrine and its metabolite desbu-tyl-lumefantrine showed a concentration-dependent inhibition of the hERG current. The period of QTc prolongation was 3.5 to 4 days after the last dose of the standard 6 dose regimen. Conclusion: Riamet induced prolonged QTc is a very rare complication. A baseline electrocardiography is therefore imminent for every patient prior to initiation of this medication to avoid cardiac arrythmias.

Matched MeSH terms: Electrocardiography
Left bundle branch area pacing for heart failure patients requiring cardiac resynchronization therapy: A meta-analysis

Jin C, Dai Q, Li P, Lam P, Cha YM

J Cardiovasc Electrophysiol, 2023 Sep;34(9):1933-1943.
PMID: 37548113 DOI: 10.1111/jce.16013

INTRODUCTION: Left bundle branch area pacing (LBBP) is a novel conduction system pacing method to achieve effective physiological pacing and an alternative to cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) for patients with heart failure with reduced ejection fraction (HFrEF). We conduted this meta-analysis and systemic review to review current data comparing BVP and LBBP in patients with HFrEF and indications for CRT.
METHODS: We searched PubMed/Medline, Web of Science, and Cochrane Library from the inception of the database to November 2022. All studies that compared LBBP with BVP in patients with HFrEF and indications for CRT were included. Two reviewers performed study selection, data abstraction, and risk of bias assessment. We calculated risk ratios (RRs) with the Mantel-Haenszel method and mean difference (MD) with inverse variance using random effect models. We assessed heterogeneity using the I2 index, with I2 > 50% indicating significant heterogeneity.
RESULTS: Ten studies (9 observational studies and 1 randomized controlled trial; 616 patients; 15 centers) published between 2020 and 2022 were included. We observed a shorter fluoroscopy time (MD: 9.68, 95% confidence interval [CI]: 4.49-14.87, I2 = 95%, p

Matched MeSH terms: Electrocardiography
Are examination findings important in screening for angina in the Malaysian patient?

Bulgiba AM

Prev Med, 2005 Jun;40(6):696-701.
PMID: 15850867

The objective of this study is to look at how well patient history and examination findings can be used in screening for angina.

Matched MeSH terms: Electrocardiography*
Design of a fuzzy-based decision support system for coronary heart disease diagnosis

Lahsasna A, Ainon RN, Zainuddin R, Bulgiba A

J Med Syst, 2012 Oct;36(5):3293-306.
PMID: 22252606 DOI: 10.1007/s10916-012-9821-7

In the present paper, a fuzzy rule-based system (FRBS) is designed to serve as a decision support system for Coronary heart disease (CHD) diagnosis that not only considers the decision accuracy of the rules but also their transparency at the same time. To achieve the two above mentioned objectives, we apply a multi-objective genetic algorithm to optimize both the accuracy and transparency of the FRBS. In addition and to help assess the certainty and the importance of each rule by the physician, an extended format of fuzzy rules that incorporates the degree of decision certainty and importance or support of each rule at the consequent part of the rules is introduced. Furthermore, a new way for employing Ensemble Classifiers Strategy (ECS) method is proposed to enhance the classification ability of the FRBS. The results show that the generated rules are humanly understandable while their accuracy compared favorably with other benchmark classification methods. In addition, the produced FRBS is able to identify the uncertainty cases so that the physician can give a special consideration to deal with them and this will result in a better management of efforts and tasks. Furthermore, employing ECS has specifically improved the ability of FRBS to detect patients with CHD which is desirable feature for any CHD diagnosis system.

Matched MeSH terms: Electrocardiography
Fulltext Congestive Heart Failure Leads to Prolongation of the PR Interval and Atrioventricular Junction Enlargement and Ion Channel Remodelling in the Rabbit

Nikolaidou T, Cai XJ, Stephenson RS, Yanni J, Lowe T, Atkinson AJ, et al.

PLoS One, 2015;10(10):e0141452.
PMID: 26509807 DOI: 10.1371/journal.pone.0141452

Heart failure is a major killer worldwide. Atrioventricular conduction block is common in heart failure; it is associated with worse outcomes and can lead to syncope and bradycardic death. We examine the effect of heart failure on anatomical and ion channel remodelling in the rabbit atrioventricular junction (AVJ). Heart failure was induced in New Zealand rabbits by disruption of the aortic valve and banding of the abdominal aorta resulting in volume and pressure overload. Laser micro-dissection and real-time polymerase chain reaction (RT-PCR) were employed to investigate the effects of heart failure on ion channel remodelling in four regions of the rabbit AVJ and in septal tissues. Investigation of the AVJ anatomy was performed using micro-computed tomography (micro-CT). Heart failure animals developed first degree heart block. Heart failure caused ventricular myocardial volume increase with a 35% elongation of the AVJ. There was downregulation of HCN1 and Cx43 mRNA transcripts across all regions and downregulation of Cav1.3 in the transitional tissue. Cx40 mRNA was significantly downregulated in the atrial septum and AVJ tissues but not in the ventricular septum. mRNA abundance for ANP, CLCN2 and Navβ1 was increased with heart failure; Nav1.1 was increased in the inferior nodal extension/compact node area. Heart failure in the rabbit leads to prolongation of the PR interval and this is accompanied by downregulation of HCN1, Cav1.3, Cx40 and Cx43 mRNAs and anatomical enlargement of the entire heart and AVJ.

Matched MeSH terms: Electrocardiography
Fulltext An Asian validation of the TIMI risk score for ST-segment elevation myocardial infarction

Selvarajah S, Fong AY, Selvaraj G, Haniff J, Uiterwaal CS, Bots ML

PLoS One, 2012;7(7):e40249.
PMID: 22815733 DOI: 10.1371/journal.pone.0040249

Risk stratification in ST-elevation myocardial infarction (STEMI) is important, such that the most resource intensive strategy is used to achieve the greatest clinical benefit. This is essential in developing countries with wide variation in health care facilities, scarce resources and increasing burden of cardiovascular diseases. This study sought to validate the Thrombolysis In Myocardial Infarction (TIMI) risk score for STEMI in a multi-ethnic developing country.

Matched MeSH terms: Electrocardiography*
Impact of cardiac care variation on ST-elevation myocardial infarction outcomes in Malaysia

Selvarajah S, Fong AY, Selvaraj G, Haniff J, Hairi NN, Bulgiba A, et al.

Am J Cardiol, 2013 May 1;111(9):1270-6.
PMID: 23415636 DOI: 10.1016/j.amjcard.2013.01.271

Developing countries face challenges in providing the best reperfusion strategy for patients with ST-segment elevation myocardial infarction because of limited resources. This causes wide variation in the provision of cardiac care. The aim of this study was to assess the impact of variation in cardiac care provision and reperfusion strategies on patient outcomes in Malaysia. Data from a prospective national registry of acute coronary syndromes were used. Thirty-day all-cause mortality in 4,562 patients with ST-segment elevation myocardial infarctions was assessed by (1) cardiac care provision (specialist vs nonspecialist centers), and (2) primary reperfusion therapy (thrombolysis or primary percutaneous coronary intervention [P-PCI]). All patients were risk adjusted by Thrombolysis In Myocardial Infarction (TIMI) risk score. Thrombolytic therapy was administered to 75% of patients with ST-segment elevation myocardial infarctions (12% prehospital and 63% in-hospital fibrinolytics), 7.6% underwent P-PCI, and the remainder received conservative management. In-hospital acute reperfusion therapy was administered to 68% and 73% of patients at specialist and nonspecialist cardiac care facilities, respectively. Timely reperfusion was low, at 24% versus 31%, respectively, for in-hospital fibrinolysis and 28% for P-PCI. Specialist centers had statistically significantly higher use of evidence-based treatments. The adjusted 30-day mortality rates for in-hospital fibrinolytics and P-PCI were 7% (95% confidence interval 5% to 9%) and 7% (95% confidence interval 3% to 11%), respectively (p = 0.75). In conclusion, variation in cardiac care provision and reperfusion strategy did not adversely affect patient outcomes. However, to further improve cardiac care, increased use of evidence-based resources, improvement in the quality of P-PCI care, and reduction in door-to-reperfusion times should be achieved.

Matched MeSH terms: Electrocardiography*
Non-invasive cardiac assessment in beta-thalassaemia major

Ong ML, Hatle LK, Lai VM, Bosco J

Int J Clin Pract, 2002 Jun;56(5):345-8.
PMID: 12137442

Iron deposition in the heart occurs in beta-thalassaemia major and contributes to cardiac dysfunction. Eighteen patients with beta-thalassaemia major were assessed clinically and had non-invasive investigations. They were young (15.5 +/- 3.6 years). Two patients had clinical heart failure. Doppler echocardiography demonstrated higher transmitral peak flow velocity in early and late diastole compared with controls (e: p<0.05, a: p<0.01). Transtricuspid peak late diastolic flow velocity was higher in patients (p<0.005). Isovolumic relaxation time was shortened (p<0.001). Pulmonary venous flow velocity was higher in diastole than systole (S: 0.51 +/- 0.11 m/s, D: 0.62 +/- 0.08 m/s). Reversal of pulmonary venous flow during atrial systole was seen in eight patients. These diastolic filling abnormalities did not significantly change with blood transfusion. Left ventricular ejection fraction was normal in patients. Two patients had cardiomegaly on chest X-ray. In beta-thalassaemia with iron overload, there is a restrictive pattern of diastolic dysfunction. This is not altered by recent blood transfusion. Left ventricular function remains relatively intact.

Matched MeSH terms: Electrocardiography/standards
Fulltext An uncommon life-threatening cause of electric alternans with sudden onset of breathlessness and chest pain

Benjamin Ng Han Sim

Borneo Journal of Medical Sciences, 2020;14(2):0-0.
MyJurnal

Phasic ECG voltage changes or electrical alternans is a well-described ECG changes seen in the pericardial effusion and cardiac tamponade. Popular as once believed, this ECG features are no longer considered pathognomonic for pericardial effusion and cardiac tamponade. Electric alternans is observed in pneumothorax especially left-sided pneumothorax. This is a case of a 41-year-old man who presented with chest pain and breathlessness to the emergency department. Assessment in the emergency unit revealed an obvious distress man with a respiratory rate of 60 breaths/min with cyanosis There were generalised rhonchi and prolonged expiratory breath sound appreciated. Chest X-ray (CXR) was done and diagnosed to have left tension pneumothorax. Initial electrocardiogram (ECG) showed electrical alternans in all leads. He was intubated for respiratory distress followed by chest tube insertion. His initial ECG findings resolved after treatment of the tension pneumothorax. Doctors need to evaluate the cardiac findings along with respiratory findings.

Matched MeSH terms: Electrocardiography
A case of situs inversus

Banu SZ

Med J Malaysia, 1977 Mar;31(3):236-40.
PMID: 904519
Matched MeSH terms: Electrocardiography
Incidental congenitally corrected transposition of the great arteries (ccTGA) in an adult with suspected coronary artery disease: review on radiological features and pathophysiology

Sayuti KA, Azizi MYSB

BMJ Case Rep, 2020 Apr 22;13(4).
PMID: 32327461 DOI: 10.1136/bcr-2019-234225

We report a case of a 46-year-old woman who has presented to a peripheral hospital with progressive exertional dyspnoea and chest discomfort. The resting ECG showed features of left-sided ventricular hypertrophy. The initial chest radiograph was reported as cardiomegaly. Initial echocardiography revealed left atrial dilatation and 'left ventricular' hypertrophy with normal ejection fraction. She was treated as possible coronary artery disease and was subsequently referred to our centre for CT coronary angiography. Findings from the CT scan were consistent with congenitally corrected transposition of the great arteries (ccTGA). This report describes the radiological features of ccTGA, its associated cardiovascular anomalies, pathophysiology and potential complications.

Matched MeSH terms: Electrocardiography
Fulltext Electrocardiogram-Based Emotion Recognition Systems and Their Applications in Healthcare-A Review

Hasnul MA, Aziz NAA, Alelyani S, Mohana M, Aziz AA

Sensors (Basel), 2021 Jul 23;21(15).
PMID: 34372252 DOI: 10.3390/s21155015

Affective computing is a field of study that integrates human affects and emotions with artificial intelligence into systems or devices. A system or device with affective computing is beneficial for the mental health and wellbeing of individuals that are stressed, anguished, or depressed. Emotion recognition systems are an important technology that enables affective computing. Currently, there are a lot of ways to build an emotion recognition system using various techniques and algorithms. This review paper focuses on emotion recognition research that adopted electrocardiograms (ECGs) as a unimodal approach as well as part of a multimodal approach for emotion recognition systems. Critical observations of data collection, pre-processing, feature extraction, feature selection and dimensionality reduction, classification, and validation are conducted. This paper also highlights the architectures with accuracy of above 90%. The available ECG-inclusive affective databases are also reviewed, and a popularity analysis is presented. Additionally, the benefit of emotion recognition systems towards healthcare systems is also reviewed here. Based on the literature reviewed, a thorough discussion on the subject matter and future works is suggested and concluded. The findings presented here are beneficial for prospective researchers to look into the summary of previous works conducted in the field of ECG-based emotion recognition systems, and for identifying gaps in the area, as well as in developing and designing future applications of emotion recognition systems, especially in improving healthcare.

Matched MeSH terms: Electrocardiography*
Fulltext Anaesthetic challenges in a patient with Wolff-Parkinson-White (WPW) syndrome for orchidectomy

Yeap TB, Teah MK, Thevarajah S, Azerai S

BMJ Case Rep, 2021 Mar 25;14(3).
PMID: 33766970 DOI: 10.1136/bcr-2020-241176

Wolff-Parkinson-White (WPW) syndrome is an extremely rare congenital cardiac conduction disorder. It is due to an aberrant pathway between the atrium and ventricle. This manuscript entails a man with an underlying WPW who was posted for an elective orchidectomy. We discussed the important perioperative precautions to prevent the precipitation of acute cardiac events.

Matched MeSH terms: Electrocardiography
Fulltext Invasive and antiplatelet treatment of patients with non-ST-segment elevation myocardial infarction: Understanding and addressing the global risk-treatment paradox

Ahrens I, Averkov O, Zúñiga EC, Fong AYY, Alhabib KF, Halvorsen S, et al.

Clin Cardiol, 2019 Oct;42(10):1028-1040.
PMID: 31317575 DOI: 10.1002/clc.23232

Clinical guidelines for the treatment of patients with non-ST-segment elevation myocardial infarction (NSTEMI) recommend an invasive strategy with cardiac catheterization, revascularization when clinically appropriate, and initiation of dual antiplatelet therapy regardless of whether the patient receives revascularization. However, although patients with NSTEMI have a higher long-term mortality risk than patients with ST-segment elevation myocardial infarction (STEMI), they are often treated less aggressively; with those who have the highest ischemic risk often receiving the least aggressive treatment (the "treatment-risk paradox"). Here, using evidence gathered from across the world, we examine some reasons behind the suboptimal treatment of patients with NSTEMI, and recommend approaches to address this issue in order to improve the standard of healthcare for this group of patients. The challenges for the treatment of patients with NSTEMI can be categorized into four "P" factors that contribute to poor clinical outcomes: patient characteristics being heterogeneous; physicians underestimating the high ischemic risk compared with bleeding risk; procedure availability; and policy within the healthcare system. To address these challenges, potential approaches include: developing guidelines and protocols that incorporate rigorous definitions of NSTEMI; risk assessment and integrated quality assessment measures; providing education to physicians on the management of long-term cardiovascular risk in patients with NSTEMI; and making stents and antiplatelet therapies more accessible to patients.

Matched MeSH terms: Electrocardiography
Fulltext An analytical model to minimize the latency in healthcare internet-of-things in fog computing environment

Shukla S, Hassan MF, Khan MK, Jung LT, Awang A

PLoS One, 2019;14(11):e0224934.
PMID: 31721807 DOI: 10.1371/journal.pone.0224934

Fog computing (FC) is an evolving computing technology that operates in a distributed environment. FC aims to bring cloud computing features close to edge devices. The approach is expected to fulfill the minimum latency requirement for healthcare Internet-of-Things (IoT) devices. Healthcare IoT devices generate various volumes of healthcare data. This large volume of data results in high data traffic that causes network congestion and high latency. An increase in round-trip time delay owing to large data transmission and large hop counts between IoTs and cloud servers render healthcare data meaningless and inadequate for end-users. Time-sensitive healthcare applications require real-time data. Traditional cloud servers cannot fulfill the minimum latency demands of healthcare IoT devices and end-users. Therefore, communication latency, computation latency, and network latency must be reduced for IoT data transmission. FC affords the storage, processing, and analysis of data from cloud computing to a network edge to reduce high latency. A novel solution for the abovementioned problem is proposed herein. It includes an analytical model and a hybrid fuzzy-based reinforcement learning algorithm in an FC environment. The aim is to reduce high latency among healthcare IoTs, end-users, and cloud servers. The proposed intelligent FC analytical model and algorithm use a fuzzy inference system combined with reinforcement learning and neural network evolution strategies for data packet allocation and selection in an IoT-FC environment. The approach is tested on simulators iFogSim (Net-Beans) and Spyder (Python). The obtained results indicated the better performance of the proposed approach compared with existing methods.

Matched MeSH terms: Electrocardiography
Fulltext Penetrating cardiac injury without tamponade

Aung T

Med J Malaysia, 1997 Dec;52(4):441-3.
PMID: 10968125

A case of unsuspected penetrating cardiac injury is presented. It was recognised by the presence of bleeding into peritoneal cavity even after the source of bleeding from intra-abdominal organs had been stopped. It highlights the importance of high index of suspicion of associated cardiac injury in high epigastric penetrating injury.

Matched MeSH terms: Electrocardiography
Fulltext Metformin and Dapagliflozin Attenuate Doxorubicin-Induced Acute Cardiotoxicity in Wistar Rats: An Electrocardiographic, Biochemical, and Histopathological Approach

Satyam SM, Bairy LK, Shetty P, Sainath P, Bharati S, Ahmed AZ, et al.

Cardiovasc Toxicol, 2023 Feb;23(2):107-119.
PMID: 36790727 DOI: 10.1007/s12012-023-09784-8

Doxorubicin is a widely used anticancer drug whose efficacy is limited due to its cardiotoxicity. There is no ideal cardioprotection available against doxorubicin-induced cardiotoxicity. This study aimed to investigate the anticipated cardioprotective potential of metformin and dapagliflozin against doxorubicin-induced acute cardiotoxicity in Wistar rats. At the beginning of the experiment, cardiac screening of experimental animals was done by recording an electrocardiogram (ECG) before allocating them into the groups. Thereafter, a total of thirty healthy adult Wistar rats (150-200 g) were randomly divided into five groups (n = 6) and treated for eight days as follows: group I (normal control), group II (doxorubicin control), group III (metformin 250 mg/kg/day), group IV (metformin 180 mg/kg/day), and group V (dapagliflozin 0.9 mg/kg/day). On the 7th day of the treatment phase, doxorubicin 20 mg/kg was administered intraperitoneal to groups II, III, IV, and V. On the 9th day (immediately after 48 h of doxorubicin administration), blood was collected from anesthetized animals for glucose, lipid profile, CK-MB & AST estimation, and ECG was recorded. Later, animals were sacrificed, and the heart was dissected for histopathological examination. We found that compared to normal control rats, CK-MB, AST, and glucose were significantly increased in doxorubicin control rats. There was a significant reversal of doxorubicin-induced hyperglycemia in the rats treated with metformin 250 mg/kg compared to doxorubicin control rats. Both metformin (180 mg/kg and 250 mg/kg) and dapagliflozin (0.9 mg/kg) significantly altered doxorubicin-induced ECG changes and reduced the levels of cardiac injury biomarkers CK-MB and AST compared to doxorubicin control rats. Metformin and dapagliflozin protected the cellular architecture of the myocardium from doxorubicin-induced myocardial injury. Current study revealed that both metformin and dapagliflozin at the FDA-recommended antidiabetic doses mitigated doxorubicin-induced acute cardiotoxicity in Wistar rats. The obtained data have opened the perspective to perform chronic studies and then to clinical studies to precisely consider metformin and dapagliflozin as potential chemoprotection in the combination of chemotherapy with doxorubicin to limit its cardiotoxicity, especially in patients with comorbid conditions like type II diabetes mellitus.

Matched MeSH terms: Electrocardiography
Ventricular bigeminy following a cobra envenomation

Ismail AK, Weinstein SA, Auliya M, Appareo P

Clin Toxicol (Phila), 2012 Jul;50(6):518-21.
PMID: 22702902 DOI: 10.3109/15563650.2012.696119

Envenoming by some species of cobras (Naja species) may include cardiotoxic effects including various dysrhythmias. However, dysrhythmias leading specifically to ventricular bigeminy have not been previously documented. We report a case of cardiotoxicity and the development of ventricular bigeminy following a cobra envenomation.

Matched MeSH terms: Electrocardiography
Diastolic dysfunction grading, echocardiographic and electrocardiogram findings in 50 patients with apical hypertrophic cardiomyopathy

Aslannif R, Suraya K, Koh HB, Tey YS, Tan KL, Tham CH, et al.

Med J Malaysia, 2019 12;74(6):521-526.
PMID: 31929479

INTRODUCTION: Apical Hypertrophic Cardiomyopathy (Apical HCM) is an uncommon variant of hypertrophic cardiomyopathy, but it is relatively more common in Asian countries. This is a retrospective, non-randomised, single centre study of patients with Apical HCM focusing on their diastolic dysfunction grading, echocardiographic parameters and electrocardiograms (ECG).
METHODS: All Apical HCM patients coming for clinic visits at the Institut Jantung Negara from September 2017 to September 2018 were included. We assessed their echocardiography images, grade their diastolic function and reviewed their ECG on presentation.
RESULTS: Fifty patient were included, 82% (n=41) were males and 18% (n=9) females. The diastolic function grading of 37 (74%) patients were able to be determined using the updated 2016 American Society of Echocardiography (ASE) diastolic guidelines. Fifty percent (n=25) had the typical ace-ofspades shape left ventricle (LV) appearance in diastole and 12% (n=6) had apical pouch. All patients had T inversion in the anterior leads of their ECG, and only 52% (n=26) fulfilled the ECG left ventricular hypertrophy (LVH) criteria. Majority of our patients presented with symptoms of chest pain (52%, n=26) and dyspnoea (42%, n=21).
CONCLUSION: The updated 2016 ASE guideline makes it easier to evaluate LV diastolic function in most patients with Apical HCM. It also helps in elucidating the aetiology of dyspnoea, based on left atrial pressure. Clinicians should have a high index of suspicion for Apical HCM when faced with deep T inversion on ECG, in addition to a thick LV apex with an aceof- spades appearance during diastole.

Matched MeSH terms: Electrocardiography/methods*
Based on Real Time Remote Health Monitoring Systems: A New Approach for Prioritization "Large Scales Data" Patients with Chronic Heart Diseases Using Body Sensors and Communication Technology

Kalid N, Zaidan AA, Zaidan BB, Salman OH, Hashim M, Albahri OS, et al.

J Med Syst, 2018 Mar 02;42(4):69.
PMID: 29500683 DOI: 10.1007/s10916-018-0916-7

This paper presents a new approach to prioritize "Large-scale Data" of patients with chronic heart diseases by using body sensors and communication technology during disasters and peak seasons. An evaluation matrix is used for emergency evaluation and large-scale data scoring of patients with chronic heart diseases in telemedicine environment. However, one major problem in the emergency evaluation of these patients is establishing a reasonable threshold for patients with the most and least critical conditions. This threshold can be used to detect the highest and lowest priority levels when all the scores of patients are identical during disasters and peak seasons. A practical study was performed on 500 patients with chronic heart diseases and different symptoms, and their emergency levels were evaluated based on four main measurements: electrocardiogram, oxygen saturation sensor, blood pressure monitoring, and non-sensory measurement tool, namely, text frame. Data alignment was conducted for the raw data and decision-making matrix by converting each extracted feature into an integer. This integer represents their state in the triage level based on medical guidelines to determine the features from different sources in a platform. The patients were then scored based on a decision matrix by using multi-criteria decision-making techniques, namely, integrated multi-layer for analytic hierarchy process (MLAHP) and technique for order performance by similarity to ideal solution (TOPSIS). For subjective validation, cardiologists were consulted to confirm the ranking results. For objective validation, mean ± standard deviation was computed to check the accuracy of the systematic ranking. This study provides scenarios and checklist benchmarking to evaluate the proposed and existing prioritization methods. Experimental results revealed the following. (1) The integration of TOPSIS and MLAHP effectively and systematically solved the patient settings on triage and prioritization problems. (2) In subjective validation, the first five patients assigned to the doctors were the most urgent cases that required the highest priority, whereas the last five patients were the least urgent cases and were given the lowest priority. In objective validation, scores significantly differed between the groups, indicating that the ranking results were identical. (3) For the first, second, and third scenarios, the proposed method exhibited an advantage over the benchmark method with percentages of 40%, 60%, and 100%, respectively. In conclusion, patients with the most and least urgent cases received the highest and lowest priority levels, respectively.

Matched MeSH terms: Electrocardiography, Ambulatory

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