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Zagidullin NS, Motloch LJ, Musin TI, Bagmanova ZA, Lakman IA, Tyurin AV, Gumerov RM, Enikeev D, Cai B, Gareeva DF, Davtyan PA, Gareev DA, Talipova HM, Badykov MR, Jirak P, Kopp K, Hoppe UC, Pistulli R, Pavlov VN. J-waves in acute COVID-19: A novel disease characteristic and predictor of mortality? PLoS One 2021; 16:e0257982. [PMID: 34648510 PMCID: PMC8516278 DOI: 10.1371/journal.pone.0257982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
Background J-waves represent a common finding in routine ECGs (5–6%) and are closely linked to ventricular tachycardias. While arrhythmias and non-specific ECG alterations are a frequent finding in COVID-19, an analysis of J-wave incidence in acute COVID-19 is lacking. Methods A total of 386 patients consecutively, hospitalized due to acute COVID-19 pneumonia were included in this retrospective analysis. Admission ECGs were analyzed, screened for J-waves and correlated to clinical characteristics and 28-day mortality. Results J-waves were present in 12.2% of patients. Factors associated with the presence of J-waves were old age, female sex, a history of stroke and/or heart failure, high CRP levels as well as a high BMI. Mortality rates were significantly higher in patients with J-waves in the admission ECG compared to the non-J-wave cohort (J-wave: 14.9% vs. non-J-wave 3.8%, p = 0.001). After adjusting for confounders using a multivariable cox regression model, the incidence of J-waves was an independent predictor of mortality at 28-days (OR 2.76 95% CI: 1.15–6.63; p = 0.023). J-waves disappeared or declined in 36.4% of COVID-19 survivors with available ECGs for 6–8 months follow-up. Conclusion J-waves are frequently and often transiently found in the admission ECG of patients hospitalized with acute COVID-19. Furthermore, they seem to be an independent predictor of 28-day mortality.
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Affiliation(s)
- Naufal Shamilevich Zagidullin
- Department of Internal Medicine I, Bashkir State Medical University, Ufa, Russian Federation
- Department of Biomedical Engineering of Ufa State Aviation Technical University, Ufa, Russian Federation
- * E-mail:
| | - Lukas J. Motloch
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Timur Ilgamovich Musin
- Department of Internal Medicine I, Bashkir State Medical University, Ufa, Russian Federation
| | | | - Irina Alexandrovna Lakman
- Department of Biomedical Engineering of Ufa State Aviation Technical University, Ufa, Russian Federation
- Department of Economics, Finance and Business, Bashkir State University, Ufa, Russian Federation
| | | | | | - Dinar Enikeev
- Department of Biomedical Engineering of Ufa State Aviation Technical University, Ufa, Russian Federation
| | - Benzhi Cai
- Department of Pharmacy at The Second Affiliated Hospital, and Department of Pharmacology (The Key Laboratory of Cardiovascular Medicine Research, Ministry of Education) at College of Pharmacy, Harbin Medical University, Harbin, China
| | | | | | - Damir Aidarovich Gareev
- Department of Internal Medicine I, Bashkir State Medical University, Ufa, Russian Federation
| | | | | | - Peter Jirak
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Kristen Kopp
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Uta C. Hoppe
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Rudin Pistulli
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany
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Mitrovic M, Nikolic T, Turnic M, Djuric D. Olanzapine - Focus on the Cardiometabolic Side Effects. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2018. [DOI: 10.1515/sjecr-2017-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractIn this article, we review the recent findings concerning weight gain, diabetes mellitus (DM), hyperlipidemia, cardiovascular side effects in patients receiving olanzapine. It will consider the OLZ is associated with an increase in metabolic syndrome or cardiovascular events, and knowledge of these risks is crucial for further monitoring of patients with OLZ-treatment. Although it is one of the most commonly prescribed and effective AATPs, olanzapine causes the most weight gain and metabolic impairments in humans. As noted with glucose abnormalities and antipsychotics, olanzapine has the greatest propensity for causing proatherogenic hyperlipidemia. The mechanism of dyslipidemia with OLZ is poorly understood, but OLZ has been shown to increase lipogenesis, reduce lipolysis, and enhance the antilipolytic effects of insulin in adipocytes. Olanzapine can induce cardiomyopathy in selected patients.Taken together, all mentioned data indicate that interventions aimed at the amelioration of obesity and cardiovascular illness need to be as multipronged and complex as the contributing psychosocial, behavioural, and biological factors that make obesity and cardiovascular illness more likely in patients with severe mental illness, including schizophrenia.
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Affiliation(s)
| | - Tamara Nikolic
- Department of Pharmacy, Faculty of Medical Sciences , University of Kragujevac , Serbia
| | | | - Dusan Djuric
- Department of Pharmacy, Faculty of Medical Sciences , University of Kragujevac , Serbia
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Ajayi OO, Holroyd S. Severe recurrent hypothermia in an elderly patient with refractory mania associated with atypical antipsychotic, valproic acid and oxcarbazepine therapy. BMJ Case Rep 2017; 2017:bcr-2017-222462. [PMID: 29197846 PMCID: PMC5720320 DOI: 10.1136/bcr-2017-222462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Hypothermia is a rare but serious condition that has been associated with various psychiatric medications. We present a 76-year-old woman with refractory mania who developed multiple episodes of severe hypothermia associated with several psychiatric medications including olanzapine, quetiapine, valproic acid and oxcarbazepine. These episodes resolved following discontinuation of the agents. The patient had never experienced hypothermia before, despite having been on these or similar agents for many years. With traditional treatments for mania not feasible, other medications were used to treat her including lithium, clonazepam, gabapentin and the novel protein kinase c inhibitor tamoxifen. The regimen resulted in some success and importantly, without triggering hypothermia. This case alerts clinicians to the rare side effect of hypothermia in response to various psychiatric medications, the fact that patients can suddenly develop this intolerance and suggests possible medications that may be used safely without triggering hypothermia.
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Affiliation(s)
- Oluwadamilare O Ajayi
- Department of Psychiatry & Behavioral Medicine, Joan C. Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
| | - Suzanne Holroyd
- Department of Psychiatry & Behavioral Medicine, Joan C. Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
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Insight into specific pro-arrhythmic triggers in Brugada and early repolarization syndromes: results of long-term follow-up. Heart Vessels 2016; 31:2035-2044. [PMID: 26968993 DOI: 10.1007/s00380-016-0828-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/26/2016] [Indexed: 02/03/2023]
Abstract
The pro-arrhythmic triggers in Brugada and early repolarization syndromes (BrS, ERS) have not been analyzed systematically except for case reports. We clinically investigated the circumstances which precede/predispose to arrhythmic events in these syndromes during long-term follow-up. A detailed history from the patients/witnesses was taken to investigate the antecedent events in the last few hours that preceded syncope/ventricular fibrillation (VF); medical records, ECG and blood test from the emergency room (ER) were reviewed. 19 patients that fulfilled the investigation criteria were followed up for 71 ± 49 months (34-190 months). Prior to the event (syncope/VF), the patients were partaking different activities in the following decreasing order; drinking alcoholic beverage, having meal, and getting up from sleep, exercise. 3 patients reported mental/physical stress prior to the event and 2 patients developed VF several days after starting oral steroid for treatment of bronchial asthma. In the ER, elevated J-wave amplitude (0.27 ± 0.15 mV) was found with 58 % of the patients having hypokalemia. After electrolyte correction and cessation of steroids, the following day plasma K+ (4.2 ± 0.3 mEq/L, P < 0.001) was significantly increased and J-wave amplitude (0.13 ± 0.1 mV, P < 0.001) was remarkably reduced. Three patients were kept on oral spironolactone/potassium supplements. During follow-up for 71 ± 49 (34-190) months, among 4 patients with VF recurrence, one patient developed VF after taking oral steroid. In ERS and BrS, hypokalemia and corticosteroid therapy add substantial pro-arrhythmic effects, but potentially treatable. Stopping steroid therapy and avoiding hypokalemia had excellent long-term outcome.
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