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Doku A, Asare BYA, Osei R, Owoo C, Djagbletey R, Akamah J, Aniteye E, Ahadzi D. Outcome of life-threatening arrhythmias among patients presenting in an emergency setting at a tertiary hospital in Accra-Ghana. BMC Cardiovasc Disord 2022; 22:361. [PMID: 35934708 PMCID: PMC9358854 DOI: 10.1186/s12872-022-02803-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 06/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Management of life-threatening arrhythmia can be incredibly challenging in advanced health systems. In sub-Saharan Africa (SSA), this is likely more challenging because of weak pre-hospital and in-hospital critical care systems. Little is known about life-threatening arrhythmia and their outcomes in SSA. The aim of this study was to examine the types and outcomes of arrhythmias among haemodynamically unstable patients presenting at a tertiary hospital in Accra-Ghana. Method This was a retrospective case series study conducted at the Korle-Bu Teaching Hospital (KBTH), Accra-Ghana. Medical records of patients who presented with or developed haemodynamically unstable arrhythmias within 24h of admission from January 2018 to December 2020 were reviewed. The demographic characteristics and clinical data including outcomes of patients were collected. Descriptive statistics were used and results presented in frequency tables. Results A total of 42 patients with life-threatening arrhythmias were included. Haemodynamically unstable tachyarrhythmias were the most common arrhythmias found among the patients (66.7%). Approximately 52% of patients had structural heart diseases whereas 26.2% had no apparent underlying cause or predisposing factor. Cardioversion (52.4%), commonly electrical (63.6%), and transvenous pacemaker implantation (23.8%) were the common initial interventions. The majority of the patients (88.1%) survived and were discharged home. Conclusion Tachyarrhythmias are the most common haemodynamically unstable arrhythmias seen among patients presenting emergently in a leading tertiary hospital in Ghana. A high survival rate was observed and cannot be extrapolated to other healthcare settings in sub-Saharan Africa with limited resources to manage these clinical entities.
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Basith S, Manavalan B, Shin TH, Park CB, Lee WS, Kim J, Lee G. The Impact of Fine Particulate Matter 2.5 on the Cardiovascular System: A Review of the Invisible Killer. NANOMATERIALS 2022; 12:nano12152656. [PMID: 35957086 PMCID: PMC9370264 DOI: 10.3390/nano12152656] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 12/26/2022]
Abstract
Air pollution exerts several deleterious effects on the cardiovascular system, with cardiovascular disease (CVD) accounting for 80% of all premature deaths caused by air pollution. Short-term exposure to particulate matter 2.5 (PM2.5) leads to acute CVD-associated deaths and nonfatal events, whereas long-term exposure increases CVD-associated risk of death and reduces longevity. Here, we summarize published data illustrating how PM2.5 may impact the cardiovascular system to provide information on the mechanisms by which it may contribute to CVDs. We provide an overview of PM2.5, its associated health risks, global statistics, mechanistic underpinnings related to mitochondria, and hazardous biological effects. We elaborate on the association between PM2.5 exposure and CVD development and examine preventive PM2.5 exposure measures and future strategies for combating PM2.5-related adverse health effects. The insights gained can provide critical guidelines for preventing pollution-related CVDs through governmental, societal, and personal measures, thereby benefitting humanity and slowing climate change.
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Affiliation(s)
- Shaherin Basith
- Department of Physiology, Ajou University School of Medicine, Suwon 16499, Korea; (S.B.); (T.H.S.); (C.B.P.)
| | - Balachandran Manavalan
- Computational Biology and Bioinformatics Laboratory, Department of Integrative Biotechnology, College of Biotechnology and Bioengineering, Sungkyunkwan University, Suwon 16419, Korea;
| | - Tae Hwan Shin
- Department of Physiology, Ajou University School of Medicine, Suwon 16499, Korea; (S.B.); (T.H.S.); (C.B.P.)
| | - Chan Bae Park
- Department of Physiology, Ajou University School of Medicine, Suwon 16499, Korea; (S.B.); (T.H.S.); (C.B.P.)
| | - Wang-Soo Lee
- Department of Internal Medicine, Division of Cardiology, College of Medicine, Chung-Ang University, Seoul 06973, Korea;
| | - Jaetaek Kim
- Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, Chung-Ang University, Seoul 06973, Korea
- Correspondence: (J.K.); (G.L.)
| | - Gwang Lee
- Department of Physiology, Ajou University School of Medicine, Suwon 16499, Korea; (S.B.); (T.H.S.); (C.B.P.)
- Department of Molecular Science and Technology, Ajou University, Suwon 16499, Korea
- Correspondence: (J.K.); (G.L.)
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Muzurović E, Medenica S, Kalezić M, Pavlović S. Primary hyperparathyroidism associated with acquired long QT interval and ventricular tachycardia. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM210016. [PMID: 34341183 PMCID: PMC8346179 DOI: 10.1530/edm-21-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022] Open
Abstract
SUMMARY We present a 54-year-old patient admitted to the emergency department due to loss of consciousness. The initial ECG registered monomorphic ventricular extrasystoles and prolonged QT interval (QT corrected (QTc) >500 ms). Sustained ventricular tachycardia (VT) was registered on 24-h Holter ECG monitoring, which clinically was presented as a crisis of consciousness. Coronary angiography and other visualization methods were normal. Implantable cardioverter-defibrillator (ICD) implantation was planned for the purpose of secondary prevention of sudden cardiac death (SCD). Laboratory and hormonal analyzes revealed primary hyperparathyroidism (PHPT), chronic kidney disease, and hypokalemia. Neck ultrasound showed a 25 mm, sharply outlined homogenous tumor mass which was separated from thyroid gland (TG) and exerted a mild impression on lower parts of the left lobe. Dual wash technetium-99m sestamibi parathyroid scintigraphy with single-photon emission CT (SPECT)/CT also showed the uptake of tracer behind the lower half of the left lobe of the TG. Surgical treatment, lower left parathyroidectomy, was performed, and pathohistological analysis verified parathyroid adenoma. The patient was rhythmically and hemodynamically stable for 7 days after surgery, without additional complaints, and was discharged from the hospital. Timely diagnosis of PHPT, correct assessment and surgical treatment, did not lead our patient to unnecessary ICD implantation. Our case suggests an additional intertwining of electrolyte disorders and ventricular arrhythmias in PHPT and more importantly emphasizes the need for caution when indicating ICD, even in patients with the most serious life-threatening arrhythmias. LEARNING POINTS Electrolyte abnormalities in PHPT can have highly malignant consequences, and the occurrence of hypokalemia in the presence of hypercalcemia is underestimated in PHPT, and the consequences can be life-threatening. Although hypercalcemia causes shortened QT interval, concomitant severe hypokalemia may overcome hypercalcemia and prolong QT interval, even in the absence of structural heart disease or LQTS. Timely diagnosis of PHPT, correct assessment and surgical treatment, do not lead to unnecessary ICD implantation.
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Affiliation(s)
- Emir Muzurović
- Department of Internal Medicine, Endocrinology Section, Clinical Center of Montenegro, Podgorica, Montenegro
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Sanja Medenica
- Department of Internal Medicine, Endocrinology Section, Clinical Center of Montenegro, Podgorica, Montenegro
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Milovan Kalezić
- Department of Cardiology, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Siniša Pavlović
- Pacemaker Center, Clinical Center of Serbia, Faculty of Medicine University of Belgrade, Belgrade, Serbia
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Bhandari B, Kanderi T, Yarlagadda K, Qureshi M, Komanduri S. Coronary vasospasm as an etiology of recurrent ventricular fibrillation in the absence of coronary artery disease: a case report. J Community Hosp Intern Med Perspect 2021; 11:510-515. [PMID: 34211659 PMCID: PMC8221133 DOI: 10.1080/20009666.2021.1915534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Vasospastic angina (VA), or Prinzmetal’s angina, is characterized by symptoms of coronary angina caused by coronary vasospasm, usually in the absence of atherosclerotic changes. It typically presents with chest pain, which can be accompanied by transient electrocardiographic changes, if visualized during the attack. It can also rarely present with severe manifestations of acute myocardial angina, ventricular fibrillation, or cardiac arrest. Case presentation:
We present a case of a 50-year-old Caucasian male who initially presented to the hospital with chest pain and was diagnosed with VA. Later, he was brought to the hospital by emergency medical services later with ventricular fibrillation, despite normal coronary anatomy on angiogram. He was managed with placement of an intra–cardiac defibrillator (ICD) for secondary prevention. The patient continued to have recurrent episodes of ventricular fibrillation with associated ICD shocks, and had multiple admissions to the hospital with similar presentations. Symptoms and arrhythmia improved after optimizing antianginal therapy. Conclusions:
Ventricular fibrillation can be an uncommon but severe manifestation during VA crises. In cases with normal coronary vasculature, it is important to recognize VA as a cause of recurrent ventricular fibrillation in order to optimize medical management for prevention of fatal arrhythmias.
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Affiliation(s)
- Binita Bhandari
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
| | - Tejaswi Kanderi
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
| | - Keerthi Yarlagadda
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
| | - Mehreen Qureshi
- Department of Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle Cardiovascular Institute, Harrisburg, PA, USA
| | - Saketram Komanduri
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
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Wattoo MA, Tabassum M, Bhutta KR, Kaneez M, Zaidi SMJ, Ijaz H, Awan J, Irshad U, Azhar MJ, Rafi Z. Correlation of Prolonged Corrected QT Interval With Ventricular Arrhythmias and In-Hospital Mortality Among ST-Elevation Myocardial Infarction Patients: A Mystique or Lucidity? Cureus 2020; 12:e12356. [PMID: 33520550 PMCID: PMC7839800 DOI: 10.7759/cureus.12356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Ventricular arrhythmias (VAs) are a frequent cause of cardiovascular mortality, especially in developing countries. Prolongation of corrected QT (QTc) interval predisposes patients to life-threatening VAs. Our study aims to assess the correlation of prolonged QTc interval with VAs and in-hospital mortality among ST-elevation myocardial infarction (STEMI) patients. Methods This cross-sectional study analyzed the data from 40 patients with a confirmed diagnosis of STEMI and prolonged QTc interval. The patients were evaluated for several characteristics including their electrocardiography (ECG) findings. The frequency of in-hospital mortality and VAs developed after admission were recorded. Spearman correlation was used to assess the correlation of prolonged QTc interval with VAs and in-hospital mortality. Results Out of 40 cases, 30 patients were males and 10 were females with a mean age hovering at 52.95 ± 10.65 years. The mean QTc interval of our patients was 512.02 ± 49.74 milliseconds (ms). A total of 11 (27.5%) patients developed VAs while 14 (35%) of the patients succumbed to the disease complications. Spearman correlation showed a strong significant positive correlation of QTc interval with VAs (rho = 0.658, p < 0.001) and in-hospital mortality (rho = 0.314, p = 0.04). Conclusion Prolonged QTc interval is positively correlated with VAs and in-hospital mortality among STEMI patients. These patients should be regularly monitored and must be managed with caution as they have increased chances to develop VAs and in-hospital mortality. There is an utmost need for curation of guidelines that aid in risk stratification and appropriate management of such patients.
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Affiliation(s)
| | | | | | - Mehwish Kaneez
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Hania Ijaz
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Javeria Awan
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Umer Irshad
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Zainab Rafi
- Cardiology, Sialkot Medical College, Sialkot, PAK
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Zhang Z, Kang J, Hong YS, Chang Y, Ryu S, Park J, Cho J, Guallar E, Shin HC, Zhao D. Long-Term Particulate Matter Exposure and Incidence of Arrhythmias: A Cohort Study. J Am Heart Assoc 2020; 9:e016885. [PMID: 33146044 PMCID: PMC7763729 DOI: 10.1161/jaha.120.016885] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Studies have shown that short-term exposure to air pollution is associated with cardiac arrhythmia hospitalization and mortality. However, the relationship between long-term particulate matter air pollution and arrhythmias is still unclear. We evaluate the prospective association between particulate matter (PM) air pollution and the risk of incident arrhythmia and its subtypes. Methods and Results Participants were drawn from a prospective cohort study of 178 780 men and women who attended regular health screening exams in Seoul and Suwon, South Korea, from 2002 to 2016. Exposure to PM with an aerodynamic diameter of ≤10 and ≤2.5 μm (PM10 and PM2.5, respectively) was estimated using a land-use regression model. The associations between long-term PM air pollution and arrhythmia were examined using pooled logistic regression models with time-varying exposure and covariables. In the fully adjusted model, the odds ratios (ORs) for any arrhythmia associated with a 10 μg/m3 increase in 12-, 36-, and 60-month PM10 exposure were 1.15 (1.09, 1.21), 1.12 (1.06, 1.18), and 1.14 (1.08, 1.20), respectively. The ORs with a 10 μg/m3 increase in 12- and 36-month PM2.5 exposure were 1.27 (1.15, 1.40) and 1.10 (0.99, 1.23). PM10 was associated with increased risk of incident bradycardia and premature atrial contraction. PM2.5 was associated with increased risk of incident bradycardia and right bundle-branch block. Conclusions In this large cohort study, long-term exposure to outdoor PM air pollution was associated with increased risk of arrhythmia. Our findings indicate that PM air pollution may be a contributor to cardiac arrhythmia in the general population.
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Affiliation(s)
- Zhenyu Zhang
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Jeonggyu Kang
- Center for Cohort Studies Total Healthcare Center Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Yun Soo Hong
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Yoosoo Chang
- Center for Cohort Studies Total Healthcare Center Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea.,Department of Clinical Research Design and Evaluation SAIHST Seoul Republic of Korea.,Department of Occupational and Environmental Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Seungho Ryu
- Center for Cohort Studies Total Healthcare Center Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea.,Department of Clinical Research Design and Evaluation SAIHST Seoul Republic of Korea.,Department of Occupational and Environmental Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jihwan Park
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Juhee Cho
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Center for Cohort Studies Total Healthcare Center Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea.,Department of Clinical Research Design and Evaluation SAIHST Seoul Republic of Korea
| | - Eliseo Guallar
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Ho Cheol Shin
- Department of Family Medicine Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Di Zhao
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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Holden AV, Begg GA, Bounford K, Stegemann B, Tayebjee MH. Phase Entrainment of Induced Ventricular Fibrillation: A Human Feasibility and Proof of Concept Study. J Atr Fibrillation 2019; 12:2217. [PMID: 32435345 DOI: 10.4022/jafib.2217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/19/2019] [Accepted: 09/21/2019] [Indexed: 11/10/2022]
Abstract
Cardioversion and defibrillation by a single high energy shock applied by myocardial or body surface electrodes is painful, causes long term tissue damage, and is associated with worsening long term outcomes, but is almost always required for treatment of ventricular fibrillation . As a initial step towards developing methods that can terminate ventricular arrhythmias painlessly, we aim to determine if pacing stimuli at a rate of 5/s applied via an implantable cardiac defibrillator (ICD) can modify human ventricular fibrillation. In 8 patients undergoing defibrillation testing of a new/exchanged intracardiac defibrillator, five seconds of pacing at five stimuli per second was applied during the 10-20 seconds of induced ventricular fibrillation before the defibrillation shock was automatically applied, and the cardiac electrograms recorded and analyzed. The high frequency pacing did not entrain the ventricular fibrillation, but altered the dominant frequency in all 8 patients, and modulated the phase computed via the Hilbert Transform, in four of the patients. In this pilot study we demonstrate that high frequency pacing applied via ICD electrodes during VF can alter the dominant frequency and modulate the probability density of the phase of the electrogram of the ventricular fibrillation.
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Affiliation(s)
- Arun V Holden
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT; UK
| | - Gordon A Begg
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Katrina Bounford
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - Berthold Stegemann
- Medtronic Plc, Bakken Research Center, Endepolsdomein 5, 6229 GW Maastricht, The Netherlands
| | - Muzahir H Tayebjee
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
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Chang S, Tzou WS. Advances in Technologies to Improve Ventricular Ablation Safety and Efficacy. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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