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Selvi F, Korkut M, Bedel C, Kuş G, Zortuk Ö. Evaluation of Tpeak-end interval, Tpeak-end/QT, and Tpeak-end/Qtc ratio during acute migraine attack in the emergency department. Acta Neurol Belg 2024; 124:949-955. [PMID: 38472697 DOI: 10.1007/s13760-024-02497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION During an acute migraine attack, changes in ventricular repolarisation parameters may occur due to an imbalance in the autonomic nervous system. Tpeak-tend (Tp-e) interval, Tp-e/QT ratio, and Tp-e/corrected QT (QTc) ratio are novel parameters of arrhythmogenesis and can be easily calculated in electrocardiography (ECG). The objective of this study is to demonstrate that novel ventricular repolarisation parameters can anticipate the risk of ventricular dysrhythmia in the migraine attack period. METHODS This research was a prospective case-control study, which recruited a total of 144 participants, including 74 migraine patients and 70 healthy volunteers in the control group (CG) who met the criteria for migraine with or without aura. All participants underwent 12-lead ECG recordings, and the study compared the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio with those of the CG. RESULTS The average age of patients experiencing migraine attacks was 38.14 ± 10.82, with 58 (76%) of these patients being female. The Tp-e interval mean was higher in the migraine attack group than the CG, with a statistically significant difference discovered (74.22 ± 20.20 ms [ms] compared to 65.39 ± 11.33 ms, p = 0.001). However, there were higher mean Tp-e/QT and Tp-e/QTc ratios in the migraine attack group compared to the CG, and this difference was found to be statistically significant (0.20 ± 0.05 vs. 0.17 ± 0.03, p = 0.001, 0.18 ± 0.52 vs 0.16 ± 0.29, p = 0.003, respectively). CONCLUSION Prolonged Tp-e interval and elevated Tp-e/QT and Tp-e/QTc ratios were observed in migraine patients who presented to the emergency department, indicating a potential risk of ventricular dysrhythmia.
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Affiliation(s)
- Fatih Selvi
- Antalya Training and Research Hospital: Antalya Egitim ve Arastirma Hastanesi, Antalya, Turkey.
| | - Mustafa Korkut
- Antalya Training and Research Hospital: Antalya Egitim ve Arastirma Hastanesi, Antalya, Turkey
| | - Cihan Bedel
- Antalya Training and Research Hospital: Antalya Egitim ve Arastirma Hastanesi, Antalya, Turkey
| | - Görkem Kuş
- Antalya Training and Research Hospital: Antalya Egitim ve Arastirma Hastanesi, Antalya, Turkey
| | - Ökkeş Zortuk
- Antalya Training and Research Hospital: Antalya Egitim ve Arastirma Hastanesi, Antalya, Turkey
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Jokonya L, Makarawo S, Mduluza-Jokonya TL, Ngwende G. Fatal status migrainosus in Chiari 1 malformation. Surg Neurol Int 2020; 10:243. [PMID: 31893144 PMCID: PMC6935960 DOI: 10.25259/sni_491_2019] [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] [Received: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 11/07/2022] Open
Abstract
Background: Headaches are common in Chiari Type 1 malformation (CM-1). The prevalence of migraine headaches in CM-1 is similar to that of the general population. However, when migraine headaches occur with CM-1, they tend to have an earlier age of onset, are more frequent and certainly more severe than when they occur without CM-1 association. The exact role or impact of CM-1 in migraine headaches has not been fully elucidated. Case Description: We report a fatal case of status migrainosus in 7 years old with CM-1 and review the literature on the possible associations. Conclusion: Migraines occurring in association with CM-1 pose a management challenge and can be potentially fatal especially if associated with autonomic symptoms. The exact pathophysiological interaction between these two conditions when they occur simultaneously needs to be further elucidated.
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Affiliation(s)
- Luxwell Jokonya
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Sydney Makarawo
- Department of Surgery, Parirenyatwa Hospital, Harare, Zimbabwe
| | | | - Gift Ngwende
- Department of Medicine, University of Zimbabwe, Harare, Zimbabwe
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Valuable research for recognising the relationship between the autonomic nervous system disturbance and migraine. Cardiol Young 2019; 29:1120. [PMID: 31284889 DOI: 10.1017/s1047951119001574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Öztürk M, Turan OE, Karaman K, Bilge N, Ceyhun G, Aksu U, Aksakal E, Gulcu O, Kalkan K, Demirelli S. Evaluation of ventricular repolarization parameters during migraine attacks. J Electrocardiol 2018; 53:66-70. [PMID: 30684863 DOI: 10.1016/j.jelectrocard.2018.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/10/2018] [Accepted: 12/21/2018] [Indexed: 01/03/2023]
Abstract
AIMS Migraine is a chronic neurovascular disorder characterized by intermittent episodes of severe headache. Abnormalities in the autonomic nervous system (sympathetic and parasympathetic nervous systems) have been detected during migraine-free periods in patients with migraine. In these patients, disrupted autonomic innervations of the heart and coronary arteries may lead to electrocardiographic changes during a migraine attack. T-wave peak-to-end interval (Tp-e interval) and Tp-e/QT ratio are relatively new markers of ventricular arrhythmogenesis and repolarization heterogeneity. In the present observational study, we investigated the changes in ventricular repolarization during migraine attacks and attack-free periods by performing 12‑lead electrocardiography (ECG). METHODS This study included 63 patients (54 [86%] women; mean age: 33.3 ± 9.9 years) with migraine. The QT and corrected QT (QTc) intervals, Tp-e interval, and Tp-e/QT ratio of the patients during migraine attacks and attack-free periods were measured by performing 12‑lead ECG. RESULTS The QT and QTc intervals, Tp-e interval, and Tp-e/QT ratio were higher during migraine attacks than during attack-free periods (P < 0.001 for all). CONCLUSION These results indicate that migraine attacks are associated with an increase in ventricular repolarization parameters compared with attack-free periods possibly because of the dysregulation of the autonomic nervous system.
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Affiliation(s)
- Mustafa Öztürk
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey.
| | | | - Kayıhan Karaman
- Department of Cardiology, Gaziosmanpaşa University, Faculty of Medicine, Tokat, Turkey
| | - Nuray Bilge
- Department of Neurology, Atatürk University, Faculty of Medicine, Erzurum, Turkey
| | - Gökhan Ceyhun
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Ugur Aksu
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Emrah Aksakal
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Oktay Gulcu
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Selami Demirelli
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
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Man YH, Meng XL, Yu TM, Yao G. Pacemaker implantation for treating migraine-like headache secondary to cardiac arrhythmia: A case report. Medicine (Baltimore) 2018; 97:e13629. [PMID: 30558049 PMCID: PMC6320178 DOI: 10.1097/md.0000000000013629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Co-occurrence of headache and arrhythmia is not rare. However, their causal relationship remains unclear. Here, we described a case of migraine-like headache relieving with pacemaker implantation. Our case study indicates that arrhythmia is causal for migraine-like headache, which, to our knowledge, has never been reported. PATIENT CONCERNS A 63-year-old woman patient suffered from paroxysmal headache with a visual aura presenting like migraine for 2 years. No ophthalmic or neurological disorder was found, but cardiac examination detected bradycardia, which was confirmed by 24-hour dynamic electrocardiogram (DCG) revealing sinus bradycardia mixed with ventricular premature beats and supraventricular tachycardia. Transcranial doppler (TCD) detected an equal echo flat plaque on the anterolateral wall of the common carotid artery (CA) bifurcation. DIAGNOSIS Migraine-like headaches secondary to arrhythmia. INTERVENTIONS The patient underwent pacemaker implantation. OUTCOMES Both visual aura and headache were resolved following pacemaker implantation. LESSONS To the best of the authors' knowledge, we are the first to report migraine-like headache as a secondary symptom of arrhythmia. Arrhythmia may aggravate insufficient blood supply to the brain due to CA lesion and induce a migraine-like headache. This case study indicated that pacemaker implantation could be a fundamental treatment for migraine-like headaches caused by cardiac arrhythmia.
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MESH Headings
- Bradycardia/complications
- Bradycardia/diagnosis
- Bradycardia/therapy
- Carotid Artery, Common/diagnostic imaging
- Carotid Artery, Common/pathology
- Diagnosis, Differential
- Electrocardiography, Ambulatory/methods
- Female
- Headache Disorders, Secondary/diagnosis
- Headache Disorders, Secondary/etiology
- Headache Disorders, Secondary/therapy
- Humans
- Middle Aged
- Migraine with Aura/diagnosis
- Pacemaker, Artificial
- Tachycardia, Supraventricular/complications
- Tachycardia, Supraventricular/diagnosis
- Tachycardia, Supraventricular/therapy
- Treatment Outcome
- Ultrasonography, Doppler, Transcranial/methods
- Ventricular Premature Complexes/complications
- Ventricular Premature Complexes/diagnosis
- Ventricular Premature Complexes/therapy
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Hostiuc S, Rusu MC, Hostiuc M, Negoi RI, Negoi I. Cardiovascular consequences of myocardial bridging: A meta-analysis and meta-regression. Sci Rep 2017; 7:14644. [PMID: 29116137 PMCID: PMC5677117 DOI: 10.1038/s41598-017-13958-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/02/2017] [Indexed: 01/18/2023] Open
Abstract
Myocardial bridging, a congenital abnormality in which a coronary artery tunnels through the myocardial fibres was usually considered a benign condition. Many studies suggested a potential hemodynamic significance of myocardial bridging and some, usually case reports, implied a possible correlation between it and various cardiovascular pathologies like acute myocardial infarction, ventricular rupture, life-threatening arrhythmias, hypertrophic cardiomyopathy, apical ballooning syndrome or sudden death. The main objective of this article is to evaluate whether myocardial bridging may be associated with significant cardiac effects or if it is strictly a benign anatomical variation. To this purpose, we performed a meta-analysis (performed using the inverse variance heterogeneity model) and meta-regression, on scientific articles selected from three main databases (Scopus, Web of Science, Pubmed). The study included 21 articles. MB was associated with major adverse cardiac events - OR = 1.52 (1.01–2.30), and myocardial ischemia OR = 3.00 (1.02–8.82) but not with acute myocardial infarction, cardiovascular death, ischemia identified using imaging techniques, or positive exercise stress testing. Overall, myocardial bridging may have significant cardiovascular consequences (MACE, myocardial ischemia). More studies are needed to reveal/refute a clear association with MI, sudden death or other cardiovascular pathologies.
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Affiliation(s)
- Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Department 2 Morphological Sciences, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Mugurel Constantin Rusu
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,MEDCENTER, Centre of Excellence in Laboratory Medicine and Pathology, Bucharest, Romania
| | - Mihaela Hostiuc
- Department of Internal Medicine and Gastroenterology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ruxandra Irina Negoi
- Department of Anatomy, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ionuț Negoi
- Department of Surgery, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Hostiuc S, Negoi I, Rusu MC, Hostiuc M. Myocardial Bridging: A Meta-Analysis of Prevalence. J Forensic Sci 2017; 63:1176-1185. [PMID: 29044562 DOI: 10.1111/1556-4029.13665] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/02/2017] [Accepted: 09/05/2017] [Indexed: 01/27/2023]
Abstract
The main objective of this article was to analyze prevalence data about myocardial bridging (MB) in published studies. To this purpose, we performed a meta-analysis of studies published in English literature that contained data about the prevalence of MB and its anatomical characteristics. The overall prevalence was 19% (CI: 17-21%); autopsy studies revealed an overall prevalence of 42% (CI: 30-55%), CT studies 22% (CI: 18-25%), and coronary angiography 6% (CI: 5-8%). Most bridges were located on the left anterior descending artery (82% overall, 63% on autopsy studies), had a mean thickness of 2.47 mm and a mean length of 19.3 mm. In conclusion, autopsy studies should be the gold standard in evaluating the actual prevalence of myocardial bridges, while in vivo high-resolution CT scanning should be preferred to coronary angiography studies.
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Affiliation(s)
- Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ionuț Negoi
- Department of Surgery, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, 042122
| | - Mugurel C Rusu
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, 020021.,MEDCENTER, Centre of Excellence in Laboratory Medicine and Pathology, Bucharest, Romania, 021021
| | - Mihaela Hostiuc
- Department of Internal Medicine and Gastroenterology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, 020021
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Yao G, Zhang XM. A Valuable Case for Recognizing the Relationship between Arrhythmia and the Biology of Migraine with Brainstem Aura. J Forensic Sci 2016; 61:288. [PMID: 27404408 DOI: 10.1111/1556-4029.12983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gang Yao
- Department of Neurology, The Second Hospital, Jilin University, 130041 Changchun, Jilin, China. .,Applied Immunology & Immunotherapy, Center for Molecular Medicine, Karolinska University Hospital at Solna, Department of Clinical Neuroscience, Karolinska Sjukhuset, S-171 76 Stockholm, Sweden.
| | - Xing-Mei Zhang
- Applied Immunology & Immunotherapy, Center for Molecular Medicine, Karolinska University Hospital at Solna, Department of Clinical Neuroscience, Karolinska Sjukhuset, S-171 76 Stockholm, Sweden
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