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Littmann L. It's Greek To Me: Electrocardiographic Lambda Sign. Am J Med 2024:S0002-9343(24)00499-6. [PMID: 39142362 DOI: 10.1016/j.amjmed.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024]
Affiliation(s)
- Laszlo Littmann
- From the Department of Internal Medicine, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA.
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2
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Wu YH, Li AH, Chen TC, Liu JK, Tsai KC, Ho MP. Compared with physician overread, computer is less accurate but helpful in interpretation of electrocardiography for ST-segment elevation myocardial infarction. J Electrocardiol 2023; 81:60-65. [PMID: 37572584 DOI: 10.1016/j.jelectrocard.2023.07.013] [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: 06/21/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Previous studies have demonstrated varying sensitivity and specificity of computer-interpreted electrocardiography (CIE) in identifying ST-segment elevation myocardial infarction (STEMI). This study aims to evaluate the accuracy of contemporary computer software in recognizing electrocardiography (ECG) signs characteristic of STEMI compared to emergency physician overread in clinical practice. MATERIAL AND METHODS In this retrospective observational single-center study, we reviewed the records of patients in the emergency department (ED) who underwent ECGs and troponin tests. Both the Philips DXL 16-Lead ECG. Algorithm and on-duty emergency physicians interpreted each standard 12‑lead ECG. The sensitivity and specificity of computer interpretation and physician overread ECGs for the definite diagnosis of STEMI were calculated and compared. RESULTS Among the 9340 patients included in the final analysis, 133 were definitively diagnosed with STEMI. When "computer-reported infarct or injury" was used as the indicator, the sensitivity was 87.2% (95% CI 80.3% to 92.4%) and the specificity was 86.2% (95% CI 85.5% to 86.9%). When "physician-overread STEMI" was used as the indicator, the sensitivity was 88.0% (95% CI 81.2% to 93.0%) and the specificity was 99.9% (95% CI 99.8% to 99.9%). The area under the receiver operating characteristic curve for physician-overread STEMI and computer-reported infarct or injury were 0.939 (95% CI 0.907 to 0.972) and 0.867 (95% CI 0.834 to 0.900), respectively. CONCLUSIONS This study reveals that while the sensitivity of the computer in recognizing ECG signs of STEMI is similar to that of physicians, physician overread of ECGs is more specific and, therefore, more accurate than CIE.
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Affiliation(s)
- Yuan-Hui Wu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
| | - Ai-Hsien Li
- Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tsan-Chi Chen
- Department of Medical Research, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Jen-Kuei Liu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuang-Chau Tsai
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Min-Po Ho
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Lasica R, Djukanovic L, Savic L, Krljanac G, Zdravkovic M, Ristic M, Lasica A, Asanin M, Ristic A. Update on Myocarditis: From Etiology and Clinical Picture to Modern Diagnostics and Methods of Treatment. Diagnostics (Basel) 2023; 13:3073. [PMID: 37835816 PMCID: PMC10572782 DOI: 10.3390/diagnostics13193073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Although the frequency of myocarditis in the general population is very difficult to accurately determine due to the large number of asymptomatic cases, the incidence of this disease is increasing significantly due to better defined criteria for diagnosis and the development of modern diagnostic methods. The multitude of different etiological factors, the diversity of the clinical picture, and the variability of the diagnostic findings make this disease often demanding both for the selection of the diagnostic modality and for the proper therapeutic approach. The previously known most common viral etiology of this disease is today overshadowed by new findings based on immune-mediated processes, associated with diseases that in their natural course can lead to myocardial involvement, as well as the iatrogenic cause of myocarditis, which is due to use of immune checkpoint inhibitors in the treatment of cancer patients. Suspecting that a patient with polymorphic and non-specific clinical signs and symptoms, such as changes in ECG and echocardiography readings, has myocarditis is the starting point in the diagnostic algorithm. Cardio magnetic resonance imaging is non-invasive and is the gold standard for diagnosis and clinical follow-up of these patients. Endomyocardial biopsy as an invasive method is the diagnostic choice in life-threatening cases with suspicion of fulminant myocarditis where the diagnosis has not yet established or there is no adequate response to the applied therapeutic regimen. The treatment of myocarditis is increasingly demanding and includes conservative methods of treating heart failure, immunomodulatory and immunospressive therapy, methods of mechanical circulatory support, and heart transplantation. The goal of developing new diagnostic and therapeutic methods is to reduce mortality from this complex disease, which is still high.
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Affiliation(s)
- Ratko Lasica
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Lazar Djukanovic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
| | - Lidija Savic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Gordana Krljanac
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Marija Zdravkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Cardiology, University Medical Center Bezanijska Kosa, 11000 Belgrade, Serbia
| | - Marko Ristic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | | | - Milika Asanin
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Arsen Ristic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
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Li J, Zhang F, Lu Y. Bevacizumab-induced arrhythmia in a patient with lung adenocarcinoma: A case report. Medicine (Baltimore) 2023; 102:e34799. [PMID: 37657003 PMCID: PMC10476766 DOI: 10.1097/md.0000000000034799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/27/2023] [Indexed: 09/03/2023] Open
Abstract
RATIONALE Cardiotoxicity is an important side effect of vascular endothelial growth factor inhibitors therapy in the treatment of cancer. Massive studies have shown bevacizumab-related hypertension, venous, and arterial thrombosis. PATIENT CONCERNS A 56-year-old female patient was treated with bevacizumab monotherapy for lung adenocarcinoma. The patient was detected a poor R-wave increase with slight ST segment elevation in V1-V3 leads, and ventricular arrhythmia. DIAGNOSIS The incidental arrhythmia caused by bevacizumab was considered. INTERVENTIONS The patients received aspirin and amiodarone (0.2 g tid) to treat arrhythmia. After consultation with the cardiology department, the patient received a diagnostic coronary angiography. Coronary angiography showed 30% of the right coronary artery stenoses and no obvious organic stenosis in the left main artery, left anterior ascending, or left circumflex. OUTCOMES The patient exhibited disappearance of chest tightness and rapid heartbeat after the treatment of amiodarone. Electrocardiogram monitoring results returning to normal. LESSONS This is the first reported case of bevacizumab-associated arrhythmia. It is advisable to consider the risk of arrhythmia in bevacizumab monotherapy or combines treatment.
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Affiliation(s)
- Jing Li
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Furong Zhang
- Department of Pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Lu
- Department of Pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yue XL, Shi XY, Jiang M, Li RJ. Acute pulmonary embolism presenting with electrocardiographic signs and serum biomarkers of ST-segment elevation myocardial infarction: a case report. J Int Med Res 2023; 51:3000605231197063. [PMID: 37677144 PMCID: PMC10492495 DOI: 10.1177/03000605231197063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 08/08/2023] [Indexed: 09/09/2023] Open
Abstract
Acute pulmonary embolism (APE) with ST-segment elevation and an upward T-wave is rare, and only a few cases have been reported to date. We herein present a case involving a man in his early 70s with an 8-hour history of dyspnea. Serial electrocardiography (ECG) demonstrated ST-segment elevation in leads V1 to V3 with an upward T-wave, laboratory tests revealed a high serum concentration of high-sensitivity cardiac troponin I, and signs of acute myocardial infarction were present. However, emergency coronary angiography revealed normal coronary arteries. A subsequent computed tomography scan of the pulmonary arteries showed findings consistent with APE. The patient's chest tightness was relieved after catheter-directed thrombolysis. Postoperative ECG showed that the ST-segment in leads V1 to V3 had fallen back and that the T-wave was inverted. The patient was discharged on rivaroxaban therapy. Clinically, the ECG findings of ST-segment elevation and an upward T-wave in APE can be easily misdiagnosed as acute myocardial infarction. Physicians should maintain clinical suspicion through risk stratification to identify APE.
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Affiliation(s)
- Xiao-lin Yue
- Qilu Medical College, Shandong University, Jinan, China
| | - Xue-yun Shi
- Qilu Medical College, Shandong University, Jinan, China
| | - Mei Jiang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
| | - Rui-jian Li
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
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Fan G, Zhou C, Hou T, Li X, Wang L, Wang C. Effects of Sacubitril/Valsartan on cardiac function, blood biochemistry and clinical efficacy in early ventricular remodeling after acute myocardial infarction. Biotechnol Genet Eng Rev 2023:1-16. [PMID: 37043670 DOI: 10.1080/02648725.2023.2197312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Ventricular remodeling (VR) after acute ST-elevation myocardial infarction (STEMI) is an important predictor for medium- and long-term prognosis. This study focuses on the relevant indexes of VR in patients with AMI, in which, the intervention effects of sacubitril/valsartan and enalapril were compared, guiding the clinical treatment. 58 patients with acute STEMI treated with PCI were divided into research group and control group. UCG was performed at 1 week, 1 month and 3 months after MI, and the patients' indexes were collected to compare VR and adverse reactions in the two groups. The test results showed that there was no statistical difference in the baseline data of patients in the two groups, which were comparable. In the blood biochemical index examination, no statistical difference was found in cTnI and NT-proBNP between the two groups. At 1 week after operation, the levels of cTnI and NT-proBNP in research group were lower than those in the control group. In ECG examination, there was no statistical significance in the levels of LVEF, LVEDD and LVESD at admission between the two groups. After 1 week, the results of LVEF, LVEDD, LVESD in the research group were higher than those in the control group. The results of this study show that sacubitril/valsartan can be used in patients with AMI instead of enalapril. Sacubitril/valsartan improves cardiac function in patients with emergency percutaneous coronary intervention (PCI) for AMI, inhibits ventricular remodeling, and has a low incidence of adverse cardiac events and adverse drug reactions.
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Affiliation(s)
- Guangci Fan
- Department of Cardiovascular (II), Hiser Medical Center of Qingdao, Qingdao Hiser Hospital Affiliated to Qingdao University, Qingdao, Shandong, China
| | - Chunyan Zhou
- Department of Pharmacy, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, Shandong, China
| | - Tingting Hou
- Department of Pharmacy, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, Shandong, China
| | - Xiaowen Li
- Department of Endoscopy Room, Zhangqiu District People's Hospital, Jinan, Shandong, China
| | - Liang Wang
- Department of Trauma Orthopedics, Zhangqiu District People's Hospital, Jinan, Shandong, China
| | - Chenghong Wang
- Department of Clinical Laboratory, Yantaishan Hospital of Yantai, Yantai, Shandong China
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ECG criteria to distinguish hypertrophic cardiomyopathy featured with "Pseudo-STEMI" from acute ST-elevation myocardial infarction. J Electrocardiol 2023; 77:10-16. [PMID: 36527914 DOI: 10.1016/j.jelectrocard.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUD The ECG profile of Hypertrophic Cardiomyopathy (HCM) includes ST-segment elevation (STE) that may lead to misdiagnosis of acute ST-segment elevation myocardial infarction (STEMI). This pseudo-STEMI may bring non-essential treatment. We aimed to confirm the ECG differences between HCM featured with pseudo-STEMI and acute STEMI. MATERIAL AND METHODS We retrospectively enrolled 59 HCM cases (Group A) and 56 acute STEMI cases (Group B). Based on the locations of STE, all the patients were divided into four subgroups, including HCM with STE in anterior leads (Group A1), anterior STEMI (Group B1), HCM with STE in inferior leads (Group A2) and inferior STEMI (Group B2). Several ECG parameters were compared between these subgroups. RESULTS ECG parameters significantly differed between these groups, especially the number of leads with TWI. We evaluated the diagnostic value of ECG profiles for those groups. ROC analysis showed that for Group A vs. Group B, number of leads with TWI showed the highest AUC value of 0.805 and its cutoff of 2.5, with 76.3% sensitivity and 76.8% specificity. For Group A1 vs. Group B1, it showed the highest AUC value of 0.801 and its cut-off point was 2.5, with 77.1% sensitivity and 79.1% specificity. For Group A2 vs. Group B2, it showed the highest AUC value of 0.822 and the cut-off value was 4.5, with 54.5% sensitivity and 92.3% specificity. CONCLUSION ECG plays a valid tool to distinguish "Pseudo-STEMI" HCM from acute STEMI, especially number of leads with TWI.
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Mercik J, Radziejewska J, Pach K, Zawadzki G, Zyśko D, Gajek J. ST-segment depression in atrioventricular nodal reentrant tachycardia: Important finding or just an artifact? Medicine (Baltimore) 2022; 101:e31806. [PMID: 36626431 PMCID: PMC9750532 DOI: 10.1097/md.0000000000031806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The ST segment is component of the QRS-T complex located between the QRS and the T wave. ST segment changes during tachycardia with narrow QRS mainly takes the form of ST segment depression. This phenomenon is often observed in young healthy people for whom an ischemic background is unlikely. MATERIALS AND METHODS The study included 104 patients (71 women and 33 men) with paroxysmal narrow QRS complex tachycardia. In all patients electrophysiological study was performed and the diagnosis of atrioventricular nodal reentrant tachycardia was established. The arrhythmogenic substrate was then eliminated successfully by subsequent ablation using radiofrequency energy which confirmed the diagnosis, all patients had measured QRS components - QR, RS and RJ during the tachycardia and during the sinusrhythm. All of the measurements were done in lead V5. RESULTS The difference RJ-QR during tachycardia and sinus rhythm correlated negatively with tachycardia cycle length (R = 0.356, P = .001), first slowly, then rapidly reaching the cycle value of about 300 ms, then it decreases, stabilizing at the cycle level of about 270. By separating the RJ-QR in tachycardia and in the sinus rhythm from the tachycardia cycle, we can see that the correlation described in this point is largely due to the correlation between the heart rate and RJ-QR length in tachycardia. CONCLUSIONS In patients with atrioventricular nodal reentrant tachycardia, there is a significant ST-segment depression during tachycardia episodes and the degree of this change is related to tachycardia cycle length. The most probable explanation of the ST-segment depression is the overlap of the QRS complex on the preceded T wave. This phenomenon is also influenced by some intrinsic properties of the individual electrocardiogram. It is possible to rule out ischemic origin of the presented ST segment change.
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Affiliation(s)
- Jakub Mercik
- Department of Emergency Medicine, Wroclaw Medical University, Poland
| | | | - Katarzyna Pach
- Students’ Scientific Association, Department of Emergency Medical Service, Wroclaw Medical University, Poland
| | - Grzegorz Zawadzki
- Students’ Scientific Association, Department of Emergency Medical Service, Wroclaw Medical University, Poland
| | - Dorota Zyśko
- Department of Emergency Medicine, Wroclaw Medical University, Poland
| | - Jacek Gajek
- Department of Emergency Medical Service, Wroclaw Medical University, Poland
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Rhana P, Barros GM, Santos VCDO, Costa AD, Santos DMD, Fernandes-Braga W, Durço AO, Santos MRV, Roman-Campos D, Vasconcelos CMLD, Cruz JS, Souza DS. S-limonene protects the heart in an experimental model of myocardial infarction induced by isoproterenol: Possible involvement of mitochondrial reactive oxygen species. Eur J Pharmacol 2022; 930:175134. [PMID: 35843301 DOI: 10.1016/j.ejphar.2022.175134] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/19/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Myocardial infarction (MI) is associated with high mortality rates, despite the fact that there are therapies available. Importantly, excessive oxidative stress may contribute to ischemia/reperfusion injury leading to death related to MI. In this scenario, naturally occurring antioxidant compounds are an important source of possible therapeutic intervention. Thus, this study sought to elucidate the mechanisms of cardioprotection of s-limonene in an isoproterenol-induced MI animal model. METHODS Wistar rats were treated with 1 mg/kg s-limonene (SL) or 100 mg/kg N-acetylcysteine (NAC, positive control) once, 30 min after isoproterenol-induced MI (applied in two doses with a 24 h interval). The protective effects of SL in the heart were examined via the serum level of creatine kinase myocardial band (CK-MB), electrocardiographic profile, infarct size and histological parameters. Using isolated cardiomyocytes, we also assessed calcium transient amplitude, cytosolic and mitochondrial oxidative stress and the expression of proteins related to oxidative stress. RESULTS SL at a concentration of 1 mg/kg attenuated isoproterenol-induced MI injury, by preventing ST-segment elevation and QTc prolongation in the ECG. SL reduced the infarct size and collagen content in cardiac tissue. At the cellular level, SL prevented increased Ca2+, associated with attenuation of cytosolic and mitochondrial oxidative stress. These changes resulted in a reduction of the oxidized form of Ca2+ Calmodulin-Dependent Kinase II (CaMKII) and restored superoxide dismutase and glutathione peroxidase activity. CONCLUSION Our data show that s-limonene promotes cardioprotection against MI injury, probably through inhibition of increased Ca2+ and attenuation of oxidative stress via CaMKII.
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Affiliation(s)
- Paula Rhana
- Department of Physiology and Membrane Biology, University of California Davis, Davis, USA; Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Alexandre Dantas Costa
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Danillo Menezes Dos Santos
- Department of Physiology, Federal University of Sergipe, São Cristóvão, Brazil; Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | - Weslley Fernandes-Braga
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Aimée Obolari Durço
- Department of Physiology, Federal University of Sergipe, São Cristóvão, Brazil; Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | - Márcio Roberto Viana Santos
- Department of Physiology, Federal University of Sergipe, São Cristóvão, Brazil; Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | - Danilo Roman-Campos
- Department of Biophysics, Federal University of São Paulo, São Paulo, Brazil
| | | | - Jader Santos Cruz
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | - Diego Santos Souza
- Department of Biophysics, Federal University of São Paulo, São Paulo, Brazil.
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Jiménez-Serrano S, Rodrigo M, Calvo C, Millet J, Castells F. From 12 to 1 ECG lead: multiple cardiac condition detection mixing a hybrid machine learning approach with a one-vs-rest classification strategy. Physiol Meas 2022; 43. [PMID: 35609610 DOI: 10.1088/1361-6579/ac72f5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/24/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Detecting different cardiac diseases using a single or reduced number of leads is still challenging. This work aims to provide and validate an automated method able to classify ECG recordings. Performance using complete 12-lead systems, reduced lead sets, and single-lead ECGs is evaluated and compared. APPROACH Seven different databases with 12-lead ECGs were provided during the PhysioNet/Computing in Cardiology Challenge 2021, where 88,253 annotated samples associated with none, one, or several cardiac conditions among 26 different classes were released for training, whereas 42,896 hidden samples were used for testing. After signal preprocessing, 81 features per ECG-lead were extracted, mainly based on heart rate variability, QRST patterns and spectral domain. Next, a One-vs-Rest classification approach made of independent binary classifiers for each cardiac condition was trained. This strategy allowed each ECG to be classified as belonging to none, one or several classes. For each class, a classification model among two binary Supervised Classifiers and one Hybrid Unsupervised-Supervised classification system was selected. Finally, we performed a 3-fold cross-validation to assess the system's performance. MAIN RESULTS Our classifiers received scores of 0.39, 0.38, 0.39, 0.38, and 0.37 for the 12, 6, 4, 3 and 2-lead versions of the hidden test set with the Challenge evaluation metric (CM). Also, we obtained a mean G-score of 0.80, 0.78, 0.79, 0.79, 0.77 and 0.74 for the 12, 6, 4, 3, 2 and 1-lead subsets with the public training set during our 3-fold cross-validation. SIGNIFICANCE We proposed and tested a machine learning approach focused on flexibility for identifying multiple cardiac conditions using one or more ECG leads. Our minimal-lead approach may be beneficial for novel portable or wearable ECG devices used as screening tools, as it can also detect multiple and concurrent cardiac conditions.
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Affiliation(s)
- Santiago Jiménez-Serrano
- Instituto ITACA, Universitat Politècnica de València, Camino de Vera s/n, Valencia, Comunitat Valenciana, 46022, SPAIN
| | - Miguel Rodrigo
- CoMMLab, Universitat de València, Av. de Blasco Ibáñez, 13, Valencia, Comunitat Valenciana, 46010, SPAIN
| | - Conrado Calvo
- Universitat Politècnica de València, Camino de Vera s/n, Valencia, Comunitat Valenciana, 46022, SPAIN
| | - José Millet
- Instituto ITACA, Universitat Politecnica de Valencia, Camino de Vera s/n, Valencia, Comunitat Valenciana, 46022, SPAIN
| | - Francisco Castells
- Instituto ITACA, Universitat Politecnica de Valencia, Camino de Vera s/n, Valencia, Comunitat Valenciana, 46022, SPAIN
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Raj Kulshrestha M, Raj A, Tiwari V, Chandra S, Tiwari BC, Jha A. Evaluation of Dual Marker Approach Using Heart-Type Fatty Acid Binding Protein and High Sensitivity Troponin-I as an Alternative to Serial Sampling for Diagnosis of Acute Myocardial Infarction. EJIFCC 2022; 33:43-55. [PMID: 35645696 PMCID: PMC9092720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Objective An early rule in (high specificity and high PPV) and early rule out (high sensitivity and high NPV) is essential for diagnosing acute myocardial infarction (AMI) to provide better utilization of resources, cost-effectiveness, and to reduce mortality. Methods Consecutive chest pain patients (n=80) with symptoms indicative of coronary artery disease reported to the emergency room within 6 hours after onset of symptoms. An alternate Dual Marker Approach (DMA; both Heart-type Fatty Acid Binding Protein (H-FABP) and High sensitive Troponin-I (hsTnI) at 0 h) was compared to the Double Sampling approach (DSA; hsTnI at 0 h and 3 h (ESC guidelines)). Results If both biomarkers were increased (n=17; 77.5%: 11 STEMI and 6 NSTEMI) above their respective cut-off value (HFABP 6.3 ng/mL and hsTnI 20.24 ng/L) at presentation, AMI ensued (100% PPV). Also, if both the markers were below their respective cut-offs at presentation, AMI was safely ruled out (n=41; with only 1 false negative). However, among the patients with either of these markers above their respective cut-off at presentation (n=22), DSA was required to find remaining AMI cases (n=4). Overall, DMA stands best for rule out (sensitivity 95.5%, NPV 97.6%) while DSA is superior for rule in (98.2% specificity, 95.2% PPV). Conclusion With the use of the proposed DMA, 58/80 (72.5%) patients with acute chest pain were reliably ruled in/ruled out for AMI at the presentation itself, while the remaining patients still required serial monitoring (DSA) for confirmation.
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Affiliation(s)
- Manish Raj Kulshrestha
- Department of Biochemistry, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Apurva Raj
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Vandana Tiwari
- Department of Biochemistry, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India,Corresponding author: Dr. Vandana Tiwari Professor & Head Department of Biochemistry Dr. Ram Manohar Lohia Institute of Medical Sciences Lucknow, 226010 India Phone: +919415197228 E-mail:
| | - Subrat Chandra
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Bhuwan Chandra Tiwari
- Department of Cardiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Ashish Jha
- Department of Cardiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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12
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Birnbaum Y, Rankinen J, Jneid H, Atar D, Nikus K. The Role of ECG in the Diagnosis and Risk Stratification of Acute Coronary Syndromes: an Old but Indispensable Tool. Curr Cardiol Rep 2022; 24:109-118. [PMID: 35028816 DOI: 10.1007/s11886-021-01628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Since its inception in 1902 by Willem Einthoven, the electrocardiogram (ECG) has fundamentally undergone minimal technological advances. Nevertheless, its clinical utility is critical, and it remains an essential tool to diagnose, risk stratify, and guide reperfusion and invasive strategies in patients with suspected acute coronary syndromes. ECG reading can be demanding, with many healthcare professionals lacking the necessary expertise to accurately interpret them. This is exacerbated by the need to constantly revisit old dogmas pertinent to the interpretation of ECGs. RECENT FINDINGS Notably, ECG leads record the global electrical activity of the heart toward and away from each electrode rather than local events. The long-held central paradigm that the various ECG leads record local events underneath specific electrodes should therefore be reassessed. For example, ST segment elevation in leads V1 and V2 usually denote antero-apical rather than septal infarction, often a misnomer utilized by the majority of clinicians. The ECG diagnosis of ST-elevation myocardial infarction (STEMI) is sometimes challenging and discerning it from non-ST-elevation myocardial infarction (NSTEMI) is of paramount importance to implement timely acute reperfusion therapy. In fact, when qualifications for emergency reperfusion therapy are based on STEMI ECG criteria, nearly one-third of cases with acute coronary occlusion are missed. Diagnostic ST elevation in the absence of left ventricular (LV) hypertrophy or left bundle-branch block (LBBB) is defined by a specific set of sex-specific criteria for new ST elevation at the J point in contiguous precordial or limb leads. However, other ECG criteria need to be kept in mind. These include, but are not limited to, new or presumably new left bundle branch block (LBBB), which is often considered as an STEMI-equivalent; ST depression in two or more precordial leads (V1-V4), denoting a true inferolateral transmural myocardial infarction; and the infrequent presentation with hyperacute T-wave changes. As our understanding of the pathology of ischemic reperfusion injury has evolved and following the introduction of new imaging modalities such as cardiac magnetic resonance imaging, we need to re-assess the old dogmas pertinent to the interpretation of ECGs and update the terms and classifications.
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Affiliation(s)
- Yochai Birnbaum
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, MS: BCM620, 77030, USA.
| | - Jani Rankinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hani Jneid
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, MS: BCM620, 77030, USA
| | - Dan Atar
- Dept. of Cardiology, Institute of Clinical Medicine, Oslo University Hospital Ulleval, University of Oslo, Oslo, Norway, Norway
| | - Kjell Nikus
- Heart Center, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland
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13
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Radha R, Al-Sayah MH. Development of Liposome-Based Immunoassay for the Detection of Cardiac Troponin I. Molecules 2021; 26:molecules26226988. [PMID: 34834080 PMCID: PMC8623906 DOI: 10.3390/molecules26226988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular diseases (CVDs) are one of the foremost causes of mortality in intensive care units worldwide. The development of a rapid method to quantify cardiac troponin I (cTnI)—the gold-standard biomarker of myocardial infarction (MI) (or “heart attack”)—becomes crucial in the early diagnosis and treatment of myocardial infarction (MI). This study investigates the development of an efficient fluorescent “sandwich” immunoassay using liposome-based fluorescent signal amplification and thereby enables the sensing and quantification of serum-cTnI at a concentration relevant to clinical settings. The calcein-loaded liposomes were utilized as fluorescent nano vehicles, and these have exhibited appropriate stability and efficient fluorescent properties. The standardized assay was sensitive and selective towards cTnI in both physiological buffer solutions and spiked human serum samples. The novel assay presented noble analytical results with sound dynamic linearity over a wide concentration range of 0 to 320 ng/mL and a detection limit of 6.5 ng/mL for cTnI in the spiked human serum.
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14
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Choi HJ, Kwon HW, Oh KJ, Song MK. Acute perimyocarditis mimicking acute myocardial infarction in a 12-year-old boy with duchenne muscular dystrophy: a case report. Acute Crit Care 2021; 37:258-262. [PMID: 34634842 PMCID: PMC9184981 DOI: 10.4266/acc.2021.00290] [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: 03/08/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022] Open
Abstract
Differential diagnosis of chest pain in the pediatric population is important but can be challenging. A 12-year-old boy with Duchenne muscular dystrophy presented with chest pain, cardiac enzyme elevation, and convex ST elevations in the inferior leads with reciprocal ST depression in the anterior leads on electrocardiogram. Echocardiography on admission revealed normal left ventricular function. Suspecting acute myocardial infarction, we performed invasive coronary angiography, which revealed normal coronary arteries. A follow-up electrocardiogram showed an acute pericarditis pattern with concave ST elevations in most leads and PR depression, and follow-up echocardiography revealed global left ventricular dysfunction, suggestive of acute perimyocarditis. Ibuprofen was administered for acute pericarditis, and a continuous milrinone infusion was commenced for myocardial dysfunction. The chest pain improved by the next day, and the ST segment elevations normalized on day 4. Echocardiography on day 9 revealed improved left ventricular function. The patient was discharged on day 11, and he is doing well without chest pain through 12 months of follow-up. The last electrocardiogram showed normal sinus rhythm without ST change. Differential diagnosis of acute myocardial infarction and acute perimyocarditis is important for proper treatment strategies and the different prognoses of these two conditions.
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Affiliation(s)
- Ho Jung Choi
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Hye Won Kwon
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Kyung Jin Oh
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
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15
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Kim B, Soepriatna AH, Park W, Moon H, Cox A, Zhao J, Gupta NS, Park CH, Kim K, Jeon Y, Jang H, Kim DR, Lee H, Lee KS, Goergen CJ, Lee CH. Rapid custom prototyping of soft poroelastic biosensor for simultaneous epicardial recording and imaging. Nat Commun 2021; 12:3710. [PMID: 34140475 PMCID: PMC8211747 DOI: 10.1038/s41467-021-23959-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/21/2021] [Indexed: 02/05/2023] Open
Abstract
The growing need for the implementation of stretchable biosensors in the body has driven rapid prototyping schemes through the direct ink writing of multidimensional functional architectures. Recent approaches employ biocompatible inks that are dispensable through an automated nozzle injection system. However, their application in medical practices remains challenged in reliable recording due to their viscoelastic nature that yields mechanical and electrical hysteresis under periodic large strains. Herein, we report sponge-like poroelastic silicone composites adaptable for high-precision direct writing of custom-designed stretchable biosensors, which are soft and insensitive to strains. Their unique structural properties yield a robust coupling to living tissues, enabling high-fidelity recording of spatiotemporal electrophysiological activity and real-time ultrasound imaging for visual feedback. In vivo evaluations of custom-fit biosensors in a murine acute myocardial infarction model demonstrate a potential clinical utility in the simultaneous intraoperative recording and imaging on the epicardium, which may guide definitive surgical treatments.
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Affiliation(s)
- Bongjoong Kim
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Arvin H Soepriatna
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Woohyun Park
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Haesoo Moon
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue College of Veterinary Medicine, West Lafayette, IN, USA
| | - Jianchao Zhao
- Chemical Diagnostics and Engineering, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Nevin S Gupta
- Chemical Diagnostics and Engineering, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Chi Hoon Park
- Chemical Diagnostics and Engineering, Los Alamos National Laboratory, Los Alamos, NM, USA
- Department of Energy Engineering, Gyeongnam National University of Science and Technology, Jinju-Si, Republic of Korea
| | - Kyunghun Kim
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Yale Jeon
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- School of Mechanical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Hanmin Jang
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- School of Mechanical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Dong Rip Kim
- School of Mechanical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Hyowon Lee
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Kwan-Soo Lee
- Chemical Diagnostics and Engineering, Los Alamos National Laboratory, Los Alamos, NM, USA.
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
| | - Chi Hwan Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA.
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
- Department of Materials Engineering, Purdue University, West Lafayette, IN, USA.
- Birck Nanotechnology Center, Purdue University, West Lafayette, IN, USA.
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16
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Eid BG, El-Shitany NAEA, Neamatallah T. Trimetazidine improved adriamycin-induced cardiomyopathy by downregulating TNF-α, BAX, and VEGF immunoexpression via an antioxidant mechanism. ENVIRONMENTAL TOXICOLOGY 2021; 36:1217-1225. [PMID: 33704910 DOI: 10.1002/tox.23120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Abstract
Few studies have reported a prophylactic effect of the anti-ischemic trimetazidine (TRI) against cardiac toxicity caused by adriamycin (ADR). However, the mechanism of action of TRI remained incomplete. The cardioprotective mechanism(s) of TRI against ADR-induced cardiotoxicity was investigated in this study. Cardiotoxicity was induced in three groups of Wistar rats by injecting a single dose of ADR (10 mg/kg, i.p.). TRI was administered in two doses regimen, low (L) (2.5 mg/kg, i.p.) and high (H) (10 mg/kg, i.p.). The results of the study showed that both TRI L and H doses improved cardiac enzymes and pathology, while only the TRI H dose improved the electrocardiogram. Both TRI L and H doses decreased malondialdehyde and increased reduced glutathione and superoxide dismutase. Only TRI H dose increased glutathione peroxidase and catalase. Both TRI L and H doses decreased interleukin-1 beta and tumor necrosis factor-alpha (TNF-α). Both TRI L and H doses downregulated TNF-α, BAX, and vascular endothelial growth factor cardiac protein expression. The data obtained in this study provided evidence that TRI opposed ADR-induced cardiotoxicity. The mechanism could be due to improved antioxidant levels as well as inhibition of inflammation and programmed cell death.
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Affiliation(s)
- Basma G Eid
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nagla Abd El-Aziz El-Shitany
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Thikryat Neamatallah
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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17
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Polcwiartek C, Atwater BD, Kragholm K, Friedman DJ, Barcella CA, Attar R, Graff C, Nielsen JB, Pietersen A, Søgaard P, Torp-Pedersen C, Jensen SE. Association Between ECG Abnormalities and Fatal Cardiovascular Disease Among Patients With and Without Severe Mental Illness. J Am Heart Assoc 2021; 10:e019416. [PMID: 33432845 PMCID: PMC7955293 DOI: 10.1161/jaha.120.019416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background ECG abnormalities are associated with adverse outcomes in the general population, but their prognostic significance in severe mental illness (SMI) remains unexplored. We investigated associations between no, minor, and major ECG abnormalities and fatal cardiovascular disease (CVD) among patients with SMI compared with controls without mental illness. Methods and Results We cross‐linked data from Danish nationwide registries and included primary care patients with digital ECGs from 2001 to 2015. Patients had SMI if they were diagnosed with schizophrenia, bipolar disorder, or severe depression before ECG recording. Controls were required to be without any prior mental illness or psychotropic medication use. Fatal CVD was assessed using hazard ratios (HRs) with 95% CIs and standardized 10‐year absolute risks. Of 346 552 patients, 10 028 had SMI (3%; median age, 54 years; male, 45%), and 336 524 were controls (97%; median age, 56 years; male, 48%). We observed an interaction between SMI and ECG abnormalities on fatal CVD (P<0.001). Severe mental illness was associated with fatal CVD across no (HR, 2.17; 95% CI, 1.95–2.43), minor (HR, 1.90; 95% CI, 1.49–2.42), and major (HR, 1.40; 95% CI, 1.26–1.55) ECG abnormalities compared with controls. Across age‐ and sex‐specific subgroups, SMI patients with ECG abnormalities but no CVD at baseline had highest standardized 10‐year absolute risks of fatal CVD. Conclusions ECG abnormalities conferred a poorer prognosis among patients with SMI compared with controls without mental illness. SMI patients with ECG abnormalities but no CVD represent a high‐risk population that may benefit from greater surveillance and risk management.
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Affiliation(s)
- Christoffer Polcwiartek
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Division of Cardiology Duke University Medical Center Durham NC.,Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Brett D Atwater
- Division of Cardiology Duke University Medical Center Durham NC
| | - Kristian Kragholm
- Department of Cardiology Aalborg University Hospital Aalborg Denmark
| | - Daniel J Friedman
- Section of Cardiac Electrophysiology Yale School of Medicine New Haven CT
| | - Carlo A Barcella
- Department of Cardiology Copenhagen University Hospital Gentofte Hellerup Denmark
| | - Rubina Attar
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Department of Clinical Sciences Lund University Lund Sweden
| | - Claus Graff
- Department of Health Science and Technology Aalborg University Aalborg Denmark
| | - Jonas B Nielsen
- Laboratory for Molecular Cardiology The Heart CenterCopenhagen University HospitalRigshospitalet Copenhagen Denmark
| | | | - Peter Søgaard
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Department of Cardiology and Clinical Research Nordsjælland Hospital Hillerød Denmark
| | - Svend E Jensen
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Department of Clinical Medicine Aalborg University Aalborg Denmark
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18
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Alqahtani F, Welle GA, Elsisy MF, Kalra A, Alhajji M, Boubas W, Berzingi C, Alkhouli M. Incidence, Characteristics, and Outcomes of Acute Myocardial Infarction among Patients Admitted with Acute Exacerbation of Chronic Obstructive Lung Disease. COPD 2020; 17:261-268. [PMID: 32366132 DOI: 10.1080/15412555.2020.1757054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The frequency, characteristics and outcomes of acute myocardial infarction (AMI) during exacerbation of chronic obstructive pulmonary disease (COPD) are unknown. Adult patients hospitalized with a principle diagnosis of acute COPD exacerbation were identified using retrospective analysis of the Nationwide Inpatient Sample (NIS) from 2003 to 2016. Patients were stratified into 2-groups with and without a secondary diagnosis of AMI. The study's endpoints were in-hospital morbidity, mortality, and resource utilization. We also assessed the impact of invasive management strategy on the same end-points. We included 6 894 712 hospitalizations, of which 56 515 (0.82%) were complicated with AMIs. Patients with AMI were older, and had higher prevalence of known coronary disease (48.9% vs. 27.4%), atrial fibrillation (23.3% vs. 15.2%), heart failure (47.8% vs. 26.2%), and anemia (20.7% vs. 14.8%) (p < 0.001). Rates of oxygen dependence were similar (16.3% vs. 16.1%, p = 0.24). In 56 486 propensity-matched pairs of patients with and without AMI, mortality was higher in the AMI group (12.1% vs. 2.1%, p < 0.001). Rates of major morbidities, non-home discharge, and cost were all higher in the AMI group. A minority (18.1%) of patients with AMI underwent invasive assessment, and those had lower in-hospital mortality before (4.9% vs. 13.8%) and after (5.0% vs. 10.0%) propensity-score matching (p < 0.001). This lower mortality persisted in a sensitivity analysis accounting for immortal time bias. AMI complicates ∼1% of patients admitted with acute COPD exacerbation, and those have worse outcomes than those without AMI. Invasive management for secondary AMI during acute COPD exacerbation may be associated with improved outcomes but is utilized in <20% of patients.
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Affiliation(s)
- Fahad Alqahtani
- Division of Cardiology, University of Kentucky, Lexington, KY, USA
| | - Garrett A Welle
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Mohamed F Elsisy
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Alhajji
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Wafaa Boubas
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Chalak Berzingi
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA
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19
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ter Haar CC, Peters RJG, Bosch J, Sbrollini A, Gripenstedt S, Adams R, Bleijenberg E, Kirchhof CJHJ, Alizadeh Dehnavi R, Burattini L, de Winter RJ, Macfarlane PW, Postema PG, Man S, Scherptong RWC, Schalij MJ, Maan AC, Swenne CA. An initial exploration of subtraction electrocardiography to detect myocardial ischemia in the prehospital setting. Ann Noninvasive Electrocardiol 2020; 25:e12722. [PMID: 31707764 PMCID: PMC7358788 DOI: 10.1111/anec.12722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/16/2019] [Accepted: 10/02/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In the prehospital triage of patients presenting with symptoms suggestive of acute myocardial ischemia, reliable myocardial ischemia detection in the electrocardiogram (ECG) is pivotal. Due to large interindividual variability and overlap between ischemic and nonischemic ECG-patterns, incorporation of a previous elective (reference) ECG may improve accuracy. The aim of the current study was to explore the potential value of serial ECG analysis using subtraction electrocardiography. METHODS SUBTRACT is a multicenter retrospective observational study, including patients who were prehospitally evaluated for acute myocardial ischemia. For each patient, an elective previously recorded reference ECG was subtracted from the ambulance ECG. Patients were classified as myocardial ischemia cases or controls, based on the in-hospital diagnosis. The diagnostic performance of subtraction electrocardiography was tested using logistic regression of 28 variables describing the differences between the reference and ambulance ECGs. The Uni-G ECG Analysis Program was used for state-of-the-art single-ECG interpretation of the ambulance ECG. RESULTS In 1,229 patients, the mean area-under-the-curve of subtraction electrocardiography was 0.80 (95%CI: 0.77-0.82). The performance of our new method was comparable to single-ECG analysis using the Uni-G algorithm: sensitivities were 66% versus 67% (p-value > .05), respectively; specificities were 80% versus 81% (p-value > .05), respectively. CONCLUSIONS In our initial exploration, the diagnostic performance of subtraction electrocardiography for the detection of acute myocardial ischemia proved equal to that of state-of-the-art automated single-ECG analysis by the Uni-G algorithm. Possibly, refinement of both algorithms, or even integration of the two, could surpass current electrocardiographic myocardial ischemia detection.
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Affiliation(s)
- Cornelia Cato ter Haar
- Department of CardiologyHeart CenterAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Department of CardiologyHeart‐Lung CenterLeiden University Medical CenterLeidenThe Netherlands
| | - Ron J. G. Peters
- Department of CardiologyHeart CenterAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jan Bosch
- Department of R&DRegionale Ambulancevoorziening Hollands MiddenLeidenThe Netherlands
| | - Agnese Sbrollini
- Department of Information EngineeringUniversità Politecnica delle MarcheAnconaItaly
| | - Sophia Gripenstedt
- Department of CardiologyHeart CenterAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Rob Adams
- Department of CardiologyHeart CenterAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | | | | | - Reza Alizadeh Dehnavi
- Department of CardiologyHeart‐Lung CenterLeiden University Medical CenterLeidenThe Netherlands
- Cardiology DepartmentGroene Hart HospitalGoudaThe Netherlands
| | - Laura Burattini
- Department of Information EngineeringUniversità Politecnica delle MarcheAnconaItaly
| | - Robbert J. de Winter
- Department of CardiologyHeart CenterAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | | | - Pieter G. Postema
- Department of CardiologyHeart CenterAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Sumche Man
- Department of CardiologyHeart‐Lung CenterLeiden University Medical CenterLeidenThe Netherlands
| | | | - Martin J. Schalij
- Department of CardiologyHeart‐Lung CenterLeiden University Medical CenterLeidenThe Netherlands
| | - Arie C. Maan
- Department of CardiologyHeart‐Lung CenterLeiden University Medical CenterLeidenThe Netherlands
| | - Cees A. Swenne
- Department of CardiologyHeart‐Lung CenterLeiden University Medical CenterLeidenThe Netherlands
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20
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Mortazavi A, Jelodar S, Edraki K, Narimani S, Ghorbani M, Karimi-Yarandi K, Asaadi S. Dual antiplatelet therapy in a patient with simultaneous aneurysmal subarachnoid hemorrhage and myocardial infarction. Surg Neurol Int 2020; 11:49. [PMID: 32257575 PMCID: PMC7110275 DOI: 10.25259/sni_472_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 02/05/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Electrocardiography (ECG) changes after subarachnoid hemorrhage (SAH) are well described. However, concurrent myocardial infarction (MI) and SAH are rarely reported, and its management remains a dilemma. We report a patient with traumatic SAH concurrent with acute MI that managed successfully by endovascular intervention and dual antiplatelet therapy. Case Description: A 47-year-old man was admitted to the emergency department with a complaint of severe headache. Diffuse SAH, with a Hunt and Hess score of 5, was noticed. ECG showed ST elevation in anterior leads, and cardiac troponin became positive. On brain computed tomography angiogram, a 6 mm anterior communicating artery aneurysm was seen. Considering the possibility of MI and SAH simultaneously, endovascular obliteration of the aneurysm was done, and then, the patient received dual antiplatelet medications until coronary angiography was done. Coronary angiography revealed normal epicardial coronary arteries. The patient was discharged with a Glasgow Coma Scale score of 15 and was visited 2 months after discharge without any new episodes of intracranial hemorrhage with a modified Rankin scale score of 2. Conclusion: Cerebral aneurysm coiling could be considered as the first choice of treatment in the case of acute MI with hemodynamic stability, before carrying out cardiac endovascular intervention or antiplatelet medication to reduce the risk of rebleeding from a brain aneurysm.
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Affiliation(s)
| | - Sina Jelodar
- Department of Neurosurgery, Sina Hospital, Tehran, Iran
| | - Keyvan Edraki
- Department of Neurosurgery, Sina Hospital, Tehran, Iran
| | - Sima Narimani
- Tehran Heart Center, Department of Interventional Cardiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghorbani
- Department of Neurosurgery, Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Sina Asaadi
- Department of Neurosurgery, Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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21
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Kim YS, Cha YS. The importance of systematic point-of-care ultrasound for chest pain with ST-segment elevation: A case report of takotsubo cardiomyopathy precipitated by spontaneous pneumothorax. HONG KONG J EMERG ME 2019. [DOI: 10.1177/1024907919893790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Patients with chest pain and concomitant ST-segment elevation on an electrocardiogram should be identified as having suspected ST-segment elevation myocardial infarction. However, various etiologies cause ST-segment elevation other than ST-segment elevation myocardial infarction, such as takotsubo cardiomyopathy. Case presentation: Here we report the case of a 77-year-old man who requested transport by helicopter emergency medical service for ST-segment elevation myocardial infarction but was consequently diagnosed with takotsubo cardiomyopathy due to spontaneous pneumothorax. En route, findings of electrocardiogram as well as focused cardiac point-of-care ultrasound could not distinguish takotsubo cardiomyopathy from ST-segment elevation myocardial infarction, but a subsequent point-of-care ultrasound could reveal occult pneumothorax, which ultimately revealed to be the culprit stress factor of takotsubo cardiomyopathy causing ST-segment elevation myocardial infarction–alike presentation. After treatment with a closed thoracostomy, he recovered from the takotsubo cardiomyopathy and pneumothorax and was discharged without any complications. Discussion and conclusion: We should consider takotsubo cardiomyopathy a disease with ST-segment elevation and spontaneous pneumothorax as one of its precipitating stressors. To clarify the diagnosis, point-of-care ultrasound using a systematic rather than region-of-interest approach may be a useful method in the emergency department.
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Affiliation(s)
- Yoon-Seop Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yong Sung Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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22
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Jain AG, Zafar H, Jain S, D'Souza J. Osborn Waves: Differential Diagnosis. Tex Heart Inst J 2019; 46:231-232. [PMID: 31708712 DOI: 10.14503/thij-17-6790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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The relationship between serum potassium concentrations and electrocardiographic characteristics in 163,547 individuals from primary care. J Electrocardiol 2019; 57:104-111. [DOI: 10.1016/j.jelectrocard.2019.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/08/2019] [Accepted: 09/04/2019] [Indexed: 12/17/2022]
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Zelfani S, Manai H, Laabidi S, Wahabi A, Akeri S, Daghfous M. Pulmonary embolism mimicking acute myocardial infarction: a case report and review of literature. Pan Afr Med J 2019; 33:275. [PMID: 31692844 PMCID: PMC6814957 DOI: 10.11604/pamj.2019.33.275.18517] [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] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/29/2019] [Indexed: 11/25/2022] Open
Abstract
The diagnosis of pulmonary thromboembolism (PTE) with changes shown by electrocardiography (ECG) is a challenge in the clinical practice due to rare pathognomonic findings. We report the case of a 37-year old woman managed in out of hospital sitting for a chest pain. Electrocardiogram was suggestive of antero-septal acute myocardial infarction (AMI). Catheterization revealed non occlusive coronary disease. Transthoracic echocardiography showed an elevated pulmonary and right heart pressures. Computed tomography pulmonary angiography confirmed the diagnosis of bilateral pulmonary embolism. PTE with ECG changes should be considered in the differential diagnosis of AMI, particularly in young patients with chest pain and ST segment elevation suggestive of acute coronary syndrome.
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Affiliation(s)
- Saida Zelfani
- Pre Hospital Emergency Department (SAMU 01), Emergency Medical Help Center of Tunis, Tunis, Tunisia
| | - Hela Manai
- Pre Hospital Emergency Department (SAMU 01), Emergency Medical Help Center of Tunis, Tunis, Tunisia
| | - Saoussen Laabidi
- Pre Hospital Emergency Department (SAMU 01), Emergency Medical Help Center of Tunis, Tunis, Tunisia
| | - Abir Wahabi
- Pre Hospital Emergency Department (SAMU 01), Emergency Medical Help Center of Tunis, Tunis, Tunisia
| | - Sara Akeri
- Pre Hospital Emergency Department (SAMU 01), Emergency Medical Help Center of Tunis, Tunis, Tunisia
| | - Mounir Daghfous
- Pre Hospital Emergency Department (SAMU 01), Emergency Medical Help Center of Tunis, Tunis, Tunisia
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Metabolic Disturbances Identified in Plasma Samples from ST-Segment Elevation Myocardial Infarction Patients. DISEASE MARKERS 2019; 2019:7676189. [PMID: 31354891 PMCID: PMC6636502 DOI: 10.1155/2019/7676189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/07/2019] [Accepted: 05/16/2019] [Indexed: 12/17/2022]
Abstract
ST-segment elevation myocardial infarction (STEMI) is the most severe form of myocardial infarction (MI) and the main contributor to morbidity and mortality caused by MI worldwide. Frequently, STEMI is caused by complete and persistent occlusion of a coronary artery by a blood clot, which promotes heart damage. STEMI impairment triggers changes in gene transcription, protein expression, and metabolite concentrations, which grants a biosignature to the heart dysfunction. There is a major interest in identifying novel biomarkers that could improve the diagnosis of STEMI. In this study, the phenotypic characterization of STEMI patients (n = 15) and healthy individuals (n = 19) was performed, using a target metabolomics approach. Plasma samples were analyzed by UPLC-MS/MS (ultra-high-performance liquid chromatography-tandem mass spectrometry) and FIA-MS (MS-based flow injection analysis). The goal was to identify novel plasma biomarkers and metabolic signatures underlying STEMI. Concentrations of phosphatidylcholines, lysophosphatidylcholines, sphingomyelins, and biogenic amines were altered in STEMI patients in relation to healthy subjects. Also, after multivariate analysis, it was possible to identify alterations in the glycerophospholipids, alpha-linolenic acid, and sphingolipid metabolisms in STEMI patients.
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26
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Søndergaard MM, Nielsen JB, Mortensen RN, Gislason G, Køber L, Lippert F, Graff C, Haunsø S, Svendsen JH, Kragholm KH, Pietersen AH, Lind BS, Hjortshøj SP, Holst AG, Struijk JJ, Torp-Pedersen C, Hansen SM. Associations between common ECG abnormalities and out-of-hospital cardiac arrest. Open Heart 2019; 6:e000905. [PMID: 31217990 PMCID: PMC6546195 DOI: 10.1136/openhrt-2018-000905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/26/2019] [Accepted: 04/26/2019] [Indexed: 12/25/2022] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is often the first manifestation of unrecognised cardiac disease. ECG abnormalities encountered in primary care settings may be warning signs of OHCA. Objective We examined the association between common ECG abnormalities and OHCA in a primary care setting. Methods We cross-linked individuals who had an ECG recording between 2001 and 2011 in a primary care setting with the Danish Cardiac Arrest Registry and identified OHCAs of presumed cardiac cause. Results A total of 326 227 individuals were included and 2667 (0,8%) suffered an OHCA. In Cox regression analyses, adjusted for age and sex, the following ECG findings were strongly associated with OHCA: ST-depression without concomitant atrial fibrillation (HR 2.79; 95% CI 2.45 to 3.18), left bundle branch block (LBBB; HR 3.44; 95% CI 2.85 to 4.14) and non-specific intraventricular block (NSIB; HR 3.15; 95% CI 2.58 to 3.83). Also associated with OHCA were atrial fibrillation (HR 1.89; 95% CI 1.63 to 2.18), Q-wave (HR 1.75; 95% CI 1.57 to 1.95), Cornell and Sokolow-Lyon criteria for left ventricular hypertrophy (HR 1.56; 95% CI 1.33 to 1.82 and HR 1.27; 95% CI 1.12 to 1.45, respectively), ST-elevation (HR 1.40; 95% CI 1.09 to 1.54) and right bundle branch block (HR 1.29; 95% CI 1.09 to 1.54). The association between ST-depression and OHCA diminished with concomitant atrial fibrillation (HR 1.79; 95% CI 1.42 to 2.24, p < 0.01 for interaction). Among patients suffering from OHCA, without a known cardiac disease at the time of the cardiac arrest, 14.2 % had LBBB, NSIB or ST-depression. Conclusions Several common ECG findings obtained from a primary care setting are associated with OHCA.
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Affiliation(s)
| | - Jonas Bille Nielsen
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Gunnar Gislason
- Department of Cardiology, Herlev Hospital, Herlev, Denmark.,National Institute of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Kobenhavn, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Kobenhavns, Denmark
| | - Claus Graff
- Department of Health, Science and Technology, Aalborg Universitet Det Sundhedsvidenskabelige Fakultet, Aalborg, Denmark
| | - Stig Haunsø
- Department of Cardiology, Rigshospitalet, Kobenhavn, Denmark.,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Rigshospitalet, Kobenhavn, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Kobenhavn, Denmark.,Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Kobenhavn, Denmark
| | - Kristian Hay Kragholm
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark.,Department of Cardiology, Regionshospital Nordjylland, Hjorring, Nordjylland, Denmark
| | - Adrian Holger Pietersen
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hillerod, Denmark
| | - Bent Struer Lind
- Department of Clinical Biochemistry, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Anders Gaarsdal Holst
- Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Kobenhavn, Denmark
| | - Johannes Jan Struijk
- Department of Health, Science and Technology, Aalborg Universitet Det Sundhedsvidenskabelige Fakultet, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark.,Department of Health, Science and Technology, Aalborg Universitet Det Sundhedsvidenskabelige Fakultet, Aalborg, Denmark
| | - Steen Møller Hansen
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark
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Abstract
BACKGROUND Rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is crucial for appropriate management. Catheterization for a false STEMI activation has risks including exposure to contrast agent and radiation, increased healthcare costs and delay in treatment of the primary medical condition. PATIENTS AND METHODS This was a single center retrospective study including all 'cath alerts' between January 2012 and December 2015. 'Cath alert' is a term used to activate the interventional cardiology team when STEMI is suspected by the emergency department physicians based on review of the initial ECG. We reviewed all STEMI alerts to understand ECG differences between true and false STEMI. RESULTS Our study population (N = 361) included 221 (61%) men and 140 (39%) women, with average age 60 ± 4.2 years. Among the 361 STEMI alerts, 82 (22.7%) did not have acute coronary syndrome. Common ECG causes of misdiagnosis included left ventricular hypertrophy (LVH, found in 40/82, 49%), early repolarization changes (20/82, 24%), right bundle branch block (RBBB) (13/82, 16%), and Brugada pattern (3/82, 4%). Multivariate regression analysis showed that LVH and RBBB were independent predictors of nonacute coronary syndrome false STEMI (odds ratio: 0.54; 95% confidence interval: 0.32-0.93; P = 0.03 for LVH, and odds ratio: 0.26, 95% confidence interval: 0.1-0.62, P = 0.004 for RBBB). CONCLUSION The incidence of false STEMI alerts was almost 23% at our center. This number might be reduced with additional training of emergency department physicians in ECG interpretation, and recognition of common causes of misdiagnosis such as LVH, early repolarization changes, RBBB, and Brugada pattern.
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28
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Effects of First High-Dose Atorvastatin Loading in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention. Am J Ther 2018; 25:e291-e298. [DOI: 10.1097/mjt.0000000000000370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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29
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Acute Pericarditis Occurring Three Days after Intravesical Instillation of Mitomycin C after Transurethral Bladder Tumor Resection in a 64-Year-Old Woman. Case Rep Cardiol 2018; 2018:9130852. [PMID: 29682358 PMCID: PMC5841117 DOI: 10.1155/2018/9130852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/16/2018] [Accepted: 01/29/2018] [Indexed: 01/11/2023] Open
Abstract
We present a 64-year-old woman who developed symptoms of acute pericarditis three days after undergoing intravesical instillation of mitomycin C following transurethral bladder tumor resection. Mitomycin C is a chemotherapeutic agent which acts by alkylation of DNA and is known to be cardiotoxic when systemically administered. Despite classic pericarditis symptoms, the patient underwent an urgent coronary angiogram due to elevated cardiac troponin I level, EKG changes, and wall motion abnormalities on her echocardiogram. During her angiogram, it was found that she had multiple stenotic coronary artery lesions, with no acute total coronary occlusions, and percutaneous coronary intervention (PCI) was done with placement of a single drug-eluting stent for a 95% stenotic lesion in the left anterior descending artery. The patient was discharged after an uneventful hospitalization on dual antiplatelet therapy with aspirin and prasugrel, and colchicine for pericarditis. It is likely that the patient's presentation was the result of a perimyocardial inflammatory process secondary to intravesically administered mitomycin C, rather than an acute coronary syndrome. While the pathophysiological basis of cardiotoxicity of systemically administered mitomycin C is well documented, more studies are needed to determine whether intravesical MMC may cause cardiotoxicity.
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30
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Patel SR, Patel VJ, Clark B, Rust G. Normalization of Diffuse ST-Depression with aVR Elevation After Rehydration in a Patient with Severe Aortic Stenosis. Am J Case Rep 2017; 18:563-567. [PMID: 28529306 PMCID: PMC5447663 DOI: 10.12659/ajcr.902510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sachin R. Patel
- Department of Internal Medicine, Florida State University, College of Medicine, Tallahassee, USA
| | - Vikas J Patel
- Department of Internal Medicine, Florida State University, College of Medicine, Tallahassee, USA
| | - Brittany Clark
- Department of Clinical Sciences, Florida State University, College of Medicine, Tallahassee, USA
| | - George Rust
- Center for Medicine & Public Health, Florida State University, College of Medicine, Tallahassee, USA
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31
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Shanmugam G, Narasimhan M, Conley RL, Sairam T, Kumar A, Mason RP, Sankaran R, Hoidal JR, Rajasekaran NS. Chronic Endurance Exercise Impairs Cardiac Structure and Function in Middle-Aged Mice with Impaired Nrf2 Signaling. Front Physiol 2017; 8:268. [PMID: 28515695 PMCID: PMC5413495 DOI: 10.3389/fphys.2017.00268] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/11/2017] [Indexed: 12/18/2022] Open
Abstract
Nuclear factor erythroid 2 related factor 2 (Nrf2) signaling maintains the redox homeostasis and its activation is shown to suppress cardiac maladaptation. Earlier we reported that acute endurance exercise (2 days) evoked antioxidant cytoprotection in young WT animals but not in aged WT animals. However, the effect of repeated endurance exercise during biologic aging (WT) characterized by an inherent deterioration in Nrf2 signaling and pathological aging (pronounced oxidative susceptibility-Nrf2 absence) in the myocardium remains elusive. Thus, the purpose of our study was to determine the effect of chronic endurance exercise-induced cardiac adaptation in aged mice with and without Nrf2. Age-matched WT and Nrf2-null mice (Nrf2-/-) (>22 months) were subjected to 6 weeks chronic endurance exercise (25 meter/min, 12% grade). The myocardial redox status was assessed by expression of antioxidant defense genes and proteins along with immunochemical detection of DMPO-radical adduct, GSH-NEM, and total ubiquitination. Cardiac functions were assessed by echocardiography and electrocardiogram. At sedentary state, loss of Nrf2 resulted in significant downregulation of antioxidant gene expression (Nqo1, Ho1, Gclm, Cat, and Gst-α) with decreased GSH-NEM immuno-fluorescence signals. While Nrf2-/- mice subjected to CEE showed an either similar or more pronounced reduction in the transcript levels of Gclc, Nqo1, Gsr, and Gst-α in relation to WT littermates. In addition, the hearts of Nrf2-/- on CEE showed a substantial reduction in specific antioxidant proteins, G6PD and CAT along with decreased GSH, a pronounced increase in DMPO-adduct and the total ubiquitination levels. Further, CEE resulted in a significant upregulation of hypertrophy genes (Anf, Bnf, and β-Mhc) (p < 0.05) in the Nrf2-/- hearts in relation to WT mice. Moreover, the aged Nrf2-/- mice exhibited a higher degree of cardiac remodeling in association with a significant decrease in fractional shortening, pronounced ST segment, and J wave elevation upon CEE compared to age-matched WT littermates. In conclusion, our findings indicate that while the aged WT and Nrf2 knockout animals both exhibit hypertrophy after CEE, the older Nrf2 knockouts showed ventricular remodeling coupled with profound cardiac functional abnormalities and diastolic dysfunction.
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Affiliation(s)
- Gobinath Shanmugam
- Cardiac Aging and Redox Signaling Laboratory, Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at BirminghamBirmingham, AL, USA
| | - Madhusudhanan Narasimhan
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences CenterLubbock, TX, USA
| | - Robbie L. Conley
- Cardiac Aging and Redox Signaling Laboratory, Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at BirminghamBirmingham, AL, USA
| | - Thiagarajan Sairam
- PSG Center for Molecular Medicine and Therapeutics, PSG Institute of Medical Sciences and Research, PSG HospitalsCoimbatore, India
| | - Ashutosh Kumar
- Immunity, Inflammation, and Disease Laboratory, NIEHS/NIHRaleigh, NC, USA
| | - Ronald P. Mason
- Immunity, Inflammation, and Disease Laboratory, NIEHS/NIHRaleigh, NC, USA
| | - Ramalingam Sankaran
- PSG Center for Molecular Medicine and Therapeutics, PSG Institute of Medical Sciences and Research, PSG HospitalsCoimbatore, India
| | - John R. Hoidal
- Division of Pulmonary, Department of Medicine, University of Utah School of MedicineSalt Lake City, UT, USA
| | - Namakkal S. Rajasekaran
- Cardiac Aging and Redox Signaling Laboratory, Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at BirminghamBirmingham, AL, USA
- PSG Center for Molecular Medicine and Therapeutics, PSG Institute of Medical Sciences and Research, PSG HospitalsCoimbatore, India
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of MedicineSalt Lake City, UT, USA
- Center for Free Radical Biology, University of Alabama at BirminghamBirmingham, AL, USA
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32
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Tan JH, Uddin A, Fernandez JP. Concurrent subarachnoid haemorrhage and ST elevation myocardial infarction. JRSM Open 2017; 8:2054270416685207. [PMID: 28203386 PMCID: PMC5298439 DOI: 10.1177/2054270416685207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Rare case of concurrent subarachnoid haemorrhage and ST elevation myocardial infarction, highlighting the importance of detailed history in an emergency.
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Affiliation(s)
- Joon H Tan
- Lincolnshire Heart Centre, Lincoln County Hospital, Lincoln LN2 5QY, UK
| | - Akhlaque Uddin
- Lincolnshire Heart Centre, Lincoln County Hospital, Lincoln LN2 5QY, UK
| | - Juan P Fernandez
- Lincolnshire Heart Centre, Lincoln County Hospital, Lincoln LN2 5QY, UK
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33
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ter Haar CC, Man SC, Maan AC, Schalij MJ, Swenne CA. Subtraction electrocardiography: Detection of ischemia-induced ST displacement without the need to identify the J point. J Electrocardiol 2016; 49:316-22. [DOI: 10.1016/j.jelectrocard.2016.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Indexed: 02/03/2023]
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34
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Diagnosing poststernotomy mediastinitis in the ED. Am J Emerg Med 2016; 34:618-22. [DOI: 10.1016/j.ajem.2015.12.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 12/30/2022] Open
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35
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Cui L, Suo Y, Zhao Y, Li G, Liu T. Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy and Apical Aneurysm Mimicking Acute ST-Elevation Myocardial Infarction. Ann Noninvasive Electrocardiol 2015; 21:98-101. [PMID: 26105174 DOI: 10.1111/anec.12284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Nonischemic ST-segment elevation may be confused as acute ST-elevation myocardial infarction (STEMI), especially in patients with atypical presenting symptoms. Among the possible differential diagnosis, hypertrophic cardiomyopathy (HCM) should be considered. Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare type of cardiomyopathy, accounting for approximately 5% of all HCM cases. ST-segment elevation on electrocardiogram (ECG) in patients with MVOHCM is a rare clinical presentation. We present a case of MVOHCM and apical aneurysm mimicking acute STEMI.
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Affiliation(s)
- Li Cui
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ya Suo
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yuntao Zhao
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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36
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Klein LR, Shroff GR, Beeman W, Smith SW. Electrocardiographic criteria to differentiate acute anterior ST-elevation myocardial infarction from left ventricular aneurysm. Am J Emerg Med 2015; 33:786-90. [DOI: 10.1016/j.ajem.2015.03.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/19/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022] Open
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