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Torres F, Shedd C, Kaza V, Bollineni S, Banga A, Mohanka MR, Ladikos N, Wijesinha M, Mahan LD, Lawrence A, Joerns J, Terada L, Timofte I. Outpatient management of Post-COVID syndrome - single center experience. Heart Lung 2024; 67:137-143. [PMID: 38759575 DOI: 10.1016/j.hrtlng.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND COVID patients continue to experience unremitting symptoms that extend far beyond the initial illness. While there is rapid accumulation of data on acute COVID treatment in hospitalized patients, little is known regarding post-COVID management. OBJECTIVES To describe our center's experience treating post-COVID sub-syndromes encountered in Post-COVID Lung Clinic. METHODS We retrospectively reviewed data on 98 post-COVID patients evaluated in our clinic between 07/01/2020-12/31/2022. We encountered three distinct post-COVID subtypes: 1) respiratory complaints associated with increased O2 requirements and abnormal CT findings (post-COVID interstitial lung disease [ILD]), 2) respiratory complaints associated with tachycardia (post-COVID dyspnea-tachycardia syndrome [DTS]). Post-COVID ILD patients (n = 28) received steroids in combination with cell cycle inhibitor (mycophenolate mofetil-MMF). Post-COVID DTS patients (n = 16) were treated with metoprolol. 3) A third, undifferentiated group presented with mild respiratory complaints and normal spirometry (n = 17) and was followed in clinic without initiation of a specific treatment. RESULTS In treated post-COVID ILD patients, mean oxygen requirements at rest (1.96 ± 1.79 L/NC) decreased to 0.89 ± 1.29 L/NC at 6 months follow-up, p = 0.005. In patients with post-COVID DTS, mean heart rate at rest decreased (98 ± 15 bpm to 79 ± 11 bpm) at 6 months follow-up, p = 0.023. 60 % of patients reported an improvement in exertional dyspnea. CONCLUSIONS Our descriptive study presents a single center outpatient COVID-19 clinic experience. We encountered 3 post-COVID sub-syndromes and describe their treatments: post-COVID interstitial lung disease [ILD] treated with a novel regimen of MMF and steroids, post COVID dyspnea-tachycardia syndrome [DTS] treated with metoprolol, and a third subgroup with mild undifferentiated symptoms without specific treatment.
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Affiliation(s)
- Fernando Torres
- The University of Texas Southwestern Medical Center, United States
| | - Christine Shedd
- The University of Texas Southwestern Medical Center, United States.
| | - Vaidehi Kaza
- The University of Texas Southwestern Medical Center, United States
| | | | - Amit Banga
- The University of Texas Southwestern Medical Center, United States
| | - Manish R Mohanka
- The University of Texas Southwestern Medical Center, United States
| | - Nicholas Ladikos
- The University of Texas Southwestern Medical Center, United States
| | - Marniker Wijesinha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, United States
| | - Luke D Mahan
- The University of Texas Southwestern Medical Center, United States
| | - Adrian Lawrence
- The University of Texas Southwestern Medical Center, United States
| | - John Joerns
- The University of Texas Southwestern Medical Center, United States
| | - Lance Terada
- The University of Texas Southwestern Medical Center, United States
| | - Irina Timofte
- The University of Texas Southwestern Medical Center, United States
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Agrawal A, Janjua D, Alsayed Ali Zeyada AA, Taher Elsheikh A. Heart failure in children and adolescents: an update on diagnostic approaches and management. Clin Exp Pediatr 2024; 67:178-190. [PMID: 37350171 PMCID: PMC10990655 DOI: 10.3345/cep.2023.00528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023] Open
Abstract
Cardiac failure is a clinical syndrome that may develop in children owing to cardiac dysfunction or underlying structural heart diseases. Considering the differences in diagnostic and therapeutic approaches for pediatric heart failure (PHF) and adult heart failure, we have reviewed the current literature on PHF. Relevant studies were extracted from MEDLINE/PubMed, Google Scholar, and Clinical Trial Registries using the terms "pediatric heart failure" or "heart failure in children" and "management" or "decongestive therapy." Recent advances in diagnostic approaches, such as cardiac magnetic resonance, speckle-tracking echocardiography, tissue Doppler imaging, and molecular diagnostic techniques, have increased our under -standing of PHF. It is imperative that clinicians evaluate the interrelated factors responsible for the develop ment of PHF, including myocardial function, pulmonary and systemic blood flow, heart rhythm, valve function, and nutritional status. Although recent advances have demon strated the efficacy of many new drugs in adult heart failure trials, it cannot be concluded that these drugs will show similar efficacy in children, considering the heterogeneous nature of the underlying mechanisms and variable pharmacody-namics and pharmacokinetics. Therefore, the underlying pathophysiology of PHF and the mechanisms of action of different drugs should be considered when selecting appropriate therapies. Further trials are needed to establi sh the efficacy and safety of these drugs, and a combined mul-ti disciplinary strategy will help enhance PHF outcomes.
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Affiliation(s)
- Amit Agrawal
- Department of Pediatrics, Gandhi Medical College, Bhopal, MP, India
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Penfold MP, Cannon BC, Wackel PL. Empiric Slow Pathway Cryoablation in Symptomatic Children Without Documented Supraventricular Tachycardia. Pediatr Cardiol 2024; 45:921-925. [PMID: 36462026 DOI: 10.1007/s00246-022-03065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
In symptomatic children without documented supraventricular tachycardia (SVT) and non-inducible atrioventricular nodal reentry tachycardia (AVNRT) the benefit of empiric slow pathway (SP) ablation is unknown. We evaluated 62 symptomatic patients without documented SVT that underwent electrophysiology study (EPS). The purpose of this study was to determine if symptoms improved after empiric SP ablation in children without documented SVT and without inducible AVNRT. Sixty-two symptomatic patients without previously documented SVT underwent EPS; 31 (50%) had inducible AVNRT and underwent SP ablation, 20 (32%) were non-inducible and underwent empiric SP ablation, 11 (18%) were non-inducible and had no ablation. After a mean follow-up of 23 ± 18 months there was no significant difference in freedom from symptoms within the non-inducible cohort regardless of whether empiric SP ablation was performed (p = 0.135). There was a significant improvement in symptoms at follow-up after SP ablation when comparing inducible and non-inducible patients (p = 0.020). During follow-up no patients had documented SVT. Symptomatic children without documented SVT do not benefit from empiric SP ablation when AVNRT cannot be induced.
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Affiliation(s)
- Michael P Penfold
- Department of Pediatrics, Mayo Clinic, Rochester, MN, 200 1st SW55901, USA.
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, 200 1 st SW55901, USA
| | - Philip L Wackel
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, 200 1 st SW55901, USA
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Katritsis DG, Fragakis N, Katritsis G, Doukas V, Marine JE, Desmukh A, Latchamsetty R, Anderson RH, Calkins H. High-resolution mapping of the circuit of typical atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol 2024; 67:599-607. [PMID: 37691082 DOI: 10.1007/s10840-023-01632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Recent anatomic and electrophysiologic evidence has provided new insight into the anatomic substrate. Previous reports on electroanatomic mapping (EAM) of the circuit of atrioventricular nodal reentrant tachycardia (AVNRT) have been limited by mapping only the triangle of Koch on the right side of the septum and by the use of conventional mapping tools. The objectives are to obtain comprehensive high-resolution mapping of typical AVNRT and to investigate the role of the atrioventricular ring tissues in the circuit. METHODS We employed EAM with the use of novel modules and algorithms for studying typical AVNRT from the right and the left sides of the septum. RESULTS We performed extensive mapping of both the atrial septum and the septal vestibule of the tricuspid valve during typical AVNRT in 9 (6 females) patients, aged 49.6 ± 12.1 years. In two of these, left septal mapping was also obtained through the aorta. The earliest initial activation was variable, emanating from the superior or medial septum. The impulse consistently appeared below the orifice of the coronary sinus, at the site where its inferoanterior margin merged with the septal vestibule of the tricuspid valve at its entrance to the right atrium. It then returned to the initial activation site, presumably through the septal vestibular myocardium. The left septal activation area corresponded to that recorded on the right side. CONCLUSIONS Typical AVNRT uses a circuit confined within the pyramid of Koch from the AV node to the septal isthmus, involving the myocardial walls of the pyramidal space.
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Affiliation(s)
- Demosthenes G Katritsis
- Hygeia Hospital, 4 Erythrou Stavrou Str, 15123, Athens, Greece.
- Johns Hopkins Hospital, Baltimore, MD, USA.
| | | | | | | | | | - Amrish Desmukh
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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Li Y, Liu S, Huang J, Xie Y, Hou A, Wei Y. Cellular-level analyses of SCN5A mutations in left ventricular noncompaction cardiomyopathy suggest electrophysiological mechanisms for ventricular tachycardia. Biochem Biophys Rep 2024; 37:101653. [PMID: 38352122 PMCID: PMC10861951 DOI: 10.1016/j.bbrep.2024.101653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
Left ventricular noncompaction cardiomyopathy (LVNC) is a cardiovascular disease characterized by arrhythmia and heart failure. In this study, LVNC myocardial samples were collected from patients who underwent heart transplantation and were analyzed using exome sequencing. Approximately half of the LVNC patients carried SCN5A variants, which are associated with clinical symptoms of ventricular tachycardia. To investigate the electrophysiological functions of these SCN5A variants and the underlying mechanism by which they increase arrhythmia susceptibility in LVNC patients, functional evaluations were conducted in CHO-K1 cells and human embryonic stem cell-derived cardiomyocytes (hESC-CMs) using patch-clamp or microelectrode array (MEA) techniques. These findings demonstrated that these SCN5A mutants exhibited gain-of-function properties, leading to increased channel activation and enhanced fast inactivation in CHO-K1 cells. Additionally, these mutants enhanced the excitability and contractility of the cardiomyocyte population in hESC-CMs models. All SCN5A variants induced fibrillation-like arrhythmia and increased the heart rate in cardiomyocytes. However, the administration of Lidocaine, an antiarrhythmic drug that acts on sodium ion channels, was able to rescue or alleviate fibrillation-like arrhythmias and secondary beat phenomenon. Based on these findings, it is speculated that SCN5A variants may contribute to susceptibility to arrhythmia in LVNC patients. Furthermore, the construction of cardiomyocyte models with SCN5A variants and their application in drug screening may facilitate the development of precise therapies for arrhythmia in the future.
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Affiliation(s)
- Yanfen Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Shenghua Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Jian Huang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Yuanyuan Xie
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Aijie Hou
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, No. 33, Wenyi Road, Shenhe District, Shenyang City, Liaoning Province, 110016, People's Republic of China
| | - Yingjie Wei
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
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Palma JA. Muscarinic control of cardiovascular function in humans: a review of current clinical evidence. Clin Auton Res 2024; 34:31-44. [PMID: 38305989 PMCID: PMC10994193 DOI: 10.1007/s10286-024-01016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE To review the available evidence on the impact of muscarinic receptor modulation on cardiovascular control in humans. METHODS In this narrative Review we summarize data on cardiovascular endpoints from clinical trials of novel subtype-selective or quasi-selective muscarinic modulators, mostly PAMs, performed in the last decade. We also review the cardiovascular phenotype in recently described human genetic and autoimmune disorders affecting muscarinic receptors. RESULTS Recent advancements in the development of compounds that selectively target muscarinic acetylcholine receptors are expanding our knowledge about the physiological function of each muscarinic receptor subtype (M1, M2, M3, M4, M5). Among these novel compounds, positive allosteric modulators (PAMs) have emerged as the preferred therapeutic to regulate muscarinic receptor subtype function. Many muscarinic allosteric and orthosteric modulators (including but not limited to xanomeline-trospium and emraclidine) are now in clinical development and approaching regulatory approval for multiple indications, including the treatment of cognitive and psychiatric symptoms in patients with schizophrenia as well as Alzheimer's disease and other dementias. The results of these clinical trials provide an opportunity to understand the influence of muscarinic modulation on cardiovascular autonomic control in humans. While the results and the impact of each of these therapies on heart rate and blood pressure control have been variable, in part because the clinical trials were not specifically designed to measure cardiovascular endpoints, the emerging data is valuable to elucidate the relative cardiovascular contributions of each muscarinic receptor subtype. CONCLUSION Understanding the muscarinic control of cardiovascular function is of paramount importance and may contribute to the development of novel therapeutic strategies for treating cardiovascular disease.
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Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, NYU Dysautonomia Center, New York University School of Medicine, 530 First Av, Suite 9Q, New York, 10016, USA.
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Rautio E, Gadler F, Gudbjörnsdottir S, Franzén S, Rydén L, Savarese G, Svensson AM, Mellbin LG. Implantable cardioverter defibrillator and cardiac resynchronization treatment in people with type 2 diabetes: a comparison with age- and sex matched controls from the general population. Cardiovasc Diabetol 2024; 23:18. [PMID: 38184588 PMCID: PMC10771698 DOI: 10.1186/s12933-023-02084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/01/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Increased risk of severe tachyarrhythmias is reported in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to explore if treatment with cardiac implantable electronic device (CIED) such as implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy- pacemaker and -defibrillator (CRT-P/CRT-D) differed in patients with vs. without T2DM. A secondary aim was to identify patient characteristics indicating an increased CIED treatment. METHOD 416 162 adult patients with T2DM from the Swedish National Diabetes Registry and 2 081 087 controls from the Swedish population, matched for age, sex and living area, were included between 1/1/1998 and 31/12/2012 and followed until 31/12/2013. They were compared regarding prevalence of ventricular tachycardia (VT) at baseline and the risk of receiving a CIED during follow-up. Multivariable Cox regression analysis was performed to estimate the risk of CIED-treatment and factors identifying patients with such risk. RESULTS Ventricular fibrillation (VF) (0.1% vs 0.0004%) and (VT) (0.2% vs. 0.1%) were more frequent among patients with T2DM compared to controls. CIED-treatment was significantly increased in patients with T2DM both in unadjusted and adjusted analyses. HR and 95% CI, after adjustment for sex, age, marital status, income, education, country of birth, coronary artery disease and congestive heart failure, were 1.32 [1.21-1.45] for ICD, 1.74 [1.55-1.95] for CRT-P and 1.69 [1.43-1.99] for CRT-D. Blood-pressure and lipid lowering therapies were independent risk factors associated to receiving CIED, while female sex was protective. CONCLUSIONS Although the proportion of VT/VF was low, patients with T2DM had a higher prevalence of these conditions and increased risk for treatment with CIED compared to controls. This underlines the importance of recognizing that T2DM patients have an increased need of CIED.
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Affiliation(s)
- Elina Rautio
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden.
| | - Fredrik Gadler
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden
- Department of Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Soffia Gudbjörnsdottir
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - Stefan Franzén
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
- Health Metrics Unit, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Rydén
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Gianluigi Savarese
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - Linda G Mellbin
- Cardiology Research Unit, Department of Medicine, Solna Karolinska Institutet, 171 76, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
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Pyari G, Bansal H, Roy S. Optogenetically mediated large volume suppression and synchronized excitation of human ventricular cardiomyocytes. Pflugers Arch 2023; 475:1479-1503. [PMID: 37415050 DOI: 10.1007/s00424-023-02831-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
A major challenge in cardiac optogenetics is to have minimally invasive large volume excitation and suppression for effective cardioversion and treatment of tachycardia. It is important to study the effect of light attenuation on the electrical activity of cells in in vivo cardiac optogenetic experiments. In this computational study, we present a detailed analysis of the effect of light attenuation in different channelrhodopsins (ChRs)-expressing human ventricular cardiomyocytes. The study shows that sustained illumination from the myocardium surface used for suppression, simultaneously results in spurious excitation in deeper tissue regions. Tissue depths of suppressed and excited regions have been determined for different opsin expression levels. It is shown that increasing the expression level by 5-fold enhances the depth of suppressed tissue from 2.24 to 3.73 mm with ChR2(H134R) (ChR2 with a single point mutation at position H134), 3.78 to 5.12 mm with GtACR1 (anion-conducting ChR from cryptophyte algae Guillardia theta) and 6.63 to 9.31 mm with ChRmine (a marine opsin gene from Tiarina fusus). Light attenuation also results in desynchrony in action potentials in different tissue regions under pulsed illumination. It is further shown that gradient-opsin expression not only enables suppression up to the same level of tissue depth but also enables synchronized excitation under pulsed illumination. The study is important for the effective treatment of tachycardia and cardiac pacing and for extending the scale of cardiac optogenetics.
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Affiliation(s)
- Gur Pyari
- Department of Physics and Computer Science, Dayalbagh Educational Institute, Agra, 282005, India
| | - Himanshu Bansal
- Department of Physics and Computer Science, Dayalbagh Educational Institute, Agra, 282005, India
| | - Sukhdev Roy
- Department of Physics and Computer Science, Dayalbagh Educational Institute, Agra, 282005, India.
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Werheim E, Sokol Z, Mody N, Owusu-Agyei J. Chronic intermittent tachycardia as a consequence of vagus nerve injury after anterior cervical discectomy and fusion: case report of a previously unreported complication. N Am Spine Soc J 2023; 16:100291. [PMID: 38143907 PMCID: PMC10746551 DOI: 10.1016/j.xnsj.2023.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 12/26/2023]
Abstract
Background The surgical approach of an anterior cervical discectomy and fusion (ACDF) navigates many important neurologic and vascular structures in the neck. More frequently reported complications are dysphagia, postoperative hematoma, cerebrospinal fluid leaks, and dysphonia. Case description This case report details an ACDF in a 49-year-old female with intractable neck pain and radicular symptoms. Following the procedure, she developed intermittent tachycardia at rest, which worsened with exertion. Outcome The cardiac workup was negative. A neck ultrasound demonstrated hypoechoic thickening of the vagus nerve, providing the diagnosis of vagus nerve injury. The patient's tachycardia has been managed with beta-blockers. Conclusions Although previously unreported, vagus nerve injury following ACDF is possible, causing sympathetic disruption, which can be managed with beta blockers.
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Affiliation(s)
- Erik Werheim
- Department of Neurosurgery, St Luke's University Health Network, 801 Ostrum St. Bethlehem, PA 18015, United States
- Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad St, Philadelphia, PA 19140, United States
| | - Zachary Sokol
- Department of Neurosurgery, St Luke's University Health Network, 801 Ostrum St. Bethlehem, PA 18015, United States
- Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad St, Philadelphia, PA 19140, United States
| | - Neha Mody
- Department of Neurosurgery, St Luke's University Health Network, 801 Ostrum St. Bethlehem, PA 18015, United States
| | - Justice Owusu-Agyei
- Department of Neurosurgery, St Luke's University Health Network, 801 Ostrum St. Bethlehem, PA 18015, United States
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Hsue W, Gagnon AL. Treating Stubborn Cardiac Arrhythmias-Looking Toward the Future. Vet Clin North Am Small Anim Pract 2023; 53:1415-1428. [PMID: 37541824 DOI: 10.1016/j.cvsm.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
As animals can develop significant side effects or remain refractory while on antiarrhythmic medical therapy for tachyarrhythmias, interventional therapies are progressively being explored. This review will highlight the principles and utilities of implantable cardioverter-defibrillators, electrophysiological mapping and catheter ablation, three-dimensional electroanatomical mapping, and stereotactic arrhythmia radiotherapy. In particular, three-dimensional electroanatomical mapping is emerging as an adjunct electrophysiology tool to facilitate activation, substrate, and pace mapping for intuitive analysis of complex tachyarrhythmias. Unlike antiarrhythmic medications, these modalities offer potential for decreasing risk of sudden death and even permanent termination of tachyarrhythmias.
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Affiliation(s)
- Weihow Hsue
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853, USA.
| | - Allison L Gagnon
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California - Davis, One Shields Avenue, Davis, CA 95616, USA.
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Kataoka N, Imamura T. How to assess haemodynamic impact of atrial fibrillation. Eur Heart J Open 2023; 3:oead123. [PMID: 38111718 PMCID: PMC10726916 DOI: 10.1093/ehjopen/oead123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/24/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama 930-0194, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama 930-0194, Japan
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12
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Na SJ, Oh DK, Park S, Lee YJ, Hong SB, Park MH, Ko RE, Lim CM, Jeon K. The Association Between Tachycardia and Mortality in Septic Shock Patients According to Serum Lactate Level: A Nationwide Multicenter Cohort Study. J Korean Med Sci 2023; 38:e313. [PMID: 37846786 PMCID: PMC10578996 DOI: 10.3346/jkms.2023.38.e313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/15/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND This study aimed to evaluate whether the effect of tachycardia varies according to the degree of tissue perfusion in septic shock. METHODS Patients with septic shock admitted to the intensive care units were categorized into the tachycardia (heart rate > 100 beats/min) and non-tachycardia (≤ 100 beats/min) groups. The association of tachycardia with hospital mortality was evaluated in each subgroup with low and high lactate levels, which were identified through a subpopulation treatment effect pattern plot analysis. RESULTS In overall patients, hospital mortality did not differ between the two groups (44.6% vs. 41.8%, P = 0.441), however, tachycardia was associated with reduced hospital mortality rates in patients with a lactate level ≥ 5.3 mmol/L (48.7% vs. 60.3%, P = 0.030; adjusted odds ratio [OR], 0.59, 95% confidence interval [CI], 0.35-0.99, P = 0.045), not in patients with a lactate level < 5.3 mmol/L (36.5% vs. 29.7%, P = 0.156; adjusted OR, 1.39, 95% CI, 0.82-2.35, P = 0.227). CONCLUSION In septic shock patients, the effect of tachycardia on hospital mortality differed by serum lactate level. Tachycardia was associated with better survival in patients with significantly elevated lactate levels.
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Affiliation(s)
- Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Hyeon Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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13
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Ezzeddine FM, Haq IU, Heinrich CK, Jain V, Enger NJ, Schultz ZC, Deshmukh AJ, Del-Carpio Munoz F, Asirvatham SJ, Kapa S, Bowen JM. Mitral annular disjunction and arrhythmias in Marfan syndrome. Heart Rhythm 2023; 20:1461-1462. [PMID: 37406872 DOI: 10.1016/j.hrthm.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ikram U Haq
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - Vaibhav Jain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nicholas J Enger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Zachary C Schultz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Juan M Bowen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota.
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14
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Sankaranarayanan A, Kazi S, Andrade C. Prevalence and predictors of QTc prolongation in patients seen in a clozapine clinic in a real-world setting in Australia. Schizophr Res 2023:S0920-9964(23)00343-2. [PMID: 37770378 DOI: 10.1016/j.schres.2023.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Many antipsychotic drugs have been associated with QTc prolongation, which is a risk factor for sudden death. We studied the prevalence and predictors of QTc prolongation in treatment-resistant schizophrenia patients who were receiving clozapine in a real-world setting. METHODS Data were extracted from the records of all schizophrenia patients aged 18-65 years, enrolled in a clozapine clinic in metropolitan Australia during October 2020 to April 2022, for whom ECG data were available. RESULTS There were 104 eligible patients. The mean age of the sample was 42 years. The sample was 56 % male. About a third of patients were receiving antipsychotic and antidepressant drugs in addition to clozapine. The mean (standard deviation) QTc was 437.0 (24.8) ms in men and 445.8 (28.5) ms in women. QTc prolongation was present in 36.5 % of the sample. In univariate analysis, higher heart rate and higher clozapine levels were significantly associated with QTc prolongation; in multivariable logistic regression analysis, nonsignificant statistical trends were observed for male sex, higher heart rate, and higher serum clozapine level. CONCLUSIONS QTc prolongation may be common in schizophrenia patients who receive clozapine in real world settings; this is a matter of much concern. Potential predictors of QTc prolongation need to be identified and these predictors and their interactions require to be explored in studies with greater statistical power.
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Affiliation(s)
- Anoop Sankaranarayanan
- Blacktown Mental Health Service, Western Sydney LHD Mental Health Service, Blacktown Hospital, Blacktown, NSW 2148, Australia; Translational Health Research Unit and School of Medicine, Blacktown Clinical School, Western Sydney University, Blacktown Hospital, Blacktown, NSW 2148, Australia.
| | - Sharmin Kazi
- Blacktown Mental Health Service, Western Sydney LHD Mental Health Service, Blacktown Hospital, Blacktown, NSW 2148, Australia.
| | - Chittaranjan Andrade
- Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences, Bangalore 560 029, India.
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15
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Rowberry R, Mortimore G. Septic pulmonary emboli: a case discussion. Br J Nurs 2023; 32:832-838. [PMID: 37737857 DOI: 10.12968/bjon.2023.32.17.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
A septic pulmonary embolus occurs from the embolisation of an infected thrombus - typically from an infected source such as an abscess - that enters the venous circulation, implanting in the lungs, which in turn causes a parenchymal infection. This case discussion gives a candid reflection on the treatment and management of a patient who was a known intravenous drug user, with a past history of a deep vein thrombosis and new presentation of a groin abscess. He was initially reviewed by a trainee advanced clinical practitioner, working out of hours in a hospital setting. This article will reflect on the patient presentation, the clinical examinations and investigations undertaken, which finally led to the diagnosis of septic pulmonary emboli. Although this condition is rare, having a high index of suspicion in patients with known risk factors may lead to early diagnosis and successful treatment.
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Affiliation(s)
- Rowena Rowberry
- Lecturer, Department of Health, Psychology and Social Care, University of Derby
| | - Gerri Mortimore
- Lecturer, Department of Health, Psychology and Social Care, University of Derby
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16
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Öztürk HF, Arslan SA, Gani Z, Aras D, Tezcan Y. From organ at risk to target organ: Dosimetric comparison of myocardial stereotactic ablative body radiotherapy between helical tomotherapy and volumetric arc therapy for refractory ventricular tachycardia. Med Dosim 2023; 48:293-298. [PMID: 37673728 DOI: 10.1016/j.meddos.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/19/2023] [Accepted: 08/03/2023] [Indexed: 09/08/2023]
Abstract
Ventricular tachycardia (VT) is an important type of arrhythmia with a risk of sudden death. Although implanted cardiac defibrillation and radiofrequency ablation are used together with medical treatments for VT, the treatment options are limited in cases that do not respond to them. Stereotactic ablative body radiotherapy (SABR) applied to VT substrates in resistant cases is an emerging treatment with positive results. Such clinical results have increased the interest in this subject. However, the ideal treatment device and method have not yet been described for this therapy, which is generally applied at a single fraction using various devices and methods. Herein, treatment planning was conducted for a total of 8 patients (11 VT substrates) using the Varian TrueBeam EDGE and TomoTherapy Radixact devices at a single center, and the results were compared dosimetrically. The Wilcoxon-signed rank test was used for the statistical analysis, and mean values were expressed as medians and interquartile ranges (IQRs). In the volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) plans, the plan coverages and conformity indexes were similar; meanwhile, the homogeneity indexes were 0.10 (IQR = 0.05) and 0.07 (IQR = 0.05), respectively, and were significantly better in the HT plan (p = 0.02). The gradient indexes were 3.18 (IQR = 0.8) and 5.33 (IQR = 3.68) in the VMAT and HT plans, respectively, and were significantly better in the VMAT plan. For the organs at risk, similar doses were observed. The maximum doses for the stomach and esophagus and the mean doses for the left lung and both lungs were significantly lower in the VMAT plan. Similarly, the maximum and mean doses for the cardiac substructures and great vessels were significantly lower in the VMAT plan. More homogeneous plans were obtained in HT, while a faster dose reduction and lower critical organ dose were observed in VMAT. Reasonable myocardial SABR plans could be obtained with both techniques. The effects of the dosimetric differences on the clinical outcomes should be evaluated in prospective clinical studies.
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Affiliation(s)
- Hüseyin Furkan Öztürk
- Department of Radiation Oncology, Yıldırım Beyazıt University, Ankara 06800, Turkey.
| | - Suheyla Aytaç Arslan
- Department of Radiation Oncology, Yıldırım Beyazıt University, Ankara 06800, Turkey
| | - Zerrin Gani
- Department of Radiation Oncology, Ankara Bilkent City Hospital, Ankara 06800, Turkey
| | - Dursun Aras
- Department of Cardiology, İstanbul Medipol University Bahçelievler Hospital, Istanbul 34196, Turkey
| | - Yılmaz Tezcan
- Department of Radiation Oncology, Yıldırım Beyazıt University, Ankara 06800, Turkey
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17
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Marill KA, Lopez S, Hark D, Spahr J, Kapadia N, Liu SW. Increased ventricular ectopy precedes Torsades de Pointes in patients with prolonged QT. J Electrocardiol 2023; 80:17-23. [PMID: 37105125 DOI: 10.1016/j.jelectrocard.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Torsades de Pointes (TdP) is a potentially lethal ventricular tachydysrhythmia. Prolonged heartrate corrected QT interval (QTc) predicts TdP; however, with poor specificity. We performed this study to identify other predictors of TdP among patients with prolonged QTc. METHODS We performed a retrospective case control study with 2:1 matching at an urban academic hospital. We searched our hospital electrocardiogram (ECG) database for tracings with heartrate ≤ 60, QTc ≥ 500, and QRS < 120, followed by a natural language search for electronic records with "Torsades," "polymorphic VT," or similar to identify TdP cases from 2005 to 19. We identified controls from a similar ECG database search matching for QTc, heartrate, age, and sex. We compared cardiologic and historical factors, medications, laboratory values, and ECG measurements including ectopy using univariate statistics. For those cases with saved telemetry strips that included preceding beats or TdP onset, we compared ectopy and TdP onset characteristics between the ECG and telemetry strips using mixed linear modeling. RESULTS Seventy-five cases including 50 with telemetry strips and 150 controls were included. Historical, pharmacologic, laboratory, and cardiologic testing results were similar between cases and controls. The proportion of telemetry tracings with premature ventricular contractions (PVC's) preceding TdP was 0.78 compared to 0.16 for case ECG's (difference 0.62(95%CI 0.44-0.75)) and 0.10 for control ECGs (difference 0.68(95%CI 0.56-0.80)). Average telemetry heartrate was 72 and QTc 549 immediately preceding TdP, similar to the ECG values. CONCLUSIONS Clinical factors don't differentiate patients with long QTc who develop TdP, however, an increase in PVC's in patients with prolonged QTc may usefully predict imminent TdP.
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Affiliation(s)
- Keith A Marill
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Samantha Lopez
- University of Texas at Southwestern Medical Center, United States of America
| | - David Hark
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | | | - Nehal Kapadia
- Department of Biomedical Engineering, Massachusetts General Hospital, Boston, MA, United States of America
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
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18
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Baig MMA, Adnan M, Baig MU, Ramzan Z. Late-onset pulmonary complications among survivors of coronavirus Disease 2019. Pak J Med Sci 2023; 39:1035-1039. [PMID: 37492317 PMCID: PMC10364300 DOI: 10.12669/pjms.39.4.6302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 07/27/2023] Open
Abstract
Objectives To assess the late-onset pulmonary complications among survivors of coronavirus disease 2019. Methods The cross-sectional analytical study was conducted in the department of Pulmonology, Sir Ganga Ram Hospital Lahore between October 2020 and March 2021. Total 288 patients visiting the hospital 12-week after recovery from COVID-19 enrolled using convenience sampling. After excluding patients (n=61) with a history of previous respiratory symptoms before the development of COVID-19, data from 227 patients was subjected to final analysis. Chest X-ray (CXR) was used to evaluate lung condition. Results Participation of middle-aged adults (54.6%) was higher than older (38.3%) and young adults (7.0%). The percentage of males was 55.5% and smokers was 29.1%. Dyspnea was the most common complication as 80.0% patients had moderate to severe dyspnea while chronic cough was 78.0% and lung fibrosis (LF) was 13.2%. The chances of LF increased with the rise in age (p-value 0.033). However, the distribution of LF was similar between males and females. The frequency of lung fibrosis in smokers was 3-time higher than among non-smokers (24.2 vs. 8.7%; p-value 0.003). The patients with LF were more dependent on O2 as compared to the patients without LF (p-value < 0.001). The frequency of tachycardia was significantly different between patients with and without LF (all p-values < 0.05). Conclusion LF is a common late-onset pulmonary complication of COVID-19 and is associated with old age, smoking, O2 dependency, tachycardia, and severe dyspnea.
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Affiliation(s)
| | - Muhammad Adnan
- Muhammad Adnan, Health Research Institute, National Institute of Health, HRI NIH Research Center FJMU, Lahore, Pakistan
| | | | - Zohaib Ramzan
- Zohaib Ramzan Department of Pulmonology, Sir Ganga Ram Hospital, Lahore, Pakistan
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19
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Korolewicz J, Meenakshisundaram R, Lim PB. Ivabradine for inappropriate sinus tachycardia-induced symptomatic Mobitz type I atrio-ventricular block: a case summary. Eur Heart J Case Rep 2023; 7:ytad192. [PMID: 37360007 PMCID: PMC10289141 DOI: 10.1093/ehjcr/ytad192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/16/2022] [Accepted: 04/13/2023] [Indexed: 06/28/2023]
Abstract
Background Inappropriate sinus tachycardia (IST) is characterized by a continuum of symptoms, and the aetiology of IST is imprecise. IST-induced autonomic dysfunction is well known, but IST-induced atrio-ventricular block is not reported to our knowledge. Case summary A 67-year-old female presented with a 4-day history of random intermittent difficulty in breathing, chest tightness, palpitations, and dizziness, with a recorded heart rate of 30 beats per minute (BPM) on home monitoring equipment. The initial electrocardiogram (ECG) demonstrated sinus rhythm with intermittent Mobitz type I second degree atrio-ventricular (AV) block, with continuous cardiac monitoring demonstrating frequent episodes of Wenckebach phenomenon throughout the day, with a sinus rate of 100-120 BPM. Echocardiogram showed no significant structural abnormalities. The patient was on bisoprolol, and hence, it was suspected Wenckebach may be due to that and so stopped. However, there was no tangible effect on rhythm 48 hours after stopping bisoprolol, leading to a suspicion of IST-induced Mobitz type I second degree AV block; and so decided to introduce ivabradine 2.5 mg twice daily. After 24 hours of Ivabradine, the patient remained in sinus rhythm with no documented episodes of Wenckebach phenomenon on cardiac monitor, a finding subsequently confirmed by 24-hour Holter monitoring. During a recent follow-up visit in clinic, the patient remained symptom-free, with an ECG demonstrating sinus rhythm at a physiological rate. Discussion Mobitz type I second degree AV block is usually due to reversible conduction block at the level of the AV node whereby malfunctioning AV nodal cells tend to progressively fatigue until they fail to conduct an impulse. Under conditions of increased vagal tone and autonomic dysfunction, Wenckebach occurrence will be increased. Thus, selective impulse conduction within the sinoatrial (SA) node by ivabradine to reduce beat conduction to the AV node in patients with IST/dysautonomia-induced Mobitz type I AV will reduce the occurrence of Wenckebach.
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Affiliation(s)
- James Korolewicz
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Du Cane Road, London W12 0HS, UK
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20
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Medina Y, Khan A, Spagnola J, Lafferty J. Resolution of Sinus Tachycardia Secondary to Hyperthyroidism With Ivabradine. J Clin Med Res 2023; 15:336-339. [PMID: 37434775 PMCID: PMC10332879 DOI: 10.14740/jocmr4940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
Currently, ivabradine is not approved for the treatment of sinus tachycardia secondary to hyperthyroidism. We aimed to increase the recognition of ivabradine as an effective alternative to, or combination with, beta-blockers in controlling sinus tachycardia secondary to hyperthyroidism. Elevated thyroid hormone levels enhance cardiac performance through a positive chronotropic effect, resulting in an increased heart rate (HR), an effect brought on by increasing the If funny current at sinoatrial node (SAN). Ivabradine is a novel, dose-dependent selective inhibitor of If channels. By decreasing SAN pacemaker activity, ivabradine allows for selective reduction of HR with a resultant increase in ventricular filling time. This mechanism sets ivabradine apart from the typical rate-reducing medications, namely beta-blockers and calcium channel blockers, which simultaneously decrease HR and myocardial contractility. We describe a case of hyperthyroidism-induced sinus tachycardia, resistant to maximal doses of beta-blocker, which was successfully managed by ivabradine. After excluding other causes of tachycardia, such as anemia, hypovolemic states, structural heart disease, drug abuse, and infection, ivabradine was given off-label for symptomatic relief of hyperthyroidism-induced sinus tachycardia. Within 24 h, HR steadily decreased to the low 80s. Our patient had a unique presentation in which he presented with hyperthyroidism-induced sinus tachycardia with no relief after administration of maximal dose of beta-blocker. Ivabradine was then given, with resolution of sinus tachycardia within 24 h.
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Affiliation(s)
- Yelizaveta Medina
- Department of Medicine, Staten Island University Hospital, Staten Island, NY 10305, USA
| | - Asif Khan
- Department of Cardiology, Staten Island University Hospital, Staten Island, NY 10305, USA
| | - Jonathon Spagnola
- Department of Cardiology, Staten Island University Hospital, Staten Island, NY 10305, USA
| | - James Lafferty
- Department of Cardiology, Staten Island University Hospital, Staten Island, NY 10305, USA
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21
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Hernandez BO, Nagatsuka M, Wright SC, Marcellino AJ, Lovin BD, Walker FO, Madden LL. Hemodynamic Changes Associated With Transcervical Laryngeal Injection of Botulinum Toxin. J Voice 2023; 37:452-455. [PMID: 33541763 PMCID: PMC8325702 DOI: 10.1016/j.jvoice.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/01/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Laryngeal dystonia is a chronic neurologic disorder characterized by intention-induced spasms of the vocal folds driven by aberrant central motor processing. The use of in-office transcervical botulinum toxin injection for the treatment of laryngeal disorders, such as laryngeal dystonia, has been deemed safe and efficacious. There is, however, no available data outlining the hemodynamic changes experienced by patients undergoing this frequently performed procedure. METHODS One hundred and one patients diagnosed with laryngeal dystonia were enrolled in this prospective study. These patients underwent transcervical laryngeal botulinum toxin injection to address their dysphonia. Vital signs where acquired prior to, and at the time of injection. Alterations in these parameters were then evaluated for statistical significance. RESULTS Statistically significant increases in mean heart rate (5.8 ± 10.8 bpm, P < 0.0001), systolic blood pressure and diastolic blood pressure (7.0 ± 9.5 mm Hg, P < 0.0001; 8.7 ± 14.7 mm Hg, P < 0.0001) were discovered. No statistically significant difference in oxygen saturation was noted and no patients in the study faced major adverse outcomes. CONCLUSIONS Though these findings may not have related to clinically significant complication, our study demonstrates the importance of understanding potential stressors in a procedure routinely performed by laryngologists. This may result in more careful patient selection, alterations in procedure, and improved safety by acting in a timely fashion if alarming changes in hemodynamic parameters are noted.
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Affiliation(s)
- Brian O Hernandez
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Moeko Nagatsuka
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen Carter Wright
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amanda J Marcellino
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Benjamin D Lovin
- Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Francis O Walker
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lyndsay L Madden
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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22
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Dasgupta S, Shalhoub K, El-Assaad I, O'Leary E, Feins EN, Triedman JK, Walsh EP, Kheir JN, Dionne A. Clinical risk prediction score for post-operative accelerated junctional rhythm and junctional ectopic tachycardia in children with congenital heart disease. Heart Rhythm 2023:S1547-5271(23)00221-7. [PMID: 36898471 DOI: 10.1016/j.hrthm.2023.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Accelerated junctional rhythm (AJR) and Junctional ectopic tachycardia (JET) are common post-operative arrhythmias associated with morbidity/mortality. Studies suggest that pre- or intra-operative treatment may improve outcomes, but patient selection remains a challenge. OBJECTIVES Our objective was to describe contemporary outcomes of post-operative AJR/JET and develop a risk-prediction score to identify patients at highest risk. METHODS Retrospective cohort study of children 0-18 years undergoing cardiac surgery (2011-2018). AJR was defined as usual complex tachycardia with ≥1:1 ventricular-atrial association and junctional rate >25th percentile of sinus rate for age but < 170 bpm while JET was defined as a rate >170 bpm. A risk prediction score was developed using random forest analysis and logistic regression. RESULTS From 6364 surgeries, AJR occurred in 215 (3.4%) and JET in 59 (0.9%). Age, heterotaxy syndrome, aortic cross-clamp time, ventricular septal defect closure and atrio-ventricular canal repair were independent predictors of AJR/JET on multivariate analysis and included in the risk prediction score. The model accurately predicted the risk of AJR/JET with a C-index of 0.72 [95% CI 0.70, 0.75]. Post-operative AJR and JET was associated with prolonged ICU and hospital length of stay, but not with early mortality. CONCLUSION We describe a novel risk prediction score to estimate the risk of post-operative AJR/JET permitting early identification of at-risk patients who may benefit from prophylactic treatment.
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Affiliation(s)
- Soham Dasgupta
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
| | - Khairy Shalhoub
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Iqbal El-Assaad
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Edward O'Leary
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Eric N Feins
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA
| | - John K Triedman
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - John N Kheir
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
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23
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Ohya A, Ohtake M, Kawamura Y, Akimoto T, Iwashita M, Yamamoto T, Takeuchi I. Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report. Int J Emerg Med 2023; 16:15. [PMID: 36858963 PMCID: PMC9976426 DOI: 10.1186/s12245-023-00490-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Subarachnoid hemorrhage and thyroid storm are similar in their clinical symptomatology, and diagnosis of these conditions, when they occur simultaneously, is difficult. Here, we report a rare case of concurrent subarachnoid hemorrhage and thyroid storm we encountered at our hospital. CASE PRESENTATION The patient was a 52-year-old woman. While bathing at home, the patient experienced a sudden disturbance of consciousness and was brought to our hospital. The main physical findings upon admittance were Glasgow Coma Scale score of E1V2M4, elevated blood pressure (208/145 mmHg), and tachycardia with atrial fibrillation (180 bpm) along with body temperature of 36.1 °C. Brain computed tomography revealed subarachnoid hemorrhage associated with a ruptured aneurysm of the posterior communicating artery branching from the left internal carotid artery, and aneurysm clipping was performed. Blood tests upon admission revealed high levels of free T3 and free T4 and low levels of thyroid-stimulating hormone. Upon determining that the patient had hyperthyroidism, thiamazole was administered. However, due to continuous impaired consciousness, fever, and persistence of tachycardia, the patient was diagnosed with thyroid storm. Oral potassium iodide and hydrocortisone were added to the treatment. The treatment was successful as the patient's symptoms improved, and she became lucid. In this case, we believe that in the presence of untreated hyperthyroidism, the onset of subarachnoid hemorrhage induced thyroid storm. Tachycardia of 130 bpm or higher, which is the diagnostic criterion for thyroid storm, rarely occurs with subarachnoid hemorrhage. Therefore, we believe it is an important factor for recognizing the presence of the thyroid storm. In this case, clipping surgery was prioritized which resulted in a favorable outcome. However, it is possible that invasive surgery may have exacerbated thyroid storm, suggesting that treatment should be tailored as per patient's condition. CONCLUSION If a pulse rate of 130 bpm or higher is observed alongside subarachnoid hemorrhage, we recommend considering the possibility of concomitant thyroid storm and testing for thyroid hormone. If concomitant thyroid storm is present, we believe that a treatment plan tailored to the patient's condition is critical, and early diagnosis will lead to a favorable outcome for the patient.
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Affiliation(s)
- Aimi Ohya
- grid.413045.70000 0004 0467 212XDepartment of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Ohtake
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan. .,Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan.
| | - Yusuke Kawamura
- grid.413045.70000 0004 0467 212XDepartment of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Taisuke Akimoto
- grid.413045.70000 0004 0467 212XDepartment of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Masayuki Iwashita
- grid.413045.70000 0004 0467 212XDepartment of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Tetsuya Yamamoto
- grid.268441.d0000 0001 1033 6139Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ichiro Takeuchi
- grid.413045.70000 0004 0467 212XDepartment of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
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Körtl T, Schach C, Sossalla S. How arrhythmias weaken the ventricle: an often underestimated vicious cycle. Herz 2023; 48:115-122. [PMID: 36695877 DOI: 10.1007/s00059-022-05158-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/26/2023]
Abstract
Arrhythmia-induced cardiomyopathy (AIC) is classified as a form of dilated cardiomyopathy in which left ventricular systolic dysfunction (LVSD) is triggered by tachycardic or arrhythmic heart rates. On the one hand AIC can develop in patients without cardiac disease and on the other hand it can appear in patients with pre-existing LVSD, leading to a further reduction in left ventricular (LV) ejection fraction. A special aspect of AIC is the potential termination or partial reversibility of LVSD; thus, AIC is curatively treatable by the elimination of the underlying arrhythmia. Since arrhythmias are often seen merely as a consequence than as an underlying cause of LVSD, and due to the fact that the diagnosis of AIC can be made only after recovery of LV function, the prevalence of AIC is probably underestimated in clinical practice. Pathophysiologically, animal models have shown that continuous tachycardic pacing induces consecutive changes such as the occurrence of LVSD, increased filling pressures, LV dilatation, and decreased cardiac output. After termination of tachycardia, reversibility of the described pathologies can usually be observed. Studies in human ventricular myocardium have recently demonstrated that various cellular structural and functional mechanisms are activated even by normofrequent atrial fibrillation, which may help to explain the clinical AIC phenotype.
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Affiliation(s)
- Thomas Körtl
- Klinik und Poliklinik für Innere Medizin II, Universitäres Herzzentrum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany
| | - Christian Schach
- Klinik und Poliklinik für Innere Medizin II, Universitäres Herzzentrum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany
| | - Samuel Sossalla
- Klinik und Poliklinik für Innere Medizin II, Universitäres Herzzentrum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany.
- Klinik und Poliklinik für Kardiologie & Pneumologie, Georg-August Universität Göttingen und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Göttingen, Germany.
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25
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Goette A, Lip GYH, Gorenek B. What acute cardiac care physicians need to know from the latest 2022 ESC Guidelines for ventricular tachycardia and sudden cardiac death. Eur Heart J Acute Cardiovasc Care 2023; 12:62-68. [PMID: 36449983 DOI: 10.1093/ehjacc/zuac149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
The present paper summarizes and comments on the latest 2022 ESC guidelines on ventricular tachycardia and sudden cardiac death. Most relevant recommendations for acute cardiovascular care physicians are addressed, particularly, in the fields of coronary artery disease, dilated cardiomyopathy, and inflammatory diseases. New recommendations encompass the implantation of a defibrillator (ICD) in the setting of acute myocarditis. Furthermore, the pathophysiology of the electrical storm including involved molecular pathways as well as the angry Purkinje fibre syndrome is presented and discussed.
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Affiliation(s)
- Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz Hospital, 33098 Paderborn, Germany.,Association for Acute CardioVascular Care: Task Force Acute Rhythm Disturbances, European Society of Cardiology, 2035 Rte des Colles, 06410 Biot, France
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK.,Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Sondra Skovvej, 15, Aalborg 9000, Denmark
| | - Bulent Gorenek
- Association for Acute CardioVascular Care: Task Force Acute Rhythm Disturbances, European Society of Cardiology, 2035 Rte des Colles, 06410 Biot, France.,School of Medicine, Cardiology Department, Eskisehir Osmangazi University, Meselik, 26480 Eskişehir, Turkey
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26
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Meng Y, Zhang Y, Zhu C, Nie C, Liu P, Chang S, Wang S. Atrial high-rate episode burden and stroke risks for patients with device-detected subclinical atrial fibrillation: A systematic review and meta-analysis. Int J Cardiol 2023; 371:211-220. [PMID: 36243183 DOI: 10.1016/j.ijcard.2022.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Atrial high-rate episode (AHRE) and stroke are related; however, the magnitude of the correlations between different AHRE burdens and stroke remains unknown. We analysed studies that evaluated this relationship. METHODS We searched for observational controlled studies that reported the associations of different AHRE burdens with stroke in populations with cardiac implantable electronic devices (CIEDs). The primary endpoint was stroke or thrombosis during follow-up. We performed subgroup analyses according to the classification criteria and research design of the included studies. RESULTS Of the 5985 studies identified, 9 met the eligibility criteria and included 42,958 patients. Patients with low and high AHRE burdens had a 1.2-fold risk of stroke (no heterogeneity) and a 2.52-fold risk of stroke (moderate heterogeneity), respectively. After excluding studies analysing the atrial fibrillation history, no significant difference in progressive stroke risk was observed for patients with a low AHRE burden (without significant heterogeneity). An increased likelihood of stroke was observed for patients with a high AHRE burden (decreased heterogeneity). Four of the nine studies classified high and low AHRE burdens using the longest AHRE time. Five studies classified high and low AHRE burdens based on the median of the total AHRE time as the cutoff value. Low and high AHRE burdens were more closely related to stroke when classified by the total AHRE duration than when classified by the single longest AHRE duration. CONCLUSIONS For populations with CIEDs without an atrial fibrillation history, a high AHRE burden was significantly associated with stroke.
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Affiliation(s)
- Yanhai Meng
- Surgical Intensive Care Unit, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Surgical Intensive Care Unit, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Yanbo Zhang
- Surgical Intensive Care Unit, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Changsheng Zhu
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changrong Nie
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Liu
- Surgical Intensive Care Unit, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuo Chang
- Surgical Intensive Care Unit, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuiyun Wang
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Yuksen C, Tienpratarn W, Promkul R, Jenpanitpong C, Watcharakitpaisan S, Yaithet J, Phonphom V. A Clinical Score for Predicting the Paroxysmal Supraventricular Tachycardia's Recurrence Risk; a Retrospective Cross-sectional Study. Arch Acad Emerg Med 2023; 11:e2. [PMID: 36620742 PMCID: PMC9807948 DOI: 10.22037/aaem.v11i1.1825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction Identifying prognostic variables associated with the probability of recurrent paroxysmal supraventricular tachycardia (PSVT) would aid decision-making regarding disposition of the patients. This study aims to develop a clinical scoring system to predict PSVT recurrence after adenosine administration in the emergency department (ED). Methods This retrospective cross-sectional study was conducted on patients who were referred to the emergency department of Ramathibodi Hospital, a university-affiliated super-tertiary care hospital in Bangkok, Thailand, with diagnosis of PSVT during a 10-year period from 01 January 2010 until 31 December 2020. The cases were divided into recurrent and non-recurrent PSVT based on the response to standard treatment and the independent predictors of recurrence were studied using multivariable logistic regression analysis. Results 264 patients were diagnosed with PSVT and successfully converted by adenosine. 24 (9.1%) had recurrent PSVT, and 240 (90.9%) had no recurrent PSVT in the same ED visit. The risk of PSVT recurrence in ED corresponded with the history of hypertension (p = 0.059), valvular heart disease (p = 0.052), heart rate ≥ 100 (p = 0.012), and systolic blood pressure < 100 after electrocardiogram (ECG) converted to sinus rhythm (p = 0.022) and total dose of adenosine (p = 0.002). We developed a clinical prediction score of PSVT recurrence with an accuracy of 79.5%. A score of 0 (low risk), 1-2 (moderate risk), and > 2 (high risk) had a positive likelihood ratio (LR+) of 0.31, 0.56 and 2.33, respectively. Conclusion It seems that, using the PSVT recurrence score we could screen the high-risk patients for PSVT recurrence (score>2) who need to be observed for at least 6-12 hours and receive cardiologist consultation in ED. In addition, the moderate and low-risk group (score 0-2) need to be observed for 1 hour and can be discharged from ED.
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Affiliation(s)
- Chaiyaporn Yuksen
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Welawat Tienpratarn
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. ,Corresponding author: Welawat Tienpratarn; Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, Thailand, 10400. E-mail:
| | - Rungrawin Promkul
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chetsadakon Jenpanitpong
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sorawich Watcharakitpaisan
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jenjira Yaithet
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 111 Moo 14, Bang Pla, Bang Phli, Samut Prakarn 10540, Thailand
| | - Viruji Phonphom
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Matsuzono K, Fujimoto S, Aoki J, Ozawa T, Kimura K. Tachycardia Changes Increase Neurological Deterioration in Patients with Acute Non-Cardioembolic Stroke: An ADS Post-Hoc Analysis. J Atheroscler Thromb 2023; 30:66-73. [PMID: 35283411 PMCID: PMC9899698 DOI: 10.5551/jat.63409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AIM A previous randomized study showed that dual antiplatelet therapy (DAPT) with aspirin and cilostazol is not superior to aspirin monotherapy for patients with acute non-cardioembolic stroke; however, the reason for this remains uncertain. We focused on the unusual side effects of cilostazol, namely, tachycardia changes, and validated their influence on patients with acute non-cardioembolic stroke. METHODS This post-hoc study extracted data from the acute aspirin plus cilostazol dual therapy study (ADS) registry, a multicenter, prospective, randomized, open-label trial. Patients were randomly allocated to the dual group (aspirin plus cilostazol) and the aspirin monotherapy group (aspirin alone). Tachycardia changes were defined as ≥ 5% heart rate increase at 48 h after admission compared with that at admission. Baseline data and outcomes were validated with four divided groups: aspirin-non-tachycardia changes (AN), aspirin-tachycardia changes (AT), dual-non-tachycardia changes (DN), and dual-tachycardia changes (DT). RESULTS Finally, 1,188 patients were analyzed in this ADS post-hoc analysis (aspirin monotherapy group, 594; dual group, 594). The proportion of change in tachycardia was 19.2% in the aspirin monotherapy group and 38.2% in the dual group (p<0.001***). Although the recurrences of symptomatic stroke and transient ischemic attack were not significantly different, the neurological deterioration was significantly different among the AN, AT, DN, and DT groups (p<0.05*). CONCLUSIONS Tachycardia changes increase neurological deterioration even in patients with non-cardioembolic acute stroke. DAPT consisting of aspirin and cilostazol increases the proportion of tachycardia changes and is not superior to aspirin monotherapy.
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Affiliation(s)
- Kosuke Matsuzono
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shigeru Fujimoto
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Junya Aoki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Tadashi Ozawa
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Abstract
Purpose Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which primarily infects the lower airways and binds to angiotensin-converting enzyme 2 (ACE2) on alveolar epithelial cells. ACE2 is widely expressed not only in the lungs but also in the cardiovascular system. Therefore, SARS-CoV-2 can also damage the myocardium. This report aimed to highlight decreased heart rate variability (HRV) and cardiac injury caused by SARS-CoV-2. Materials and Methods We evaluated three COVID-19 patients who died. Patients' data were collected from electronic medical records. We collected patient's information, including baseline information, lab results, body temperature, heart rate (HR), clinical outcome and other related data. We calculated the HRV and the difference between the expected and actual heart rate changes as the body temperature increased. Results As of March 14, 2020, 3 (2.2%) of 136 patients with COVID-19 in Tianjin died in the early stage of the COVID-19 epidemic. The immediate cause of death for Case 1, Case 2, and Case 3 was cardiogenic shock, cardiac arrest and cardiac arrest, respectively. The HRV were substantially decreased in the whole course of all three cases. The actual increases in heart rate were 5 beats/min, 13 beats/min, and 4 beats/min, respectively, less than expected as their temperature increased. Troponin I and Creatine Kinase MB isoenzyme (CK-MB) were substantially increased only in Case 3, for whom the diagnosis of virus-related cardiac injury could not be made until day 7. In all three cases, decreased in HRV and HR changes occurred earlier than increases in cardiac biomarkers (e.g., troponin I and CK-MB). Conclusions In conclusion, COVID-19 could affect HRV and counteract tachycardia in response to increases in body temperature. The decreases of HRV and HR changes happened earlier than the increases of myocardial markers (troponin I and CK-MB). It suggested the decreases of HRV and HR changes might help predict cardiac injury earlier than myocardial markers in COVID-19, thus its early identification might help improve patient prognosis. Supplementary Information The online version contains supplementary material available at 10.1007/s44231-022-00024-1.
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Affiliation(s)
- Chengfen Yin
- Department of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Jianguo Li
- Department of Respiratory and Critical Medicine, Tianjin Haihe Hospital, Tianjin, China
| | - Zhiyong Wang
- Department of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Yongle Zhi
- Department of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Lei Xu
- Department of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
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Hanson J, Richley M, Hsu JJ, Lin J, Afshar Y. Postural orthostatic tachycardia syndrome and orthostatic hypotension in post-acute sequelae of COVID-19 during pregnancy: a case report. Eur Heart J Case Rep 2022; 6:ytac453. [PMID: 36518330 PMCID: PMC9732766 DOI: 10.1093/ehjcr/ytac453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/04/2022] [Accepted: 11/23/2022] [Indexed: 09/02/2023]
Abstract
BACKGROUND Patients with post-acute sequelae of COVID-19 (PASC) often experience the addition of new symptoms after recovery from COVID-19 illness. These may include orthostatic intolerance and autonomic dysfunction, and postural orthostatic tachycardia syndrome has been described to occur in a proportion of patients with PASC. CASE SUMMARY In this report, we present a 32-year-old pregnant woman (G3P2) who experiences severe orthostatic symptoms as part of her PASC syndrome, which is decoupled from normal physiologic changes of pregnancy. At 25 weeks of gestation, she was evaluated for increasing episodes of dyspnoea, marked tachycardia with minimal exertion, intermittent non-exertional chest pain, and presyncope. This patient had a moderate course of COVID-19 at 12 weeks of gestation, for which she received monoclonal antibody therapy (casirivimab/imdevimab). The patient then had complete resolution of COVID-19 symptoms and felt well for 1 month prior to developing orthostatic symptoms at 25 weeks of gestation. Evaluation with a NASA Lean Test revealed marked orthostatic tachycardia, as well as delayed orthostatic hypotension. Given her COVID-19 illness 4 months prior, PASC involving autonomic dysfunction was diagnosed. DISCUSSION Patients with orthostatic symptoms in PASC should be carefully evaluated with dedicated active stand tests, such as the NASA Lean Test, to characterize the autonomic response to standing. In pregnant patients, an understanding of normal pregnancy physiology is crucial to correctly identify abnormal findings in such tests.
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Affiliation(s)
- Justin Hanson
- Division of Cardiology, David Geffen School of Medicine at UCLA, 100 Medical Plaza Suite 630, Los Angeles, CA 90095, USA
| | - Michael Richley
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suites 430 & 220, Los Angeles, CA 90095, USA
| | - Jeffrey J Hsu
- Division of Cardiology, David Geffen School of Medicine at UCLA, 100 Medical Plaza Suite 630, Los Angeles, CA 90095, USA
- Ahmanson/UCLA Cardiomyopathy Center, Division of Cardiology, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 630, Los Angeles, CA 90095, USA
| | - Jeannette Lin
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 630, Los Angeles, CA 90095, USA
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suites 430 & 220, Los Angeles, CA 90095, USA
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Abstract
Postural orthostatic tachycardia syndrome (POTS) is a complex multisystem disorder characterized by orthostatic intolerance and tachycardia and may be triggered by viral infection. Recent reports indicate that 2%-14% of coronavirus disease 2019 (COVID-19) survivors develop POTS and 9%-61% experience POTS-like symptoms, such as tachycardia, orthostatic intolerance, fatigue, and cognitive impairment within 6-8 months of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Pathophysiological mechanisms of post-COVID-19 POTS are not well understood. Current hypotheses include autoimmunity related to SARS-CoV-2 infection, autonomic dysfunction, direct toxic injury by SARS-CoV-2 to the autonomic nervous system, and invasion of the central nervous system by SARS-CoV-2. Practitioners should actively assess POTS in patients with post-acute COVID-19 syndrome symptoms. Given that the symptoms of post-COVID-19 POTS are predominantly chronic orthostatic tachycardia, lifestyle modifications in combination with the use of heart rate-lowering medications along with other pharmacotherapies should be considered. For example, ivabradine or β-blockers in combination with compression stockings and increasing salt and fluid intake has shown potential. Treatment teams should be multidisciplinary, including physicians of various specialties, nurses, psychologists, and physiotherapists. Additionally, more resources to adequately care for this patient population are urgently needed given the increased demand for autonomic specialists and clinics since the start of the COVID-19 pandemic. Considering our limited understanding of post-COVID-19 POTS, further research on topics such as its natural history, pathophysiological mechanisms, and ideal treatment is warranted. This review evaluates the current literature available on the associations between COVID-19 and POTS, possible mechanisms, patient assessment, treatments, and future directions to improving our understanding of post-COVID-19 POTS.
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Affiliation(s)
- Cameron K Ormiston
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, California; Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Iwona Świątkiewicz
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, California; Department of Cardiology and Internal Medicine, Nicolaus Copernicus University Torun, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Pam R Taub
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, California.
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Jang MJ, Kim JH, Jeong HJ. Uncontrolled high blood pressure under total intravenous anesthesia with propofol and remifentanil: A case report. World J Clin Cases 2022; 10:9411-9416. [PMID: 36159423 PMCID: PMC9477663 DOI: 10.12998/wjcc.v10.i26.9411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/06/2022] [Accepted: 08/12/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although propofol generally reduces blood pressure, rarely, it causes hypertension. However, the mechanism by which propofol increases blood pressure has not been established, and so far, there are only a few reported cases.
CASE SUMMARY A 46-year-old woman, diagnosed with thyroid cancer, was administered general anesthesia with propofol and remifentanil for a thyroid lobectomy. An increase in the concentrations of intravenous anesthetics further increased her blood pressure. The blood pressure remained stable when anesthesia was maintained with sevoflurane and remifentanil after the interruption of propofol administration.
CONCLUSION We concluded that propofol administration was the cause of increased blood pressure.
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Affiliation(s)
- Min Jung Jang
- Anesthesiology and Pain Medicine, National Cancer Center, Goyang 10408, South Korea
| | - Jee Hee Kim
- Anesthesiology and Pain Medicine, National Cancer Center, Goyang 10408, South Korea
| | - Hae Jeong Jeong
- Anesthesiology and Pain Medicine, National Cancer Center, Goyang 10408, South Korea
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33
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Shanefield SC, Kelly MN, Posa M. Wearable Technology Leads to Initial Workup of Graves' Disease in an Adolescent Female. J Adolesc Health 2022; 71:370-372. [PMID: 35660129 DOI: 10.1016/j.jadohealth.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022]
Abstract
Graves' disease is the most common form of hyperthyroidism in the pediatric population. While the most prevalent symptoms seen in children with Graves' disease include goiter and excessive sweating (Minamitani et al., 2017), diagnosis is frequently delayed due to presentation with non-specific symptoms (Léger et al., 2018). This case report is of a 12-year-old female who presented to her pediatrician with a one month history of episodes of tachycardia both with physical exertion and at rest. Notably, these episodes were discovered on her electronic smartwatch by its heart rate monitoring feature. Further pertinent positives elicited in the patient's review of systems included increasing anxiety, diaphoresis, intermittent hand tremors, and recent weight loss. These findings led to further workup that included thyroid studies, culminating in a diagnosis of Graves' disease. Indeed, this patient's smartwatch aided in her initial presentation to her physician and allowed for prompt workup and diagnosis. There exist limited studies to date on the use of smartwatches to detect cardiac-related conditions in children, which may be due to the absence of Food and Drug Administration approval for certain cardiac-related smartwatch features in this patient population.
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Affiliation(s)
| | - Maria N Kelly
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - Molly Posa
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
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34
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Kamali F, Haghjoo M, Pasebani Y, Alizadehdiz A, Emkanjoo Z, Fazelifar A, Masoudkabir F, Keykhavani A, Madadi S. A Comprehensive Review of Left Ventricular Summit Ventricular Arrhythmias. J Tehran Heart Cent 2022; 17:91-102. [PMID: 37252083 PMCID: PMC10222943 DOI: 10.18502/jthc.v17i3.10841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/10/2022] [Indexed: 05/31/2023] Open
Abstract
The catheter ablation of idiopathic ventricular arrhythmias is accepted as a first-line treatment as it successfully eliminates about 90.0% of such arrhythmias. One of the most challenging ventricular arrhythmias originates from the left ventricular summit (LVS), a triangular epicardial space with the left main bifurcation as its apex. This area accounts for about 14.0% of LV arrhythmias. The complex anatomy of this region, accompanied by proximity to the major epicardial coronary arteries and the presence of a thick fat pad in this region, renders it a challenging area for catheter ablation. This article presents a review of the anatomy of the LVS and relevant regions and discusses novel mapping and ablation techniques for eliminating LVS ventricular arrhythmias. Additionally, we elaborate on the electrocardiographic (ECG) manifestations of arrhythmias from the LVS and their successful ablation via the direct approach and the adjacent structures.
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Affiliation(s)
- Farzad Kamali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Haghjoo
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Pasebani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfath Alizadehdiz
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Emkanjoo
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amirfarjam Fazelifar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ala Keykhavani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Madadi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Arun Kumar P, Dasari M, Sahu KK, Al-Seykal I, Mishra AK. Understanding the EKG changes in methemoglobinemia. Ann Hematol 2022; 101:2107-2110. [PMID: 35723711 DOI: 10.1007/s00277-022-04878-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/04/2022] [Indexed: 11/25/2022]
Abstract
Methemoglobin is a form of hemoglobin that has been oxidized, changing its heme iron configuration from the ferrous to the ferric state. Unlike normal hemoglobin, methemoglobin does not bind oxygen and as a result, cannot deliver oxygen to the tissues. At the presentation in the emergency department, an electrocardiogram (EKG) is usually performed as a reflex for patients admitted for shortness of breath to rule out acute coronary syndrome. Very limited data is available on EKG abnormalities in patients with methemoglobinemia. In this study, we retrospectively analyzed the pattern of EKG changes in patients with methemoglobinemia.
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Affiliation(s)
| | | | - Kamal Kant Sahu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Soroken C, Posfay-Barbe KM, Caflisch M, Z'Graggen WJ. Postural tachycardia syndrome among adolescents. Arch Pediatr 2022; 29:398-403. [PMID: 35523634 DOI: 10.1016/j.arcped.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/20/2022] [Accepted: 03/26/2022] [Indexed: 12/01/2022]
Abstract
Postural tachycardia syndrome (PoTS) is a polymorphic clinical syndrome that is underdiagnosed, especially in adolescents. It is a form of dysautonomia, but its exact physiopathology remains elusive. Several pathologies can mimic PoTS; it is characterized by heterogeneous symptoms that accompany a disproportionate tachycardia upon the upright position. It can significantly impact the patients' quality of life. Only a Schellong test is useful for making the diagnosis. Treatment in PoTS is primarily symptomatic with the main goal being to restore the patient's condition as quickly as possible. We report here the diagnosis and management of seven adolescents, aged 11-16, who have been followed up since 2015.
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Affiliation(s)
- C Soroken
- Department of Pediatrics, Geneva University Hospitals, Willy-Donzé Street 6, 1205 Geneva, Switzerland.
| | - K M Posfay-Barbe
- Department of Pediatrics, Geneva University Hospitals, Willy-Donzé Street 6, 1205 Geneva, Switzerland
| | - M Caflisch
- Department of Pediatrics, Geneva University Hospitals, Willy-Donzé Street 6, 1205 Geneva, Switzerland
| | - W J Z'Graggen
- Departments of Neurology and Neurosurgery, Inselspital, Bern University Hospital, Freiburgstrasse 16, 3010 Bern, Switzerland
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Abstract
A 44-year-old man had persistent fever following a severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection. Because of progressive sinus tachycardia, thyroid hormones were measured which showed hyperthyroidism. Thyroid sonography revealed enlargement of the thyroid gland with hypoechoic areas with blurred margins. We diagnosed subacute granulomatous thyroiditis associated with SARS-CoV‑2 infection and initiated therapy with prednisolone. This therapy resulted in rapid improvement of the patient's clinical condition and complete remission after three months.
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Abstract
Heart rate is well established in the diagnosis of shock; however, the mechanisms regulating heart rate, systemic resistance and blood pressure remain unclear. The concept of heart rate control in shock-related tachycardia has been known for about 50 years. Elevated heart rates in septic shock have been identified as an indicator of increasingly inefficient hemodynamics, worsening perfusion and organ function as well as of an unfavourable prognosis. Many drugs used for heart rate control also lower blood pressure. The challenge of this therapeutic concept is achieving optimal heart rate control without provoking critical hypotension. Only in recent years has the development of highly cardioselective, short- and ultrashort-acting β‑blockers such as esmolol and landiolol made it possible to prove the feasibility and usefulness of heart rate control in certain types of shock.
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Sayida S, Obeid A, Jubran L, Mualem TY, Assalia A, Mahajna A. The Relationship Between Tachycardia After Laparoscopic Sleeve Gastrectomy and the Development of Postoperative Complications. Obes Surg 2022. [PMID: 35247161 DOI: 10.1007/s11695-022-05938-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bariatric surgery can be associated with severe complications. Tachycardia is an important indicator of certain complications, such as anastomotic leak and hemorrhage. Our aim was to examine the relationship between tachycardia following sleeve gastrectomy and the appearance of associated complications. METHODS Patients who underwent sleeve gastrectomy over a 2-year period were included in the study. Participants were divided into two groups: the first included patients who suffered from postoperative tachycardia and the second patients with normal postoperative heart rates. Complications in both groups were examined. Other parameters that predict the onset of complications were also reviewed. RESULTS A total of 457 patients were included. Postoperative tachycardia was measured in 181 (39.6%) patients; 17 (3.7%) suffered from bleeding and 4 (1%) from staple line leakage. Postoperative bleeding was more common among patients with tachycardia than among those without (14 (7.7%) vs. 3 (1.1%), respectively). Patients in the tachycardia group had more staple line leakages than those in the normal heart rate group (3 (2%) vs. 1 (0%), respectively); tachycardia was also attributed to postoperative pain or other minor complications in 160 (88%) patients. Age ≥ 40 years was found to be predictive factor for postoperative complications. CONCLUSIONS The most common causes of tachycardia postoperatively were pain and minor complications. Tachycardia is an essential indicator of postoperative minor and major complications, mainly staple line leakage and bleeding. This should prompt immediate medical intervention in order to avoid serious adverse events.
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Hossain ME, Akter N. NaHCO 3, L-arginine, and vitamin C supplemented vegetable diet ameliorates tachycardia and polycythemia in the broiler chicken. Trop Anim Health Prod 2022; 54:122. [PMID: 35233685 DOI: 10.1007/s11250-021-02993-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022]
Abstract
The study aimed to investigate if vegetable-based high-energy mash diets supplemented with NaHCO3, L-arginine + vitamin C, and vegetable oils were effective against tachycardia and polycythemia in the broiler chicken. A total of 256 Ross-308 day-old male broiler chicks were randomly distributed into eight dietary treatment groups in a three-way ANOVA with 2 × 2 × 2 factorial arrangement (three factors, i.e., NaHCO3, L-arginine + vitamin C, and vegetable oil each with two levels, e.g., 0 and 0.1% of NaHCO3 and L-arginine + vitamin C; 3 and 4% of vegetable oil supplemented with basal diet) for a period of 35 days. Iso-caloric and iso-nitrogenous diets were formulated and supplied ad libitum. The final live weight (FLW), average daily feed intake (ADFI), average daily gain (ADG), feed efficiency (FE), carcass traits, cardio-pulmonary morphometry, total protein (TP), hemoglobin (Hb), triiodothyronine (T3), incidence of tachycardia, and polycythemia were examined. Supplementation of NaHCO3 increased 2.2% ADFI, 5.5% FE, and 23.2% TP. The L-arginine + vitamin C increased 2.4% FLW and decreased 1.9% heart rate. Vegetable oil increased 1.3% ADFI, 4.2% ADG, 8.6% FE, 23.1% Hb, and 15.5% PCV. The NaHCO3, L-arginine + vitamin C, and vegetable oil additively interacted to increase 31.5% T3 at the expense of 21.1% of the weight of the right ventricle (RV). The RV:TV, carcass traits, and hemato-biochemical indices remained within normal range irrespective of the levels of the supplementations of the test ingredients. It was concluded that vegetable-based high-energy mash diets were not susceptible to tachycardia and polycythemia. The addition of NaHCO3 and L-arginine + vitamin C ameliorated the propensity of tachycardia and polycythemia without deteriorating performance, carcass traits, and hemato-biochemical indices of the broiler chicken in a dose-dependent manner.
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Affiliation(s)
- Md Emran Hossain
- Department of Animal Science and Nutrition, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Zakir Hossain Road, Khulshi, Chattogram, 4225, Bangladesh.
| | - Nasima Akter
- Department of Dairy and Poultry Science, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Zakir Hossain Road, Khulshi, Chattogram, 4225, Bangladesh
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Liu S, Bilston LE, Flores Rodriguez N, Wright C, McMullan S, Lloyd R, Stoodley MA, Hemley SJ. Changes in intrathoracic pressure, not arterial pulsations, exert the greatest effect on tracer influx in the spinal cord. Fluids Barriers CNS 2022; 19:14. [PMID: 35135574 PMCID: PMC8822685 DOI: 10.1186/s12987-022-00310-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) circulation in the brain has garnered considerable attention in recent times. In contrast, there have been fewer studies focused on the spine, despite the expected importance of CSF circulation in disorders specific to the spine, including syringomyelia. The driving forces that regulate spinal CSF flow are not well defined and are likely to be different to the brain given the anatomical differences and proximity to the heart and lungs. The aims of this study were to determine the effects of heart rate, blood pressure and respiration on the distribution of CSF tracers in the spinal subarachnoid space, as well as into the spinal cord interstitium. METHODS In Sprague Dawley rats, physiological parameters were manipulated such that the effects of spontaneous breathing (generating alternating positive and negative intrathoracic pressures), mechanical ventilation (positive intrathoracic pressure only), tachy/bradycardia, as well as hyper/hypotension were separately studied. To investigate spinal CSF hydrodynamics, in vivo near-infrared imaging of intracisternally infused indocyanine green was performed. CSF tracer transport was further characterised with in vivo two-photon intravital imaging. Tracer influx at a microscopic level was quantitatively characterised by ex vivo epifluorescence imaging of fluorescent ovalbumin. RESULTS Compared to mechanically ventilated controls, spontaneous breathing animals had significantly greater movement of tracer in the subarachnoid space. There was also greater influx into the spinal cord interstitium. Hypertension and tachycardia had no significant effect on spinal subarachnoid spinal CSF tracer flux and exerted less effect than respiration on tracer influx into the spinal cord. CONCLUSIONS Intrathoracic pressure changes that occur over the respiratory cycle, particularly decreased intrathoracic pressures generated during inspiration, have a profound effect on tracer movement after injection into spinal CSF and increase cord parenchymal tracer influx. Arterial pulsations likely drive fluid transport from perivascular spaces into the surrounding interstitium, but their overall impact is less than that of the respiratory cycle on net tracer influx.
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Affiliation(s)
- Shinuo Liu
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Neftali Flores Rodriguez
- Sydney Microscopy and Microanalysis, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Courtney Wright
- Sydney Microscopy and Microanalysis, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Simon McMullan
- Department of Biological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Robert Lloyd
- Neuroscience Research Australia, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Marcus A Stoodley
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Sarah J Hemley
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, 2109, Australia.
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Daengbubpha P, Wittayachamnankul B, Sutham K, Chenthanakij B, Tangsuwanaruk T. Comparing methods of adenosine administration in paroxysmal supraventricular tachycardia: a pilot randomized controlled trial. BMC Cardiovasc Disord 2022; 22:15. [PMID: 35081915 PMCID: PMC8790832 DOI: 10.1186/s12872-022-02464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intravenous adenosine is the recommended treatment for paroxysmal supraventricular tachycardia (PSVT). There is no official recommended method of giving adenosine. We compared the success rates between a standard and alternative method of first dose intravenous adenosine in PSVT. Methods A pilot parallel randomized controlled study was conducted in the emergency department of a tertiary care hospital. Eligible patients were stable PSVT adult patients. We used block randomization and divided them into two groups, the standard method (double syringe technique of 6 mg of adenosine), and the alternative method (similar to the standard method, then immediately followed by elevating the arm to 90° perpendicular to a horizontal plane for 10 s). The primary outcome was the success rate of electrocardiogram (ECG) response which demonstrated termination of PSVT (at least two-fold of the RR-interval widening or sinus rhythm conversion). Secondary outcomes were complications within one minute after the injection. Results We allocated 15 patients in each group and analyzed them as intention-to-treat. The success rate was 86.7% in the alternative group and 80% in the standard group (risk difference 6.7%, 95% confidence interval − 19.9 to 33.2%, P 1.00). Complications within one minute after adenosine injection were also similar in both groups, 14 of 15 patients (93%) in each group had no complications, without significant difference. Conclusions No evidence of the difference between alternative and standard methods occurred, in terms of the success rate of ECG response and complications within one minute after adenosine injection. The standard method of adenosine injection is a safe, easy-to-administer, and widely available treatment for PSVT. Trial Registration: TCTR20200609001.
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Affiliation(s)
- Phruek Daengbubpha
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawaroros Road, Sribhumi, Amphoe Muang Chiang Mai, Chiang Mai, 50200, Thailand
| | - Borwon Wittayachamnankul
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawaroros Road, Sribhumi, Amphoe Muang Chiang Mai, Chiang Mai, 50200, Thailand
| | - Krongkarn Sutham
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawaroros Road, Sribhumi, Amphoe Muang Chiang Mai, Chiang Mai, 50200, Thailand
| | - Boriboon Chenthanakij
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawaroros Road, Sribhumi, Amphoe Muang Chiang Mai, Chiang Mai, 50200, Thailand
| | - Theerapon Tangsuwanaruk
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawaroros Road, Sribhumi, Amphoe Muang Chiang Mai, Chiang Mai, 50200, Thailand.
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Leroux J, Strik M, Ramirez FD, Ploux S, Sacristan B, Chabaneix-Thomas J, Jalal Z, Thambo JB, Bordachar P. Using a smartwatch to record an electrocardiogram in the pediatric population. J Electrocardiol 2022; 71:25-27. [PMID: 35016137 DOI: 10.1016/j.jelectrocard.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 10/19/2022]
Abstract
The accuracy of smartwatch ECG recordings in adults has been demonstrated primarily in the automated diagnosis of atrial fibrillation. While the detection of atrial fibrillation is a priority among adults given the arrhythmia's prevalence and actionable ramifications, the potential value of smartwatch ECG recordings in children differs considerably. In this case series, we will describe some examples of smartwatch ECGs recorded in children, highlighting the feasibility and potential indications of this technology in the pediatric population.
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Affiliation(s)
- Justine Leroux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France
| | - Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France.
| | - F Daniel Ramirez
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sylvain Ploux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Benjamin Sacristan
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Julie Chabaneix-Thomas
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Zakaria Jalal
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Jean-Benoit Thambo
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
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Andric T, Winckel K, Tanzer TD, Hollingworth S, Smith L, Isoardi K, Tan O, Siskind D. Estimation of cardiac QTc intervals in people prescribed antipsychotics: a comparison of correction factors. Ther Adv Psychopharmacol 2022; 12:20451253221104947. [PMID: 35747226 PMCID: PMC9210090 DOI: 10.1177/20451253221104947] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A prolonged electrocardiogram (ECG) QT interval is associated with cardiac events and increased mortality. Antipsychotics can prolong the QT interval. The QT interval requires correction (QTc) for heart rate using a formula or QT-nomogram. The QT and QTc can be calculated automatically by the ECG machine or manually; however, machine-measured QT(c) intervals may be inaccurate. OBJECTIVE We aimed to investigate the mean QTc and proportion of prolonged QTc intervals in people taking antipsychotic medicines. METHODS We conducted an observational retrospective chart review and data analysis of all consecutive patients taking antipsychotics, with an ECG record, admitted to the psychiatric unit of a large tertiary hospital in Brisbane, Australia, between 1 January 2017 and 30 January 2019. We investigated the mean QTc of people taking antipsychotics to determine differences using (a) machine versus manual QT interval measurement and (b) QTc correction formulae (Bazett, Fridericia, Framingham, Hodges and Rautaharju) and the QT-nomogram. We also determined the number of people with a prolonged QTc using different methods and compared rates of prolonged QTc with antipsychotic monotherapy and polypharmacy. RESULTS Of 920 included people, the mean (±SD) machine-measured, Bazett-corrected QT interval (recorded from the ECG) was 435 ms (±27), significantly longer (p < 0.001) than the mean manually measured corrected QT intervals with Fridericia 394 ms (±24), Framingham 395 ms (±22), Hodges 398 ms (±22) and Rautaharju 400 ms (±24) formulae. There were significantly more people with a prolonged QTc using machine-measured QT and the Bazett formula (12.0%, 110/920) when compared with manually measured QT and the Fridericia formula (2.2%, 20/920) or QT-nomogram (0.7%, 6/920). Rates of QTc prolongation did not differ between people taking antipsychotic polypharmacy compared with monotherapy. CONCLUSION Machine-measured QTc using the Bazett formula overestimates the QTc interval length and number of people with a prolonged QTc, compared with other formulae and the QT-nomogram. We recommend manually measuring the QT and correcting with the Fridericia formula or QT-nomogram prior to modifying antipsychotic therapies.
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Affiliation(s)
- Teodora Andric
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Karl Winckel
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Lesley Smith
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Katherine Isoardi
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Olivier Tan
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Dan Siskind
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Ditali V, Garatti L, Morici N, Villanova L, Colombo C, Oliva F, Sacco A. Effect of landiolol in patients with tachyarrhythmias and acute decompensated heart failure (ADHF): a case series. ESC Heart Fail 2021; 9:766-770. [PMID: 34962097 PMCID: PMC8788023 DOI: 10.1002/ehf2.13763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/21/2021] [Accepted: 11/27/2021] [Indexed: 12/21/2022] Open
Abstract
Tachycardia and rapid tachyarrhythmias are common in acute clinical settings and may hasten the deterioration of haemodynamics in patients with acute decompensated heart failure (ADHF), treated with inotropes. The concomitant use of a short‐acting β1‐selective beta‐blocker, such as landiolol, could rapidly and safely restore an adequate heart rate without any negative inotropic effect. We present a case series of five patients with left ventricular dysfunction, admitted to our Intensive Cardiac Care Unit with ADHF deteriorated to cardiogenic shock, treated with a combination of landiolol and inotropes. Landiolol was effective in terms of rate control and haemodynamics optimization, enabling de‐escalation of catecholamine dosing in all patients. The infusion was always well tolerated without hypotension. In conclusion, a continuous infusion of a low dose of landiolol (3–16 mcg/kg/min) to manage tachycardia and ventricular or supraventricular tachyarrhythmias in haemodynamically unstable patients may be considered.
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Affiliation(s)
- Valentina Ditali
- School of Medicine and Surgery, University of Pavia, Pavia, Italy
| | - Laura Garatti
- Department of Cardiology De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Nuccia Morici
- Department of Cardiology De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luca Villanova
- Department of Cardiology De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Claudia Colombo
- Department of Cardiology De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabrizio Oliva
- Department of Cardiology De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alice Sacco
- Department of Cardiology De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Panpruang P, Wongwandee M, Rattanajaruskul N, Roongsangmanoon W, Wongsoasu A, Angkananard T. Alice in Wonderland Syndrome-Like Seizure and Refractory Supraventricular Tachycardia. Case Rep Neurol 2021; 13:716-723. [PMID: 34950010 PMCID: PMC8647104 DOI: 10.1159/000519509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/21/2021] [Indexed: 11/30/2022] Open
Abstract
Alice in Wonderland syndrome (AIWS) is a rarely curious visual perceptual disorder which has been associated with diverse neurologic and psychiatric problems. It may be a manifestation in migraine, epileptic seizures, encephalitis, other brain lesions, medication-related side effects, schizophrenia, and depressive disorders. Principal character of AIWS is the disproportion between the external world and the self-image in which micropsia (objects appear smaller), macropsia (objects appear larger), and teleopsia (objects appear further away) are frequently reported. The cases of temporal lobe epilepsy may present with complex visual auras of visual distortions (e.g., micropsia and macropsia) like AIWS. We report an unusual case of an elderly man who presented with AIWS, focal impaired awareness seizures, ictal tachyarrhythmia, multiple episodes of transient visual disturbances of macropsia and transient loss of consciousness. During those symptoms, telemetry showed self-limited supraventricular tachycardia several times which could not be regulated with heart rate-controlled medication. The electroencephalography was later tested and showed rhythmic theta activity over the right cerebral hemisphere. He was treated with levetiracetam, and all his symptoms and tachyarrhythmias were gradually resolved thereafter. Refractory response to treatment would remind the physicians to reassess for the correct diagnosis.
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Affiliation(s)
- Pitirat Panpruang
- Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Monton Wongwandee
- Division of Neurology, Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Nattapun Rattanajaruskul
- Division of Cardiovascular Medicine, Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Worawut Roongsangmanoon
- Division of Cardiovascular Medicine, Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Arthit Wongsoasu
- Division of Cardiovascular Medicine, Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Teeranan Angkananard
- Division of Cardiovascular Medicine, Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
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47
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Stoecklein HH, Pugh A, Johnson MA, Tonna JE, Stroud M, Drakos S, Youngquist ST. Paramedic Rhythm Interpretation Misclassification is Associated with Poor Survival from Out-of-Hospital Cardiac Arrest. Resuscitation 2021; 171:33-40. [PMID: 34952179 DOI: 10.1016/j.resuscitation.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Early recognition and rapid defibrillation of shockable rhythms is strongly associated with survival in out of hospital cardiac arrest (OHCA). Little is known about the accuracy of paramedic rhythm interpretation and its impact on survival. We hypothesized that inaccurate paramedic interpretation of initial rhythm would be associated with worse survival. METHODS This is a retrospective cohort analysis of prospectively collected OHCA data over a nine-year period within a single, urban, fire-based EMS system that utilizes manual defibrillators equipped with rhythm-filtering technology. We compared paramedic-documented initial rhythm with a reference standard of post-event physician interpretation to estimate sensitivity and specificity of paramedic identification of and shock delivery to shockable rhythms. We assessed the association between misclassification of initial rhythm and neurologically intact survival to hospital discharge using multivariable logistic regression. RESULTS A total of 863 OHCA cases were available for analysis with 1,756 shocks delivered during 542 (63%) resuscitation attempts. Eleven percent of shocks were delivered to pulseless electrical activity (PEA). Sensitivity and specificity for paramedic initial rhythm interpretation were 176/197 (0.89, 95% CI 0.84-0.93) and 463/504 (0.92, 95% CI 0.89-0.94) respectively. No patient survived to hospital discharge when paramedics misclassified the initial rhythm. CONCLUSIONS Paramedics achieved high sensitivity for shock delivery to shockable rhythms, but with an 11% shock delivery rate to PEA. Misclassification of initial rhythm was associated with poor survival. Technologies that assist in rhythm identification during CPR, rapid shock delivery, and minimal hands-off time may improve outcomes.
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Affiliation(s)
- H Hill Stoecklein
- Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States; Salt Lake City Fire Department, Salt Lake City, Utah, United States.
| | - Andrew Pugh
- Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - M Austin Johnson
- Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Joseph E Tonna
- Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Michael Stroud
- Salt Lake City Fire Department, Salt Lake City, Utah, United States
| | - Stavros Drakos
- Division of Cardiology, University of Utah School of Medicine, Salt Lake City, Utah, United States; Nora Eccles Harrison Cardiovascular Research and Training Institute, Salt Lake City, Utah, United States
| | - Scott T Youngquist
- Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States; Salt Lake City Fire Department, Salt Lake City, Utah, United States
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48
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Senarath S, Nanayakkara P, Beale AL, Watts M, Kaye DM, Nanayakkara S. Diagnosis and management of arrhythmias in pregnancy. Europace 2021; 24:1041-1051. [PMID: 34904149 DOI: 10.1093/europace/euab297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Arrhythmias are the most common cardiac complications occurring in pregnancy. Although the majority of palpitations in pregnancy may be explained by atrial or ventricular premature complexes, the full spectrum of arrhythmias can occur. In this article, we establish a systematic approach to the evaluation and management of arrhythmias in pregnancy. Haemodynamically unstable arrhythmias warrant urgent cardioversion. For mild cases of benign arrhythmia, treatment is usually not needed. Symptomatic but haemodynamically stable arrhythmic patients should first undergo a thorough evaluation to establish the type of arrhythmia and the presence or absence of structural heart disease. This will ultimately determine the necessity for treatment given the potential risks of anti-arrhythmic pharmacotherapy in pregnancy. We will discuss the main catalogue of anti-arrhythmic medications, which have some established evidence of safety in pregnancy. Based on our appraisal, we provide a treatment algorithm for the tachyarrhythmic pregnant patient.
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Affiliation(s)
- Sachintha Senarath
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - Pavitra Nanayakkara
- Department of Obstetrics and Gynaecology, The Epworth Hospital, Richmond, Victoria, Australia
| | - Anna L Beale
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Monique Watts
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - David M Kaye
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Shane Nanayakkara
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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49
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Ståhlberg M, Reistam U, Fedorowski A, Villacorta H, Horiuchi Y, Bax J, Pitt B, Matskeplishvili S, Lüscher TF, Weichert I, Thani KB, Maisel A. Post-COVID-19 Tachycardia Syndrome: A Distinct Phenotype of Post-Acute COVID-19 Syndrome. Am J Med 2021; 134:1451-1456. [PMID: 34390682 PMCID: PMC8356730 DOI: 10.1016/j.amjmed.2021.07.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023]
Abstract
In this paper we highlight the presence of tachycardia in post-acute COVID-19 syndrome by introducing a new label for this phenomenon-post-COVID-19 tachycardia syndrome-and argue that this constitutes a phenotype or sub-syndrome in post-acute COVID-19 syndrome. We also discuss epidemiology, putative mechanisms, treatment options, and future research directions in this novel clinical syndrome.
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Affiliation(s)
- Marcus Ståhlberg
- Cardiology, Heart, Vascular and Neuro Theme, Karolinska University Hospital and Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Ulrika Reistam
- Cardiology, Heart, Vascular and Neuro Theme, Karolinska University Hospital and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Humberto Villacorta
- Division of Cardiology, Fluminense Federal University, Niterói, Rio de Janeiro State, Brazil
| | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Thomas F Lüscher
- Heart Division, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, London, UK; Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Immo Weichert
- Acute Medicine Department, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Khalid Bin Thani
- Department of Cardiology, Salmaniya Medical Complex, Manama, Bahrain
| | - Alan Maisel
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla
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50
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Li YH, Hung SC, Hung HC, Chan KC, Li YC, Liu LL, Chao WY, Huang JW, Hsu HW. Overview of drug treatment for paroxysmal supraventricular tachycardia in Taiwan emergency departments: Adenosine using trend from 2000 to 2012. Australas Emerg Care 2021; 25:224-228. [PMID: 34824046 DOI: 10.1016/j.auec.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Before 2010, guidelines recommended adenosine 6, 12, and a repeat dose of 12 mg for paroxysmal supraventricular tachycardia (PSVT). After 2010, these doses were reduced to two. This study aims to outline adenosine using trend from 2000 to 2012 in Taiwan emergency departments (EDs). METHODS This was an ecological study. PSVT were drawn from one million individuals of the National Health Insurance Database. The χ2 test was used to determine an association between different adenosine doses and other antiarrhythmic drugs (OADs), including verapamil, diltiazem, amiodarone, digoxin, and labetalol. RESULTS There were 3361 PSVT visits from 2000 to 2012; 834 (24.8%) did not receive an antiarrhythmic drug, and 2527 (75.2%) did, either adenosine with/without OADs or OADs alone. The use of an OAD was significantly different between the adenosine 6-18 mg and 19 + mg groups. CONCLUSIONS Most PSVT episodes converted with adenosine within 18 mg, and the success conversion rate was 62.2%. It could be up to 65.2% if they received more. Of the patients who did not have their PSVT reverted with< 18 mg, 37.8% could have been successfully treated with more doses. The necessity of using the 3rd dose of adenosine is needed to be further explored.
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Affiliation(s)
- Ya-Hsin Li
- Department of Health Policy and Management, Chung-Shan Medical University, Taichung, Taiwan, ROC
| | - Shih-Chang Hung
- Department of Emergency Medicine, Nantou Hospital, Nantou, Taiwan, ROC.
| | - Hung-Chang Hung
- Department of Internal Medicine, Nantou Hospital, Nantou, Taiwan, ROC; Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
| | - Kuei-Chuan Chan
- Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan, ROC; School of Medicine, Chung-Shan Medical University, Taichung, Taiwan, ROC
| | - Ya-Chin Li
- Department of Emergency Medicine, Nantou Hospital, Nantou, Taiwan, ROC
| | - Ling-Ling Liu
- Department of Nursing, Nantou Hospital, Nantou, Taiwan, ROC
| | - Wen Yi Chao
- Department of Public Health, China Medical University, Taichung, Taiwan, ROC
| | - Jong-Wen Huang
- Department of Emergency Medicine, Nantou Hospital, Nantou, Taiwan, ROC
| | - Huan-Wen Hsu
- Department of Emergency Medicine, Nantou Hospital, Nantou, Taiwan, ROC
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