Abnormal ECG Changes Research Articles

Implementation of Global Longitudinal Strain (GLS) in NON-ST Segment Elevation Myocardial Infarction in AL-Yarmook Teaching Hospital

Background: It would be advantageous to develop a noninvasive diagnostic tool that could more reliably distinguish between persons who would benefit from early coronary angioplasty and revascularization and those who would not in non-ST-segment elevation acute coronary syndrome. The LVGLS assessment is painless and may be completed quickly without putting patients through intense activities. Aim of study: To evaluate wall motion abnormality by (GLS) method in comparison with 2D echo and ECG changes. Material and method: A cross sectional study that included 60 patients who admitted to Al-Yarmouk teaching hospital due to new onset of acute coronary syndrome. Result: Mean GLS of patients was -13.61 ± 1.67, and the largest proportion of them were aged 56-60 yrs. regarding echo finding, 80% show hypokinetic motion wall abnormality. Patients with abnormal ECG changes, hypokenisia and low EF had significantly lower mean of GLS (p-value 0.0001, 0.0001, 0.004, respectively). The prediction value of GLS over EF was higher when comparing them according to presence of ECG changes and MWA. Conclusion: GLS is a powerful predictor of left ventricular function and appears to be a better metric than ejection fraction in NSTEMI patients.

CaMKII regulates the proteins TPM1 and MYOM2 and promotes diacetylmorphine-induced abnormal cardiac rhythms

Although opioids are necessary for the treatment of acute pain, cancer pain, and palliative care, opioid abuse is a serious threat to society. Heroin (Diacetylmorphine) is the most commonly abused opioid, and it can have a variety of effects on the body's tissues and organs, including the well-known gastrointestinal depression and respiratory depression; however, there is little known about the effects of diacetylmorphine on cardiac damage. Here, we demonstrate that diacetylmorphine induces abnormal electrocardiographic changes in rats and causes damage to cardiomyocytes in vitro by an underlying mechanism of increased autophosphorylation of CaMKII and concomitant regulation of myocardial contractile protein TPM1 and MYOM2 protein expression. The CaMKII inhibitor KN-93 was first tested to rescue the toxic effects of heroin on cardiomyocytes in vitro and the abnormal ECG changes caused by heroin in SD rats, followed by the TMT relative quantitative protein technique to analyze the proteome changes. Diacetylmorphine causes increased phosphorylation at the CaMKII Thr287 site in myocardium, resulting in increased autophosphorylation of CaMKII and subsequent alterations in myocardial contractile proteins, leading to myocardial rhythm abnormalities. These findings provide a theoretical basis for the treatment and prevention of patients with arrhythmias caused by diacetylmorphine inhalation and injection.

What Is the Truth Behind Abnormal ECG Changes?

What Is the Truth Behind Abnormal ECG Changes?

ОПЫТ НАБЛЮДЕНИЯ ДЕТЕЙ С КАВАСАКИ-ПОДОБНЫМ (МУЛЬТИСИСТЕМНЫМ ВОСПАЛИТЕЛЬНЫМ) СИНДРОМОМ В ВОСТОЧНО-СИБИРСКОМ РЕГИОНЕ РОССИИ

The pathogenetic basis for Pediatric Multisystem Inflammatory Syndrome (PMIS) associated with SARS-CoV-2 is systemic vasculitis resulting from hyperproduction of pro-inflammatory cytokines associated with dysregulation of the immune response. Clinical manifestations of PMIS include fever with features of Kawasaki Syndrome (KS) and multi-organ dysfunction coupled with frequent unusual heart involvement, ranging from mild with minimal ECG changes or elevated troponin to fulminant myocarditis or Takotsubo syndrome (TTS). The purpose of the research was to study the characteristics of cardiovascular disorders in Kawasaki-like multisystem inflammatory syndrome associated with COVID-19 in children observed in the East Siberian area of Russia. A single-center retrospective cohort study was carried out on the basis of the Irkutsk Oblast Regional Children's Clinical Hospital (Irkutsk, Russia): 36 patients with PMIS associated with COVID-19 in Nov. 18, 2020 - Dec. 31, 2021, including 21 boys (M/F ratio 1.4:1) at the average age of 7.5 years old (1.5 months to 17 years old). The diagnostic signs of KS were observed in 34 (94%) children, including the complete set of diagnostic signs in 21 (58%). Refractory fever and a sharp increase in inflammatory biomarkers were detected in all 36 (100%) children; multiorgan dysfunction in 31 (86%); thrombocytopenia in 24 (67%); gastrointestinal syndrome in 25 (69%); cerebral dysfunction in 24 (66)%; various cardiovascular disorders in 30 (83%), including: dilatation of the left ventricle (LV) and a decrease in myocardial contractility in 3 (8%); moderate coronary dilatation in 5 (14%); thickening of the posterior LV walls in diastole in 5 (13%); thickening of the interventricular septum in diastole in 6 (16%). According to the MRI results performed in 15 children the signs of myocardial damage were found in 6 (40%). LV dilatation and decreased myocardial contractility were noted in 3 (8%) children, clinically apparent thrombotic complications in 3 (8%) children as well, and severe neurological deficit in one patient (3%). An increase in the level of D-dimer was observed in 26 (72%) patients, thrombocytopenia in 24 (67%), a statistically significant correlation between thrombocytopenia and myocardial damage was found (R=-0.506, p=0.001). The treatment measures were given as follows: inotropic support (dobutrex/dobutamine) was received by 8 (22%), artificial lung ventilation - by 8 (22%), intravenous human immunoglobulin 1.5-2.0 g/kg/course - by 28 (77%), dexamethasone - by 24 (67%), tocilizumab - by 2 (5%) patients. All 36 (100%) patients have survived. Conclusion: the Kawasaki-like multisystem inflammatory syndrome associated with COVID-19 was accompanied by the cardiovascular disorders (pericarditis, arrhythmias, abnormal ECG changes, elevated troponin and/or natriuretic peptide, LV thickening on echocardiography, coronary dilatation) in most patients, although LV dilatation and decreased myocardial contractility were observed in a few cases only. A negative correlation between thrombocytopenia and myocardial damage was found, which may indicate the involvement of thrombotic microvascular inflammation in the genesis of myocardial disorders.

S1601 An Unusual Case of Acute Cholecystitis and Bradycardia (Cope's Sign)

Introduction: Patients with acute cholecystitis present with right upper quadrant or epigastrium pain, nausea, and vomiting. Fever, leukocytosis, and a positive Murphy's sign support the diagnosis. Oftentimes, acute cholecystitis may mimic cardiovascular disease. Bradycardia is one of the rare presentations of cholecystitis and is called the "Cope's sign." Sir Zachary Cope was the first patient who presented with cardio-biliary reflex in 1970. Very few cases have been reported. Case Description/Methods: A 55-year-old male presented with retrosternal chest pain, diaphoresis, and vomiting followed by epigastric pain. Symptoms started one night prior to admission and he thought they were attributed to the raw chicken he ate for dinner. Examination showed a diaphoretic man with abdominal tenderness and bradycardia. His symptoms were concerning because the chest pain and bradycardia were compatible with inferior-wall Ml. However, troponins were negative. EKG showed sinus bradycardia with 42 beats/min (Figure 1). To further aid investigation, abdominal US was ordered which revealed gallstones, pericholecystic fluid and gallbladder wall thickening. He was diagnosed as a case of acute cholecystitis which presented as a cardio-biliary reflex and bradyarrthythmia. He was treated with IV fluids, pain control, and antibiotics. Surgery recommended urgent cholecystectomy. Discussion: Cardio-biliary reflex exists and can result in serious consequences. Bradyarrhythmia is the most common presentation of cardio-biliary reflex. Cardio-biliary reflex is believed to be vagally mediated and notably has been triggered by pain in the gallbladder via autonomic vagal innervations. A case-control study by Kaufman and Lubera reported that the increased vagal tone caused by the gallbladder could mimic myocardial infarction or cause bradyarrhythmia and even complete heart block. Patients with acute cholecystitis having abnormal ECG changes should be managed cautiously to avoid possible complications. This case highlights the rare case of acute cholecystitis with cope sign. Clinicians should have a high suspicion and order appropriate studies since these patietns can present as myocardial infarction.Figure 1.: EKG showed sinus bradycardia with 42 beats/min.

“ A STUDY OF CARDIOVASCULAR ABNORMALITY IN HYPERTENSIVE PATIENTS”

Introduction: Hypertension is a common health problem in developed countries and a major risk factor for cardiovascular diseases. Hypertension exhibits an iceberg phenomenon where unknown morbidity exceeds the known morbidity. Genetic and environmental factors are also reported to play a key role in hypertension, 90% of which are better classied as idiopathic. The cause of cardiovascular diseases in the hypertensive patient is blood pressure raised which is present chronically however the cause of elevated BP are different. In adults, 90% of hypertension cases are of essential hypertension .The Remaining 10% of hypertension cases with chronically elevated BP accounts for secondary cause. In hypertensive patient, the risk of cardiovascular disease is increases in men and women. Hypertension and diabetes mellitus are among the most common chronic non-communicable diseases and multifactorial disorders affecting both developed and developing countries and occur at a higher prevalence in the older age group and result from both genetic and environmental etiological factors. The aim of Study of Cardiovascular Abnormality in the Hypertension Patient. Methods: A prospective observational study consists of 95 cases of hypertension is undertaken to study the cardiovascular abnormality by ECG and ECHO. The study will be conducted on patients suffering from hypertension. A written informed consent will be taken from all the patients who are included in study group. All the data of the patients will be recorded on a pretested Performa. Preliminary data like name, age, sex, occupation, residence, date will be recorded. Detailed lipid prole study will be done to nd the correlation in patients with hypertension. All data will be statistically analyzed. Results: Out of 95 cases in the study group, 51 were female cases and 44 were males, 31 cases (7th decade), 40 cases (6th decade), 14 cases (5th decade), 8 cases(4th decade), 2 cases (< 3rd decade). Abnormal ECG changes which constitutes 85 patients, ST elevation was present in 12 patients and T-wave inversion was present in 47 patients, followed by 16 patients were shows left ventricular hypertrophy, 8 cases of cardiomyopathy which shows low voltage complexes. Coronary artery disease was predominant nding in the patients of hypertensive cardiovascular disease which was present in 54 cases out of 95 cases, of which 31 were male patients and 23 were female patients. CAD in hypertension (57%), the incidence of CAD was more in elderly and other abnormalities in hypertensive patients were left ventricular hypertrophy(11.6%), heart failure{due to cardiomyopathy(8.2%) and CAD} and valvular heart disease(4.2%). Conclusion: Cardiovascular abnormality in hypertensive patients encompasses a broad spectrum including coronary artery disease, asymptomatic LVH (either a concentric or an eccentric pattern) and clinical heart failure (with either a preserved or a reduced LVEF) stroke, heart failure, cardiomyopathy, arrhythmia, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis. Elderly age, smoking habits, chronic alcoholism and long standing history of DM have emerged as important risk factor for cardiovascular disease in hypertensive patients.

Effect of stellate ganglion block versus intraluminal application of verapamil-nitroglycerine solution on internal mammary artery graft blood flow rate in patients undergoing on-pump coronary artery bypass grafting

Background Left internal mammary artery (IMA) graft is the most promising arterial conduit for coronary artery bypass grafting. Stellate ganglion block (SGB) induces sympathetic blockade and is used to prevent or control spasm of the internal mammary artery. The purpose of this study was to investigate the effect of left SGB on left IMA blood flow rate. Patients and methods A total of 170 patients aged between 65 and 70 years, with American Association of Anesthesiologists physical status II and III, and scheduled for elective coronary artery bypass grafting, were randomly allocated to either a SGB group or a verapamil-nitroglycerine group. In the SGB group, the patients received SGB using 8 ml of bupivacaine 0.25%. In the verapamil-nitroglycerine group, the patients received intraluminal injection of the harvested IMA graft with a solution, containing verapamil 5 mg, nitroglycerine 2.5 mg, heparin 500 U, 8.4% NAHCO3 0.2 ml, and ringer solution 40 ml, throughout its whole length using a small syringe, and with a low dose of intravenous nicardipine infusion started after harvesting (5 mg nicardipine in 100 ml saline at a rate of 0.5 mg or 10 ml/h). IMA blood flow rate (primary outcome), abnormal ECG changes, ICU length of stay, intra-aortic balloon usage, pre–postoperative pulse rate and blood pressure, incidence of atrial fibrillation, radio-femoral arterial pressure difference, pre–postoperative ejection fraction, need for re-exploration, and mortality rate were observed. Results This prospective study showed a significant increase of IMA blood flow rate (P Conclusion The results of this study showed that SGB prevents IMA spasm, increases its blood flow rate, and decreases incidence of atrial fibrillations compared with intraluminal injection of verapamil and nitroglycerine combined with intravenous nicardipine.

Alterations in Serum Magnesium and Electrocardiographic Variables of Adult Hypertensive Humans

As the most important risk factor for cardiovascular diseases worldwide, Hypertension has been found to be a major public health challenge with high prevalence in Africans and Nigerians especially with a rapidly growing population. It has been postulated that hypomagnesemia contributes to the development of hypertension and cardiovascular disease. This study was therefore undertaken to determine the relationship between serum magnesium levels and electrocardiographic changes in adult humans with hypertension. To achieve this, one hundred and sixty two (162) hypertensives were recruited from the University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria. Participants’ Blood pressure, electrocardiographic changes, antihypertensive medications and serum magnesium (Mg2+) levels were investigated. Using the Pearson Product Moment Correlation Coefficient and ANOVA, Statistical measures of association (correlation) were conducted on obtained variables. A low incidence of hypomagnesaemia was observed on the average, with a high incidence of patients presenting with abnormal ECG changes; including Left Ventricular Hypertrophy. In addition, only weak correlations were observed for ECG parameter and serum Mg2+levels for sampled subjects, with p-value returning a statistically significant decrease upon comparison of means (Using the One-Way Analysis of Variance (ANOVA); Other influences like antihypertensive medications, blood pressure duration and control returned an significant (weak negative) correlation with serum Mg2+ concentration. There is therefore a weak negative correlation between serum magnesium levels and ECG variables, including Q wave duration and QT interval duration in hypertensive adults

NLRP3 inflammasome activation is associated with PM2.5 -induced cardiac functional and pathological injury in mice.

Growing evidences indicate that inflammation induced by PM2.5 exposure has been considered as a major driving force for the development of cardiovascular diseases. However, the mechanisms underlying PM2.5 -induced cardiac injury remain unclear. This study aims to investigate the role of NLRP3 inflammasome in PM2.5 -induced cardiac functional and pathological injury in mice. In this study, BALB/c mice were intratracheally instilled with PM2.5 suspension (4.0 mg/kg BW) for 5 days to set up a cardiac injury model, which was evaluated by electrocardiogram monitoring, HE and Masson staining. Then, the effects of PM2.5 on the expression of α-SMA, NLRP3, IL-1β, and IL-18 proteins and the activation of caspase-1 and IL-1β were investigated. The results showed that PM2.5 exposure induced characteristic abnormal ECG changes such as the abnormality of heart rhythm, tachycardia, and T-wave reduction. Inflammatory cell infiltration and fibrosis were observed in the heart tissues of PM2.5 -exposed mice. Meanwhile, PM2.5 exposure increased the expression of α-SMA. And, NLRP3 activation-associated proteins of NLRP3, IL-1β, IL-18, Cleaved caspase-1 p10, and Cleaved IL-1β were upregulated in heart tissue of PM2.5 -induced mice. In summary, PM2.5 exposure could induce cardiac functional and pathological injury, which may be associated with the activation of NLRP3 inflammasome.

Vascular calcification abrogates the nicorandil mediated cardio-protection in ischemia reperfusion injury of rat heart

The present study was aimed to determine the efficacy of nicorandil in treating cardiac reperfusion injury with an underlying co-morbidity of vascular calcification (VC). Adenine diet was used to induce VC in Wistar rat and the heart was isolated to induce global ischemia reperfusion (IR) by Langendorff method, with and without the nicorandil (7.5mg/kg) pre-treatment and compared with those fed on normal diet. The adenine-treated rats displayed abnormal ECG changes and altered mitochondrial integrity compared to a normal rat heart. These hearts, when subjected to IR increased the infarct size, cardiac injury (measured by lactate dehydrogenase and creatine kinase activity in the coronary perfusate) and significantly altered the hemodynamics compared to the normal perfused heart. Nicorandil pretreatment in rat fed on normal diet enhanced the hemodynamics significantly (P<0.05) along with a substantial reduction in the mitochondrial dysfunction (measured by high ADP to oxygen consumption ratio, respiratory control ratio, enzyme activities and less swelling behavior) when subjected to IR. However, this cardio-protective effect of nicorandil was absent in rat heart with underlying calcification. Our results suggest that, the protective effect of nicorandil, a known mitochondrial ATP linked K+ channel opener, against myocardial reperfusion injury was confined to normal rat heart.

Prevalence of acute kidney injury in cardiac patients in the Intensive Care Unit

Acute kidney injury (AKI) has consistently been associated with adverse clinical outcome after acute myocardial infarction (MI). In addition, AKI is well-known as a potent predictor of the clinical course in heart failure patients. The aim of this study was to assess the prevalence and risk factors of AKI in patients with acute MI and congestive heart failure (CHF) in the ICU at Zagazig University Hospitals, Egypt. This study included 100 patients with acute MI and 100 patients with CHF admitted to the ICU. They were subjected to careful history taking, thorough clinical examination, ECG and echocardiographic evaluation, and laboratory investigations, including cardiac enzyme evaluation, renal profile, and fasting blood glucose. Definitions of AKI depend on the measurement of serum creatinine as a surrogate marker for the glomerular filtration rate, in addition to the calculation of estimated glomerular filtration rate. The proportion of patients who experienced AKI was 47% in patients with CHF and 45% in patients with acute MI. They were significantly older in age (P=0.013 and 0.004, respectively). In CHF, patients with AKI had significantly higher fasting blood sugar (P=0.011), abnormal ECG changes (P=0.001), lower ejection fraction (P=0.034), and lower diastolic dysfunction (P=0.027). However, in acute MI, patients with AKI had significantly higher fasting blood sugar (P=0.013) and higher troponin I level (P=0.015). The most important risk factors for AKI in patients with CHF are older age, higher frequency of diabetes mellitus, abnormal ECG changes, lower ejection fraction, and diastolic dysfunction. However, high troponin I and older age are the most important risk factors for AKI in patients with acute MI. Careful monitoring of susceptible patients in the ICU is recommended for early detection and management of AKI in those patients.

English

BACKGROUND: Stroke is common life threatening disorder. It is the third leading cause of death in developed countries after cardiovascular disease and cancer. OBJECTIVE: 1.To study ECG and 2D echocardiographic changes in different types of strokes. 2. To know whether such changes have any prognostic significance. MATERIAL AND METHOD: The material of study comprised of 100 Patient admitted in a Medical College & associated Hospital of central India, from May 2009 to Sept. 2011. RESULTS: Abnormal ECG changes were more common among hemorrhagic patients (78.12%) compared to infarct patients (67.64%). 2D echo abnormalities were more common among hemorrhage group (75%) than in infarct (44.12%). None of the ECG changes had much significance on mortality and was statistically insignificant (p>0.05) while LV dysfunction showed significant mortality in stroke patients and was statistically significant (p<0.001). CONCLUSION: ECG abnormalities in stroke patients do not have any prognostic significance, while LV dysfunction had prognostic significance in predicting mortality.

Association of plasma potassium concentration with muscle tone, ECG, and levels of serum muscle enzymes in patients with hypokalemic periodic paralysis

Objective To explore the association of plasma potassium concentration with muscle tone, ECG, and levels of serum muscle enzymes in patients with hypokalemic periodic paralysis.Methods The muscle tone, ECG, levels of serum muscle enzymes, and plasma potassium concentration wore measured and then analyzed in 80 patients. Results Of 80 patients, 20 patients had mild hypokalemia, 34 had moderate hypokalemia, and 26 had severe hypokalemia. The relation between muscle tone and potassium was not stable ( P＞ 0.05 ). 68 patients ( 85% ) developed abnormal ECG changes; the occurrence of abnormal ECG increased with the decrease in potassium levels. 64 patients( 80% ) had an elevated levels of muscle enzymes; and the levels of muscle enzymes were negatively related with potassium concentration. Conclusions Understanding of the association of plasma potassium concentration with with muscle tone, ECG, and levels of serum muscle enzymes is very important in the diagnosis and treatment of hypokalemic periodic paralysis. Key words: Hypokalemic periodic paralysis; Plasma potassium concentration; Muscle tone; Electrocardiogram; Serum muscle enzymes

Comparison of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation

Objective:The present study compared the efficacy of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation.Design:Prospective, randomized, placebo controlled, double-blinded study.Setting:Operation room.Patients and Methods:75 ASA physical status I and II adult patients, aged 18-45 years undergoing elective surgical procedures, requiring general anesthesia and orotracheal intubation.Interventions:Patients were allocated to any of the three groups (25 each)-Group C (control)10 ml 0.9% saline i.v. Group E (esmolol) 0.5 mg/kg diluted with 0.9% saline to 10 ml i.v. Group L (labetalol) 0.25 mg/kg diluted with 0.9% saline to 10 ml i.v. In the control group 10 ml of 0.9% saline was given both at 2 and 5 min prior to intubation. In the esmolol group 0.5 mg/kg of esmolol (diluted with 0.9% saline to 10 ml) was given 2 min prior and 10 ml of 0.9% saline 5 min prior to intubation. In the labetalol group 10 ml of 0.9% saline was administered 2 min prior and 0.25 mg/kg of labetalol (diluted with 0.9% saline to 10 ml) 5 min prior to intubation. All the patients were subjected to the same standard anesthetic technique.Measurements:Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded prior to induction, at time of intubation and 1, 3, 5, and 10 min after intubation. Mean arterial pressure (MAP) and rate pressure product (RPP) were calculated. Abnormal ECG changes were also recorded.Results:Compared to placebo and esmolol (0.5 mg/kg), labetalol (0.25 mg/kg) significantly attenuated the rise in heart rate, systolic blood pressure, and RPP during laryngoscopy and intubation. However, the difference was not statistically significant among the values for DBP and MAP.Conclusion:In lower doses, labetalol (0.25 mg/kg) is a better agent than esmolol (0.5 mg/kg) in attenuating the sympathomimetic response to laryngoscopy and intubation.

ECG CHANGES DURING UPPER GASTROINTESTINAL TRACT ENDOSCOPY (A PROSPECTIVE STUDY)

This study aimed to evaluate the cardiac changes and complications that occurred in patients who underwent upper gastrointestinal tract endoscopy. The study was conducted from January 2002 to December 2002at Basrah General Hospital and Al-Sadir Teaching Hospital. One hundred and forty eight patients complaining of upper gastrointestinal tract disorders were included in this study. Detailed history, physical examination and ECG was taken before, during and half hour after endoscopic examination. Patients were divided into two groups according if they have previous cardiopulmonary diseases. One hundred and forty eight patients included in the study, 91 males and 57 females. The age group between 20–40 years represent the commonest group underwent oesophagogastroduodenoscopy (O.G.D) examination. All ECG changes that developed in patients before endoscopic examination arise from those who had cardiopulmonary diseases. Forty-two (40.4%) and 21 (47.7%) patients from group I. and group II. respectively showed abnormal ECG changes while 18 (17.3%) and 13 (29.5%) patients from group I. and group II. respectively showed abnormal ECG findings half hour after endoscopic examination . Bradycardia represents the commonest ECG changes occurred during and half hour after examination. We concluded that OGD is a safe procedure but in elderly patients and those with cardiopulmonary disease ECG monitoring should be done during endoscopic examination

An analysis of abnormal distribution and trend of ECG derived from medical examination

目的 分析比较我市行政事业单位人员体格检查中异常心电图的分布与变化趋势,为心血管病流行病学的研究提供依据.方法回顾近年3次体检共11714例次心电图资料,从异常心电图的分布情况,年龄、性别及3次结果分类统计,予以横向及纵向的比较.结果(1)各项指标在异常心电图中所占比例依次为窦性心律失常41%,ST-T异常24%、其他心律失常13%、室内阻滞10%、R波高电压7%、房室或窦房阻滞等.(2)各项指标除窦性心律失常外,均随年龄增加而递长.(3)各项指标异常率除ST-T异常外,男女比较均为男性＞女性.(4)各项指标在3次体检对比中无变化.结论心血管病的患病率随年龄的增加而增高,同时男性患病的危险性高于女性。

A Case of Ofloxacin-induced Torsades de Pointes and Abnormal ECG Change Mimicking Acute Myocardial Infarction

While some fluoroquinolone antibiotics can cause QT prolongation and Torsades de Pointes (TdP, serious proarrhythmic effects from ofloxacin have not been reported. Here, we report a case of ofloxacin-induced Torsades de Pointes with abnormal ECG changes, mimicking acute myocardial infarction. A 68-year-old man developed syncope following hospital admission for the treatment of pulmonary tuberculosis. TdP and marked QT prolongation (QT＝0.44 sec, QTc＝0.62 sec were noted, with no remarkable serum electrolyte abnormality. The QT prolongation was followed by ST segment elevation, mimicking acute myocardial infarction. After discontinuation of ofloxacin, the QT interval shortened to 0.336 sec (QTc＝0.481 sec, with no recurrence of TdP, although the QT interval remained mildly elevated during the hospital course. From this case, we propose that care should be taken in the use of ofloxacin, especially in patients susceptible to TdP. (Korean Circulation J 2002;32(9 :815-819

Familial aggregation of diabetic kidney disease in Type 2 diabetes in south India

The study was done to assess whether there was a familial aggregation of diabetic kidney disease (DKD) in Type 2 diabetic subjects. The profile of associated complications was also studied. Two groups of diabetic siblings of Type 2 diabetic patients, matched for age, body mass index (BMI) and duration of diabetes mellitus were studied. The siblings also had Type 2 diabetes. Group A comprised of siblings of probands with diabetic nephropathy and retinopathy ( n=30, M:F=20:10) and Group B were siblings of probands without diabetic nephropathy or microalbuminuria (MAU) ( n=30, M:F=14:16). Anthropometry, measurement of blood pressure and tests for proteinuria, MAU and retinopathy and ECG and biothesiometry were carried out for all study subjects. Persistent proteinuria was present in 15 (50%) siblings in group A and none in group B. MAU was detected in 26.7% ( n=7) in Group A and 3.3% ( n=1) in Group B ( P=0.057). Thus a total of 22 out of 30 cases in Group A had albuminuria. In Group A, seven (23.3%) had proteinuria and hypertension. Hypertension was present in nine (30.0%) in group A, and in five (16.7%) in group B (NS). Occurrence of retinopathy was found to be significantly higher in group A than in group B (33.3 vs 6.7%, χ 2=5.1, P=0.023). Abnormal ECG changes were present in 10% and 6.7% in Group A and Group B, respectively. In Group A, one patient had peripheral vascular disease (PVD) while in Group B none had PVD. A comparison of sib pairs, matched for age, duration of diabetes and the level of metabolic control showed that there was strong familial clustering of diabetic kidney disease in south Indians with Type 2 diabetes. This was independent of the familial clustering of diabetes. Prevalence of other vascular complications were also higher in Group A.

Analysis of electrocardiographic changes in status epilepticus

The high mortality associated with status epilepticus (SE) has been hypothesized to result partially from neurologically induced changes in cardiac function. To test this hypothesis, we reviewed electrocardiograms of 60 patients presenting in status epilepticus. Sequential electrocardiograms before, during and after ictal episodes were compared to define changes from baseline studies. 58.3% of the SE patients (N = 35) exhibited significant abnormalities on electrocardiograms obtained within 24 h of status epilepticus. Specific electrocardiographic changes included arrhythmias, axis changes, conduction abnormalities and ischémie patterns. All of these abnormal ECG changes met generally accepted cardiologie standards for a high risk of myocardial dysfunction or ischemia. The association of ECG changes with mortality was statistically significant. These results indicate that a significant proportion of SE patients are at risk for cardiac dysfunction and that close monitoring of cardiac function is indicated during and after SE.

The effect of diltiazem on the coronary haemodynamic and cardiac functional effects produced by intracoronary administration of endothelin‐1 in the anaesthetized dog

1. We have studied the effect of the calcium channel antagonist, diltiazem, on the coronary haemodynamic and cardiac functional responses produced by intracoronary (i.c.) administration of endothelin-1 (ET-1) in anaesthetized dogs. 2. ET-1, 1, 3 and 10 ng kg-1 i.c., produced dose-related increases in coronary blood flow with no cardiac functional or systemic haemodynamic changes. ET-1, 30, 100 and 300 ng kg-1 i.c., produced dose-related reductions in coronary artery blood flow. The reduction in coronary blood flow was accompanied by dose-related falls in cardiac output, mean arterial pressure, +dP/dt and -dP/dt and increases in left ventricular end-diastolic pressure. However, there was no reflex tachycardia in response to the fall in blood pressure and at 300 ng kg-1, ET-1 produced a 22% reduction in heart rate. 3. Following a series of abnormal ECG changes, four out of five dogs died of ventricular fibrillation at 13 +/- 2 min after 300 ng kg-1 ET-1. 4. The administration of diltiazem (15 micrograms kg-1 min-1, i.v.) reduced mean arterial pressure by 10% and heart rate by 15%, and increased coronary blood flow by 39%. Diltiazem did not have any significant effect on the coronary dilator response to low doses of ET-1. Although there was a general trend for diltiazem to inhibit the coronary vasoconstrictor responses to ET-1, diltiazem significantly attenuated only the reduction in coronary blood flow produced by 100 ng kg-1 ET-1 by 60% but not the response to 30 or 300 ng kg-1 ET-1. Two out of five diltiazem-treated dogs died of ventricular fibrillation with a mean time to death of 20 min following treatment with ET-1 (300 kg- 1). 5. ET-1 is a very potent coronary vasodilator. At slightly higher doses ET-1 is also a coronary vasoconstrictor. ET-1 also appears to have direct cardiotoxicity independent of myocardial ischaemia. The vasoconstrictor activity and direct cardiotoxicity are only weakly inhibited by diltiazem.