Abnormal Electrocardiogram Findings Research Articles

Assessment of Repeated Electrocardiogram Findings in Pediatric Multisystem Inflammatory Syndrome Associated with COVID-19

Background: Cardiac involvement, stemming from the novel multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease-2019 (COVID-19), leads to common and severe complications. Objectives: The aim of this study is to compare and evaluate repetitive electrocardiogram (ECG) results and laboratory indicators in children diagnosed with MIS-C upon their initial hospital admission. Methods: This prospective, single-center study, conducted between December 2020 and October 2022, included repeated electrocardiographic and laboratory tests. Changes in the ECG over the course of the disease were regularly recorded for three months. Results: This study included 72 patients, 25 of whom were female. Mitral regurgitation and left ventricular systolic dysfunction were observed in 25% of the patients. Statistically significant differences (P < 0.05) were detected among the serial measurements of absolute neutrophil-lymphocyte count, CRP, procalcitonin, ESR, D-dimer, troponin T, pro-BNP, ferritin, and interleukin-6. Significant differences were also observed in heart rate, PR interval, QRS duration, QT duration, Fredericia QTc, JT interval, presence of sinus tachycardia, presence of first-degree AV block, presence of wide QRS, abnormal QRS axis, abnormal T axis, long QTc, and ST-T changes (P < 0.05). Additionally, significant differences were noted in the absolute lymphocyte count, troponin levels, and ferritin levels between patients with prolonged abnormal ECG findings and those whose ECG findings were normal or had returned to normal. Furthermore, statistically significant differences were observed in absolute lymphocyte count, ferritin, and fibrinogen levels among the other four groups (P < 0.05). Conclusions: Electrocardiogram findings in patients measured serially appear to improve over time. Since patients with MIS-C may experience ECG abnormalities that could lead to arrhythmias, close monitoring and the establishment of standardized approaches are essential. Long-term ECG abnormalities were associated with a decrease in absolute lymphocyte count and elevated levels of troponin, ferritin, and fibrinogen.

The Association Between Components of Metabolic Syndrome and Abnormal Electrocardiograms in the Saudi Population: A Retrospective Study.

Saudi Arabia has a high metabolic syndrome (MetS) prevalence. Having MetS increases the risk of cardiovascular disease (CVD), CVD mortality, and myocardial infarction (MI). There is a lack of information regarding MetS and electrocardiogram (ECG) abnormalities in Saudi Arabian populations. Further, it is unclear to what extent MetS components are associated with abnormal ECGs in Saudi populations. We investigated whether ECG abnormalities and MetS are associated with Saudi adults. Furthermore, we assessed the relationship between ECG abnormalities and the components of MetS based on the age and gender of the individuals. Materials and methods: A retrospective study was conducted at Dr Soliman Fakeeh Hospital in Jeddah, Saudi Arabia, on 208 patients with MetS. Participants' clinical and laboratory data were examined. A detailed analysis of the ECG was performed. ECG abnormalities were divided into minor and major abnormalities based on Novacode criteria. In addition to ischemic ECG findings, the ECG showed prolonged PR intervals, prolonged P duration, prolonged QRS duration, and prolonged QTc intervals. Results: One hundred and thirty-seven participants (65.9%) had elevated fasting blood glucose (FBS), 129 had central obesity (62%), 93 had high blood pressure (BP) (44.7%), 74 had elevated triglycerides (35.6%), and 49 had low high-density lipoprotein (23.6%).An abnormal ECG was found in 86 (41.3%) participants. It consisted of ischemic ECGs, atrioventricular (AV) block (first and second degrees), bundle branch block (right bundle branch block [RBBB], left bundle branch block [LBBB], RBBB with left anterior hemiblock, RBBB with right anterior hemiblock), arrhythmias (premature ventricular contractions [PVCs], premature atrial complexes [PACs], atrial fibrillation [AF], sinus bradycardia, sinus arrhythmia), prolonged QTc, prolonged PR interval, and prolonged QRS duration. There were 29 (13.9%) cases with multiple ECG abnormalities, 57 (27.4%) had one abnormal ECG, 42 (20.2%) had minor abnormal ECGs, and 44 (21.2%) had major abnormal ECGs. Middle-aged and elderly males accounted for the majority of these ECG changes. In the central obesity group, 22 participants (10.6%) had ischemic ECGs, 18 (8.7%) had prolonged QTc, 10 (4.8%) had first-degreeAV block, 6 (2.9%) had sinus bradycardia, 7 (3.4%) had RBBB, 4 (1.9%) had LBBB, 3 (1.4%) had PVCs, 2 (1%) had ventricular preexcitation, and one (0.5%) had PACs. An elevated FBS group included 19 participants (9.1%) with an ischemic ECG, 18 (8.7%) with a prolonged QTc, 11 (5.3%) with a first-degreeAV block, 9 (4.3%) with sinus bradycardia, 6 (2.9%) with slight ST-T abnormality, 5 (2.4%) with RBBB, and 5 (2.4%) with LBBB. Finally, one (0.5%) of these patients had second-degreeAV block, RBBB with left anterior hemiblock, left anterior hemiblock, PVCs, AF, ventricular preexcitation, and sinus arrhythmia for each. Saudi Arabian populations with MetS were strongly associated with abnormal ECG findings, particularly ischemic ECG findings, AV block (firstand second degrees), and BBB (RBBB, LBBB). Middle-aged and elderly males accounted for the majority of these ECG changes. The most important factors contributing to ECG changes were elevated FBS and central obesity.

Association of abnormal electrocardiography response on dobutamine stress echocardiogram with longer-term major adverse cardiovascular events in women with symptoms of ischemic heart disease.

Prior work demonstrates patients with positive (+) electrocardiogram (ECG) but negative (-) echocardiogram wall motion abnormalities (WMAs) on dobutamine stress echocardiography (DSE) testing have an elevated of major adverse cardiovascular events (MACEs). In this study, we aimed to evaluate the long-term prognosis of women with suspected ischemia with no obstructive coronary artery (INOCA) disease by utilizing core lab read DSE, specifically focusing on those with + ECG findings. Among women with signs and symptoms of myocardial ischemia undergoing clinically indicated coronary angiography enrolled in the Women's Ischemia Syndrome Evaluation (WISE) [1997-2001], a prospective cohort study, 99 underwent standardized DSE by site design. Women with positive DSE (n=17), defined as an increase in score based on wall motion scoring index were excluded except for akinetic to dyskinetic (n=10), providing 82 patients in this analysis. ECG was assessed by core laboratory and (+) ECG was defined as >1 mm ST change. Non-obstructive coronary artery disease (CAD) was assessed by core laboratory quantitative coronary angiography and defined as <50% epicardial stenosis. All-cause death follow-up was an average of 8 years, while adjudicated MACE [all-cause mortality, nonfatal myocardial infarction (MI), nonfatal stroke, heart failure hospitalization] was an average of 5.5 years. Comparisons among subject groups [i.e., (+) ECG and (-) ECG] were made using chi-square or Fisher's exact tests for categorical variables and t-test or Wilcoxon rank-sum test for continuous variables. Demographic profile included a mean age 59±10 years; 55% had hypertension (HTN), 29% diabetes mellitus (DM), and 72% non-obstructive CAD. Overall, 9/82 women (11%) had (+) ECG in the absence of WMAs. There were significant differences in family history of CAD (P=0.009) and vasodilator (P=0.042) use between the (+) ECG and (-) ECG groups, but otherwise had no significant demographic or clinical differences. At longer-term follow up, patients with (+) ECG had higher risk of MACE [unadjusted hazard ratio (HR): 4.91, 95% confidence interval (CI): 1.83, 13.19, P=0.002]. Abnormal stress ECG findings on dobutamine stress testing with a negative DSE should be viewed as an indicator of longer-term risk in women with signs and symptoms of ischemia.

Hypokalemia as a risk factor for prolonged QT interval and arrhythmia in inherited salt-losing tubulopathy

Purpose: To analyze electrocardiograms (ECGs) of patients with a salt-losing tubulopathy (SLT) and to determine the frequency and risk factors for long QT and arrhythmia.Methods: A total of 203 patients aged &lt;19 years with SLT, specifically Bartter syndrome and Gitelman syndrome, who had a 12-lead ECG were included in this retrospective study. We analyzed the presence of an arrhythmia or prolonged corrected QT (QTc) on ECGs obtained for these patients. Demographic and laboratory data were compared between patients with abnormal and normal ECG findings.Results: Out of the 203 SLT patients, 38 (18.7%) underwent electrocardiography and 10 (40.0%) of 25 patients with inherited SLT had abnormal ECG findings, including prolonged QTc and arrhythmias. The abnormal ECG group had significantly lower serum potassium levels than the normal group (median [interquartile range]: 2.50 mmol/L [2.20–2.83] vs. 2.90 mmol/L [2.70–3.30], &lt;i&gt;p&lt;/i&gt;=0.036), whereas other serum chemistry values did not show significant differences. The cutoff level for a significant difference in QTc interval was serum potassium level &lt;2.50 mmol/L. One cardiac event occurred in a 13-year-old boy, who developed paroxysmal supraventricular tachycardia and underwent cardiac ablation. No sudden cardiac deaths occurred in this cohort.Conclusions: The incidence of ECG abnormalities in patients with inherited SLT was 40.0%, whereas the ECG screening rate was relatively low (18.7%). Therefore, we recommend ECG screening in patients with inherited SLT, especially in those with serum potassium level &lt;2.50 mmol/L.

Electrocardiographic findings and cardiovascular risk profile in paralympic athletes

Abstract Funding Acknowledgements Type of funding sources: None. Background Paralympic athletes are a special group of elite athletes with unique cardiovascular issues. Recently, the term "Paralympic medicine" has been used to describe the specific medical conditions of athletes participating in the Paralympics. However, there are limited data regarding cardiovascular screening in Paralympic athletes. Purpose To assess the prevalence of normal and abnormal cardiac findings and cardiovascular risk factors in a subset of male Paralympic athletes. Methods From April 2019 to July 2021, male Paralympic athletes who were selected for participation in Paralympic Games in non-endurance sports disciplines, underwent cardiac screening including history, physical examination, 12-leads electrocardiogram (ECG), echocardiography and blood test. Athletes were classified according to the sports disciplines into three groups: 1) skill (archery, shooting, taekwondo, judo); 2) power (weightlifting, discus throwing, shot putting, javelin throwing) and 3) mixed (sitting volleyball, wheelchair basketball, rowing). As well as divided base on the type of disability into two groups: 1) athletes with spinal cord injury (SCI), and 2) athletes with non-spinal cord injuries (NSCI). All ECG were interpreted according to international recommendations for ECG interpretation in athletes. Results Among 82 Paralympic athletes (mean age, 33.7 [21-49] years), there were 19 (23%) in skill, 25 (31%) in power, and 38 (46%) in mixed sports disciplines and 24 (30%) had SCI and 58 (70%) had NSCI. There were no abnormalities observed in two-dimensional echocardiography. Normal ECG findings were seen in 28 athletes (34.1%) with a higher prevalence in athletes with NSCI (41.3%) and participated in mixed (47.3%) sports discipline (p&amp;lt;0.001). Borderline ECG findings were detected in 6 (7.3%) with more frequent in athletes with SCI (12.5%) and participated in power (16%) sports disciplines (p&amp;lt;0.001). The prevalence of abnormal ECG findings were 3.6% and there was no significant difference regard to type of disability and sports disciplines. Cardiac risk factors including hypertension was detected in 8 (9.7%); triglycerides &amp;gt;200 mg/dl in 21 (25.6%), total cholesterol &amp;gt;200 mg/dl in 15 (18.2%), 25-hydroxyvitamin D3 &amp;lt;30 ng/ml in 35 (42.6%), low-density lipoprotein cholesterol &amp;gt;130 mg/dl in 8 (9.7%), very low-density lipoprotein cholesterol ≥50 mg/dl in 15 (18.2%) and high-density lipoprotein cholesterol &amp;lt;40 mg/dl in 7 (8.5%); that were significantly more frequent in athletes with SCI and athletes participated in power sports disciplines (p&amp;lt;0.001). Conclusions The overall prevalence of borderline ECG findings and cardiovascular risk factors are unexpectedly high in Paralympic athletes. This study emphasizes that Paralympic athletes especially those with SCI and participating in power sports disciplines are not immune from cardiovascular risk factors and requires more medical care attention through relevant cardiovascular screening strategies.

Electrocardiographic findings in pediatric versus young-adolescent athletes: A comparative analysis using general international criteria

BackgroundThe inclusion of electrocardiogram (ECG) in medical examinations for sports practice serves as a valuable tool for identifying potential life-threatening conditions during physical exercise. However, its applicability in young individuals remains a subject of controversy, primarily due to relatively high rates of false positives and the associated costs of further investigations. Furthermore, the validation of International Criteria for athletes below 12 years of age in optimizing pre-participation screening for young athletes is yet to be established. In light of these considerations, this study aims to describe the prevalence of ECG findings in a sample of children and young-adolescent athletes aged 11–16 years, employing refined Seattle interpretation criteria. Additionally, we seek to compare these findings based on age group and sex. MethodsThis was a retrospective and observational study of 3747 athletes 11–16 year-olds. Evaluation included interviewer-administered questionnaires for relevant history, physical examination and resting 12 - lead ECG for each participant. The primary outcome measure was abnormal ECG findings according to the International Recommendations for Electrocardiographic Interpretation in Athletes. ResultsAmong the evaluated population of pediatric and young adolescent athletes (77.5% boys; >99% Caucasian), the vast majority exhibited normal electrocardiogram (ECG) results, with adaptive findings related to sports participation being more frequent among young adolescents and males. The presence of significant ECG abnormalities in young-adolescent athletes was uncommon (2.05%; 1.92% children and 2.32% young-adolescent) and required additional examinations. 0.27% of the total population were diagnosed with a previously unknown cardiac pathology only through the ECG. ConclusionsThis study provides valuable insights into the prevalence of normal, borderline, and abnormal electrocardiogram (ECG) findings in a large population of pediatric and young-adolescent athletes. These findings serve as guidance in detecting potentially serious cardiac alterations within this specific group, considering variations based on age and sex. The study confirms that ECG screening is a useful tool for identifying cardiac abnormalities in pediatric and young-adolescent athletes, even though the prevalence of significant findings in this population is relatively low. Furthermore, our findings support the utilization of the refined Seattle criteria as a sensitive and specific technique for screening pediatric and young-adolescent athletes, further enhancing the accuracy of ECG-based evaluations.

Comprehensive pathological and genetic investigation of three young adult myotonic dystrophy type 1 patients with sudden unexpected death.

The mechanism and pathological substrate of arrhythmogenic events in dystrophic myopathy type 1 (DM1) have not been fully established, especially for patients without progression of motor and/or cardiac disability. Therefore, we aimed to clarify the pathological appearance and genetic factors, other than CTG repeats in DMPK, associated with sudden cardiac death in patients with DM1. A pathological investigation including the cardiac conduction system in the heart and whole-exome sequencing was conducted for three young adults (Patient 1; 25-year-old female, Patient 2; 35-year-old female, Patient 3; 18-year-old male) with DM1 who suffered sudden death. Only Patient 1 showed abnormal electrocardiogram findings before death. The pathological investigation showed severe fibrosis of the atrioventricular conduction system in Patient 1 and severe fatty infiltration in the right ventricle in Patient 2. Several minimal necrotic/inflammatory foci were found in both patients. Patient 3 showed no significant pathological findings. A genetic investigation showed CORIN_p.W813* and MYH2_p. R793* in Patient 1, KCNH2_p. V794D and PLEC_p. A4147T in Patient 2, and SCN5A_p.E428K and SCN3B_ p.V145L in Patient 3 as highly possible pathogenic variants. The present study showed varied heart morphology in young adults with DM1 and sudden death. Synergistic effects of various genetic factors other than CTG repeats may increase the risk of sudden cardiac death in DM1 patients, even if signs of cardiac and skeletal muscle involvement are mild. Comprehensive genetic investigations, other than CTG repeat assessment, may be useful to estimate the risk of sudden cardiac death in DM1 patients.

Characteristics of Electrocardiogram Findings in Fulminant Myocarditis.

Fulminant myocarditis (FM) is an acute and severe form of myocarditis with rapid progression and poor clinical outcomes in the absence of acute or chronic coronary artery disease. Electrocardiogram (ECG) abnormalities can provide preliminary clues for diagnosis; however, there is a lack of systemic descriptions on ECG changes in FM populations. Thus, a retrospective analysis of 150 consecutive FM patients and 300 healthy controls was performed to determine the characteristic ECG findings in FM. All patients included had markedly abnormal ECG findings. Specifically, 83 (55.33%) patients had significantly lower voltage with remarkably decreased QRS amplitudes in all leads compared with healthy controls (p < 0.01), and 77 (51.33%) patients had a variety of arrhythmias with lethality ventricular tachycardia/ventricular fibrillation in 21 (14.00%) patients and third-degree atrioventricular block in 21 (14.00%) patients, whereas sinus tachycardia was only found in 43 (28.67%) patients with the median heart rate (HR; 88.00 bpm, IQR: 76.00-113.50) higher than that of controls (73.00 bpm, IQR: 68.00-80.00) (p = 0.000). Conduction and repolarization abnormalities were common in patients. A longer QTc interval (452.00 ms, IQR: 419.00-489.50) and QRS duration (94.00 ms, IQR: 84.00-119.00) were observed in patients compared to controls (QTc interval = 399.00 ms, IQR: 386.00-414.00; QRS duration = 90.00 ms, IQR: 86.00-98.00) (p < 0.05). Additionally, HR > 86.50 bpm, QTc > 431.50 ms, and RV5 + SV1 < 1.715 mV can be used to predict FM. Thus, marked and severe ECG abnormalities provide preliminary clues for the diagnosis of FM.

Electrocardiographic characteristics fail to predict acute coronary occlusions in out-of-hospital cardiac-arrest patients without ST-segment elevation

BackgroundA minority of out-of-hospital cardiac arrest patients have an acutely occluded coronary artery without manifesting ST-segment elevation on their post-resuscitation ECG. Identifying such patients is an issue to providing timely reperfusion therapy. We aimed to evaluate the usefulness of the initial post-resuscitation electrocardiogram in out-of-hospital-cardiac-arrest patients for selection to perform early coronary angiography. MethodsThe study population consisted of 74 of the 99 randomized patients from the PEARL clinical trial with both ECG and angiographic data. The purpose of this study was to investigate initial post-resuscitation electrocardiogram findings from out-of-hospital cardiac arrest patients without ST-segment elevation for any association with the presence of acute coronary occlusions. Secondarily, we aimed to observe the distribution of abnormal electrocardiogram findings and survival to hospital discharge of subjects. ResultsInitial post-resuscitation electrocardiogram findings, including ST-depression, T-wave inversion, bundle branch block, non-specific changes, were not associated with the presence of an acutely occluded coronary. Normal post-resuscitation electrocardiogram findings were associated with patient survival to hospital discharge but were not associated with the presence or absence of an acute coronary occlusion. ConclusionsElectrocardiogram findings cannot exclude or identify the presence of an acutely occluded coronary in out-of-hospital-cardiac-arrest patients without ST-segment elevation.An acutely occluded coronary may be present regardless of normal electrocardiogram findings.

Six-month cardiac outcomes in children with multisystem inflammatory syndrome in children.

Multisystem inflammatory syndrome in children is a rare, post-infectious complication of SARS-CoV-2 infection in children. We aimed to assess the long-term sequelae, particularly cardiac, in a large, diverse population. We performed a retrospective cohort study of all children (aged 0-20 years, n = 304) admitted to a tertiary care centre with a diagnosis of multisystem inflammatory syndrome in children from March 1, 2020 to August 31, 2021 and had at least one follow-up visit through December 31, 2021. Data were collected at hospitalisation, 2 weeks, 6 weeks, 3 months, and 1 year after diagnosis, where applicable. Cardiovascular outcomes included left ventricular ejection fraction, presence or absence of pericardial effusion, coronary artery abnormalities, and abnormal electrocardiogram findings. Population was median age 9 years (IQR 5-12), 62.2% male, 61.8% African American (AA), and 15.8% Hispanic. Hospitalisation findings included abnormal echocardiogram 57.2%, mean worst recorded left ventricular ejection fraction 52.4% ± 12.4%, non-trivial pericardial effusion 13.4%, coronary artery abnormalities 10.6%, and abnormal ECG 19.6%. During follow-up, abnormal echocardiogram significantly decreased to 6.0% at 2 weeks and 4.7% at 6 weeks. Mean left ventricular ejection fraction significantly increased to 65.4% ± 5.6% at 2 weeks and stabilised. Pericardial effusion significantly decreased to 3.2% at 2 weeks and stabilised. Coronary artery abnormalities significantly decreased to 2.0% and abnormal electrocardiograms significantly decreased to 6.4% at 2 weeks and stabilised. Children with multisystem inflammatory syndrome in children have significant echocardiographic abnormalities during the acute presentation, but these findings typically improve within weeks. However, a small subset of patients may have persistent coronary abnormalities.

Relationship Between Caffeine Consumption and Young Athletes' Comorbidities, Exercise-Related Symptoms, and Baseline Electrocardiogram.

Caffeine consumption causes diverse physiologic effects that can affect athletes both positively and negatively. There is a lack of research investigating the long-term effects of caffeine intake on exercise and on overall cardiovascular health in young athletes. Certain characteristics such as age, body mass index (BMI), race, and medical diagnoses are associated with increased caffeine use, and there is a relationship between caffeine consumption and symptoms during exercise and cardiovascular abnormalities in young athletes. Cross-sectional study. Level 4. This study utilized the HeartBytes National Youth Cardiac Registry to collect data related to demographics, caffeine use, and physical examination and electrocardiogram (ECG) findings of 7425 12- to 20-year-olds (60.6% male, 39.4% female) who attended a Simon's Heart cardiac screening event between 2014 and 2021. Univariable and multivariable logistic regression models were used for analysis. Persons who consumed caffeine were more likely to have attention deficit hyperactivity disorder (ADHD) (adjusted odds ratio [aOR], 1.43; CI, 1.15-1.76]; P < 0.01) and more likely to have a BMI ≥30 kg/m2 (aOR, 1.69; CI, 1.27-2.25]; P < 0.01) compared with nondrinkers. After controlling for age, gender, race, and BMI, there were no significant differences in symptoms during exercise (aOR, 1.27; CI, 0.97-1.66; P = 0.08) or abnormal ECG findings (OR, 0.93; CI, 0.66-1.31; P = 0.70) between those who consume caffeine and those who do not. Caffeine consumption was associated with increased BMI and increased likelihood of having ADHD; however, caffeine use overall was not associated with increased risk of symptoms during exercise or ECG abnormalities. Whereas caffeine consumption overall did not increase risk of exercise-related symptoms, soda drinkers were at higher risk for symptoms during exercise, and coffee drinkers were at higher risk of syncope with exercise. Prospective studies with longitudinal follow-up and more specific outcomes data is the next step in qualifying the impact of caffeine on young athletes.

Do we need to worry for metabolic syndrome in patients of periorbital melanosis? A case report of a middle-aged female

Background: In today's world, periorbital melanosis (PM), frequently referred to as dark circles, is of great cosmetic importance. This condition not only has a huge psychological impact but, it could also possibly be an indication of acanthosis nigricans (AN). Recently, it has been recognized as a distinct manifestation of metabolic syndrome. Methods: We studied one case of a middle aged female who came with a complaint of periorbital darkening. Relevant clinical and laboratory investigations were carried out. Results: Along with periorbital hyperpigmentation, she was also found to have axillary darkening consistent with AN. Further evaluation revealed abnormal electrocardiogram findings and she fulfilled the criteria of metabolic syndrome. Conclusion: We emphasize the need for evaluating such patients of PM for underlying metabolic syndrome.

Toxic myocarditis presenting as an acute coronary syndrome

BackgroundAcute myocarditis is one of the causes of acute non-ischemic myocardial injury mimicking acute coronary syndrome (ACS) on presentation. It is usually underdiagnosed due to the non-specificity of presenting symptoms, elevated troponin levels, and abnormal ECG (electrocardiogram) findings. Delayed contrast-enhanced cardiac MRI (CMR) is known as the gold standard imaging modality for differentiating acute non-ischemic myocardial injury from infarcted myocardium. The most frequent cause of myocarditis is viral infections, but further infrequent causes include other infectious pathogens, toxins, hypersensitivity drug reactions, and autoimmune diseases. Cannabis is one of the most abused illicit and recreational drugs in the world among adolescents and adults. Also, many reports of marijuana-associated cardiovascular risks have been established previously, mainly presenting as arrhythmias, myocardial infarction, and myocarditis.Case presentationA 19-year-old female, complaining of radiating chest pain to the left arm and jaw, along with associated sweating for 1 day. Initial work-up showed elevated troponin levels with ST segment elevation on ECG. On further investigation, CMR showed findings of myocarditis and negative virology work-up led to a work-up of proper history, which revealed marijuana abuse, with a history of consumption 3 days before presentation. Hence, it was diagnosed as toxic myocarditis secondary to presumed cannabis abuse and treated for same.ConclusionsNon-ischemic myocardial injury causes like myocarditis should be considered in young patients especially, who are presenting to emergency with ACS. CMR should be used as a first line diagnostic imaging modality (based on its availability) in cases mimicking an ACS or suspected myocarditis, especially in young patients. Though viral etiology is considered the most common cause of myocarditis, less common causes such as toxic myocarditis must be considered in cases of young individuals presenting with ACS in an emergency.

Abstract 14707: Electrocardiographic Abnormalities Are Common in DCM Patients’ Family Members With Early Manifestations of DCM

Introduction: Imaging and 12-lead electrocardiogram (ECG) are recommended to screen individuals at risk of dilated cardiomyopathy (DCM). Few studies have examined the yield of ECG testing in these individuals. We hypothesized that ECG abnormalities are more frequent in DCM patients’ family members with early imaging manifestations of DCM than in those without. Methods: The multisite DCM Precision Medicine Study collected contemporaneous imaging and ECG in 1226 First Degree Relatives (FDRs) of DCM patients aged ≥ 18 years between 06/2016 and 04/2021. Imaging results were used to classify participants into four phenotype groups: left ventricular systolic dysfunction alone (LVSD), left ventricular enlargement alone (LVE), DCM (both LVSD and LVE), or normal (neither LVE nor LVSD). ECG status was defined as normal, borderline, or abnormal. Analysis of the probability of a borderline or abnormal ECG result was performed using a generalized linear mixed model accounting for clinical site heterogeneity and intrafamilial correlation. Results: Both imaging and ECG findings were normal in 57% of FDRs. ECG findings were abnormal or borderline in 42% of FDRs with LVSD or LVE and 87% of FDRs with DCM. As shown in Table, FDRs with DCM were more likely than FDRs with no LVE or LVSD to have abnormal or borderline ECGs after adjusting for race, ethnicity, age, sex, and family ascertainment site (OR: 13.17; 95% CI: 5.18 - 33.50). African American FDRs had higher adjusted odds of abnormal or borderline ECG findings than White FDRs (OR: 1.59; 95% CI: 1.15 - 2.20). FDRs in the 4th quartile by age had higher adjusted odds of abnormal or borderline ECG findings than FDRs in the 1st quartile (OR: 4.36; 95% CI: 3.01 - 6.33). Conclusions: An abnormal or borderline ECG was substantially more likely in at-risk FDRs who, by imaging, had DCM. This study supports the use of ECG testing in the screening of FDRs for DCM.

Cardiovascular Involvement in Patients Recovered from COVID-19: Reality or Fantasy?

Background: COVID-19 infection has been associated with cardiovascular complications in 7-28% of hospitalized patients, with the diagnosis based on biomarkers elevation. Subclinical cardiac involvement in outpatients recovered from COVID-19 represents a growing concern, as well as mid- or long-term cardiovascular effects. Objective: The aim of the present study was to determine the usefulness of detecting cardiovascular involvement in outpatients recovered from COVID-19, and its association with symptoms and risk factors. Methods: Between September 2020 and March 2021, 668 patients &gt;18 years were prospectively included. All the patients had to have COVID-19 confirmed diagnosis by a positive reverse transcription-polymerase chain reaction (RT-PCR) test in a respiratory tract sample COVID-19. They were evaluated with physical examination, electrocardiogram (ECG) and Doppler echocardiography. Patients with symptoms suggestive of risk or abnormal findings on ECG or echocardiogram underwent cardiac magnetic resonance imaging (CMRI) with gadolinium-based contrast agent. Results: Mean age was 42.9 ± 14.9 years and 56.9% were women; 12.9% were hypertensive, 4.3% were diabetic and 6.9% obese. Overall, 57.6% had no cardiovascular risk factors and only 4.2% had a history of cardiovascular disease. The disease was mild in 73.2%; 16.3% required hospitalization and 1.05% needed mechanical ventilation. Only 5 patients had myocarditis diagnosed by CMRI, and both pericardial effusion and abnormal repolarization were significantly associated with myocarditis (p &lt; 0.0001). Conclusions: Abnormal ECG or echocardiographic findings were uncommon in our cohort. The diagnosis of viral myocarditis was made in 5 cases with clinical signs and symptoms, and was confirmed by CMRI.

20-Year-Old Man With Elevated Liver Tests

20-Year-Old Man With Elevated Liver Tests

Electrocardiographic and echocardiographic findings in children with dengue infection.

ABSTRACTBackground:The mechanism of myocardial damage in dengue could be the release of inflammatory mediators or the direct action of the dengue virus on myocytes leading to myocarditis. The release of inflammatory mediators is more in a severe form of the disease that correlates to the higher incidence of cardiac manifestations in patients with severe dengue.Aim:To determine the electrocardiographic and two-dimensional (2D)-echocardiographic findings in children with dengue infection and to find a correlation with disease severity.Materials and Methods:A total of 150 children between 1 month and 12 years of age seropositive for dengue Non-specific antigen 1 (NS1) Enzyme linked immunosorbent assay (ELISA) or dengue Immunoglobulin M (IgM) ELISA were studied in the Department of Pediatric Medicine of a tertiary care government hospital. The patients were undertaken for 12 lead electrocardiograms (ECGs) and echocardiograms.Results:Out of the 150 dengue seropositive cases, 61 cases were of mild dengue, 67 cases were of dengue with warning signs (DWSS), and 22 cases were severe dengue cases. Abnormal ECG was found in 78 cases (52%) in a total of 150 cases in terms of rate, prolonged PR interval (interval between atrial depolarization and ventricular activation), ST (ventricular repolarisation)-segment depression, and low-voltage complexes. Abnormal 2D- echocardiography (ECHO) was found in 70 (46.6%) out of 150 in terms of the ejection fraction (EF) <55%, Early diastole/atrial contraction (E/A) ratio <1, and the presence of pericardial effusion.Conclusion:Nearly 50% of the patients have abnormal ECG and ECHO findings, more so in the severe dengue group. There is a statistically significant association of the EF between mild dengue, DWWS with severe dengue (P =0.001).

Study of Cardiac Manifestation in Patients with Seropositive Dengue Fever and to Find Correlation with Subclinical Cardiac Involvement

Objective: The main objective of the present study was to observe the electrocardiogram (ECG) changes in dengue fever and to find correlation with subclinical cardiac involvement. Methods: This was an observational, prospective, non-randomized study. High grade fever for one to five days diagnosed as dengue infection later confirmed by dengue tests (NS1, IgG and IgM ELISA) were included in this study. Prior to the commencement of the study informed consent was taken from all the participants. With 12 lead ECG taken during the febrile phase of dengue fever randomly selected serologically confirmed cases of dengue fever were evaluated at an interval of 24 hrs. for a total of five days. On the day of admission when the patient was afebrile, echocardiography was done. Plasma leakage was diagnosed by presence of any one of four: subcutaneous oedema (pedal oedema, facial puffiness) or pleural effusion or pericardial effusion or ascites. Result: A total 80 patients who were admitted to hospital during study periods due to symptoms of dengue fever and IgM dengue positive status were included in this study. Among this total population of 80 patients (N=80) 48 were male and 32 were female. Out of these, majority were diagnosed as DF 52 (65%), 23 (29%) were diagnosed as DHF and rest only 5 (6%) were diagnosed as DSS. Total 54 patients were found to have normal ECG among which 35 were having dengue fever, 16 were having DHF and 3 were having DSS. Total 2 patients were diagnosed to have left ventricular hypertrophy among which one had dengue fever and rest two had DHF. ST depression was observed in total 7 patients in which 5 were had dengue fever and 2 were had DHF. Relative bradycardia was found in 14, tall t waves in 2 and ventricular ectopics in 1 patient (table 2). Abnormal ECG findings were compared using Chi-square test and were found to be statistically significant (P &lt; 0.05) in dengue fever and DHF. There was statistically significant correlation between ECG abnormalities and abdominal pain and mucosal bleed. The presence of plasma leakage were observed among 77 (96.3%) patients. Proportion of echocardiography abnormalities were higher among patients with plasma leak 6 (30%) as compared to without plasma leak 9 (15%), this difference was not found to be statistically significant Conclusion: In all type of Dengue infections incidence of cardiac involvement was quite high. Due to the overlapping clinical manifestations such as capillary leak associated with DENV infection, tachycardia, pulmonary edema, and hypotension as well as due to the low index of clinical suspicion cardiac involvement in dengue fever is often underdiagnosed. Keywords: Cardiac manifestation, dengue infection, echocardiography, electrocardiography.

Diagnostic yield and cost analysis of electrocardiographic screening in Swiss paediatric athletes

ObjectivesAthletes performing sports on high level are at increased risk for sudden cardiac death. This includes paediatric athletes, even though data on screening strategies in this age group remain scarce. This study aimed to assess electrocardiogram interpretation criteria in paediatric athletes and to evaluate the cost of screening. MethodsNational, multicentre, retrospective, observational study on 891 athletes of paediatric age (<18 years) evaluated by history, physical examination and 12-lead electrocardiogram. The primary outcome measure was abnormal electrocardiogram findings according to the International Recommendations for Electrographic Interpretation in Athletes. The secondary outcome measure was cost of screening. Results19 athletes (2.1%) presented abnormal electrocardiogram findings requiring further investigations, mainly abnormal T-wave inversion. These 19 athletes were predominantly males, performing endurance sports with a mean volume of 10 weekly hours for a mean duration of 6 years of training. Further investigations did not identify any relevant pathology. All athletes were cleared for competition with regular follow-up. Total costs of the screening were 108,860 USD (122 USD per athlete). ConclusionsOur study using the International Recommendations for Electrographic Interpretation in Athletes identified a low count of abnormal findings in paediatric athletes, yet raising substantially the cost of screening. Hence, the utility of electrocardiogram-inclusive screening of paediatric athletes remains to be elucidated by longitudinal data.

CORRELATION BETWEEN PREOPERATIVE ELECTROCARDIOGRAM FINDINGS AND NT-PROBNP AND POSTOPERATIVE CARDIAC EVENTS AFTER NONCARDIAC SURGERY

<h3>BACKGROUND</h3> Preoperative electrocardiogram (ECG) are routinely ordered in adults undergoing noncardiac surgery, yet ECG abnormalities have not been found to predict postoperative cardiac complications. Abnormal ECG findings may lead to unnecessary preoperative medical consultation and cardiac imaging. Preoperative NT-proBNP has been shown to enhance cardiac risk prediction and has not been compared to ECG. <h3>METHODS AND RESULTS</h3> We included a consecutive sample of 1000 patients seen at the preoperative assessment clinic prior to elective noncardiac surgery at a single tertiary-care centre. Eligible patients were either 65 years or older, or 45 to 64 years with at least one risk factor according to the Revised Cardiac Risk Index (RCRI). Mean age was 67.3 years (standard deviation 9.5), 53.7% were male, 52.6% had hypertension, 23.7% diabetes, and 13.6% prior history of coronary artery disease. Two thirds (63.1%) underwent surgery with overnight stay, the remainder had same-day surgery. The majority (97.1%) of patients had a preoperative ECG ordered, of which 51.2% had at least one abnormal ECG finding. The most common abnormal ECG findings as reported by the automated ECG interpretation were supraventricular arrythmias (181/971; 18.6%), non-specific ST-T waves abnormalities (99/971; 10.2%) and previous myocardial infarction (134/971; 13.8%). Following the abnormal ECG findings, 8.0% (95% confidence interval [CI] 6.0%-10.8%) of patients had a preoperative medical consultation or cardiac imaging ordered. Routine preoperative NT-proBNP was obtained in 29.3% (293/1000), of which 34.8% (102/293) had NT-proBNP ≥200 ng/L. For patients who underwent inpatient surgery (n=631), the 30-day incidence of major cardiac complications was 5.9% (95% CI 4.3%-8.0%). No ECG finding was associated with postoperative cardiac events, alone or in combination. A preoperative ECG finding of partial or complete left bundle branch block and supraventricular arrythmia had a weak correlation with preoperative NT-proBNP ≥200 ng/L (Pearson's R 0.185 p=0.003 and 0.202 p=0.001, respectively). In patients who had a preoperative NT-proBNP measured and underwent in-hospital surgery, NT-proBNP ≥200 ng/L was independently associated with postoperative major cardiac events (adjusted odds ratio 6.68, 95% CI 2.22-19.56). <h3>CONCLUSION</h3> In patients undergoing elective noncardiac surgery, abnormal findings were common on routine ECG and led to medical consultation or cardiac imaging in 1 in 12 patients. Abnormal ECG findings were not associated with postoperative cardiac events but preoperative NT-proBNP was a strong predictor of cardiac complications. Clinicians may consider using NT-proBNP for preoperative cardiac risk stratification in patients with abnormal ECG findings to identify patients at higher risk.