Abnormal Electrocardiogram Results Research Articles

Prevalence and impact of viral myocarditis in patients with severe fever with thrombocytopenia syndrome.

To explore the association and impact between viral myocarditis and mortality in patients with severe fever with thrombocytopenia syndrome. A dynamic analysis was conducted between fatal group and nonfatal group regarding the daily epidemiology data, clinical symptoms, and electrocardiogram (ECG), echocardiogram, and laboratory findings. Outcomes of patients with and without viral myocarditis were compared. The association between viral myocarditis and mortality was analyzed. Among 183 severe fever with thrombocytopenia syndrome patients, 32 were in the fatal group and 151 in the nonfatal group; there were 26 (81.25%) with viral myocarditis in the fatal group, 66 (43.70%) with viral myocarditis in the nonfatal group (p < 0.001), 79.35% of patients had abnormal ECG results. The abnormal rate of ECG in the fatal group was 100%, and in the nonfatal group was 74.83%. Univariate analysis found that the number of risk factors gradually increased on Day 7 of the disease course and reached the peak on Day 10. Combined with the dynamic analysis of the disease course, alanine aminotransferase, aspartate aminotransferase, creatine kinase, creatine kinase fraction, lactate dehydrogenase, hydroxybutyrate dehydrogenase, neutrophil count, serum creatinine, Na, Ca, carbon dioxide combining power, amylase, lipase, activated partial thromboplastin time and thrombin time had statistically significant impact on prognosis. The incidence of fever with thrombocytopenia syndrome combined with viral myocarditis is high, especially in the fatal group of patients. Viral myocarditis is closely related to prognosis and is an early risk factor. The time point for changes in myocarditis is Day 7 of the course of the disease.

A patient with large ostium primum atrial septal defect who underwent open heart surgical closure with pericardial patch: a case report

Introduction: Atrial septal defect (ASD) is one of the most common congenital heart diseases and often diagnosed in adulthood. ASD represents a spectrum of disease with symptoms that vary from asymptomatic to right-sided cardiac volume overload, pulmonary arterial hypertension and atrial arrhythmias depending on the size of the defect, size of the shunt and associated anomalies. We reported a patient with large ostium primum ASD who underwent surgical closure with a pericardial patch. Case Description: A 18 years old man came with chief complaint of abnormal ECG results of the screening examination of police candidates from Bhayangkara Hospital Manado. The patient had no complaints during admission. The patient could still carry out daily activities without any obstacles. The patient also could do high intensity sport without complaints of shortness of breath, heavy chest, or headaches. .Electrocardiogram (ECG) examination showed sinus rhythm, heart rate 74 beats per minute, left anterior fascicular block (LAFB), complete right bundle branch block (RBBB) and fragmented QRS at inferior leads. Transthoracic and transesophageal echocardiography revealed large ostium primum ASD L-R shunt. Open heart ASD surgical closure with pericardial patch was done with good results and no residual shunt. Conclusion: Large ostium primum ASD are associated with significant systemic-to-pulmonary shunts that results in desaturation requiring surgical closure. Large shunt of ASD patients who have a dilated right heart are associated with increased age-related morbidity and mortality. ASD with right heart dilatation should be considered for closure once the diagnosis is established regardless of the patient's age.

Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021

Vaccination against COVID-19 provides clear public health benefits, but vaccination also carries potential risks. The risks and outcomes of myocarditis after COVID-19 vaccination are unclear. To describe reports of myocarditis and the reporting rates after mRNA-based COVID-19 vaccination in the US. Descriptive study of reports of myocarditis to the Vaccine Adverse Event Reporting System (VAERS) that occurred after mRNA-based COVID-19 vaccine administration between December 2020 and August 2021 in 192 405 448 individuals older than 12 years of age in the US; data were processed by VAERS as of September 30, 2021. Vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna). Reports of myocarditis to VAERS were adjudicated and summarized for all age groups. Crude reporting rates were calculated across age and sex strata. Expected rates of myocarditis by age and sex were calculated using 2017-2019 claims data. For persons younger than 30 years of age, medical record reviews and clinician interviews were conducted to describe clinical presentation, diagnostic test results, treatment, and early outcomes. Among 192 405 448 persons receiving a total of 354 100 845 mRNA-based COVID-19 vaccines during the study period, there were 1991 reports of myocarditis to VAERS and 1626 of these reports met the case definition of myocarditis. Of those with myocarditis, the median age was 21 years (IQR, 16-31 years) and the median time to symptom onset was 2 days (IQR, 1-3 days). Males comprised 82% of the myocarditis cases for whom sex was reported. The crude reporting rates for cases of myocarditis within 7 days after COVID-19 vaccination exceeded the expected rates of myocarditis across multiple age and sex strata. The rates of myocarditis were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.9 per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and 56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively). There were 826 cases of myocarditis among those younger than 30 years of age who had detailed clinical information available; of these cases, 792 of 809 (98%) had elevated troponin levels, 569 of 794 (72%) had abnormal electrocardiogram results, and 223 of 312 (72%) had abnormal cardiac magnetic resonance imaging results. Approximately 96% of persons (784/813) were hospitalized and 87% (577/661) of these had resolution of presenting symptoms by hospital discharge. The most common treatment was nonsteroidal anti-inflammatory drugs (589/676; 87%). Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose in adolescent males and young men. This risk should be considered in the context of the benefits of COVID-19 vaccination.

Distinguishing Uveitis Secondary to Sarcoidosis From Idiopathic Disease

Idiopathic disease is the most frequent diagnosis in a uveitis clinic. The need to distinguish sarcoidosis from idiopathic uveitis is controversial. However, cardiac involvement in sarcoidosis can be life-threatening. To report a series of patients with uveitis and cardiac sarcoidosis to illustrate the importance of categorizing the causes of uveitis. This retrospective observational case series reviewed the medical records of 249 patients with uveitis who were referred to the Casey Eye Institute between July 1, 2008, and February 28, 2017. We describe patients who initially received a diagnosis of idiopathic uveitis but subsequently received a diagnosis of sarcoidosis. Clinical data, including ophthalmologic findings, were collected. We summarized the number of patients who initially presented with idiopathic uveitis, the number of patients who recived a classification of idiopathic uveitis after evaluation, the number of patients who underwent chest computed tomography or an electrocardiogram, and the number of patients with ocular sarcoidosis. Of 33 patients with sarcoidosis, 21 (63.6%) were women and the mean (SD) age was 53.5 (13.8) years. Of 249 patients, the referring diagnosis was idiopathic uveitis for 179 (72%). After history, examination, and laboratory testing, 127 (51%) were still considered to have idiopathic disease. Fifty-three of the 179 patients (30%) with idiopathic disease underwent chest computed tomography scanning. A diagnosis of presumed sarcoidosis, usually on the basis of a chest computed tomography scan, was made in 19 patients (36.2%). As 14 patients (5.6%) were previously known to have sarcoidosis, 33 patients (13.3%) were evaluated with definite or presumed ocular sarcoidosis. We obtained electrocardiograms as a screen for cardiac sarcoidosis on 14 (42.4%) of these patients. Nine patients with abnormal electrocardiogram results were referred to cardiologists. Four of the 19 patients (21.1%) who were referred for idiopathic uveitis but subsequently received a diagnosis of presumed sarcoidosis were found to have episodes of ventricular tachycardia that required implantable cardiac defibrillators. Distinguishing ocular sarcoidosis from idiopathic uveitis had potentially life-saving implications for these patients. The present case series shows the potential utility of distinguishing sarcoidosis-associated uveitis from idiopathic uveitis. We suggest that patients older than 40 years with a history of idiopathic uveitis be evaluated with chest computed tomography and an electrocardiogram if sarcoidosis is suggested on ophthalmic examination.

Patients With Type A Acute Aortic Dissection Presenting With an Abnormal Electrocardiogram

The electrocardiogram (ECG) is often used in the diagnosis of patients presenting with chest pain to emergency departments. Because chest pain is a common manifestation of type A acute aortic dissection (TAAAD), ECGs are obtained in much of this population. We evaluated the effect of particular ECG patterns on the diagnosis and treatment of TAAAD. TAAAD patients (N= 2,765) enrolled in the International Registry of Acute Aortic Dissection were stratified based on normal (n= 1,094 [39.6%]) and abnormal (n= 1,671 [60.4%]) findings on presenting ECGs and further subdivided according to specific ECG findings. Time data are presented in hours as medians (quartile 1 to quartile 3). Patients with ECGs with abnormal findings presented to the hospital sooner after symptom onset than those with ECGs with normal findings (1.4 [0.8 to 3.3] vs 2.0 [1.0 to 3.3]; p= 0.005). Specifically, this was seen in patients with infarction with new Q waves or ST elevation (1.3 [0.6 to 2.7] vs 1.5 [0.8 to 3.3]; p= 0.049). Interestingly, the time between symptom onset and diagnosis was longer with infarction with old Q waves (6.7 [3.2 to 18.4] vs 5.0 [2.9 to 11.8]; p= 0.034) and nonspecific ST-T changes (5.8 [3.0 to 13.8] vs 4.5 [2.8 to 10.5]; p= 0.002). Surgical mortality was higher in patients with abnormal ECG findings (20.6% vs 11.9%, p < 0.001), especially in those with ischemia by ECG (25.7% vs 16.8%, p < 0.001) and infarction with new Q waves or ST elevation (30.1% vs 17.1%, p < 0.001). TAAAD patients presenting with abnormal ECG results are sicker, have more in-hospital complications, and are more likely to die. The frequency of nonspecific ST-T abnormalities and its association with delay in diagnosis and treatment presents an opportunity for practice improvement.

Prevalence of electrocardiographic abnormalities in young, elite Japanese athletes.

The question as to whether or not electrocardiogram (ECG) evaluations should be performed in all athletes is still controversial. So, in this study, the prevalence of electrocardiographic abnormalities was evaluated in young, elite Japanese athletes. Subjects included 174 male and 101 female Japanese athletes (mean age, 21.5 years). Sports activities included baseball, basketball, diving, fencing, gymnastics, judo, rhythmic gymnastics, soccer, swimming, tennis, track and field, volleyball, and water polo. A 12-lead resting ECG was recorded and evaluated. We used the criteria for distinctly abnormal ECG patterns as defined by Pelliccia et al. Subjects were divided into 2 groups on the basis of their exercise training type: an endurance training group and a static training group. Twenty six of 174 male subjects (14.9%) and 11 of 101 (10.9%) female subjects presented with abnormal ECG results. ECG abnormalities were observed much more frequently in track athletes compared to athletes of other sporting events. Field players did not present with any ECG abnormalities. Overall, the incidences of ECG abnormalities were statistically lower in the static exercise training group than in the endurance training group both in male and female. High voltage of left ventricle was observed in 114 of 175 male subjects (65.1%), and 27 of 101 female subjects (26.7%). The prevalence of ECG abnormalities in young, elite, Japanese athletes was comparable to that previously reported by both Western and Asian investigators.

Factors influencing electrocardiogram results in workers exposed to noise in steel-making and steel-rolling workshops of an iron and steel plant

To investigate the factors influencing the electrocardiogram results in the workers exposed to noise in steel-making and steel rolling workshops of an iron and steel plant. From September to December, 2013, cluster sampling was used to select 3 150 workers exposed to noise in the steel-making and steel-rolling workshops of an iron and steel plant, and a questionnaire survey and physical examinations were performed. The number of valid workers was 2 915, consisting of 1 606 workers in the steel-rolling workshop and 1 309 in the steel-making workshop. The electrocardiogram results of the workers in steel-making and steel-rolling workshops were analyzed. The overall abnormal rate of electrocardiogram was 26.35%, and the workers in the steel-making workshop had a significantly higher abnormal rate of electrocardiogram than those in the steel-rolling workshop(32.24% vs 21.54%, P<0.05). Male workers had a significantly higher abnormal rate of electrocardiogram than female workers(27.59% vs 18.61%, P<0.05). The workers with a drinking habit had a significantly higher abnormal rate of electrocardiogram than those who did not drink(28.17% vs 23.75%, P<0.05). The workers exposed to high temperature had a significantly higher abnormal rate of electrocardiogram than those who were not exposed to high temperature(29.43% vs 20.14%, P<0.05). The abnormal rates of electrocardiogram in the workers with cumulative noise exposure levels of <90, 90~94, 95~99, 100~104, and 105~113 dB(A)·year were 21.21%, 21.76%, 26.50%, 27.27%, and 32.16%, respectively, with significant differences between any two groups(P<0.05). The multivariate logistic regression analysis showed that a cumulative noise exposure of 105-113 dB(A)·year(OR=1.36, 95% CI: 1.03~1.80), a drinking habit(OR=1.20, 95% CI: 1.01~1.43), and high temperature(OR=1.60, 95% CI: 1.32~1.92) were the risk factors for abnormal electrocardiogram results. High cumulative noise exposure, alcohol consumption, and high temperature may affect the abnormal rate of electrocardiogram in the workers exposed to noise in steel-making and steel-rolling workshops.

Electrocardiograms of Adult Outpatients Followed-Up in Basic Health Care Units in the Community of the South Region of São Paulo City

The electrocardiogram (ECG) is an important, available, and inexpensive diagnostic tool to assess cardiac symptoms. Few studies address the prevalence of ECG abnormalities or changes of a normal tracing in ECG in outpatients. Our objective was to evaluate ECGs of adult outpatients to determine whether changes from a normal tracing could disclose the patients' cardiovascular health status. We evaluated all elective ECGs obtained in adult outpatients, from January 2009 to January 2010, at a municipal hospital in the city of São Paulo, Brazil. Electrocardiography was performed with a 3-channel, 12-lead machine (Dixtal Cardio-page EP-3, Dixtal Biomedica, São Paulo, Brazil), and results were interpreted by a cardiologist. Electrocardiography was performed in 3567 adult outpatients, 62.5% of whom were women, with a mean age of 51 years (standard deviation [SD] = 16 years). Of the 1918 patients whose ECGs showed abnormalities (mean age = 56 years, SD = 15 years), 1137 were women. Electrocardiographic changes were found in 1184 of the patients. Minor changes were found in 38.3% of patients. A total of 3133 changes were found in 1918 abnormal ECG results. There was a statistical difference related to sex and age, and abnormal ECG results were more frequent in men. There was a high prevalence of abnormal ECG results in the population studied. There were more ECGs obtained from women; however, men and elderly patients more frequently had abnormal ECG results.

Unexpectedly abundant coronary Thebesian system: Possible cause of chest pain and abnormal electrocardiogram results

Unexpectedly abundant coronary Thebesian system: Possible cause of chest pain and abnormal electrocardiogram results

Pediatric myocarditis: presenting clinical characteristics

Objective The objective of the study was to characterize the clinical profiles of pediatric patients with acute myocarditis and dilated cardiomyopathy (DCM) before diagnosis. Methods A retrospective cross-sectional study was conducted to identify patients with myocarditis and DCM who presented over a 10-year span at 2 tertiary care pediatric hospitals. Patients were identified based on the International Classification of Diseases, Ninth Revision, diagnostic codes. Results A total of 693 charts were reviewed. Sixty-two patients were enrolled in the study. Twenty-four (39%) patients had a final diagnosis of myocarditis, and 38 (61%) had DCM. Of the 62 patients initially evaluated, 10 were diagnosed with myocarditis or DCM immediately, leaving 52 patients who required subsequent evaluation before a diagnosis was determined. Study patients had a mean age of 3.5 years, 47% were male, and 53% were female. Common primary complaints were shortness of breath, vomiting, poor feeding, upper respiratory infection (URI), and fever. Common examination findings were tachypnea, hepatomegaly, respiratory distress, fever, and abnormal lung examination result. Sixty-three percent had cardiomegaly on chest x-ray, and all had an abnormal electrocardiogram results. Conclusions These data suggest children with acute myocarditis and DCM most commonly present with difficulty breathing. Myocarditis and DCM may mimic other respiratory or viral illnesses, but hepatomegaly or the finding of cardiomegaly and an abnormal electrocardiogram result may help distinguish these diagnoses from other more common pediatric illnesses.

Hamartomas of mature cardiac myocytes: report of 7 new cases and review of literature

Only 8 cases of hamartomas of mature cardiac myocytes have been reported. The aim of the study was to describe 7 new cases and provide clinicopathologic correlation. Our anatomical pathology database was searched for all cases of cardiac hamartoma, of which 7 represented mature myocyte type. Medical records were reviewed for clinical information, and microscopic slides were evaluated for extent of characteristics. Five males and 2 females ranged in age from 6 months to 74 years (mean, 23 years). There were 11 ventricular hamartomas (8 left free wall, 2 right free wall, 1 septum). Death in 3 infants was unrelated to incidental hamartomas discovered at autopsy. A 10- and 16-year-old were asymptomatic but had abnormal electrocardiogram (ECG) results, which led to detection of cardiac masses by imaging studies. Two adult males had only mild coronary disease angiographically. The 57-year-old, who died suddenly, had a 7-year history of abnormal ECG results. The 74-year-old, who died after aortic surgery, had a 3-year history of chest discomfort. Their hamartomas were identified at autopsy and contributed to sudden death in 1. Microscopically, all hamartomas were involved by myocyte hypertrophy and disarray, without inflammation or calcification. Myocyte vacuolization and venular dilatation occurred only in the pediatric cases, and interstitial adipose tissue only affected 1 adult. In conclusion, hamartomas of mature cardiac myocytes may be detected at any age. They primarily affect males, arise predominantly in the left ventricle, are asymptomatic, may have nonspecific ECG findings, and rarely may be associated with sudden death. Microscopic findings in infants differ from older patients.

Exercise Test Response and Cardiorespiratory Fitness Independently Predict Coronary Heart Disease Mortality In Asymptomatic Men

We have shown that abnormal exercise test responses (ETR), denned as abnormal electrocardiogram results, abnormal blood pressure response and exercise-induced chest pain, are directly associated with death from coronary heart disease (CHD) in initially asymptomatic men. Cardiorespiratory fitness (CRF) is also inversely associated with CHD risk. The enhancement in CHD risk prediction when considering both maximal ETR and CRF is less understood. PURPOSE: We examined the associations between CRF and ETR and CHD mortality in 42,329 men (mean±SD, age 43±10 years) who completed a preventive medical examination at the Cooper Clinic, Dallas, TX between 1970 and 2001. METHODS: At baseline, all men were asymptomatic and free of physician diagnosed myocardial infarction or stroke, and had clinical measures including resting blood pressure, fasting blood chemistry, and a symptom-limited maximal treadmill exercise test. CRF categories were based on age-specific distributions of exercise duration denned as low (lowest 20%) and moderate-high CRF (highest 80%). An abnormal ETR was denned above. An equivocal ETR was denned as an equivocal exercise electrocardiogram. Framingham risk scores (FRS) were computed and men were grouped in categories of <10% and >10%. Mortality follow-up was through 2003 primarily using the National Death Index. RESULTS: During an average follow-up of 17.4±7.9 years, 632 (1.5%) CHD deaths occurred. Approximately 6% of men had an equivocal ETR and 6% had an abnormal ETR. Age-adjusted CHD mortality rates per 10,000 person-years of exposure across low and moderate-high CRF groups were 11.4 and 4.9 for men with normal ETR, 31.3 and 13.5 for men with equivocal ETR and 59.6 and 27.4 for men with abnormal ETR. Based on a Cox regression model that included baseline exam year, age, CRF, ETR, FRS, all were independently associated with CHD mortality. Hazard ratios (95% CI) were 0.50 (0.42–0.59) for moderate-high CRF; 1.5 (1.2–2.0) for equivocal ETR, 2.4 (2.0–3.0) for abnormal ETR; 2.0 (1.6–2.4) for FRS ≥10%. Comparison of likelihood ratios indicated enhanced CHD risk prediction based on a model that included both CRF and ETR compared with either CRF or ETR alone. When grouped on ETR categories of normal, equivocal, and abnormal, hazard ratios (95% CI) for CHD mortality in men with moderate-high CRF were 0.48 (0.39–0.59), 0.48 (0.29–0.77) and 0.55 (0.39–0.76), respectively. CONCLUSION: In asymptomatic men without known CHD, CRF appears to enhance CHD risk prediction based on ETR alone. These findings indicate that functional and hemodynamic responses from maximal exercise testing can be valuable in assessing individuals seen in preventive medical settings.

Relevance of routine admission electrocardiograms for psychiatric patients.

To make clinically relevant recommendations for electrocardiogram (ECG) testing among psychiatric patients, the study examined the practice of ordering ECGs for this population. The records of 4,045 patients consecutively admitted for psychiatric care to seven community teaching hospitals over one year were examined. The frequency of ECG orders was documented, and abnormal ECG results were grouped into two categories: relevant to psychiatric treatment (ischemia or conduction defects) and incidental to treatment (minor abnormalities and screening abnormalities). For those with abnormalities, additional cardiac follow-up data were recorded. Associations between ECG results and patients' characteristics were analyzed. ECGs were performed for 2,857 (71 percent) of first admissions, of which 2,225 (78 percent) showed neither relevant nor screening abnormalities. Eighteen percent of those tested had relevant abnormalities, most commonly a first-degree atrioventricular block or some evidence of a myocardial infarction. ECG screening abnormalities were found for another 4 percent, primarily left ventricular hypertrophy (3 percent), but no follow-up occurred for 46 percent of these patients. Among patients under 40 years of age, 8 percent had relevant abnormalities, and 3 percent had screening abnormalities. Among patients without apparent cardiac risk, 10 percent had relevant and 3 percent had screening abnormalities. More than half the patients who had a second or third admission during the year had a repeat ECG, even when previous ECGs were normal. Routine ECG is not an effective treatment or screening tool in this population, and substantial cost savings could result from more selective testing, particularly among young patients, those at low risk, and those with repeat admissions.