Abnormal Electrocardiographic Changes Research Articles

Abnormal ECG Findings of Known Type 2 Diabetics Attending the Endocrinology Clinic at the Federal Medical Centre, Yenagoa

Diabetes mellitus is a chronic disease with life-threatening micro- and macro-vascular complications with cardiovascular complications being the major cause of death among those with type 2 diabetes. The study was aimed at evaluating the abnormal electrocardiographic changes associated with type 2 diabetes mellitus among diabetic patients attending the endocrinology clinic in FMC Yenagoa during the study period. The study made use of 162 apparently healthy individuals and 300 diabetic patients. Interviewer-administered questionnaire, 12-lead ECG and fasting blood sugar were the study tools. The data obtained were analyzed using descriptive statistics, paired sample T-test and Pearson Product Moment correlation. The results revealed that the ECG abnormalities associated with type 2-DM were abnormal axis, widened QRS duration, elevated and depressed ST-segment and LVH. Again, age, gender, BMI, smoking and FSB were the risk factors found to be associated with cardiac abnormalities. A close and regular monitoring of the FBS, BP and ECG were therefore recommended for diabetic 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.

Management of cardiovascular symptoms after Pfizer-BioNTech COVID-19 vaccine in teenagers in the emergency department

Cardiovascular complications after Pfizer-BioNTech COVID-19 (BNT) vaccination are a concern, especially in adolescents. We analyzed the risk factors for myocarditis after BNT vaccination. We used a special evaluation protocol for all patients aged 12-18 years who presented to our emergency department with cardiovascular symptoms after BNT vaccination. A total of 195 patients (109 boys and 86 girls) were enrolled. Eleven (5.6%) patients presented with arrhythmia (arrhythmia group), 14 (7.2%) had a diagnosis of pericarditis/myocarditis (the peri/myocarditis group), and the remaining 170 were controls (no cardiac involvement). Chest pain (77.6%) was the most common symptom. The median time from vaccination to symptom onset was 3 days. In the peri/myocarditis group (13 myocarditis and 1 pericarditis), the median time to the peak troponin T level was 5 days after vaccination. Abnormal electrocardiographic changes, including ST-T changes and conduction blocks, were more commonly detected in the peri/myocarditis group (85.7% vs. 12.4% in the control group, p<0.01). Echocardiography revealed normal ventricular function in all patients. Symptoms were resolved before discharge in all, with the median duration of hospital stay being 4 days. The electrocardiography was the most appropriate screening tool for myocarditis, with a sensitivity and specificity of 85.7% and 87.6%, respectively. Pericarditis or myocarditis was diagnosed in 7.2% of adolescents presenting to the emergency department with cardiovascular symptoms after BNT vaccination. In addition to the troponin T level, ECG change listed above can be used as a screening tool for vaccine-induced cardiac complications.

Study an elderly people's abnormal electrocardiographic changes at government hospital

Population aging is one of the demographic characteristics of the 21st century. This process is necessarily accompanied by an increase in the prevalence of cardiovascular diseases that may have expression on the electrocardiogram (ECG). Aim: to study an elderly people's abnormal electrocardiograph at government hospital. Material and Methods:All the Patients were admitted in the department of Medicine at Government medical college, Kadapa, Andhra Pradesh, India. Study period January 2021 to june 2021These participants were then clinically examined and studied in accordance with the study's guidelines to generate the necessary data, which was then categorised, tabulated, and classed before being subjected to analysis. Total 300 persons should taken in the study.150 were healthy one and 150 were patients. The age of the persons should be 65 years and above, both the sex were included. Conclusion: Atrial fibril-lation was the most prevalent rhythm abnormality. With no association to sex or skin tone, ventricular repolarization changes outweighed ventricular depolarization changes. There were a sizable number of instances with extended QT, left ventricular hypertrophy, and anomalous left atrium.

Ursolic acid prevents cyclophosphamide induced myocardial oxidative tissue damage in wistar rats

Herbs and spices of natural origin have been used traditionally for culinary and therapeutic purposes. Ursolic acid, a pentacyclic triterpenoid, is a major component of various foods, herbs and spices utilized in daily life. The purpose of this study was to investigate the cardio-protective action of ursolic acid against cardio-toxicity induced by cyclophosphamide. Animals were randomly divided into control group (1% dimethyl sulfoxide, s.c.), toxic control (Cyclophosphamide 200 mg/kg, i.p.), ursolic acid treated (40 mg/kg, s.c.) and ursolic acid-cyclophosphamide combination treatment. Animals were sacrificed at the end of the treatment period and biochemical, electrocardiographic and histopathological changes were measured. Cyclophosphamide treatment showed marked increase in biomarker enzymes (CKNAC, CKMB, LDH, AST, and ALT), decreased tissue antioxidants (SOD, catalase &amp; GSH), hyperlipidemia (TC, TG) and abnormal electrocardiographic (HR, RR, QRS, QT &amp; PR intervals) and histopathological changes. Ursolic acid treatment restored tissue antioxidants, normalised biochemical and electrocardiographic parameters and prevented structural damage of the myocardium. Findings from this study indicate the protective role of ursolic acid against cardiotoxicity caused by cyclophosphamide.

A prospective study of electrocardiographic and echocardiographic changes in patients with cerebrovascular accidents

Background: Cerebrovascular accident also called as stroke is defined as the sudden onset of neurological deficit that can be attributable to a focal vascular cause. Many studies in the past have demonstrated the fact that neurological abnormalities produce Electrocardiographic changes without any underlying cardiac lesions. Present study is done to analyze different changes in Electrocardiogram and echocardiographic patterns in the cases of cerebrovascular accidents and to assess whether these different changes have got any prognostic significance in these patients.Methods: In this study 100 patients of acute stroke admitted between May 2011 to August 2012 in Vydehi institute of medical sciences and research centre were considered and subjected to CT scan of brain, Electrocardiogram and 2D echocardiography within 24 hours of admission. Follow-up was done within the hospital to know the prognosis of all the patients.Results: Out of 100 patients majority of them had ischemic stroke accounting for 80% and remaining 20% of patients had haemorrhagic stroke. Abnormal Electrocardiographic changes were seen in 64% patients and 58% patients showed abnormal Echocardiography. ECG changes seen are Tachycardia, QTc prolongation, T wave inversion, ST depression, U waves and Bradycardia. Commonly seen echocardiographic changes were LV dysfunction, mitral valve abnormality, aortic valve abnormality. Overall mortality in patients with abnormal ECG was 28.12% compared to 11.11% in patients with normal ECG and it was statistically not significant. Overall mortality in patients with abnormal 2D echocardiography was 31.03% compared to patients with normal 2D Echocardiography which was 4.76% and it was statistically significant.Conclusions: From this study we conclude that ECG abnormalities in stroke patients do not have any prognostic significance. But LV dysfunction has prognostic significance in predicting mortality in cerebrovascular accident.

A prospective study of electrocardiographic and echocardiographic changes in patients with cerebrovascular accidents

Background: Cerebrovascular accident also called as stroke is defined as the sudden onset of neurological deficit that can be attributable to a focal vascular cause. Many studies in the past have demonstrated the fact that neurological abnormalities produce Electrocardiographic changes without any underlying cardiac lesions. Present study is done to analyze different changes in Electrocardiogram and echocardiographic patterns in the cases of cerebrovascular accidents and to assess whether these different changes have got any prognostic significance in these patients.Methods: In this study 100 patients of acute stroke admitted between May 2011 to August 2012 in Vydehi institute of medical sciences and research centre were considered and subjected to CT scan of brain, Electrocardiogram and 2D echocardiography within 24 hours of admission. Follow-up was done within the hospital to know the prognosis of all the patients.Results: Out of 100 patients majority of them had ischemic stroke accounting for 80% and remaining 20% of patients had haemorrhagic stroke. Abnormal Electrocardiographic changes were seen in 64% patients and 58% patients showed abnormal Echocardiography. ECG changes seen are Tachycardia, QTc prolongation, T wave inversion, ST depression, U waves and Bradycardia. Commonly seen echocardiographic changes were LV dysfunction, mitral valve abnormality, aortic valve abnormality. Overall mortality in patients with abnormal ECG was 28.12% compared to 11.11% in patients with normal ECG and it was statistically not significant. Overall mortality in patients with abnormal 2D echocardiography was 31.03% compared to patients with normal 2D Echocardiography which was 4.76% and it was statistically significant.Conclusions: From this study we conclude that ECG abnormalities in stroke patients do not have any prognostic significance. But LV dysfunction has prognostic significance in predicting mortality in cerebrovascular accident.

Electrocardiographic Changes in Different Grades of Hypertensive Patients: Experience of 400 Cases in Bangladesh

Background: Determination of the electrocardiographic changes among the hypertensive patients can reveal the early cardiac abnormalities. Objectives: The purpose of the present study was to find out the common electrocardiographic (ECG) changes in different grades of hypertensive patients. Methodology: This cross sectional study was conducted among mild to severe grade hypertensive patients attended in the Department of Medicine at Rajshahi Medical College and Hospital, Rajshahi during the period of July 2009 to June 2010 for a period of one year. Data were collected by face to face interview with a pre-designed structured questionnaire. Measurement of the blood pressure and the 12-lead surface electrocardiogram were done among the study group in a resting state. Results: A total number of 400 mild to severe grade hypertensive patients were recruited for this study of which male was 300 cases and female were 100 cases. The age ranges was 30 to 60 years, Among 400 hypertensive patients, abnormal electrocardiographic changes were found in 212(53%) patients. Among the mild, moderate and severe cases, the changes were 38.8%, 65% and 100% respectively. Conclusions: There is an association between hypertension and ECG changes which is more pronounced in severe hypertension.Journal of Science Foundation, January 2016;14(1):26-29

Dihydromyricetin prevents cardiotoxicity and enhances anticancer activity induced by adriamycin.

Adriamycin, a widely used anthracycline antibiotic in multiple chemotherapy regimens, has been challenged by the cardiotoxicity leading to fatal congestive heart failure in the worst condition. The present study demonstrated that Dihydromyricetin, a natural product extracted from ampelopsis grossedentat, exerted cardioprotective effect against the injury in Adriamycin-administrated ICR mice. Dihydromyricetin decreased ALT, LDH and CKMB levels in mice serum, causing a significant reduction in the toxic death triggered by Adriamycin. The protective effects were also indicated by the alleviation of abnormal electrocardiographic changes, the abrogation of proliferation arrest and apoptotic cell death in primary myocardial cells. Further study revealed that Dihydromyricetin-rescued loss of anti-apoptosis protein ARC provoked by Adriamycin was involved in the cardioprotection. Intriguingly, the anticancer activity of Adriamycin was not compromised upon the combination with Dihydromyricetin, as demonstrated by the enhanced anticancer effect achieved by Adriamycin plus Dihydromyricetin in human leukemia U937 cells and xenograft models, in a p53-dependent manner. These results collectively promised the potential value of Dihydromyricetin as a rational cardioprotective agent of Adriamycin, by protecting myocardial cells from apoptosis, while potentiating anticancer activities of Adriamycin, thus further increasing the therapeutic window of the latter one.

Analysis of Electrocardiographic Changes in Cerebrovascular Accidents

Backgroundthe interrelationship of cerebrovascular disease and cardiovascular disease has been repeatedly emphasised and the decompensation in one system can adversely affect the other. The possibility of cerebrovascular accidents (CVA) could result in cardiac rhythm disturbances or structural damage and may be associated with abnormal Electro-Cardiographic Changes (ECG) even in patients without apparent heart disease. Methodsa total of 60 CVA cases have been evaluated and associated ECG changes were analyzed. Resultsin the present study, 83.3% patients showed abnormal ECG changes. All patients (100%) with cerebral haemorrhage, Sub-arachanoid Haemorrhage (SAH), Cortical Venous Thrombosis (CVT) had ECG changes whereas it was only 64.28% in Cerebral Thrombosis. Conclusiondifferent ECG changes are observed in CVA cases even in absence of primary cardiac disease and these ECG changes can be predictor of prognosis.

Electrocardiographic changes after injury in a rat model of combined crush injury

BackgroundCrush injury from debris, combined with hypoxia and water and food deprivation (combined crush injury), is common in industrial accidents and events such as earthquakes and terrorist attacks. Whether electrocardiographic changes are associated with combined crush injury is unclear. MethodsThirty-six rats underwent electrocardiography at baseline then were randomly assigned to 6 groups of 6. Bilateral hind limbs of all rats were compressed with custom-made clips (pressure 4.5 ± 0.3 kg), and the rats were put into a hypoxic compartment (oxygen concentration 10% ± 0.1%) for 72 hours without food or water. After 72 hours, the rats were moved to a normoxic environment, where the clips were removed (decompression) and food and water were freely accessible. Electrocardiography was performed in a different group at each of days 0, 1, 3, 7, 14, and 28 after decompression. ResultsOne rat died at 0.6 days. Among the remaining 35 rats, 28 (80%) had abnormal electrocardiographic changes: ST-segment depression (n = 25), tall-peaked T waves (n = 16), arrhythmias (n = 4), abnormal Q waves (n = 2), wide QRS complexes (n = 2) and QT prolongation (n = 1). The abnormality rates among assessed rats were 100% on days 0, 1, and 3; 83% on day 7; and 50% on days 14 and 28. ConclusionsThe findings suggest that abnormal electrocardiographic changes were seen in rats after simulated combined crush injury and decompression and were slow to resolve.

Electrocardiographic changes after dipyridamole infusion in patients undergoing myocardial perfusion imaging

Although the diagnostic and prognostic importance of perfusion defects has been clearly established, the meaning of the development and characteristics of electrocardiographic (ECG) changes during dipyridamole infusion is less well defined. This study tries to evaluate the prevalence and significance of ECG changes after dipyridamole infusion and their relation to ischemia in myocardial perfusion single-photon emission computed tomography (SPECT). Two hundred patients underwent 2-day dipyridamole stress/rest Tc-99m-sestamibi myocardial perfusion SPECT. Basal and post dipyridamole ECGs were analyzed. Myocardial perfusion images were interpreted visually and semiquantitatively. New ECG changes were noted in 20.2% of cases and consisted of 1.1% T-wave flattening, 1.1% T-wave inversion and 14.8% ST depression and 4.2% psuedonormalization. Abnormal ECG changes were noted after dipyridamole infusion in approximately 27.7% of patients with and 14.3% of patients without reversible defect in myocardial perfusion SPECT. A new ST depression was noted in lateral leads in 72.2% of new ST changes. The mean post-dipyridamole heart rate increment in patients with reversible or partially reversible defects was significantly lesser than in patients with normal myocardial perfusion SPECT. In addition, the corrected QT interval (QTc) increment in patients with reversible defects was significantly more than in patients with fixed defects; however, there was no difference when compared with patients with no defects. Using linear regression model, the severity of ST depression and QTc increment were significant predictors of summed difference score. Sensitivity, specificity, and negative and positive predictive values of ST-segment depression for the diagnosis of ischemia were 20.2, 89.5, 60.7, and 58.4%, respectively. The most common ECG change seen after dipyridamole infusion is ST-segment depression. The new ST-segment depression after dipyridamole infusion is highly specific for ischemia. Reversible defects are associated with a lesser increment in heart rate, whereas QTc increment and severity of ST segment depression were significant predictors of summed difference score.

Cardiac protection effect of fructose-1, 6-diphosphate in patients with primary bone cancer treating with chemotherapy

Objective To investigate the cardiac protection effect of venous fructose-1,6-diphosphate in pa-tients with primary bone malignant tumors. Methods 178 patients received 9 times of chemotherapy were randomly divided into non-cardiac protective therapy group (A group)and cardiac protective therapy group(B group). The car-diac toxicity was reflected by abnormal electrocardiographic changes. The abnormal electrocardiographic changes were compared in two groups. Results Abnormal electrocardiographic changes were significantly decreased in B group eompared with A group (30 vs 81 ,P <.05). Conclusion The cardiac protective medicine fructose-1,6-diphosphate efficiently decreased the cardiac toxicity in patients with primary bone malignant tumors treating with chemotherapy. Key words: Bone nenoplasms; Drug therapy; fructose-1,6-diphosphate; electrocardiogram

Abnormal ECG patterns during the acute phase of subarachnoid hemorrhage in patients without previous heart disease

Abstract Subarachnoid hemorrhage (SAH) occurs primarily during early to mid-adulthood; approximately 30% of individuals with SAH die within 2 weeks, and mortality is 30% to 45%. SAH happens suddenly, without patients being aware of previous heart abnormalities. Here, we performed a pilot single cohort (historical) study to examine the hypothesis that early abnormal electrocardiographic (ECG) changes may reveal unknown but “silent” heart pathologies in SAH patients without previous heart disease (PHD). Data were collected retrospectively on 56 consecutive patients during the acute phase of SAH (29 men, 27 women; mean age 49.0 ± 6.2 years) with different degrees of neurologic deficit (Hunt-Hess scale assessment) in a 2-year period single-cohort study. Repolarization abnormalities were most frequent (p&lt;0.05) and were independent of a history of PHD, although it corresponded to a higher risk for such abnormalities (odds ratio OR=3.21; CI95%=1.01–10.22). ECG changes in patients without PHD were similar to those in PHD patients, confirming the hypothesis that SAH is associated with previously “silent” heart pathology. The increased frequency of ECG changes in PHD patients and their high incidence in no-PHD patients suggested a neurogenic form of myocardial dysfunction following SAH. Notably, repolarization changes were more frequent in patients with less severe deficit (p&lt;0.05), whereas rhythm and conductive abnormalities were more frequent in patients with more severe neurologic deficit.

Exercise Performance of Asymptomatic Subjects with Hereditary Hemochromatosis: The Increase in Abnormal Electrocardiographic Changes and Complex Arrhythmias

Exercise performance and electrocardiogram (ECG) responses in hereditary hemochromatosis (HH) subjects who are New York Heart Association Functional Class I are unknown. Thus, we evaluated exercise performance and ECG responses in asymptomatic HH subjects. We recruited a total of 43 HH subjects and 21 normal control subjects through NHLBI-sponsored “Heart Study of Hemochromatosis.” They underwent metabolic stress testing using Bruce protocol and exercise performance and exercise ECG parameters were obtained. The overall exercise performance of HH subjects was comparable to control subjects. However, ischemic ECG changes were frequently seen in this group (42% vs 5%, P<0.05). Additional cardiac stress imaging demonstrated no evidence of significant ischemic heart disease in any subjects who had an abnormal test, indicating that they were likely false positive responses. The occurrence of supraventricular (SVT) and ventricular tachycardia (VT) was only observed in HH. The incidence of complex arrhythmias (couplet ventricular ectopics, SVT, and VT) was significantly higher in HH subjects (19% vs 0%, P<0.05). Induction phlebotomy treatment did not affect exercise performance and ischemic ECG changes (41%) in HH. In conclusion, asymptomatic HH subjects appear to have comparable exercise capacity to normal subjects. However, abnormal ischemic stress ECGs and complex arrhythmias are more frequently seen in HH. The significance of these findings warrants further investigation of electrocardiographic instability of HH subjects during exercise.

SCORPION ANTIVENOM REVERSES METABOLIC, ELECTROCARDIOGRAPHIC, AND HORMONAL DISTURBANCES CAUSED BY THE INDIAN RED SCORPION Mesobuthus tamulus concanesis, Pocock ENVENOMATION

Electrocardiographic (ECG) changes were induced in dogs by injection of scorpion venom from Mesobuthus tamulus concanesis, Pocock. Venom (3 mg/kg body weight) was given subcutaneously (SQ) while 10 ml of scorpion antivenom (SAV) was administered intravenously (IV) to experimental dogs. Group 1 received only the venom; Groups 2, 3, and 4 received SAV at 0, 30, and 60 min, respectively, following envenoming. Thick, ropy and profuse salivation; muscle fasciculation; clonus and tetany-like contractions; frequent urination; and bowel emptying sometimes stained with bile and occasionally blood and bile were observed 20-25 minutes after envenoming. Following envenoming, hyperglycemia, increase in free fatty acid (FFA) levels, and reduction in triglyceride levels were observed in Groups 1, 3, and 4. There was an initial rise in insulin levels at 30 min followed by a reduction at 60 min. SAV caused a subsequent rise in insulin levels but there was a reduction in blood sugar to euglycemia levels and lipogenesis (reduction in FFA and increase in triglycerides levels) in Groups 3 and 4. Abnormal ECG changes and arrhythmias were not observed after SAV. Normal sinus rhythm was restored in Group 4. Scorpion envenoming with multi-system-organ failure (MSOF), characterized by a massive release of counter-regulatory hormones (catecholamines, glucagon, cortisol), angiotensin-II, and changes in insulin secretion, is a condition of fuel-energy deficits and an inability to utilize the existing metabolic substrates. These disturbances are reversed by SAV possibly through insulin release. It is concluded that SAV, under the laboratory conditions, effectively neutralizes, prevents, and reverses scorpion venom toxicity.

Vasotonic angina: A spectrum of ischemic sysdroms involving function abnormalities of the epicardial and microvascular coronary circulation

Objectives. The present study was undertaken to investigate the response of large and small coronary arteries in a subgroup of patients with no or minimal coronary artery disease found to have objective signs of myocardial ischemia.Background. Many patients apparently have normal coronary arteries despite abnormal electrocardiographic (ECG) changes during spontaneous angina attacks or exercise stress testing.Methods. Twenty-five patients with no or minimal (<30% stenosis) coronary artery disease were chosen from a pool initially selected on the basis of spontaneous anginal attacks and ST segment shifts in the anterior leads. Of these, 10 were grouped as having variant angina (at least one episode of ST elevation) and the remaining 15 as having syndrome X (exercise-induced anginal pain, ST depression and reversible thallium abnormalities). Data were compared with those obtained in 10 patients with stable angina and documented coronary artery disease. Eighteen patients with supraventricular arrhythmias and normal coronary arteries served as control patients. Patients showing focal spasm during ergonovine testing were not included in the subsequent angiographic analysis. Great cardiac vein blood flow, aortic pressure and changes in coronary artery diameter were measured at rest and 2 to 4 min after hyperventilation in the remaining study group. The same procedure was repeated after sublingual administration of 0.3 mg of nitroglycerin in eight patients (four with syndrome X and four with variant angina).Results. Hyperventilation induced diffuse epicardial coronary diameter reduction, which was marginal in control patients (9 ± 4%) and those with coronary artery disease (5 ± 3%) but severe (p < 0.001) in those with variant angina (28 ± 14%) or syndrome × (25 ± 13%). Concomitant determination of coronary flow showed significant (p < 0.001) decreases in those with variant angina (25 ± 11%) and syndrome × (28 ± 10%) but not in control patients (5 ± 8%) or those with coronary artery disease (4 ± 5%), Changes in great cardiac vein blood flow during hyperventilation were similar before and after nitroglycerin.Conclusions. These indicate vasoconstrictor stimuli may trigger a diffuse abnormal response of both epicardial and resistance vessels in some patients with chest pain and angiographicaily normal coronary arteries. Patients showing such diffuse vasoconstrictor abnormalities are suggested to have a single pathogenetic entity with a spectrum of ECG manifestations ranging from ST depression to ST elevation.

Ambulatory esophageal manometry, pH-metry, and holter ECG monitoring in patients with atypical chest pain

Standard Holter electrocardiographic (ECG) monitoring was combined with ambulatory esophageal manometry and pH-metry in 25 patients with atypical chest pain in order to determine whether an association could be found between spontaneous pain episodes and ischemic ECG changes or esophageal dysfunction. Results of ambulatory testing were compared to those obtained with standard esophageal manometry and provocative testing. Twenty-two of the 25 patients experienced a total of 88 pain episodes during ambulatory testing. Although 15 of the 22 patients (68%) experiencing pain during testing had at least one pain episode that correlated temporally with gastroesophageal reflux, esophageal dysmotility or ischemic ECG changes, 65% of all pain episodes were unrelated to abnormal esophageal events or ECG changes. Seventeen percent of pain episodes were associated with gastroesophageal reflux, 15% with esophageal dysmotility, and 2% with a combined acid reflux and esophageal dysmotility event. Only one pain episode was associated with ischemic ECG changes. Twelve of the 15 patients with chest pain episodes associated with reflux or esophageal dysmotility had other identical pain episodes in which there was no correlation. Reproduction of a patient's pain during standard manometry with provocative testing did not predict a strong correlation between the patient's spontaneous pain episodes and esophageal dysfunction during ambulatory recordings. In summary, patients with atypical chest pain have relatively few spontaneous pain episodes that correlate with gastroesophageal reflux, esophageal dysmotility, or ischemic ECG changes. It appears that different stimuli can trigger identical episodes of chest pain, which suggests that many of these patients may have dysfunction of their visceral pain sensory mechanisms.

Arterial blood oxygen desaturation in infants and children during upper gastrointestinal endoscopy

Arterial blood oxygen desaturation and abnormal electrocardiographic changes have been reported in adults undergoing upper gastrointestinal endoscopy. We studied 32 infants and children less than 12 years of age using pulse oximetry and continuous electrocardiography before, during, and after upper gastrointestinal endoscopy performed under intravenous sedation. Sinus tachycardia was the most common electrocardiographic change, and no clinically significant electrocardiographic abnormalities were induced by the procedure. Desaturation to less than or equal to 90% was found in 37.5% of the patients and was most commonly noted during the endoscopy procedure and in patients with cardiopulmonary disease. The desaturation was unpredictable because there was no correlation between desaturation and medication, tolerance to the procedure, weight, or age of the child. Some patients who subjectively appeared to tolerate the procedure well had significant desaturation. The use of pulse oximetry should be considered for all children undergoing upper gastrointestinal endoscopy.

The effects of successful PTCA on left ventricular function: Assessment by exercise echocardiography

To assess the usefulness of exercise echocardiography in the follow-up of patients after percutaneous transluminal coronary angioplasty (PTCA), we studied 56 patients at rest and immediately following exercise with two-dimensional echocardiography. Sixty-nine of 73 stress/echo studies (94%) were suitable for interpretation. Seventeen patients (group I) with significant coronary artery disease (CAD) were studied before and after PTCA. Sixteen patients with coronary disease not undergoing PTCA (group II) and 23 individuals without significant coronary disease (group III) served as age-matched controls. Left ventricular ejection fraction did not change significantly in group I patients prior to PTCA (56 ± 7 versus 54 ± 12, p = ns) or in group II patients (52 ± 10 versus 56 ± 15, p = ns), rest versus immediate after exercise measurements. Following angioplasty, left ventricular ejection fraction increased in group I patients from 55 ± 7 to 65 ± 8, p < 0.001 from rest to exercise, and to a similar extent in group III individuals (55 ± 6 to 66 ± 8, p < 0.001). Electrocardiographic (ECG) evidence of ischemia (>1 mm ST segment depression) was found in 13 of 17 group I patients prior to PTCA and in 8 of 16 group II patients (CAD). None of the 25 normal patients and four of the group I patients following PTCA had abnormal ECG changes with exercise. New exercise-induced echocardiographic wall motion abnormalities were found in 12 of 17 group I patients prior to PTCA and in none of the group I patients following PTCA. Eight of 16 group II patients and none of the group III patients had exercise-induced wall motion abnormalities noted. The combination of exercise-induced wall motion abnormalities and 1 mm ECG ST segment depression improved the sensitivity over either technique alone (16 of 17 group I patients prior to PTCA and 15 of 16 group II patients had either echocardiographic or ECG evidence of ischemia, while four of the group I patients following PTCA and none of the normal individuals exhibited abnormalities with exercise). These data suggest that the addition of two-dimensional echocardiography to standard ECG exercise testing may be helpful in assessing the functional significance of coronary artery lesions prior to angioplasty and evaluating the results of successful angioplasty on left ventricular global and regional function.