Abnormal Electrocardiographic Findings Research Articles

Electrocardiographic, Ultrasonographic, and Echocardiographic Findings in Hypothyroidism: A Cross-Sectional Study

Background: Hypothyroidism, a common endocrine disorder, significantly impacts cardiovascular health and thyroid gland structure. Electrocardiography (ECG), ultrasonography (USG) of the neck, and echocardiography (2D Echo) are essential tools for evaluating these complications. Despite the well-known risks, comprehensive assessments combining these modalities are often underutilized in clinical practice. The study evaluated electrocardiographic, ultrasonographic, and echocardiographic findings in hypothyroid patients to identify prevalent abnormalities and associated risk factors. Methods: A total of 260 hypothyroid patients were included. Data collection involved clinical history, blood tests, ECG, USG neck, and 2D Echo. Statistical analysis was done using SPSS version 20, with qualitative variables analyzed using Chi-square tests and quantitative variables using multivariate analysis and logistic regression. Results: The study revealed that 65% of patients had abnormal ECG findings, with sinus bradycardia (20%) and prolonged QT interval (17%) being most common. USG neck showed thyromegaly in 48.1% and nodules in 40% of patients. Echocardiographic assessment indicated systolic dysfunction in 30% and diastolic dysfunction in 40% of patients. Higher TSH levels were significantly associated with increased prevalence of cardiac dysfunction (p < 0.01). Conclusion: Hypothyroidism significantly affects both cardiac function and thyroid gland structure. The study underscores the necessity for comprehensive diagnostic assessments, including ECG, USG, and echocardiography, to detect and manage complications early. Effective control of thyroid function is crucial in mitigating cardiovascular risks. Recommendations: Regular monitoring of thyroid and cardiac health in hypothyroid patients is recommended. Future research should focus on long-term outcomes of integrated diagnostic assessments and the effectiveness of early interventions. Keywords: Hypothyroidism, Electrocardiography, Ultrasonography, Echocardiography, Cardiac Dysfunction

Electrocardiographic Abnormalities in Patients with Hyperkalemia: A Retrospective Study in an Emergency Department in Colombia.

Hyperkalemia is a prevalent electrolyte disorder related to elevated serum potassium levels, resulting in diverse abnormal electrocardiographic findings and associated clinical signs and symptoms, often necessitating specific treatment. However, in some patients, these abnormal findings may not be present on the electrocardiogram even in elevated serum potassium levels. This study aims to identify electrocardiographic abnormalities related to the severity of hyperkalemia and the clinical outcomes in an emergency department in southwestern Colombia. This is a retrospective cross-sectional descriptive study. We described the electrocardiographic findings, clinical characteristics, treatment, and outcomes related to the degrees of hyperkalemia. The potential association between the severity of hyperkalemia and electrocardiographic findings was evaluated. A total of 494 patients were included. The median of the potassium level was 6.6 mEq/L. Abnormal electrocardiographic findings were reported in 61.5% of the cases. Mild and severe hyperkalemia groups reported abnormalities in 59.9% and 61.2%, respectively. The most common electrocardiography abnormalities were the peaked T wave 36.2%, followed by wide QRS 83 (16.8%). Only 1.4% of patients had adverse outcomes. The abnormal findings were registered in 61.5%. Mortality was 11.9%. The peaked T wave was the most common finding across different levels of hyperkalemia severity. High serum potassium levels are related with abnormal ECG. However, patients with different degrees of hyperkalemia could not describe abnormal ECG findings. In a high proportion of patients with renal chronic disease and hyperkalemia, the abnormalities in the ECG could be minimal or absent.

Prevalence of abnormal electrocardiographic findings and associated factors among patients with epilepsy at Jimma Medical Center, Ethiopia; Hospital-based cross-sectional study.

A person with epilepsy experiences recurrent seizures as a result of a persistent underlying disorder. About 50 million people globally are impacted by it, with 4 million of those being in Sub-Saharan Africa. One of the most frequent comorbidities that raise the mortality and morbidity rates of epileptic patients is abnormal Electrocardiographic (ECG) findings. Thus, the purpose of this study is to evaluate the prevalence of abnormal ECG findings in epileptic patients that might lead to increased risk of sudden cardiac death. A hospital based cross-sectional study was at Jimma Medical Center of Ethiopia on epileptic patients who were on follow-up at neurologic clinics during the data collection period. The malignant ECG characteristics and was identified using the ECG abnormality tool. To facilitate analysis, the gathered data was imported into Epidata version 3.1 and exported to the SPSS version 26. The factors of abnormal ECG and sudden death risk were examined using bivariate logistic regression. The study comprised 190 epileptic patients, with a mean age of 32 years. There were more men than women, making up 60.2%. A 43.2% (n = 80) frequency of ECG abnormalities was identified. According to the study, early repolarization abnormalities were the most common ECG abnormalities and increased with male sex and the length of time a person had seizures (AOR) of 4.751 and 95% CI (.273,.933), p = 0.029, compared to their female counterparts. The frequency of malignant ECG alterations in epileptic patients on follow-up at Jimma Medical Center in Ethiopia is described in the study. According to the study, there were significant ECG alterations in epileptic individuals. Male gender and longer duration of epilepsy raise the risk of abnormal ECG findings that could result in sudden cardiac death.

Electrocardiographic abnormalities are prognostic of the clinical outcomes and mortality of patients with subarachnoid hemorrhages

PurposeWe explored the relationships between electrocardiographic (ECG) abnormalities and the clinical outcomes and mortality of patients with non-traumatic aneurysmal subarachnoid hemorrhages (SAHs). MethodsThis retrospective cohort study enrolled consecutive adult patients who presented to emergency departments with non-traumatic aneurysmal SAHs. We recorded their demographics, clinical characteristics, and ECG findings, and explored the relationships between ECG abnormalities, on the one hand, and 28-day mortality and prognosis, on the other. ResultsWe enrolled 158 patients, 76 females (48.10%) and 82 males (51.90%) of average age 54.70 ± 7.07 years. A total of 107 patients (67.72%) exhibited at least one ECG abnormality, most commonly a T-wave change (n = 54, 34.18%). Such patients evidenced significantly higher Hunt-Hess and Fisher scale scores than those without abnormalities (both p < 0.001). Patients with abnormal ECG findings experienced more unfavorable outcomes and higher mortality than others (both p < 0.001). ECG abnormalities, including PR prolongation, pathological Q waves, QRS widening, left bundle branch blocks, premature ventricular contractions, ST segment changes, and T-wave changes, were more common in non-survivors and patients with Hunt-Hess scores of 4–5 compared to survivors and those with Hunt-Hess scores <4, respectively. Moreover, increased age and presence of abnormal ECG findings were independent predictors of mortality in aneurysmal SAHs. ConclusionsPatients with abnormal ECG findings exhibited unfavorable clinical outcomes and increased mortality rates. Abnormal ECG findings combined with higher Hunt-Hess or Fischer grade scores usefully predict adverse clinical outcomes in and mortality of SAH patients.

Electrocardiographic abnormalities in patients with sickle cell disease: A systematic review and meta-analysis.

Previous studies have documented that electrocardiography (ECG) can reveal a range of abnormalities, offering valuable insights into the cardiac evaluation of patients with sickle cell disease (SCD). The objective of this study is to assess the patterns of ECG abnormalities observed in these patients with SCD, and to determine their prevalence. We systematically reviewed the literature using online databases of PubMed, Scopus, Web of Science, Embase, and Google Scholar to identify original studies that reported findings of standard ECG assessments in patients with SCD. Statistical analyses were performed using the random effects model. Additional analyses including sensitivity analysis and subgroup analysis were also conducted. Analysis of data from 59 studies involving 897,920 individuals with SCD revealed that 75% of these patients had abnormal ECG findings (67%-81%), which were predominantly nonspecific ST-T changes, left ventricular hypertrophy, T-wave changes, prolonged corrected QT (QTc) interval, and ischemic changes. Besides, it was shown that these patients had significantly higher odds of having any ECG abnormalities (OR of 17.50, 4.68-65.49), right atrial enlargement (6.09, 1.48-25.09), left ventricular hypertrophy (3.45, 1.73-6.89), right ventricular hypertrophy (7.18, 2.28-22.57), biventricular hypertrophy (10.11, 1.99-51.38), prolonged QTc interval (5.54, 2.44-12.59), ST depression (3.34, 1.87-5.97), and T-wave changes (5.41, 1.43-20.56). Moreover, the mean of QTc interval was significantly higher among those with SCD (23.51milliseconds, 16.08-30.94). Our meta-analysis showed a higher prevalence of abnormal ECG findings among individuals with SCD. A significant proportion of these patients had various ECG abnormalities, suggesting a potential need for regular ECG assessments for patients with SCD.

Prevalence of electrocardiographic abnormalities among Iranian children and adolescents and associations with blood pressure and obesity: findings from the SHED LIGHT study.

There are few studies for detecting rhythm abnormalities among healthy children and adolescents. The aim of the study was to investigate the prevalence of abnormal electrocardiographic findings in the young Iranian population and its association with blood pressure and obesity. A total of 15084 children and adolescents were examined in a randomly selected population of Tehran city, Iran, between October 2017 and December 2018. Anthropometric values and blood pressure measurements were also assessed. A standard 12-lead electrocardiogram was recorded by a unique recorder, and those were examined by electrophysiologists. All students mean age was 12.3 ± 3.1 years (6-18 years), and 52% were boys. A total of 2900 students (192.2/1000 persons; 95% confidence interval 186-198.6) had electrocardiographic abnormalities. The rate of electrocardiographic abnormalities was higher in boys than girls (p < 0.001). Electrocardiographic abnormalities were significantly higher in thin than obese students (p < 0.001), and there was a trend towards hypertensive individuals to have more electrocardiographic abnormalities compared to normotensive individuals (p = 0.063). Based on the multivariable analysis, individuals with electrocardiographic abnormalities were less likely to be girls (odds ratio 0.745, 95% confidence interval 0.682-0.814) and had a lower body mass index (odds ratio 0.961, 95% confidence interval 0.944-0.979). In this large-scale study, there was a high prevalence of electrocardiographic abnormalities among young population. In addition, electrocardiographic findings were significantly influenced by increasing age, sex, obesity, and blood pressure levels. This community-based study revealed the implications of electrocardiographic screening to improve the care delivery by early detection.

Assessment of cardiac arrhythmias, P wave and QT dispersion in systemic sclerosis

Cardiac involvement in systemic sclerosis (SSc) is significant cause of SSc-related mortality. The objective of the study was to assess cardiac arrhythmias, P wave and QT dispersion in SSc patients. 40 SSc patients and 40 healthy participants who had similar sociodemographic characteristics with the patients were enrolled in the study. P wave dispersion (Pd), QT dispersion (QTd), and corrected QT (QTc) dispersion (QTcd) were calculated by measuring maximum (max) and minimum (min) of P wave, QT interval, QTc in 12-leads electrocardiography (ECG). Cardiac arrhythmias and conduction disorders were assessed by ECG and Holter-ECG. The mean age of SSc patients (92.5% of females) was 50.9±13.9 years similar with the healthy group (51.4±8.9). Abnormal ECG findings were found in 27.5% of SSc patients and remarkably higher in comparison to the healthy participants (p=0.019). The most frequently reported abnormal ECG findings were left anterior fascicular block (15%), ventricular premature beat (10%) and first-degree atrioventricular heart block (5%). The comparison of dispersion showed no statistically important difference in Pd between two groups (p=0.69) while QTd, QTc, QTcd, QTc min, and QTc max were markedly prolonged in patients with SSc (p=0.039; p&lt;0.001; p=0.021; p&lt;0.001; p&lt;0.001, respectively). The assessment of Holter-ECG demonstrated that supraventricular tachycardia was frequently detected in patients with SSc (22.5% vs 2.5%; p=0.007). This study indicated a significantly elevated incidence of abnormal ECG results and SVT, an arrhythmia not typically identifiable through standard ECG but detectable via Holter monitoring, in patients with SSc. In the study, QTd, QTc, and QTcd intervals were significantly longer in SSc patients, which may indicate a susceptibility to arrhythmias.

Electrocardiography score based on the Minnesota code classification system predicts cardiovascular mortality in an asymptomatic low-risk population

Background The use of a single abnormal finding on electrocardiography (ECG) is not recommended for stratifying the risk of cardiovascular (CV) events in low-risk general populations because of its low discriminative power. However, the value of a scoring system containing multiple abnormal ECG findings for predicting CV death has not been sufficiently evaluated. Methods In a prospective community-based cohort study, 8417 participants without atherosclerotic CV diseases (ASCVDs) and any related symptoms were followed for 18 years. The standard 12-lead ECGs were recorded at baseline and the ECG findings were categorized using the Minnesota code classification. CV deaths were defined as death from myocardial infarction (MI), chronic ischemic heart disease, heart failure, fatal arrhythmia, cerebrovascular event, pulmonary thromboembolism, peripheral vascular disease and sudden cardiac arrest and identified using the Korean National Statistical Office (KOSTAT) database. Results In a multivariate Cox proportional hazard (CPH) model, major and minor ST-T wave abnormalities, atrial fibrillation (AF), Q waves in the anterior leads, the lack of Q waves in the posterior leads, high amplitudes of the left and right precordial leads, left axis deviation and sinus tachycardia were associated with higher risks of CV deaths. The ECG score consisted of these findings showed modest predictive values represented by C-statistics that ranged from 0.632 to 760 during the follow-up and performed better in the early follow-up period. The ECG score independently predicted CV death after adjustment for relevant covariates in a multivariate model, and improved the predictive performance of the 10-year ASCVD risk estimator and a model of conventional risk factors including age, diabetes and current smoking. The combined ECG score (Harrell’s C-index: 0.852, 95% confidence interval [CI], 0.828–0.876) composed of the ECG score and the conventional risk factors outperformed the 10-year ASCVD risk estimator (Harrell’s C-index: 0.806; 95% CI, 0.780–0.833) and the model of the conventional risk factors (Harrell’s C-index: 0.841, 95% CI, 0.817–0.865) and exhibited an excellent goodness of fit between the predicted and observed probabilities of CV death. Conclusions The ECG score could be useful to predict CV death independently and may add value to the conventional CV risk estimators regarding the risk stratification of CV death in asymptomatic low-risk general populations.

Electrocardiographic Findings in Genotype-Positive and Non-sarcomeric Children with Definite Hypertrophic Cardiomyopathy and Subclinical Variant Carriers.

In children with hypertrophic cardiomyopathy (HCM), the genotype-phenotype association of abnormal electrocardiographic (ECG) features in the backdrop of gene positivity has not been well described. This study aimed to describe the abnormal ECG findings in children with HCM harboring who have genetic variants and determine the association with major adverse cardiac events (MACE). We retrospectively analyzed 81 variants-positive, phenotype-positive (V+P+), 66 variant-positive, phenotype-negative (V+P-), and 85 non-sarcomeric subjects. We analyzed ECG findings and clinical outcomes in the three groups of subjects. Repolarization abnormalities (ST and T wave changes) and pathologic Q waves were the most common abnormalities in variant and non-sarcomeric subjects. The V+P+ group showed higher occurrence of ST segment changes and T wave abnormalities compared to V+P- group. Independent predictors of MACE included ST segment changes (OR 3.54, CI 1.20-10.47, p = 0.022). T wave changes alone did not predict outcome (OR 2.13, CI 0.75-6.07, p = 0.157), but combined repolarization abnormalities (ST+T changes) were strong predictors of MACE (OR 5.84, CI 1.43-23.7, p = 0.014) than ST segment changes alone. Maximal wall z score by echocardiography was a predictor of MACE (OR 1.21, CI 1.07-1.37, p = 0.002). Despite the presence of significant myocardial hypertrophy (z score > 4.7), voltage criteria for LVH were much less predictive. In the non-sarcomeric group, RVH was significantly associated with MACE (OR 3.85, CI 1.08-13.73, p = 0.038). These abnormal ECG findings described on the platform of known genetic status and known myocardial hypertrophy may add incremental value to the diagnosis and surveillance of disease progression in children with HCM. Select ECG findings, particularly repolarization abnormalities, may serve as predictors of MACE in children.

The impact of ethnicity on abnormal electrocardiographic findings in elite Brazilian football players: B-pro foot ECG pilot study

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Black athletes may be more likely to have uncommon electrocardiogram findings than white athletes. The prevalence of abnormal electrocardiographic findings in elite Brazilian football players (EBFP) of different ethnicities is unknown. Purpose To compare the prevalence of these changes and their correlation with the echocardiogram and cardiac magnetic resonance (CMR) in Caucasian, Mixed-race (MR), and Afro-Brazilian (AB) EBFP. Methods A multicenter cross-sectional descriptive study was conducted with exams performed on EBFP as a pre-participation assessment from February 18, 2002, through October 20, 2022. Results 4,363 EBFP from 51 professional clubs (from all five regions of Brazil; 15 states, and 21 cities), aged 15-35 years (median: 19 years; IQR: 16-23) were evaluated. 2,027 were Caucasians, 1,324 were MRs, and 1,012 were ABs. T-wave inversion (TWI) in leads II and aVF (4.2% vs. 2.3%), V5 (4.0% vs. 1.7%), and in V5-V6 (3.0% vs. 1.4%) was more common in AB than in Caucasian players, respectively (P = 0.002 for all comparisons). In addition, AB demonstrated a significantly greater prevalence of inferolateral TWI (2.3%) than Caucasian (1.1%), and MR (1.3%) EBFP, respectively. TWI in leads V1-V3 in Caucasians or MRs &amp;gt;16 years was present in 0.9% (30/3,351). PR interval ≥400 ms was observed in one Caucasian and in one AB athlete. The Wolff-Parkinson-White pattern was identified in two Caucasians, and a suggestive case of a type 2 Brugada Pattern in one Caucasian. Overall, 208 (4.8%) EBFP had electrocardiographic changes considered to be abnormal (4.5% in Caucasians, 4.8% in MRs, and 5.2% in ABs). Of these, 150/208 (72.1%) underwent an echocardiogram. Isolated inferior TWI was not associated with echocardiographic abnormalities (n = 25), similar to persistent juvenile TWI patterns (in Caucasians or MRs). However, TWI in inferolateral leads was associated with 10.5% echocardiographic abnormalities (4/38). Of these, 75% (3/4) had abnormal CMR findings: one AB with hypertrophic cardiomyopathy (CMP), and two Caucasians with non-compaction CMP; one Caucasian with an abnormal echocardiogram demonstrated normal CMR, suggesting "athlete's heart". Finally, one AB had normal echocardiogram results, but the CRM showed a finding compatible with apical hypertrophic CMP. Conclusion In this large cohort of EBFP, approximately 5% of the electrocardiographic findings were considered abnormal. In those with inferolateral TWI, the use of CMR may indicate the presence of potentially malignant cardiac disease, even with normal echocardiographic findings. AB ethnicity was associated with a higher prevalence of TWI in the inferior and/or lateral leads in comparison to Caucasian or MR ethnicities.

Acute neurogenic stunned myocardium in a patient with Guillain-Barré syndrome: case report.

A 65-year-old man with GBS presented with reversible left ventricular systolic failure. On first presentation, our patient had no history or indications of heart malfunction. During the clinical manifestation of his autonomic dysfunction, he had electrocardiographic alterations, modestly increased cardiac enzymes, significant left ventricular systolic dysfunction, and segmental wall motion irregularity. Once the initial episode was over, these anomalies and his symptoms resolved quickly. We believe the reversible left ventricular dysfunction was caused by the toxic impact of elevated catecholamines as well as transiently injured sympathetic nerve endings in the myocardium, which was apparently caused by GBS. We recommend that echocardiography be performed in patients who exhibit clinical signs of autonomic dysfunction, particularly if they are associated with abnormal electrocardiographic findings, cardiac enzyme elevation, or hemodynamic instability, so that appropriate medical therapy can be instituted as soon as possible. GBS is a not a very rare situation in our context. Thus, doctors are supposed to know the life-threatening complications such as neurogenic stunned myocardium and be prepared to dodge it.

Long COVID in Uganda: Electrographic findings among patients at risk.

COVID-19 has a significant cardiovascular involvement. Electrocardiographic (ECG) abnormalities among people at a risk of Long COVID in Uganda was investigated. A cross-sectional study was conducted from February to June 2022 at the post COVID - 19 clinic in Mulago National Specialized Hospital, Kampala. A standard resting ECG was performed on individuals at least 2 months following acute COVID-19, with a negative SARS-CoV-2 reverse-transcription polymerase chain reaction. Sociodemographic and clinical characteristics as well as vital signs were recorded for all study participants. Of the 244 study participants, 117 (47.9%) were female. The median age of all the participants was 33.0 (interquartile range: 26.0 - 43.5) years. Twenty-five (10.2%) participants had a history of smoking while 117 (48%) had a history of alcohol intake. In total, 46 (18.9%) had abnormal ECG findings (95% Confidence Interval (CI): 14.39 - 24.29) and non-specific T-wave inversion (n = 16, 34%) was the most frequent ECG abnormality. The proportion of participants with ECG abnormalities was 48% lower among females (adjusted prevalence ratio (aPR): 0.52, 95% CI: 0.28 - 0.96, p value < 0.05) and 2-fold greater for those with a history of smoking (aPR: 2.03, 95% CI:1.096 - 3.776, p value < 0.05). One in five Ugandans who were checked at the clinic at a risk of Long COVID showed ECG abnormalities. ECG screening is suggested to be integrated into the follow-up care of those at a risk of Long COVID.

5597164 BURDEN AND RISK FACTOR TO ACUTE MYOCARDIAL ISCHAEMIA IN CHILDREN WITH SICKLE CELL ANAEMIA

Introduction: Sickle cell anaemia (SCA) is a genetic disorder of haemoglobin synthesis with multi-organ manifestations. Myocardial ischaemia (MI) and infarction as a result of sickling are not commonly reported, often overshadowed by the more dramatic presentation of musculoskeletal pain. Studies have postulated that sudden deaths during vaso-occlusive crisis (VOC) may be secondary to the arrhythmogenic effect of severe MI. Aim: This study compared the prevalence of MI and associated risk factor in children with SCA aged 6 months to 18 years in VOC and steady state at the Lagos University Teaching Hospital using both cardiac troponin T (cTnT) and electrocardiography (ECG) as recommended by the fourth universal definition of MI (2018). Methodology: A cross-sectional comparative study conducted over 10months (March and December 2019). The participants were 250 children (125 age and gender-matched children with SCA in VOC and steady state respectively). Informed consent was obtained from the parents or caregivers while assent was obtained from children 10 years and above. Socio-demographic data and relevant history were obtained using an interviewer-administered questionnaire. Targeted clinical examination with focus on the cardiovascular system was done. All study participants had ECG performed and blood samples taken for cTnT, full blood count, electrolyte, urea, and creatinine. Myocardial ischaemia was defined as cTnT level greater than 100ng/L which is the 99th percentile and abnormal ECG findings indicative of MI (wide Q wave, ST-segment elevation or prolonged QT interval corrected for heart rate with accompanying Q wave abnormalities). Statistical package for social sciences (SPSS) software version 20 was used for analysis, statistical association was declared significant if the p-value was <0.05. Results: The prevalence of MI using cTnT alone in children with SCA in VOC and steady state was 42.4% (53) and 23.2% (29) respectively while with ECG alone, the prevalence of MI in children with SCA in VOC and steady state was 40.8% (51) and 20.8% (26) respectively. The prevalence of MI using both cTnT and ECG in children with SCA in VOC and steady state was 38.4% and 20% respectively and this was statistically significant (p-valve 0.001). In relation to VOC, the mean age (10.0±4.1), mean WBC (20,131.2±7,268.0), mean platelet count (461,208.0±143,956.8) and pain score of children with MI was significantly higher compared to those without MI. Among the steady state children, higher mean age (11.6±3.5), lower mean PCV (22.3±3.7) and higher mean platelet count (446,240.0±140,841.0) was significant in children in steady state with MI compared to those without MI. Furthermore, on multivariate analysis, the mean age & mean platelet count; mean age & low PCV; were significantly associated with MI in children with VOC and steady state respectively. The older age group in both study participants had a higher prevalence of MI. Combining both cTnT and ECG in the diagnosis of MI gave similar prevalence compared to using either cTnT or ECG alone. Conclusion: Myocardial ischaemia (MI) is prevalent in children with SCA. Children with SCA should routinely be screened for MI during VOC and steady state especially adolescents with SCA for early intervention.

Sinus rhythm electrocardiographic abnormalities, sites of origin, and ablation outcomes of ventricular premature depolarizations initiating ventricular fibrillation

BackgroundVentricular fibrillation (VF) can be initiated by ventricular premature depolarizations (VPDs) in the absence of obvious structural abnormalities. ObjectiveThe purpose of this study was to determine the prevalence of 12-lead electrocardiographic (ECG) sinus rhythm reduced QRS amplitude, QRS fractionation (QRSf), and early repolarization (ER) pattern, and the outcome of catheter ablation and VPD anatomic distribution in patients with VPDs initiating VF. MethodsWe compared a cohort with no apparent structural heart disease and VPDs initiating VF (group 1; n = 42) to a reference cohort (group 2; n = 61) of patients with no structural heart disease and symptomatic unifocal VPDs. ResultsA reduced QRS amplitude (<0.55 mV) in aVF (59% vs 10%; P <.001), QRSf in ≥2 contiguous leads (50% vs 16%; P <.001), and ER pattern (21.4% vs 1.6%; P = .01) were more common in group 1 than in group 2. At least 1 abnormal ECG finding was present in 34 group 1 patients (81%) vs 17 group 2 patients (28%) (P <.001). VPD origin included right ventricular and left ventricular distal Purkinje system and moderator band/papillary muscles in 83% of group 1 patients vs 18% of group 2 patients (P <.001). VF was eliminated with a single ablation procedure in 77% of group 1 patients with at least 2 years of follow-up. ConclusionA reduced QRS amplitude (<0.55 mV) in aVF, QRSf in ≥2 contiguous leads, and/or an ER pattern are frequently observed in patients with VPDs initiating VF. VPDs initiating VF typically originate from the distal Purkinje system and papillary muscles and can be successfully eliminated with catheter ablation.

Clinical Implications of Cardiac Symptoms and Electrocardiographic Abnormalities for Advanced Liver Fibrosis in Patients with Nonalcoholic Fatty Liver Disease.

Background and Objectives: Advanced liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) can be a major predictor of cardiovascular disease (CVD) events and cardiac complications. However, the clinical significance of cardiac symptoms and abnormal electrocardiography (ECG) findings in patients with NAFLD associated with advanced liver fibrosis is unclear. Therefore, our study was aimed to evaluate the clinical implications based on the association between cardiac symptoms with ECG abnormalities for advanced liver fibrosis in patients with NAFLD. Materials and Methods: Of 31,795 participants who underwent health checkups, 6293 were diagnosed with NAFLD using ultrasound and inclusion criteria in a retrospective cross-sectional study. Advanced liver fibrosis was assessed based on a low NAFLD fibrosis score (NFS) and fibrosis-4 index (Fib-4) cut-off values (COVs). Cardiac data were assessed using a cardiac symptom questionnaire and 12-lead electrocardiography (ECG). Results: Among 6293 NAFLD patients with NAFLD, 304 (4.8%) experienced cardiac symptoms. NFS and Fib-4 indicated higher rates of advanced fibrosis in the cardiac-symptomatic group than in the non-symptomatic group (NFS: 7.3 vs. 4.1%; Fib-4: 7.8 vs. 3.7%; both p < 0.001). Cardiac symptoms were independently associated with advanced liver fibrosis using a step-wise-adjusted model and NFS and Fib-4 (final adjusted odds ratio (aOR), 1.40; 95% CI, 1.06-1.85; p = 0.018 for NFS; aOR, 1.67; 95%, 1.30-2.15; p < 0.001 for Fib-4). Cardiac symptoms with abnormal ECG findings independently predicted advanced liver fibrosis (aOR, 2.43; 95% CI, 1.72-3.39; p < 0.001 for NFS; aOR, 3.02; 95% CI, 2.19-4.15; p < 0.001 for Fib-4). Conclusions: Patients who have had cardiac symptoms and some ECG abnormalities may have a higher association with advanced liver fibrosis.

ECG CHANGES IN DENGUE FEVER

Background: Dengue is one of the most important viral diseases globally and a majority of symptomatic infections result in a benign course. However, a small number of patients develop severe manifestations, including myocardial impairment, arrhythmias, and fulminant myocarditis. Dengue is known to affect various systems. The cardiovascular system is one of them. This study was conducted to observe the presence of electrocardiographic (ECG) changes in patients presenting with dengue fever. Material and method: This was a cross sectional analytical study conducted at Jhalawar medical college and hospital, Jhalawar, Rajasthan. 146 cases were selected after taking into account the inclusion and exclusion criteria from serologically confirmed dengue cases. The details of the patient's clinical presentation and examination was noted.ECG was carried out to all patients. Results: Out of 146 patients,58 patients had normal ECG. Abnormal ECG findings like sinus bradycardia ,tachycardia ,ST-T changes,bundle branch block were noted among 88 patients. Conclusion: ECG changes can occur in dengue infection, most common finding were sinus bradycardia. ECG abnormalities were common but all the ECG changes were reversible. There was no evidence of myocarditis in any of the patients

PS-C16-7: ASSOCIATION OF ELECTROCARDIOGRAM FINDINGS WITH MORTALITY IN COVID-19 PATIENTS

Objective: The COVID-19 virus has greatly debilitated a lot of patients in the Philippines. Baseline demographic characteristics and other parameters such as baseline electrocardiographic (ECG) findings were investigated to act as predictors for mortality among admitted patients who are RT-PCR positive for COVID. This study aims to determine the association of baseline ECG findings including both normal and abnormal variants such as those suggestive of acute cardiac injury and hypertrophy with mortality of these patients. Design and method: This is a retrospective study of patients admitted from March 2020 to May 2021 who were diagnosed to have COVID-19 thru an RT-PCR swab. Inclusion criteria include a recorded baseline ECG. Demographic characteristics were also included. Patients were divided according to their ECG findings as normal and abnormal. Among those with abnormal ECG findings, they were further subdivided into those with ischemic changes, hypertrophy, and miscellaneous (bundle branch blocks). Results: A total of one hundred thirty-six (136) patients were included in this study. Among the abnormal ECG findings obtained, the miscellaneous group particularly those with right bundle branch block was noted to be associated with mortality (OR = 4.86, 95% CI 1.04–22.7, p = 0.044). Other ECG findings such as ischemic changes and hypertrophy showed no significant association. Conclusion: Among the different classifications of ECG findings, those with baseline ECG findings of right bundle branch block showed a positive association with mortality. Other parameters such as demographic features are also noted to have no association with mortality. Further investigation and a higher population number are suggested to further conclude these findings.

S-29-6: ELECTROCARDIOGRAPHIC ABNORMALITIES AMONG NEWLY PRESENTING HYPERTENSIVE PATIENTS: REPORT FROM CARDIOVASCULAR RISK PREDICTION REGISTRY

Background: Cardiovascular diseases (CVDs) have become a significant public health concern globally. Standard electrocardiography (ECG) remains an essential diagnostic procedure for cardiovascular risk stratification in hypertension. The co-existence of electrocardiographic abnormalities with hypertension is associated with an increased risk of cardiovascular morbidity and mortality. Data showing electrocardiographic abnormalities among newly diagnosed hypertensives in this environment is limited. Objective: To provide the spectrum of ECG abnormalities among newly presenting hypertensive patients seen at the University College Hospital, Ibadan. Design and method: This observational study was conducted using data from the Cardiovascular Risk Prediction (CRP) registry domiciled at University College Hospital (UCH). Data collection spanned from 2019 to 2022. New patients presenting with hypertension at the cardiology clinic were received and assessed, and cardiovascular risk factors were stratified to identify cardiovascular morbidity and mortality indicators. All participants underwent standard 12 lead ECG. Fasting venous blood was collected to assess serum electrolytes, urea, creatinine, and lipid panels. Statistical Analysis was performed using Statistical Package for Social Sciences (SPSS) version 21. Results: Six hundred and twelve participants comprising 49.7% of women with a mean age of 53.66 ± 15.5 years with complete ECG interpretations were analyzed. A third of the participants had Left ventricular hypertrophy (LVH), with one in ten having strain patterns. About 19%, 10.6%, and 1.8% of participants presented with conduction abnormalities, left atrial enlargement (LAE), and atrial fibrillation, respectively. Mean age, blood pressure parameters, and QT/QTc intervals were comparable in both sexes. Compared to women, men had higher mean urea (29.81 ± 14.1 vs 26.45 ± 11.3 mg/dl;p &lt; 0.002) and creatinine (1.21 ± 0.6 vs 0.94 ± 0.4 mg/dl; p &lt; 0.0001)) and greater proportion of conduction abnormalities (22.1% vs 15.9%;p = 0.05), LVH(36.9% vs 27.6%;p = 0.014), LVH plus strain pattern(13.4% vs 7.0%;p = 0.009), and LAE (13.5% vs 0.7%;p = 0.019). Women were heavier with higher mean total cholesterol (191.75 ± 44.5 vs. 179.92 ± 47.9 mg/dl; p &lt; 0.004) and LDL cholesterol (121.83 ± 37.6 vs. 114.35 mg/dl; p = 0.21). Participants with LVH had higher mean Systolic (146.87 ± 24.7 vs142.19 ± 23.1 mmHg; p = 0.023) and diastolic blood pressure (91.15 ± 16.5 vs 85.97 ± 13.4mmHg; &lt; 0.0001),creatinine (1.15 ± 0.7 vs 1.04 ± 0.41 mg/dl; p = 0.017) and QTc interval (483 ± 83.5 vs 463.81 ± 55.6; ms p &lt; 0.007) and coexisted with LAE compared with those without LVH. Conclusion: Left ventricular hypertrophy was the predominant abnormality in the studied population. Abnormal ECG findings were more common in men, and those with LVH had more cardiovascular risk than women. Early identification and management of these risks are essential in preventing cardiovascular morbidity and mortality.

Unexplained Syncope With Abnormal ECG Findings in the Emergency Department: Don't Miss the Epsilon Wave!

Arrhythmogenic cardiomyopathy (AC) is a genetic cardiac disorder associated with sudden cardiac death, specifically in young adults (D. Corrado, C. Basso, & D. Judge, 2017). AC is a disease of the heart muscle fibers and it is not usually diagnosed until its advanced stages. Typical AC presentation in the emergency department (ED) includes cardiac syncope, palpitations, ventricular arrhythmias, or resolved cardiac arrest. The epsilon wave is the hallmark and the major electrocardiographic (ECG) diagnostic criterion for AC in the later stages of the disease process (A. R. Perez-Riera et al., 2019). A definite diagnosis of AC is of high complexity and not typically made by emergency providers; however, many cases of advanced AC are discovered in the ED as a result of syncope. The purpose of this case review is to discuss the typical presentation, ECG findings, and emergency providers' role in the management of patients with suspected AC.

The study of electrocardiographic changes in type II diabetes mellitus

Background: The predictions of the silent ischemia in the asymptomatic patients were done with the Electrocardiographic (ECG) abnormalities findings. The high risk of the cardiac morbidity and mortality was statistically associated with abnormal ECG findings. Aims and Objectives: To reduce patient mortality and morbidity, the current analysis was performed on diabetes patients to look for ECG alterations. Materials and Methods: A total of 100 people were used, 50 of whom had type-2 diabetes mellitus and 50 of whom were healthy, non-diabetic volunteers whose ages and sexes matched the patients with type-2 diabetes. The 12-lead ECG instrument was used to record the electrographic markings. For fasting blood sugar blood was collected after a minimum 8 h overnight fasting and for PP2BS blood was collected 2 h after lunch. Results: In people with type II diabetes mellitus, the P wave’s amplitude significantly decreased. When compared to controls, type II diabetics’ QRS complex duration was noticeably longer. When compared to controls, (type II DM) Type 2 diabetes mellitus sufferers had a significantly longer QT and QTC interval. When type II diabetics were compared to controls, the ST segment alterations were significantly different. When compared to controls, type II diabetes showed a considerable T-wave alteration. Conclusion: The ST segment deviation from the isoelectric line is a predictor of coronary events in an asymptomatic diabetic population. The incidence of sudden mortality due to cardiovascular disease in diabetics is reduced as a result of early detection of QT and QTC alterations, which are good indicators of cardiovascular disease risk in diabetics.