Abnormal Electrocardiographic Findings Research Articles

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.

Electrocardiographic Changes among Moderate and Severe COVID-19 Patients in a Tertiary Care Teaching Hospital at Shahdol, Madhya Pradesh, India: A Record-based Study

Introduction: Electrocardiographic (ECG) abnormalities in Coronavirus Disease 2019 (COVID-2019) patients are largely unknown. ECG changes in COVID-19 disease may guide to initiate therapeutic anticoagulation, more so in moderate and severe disease. Aims: To identify various ECG changes in moderate and severe COVID-19 patients and to ascertain the association between initial ECG changes and disease outcome. Materials and Methods: This was retrospective record-based study was conducted in the Department of Internal Medicine, Birsa Munda Medical College, Shahdol, Madhya Pradesh, India, on 216 patients with laboratory-confirmed COVID-19 in a tertiary care teaching hospital from March 2021 to June 2021. Demographic and clinical data including ECG were extracted from medical records of the patients and if needed, the patients were followed-up till outcome. COVID-19 disease severity was considered based on oxygen saturation at room air (moderate: 94%-90%; severe: <90%). Data were entered using the Epicollect5 mobile application to minimise errors. Results: A total of 216 patients were included (35 to 54 years), the majority were male. Mortality rate was 46.3%. Total 57.4% of ECG changes were classified as abnormal. Sinus tachycardia was the most common abnormality followed by ischaemic changes. Left axis deviation in ECG was more commonly seen than right axis deviation. Total 53.2% of patients with abnormal ECG findings and 36.9% with normal ECG findings died. Mortality was very high in patients with ischaemic changes. Conclusion: COVID-19 patients with ischaemic changes in ECG were significantly associated with increased mortality. Hence, early detection of these changes in COVID-19 patients is vital and will help primary care physicians to intervene early and help in deciding therapeutic anticoagulation requirements in patients with COVID-19.

Clinical and radiological characteristics of patients with spontaneous and post-traumatic subarachnoid hemorrhage: A retrospective observational study

Background/Aim. Several serious complications can accompany both spontaneous and post-traumatic sub-arachnoid hemorrhage (SAH) such as the development of intracranial hypertension, hydrocephalus, re-bleeding, cerebral hypoxia, cerebral vasospasm, impaired pituitary function, electrolyte imbalance, and electrocardiographic (ECG) abnormalities. Although there is a declining trend in mortality, the treatment of SAH and its complications represents a challenge even in imposing neurosurgical centers. The aim of the study was to compare some clinical characteristics and complications between spontaneous and post-traumatic SAH. Methods. The retrospective study included 138 patients treated at the Department of Neurosurgery from January 2018 to January 2023. There were 71 patients with spontaneous and 67 patients with post-traumatic SAH. Results. A predominance of spontaneous SAH in female and post-traumatic SAH in male patients (p < 0.001) was found. There was a statistically significant difference in the frequency of hydrocephalus between groups of spontaneous and post-traumatic SAH patients (p = 0.013). Cerebral vasospasm was significantly more prevalent in patients with spontaneous SAH (p < 0.001). A statistically significant association was also obtained between the thickness of the coagulum in these two groups (p < 0.001). Patients with spontaneous SAH were significantly more likely to have a negative T wave in E CG findings (p < 0.001). Furthermore, there was no statistically significant difference regarding electrolyte imbalance in these two groups of patients with SAH. Conclusion. There were statistically significant differences between gender distribution, the frequency of abnormal ECG findings in the form of a negative T wave, greater coagulum thickness, vasospasm occurrence, and a higher rate of hydrocephalus in patients with spontaneous SAH compared to patients with post-traumatic SAH.

Short-term electrocardiographic and echocardiographic effects of levothyroxine replacement in adults with newly diagnosed hypothyroidism

Background and Aims: Thyroid hormones play a key role in modulating the cardiac function and structure. Expectedly, thyroid hormone deficiency in primary hypothyroidism has a profound and clinically relevant effect on the cardiac structure and function manifesting in characteristic electrocardiographic and echocardiographic (ECHO) abnormalities. The aim is to evaluate the effects of levothyroxine replacement therapy on the electrocardiographic (ECG) and ECHO changes in patients with primary hypothyroidism by assessing the changes in ECG and ECHO before and after 6 weeks of optimal levothyroxine (LT4) treatment in adults with newly diagnosed primary hypothyroidism. Methodology: Prospective, observational study conducted in the department of medicine in an armed forces tertiary care teaching hospital from October 2018 to April 2021. We studied newly diagnosed adults with primary hypothyroidism who were treated with optimal LT4 replacement. Descriptive statistics along with Student's t-test and Chi-square test were used to determine the statistical significance. Results: In 152 participants, the mean age was 41.0 ± 13.2 years and 79% were female. After 6 weeks of LT4 treatment, the proportion of participants with abnormal ECG findings reduced significantly (from 77% to 14.5%, P < 0.0001) with a significant reduction in those having sinus bradycardia (P < 0.0001) and low-voltage complexes (P < 0.0001). On ECHO, there was a significant improvement in left ventricular ejection fraction (P < 0.001), fractional shortening (P < 0.001), and a significant reduction in myocardial thickness parameters. The systolic and diastolic function improved significantly after 6 weeks of treatment. The proportion of patients without pericardial effusion increased from 34.9% to 79.6%. Conclusion: Replacement therapy with LT4 in newly diagnosed primary hypothyroid patients substantially improves cardiac structure, systolic and diastolic function and has a positive impact on underlying pericardial effusion. A large, prospective, trial is necessary to determine the long-term effects after thyroid hormone replacement.

Exercise Stress Electrocardiography Using the Two-Minute Jump Test in Children.

Although the treadmill and cycle ergometer are commonly used for exercise stress electrocardiography (ECG) testing, they are often difficult to perform with children. We herein evaluated the utility and safety of the 2-minute jump test (2MJT) as a simple, alternative exercise test. One hundred patients, including 60 male patients, with an average age at study commencement of 10.7±3.5years (mean±standard deviation) and with no exercise restriction who underwent a cardiac check-up between November 2020 and March 2022 at the study center were included. After recording their resting ECG, they jumped for 2minutes during ECG recording, and the change in heart rate (HR), ECG findings, and occurrence of adverse events were investigated. As a result, patients jumped 185±60 times in two minutes, and their HR increased from 76±13 beats/min at rest to 172±18 beats/min at peak during the test. Ninety (90%) patients attained the ideal target HR of > 150 beats/minute. During the recovery period after loading, five patients had abnormal ECG findings (ventricular extrasystoles, second-degree atrioventricular block, and atrial extrasystoles in two, two, and one patient, respectively) but completely resolved spontaneously within three minutes. Our findings suggested that the 2MJT is a useful and safe exercise test capable of inducing sufficient increase in HR in a short time in children.

SINUS NODE DISEASE IN A YOUNG FEMALE WITH CARDIOGENIC SYNCOPE

Sinus node dysfunction (SND) is characterized by disease of the sinus node and/or contiguous atrial tissue resulting in the generation of heart rate that is not commensurate with the physiologic need of the body due to various causes. SND is an ailment commonly found in the advanced age group, with a mean age of 68 years, and is rarely found in the young. Making a diagnosis requires the presence of symptoms to coincide with the abnormal electrocardiographic (ECG) findings, and the symptoms of SND are non-specific. There is a limited report of this condition in the young, and available reports show that most cases of SND occur in the young and children with underlying heart defects and mostly in males. The report describes an unusual presentation of ‘sinus node disease’ in a young Caucasian female with no underlying cardiac abnormalities that presented with syncope and sinus bradycardia. A 36-year-old Caucasian female presented to our facility with complaints of recurrent episodes of a brief period of loss of consciousness associated with intermittent palpitations and no background cardiovascular disease. Rest 12-lead ECG showed bradycardia, while a 24-hour Holter ECG showed periods of bradycardia, ‘supraventricular tachycardia’, and tachycardia- bradycardia occurring with symptoms. A diagnosis of SND was made and a permanent pacemaker was offered, but she and her spouse opted to have the procedure done in her home country. ‘Sinus node disease’ through an ailment of the aged can be found in the young without underlying cardiac defects and can be suspected in people with unexplained syncope.

Sternal Fractures Due to Blunt Chest Trauma: A Diagram of Management

&lt;p&gt;Objective: Sternal fractures due to blunt chest trauma become more common with increasing road traffic accidents. The outcomes of patients with isolated sternal fracture are promising. However, complicated sternal fractures are associated with injuries of the thorax and other organs, and the diagnosis and treatment are challenging. This article reviews the clinical features of sternal fractures due to blunt chest trauma and sum up a management diagram. Methods: Literature was retrieved in the PubMed, Google Scholar and &amp;ldquo;Baidu&amp;rdquo; Scholar for English articles published since 2011. The recruited articles were taken as study materials of this review. Results: The misdiagnosed rate was 5.53% for chest roentgenograph and was 6.25% for sonography in diagnosing sternal fractures. Sternal fractures were a complicated type with associated injuries of other organs in an absolute majority, while they were an isolated type in only 1.17% of patients. Only small portions of patients have an abnormal electrocardiographic finding and (or) an elevated cardiac enzyme level. Surgical treatment was necessary in almost 60% of patients and conservative in about 40%. The outcomes of patients were promising and patients with a poor prognosis were usually not due to the sternal fracture but due to the associated injuries instead. Conclusions: Isolated sternal fractures do not need routine admission but a pain relief. Patients with an abnormal finding of electrocardiogram and (or) an elevated cardiac enzyme level are recommend admitted for monitoring to exclude heart injury and for necessary conservative treatment. A surgical treatment of sternal fixation of sternal fractures are warranted for majority of patients with complicated/displaced sternal fractures. The outcomes of patients are generally promising.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Takotsubo Cardiomyopathy: Narrative Review With Relation to COVID-19

Takotsubo cardiomyopathy (TC) is a unique heart disease which mimics the clinical symptoms and features of acute coronary syndrome (ACS) and is seen more commonly in postmenopausal females. In this condition, abnormal electrocardiographic findings like ST-segment elevation/depression, T wave inversion, and an abnormal/absence of Q wave, along with echocardiographic disturbances like regional wall motion abnormalities and a sudden decrease in the ejection fraction are observed. However, coronary angiography shows no coronary artery obstruction. Interestingly, the left ventricle in TC develops a characteristic appearance similar to that of a “Tako-tsubo” (Japanese pot). Such peculiar observations become important when diagnosing TC in a clinical setting. TC is often caused by a catecholamine surge due to mass sympathetic activation usually preceded by an emotional/physical trigger, however the exact etiology and mechanism of pathophysiology still remain unclear. With growing awareness and prevalence of TC, it becomes crucial for clinicians to differentially diagnose TC from other heart conditions with the help of well-known diagnostic tools. Moreover, amidst the ongoing pandemic, the cytokine storm associated with COVID-19 may be accompanied with a catecholamine surge in the body, which in turn might increase the risk and incidence of TC in patients.

Prevalence of abnormal electrocardiographic findings in a brazilian cohort of young football players: B-pro foot ECG pilot study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Hospital de Clínicas de Porto Alegre Research and Event Incentive Fund (FIPE-HCPA) Introduction The 12-lead resting electrocardiogram is a useful tool for diagnosing pathological conditions in athletes. The prevalence of electrocardiographic abnormalities in Brazilian soccer players are unknown. Purpose To describe the prevalence of abnormal electrocardiographic findings in young Brazilian soccer players based on the "2017 International Criteria for Electrocardiographic Interpretation in Athletes". Methods Continuous variables were displayed as mean and standard deviation or median and interquartile range, while prevalence’s with 95% confidence intervals, and stratified by race. Intra-group differences were estimated by linear models or binomial and multinomial logistic regressions. Type I error was set to set a at 0.05. An additional margin of 0.025 was considered at the discretion of the statistician conditioned to the quality of the model. All analysis were running in Stata version 16.0.0. Results 2,581 young Brazilian soccer players from 27 clubs (mainly first division), aged 15-35 years (median: 18 years) were evaluated. 1,268 (49.1%) were Caucasians, 796 (30.8%) Mixed-Race (MR) and 517 (20.1%) Afro-Brazilians (AB). T-wave inversion (TWI) in the inferior leads (3.0%), high lateral leads (DI/aVL) (0.6%), V5 (2.3%), V6 (1.8%), and V5-V6 (1.7%) were present. Six Caucasians (0.5%) presented TWI in V1-V4. Prolonged corrected QT interval (QTc) (0.5%), QRS ≥140 ms (0.2%), "pathological" anterior Q waves (0.2%), lateral ST-segment depression (0.07%), premature ventricular contractions (0.5%), Mobitz type II atrioventricular block (0.03%), and a Wolff-Parkinson-White pattern (0.04%) were also observed. There were no athletes with short QTc interval, epsilon waves, profound sinus bradycardia (&amp;lt;30 beats per minute), complete left bundle branch block, third-degree atrioventricular block, or Brugada pattern (1, 2 or 3). Overall, 111/2,581 (4.3%) soccer players had electrocardiographic changes considered to be abnormal (4.4% in Caucasians, 4.5% in MR and 6.4% in AB). There was no difference between the abnormal findings among races, except for the prevalence of TWI in V6, which was higher in AB compared to Caucasians (3.1% versus 1.2%, respectively; P = 0.01). Conclusion To the best of our knowledge, this is the first large electrocardiographic cohort of Brazilian young soccer players to be described. In this sample, we evidence a prevalence &amp;lt;5% of abnormal findings according to the "2017 International Criteria for Electrocardiographic Interpretation in Athletes". Additional evaluation in all these cases is indicated.

Predicting factors for electrocardiographic findings in patients with tramadol-induced seizure

Seizure and electrocardiographic (ECG) abnormalities are of the most common complications of tramadol toxicity. This study aimed to show the prevalence and predictive value of various factors for ECG findings in patients with tramadol-induced seizures. In a descriptive cross-sectional study, 146 patients with tramadol-induced seizures referred to Poursina Hospital, Guilan, Iran, between June and November 2018 were enrolled. The clinical manifestations, such as blood pressure, respiratory rate, and pulse rate (PR), and ECG parameters, including PR interval, QRS duration, R wave in aVR lead, and corrected QT interval, were assessed. Appropriate statistical tests were used to analyze the data. We showed that tramadol dose was significantly higher in patients with abnormal ECG findings compared with those with normal ECG pattern both upon admission (p = 0.001) and after 6 hours of admission (p = 0.001). The results found the predictive value of tramadol dose for abnormal ECG patterns upon admission (odds ratio (OR) 1.014, 95 percent CI 1.008 to 1.020) and 6 hours later (OR 1.008, 95 percent CI 1.003 to 1.013) in these patients. In addition, it was revealed that PR was a strong predictor of abnormal ECG findings in patients with tramadol-induced seizures upon admission (OR 1.085, 95 percent CI 1.038 to 1.134). Nevertheless, age only predicted abnormal findings 6 hours later (OR 1.104, 95 percent CI 1.019 to 1.195). Tramadol dose, age, PR, and seizures frequency could be used as indicators of abnormal ECG findings in patients with tramadol-induced seizures. The results of our study showed a high prevalence of sinus tachycardia, terminal S and R waves in aVR lead terminal S wave, and the combination of these abnormalities in this subset of patients.

T-wave Inversions in Cerebellar and Occipital Lobe Infarcts in the Setting of Deep Vein Thrombosis and Pulmonary Embolism Suggestive of Paradoxical Emboli: A Case Report

Cardiological causes account for the majority of acute electrocardiographic (ECG) changes. The reason for this fear is the irreversibility of myocardial necrosis. Generally, various changes can be observed in the ECG, including ST-T changes, QTc prolongation, arrhythmias, and T-wave inversions. Even though T-wave inversions can be seen in myocardial ischemia/infarction, they are rarely seen in acute cerebrovascular accidents (CVAs). We present the case of a 66-year-old woman who initially presented at our facility with dizziness in the context of orthostatic hypotension. An initial cardiac evaluation revealed no cardiac involvement. She was treated with intravenous fluids (IVF), which improved her symptoms. The patient's mental status was markedly altered approximately four days after admission. In this instance, she was found to have abnormal ECG findings (not previously observed on the ECG that was obtained on the day of admission), elevated troponin T levels, as well as elevated pro-B-type natriuretic peptide (pro-BNP). The patient was given aspirin and clopidogrel immediately and was placed on a heparin drip for a suspected non-ST elevation myocardial infarction (NSTEMI). A non-contrast computed tomography of the head revealed an acute cerebrovascular accident (CVA), following which the heparin drip was stopped. The patient was then transferred to another acute care facility capable of performing neurosurgical interventions. Additionally, a computed tomography angiography (CTA) of the chest and lower extremities venous duplex showed bilateral pulmonary emboli and deep venous thrombosis (DVT), respectively.

The prognostic role of interatrial block among COVID-19 patients hospitalized in medicine wards.

IntroductionSome abnormal electrocardiographic findings were independently associated with increased mortality in patients admitted for COVID‐19; however, no studies have focussed on the prognosis impact of the interatrial block (IAB) in this clinical setting. The aim of our study was to assess the prevalence and clinical implications of IAB, both partial and advanced, in hospitalized COVID‐19 patients.MaterialsWe retrospectively evaluated 300 consecutive COVID‐19 patients (63.22 ± 15.16 years; 70% males) admitted to eight Italian Hospitals from February 2020 to April 2020 who underwent twelve lead electrocardiographic recording at admission. The study population has been dichotomized into two groups according to the evidence of IAB at admission, both partial and advanced. The differences in terms of ARDS in need of intubation, in‐hospital mortality and thromboembolic events (a composite of myocardial infarction, stroke and transient ischaemic attack) have been evaluated.ResultsThe presence of IAB was noticed in 64 patients (21%). In the adjusted logistic regression model, the partial interatrial block was found to be an independent predictor of ARDS in need of intubation (HR: 1.92; p: .04) and in‐hospital mortality (HR: 2.65; p: .02); moreover, the advanced interatrial block was an independent predictor of thrombotic events (HR: 7.14; p < .001).ConclusionsAmong COVID‐19 patients hospitalized in medical wards, the presence of interatrial block is more frequent than in the general population and it might be useful as an early predictor for increased risk of incident thrombotic events, ARDS in need of intubation and in‐hospital mortality.

Myocarditis in Athletes Recovering from COVID-19: A Systematic Review and Meta-Analysis.

Background: To assess the event rates of myocarditis detected by Cardiac Magnetic Resonance (CMR) in athletes who recovered from COVID-19. Methods: A systematic literature search was performed to identify studies reporting abnormal CMR findings in athletes who recovered from COVID-19. Secondary analyses were performed considering increased serum high sensitivity troponin (hs-Tn) levels and electrocardiographic (ECG) and echocardiographic (ECHO) abnormalities. Results: In total, 7988 athletes from 15 studies were included in the analysis. The pooled event rate of myocarditis was 1% (CI 1–2%), reaching 4% in the sub-group analysis. In addition, heterogeneity was observed (I2 43.8%). The pooled event rates of elevated serum hs-Tn levels, abnormal ECG and ECHO findings were 2% (CI 1–5%), 3% (CI 1–10%) and 2% (CI 1–6%), respectively. ECG, ECHO and serum hs-Tn level abnormalities did not show any correlation with myocarditis. Conclusions: The prevalence of COVID-19-related myocarditis in the athletic population ranges from 1 to 4%. Even if the event rate is quite low, current screening protocols are helpful tools for a safe return to play to properly address CMR studies. Trial registration: the study protocol was registered in the PROSPERO database (registration number: CRD42022300819).

Prognostic Value of Electrocardiographic Abnormalities and Troponin-I Elevation in Hospitalized COVID-19 Patients

Background: Corona Virus Disease (COVID -19) patients present mainly with respiratory manifestations and viral pneumonia. The cardiovascular presentation includes early signs of acute myocardial injury. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or nonspecific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities and mortality. Methods and materials: It was a prospective observational study, conducted in four tertiary care Private Hospitals of Chattogram City of Bangladesh. The study enrolled 181 consecutive patients admitted to hospital from June 01, 2020 to December 31, 2020 due to Covid-19 disease on the basis of presentation of signs and symptoms severity. Upon admission, routine investigations cTnI and ECG were carried out. Results: Mean age of the patients was 54.3±7.3 years with 63.5% male. Hypertension was the most common comorbidity followed by diabetes and obesity. 57.1% of the patients had abnormal ECG. Abnormal axis deviation [26 % (left axis deviation 23.9% vs right axis deviation 2.0%)], Poor R wave progression (22.9%), T inversion (14.5%), left ventricular hypertrophy (LVH) (11.4%) followed by ST segment depression (8.3%) were major findings observed in the study population. Presence of LVH (p=0.008), ST segment elevation (p≤0.001), ST segment depression (p≤0.001) and T inversion (p=0.003) showed statistically significant association with Severe COVID-19 disease. 48.2% had raised cTnI level. Thirteen (7.2%) patients expired in hospital. The mortality rate increased with incrementally higher troponin group: 12/18 than mildly elevated troponin 1/63 (p &lt; 0.01). The presence of an abnormal ECG finding resulted in significant in the intermediate Troponin elevation group (0.05-1 ng/ml) but not in the low (&lt;0.05 ng/ml) or high (&gt; 1 ng/ml) Troponin elevation groups. There were statistically significant association between between cTnI level and death; and between ECG findings and death. Conclusion: Study conclude that Troponin-I level and ECG are a prognostic factor for mortality in hospitalized COVID-19 patients. Bangladesh Heart Journal 2021; 36(2): 105-112

Unexplained Syncope: The Importance of the Electrophysiology Study

Syncope of cardiac origin may be associated with an increased risk of sudden cardiac death if not treated in a timely and appropriate manner. The diagnostic approach of syncope imposes a significant economic burden on society. The investigation and elucidation of the pathogenetic mechanism of syncope are of great clinical importance, as both prognosis and appropriate therapeutic approaches depend on these factors. The responsible mechanism of presyncope or syncope can only be revealed through the patient history, baseline clinical examination and electrocardiogram. The percentage of patients who are diagnosed with these tests alone exceeds 50%. In patients with a history of organic or acquired heart disease or/and the presence of abnormal findings on the electrocardiogram, a further diagnostic electrophysiology inclusive approach should be followed to exclude life threatening arrhythmiological mechanism. However, if the patient does not suffer from underlying heart disease and does not show abnormal electrocardiographic findings in the electrocardiogram, then the probability in the electrophysiology study to find a responsible cause is small but not absent. The role of a two-step electrophysiology study inclusive risk stratification approach for the effective management of the former is thoroughly discussed in this review.

Exercise characteristics and incidence of abnormal electrocardiogram response in long-distance runners with exercise-induced hypertension.

ABSTRACTWhile long‐distance running has important health benefits, chronic elevation of blood pressure during exercise might induce cardiac events and sudden death. This study aimed to investigate characteristics of exercise and incidence of abnormal exercise electrocardiography findings in long‐distance runners with exercise‐induced hypertension. Long‐distance runners (n = 606) underwent a questionnaire survey, history taking, and exercise stress testing, and they were classified into the non‐exercise‐induced (n = 268) and exercise‐induced (n = 338) hypertension groups. Exercise‐induced hypertension was defined as systolic blood pressure ≥210 mm Hg during maximal exercise. Abnormal electrocardiogram response (AER) were defined as abnormal electrocardiography findings, such as arrhythmias or ST‐segment changes, during exercise stress testing. There were no differences in general and exercise‐related characteristics between the non‐exercise‐induced and exercise‐induced hypertension groups. The AER group (AERg, n = 37) had a significantly longer training history and total exercise time than the non‐AER group (non‐AERg, n = 569) (p < .05). Atrial arrhythmias and ST‐segment depression were more prevalent in the exercise‐induced hypertension group than in the non‐exercise‐induced hypertension group (atrial arrhythmias: 5% [17/338] vs. 1.9% [5/268]; ST‐segment depression: 2.7% [9/338] vs. .4% [1/268]; p < .05). The incidence of AER was significantly higher in the exercise‐induced hypertension group (n = 30, 8.8%) than in the non‐exercise‐induced hypertension group (n = 7, 2.6%) (p < .05). This study showed that long‐distance runners with AER had a longer training history and total exercise time than those without AER, and the exercise‐induced hypertension group had a higher rate of AER.

Electrocardiographic Findings and In-Hospital Mortality of COVID-19 Patients; a Retrospective Cohort Study.

Background:Although current evidence points to the possible prognostic value of electrocardiographic (ECG) findings for in-hospital mortality of COVID-19 patients, most of these studies have been performed on a small sample size. In this study, our aim was to investigate the ECG changes as prognostic indicators of in-hospital mortality.Methods:In a retrospective cohort study, the findings of the first and the second ECGs of COVID-19 patients were extracted and changes in the ECGs were examined. Any abnormal finding in the second ECG that wasn’t present in the initial ECG at the time of admission was defined as an ECG change. ECGs were interpreted by a cardiologist and the prognostic value of abnormal ECG findings for in-hospital mortality of COVID-19 patients was evaluated using multivariate analysis and the report of the relative risk (RR).Results:Data of the ECGs recorded at the time of admission were extracted from the files of 893 patients; likewise, the second ECGs could be extracted from the records of 328 patients who had an initial ECG. The presence of sinus tachycardia (RR = 2.342; p <0.001), supraventricular arrhythmia (RR = 1.688; p = 0.001), ventricular arrhythmia (RR = 1.854; p = 0.011), interventricular conduction delays (RR = 1.608; p = 0.009), and abnormal R wave progression (RR = 1.766; p = 0.001) at the time of admission were independent prognostic factors for in-hospital mortality. In the second ECG, sinus tachycardia (RR = 2.222; p <0.001), supraventricular arrhythmia (RR = 1.632; p <0.001), abnormal R wave progression (RR = 2.151; p = 0.009), and abnormal T wave (RR = 1.590; p = 0.001) were also independent prognostic factors of in-hospital mortality. Moreover, by comparing the first and the second ECGs, it was found that the incidence of supraventricular arrhythmia (RR = 1.973; p = 0.005) and ST segment elevation/depression (RR = 2.296; p <0.001) during hospitalization (ECG novel changes) are two independent prognostic factors of in-hospital mortality in COVID-19 patients.Conclusion:Due to the fact that using electrocardiographic data is easy and accessible and it is easy to continuously monitor patients with this tool, ECGs can be useful in identifying high-risk COVID-19 patients for mortality.

The prognostic significance of electrocardiography findings in patients with coronavirus disease 2019: A retrospective study.

BackgroundCoronavirus disease 2019 (COVID‐19) has reached a pandemic level. Cardiac injury is not uncommon among COVID‐19 patients. We sought to describe the electrocardiographic characteristics and to identify the prognostic significance of electrocardiography (ECG) findings of patients with COVID‐19.HypothesisECG abnormality was associated with higher risk of death.MethodsConsecutive patients with laboratory‐confirmed COVID‐19 and definite in‐hospital outcome were retrospectively included. Demographic characteristics and clinical data were extracted from medical record. Initial ECGs at admission or during hospitalization were reviewed. A point‐based scoring system of abnormal ECG findings was formed, in which 1 point each was assigned for the presence of axis deviation, arrhythmias, atrioventricular block, conduction tissue disease, QTc interval prolongation, pathological Q wave, ST‐segment change, and T‐wave change. The association between abnormal ECG scores and in‐hospital mortality was assessed in multivariable Cox regression models.ResultsA total of 306 patients (mean 62.84 ± 14.69 years old, 48.0% male) were included. T‐wave change (31.7%), QTc interval prolongation (30.1%), and arrhythmias (16.3%) were three most common found ECG abnormalities. 30 (9.80%) patients died during hospitalization. Abnormal ECG scores were significantly higher among non‐survivors (median 2 points vs 1 point, p < 0.001). The risk of in‐hospital death increased by a factor of 1.478 (HR 1.478, 95% CI 1.131–1.933, p = 0.004) after adjusted by age, comorbidities, cardiac injury and treatments.ConclusionsECG abnormality was common in patients admitted for COVID‐19 and was associated with adverse in‐hospital outcome. In‐hospital mortality risk increased with increasing abnormal ECG scores.

Electrocardiographic findings in non-critical patients with coronavirus disease-2019

Background/Aim: Cardiovascular involvement in patients with coronavirus disease 2019 (COVID-19) is closely related to the course of the disease; however, this issue has not been adequately studied in Turkey. Thus, we aimed to investigate the electrocardiography (ECG) findings in noncritical patients with COVID-19 in Turkey. Methods: This retrospective cohort study was conducted on non-critical patients with COVID-19 with no history of any cardiac disease. The laboratory parameters and ECG findings of the patients at the time of admission were analyzed. Results: In total, 100 patients with a mean age of 56.8 (16.7) years were included in the study, among which 54 were males. The rate of patients having at least one abnormal ECG finding, ST segment pathology, and elevated troponin level were 58%, 26%, and 48%, respectively. The respiratory rate and mean troponin level were higher and the mean lymphocyte count was lower in patients with ST segment pathology than in patients without. The respiratory rate, fibrinogen level, and incidence of T negativity and abnormal ECG findings were higher, and the lymphocyte count was lower in patients with elevated troponin levels than in patients with normal troponin levels (P0.03 mg/mL (P