Cardiovascular Signs Research Articles

Development of cardiovascular complications and their correlation with Lyme disease.

Cardiovascular disease is at the forefront of global health issues and contributes to myocardial infarction, stroke, and even death. Lyme disease (LD), spread by ticks of the genus Ixodes, is a contributing factor to the potential development of abnormalities in the heart. The bacterial agents Mycoplasma pneumoniae, Chlamydia pneumoniae, and Borrelia burgdorferi are known to cause a variety of infections and we speculate that infection with Borrelia is a contributing factor to cardiac abnormalities, especially Lyme carditis (LC). Patients who demonstrate undiagnosed cardiac abnormalities should be monitored for potential infection with Lyme disease and, consequently LC. Lyme carditis affects up to 10% of patients that have been diagnosed with LD and additionally, it indiscriminately manifests across a range of ages, from the pediatric populace to the elderly. Given the grave cardiac abnormalities that can arise from LC and the propensity for misdiagnosis, it is critical that medical professionals be aware of the cardiovascular signs and symptoms of Atrioventricular Heart Block (AHB). AHB can lead to third degree heart block in patients and potentially lead to death if left not properly diagnosed and treated. Essential treatments are readily available for Lyme carditis, which include a range of antibiotics and surgical procedures. In this review, we highlight not only the true nature of Lyme disease, but more importantly, the positive correlation between LD and a variety of undiagnosed heart complications.

Perioperative anaphylaxis in children: Etiology, time sequence, and patterns of clinical reactivity.

Perioperative anaphylaxis (PA) in children is an uncommon but potentially life-threatening complication associated with anesthesia. Early identification and management of PA is essential to optimize clinical outcomes. We performed a retrospective study of anesthesia records from pediatric patients with PA from centers in the United Kingdom, France, and the United States over a period of 10years. Time sequence of clinical signs and physiological variables during PA were collected, along with results of allergy testing. Twenty-nine children with PA were included. Median age was 11years. Based on the modified Ring and Messmer Grading Scale, severe reactions were seen in 25 (86%) members of this cohort, with 4 (14%) experiencing cardiac arrest. Life-threatening hypotensionwas the first clinical sign of PA in 59% of cases, followed by tachycardia and bronchospasm. In 16 (55%) cases, the initial signs of PA involved multiple organ systems. When the initial signs of PA were cardiovascular and/or respiratory, more epinephrine doses were administered. Average time from initial sign of PA to treatment with epinephrine was 6minutes (SD: 6, range: 1-25). The causative allergen was identified in 15 patients. Severe hypotension is the most common presenting sign of PA in children. Initial cardiovascular and/or respiratory signs are associated with the need for increased epinephrine doses. Further studies should optimize the prediction, identification, and early management of PA in children.

Clinical and diagnostic difficulties in management of patients with laminopathies

Mutations in the LMNA gene cause developing of several phenotypes, both with isolated involvement of cardiac, muscle, adipose and bone tissues, and with their combination. The dominance of cardiovascular signs in the clinical performance and false clarity in nosology definition can cause underestimation of subclinical markers of other systems partaking. It leads to an incorrect interpretation of the true disease etiology, failure in genetic diagnostics, and untimely determination of the correct management and prognosis. The article presents clinical cases that demonstrate both the most typical manifestations of laminopathy and rare combinations of symptoms, which represent a certain diagnostic difficulty.

Local Anesthetic Systemic Toxicity: A Narrative Literature Review and Clinical Update on Prevention, Diagnosis, and Management.

The objective of this narrative review of local anesthetic systemic toxicity is to provide an update on its prevention, diagnosis, and management. The authors used a MEDLINE search of human studies, animal studies, and case reports and summarize findings following the American Society of Regional Anesthesia and Pain Medicine practice advisories on local anesthetic systemic toxicity. Between March of 2014 and November of 2016, there were 47 cases of systemic toxicity described. Twenty-two patients (47 percent) were treated with intravenous lipid emulsion and two patients (4.3 percent) died. Seizures were the most common presentation. The spectrum of presenting neurologic and cardiovascular symptoms and signs are broad and can be obscured by perioperative processes. Local anesthetic type, dosage, and volume; site of injection; and patient comorbidities influence the rate of absorption from the site of injection and biodegradation of local anesthetics. Consider discussing appropriate dosages as a component of the surgical "time-out." A large-volume depot of dilute local anesthetic can take hours before reaching peak plasma levels. Oxygenation, ventilation, and advanced cardiac life support are the first priorities in treatment. Lipid emulsion therapy should be given at the first sign of serious systemic toxicity with an initial bolus dose of 100 ml for adults weighing greater than 70 kg and 1.5 ml/kg for adults weighing less than 70 kg or for children. All physicians who administer local anesthetics should be educated regarding the nature of systemic toxicity and contemporary management algorithms that include lipid emulsion therapy.

Clinical and Laboratory Features of Patients with Acquired Thrombotic Thrombocytopenic Purpura: Fourteen Years of the Milan TTP Registry.

Acquired thrombotic thrombocytopenic purpura (TTP) is a rare thrombotic microangiopathy caused by the immune-mediated severe deficiency of ADAMTS13. We hereby report the demographic and disease-related data of acquired TTP patients recorded in the Milan TTP Registry (www.ttpdatabase.org). We performed a cross-sectional study of 302 individuals enrolled in our registry for an acute episode of acquired TTP occurred between 2002 and 2015 (female 77%; median age at onset 40 years, interquartile range: 30-50). Twenty per cent of patients had concomitant autoimmune disorders. Among potential triggers of acute episodes, infections were the most prevalent (27%), followed by estroprogestinics use and pregnancy (5 and 4% of women, respectively). At presentation, systemic (72%), bleeding (68%) and neurological (43%) symptoms were the most frequent, whereas a lower prevalence of renal (18%) and cardiovascular (10%) signs and symptoms was observed. Almost all acute events were treated by plasma exchange and steroids, and 15% by rituximab. Exacerbation of acute TTP occurred in 15% of events. The TTP-related mortality was 5%. In survivors, the median number of plasma exchange procedures to remission was 9 (interquartile range: 6-14), longer for first events than relapses (median difference 3, 95% confidence interval: 2-4). Of 251 survivors of the first TTP episode with at least a 6-month follow-up, 55% had a relapse. In conclusion, acquired TTP is a severe disease with highly variable clinical presentation, usually requiring a long hospitalization. The Milan TTP Registry represents a powerful tool to improve our knowledge and management of acquired TTP.

Role of Thiamin in Health and Disease.

Thiamin is a hydrosoluble vitamin that plays a role in several biological processes, mainly in glucose metabolism. There are several risk factors for developing thiamin deficiency, such as malnutrition, refeeding syndrome, gastrointestinal surgery, and alcoholism. Recently, the role of thiamin in critically ill patients has gained prominence, and the prevalence of thiamin deficiency was found to be increased in patients with severe burns, major surgery, septic shock, end-stage renal disease, and heart failure. In adults, thiamin deficiency presents as encephalopathy, dry beriberi (with neurological signs and symptoms), or wet beriberi (with cardiovascular signs and symptoms). Thiamin deficiency can be diagnosed clinically, and all clinicians should be aware of this disease, especially in patients with risk factors for thiamin deficiency. Thiamin supplementation should be started as early as possible in patients suspected to have thiamin deficiency. Treatment is safe, inexpensive, simple, and life-saving. Diagnosis is confirmed on a positive response to treatment.

Wheat allergy – clinical implications and management

Grain allergies are common food allergies, that are typically but not only seen in individuals with other associated food allergies. The immunologic responses to grain proteins can be IgE and/or non-IgE mediated. Wheat allergy is the most common of the cereal grain allergies. It usually begins in early childhood and is outgrown by adolescence, although some retain it beyond the teenage years. Immunoglobulin E (IgE)-mediated wheat allergy is reported to affect 0.2 to 1.3 percent of children in Europe and 0.4 percent of children in the United States. The onset of wheat allergy in adulthood is typically not seen, unless it is related to an occupational exposure. Epidemiologic data for the other grains is largely missing. Immunoglobulin E (IgE)-mediated food-triggered reactions generally occur immediately, within minutes to two hours after ingestion. These reactions can present with skin, oropharyngeal, upper and lower respiratory tract, gastrointestinal tract, and/or cardiovascular signs and symptoms. The reactions can vary from mild cutaneous reactions to life-threatening anaphylaxis. Positive diagnose is based on determining the plasmatic level of specific IgE and performing skin prick test for wheat, methods that have poor specificity and sensitivity in predicting oral food challenge test outcomes. The gold standard test remains oral food challenge (OFC) test for wheat. Most of the studies have proven its utility, even in children with high levels of wheat specific IgE. The diagnose of non-IgE mediated reactions is based on clinical presentation and plasmatic levels of specific antibodies, other than IgE. The management of grain allergy does not differ from that of other food allergies. It requires instructions on avoidance and treatment of reactions in the event of accidental exposure. It includes education about grain alternatives. It also includes monitoring for nutritional issues and for the resolution of the allergy. Preliminary data on specific oral tolerance induction to wheat through oral desensitization protocols have shown some promise in children, but it is still considered an experimental therapy.

Clinical Presentation, Diagnosis, and Management of Air Embolism During Endoscopic Retrograde Cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure that is widely used by endoscopists and has a robust therapeutic profile. It uses endoscopy and imaging for a variety of diagnostic as well as therapeutic purposes. It is used for the management of a lot of pancreaticobiliary diseases such as obstructive jaundice, obstruction related to bile ducts, pancreatic biliary tumors, and traumatic or iatrogenic damage to the bile ducts. Other therapeutic interventions that can be done via ERCP include sphincterotomy, dilation of strictures, removal of biliary stones and placement of stents. Air embolism presents with cardiovascular, pulmonary, and neurologic signs and symptoms. Treatment of air embolism should be started early in suspected cases, and it should be in the differential diagnoses of various complications secondary to high risk of ERCP, especially if a cardiopulmonary compromise is present. Air embolism is rare but a serious complication associated with ERCP. The physicians must keep this in mind while performing ERCP in patients with predisposing risk factors. This review highlights the mechanism, causes, risk factors, pathophysiology, clinical signs, diagnostic modalities, treatment, and preventive measures to deal with this catastrophic complication.

The health effects of carbon monoxide in chronic exposure to low concentrations

Background: Acute exposure to carbon monoxide could be caused poisoning but in chronic exposure might be caused some symptoms and signs. Objective: The objective of this study was to determine the health effects of carbon monoxide in low concentration. Materials and Methods: It was a cohort study with >10 years follow-up. The people who were employed in different industries were participated in this study. Groups were followed for cardiovascular and neurological symptoms and signs. These groups were exposed to low concentrations of carbon monoxide; according to exposure levels, working sections were divided to five groups: Working section A, working section B, working section C, working section D, and working section E. Carbon monoxide concentrations, symptoms, and signs were determined. Data were analyzed with SPSS 16 Analysis of variance, Chi-square, Exact test, and relative risks with considering P < 0.05 as significant level. Results: Working section B had the most carbon monoxide concentration; 9.01 ± 0.62 part per million. Cardiovascular and neurological symptoms and sign were determined. Chronic fatigue, palpitation of heartbeat, loss of memory, and impaired decision-making were the most in Group B and relative risks were 1.62 (1.07–2.43), 1.60 (1.09–2.33), 1.50 (1.07–2.82), and 1.46 (1.08–2.72). Conclusions: Carbon monoxide had health effects in low concentration and might be caused, chronic fatigue, palpitation of heartbeat, loss of memory, and impaired decision-making.

Frame Registration for Motion Compensation in Imaging Photoplethysmography.

Imaging photoplethysmography (iPPG) is an emerging technology used to assess microcirculation and cardiovascular signs by collecting backscattered light from illuminated tissue using optical imaging sensors. An engineering approach is used to evaluate whether a silicone cast of a human palm might be effectively utilized to predict the results of image registration schemes for motion compensation prior to their application on live human tissue. This allows us to establish a performance baseline for each of the algorithms and to isolate performance and noise fluctuations due to the induced motion from the temporally changing physiological signs. A multi-stage evaluation model is developed to qualitatively assess the influence of the region of interest (ROI), system resolution and distance, reference frame selection, and signal normalization on extracted iPPG waveforms from live tissue. We conclude that the application of image registration is able to deliver up to 75% signal-to-noise (SNR) improvement (4.75 to 8.34) over an uncompensated iPPG signal by employing an intensity-based algorithm with a moving reference frame.

Practical guide for the management of systemic toxicity caused by local anesthetics.

Systemic toxicity from local anesthetics can occur in any of the wide range of situations in which these agents are used. This practical guide is created to generate a shared awareness of the prevention, diagnosis, and treatment of local anesthetic systemic toxicity among all medical professionals who perform nerve blocks. Systemic toxicity of local anesthetic is induced by an increase of its protein-unbound plasma concentration. Initial symptoms are characterized by central nervous system signs such as excitation, convulsions, followed by loss of consciousness and respiratory arrest. These symptoms are often accompanied with cardiovascular signs such as hypertension, tachycardia and premature ventricular contractions. Further increase of plasma concentration of local anesthetic induces bradycardia, conduction disturbances, circulatory collapse and asystole. The incidence of local anesthetic systemic toxicity is 1-11 cases per 10,000. Infants, patients with decreased liver function and low cardiac output are vulnerable to systemic toxicity. When performing regional anesthesia, the guideline-directed monitoring, securing a venous line, preparation of medication to treat convulsions and lipid emulsions are required. For prevention of local anesthetic systemic toxicity, small-dose, divided administration, using agents with low toxicity such as ropivacaine and levobupivacaine, performing an aspiration test are recommended. If systemic toxicity is suspected, halt administration of local anesthetic, request assistance, secure venous line, airway, administration of 100% oxygen and if necessary tracheal intubation and artificial respiration should be immediately performed. Benzodiazepines are recommended to treat convulsions. Administration of 20% lipid emulsion according to the protocol is recommended to treat severe hypotension and arrhythmia.

Beriberi disease in an 11-year-old girl with total colectomy

Beriberi or vitamin B1 deficiency is a rare disease in the developed world and more common in developing countries due to poverty and malnutrition. It usually presents with neurological manifestations (dry beriberi) or cardiovascular signs (wet beriberi). We report a case of dry beriberi in an 11-year-old girl with total colectomy who presented to our hospital with ataxic gait and muscle weakness. Her symptoms started 1 week after she underwent cholecystectomy for her chronic abdominal pain. Nerve conduction study showed sensory demyelinating neuropathy and she had low levels of serum vitamin B1. Her condition improved significantly after taking vitamin B1 supplementation. To the best of our knowledge, this is the first case report of thiamine deficiency in a child with a total colectomy.

Thyroid storm and myxoedema: two reversible causes of acute heart failure

Cardiovascular signs and symptoms can prevail in both hypothyroidism and hyperthyroidism. Case 1: 30-year-old female with acute right heart failure as first manifestation of Graves’ disease. It illustrates some of its cardiovascular complications, particularly pulmonary hypertension, tricuspid regurgitation, atrial fibrillation, mitral valve prolapse and mitral regurgitation. Case 2: 83-year-old-man with a severe primary hypothyroidism/ myxoedema crisis presented to emergency department with extreme bradyarrhythmia with hemodynamic impact and heart failure signs, which led to implantation of definitive pacemaker. Thyroid disorders are treatable entities and most cardiovascular changes are reversible. Early diagnosis is mandatory and can avoid severe complications and, eventually, invasive therapeutics interventions. Pulmonary hypertension and acute heart failure, especially in young adults, should be screened for underlying hyperthyroidism.

Catecholamine-Induced Cardiomyopathy in Pheochromocytoma: How to Manage a Rare Complication in a Rare Disease?

Pheochromocytomas and paragangliomas (PHEOs) are rare neuroendocrine tumors. Clinical manifestations include different cardiovascular signs and symptoms, which are related to excessive secretion of catecholamines. Catecholamine-induced cardiomyopathy in PHEO (CICMPP) is a rare but dreaded complication of PHEO. Once patient is diagnosed with this condition, the prognosis is worse and a surgical risk is much higher than expected. This article focuses on how catecholamines affect the heart and the pathophysiologic mechanism of CICMPP. The cardiovascular responses to catecholamine depend mostly on which catecholamine is released as well as the amount of catecholamine that is released. The acute release of norepinephrine and epinephrine from PHEO increases heart rate, systemic vascular resistance, myocardial contractility, and reduces venous compliance. The excessive adrenergic stimulation by catecholamine results in severe vasoconstriction and coronary vasospasm, myocardial ischemia, and subsequently damage, and necrosis. Chronically elevated catecholamine levels lead to significant desensitization of cardiac β-adrenoceptors. The increased levels of the enzyme β-adrenoceptors kinase (βARK) in the heart seems to mediate these biochemical and physiological changes that are consistently correlated with attenuated responsiveness to catecholamine stimulation. Through these mechanisms different types of cardiomyopathy (CMP) can be formed. This review discusses extensively the 3 types of cardiomyopathies that can be present in a PHEO patient. It also provides the clinical presentation and diagnostic and therapeutic algorithm in managing patients with CICMPP.

Characteristics of Tianeptine Exposures Reported to the National Poison Data System - United States, 2000-2017.

Tianeptine (marketed as Coaxil or Stablon) is an atypical tricyclic drug used as an antidepressant in Europe, Asia, and Latin America. In the United States, tianeptine is not approved by the Food and Drug Administration (FDA) for medical use and is an unscheduled pharmaceutical agent* (1). Animal and human studies show that tianeptine is an opioid receptor agonist (2). Several case studies have reported severe adverse effects and even death from recreational abuse of tianeptine (3-5). To characterize tianeptine exposures in the United States, CDC analyzed all exposure calls related to tianeptine reported by poison control centers to the National Poison Data System (NPDS)† during 2000-2017. Tianeptine exposure calls, including those for intentional abuse or misuse, increased across the United States during 2014-2017, suggesting a possible emerging public health risk. Most tianeptine exposures occurred among persons aged 21-40 years and resulted in moderate outcomes. Neurologic, cardiovascular, and gastrointestinal signs and symptoms were the most commonly reported health effects, with some effects mimicking opioid toxicity. A substantial number of tianeptine exposure calls also reported clinical effects of withdrawal. Among 83 tianeptine exposures with noted coexposures, the most commonly reported coexposures were to phenibut, ethanol, benzodiazepines, and opioids.

Knowledge about cardiovascular disease in Portugal

ObjectivesTo characterize specific knowledge on cardiovascular disease, particularly stroke and myocardial infarction (MI), and its relationship with sociodemographic factors, health literacy and clinical history, among the Portuguese population. MethodsIn a cross-sectional study conducted in 2012, a total of 1624 Portuguese-speaking residents of mainland Portugal, aged between 16 and 79 years, were assessed through face-to-face interviews using a structured questionnaire. ResultsAround 30% of participants were unable to estimate the risk of MI or stroke. On average, those who responded estimated that 34.2% and 35.6% of Portuguese will suffer a stroke or MI, respectively, during their lifetime. “Not smoking” (36.8%) and a “healthy diet” (32.8%) were identified as the most important behaviors for prevention of cardiovascular disease, and less than half of the participants responded that the most appropriate option in the presence of acute cardiovascular signs or symptoms was to call the emergency number. “Dependence on daily activities” (90.7%) and “impaired speech” (89.8%) were frequently recognized as consequences of stroke, while “heart failure” (86.4%) and “dependence on daily activities” (85.3%) were the most frequently identified consequences of MI. Overall, participants with adequate health literacy revealed more appropriate cardiovascular health-related knowledge. ConclusionsThere are important gaps in cardiovascular health-related knowledge in the Portuguese population. Health education strategies and practices should be sensitive to the differences in health literacy described herein, in order to improve cardiovascular health knowledge among the Portuguese population.

Advanced and Accurate Mobile Health Tracking Devices Record New Cardiac Vital Signs.

Cardiovascular disease remains the leading cause of death and disease worldwide. As demands on an already resource-constrained healthcare system intensify, disease prevention in the future will likely depend on out-of-office monitoring of cardiovascular risk factors. Mobile health tracking devices that can track blood pressure and heart rate, in addition to new cardiac vital signs, such as physical activity level and pulse wave velocity (PWV), offer a promising solution. An initial barrier is the development of accurate and easily-scalable platforms. In this study, we made a customized smartphone app and used mobile health devices to track PWV, blood pressure, heart rate, physical activity, sleep duration, and multiple lifestyle risk factors in ≈250 adults for 17 continual weeks. Eligible participants were identified by a company database and then were consented and enrolled using only a smartphone app, without any special training given. Study participants reported high overall satisfaction, and 73% of participants were able to measure blood pressure and PWV, <1 hour apart, for at least 14 of 17 weeks. The study population's blood pressure, PWV, heart rate, activity levels, sleep duration, and the interrelationships among these measurements were found to closely match either population averages or values obtained from studies performed in a controlled setting. As a proof-of-concept, we demonstrated the accuracy and ease, as well as many challenges, of using mHealth technology to accurately track PWV and new cardiovascular vital signs at home.

Immediate Hypersensitivity to Contrast Agents: The French 5-year CIRTACI Study

BackgroundIodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors. MethodsPatients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed by intradermal tests (IDT) with the culprit CM diluted 1:10, “potentially allergic” IH by positive IDT with pure CM, and non-allergic IH by negative IDT. FindingsAmong 245 skin-tested patients (ICM = 209; GBCM = 36), allergic IH to ICM was identified in 41 (19.6%) and to GBCM in 10 (27.8%). Skin cross-reactivity was observed in 11 patients with ICM (26.8%) and 5 with GBCM (50%). Allergy frequency increased with clinical severity and histamine and tryptase concentrations (p < 0.0001). Cardiovascular signs were strongly associated with allergy. Non-allergic IH was observed in 152 patients (62%) (ICM:134; GBCM:18). Severity grade was lower (p < 0.0001) and reaction delay longer (11.6 vs 5.6 min; p < 0.001). Potentially allergic IH was diagnosed in 42 patients (17.1%) (ICM:34; GBCM:8). The delay, severity grade, and mediator release were intermediate between the two other groups. InterpretationAllergic IH accounted for <10% of cutaneous reactions, and >50% of life-threatening ones. GBCM and ICM triggered comparable IH reactions in frequency and severity. Cross-reactivity was frequent, especially for GBCM. We propose considering skin testing with pure contrast agent, as it is more sensitive than the usual 1:10 dilution criteria.

BS05. Orthostatic hypotension and syncope in patients with ehlers-danlos syndrome

Introduction Postural tachycardia Syndrome (POTS) is a form of chronic orthostatic intolerance where the hallmark physiological trait is an excessive increase in heart rate upon standing. POTS is a final common pathway for a number of overlapping conditions, including lower body autonomic neuropathy, elevated sympathetic tone, mast cell activation, deconditioning, the presence of certain antibodies and hypovolemia. It also has similarities to chronic fatigue syndrome, Ehlers-Danlos Syndrome (EDS), vasovagal syncope and inappropriate sinus tachycardia. EDS is an heterogeneous disorder associated with inherited abnormalities of collagen structure. Patients develop hyper-extensibility, joint hypermobility and fragile connective tissue. Patients with EDS type III frequently have symptoms of autonomic dysregulation such as palpitations, lightheadedness, chest pain, presyncope and syncope that are also common in patients with POTS. Connective tissue abnormalities in EDS could lead to vascular laxity, predipose patients to orthostatic blood pooling in the lower extremities and orthostatic intolerance. These patients might have a peripheral neuropahty that could contribute to autonomic impairment. Methods Clinical records of patients diagnosed with Ehlers Danlos treated at Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran were reviewed retrospectively during a 10 year period (1987–2017). Results 29 patients were found to have a diagnosis of EDS. The female-to-male ratio was 3:1, while the mean age was 29. One patient died due to a ruptured aortic aneurysm. 9 (34.6%) patients had a history of presyncope, 14 patients (53%) had low blood pressure and 12 (46.15%) patients had heart rate values above 80 beats per minute. Mean systolic blood pressure was 107.2 ± 16, diastolic blood pressure 67.3 mmHg ± 10.8 with a mean heart rate of 80.1 ± 11.8. The most common Ehlers Danlos phenotype found was type III, which ocurred in 5 patients (40%). Type IV was found in 5 patients (26%), 3 patients (20%) presented with type VI and only two patients with type VII and type IX, respectively. We could not have the type of 14 patients. Conclusion Although is known that patients with the EDS may present with syncope or presyncopal episodes it is not known the percentage of patients who have dysautonomic cardiovascular symptoms and signs. We found that 53% of the patients have orthostatic intolerance, 34% had syncopal episodes and 46% could be diagnosed with POTS. One patient died due to a thoracic aortic aneurysm.

Smart Garment Fabrics to Enable Non-Contact Opto-Physiological Monitoring.

Imaging photoplethysmography (iPPG) is an emerging technology used to assess microcirculation and cardiovascular signs by collecting backscattered light from illuminated tissue using optical imaging sensors. The aim of this study was to study how effective smart garment fabrics could be capturing physiological signs in a non-contact mode. The present work demonstrates a feasible approach of, instead of using conventional high-power illumination sources, integrating a grid of surface-mounted light emitting diodes (LEDs) into cotton fabric to spotlight the region of interest (ROI). The green and the red LEDs (525 and 660 nm) placed on a small cotton substrate were used to locally illuminate palm skin in a dual-wavelength iPPG setup, where the backscattered light is transmitted to a remote image sensor through the garment fabric. The results show that the illuminations from both wavelength LEDs can be used to extract heart rate (HR) reaching an accuracy of 90% compared to a contact PPG probe. Stretching the fabric over the skin surface alters the morphology of iPPG signals, demonstrating a significantly higher pulsatile amplitude in both channels of green and red illuminations. The skin compression by the fabric could be potentially utilised to enhance the penetration of illumination into cutaneous microvascular beds. The outcome could lead a new avenue of non-contact opto-physiological monitoring and assessment with functional garment fabrics.