Chest ECG Research Articles

FUKUYAMA CONGENITAL MUSCULAR DYSTROPHY: P.343Complications of Fukuyama congenital muscular dystrophy revealed from a nationwide registry

Clinical characteristics Fukuyama congenital muscular dystrophy (FCMD) is characterized by hypotonia, symmetric generalized muscle weakness, and CNS migration disturbances that result in changes consistent with cobblestone lissencephaly with cerebral and cerebellar cortical dysplasia. Mild, typical, and severe phenotypes are recognized. Onset typically occurs in early infancy with poor suck, weak cry, and floppiness. Affected individuals have contractures of the hips, knees, and interphalangeal joints. Later features include myopathic facial appearance, pseudohypertrophy of the calves and forearms, motor and speech delays, intellectual disability, seizures, ophthalmologic abnormalities including visual impairment and retinal dysplasia, and progressive cardiac involvement after age ten years. Swallowing disturbance occurs in individuals with severe FCMD and in individuals older than age ten years, leading to recurrent aspiration pneumonia and death. Diagnosis/testing The diagnosis of FCMD is established in a proband by identification of biallelic pathogenic variants in FKTN on molecular genetic testing. Management Treatment of manifestations: Physical therapy and stretching exercises, treatment of orthopedic complications, assistance devices such as long leg braces and wheelchairs, use of noninvasive respiratory aids or tracheostomy, prompt treatment of acute respiratory tract infections, antiepileptic drugs, medical and/or surgical treatment for gastroesophageal reflux, gastrostomy tube placement when indicated to assure adequate caloric intake, cardiomyopathy treatment as per cardiologist. Surveillance: Monitor: Respiratory function in individuals with advanced disease; For myocardial involvement by chest x-ray, ECG, and echocardiography in individuals older than age ten years; Gastrointestinal function, and for signs/symptoms of gastroesophageal reflux; For foot deformities and scoliosis. Genetic counseling FCMD is inherited in an autosomal recessive manner. At conception, each sib of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Carrier testing for at-risk family members and prenatal diagnosis for pregnancies at increased risk are possible if the pathogenic variants in the family are known.

A Novel Front-End Design for Bioelectrical Signal Wearable Acquisition

Mismatch of front-end branches introduced by the numerical error of the peripheral components will limit the matching level of the front end and lead to the difficulty for obtaining high common mode rejection ratio. In this paper, a novel front-end design is proposed for high-quality bioelectrical signal wearable acquisition. Through partial public dc bias circuit and virtual right leg drive circuit, the common-mode rejection ration of the proposed design can be improved effectively without accurate matching the peripheral components, which is valuable for engineering simplification and wearable device development. Both theoretical analysis and experiment results are given to show the advantages of the proposed design compared with the traditional design. Based on the proposed front-end design, an ECG system with common precision configuration of peripheral components is developed, and its common-mode rejection ratio can reach 100 dB. Three wearable ECG applications, portable finger ECG measurement, palm ECG acquisition for cycling, and chest ECG test under different motion states, are carried out and the experimental results of the proposed design are compared with those of traditional design with the same parameter error, which show that the developed ECG system with the proposed design can effectively suppress power line interference and motion artifact and has the superiority for bioelectrical signal wearable acquisition.

44. Buerger’s disease with severe eosinophilia and acute critical ischemia

IntroductionBuerger’s disease usually presents with normal blood tests. We present a case with significant eosinophilia, a phenomenon rarely reported. Eosinophilia with acute onset Raynaud’s and critical ischemia can be atypical early manifestation of Buerger’s disease (thromboangiitis obliterans).Case descriptionA case report of a 24-year-old male, smoker, with no other history, presented acutely, complaining of cool, painful hands with tricolour changes with worsening for 48 hours. On examination, apart from features of Raynaud’s and tender fingers, he had good perfusion, as shown by Doppler testing. Blood tests showed eosinophilia; 13x10*9 (Normal 0.04-0.40 x10*9) and mild raised C-reactive protein 24 (normal range <10.0 mg/L). Chest radiograph, ECG, and echocardiography showed no abnormalities. The results of initial screening including Immunoglobulins, complements, ANA, ANCA, RF, APLA and CCP were all negative. As there were no critical features of ischemia, we considered the patient for discharge from the hospital with a plan for close review. We strongly advised him not to smoke. He re-admitted within a week with worsening of Raynaud’s and features of critical ischemia with bluish nail and fingertip and some early features of mild digital necrosis. We began treatment with intravenous heparin, aspirin, and iloprost (prostacyclin) infusion for 10 days. The patient’s digital ischemia and intermittent claudication showed some improvement after 1 week, but eosinophilia persisted at 11x10*9 with ruminant pain in digits. The importance of smoking cessation was re-emphasised. Magnetic resonance angiography showed no occlusion of the distal arteries of the upper and lower extremities. Capillaroscopy showed micro haemorrhages (no connective tissue disease/scleroderma pattern abnormality). Investigations for parasitic infections and malignancy were negative. HIV / Hepatitis B/C CMV/EBV/Parvovirus IGM was all undetected. Schistosoma testing was negative. Haematology investigated him for the rare possibility of the genetic mutation for hypereosinophilic syndrome (PDGFRA and FIP1L1 genes) which was negative and underwent bone marrow biopsy which was also normal.We started him on oral prednisolone 1 mg/kg body weight with complete resolution of eosinophilia and ischemic symptoms plus Raynaud’s. Smoking stopped with help.DiscussionBuerger’s disease is a rare disease of exclusion and recognised as one form of vasculitis with a strong association with smoking and nicotine. There has been no consensus or any significant data for any specific therapies proven a benefit in this condition, more than in alone stopping smoking or even oral tobacco products. The main characteristic features of this form are present in young smokers with no systemic disease manifestation, normal inflammatory response, and negative immunology.Eosinophilia has only rarely been a feature of the presentation of Buerger’s disease. Its presence does not imply a systemic vasculitis or a related syndrome. Although there is limited evidence for the use of steroids in this condition, inflammatory features such as eosinophilia could strengthen the rationale for using steroids in certain cases by halting the ongoing immune driven inflammatory cascade. The presence of eosinophilia might suggest alternative pathogenic mechanisms in certain cases of Buerger’s.Key learning pointsTo recognise eosinophilia as a marker in atypical Buerger’s disease presentation. Being a disease of exclusion we have to rule out all other possibilities including some rare ones as was done in this case by seeking advice from infectious disease and haematology team.Conflicts of interestThe authors have declared no conflicts of interest.

Accuracy of commercially available heart rate monitors in athletes: a prospective study.

Endurance athletes, particularly competitive runners, are using wrist worn devices with the heart rate (HR) feature to guide their training. However, few studies have assessed the effectiveness of these at high levels of exertion. The purpose of this study was to measure the accuracy of the HR monitor feature in four watches at six different treadmill speeds. This prospective study recruited 50 healthy, athletic adults (68% male, mean age of 29, and mean BMI of 23 kg/m2). All subjects wore a three lead ECG and Polar H7 chest strap monitor and two different randomly assigned wrist worn HR monitors. These included the Apple Watch III, Fitbit Iconic, Garmin Vivosmart HR, and Tom Tom Spark 3. Once all devices were on, they were asked to run at the following speeds on a treadmill (in mph): 4, 5, 6, 7, 8, and 9 for two min. HR was assessed on all devices and agreement among measurements determined with Lin's concordance correlation coefficient (CCC) (rc). The Polar H7 chest strap had the greatest agreement with the ECG (rc=98). This was followed by the Apple Watch III (rc=96). The Fitbit Iconic, Garmin Vivosmart HR, and Tom Tom Spark 3 all had the same level of agreement (rc=89). The Polar H7 chest strap was the most accurate, and the Apple Watch was superior among watches. For endurance athletes and their coaches, a chest strap device or Apple Watch may be the best choice for guiding workouts and performance.

A case of subacute thyroiditis associated with complete occlusion of right coronary artery

Case presentation: A case is a 72-year-old male, and developed fever, sore throat and immigrating neck pain, without shortness of breath (SOB). He showed pulse 96/min, Temp 38.8C, BP 146/90mmHg, respiration and SpO2 normal. Physicals were slight tenderness in thyroid, and laboratory data revealed free T3/T4 10.7pg/mL/5.4ng/dL. He was diagnosed as subacute thyroiditis. ECG showed incomplete right bundle block branch (RBBB) and Holter ECG showed pulse rate 70-144/min and the average was 95.8/min for 24 hours. HbA1c increased from 6.4% to 7.4% for 6 weeks. For the treatment, prednisolone 20mg/day was started and reduced gradually, and thyroid function was normalized. Consecutively, he developed chest discomfort and oppression with unremarkable ECG changes and chest CT showed only the calcification of coronary arteries. Coronary angiography showed occlusion of the right proximal coronary artery (RCA, #2:100%), left anterior descending (LAD, #6:75%, #7:90%). Coronary angioplasty was operated immediately. By placing a drug-eluting stent, RCA was re-opened successfully. His symptoms disappeared, and clinical course was improved. Discussion: Subacute thyroiditis may bring hyperthyroidism and tachycardia, increased metabolism for circulatory system. Then, subacute thyroiditis would give burden and stress for coronary heart function. It is suggested that hyperthyroidism would aggravate the coronary stenosis. We have to consider such complex pathophysiology for the diseased states in the clinical medical practice.

A Comparative Study of Pulse Oximetry Screening and Clinical Examination in Diagnosis of Congenital Heart Disease

Background: Pulse oximetry is a reliable and non-invasive method for measuring oxygen saturation and has a rapid response. During the past several years pulse oximetry has gained wide spread use in the neonatal oxygen monitoring. The present study was done to determine if a pulse oximetry screening combined with clinical examination is superior in the diagnosis of congenital heart disease to clinical examination alone. Subjects and Methods: The term new-born babies born in NARAYANA medical college and Hospital during the study period of 12months (February 2018 to January 2019) had a thorough clinical examination on day 2 of life with emphasis on peripheral pulses, cyanosis, tachypnea, cardiac pulsations and murmurs. Pulse oximetry screening was done within 4hrs of birth and at 48-72hrs of life. Chest X-ray, ECG and Echocardiogram were done for those babies with either abnormal clinical examination or pulse oximetry reading.Clinical examination was done again 2 weeks after discharge. Results: Though routine clinical examination is effective in detection of congenital heart disease in new-borns, combining pulse oximetry and clinical examination after birth had a higher sensitivity for detection of congenital heart diseases in new-borns. Conclusion: Combining clinical examination and pulse oximetry can enhance the clinician’s ability to detect life-threatening congenital heart disease in a timely manner. This issue requires the formulation of national policy that will make screening for CCHD a priority.

Frequency and prognosis of type 2 myocardial infarction vs non ischemic myocardial injury: Large observational study from an emergency department

Type 2 Myocardial Infarction (T2MI), due to myocardial oxygen supply-demand mismatch in the absence of atherothrombosis and of non-ischemic myocardial injury (NIMI), i.e. troponin elevation without overt ischemia are new emerging physiopathological entities. We aimed to investigate frequencies and characteristics of T2MI and NIMI in current routine clinical practice of emergency unit. Among patients admitted from 2014 to 2016 in a university hospital emergency unit ( N = 82,543), patients with elevated troponin Ic (≥ 0.10μg/L) ( N = 4568) were adjudicated as T2MI if symptoms or signs of myocardial ischemia (typical chest pain and/or ECG changes), or as NIMI without such signs. Patients with missing admission biological data ( N = 112) or T1MI ( N = 2467) were excluded. Among the 1989 patients included, 539 (27%) were diagnosed as T2MI and 1450 (73%) as NIMI. When compared with NIMI, T2MI had higher troponin levels (0.27 (0.14–0.71) vs 0.22 (0.13–0.54) μg/L, P = 0.008, respectively). Risk factors were similar for both groups (age (84(74–90) vs 84(75–91) y, P = 0.3), male sex (43 vs 48%, P = 0.07), hypertension (67 vs 71%, P = 0.133), diabetes (25 vs 25%, P = 0.9), prior CAD (24 vs 26%, P = 0.342), systemic inflammatory response syndrome (SIRS) (47 vs 49%, P = 0.3), and systolic blood pressure (SBP) (130 (111–153) vs 132 (112–153) mmHg, P = 0.545). Biological data on admission were also similar (hyperglycemia (glucose ≥ 11mmol/L), 14 vs 13%, P = 0.37, creatinine (96 (72–148) vs 94 (72–141) μmole/L, P = 0.598), anemia (Hemoglobin ≤ 10g/dL, 13 vs 14%, P = 0.5), C-reactive protein elevation (CRP ≥ 3mg/L, 88 vs 89%, P = 0.7)). Moreover, in-hospital mortality was high and similar for both groups (15 vs 18%, P = 0.2), even when adjusted for confounding. This large real-life study shows that NIMI and T2MI are common and share the same risk factors, characterized by a high rate of infections and anemia and a high risk of hospital mortality.

Infection and type 2 myocardial infarction: A large observational study from emergency department

Troponin elevation is frequent in patients with acute infection (AI) admitted to emergency unit (EU). Acute infection has been suggested as a common trigger in type 2 myocardial infarction (T2MI), corresponding to a myocardial oxygen supply-demand mismatch without atherothrombosis. We aim to characterize risk factors of T2MI occurrence and in-hospital mortality in patients admitted to an EU with AI and elevated troponin. Among the medical records of all the patients admitted from 2014 to 2016 in a university hospital EU ( N = 82,543), patients with a diagnosis of AI and elevated troponin Ic (≥ 0.10μg/L)( N = 714) were systematically adjudicated as T2MI in the presence of symptoms of myocardial ischemia (typical chest pain and/or ECG changes). Among the 714 patients included (aged 85, 50% male), 185 (26%) were classified as T2MI, of whom infection site was pulmonary tract ( N = 111), urinary tract ( N = 27), skin ( N = 15), digestive tract ( N = 9) or other or indefinite site ( N = 23). By multivariate analysis, a history of chronic obstructive pulmonary disease (COPD) (OR (95% CI): 0.53 (0.30–0.96)), high temperature (OR: 0.86 (0.74–0.99) per °C) and elevated creatinine (0R 0.998 (0.996–1.000) per μmol/L) were associated with a lower risk of T2MI, whereas age, site of infection, C-reactive protein and troponin rates were not predictors of T2MI. Death rate was similar among patients with or without T2MI (21 vs 23%, P = 0.6). In contrast, age, troponine, creatinine or C-reactive protein elevations were independent predictors of mortality. Our large real-life study shows that in patients admitted to an EU with AI and troponin elevation, T2MI is a common feature, especially in the absence of temperature elevation, renal insufficiency or history of COPD, but is not an independent factor of in-hospital mortality.

Standard ECG lead I prospective estimation study from far-field bipolar leads on the left upper arm: A neural network approach

In this study, the feasibility of interpreting heart rhythms from far-field bipolar ECG arm-band lead recordings on the left-upper-arm (LUA), is evaluated in a clinical multichannel arm-ECG mapping database (N = 153 subjects) for the prospective development of long-term heart rhythm monitoring from comfortable arm wearable devices. A preliminary multivariable linear regression analysis on ECG chest Lead I from 10 selected far-field bipolar leads along the left arm, indicated that 3 of them in the LUA were relevant and worth evaluating in more detail from a heart rhythm information perspective.To derive a good and effective estimation process, a time series non-linear regression point estimator, using an artificial neural network with 2 lags was investigated, showing a correlation coefficient of up to 0.969 for a single subject. Then, a vector approach was adopted for the whole LUA database, aiming to develop a subject independent estimation process of the P-QRS-T waveform interval and its heart rhythm attributes in the standard chest Lead I. In the same study, the first 96 coefficients, of the Discrete Cosine Transform on the P-QRS-T interval were used as a means for reducing the dimensionality of the input space, with a loss of just 0.1% in power, and reducing the dimensionality to just 5% of the original size. The trained ANN for ECG Lead I estimation from one upper arm Lead-1 showed a correlation coefficient above 80% on a beat-to-beat basis, an improvement on all but 1.34% of the beats estimated for a typical train/test partition of the LUA database. The non-triviality of the results was tested with random and intentional true negatives. Information theory analytics revealed that there is an estimated information of 1.6 bits/beat between LUA armband bipolar leads and the standard Lead I.

Effectiveness of a Pulse Oximetric Screening for the Detection of Congenital Heart Disease in Asymptomatic New-Borns- An Observational Study.

Background: This study was designed to evaluate the effectiveness of routine postnatal clinical examination and pulse oximetry screening in detecting congenital heart disease in new-borns. Subjects and Methods: The term new-born babies born in narayana medical college and Hospital during the study period of 12months had a thorough clinical examination on day 2 of life with emphasis on peripheral pulses, cyanosis, tachypnea, cardiac pulsations and murmurs. Pulse oximetry screening was done within 4hrs of birth and at 48-72hrs of life. Chest X-ray, ECG and Echocardiogram were done for those babies with either abnormal clinical examination or pulse oximetry reading. Clinical examination was done again 2 weeks after discharge. Results: The sensitivity 26% for oximetry alone and 60% for clinical examination alone. Specificity was 99.8% for pulse oximetry alone, and 98% for clinical examination alone. Conclusion: Pulse oximetry can enhance the clinician’s ability to detect life threatening CHD in a timely manner.

Mobile ECG and SPO2 Chest Pain Subjective Indicators of Patient with GPS Location in Smart Cities

Mobile ECG and SPO2 Chest Pain Subjective Indicators of Patient with GPS Location in Smart Cities

Infection and type 2 myocardial infarction: A large observational study from emergency department.

Troponin elevation is frequent in patients with acute infection (AI) admitted to emergency unit (EU). Acute infection (AI) has been suggested as a common trigger in type 2 myocardial infarction (T2MI), corresponding to a myocardial oxygen supply-demand mismatch without atherothrombosis. We aim to characterize risk factors of T2MI occurrence and in-hospital mortality among patients admitted to an EU with AI and elevated troponin. Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital EU ( n = 82,543), patients with a diagnosis of AI and elevated troponin Ic (≥ 0.10 μg/L)( n = 714) were systematically adjudicated as T2MI in the presence of symptoms or signs of myocardial ischemia (typical chest pain and/or ECG changes). Among the 714 patients included (aged 85, 50% male), 185 (26%) were classified as T2MI, of whom infection site was pulmonary tract ( n = 111), urinary tract ( n = 27), skin ( n = 15), digestive tract ( n = 9) or other or indefinite site ( n = 23). By multivariate analysis, a history of chronic obstructive pulmonary disease (COPD) [OR (95% CI): 0.53 (0.30–0.96)], high temperature [OR: 0.86 (0.74-0.99) per °C] and elevated creatinine (0R 0.998 (0.996–1.000) per μmol/L) were associated with a lower risk of T2MI, whereas age, site of infection, C-reactive protein and troponin rates were not predictors of T2MI. Death rate was similar among patients with or without T2MI (21 vs. 23%, P = 0.6). In contrast, age, troponine, creatinine or C-reactive protein elevations were independent co-variates associated with mortality. Our large real-life study shows that in patients admitted to an EU with AI and troponin elevation, T2MI is a common feature, in the absence of temperature elevation, renal insufficiency or history of COPD. In such patients, inflammatory and cardiac biomarkers levels were independently associated with early mortality.

Frequency and prognosis of type 2 myocardial infarction vs. non-ischemic myocardial injury: Large observational study from an emergency department.

In current routine clinical practice of emergency unit, frequencies and characteristics of Type 2 Myocardial Infarction (T2MI), due to myocardial oxygen supply-demand mismatch in the absence of atherothrombosis and of non-ischemic myocardial injury (NIMI), i.e. troponin elevation without overt ischemia, remains to be investigated. Among medical records of all the patients admitted from January 2014 to December 2016 in a university hospital emergency unit ( n = 82,543), patients with elevated troponin Ic (≥ 0.10 μg/L) ( n = 4568) were adjudicated as T2MI if symptoms or signs of myocardial ischemia (typical chest pain and/or ECG changes), or as NIMI without such signs. Patients with missing admission biological data ( n = 112) or T1MI ( n = 2467) were excluded. Among the 1989 patients included, 539 (27%) were diagnosed as T2MI and 1450 (73%) as NIMI. When compared with NIMI, T2MI had higher troponin levels [0.27 (0.14–0.71) vs. 0.22 (0.13–0.54) μg/L, P = 0.008, respectively]. Risk factors were similar for both groups [age 84(74–90) vs. 84(75–91) y, P = 0.3], male sex (43 vs. 48%, P = 0.07), hypertension (67 vs. 71%, P = 0.133), diabetes (25 vs. 25%, P = 0.9), prior CAD (24 vs. 26%, P = 0.342), systemic inflammatory response syndrome (SIRS) (47 vs. 49%, P = 0.3), and systolic blood pressure (SBP) (130 (111–153) vs. 132 (112-153) mmHg, P = 0.545). Biological data on admission were also similar [hyperglycemia (glucose ≥ 11 mmol/L), 14 vs. 13%, P = 0.37, creatinine [96 (72–148) vs. 94 (72–141) μmole/L, P = 0.598], anemia (Hemoglobin ≤ 10 g/dL, 13 vs. 14%, P = 0.5), C-reactive protein elevation (CRP ≥ 3 mg/L, 88 vs. 89%, P = 0.7)]. Moreover, in-hospital mortality was high and similar for both groups (15 vs. 18%, P = 0.2), even when adjusted for confounding. This large real-life study shows that NIMI and T2MI are common and share the same risk factors, characterized by a high rate of infections and anaemia and a high risk of hospital mortality.

Quantitative assessment of pericardial delayed hyperenhancement helps identify patients with ongoing recurrences of pericarditis

ObjectivesRecurrences of pericarditis (RP) are often difficult to diagnose due to lack of clinical signs and symptoms during subsequent episodes. We aimed to investigate the value of quantitative assessment of...

Clinical effects of reported synthetic cannabinoid exposure in patients admitted to the intensive care unit

ObjectiveTo characterize the clinical presentation and hospital course of patients with reported synthetic cannabinoid (SC) exposure requiring Intensive Care Unit (ICU) admission. DesignRetrospective case series of patients admitted to medical or cardiac ICU. SettingUrban tertiary care center. ParticipantsAdults ≥18 years old admitted from the emergency department (ED) in 2015. MeasurementsDemographics, Sequential Organ Failure Assessment (SOFA) scores, and clinical parameters documenting the effects and hospital course. Results23 patients met inclusion criteria. Median age was 47 years (interquartile range [IQR], 32–54); 83% male; 78% black. Patients were generally tachycardic (HR > 100), (65%) and hypertensive (SBP > 140), (65%) on admission. The initial chest X-ray and ECG were abnormal in 43% and 68% of patients, respectively. Pulmonary edema and tachycardia were the most common findings. Head CT imaging was abnormal in 5% of patients. Troponin was elevated >1.0 ng/ml in 3 of 19 patients (16%). Other exposures detected on admission were marijuana (30%), alcohol (30%), and benzodiazepines (26%). The median SOFA score was 6 on admission and decreased over the next 3 days. SOFA scores were primarily driven by altered neurologic status and respiratory failure. 91% required mechanical ventilation, 30% had seizures as a part of presentation, 18% required vasopressors, and 5% needed dialysis. Median hospital and ICU lengths of stay were 2.6 (IQR 1.4–3.5) and 1.6 (IQR 0.9–2.5) days, respectively. The median hospital charge was $37,008. All patients survived the index hospitalization. ConclusionsPatients admitted to ICU after SC exposure exhibit significant organ dysfunction, particularly neurologic and respiratory. Prognosis is good with supportive care.

Variations of Heart Rate, Pulse Arrival Time and Blood Pressure in a Versatile Laboratory Protocol.

Many studies dealing with blood pressure modeling are evaluated based on a single type of provocation. This paper investigates widely used provocations such as controlled breathing, mental arithmetic and Stroop tests, Valsalva maneuver, cold pressor and muscle tension and combines them in a versatile laboratory protocol. The protocol was tested in an experiment where pulse arrival time (PAT) and heart rate (HR) were measured with chest ECG and finger PPG sensors and blood pressure (BP) with continuous fingercuff monitor. The experiment results show that mental tasks provoked HR, BP and PAT very little while cold pressor and muscle tension had strong impact in all parameters. Valsalva maneuver had strongest impact in HR and PAT but the effect was transient like. We also predicted systolic BP based on the PAT values. We selected nine points in the protocol to calculate linear prediction model for each subject and then fitted data points to the models. If only the calibration points are taken into account, the correlation between the predicted and measured systolic BP was 0.91. When all the data points are fed into model, correlation was 0.75.

A study on clinical and echocardiographic evaluation of neonatal cardiac murmurs and their follow up at 6 weeks of age

BACKGROUND: Congenital heart disease (CHD) is one of the most common congenital malformations. Presence of cardiac murmur could be a warning sign of serious CHD. This study is done to emphasize the meticulous examination of the neonates for murmur and early referral for diagnosis and interventional therapy. OBJECTIVES: a. To determine the presence or absence of heart disease in neonates with cardiac murmurs. b. To identify clinical characteristics which differentiate pathological murmur from functional murmur. c. To assess the reliability of routine clinical neonatal evaluation in diagnosing CHD. d. Follow up of babies with detected lesion at 6 weeks of age to know about the evaluation of murmur. METHODOLOGY: Hospital based prospective study was conducted for a period of 12 months. All term neonates delivered in our hospital with cardiac murmurs were taken up for study. Detailed history was taken and associated clinical features noted. Chest X-ray and ECG were taken. Following which all neonates underwent echocardiography. Parents of babies with detected abnormality were counseled. These babies were followed up at 6 weeks of age for persistence of murmur and CHD. RESULTS: Among 4116 deliveries, 98 neonates with cardiac murmur were taken up for study. The percentage of having CHD among neonates with murmur was 53.06%. The incidence of heart disease in our hospital was 12.6%. VSD was the commonest defect. Incidence of CHD is higher in neonate of consanguineous parents. It is possible to make clinical diagnosis of murmur as innocent or pathological based on associated clinical features, X-ray and ECG abnormalities. CONCLUSION: It is important to evaluate all neonatal cardiac murmurs before they become symptomatic. Early diagnosis aids in early referral and appropriate intervention. These reduce morbidity and mortality . By evaluation of neonates based only on murmurs few CHD can be missed.

PERAN PERAWAT DALAM IDENTIFIKASI DINI DAN PENATALAKSANAAN PADA ACUTE CORONARY SYNDROME

The role of nurses in the early identification and treatment on Acute Coronary Syndrome. Introduction : Acute Coronary Syndrome ( ACS ) is an emergency in the coronary arteries . Nurses are very necessary to provide treatment of acute coronary syndrome accurately and precisely both prehospital and intrahospital . Methods: The literature search from April 2006 through April 2016 in MEDLINE, NCBI, CINAHL using key words : Acute Coronary Syndrome, treatment and does not restrict the research sampling. Results: Based on the literature review 10 obtained the enforcement of early diagnosis of ACS should be done immediately, which can be done by looking of three criteria: chest pain, ECG changes and sign biochemical (biomarker serum). Discussion: The nursing care must have role in the management of ACS. Therefore the quality of care given depends on the knowledge and skills of nurses both prehospital and intrahospital

A protocol for a prospective observational study using chest and thumb ECG: transient ECG assessment in stroke evaluation (TEASE) in Sweden

IntroductionAtrial fibrillation (AF) causes ischaemic stroke and based on risk factor evaluation warrants anticoagulation therapy. In stroke survivors, AF is typically detected with short-term ECG monitoring in the stroke unit....

TCTAP C-128 Distal Wire Coronary Perforation Managed Successfully with Gelfoam®

### Patient Initials or Identifier Number Mdm L.X.J ### Relevant Clinical History and Physical Exam Case 1- Mdm L.X.J. 85year old female. No past medical history of note. Presented with chest pain and ECG showed anterior ST elevation. Severe LAD/D1 disease treated with provisional LAD stenting