Common ECG Finding Research Articles

J-WAVES AND CARDIAC BIOMARKERS ARE ASSOCIATED WITH LONG-TERM CARDIOVASCULAR OUTCOMES IN HOSPITALIZED COVID-19 PATIENTS

HighlightsWe propose serum biomarkers as risk assessment tools for patients with COVID-19.J-waves are a common ECG finding, detected in 4–6% of the population, and are a risk factor for ventricular tachycardia and mortality in COVID-19 patients. Aim. To evaluate the prognostic potential of a combination of cardiac-specific biomarkers and ECG J-waves regarding long-term mortality and cardiovascular complications after discharge in patients with COVID-19-associated pneumonia.Methods. Serum biomarkers sST2, VCAM-1 and hs-TnI were assessed at admission in 254 patients hospitalized with COVID-19-associated pneumonia. ECGs on admission were analyzed for the presence of J waves. Clinical and laboratory characteristics of patients, as well as biomarker concentrations and the presence of J-waves on the ECG, were correlated with mortality and cardiovascular complications after discharge at 12 months [FU: 347 (310, 449) days]. Cox proportional hazards models were used to identify predictors of the risk of mortality and the composite endpoint up to one year after discharge.Results. A high level of VCAM-1 was a significant predictor of the risk of a combined endpoint (MI, stroke, pulmonary embolism, sudden death): HR = 1.049, CI 95%: 1.016–1.083; and high sST2 level was a significant predictor of the risk of both death (HR = 1.006, CI 95%: 1.004–1.007) and the composite endpoint (HR = 1.005, CI 95%: 1.003–1.006). In the generalized multivariate model, when other influencing factors were combined, the presence of a J-wave on the ECG during hospitalization was statistically insignificant (p > 0.5) for predicting sudden death up to a year after discharge.Conclusion. In hospitalized COVID-19 survivors, elevated hsTnI and sST2 levels on admission were strong predictors of CV events during long-term follow-up. On the other hand, the significance of the J-wave on the ECG in predicting long-term CV events remains borderline.

Cardiac screening with ECG in the young: significance of T wave inversion, T wave depth and T wave/QRS ratio

Abstract Background In young apparently healthy individuals, repolarization changes at the ECG may suggest an underlying cardiomyopathy. Purpose This study aims to investigate the clinical significance of T waves depth and T/QRS ratio in young individuals who underwent cardiac screening and exhibited T wave inversion (TWI) at the ECG. Methods We analysed a database of individuals aged 14 to 35 years who underwent cardiac screening, which included a health questionnaire and 12-lead ECG with a charitable organisation, between 2008 and 2013. All individuals included had recently responded to a follow-up online health questionnaire or had documented outcomes on a national digital database. The amplitudes of QRS (peak to peak) and T waves (mV) were measured in the leads where TWI was present; the average T/QRS ratio and average TWI depth were calculated. Results Our cohort comprised 5360 subjects (mean age of 21 ± 6 years, 61% males). Of the 358 (7%) who were referred for further investigations based on their screening findings, 255 (5%) had an abnormal ECG. TWI was documented in 120 (2%) individuals [anterior TWI in 78, inferior TWI in 16, lateral TWI in 6, and overlaps in 20 cases]. After further investigations, 16/120 (13%) individuals were diagnosed with cardiomyopathy [9 hypertrophic cardiomyopathy (HCM), 5 arrhythmogenic cardiomyopathy (ACM), 1 dilated cardiomyopathy (DCM), and 1 left ventricular non-compaction cardiomyopathy (LVNC)]. Of the remaining 104/120 individuals, 18 were diagnosed with other cardiac conditions and 86 were not found to have a cardiac disease. During a mean follow-up of 8.1 ± 1.2 years, no deaths were documented among the 16 individuals diagnosed with a cardiomyopathy, but 3 of them experienced a sudden cardiac arrest (all of them had ACM). In individuals diagnosed with a cardiomyopathy both average T/QRS ratio and average TWI depth were higher compared to the rest (0.128 vs 0.117; p = 0.54 and 0.281 vs 0.162 mV; p = 0.03, respectively). Average T/QRS ratio and average TWI depth were higher in individuals diagnosed with HCM compared with the ones diagnosed with other cardiomyopathies (0.133 vs 0.115; p = 0.68 and 0.336 vs 0.164 mV; p = 0.05, respectively). Conclusion T wave inversion is a relatively common ECG finding in young apparently healthy individuals and this feature leads to a diagnosis of cardiomyopathy in 13% of cases. Among subjects exhibiting TWI, T/QRS ratio and T wave depth appear higher in the ones who are eventually diagnosed with cardiomyopathies.Figure 1.Flowchart of patient selection

Macrophage Migration Inhibitory Factor Gene Polymorphism in Acute Coronary Syndrome.

Background Acute coronary syndrome (ACS) is a result of the interplay between genetic and environmental risk factors. A unique cytokine macrophage migration inhibitory factor (MIF), expressed by inflammatory cells, acts via a cluster of differentiation 74 (CD74) and a cluster of differentiation 44 (CD44) receptors, leading to the recruitment of mononuclear neutrophils and lymphocytes. This cascade results in exaggerated inflammation and atherosclerosis. MIF's distinctive characteristics and functions make it an essential target for achieving therapeutic atherosclerosis regression, setting it apart from other cytokines. Hence, this study aims to detect the MIF gene polymorphism in ACS patientsand to assess the incidence of in-hospital major adverse cardiac events (MACE). Methodology This study was conducted in a tertiary care hospital. A total of 90 patients who had ACS were enrolled, of which 83 were included, and seven patients were excluded based on exclusion criteria (four cases of old myocardial infarction, two cases of valvular heart disease, and one case of dilated cardiomyopathy). After detailed clinical examination, laboratory evaluation, and genetic test, patients were divided into two groups based on MIF gene mutation. Five patients who had positive MIF gene mutationwere termed as group A (n=5), and 78 patients with negative MIF gene mutation were termed as group B (n=78). The statistical analysis for the collected data was done using IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, USA). Results Out of the 83 patients in this study, the male gender was predominant; there were three male patients in group A (n=3; 60%) and 48 male patients in group B (n=48; 61.5%). The most common age group was between 60 and 69 years; two of five patients (n=2; 40%) in group A and 30 out of 78 patients (n=30; 38.4%) in group B belonged to this age group. The common symptomwas chest pain present infive patients in group A (n=5; 100%) and 76 patients (n=76; 97.5%) in group B. A common risk factor in group A patientswas tobacco chewing, seen in three patients (n=3; 60%), and group B smoking was the most common risk factor seen in 30 patients (n=30; 38.5%). The most common ECG finding in group A was ST-elevation myocardial infarction (STEMI), seen in three patients(n=3; 60%), and in group B, the commonest ECG finding was non-ST-elevation myocardial infarction (NSTEMI) seen in 23 patients (n=23; 29.5%). The most common MACE was heart failure seen in two patients in group A (n=2; 40%) and in 50 patients in group B (n=50; 64.1%), followed by arrhythmias seen in one patient in group A (n=1; 20%), and eight patients in group B (n=8; 10.3%). Conclusion This study demonstrated a significant positive association betweenMIF gene polymorphism and the occurrence of cardiovascular events like myocardial infarction, with a statistically significant p-value (p=0.001). This study showed the presence of the disease in young age groups and individuals without conventional risk factors, underscoring the importance of genetic studies. Genetic risk factors independently contribute to the pathophysiology of coronary artery disease; hence, understanding the mechanisms of these genes and incorporating genetic testing into standard clinical practice can help future research to developtherapeutic agents that can specifically target these genes.

Abstract 3111: A Systematic Review Of Vaccination-induced Takotsubo Cardiomyopathy: A 2024 Update

Background: Vaccine has potential to cause severe cardiac complications. Takotsubo cardiomyopathy (TCM) induced by vaccine is a life-threatening complication, albeit rarely reported. Our study provides a comprehensive insight into this patient cohort on a large scale. Methods: We conducted a systemic literature search in PubMed and EMBASE up to January 5, 2024, using MeSH terms for "vaccine" and "takotsubo cardiomyopathy" to identify cases of vaccine-induced TCM (Figure 1). Results: Our study included 25 cases of TCM with a median age of 63 ± 18.28 years. Of those, 80% were female. TCM was reported in patients after the coronavirus virus 2019 (COVID-19) vaccine (92%) and influenza vaccine (8%). Of COVID-19 vaccines, 88% were mRNA (Moderna, Pfizer) types. Most TCM cases were reported after 2nd dose of vaccine (44%). Chest pain (56%) and dyspnea (44%) were the most common symptoms, with a median time of 3 ± 2.02 days from vaccination to the first symptom onset. Cardiac troponins were elevated in 92% of patients, and ST-segment change (76%) was the most common ECG finding. All patients had left ventricular ejection fraction (LVEF) of 50%, with severe cardiomyopathy (EF 30%) in 24%. LV dysfunction was the most common finding (88%) on echocardiogram. A total of 92% of patients were discharged with improved symptoms after a median length of hospital stay of 7 ± 3.42 days (Figure 2). Conclusion: Although very rare, TCM is a life-threatening complication of vaccine. TCM should be included in the differential diagnosis of patients presenting with post-vaccination chest pain or dyspnea, especially after mRNA vaccines, warranting continued surveillance and regulated reporting of vaccine-related cardiac complications.

Cardiac abnormalities in stable chronic obstructive pulmonary disease: correlations and predictors

Abstract Background Patients with stable chronic obstructive pulmonary disease (COPD) are more likely to have cardiac abnormalities, which increase morbidity and mortality. The aim of the study is to explore correlations and probable predictors for these abnormalities in stable COPD patients. Patients and methods We conducted a prospective cohort study including 91 stable COPD cases, who were admitted to a tertiary health-care center during the period from August 2021 to January 2022. Spirometry, arterial blood gas, and ECG were performed for all participants. They were categorized using GOLD guidelines (2021) and assessed by two-dimensional Doppler echocardiography using the American and European Association of Echocardiography ASE recommendations. Results The study included 91 COPD patients; their mean age was 60.5 years with male predominance (62.6%). Of the patients, 76.9% were smokers and 49.5% of patients have respiratory failure type II. The most common abnormal ECG findings were P pulmonale, ventricular ectopic, and ischemic changes, which were more detected in severe COPD patients (94.29%). Echocardiographic assessment showed abnormal findings in almost 65%, more in the severe group. The most frequent findings were signs of pulmonary hypertension (PH) (72.5%), right ventricular dilatation (49.5%), and hypokinesia (21.98%). Risk factors of cardiac abnormalities were respiratory failure, COPD duration, comorbidities, and COPD stage. Conclusion Right ventricle dilatation, hypokinesia, and PH showed a positive correlation with echocardiographic findings and COPD severity. Respiratory failure and COPD duration were independent predictors of arrhythmia; COPD stage and the number of comorbidities were predictors of cardiac ischemia, while respiratory failure and comorbidities were predictors of PH.

The Case Files

The Case Files

Clinical profile of patients admitted with pericardial effusion in Shahid Gangalal National Heart Centre, Kathmandu, Nepal

Background and Aims: Pericardial effusion is a common finding in every day clinical practice. It is caused by a range of local and systemic disorders, many of which could be idiopathic. Pericardial effusions can be acute or chronic. The etiology of pericardial effusion varies in different parts of the world and is related to the relative prevalence of different diseases.
 Methods: This is a retrospective study where data from all the cases admitted with pericardial effusion in the SGNHC from January 2021 to December 2022 were included. Altogether 218 cases diagnosed with pericardial effusion established by Echocardiograpy were included. Evaluation for the cause of pericardial effusion was done. Iatrogenic (cardiac surgery, catheterization) and post-traumatic cases and age <15 years were excluded. Demographic profile, common causes, the presentation and the clinical outcome of the patients were documented.
 Results: Majority of patients were aged between 56-75 years. Most common etiology of pericardial effusion was tuberculosis (56%) followed by heart failure (11%), Hypothyroidism (6.4%) and malignancy (5.6%). Tachycardia was the most common ECG finding in 152 (69.7%) followed by Low voltage ECG in 96 (44%). The most common clinical feature was breathlessness in 85% followed by tachycardia in 56% of the patient.
 Conclusion: Tuberculosis, Heart Failure and Hypothyroidism were the common causes of Pericardial effusion with male predominance. Breathlessness was the most common presenting symptom.

Postinfluenza Cardiac Tamponade: A Review of Published Case Reports.

Increased vaccination rates and better understanding of influenza virus infection and clinical presentation have improved the disease's overall prognosis. However, influenza can cause life-threatening complications such as cardiac tamponade, which has only been documented in case reports. We searched PubMed/Medline and SCOPUS and EMBASE through December 2021 and identified 25 case reports on echocardiographically confirmed cardiac tamponade in our review of influenza-associated cardiac tamponade. Demographics, clinical presentation, investigations, management, and outcomes were analyzed using descriptive statistics. Among 25 cases reports [19 adults (47.6 ±15.12) and 6 pediatric (10.1 ± 4.5)], 15 (60%) were females and 10 (40%) were male patients. From flu infection to the occurrence of cardiac tamponade, the average duration was 7±8.5 days. Fever (64%), weakness (40%), dyspnea (24%), cough (32%), and chest pain (32%) were the most prevalent symptoms. Hypertension, diabetes, and renal failure were most commonly encountered comorbidities. Sinus tachycardia (11 cases, 44%) and ST-segment elevation (7 cases, 28%) were the most common ECG findings. Fourteen cases (56%) reported complications, the most common being hypotension (24%), cardiac arrest (16%), and acute kidney injury (8%). Mechanical circulatory/respiratory support was required for 14 cases (56%), the most common being intubation (9 cases, 64%). Outcomes included recovery in 88% and death in 3 cases. With improving vaccination rates, pericardial tamponade remains an infrequently encountered complication following influenza virus infection. The complicated cases appear within the first week of diagnosis, of which nearly half suffer from concurrent complications including cardiac arrest or acute kidney injury. Majority of patients recovered with timely diagnoses and therapeutic interventions.

Acil Servise Başvuran Covid-19 Hastalarında sık görülen EKG Değişiklikleri ve EKG Bulgularının Prognostik Önemi

Aim: 
 It is known that cardiac involvement may occur in patients with COVID-19 infection. And one of the best diagnostic tools of cardiac involvement is the ECG. The aim of this study is to investigate the common ECG findings in COVID-19 infection and the effect of these findings on the prognosis.
 Material and Method:
 215 patients who applied to our emergency department between 04.06.2022 and 04.08.2022 and met the criteria for inclusion in the study were included in this study. All patient results and ECG images were accessed from the hospital data recording system. The results were used for statistical analysis.
 Results:
 Of 215 patients, 118 were female and 97 were male, and the mean age was 58±21 years. Of these patients, 52 were hospitalized in the service and 17 were hospitalized in intensive care units, and 146 patients were discharged from the emergency department. The most common ECG finding was ST-T wave change. It was observed that there was a correlation between the detection of VT in the ECG and the intensive care unit admission. It was observed that the ECG findings of the patients had no effect on the prognosis.
 Conclusion: 
 All ECG findings can be seen in patients admitted to the emergency department with COVID-19 infection. The most common ECG finding is ST-T wave change. In addition, long QTc, sinus tachycardia and AF are also common. However, no correlation was found between ECG findings and disease prognosis.

Anaesthesia for elite athletes.

Sports participation has been growing rapidly since the 1960s. Anaesthesiologists are increasingly confronted with athletes in a peri-operative setting. The right choice of type of anaesthesia technique, pain management of injuries, specific physiologic adaptations of the athlete and knowledge of prohibited substances are eminent for a correct approach of this subpopulation. This review aims to give an overview of athletes' specific anaesthetic management in peri-operative and postoperative settings and to guide the nonspecialised anaesthetist. We comprehensively reviewed the literature, gathered all the information available on, and synthesised it in a narrative way, regarding preoperative evaluation, intraoperative implications and postoperative pain management of the elite athlete undergoing a surgical procedure. An anaesthesiologist should recognise the most common benign ECG findings in athletes like bradycardia, isolated left ventricle hypertrophy on voltage criteria and early repolarisation as normal features in the athlete's heart. Isotonic physiology typically produces four-chamber dilation. In contrast, isometric stress creates high intravascular pressure leading to left ventricular hypertrophy. Pre-operative evaluation should also identify possible consumers of performance-enhancing drugs. Intraoperative points of interest for the anaesthesiologist is mainly avoiding drugs on the prohibited list of the World Anti-Doping Agency (WADA). Postoperative and chronic pain management are still developing fields in this population. The International Olympic Committee (IOC) proposed treating acute pain with a combination of paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, injectable NSAIDs and local anaesthetics. It may be suggested that chronic pain management in elite athletes could benefit from treatment in specialised multidisciplinary pain clinics. This literature review aims to serve as a guide for the anaesthesiologist taking care of the elite athlete.

CLINICAL PROFILES OF PATIENTS UNDERGOING PACEMAKER IMPLANTATION

Background and Objective: The implantation of a permanent cardiac pacemaker for the treatment of bradyarrhythmia is one of the most popular cardiac interventions. The goal of this study is to look at the clinical profiles of individuals who have permanent pacemakers implanted Material and Methods: The study was conducted using observational methods. The study included patients who received a permanent pacemaker for bradyarrhythmias between November 2019 and November 2021. A thorough review of the demographic profile and indications was performed. Results: The vast majority of the 312 patients were older, with the majority being between the ages of 56 and 88 years old (75 % ). Pacemakers were implanted in more men than in women. Complete heart block was the most common ECG finding and the most common presenting symptom was syncope. The most prevalent sign of pacing was acquired A-V block, and the most common pacemaker mode was single chamber (VVI/VVIR). Conclusion: Acquired A-V block and SSS were found to be the most common reasons for pacemaker implantation in our study. Higher implantation rates were linked to advanced age and male gender.

Using Patch ECG Device During Lower Third Molar Surgery

This study aimed to evaluate cardiac activity changes during lower third molar surgery concerning gender and anxiety levels. Thirty healthy subjects who required lower third molar surgery filled out Norman Corah dental anxiety scale (DAS) before surgery. A patch ECG device (Savvy, Institute ''Jožef Stefan'', Ljubljana, Slovenia) was applied to the patient to evaluate heart rate (HR) and heart rhythm. These parameters were assessed in 8 different intervals. Periods of the highest mean HR values—incision and flap elevation compared to the period with minimal mean HR values—during suturing showed statistical significance difference (p<0.05). The most common outstanding ECG finding was sinus tachycardia, especially in anxious compared to non-anxious patients. Extraction difficulty score was correlated with the procedure duration time and with the abnormal ECG findings in the period of tooth extraction. Significant cardiac activity changes are detected during surgery. Physiological manifestations of anxiety may be evaluated successfully using a patch ECG device.

Acute Toxic Effects of the New Psychoactive Substance \u201cVoodoo\u201d among Patients presented to the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH), Egypt, during 2017

BackgroundVoodoo is a heterogeneous mixture of psychoactive substances that has recently grown in popularity among youth in Egypt. Patients can present with a variety of manifestations that may lead to death in some cases. This study assessed the acute toxic effects of voodoo among patients presented to the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH) during a one year period.MethodsThis is a retrospective study of all patients presented with voodoo intoxication at the PCC-ASUH from 1 January 2017 to 31 December 2017. Clinical data, routine laboratory findings, and ECG results as well as duration of hospitalization and outcome were compiled from hospital records.ResultsSeventy-one voodoo intoxication cases meeting the inclusion criteria were analyzed (mean age: 25.19 ± 9.54 years, range: 15–50 years, 97.2 % male). Pulse, blood pressure, and respiratory rate were normal in more than half of all patients. Neurological abnormalities including agitation, hallucinations, disturbance of consciousness were the most frequent manifestations. Respiratory acidosis was the most common laboratory finding (54.9 %), followed by increased serum urea (43.6 %), hypokalemia (33.8 %), hyperglycemia (28.1 %), and leukocytosis (26.7 %). The most common ECG finding was sinus tachycardia (31 %), followed by QT prolongation (15.4 %). More than half of the studied patients (53.5 %) co-administered other illicit substances, most frequently cannabis and tramadol. Most patients recovered fully and were discharged, but death occurred in two cases.ConclusionsVoodoo toxicity can manifest with many presentations, hampering timely diagnosis. Clinicians should consider possible voodoo poisoning in patients presenting with a history of drug use with neurological symptoms, and they should conduct follow-up arterial blood gases, electrolytes and ECG as voodoo may contain potentially fatal psychoactive substances.

English

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a global issue with smoking being the most important risk factor. Co-existence of both COPD and cardiovascular diseases is very common and has diagnostic, therapeutic and prognostic implications. The cardiac manifestations of chronic obstructive pulmonary disease are numerous. COPD affects pulmonary blood vessels, right ventricle as well as left ventricle leading to the development of pulmonary hypertension, cor pulmonale, right ventricular dysfunction and left ventricular dysfunction. Because cardiac abnormalities clearly contribute to overall morbidity of COPD, an understanding of their role and potential for treatment is vital. The purpose of this study was to evaluate various cardiac manifestations in chronic obstructive pulmonary disease patients and to observe correlation with its severity. METHODS This hospital based observational study was done in Gauhati Medical College and Hospital attending in-patient department (IPD) and out-patient department (OPD) of Department of General Medicine from 1st July 2018 to 30th June 2019. A total of 140 patients were included in this study. RESULTS Majority of the patients were in the age group of 60 - 70 years. Cardiovascular manifestations were most commonly observed in very severe stage of COPD (GOLD IV). Overall, 91 patients had ECG changes. The most common ECG findings were P pulmonale and right ventricular hypertrophy (RVH). Pulmonary arterial hypertension (PAH) and tricuspid regurgitation (TR) were common echocardiography findings. CONCLUSIONS Cardiac manifestations were more prevalent in COPD GOLD III and IV stages and therefore with increasing severity of COPD, occurrence and severity of cardiac complications becomes more prevalent. ECG and echocardiography are essential investigational tools for diagnosing COPD patients with cardiac complications and assessing their severity. However, a prospective study including a larger sample size is required to arrive at a definite conclusion. KEYWORDS COPD, Cardiac manifestations, ECG, Echocardiography, PAH, RVH

Study of Cardiovascular Manifestations in Patients with Thyroid dysfunction at Tertiary Care Center

Introduction: Thyroid hormones have effects on virtually every organ system. The heart is the major target organ for thyroid action. It was thought that thyroid disorder is a circulatory disorder and manifestations of thyroid disorders are due to changes in cardiac work. Over the period it has become clear that the explanation for the altered circulatory hemo-dynamics of thyroid disease is because of involvement of cardiovascular system. Aims and Objectives: To find out the incidence of overt and subclinical cardiac manifestations in patients with thyroid dysfunction and to compare the prevalence of overt and subclinical cardiac manifestations in two subsets of patients belonging to hyperthyroid and hypothyroid groups respectively. Materials and Methods: It was an observational study carried out at the Department of Medicine for the period of August 2017 to December 2019. In total, 230 newly diagnosed patients with thyroid dysfunction were included in the study. Focused clinical and detailed cardiovascular system examination, necessary biochemical investigations were done. All patients underwent detailed 12 lead electrocardiogram and 2D Echo-cardiography procedure. Incidence of overt and subclinical cardiac manifestations in Hyperthyroid and Hypothyroid cases was calculated; and the Prevalence of overt and subclinical manifestations in the two subsets of patients belonging to Hyperthyroid and Hypothyroid groups respectively was compared and data was analyesd. Results: Total hypothyroid patients were 115 and that of hyperthyroid were 115. Incidence of thyroid is much more common in females as compared to males (81% in hyperthyroidism and 92% in hypothyroidism). In hyperthyroid group, 92% patients showed cardiac involvement either in the form of ECG, CXR, 2D ECHO abnormalities and in hypothyroid patients it was 93%. Statistically significant patients presented with symptoms of congestive cardiac failure in hyperthyroid group (73%) but not in hypothyroid group. In the both groups, fatigue was the most commonest presenting symptom related to cardiovascular system. In hypothyroid group, most common cardiac sign was Pulse, Pressure<40 mm of Hg (73%) whereas in hyperthyroidism it was sinus tachycardia (73%). 73% hyperthyroid patients showed sinus tachycardia as the most common ECG finding where again 73% hypothyroid patients showed ST-T changes as a most common ECG finding. Nearly 70% hyperthyroid patients had ejection fraction more than 60% on Echocardiogrphy the procedure and almost all patients of hypothyroidism had ejection fraction less than 60%. Conclusion: Thyroid dysfunction was found to be more common in the females with 41-50 years of age group in hypothyroidism group and 21-30 years in the hyperthyroidism group. Cardiovascular manifestations were the major presenting factors in both the groups pointing towards the adverse effects of thyroid dysfunction, Dyspnea and fatigue were the major cardiac symptoms in the hypothyroidism group. While chest pain and fatigue were the major cardiac symptoms in the hyperthyroidism group. The ECG and 2D ECHO findings in the current study also suggested that in both the groups of thyroid dysfunction, cardiac manifestations are likely to have higher incidence.

Sinus Tachycardia as a Predictor of Severe Carbonmonoxide Poisoning

Introduction: Carbonmonoxide (CO) poisoning is one of the most frequent intoxications in the world. Theheart is one vital organ affected in CO intoxication. In this study, we aimed to investigate characterstics andelectrocardiographic abnormalities of patients with CO poisoning.Material and Methods: In a two-year period, we analyzed patient records admitted to our EmergencyDepartment (ED), retrospectively. Demographical characteristics (age, gender, monthly distribution, sourcesof poisoning, etc), vital signs, laboratory findings, Glasgow Coma Scale (GCS) scores and ECG findingswere investigated. Additionally, treatment method, source of exposure and length of stay (LOS) in the EDwere investigated. Then, patients were divided into 2 groups as to normobaric oxygen therapy (NBO) andhyperbaric oxygen therapy (HBO) groups according to the treatment methods. Two groups were comparedin terms of electrocardiographic abnormalities.Results: Atotal of 75 patients were involved. The most common source of CO poisoning was stoves (n=71,94.6%). The most common complaint was found to be nausea and vomiting (n=24, 32%). Mean GCS scoreof the patients was 14. Mean carboxyhemoglobin levels were found to be 15%, mean saturation was 95.9%.Five (6.6%) of the patients have undergone HBO in addition to NBO. The most common ECG finding wasfound to be normal sinus rythm in 52 patients (69.3%), followed by sinus tachycardia in 10 patients (13.3%),bradycardia in 4 patients (5.3%), ST depression in 2 patients (2.6%). Four of 5 patients who underwent HBOhad tachycardia on ECG.Conclusion: Use of stoves for heating purposes increases the risk for poisoning particularly in wintermonths. Although physicians must be aware of its ischemic effects of CO poisoning on cardiovascularsystem, sinus tachycardia may be a predictor of CO poisoning severity.

A study of cardiovascular manifestations of thyroid disorders

Background: Dysfunction and anatomic abnormalities of the thyroid gland are among the most common diseases of the endocrine glands. The study has been undertaken with the aim to assess the different cardiovascular manifestations in patients of hypothyroidism and hyperthyroidism in Manipur and find out any correlation of it with age, sex, type of thyroid disorder and BMI. Materials and Method: The study was a cross sectional study of patients who were diagnosed as hypothyroid or hyperthyroid in the Department of Medicine, Regional Institute of Medical Sciences(RIMS), Imphal, Manipur. Clinical parameters including history and clinical examination were recorded including thyroid function testing, ECG, chest X-ray, trans-thoracic echocardiography. Results: Among 59 patients of thyroid disorder studied, 38 patients were found to be hypothyroid and 21 patients hyperthyroid. The average BMI in hypothyroid patient was 27.25. The average BMI in hyperthyroid patients was 25.41 which were lower than hypothyroid. Diastolic hypertension was found in 44.7% of hypothyroid patients. Sinus bradycardia and sinus tachycardia were the most common ECG findings in hypothyroid and hyperthyroid patients respectively. 15.8% had cardiomegaly on chest x-ray in hypothyroid patients while 9.5% had cardiomegaly in hyperthyroid patients. On echocardiographic evaluation, 13.1% and 9.5% had pericardial effusion in hypothyroid and hyperthyroid groups respectively.

Electrocardiographic findings of methanol toxicity: a cross-sectional study of 356 cases in Iran

BackgroundMethanol is widely used in industry; however, methanol poisoning is not common. In this regard, a number of outbreaks have been recently reported due to inappropriate processing of alcoholic beverages. Shiraz, a city located in the southern part of Iran, faced one of such outbreaks in 2020 during COVID-19 pandemic. There is no sufficient literature on the electrocardiographic findings in methanol toxicity. This study aimed to address this gap in the literature.MethodA total of 356 cases with methanol toxicity referred to Shiraz University of Medical Science Tertiary Hospitals (Faghihi and Namazi) in March and April, 2020. The clinical findings of blindness and impaired level of consciousness, lab data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected.ResultsThe most common ECG findings were J point elevation (68.8%), presence of U wave (59.2%), QTc prolongation (53.2% in males and 28.6% in females), and fragmented QRS (33.7%). An outstanding finding in this study was the presence of myocardial infarction in 5.3% of the cases. This finding, to the best of our knowledge, has only been reported in a few case reports. Brugada pattern (8.1%) and Osborn wave (3.7%) were the other interesting findings.In multivariate analysis, when confounding factors were adjusted, myocardial infarction, atrioventricular conduction disturbances, sinus tachycardia, and the prolonged QTC > 500 msecond were four independent factors correlated with methanol toxicity severity measured with arterial blood PH on arterial blood gas measurements, with odds ratios of 12.82, 4.46, 2.32 and 3.15 (P < 0.05 for all), respectively.ConclusionElectrocardiographic variations during methanol intoxication are remarkable and well-correlated with poisoning severity. Myocardial infarction was an egregious and yet a common concerning finding in this sample, which need to be ruled out in methanol toxicity.

Associations between common ECG abnormalities and out-of-hospital cardiac arrest

BackgroundOut-of-hospital cardiac arrest (OHCA) is often the first manifestation of unrecognised cardiac disease. ECG abnormalities encountered in primary care settings may be warning signs of OHCA.ObjectiveWe examined the association between...

318 Study of the Clinical, ECG and Biochemical Spectrum of Cardiovascular Complications in Patients of Aneurysmal Subarachnoid Haemorrhage An Initial Experience at a Tertiary Centre in India

Abstract INTRODUCTION Subarachnoid haemorrhage (SAH) following aneurysmal rupture is an extremely fatal condition with mortality as high as 45%. Apart from the intra-cranial causes, there are cardiovascular events which add to the morbidity and mortality. Eg: myocardial ischemia, arrhythmia's and heart blocks. These can manifest with deranged cardiac biomarkers. However, quantitative assessment of these biochemical markers and its co-relation with prognosis in patients of aneurysmal SAH has not been adequately studied. METHODS After obtaining ethical clearance, we conducted a prospective observational study in our department. The study included all patients of aneurysmal SAH with ictus less than 48 hours at the time of admission.Excluded were patients with past history of coronary artery disease or cardiac surgery. The patient's heart rate, blood pressure, pupillary response, GCS Score, any neurodeficits, cranial nerve palsies, Hunt and Hess/WFNS grade of SAH were noted on admission. Serum cardiac enzymes (Troponin T, Total creatine phosphokinase, cardiac specific creatine phosphokinase), serum brain natriuretic peptide (BNP) and C reactive protein levels were done for 6 consecutive days from the day of admission. Patient also underwent a 12 lead ECG and 2D Echocardiography on days 0, 1 and 5. RESULTS &gt;Serum levels of troponin T, total creatine phosphokinase and BNP were statistically associated with outcome. Abnormal levels of these markers were associated with a poor outcome. ECG abnormalities were observed in 76% of the cases. Prolonged QTc interval was the most common abnormal ECG finding among the patients who died. One patient developed 3rd degree heart block following aneurysmal SAH and another patient developed left ventricular dysfunction with an ejection fraction of 40%. CONCLUSION Cardiovascular complications are common in patients of aneurysmal SAH. Serum quantitative levels of Troponin T, total creatine phosphokinase and BNP show statistical significant association with outcome and can be incorporated in the battery of tests in SAH patients for predicting outcome.