ECG Changes In Patients Research Articles

The Significance of Right-Sided Precordial ECG Leads (V3R and V4R) in Assessing Right Ventricular Dysfunction: ASingle Center Cross-Sectional Study.

Right ventricular systolic dysfunction is associated with poor prognosis and increased mortality rates. Our objective was to investigate ECG changes in patients with this condition, focusing on the right-sided precordial leads. In this cross-sectional study, 60 patients with right ventricular dysfunction were included from April 2020 to April 2021. Cardiac structure and function were assessed using 2D transthoracic echocardiography. Standard 12-lead electrocardiograms and right-sided precordial ECGs (V3R-V4R) were obtained and analyzed for QRS complex configuration, ST-segment elevation, and T-wave morphology. In our study, the majority were male (70.0%) with a mean age of 58.76 years. The most common initial diagnoses were pulmonary thromboembolism (43.3%), chronic obstructive pulmonary disease (26.7%), and pulmonary hypertension (25.0%). The predominant ECG finding in the right-sided precordial leads (V3R, V4R) was a deep negative T wave (90.0%). Patients with severe right ventricular systolic dysfunction often exhibited a qR pattern (41.2%), whereas those with nonsevere dysfunction showed rS and QS patterns (55.8%). Approximately 41.0% of severe RV dysfunction cases had ST segment depression in the right-sided precordial leads, and 28.0% of patients displayed signs of right atrial abnormality. The study found that qR, rS, and QS patterns were more prevalent in V3R and V4R leads among patients with severe and nonsevere right ventricular systolic dysfunction. The most common ECG feature observed was deep T-wave inversion in these leads. The study recommends using right-sided precordial leads in all patients with RV systolic dysfunction for early detection and risk stratification.

ECG Changes in Patients with Amitriptyline Intoxication; P, QT, QTC, T and PR Wave Dispersion: A Retrospective Study

Objective: Amitriptyline intoxication is a life-threatening condition as it can cause cardiac arrhythmias. This study aims to examine the ECG changes in patients with amitriptyline intoxications who were admitted to the emergency department and to compare the P-wave, T-wave, QT, QTC, and PR dispersions with healthy controls.
 Material and Methods: The sample of the current retrospective study consists of only 46 patients with amitriptyline intoxication and 65 healthy controls. The 12-channel ECG recordings of the participants were evaluated by two experienced cardiologists. P wave, T wave, QT, QTC, and PR distance, minimum, maximum, and dispersion values were measured. The obtained data were recorded on the data set and subjected to statistical analysis.
 Results: There was no significant difference in sociodemographic variables between patients with amitriptyline intoxication and the control group. The main symptoms of the patients were as follows: 28.3% (n=13) lethargy, 32.6% (n=15) nausea-vomiting, 21.7% (n=10) unconsciousness, and 17.4% (n=8) other. According to the analysis of amitriptyline intoxication and ECG parameters of healthy controls, P-wave, T-wave, QT, QTC, and PR dispersion were higher in the intoxication group than in the healthy controls (p0.05). The patient group had a higher heart rate than the control group (p=0.026).
 Conclusion: The current study found that P-wave, T-wave, QT, QTC, and PR dispersion were higher in the amitriptyline intoxication group than in the control group, which is thought to play a role in cardiac arrhythmias. Clinicians should be on alert for any ECG changes in these cases.

Electrocardiogram Changes in Patients with Positive Troponin I Presenting with Non-ST-Elevation Myocardial Infarction

Objectives: Unlike “ST-segment elevation myocardial infarction (STEMI)”, there is a wide spectrum of ECG changes for Non-STEMI (NSTEMI) patients with varying prognostic implications. Therefore, the purpose of this study was to determine the frequency of ECG changes in patients with positive high-sensitive troponins (hs-cTn) presenting with NSTEMI. Methodology: This Cross sectional study included 282 patients with positive hs-cTn diagnosed with NSTEMI. Standard 12-lead ECG was performed for all the patients. The clinical profile and ECG changes such as ST elevation in aVR, T wave inversion, and ST depression were noted. Results: Out of 282 patients, 68.1% (192) were male, mean age was 58.5 ± 10.6 years, 56.7% (160) were hypertensive, and 39.7% (112) were diabetic. The ECG was normal in 8.2% (23) while, 64.5% (182) had ST-depression, out of which 1.1% (2) had ST-depression of <1mm, 78% (142) had ST-depression of 1-2mm, and remaining 20.9% (38) had ST-depression of >2mm. T-wave inversions were observed in 45.7% (129). ST-elevation of ≥1 mm in lead aVR was noted in 19.1% (54) patients. Conclusion: A considerable number of NSTEMI patients with positive hs-cTn showed no specific ECG changes. ST-depression followed by T wave inversion and ST-elevation in aVR were the most commonly observed ECG findings in these patients. Considering the prognostic implications and association of these changes with the severity of diseases, prompt decision-making regarding invasive management strategy could be helpful in improving the outcomes of these patients.

A COMPARATIVE STUDY OF LIPID PROFILE AND ECG CHANGES IN ISCHEMIC AND HAEMORRHAGIC STROKE

Objective The study was done to compare the risk factors, lipid prole, and ECG changes in patients of ischemic and haemorrhagic stroke. Methodology All patients clinically and radiologically diagnosed to be ischemic or haemorrhagic stroke, detailed history, clinical examination, ECG, CT scan brain and routine blood investigation was done on arrival.MRI brain was done when required. Repeat CT scan brain and clinical evaluationwas done after 24 hours to look for complications or improvements, as well as ECG was repeated to look for development of any further changes and comparison was made. Results Out of 80 patients, 34(42.5%) suffered from Haemorrhagic stroke and 46(57.5%) suffered from ischemic stroke. Out of 34 patients who suffered from haemorrhagic stroke 25 had history of hypertension, 22 had history of diabetes, 20 had history of smoking, 12 had history of stroke, 22 had history of alcohol intake, 8 was found to have obesity, and 12 had sedentary lifestyle. Out of 46 ischemic stroke patients, 44 had history of hypertension, 34 had history of diabetes, 24 had history of smoking, 18 had history of stroke, 22 had history of alcohol intake, 9 were obese, and 23 had sedentary lifestyle. Lipid prole was found to be elevated in both type of stroke, however, total cholesterol and LDL were more in ischemic comparatively, while HDL and triglyceride was higher in haemorrhagic. ECG changes were seen in 52.5% of the patients and were more common in haemorrhagic stroke. Conclusion It was seen that the risk factors such as older age, hypertension, diabetes, dyslipidemia, sedentary lifestyles favoured ischemic stroke and smoking, alcohol, obesity favoured haemorrhagic stroke. Higher cholesterol and LDLlevels favoured ischemic more than haemorrhagic stroke. ECG changes were more common in haemorrhagic stroke

ODP112 Post-infusion ECG Changes in Patients Receiving Intravenous Bisphosphonates: a Systematic Review and Meta-Analysis

Abstract Bisphosphonates are the first-line treatment for several bone and mineral disorders. Randomized trials and cohort studies have reported increased rates of atrial fibrillation in patients receiving bisphosphonates, however, uncertainty remains as to whether other electrical disturbances are precipitated by bisphosphonates. We aimed to review the literature for studies reporting ECG findings in patients receiving intravenous bisphosphonates for any indication. We searched MEDLINE and EMBASE on 06/01/2022 for studies reporting ECG parameters following administration of intravenous bisphosphonates. We excluded studies that only reported atrial fibrillation, case reports and animal or cell-based studies. Study quality was assessed using the Newcastle-Ottawa Scale. Continuous data were meta-analysed if reported in at least two studies. Random-effects models were fitted and reported as standardized mean difference (SMD) with 95% confidence intervals (95%CI). Heterogeneity was determined by the I 2 statistic. All data were computed using R (4.1.1). We found 1,123 records of which six met our inclusion and exclusion criteria, of which five had data for meta-analysis. Studies were of low to moderate quality. Five studies used zoledronic acid while one study used pamidronate. Most studies [n=4] were conducted in postmenopausal women with osteoporosis, one study was conducted in patients with bone metastases and one study was conducted in children with cerebral palsy and osteoporosis. Most studies [n=4] reported outcomes in the sub-acute (>24 hours) phase. Study populations ranged from n=15 to n=116. There was a significant difference in QTc dispersion (SMD= -0.456 milliseconds [95%CI: -0.800 to -0.113]; I 2 = 0%; n= 67 patients; k= 2 studies) but no differences in heart rate, P wave (maximum), P wave (minimum), P wave dispersion, PR interval, QRS duration, QTc (maximum), QTc (minimum), or QTc. The correlation between pre- and post-infusion QTc dispersion was rho= 0.981 (p=0.866). Results were unchanged when analysing studies reporting acute or sub-acute phase ECG changes. Overall, there is insufficient and low quality evidence to support an association between intravenous bisphosphonate administration and acute phase dysrhythmias. These data underscore the importance of performing a pre-infusion ECG to evaluate potentially unreported conduction abnormalities. Presentation: No date and time listed

Prognostic Significance of Echocardiographic and ECG Changes in Patients with Acute Pancreatitis

Prognostic Significance of Echocardiographic and ECG Changes in Patients with Acute Pancreatitis

Remote Monitoring of Cardiovascular Risks of Medical Rehabilitation of Ischemic Stroke Patients Using Information and Telecommunication Systems

Due to the high incidence of cerebral stroke, the relevance of the problem of medical rehabilitation for this category of patients is beyond doubt. The increase in disability rates due to movement disorders among stroke survivors (3.2 per 100,000 population) necessitates the introduction of innovative rehabilitation technologies. Patients with cerebral stroke have a high risk of cardiocerebral complications, which should not limit the possibilities of medical rehabilitation. Therefore, the control of possible MR-risks is an important organizational aspect and can be implemented through the introduction of information and communication (ICT) and telemedicine technologies. Conducting dynamic telemetric ECG monitoring during of medical rehabilitation allows to prevent the development of possible cardiovascular risks and personalize the medical rehabilitation program. Aim. To study the effectiveness of remote tele-ECG monitoring based on information and communication technologies for assessing the cardiovascular risks of medical rehabilitation in patients with ischemic stroke. Material and methods. The study included 83 patients with ischemic stroke, mean age 55 [51; 57]), women – 44.6%, men – 55.4%; 42 patients in the early and 41 patients in the late recovery periods of ischemic stroke. All patients underwent a complex of multimodal rehabilitation techniques to restore hand dysfunction and statolocomotor disorders, carried out sequentially during one visit. For the purpose of dynamic control of probable cardiovascular risks, objectification of the state of the cardiovascular system, correction of the intensity and duration of rehabilitation loads, a portable information and communication technologies-based telecardiac complex was used for ECG registration. The ECG parameters were assessed in real time, as well as the stored data on the CardioOblako service. Results and discussion. The spectrum of ECG changes in patients in the early and late recovery periods of ischemic stroke was revealed. The dependence of ECG indexes and their dynamics on the duration of ischemic stroke and its subtype was determined. Asymptomatic changes in the form of heart rhythm disorders (14,4% – supraventricular rhythm disorders, 9,6% – ventricular extrasystoles of the 1st class), as well as repolarization processes (9,6% of cases) were registered during the course of rehabilitation measures. When discussing the results obtained, the probable neurogenic character of cardiac rhythm and conduction disturbances as a consequence of central neurogenic cardiovascular regulation, which is stabilized by central nervous system neuroplasticity over time, is emphasized. At the same time, the literature indicates that these processes can be regulated by therapeutic and rehabilitative measures. In our study, correction of the intensity and duration of rehabilitation loads normalized the changes of ECG indices registered in the process of medical rehabilitation. Conclusion. We determined the need for a comprehensive cardiovascular risk assessment program for patients with IS with the participation of a therapist/cardiologist using dynamic telemetric ECG monitoring during of medical rehabilitation for the timely detection and prevention of cardiovascular complications of medical rehabilitation, personalization of the medical rehabilitation program.

Cerebral Autoregulation and Cardiovascular Physiology Dysfunction in Traumatic Brain Injury Cases: A Brief Review

Introduction: Traumatic brain injury (TBI) is one of the leading causes of death and disability in the early years of life. Post-TBI physiological alterations vary across adult and pediatric patients and severity. This disease affects the quality of life of most people. Acute hemiparesis can cause cognitive impairments. It may also impact mood, memory, and decision-making. Furthermore, parasympathetic dysfunction and sympathetic activation appear to contribute to cardiac injury via modulation of the myocardial inflammatory response via acetylcholine receptors.
 Purpose: This review aims to explain the neuronal response and cardiac dysfunction after traumatic brain injury cases.
 Methods: The review used Pubmed and Google Scholar to search for articles on traumatic brain injury, neuronal response, and cardiac biomarkers. The articles were chosen for their language, publishing, content, exposure, and outcome. The main reference is obtained from up to 79 articles that meet the inclusion requirements.
 Results: TBI can cause localized brain injury or diffuse brain injury from physical trauma such as diffuse axonal injury or brain edema. Repeated concussions raise the likelihood of chronic neurological, cognitive, and behavioral issues. Stress-induced catecholamine surges and inflammatory mediator production in response to trauma may also endanger cardiac disturbances. ECG changes in patients with severe traumatic brain injury are associated with cardiac dysfunction. Cardiac enzymes can be used as a diagnostic tool and indicate the patient's prognosis.
 Conclusion: Cerebral autoregulation and cardiac physiological responses have a synergistic relationship in maintaining tissue homeostasis in patients with traumatic brain injury. Patients with TBI may experience cardiac dysfunction as a result of the body’s exaggerated systemic response to brain injury.

Diagnostic and prognostic role of the electrocardiogram in patients with pericarditis

ObjectiveThe ECG has been traditionally used to support the diagnosis of pericarditis. However, the pericardium is electrically silent and ECG changes may imply concurrent myocardial involvement rather than simple pericarditis....

Differentiating typical tako tsubo syndrome from extensive anterior ST-elevation myocardial infarction: look behind the anterior wall

Abstract Funding Acknowledgements Type of funding sources: None. Tako-Tsubo Syndrome (TTS) consists in transient left ventricular dysfunction resembling in its typical form acute anterior ST-elevation myocardial infarction (STEMI). Early non-invasive differential diagnosis, crucial for therapeutic purposes, appears difficult according to available data. Purpose to systematically analyze LV function and ECG changes in patients with acute anterior STEMI and TTS, to identify parameters possibly useful for differential diagnosis. Methods this is a retrospective cohort study, with 2 groups: patients with anterior STEMI and extensive apical involvement at echocardiography (n = 22); patients with TTS (n = 22) and ECG changes diagnostic for anterior STEMI at presentation (n = 22). They underwent a comprehensive clinical and echocardiographic evaluation in acute phase, including 2D speckle tracking longitudinal strain. We created new indexes based on wall motion impairment of inferior and inferior-lateral walls: the Inferior apex ratio (IAR) and inferior-lateral apex ratio (ILAR) (see picture). Results TTS and STEMI patients were similar for age (74.7 ± 9.1 vs 73.4 ± 14.1 y), sex, and main biochemical data except for higher peak troponin I in STEMI (1323 ± 622 vs 377 ± 220 ng/L, p = 0.01). ST segment elevation in V1 (V1e) was significantly less common in TTS (p < 0.001) while increased ratio of ST segment elevation in V4-V6 to V1-V3 (∑Ste V4-V6/∑Ste V1-V3≥1) was more common in TTS (p < 0.001). Among ECG parameters, absence of V1e had the best sensitivity (86%) and specificity (86%) in predicting TTS. LVEF values were similar (means: 45% in both groups) with EDVI greater in TTS (55.5 ±12.3 vs 46.6 ± 11.0 ml/m2, p = 0.02). WMSI was greater in TTS patients (2.2 ± 0.1 vs 1.9 ± 0.1, p < 0.0001), mainly for greater scores of mid segments. Global longitudinal strain was impaired in TTS (-8.1 ± 2.5 %) and in anterior STEMI (-7.9 ± 2.7, p = 0.8). By analyzing the single segments, strain was significantly more compromised in TTS in mid inferior (MI) (-4.3 ± 6.4 vs -9.9 ± 5.5 % in STEMI, p = 0.003) and mid inferior-lateral (MIL) segments (-5.4 ± 5.4 vs -9.6 ± 4.9 %, p = 0.009). Mean IAR was 0.7 ± 0.3 in TTS vs 1.8 ± 0.6 in STEMI, p < 0.0001; mean ILAR was 0.7 ± 0.1 in TTS vs 2.0 ± 0.9 in STEMI, p < 0.0001. ILAR was < I in all TTS patients, and > 1 in all STEMI cases. IAR < 1 showed 90% sensitivity and 95% specificity in predicting TTS. By multivariate linear regression analysis, strain values of MI and MIL segments were significantly associated with TTS (Beta: -0.98 and -0.97 respectively, p < 0.0001), independently from age, sex, and EDVI. IAR and ILAR values were significantly associated with TTS (Beta: -0.81 and -0.76 respectively, p < 0.0001) independently from the same co-variates as above. Conclusions evidence of impaired contractility extending beyond apex to mid inferior and inferior-lateral walls, assed by longitudinal strain or by IAR and ILAR, can help to discriminate TTS from extensive anterior STEMI, more accurately than ECG parameters. Abstract Figure. Examples of ILAR index Abstract Figure. IAR and ILAR distributions

Abstract 12060: Comparison of Sites of Wall Thickening and Abnormal Late Enhancement on Cardiac CT and Magnetic Resonance Imaging with Electrocardiography Findings in Patients with Confirmed Cardiac Amyloidosis

Introduction: Left ventricular (LV) wall thickening and diastolic dysfunction on a TTE without a high voltage R wave on V5 leads on an ECG to a diagnosis of cardiac amyloidosis (CA). However, amyloid sometimes invades right ventricle (RV), and left (LA) and right (RA) atria, causing ECG changes such as sick sinus syndrome (SSS), arrhythmia, and QRS wave axis deviation. Hypothesis: We hypothesize that there is the relationship between sites of wall thickening and abnormal late enhancement (LE) on cardiac CT and MRI, suggesting amyloid invasion, with ECG findings in patients with CA confirmed by biopsy. Methods: A total of 26 patients (11 females) with suspected CA, who had LV wall thickening by TTE without a high voltage R wave in V5 leads, underwent cardiac CT. 5 patients (3 females, mean age 73 years) were diagnosed with CA. 4 patients underwent MRI. Results: Case 1 had wall thickening in the basal interventricular septum (IVS), LV inferior-posterior wall, LA on CT, LE in endocardium in whole LV, RV, and RA on CT, and LE in endocardium in whole LV, RV, LA, and IVS on MRI. ECG showed SSS (junctional rhythm), left QRS axis deviation, no low voltage R wave in limb leads, and a mild LA load. Case 2 had wall thickening in whole LV, RV, LA, and IVS on CT, and unclear (CT) or no (MRI) LE. ECG revealed SSS (junctional rhythm), a normal QRS axis, no low voltage R wave in limb leads, and no LA load. Case 3 had wall thickening in LA and basal IVS on CT, abnormal LE in the LA and basal IVS on CT, and LE in the LA only on MRI. ECG revealed atrial tachycardia, a normal QRS axis with low voltage R wave in limb leads, and no LA load. Case 4 had wall thickening in the LA, an RV moderator band on CT, an unclear LE on CT, and LE in whole LV, endocardium in the RV, and whole IVS on MRI. ECG showed a normal sinus rhythm, left QRS axis deviation, with low voltage R wave in limb leads, and no LA load. Case 5 had wall thickening in the IVS, LV lateral wall, LV anterior wall, RA, RV outflow tract, and RA appendage, and no abnormal LE on CT (MRI not performed). ECG revealed a normal sinus rhythm, right QRS axis deviation, with low voltage R wave in limb leads, and a mild LA load. Conclusions: This pilot study revealed the presence of wall thickening and abnormal LE in RV, LA, and RA in addition to LV would be important which may influence ECG changes in patients with CA.

Abstract 12086: Relationship of Cardiac Rhythm and Other Electrocardiogram Findings with Sites of Wall Thickening and Abnormal Late Enhancement in Patients with Confirmed Cardiac Amyloidosis

Introduction: Left ventricular (LV) wall thickening and diastolic dysfunction on TTE without high voltage R wave on ECG to a diagnosis of cardiac amyloidosis (CA). However, amyloid sometimes invade right ventricle (RV), and left (LA) and right (RA) atria to cause ECG changes such as sick sinus syndrome (SSS), arrhythmia, and QRS axis deviation. Hypothesis: We hypothesized that sites of wall thickening and abnormal late enhancement (LE) on cardiac CT and MRI, suggesting amyloid invasion, correlated with cardiac rhythm and other ECG findings in patients with CA confirmed by biopsy. Methods: 26 patients (11 females) with suspected CA, showing LV wall thickening by TTE without a high voltage R wave, underwent cardiac CT. 5 patients (3 females, mean 73 years) were diagnosed with CA: complicated multiple myeloma, 2; senile ATTR (transthyretin) amyloidosis, 1; immunoglobulin light chain amyloidosis 1; and transthyretin mutation, 1. 4 patients underwent cardiac MRI. Results: 2 patients (cases 1 and 2) had SSS (junctional rhythm), 1 had atrial tachycardia, and the remaining 2 (cases 4 and 5) had a normal sinus rhythm. In case 1, ECG showed a left QRS axis deviation, no low voltage R wave and a mild LA load. Wall thickening in basal interventricular septum (IVS), LV inferior-posterior wall, LA on CT, LE in endocardium in whole LV, RV, and RA on CT, and LE in endocardium in whole LV, RV, LA, and IVS on MRI were observed. In case 2, ECG showed a normal QRS axis, no low voltage R wave, no LA load, wall thickening in whole LV, RV, LA, and IVS on CT, and unclear (CT) or no (MRI) LE. In case 3, ECG showed a normal QRS axis, with low voltage R wave, no LA load, wall thickening in LA and basal IVS on CT, LE in LA and basal IVS on CT, and LE in LA only on MRI. In case 4, ECG showed left QRS axis deviation, a low voltage R wave, and no LA load, wall thickening in LA and RV on CT, unclear LE on CT, and LE in whole LV, endocardium in RV, and whole IVS on MRI. In case 5, ECG showed a right QRS axis deviation, low voltage R wave, and a mild LA load, wall thickening in IVS, LV lateral wall, LV anterior wall, RA, RV outflow tract, and RA appendage, and no LE on CT (MRI not performed). Conclusions: The presence of wall thickening and abnormal LE in RV, LA, and RA in addition to LV on CT or MRI would be important which may influence ECG changes in patients with CA.

Flecainide induced ST segment changes can mimic pathological ECG changes in patients undergoing exercise testing: A case report.

Flecainide induced ST segment changes can mimic pathological ECG changes in patients undergoing exercise testing: A case report.

ECG changes in patients with breast cancer 2.5—3 years after anticancer treatment

ECG changes in patients with breast cancer 2.5—3 years after anticancer treatment

Prevalência das alterações eletrocardiográficas nos pacientes da Rede de Teleassistência de Minas Gerais, MG, Brasil

O eletrocardiograma é uma ferramenta muito utilizada para rastrear e detectar doenças cardíacas, que são uma dasprincipais causas de morte no Brasil. Alguns países vêm utilizando os recursos da telemedicina para possibilitar cuidadosà saúde nas situações em que a distância é um fator crítico, até mesmo no caso de doenças cardiovasculares. O Estadode Minas Gerais, por exemplo, conta desde 2006 com um sistema de telecardiologia, na Rede de Teleassistência de MinasGerais, que já abrange mais de 90% da população mineira. O presente trabalho busca identificar as principais alteraçõeseletrocardiográficas em pacientes da Rede de Teleassistência de Minas Gerais. Foi realizado um estudo retrospectivo,exploratório e descritivo dos eletrocardiogramas no período de janeiro a dezembro de 2011, a amostra aleatóriacomposta por 4.000 exames, em relação aos 318.387 exames laudados nesta base de dados em 2011. Esta amostratambém é estatisticamente proporcional à soma da população de todos os municípios que estão diretamenterelacionados a cada polo. Todos os exames desta amostra que possuíam alterações eletrocardiográficas foram agrupadose analisados quantitativamente. A principal alteração eletrocardiográfica encontrada em todos os polos da Rede deTeleassistência de Minas Gerais foi relacionada aos bloqueios intraventriculares (25,64%), seguido das arritmias cardíacas(22,86%). Dessa forma, os resultados do estudo poderão fornecer subsídios que auxiliem no planejamento de políticaspúblicas, colaborando para nortear programas que promovam uma assistência de qualidade na área.Palavras-chave: Eletrocardiografia; Telemedicina; Doenças Cardiovasculares.

CORRELATIONS OF CARDIOVASCULAR INDICATORS IN INSULIN-DEPENDENT DIABETES IN CHILDREN

In the study we examined children with type 1 diabetes, aged 8 to 17 years, divided into groups depending on the duration of the disease (up to 5 years and over 5 years) in order to study the electrocardiographic changes by daily Holter ECG monitoring depending on the duration of the disease, glycaemia and insulin therapy. Holter ECG monitoring was performed by ECG monitoring complex “DiaCard” ("SOLVAIG" JSC, Kyiv, Ukraine). During the monitoring, the subjects kept a diary of activity with a record of the symptoms, time and dose of insulin and other drugs, as well as indicators of glycaemia, time and quality of sleep. In addition to arrhythmias and conduction parameters, standard parameters of the whole ECG were determined, including ST segment analysis, as well as QT and QT corrected intervals and their dispersion. All ECG parameters per day were evaluated in comparison with the normative values of heart rate in healthy children according to sex and age. The results indicate that regardless of the duration of the disease, there are cardiac dysrhythmias, mainly associated with changes in the automatism of the sinus node and increased activity of ectopic foci of rhythm, which weakens the parasympathetic effects on the heart. Correlation analysis of the detected ECG changes in patients confirmed the progressive effect of the sympathetic part of the autonomic nervous system on heart rate, the relationship of glycaemia with repolarization of ventricles and heart rate, cardiac arrhythmias with changes in sleep structure and awakening according to heart rate. These data can be used to optimize the diagnosis of diabetic heart disease in children and to identify patients who need close attention from cardiologists.

Prevalence of Echocardioghraphic and ECG Changes in Patients With Acute Pancreatitis and Its Impact on Outcome.

Prevalence of Echocardioghraphic and ECG Changes in Patients With Acute Pancreatitis and Its Impact on Outcome.

ECG Changes in Patients of Visceral Leishmaniasis (Kala-Azar) Receiving Sodium Stibogluconate Therapy

Kala-Azar is a devastating parasitic disease caused by Leishmania donovani, increasing in our country and turning into serious public health problem in Bangladesh due to multiple problems. The standard drug for treatment of Kala- Azar is still Sodium Stibogluconate (SAG) in our country due to high cost of liposomal Amphotericin B. The aim of this study is to see the cardiac complication and electrographic alterations during SAG therapy in standard dose. One hundred and twenty five patients (62.4% male and 37.6% female) were included in this study. All had normal ECG prior to therapy. Various electrographic alterations were noted in 31 (24.8%) of the cases after starting antimony therapy. Most common changes seen in our study were T wave inversion (24.4%), reduced amplitude of T wave (7.3%) and ventricular ectopic (8%). These changes were observed during 2nd to 3rd weeks of therapy and disappeared within two weeks of stoppage of further antimony therapy. Alteration in ECG might be the prior evidence of cardiotoxicity and might explain sudden deaths encountered during antimony in Kala-Azar. Close clinical observations and ECG monitoring of the patients receiving antimony therapy for Kala-Azar is essential for early detection of cardiotoxicity and thereby to prevent further complications including sudden death Faridpur Med. Coll. J. Jul 2018;13(2): 70-73

Carotid artery atherosclerosis and ECG changes in patients with systemic lupus erythematosus: relation to disease activity and severity

AimThis study aimed to detect atherosclerotic changes in the carotid arteries of systemic lupus erythematous (SLE) patients as an indicator of cardiovascular risk factors and to correlate the findings with disease severity and activity parameters as well as to study specific ECG changes in these patients to elucidate possible associations between these variables.Patients and methodsThis study included 30 SLE patients who met the Systemic Lupus International Collaborating Clinics (SLICC) criteria (group I), 30 rheumatoid arthritis (RA) patients diagnosed according to the American College of Rheumatology/European league against rheumatism (EULAR) 2010 criteria (group II), and 30 apparently healthy volunteers age and sex matched to the SLE patients’ group (group III). All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity using the Systemic Lupus Erythematous Disease Activity Index (2 K) score and assessment of damage by the SLICC/American College of Rheumatology Damage Index (SDI). Laboratory investigations included: complete blood count, erythrocyte sedimentation rate, lipid profile, immunological profile (antinuclear antibodies, anti-double-stranded DNA antibody, anticardiolipin antibody, and complements C3 and C4). The right common carotid artery was scanned by ultrasound and the average of carotid intima media thickness (CIMT) was calculated (mean of four readings) for all participants participating in the study. ECG was also done for all participants.ResultsThe mean CIMT was higher in RA patients (0.71±0.194 mm) with a nonsignificant difference compared with SLE patients (0.68±0.197 mm) and a high statistically significant difference (P<0.001) compared with healthy controls (0.34±0.09 mm). There was no statistically significant correlation of the mean CIMT (mm) with SLICC damage index (P=0.09) and disease activity score (P>0.05). Abnormal ECG findings were observed in 3/30 SLE patients (10%), 10/30 RA patients (33.3%), and one/30 healthy control (3.3%), with statistically significant difference (P<0.03) among groups. The presence or absence of abnormal ECG findings showed statistically insignificant differences regarding patients’ disease activity and mean CIMT.ConclusionAlthough ECG changes were present in 10% of our SLE patients, association of specific ECG changes could not be confirmed. A greater prevalence of increased CIMT was observed in SLE patients, emphasizing the important role of this disease in the development of premature atherosclerosis which did not correlate with disease activity or severity parameters.

Can abnormal dispersion of ventricular repolarization be a predictor of mortality in arrhythmogenic right ventricular cardiomyopathy: The importance of Tp-e interval.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by ventricular arrhythmias and specific ventricular pathology. Repolarization abnormalities, the significant contributor to life-threatening arrhythmias and mortality, are frequently observed ECG changes in patients with ARVC. This study aimed to evaluate the changes in Tp-e interval, Tp-e/QT, Tp-e/QTc ratio, and traditional electrocardiographic features of electrical dispersion in patients with ARVC. A total of 105 participants were enrolled in the current study. The ARVC group consisted of 40 subjects (30 men, with a median of 35 (26-41) years), and the control group included of 65 age and sex-matched individuals (42 men, with a median of 37 (24-45) years). The Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were measured by the 12-lead electrocardiogram. Tp-e interval, cTp-e interval, Tp-e/QT, and Tp-e/QTc ratio were significantly higher in ARVC patients compared to the control group (all p<0.001). Tp-e interval, cTp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were significantly increased in deceased ARVC patients compared to the survival group (p=0.038, p<0.001, p=0.006, p=0.032, respectively). In the multivariate analysis, RV-FAC and cTp-e interval level (p<0.05 for each parameter) were associated with all-cause mortality [odds ratio 1.747 95% CI (1.012-3.018); p=0.045 and odds ratio 1.166, 95% CI (1.017-1.336); p=0.027, respectively]. Tp-e interval, cTp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were prolonged in patients with NC. We revealed that abnormal dispersion of ventricular repolarization suggests the increased risk of mortality in ARVC.