Abnormal Electrocardiogram Research Articles

ELECTROCARDIOGRAPHY FINDINGS IN BLUNT CHEST TRAUMA AT TERTIARY CARE HOSPITAL PESHAWAR

Introduction: Blunt chest trauma is a significant cause of morbidity and mortality, often leading to a range of cardiac complications detectable through electrocardiogram (ECG) abnormalities. Objectives: The primary objective of this research was to identify the early onset of myocardial damage in patients with acute blunt chest injuries using ECG. The secondary objective is being to compare the ECG changes between paediatric and adult trauma patients. Methodology: This cross-sectional study was conducted in the Emergency department (ED) and patients admitted with acute blunt chest trauma were included in the current study. A total of 281 patients were included based on the following inclusion criteria: patients of all ages with blunt chest trauma. Exclusion criteria included preexisting cardiac and neurological conditions, penetrating chest injuries, pregnant women and incomplete medical records. Demographic and clinical data were collected, and a standard 12-lead ECG was performed and analyzed for abnormalities. Statistical analysis was done using SPSS version 26, where chi square test was applied to identify factors that may be associated with ECG abnormalities and assess age-related differences in ECG findings. Results: ECG findings in patients with blunt chest trauma, recorded in 30.9% of the total sample. Sinus arrhythmia's, particularly sinus tachycardia were the most common findings in both adults (6.2%) and pediatrics (8.1%). In adult’s sinus tachycardia was followed by ST segment changes and atrial fibrillation. In pediatrics, sinus tachycardia was accompanied by PVCs and supraventricluar tachycardia. Conclusion: Sinus arrhythmias were the most common findings in both group, followed by ST segment changes and atrial fibrillation in adults while in pediatrics, followed by PVCs and SVT.

ELECTROCARDIOGRAPHIC CHANGES AMONG PATIENTS WITH CIRRHOSIS RELATED TO VIRAL HEPATITIS

Background: Liver cirrhosis, characterized by regenerative nodules and fibrosis, is a major cause of morbidity and mortality worldwide, particularly in Asia. It is frequently associated with cardiac and electromechanical abnormalities, including prolonged QT intervals, low QRS voltage, left ventricular hypertrophy, and T-wave inversions. Although these abnormalities have been extensively studied in alcoholic liver disease, data on cirrhosis caused by viral hepatitis, particularly hepatitis B and C, remain limited. Objective: This study aimed to document the frequency and types of electrocardiographic changes in patients with cirrhosis caused by viral hepatitis (hepatitis B and C). Methods: This cross-sectional study was conducted at the Hepatogastroenterology Department of the Sindh Institute of Urology and Transplantation between March and August 2024. A total of 175 patients aged 18–65 years with cirrhosis secondary to hepatitis B or C were included using non-probability consecutive sampling. Patients with pre-existing cardiac diseases or other confounding conditions were excluded. Clinical and laboratory data, including Child-Turcotte-Pugh (CTP) and MELD scores, were collected. Electrocardiograms (ECGs) were assessed for QT prolongation, low QRS voltage, left ventricular hypertrophy, and ST-T wave changes. Data were analyzed using SPSS version 20, with results expressed as means and percentages. Results: The mean age of participants was 48.9 ± 9.1 years, with 60% being male. Hepatitis C was the leading cause of cirrhosis (57.1%), followed by hepatitis B (22.9%) and hepatitis B-D co-infection (20%). ECG abnormalities were observed in 54.3% of patients, with prolonged QT intervals being the most frequent (22.3%), followed by combined low QRS voltage and ST-T changes (16%), isolated low QRS voltage (8.6%), and left ventricular hypertrophy (3.4%). Conclusion: Electrocardiographic abnormalities, particularly QT prolongation and low QRS voltage, are common in cirrhotic patients with viral hepatitis and correlate with disease severity. Routine cardiac evaluations could enhance disease monitoring and prognostic assessment in this population.

CO2 field-flooding devices offer potential value for cardiopulmonary bypass procedures for CHD performed via a right-side small incision approach

ObjectiveThis study sought to evaluate the value of a CO2 field-flooding device in cardiopulmonary bypass (CPB) surgical procedures for congenital heart disease (CHD) performed via a right-side small incision approach.MethodsBetween April 2022 and December 2023, 234 children with simple CHD who underwent CPB via a right-side small incision approach were separated into a control group (n = 93) without the use of a CO2 field-flooding device and a treatment group (n = 141) in which this device was added to the traditional surgical manual exhaust. Demographic, perioperative, arterial blood gas (ABG), and laboratory test data were then compared between these groups of patients.ResultsThere was a significant difference in abnormal electrocardiogram (ECG) after aorta de-clamping during CPB, and interventions for abnormal ECG after aorta de-clamping during CPB between the control and treatment groups (17(18.3%) vs.14(9.9%), P = 0.048;12(85.7%) vs.7(50%),P = 0.013). The treatment group exhibited a lower pH (7.34 ± 0.07 vs. 7.36 ± 0.06, P = 0.039) and a higher PaCO2 (43.08 ± 7.36 vs. 38.86 ± 5.65 mmHg, P = 0.042) at the time of 30 min after initiation of CPB. A significant reduction in postoperative CK-MB was observed in treatment group (41.20 ± 17.88 vs. 56.57 ± 22.99 U/L, P = 0.002). Lower 3-day postoperative CRP levels were also observed in the treatment group relative to control (5.77 ± 0.48 vs. 9.45 ± 0.98 mg/L, P < 0.001). The S100ß concentration in the relevant patient cohort increased significantly from the time just after induction, intubation, and installation of the right central venous line to the time of admission to CCU (71.61 ± 11.83 vs. 124.04 ± 38.80, P = 0.01) and at the time of 24 h after operation (71.61 ± 11.83 vs. 101.97 ± 30.31, P = 0.01). No differences on S100β serum concentration level were found at the time of installation of the right central venous line between two groups. But there were statistically significant differences in S100β serum concentration level at the time of admission to CCU between control group and treatment group. (161.19 ± 6.62 vs. 86.89 ± 9.69 pg/ml, P = 0.01). Similar results were observed at the time of 24 h after operation. (127.62 ± 19.44 vs. 76.33 ± 10.40, P = 0.01).ConclusionThese data suggest that the CO2 field-flooding device can safely be used when performing CPB surgical procedures via a right-side small incision approach to treat CHD without hypercapnia. The use of such a CO2 field-flooding device at a flow rate of 5 L/min may help protect against cardiac and nervous system damage in children undergoing CHD surgery.

Osimertinib induced cardiac failure and atrial flutter in a patient with advanced pulmonary adenocarcinoma: A case report and review of the literature

&lt;b&gt;Background: &lt;/b&gt;Osimertinib-induced cardiotoxicity is a significant but rare condition. This article reports a case of an elderly patient who developed cardiac failure and atrial flutter due to Osimertinib treatment, potentially related to both the drug and the patient’s underlying factors.&lt;br /&gt; &lt;b&gt;Case presentation:&lt;/b&gt; A 63-year-old man diagnosed with advanced non-small cell lung cancer (NSCLC) with bone metastasis was found to have an epidermal growth factor receptor mutation (exon 19 deletion). He had undergone four prior treatment regimens, including afatinib and bevacizumab. After two years, he developed resistance and experienced brain and bone metastases, prompting a switch to Osimertinib (80 mg/day). Before starting Osimertinib, he had a history of coronary artery disease and hypertension, with a normal electrocardiogram (ECG) and a left ventricular ejection fraction (LVEF) of 53%. However, nearly two months after initiating Osimertinib, he was presented with cardiac failure symptoms, with LVEF decreasing to &amp;lt;53% and atrial flutter observed on ECG. Suspecting drug-induced cardiotoxicity, Osimertinib was discontinued. Following cessation of the drug, his cardiac function improved, and the ECG abnormalities resolved. This case represents the first reported instance of concurrent cardiac failure and atrial flutter associated with Osimertinib treatment.&lt;br /&gt; &lt;b&gt;Conclusions: &lt;/b&gt;As Osimertinib continues to significantly enhance survival in NSCLC, there remains a need for active monitoring of cardiac adverse events in patients undergoing Osimertinib treatment. These events can be life-threatening but are usually reversible after discontinuation of the drug.

Right vertical axillary incision vs. median sternotomy for congenital ventricular septal defect repair in children: a propensity score-matched study.

To retrospectively assess the outcomes of open-heart repair for ventricular septal defect in children using a right vertical axillary incision compared to median sternotomy. From January 2022 to May 2023, children who underwent open-heart surgery for the repair of congenital ventricular septal defect in our department were selected for a propensity score-matched study. The propensity score matching method was utilized to pair children in the right vertical axillary incision group with those undergoing surgery via median sternotomy at a 1:1 ratio, based on age and weight. There were 35 cases in each group. In the right vertical axillary incision group, the median age was 15 (7-40) months and the median weight was 8 (7-12) kg. In the median sternotomy group, the median age was 7 (3-37) months and the median weight was 7 (5-14) kg. The age (Z = -1.871, p = 0.061) and weight (Z = -1.462, p = 0.144) of the two groups showed no significant differences. The right vertical axillary incision group exhibited a significantly shorter incision length compared to the median sternotomy group (p < 0.001). Additionally, the median postoperative drainage was lower in the right vertical axillary incision group than in the median sternotomy group (p = 0.044), indicating statistical significance. No significant differences were observed between the groups concerning operation time (p = 0.565), bypass time (p = 0.855), cross-clamp time (p = 0.204), oxygenation index one hour post-surgery (p = 0.651), pleural effusion at 12 h post-surgery (p = 0.470), abnormal postoperative electrocardiogram (p = 0.452), cardiac intensive care unit duration (p = 0.211), or length of hospital stay (p = 0.095). The hospitalized children were followed up for 3 months to 1 year, during which there were no fatalities or complications. Open-heart repair of congenital ventricular septal defect through a right vertical axillary incision is a safe and effective surgical technique that minimizes surgical trauma and enhances aesthetic outcomes.

Association of Cardiovascular Risk Factors With Major and Minor Electrocardiographic Abnormalities: A Report From the Cross-Sectional Phase of Tehran Cohort Study.

In the current study, we aimed to identify the association between major and minor electrocardiographic abnormalities and cardiovascular risk factors. We used the Tehran cohort study baseline data, an ongoing multidisciplinary, longitudinal study designed to identify cardiovascular disease risk factors in the adult population of Tehran. The electrocardiograms (ECGs) of 7630 Iranian adults aged 35 years and above were analyzed. ECG abnormalities were categorized into major or minor groups based on their clinical importance. Results were obtained by multivariable logistic regression and are expressed as odds ratios (ORs). A total of 756 (9.9%) participants had major ECG abnormalities, while minor abnormalities were detected in 2526 (33.1%). Males comprised 45.8% of the total population, and 41.8% of them had minor abnormalities. Individuals with older age, diabetes (OR = 1.35; 95% CI: 1.11-1.64), and hypertension (OR = 2.21; 95% CI: 1.82-2.68) had an increased risk of major ECG abnormalities. In contrast, intermediate (OR = 0.69; 95% CI: 0.57-0.84) and high physical activity levels (OR = 0.66; 95% CI: 0.51-0.86) were associated with a lower prevalence of major abnormalities. Male sex, older age, hypertension, and current smoking were also associated with an increased prevalence of ECG abnormalities combined (major or minor). Major and minor ECG abnormalities are linked with important cardiovascular risk factors such as diabetes and hypertension. Since these abnormalities have been associated with poor outcomes, screening patients with cardiovascular risk factors with an ECG may distinguish high-risk individuals who require appropriate care and follow-up.

Bradycardia in severely dehydrated cholera patient: A case report

Rationale: Cholera is an acute diarrheal disease caused by the ingestion of food or water contaminated by Vibrio cholerae. It threatens global health and signifies a lack of proper access to clean water and sanitation. If not treated properly, cholera causes severe watery diarrhea that can lead to hypovolemic shock. Patient’s Concern: A 23-year-old male patient was admitted with severe diarrhea with a frequency of fifteen to twenty loose, watery stools and was severely dehydrated. The patient developed severe bradycardia with a positive serum troponin level and no chest pain. Initial electrocardiogram on the day of admission was sinus tachycardia with a heart rate of 120 beats/min on the third day of admission, the patient developed bradycardia with a heart rate of 45 beats/min with a prolonged QT interval of 550 msec (corrected QT interval 476 msec). Diagnosis: Cholera with sinus bradycardia with prolonged QT interval. Interventions: Based on the clinical situation and the inferior vena cava status determined by ultrasound, a thorough fluid resuscitation using crystalloids was performed. The patient was then administered antibiotics: oral doxycycline 300 mg STAT and intravenous ciprofloxacin 15 mg/kg twice daily for three days. Outcomes: After 5 days of adequate hydration and antimicrobial treatment, diarrhea was resolved and heart rate improved with no electrocardiogram abnormalities. Lessons: This case report highlights the importance of timely diagnosis and managing severe diarrhea in cholera patients to prevent morbidity and mortality. Public awareness regarding cholera and its complications is necessary for the betterment of the community.

A 52-week, open-label, observational study evaluating tolerability, efficacy and physicians satisfaction of rivastigmine oral solution in Alzheimer's disease in Taiwan

Background There is limited data on the use of rivastigmine oral solution in patients with Alzheimer's disease (AD). Objective To evaluate the tolerability, efficacy and physicians’ satisfaction of Rivast® (rivastigmine oral solution 2 mg/ml) in Taiwanese patients with mild to moderate AD over a 52-week period. Methods An open-label, non-comparative, observational study was conducted across four hospitals in Taiwan. 142 Patients with mild to moderate AD were enrolled. Adverse events and adherence rates were monitored throughout the 52-week study period, while cognitive (Mini-Mental State Examination (MMSE)) and global functional outcomes (Clinical Dementia Rating (CDR)-Sum of Boxes) were recorded at baseline and at week 52. Factors associated with discontinuation, adverse events, and declines in cognitive and global function were determined. Results The study achieved a 92.3% adherence rate, with 19% experiencing adverse events. The optimal dose was 3.8 ml, reached within 8.3 weeks. 43.7% of the patients reached an optimal dose of 4 ml and 59.8% achieved optimal dose within 4 weeks. Age and clinically significant electrocardiogram (EKG) abnormalities were associated with a higher risk of discontinuation, while female patients exhibited a lower risk. Additionally, both a higher initial dose and a higher optimal dose were associated with a reduced risk of adverse effects. Abnormal EKG findings were significantly associated with cognitive decline. More time to optimal dose was significantly associated with worse global function. All physicians regarded the medication is ease of use and the administration schedule is simple. Conclusions This study provides valuable insights into the tolerability and efficacy of rivastigmine oral solution in Taiwanese patients with mild to moderate AD.

Cardiovascular Disease Screening in Primary School Children.

Screening for cardiovascular disease (CVD) and its associated risk factors in childhood facilitates early detection and timely preventive interventions. However, limited data are available regarding screening tools and their diagnostic yield when applied in unselected pediatric populations. To evaluate the performance of a CVD screening program, based on history, 12-lead ECG and phonocardiography, applied in primary school children. The methods used were prospective study, with voluntary participation of third-grade primary school children in the region of Crete/Greece, over 6 years (2018-2024). Personal and family history were collected by using a standardized questionnaire and physical evaluation (including weight, height, blood pressure measurement), and cardiac auscultation (digital phonocardiography (PCG)) and 12-lead electrocardiogram (ECG) were recorded at local health stations (Phase I). Following expert verification of responses and obtained data, assisted by designated electronic health record with incorporated decision support algorithms (phase II), pediatric cardiology evaluation at the tertiary referral center followed (phase III). A total of 944 children participated (boys 49.6%). A total of 790 (83.7%) had Phase I referral indication, confirmed in 311(32.9%) during Phase II evaluation. Adiposity (10.8%) and hypertension (3.2%) as risk factors for CVD were documented in 10.8% and 3.2% of the total population, respectively. During Phase III evaluations (n = 201), the majority (n = 132, 14% of total) of children were considered as having a further indication for evaluation by other pediatric subspecialties for their reported symptoms. Abnormal CVD findings were present in 69 (7.3%) of the study population, including minor/trivial structural heart disease in 23 (2.4%) and 17 (1.8%), respectively, referred due to abnormal cardiac auscultation, and ECG abnormalities in 29 (3%), of which 6 (0.6%) were considered potentially significant (including 1 case of genetically confirmed channelopathy-LQT syndrome). CVD screening programs in school children can be very helpful for the early detection of CVD risk factors and of their general health as well. Expert cardiac auscultation and 12-lead ECG allow for the detection of structural and arrhythmogenic heard disease, respectively. Further study is needed regarding performance of individual components, accuracy of interpretation (including computer assisted diagnosis) and cost-effectiveness, before large-scale application of CVD screening in unselected pediatric populations.

Smoking-associated electrocardiographic abnormalities predict cardiovascular mortality

Background —Smoking is associated with arrhythmia and sudden cardiac death, but the biological mechanisms remain unclear. In electrocardiogram (ECG) recordings abnormal durations of ventricular repolarization (QT interval), atrial depolarization (P wave), and atrioventricular depolarization (PR interval and segment), predict cardiac arrhythmia and mortality. Previous analyses of the National Health and Nutrition Examination Survey (NHANES) database for associations between smoking and ECG abnormalities were incomplete. To elucidate how smoking affects cardiac excitation, we assessed in a nationally representative sample (NHANES III) the association between serum cotinine and P duration, PR interval, PR segment, rate-corrected QT (QTc), QRS duration, and JT interval. Methods and Results—We analyzed data from 5,653 adults using survey-weighted multinomial logistic regression to estimate associations between tobacco use (> 15 ng/ml serum cotinine) and short (< 5th percentile) or long (> 95th percentile) ECG intervals, relative to reference (5–95th percentile). After adjustment for demographics, risk factors, and conduction-altering medications, smoking was associated with a higher odds of short PR interval, PR segment, and QRS, and long JT. Broader effects of smoking on ECG were also assessed by survey-weighted linear regression of continuous cotinine and ECG, which revealed cotinine inversely associated with PR segment and QTc. Over a 22-year follow-up, many ECG abnormalities predicted cardiovascular mortality in smokers, including long JT, QRS, and QTc, and short QRS, whereas only short JT predicted mortality in nonsmokers. Conclusions —Smoking increases likelihood for rapid atrioventricular and ventricular depolarization and slow ventricular repolarization, which may promote cardiac arrhythmia and mortality.

Alteraciones mayores del electrocardiograma y riesgo cardiovascular en población mediterránea de medio y alto riesgo

Major electrocardiogram abnormalities (MECG) are common in middle-aged and older individuals and could be an important factor in predicting cardiovascular events. To analyse the association between MECG (Minnesota classification) and CVE independently of classic cardiovascular risk factors (CVRF), and to assess whether they improve the prediction according to the Spanish Coronary Event Risk Function (FRESCO). 1.752 participants included in three nodes of the PREDIMED study aged between 55 and 80 years with medium or high CVRF. Mean follow-up time was 5.1 years. Cumulative CVE incidence was estimated by sex with and without MECG, and hazard ratios by sex were estimated using multivariate Cox regressions adjusted for randomization group and CCRF (FRESCO). Harrel's C Indices, Nam d'Agostino, Net Reclassification Improvement, and Integrated Discrimination Improvement were calculated. At baseline, 25% of the participants shows major electrocardiogram abnormalities (AMECG). During follow-up, there were 112 cardiovascular events (16 cardiovascular deaths, 15 acute myocardial infarctions, 38 anginas, 43 strokes). MECG were significantly associated with the onset of CVE. In men, left ventricular hypertrophy (LVH) criteria were associated with T-wave inversion (HR: 17.88, 95% CI: 5.51-58.03, pvalor<.001) and QT interval prolongation (HR: 2.41, 95% CI: 1.38-4.21, pvalor=.002); in women, atrial fibrillation (HR: 5.7, 95% CI: 1.76-18.72, pvalor=.006) and ST-segment depression (HR: 3.24, 95% CI: 1.36-7.71, pvalor<.001) were associated. No significant improvement in MECG prediction compared to FRESCO was observed. MECG are independently associated with the occurrence of CVE, but do not improve risk prediction beyond traditional risk factors.

Evaluating the diagnostic accuracy of reduced lead paediatric electrocardiograms.

Alternate electrocardiogram acquisition with fewer leads lacks systematic evaluation in children. This study aims to determine if electrocardiograms with fewer leads maintain diagnostic accuracy in paediatrics. This is a single-centre review of 200 randomly selected standard 12-lead electrocardiograms from our hospital database (2017-2020) for patients aged 2 weeks to 21 years. An overlay technique generated 8-lead (limb + V1/V6) and 6-lead (limb only) variations of the 12-lead tracings, resulting in a total of 600 electrocardiograms, which were then interpreted by two independent paediatric electrophysiologists. In total, 18% (35/200) of the baseline electrocardiograms were abnormal. Intervals were measured in lead II for all electrocardiograms. Comparing 12-lead to 6- and 8-lead electrocardiograms, there was almost perfect agreement for specific rhythm identification (97.5-100%, κ 0.85-1). The 8-lead showed substantial agreement with 12-lead electrocardiograms when identifying specific electrocardiogram patterns (97.5-100%, κ 0.66-1). A similar degree of agreement was not demonstrated with the 6-lead variant. Utilising the 12-lead electrocardiogram as the gold standard, sensitivity and specificity of the 8- and 6-lead electrocardiogram were > 89% for specific rhythm identification. Specificity for specific pattern recognition was > 99% while sensitivity was < 90% for certain variables for both 6- and 8-lead electrocardiogram, likely due to smaller sample size and fewer abnormal electrocardiograms. There was high percent reader agreement (92.5-100%). 8-lead electrocardiograms provide comparable diagnostic accuracy to 12-lead electrocardiograms for children. This information holds potential for future technological advancements in electrocardiogram acquisition tailored specifically for paediatrics. Additional studies are required to further refine conventional electrocardiogram acquisition.

Clinical significance of elevated serum cardiac troponin T and associated risk factors in patients diagnosed with acute ischemic stroke

Objective: We explored the clinical significance and associated risk factors of increased levels of serum cardiac troponin T (cTnT) in individuals suffering from acute ischemic stroke (AIS). Methods: Our study subjects consisted of patients who were admitted with AIS within 48 hours of its onset. These study participants were categorized based on their levels of cTnT into two groups: normal cTnT group and elevated cTnT group. We collected and subjected a range of data to statistical analysis, including general clinical traits, medical history, laboratory test results, electrocardiograms, imaging scans, and medical records like the National Institute of Health Stroke Scale (NIHSS) scores of the patients. Results: Out of the 232 patients diagnosed with AIS, 84 individuals (36.21%) exhibited raised levels of cTnT. When comparing this elevated cTnT cohort to the group with regular cTnT levels, those with elevated cTnT were older [with a median age of 76 year (interquartile range: 67 to 83) as compared to 70 year interquartile range: 61 to 79), P = 0.002], and they presented with higher NIHSS scores upon admission [8.5 (interquartile range: 4 to 14) compared to 5 (interquartile range: 2 to 9), p = 0.002]. In addition, a larger percentage of patients in the elevated cTnT group had both coronary artery disease (23.81% vs. 7.43%, P &lt; 0.001) and cardiac insufficiency (25.00% vs. 3.38%, P &lt; 0.001) as comorbidities. Meanwhile, the elevated cTnT group also displayed a higher occurrence of electrocardiogram abnormalities, including bundle branch block (29.76% vs. 9.46%, P &lt; 0.001) and atrial fibrillation (32.14% vs. 11.49%, P &lt; 0.001), in comparison to the normal cTnT group. The clinical data and related laboratory indicators of patients were collected for risk factor analysis, which showed that bundle branch block [odds ratio (OR) = 4.17, 95% confidence interval (95%CI) = 1.43–12.16), log to base 10 N-terminal pro-brain natriuretic peptide (Log10NT-proBNP; OR = 3.41, 95%CI = 1.62-7.16), cystatin C (OR = 6.86, 95%CI = 2.01–23.43), and neutrophil/lymphocyte ratio (OR = 1.13, 95%CI = 1.02–1.25) were independent risk factors for elevated cTnT in patients with AIS. Conclusions: Older patients with AIS who had higher levels of cTnT exhibited more severe neurological impairments and a greater number of comorbidities. Furthermore, an elevated cTnT in patients with AIS may be linked to cardiac insufficiency, changes in kidney function, and signs of inflammation.

IMPACT OF COVID-19 ON DIAGNOSTIC ANALYSIS OF MYOCARDITIS

Introduction: Myocarditis is a disease caused by inflammation of the heart muscle, the myocardium. The myo-cardium is responsible for contracting and relaxing to pump blood in and out of the heart and the rest of the body. When this muscle becomes inflamed, its ability to pump blood becomes less effective. This causes prob-lems such as abnormal heartbeat, chest pain, or breathing disorders. In extreme cases, it can also cause blood clots that lead to heart attack, stroke, and even death. Purpose: To study the aggravating factors of COVID-19 that caused myocarditis and its prevention. Despite the distinctive clinical signs of patients with COVID-19, there are still elements that remain undiscovered, such as the prognostic factors of COVID-19, which include external factors, such as viral load and internal factors, which include the health conditions of the individual, the incidence rate of myocarditis and distinguishing signs. Materials and Methods: This is a retrospective study highlighting the clinical and radiographic signs of the above cases diagnosed with COVID-19. Demographic, epidemiologic, radiologic, and laboratory data collected from medical record reviews of adult patients diagnosed with COVID-19 provided the basis for their follow-up. Measurement of the cycle threshold value (Ct), real-time PCR (RT-PCR), electrocardiogram (ECG), and meas-urement of pulmonary inflammation index (PII) values were among the most frequent examinations performed in these patients. Results: In the study, 75 adult patients diagnosed with COVID-19 admitted to QSUNT were included, of which 15 cases were severe and 60 were in stable condition. The viral load of severe cases was significantly higher than that of stable patients, regardless of PCR values. Typical Ct abnormalities were more likely to exist in the severe group than in the non-severe group, associated with consolidation and thickening of the interlobular sep-tum and increased PII values. Of the 75 patients, 12 patients were noted to have an abnormal ECG and elevated serum myocardial enzyme levels, and five were clinically diagnosed with SARS-COV-2-induced myocarditis. Conclusion: During the patient study, three independent risk factors of COVID-19 were identified, which in-cluded age, PII, and Ct value. The Ct value is closely related to the severity of COVID-19 and may act as a pre-dictor of the clinical severity of early-stage COVID-19. Oxygen pressure, along with laboratory tests, are ele-ments that should not be neglected as they are also closely related to the severity of COVID-19.

Pulmonary involvement in systemic sclerosis: can sex play a role?

Systemic sclerosis (SSc) is a rare and complex autoimmune disease with significant complications. During the last few years, research interest focuses on the differences between female and male patients. However, there is a lack of data regarding the role of sex in the presence of small airway disease (SAD). Therefore, we aimed to investigate the impact of sex on pulmonary involvement in a cohort of SSc patients, focusing primarily on small airways. For this retrospective study, consecutive patients with a diagnosis of SSc, that visited our department until January 2024, were recruited. Demographic data, disease manifestations, serological profile, and internal organ involvement were compared between the two groups. In total 393 patients (female-to-male ratio 6:1) were included. Median time to diagnosis after the onset of Raynaud's was significantly longer for female patients. Electrocardiogram abnormalities were more common in male patients, while telangiectasias, calcinosis and arthralgias were more common in female individuals. Moreover, male SSc patients exhibited a higher prevalence of ILD and shorter time until the diagnosis of ILD. However, female individuals demonstrated a lower maximal-mid expiratory flow rate (MMEF) and higher ratio of residual volume to total lung capacity. Interestingly, sex remained an independent predictor of MMEF, in the multivariate analysis. Our results showed that, although ILD is more common in male SSc patients, SAD was more prevalent among female individuals. Importantly, female sex remained an independent predictor of SAD. This study further supports the presence of sex-related differences in SSc, with important implications in disease course and management.

Sepsis, Hypothermia, and the Emergence of Osborn Waves: A Case Report

Hypothermia and sepsis are two serious clinical entities with overlapping presentations, both capable of inducing electrocardiogram (ECG) abnormalities. We present a rare case of a 43-year-old male patient with coincident sepsis, acute kidney injury, and profound hypothermia that was complicated by the development of Osborn ( J) waves and conduction abnormalities on the ECG. The patient’s core temperature was gradually restored to normal utilizing both passive and active rewarming techniques, resulting in the disappearance of the Osborn wave. Concurrently, his cognitive state and cardiovascular parameters became stable after intensive sepsis treatment. Osborn waves arise from changes in the action potential and ion channel activity between the epicardium and the endocardium. These phenomena can be detected in several medical circumstances, including hypothermia, sepsis, subarachnoid hemorrhage, Brugada syndrome, and acute coronary syndrome. This case highlights the complexity of the diagnosis and management of such clinical scenarios.

Analysis of the influencing factors of abnormal blood pressure and electrocardiogram in occupational motor vehicle drivers

Objective: To explore the influencing factors of abnormal blood pressure and electrocardiogram (ECG) in occupational motor vehicle drivers. Methods: In January 2024, a cluster sampling method was used to study 606 occupational motor vehicle drivers from a transportation service enterprise in Beijing who completed occupational health examination in 2023 in Peking University Third Hospital as observation group and 596 non-occupational motor vehicle drivers as control group. The data of personal history, occupational history, blood pressure and ECG were collected, and the effects of occupational motor vehicle driving on hypertension and ECG were analyzed by multivariate logistic regression. Results: The age of workers in the observation group was (34.1±7.8) years old, and the length of service was (7.0±7.1) years. The age of the control group was (33.8±7.6) years old, and the working age was (7.7±6.5) years. There was no significant difference in age and length of service between the two groups (t=0.62, -1.90, P=0.538, 0.057). Systolic blood pressure (133.0±14.7) mmHg, diastolic blood pressure (83.7±11.6) mmHg, hypertension detection rate of 33.0% (200/606), ECG abnormality detection rate of 39.9% (242/606). They were significantly higher than those in the control group [ (127.8±14.4) mmHg, (77.5±11.0) mmHg, 24.7% (147/596), 31.0% (185/596) ], and the differences were statistically significant (P<0.05). Multivariate logistic regression analysis showed that occupational motor vehicle driving were risk factors for hypertension and abnormal ECG (OR= 1.210, 1.578; 95% CI: 1.145-1.231, 1.237-2.012; P<0.001) . Conclusion: Occupational motor vehicle driving may increase the risk of hypertension and abnormal ECG in workers.

Genetic and clinical characteristics of 26 cases with glycogen storage disease type Ⅲ

Objective: To investigate the genetic, clinical, and post-treatment characteristics of patients with glycogen storage disease type Ⅲ (GSD Ⅲ). Methods: A retrospective cohort analysis was performed on the genetic and clinical data of 26 cases with GSD Ⅲ who visited the Children's Hospital affiliated with Fudan University from June 2017 to December 2023. The patients were divided into non-missense variation and missense variation groups according to the types of mutation in the AGL gene.The correlation between genotype and phenotype was analyzed. All patients were treated with uncooked cornstarch after diagnosis. The changes before and after treatment were compared in patients who underwent more than twelve months of follow-up. A P value of <0.05 was used to denote statistical significance. Results: Among the 26 cases enrolled, 13 were female and 13 were male, and the median age of diagnosis was 28 (6 to 134) months. A total of thirty-five different types of AGL gene variation were detected, with c.1735+1G＞T (9/52, 17.3%) as the hotspot variation. The common clinical manifestations were elevated aminotransferases (26/26, 100%), hepatomegaly (25/26, 96.2%), fasting hypoglycemia (25/26, 96.2%), hyperketonemia (16/18, 88.9%), hypertriglyceridemia (TG) (20/26, 76.9%), elevated CK (16/25, 64.0%), and an abnormal electrocardiogram (12/16, 75.0%). Four cases (15.4%) had symptoms of myopathy at diagnosis. Liver biopsy was performed in eighteen cases, among whom 83.3% (15/18) had liver fibrosis≥S2. The number of cases with elevated levels of CK (P＝0.031) and ALT (P＝0.038)was pronounced in the non-missense variation group compared to that in the missense variation group. There were no statistically significant differences in age, height, liver size, degree of fibrosis, fasting blood glucose (Glu) and TG (P>0.05). The median follow-up time of 14 cases was 40.5 (20-73) months, with improvement in body stature, reduced liver size, decreased ALT and TG, and improved Glu. However, four (28.6%) cases had new myopathy symptoms with raised CK (P<0.05) and with advancing age, increased ALT diminished while CK level elevated (P<0.05). Conclusions: The common clinical manifestations at the early stage of the GSD Ⅲdiagnosis are elevated aminotransferases, hepatomegaly, fasting hypoglycemia, hyperketonemia, high triglycerides, elevated CK, and fibrotic liver in China. Myopathy symptoms may arise following uncooked cornstarch treatment; however, there is significant improvement in height, liver-related, and metabolic parameters.

Aeromedical Fitness Considerations in Myocardial Bridging: A Case Study and Literature Review

Aims: Management of cardiac disease in aeromedical expertise can be challenging for asymptomatic crew members, especially during the first aeromedical examination, myocardial bridging is a good example. Presentation of Case: A 24-year-old student pilot candidate shows repolarization disorders at the ECG in the aeromedical examination, the exploration allowed the discovery of a myocardial bridge on The Coronary computed tomographic angiography (CCTA) of the left anterior descending (LAD) coronary artery responsible for tight stenosis. Discussion: The prevalence of MB varies according to the method of investigation, ranging from 2% in coronary angiography and 19% in coronary computed tomography to 42% in autopsy.The prevalence among active civilian aircrew (pilots and cabin crew) monitored at CEMPN is 0.4%, all revealed by electrocardiogram abnormalities. MB are usually small and of no clinical significance, the myocardial bridge proximal segment has been associated with atherosclerosis. Symptomatic patients with myocardial bridges as their only cardiac abnormality may present with myocardial ischemia, acute coronary syndromes, coronary spasm, syncope or even sudden death. The initial therapeutic strategy in the treatment of MB is medical management. Revascularization is indicated by PCI or surgery, including coronary artery bypass grafting (CABG) or myotomy in the case of symptoms recalcitrant to maximal medical treatment. The aviation environment may expose aircrew to additional physiological stressors, including hypobaria, hypoxia and sustained acceleration (+Gz). Such exposure may present a risk if associated with cardiovascular abnormalities, potentially leading to incapacity to fly due to symptoms or complications of the myocardial bridge. Conclusion: The myocardial bridge is an anatomical variant rather than a congenital anomaly with varied symptomatology (ECG abnormality, stable or unstable angina or sudden death), the aeromedical decision is made on a case-by-case basis, and makes a challenge diagnostic, particularly for asymptomatic crews.

Abstract 4144526: A Case Presentation of Severe Left Ventricular Dysfunction from Focal Myocarditis due to Immune Checkpoint Inhibitor

Introduction: Immune checkpoint inhibitors (ICI), such as pembrolizumab, are an effective immunotherapy for several malignancies, however, have been associated with adverse events including myocarditis and accelerated atherosclerosis. ICI myocarditis is associated with a mortality rate of up to 33%. This case reports a patient on pembrolizumab with an atypical presentation. Case presentation: A 75-year-old female with a past medical history significant for lung cancer on pembrolizumab and myasthenia gravis presented to the hospital with dyspnea and mild, intermittent exertional chest discomfort. She denied nausea, radiation of pain, diplopia, weakness in extremities, or dysphagia. Workup revealed a leucocyte count of 13,500 cells/uL, pro-brain natriuretic peptide of 13,458 pg/mL, troponin of 26 ng/L, and a normal erythrocyte sedimentation rate and C reactive protein. A chest computed tomography was performed that showed mild bilateral pleural effusion and no pulmonary embolism. A nuclear stress test showed no evidence of ischemia but showed a severely reduced left ventricular ejection fraction (LVEF) at 29%. An echocardiogram confirmed that the ejection fraction was reduced at 23% (baseline LVEF was 60% from 1 year ago). Cardiac MRI revealed a mildly increased regional T2 signal in the anterolateral wall, mildly elevated extracellular volume fraction, and no late gadolinium enhancement. With ongoing clinical suspicion despite equivocal findings on cardiac MRI, an endomyocardial biopsy was done that revealed a single small aggregate of lymphocytes present in 1 of 6 tissue samples. Ultimately, with the single site of aggregated lymphocytes on biopsy, a diagnosis of ICI myocarditis was determined, and the patient was started on high-dose intravenous glucocorticoids as well as bisoprolol, empagliflozin, spironolactone, and Entresto for heart failure management as she was able to tolerate. Discussion: Myocarditis due to pembrolizumab is a rare, but potentially lethal adverse effect. Patients typically have abnormal electrocardiograms and elevated cardiac biomarkers. Cardiac MRIs have sensitivity and specificity of 68% and 91% respectively for diagnosis, and the gold standard is endomyocardial biopsy however, it is limited due to sampling error. Our patient had an unusual presentation, but with both imaging and biopsy, we found a case of focal myocarditis with severe left ventricular dysfunction, which typically is seen with fulminant myocarditis.