ST-T Changes In Electrocardiogram Research Articles

A study of cardiovascular profile in patients with primary hypothyroidism

Introduction and Aim: Raised cardiovascular morbidity is common among patients with primary hypothyroidism. Study of electrocardiogram (ECG) and echocardiography (ECHO) and correlation with lipid profile may help in early detection of cardiovascular diseases in hypothyroidism. By this study, we aimed at studying the cardiovascular profile in patients with primary hypothyroidism and correlating ECHO and ECG changes in primary hypothyroidism with the LDL cholesterol. Materials and Methods: This was a single centre cross-sectional observational study. All patients diagnosed with primary hypothyroidism were included. The laboratory parameters pertaining to primary hypothyroidism were recorded. ECG and ECHO were noted and correlated with lipid profile. Results: Total 240 subjects were selected according to inclusion and exclusion criteria, of which males were 25% and females 75%. Mean ± SD of LDL-C among subjects having ST-T changes was 160.98 ±14.86. Mean ± SD of LDL-C among subjects having no ST-T changes was 128±10.15. Unpaired student t test was used to compare mean of lipid profile in patient having ST-T changes with patients having no ST-T changes. A strong correlation was observed between LDL cholesterol and ST-T changes in ECG (P value =0.001) Conclusion: Diastolic dysfunction is more common than systolic dysfunction in primary hypothyroidism. LDL levels were high in patients with primary hypothyroidism who had ST-T changes in electrocardiogram. Levothyroxine replacement causes decrease in Total as well as LDL cholesterol in primary hypothyroidism. ECG changes correlated with abnormal lipid profile in patients with primary hypothyroidism.

Recommendation for Inclusion of Surface Echocardiography in Evaluation of Chest Pain in Acute Emergency Care

Abstract Objective A significant number of conditions may mimic acute myocardial infarction when patients present to acute emergency care (AEC) with chest pain. A proportion of such patients may exhibit ST segment abnormality on the electrocardiogram (ECG) which is due to conditions other than acute coronary syndromes (ACS) or myocardial infarction. The American Heart Association/American College of Cardiology guidelines (2015) algorithm for ACS does not include echocardiographic evaluation in the assessment of chest pain. Patients with chest pain may be subjected to investigations and interventions based on ECG leading unwarranted invasive procedures, which may prove unnecessary, futile, and even detrimental. This study was performed to determine if a bedside echocardiography would help identify the conditions that do not need intervention and might possibly change the treatment pathway at the right time. Materials and Methods In a prospective observational study design, adult patients presenting to AEC with chest pain were included in the study. After the assessment of airway, breathing and circulation, and initiation of bed side monitoring, a 12-lead ECG was obtained. Patients exhibiting a significant ST change on ECG were subjected to bedside echocardiography, that is, two-dimensional (2D) transthoracic echocardiography (2D-TTE) with a cross reference to a consultant cardiologist for the precise assessment and diagnosis. The findings of echocardiography were correlated with electrocardiogram for possible diagnostic coronary angiography and percutaneous coronary intervention. The results of ECG, echocardiography, and coronary angiography (if done) were analyzed to determine the sensitivity and specificity of echocardiography for ACS. Results Among 385 patients in the study, 312 were suspected to suffer acute coronary syndrome; among these patients, eight patients turned out to have chest pain due to non-ACS. Of the 73 patients, the chest pain was suspected to be not of cardiac ischemia origin; among these patients, 66 patients were true negative and 7 patients were false positive. Echocardiography was the predictive of ischemic chest pain with a predictive value of 97.7%. The specificity of echocardiography calculated from the above confusion matrix was 90.4% and sensitivity was 97.4%. The positive predictive value of 2D-TTE was 97.7% and negative predictive value was 89.1%. The overall accuracy of bedside 2D-TTE was 96.1%. Conclusion Echocardiography was found to be an effective tool in aiding diagnosis of a patient presenting to AEC with chest pain and ST-T changes in ECG. A significant percentage of patients (18.7%) presented to AEC with chest pain, ST-T changes and found to have causes other than ACS, and screening echocardiography (2D-TTE) was able to identify 90.4% of those cases. From this study, we conclude that bedside echocardiography had high specificity (90.4%) and sensitivity (97.43%) in identifying regional wall motion abnormality due to ACS. Hence, bedside echocardiography is recommended in patients with chest pain and ST-segment abnormality to avoid unnecessary delay in diagnosis and invasive interventions in non-ACS.

Meta-analysis on effect of Shenfu injection in treating angina pectoris

To systematically evaluate the efficiency and safety of Shenfu injection in treating patients with angina pectoris. Retrievals were made in Embase, Pubmed, Cochrane Library, Clinical Trials.gov, CNKI, CBM, VIP and Wanfang (before September 2015) for randomized or semi-randomized controlled trials reporting data of Shenfu injection in the adjuvant treatment of angina pectoris. The quality of included trials was evaluated according to tool evaluation at cochrane.org. STATA version 12.0 was applied for Meta analysis after quality assessment of included studies. Finally, a total of 17 studies, including 16 randomized controlled trials (RCTs) and 1 controlled clinical trial (CCT) involving 1 309 patients, met the inclusion criteria, of which 659 patients received Shenfu injection treatment. Meta-analysis results showed that Shenfu injection treatment group significantly improved angina pectoris symptoms (OR=3.38, 95%CI： 2.47-4.64, P=0.000) and ischemic ST-T changes in electrocardiogram (OR=3.30, 95%CI： 2.22-4.90, P=0.000), compared with control group. In the Meta-regression analysis, the average age of patients was positively correlated with the improved clinical (β=0.17) and electrocardiogram (β=1.15) efficacies. Major complication rate of Shenfu injection was 3.4%, and no serious adverse events were reported. Current clinical evidence in this study proved that Shenfu injection could significantly improve clinical symptoms and ECG ischemic changes for angina pectoris patients, with a good safety.

Relationship between the ischemic ST-T changes in ECG and the coronary artery diseases

To analyze the relationship between the ischemic ST-T changes in electrocardiogram (ECG) and the coronary artery diseases based on the perspective of diagnostics. A total of 341 patients, who underwent coronary angiography in Department of Cardiology of Xiangya Hospital, Central South University from June 2013 to April 2014, were enrolled for this study. The internationally recognized diagnostic criteria for ischemic ST-T changes in ECG and the Judkins diagnostic criteria for coronary angiography were applied, respectively. The sensitivity and specificity of ECG were analyzed. There were more ischemic ST-T changes in women than that in men (P<0.01). Ischemic changes in coronary angiography were not significantly different between male and female patients (P>0.05). For ischemic diagnostic tests by ECG ST-T, the total sensitivity and specificity was 83.6% and 54.4%, respectively. The sensitivity and specificity was 82.3% and 68.0% or 85.0% and 28.2% in the male or female group, respectively. Ischemic ST-T changes in ECG possess important value in the diagnosis of the coronary artery diseases. The sensitivity of ECG in the diagnosis of myocardial ischemia in women was higher than that in men, whereas the specificity of ECG in the diagnosis of myocardial ischemia in men was higher than that in women.

Fixing the “Broken Heart”

Broken-heart syndrome also known as Left ventricular apical ballooning syndrome or Stress-induced cardiomyopathy or Takotsubo cardiomyopathy is an important clinical entity, which presents clinically, similar to acute coronary syndrome with an acute onset of chest pain, ST-T changes in electrocardiogram, and moderate cardiac enzyme elevation. Recent studies have shown that it accounts for 1%-2% of cases of ST-elevation infarction. An episode of intense emotional or physiologic stress has been reported before its presentation and is presumed to be the triggering factor in the pathogenesis. The pathophysiology of this syndrome still remains unclear, and management is mostly empiric and supportive. In this review, we have discussed various pathophysiologic mechanisms underlying this cardiomyopathy and their pharmacological implications and role of medications such as aspirin, beta blockers, angiotensin-converting enzyme inhibitors, and statins for patients presenting with this syndrome in treatment and prevention.

Circulating soluble CD40 ligand mediates the interaction between neutrophils and platelets in acute coronary syndrome

Following plaque rupture, activated platelet will induce subsequent inflammatory process including neutrophil recruitment. In vitro study demonstrated an interaction between neutrophils and platelets via a mechanism involving CD40-CD40 ligand. However, whether this mechanism exists in the clinical setting remains unknown. Fifty-four patients with acute myocardial infarction (AMI) and 25 with unstable angina of pain onset of < or = 24 h were enrolled consecutively. Acute myocardial infarction was diagnosed from three diagnostic criteria, i.e., anginal pain, electrocardiogram ST-T changes, and cardiac enzyme elevation. Unstable angina was diagnosed in patients without elevated cardiac enzymes. Peripheral venous blood was drawn at admission for routine blood count and soluble CD40 ligand (sCD40L) measurement. Neutrophil count was determined by an automated blood cell counter. Circulating sCD40L was measured using a standard enzyme-linked immunosorbent assay. Neutrophil count was significantly higher in AMI as compared with unstable angina (P < 0.001), whereas circulating sCD40L did not significantly differ. Despite marked elevation, no correlation was observed between neutrophil count and circulating sCD40L in AMI. Interestingly, we observed a strong and positive significant correlation between neutrophil count and circulating sCD40L level (r = 0.607, P = 0.002) in unstable angina. Circulating sCD40L is associated with neutrophil count and may mediate interaction between neutrophils and platelets in acute coronary syndrome, particularly in unstable angina.

Prevalence of Metabolic Syndrome and Its Associations with Other Metabolic Disorders and Cardiovascular Changes in Health Examination Population in Beijing

To investigate the prevalence of metabolic syndrome (MS) and its associations with other metabolic disorders and cardiovascular changes in health examination population in Beijing. Totally, 10,916 individuals who received health examination in Health Examination Center of Peking Union Medical College Hospital were enrolled. The height, weight, blood pressure, serum levels of triglyceride, high-density lipoprotein cholesterol (HDL-C), and fasting blood glucose were recorded. MS was diagnosed based on the working criteria of Chinese Diabetes Society 2004 (CDS2004). Meanwhile, other metabolic disorders, including fatty liver and hyperuricemia, were recorded. The cardiovascular changes were reflected by the reports of electrocardiogram (ECG) ST-T changes and atherosclerosis of retinal arteries. The overall prevalence rate of MS was 6.1% (666/10,916) in the population. The prevalence rate of MS in male was much higher than that in female (9.0% vs. 2.7%, P=0.000). For individuals with MS, the prevalence rates of fatty liver and hyperuricemia were significantly higher than those without MS, respectively (70.4% vs. 35.4%, P=0.000; 29.9% vs. 17.7%, P=0.000). As for cardiovascular changes, the prevalence rates of ECG ST-T changes and atherosclerosis of retinal arteries were significantly higher in individuals with MS than those without MS, respectively (13.8% vs. 11.7%, P=0.012; 12.0% vs. 6.8%, P=0.000). The prevalence of MS in Beijing population is high. The individuals with MS have a higher risk for other metabolic disorders and cardiovascular changes.

The relativity analysis of cerebral apoplexy and ST-T changes in electrocardiogram

目的 探讨ST-T改变与脑卒中的相关性、发生机制及临床意义.方法回顾分析脑卒中患者2 160例心电图资料;比较ST-T明显改变者80例(观察组)和ST-T无明显改变者98例(对照组)的临床资料,包括合并其他常见病、出现心电图异常的情况.结果 2 160例中出现心电图异常1 327例,其中ST-T改变756例,占异常心电图的56.97%.与对照组比较,观察组合并高血压、冠心病、呼吸衰竭、电解质紊乱、心脏扩大及多种心电图异常发生率高(P＜0.05或P＜0.01).结论脑卒中患者心电图ST-T的改变,部分是受神经-体液及代谢-营养障碍的影响而出现的变化,即神经原性改变,可随病情好转而变化;部分则与原有的基础病相关,受其心脏在功能上或器质上已出现的病理性改变而影响,不随病情而变化。

The Relationship of Dietary Factors to Cardiovascular Diseases among Japanese in Okinawa and Japanese Immigrants, Originally from Okinawa, in Brazil.

To investigate the relationship of dietary factors to cardiovascular diseases, we conducted a study of 234 middle-aged Japanese men and women in Okinawa (JJ), and 160 Japanese immigrants of similar age, originally from Okinawa, in Brazil (JB). JB showed double the prevalence (%) of ST-T changes in the electrocardiogram (ECG) (JJ: M3.4, F4.4, JB: M8.3, F10.1) and of hypertension (HT) (JJ: M15.9, F18.4; JB: M32.8, F36.4, p<0.05) when this was assessed on BP≥160/95 and/or the taking of antihypertensive medication; however the mean level of blood pressure did not differ. A gradient in the rate of HT in men and of ECG ST-T changes in both sexes was observed from JJ to JB of first-generation and to JB of second-generation. JB had much higher body mass index (kg/m2) (JJ: M24.8±0.3, F24.8± 0.4; JB:M26.2±0.4, F26.5±0.4, p<0.01) in both sexes, and an 8-fold higher rate of oral contraceptive usage (p<0.001). Total cholesterol level showed no significant difference between JJ and JB. 24-hour urinary taurine excretion in both sexes and plasma phospholipid n-3 fatty acid level in men were significantly higher in JJ than in JB. The dietary pattern in Japanese immigrants in Brazil, characterized by low fish and large meat intake, is possibly responsible for the higher risk of HT and ECG ST-T changes, indicating the importance of dietary rather than genetic factors. (Hypertens Res 1992; 15: 45-55)

Left ventricular function and cardiac hypertrophy in case of mild hypertension with marked ST-T changes in electrocardiogram : M. Ryono, Y. Ueno, O. Mohara, M. Arita, T. Minakata, H. Ohtani, I. Nishio, Y. Masuyama. Department of Medicine, Wakayama Medical College, Wakayama, Japan

Left ventricular function and cardiac hypertrophy in case of mild hypertension with marked ST-T changes in electrocardiogram : M. Ryono, Y. Ueno, O. Mohara, M. Arita, T. Minakata, H. Ohtani, I. Nishio, Y. Masuyama. Department of Medicine, Wakayama Medical College, Wakayama, Japan

Echocardiographic classification of hypertensive heart disease. A correlative study with clinical features.

Forty patients with systemic hypertension were classified into 4 types based on the left ventricular echocardiographic findings. Patients with normal left ventricular echogram, type I, showed little clinical symptoms and signs of hypertensive involvement. Higher systolic pressure and marked hypertensive retinal and renal changes were observed in patients with symmetric hypertrophy of the left ventricle, type II. Congestive heart failure was dominantly present in those with dilatation of the left ventricle, type IV. High voltages and marked ST-T changes in electrocardiogram were usually found in patients with asymmetric septal hypertrophy, type III, while retinal and renal damages were mild. Left ventriculograms obtained from 6 cases in type III also revealed hypertrophy of the interventricular septum and one of them demonstrated left ventricular outflow tract obstruction. These cardiac features in type III, which are quite similar to those in hypertrophic cardiomyopathy, seemed to be a secondary change induced by systemic hypertension on the basis of some predisposition.

Experimental studies of ST-T changes in electrocardiogram: effect of local or total hypoxemia of the canine heart on the unipolar lead electrogram and on the trans-membrane potential recorded from the ventricular epicardial surface

To clarify the mechanism of ST-T changes in electrocardiogram, these changes that appear on the direct unipolar electrogram recorded from the ventricular surface were compared with the changes of transmembrane potentials simultaneously recorded from the vicinity of direct unipolar electrogram. This study was conducted on the in situ canine heart under conditions of total and local hypoxemia. Method Seventy-seven mongrel dogs weighing about 15 kg were used, and each animal was anesthetized intravenously by pentobarbital sodium 25 mg per kg of body weight. Then the heart was exposed after performing thoracotomy under artificial positive pressure respiration. In order to prevent the undue movement of recording site on ventricular surface, the inner and outer rings attached to the supporting frame were placed over the pericardial surface, and then the portion of the pericardium within the inner ring was dissected away. Ringer's solution with the temperature of approximately 33°C was constantly dripped upon the epicardial surface, in order to prevent dryness. Using the central terminal system of Wilson, a unipolar surface electrogram was taken simultaneously with transmembrane potentials from the epicardium within the inner ring. The surface electrode consisted of tungsten wire 100 micron in diameter, and was gently placed on the ventricular surface by micromanipulator. The transmembrane potential of the individual cell was recorded from a flexibly mounted ultramicroelectrode such as described by WOODBURY and BRADY (1956). The indifferent electrode consisted of tungsten wire with a diameter of about 100 micron, placed 2 to 4 mm away from the site of penetration by microelectrode. Total hypoxemia of the ventricles was induced by letting a dog inhale the mixture-gas of oxygen 4% and of nitrogen gas 96% for from 6 to 8 minutes. For producing the local hypoxemia of the ventricle, approximately 120 ml of venous blood was taken from the femoral vein by syringe. At this time special care was paid to venous blood, that is, venous blood was kept from exposure to room-air by a layer of floating liquid paraffin in the syringe. This venous blood was kept at approximately 36°C. This venous blood was perfused at a pressure of 100 mmHg into the artificial coronary circuit made between the left carotid artery and the anterior descending branch of the canine left coronary artery (heparinized 500 units per kg/body weight). The room temperature was kept between 24 to 25°C through-out the experiment.