Changes In Heart Rhythm Research Articles

Алгоритм количественной оценки кардиореспираторной синхронизации для характеристики функционального состояния и межсистемных взаимодействий у спортсменов

Introduction. The rhythm of the heart (heart rate, HR) is closely related to the rhythm of breathing. The phenomenon of respiratory sinus arrhythmia (an increase in heart rate during inhalation and a decrease during exhalation) is well known. Cardiorespiratory interactions and synchronization of these two signals are evaluated differently in the literature. The purpose of this work was to propose and test an approach to assess cardiorespiratory synchronization – the calculation of the cross-correlation coefficient between heart rate and respiration curve, for a more objective characterization of an athlete’s bodily states. Methods. A photoplethysmogram and respiration were recorded in 45 healthy athletes (18-25 years old) in three situations: rest, paced breathing at 6 times per minute (resonant frequency) and the performance of a sensorimotor task (tapping with the rhythmic metronome sounds and then reproducing a given rhythm from memory). For the HR and respiration curves, filtering and smoothing algorithms using the Savitsky-Goley method were applied sequentially, and then the cross-correlation coefficient between the two curves was calculated. The spectral parameters of heart rate variability (LF and HF) were also obtained, since during spontaneous breathing its contribution to the HR is reflected in HF band, and when breathing at a resonant frequency, a peak occurs at a frequency of 0.1 Hz in the LF band. Results. The cross-correlation coefficient, as well as the peak of HR spectral power at 0.1 Hz, increases significantly when breathing at a resonant frequency. The relationship between these indicators is most accurately described not by a linear, but by a logarithmic dependence. When performing a sensorimotor task, the so-called respiratory waves in the heart rhythm spectrum (HF) do not change from rest to tapping by a metronome and then to holding the rhythm by memory. At the same time, the cross-correlation coefficient demonstrates significant changes between these situations. In addition, a significant correlation was found between the change in the cross-correlation coefficient and the stability of rhythm maintenance (from memory): an increase in the cardiorespiratory synchronization leads to a decrease in motor rhythm stability. Conclusion. Assessment of cardiorespiratory synchronization due to the peculiarities of both signals (changes in heart rate and respiratory phases) requires preliminary preparation of data arrays: filtering and smoothing the stepped curve of heart rate dynamics. The calculation of the cross-correlation coefficient can be used to assess cardiorespiratory synchronization in real time and is likely to be applicable in short time fragments to assess emotional reactions and other short-term fluctuations in psychophysiological conditions, where the classical method of assessing changes in heart rhythm in the frequency or time domains is not applicable.

The new face of diabetes mellitus — rhythm and conduction disorders

This review article is devoted to changes in heart rhythm against the background of type 2 diabetes mellitus, which is one of the most common endocrine diseases. In recent years, there has been an increasing association between type 2 diabetes mellitus and heart rhythm disorders. Arrhythmias such as tachycardia, bradycardia and atrial fibrillation are common in patients with type 2 diabetes and can have serious consequences on health and quality of life. Type 2 DM is increasingly common worldwide due to the rise in sedentary lifestyles, overweight, abdominal forms of obesity, and diets containing too much fat and carbohydrates. Insulin-independent diabetes is a metabolic disease responsible for autonomic neuropathy of the heart that affects both sympathetic and parasympathetic fibers, which can be explained by the adverse effect of blood glucose levels on heart rate variability (HRV). Although the gold standard is cardiovascular reflex tests to assess cardiovascular autonomic neuropathy, one of the most important is the measurement of heart rate variability (HRV). HRV is the variation between two consecutive contractions: the higher the variation, the higher the activity of the parasympathetic nervous system. A high HRV reflects the fact that a person can constantly adapt to changes in the microenvironment. Thus, low HRV is a marker of cardiovascular risk.

Neuroanesthesia Management in Cavernous Sinus Meningioma Craniotomy Patients

The most prevalent primary cavernous sinus (CS) lesion is cavernous sinus meningioma (CSM). Of all intracranial neoplasms, 1% are tumors in CS, and 41% are CSM. For contemporary neurosurgeons, orbital involvement in cavernous sinus meningiomas (CSMs) poses special difficulties. The condition is known as cavernous sinus meningioma (CSM) gradually impairs vision and may ultimately result in chiastic compression. Since January 2023, a male 55-year-old had been admitted to the hospital with cephalgia and mild diplopia in his right eye. Cavernous meningiomas were discovered using CT scans, and a craniotomy procedure was scheduled to remove the tumor. In order to facilitate intubation, the patient was given a premedication of sufentanyl for analgesia and was then given general anesthesia. Rocuronium was used to relax the muscles. Desflurane is an attractive option available to anesthesiologists to maintain general anaesthesia. This surgical procedure of removing intracranial tumours requires proper induction and monitoring of the patient's condition during surgery to prevent increased intracranial pressure. Intracranial elevation can cause systemic changes such as hypertension and changes in heart rhythm, as well as cerebral artery spasm, and lead to cerebral infarction and cerebral ischemia. An effective neuroanesthesia management program can help preserve hemodynamic stability and improve results during craniotomy surgery for the removal of meningiomas

Real-Time Changes of Heart Rhythm Using MATLAB

Highest mortality from cardiovascular disease (CVD) in 2019: 17.9 million people died worldwide, accounting for 32% of all deaths, 85% of which were due to heart attack and stroke. In Indonesia, 651,481 people die from cardiovascular disease each year, including 331,349 from stroke, 245,343 from coronary heart disease, and 50,620 from hypertension and other cardiovascular diseases. Disturbance of changes in heart rhythm is a condition when the heart's electrical activity is irregular, it can be faster or slower than usual. This disorder is closely related to cardiovascular diseases such as hypertension, heart failure, valvular heart disease, and coronary artery disease. Changes in heart rhythm are usually not dangerous, but if the heartbeat starts to feel abnormal, it can be fatal and cause sudden death. Changes in heart rhythm can be detected using an electrocardiogram, often called an EKG. The function of the EKG is to record information about the state of the heart using electrodes attached to the body. An EKG examination usually has to be done in a hospital to find out the disease the patient is suffering from. This study implements an ECG signal real-time monitoring and processing system using AD8232 sensor module and will display the resulting ECG signal in MATLAB software. This test will be monitored using Simulink MATLAB on the MATLAB R2022b software. Testing the ECG signal studied there were two activities, namely normal activity and after exercising for five minutes. The test was carried out in a sitting position using a 21 years old woman. The results obtained from the system are made using the AD8232 sensor module has been successfully implemented using R peak detection to generate real-time heart rate. It was found that the heart rate varies between 85 to 90 beats per minute during normal activity. Meanwhile, the heart rate after five minutes of exercise reaches 107 to 111 beats per minute. From this heartbeat, we can assume that the heart is functioning normally.

EPH43 Potential Association of Remdesivir and Hyperkalemia: A Disproportionality Analysis in USFDA Adverse Event Reporting System Database

Signal detection is one of the most advanced and promising techniques in the world of pharmacovigilance. Remdesivir is approved for emergency use by the US Food and Drug Administration (FDA) for patients with coronavirus disease 2019 (COVID-19). Its benefit- risk ratio is still being explored because data in the field are rather scant. On the other hand hyperkalemia is a potentially life-threatening electrolyte disorder. Severe hyperkalemia can occur suddenly and can cause life-threatening heart rhythm changes (arrhythmia) that cause a heart attack. Even mild hyperkalemia can cause heart related problems over time if not treated. To evaluate the potential association of Remdesivir with risk of Hyperkalemia by analyzing the spontaneous reports through disproportionality analysis. Data were obtained from the public release of data in FAERS. Case/non-case method was adopted for the analysis of association between Remdesivir use and Hyperkalemia. The data-mining algorithm used for the analysis were Reporting Odds Ratio(ROR) and Proportional Reporting Ratio (PRR). A value of ROR-1.96SE>, PRR≥2 were considered as positive signal. A total of 7 DE’s associated with Remdesivir use and hyperkalemia were reported. The mean age of the patients of Remdesivir associated events was found to be 75 years [95% CI]. The reports by gender were distributed with a male to female ratio of 3:1, though gender was not revealed in 3 reports. The data mining algorithms exhibited positive signal for hyperkalemia (PRR: 2.349, ROR: 2.354) upon analysis as those were well above the pre-set threshold. Three case reports were identified which strengthened these findings and highlighted the importance of laboratory parameters for the early detection of hyperkalemia The current study found a potential risk of hyperkalemia with the use of Remdesivir and there is an urgent need to thoroughly investigate the same and take the necessary action to avoid or minimize the risk.

Adverse effects post vaccination against COVID-19 in adolescents

Introduction: immunization against Covid-19 can attract short or long-term effects, these can be mild (headache, pain at the puncture site), moderate (nausea, vomiting, diarrhea, rash, fever (>38°), pruritus, lymph node inflamation) or serious (facial paralysis, facial swelling, anaphylaxis, changes in heart rhythm, coagulation disorders, arterial hypertension, transverse myelitis, Guillan Barre syndrome), in the following study will be revealed the effects produced after the application of the vaccine against COVID-19 in adolescents. Objective: to identify the adverse effects after the application of the third dose of the vaccine against COVID-19 in high school students of the Joaquín Lalama Educational Unit. Method: cross-sectional study, with a quantitative approach, of a cross-sectional non-experimental design with a descriptive correlational scope. The study population are adolescents from 14 to 19 years old, high school students of the Joaquín Lalama Educational Unit. For data collection, the questionnaire called COVID-19 Side effects and vaccination was used. For the processing and analysis of the information, the IBPM SPSS statistical platform will be used, as well as tables for its correct interpretation. Results: after the analysis of the surveys applied to adolescents, it was found that there were no serious adverse effects in a large part of the population, but there were mild adverse effects, data similar to other studies carried out by other authors

The accuracy of the Stroke Risk Analysis (SRA) system for predicting atrial fibrillation in patients in the postoperative period of myocardial revascularization.

Postoperative myocardial revascularization atrial fibrillation (POAF) is a clinical complication that affects about 30% of patients and its mechanisms of origin are still poorly understood. This fact makes it difficult to identify the patient at greatest risk for this arrhythmia. This mission seems evident due to the complications it entails, including longer hospital stays, risk of stroke, heart failure, and death. There are reports of preoperative clinical aspects inherent to the patient's condition, such as gender and age, and discontinuation of beta-blockers as risk factors. In addition, additional information obtained by electrocardiogram, echocardiogram, and blood count data, for example, present only modest predictive results. The analysis of heart rate and heart rate variability obtained by the Stroke Risk Analysis System (SRA) is a technique used to predict ambulatory atrial fibrillation (AF), using recordings of only one hour showing good accuracy. This system, however, has not yet been used to predict the emergence of POAF. The rationale for its use is based on the suspicion that the emergence of POAF is strongly related to sympatho-vagal imbalance and the increase in atrial ectopia, that is, changes in heart rhythm, the main variables analyzed by the SRA algorithm. To assess the accuracy of the SRA to identify patients at risk of having POAF after coronary artery bypass graft surgery (CABG). 114 consecutive patients with coronary artery disease underwent coronary artery bypass grafting between the years 2015 and 2018. Between the first and fifth postoperative days, they underwent continuous electrocardiographic monitoring using the Holter system for cardiac rhythm analysis. Patients were divided into two groups: Group I was formed of those with POAF and Group II included patients without POAF. The tracings obtained by Holter were reanalyzed using the CardioManager®/Cardios program, converted and divided into one-hour sections using the SRA®/Cardios and Geratherm Converter program and submitted to the SRA-Apoplex medical/Geratherm® analysis algorithm. The SRA identifies three possibilities for classifying patient risk: a) Risk 0: patient in sinus rhythm; b) Risk 1: patient at increased risk for paroxysmal AF; c) Risk 2: patient with AF already present. For Group I, SRA were considered positive when Risks 1 and 2 were identified. For Group II, those identified as Risk 0 were considered negative SRA. POAF occurred in 33/114 patients (28%). The sensitivity, specificity, positive predictive value, and negative predictive value of the SRA to identify patients with POAF were 69%, 84%, 69%, and 82%, respectively; the positive and negative likelihood ratios, in addition to the accuracy of the SRA were, respectively, 4.3%, 0.36%, and 79%. A subanalysis of the results of the day on which AF occurred was performed on the records obtained in the first three hours of recording and up to three hours before the appearance of POAF. In the first period, the SRA was able to predict POAF in 57% of cases, while in the second period, the system identified the arrhythmia in 83% of cases. a) The SRA presents good accuracy to predict POAF; b) its accuracy is moderate in the first three hours of recording; c) the accuracy increases significantly near the beginning of POAF; d) these findings indicate that electrophysiological changes that precede POAF are acute, occurring a few hours before the event and are identified by the SRA algorithm.

Intervensi Audio Terapi Murottal Al-Quran pada Pasien Penyakit Jantung Koroner dengan Masalah Keperawatan Ansietas di Ruang ICU RSUD Dr. T.C.Hillers Maumere

Coronary heart disease (CHD) is a disease that occurs due to decreased oxygen flow to the heart as a result of a buildup of plaque in the arteries. Patients with CHD usually feel afraid because they are exposed to the most vital parts of the body which can be at risk of death, this is what causes CHD patients to feel anxious. Anxiety that is not resolved can cause changes in heart rhythm which can make the patient's condition worse. One of the non-pharmacological techniques for dealing with anxiety is audio murottal Al-Quran therapy. The purpose of this case study was to determine the effect of murottal Al-Quran audio therapy on the anxiety level of CHD patients. The method used is descriptive method with a case study approach. The sampling technique was purposive sampling which met the inclusion criteria. The instrument used is State Trait Anxiety Inventory (STAI). The results of the application of murrotal audio therapy in CHD patients showed that there was a change where the patient's anxiety level decreased from moderate anxiety level (STAI score: 64) to not anxious (STAI score: 22). Conclusion: there is an effect of murrotal audio therapy on CHD STEMI patients in the ICU room of dr. T.C. Hillers Maumere .

Increased heart rhythm in response to high-dose intravenous methylprednisolone pulse therapy of moderate-to-severe Graves’ orbitopathy.

ABSTRACT
 Background: Intravenous glucocorticoids pulses administration is the main therapeutic option in the treatment of Graves’ orbitopathy. Such therapy could relate to the multiple adverse effects. The aim of the study is evaluation the influence of intravenous methylprednisolone (IVMP) pulse therapy on the heart rhythm (HR) changes in patients with active, moderate-to-severe Graves’ Orbitopathy (GO).
 Methods: We studied 20 patients with moderate-to-severe GO. All patients received 12 IVMP pulses (6x500 mg plus 6x250mg) at equal time intervals in a weekly schedule. We performed Holter ECG monitoring for 3 consecutive days (the day before, the day of IVMP and day after IVMP) to monitor HR and arrhythmias. We compared changes in HR between these 3 days and set time interval when the alteration was significant. This evaluation was performed during the 1st, 6th and 12th IVMP pulse.
 Results: Increased HR, in comparison with the day before, was registered on the day of IVMP administration. The most significant increase in HR started 5 hours (h) after a pulse administration and lasted 12 h. There were no significant differences in HR between the day before and the day after IVMP. We did not notice any major adverse cardiac events including severe arrhythmias.
 Conclusions: IVMP therapy is associated with increased HR, that occurs a few hours after infusion, lasts several hours and is transient. 
 Keywords: Graves’ ophthalmopathy; Graves’ disease; glucocorticoids; heart rate

Взаимосвязь показателей вариабельности гликемии и нарушений сердечного ритма у пациентов с сахарным диабетом 1 типа

Objective: To study indicators of glycemic variability (GV) and their relationship with cardiac arrhythmias in patients with type 1 diabetes mellitus according to glucocardiomonitoring data. Design: Cross-sectional study. Materials and methods. The study included 72 patients with type 1 diabetes without previously diagnosed cardiovascular pathology. Of these, 34 patients received insulin pump therapy, 38 received multiple insulin injections. The average age of patients was 39.7 ± 15.9 years, the average duration of type 1 diabetes was 15.4 ± 10.8 years. The level of glycated hemoglobin (HbA1c) was determined in patients, and according to continuous glucose monitoring (CGM), GV indices were calculated: SD (standard deviation), CONGA (continuous overall net glycemic action), LI (lability index), MAGE (mean amplitude of glycemic excursions), MAG (mean absolute glucose). Simultaneously with CGM, Holter monitoring of the electrocardiogram was carried out: heart rate (HR), the presence and time of occurrence of arrhythmias, variability of the corrected QT interval (QTc), and the presence of ischemic changes were assessed. A correlation analysis of the relationships between GV levels and heart rhythm disorders was carried out. Results. Regardless of the type of insulin therapy, GV indicators in patients with type 1 diabetes were higher than the reference values for healthy individuals. Only 19 (26%) patients reached the target HbA1c level. In 62 (86%) people, various heart rhythm disturbances were registered, in 30 (42%) of patients there was a decrease in the circadian index (CI) of heart rate, and in 14 (19%) there was a prolongation of the QTc interval. The results of the correlation analysis showed that with an increase in GV, the HR CI decreased and the frequency of supraventricular and ventricular extrasystoles increased. Conclusion. The detected changes in heart rhythm against the background of increased GV in patients with type 1 diabetes indicate a high risk of developing a cardiovascular process. Strict glycemic control and normalization of GV can better reduce the risk of cardiac arrhythmia and the development of DCAN in patients with type 1 diabetes. Keywords: type 1 diabetes mellitus, glycemic variability, cardiovascular disease, diabetic cardiovascular autonomic neuropathy

Determination of The Features of The Formation of Functional Training of The Cadets of The Institutions of Higher Education of The MIA of Ukraine

Determination of the features of the formation of functional fitness of the cadets of higher education institutions of the Ministry of Internal Affairs of Ukraine in the process of their educational and training classes is extremely important for ensuring the adaptive capabilities of the body and creating optimal conditions for increasing general and special physical fitness. Structural and functional restructuring of the regulation of the human body occurs under the influence of the educational and training process. The prerequisites for the development of the program for improving the physical and functional readiness of the cadets were the determination of the features of their functional state of the cardiovascular, respiratory, and vegetative systems at the beginning of the pedagogical research. The purpose of the study is to investigate the peculiarities of the formation of functional readiness of the cadets of higher education institutions of the Ministry of Internal Affairs of Ukraine. The object of the study is the functional training of the cadets of the Military Academy of the Ministry of Internal Affairs of Ukraine. The subject of the study is the cadets of the Military Academy of the Ministry of Internal Affairs of Ukraine. The subject of the study is the level of professional training of the cadets of the Military Academy of the Ministry of Internal Affairs of Ukraine. Research methods: theoretical analysis, systematization and generalization of data, methods of assessing the functional state of the external respiratory system, central hemodynamics and autonomic nervous system, methods of assessing the contractile function of the heart, methods of mathematical processing of the obtained results. Study results. In connection with the activity of mechanisms of neurohormonal regulation, changes in heart rhythm were considered as a result of the activity of various parts of the autonomic nervous system that modulated cardiac activity and heart rhythm. The need for a preventive approach to vegetative disorders in cadets of the Military Academy of the Ministry of Internal Affairs of Ukraine was established, the functional state of the sympathoadrenal system was determined, and the peculiarities of the vegetative regulation of the heart rhythm were revealed. The basis of pre-hospital diagnosis is the assessment of regulation, which made it possible to assess the functional status and reserves of adaptation due to the speed of response. Conclusions. According to the results of the survey of the cadets conducted at the ascertainment stage of the pedagogical research, reduced functional capabilities of the cardiovascular, respiratory and vegetative systems were established, which created the prerequisites for the development of an experimental program for their improvement through the use of means that include the whole body, universal schemes for engaging motility in several planes movements such as the basic elements of Jiu-Jitsu.

Atrial Fibrillation Detected After Acute Ischemic Stroke

Atrial fibrillation (AF) increases 4-5 times incidence of cardiac embolic stroke. In contrast, as many as 70% of AF cases can be detected in stroke within three days of onset, and this can affect the patient's prognosis. This case report describes the causal pathophysiology of AF and acute stroke and identifies the associated risk factors. Case 1 is a 44-year-old woman, acute stroke with acute decrease level of consciousness. The patient came with status epilepticus and a hypertensive emergency. Obtained a history of stroke, uncontrolled hypertension, and myocardial infarction. Initial Score National Institutes of Health Stroke Scale (NIHSS) was 33 and CHA2DS2-VASc was 5. Investigation non-contrast head Computed Tomography (CT) scan showed no bleeding and echocardiography (ECG) showed AF with rapid ventricular response. The patient died after 3 days of treatment. Case 2 is an 83-year-old woman, acute stroke with acute decrease level of consciousness and right motor lateralization. There was a history of hypertension and stroke with left hemiparesis. The initial NIHSS was 28 and CHA2DS2-VASc was 6. Investigations non-contrast head CT scan showed no bleeding and ECG showed AF with normal ventricular response. The patient was discharged from the hospital after being treated for 22 days with NIHSS of 20. Several risk factors for post-stroke AF are elderly, hypertension, subtype of ischemic stroke, prior stroke, and comorbidities such as DM and hypertension. Post-stroke AF can occur because of changes in heart rhythm through autonomic disorders, increased plasma catecholamine levels, and inflammatory reactions. Early Recognition of risk factors, focusing on patients at higher risk of AF detected after stroke becomes important for comprehensive management of stroke with AF.
 Keywords: acute ischemic stroke, atrial fibrillation, CHA2DS2-VASc score, risk factors.

Association between Thoracic Radiation and Heart Rhythm Disorders: Toward a Model for Describing Long-Term Cardiac Risk from Radiotherapy

<h3>Purpose/Objective(s)</h3> Radiation-induced heart disease (RIHD) is a major source of morbidity and mortality in patients receiving thoracic radiation. The impact of thoracic radiation on heart rhythm changes remains poorly understood. To further define this association, we retrospectively collected electrocardiogram (ECG) data from patients who received thoracic radiation at our institution and analyzed heart rhythm changes as a function of treatment time and delivery technique. <h3>Materials/Methods</h3> We retrospectively reviewed all patients who received thoracic radiation from 2005-2020 at our institution and identified those who also had digitized ECGs. Abnormal ECGs were defined as ventricular rates (VR) <60 or >100, or incalculable PR intervals as surrogate for composite arrhythmia (CA) of atrial fibrillation/flutter and 2^nd/3^rd degree AV block. We compared atrial rates (AR) and VR via unpaired Wilcoxon rank sum test, paired Wilcoxon test for nearest pre- and post-RT ECGs, and calculated odds ratio (OR) with χ² test. All statistics were performed using statistical software. <h3>Results</h3> We identified 1034 patients with 5332 ECGs, and included 360 patients who had ECGs before and after radiation therapy (RT) with a total of 3328 ECGs available for review. 49.4% (178/360) vs 63.4% (229/360) of patients had an abnormal ECG before RT vs after RT, OR 1.79 (95% CI 1.33 – 2.41, χ² = 14, p < 0.001). Median and interquartile range (IQR) ECGs were obtained 305 days (875) before and 290 days (714) after radiation start date. In all ECGs, pre- vs post-RT AR [77 (27) bpm vs 89 (34) bpm] and VR [77 (24) bpm vs 87 (31) bpm] were statistically greater, (p < 0.001). There were no differences in odds of prolonged PR interval >200 ms or QRS length >120 ms after RT. We analyzed the closest pre- and post-RT ECGs for each patient (720 ECGs total); ECG were obtained 54 (201) days before and 101 (360) days after start of radiation. On paired analysis, AR [76 (24) vs 84 (31) bpm] and VR [76 (23) vs 83 (29) bpm], remained greater, p < 0.001. Of the 182 patients with exclusively normal ECGs before RT, 125 (68.7%) had an abnormal ECG after RT, persistent over multiple ECGs in 70 (56%) patients. 43 patients had new CA after RT (55/360 vs 98/360, OR 2.07, 95% CI 1.44-3.01, χ² = 15, p < 0.001), persistent over multiple ECGs in 27 (63%) patients. 183 patients received SBRT and had no significantly increased odds for CA, however the 177 patients who received conventionally fractionated RT (CFRT) had higher odds for CA after CFRT, OR 2.45 (1.45 – 4.24, χ² = 15, p < 0.001). <h3>Conclusion</h3> Our population had increased AR/VR and increased odds of abnormal ECG and CAs after thoracic radiation. Odds of CAs were highest in patients receiving CFRT. These abnormalities appeared to persist in some patients long after RT. These data strongly suggest that further prospective studies are needed to further define associated risks and to develop mitigation strategies for arrhythmia and conduction abnormalities.

Left atrial vorticity is independently associated with embolic brain infarcts and represents a promising imaging biomarker of cardioembolism in sinus rhythm and atrial fibrillation

Abstract Background Atrial fibrillation (AF) is associated with embolic stroke, but risk scores such as CHA2DS2-VASc perform only modestly (C statistics 0.6–0.7). Meanwhile, up to 25% of embolic strokes in patients without AF have no identifiable cause, and occult left atrial (LA) thromboembolism may be a relevant mechanism in such cases. Purpose We hypothesised that imaging of left atrial blood flow could improve embolic risk prediction in patients with and without AF. We used 4D flow magnetic resonance imaging (MRI) to identify a biomarker that is: (a) independently associated with embolic brain infarction by brain MRI, (b) able to stratify blood flow characteristics both during AF and in sinus rhythm (SR), and (c) reproducible. Methods We recruited 3 patient cohorts to respectively address each aim. Firstly, to assess the association between LA flow parameters and embolic brain infarcts, we recruited cohort A, consisting of 134 patients (41% female; age 70±9 years) with a history of ischaemic stroke (N=44) or no history of stroke but with CHA2DS2VASc score ≥1 (N=90). Next, the sensitivity of 4D flow parameters to rhythm change was assessed in cohort B: 37 patients with persistent AF studied before and after cardioversion, whose results were compared with those of 23 healthy controls in SR [CHA2DS2-VASc = 0.0 (0.0–0.0)]. Finally, scan-rescan coefficients of variation (CV) and interval-scan CV at 30 days were determined in Cohort C (86 subjects; 64 in SR, 22 in AF). Brain MRI was used to identify large non-cortical or cortical brain infarcts (LNCCI) – i.e. infarcts likely to be embolic in origin. Results At least one LNCCI was present in 39 of 134 patients in cohort A. Lower LA vorticity was significantly associated with higher risk of prevalent LNCCIs (Figure 1), after adjustment for AF, age, and CHA2DS2VASc score [OR=2.10 (95% CI 1.12–3.92) per SD, P=0.02]. This association remained significant after further adjustment for other cardiac parameters (all P&amp;lt;0.05, Figure 1). By contrast, there was no significant association between peak velocity and LNCCIs (P=0.21). LA vorticity was sensitive to rhythm change, improving significantly in patients in cohort B in SR at ≥4 weeks after cardioversion (CV) of persistent AF (Figure 2A, paired P&amp;lt;0.001 vs pre-CV), but remained impaired compared to healthy controls (Figure 2B, P&amp;lt;0.01). Finally, reproducibility studies in cohort C showed that LA vorticity had a same-day scan-rescan CV of 7% without significant differences between SR and AF subjects (P&amp;gt;0.05), and also showed no significant temporal variability on interval scanning (P&amp;gt;0.05). Conclusions LA vorticity is reproducible, sensitive to changes in heart rhythm, and independently associated with embolic brain infarcts, suggesting a promising imaging biomarker of cardioembolism in SR and AF. LA blood flow imaging could improve stroke prediction and the personalisation of decisions about anticoagulation, regardless of heart rhythm. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Oxford BRC, BHF

Cardiomyocyte-specific loss of plasma membrane calcium ATPase 1 impacts cardiac rhythm and is associated with ventricular repolarisation dysfunction

Plasma membrane calcium ATPase 1 (PMCA1, Atp2b1) is emerging as a key contributor to cardiac physiology, involved in calcium handling and myocardial signalling. In addition, genome wide association studies have associated PMCA1 in several areas of cardiovascular disease including hypertension and myocardial infarction. Here, we investigated the role of PMCA1 in basal cardiac function and heart rhythm stability. Cardiac structure, heart rhythm and arrhythmia susceptibility were assessed in a cardiomyocyte-specific PMCA1 deletion (PMCA1CKO) mouse model. PMCA1CKO mice developed abnormal heart rhythms related to ventricular repolarisation dysfunction and displayed an increased susceptibility to ventricular arrhythmias. We further assessed the levels of cardiac ion channels using qPCR and found a downregulation of the voltage-dependent potassium channels, Kv4.2, with a corresponding reduction in the transient outward potassium current which underlies ventricular repolarisation in the murine heart. The changes in heart rhythm were found to occur in the absence of any structural cardiomyopathy. To further assess the molecular changes occurring in PMCA1CKO hearts, we performed proteomic analysis. Functional characterisation of differentially expressed proteins suggested changes in pathways related to metabolism, protein-binding, and pathways associated cardiac function including β-adrenergic signalling. Together, these data suggest an important role for PMCA1 in basal cardiac function in relation to heart rhythm control, with reduced cardiac PMCA1 expression resulting in an increased risk of arrhythmia development.

Screening for Heart Disease in the Age of Digital Health Technologies: Who, When, and How?

Heart disease affects much of the world’s population, yet many people have no idea that they could have something wrong with them. An opportunity therefore exists for targeted screening for conditions such as cardiovascular disease, heart rhythm changes, valvular heart disease, structural abnormalities, and more subtle, rarer inherited heart conditions. At the same time, the rapid development of digital health technologies and clinical support systems is providing patients and their doctors access to augmented intelligence solutions to diagnose these conditions. This article will focus on how the emerging field of digital health technology can aid screening for heart disease and explore its usefulness in disease specific and population specific groups.

Case Report on Seizures Disorder

Introduction: Seizures are periods of aberrant motor, sensory, autonomic, or mental activity caused by discharge from brain neurons [1]. Epilepsy is defined as the two or more unprovoked seizures that occur more than 24 hours apart [2]. There are three types of seizures: focal, generalized, and unknown. Generalized seizures arise in bilaterally dispersed networks and rapidly activate them [3]. The origin of focal seizures is assumed to be in one hemisphere of the brain. Epileptic spasms are an example of the unknown kind [4].&#x0D; Main symptoms: The signs and symptoms of a seizure can range from minor to severe; these are as follows; perplexity, stare, Jerking motions of the arms and legs, Loss of awareness, Fear, anxiety, and other cognitive symptoms.&#x0D; Diagnosis: The initial step for a physician is to rule out alternative possibilities, such as nonepileptic seizures. These might seem like seizures, but they're usually caused by other things like low blood sugar or high blood pressure, changes in heart rhythm, or mental stress.&#x0D; Therapeutic Intervention: Tab. Levetiracetam 500mg * OD, Tab. Carbamazepine 200mg * TDS, Tab. Escitalopram 10mg * OD, Tab. Neurobion forte 1mg * OD.&#x0D; Outcome: After treatment the patient show improvement. His temporary confusion got reduced, he is now aware to many things.&#x0D; Conclusion: My patient was Admitted to AVBRH with a known case of Seizures Disorder and he had a complaint of temporary confusion and he was not aware to his surroundings. After getting appropriate treatment his condition was improved.

Myocardial and Arrhythmic Spectrum of Neuromuscular Disorders in Children.

Neuromuscular disorders (NMDs) are highly heterogenous from both an etiological and clinical point of view. Their signs and symptoms are often multisystemic, with frequent cardiac involvement. In fact, childhood onset forms can predispose a person to various progressive cardiac abnormalities including cardiomyopathies (CMPs), valvulopathies, atrioventricular conduction defects (AVCD), supraventricular tachycardia (SVT) and ventricular arrhythmias (VA). In this review, we selected and described five specific NMDs: Friedreich’s Ataxia (FRDA), congenital and childhood forms of Myotonic Dystrophy type 1 (DM1), Kearns Sayre Syndrome (KSS), Ryanodine receptor type 1-related myopathies (RYR1-RM) and Laminopathies. These changes are widely investigated in adults but less researched in children. We focused on these specific topics due their relative frequency and their potential unexpected cardiac manifestations in children. Moreover these conditions present different inheritance patterns and mechanisms of action. We decided not to discuss Duchenne and Becker muscular dystrophies due to extensive work regarding the cardiac aspects in children. For each described NMD, we focused on the possible cardiac manifestations such as different types of CMPs (dilated-DCM, hypertrophic-HCM, restrictive-RCM or left ventricular non compaction-LVNC), structural heart abnormalities (including valvulopathies), and progressive heart rhythm changes (AVCD, SVT, VA). We describe the current management strategies for these conditions. We underline the importance, especially for children, of a serial multidisciplinary personalized approach and the need for periodic surveillance by a dedicated heart team. This is largely due to the fact that in children, the diagnosis of certain NMDs might be overlooked and the cardiac aspect can provide signs of their presence even prior to overt neurological diagnosis.

Assessment of heart rate variability and tone of the autonomic nervous system in puberty-aged children with undifferentiated connective tissue dysplasia

Abstract Within the framework of the research into pathological conditions and syndromes associated with undifferentiated connective tissue dysplasia (UCTD), an emphasis needs to be placed on the changes in heart rhythm. In puberty, the severity of neurovegetative disorders caused by the presence of UCTD might increase manifold. The features of heart rate variability (HRV) in pubertal children against the background of UCTD have been studied insufficiently and require more detailed analysis. This study aims to assess heart rate variability and tone of the autonomic nervous system (ANS) in puberty-aged children with UCTD. Two groups of children were examined, with methods including electrocardiography and cardiointervalography. The main group consisted of 36 puberty-aged children with UCTD, the control group consisted of 30 healthy children. ANS tone was assessed based on the HRV. In the control group of children aged 11, the value of variation range (VR) was 0.18±0.4, mode amplitude (MA) 35.2±2.4, stress index (IN) 72.8±4.3, which corresponds to the state of vegetative balance. As the puberty progresses, the state of eutonia is replaced by the activation of the sympathetic division of the ANS, which becomes most pronounced at the age of 13 years. In the control group of children aged 13, the value of VR was 0.08±0.02, MA 61.7±2.1, SI 210.6±8.6, which corresponds to moderate sympathicotonia. By the end of puberty, in healthy children, the severity of sympathetic activation begins to decrease, and at the age of 15 years, vegetative balance is again observed. However, this pattern is violated in children with UCTD. Upon entering puberty, moderate activation of the sympathetic division of the ANS is already observed in children with UCTD. At the age of 11 years in this group, the value of VR is 0.06±0.02, MA 72.4±3.1, SI 211.2±8.6. At the age of 13, pronounced sympathicotonia is observed, which is confirmed by the values of VR - 0.04±0.01, MA 80.2±4.3 and SI 34.3±14.7. By the end of puberty in children with UCTD, in contrast to the control group, the analyzed parameters indicate not an equilibrium of the ANS, but the predominance of parasympathetic activation. The research provides an insight into heart rate variability in puberty-aged children with UCTD. It was established that healthy children enter puberty in a state of equilibrium of the autonomic nervous system, which in the middle of puberty is replaced by moderate sympathicotonia, and then returns to its original values. Children with the presence of UCTD enter puberty with moderately pronounced sympathicotonia, which gradually increases to pronounced values and is replaced by moderate vagotonia. Funding Acknowledgement Type of funding sources: None.

Efficacy and Safety of 5-Hydroxytryptamine-3 Receptor Antagonists (5-HT3 RAs) for The Prevention of Chemotherapy-Induced Nausea and Vomiting in Cancer Patients: A Review

Objective: This review provides an update review of the efficacy and safety of 5-hydroxytryptamine-3 receptor antagonists in the prevention of chemotherapy-induced nausea and vomiting (CINV) in cancer patients.&#x0D; Methods: The information was collected from electronic scientific search engines from PubMed, Science Direct, Scopus, and Google Scholar. The publication dates covered were from 2010 to 2020. The primary endpoint was the percentage of patients who achieved a complete response (CR), complete control (CC), no nausea, no emesis, or no rescue medication.The secondary endpoint was the percentage of patients who experience constipation related to 5-HT RA constipation, headache, diarrhea, or dizziness, as well as changes in heart rhythm.&#x0D; Results: Fourteen articles were identified. Palonosetron has the same effectiveness as granisetron as but more effective than ondansetron in the delayed phase and overall. Adverse effects that often occur due to the use of palonosetron, granisetron, and ondansetron are constipation and headache. Some of the articles also mentioned that palonosetron does not cause changes in heart rhythm but granisetron and ondansetron do cause changes in the electrocardiogram (ECG) at certain doses.&#x0D; Conclusion: Palonosetron has the same effectiveness as granisetron, and more effective than ondansetron in delayed, and overall phases. The use of palonosetron, granisetron, and ondansetron cause constipation and headaches at all doses, palonosetron does not cause ECG abnormalities whereas granisetron and ondansetron cause ECG changes.&#x0D; Keywords: palonosetron, ondansetron, granisetron, 5-HT3 RAs, cancer, nausea, vomiting, CINV.