Electrocardiography In Patients Research Articles

Clinical Profile, Immediate- and Short-term Outcome of Patients with Intermediate-risk Acute Pulmonary Thromboembolism.

Long-term outcomes of acute pulmonary thromboembolism (PTE) have been reported. However, the immediate- and short-term outcomes have not been reported adequately. Primary objective was to determine the patient characteristics, and immediate- and short-term outcomes of intermediate-risk PTE, and the secondary objective was to evaluate the benefit of thrombolysis in normotensive PTE patients. This study included patients diagnosed with acute intermediate PTE. Patient's electrocardiography (ECG) parameters along with echocardiography (echo), etc., conducted at the time of admission, during their stay in hospital, at the time of discharge, and during follow-up were recorded. The patients were treated using thrombolysis or anticoagulants depending on hemodynamic decompensation. During follow-up, they were reassessed for echo parameters-right ventricular (RV) function and pulmonary arterial hypertension (PAH). Among 55 patients, 29 (52.73%) were diagnosed with intermediate high-risk PTE and 26 (47.27%) with intermediate low-risk PTE. They were normotensive and most of them had a simplified pulmonary embolism severity index (sPESI) score <2. Typical ECG pattern S1Q3T3 along with echo patterns and elevated cardiac troponin levels were observed in most of the patients. Patients treated with thrombolytic agents showed a reduction in hemodynamic decompensation as opposed to patients treated with anticoagulants who had clinical signs of right heart failure (RHF) on follow-up after 3 months. This study contributes to the existing literature on outcomes of intermediate-risk PTE and the effect of thrombolysis on patients with hemodynamic stability. Thrombolysis reduced the incidence and progression of RHF in patients with hemodynamic instability. Mathiyalagan P, Rajangam T, Bhargavi K, Gnanaraj R, Sundaram S. Clinical Profile, Immediate- and Short-term Outcome of Patients with Intermediate-risk Acute Pulmonary Thromboembolism. Indian J Crit Care Med 2022;26(11):1192-1197.

Çok Ölçekli Temel Bileşen Analizi ve Evrişimsel Sinir Ağları ile Elektrokardiyografi Sinyallerinden Miyokart Enfarktüsünün Tespiti

Myocardial Infarction is a vital disease that needs to be intervened in a very short time. The analysis of the patient's electrocardiography (ECG) data has an important place in the diagnosis. For this reason, computer aided decision support systems have been used in recent years in order to determine this disease more quickly and accurately. In this study, classification was made using convolutional neural network algorithms on the ECG signals obtained from 61 patients diagnosed with myocardial infarction and 52 healthy individuals. ECG signals are preprocessed with three different filters by applying finite impulse response (FIR) filter, infinite impulse response (IIR) filter and multiscale principal component analysis. According to the results obtained, classification success was achieved with 92.3% accuracy by using the preprocessed signals using multi-scale principal component analysis, and it was seen that more successful classification performance was obtained compared to the classification of the preprocessed signals with the help of FIR, IIR filter.

Assessment of risk factors among female patients with various Acute Coronary Syndrome types presenting to Cardiology unit DHQ Kohat, Pakistan.

Background: There is limited literature regarding the risk factors associated with acute coronary syndrome among female patients of the region, while none was previously reported from Kohat, Pakistan. Therefore, the present study aims to assess the risk factors among female patients with various types of Acute Coronary Syndrome (ACS).&#x0D; Methodology: A descriptive cross-sectional study was conducted from June 2021 to February 2022. A total of 500 female patients with ACS admitted to the Cardiology Unit at DHQ Kohat were enrolled, and data were collected using a structured questionnaire. The risk factors were determined with respect to ACS types. The patient's electrocardiography (ECG) and cardiac biomarkers were assessed, and blood samples were obtained to estimate lipid parameters.&#x0D; Results: The mean age of enrolled ACS females was 54.20 ± 9.20 years. Of the total, 74.6% were diagnosed with non-ST segment elevation myocardial infarction (NSTEMI), ST-segment elevation myocardial infarction (STEMI) was present among 6.0% of the enrolled cases, and 19.4% had unstable angina. Hypertension was the most prevalent risk factor (53.2%), followed by diabetes (51.4%). The studied risk factors mean age, blood pressure, body mass index (BMI), past medical history, and family history of ACS were significantly different among the different ACS types (p&lt;0.05). &#x0D; Conclusion: In conclusion, age, blood pressure, BMI, past medical history (presence of diabetes and hypertension), and family history of ACS among female patients are significantly associated with various ACS types.

Application of remote mobile monitoring using the “ECG-DONGLE” electrocardiograph in patients with chronic heart failure

The urgency of remote monitoring of the patients condition, early diagnosis, and timely detection of precursors of deterioration during chronic heart failure using the telemonitoring systems is substantiated. We examined 10 patients (4 women and 6 men aged 64 12 years) suffering from a heart failure with a high risk of adverse outcomes, the mean left ventricular ejection fraction was 34.4% (32.1%; 37.6%), as well as 10 healthy men (control group, mean age 21 3 years). Each participant was provided with a home monitoring and communication kit (tablet computer with the Internet access, mobile ECG-Dongle electrocardiograph). Also, an individual plan for the treatment of heart failure and associated diseases was developed for the participants. The resulting image using a mobile electrocardiograph ECG-Dongle fully corresponds to the data of a stationary 12-lead electrocardiograph. The use of monitoring the electrocardiogram using a remote access solves the problem of timely personalized identification of predictors of deterioration in the patients circulatory system, while helping to identify a possible cause of destabilization of the course of heart failure, which contributes to the timely correction of the therapy in the early stages. Mobile computing technologies for a remote access, data transfer, and information processing are now being introduced in telemonitoring systems. The remote rehabilitation monitoring system based on the mobile communication could be used as an auxiliary model of outpatient care in the management of patients suffering from a chronic heart failure. We believe that by using such systems, work with the patient could be more effective, namely, self-control of behavior and improved quality of life, which in turn, could lead to a decrease in the rate of the repeated hospitalizations and mortality of the patients suffering from a chronic heart failure.

217Comparative analysis of multiple leads smartphone electrocardiograph versus standard 12-leads electrocardiograph in patients with hypertrophic cardiomyopathy

217Comparative analysis of multiple leads smartphone electrocardiograph versus standard 12-leads electrocardiograph in patients with hypertrophic cardiomyopathy

Single Derivation Fragmented QRS Can Predict Poor Prognosis in Successfully Revascularized Acute STEMI Patients.

BackgroundQRS fragmentation (fQRS) is classically defined as the presence of slurred QRS morphology in at least two contiguous leads, and its prognostic importance has been shown in ST elevation myocardial infarction (STEMI). However, no study has investigated the significance of single lead fQRS (sl-fQRS) in surface electrocardiography (ECG).ObjectivesTo evaluate whether sl-fQRS is as valuable as classical fQRS in patients with acute STEMI who had successful revascularization with primary percutaneous coronary intervention (pPCI).MethodsWe included 330 patients with a first STEMI who had been successfully revascularized with pPCI. The patient’s electrocardiography was obtained in the first 48 hours, and the patients were divided into three groups according to the absence of fQRS (no-fQRS); fQRS presence in a single lead (sl-fQRS); and ≥2 leads with fQRS (classical fQRS).ResultsIn-hospital mortality was significantly higher both in patients with sl-fQRS and in patients with ≥ 2 leads with fQRS compared to patients with no-fQRS. In ROC curve analysis, ≥ 1 leads with fQRS yielded a sensitivity of 75% and specificity of 57.4% for the prediction of in-hospital mortality. Multivariate analysis showed that sl-fQRS is an independent predictor of in-hospital mortality (OR: 3.989, 95% CI: 1.237-12.869, p = 0.021).ConclusionsAlthough the concept of at least two derivations is mentioned for the classical definition of fQRS, our study showed that fQRS in only one lead is also associated with poor outcomes. Therefore, ≥1 leads with fQRS can be useful when describing the patients under high cardiac risk in acute STEMI.

Differential diagnosis of early repolarization and nonspecific ST-segment elevation

During the last years, because of the emergence of new algorithms to identify the early repolarization, clinicians are confused to define it on electrocardiography (ECG). It is very important to define the patients who are at the higher risk of life threatening arrhythmias. Presence of early repolarization is accepted as an arrhythmogenic factor. Therefore, the differential diagnosis between early repolarization and nonspecific ST-segment elevation should be clearly identified. Recently, Dr. Stefan Peters [ [1] Peters S. Differentiation between arrhythmogenic cardiomyopathy and early repolarization pattern: a case report with these two entities. Int. J. Cardiol. 2016; 215: 132-134 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ] reported an interesting case of a patient with both early repolarization and arrhythmogenic cardiomyopathy. However, we think that this finding may be due to not considering the diagnostic criteria of early repolarization which was recommended by the consensus document [ [2] Macfarlane P.W. Antzelevitch C. Haissaguerre M. Huikuri H.V. Potse M. Rosso R. Sacher F. Tikkanen J.T. Wellens H. Yan G.X. The early repolarization pattern: a consensus paper. J. Am. Coll. Cardiol. 2015; 66: 470-477 Crossref PubMed Scopus (248) Google Scholar ]. According to consensus document [ [2] Macfarlane P.W. Antzelevitch C. Haissaguerre M. Huikuri H.V. Potse M. Rosso R. Sacher F. Tikkanen J.T. Wellens H. Yan G.X. The early repolarization pattern: a consensus paper. J. Am. Coll. Cardiol. 2015; 66: 470-477 Crossref PubMed Scopus (248) Google Scholar ], the diagnosis of early repolarization should be made if all of the following criteria are met; a) presence of an end-QRS notch or slur on the downslope of a prominent R-wave. If there is a notch, it should lie entirely above the baseline. The onset of a slur must also be above the baseline, b) Jpeak (Jp) is ≥0.1 mV in 2 or more contiguous leads of the 12-lead ECG, excluding leads V1 to V3, and, c) QRS duration is <120 ms. In this interesting report by Dr. Peters [ [1] Peters S. Differentiation between arrhythmogenic cardiomyopathy and early repolarization pattern: a case report with these two entities. Int. J. Cardiol. 2016; 215: 132-134 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ], first ECG (Fig. 1 in the case report) seems as ECG noise rather than early repolarization. Additionally, the second ECG (Fig. 2 in the case report) does not meet the all of the criteria recommended by consensus document. Therefore, ST-segment elavation in this patient's ECG should be defined as nonspecific ST-segment elevation rather than early repolarization. The consensus document also recommended this definition [ [2] Macfarlane P.W. Antzelevitch C. Haissaguerre M. Huikuri H.V. Potse M. Rosso R. Sacher F. Tikkanen J.T. Wellens H. Yan G.X. The early repolarization pattern: a consensus paper. J. Am. Coll. Cardiol. 2015; 66: 470-477 Crossref PubMed Scopus (248) Google Scholar ]. Similar to our perspective, Biernacka et al. [ [3] Biernacka K.E. Piotr K. Krzysztof D. Olgierd W. Early repolarization in patients with arrhythmogenic right ventricular cardiomyopathy is not frequent phenomenon. Int. J. Cardiol. 2016; 222: 982-983 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ] demonstrated that early repolarization in patients with arrhythmogenic right ventricular cardiomyopathy is not a frequent phenomenon when the new diagnostic criteria of the early repolarization are used for its definition.

Severe hemodynamic deterioration caused by cardiac herniation during endoscopic thoracic sympathicotomy in a patient with previously undiagnosed congenital pericardial defect.

Severe hemodynamic deterioration caused by cardiac herniation during endoscopic thoracic sympathicotomy in a patient with previously undiagnosed congenital pericardial defect.

The Cross-Talk Between Spinal Cord Stimulators and the Confirm™ Cardiac Monitor

Spinal cord stimulators (SCS) function by transmission of electrical impulses to electrode contacts placed within the epidural space depending on the painful area to be treated. Because of the electrical nature of the SCS, there has been concern about the interaction between these devices and devices that monitor or augment the cardiac system. Implantable loop recorders help to identify the causes of syncope or palpitation by continuously evaluating and recording portions of an electrocardiograph in patients being evaluated for cardiac conduction arrhythmias. The purpose of the study is to simulate the possible effects of spinal cord stimulation on a Confirm cardiac monitor (St. Jude Medical, St. Paul, MN, USA). Twenty patients without preexisting cardiac disease, who were successfully being treated with SCS, were enrolled. Confirm loop recorders (St. Jude Medical) were placed on their chest wall in a noninvasive manner, with all programmed at identical settings. Multiple stimulation settings were adjusted on the stimulators and the recordings from the Confirm loop recorder were analyzed for evidence of interference. Fifteen of the patients had no electrical noise detected at any of the tested combinations of stimulation. Five patients had some electrical "noise" detected by the loop recorder, but it did not inhibit the cardiologist evaluating the recording from analyzing the electrocardiograph for diagnostic purposes. At no point with any of the patients at any tested setting was there an appearance of a life-threatening arrhythmia. Our study demonstrates that spinal cord stimulation is unlikely to interfere with the data collected by the Confirm loop recorder, and the presence of an SCS should not interfere with the ability to use a loop recorder for diagnostic purposes.

Artefactual spikes in electrocardiography: a worthwhile introspection

Electrical devices, which have become an integral part of our daily life, may influence the electrical recording of the heart. These disturbances from external sources outside of the heart's own activity produce changes in the electrocardiography (ECG) of the patient, simulating rhythmic disturbances of the heart. Understanding these disturbances is essential in order to better interprete the ECG. Common sources of electrical interferences include external devices, such as alternating current and improper earthing, and surgical procedures like diathermy. We report a case of electrical interference in a patient's ECG due to an inserted bladder stimulator. This case report highlights the importance of precise identification of artefacts in the interpretation of ECG, as well as prompt localisation and elimination of the source of interference.