Screening Electrocardiography Research Articles

Cardiac screening in patients with infantile hemangiomas before propranolol treatment

Purpose: The aim of this study is to evaluate the cardiac findings of patients with Infantile hemangiomas (IH) prior to propronalol treatment and to compare our findings with literature data and verify the need for detailed cardiac screening.
 Materials and Methods: We performed a single-center retrospective review of patients diagnosed with IH who underwent cardiac screening between October 2021 and October 2022. Charts were reviewed and symptoms, heart rate, blood pressure, electrocardiogram, and echocardiogram findings were recorded for each patient.
 Results: Of the 50 patients, 30 were female. The mean age and weight were 7.1±7.3 months and 7.6±3.0 kg. Electrocardiography screening did not reveal any contraindication for treatment. Propranolol significantly reduced heart rate and systolic blood pressure (baseline: 120.2±10.5 bpm/89.6±17.6 mmHg; 1st week: 118.5±10.4 bpm/88.7±17.5 mmHg; 2nd week: 117.8±9.5 bpm/88.7±17.3 mmHg; 2nd month: 116.5±9.4 bpm/88.6±17.3 mmHg). Diastolic pressure reduction was significant only between ‘baseline- 1st week and ‘baseline- 2nd month (58.9±15.6 vs 58.2±15.8 mmHg; 58.9±15.6 vs 57.9±15.5 mmHg, respectively). 
 Conclusion: Screening electrocardiography and hospitalization for initiation of propranolol therapy is not necessary in most infants. Given the low frequency of complications, it seems medical history and physical examination are the cornerstones for safe initiation and monitoring of β-blocker treatment. Electrocardiography and BP control should be part of the pretreatment evaluation in high-risk patients.

Prevalence and diagnostic yield of investigating t wave inversion in a large unselected pre-participation cohort of young Asian males

Abstract Background/Introduction T wave inversion (TWI) is a potentially abnormal finding on pre-participation screening electrocardiography (ECG), as it may suggest an underlying cardiomyopathy that should be risk stratified appropriately to minimise the risk of sports-related sudden cardiac death. Existing international guidelines prescribe criteria for investigating TWI in athletes. However, it is not established if these criteria can be extrapolated to screening unselected individuals. There is also evidence recommending against investigating specific patterns of anterior TWI in certain subsets of athletes due to low diagnostic yield; whether these exemptions may apply to non-athletes is uncertain. Given the importance of physical activity for primary prevention of cardiovascular disease in the general population, more evidence to guide pre-participation ECG screening of unselected individuals is needed. Purpose Firstly, to determine the epidemiology of abnormal TWI in a large unselected pre-participation cohort of young males of predominantly Asian ethnicity. Secondly, to determine the diagnostic yield of an echocardiography-guided approach to investigating individuals with abnormal TWI for a cardiomyopathy. Methods All individuals who attended a national centre for pre-enlistment cardiac screening over 39 months from 2017 were examined. Demographic data, anthropometric data and standardised physical fitness test scores were collected. Resting 12-lead ECG was performed for all individuals. Those with abnormal TWI, defined as a negatively deflected T wave of at least 0.1 mV amplitude in two contiguous leads, were referred to tertiary centres for echocardiography. Results 69,714 consecutive males of mean age 17.9±1.1 years were screened. 562 individuals (0.8%) displayed abnormal TWI. Better aerobic fitness, but not muscular strength, was associated with a higher prevalence of abnormal TWI in general and specifically in the anterior territory, although not beyond leads V1-V2. Aerobic fitness had no association with abnormal TWI in the inferior territory or lateral territory. Of those with abnormal TWI, 12 individuals (2.1%) were newly diagnosed with a cardiomyopathy. Significant factors associated with a cardiomyopathy diagnosis were abnormal TWI in the lateral territory, abnormal TWI in the anterior territory beyond lead V2, deeper maximum TWI depth, presence of hypertension and higher body mass index. No individual presenting with TWI restricted to solely leads V1-V2 and/or two inferior leads without abnormal TWI in other contiguous leads was diagnosed with a cardiomyopathy. Conclusion Investigating abnormal TWI in an unselected pre-participation cohort of young Asian males had a significant yield, particularly in individuals manifesting abnormal TWI in the lateral territory and the anterior territory beyond lead V2. The ECG finding of anterior TWI in an unselected population may not be as benign as that in athletic populations. Funding Acknowledgement Type of funding sources: None. Abnormal TWI: Prevalence and Yield

Physician adherence to ‘Seattle’ and ‘International’ ECG criteria in adolescent athletes: An analysis of compliance by specialty, experience, and practice environment

BackgroundScreening electrocardiography (ECG) for athletes is both controversial and rapidly evolving. While identifying an abnormal ECG could detect a serious cardiovascular disease, falsely interpreting a benign ECG pattern as abnormal can lead to unnecessary testing, cost, and anxiety. Though recent refinements of athlete screening ECG criteria have significantly improved its accuracy, in clinical practice physician adherence to these criteria may vary. MethodsWe analyzed physician adherence to contemporary athlete ECG criteria in a large, national athlete screening registry. 1577 consecutive screening ECGs were independently re- interpreted to assess for physician adherence to Seattle Criteria or International Criteria, respective to the criteria in place when the screening was performed. We further determined the most common ECG interpretations that deviated from these criteria, and analyzed physician characteristics for independent predictors of adherence to published ECG criteria. ResultsThough overall adherence to contemporary criteria was high, 60.4% of ECGs interpreted as abnormal did not meet athlete ECG criteria for pathology when independently re- read. The most common ECG patterns misinterpreted as abnormal were isolated left ventricular hypertrophy (LVH) and non-pathologic T-wave inversions (TWI). Multivariate regression identified three independent predictors of adherence to athlete ECG criteria: participating in a screening overseen by the organization's medical leadership, electrophysiology specialists and adult cardiologists. ConclusionThis study highlights the need for quality control measures and continued clinician education in a controversial and rapidly evolving field. Clinician education for athlete screening ECG criteria should emphasize the recent changes in how TWI and LVH voltage criteria should be interpreted in this patient population.

P4457Cardiac screening is improved by the addition of vectorcardiography

Abstract Background The most common cause of sudden cardiac death in the United State of America is hypertrophic cardiomyopathy, while other causes such as left ventricular hypertrophy, ion-channelopathies, and other causes are also significant. Screening programs typically involve electrocardiograms with mainly false positive results. Little data regarding EKG and echocardiographic screening combined have been published. Methods During 2016–2019, over 15000 patients were screened by the Heartfelt Cardiac screening program. Screening electrocardiograms and echocardiograms including parasternal short/long axis, 4-chamber views, coronary assessment with color doppler and subcostal views with color doppler for assessment of septal defects, were performed. Results 15,329 patients were screened under 35 years of age, mean age 17 years, with 36 hypertrophic cardiomyopathy patients, 61 borderline left ventricular hypertrophy patients noted, 30 patients with left ventricular dysfunction were noted, 47 patients with mitral valve prolapse, 27 patients with atrial septal defects, 39 patients with Wolf-Parkinson-White, 21patients with ideopathic dilated cardiomyopathy were discovered. Screening electrocardiography was helpful for Wolf-Parkinson-White identification, while echocardiogram was most helpful for detection of the above other defects. Screening EKG only identified 45% of those patients with myocardial disease (per above) with the modified Seattle Screening and ESC screening criteria. Conclusion Screening echocardiogram adds value for screening athletes under 35 years at risk for sudden cardiac death. Consideration of cost-effective echo screening should be considered as part of routine screening.

Analiza rozpoznań elektrokardiograficznych u dzieci z nieprawidłowym wynikiem przesiewowego EKG wykonanego w szkole

Introduction. Electrocardiography (ECG) is one of the fundamental procedures used as a diagnostic tool in pediatric cardiology. ECG is indispensable in the evaluation of children with arrhythmias, some of which like in long QT syndrome and Wolff- Parkinson-White (WPW) syndrome could be life threatening. Aim. The aim of the study was to analyze diagnostic tests of the cardiovascular system in children with abnormal ECG screening performed at school. Material and methods. Abnormal ECG screening in 31 children, aged 7-13 years old (average 10.6 years) was re-analyzed. In all 31 children referred to pediatric cardiology department ECG and echocardiogram were performed. In case of arrhythmia suspicion, 24-hour Holter ECG monitoring and exercise test were also done. Results. Based on ECG screening performed at school, initially in 22 out of the 31 children significant changes in ECG were found and minor in 9. After verification in the pediatric cardiology department 50% of children with previously diagnosed significant changes in ECG were considered to have a normal ECG. Only in 2 children pathology was confirmed (WPW syndrome and QT prolongation). The most frequent falsely diagnoses in ECG included: hypertrophy of the left ventricle, heart axis deviation, nonspecific repolarization changes, partial right bundle branch block. Conclusions. 1. The interpretation of the ECG in children requires taking into account the age differences and should be carried out by a pediatric cardiologist. 2. Most of the changes found in screening ECG in children were irrelevant without clinical significance.

Utility of routine electrocardiographic screening before initiation of propranolol for infantile hemangiomas.

Screening electrocardiography (ECG) before initiation of propranolol for treatment of infantile hemangiomas (IH) is controversial. A retrospective chart review was conducted to assess the utility of pretreatment ECG in infants with IH starting propranolol. Although nearly half of the ECGs were abnormal, no contraindications to treatment were identified from screening ECG, and no association was found between any of the reported side effects and abnormal ECG. These results support previously published data, and in a larger cohort, providing further confirmation that pretreatment ECG is not necessary in most infants with IH.

Identifying the ICE-Hearts: Examining the Utility of Electrocardiography in Screening for Methamphetamine-Induced Cardiac Pathology

Background: Cardiac complications play a large role in increasing methamphetamine-related mortality. Purpose: To determine the frequency and severity of ECG abnormalities amongst methamphetamine users compared to a control group. Methods: We conducted a retrospective cohort analysis on 212 patients admitted to a tertiary hospital (106 patients with methamphetamine abuse, 106 age and gender-matched control patients). ECGs were analysed according to American College of Cardiology guidelines, and compared to echocardiographic (TTE) findings. Results: Mean age was 33.4 years, with 73.6% male gender, and no significant differences between groups in smoking status, ECG indication, or coronary angiography rates. Methamphetamine users were more likely to have psychiatric admissions (22.6% vs 1.9%, p<0.0001). Overall, ECG abnormalities were significantly more common (71.7% vs 32.1%, p<0.0001) in methamphetamine users, particularly tachyarrhythmias (38.7% vs 26.4%, p<0.0001), right axis deviation (7.5% vs 0.0%, p=0.004), left ventricular hypertrophy (26.4% vs 4.7%, p<0.0001), p pulmonale pattern (7.5% vs 0.9%, p=0.017), inferior Q waves (10.4% vs 0.0%, p=0.001), lateral T wave inversion (3.8% vs 0.0%, p=0.043), and longer QTc interval (436.41 ± 31.61ms vs 407.28 ± 24.38ms, p<0.0001). TTE (n=24) demonstrated left ventricular dysfunction (38%), thrombus (8%), valvular lesions (17%), infective endocarditis (17%), and pulmonary hypertension (13%). ECG was only moderately sensitive at predicting abnormal TTE. Conclusion: ECG abnormalities are more common in methamphetamine users than age and gender- matched controls. We suggest ECGs should be performed in all methamphetamine users presenting to hospital. Methamphetamine users with abnormal ECGs should be considered for further cardiac investigations.

HIS LEFT BUNDLE BRANCH BLOCK — PREVALENCE AND RISK FACTORS FOR ELECTRICAL AND MECHANICAL DYSSYNCHRONY

Aim. To study the risk factors of electrical and mechanical dyssynchrony development in complete left bundle branch block (CLBBB) Material and methods . In the study, we included patients with CLBBB on screening electrocardiography (ECG) and admitted consequentially to cardiologist of FSBHI SMCC FMBA of Russia. All patients underwent standard investigation that included anamnesis, physical examination, lab tests, ECG, echocardiography (EchoCG). If indicated, stress-EchoCG, coronary arteriography, magneteresonance imaging (MRI) with Gadolinium were done. Mechanical dyssynchrony was assessed at three levels: atrioventricular, interventricular, intraventricular. Results . The prevalence of novel CLBBB cases was 15,9 per 10000 ECGs, or 0,16%, among those 43,3% of patients had unsymptomatic or subclinical course. To the study we included 93 patients (49,5% were male), mean duration of QRS was 148,2±14,5 ms. Most influence on the development of electrical dyssynchrony had male gender (p=0,004), CHD in anamnesis (p=0,011), end-diastolic volume (EDV) of the left ventricle (LV) (p&lt;0,001) and velocity of early phaseLV filling E (p=0,006). The values of mechanical dyssynchrony at atriovetricular (AVD), inter(IVD) and intraventricular (NVD) levels were 46,18±6,78%, 65,23±17,04 ms и 87,22±30,51 ms. The relation revealed, of AVD from the following variables: male gender, surface of mitral regurgitation (Smr), velocity of blood flow in early diastolic filling of the LV (E), time of isovolumic relaxation of LV. IVD was found in 87 (93,5%) patients. Development of IVD was related to female gender, age, myocardium mass index of LV (MMILV) and peak E of early filling of LV. Technical possibility of MVD with 2D-EchoCG existed just in 40% of the participants due to zones of akinesis, hypokinesis and due to difficulties of correct positioning for localization. Conclusion. CLBBB can be found on ECG of patients with a variety of cardiovascular diseases. Factors leading to electrical and mechanical dyssynchrony in CLBBB patients are seriously heterogeneous.

Pediatric hearing loss.

On the basis of strong research, universal newborn screening should be performed before age 1 month with repeat or follow-up testing for those who do not pass performed before age 3 months and intervention started before age 6 months. On the basis of strong research and consensus statement, tympanostomy tubes should be considered for individuals with bilateral persistent middle ear effusion for 3 months or greater and a documented conductive hearing loss. On the basis of consensus statement, all children with suspected hearing loss should have an age appropriate hearing test. On the basis of strong research, the most common form of congenital hearing loss is genetic. Most of this is nonsyndromic hearing loss.

What Now With Screening Electrocardiography?

Editorials20 September 2011What Now With Screening Electrocardiography?Michael S. Lauer, MDMichael S. Lauer, MDFrom National Heart, Lung, and Blood Institute, Bethesda, MD 20892.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-6-201109200-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Fifty years ago in these pages, Kannel and colleagues (1) presented Framingham Heart Study data on “factors of risk” for coronary heart disease. Thirteen years earlier, the National Institutes of Health established an epidemiologic cohort study in Framingham, Massachusetts, in partial response to an epidemic of cardiovascular disease. Kannel and colleagues enrolled 5127 adults between the ages of 30 and 62 years who were free of coronary heart disease. During 6 years of follow-up, 186 men and women developed disease. The authors found that elevated blood pressure, elevated cholesterol concentration, and electrocardiographic evidence of left ventricular hypertrophy were strong independent ...

Index of Suspicion in the Nursery

A woman is admitted for induction of labor at 40-3/7 weeks' gestation. Prenatal care was initiated at 21 weeks' gestation. Ultrasonographic examinations at 23 and 34 weeks' gestation revealed a slightly enlarged right kidney and polyhydramnios, with amniotic fluid indices of 18.6 and 26.7, respectively. An emergency cesarean section is performed for fetal distress. Meconium-stained fluid is noted at delivery. A female infant weighing 3,140 g (10th to 25th percentile for weight) is delivered and assigned Apgar scores of 2, 5, and 9 at 1, 5, and 10 minutes, respectively. At delivery, she is flaccid and apneic but responds quickly to nasal and oral suctioning, stimulation, and bag-mask ventilation. She requires endotracheal intubation for worsening respiratory distress and desaturations. Her initial chest radiograph shows an enlarged cardiac silhouette and diffusely hazy lung fields (Fig. 1). An additional study is performed, which helps to explain the infant's presentation. Figure 1. Chest radiograph shows an enlarged cardiac silhouette and bilateral streaky opacities. Physical examination reveals a grade II/VI systolic ejection murmur along the left sternal border without radiation. Peripheral pulses are diminished in all extremities. She is having moderate respiratory distress on mechanical ventilation support. Her abdomen is soft but distended, and the liver edge is palpable 4 cm below the right costal margin and extends across the midline. No splenomegaly is noted. A palpable mass in the right flank is also detected. A three-vessel cord is present, with a prominent umbilical vein. An abdominal radiograph demonstrates a paucity of bowel gas consistent with ascites and hepatomegaly (Fig. 2). Laboratory results include a white blood cell count of 8.0×103/μL (8.0×109/L) with a normal differential count, a hematocrit of 24% (0.24), and a platelet count of 71×103/μL (71×109/L). Bacterial and viral cultures are negative. Figure 2. Abdominal radiograph of …

Electrocardiographic Screening in Children With Attention-Deficit Hyperactivity Disorder

Some investigators have suggested that children receiving stimulant medications to manage attention-deficit hyperactivity disorder should undergo screening electrocardiography to identify asymptomatic cardiac disease. However, no study to date has examined the efficacy and costs of this strategy. In the present study we sought to determine the utility of electrocardiographic screening in children with attention-deficit hyperactivity disorder. We reviewed the clinical experience of electrocardiographic screening of subjects with attention-deficit hyperactivity disorder <21 years of age from April to September 2008. Additional cardiac care and testing that resulted from an abnormal initial electrocardiogram were recorded. Screening electrocardiograms were obtained in 1,470 children with attention-deficit hyperactivity disorder and were interpreted as abnormal in 119 subjects (8.1%). Further evaluation of these 119 subjects included 63 transthoracic echocardiograms, 5 stress tests, and 9 Holter monitor studies. Cardiac disease was identified in 5 subjects (0.3% of entire cohort), yielding a positive predictive value of 4.2%. Cardiac diagnoses included ventricular pre-excitation syndrome (n = 2), bicuspid aortic valve (n = 2), and moderate secundum atrial septal defect (n = 1). The mean cost of electrocardiographic screening including further testing for subjects with abnormal initial screen results was $58 per child. The mean cost to identify a true-positive result was $17,162. In conclusion, electrocardiographic screening for children with attention-deficit hyperactivity disorder can successfully identify cardiac disease in otherwise asymptomatic subjects, although the positive predictive value is low. Ongoing studies are needed to know what role electrocardiographic screening should play in the management of children with attention-deficit hyperactivity disorder.

Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review

Objective To review the accuracy of electrocardiography in screening for left ventricular hypertrophy in patients with hypertension.Design Systematic review of studies of test accuracy of six electrocardiographic indexes: the Sokolow-Lyon...

The Role of Limited Echocardiography and Electrocardiography in Screening Physicals for Amateur Athletes

Sudden cardiac death in seemingly healthy young people during exertion has led to preparticipation assessment of athletes. Typically, cardiac evaluation is limited to auscultation by a primary care provider. Screening electrocardiography is controversial. The value of limited echocardiography is unknown. High school athletes undergoing preparticipation evaluation for organized athletics completed a medical history questionnaire and were examined with standardized history and physical, 12-lead electrocardiogram, and a limited two-dimensional echocardiogram. The studies were interpreted by cardiologists. Of 95 subjects recruited, there were 55 females and 40 males. There were 10 abnormalities detected requiring further evaluation, two by electrocardiogram and eight by echocardiography. Only one abnormality was found with screening physical examination. Abnormalities occurred with similar frequency (13% vs. 9%) in those with and without cardiovascular symptoms. Screening echocardiography and electrocardiography are of benefit in identification of cardiac anomalies not appreciated on routine physical examinations. Further study of these screening modalities is warranted.

Preoperative Screening Electrocardiography

General Surgery Service, Ireland Army Community Hospital, Fort Knox, Kentucky and Department of Surgery, Uniformed University of the Health Sciences, Bethesda, Maryland

Preoperative Screening Electrocardiography

Preoperative Screening Electrocardiography

Long-term Follow-up of Cardiac Rhythm in Repaired Total Anomalous Pulmonary Venous Drainage

Seven consecutive patients with total anomalous pulmonary venous drainage were operated at the Medical College of Ohio at Toledo and long-term follow-up is reported on their rhythm status. The patients were generally under 3 months of age at operation. All patients are alive at the present time. The median length of follow-up is 4 years. Five of the 7 patients demonstrated ectopic pacemaker activity and 2 exhibited episodes of nodal rhythm as well. In general, these were not apparent on standard screening electrocardiography. There was no correlation between the presence or absence of this arrhythmia and the type of repair. It is concluded that arrhythmias may be present in these patients, but that they are unrelated to the type of surgery performed. The ectopic atrial focus may be of no clinical significance but there is more cause for concern in those patients with nodal rhythm.

Routine electrocardiography in screening for pulmonary embolism.

In a group of 245 patients with clinical suspicion of pulmonary embolism we analyzed the ECG for 22 signs that have been associated with this disease. Subsequently, the patients were divided into two groups: those with confirmed embolism and those in whom embolism was not confirmed. The occurrence of the ECG signs was assessed separately for the two groups. Furthermore, we related ECG features to severity of embolism as estimated at lung scan. Tachycardia and S-T depression were the commonest findings in both groups. P-R displacement, late R in a VR, S1Q3T3, S slurred and T inversion in V1-V2 were more frequent in embolic than in nonembolic patients (p less than 0.05 or less). All the above mentioned signs were more frequent at diagnosis than at recovery in embolic patients (p less than 0.05 or less), whereas only tachycardia was more frequent at diagnosis than at control in nonembolic patients (p less than 0.001). S-T depression and T inversion in V1-V2 were also associated to severity of embolism. Since some ECG signs are very frequent or specific in pulmonary embolism, this condition should always be suspected when they are found and, particularly, when previously absent in the same patients and/or not explained by other conditions.

Study of cardiac arrhythmias and other forms of conduction abnormality in newborn infants.

In an unselected population of 2030 newborn infants studied by electrocardiography (ECG) between April 1975 and April 1977, 35 were found to have arrhythmias or other cardiac conduction abnormalities. Further investigation by means of 24-hour ECG monitoring showed that apparently serious tachyarrhythmias, such as ventricular tachycardia and slow heart rates associated with sinoatrial block, may be present without clinical disturbance in some newborn babies. Six infants had both bradycardia and tachycardia in the 24-hour recording, although the screening ECG had shown only one of these abnormalities. The alarming ECG appearance of some of the arrhythmias suggested a possible aetiological link with some unexplained sudden infant deaths: a multicentre study could determine this more readily and is therefore recommended.

Evaluation of Routine ECG Screening of an Outpatient Population With Computer Diagnoses

A study was performed at the Hartford Hospital to determine the value of routine screening electrocardiography in an outpatient population. Screening electrocardiograms were abnormal in 1,197 of 2,924 cases (40.9%). Dependence upon physician request or upon a positive response to a cardiovascular questionnaire resulted in the exclusion of almost one half of presumably unsuspected abnormalities. In a few clinics, the screening yield of abnormality approached the yield resulting from ECGs requested by physicians. In others, in the face of a virtual lack of requested ECGs, there was a significant frequency of screening abnormalities. Screening electrocardiography produced a yield of abnormality sufficient for it to be recommended as a regular hospital procedure. Interpretation of ECGs and compilation of statistical data were performed by automated methods, with the use of computer analysis.