Sinoatrial Block Research Articles

Holter Monitoring Analysis of Women Infected with the Human Immunodeficiency Virus.

The aim of the study was to assess the clinical features of women infected with the human immunodeficiency virus (HIV) using Holter monitoring. Thirty-five female patients infected with HIV using a Holter monitor at the Ditan Hospital were retrospectively analyzed. In terms of basic rhythms, there were 30 cases of sinus rhythm, 27 cases of ventricular premature beat, 26 cases of supraventricular premature beat, 12 cases of mild reduction of HRV, 9 cases of normal heart rate variability (HRV), 8 cases of supraventricular tachycardia, 5 cases of abnormal ST-segment changes and 2 cases of sinus bradycardia 2 cases of paroxysmal atrial fibrillation 2 cases of junctional escape rhythm. There was only one case in each of the following ECG changes: persistent atrial fibrillation, sinus tachycardia, couplet supraventricular premature beats, accelerated idioventricular rhythm, sinoatrial block, second-degree Mobitz type I atrioventricular block, second-degree Mobitz type II atrioventricular block, complete right bundle branch block, T-wave abnormality, and significant reduction of HRV. The Holter monitor can show more changes in the electrocardiogram (ECG) of HIV-- positive patients, particularly significant ECG abnormalities, such as paroxysmal atrial fibrillation, and can direct early clinical treatment to serious adverse results.

Transvesical blockade of the obturator nerve to prevent adductor contraction in transurethral resection of urinary bladder tumor.

Urinary bladder tumors are one of the most common urological malignancies. Traditionally, it has been managed with trans-urethral resection of urinary bladder tumor (TURBT) for both diagnostic and therapeutic purposes. During TURBT of lateral wall tumors, there is risk of obturator nerve reflex (ONR), which can lead to serious complications such as inadvertent bleeding and urinary bladder perforation. To prevent this, obturator nerve block is given after spinal anesthesia. In this study, we have used the transvesical approach to block the obturator nerve. In total, 60 patients were included in the study. In 30 of them, TURBT was performed under only SA and transvesical obturator nerve block (ONB). In the other 30 patients, TURBT was performed under SA and peripheral nerve stimulator (PNS) guided obturator nerve block (performed by anesthetists) was given. The patients underwent TURBT using conventional monopolar cautery. The procedure time and peri-operative complications were studied. In all patients, informed consent was taken. In this study, 30 ONBs (all bilateral) were performed transvesically. After confirming the location of the obturator nerve, transvesical ONB was given using local anesthetic. Two patients (6.67%) experienced adductor jerk during the operation. In the 30 patients who underwent peripheral nerve stimulator (PNS) guided ONB, 6 of the patients (20%) experienced adductor jerk during the operation and 1 of those (3.33%) suffered from urinary bladder perforation which was managed conservatively. Transvesical ONB is an easy method to prevent adductor jerk during TURBT of lateral wall tumors. The learning curve is less and it has a high success rate.

Влияние поражения сердца на прогноз у пациентов с системным AL-амилоидозом

AIM. To assess the clinical features as well as the factors affecting prognosis and long-term treatment outcomes in systemic AL amyloidosis patients with cardiac involvement. MATERIALS & METHODS. The trial enrolled 123 systemic AL amyloidosis patients with cardiac involvement who were treated at the RM Gorbacheva Scientific Research Institute in 2004–2023. The patients were 34–85 years of age (median 61 years); there were 61 women (49.6 %) and 62 men (50.4 %). RESULTS. Cardiac disease grades 1, 2, 3a, and 3b were identified in 13.8 %, 50.4 %, 17.9 %, and 17.9 % of AL amyloidosis patients, respectively. Chronic cardiac failure (CCF) developed in 65.9 % (n = 81), and severe cardiac failure was detected in 25.4 % (n = 31) of patients. Most of them (90,2 %), despite CCF, preserved left ventricular ejection fraction (> 40 %) with the mean value of 59.6 % (range 33–78 %). The left ventricular stroke volume index (SVI) was below the normal values (< 41 mL/m2) in 92.7 % of patients. The mean SVI value was 26.1 mL/m2 (range 8.3–49.5 mL/m2). The lower SVI was associated with cardiac disease grades. This parameter appeared to be 30.9 mL/m2, 26.8 mL/m2, 24.8 mL/m2, and 21.4 mL/m2 in grades 1, 2, 3a, and 3b (p = 0.006), respectively. Total global strain (TGS) in the left ventricle myocardium was decreased (< 20 %) in 94.6 % of patients. The mean TGS value was 13.8 % (range 4.4–34.8 %). TGS was diminishing with increasing cardiac disease grade (grade 1 with 17.8 %, grade 2 with 14.6 %, grade 3a with 13.1 %, and grade 3b with 9.6 %) (p = 0.007). Atrial fibrillation was reported in 23 % of patients, supraventricular tachycardia was observed in 31.9 %, and supraventricular extrasystoles were registered in 39.7 %. Ventricular extrasystoles were found in 73.7 % of patients, and ventricular tachycardia was seen in 13.2 %. Sinoatrial block was reported in 6.6 % of patients, and atrioventricular block was identified in 19.8 %. Syncope occurred in 12.3 % of patients. An artificial cardiac pacemaker was implanted in 8 patients. The thromboembolism rate was 13 %: the myocardial infarction rate was 11.4 %, and the rate of acute cerebrovascular accidents was 5.7 %. Atrial clots were detected in 2 (1.6 %) patients. The cumulative incidence of hematologic response for 2 years was 57 % and did not depend on cardiac disease grade, the 2-year rate of cardiac response was 39.1 %. Before achieving hematologic and cardiac responses, mortality was 26.5 % and 29.9 %, respectively. The overall 5-year survival was 62.6 %, and the 5-year hematologic progression-free and major organ impairment-free survival was 39.3 %. Cox regression model confirmed 3 independent predictors of poor prognosis: the level of NT-proBNP ≥ 2500 pg/mL (p = 0.004), SVI < 25 mL/m2 (p = 0.0174), and prior syncope (p = 0.0191). The achievement of hematologic response had a positive effect on survival rates (p < 0.0001). CONCLUSION. A comprehensive assessment of cardiac damage by the time of primary AL amyloidosis diagnosis as well as appropriate treatment of this disease can reduce the risk of early cardiac mortality and enhance chances of not only achieving hematologic response but also improving survival rates.

Use of machine learning and Poincaré density grid in the diagnosis of sinus node dysfunction caused by sinoatrial conduction block in dogs.

Sinus node dysfunction because of abnormal impulse generation or sinoatrial conduction block causes bradycardia that can be difficult to differentiate from high parasympathetic/low sympathetic modulation (HP/LSM). Beat-to-beat relationships of sinus node dysfunction are quantifiably distinguishable by Poincaré plots, machine learning, and 3-dimensional density grid analysis. Moreover, computer modeling establishes sinoatrial conduction block as a mechanism. Three groups of dogs were studied with a diagnosis of: (1) balanced autonomic modulation (n = 26), (2) HP/LSM (n = 26), and (3) sinus node dysfunction (n = 21). Heart rate parameters and Poincaré plot data were determined [median (25%-75%)]. Recordings were randomly assigned to training or testing. Supervised machine learning of the training data was evaluated with the testing data. The computer model included impulse rate, exit block probability, and HP/LSM. Confusion matrices illustrated the effectiveness in diagnosing by both machine learning and Poincaré density grid. Sinus pauses >2 s differentiated (P < .0001) HP/LSM (2340; 583-3947 s) from sinus node dysfunction (8503; 7078-10 050 s), but average heart rate did not. The shortest linear intervals were longer with sinus node dysfunction (315; 278-323 ms) vs HP/LSM (260; 251-292 ms; P = .008), but the longest linear intervals were shorter with sinus node dysfunction (620; 565-698 ms) vs HP/LSM (843; 799-888 ms; P < .0001). Number and duration of pauses, not heart rate, differentiated sinus node dysfunction from HP/LSM. Machine learning and Poincaré density grid can accurately identify sinus node dysfunction. Computer modeling supports sinoatrial conduction block as a mechanism of sinus node dysfunction.

Sino-atrial block due to Guillan-Barré syndrome: a rare case

Kontext: Vznik trombózy po zavedení transvenózní elektrody představuje podceňovaný problém. Přes její vysokou incidenci zůstává většina případů nediagnostikovaných, protože je klinicky němá. Byla popsána řada rizikových faktorů predisponujících k tvorbě sraženin na elektrodách přístroje. Protože nejsou k dispozici žádné doporučené postupy (guidelines) ani důkazy ohledně optimální léčby, záleží způsob odstraňování endokavitárních sraženin z elektrod kardiostimulátoru na individuální volbě mezi chirurgickou extrakcí katétrem, trombolýzou nebo antikoagulační léčbou. U některých pacientů může léčbu dále komplikovat křehká rovnováha mezi krvácivými a trombotickými příhodami. Popis případu: Popisujeme případ 86letého muže se srdečním selháním a silně sníženou ejekční frakcí v důsledku chronické ischemické kardiomyopatie. Bylo u něj zjištěno několik komorbidit a v anamnéze měl hlubokou žilní trombózu i závažné krvácení. U pacienta došlo k rozvoji plicní embolie: v místě vzniku tromboembolie visela na elektrodě kardiostimulátoru sraženina. Závěr: Antikoagulace s antagonisty vitaminu K umožnila poměrně bezpečné řešení problému s trombózou (nebo tromboembolií) a krvácením. &#169; 2022, ČKS.

P347 SHORT–TERM EFFECTIVENESS OF TAFAMIDIS THERAPY IN PATIENTS WITH TRANSTYRETIN CARDIAC AMYLOIDOSIS: EVALUATION OF CLINICAL–INSTRUMENTAL AND BIOHUMORAL PARAMETERS

Abstract Background In the ATTRACT trial, Tafamidis has been shown to be effective in patients with transthyretin amyloidosis (ATTR) by improving quality of life and survival at 30–month follow–up. However, it‘s not clear which are the clinical–instrumental and bio–humoral parameters that change first and after how long time from the begging of treatment. Methods In our cardiomyopathy tertially referral center from January 2022 to October 2022, 47 patients with ATTR (73% males, 27% females, mean age 75±16 years) were admitted for the evaluation of the possible TTR treatment. Of these,30 received treatment with Tafamidis and 10 (M, mean age 77±11 years, 9ATTRwt, 1vATTR) completed a six months follow–up and constituted our patient population. The following parameters werecollected at baseline and after six–months follow–up: 6 minute walking test, Kansas score, NYHA class, NT–pro BNP,echocardiographic ejection fraction, 12 lead ECG with assessment of amplitude of QRS voltages, heart rhythm, presence of Q waves of pseudo necrosis, number of ventricular/supraventricular ectopic beats, presence of atrioventricular (AV) blocks, sinus blocks, hemiblocks, bundle branch blocks, QTc length, type and dose of additional medications. Results No patient changed the antiarrhythmic therapy during the six months follow–up, and no ventricular arrhythmias nor sinoatrial blocks were recorded. Two patients had pacemaker (PM) before the beginning of thetherapy and no PM was implanted during the follow–up. There was no significant difference in QRS voltage amplitude (p=0.157), atrial fibrillation (p=0.785), Q waves of pseudonecrosis (p= 1.000), ectopic beats (p= 1.000), AV blocks (p= 1.000), hemiblocks (p= 1.000), bundle branch blocks (p= 1.000), QTc (p= 0.813), ejection fraction (p= 0.317), NYHA class (p= 0.564), NTproBNP (p=0.273). Statistically significant differences were found in the Kansas score (p=0.042) and in the 6 minute walking test (p= 0.018). Conclusions Tafamidis is able to improve quality of life andfunctional capacity in ATTR patients early in the course of the treatment. The stability of the other parameters, that tend to fast worsen in the natural course of the disease, demonstrates the ability of Tafamidis to halt and possibly revert amyloidosis.

Abnormal transmitral flow: what is the rhythm?

Echocardiography was performed on 78-year-old woman for the follow-up of moderate mitral valve regurgitation (MR). A single-lead electrocardiographic (ECG) tracing showed bradycardia with irregular heart rhythm between 46 and 53 beats per minute. The echocardiographic image of pulsed wave Doppler at mitral inflow is displayed in Panel. There was a progressive shortening of the interval between E (early) and A (late) diastolic filling waves, followed by an absent A wave. A gradual shortening of the A-A wave interval was also noted. The interval between A wave and MR envelope remains constant. This typical pattern is consistent with Wenckebach phenomenon in sinoatrial (SA) exit block. SA exit block is due to failed propagation of pacemaker impulses beyond the SA node. In Type I second-degree SA block (Wenckebach), there is a progressive delay in the conduction from the SA node to the atrium until one impulse is completely blocked, leading to intermittent failure of atrial depolarization and ensuing absence of A wave in the Doppler inflow pattern. Moreover, the A-A wave interval is gradually decreased (i.e. the atrial rate accelerates) as the increment in the conduction delay from the SA node to the atrium becomes progressively smaller.

OrbitNet—A fully automated orbit multi-organ segmentation model based on transformer in CT images

The delineation of orbital organs is a vital step in orbital diseases diagnosis and preoperative planning. However, an accurate multi-organ segmentation is still a clinical problem which suffers from two limitations. First, the contrast of soft tissue is relatively low. It usually cannot clearly show the boundaries of organs. Second, the optic nerve and the rectus muscle are difficult to distinguish because they are spatially adjacent and have similar geometry. To address these challenges, we propose the OrbitNet model to automatically segment orbital organs in CT images. Specifically, we present a global feature extraction module based on the transformer architecture called FocusTrans encoder, which enhance the ability to extract boundary features. To make the network focus on the extraction of edge features in the optic nerve and rectus muscle, the SA block is used to replace the convolution block in the decoding stage. In addition, we use the structural similarity measure (SSIM) loss as a part of the hybrid loss function to learn the edge differences of the organs better. OrbitNet has been trained and tested on the CT dataset collected by the Eye Hospital of Wenzhou Medical University. The experimental results show that our proposed model achieved superior results. The average Dice Similarity Coefficient (DSC) is 83.9%, the value of average 95% Hausdorff Distance (HD95) is 1.62 mm, and the value of average Symmetric Surface Distance (ASSD) is 0.47 mm. Our model also has good performance on the MICCAI 2015 challenge dataset.

Long-term risk of new-onset arrhythmia in ST-segment elevation myocardial infarction according to revascularization status.

Emerging data show that complete revascularization (CR) reduces cardiovascular death and recurrent myocardial infarction in ST-segment elevation myocardial infarction (STEMI). However, the influence of revascularization status on development of arrhythmia in the long-term post-STEMI phase is poorly described. We hypothesized that incomplete revascularization (ICR) compared with CR in STEMI is associated with an increased long-term risk of new-onset arrhythmia. Patients with STEMI treated with primary percutaneous coronary intervention (PPCI) at Copenhagen University Hospital, Rigshospitalet, Denmark, with CR or ICR were identified via the Eastern Danish Heart registry from 2009 to 2016. Using unique Danish administrative registries, the outcomes were assessed. The primary outcome was new-onset arrhythmia defined as a composite of atrial fibrillation/flutter (AF), sinoatrial block, advanced second- or third-degree atrioventricular block, ventricular tachycardia/fibrillation (VT), or cardiac arrest (CA), with presentation >7 days post-PPCI. Secondary outcomes were the components of the primary outcome and all-cause mortality. A total of 5103 patients (median age: 62.0 years; 76% men) were included, of whom 4009 (79%) and 1094 (21%) patients underwent CR and ICR, respectively. Compared with CR, ICR was associated with a higher risk of new-onset arrhythmia [hazard ratio (HR), 1.33; 95% confidence interval (CI), 1.07-1.66; P = 0.01], AF (HR, 1.29; 95% CI, 1.00-1.66; P = 0.05), a combined outcome of VT and CA (HR, 1.77; 95% CI, 1.10-2.84; P = 0.02) and all-cause mortality (HR, 1.27; 95% CI, 1.05-1.53; P = 0.01). All HRs adjusted. Among patients with STEMI, ICR was associated with an increased long-term risk of new-onset arrhythmia and all-cause mortality compared with CR.

190 FATAL PEMBROLIZUMAB CARDIOTOXICITY REFRACTORY TO CORTICOSTEROID THERAPY: A CASE REPORT OF CLINICALLY SUSPECTED MYOCARDITIS.

Abstract We report the case of an 80 years old, fit, mildly hypertensive man receiving adjuvant immunotherapy with Pembrolizumab for stage IIIC (pT4a pN1b) cutaneous nodular melanoma, for which he had also undergone radical surgery. His preoperative ECG was unremarkable. Few days after his first Pembrolizumab dose, he started complaining of gradually worsening muscle aches and weakness and double vision, as well as of brief episodes of otherwise asymptomatic palpitations, so that he finally showed up at the Emergency Department (day 1). Clinical examination revealed mild hypertension, low-grade temperature, subtotal bilateral ophthalmoplegia, fatigable left palpebral ptosis, dysarthria, dysphagia, and neck and limb hyposthenia. Laboratory analyses indicated an inflammatory state with mild neutrophilia and elevated C reactive protein, associated to an increase in serum creatinine, creatine kinase and transaminases. Chest x-ray and brain CT demonstrated no alterations. The ECG showed sinus rhythm at 90 bpm and a previously unknown right bundle branch block (RBBB). The patient was admitted to the Internal Medicine ward in the suspect of Pembrolizumab toxicity leading to myositis and myasthenia and to hepatorenal dysfunction, and Methylprednisolone 1 mg/kg/day was administered intravenously ex adiuvantibus, together with Pyridostigmine and low flow oxygen. The next morning (day 2), dyspnea and palpitations ensued, atrial fibrillation at 130 bpm with RBBB was recorded, while the echocardiogram showed normal biventricular dimensions and systodiastolic function, mild aortic and mitral regurgitations, and the absence of pericardial effusion or inferior vena cava congestion. A single, oral, 60 mg dose of Diltiazem was administered, but suspended few hours later upon evidence of atrioventricular block (AVB) 2:1 (HR 40 bpm) quickly escalating to 3:1 (HR 40 bpm) and, later on, of atrial fibrillation with slow ventricular rate (HR 36 bpm). Given a CHA2DS2-VASc score equal to 3, anticoagulation was started. The patient was then moved to the intensive care unit for bradycardia and worsening tachydyspnea. Respiratory function as well as clinical and laboratory parameters of neuromuscular, renal and hepatic impairment began improving (day 3). However, rhythm monitoring showed progression of conduction anomalies with the appearance of sino-atrial block, left bundle branch block and alternance between Mobitz I AVB, AVB 2:1 and complete AVB. High-sensitivity cardiac troponin I remained stably highly elevated, around 25000 ng/L. Control echocardiography showed the onset of mild left ventricular systolic dysfunction with a mild pericardial effusion. A cardiac magnetic resonance was planned to corroborate the hypothesis of Pembrolizumab-induced myocarditis. However, on day 5 respiratory and hemodynamic worsening occurred, up to cardiocirculatory arrest due to an electrical storm of ventricular tachycardia and fibrillation, despite in-range electrolytes, with emergency echocardiogram revealing also a dysfunctioning right ventricle. Despite prolonged resuscitation attempts, including high-dose corticosteroid, death ensued. Widely used in cancer treatment, immune checkpoint inhibitors (ICI) bear the potential for immune-related adverse events, including cardiovascular ones: brady- and tachy- arrhythmias, acute myocardial infarction, pericarditis, myocarditis, pulmonary embolism, and vasculitis; in particular, ICI-related myocarditis, reportedly highly arrhythmogenic, often occurs together with myositis and myasthenia (“triple M rule”); despite immunosuppression, mortality still remains high.

S103 Prevalence of Cardiac Conduction Disorders of Interest Among Adults With Moderately-to-Severely Active Ulcerative Colitis in the US: A Real-World Analysis

Background: Ozanimod, a once-daily oral medication, is the first sphingosine 1-phosphate receptor modulator approved for adults with moderately to severely active ulcerative colitis (UC). An electrocardiogram is needed to determine whether conduction abnormalities are present prior to treatment initiation. Contraindications to ozanimod use that may be identified with an electrocardiogram include presence of Mobitz type II second-degree or third-degree (complete) atrioventricular (AV) block, sick sinus syndrome, or sino-atrial block, unless the patient has a functioning pacemaker. This analysis used MarketScan Commercial claims data to estimate the real-world prevalence of select cardiac conduction disorders among adult patients with UC in the US. Methods: Data from October 1, 2016 to September 30, 2021 were obtained for adult patients with ≥2 UC diagnostic claims within 12 months and continuous medical enrollment of 12 months before the index date. The prevalence of an ICD-10-CM diagnosis code for second-degree (I44.1) or complete AV block (I44.2), sick sinus syndrome (I49.5), or sino-atrial block (I45.5) was analyzed. Prevalence rates were stratified by patient demographics, use of heart rate–lowering medications (anti-arrhythmics, beta blockers, calcium channel blockers, disopyramide, or ivabradine), or an implanted pacemaker use. Sensitivity analyses identified cardiac conduction disorders within the pre-index period and in a US claims database (IQVIA PharMetrics Plus). Descriptive analyses are reported. Results: In total, 79,832 patients with UC met the inclusion criteria; 52.5% were female and mean (SD) age was 45.8 (13.1) years. Of all patients, 29 (0.04%) had second-degree AV block, 41 (0.05%) had complete AV block, 145 (0.18%) had sick sinus syndrome, and 12 (0.02%) had sino-atrial block. The prevalence rate of all the selected cardiac conduction disorders for patients aged ≥50 years old (n = 35,912; 0.05%, 0.09%, 0.32%, and 0.03%, respectively) was numerically higher than for patients aged <50 years old (n = 43,920; 0.03%, 0.02%, 0.07%, and 0.01%, respectively). The prevalence rate for those using heart rate–lowering medications (n = 15,468; 0.08%, 0.17%, 0.52%, and 0.03%, respectively) was numerically higher than for patients without heart-rate-lowering medications (n = 64,364; 0.02%, 0.02%, 0.10%, and 0.01%, respectively). Among patients without implanted pacemaker use (n = 79,607), the prevalence rate was 0.02%, 0.02%, 0.11%, and 0.01%, respectively. Prevalence rates observed in sensitivity analyses were similar to those observed in the main analysis. Conclusion(s): Overall, the proportion of patients with cardiac conduction disorders was less than 0.2% in this real-world commercial claims sample of 79,832 adult patients with UC in the US. The prevalence remained less than 0.6% in high-risk populations including patients aged ≥50 old and those receiving heart rate–lowering medications. Though these data may be subject to miscoding (especially overcoding for sick sinus syndrome) given the claims nature of the data source, they highlight the extremely low prevalence of select cardiac condition disorders that may be identified by using an electrocardiogram in patients with UC.

Role of Endothelin-1 in Right Atrial Arrhythmogenesis in Rabbits with Monocrotaline-Induced Pulmonary Arterial Hypertension.

Atrial arrhythmias are considered prominent phenomena in pulmonary arterial hypertension (PAH) resulting from atrial electrical and structural remodeling. Endothelin (ET)-1 levels correlate with PAH severity and are associated with atrial remodeling and arrhythmia. In this study, hemodynamic measurement, western blot analysis, and histopathology were performed in the control and monocrotaline (MCT, 60 mg/kg)-induced PAH rabbits. Conventional microelectrodes were used to simultaneously record the electrical activity in the isolated sinoatrial node (SAN) and right atrium (RA) tissue preparations before and after ET-1 (10 nM) or BQ-485 (an ET-A receptor antagonist, 100 nM) perfusion. MCT-treated rabbits showed an increased relative wall thickness in the pulmonary arterioles, mean cell width, cross-sectional area of RV myocytes, and higher right ventricular systolic pressure, which were deemed to have PAH. Compared to the control, the spontaneous beating rate of SAN–RA preparations was faster in the MCT-induced PAH group, which can be slowed down by ET-1. MCT-induced PAH rabbits had a higher incidence of sinoatrial conduction blocks, and ET-1 can induce atrial premature beats or short runs of intra-atrial reentrant tachycardia. BQ 485 administration can mitigate ET-1-induced RA arrhythmogenesis in MCT-induced PAH. The RA specimens from MCT-induced PAH rabbits had a smaller connexin 43 and larger ROCK1 and phosphorylated Akt than the control, and similar PKG and Akt to the control. In conclusion, ET-1 acts as a trigger factor to interact with the arrhythmogenic substrate to initiate and maintain atrial arrhythmias in PAH. ET-1/ET-A receptor/ROCK signaling may be a target for therapeutic interventions to treat PAH-induced atrial arrhythmias.

Features of the cardiovascular system in newborns, carrying out the cerebral ischemia

Aim. To identify the features of the function of the cardiovascular system in newborns with cerebral ischemia (CI) of hypoxic origin.&#x0D; Materials and methods. In the neurological department of the children's hospital in 64 newborns coming from maternity hospitals with CI, a clinical and instrumental examination confirmed the diagnosis of CI of hypoxic origin after excluding structural damage to cardiomyocytes, infectious, traumatic and dysmetabolic causes of its occurrence; 12.2% of children were diagnosed with CI of easy degree, 81.2% CI of moderate severity; the control group consisted of 24 healthy full-term children, comparable in age. All patients were examined by a pediatric cardiologist with an electrocardiogram (ECG), echocardiographic ultrasound screening assessment of the heart (ECHO-CG), Holter electrocardiogram monitoring, cardiointervalography.&#x0D; Results. In newborns, who underwent CI, there is a higher heart rate, more often there is a single supraventricular extrasystole. Bradycardia with heart rate less than 100 beats/min, sino-atrial block II degree, atrioventricular block II degree were recorded only in newborns after CI. According to ECHO-CG data, a hypokinetic type of hemodynamics takes place in newborns with CI. A decrease in cardiac output reflects a narrowing of the adaptive range of its regulation. In every second child with CI, homeostasis is achieved by a sharp overstrain of the autonomic nervous system regulatory systems, which is most likely based on a shift in regulation from the reflex vegetative to the humoral-metabolic type. As the severity of CI progresses, depletion of reserves to support reflex and humoral homeostasis has been established.&#x0D; Conclusion. In connection with the revealed clinical and instrumental features of the cardiovascular system, newborns with CI who came under the supervision of pediatricians at children's clinics, at the age of one month, in addition to a neurological examination, an examination of a pediatric cardiologist with an ECG is shown. If, according to ECG data, heart rhythm and conduction abnormalities, fluctuations in the duration of the QT interval are detected, CI and/or HM-ECG are indicated to determine further observation tactics.

Transient Sinoatrial and Atrioventricular Block in the Acute Phase of COVID-19 Infection

Transient Sinoatrial and Atrioventricular Block in the Acute Phase of COVID-19 Infection

Ponesimod oral therapy for the treatment of relapsing forms of multiple sclerosis in adults and its precautions in cardiovascular disease patients

The ponesimod oral therapy was approved in March 2021 by the United States Food and Drug Administration for relapsing forms multiple sclerosis (MS). Ponesimod is a sphingosine 1-phosphate (S1P) receptor 1 modulator that acts selectively as an anti- inflammatory agent and provides a suitable microenvironment for the function of the other neuroprotective agents. Ponesimod is contraindicated in patients who in the last 6 months, have experienced myocardial infarction, unstable angina, stroke, transient ischemic attack (TIA), decompensated heart failure requiring hospitalization, or Class III or IV heart failure. Also contraindicated in patients who have the presence of Mobitz type II second-degree, third-degree atrioventricular (AV) block, sick sinus syndrome, or sino-atrial block, unless the patient has a functioning pacemaker. This article briefs the information about dosage, precautions and warnings required in cardiovascular disease patients before initiation of ponesimod oral therapy.

Case Report on Sick Sinus Syndrome

Abstract: Sick sinus syndrome (SSS) a cardiac conduction disorder characterized by the symptomatic dysfunction of sinoatrial node. The sinus node is normal pacemaker of the heart and is responsible for the regular, rhythmic, heartbeat. Sick sinus syndrome affects about 3 out of every 10000 persons, and becomes more common with advancing age. The symptoms of the sick sinus syndrome include palpitations, fainting or dizziness, fatigue, weakness, confusion, chest pain, and disturbed sleep. Women and men are affected equally. As the age increases the number of pacemaker cells in the sinus node decreases and the normal wear and tear on the sinus node and the conduction system may result in SSS. The diagnosis is done by ECG, Holter monitor. In ECG SSS usually manifests as sinus bradycardia, sinus arrest, or sinoatrial block, and sometimes accompanied by supraventricular tachy arrthymias. The treatments of SSS include implantation of artificial pacemaker.

Severe Oleander Poisoning Presenting with Hyperkalaemia and Unusual Electrocardiographic Changes.

BackgroundHyperkalaemia in oleander (Nerium oleander) poisoning has been associated with a poor prognosis. Different electrocardiographic (ECG) presentations are possible because of vagotonia and hyperkalaemia.Methods/ResultsWe report a series of three cases of oleander poisoning in which ECG showed unusual hyperkalaemia features, such as bradyarrhythmia, sinoatrial block, atrioventricular block and junctional rhythm.ConclusionsIf arterial blood gas analysis or laboratory values indicate hyperkalaemia in oleander poisoning, the hyperkalaemia should be treated immediately, even if the ECG does not show typical hyperkalaemia features.LEARNING POINTSHyperkalaemia in oleander poisoning is associated with a poor prognosis.Hyperkalaemia should be treated aggressively in oleander poisoning even if the ECG does not show typical features, as mimics other conditions on ECG.

Positioning Ozanimod in Ulcerative Colitis: Restoring Leukocyte Traffic Under Control

Positioning Ozanimod in Ulcerative Colitis: Restoring Leukocyte Traffic Under Control

C88. Sick sinus syndrome in acute anterior myocardial infarction: when culprit strategy ended up jeopardy

Abstract Background Atrial arrhythmias occur in 10% of acute myocardial infarctions and increases incidence of death. Altered heart rhythm with brady-tachy episodes indicates sinus node dysfunction ordinarily cause by inferior myocardial infarction. Case Description A 66-year-old-man, diagnosed with 2 days onset Acute Anterior Myocardial Infarction with history of syncope after chest pain, referred with sinus arrest and junctional rhythm that changed into atrial fibrillation. During hospitalization the heart rhythm changing periodically from bradycardia to tachycardia repeatedly with witnessed new ST elevation in inferior lead before an episode of cardiac arrest. After primary PCI to the RCA as the new culprit lesion, chest pain was relieved but hemodynamic condition was not stable and the rhythm remained continuously altered. Discussion Sick sinus syndrome is a cardiac conduction disorder characterized by symptomatic dysfunction of the sinoatrial node generally manifests as sinus bradycardia, sinus arrest, or sinoatrial block, and accompanied by supraventricular tachyarrhythmias (tachy-brady syndrome). This case of acute myocardial infarction with 3 vessel diseased lesion and total occlusion in RCA affected sinoatrial node causing sick sinus syndrome. Recently multi-vessels PCI strategy increasingly recommended at the time of primary PCI for patient with arrhythmia. Conclusion A man 66 years old with acute anterior MI compelling with sick sinus syndrome on presentation because apparently the culprit lesion was RCA. Unfortunately, at that time non-IRA lesion were not opened and TPM was not available, bradycardia continues and the patient ended up being jeopardy.

C88. Sick sinus syndrome in acute anterior myocardial infarction: when culprit strategy ended up jeopardy

Abstract Background Atrial arrhythmias occur in 10% of acute myocardial infarctions and increases incidence of death. Altered heart rhythm with brady-tachy episodes indicates sinus node dysfunction ordinarily cause by inferior myocardial infarction. Case Description A 66-year-old-man, diagnosed with 2 days onset Acute Anterior Myocardial Infarction with history of syncope after chest pain, referred with sinus arrest and junctional rhythm that changed into atrial fibrillation. During hospitalization the heart rhythm changing periodically from bradycardia to tachycardia repeatedly with witnessed new ST elevation in inferior lead before an episode of cardiac arrest. After primary PCI to the RCA as the new culprit lesion, chest pain was relieved but hemodynamic condition was not stable and the rhythm remained continuously altered. Discussion Sick sinus syndrome is a cardiac conduction disorder characterized by symptomatic dysfunction of the sinoatrial node generally manifests as sinus bradycardia, sinus arrest, or sinoatrial block, and accompanied by supraventricular tachyarrhythmias (tachy-brady syndrome). This case of acute myocardial infarction with 3 vessel diseased lesion and total occlusion in RCA affected sinoatrial node causing sick sinus syndrome. Recently multi-vessels PCI strategy increasingly recommended at the time of primary PCI for patient with arrhythmia. Conclusion A man 66 years old with acute anterior MI compelling with sick sinus syndrome on presentation because apparently the culprit lesion was RCA. Unfortunately, at that time non-IRA lesion were not opened and TPM was not available, bradycardia continues and the patient ended up being jeopardy.