scholarly journals Assessing the utility of screening electrocardiograms in pediatric patients following COVID-19

2021 ◽  
pp. 1-19
Author(s):  
Ari J. Gartenberg ◽  
Travus J. White ◽  
Khoi Dang ◽  
Maully Shah ◽  
Stephen M. Paridon ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Stress Test ◽  
Severe Disease ◽  
Retrospective Chart Review ◽  
Exercise Stress Test ◽  
Primary Care Providers ◽  
Exercise Stress ◽  
Care Providers ◽  
Premature Ventricular Contractions ◽  
Small Cohort

Abstract Objective: To determine the utility of screening electrocardiograms after SARS-CoV-2 infection among pediatric patients in detecting myocarditis related to COVID-19. Study Design: A retrospective chart review was performed at a large pediatric academic institution to identify patients with prior SARS-CoV-2 infection who received a screening electrocardiogram by their primary care providers and were subsequently referred for outpatient cardiology consultation due to an abnormal electrocardiogram. The outcomes were the results from their cardiology evaluations, including testing and final diagnoses. Results: Among 46 patients, during their preceding COVID-19 illness, the majority had mild symptoms, four were asymptomatic, and one had moderate symptoms. The median length of time from positive SARS-CoV-2 test to screening electrocardiogram was 22 days, and many electrocardiogram findings that prompted cardiology consultation were normal variants in asymptomatic adolescent athletes. Patients underwent frequent additional testing at their cardiology appointments: repeat electrocardiogram (72%), echocardiogram (59%), Holter monitor (11%), exercise stress test (7%), and cardiac MRI (2%). Five patients were incidentally diagnosed with congenital heart disease or structural cardiac abnormalities, and three patients had conduction abnormalities (premature atrial contractions, premature ventricular contractions, borderline prolonged QTc), although potentially incidental to COVID-19. No patients were diagnosed with myocarditis or ventricular dysfunction. Conclusion: In a small cohort of pediatric patients with prior COVID-19, who were primarily either asymptomatic or mildly symptomatic, subsequent screening electrocardiograms identified various potential abnormalities prompting cardiology consultation, but no patient was diagnosed with myocarditis. Larger multi-center studies are necessary to confirm these results and to evaluate those with more severe disease.

Abstract 15780: The Utility of Exercise Stress Testing in the Evaluation of Ischemia Among Pediatric Patients With Exertional Chest Pain

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nicholas Robles ◽  
Shailendra Upadhyay
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Pediatric Patients ◽  
Stress Test ◽  
Retrospective Chart Review ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Z Score ◽  
Coronary Artery Abnormalities ◽  
Myocardial Perfusion Study

Introduction: Exertional chest pain (CP) regularly prompts performing an exercise stress test (EST) out of concern for exercise-induced ischemia. We aimed to study the diagnostic utility of EST in the evaluation of ischemia among pediatric patients without previously diagnosed congenital heart disease (CHD) who present with exertional CP and to correlate EST results with available cardiac imaging findings. Methods: Retrospective chart review of all pediatric patients who underwent EST for exertional CP from Jan 2015 to Dec 2019 at our institution. Exercise stress test was performed on treadmill utilizing Bruce protocol. Analysis included demographic medical records and all available cardiac testing. Results: A total of 106 patients (56 males; 53%) were included. Cohort mean age, height, and weight were 15.1 ± 2.6 years (range: 7.3 - 19.6yr), 165 ± 12.7 cm, and 67.5 ± 26.2 kg. ST-T wave changes were noted in 8 patients (7.5%), 7 of which were non-specific and read as normal ESTs. One (0.94%) EST was suggestive of ischemic changes. His echocardiogram (echo) showed mild thickening of papillary muscles and ventricular septum. A follow-up exercise myocardial perfusion study showed no abnormality. Echo was performed on 86/106 (81%) patients. Of these, 23/86 (27%) had incidental abnormalities on echo; none contributed to the patients’ CP. Five patients (5/86; 5.8%) had notable coronary artery abnormalities on echo; all had normal ESTs. Two of these were confirmed by Cardiac CTA: 1) Left Main Coronary Artery (LMCA) arising from non-coronary cusp, and 2) dilated LMCA (Z-score 4.67) with slight dilation of Left Anterior Descending (Z-score 2.54). In the other 3 of 5 ( prominent LMCA, possible CA fistula, RCA with more leftward origin ) further coronary evaluations were not performed. Conclusions: Incidental non-specific echo abnormalities are common among pediatric patients who undergo EST for exertional CP. EST was negative in patients with coronary artery abnormalities. ESTs have a low yield in identifying cardiac abnormalities among pediatric patients without previously diagnosed CHD undergoing evaluation for exertional CP. Larger studies are needed to better evaluate the utility of EST in patients with coronary artery anomalies.

scholarly journals Premature Ventricular Contractions During the Recovery Phase of Exercise Are Only Associated with Increased Cardiovascular Mortality when Present Together with Echocardiographic Abnormalities

2021 ◽  
Author(s):  
Thomas Lindow ◽  
Magnus Ekstrom ◽  
Lars Brudin ◽  
Kristofer Hedman ◽  
Martin Ugander
Keyword(s):  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Recovery Phase ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Structural Explanation ◽  
Premature Ventricular Contractions ◽  
Increased Risk

Background: Premature ventricular contractions (PVCs) during the recovery of exercise stress testing are associated with increased cardiovascular mortality, but the cause remains unknown. We aimed to evaluate the association of PVCs during recovery with abnormalities on echocardiography, and to evaluate their combined prognostic performance. Methods: Echocardiographic abnormalities (reduced left ventricular (LV) ejection fraction, valvular heart disease, LV dilatation, LV hypertrophy, or increased filling pressures) and the presence of PVCs during recovery (≥1/min) were identified among patients having undergone resting echocardiography within median [interquartile range] 0 [0-2] days of an exercise stress test. The association between such changes and cardiovascular mortality was analyzed using Cox regression adjusted for age, sex, clinical and exercise variables. Results: Among included patients (n=3,106, 219 events, 7.9 [5.4-11.1] years follow-up), PVCs during recovery was found in 1,327 (43%) patients, among which prevalence of echocardiographic abnormalities was increased (58% vs. 43%, p<0.001). Overall, PVCs during recovery was associated with increased cardiovascular mortality (adjusted hazard ratio (HR) [95% confidence interval] 1.6 [1.2-2.1], p<0.001). When combined with echocardiographic abnormalities, PVCs during recovery was only associated with increased risk when such were present (adjusted HR 3.3 [2.0-5.4], p<0.001), and not when absent (adjusted HR 1.4 [0.7-2.6], p=0.26), in reference to those with neither. Conclusion: PVCs during recovery was associated with increased prevalence of echocardiographic abnormalities. Increased risk of cardiovascular mortality was observed only for subjects with PVCs if concomitant echocardiographic abnormalities were present. This provides a structural explanation for the increased long-term cardiovascular risk among patients with PVCs during recovery.

DOES THE EXERCISE STRESS TEST OVER DIAGNOSE LONG QT IN PEDIATRIC PATIENTS?

2018 ◽  
Vol 34 (10) ◽  
pp. S4
Author(s):  
H. Romans ◽  
K. Armstrong ◽  
A. De Souza ◽  
S. Sanatani
Keyword(s):  
Pediatric Patients ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Long Qt

Abstract 12942: Association of Exercise Performance With Hemodynamic and Imaging Parameters in Fontan Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alyson R Pierick ◽  
Michael Kelleman ◽  
Megan Stark ◽  
Danish Vaiyani ◽  
Robert Whitehill ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Stress Test ◽  
Fontan Operation ◽  
Retrospective Chart Review ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Surveillance Program ◽  
Primary Analysis ◽  
Lateral Tunnel ◽  
Fontan Patients

Introduction: The Fontan operation results in hemodynamic, anatomic and functional alterations in single ventricle (SV) heart disease. Studies have shown that SV patients have reduced exercise capacity. We sought to determine hemodynamic and anatomic associations with exercise capacity in our Fontan cohort. Methods: We performed a retrospective chart review of all patients born 2002-2012 who underwent Fontan palliation and followed in our Fontan Surveillance Program. Surveillance cardiac magnetic resonance (cMR), cardiac catheterization (cath), and exercise stress test (EST) data were collected. Primary analysis was association of cMR and cath data on EST outcomes including percent-predicted maximum oxygen consumption (ppVO 2 max) and oxygen pulse (ppO 2 Pulse). Results: A total of 222 patients were included, 45.5% with a systemic left ventricle (LV). Hypoplastic left heart syndrome was the underlying cardiac diagnosis in 1/3 of patients. The vast majority of the Fontan procedures performed were fenestrated, 44% extracardiac conduits and 42% with a lateral tunnel graft. A total of 185 cMRs, 274 caths, and 136 ESTs were performed. The median respiratory exchange ratio and ppVO 2 max were 1.11 L/sec and 73% respectively, with a preserved ppO 2 Pulse of 93.5%. Results of correlational analysis are shown in the table. Over serial ESTs, patients with a single RV had a more gradual, but not significant decline in ppVO 2 max than patients with a single LV, r s -0.321 and -0.544 respectively (p = 0.28). Conclusions: While hemodynamic parameters do not correlate with EST functional endpoints, anatomic factors such as the Nakata index are associated with EST performance. Surveillance of Fontan patients should include regular cMR to assess for subtle changes in ejection fraction, pulmonary artery diameter and differential pulmonary blood flow. Multicenter longitudinal studies with protocolized timing are needed to further elucidate correlates of good exercise capacity.

Management Landscape of Pediatric Hidradenitis Suppurativa

2021 ◽  
pp. 1-4
Author(s):  
Justine R. Seivright ◽  
Erin Collier ◽  
Tristan Grogan ◽  
Terri Shih ◽  
Marcia Hogeling ◽  
...  
Keyword(s):  
Primary Care ◽  
Hidradenitis Suppurativa ◽  
Chart Review ◽  
Age Of Onset ◽  
Severe Disease ◽  
Retrospective Chart Review ◽  
Primary Care Providers ◽  
Care Providers ◽  
Delay In Diagnosis ◽  
Mean Delay

<b><i>Introduction:</i></b> Pediatric hidradenitis suppurativa (HS) is an understudied condition, and the literature describing the provider landscape for this disease is limited. We aim to characterize healthcare utilization in a cohort of pediatric HS patients at an academic institution. <b><i>Methods:</i></b> Patients diagnosed with HS before age 18 were identified via retrospective chart review using ICD-9/10 codes for HS. Data on demographics and HS providers were collected. <b><i>Results:</i></b> We found that half of the pediatric HS patients first presented to primary care with their HS symptoms. There was a mean delay in diagnosis of 2 years. Dermatologists and pediatricians were the principal HS care providers, and dermatologists most frequently prescribed treatment or procedures (63%). We also found a low rate of utilization of the HS specialty clinic (11%). Females, patients with more severe disease, and patients with earlier age of onset were more likely to be seen by a dermatologist. <b><i>Conclusions:</i></b> Dermatologists play a pivotal role in pediatric HS management as principal care providers for patients. Increasing HS awareness among primary care providers, including pediatricians, is critical for early diagnosis and initiation of treatment.

scholarly journals Cardiac Rehabilitation and Physical Performance in Patients after Myocardial Infarction: Preliminary Research

2021 ◽  
Vol 10 (11) ◽  
pp. 2253
Author(s):  
Agnieszka Grochulska ◽  
Sebastian Glowinski ◽  
Aleksandra Bryndal
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Physical Performance ◽  
Stress Test ◽  
Maximal Oxygen Consumption ◽  
Exercise Stress Test ◽  
Health Condition ◽  
Exercise Stress ◽  
Test Time ◽  
Before And After

(1) Background: Cardiovascular diseases, in particular, myocardial infarction (MI), are the main threats to human health in modern times. Cardiac rehabilitation (CR), and especially increased physical activity, significantly prevent the consequences of MI. The aim of this study was to assess physical performance in patients after MI before and after CR. (2) Methods: 126 patients after MI were examined. They were admitted to the cardiac rehabilitation ward twice: in the 3rd month after MI, and then in the 6th month after the last rehabilitation session. CR lasted 20 treatment days (4 weeks with 5 treatment days and 2 days’ break). The exercise stress test on the treadmill and a 6-minute walk test (6MWT) were used to assess physical performance. Patients were assigned to an appropriate rehabilitation model due to their health condition. (3) Results: In the studied group, the exercise stress test time and the metabolic equivalent of task (MET), the maximal oxygen consumption (VO2max), and 6MWT score increased significantly (p = 0.0001) at two time-points of observation. (4) Conclusion: CR significantly improves physical performance in patients after MI.

scholarly journals P1398 Echocardiographic continuous monitoring of exercise stress test using probe fixation device

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Wdowiak-Okrojek ◽  
P Wejner-Mik ◽  
Z Bednarkiewicz ◽  
P Lipiec ◽  
J D Kasprzak
Keyword(s):  
Image Quality ◽  
Physical Exercise ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Bicycle Ergometer ◽  
Exercise Stress ◽  
Fixation Device ◽  
The Mean ◽  
First Time

Abstract Background Stress echocardiography (SE) plays an important role among methods of noninvasive diagnosis of ischemic disease. Despite the advantages of physical exercise as the most physiologic stressor, it is difficult (bicycle ergometer) or impossible (treadmill) to obtain and maintain the acoustic window during the exercise. Recently, an innovative probe fixation device was introduced and a research plan was developed to assess the feasibility of external probe fixation during exercise echocardiography on a supine bicycle and upright treadmill exercise for the first time. Methods 37 subjects (36 men, mean age 39 ± 16 years, 21 healthy volunteers, 16 patients with suspected coronary artery disease) were included in this study. This preliminary testing stage included mostly men due to more problematic probe fixation in women. All subjects underwent a submaximal exercise stress test on a treadmill (17/37) or bicycle ergometer (11/37). Both sector and matrix probes were used. We assessed semi-quantitatively the quality of acquired apical views at each stage – the four-point grading system was used (0-no view, 1-suboptimal quality, 2-optimal quality, 3-very good quality), 2-3 sufficient for diagnosis. Results The mean time required for careful positioning of the probe and image optimization was 12 ± 3 min and shortened from 13,7 to 11,1 minutes (mean) in first vs second half of the cohort documenting learning curve. At baseline, 9 patients had at least one apical view of quality precluding reliable analysis. Those patients were excluded from further assessment. During stress, 17 patients maintained the optimal or very good quality of all apical views, whereas in 11 patients the quality significantly decreased during the stress test and required probe repositioning. The mean image quality score at baseline was 2,61 ± 0,48 and 2,25 ± 0,6 after exercise. Expectedly, good image quality was easier to obtain and maintain in the supine position (score 2,74 ± 0,44) points as compared with upright position (score 2,25 ± 0,57). Conclusion This preliminary, unique experience with external probe fixation device indicates that continuous acquisition and monitoring of echocardiographic images is feasible during physical exercise, and for the first time ever - also on the treadmill. This feasibility data stem from almost exclusively male patients and the estimated rate of sufficient image quality throughout the entire test is currently around 60%. We are hoping, that gaining more experience with the product could increase the success rate on exercise tests. Abstract P1398 Figure. Treadmill and ergometer stress test

Presentation and Referral Patterns in Pediatric Closed Hand Fractures

Hand ◽  
2021 ◽  
pp. 155894472110085
Author(s):  
Landis R. Walsh ◽  
Laura C. Nuzzi ◽  
Amir H. Taghinia ◽  
Brian I. Labow
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Pediatric Patients ◽  
Primary Care Providers ◽  
Care Providers ◽  
Referral Patterns ◽  
Old Patients ◽  
Hand Surgeon ◽  
Hand Fractures ◽  
The Mean

Background Although pediatric hand fractures are common and generally have good outcomes, they remain a considerable source of anxiety for non–hand surgeons, who are less familiar with these injuries. We hypothesized that this anxiety may manifest as inefficiency in referral patterns. Methods The records of pediatric patients with isolated, closed hand fractures without concurrent trauma seen at our institution by a hand surgeon between January 2017 and December 2018 were retrospectively reviewed. Results There were 454 patients included; 62.1% were men, and the mean age was 9.6 years at initial encounter. Most patients (89.6%) were treated nonoperatively and incurred few complications (0.5%). Roughly half of all cases (n = 262) initially presented to an outside provider. Of these, 24.0% (n = 64 of 262) were evaluated by 2+ providers before a hand surgeon. Most commonly, these patients were referred from an outside emergency department (ED) to our ED before hand surgeon evaluation (n = 45 of 64). Forty-seven patients required surgery; however, none were performed urgently. Although a greater proportion of 7- to 11-year-old patients saw 2+ providers prior to a hand surgeon ( P = .007), fewer required surgery ( P < .001). Conclusions Pediatric closed hand fractures are mainly treated nonoperatively and nonemergently with generally excellent outcomes. Our data suggest that many patients continue to be referred through the ED or multiple EDs/providers for treatment. These inefficient referral patterns demonstrate the need for better education for ED and primary care providers, as well as better communication between these providers and local pediatric hand surgeons. Advancements in these areas are likely to improve efficiency of care and decrease costs.

Sign in / Sign up

Export Citation Format

Share Document