scholarly journals Natural history of the electrical axis during the first four weeks of life

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Paerregaard ◽  
J Kock ◽  
C Pihl ◽  
A Pietersen ◽  
K.K Iversen ◽  
...  
Keyword(s):  
Heart Disease ◽  
Heart Diseases ◽  
Structural Heart Disease ◽  
Funding Source ◽  
Axis Deviation ◽  
General Population Study ◽  
Gestation Age ◽  
History Of ◽  
The Right ◽  
Heart Foundation

Abstract Background The QRS axis represents the sum of the amplitudes and orientation of the ventricular depolarization. In newborns, the QRS axis is generally directed downward and to the right and left axis deviation (LAD) may be associated with heart disease. Accurate interpretation of abnormalities in the QRS axis may facilitate early diagnosis of heart diseases in newborns. Purpose To describe the evolution of the QRS axis during the first four weeks of life and provide updated, digitalized, normal values from healthy newborns. Methods Electrocardiograms from 12,317 newborns (age 0–28 days) included in a regional, prospective, general population study from 2016–2018 were analyzed. Electrocardiograms were obtained and analyzed with a computerized algorithm with manual validation. The algorithm calculated the QRS mean axis using the net amplitudes of three leads I, II, and III. The four main QRS axis classifications were: “adult normal” axis (+1° to +90°), left axis deviation (LAD, 0° to −90°), right axis deviation (RAD, +91° to +180°), and extreme axis deviation (EAD, +181° to +270°). Echocardiograms were performed according to standard guidelines. Only newborns with an echocardiography excluding structural heart disease were included. Results Electrocardiograms from 12,317 newborns with a median age at examination of 12 days (52% boys) were included. The median QRS axis was 119° at the ages 0–7 days and shifted leftwards to 102° at the ages 22–28 days (p<0.001). We found that girls had significant less pronounced right axis deviation than boys (111° vs 117°, p<0.001) and that increasing gestational age was associated with more pronounced right axis deviation (104° vs 116°, p<0.05). Infant size did not affect the axis (p>0.05). Only 0.5% had LAD (0° to −90°) and 1.1% had an axis within the interval +240° to +30° indicating that a QRS axis in this expanded interval is unusual in healthy newborns. Conclusion The QRS axis showed a gradual leftward-shift during the first four weeks of life and was affected by sex and gestation age but unaffected by infant size. LAD occurred in only 0.5% of the newborns. Our data serve as updated reference values, which may facilitate clinical handling of newborns. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): This work was supported by the Danish Children Heart Foundation, Snedkermester Sophus Jacobsen and wife Astrid Jacobsen's foundation (Grant 19-R112-A5248-26048), the Research Council at Herlev-Gentofte Hospital and Toyota-Fonden, Denmark.

scholarly journals Analysis of Sociodemographic and Clinical Factors Associated with Hospitalized Stroke Patients of Bangladesh

1970 ◽  
Vol 6 (1) ◽  
pp. 19-23 ◽  
Author(s):  
AM Hossain ◽  
NU Ahmed ◽  
M Rahman ◽  
MR Islam ◽  
G Sadhya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Low Income ◽  
Heart Diseases ◽  
Previous History ◽  
Stroke Patients ◽  
College Hospital ◽  
Cross Sectional ◽  
History Of

A hospital based cross sectional study was carried out to analyze prevalence of risk factors for stroke in hospitalized patient in a medical college hospital. 100 patients were chosen using purposive sampling technique. Highest incidence of stroke was between the 6th and 7th decade. Patients came from both urban (54%) and rural (46%) areas and most of them belong to the low-income group (47%). In occupational category; service holder (28%) and retired person (21%) were the highest groups. Most of the study subjects were literate (63%). CT scan study revealed that the incidence of ischaemic stroke was 61% and haemorrhagic stroke 39%. Analysis indicated hypertension as major risk factor for stroke (63%) and major portion of the patients (42.85%) were on irregular or no treatment. Twenty four percent of the patients had heart diseases and out of 24 patients 45.83% were suffering from ischaemic heart disease. The present study detected diabetes in 21% patients. Fifty three percent of the study subjects were smoker, 39% patients had habit of betelnut chewing. Out of 26 female patients, only 23% had history of using oral contraceptives. Majority of the patients were sedentary workers (46%). Thirty seven percent of the stroke patients were obese. Among the stroke patients 9% had previous history of stroke and 3% had TIA respectively. Most of the patients (21%) were awake while they suffered from stroke and the time of occurrence was mostly in the afternoon (46%). This study found that hypertension, cigarette smoking, ischaemic heart disease and diabetes mellitus are the major risk factors prevalent in our community while other risk factors demand further study. Key words: stroke; risk factors; hospitalized patients; Bangladesh. DOI: 10.3329/fmcj.v6i1.7405 Faridpur Med. Coll. J. 2011;6(1): 19-23

scholarly journals The Changing Paradigm in the Treatment of Structural Heart Disease and the Need for the Interventional Imaging Specialist

2016 ◽  
Vol 11 (2) ◽  
pp. 135
Author(s):  
Nina C Wunderlich ◽  
Harald Küx ◽  
Felix Kreidel ◽  
Ralf Birkemeyer ◽  
Robert J Siegel ◽  
...  
Keyword(s):  
Heart Disease ◽  
Heart Diseases ◽  
Three Dimensional ◽  
Structural Heart Disease ◽  
Percutaneous Treatment ◽  
Interventional Imaging ◽  
Key Factor ◽  
Structural Heart Diseases ◽  
Specialist Standard ◽  
Contrast Ventriculography

Percutaneous interventions in structural heart diseases are emerging rapidly. The variety of novel percutaneous treatment approaches and the increasing complexity of interventional procedures are associated with new challenges and demands on the imaging specialist. Standard catheterisation laboratory imaging modalities such as fluoroscopy and contrast ventriculography provide inadequate visualisation of the soft tissue or three-dimensional delineation of the heart. Consequently, additional advanced imaging technology is needed to diagnose and precisely identify structural heart diseases, to properly select patients for specific interventions and to support fluoroscopy in guiding procedures. As imaging expertise constitutes a key factor in the decision-making process and in the management of patients with structural heart disease, the sub-speciality of interventional imaging will likely develop out of an increased need for high-quality imaging.

scholarly journals Additive beneficial effects of beta blockers in the prevention of symptomatic heart failure

2016 ◽  
Vol 72 (1) ◽  
Author(s):  
Alberto Genovesi Ebert ◽  
Furio Colivicchi ◽  
Marco Malvezzi Caracciolo ◽  
Carmine Riccio
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Heart Disease ◽  
Beta Blockers ◽  
Structural Heart Disease ◽  
Symptomatic Heart Failure ◽  
Post Hoc Analysis ◽  
Lv Dysfunction ◽  
History Of ◽  
Post Hoc

The prevention of symptomatic heart failure represents the treatment of patients in the A and B stages of AHA/ACC heart failure classification. Stage A refers to patients without structural heart disease but at risk to develop chronic heart failure. The major risk factors in stage A are hypertension, diabetes, atherosclerosis, family history of coronary artery disease and history of cardiotoxic drug use. In this stage, blockers hypertension is the primary area in which beta blockers may be useful. Beta blockers seem not to be superior to other medication in reducing the development of heart failure due to hypertension. Stage B heart failure refers to structural heart disease but without symptoms of heart failure. This includes patients with asymptomatic valvular disease, asymptomatic left ventricular (LV) dysfunction, previous myocardial infarction with or without LV dysfunction. In asymptomatic valvular disease no data are available on the efficacy of beta blockers to prevent heart failure. In asymptomatic LV dysfunction only few asymptomatic patients have been enrolled in the trials which tested beta blockers. NYHA I patients were barely 228 in the MDC, MERIT and ANZ trials altogether. The REVERT trial was the only trial focusing on NYHA I patients with LV ejection fraction less than 40%. Metoprolol extended release on top of ACE inhibitors ameliorated LV systolic volume and ejection fraction. A post hoc analysis of the SOLVD Prevention trial demonstrated that beta blockers reduced death and development of heart failure. Similar results were reported in post MI patients in a post hoc analysis of the SAVE trial (Asymptomatic LV failure post myocardial infarction). In the CAPRICORN trial about 65% of the patients were not taking diuretics and then could be considered asymptomatic. The study revealed a reduction in mortality and a non-significant trend toward reduction of death and hospital admission for heart failure. Conclusions: beta blockers are not specifically indicated in stage A heart failure. On the contrary, in most of the stage B patients, and particularly after MI, beta blockers are indicated to reduce mortality and, probably, also the progression toward symptomatic heart failure.

Sustained and non-sustained ventricular tachycardia and no associated heart disease (idiopathic ventricular tachycardia)

ESC CardioMed ◽  
2018 ◽  
pp. 2288-2293
Author(s):  
Victor Bazan ◽  
Enrique Rodriguez-Font ◽  
Francis E. Marchlinski
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Drug Therapy ◽  
Catheter Ablation ◽  
Beta Blockers ◽  
Young Patients ◽  
Structural Heart Disease ◽  
Holter Monitoring ◽  
Severe Arrhythmia ◽  
The Right

Around 10% of ventricular arrhythmias (VA) occur in the absence of underlying structural heart disease. These so-called ‘idiopathic’ VAs usually have a benign clinical course. Only rarely do these “benign” arrhythmias trigger polymorphic ventricular tachycardia (PVT) and idiopathic ventricular fibrillation (VF). Due to their focal origin and to the absence of underlying myocardial scar, the 12-lead ECG very precisely establishes the right (RV) or left (LV) ventricular site of origin of the arrhythmia and can help regionalizing the origin of VT for ablation. A 12-lead ECG obtained during the baseline rhythm and 24-hour ECG Holter monitoring are indicated in order to identify structural or electrical disorders leading to PVT/VF and to determine the VA burden. The most frequent origin of idiopathic VAs is the RV outflow tract (OT). Other origins include the LVOT, the LV fascicles (fascicular VTs), the LV and RV papillary muscles, the crux cordis, the mitral and tricuspid annuli and the RV moderator band. Recognizing the typical anatomic sites of origin combined with a 12 lead ECG assessment facilitates localization.  Antiarrhythmic drug therapy (including use of beta-blockers) or catheter ablation may be indicated to suppress or eliminate idiopathic VAs, particularly upon severe arrhythmia-related symptoms or if the arrhythmia burden is high and ‘tachycardia’-induced cardiomyopathy is suspected. Catheter ablation is frequently preferred to prevent lifelong drug therapy in young patients.

scholarly journals Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e036827 ◽  
Author(s):  
Bárbara Martins Bechtlufft ◽  
Bruno Ramos Nascimento ◽  
Craig Sable ◽  
Clara Leal Fraga ◽  
Márcia Melo Barbosa ◽  
...  
Keyword(s):  
Heart Disease ◽  
Public Schools ◽  
Rheumatic Heart Disease ◽  
Heart Diseases ◽  
Diagnostic Category ◽  
Secondary Outcome ◽  
Unfavourable Outcome ◽  
History Of ◽  
Rheumatic Heart

ObjectivesEchocardiographic (echo) screening is an important tool to estimate rheumatic heart disease (RHD) prevalence, but the natural history of screen-detected RHD remains unclear. The PROVAR+ (Programa de RastreamentO da VAlvopatia Reumática) study, which uses non-experts, telemedicine and portable echo, pioneered RHD screening in Brazil. We aimed to assess the mid-term evolution of Brazilian schoolchildren (5–18 years) with echocardiography-detected subclinical RHD and to assess the performance of a simplified score consisting of five components of the World Heart Federation criteria, as a predictor of unfavourable echo outcomes.SettingPublic schools of underserved areas and private schools in Minas Gerais, southeast Brazil.ParticipantsA total of 197 patients (170 borderline and 27 definite RHD) with follow-up of 29±9 months were included. Median age was 14 (12–16) years, and 130 (66%) were woman. Only four patients in the definite group were regularly receiving penicillin.Primary and secondary outcome measuresUnfavourable outcome was based on the 2-year follow-up echo, defined as worsening diagnostic category, remaining with mild definite RHD or development/worsening of valve regurgitation/stenosis.ResultsAmong patients with borderline RHD, 29 (17.1%) progressed to definite, 49 (28.8%) remained stable, 86 (50.6%) regressed to normal and 6 (3.5%) were reclassified as other heart diseases. Among those with definite RHD, 13 (48.1%) remained in the category, while 5 (18.5%) regressed to borderline, 5 (18.5%) regressed to normal and 4 (14.8%) were reclassified as other heart diseases. The simplified echo score was a significant predictor of RHD unfavourable outcome (HR 1.197, 95% CI 1.098 to 1.305, p<0.001).ConclusionThe simple risk score provided an accurate prediction of RHD status at 2-year follow-up, showing a good performance in Brazilian schoolchildren, with a potential value for risk stratification and monitoring of echocardiography-detected RHD.

scholarly journals Determinants of development of permanent atrial fibrillation and its treatment

EP Europace ◽  
1999 ◽  
Vol 1 (1) ◽  
pp. 35-39 ◽  
Author(s):  
L. Gianfranchi ◽  
M. Brignole ◽  
C. Menozzi ◽  
G. Lolli ◽  
N. Bottoni
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Risk Group ◽  
Pacemaker Implantation ◽  
Structural Heart Disease ◽  
High Risk Group ◽  
Symptom Duration ◽  
Permanent Atrial Fibrillation ◽  
History Of

Abstract We evaluated the rate of progression of permanent atrial fibrillation (AF) and identified clinical factors that predict this event in 63 consecutive patients who had undergone AV junctional ablation and DDDR pacemaker implantation for drug-refractory paroxysmal atrial fibrillation/flutter. Immediately after ablation, anti-arrhythmic drugs were discontinued in all cases. Permanent AF was con-sidered to have developed if AF was present on two consecutive 6-monthly examinations with no interim documented sinus rhythm. During a mean follow-up of 23±16 months, 22 (35%) of the 63 patients developed permanent AF. The actuarial estimate of progression of permanent AF was 22%, 40% and 56%, respectively, 1, 2 and 3 years after ablation. Age and underlying heart disease were independent predictors of progression of permanent AF. Only one (6%) of 16 patients with idiopathic AF had permanent AF (low risk group). Among the 47 patients with structural heart disease, permanent AF developed in 18 (62%) of the 29 who were aged >75 years or had >12 arrhythmic episodes per year and a symptom duration >4 years (high risk group), but only in three (17%) of the remaining 18 patients who did not (intermediate risk group). In conclusion, during a 3-year follow-up period, about half of the patients with a history of drug-refractory paroxysmal AF did not develop permanent AF after AV junctional ablation and dual-chamber pacemaker implantation, even in the absence of anti-arrhythmic drug therapy. Moreover, subgroups of patients whose risk of permanent AF progression differed were identified on the basis of simple baseline clinical variables. The results of this study form the necessary background for the correct management of patients after AV junction ablation and for the planning of future trials in this field.

P4784Efficacy and safety of dronedarone by duration of atrial fibrillation history: a post-hoc analysis of the ATHENA trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Blomstrom-Lundqvist ◽  
N Marrouche ◽  
S Connolly ◽  
V Corp Dit Genti ◽  
M Wieloch ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
New York ◽  
Heart Disease ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
Efficacy And Safety ◽  
History Of ◽  
Summary Relative Risk ◽  
Post Hoc ◽  
Symptom Recurrence

Abstract Background Atrial fibrillation (AF) is known to progress over time and the effectiveness of antiarrhythmic therapy may vary based on the duration of a patient's AF history. Outcomes with dronedarone (DRO) based on duration of AF/atrial flutter (AFL) history have not been previously characterized. Purpose To evaluate the efficacy and safety of DRO by time since first known AF/AFL episode in patients studied in the ATHENA trial. Methods 2859 (61.8%) patients from ATHENA with documented first known AF/AFL episode (of 4628 total patients randomized) were included in the analysis. Among these patients, first AF/AFL episode was reported at <3 months (shorter history), 3 to <24 months (intermediate), and ≥24 months (longer) in 1296 (45.3%), 845 (29.6%) and 718 (25.1%) patients, respectively. AF/AFL recurrence was evaluated in patients in sinus rhythm at baseline by ECG during study visits or symptom recurrence. Results Demographics (age, sex) were similar across all groups. Patients with longer AF/AFL history tended to have higher prevalence of coronary heart disease and structural heart disease; and were more likely to have AF/AFL (by 12-lead ECG) at baseline (30%) compared to 26% and 16% for intermediate and shorter history groups. Patients with a longer AF history likely had a prior ablation for AF/AFL (7%) vs patients with an intermediate (2%) or shorter AF/AFL history (1%), and more likely required cardioversion during the study (24%) vs intermediate (17%) and shorter history groups (11%). Outcomes and efficacy are reported in Table 1. Rates of treatment-emergent adverse events (TEAEs), serious TEAEs, permanent drug discontinuations, and deaths were similar across all AF/AFL groups. Table 1. Outcomes and efficacy summary Relative Risk, dronedarone (DRO) vs placebo (PBO)1 (95% CI)1,2 AF/AFL <3 months AF/AFL 3 to <24 months AF/AFL ≥24 months PBO (n=626) DRO (n=670) PBO (n=429) DRO (n=416) PBO (n=363) DRO (n=355) First CV hospitalization3 or death (any cause) 0.79 (0.65, 0.96) 0.72 (0.56, 0.92) 0.84 (0.66, 1.07) First CV hospitalization 0.78 (0.64, 0.96) 0.70 (0.55, 0.91) 0.82 (0.63, 1.05) Death (any cause) 0.82 (0.54, 1.24) 0.85 (0.43, 1.68) 1.13 (0.61, 2.10) First AF/AFL recurrence4 0.80 (0.65, 0.97) 0.67 (0.53, 0.84) 0.81 (0.65, 1.02) 1Cox regression model. 2On study period, all randomized patients. 3Main reason was AF/other supraventricular rhythm disorders. 4On selected patients in sinus rhythm at baseline (AF/AFL <3 months: PBO n=514, DRO n=529; 3 to <24 months: PBO n=288, DRO n=312; ≥24 months: PBO n=252, DRO n=250). CV = Cardiovascular. Conclusions Nearly half the patients in ATHENA had a shorter history (<3 months) of AF/AFL prior to randomization. Patients with a longer history of AF/AFL had a greater burden of AF/AFL based on baseline rhythm status, ablation history, and cardioversions required post randomization. Despite these differences, clinical outcomes, efficacy, and safety of DRO appeared to be generally consistent irrespective of duration of AF/AFL history. Acknowledgement/Funding Sanofi, New York, New York, United States of America

scholarly journals Sudden death in the young adult: A Tunisian autopsy-based series

2020 ◽  
Author(s):  
Said Saadi ◽  
Sami Ben Jomaa ◽  
Mariem Bel Hadj ◽  
Dorra Oualha ◽  
Nidhal Haj Salem
Keyword(s):  
Young Adults ◽  
Heart Disease ◽  
Sudden Death ◽  
Heart Diseases ◽  
Clinical Information ◽  
Structural Heart Disease ◽  
Common Denominator ◽  
The Common ◽  
Almost All ◽  
Prevention Methods

Abstract Background: We aim to study the profile, and pathological characteristics of sudden death in young in purpose of recommendations for prevention. Methods: We performed a retrospective cohort study using autopsy data from the Department of Forensic Medicine of Monastir (Tunisia). A review of all autopsies performed for 28 years was done (August 1990 to December 2018). In each case, clinical information, and circumstances of death were obtained. A complete forensic autopsy and histological, and toxicological investigations were performed. We have included all sudden death in persons aged between 18 years and 35 years.Results: We collected 137 cases of sudden death during the studied period. The mean age of the studied population was 26.47 years. Almost 72% deaths were classified as cardiac death, and was due to ischemic heart disease in 32.32%. Sudden death was attributed to a pleuropulmonary cause in 7.4%, an abdominal cause in 6%, and from a neurological origin in 4.5%. The cause of sudden death in this group was not established by 9.5%.Conclusion: In this series, sudden death in young adults occurs mainly in a smoking male, aged between 18 and 24 years old, occurring at rest, in the morning, and early in the week. It is more common, especially in summer. Sudden death is most often the first manifestation of pathologies, especially unsuspected heart diseases. The predominance of cardiovascular causes is the common denominator of almost all studies reported in the literature. Our findings suggest that prevention of sudden death among young adults under the age of 35 years should also focus on evaluation for causes not associated with structural heart disease.

scholarly journals Echocardiographic and Electrocardiographic Findings in COVID-19 Patients; A Cross-Sectional Study

2022 ◽  
Author(s):  
Faeze Keihanian ◽  
Hoorak Poorzand ◽  
Amin Saeidinia ◽  
Ali Eshraghi
Keyword(s):  
Heart Disease ◽  
Previous History ◽  
Structural Heart Disease ◽  
Cross Sectional Study ◽  
Imaging Data ◽  
Sectional Study ◽  
Cross Sectional ◽  
History Of ◽  
Electrocardiographic Findings ◽  
Polymerase Chain

Abstract Background: There are still many gaps in our knowledge regarding the direct cardiovascular injuries due to COVID-19 infection. In this study, we tried to find out the effect of SARS-CoV-2 infection on cardiac function in patients without any history of structural heart disease by electrocardiographic and echocardiographic evaluations.Methods: This was a cross-sectional study on patients with COVID-19 infection admitted to Imam Reza hospital, Mashhad, Iran between 14 April and 21 September 2020. COVID-19 infection was verified by a positive reverse-transcriptase polymerase chain reaction (PCR) assay for SARS-CoV-2 using nasopharyngeal/oropharyngeal samples. We enrolled all patients over 18 years old with definite diagnosis of COVID-19 infection. All patients underwent a comprehensive transthoracic echocardiography at the first week of admission. Clinical and imaging data were collected prospectively. Results: In total, 142 patients were enrolled in this study. The mean age of participants was 60.69± 15.70 years (range: 30-90 years). Most patients were male (82, 57.7%). Multivariate analysis showed that O2 saturation at admission was independently a predictor of re-hospitalization (P<0.001). RV size (P<0.001), dyslipidemia (P<0.001), ejection fraction (EF) (P<0.001), age (P=0.020), systolic blood pressure (P=0.001), O2 saturation (P=0.018) and diabetes (P=0.025) independently predicted 30-days mortality. Conclusion: Echocardiography can be used for risk assessment in patients with COVID-19, especially in those with previous history of diabetes and dyslipidemia. The infection could result in Ventricular dysfunction, even in those without previous history of structural heart disease.

Sign in / Sign up

Export Citation Format

Share Document