scholarly journals Detection of unexpected ischaemia due to left main disease during tele-rehabilitation using 12-lead electrocardiogram monitoring: a case report

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Sara Katzburg ◽  
Horesh Dor-Haim ◽  
Abraham Teddy Weiss ◽  
David Leibowitz
Keyword(s):  
Ecg Monitoring ◽  
Left Main ◽  
Coronary Syndrome ◽  
St Depression ◽  
Home Based ◽  
Clinically Significant ◽  
Repeat Angiography ◽  
Obtuse Marginal ◽  
Electrocardiogram Monitoring ◽  
Tele Monitoring

Abstract Background Cardiac rehabilitation (CR) reduces mortality and improves quality of life. Unfortunately, participation in CR remains low and studies have examined the use of home-based tele-monitoring to improve participation in CR. These studies generally utilized single- or three-lead electrocardiogram (ECG) channels with limited sensitivity to detect ischaemic changes. In this report, we describe detection of unexpected, significant left main coronary disease in a patient participating in a home CR programme using a unique 12-lead ECG monitoring system. Case summary A 68-year-old man was referred for CR after acute coronary syndrome and stent implantation to the obtuse marginal. Three months following this intervention, he began complaining of chest pain. Repeat coronary angiogram showed a borderline lesion in the left main not felt to be clinically significant. The patient performed CR and was monitored with the Master Caution® System, a digital platform including a garment with 10 textile electrodes (Master Caution garment) configuring a device which enables 12 lead ECG. While being monitored, the ECG technician detected 1–2 mm ST-depression in leads 1, L V2–V5. The patient was asymptomatic at the time the ST-depressions were noted. Repeat angiography revealed a significant increase in the severity of the left main lesion and the patient was referred for bypass surgery. Discussion This life-threatening diagnosis could easily have been missed using conventional ECG monitoring and our case demonstrates the potential clinical utility of tele-monitoring with a 12-lead digital home ECG monitoring device.

scholarly journals Incidence of cardiac arrhythmias in patients with COVID-19 infection according to 24-hour electrocardiogram monitoring

2021 ◽  
Vol 23 (6) ◽  
pp. 759-765
Author(s):  
V. O. Zbitnieva ◽  
O. B. Voloshyna ◽  
I. V. Balashova ◽  
O. R. Dukova ◽  
I. S. Lysyi
Keyword(s):  
Cardiovascular Disease ◽  
Cardiac Arrhythmias ◽  
Sinus Tachycardia ◽  
Ecg Monitoring ◽  
Inappropriate Sinus Tachycardia ◽  
Ventricular Extrasystoles ◽  
Significant Difference ◽  
History Of ◽  
Clinically Significant ◽  
Electrocardiogram Monitoring

Cardiac arrhythmias in patients with COVID-19 infection may be due to many pathophysiological factors. Further study on the structure of arrhythmias in this category of patients will reveal clinically significant arrhythmias and select the optimal management. The aim: to determine the features of arrhythmias in patients with and without concomitant cardiovascular disease who suffered from COVID-19 infection based on the results of 24-hour electrocardiogram (ECG) monitoring. Materials and methods. 84 patients (45 men – 53.5 %, 39 women – 46.5 %) who had COVID-19 infection over 12 weeks previously were examined. Patients were divided into 2 groups – with and without a history of concomitant cardiovascular disease. The patient groups did not differ in age (P = 0.33) and sex (P = 0.58, P = 0.64). 24-hour ECG monitoring was performed on a Cardiosens K device (XAI-MEDICA, Kharkiv) according to the standard method. Results. Comparison of 12-channel ECG data did not reveal a significant difference in the incidence of single atrial (P = 0.13) and ventricular extrasystoles (P = 0.37) between the two groups, but sinus tachycardia was significantly more common in patients without concomitant cardiovascular disease (P = 0.022). According to 24-hour ECG monitoring, a significantly higher total number of arrhythmias, in particular, supraventricular extrasystoles (P = 0.009), high gradations of ventricular arrhythmias: paired ventricular extrasystoles (P = 0.041), ventricular bigeminy (P = 0.005), ventricular trigeminy (P = 0.004), ventricular salvos (P = 0.017) were detected significantly more frequently in patients with concomitant cardiovascular disease after COVID-19 infection than those in the comparison group. The results of 24-hour ECG monitoring also showed that patients without cardiovascular disease were significantly more likely to have inappropriate sinus tachycardia (P = 0.03) and postural orthostatic tachycardia (P = 0.04). Paroxysmal arrhythmias were significantly more common in patients with concomitant cardiovascular pathology, namely unstable (P = 0.002) and stable paroxysms of atrial tachycardia (P = 0.014), unstable paroxysms of monomorphic ventricular tachycardia (8.3 %), paroxysms of atrial fibrillation (6.2 %). Conclusions. 24-hour ECG monitoring should be advised in patients with COVID-19 infection and concomitant cardiovascular disease in addition to recording a standard 12-channel ECG to detect prognostically unfavorable cardiac arrhythmias, possible arrhythmogenic manifestations of post-COVID-19 syndrome and choose management tactics for these patients.

scholarly journals A Case of Left Main Coronary Artery Disease in an Octogenarian Treated Surgically and Complicated by Myocardial Infarction: Decisions, Techniques, Rescue and Final Outcome

2013 ◽  
Vol 6 ◽  
pp. CCRep.S11542
Author(s):  
Antoine Kossaify ◽  
Gilles Grollier
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Bypass Graft ◽  
Left Main ◽  
Coronary Syndrome ◽  
Left Anterior Descending Artery ◽  
Main Coronary Artery Disease ◽  
Artery Disease

We report on an octogenarian patient presenting with an acute coronary syndrome due to significant left main coronary artery disease and severe ostial stenosis of the left anterior descending artery disease. Emergent bypass graft performed with “beating heart” consisted of left internal mammary graft to the mid left anterior descending artery with an “over-stent” anastomosis. The immediate post-operative phase was simple, however the patient presented on post-operative day 8 with extensive anterior myocardial infarction and cardiogenic shock. Emergent coronary angiogram showed subocclusive anastomotic stenosis. Percutaneous coronary intervention was performed on left main, proximal left anterior descending, and proximal circumflex arteries. Subsequently, the patient restored a satisfactory hemodynamic condition. A focus on the importance of decision for management of left main disease especially in octogenarian is presented, along with a review of the pertinent literature.

Elderly woman presenting with multivessel coronary artery disease and Takotsubo syndrome

2021 ◽  
Vol 14 (7) ◽  
pp. e242367
Author(s):  
Hari Vivekanantham ◽  
Martin Scoglio ◽  
Philipp Suter ◽  
Stephane Cook ◽  
Yann Roux ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Takotsubo Syndrome ◽  
Left Main ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Left Anterior Descending Artery ◽  
Artery Disease

Takotsubo syndrome is an acute and often reversible condition, with initial presentation mimicking acute coronary syndrome. Typically, patients present with left ventricular regional wall motion abnormalities, without a corresponding coronary artery obstruction on angiography. Coexistence of a coronary artery disease is possible and may render the distinction between the two entities particularly challenging. We report the case of a 94-year-old woman with chest pain after an emotional upset and acute myocardial injury. Transthoracic echocardiogram (TTE) revealed a severely reduced left ventricular ejection fraction (LVEF) with apical ballooning. Coronary angiogram showed significant stenosis of the distal left main coronary artery and of the mid-left anterior descending artery, as well as a 30%–50% stenosis of the mid-distal right coronary artery. Revascularisation was deferred and antiplatelet as well as heart failure therapy begun. A repeat TTE 6 days later revealed a quasi-normalised LVEF. Ultimately, percutaneous coronary revascularisation of the left main and left anterior descending artery was performed, with favourable outcome at 6-month follow-up.

scholarly journals Heart rhythm and autonomic regulation disorders in chronic coronary syndrome patients with community-aсquired pneumonia

2021 ◽  
Vol 23 (6) ◽  
pp. 766-771
Author(s):  
T. O. Kulynych ◽  
O. O. Lisova ◽  
O. V. Shershnova ◽  
A. V. Hrytsai
Keyword(s):  
Heart Rate ◽  
Total Duration ◽  
Heart Rhythm ◽  
Main Group ◽  
Autonomic Regulation ◽  
Control Group ◽  
Ecg Monitoring ◽  
Coronary Syndrome ◽  
St Segment ◽  
Heart Rhythm Disorders

Pneumonia presents a considerable challenge in patients with cardiovascular disease due to an increase in the incidence, difficulties of diagnosis and treatment, high mortality. Aim: to study the characteristics of cardiac arrhythmias and heart rhythm autonomic regulation in patients with chronic coronary syndrome (CCS) and community-acquired pneumonia (CAP), and to define their relationship with the clinical features of the disease. Materials and methods. A monocenter cross-sectional study analyzed 90 patients with CCS in parallel groups. The main group included 60 CCS patients with CAP; the control group consisted of 30 patients without concomitant CAP. A complex clinical examination of patients was performed on 1–3 days of hospital stay in accordance with the National Recommendations. Holter ECG monitoring was performed using a CARDIOSENS K device (XAI-MEDICA, Ukraine). Results. Based on the results of 24-hour ECG monitoring, heart rhythm disorders, increased duration of myocardial ischemia and ST-segment depression depth with an increase in the total duration of tachycardia episodes within 24 hours were more common in the main group patients. The severity of CAP on the PSI/PORT scale was correlated with the 24-hour mean heart rate (r = +0.31, P < 0.05), the number of ventricular extrasystoles – with respiratory rate (r = +0.29, P < 0.05), supraventricular extrasystoles – with the duration of ST-segment depression (r = +0.57, P < 0.05). In patients with CCS and CAP, there was a decrease in the total heart rate variability (HRV), mainly in the passive period, combined with an increase in the LF/HF ratio and stress index (SI), which was directly correlated with the severity of CAP and intoxication syndrome. Conclusions. Patients with CCS and CAP are characterized by the increased 24-hour heart rate, duration of ST-segment depression, frequency of supraventricular and ventricular arrhythmias on 24-hour Holter monitoring, paroxysms of atrial fibrillation with the decreased total HRV combined with significantly increased activity of the sympathetic autonomic nervous system.

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