scholarly journals Usefulness of a smartphone-based event recorder for ambulatory patients presenting with palpitations

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M E Salar Alcaraz ◽  
F Buendia Santiago ◽  
P J Flores Blanco ◽  
E Cabrera Romero ◽  
D Fernandez Vazquez ◽  
...  
Keyword(s):  
Primary Care Physicians ◽  
Diagnostic Yield ◽  
Event Recorder ◽  
Funding Sources ◽  
Electrocardiographic Monitoring ◽  
Technological Advances ◽  
Cardiology Department ◽  
History Of ◽  
Electrocardiographic Findings ◽  
Electrocardiogram Ecg

Abstract Background Palpitations are a common complaint among patients seen by primary care physicians (16%). Recent technological advances have led to several novel electrocardiographic monitoring devices. AliveCor Kardia Mobile® (AliveCor, Inc., Mountain View, CA, USA) is a smartphone-based event recorder that allows take an electrocardiogram (ECG) recording during 30 seconds. The usefulness of this device has been studied in atrial fibrillation screening, however, its usefulness in the diagnosis of palpitations is not well known. Objective Evaluate the diagnostic yield of the AliveCor Kardia Mobile® device in unselected patients referred to the cardiologist for the study of palpitations. Methods Uni-centre retrospective study. From September 2018 to October 2020, consecutive patients with palpitations referred to cardiology department were included. After an initial evaluation it was decided monitoring ECG of these patients with this device if they had access to a compatible smartphone. They were instructed to record ECG when they had symptoms. ECG tracings and clinical characteristics were analysed. Results 152 patients were included. Mean age 42±15 years, 68% female. Most of the patients did not have heart disease and about 25% had a history of anxiety-depressive syndrome (Table 1). After monitoring, 31 (20%) patients had rhythm disturbances during symptoms, 82 (54%) patients had no rhythm disturbances related to the symptoms and 39 (26%) patients had no symptoms. Table 2 shows the electrocardiographic findings. Patients with palpitations of arrhythmic origin were older and presented less anxiety/depression (Table 1). Age was the only independent predictor of palpitations of arrhythmic origin (OR, × year: 1.03, 95% CI 1.01–1.06; p=0.035). Conclusions The AliveCor Kardia Mobile® device is easy to use and diagnosed the aetiology of palpitations in a high proportion of patients (74%) referred for specialist evaluation. FUNDunding Acknowledgement Type of funding sources: None.

Cardiac event recording yields more diagnoses than 24–hour Holter monitoring in patients with palpitations

2005 ◽  
Vol 11 (1_suppl) ◽  
pp. 14-16 ◽  
Author(s):  
S Scalvini ◽  
E Zanelli ◽  
G Martinelli ◽  
D Baratti ◽  
A Giordano ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Symptomatic Patient ◽  
Holter Monitoring ◽  
Common Symptom ◽  
Call Centre ◽  
Event Recorder ◽  
Event Recording ◽  
The One ◽  
Electrocardiogram Ecg ◽  
To Receive

Palpitation is a common symptom that sometimes results from a substantial cardiac arrhythmia. We compared the diagnostic yield of trans-telephonic event monitors with those of Holter monitoring in patients with intermittent palpitations. In all, 310 patients were randomly assigned to receive an event recorder or 24–hour Holter monitoring. Event recorders were used for seven days or until two recordings were obtained while symptoms occurred. The main end-point was an electrocardiogram (ECG) recorded during symptoms. The patients with palpitation recorded the one-lead ECG trace and sent it to a telemedicine call centre, where a nurse responded. There were 119 symptomatic patients in the event recorder group and 74 in the Holter group. The total costs were €6019 for event recording and €9605 for Holter monitoring. The average costs were €51 per symptomatic patient detected by event recorder monitoring and €1 30 per symptomatic patient detected by Holter monitoring. More patients therefore received a clear diagnosis, and more quickly, when using event recording than with Holter monitoring. For this reason, event recorders are preferable to Holter monitors for patients with palpitations.

Role of implantable loop recorder in the clinical diagnosis of syncope: Results of the introduction of an effective diagnostic tool

2015 ◽  
Vol 156 (15) ◽  
pp. 609-613
Author(s):  
Miklós Somlói ◽  
Emil Toldy-Schedel ◽  
Zoltán Nényei ◽  
Róbert Böszörményi ◽  
János Tomcsányi
Keyword(s):  
Clinical Practice ◽  
Diagnostic Yield ◽  
Diagnostic Algorithm ◽  
Definitive Treatment ◽  
Implantable Loop Recorder ◽  
Everyday Clinical Practice ◽  
Loop Recorder ◽  
Early Application ◽  
Electrocardiographic Monitoring ◽  
The Everyday

Introduction: Extension of electrocardiographic monitoring via loop recorder implantation may increase the diagnostic yield of syncope work-up. Aim: In this retrospective observational study, the authors wanted to evaluate the diagnostic performance of implantable loop recorder in the everyday clinical practice. Method: The authors analyzed the electronically stored data of all patients who underwent loop recorder implantation between 2005 and 2014 in their cardiology department because of recurrent syncope of undetermined origin. Results: There were 52 loop recorder implantations within the study period. During the 167 (±136) days of monitoring, 36 (69.2%) diagnostic events occurred. In two-thirds of events, (46.2% of all monitored patients) a specific arrhythmia diagnosis was reached, allowing definitive treatment in these cases. In this selected population, there was no correlation between age, presence of known high-risk predictors, or accompanying trauma, and the mechanism of syncope. Conclusions: The high diagnostic rate of implantable loop recorder in the everyday clinical practice is in accordance with the findings in prospective clinical studies. This observation supports the early application of loop recorder in the diagnostic algorithm of syncope. Orv. Hetil., 2015, 156(15), 609–613.

Apical hypertrophic cardiomyopathy with subendocardial late gadolinium enhancement in an adolescent

2020 ◽  
pp. 1-3
Author(s):  
Simona Boroni Grazioli ◽  
Marc-Philip Hitz ◽  
Inga Voges
Keyword(s):  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
Resonance Imaging ◽  
Gadolinium Enhancement ◽  
Apical Hypertrophic Cardiomyopathy ◽  
T Wave ◽  
Wave Inversion ◽  
Cardiology Department ◽  
History Of ◽  
Rare Diagnosis

Abstract A 17-year-old boy with a history of dyspnea attacks and chest pain was referred to our paediatric cardiology department. Electrocardiogram at presentation showed T-wave inversion in the inferior leads. Cardiovascular magnetic resonance imaging revealed the rare diagnosis of apical hypertrophic cardiomyopathy with subendocardial late gadolinium enhancement, missed by echocardiography.

scholarly journals Midventricular takotsubo syndrome: different dyskinesia location leading to a different electrocardiogram?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Padilla Lopez ◽  
A Duran Cambra ◽  
M Vidal Burdeus ◽  
L Rodriguez Sotelo ◽  
J Sanchez Vega ◽  
...  
Keyword(s):  
Acute Phase ◽  
Clinical Symptoms ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
Funding Sources ◽  
Wave Inversion ◽  
St Segment ◽  
Electrocardiogram Ecg ◽  
Study Inclusion

Abstract Funding Acknowledgements Type of funding sources: None. Background Takotsubo syndrome (TKS) is characterized by the appearance of apical reversible dyskinesia in its typical form. Electrocardiogram (ECG) in the acute phase (<12 from symptom onset) generally shows anterior ST segment elevation. Nonetheless, other atypical forms of TKS have been described depending on the location of the dyskinetic segments, such as, mid-ventricular, basal and focal forms. Considering the different segments involved in these atypical forms, it seems reasonable to consider that ST changes in acute phase ECG could be different. Purpose To compare ECG in the acute phase of typical TKS versus mid-ventricular TKS, as it was the more frequent form of atypical TKS in our registry. Methods Patients included in the prospective TKS registry of our center according to the Mayo Clinic diagnostic criteria, with the first ECG performed less than 12 hours from the symptoms onset were reviewed. All cardiac left ventriculographies were reviewed to ensure a correct classification of the different types of TKS. Results A total of 297 patients were included in our local registry. 80 patients met our study inclusion criteria. 56 ECGs of typical apical TKS were compared to 24 ECGs of atypical midventricular TKS. There were no differences between the baseline characteristics in both groups, except for mid-ventricular TKS, that was more frequently triggered by physical stressor. Regarding the ECG analysis, the main difference found in our serie was related to ST-segment deviation (Table 1). While ST-segment elevation was more common in typical TKS than in atypical TKS (73% vs 50%), ST-segment depression (generally in inferior leads) was observed in 54% of patients with atypical TKS and in no patient with typical TKS (figure 1). Conclusion The different location of dyskinesia between typical TKS and mid-ventricular TKS is associated to significant differences in the ECG obtained in the first hours after the onset of the clinical symptoms. The presence of ST-segment depression is highly suggestive of mid-ventricular TKS. ECG characteristicsTypical (n = 56)Midventricular (n = 24)pSTe > 1mm, no (%)41 (73)12 (50)0,044STd >0,5 mm, no (%)013 (54)< 0,001T wave inversion, no (%)12 (21)4 (17)0,626Q wave, no (%)22 ( 39)12 (50)0,374cQT, mean (SD)445 (54)438 (37)0,578QRS low voltages*, n (%)9 ( 16)1 (4)0,328STe ST-segment elevation, STd: ST-segment depression, cQT: corrected QT interval *Voltages <5mm in all limb leads or <10mm in all precordial leads Abstract Figure. 12-lead ECG and left ventriculography

scholarly journals A Rational Evaluation of the Syncope Patient: Optimizing the Emergency Department Visit

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 514
Author(s):  
Tarek Hatoum ◽  
Robert S. Sheldon
Keyword(s):  
Emergency Department ◽  
Diagnostic Yield ◽  
Clinical Decision ◽  
Emergency Department Visits ◽  
Decision Tools ◽  
Short And Long Term ◽  
Electrocardiogram Ecg ◽  
Structured Approach

Syncope accounts for up to 2% of emergency department visits and results in the hospitalization of 12–86% of patients. There is often a low diagnostic yield, with up to 50% of hospitalized patients being discharged with no clear diagnosis. We will outline a structured approach to the syncope patient in the emergency department, highlighting the evidence supporting the role of clinical judgement and the initial electrocardiogram (ECG) in making the preliminary diagnosis and in safely identifying the patients at low risk of short- and long-term adverse events or admitting the patient if likely to benefit from urgent intervention. Clinical decision tools and additional testing may aid in further stratifying patients and may guide disposition. While hospital admission does not seem to offer additional mortality benefit, the efficient utilization of outpatient testing may provide similar diagnostic yield, preventing unnecessary hospitalizations.

Predictors Factors of Onset de Novo Heart failure after STEMI

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Abouradi ◽  
H Choukrani ◽  
A Maaroufi ◽  
A Drighil ◽  
R Habbal
Keyword(s):  
Heart Failure ◽  
De Novo ◽  
Microvascular Disease ◽  
Prior History ◽  
Killip Class ◽  
Funding Sources ◽  
Significant Difference ◽  
Primary Coronary Angioplasty ◽  
History Of ◽  
Predictor Factors

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION STEMI gets complicated very often by a heart failure (HF), which it is important to know associated factors. The aim of this study  was to determinate the predictor factors of onset of de novo HF after STEMI in patients with no prior history of heart failure recorded at baseline. METHODS A retrospective, descriptive study from 1 center in Morocco, including 210 patients hospitalized in a cardiology intensive care unit for STEMI from September 2019 to November 2020. The main outcomes were HF Killip class at hospital presentation and intra-hospital mortality. RESULTS The main age was 59.3 ± 7.02 and Sex ratio: 2, 86. The incidence of de novo HF at admission was higher in women (40, 4% vs. 29.5%, [OR 1, 61; 95%, [CI] 0, 83-3, 11). Forty-nine point eight percent were in Killip≥ 2. The method of early revascularization was Thrombolysis in 82, 3% compared to primary coronary angioplasty without significant difference in onset of the novo HF. There was no association of age, comorbidities, delay to hospital presentation and coronary involvement with incidence of onset of de novo HF.  Women had higher mortality than men with the novo HF (28, 6% vs. 20.5%; OR: 1, 55; 95%). CONCLUSION  Gender has appeared associated to onset of de novo HF after STEMI with a superiority of the female sex after controlling for others factors described in the literature. Anterior studies have related this to the increased prevalence of microvascular disease in women predisposing them to heart failure after STEMI.

scholarly journals Increased C-reactive protein concentrations in patients admitted to the emergency department with troponin level elevations decreases the probability of myocardial ischemia

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
SR Meisel ◽  
OM Kobo ◽  
M Kleisener Shochat ◽  
M Saada ◽  
N Amsalem ◽  
...  
Keyword(s):  
Emergency Department ◽  
Myocardial Ischemia ◽  
Cardiac Injury ◽  
Medical Problem ◽  
Troponin Level ◽  
Elevated Troponin ◽  
Reactive Protein ◽  
Funding Sources ◽  
Cardiology Department ◽  
Inflammatory State

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients frequently present to the emergency department (ED) with chest pain, dyspnea, or other symptoms with elevated troponin level. This finding prompts a provisional diagnosis of myocardial ischemia and raises the need to exclude this possibility. However, elevated blood troponin may be the result of a systemic inflammatory or infectious state merely representing cardiac injury and not myocardial ischemia. Purpose We hypothesized that the ratio of CRP/troponin could reflect the extent of the systemic inflammatory state that induces an attendant cardiac injury, which if sufficiently high could exclude myocardial ischemia. Methods Study population included 10774 patients admitted to the ED during the years 2016-2019 with cTn level higher > 14 ng/liter. CRP level was measured in all patients and CRP/troponin ratio was assessed against discharge diagnosis of myocardial ischemia, in order to evaluate its ability to exclude ischemic etiology of symptoms. The incidence of myocardial ischemia among study patients decreased with increasing CRP/troponin value. Results The prevalence of myocardial ischemia was 760/2694 patients (28.2%), 415/2694 (15.4%), 294/2695 (10.9%) and 130/2694 (4.8%) with 1st-4th CRP/troponin quartile, respectively (p < 0.0001). Logistic regression has shown that the probability of myocardial ischemia decreased by 53%, 68%, and 87% in the second to fourth CRP/troponin quartile compared with the first quartile, respectively (p < 0.0001). Conclusion The present study has shown that increased CRP level seems to modulate the specificity of simultaneous troponin as a marker of ischemia. As CRP level increases, so increases the likelihood that concomitant elevated troponin is due to myocardial injury and not due to myocardial ischemia. The clinical implication is that in the presence of a high CRP/troponin ratio, admission to the cardiology department and coronary investigation are unnecessary, whereas appropriate investigation of the actual medical problem is warranted.

Ramadan and blood pressure: importance of chronotherapy

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
MA Bejar ◽  
I Zairi ◽  
I Ben Mrad ◽  
B Besbes ◽  
K Mzoughi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Dual Therapy ◽  
Average Heart Rate ◽  
Hypertensive Patients ◽  
Mean Values ◽  
Funding Sources ◽  
Cardiology Department ◽  
Group 2 ◽  
And Gender

Abstract Funding Acknowledgements Type of funding sources: None. Background During Ramadan, alterations in the daily patterns of sleep, activities and medication timing might contribute to changes in blood pressure (BP) and heart rate among hypertensive patients. The aim of this study was to examine the effect of medication timing during Ramadan on blood pressure and heart rate in hypertensive subjects taking their treatment once daily. Methods The study prospectively recruited 44 hypertensive patients between April and June 2019, followed up at the cardiology department of our   Hospital. A 24-hour pressure monitoring was carried out during two periods: prior to Ramadan and during the last ten days of Ramadan. Results We studied 29 women and 15 men, mean age was 58.7 years. 34% of the patients were diabetics and 16% had coronaropathy. 46% of the patients were on monotherapy, 43% on dual therapy and 11% on a triple antihypertensive therapy. During Ramadan, 57% of the patients took their treatment during the dinner (group1), whereas 43% took their treatment during the Shour (group 2). Average 24hour blood pressure in the whole group was 129 ± 18/74 ± 10 mmHg before Ramadan and 129 ± 19/74 ± 10 mmHg during Ramadan (p > 0.05). Daytime and nighttime mean values of systolic and diastolic blood pressure as well as mean values of heart rate were not different between both periods regardless of age and gender. However, during Ramadan, those who took their treatment after dinner had significant higher values of 24 hour systolic BP, awake systolic and diastolic BP, asleep systolic and diastolic BP than those who took their treatment with the shour (p < 0.05). Conclusion In this study, there were no significant changes in systolic and diastolic blood pressures as well as heart rate during the 2 periods. However, during Ramadan, a slight superiority of taking the treatment with the shour is observed. Average values of BP and heart rate Group 1 Group 2 p 24 hour SBP (mmHg) 134 ± 23 122 ± 6 0.017 24 hour DBP (mmHg) 76 ± 12 70 ± 5 0.052 Awake SBP (mmHg) 138 ± 23 125 ± 6 0.012 Awake DBP (mmHg) 79 ± 12 73 ± 5 0.044 Asleep SBP (mmHg) 127 ± 26 114 ± 12 0.030 Asleep DBP (mmHg) 71 ± 13 65 ± 7 0.045 24 hour average heart rate (bpm) 71 ± 7 70 ± 6 0.524 Awake average heart rate (bpm) 76 ± 7 74 ± 7 0.322 Asleep average heart rate (bpm) 65 ± 7 65 ± 7 0.931 Average values of blood pressure and heart rate in both groups Abstract Figure. 24hour course of blood pressure

Collaborative Research Funding

2014 ◽  
Vol 36 (4) ◽  
Author(s):  
Markus Behnke ◽  
Laura McConnell ◽  
Chris Ober
Keyword(s):  
International Collaboration ◽  
Research Funding ◽  
International Committee ◽  
Research Projects ◽  
Scientific Success ◽  
Funding Sources ◽  
Chemistry Research ◽  
National Organizations ◽  
Recent Developments ◽  
History Of

Within a changing research world, international collaboration has become even more important in achieving scientific success. Given the increased need and desire for multinational research, the actors are forced to identify appropriate funding sources. Whereas, science knows no international boundaries, support for scientific research, including in chemical sciences, is mostly provided by the national funding organizations. This is particularly true for the chemical sciences, where most research projects are relatively small in size and with respect to the number of involved PIs. Traditionally, national organizations are reluctant to provide funds to non-domestic researchers, and in practice, funding truly international research projects can be a real challenge for a variety of technical and bureaucratic reasons. In an effort to change this, an international Committee on Chemistry Research Funding (CCRF)—backed by several leading funding organizations—was established by IUPAC in December 2007 to promote increased international collaboration and networking in the global chemistry community. The following report gives a short overview on the history of IUPAC’s involvement in service for chemistry research funding and on the most recent developments.

scholarly journals Clinical Evaluation of Three Carotenoid Containing Supplements Using Fingertip Reflection Spectroscopy Measurements (P02-009-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Dawna Salter-Venzon ◽  
Kevin Gellenbeck ◽  
Chun Hu
Keyword(s):  
Vegetable Intake ◽  
Beta Carotene ◽  
Reflection Spectroscopy ◽  
Open Label ◽  
Open Label Study ◽  
Funding Sources ◽  
Supplement Group ◽  
Supplement Usage ◽  
History Of ◽  
Carotene Beta

Abstract Objectives Recent technology improvements have allowed measurement of carotenoid pigments utilizing simple reflection spectroscopy fingertip measurements (Veggie Meter®) (1). We used this technique to measure the effect of ingestion of three different dietary supplements containing carotenoids of different types and potencies: Vision Health with Lutein, Multi Carotene (beta carotene, alpha carotene, lutein, zeaxanthin), or Concentrated Fruits & Vegetables (lutein, lycopene) (2). Methods In an open label study, a total of 24 volunteers (8 for each of the study products) consumed the supplements daily according to label recommendations. Veggie Meter® measurements were taken on Day 0 and Weeks 2, 4, 6, 8, 10 and 12. Supplements were consumed for the first 6 weeks and then were discontinued for the following 6 weeks. Questionnaires were used at baseline, 6 and 12 weeks to obtain a brief history of supplement usage and fruit/vegetable intake. Results In most subjects, the veggie meter measurement increased from baseline after 6 weeks of supplementation, which then returned towards the baseline in the six weeks after supplementation was stopped. Responses from the three supplements varied in magnitude based on dosage and carotenoid type. There was also noticeable variation in individual responses within each supplement group. Conclusions Reflection spectroscopy fingertip measurements provided data supporting the notion that carotenoids deposit in the skin in response to supplementation with carotenoid containing supplements. This may suggest this method is a useful to monitor carotenoid status and indicate when diet modifications would be beneficial to individuals. Funding Sources Funding for the study was provided by Access Business Group/Amway.

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