Abstract 46: Study of Symptoms Variation in the Morning and Evening in Postural Orthostatic Tachycardia Syndrome (POTS)

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia that is estimated to impact between 1,000,000 and 3,000,000 Americans and millions more around the world. Patients chronically have symptoms that are worse with upright posture and that improve with recumbence. Symptoms often include orthostatic intolerance such as dizziness, fatigue, excessive sweating and many others. The aim of this study is to determine the variation of symptoms early morning after wake up and evening at 4 PM. Methods: The Autonomic nervous system questionnaire consisting of eight POTS symptoms palpitations, headaches, dizziness, shortness of breath(SOB), chest pain, weakness, blurred vision and heaviness of feet was handover to the patients at our clinic. 42 POTS patients participated in the study, participated patients had been asked to scale their symptoms early morning after wake up and evening at 4 PM. Symptoms were defined 0 as Never,1 as mild,2 as moderate,3 as severe ,4 as extreme and 5 impairing daily function and living. Results: Out of 42 POTS patients 90% are female (38/42, age 31.74±10.67) and 10% are males (4/42, age 30.75±13.20), symptoms were scaled early morning after wake up vs symptoms scaled evening at 4 pm results in mean±SD and Anova P value. Palpitations 1.69±1.32 vs 2.45±1.38 (P =0.01), Dizziness 2.40±1.38 vs 2.67±1.46 (P =0.40), Chest pain 0.93±1.02 vs 1.52±1.27 (P=0.02), SOB 1.36±1.32 vs 1.81±1.40 (P=0.13), Weakness 2.79±1.37 vs 3.12±1.38 (P=0.27), Blurred vision 1.38±1.29 vs 1.48±1.27 (P=0.73), Headaches 1.74±1.36 vs 2.52±1.38 (P =0.01), Heaviness of feet 0.95±1.19 vs 1.43±1.53 (P =0.11). Conclusion: Our study results demonstrated that the patients with POTS had significant variation in symptoms Palpitations, Chest pain, Headaches in evenings when compared to early morning after wake up.

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ACUTE CORONARY SYNDROME;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.03.1544 ◽

2017 ◽

Vol 24 (03) ◽

pp. 409-413

Author(s):

Naveed Aslam Lashari ◽

Nadia Irum Lakho ◽

Sarfaraz Ahmed Memon ◽

Ayaz Ahmed ◽

Muhammad Fahad Waseem

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Coronary Syndrome ◽

Study Results ◽

Artery Obstruction ◽

Conventional Risk Factors ◽

Typical Chest Pain

Introduction: ACS is defined as the cluster of symptoms arising due to the rapiddrop of blood flow to the heart because of coronary artery obstruction. It is stated that worldwidearound 17 million people die due to cardiovascular diseases of which half of the deaths arereported due to ACS. Chest pain is known to be the most leading factor associated with ACS.Objectives: To determine the frequency of acute coronary syndrome, its types and commoncontributing factors in patients presenting with typical chest pain in a secondary care hospital.Study Design: Cross sectional study. Setting: Medical Unit, PAF Hospital Mushaf Sargodha.Period: October 2013 to March 2014. Methodology: A total of 280 patients of either gender,aged 20 to 80 years presented with typical chest pain with or without conventional risk factorswere included in the study. Results: Majority (68.9%) was males and 31.1% were female. Acutecoronary syndrome was observed in 131(46.8%) patients. Out of these 131 patients, 55% hadNSTEMI, 28.2% had unstable angina and 16.8% had STEMI. A higher proportion of femaleswere found to have ACS as compared to males (75.9% vs 33.7%, P-value<0.0001). Out of131 patients, 40.5% were diabetic, 29.8% were hypertensive 16% were hyperlipidemic, while13.7% were smokers. Conventional risk factors except smoking were observed more in femalesas compared to males. Conclusion: Majority of patients with acute coronary syndrome werefemales and diabetic. NSTEMI was the most common type of ACS. Prevalence of conventionalrisk factors was found more in females with ACS.

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Evaluation of applying chest pain guidelines in coronary care patients on their health outcome

International Journal of Advanced Nursing Studies ◽

10.14419/ijans.v6i2.8282 ◽

2017 ◽

Vol 6 (2) ◽

pp. 99

Author(s):

Eman Shahin ◽

Mona Hasan

Keyword(s):

Health Outcome ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Nursing Care ◽

University Hospital ◽

Respiratory Pattern ◽

P Value ◽

Coronary Syndrome ◽

Study Results ◽

Coronary Care

Background: the National Heart, Lung, and blood Institute estimate that each year approximately 785,000 Americans will have a new coronary attack and approximately 470,000 will have a recurrent attack. Chest pain is one of the most common symptoms of coronary artery disease or acute coronary syndrome. Objectives: this study aims to compare between routine nursing care of chest pain and chest pain guidelines in patients with acute coronary syndrome and assess health outcome after application of chest pain guidelines in acute coronary syndrome patients. Method: Quasi experimental research design was used in the current study. The study was conducted at the coronary care unit of Suez canal University Hospital. Sample; consecutive of 70 patients was included in the study. Four tools were used for study data collection that named the chest pain guidelines evidence based nursing care in patients with angina pectoris, visual analog scale to assess chest pain, dyspnea scale to assess breathing pattern and fourth one was lab investigation to assess patient health prognosis. Results: The study results revealed an improvement of patients’ health outcome represented in a significant reduction in complain of chest pain, blood pressure and insufficient sleeping with P-value of 0.000 after applying guidelines of care regarding chest pain. Additionally, the respiratory pattern and respiratory rate improved significantly with P-value of 0.000. Moreover, lab investigation showed significantly decrease in LHD level with P-value of 0.000. Conclusion: The current study concluded that application of chest pain guidelines intervention could be improved patients health outcomes.

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Abstract 227: Single-blind Study of Q-sweat in Postural Orthostatic Tachycardia Syndrome (POTS)

Circulation Research ◽

10.1161/res.119.suppl_1.227 ◽

2016 ◽

Vol 119 (suppl_1) ◽

Author(s):

Muhammad M Ahsan ◽

Tara Thompson ◽

Chandralekha Ashangari ◽

Amer Suleman

Keyword(s):

Orthostatic Intolerance ◽

Electrical Current ◽

The Body ◽

Blind Study ◽

Sweat Glands ◽

Postural Orthostatic Tachycardia Syndrome ◽

Onset Latency ◽

Excessive Sweating ◽

Sweat Production ◽

Single Blind

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia that is estimated to impact between 1,000,000 and 3,000,000 Americans and millions more around the world. Symptoms often include orthostatic intolerance such as dizziness, fatigue, excessive sweating and many others. The aim of this study is to determine the Q-sweat study in POTS patients. Methods: This study was a randomized, single-blind study. Patients evaluated between October 2014 to June 2015 were included. The skin on the leg and wrist is wiped with acetone, then alcohol and dried, cleaning the skin in preparation for the test. Four electrodes filled with acetylcholine are placed on three areas of the leg and one area on the wrist. A mild electrical current called iontophoresis is then applied to help the drug stimulate the sweat glands. This evokes sweating at the site, but it also allows the body to release its own acetylcholine, resulting in sweat production at nearby sites. After a stimulus (e.g. a deep breath) any deviation from the baseline is reported. If no change is seen, a stronger stimulus is applied (e.g. electrical stimulation) and if there is still no change seen, an “absent response” is reported. The onset latency and magnitude of response can be quantified, although the results are highly variable within and between subjects. The sweat response is measured Q-sweat recordings of Left proximal leg, Left distal leg and Left foot sites were analyzed. Results are categorized as Normal response, no response, hung up and prolong response. Results: A total 144 POTS patients were included, Out of 144 POTS patients 88% are females (n=127, mean age 31.93±12.37) and 12% are males (n=17, mean age 31.59±11.14), Left proximal leg site 69/144(48%) Patients had hung up, 8/144(6%) had No response, 29/144(20%) had Normal, 38/144(26%) had Prolong. Left distal leg site 72/144(50%) had hung up, 13/144(9%) had No response, 23/144(16%) had Normal, 36/144(25%) had Prolong. Left foot site 36/144(25%) had hung up, 35/144(24%) had No response, 40/144(28%) had Normal, 33/144(23%) had Prolong response. Conclusion: Postural Orthostatic Tachycardia Syndrome had a higher percentage of patients with Hung up response.

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Association of age and symptoms with frequency of Premature Ventricular Contractions on 24 hours Holter monitoring

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.2.2873 ◽

2021 ◽

Vol 37 (2) ◽

Author(s):

Shazadi Ambreen ◽

Humaira Fayyaz Khan ◽

Azmat Hayyat ◽

Nasar Abbas Shamsi

Keyword(s):

Chest Pain ◽

Health Care Professionals ◽

Armed Forces ◽

Holter Monitoring ◽

P Value ◽

Shortness Of Breath ◽

Cross Sectional ◽

Premature Ventricular Contractions ◽

Specific Symptom ◽

Asymptomatic Patients

Objectives: This study was done with the objective to identify the determinants of mild, moderate and frequent burdens of premature ventricular contractions (PVCs) which may guide the health care professionals to stratify the high risk patients on basis of their symptoms. Methods: It was a cross sectional descriptive study conducted in Islamic International Medical College (IIMC) in collaboration with Armed Forces Institute of Cardiology (AFIC) from 18th April 2016 to 20th March 2018. It comprised 60 diagnosed patients of PVCs, divided into three groups on the basis of their PVCs burden determined by Holter monitoring report. Each group of mild (Group-A), moderate (Group-B) and frequent burden (Group-C) constituted 20 patients having PVC burden <10%, 10-20% and >20% respectively. All patients were evaluated for their symptoms by a cardiologist. Statistical analysis was done to determine the association of patient’s symptom and age with mild, moderate and frequent PVCs burden. Results: PVCs were significantly associated with presence of symptoms as compared to asymptomatic patients. While no significant correlation of age or any specific symptom (palpitations, chest pain, dizziness, shortness of breath) was found with mild, moderate and frequent PVCs burden with p-value of 0.466. Conclusions: Mild, moderate or frequent PVCs burden are not associated with any specific symptom predominantly or old age. So, it is equally important for all the patients presenting with any symptom of palpitations, chest pain, dizziness or shortness of breath to undergo the work up of PVCs, irrespective of their age. doi: https://doi.org/10.12669/pjms.37.2.2873 How to cite this:Ambreen S, Fayyaz H, Hayat A, Shamsi NA. Association of age and symptoms with frequency of Premature Ventricular Contractions on 24 hours Holter monitoring. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.2873 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Penatalaksanaan IMD pada Ibu Postpartum Sectio Caesarea Mempengaruhi Status Gizi dan Kecepatan Produksi ASI

Jurnal Bidan Cerdas (JBC) ◽

10.33860/jbc.v2i2.68 ◽

2020 ◽

Vol 2 (2) ◽

pp. 112-120

Author(s):

Nursari Abdul Syukur ◽

Susi Purwanti

Keyword(s):

Breast Milk ◽

Nutritional Status ◽

Milk Production ◽

Quantitative Research ◽

Milk Protein ◽

Sectio Caesarea ◽

Control Group ◽

P Value ◽

Study Results

Many mothers who give birth to Sectio Caesarea (SC) do not Initiate Early Breastfeeding (IMD), which fails exclusive breastfeeding. This study aimed to determine the effect of IMD management in postpartum SC mothers on nutritional status, speed of milk production, and quality of breast milk protein. Method: quantitative research with quasi approach experiment. The research design used was a pre-post-test control non-equivalent control group. A sampling of this study used the Consecutive method sampling with a sample of 20 mothers who gave birth by cesarean section (SC). Hypothesis testing uses the independent t-test and the Mann-Whitney test. The study results showed an influence on the management of IMD in postpartum SC mothers on the speed of ASI production (p-value=0.004) and nutritional status (p-value=0.028). There was no effect of IMD management on postpartum SC mothers on the quality of breast milk protein (p-value = 0.543). This study recommends that the hospital implement an IMD promotion program before the abdominal wall is closed as a form of intervention to increase milk production and maternal nutritional status

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A STUDY OF ENDOMETRIAL THICKNESS IN TRANS VAGINAL SONOGRAPHY IN RELATION WITH HISTOPATHOLOGY REPORT IN DILATION & CURRATAGE IN AUB WOMEN

10.36106/paripex/1 ◽

2019 ◽

pp. 1-2

Keyword(s):

Comparative Study ◽

Endometrial Thickness ◽

P Value ◽

First Line ◽

Non Invasive ◽

Dilation And Curettage ◽

Study Results ◽

Vaginal Sonography ◽

In Trans

A study of of endometrial thickness on TVS in relation with histopathology report on dilation and curettage. AIM AND OBJECTIVE-To set a cut off limit of endometrial thickness on TVS for differtiating between normal and abnormal endometrium. MATERIAL AND METHOD-hospital based comparative study. RESULTS-TVS is non invasive ,simple first line procedure in AUB women. Mean endometrial thickness in normal endometrial group was 8.00±2.44 mm and in abnormal endometrial group was 15.16±33 mm.The difference was found highly significant (p value<.001)

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A 28-Year-Old Man With Chest Pain, Shortness of Breath, and Hemoptysis After Recovery From Coronavirus Disease 2019 Pneumonia

CHEST Journal ◽

10.1016/j.chest.2020.07.096 ◽

2021 ◽

Vol 159 (1) ◽

pp. e35-e38

Author(s):

John Odackal ◽

Tijana Milinic ◽

Tim Amass ◽

Edward D. Chan ◽

Jeremy Hua ◽

...

Keyword(s):

Chest Pain ◽

Shortness Of Breath

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Adding stress biomarkers to high sensitivity troponin measurements increases precision and efficacy of rapid rule out protocols for NSTEMI

European Heart Journal ◽

10.1093/ehjci/ehaa946.1698 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

I Restan ◽

O.T Steiro ◽

H.L Tjora ◽

J Langoergen ◽

T Omland ◽

...

Keyword(s):

Chest Pain ◽

Acute Chest Pain ◽

High Sensitivity ◽

Final Diagnosis ◽

Public Institution ◽

P Value ◽

Funding Source ◽

University Hospitals ◽

High Sensitivity Troponin ◽

Rule Out

Abstract Background NSTEMI may be ruled out in patients presenting with acute chest pain based on low baseline high sensitivity troponin (cTn) at admission. This procedure is limited by a low expected frequency of ruled out non-cardiac chest pain (NCCP) patients. Purpose To investigate if stress-induced biomarkers (glucose or copeptin) combined with cTn can increase the rate of NCCP ruled out without an unacceptable increase in incorrectly ruled out NSTEMI. Method 971 patients with suspected NSTE-ACS were included. Final diagnosis was adjudicated by two independent cardiologists using clinical data including routine cTnT. Additionally, baseline cTnI, cTnI from Singulex Clarity System (cTnI(sgx)), copeptin and glucose were measured. Diagnostic performance to rule out NSTEMI was compared between the ESC rule out algorithms for cTnT and cTnI(Abbott), a local cTnI(sgx) algorithm and different combinations of cTn with copeptin or glucose Results Median age 61 years, 60% male. 13% had NSTEMI, 12% had UAP and 60% NCCP. Distribution of copeptin and glucose concentrations (NSTEMI and NCCP) is shown in figure 1. Copeptin and cTnT produces an algorithm with lower miss rate for NSTEMI, increased rule out rate for NCCP and significantly higher AUC (DeLong test, p value <0.001) compared to the ESC algorithm (Table 1). cTnI(sgx) and copeptin showed higher rule out for NCCP and higher AUC (p value <0.001), however an increased rule out rate for NSTEMIs. Combining cTnI(Abbott) and glucose gave a similar miss rate for NSTEMI as ESC, but increased rule out rate for NCCP and higher AUC (p value <0.001). Conclusion Combining cTnT or cTnI(sgx) with copeptin; or cTnI with glucose, improves diagnostic precision and efficacy of rule out protocols for NSTEMI in patients presenting with acute chest pain. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Western Norway Regional Health Authority; Haukeland and Stavanger University Hospitals

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Circulating levels of growth hormone in postural orthostatic tachycardia syndrome

Scientific Reports ◽

10.1038/s41598-021-87983-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Madeleine Johansson ◽

Fabrizio Ricci ◽

Janin Schulte ◽

Margaretha Persson ◽

Olle Melander ◽

...

Keyword(s):

Heart Rate ◽

Growth Hormone ◽

Orthostatic Intolerance ◽

High Sensitivity ◽

Symptom Assessment ◽

Postural Orthostatic Tachycardia Syndrome ◽

Daily Life Activities ◽

Median Plasma ◽

Symptom Assessment Scale ◽

Plasma Gh

AbstractPostural orthostatic tachycardia syndrome (POTS) is a cardiovascular autonomic disorder with poorly understood etiology and underlying pathophysiology. Since cardiovascular morbidity has been linked to growth hormone (GH), we studied GH levels in patients with POTS. We conducted an age-sex-matched case–control study in patients with POTS (age 31 ± 9 years; n = 42) and healthy controls (32 ± 9 years; n = 46). Plasma GH levels were measured using high-sensitivity chemiluminescence sandwich immunoassay. The burden of orthostatic intolerance symptoms was assessed by the Orthostatic Hypotension Questionnaire (OHQ), consisting of a symptom assessment scale (OHSA) and a daily activity scale (OHDAS). POTS patients had significantly higher composite OHQ score than controls, more symptoms and less activity. Supine heart rate and diastolic blood pressure (BP), but not systolic BP, were significantly higher in POTS. Median plasma GH levels were significantly lower in POTS (0.53 ng/mL) than controls (2.33 ng/mL, p = 0.04). GH levels were inversely related to OHDAS in POTS and supine systolic BP in POTS and controls, but not heart rate neither group. POTS is associated with lower GH levels. Impairment of daily life activities is inversely related with GH in POTS. A higher supine diastolic BP is inversely associated with GH levels in POTS and healthy individuals.

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Triage Ability of Emergency Medical Services Providers and Patient Disposition: A Prospective Study

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00027552 ◽

1999 ◽

Vol 14 (3) ◽

pp. 67-72 ◽

Cited By ~ 17

Author(s):

John R. Richards ◽

Stephen J. Ferrall

Keyword(s):

Chest Pain ◽

Emergency Medical Services ◽

Patient Characteristics ◽

University Hospital ◽

Medical Services ◽

Shortness Of Breath ◽

Study Objective ◽

Patient Disposition ◽

Emergency Medical ◽

Respiratory Complaints

AbstractStudy objective:To determine the ability of emergency medical services (EMS) providers to subjectively triage patients with respect to hospital admission and to determine patient characteristics associated with increased likelihood of admission.Methods:A prospective, cross-sectional study of a consecutive sample of patients arriving by ambulance during the month of February 1997 at an urban, university hospital, Emergency Department. Emergency medical services providers completed a questionnaire asking them to predict admission to the hospital and requested patient demographic information. Predictions were compared to actual patient disposition.Results:A total of 887 patients were included in the study, and 315 were admitted to the hospital (36%). With respect to admission, emergency medical services providers had an accuracy rate of 79%, with a sensitivity of 72% and specificity of 83% (kappa = 0.56). Blunt traumatic injury and altered mental status were the most common medical reasons for admission. Variables significantly associated with high admission rates were patients with age > 50 years, chest pain or cardiac complaints, shortness of breath or respiratory complaints, Medicare insurance, and Hispanic ethnicity. The emergency medical services providers most accurately predicted admission for patients presenting with labor (kappa = 1.0), shortness of breath / respiratory complaints (kappa = 0.84), and chest pain (kappa = 0.77).Conclusion:Emergency medical services providers can predict final patient disposition with reasonable accuracy, especially for patients presenting with labor, shortness of breath, or chest pain. Certain patient characteristics are associated with a higher rate of actual admission.

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