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

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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Significance of N-Terminal Pro Brain Natriuretic Peptide as a Diagnostic Tool for Premature Ventricular Contractions in Patients with Preserved Left Ventricular Function"

10.21203/rs.3.rs-263047/v1 ◽

2021 ◽

Author(s):

Shazadi Ambreen ◽

Humaira Fayyaz khan ◽

Azmat Hayat ◽

Shazia Ali

Keyword(s):

Left Ventricular Function ◽

Ventricular Function ◽

Pearson Correlation ◽

Armed Forces ◽

Left Ventricular ◽

Ethical Review ◽

Control Group ◽

P Value ◽

Premature Ventricular Contractions ◽

Asymptomatic Patients

Abstract ObjectiveThe study was aimed to evaluate the levels of NT-proBNP in mild, moderate and frequent ventricular ectopic burden in patients with preserved left ventricular function.Material and methodsA case control study was conducted in Islamic International Medical College (IIMC) in collaboration with Armed Forces Institute of Cardiology (AFIC) after approval from ethical review committee (ERC) of Riphah University (Ref #Riphah/IIMC/ERC/17/0230). It comprised of 120 Premature ventricular contractions (PVCs) patients with 40 patients in each group of mild (<10%), moderate (10-20%) and frequent (>20%) PVCs burden. 40 healthy subjects with no PVCs were taken as a control group. NT-proBNP levels were measured in all groups and statistical analysis was done by applying ANOVA and Pearson correlation tests to evaluate its association with PVCs burdenResultsNT-proBNP levels were found to be raised in all PVCs burden of <10%, 10-20% and >20% as compare to control group with p value of 0.039, 0.02 and 0.009 respectively. p value of ≤0.05 was considered significant. Symptomatic and asymptomatic patients show higher NT-proBNP levels as compared to control group with p-value of .002 and .04.Conclusion It is concluded that NT-proBNP levels are raised in patients of PVCs. This finding can be helpful for diagnostic purposes of PVCs.

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Pre and post flooding malaria parasitemia in gravid women, South East, Nigeria

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1368 ◽

2021 ◽

Vol 2 (5) ◽

Author(s):

Ekwebene OC ◽

◽

Obidile VC ◽

Nnamani CP ◽

Eleje GU ◽

...

Keyword(s):

Climate Change ◽

Pregnant Women ◽

Health Care Professionals ◽

Malaria Parasite ◽

P Value ◽

Cross Sectional ◽

Vector Borne Diseases ◽

Seasonal Flooding ◽

Vector Borne ◽

The Relationship

The effect of global change on the incidence of vector borne diseases including malaria is of great importance. Malaria has been regarded as one of the most sensitive disease that responds fast to climate change. Pregnant women tend to have reduced immunity are more vulnerable to vector borne diseases such as malaria especially with climate change like flooding where these vectors borne diseases are endemic. To measure malaria parasitaemia in gravid women pre and post flooding and also to determine the relationship between malaria and seasonal flooding in South east Nigeria. This was a hospital-based cross-sectional study involving pregnant women aged 15- 45 years attending the antenatal clinics of two maternity centres in a rural community South east Nigeria. Malaria was determined using the thick and thick blood films. Plasmodium falciparum species was examined in this study. Chi-square was used to assess the relationship between malaria and seasonal flooding. One Hundred and fifty pregnant women were recruited for the study. The prevalence of malaria in the gravid women pre and post flooding were 60.00% and 65.30% respectively. Malaria parasite was highest in the gravid women aged 28-31 years and the primigravids. There was no statistical difference between malaria and parity. The mean parasite density in the gravid women was significantly higher post flooding than pre flooding with p-value of 0.001. There was no significant relationship between malaria parasite in gravid women and the periods of investigation. The prevalence of malaria parasite among gravid women in the study area is high regardless of the seasonal flooding. Hence, the need for adherence to malaria prophylaxis protocol by the health care professionals and increase on community health education on malaria preventive strategies.

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Gender-Related Differences of Cardiac Troponin-I Levels in Patients with Acute Myocardial Infarction at Time of Acute Chest Pain

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i52a33576 ◽

2021 ◽

pp. 199-205

Author(s):

Mahir Abdulkadhum Khudhair Alzughaibi ◽

Ammar Waheeb Obeiad ◽

Nassar Abdalaema Abdalhadi Mera ◽

Mohammed Sadeq Hamzah Al-Ruwaiee

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chest Pain ◽

Troponin I ◽

Statistical Significance ◽

Acute Chest Pain ◽

Blood Analysis ◽

P Value ◽

Cross Sectional ◽

Time Of Admission

Background: Cardiac Troponins-I (CTNI) are myoregulatory polypeptides that control the actin-myosin interface, considered specific to cardiomyocytes. Age and sex variances in the extent of CTNI levels have arisen a recent debatable emphasis. Existing revisions do not display a reliable clinical power of sex-specific CTNI 99th centiles, which actually might mirror procedural aspects. Nevertheless, from a biochemical viewpoint, the trends of sex-specific CTNI 99th centiles seem sensible for the ruling-in of acute myocardial infarction AMI. Vulnerable females may be missed when applying the male sex-specific threshold. This study aimed to determine whether gender differences in CTNI exist in patients with AMI presented with chest pain. Methodology: The study was a cross-sectional, single-center, included 236-patients with AMI diagnosis by cardiologists at Merjan teaching hospital during the period from April to July 2020 from patients attending the hospital for cardiac consultation complaining of acute chest pain suggestive of AMI. Blood analysis had initiated at the time of admission included serum creatinine, blood urea, R/FBS, WBCs, PCV, and serum CTNI. A p-value below 0.05 specifies statistical significance. All statistical bioanalyses had performed by IBM-SPSS, version-25 for Windows. Results: The mean age of participants was 67.5 years, the men were dominant 76.2%. The incidence of DM and hypertension were significantly high and 24.5% of the patients were current smokers. Biochemical serum analysis revealed mean creatinine, urea, sugar, and STI values were 79.8±4.2 mmol/l, 15.9±1.7 mmol/l, 10.9±0.9 mmol/l, and 7.9±0.6 ng/ml separately. Both hypertension and smoking were significantly (p-0.001) more among males compared to the females, which is not the case for the prevalence of DM. The males were heavier significantly than females (p-0.001). Almost, there was no impact of gender on most of the other study variables other than serum TNI levels, which were significantly higher among the males (p-0.001). Conclusion: In patients with AMI presented with acute chest pain, the routine of CTNI in the diagnosis of AMI is based on the patient's gender. The application of gender-dependent cutoff levels for CTNI analyses appears to be highly suggested.

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

Circulation Research ◽

10.1161/res.119.suppl_1.46 ◽

2016 ◽

Vol 119 (suppl_1) ◽

Author(s):

Muhammad M Ahsan ◽

Tara Thompson ◽

Chandralekha Ashangari ◽

Amer Suleman

Keyword(s):

Chest Pain ◽

Orthostatic Intolerance ◽

Early Morning ◽

P Value ◽

Postural Orthostatic Tachycardia Syndrome ◽

Shortness Of Breath ◽

Blurred Vision ◽

Excessive Sweating ◽

Study Results ◽

Daily Function

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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Mitral Valve Prolapse and Athletic Participation in Children and Adolescents

PEDIATRICS ◽

10.1542/peds.95.5.789 ◽

1995 ◽

Vol 95 (5) ◽

pp. 789-790

Author(s):

Keyword(s):

Mitral Valve ◽

Children And Adolescents ◽

Mitral Valve Prolapse ◽

Holter Monitoring ◽

Premature Ventricular Contractions ◽

Benign Condition ◽

Migraine Headaches ◽

Asymptomatic Patients ◽

Vascular Accidents

Mitral valve prolapse (MVP) is generally a benign condition characterized by the protrusion of the mitral valve leaflets into the left atrium during systole. The prevalence of MVP in individuals under the age of 18 years is estimated to be 5% but is higher in those with Marfan's syndrome and other collagen vascular disorders.1 A midsystolic nonejection click with or without a late systolic murmur is the auscultatory hallmark of this syndrome. The diagnosis of MVP in children and adolescents should be based primarily on auscultatory findings and not on minor echocardiographic findings.1 The prognosis in children and adolescents with isolated MVP appears to be excellent and complications are rare. In 553 children, aged 15 days to 18 years, who were involved in studies with a follow-up period of 6 to 9 years, the following were reported: subacute bacterial endocarditis (one case), cerebral vascular accidents (two cases), migraine headaches (four cases), and chest pain (12 cases).2,3 Only four cases of sudden death have been reported in patients younger than 20 years of age.1-4 In a study of 103 patients with MVP, 16% were found to have premature ventricular beats during exercise electrocardiography (ECG) (exercise test).3 Thirty-eight percent were found to have premature ventricular contractions (PVCs) on 24-hour ECG (Holter) monitoring. This study, however, does not report the true prevalence of dysrhythmias because all these subjects had been referred to a pediatric cardiologist for evaluation. It is likely that these reported numbers are high because asymptomatic patients are less often referred.

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EFFECT OF PREANALYTICAL VARIABLES ON SERUM THYROID STIMULATING HORMONE ANALYSIS BY CHEMILUMINESCENCE METHOD

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-1.6202 ◽

2021 ◽

Vol 71 (Suppl-1) ◽

pp. S102-05

Author(s):

Ambreen Rehman ◽

Naveed Asif ◽

Saima Shakeel Malik ◽

Waqas Sheikh ◽

Quratulain . ◽

...

Keyword(s):

Venous Blood ◽

Armed Forces ◽

Epidemiological Studies ◽

Cross Sectional Study ◽

Thyroid Stimulating Hormone ◽

P Value ◽

Cross Sectional ◽

Specimen Handling ◽

Tsh Levels ◽

Stimulating Hormone

Objective: To identify effect of pre-analytical variables on serum thyroid stimulating hormone. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Pathology (AFIP) Rawalpindi, Department of Chemical Pathology & Endocrinology, from Mar 2018 to Aug 2018. Methodology: Hundred subjects with ages ranging from 18 to 34 years, irrespective of gender, were randomly selected for this study. Five milliliters venous blood sample was collected from each subject in a serum separator and divided into two aliquots. First aliquot was centrifuged and analyzed immediately for TSH, while second aliquot was stored for 24 hours and was then analyzed. TSH was measured by third generation assay usingchemiluminescence technique on ADVIA Centaur® XP. Serum TSH levels were also analyzed twice daily; in the morning (0800 to 0900 hours) and afternoon (1400 to 1600 hours). Data was analyzed using SPSS version 24. Frequency and percentages were calculated for qualitative variables like gender and pre-analytical variables. Test of significance Mann-Whitney U-test was applied and p-value <0.05 was taken as significant. Results: Mean age of subjects was 23 ± 3.4 years. Change in circadian rhythm was observed in 17 (28%) males and 14 (36%) females. Statistically significant association was found between morning and evening TSH levels, while no change was observed in TSH level by early and late centrifugation of samples. Conclusion: TSH levels vary significantly between blood samples collected at different timings of the day from the same person. TSH is resistant to degradation, immunologically stable, and reasonably insensitive to potential problems associated with routine specimen handling, when measured by immunoassay technique. Therefore, it is helpful in large epidemiological studies and small size laboratory, which require long transportation time and storage.

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CLINICAL PRESENTATION OF ACUTE MYOCARDIAL INFARCTION IN ELDERLY PATIENTS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i3.1790 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Rajesh Kumar Singhal ◽

Harsha Kumar Gowardhan

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chest Pain ◽

Elderly Patients ◽

The Elderly ◽

Shortness Of Breath ◽

Cross Sectional ◽

Clinical Presentations ◽

Myocardial Infraction

Background: The cardiovascular diseases (CVDs) have become the leading cause of mortality worldwide. There is an increasing burden on health care systems associated with MIs in the elderly, differences in clinical picture, and difficulties in dealing with elderly patients with myocardial infraction (MI). Aim: The aim of study is to evaluate the different clinical presentations, risk factors and complications of elderly patients presenting with acute myocardial infarction. Methods: This is a retrospective, cross sectional study done over a period of 1 year. A total of 100 elderly patients who were diagnosed as AMI were included in the study. We studied Demographic features, cardiovascular risk factors, varied clinical presentations Electrocardiogram (ECG) findings from the history proformas and documented. Results: A total of 100 patients diagnosed with MI were studied. Mean age of the study population was 69.41 years and were predominantly male (84%). The most common presenting symptom was chest pain (79%) followed by sweating (7%), followed by shortness of breath (5%), giddiness (4%) vomiting (3%) and palpitations (2%). hypertension was commonly seen in elderly (56%) followed by diabetes (39%), smoking (28%), dyslipidaemias (12%), history of CAD (9%) and obesity (6%). Mortality rate was 26% and maximum (11%) patients belonged to age group >80 years. Conclusion: We conclude that chest pain is the most common presentation in elderly AMI patients, but other atypical symptoms such as shortness of breath, giddiness, vomiting, without chest pain can also be the common presenting signs. Early and prompt management as appropriate should be provided to avoid morbidity and mortality in elderly. Keywords: Clinical Profile, Mortality, Myocardial Infarction, Risk Factors.

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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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EFFECTIVENESS OF MISWAK AS COMPARED WITH TOOTHBRUSH: A CROSS-SECTIONAL STUDY

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i5.7295 ◽

2021 ◽

Vol 71 (5) ◽

pp. 1582-84

Author(s):

Hassam Anjum Mir ◽

Mubashir Sharif ◽

Ali Asif ◽

Maleeha Shamim ◽

Maaz Qureshi ◽

...

Keyword(s):

Armed Forces ◽

Cross Sectional Study ◽

Index Score ◽

Plaque Index ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

Significant Difference ◽

Group A ◽

Group B

Objective: To determine if the traditional chewing stick Miswak was as effective in cleaning teeth as Toothbrush. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi, from Aug 2020 to Jan 2021. Methodology: A total of 300 subjects were included which were divided in two groups on the basis of whether they used miswak or toothbrush as a cleaning aid. Group A was toothbrush users and group B was Miswak user. Plaque Index was used to determine the cleanliness of teeth. The scores were recorded and data analyzed using SPSS-23. Results: The means and standard deviations of Plaque Index score for group A and B were 0.96 ± 0.58 and 0.98 ± 0.56 respectively. The comparison of Plaque Index score for both groups was insignificant with the p-value of 0.083. Conclusion: Within the limitations of this study, it is concluded that, no significant difference was found in the effectiveness of traditional miswak and tooth brush. It is recommended that if the technique of teeth cleaning is good then any of the abovementioned means of teeth cleaning can be used.

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P351Therapeutic inefficacy and pro-arrhythmic nature of metoprolol succinate and carvedilol therapy in patients with idiopathic, frequent, monomorphic premature ventricular contractions

EP Europace ◽

10.1093/europace/euaa162.024 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

O E Turan ◽

C Hasdemir

Keyword(s):

Drug Therapy ◽

Therapeutic Efficacy ◽

Poor Response ◽

Holter Monitoring ◽

P Value ◽

Premature Ventricular Contractions ◽

Metoprolol Succinate ◽

Presenting Symptoms ◽

First Line Therapy ◽

Study Population

Abstract Funding Acknowledgements None Background Anti-arrhythmic drugs remain the first-line therapy for treatment of idiopathic ventricular arrhythmias in clinical practice. Purpose The aim of this study was to assess the therapeutic efficacy of extended-release metoprolol succinate (MetS) and carvedilol for idiopathic, frequent, monomorphic premature ventricular contractions (PVCs). Methods Study population consisted of 115 consecutive patients: 72 received MetS and 43 received carvedilol. All patients underwent 24-hour Holter monitoring at baseline and during drug therapy. PVC burden response to drug therapy was categorized as "Good" (≥80% reduction), "Poor" (either < 80% reduction or ≤ 50% increase) and "Pro-arrhythmic" response (> 50% increase) based on change in PVC burden compared to baseline. Results Presenting symptoms were palpitations in 69 (60%), shortness of breath/chest pain/syncope in 12 (10.5%), and coincidentally discovered in 34 (29.5%) patients. Mean MetS and carvedilol dosages were 65.57 ± 30.67 mg/day and 23.66 ± 4.26 mg/day, respectively. "Good", "Poor" and "Pro-arrhythmic" response was observed in 13.9% and 23.3%, 61.1% and 60.5%, and 25% and 16.2% of patients treated with MetS and carvedilol, respectively. In patients with relatively high (≥16%) PVC burden, "Poor" response was observed in 86.9% and 76% of patients treated with MetS and carvedilol, respectively. Side-effects and/or intolerance were observed in 5.5 % and 13.9 % of patients treated with MetS and carvedilol, respectively. Conclusions MetS and carvedilol for idiopathic, frequent, monomorphic PVCs is frequently inefficient. Therapeutic efficacy decreases further in patients with relatively high (≥16%) PVC burden. "Pro-arrhythmic" response was observed in approximately one quarter of the patients. All patients Metoprolol Succinate (n = 71) Carvedilol (n = 43) p value Good response,n (%) 7 (9.9) 7 (16.3) 0.38 Poor response,n (%) 46 (64.8) 29 (67.4) 0.38 Pro-arrhythmic response,n (%) 18 (25.4) 7 (16.3) 0.38 Patients with PVC burden≥%16 Metoprolol Succinate (n = 22) Carvedilol (n = 25) Good response,n (%) 1 (4.5) 3 (12) 0.56 Poor response,n (%) 20 (91) 20 (80) 0.56 Pro-arrhythmic response,n (%) 1 (4.5) 2 (8) 0.56 Therapeutic response to Metoprolol Succinate and Carvedilol

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