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.

Do Deeper Levels of Cervical Biopsies Preceded by a Pap Smear Diagnosis of LSIL, ASCUS, or NILM/HPV+ Increase the Yield of Identifying Clinically Significant Lesions?

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S163-S164
Author(s):  
K G Manjee ◽  
W G Watkin
Keyword(s):  
Pap Smear ◽  
Past History ◽  
Prior History ◽  
Cervical Biopsy ◽  
P16 Immunohistochemistry ◽  
Hpv Status ◽  
Significant Difference ◽  
History Of ◽  
Clinically Significant ◽  
Almost All

Abstract Introduction/Objective Cervical biopsy is performed following an abnormal pap smear or positive HPV testing in an attempt to uncover clinically significant lesions [HSIL/invasive carcinoma (HSIL+)]. An excisional procedure is considered if biopsy confirms HSIL+. When preceded by pap smear of LSIL, ASCUS, NILM/HPV+ or persistent HPV, continued surveillance is recommended for biopsies showing no SIL or LSIL. In our laboratory, cervical biopsies are routinely sectioned at 3 levels. Deeper levels are often ordered when initial sections are non-diagnostic. p16 immunohistochemistry, with or without deeper levels, is often ordered to confirm HSIL, or to differentiate HSIL from mimics. In this study, we examine whether and in what clinical situations does obtaining additional levels uncover clinically significant lesions. Methods 430 cervical biopsies between January-May 2018, with recent cytology of LSIL, ASCUS or NILM/HPV+ were identified in the pathology database. HPV status (if known), final biopsy diagnosis and past history of LSIL/HSIL were recorded. For each biopsy, orders for additional levels and/or p16 immunohistochemistry were recorded resulting in 4 categories: C1-no additional levels or p16, C2-deeper only, C3-deeper+p16 and C4-p16 only. Final diagnoses were divided into HSIL+, LSIL and no SIL. Results There was no significant difference in prior history of LSIL/HSIL and HPV status between all categories. Biopsy results were as follows: HSIL+: 11/222 (5%) C1; 1/78 (1%) C2; 7/43 (16%) C3; 15/87 (17%) C4 LSIL: 91/222 (41%) C1; 7/78 (9%) C2; 16/43 (37%) C3; 35/87 (40%) C4 No SIL: 120/222 (54%) C1; 70/78 (90%) C2; 20/43 (46%) C3; 37/87 (42%) C4 The average number of additional levels in C2 and C3 was 3.8 and 1.8, respectively. Conclusion Deeper levels alone did not enhance the detection of HSIL+. Almost all LSIL/HSIL were detected when initial levels were diagnostic or suspicious and supported by p16 immunohistochemistry. 3 levels are adequate to detect clinically significant lesions.

scholarly journals Assessment of the relationship between periodontal disease and cardiovascular disorders: a questionnaire-based study

2016 ◽  
Vol 89 (4) ◽  
pp. 534-541 ◽  
Author(s):  
Anca Ionel ◽  
Ondine Lucaciu ◽  
Cosmina Bondor ◽  
Minodora Moga ◽  
Aranka Ilea ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Family History ◽  
Periodontal Disease ◽  
Sport Activity ◽  
Fresh Fruit ◽  
Atherosclerotic Cardiovascular Disease ◽  
Significant Difference ◽  
History Of ◽  
Smoking Duration

Background and aims. Periodontitis is an inflammatory disease, characterized by the loss of connective tissue and alveolar bone. There is an increasing evidence that periodontitis is associated with a number of chronic diseases. The aim of this study was to analyze the correlation between periodontitis and certain systemic diseases by identifying their risk factors in a population from North-West Romania.Methods. A questionnaire-based study was conducted on participants ≥45 years of age in 4 dentistry or family medicine practices from the Cluj and Bihor counties, Romania, over a time frame spanning two months. The interviewer-administered questionnaire included 42 items assessing risk factors for periodontal and cardiovascular disease, current diagnostic and medical treatment of the participants, their diet and oral hygiene habits.Results. Of 108 participants included in the study, 63 (58.3%) declared a previous diagnosis of periodontitis. A significant difference was observed between the participants with declared diagnosis of periodontitis (PD+) and participants without declared diagnosis of periodontitis (PD-) for fresh fruit consumption (p=0.01) and increased sport activity (p=0.009). A significant difference between groups was observed in the case of smoking duration (p=0.047), participants with >10 years of smoking were more likely to declare a diagnosis of periodontitis. Also, PD+ participants were more likely to have a family history of periodontal disease (p<0.001). Multivariate analyses suggested periodontitis as a predictive variable for atherosclerotic coronary artery disease with an OR of 4.85 (95% confidence interval 1.01–23.29, p=0.049).Conclusion. Our study found a statistically significant association between periodontal disease and a known family history of periodontal disorders and smoking duration. Daily intake of fresh fruit and increased sport activities were found to be protective factors against periodontal disease, while periodontitis was found as a risk factor for atherosclerotic cardiovascular disease.

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.

Suicide in probation: Towards the ideation-to-action model

2021 ◽  
pp. 026455052110415
Author(s):  
Charlie Brooker ◽  
Karen Tocque ◽  
Georgia West ◽  
Alice Norman-Taylor ◽  
James Fowler
Keyword(s):  
Suicide Ideation ◽  
Suicide Attempts ◽  
Psychological Treatment ◽  
Secondary Analysis ◽  
Control Group ◽  
Significant Difference ◽  
Action Model ◽  
History Of ◽  
Clinically Significant ◽  
A Prospective Study

Suicide in probation services is far higher than the general population. This paper presents secondary analysis of data previously used to evaluate the outcome of delivering psychological treatment to probationers in London. A sample of probation service users who screened positive for clinically significant symptoms of distress and were subsequently assessed and offered treatment ( n = 274) were allocated retrospectively to one of three groups: those with a history of suicidal ideations but no suicide attempts (ideation group), those with a history of a suicidal act (attempt group) or a control group where suicide was not evident (no history group). Results indicate no significant difference between the ideation and the attempt groups, but significant differences between these and the no history group. The findings are discussed within the context of the suicide ideation-to-action models that have been debated in other offender settings. We conclude that a more nuanced understanding of suicidal acts and suicide attempts is required in probation services including a prospective study that tests the ideation-to-action model.

scholarly journals Inappropriate Sinus Tachycardia Following Viral Illness

2021 ◽  
Vol 11 (2) ◽  
pp. 219-222
Author(s):  
Khalid Sawalha ◽  
Fuad Habash ◽  
Srikanth Vallurupalli ◽  
Hakan Paydak
Keyword(s):  
Viral Infection ◽  
Medical History ◽  
Sinus Tachycardia ◽  
Esophageal Disease ◽  
Shortness Of Breath ◽  
Past Medical History ◽  
Inappropriate Sinus Tachycardia ◽  
Laboratory Findings ◽  
Viral Illness ◽  
History Of

A 67-year-old female patient with a past medical history of menopause, migraines, and gastro-esophageal disease presented with palpitation, fatigue, and shortness of breath. One month prior to her presentation, she reported having flu-like symptoms. Her EKG showed sinus tachycardia with no other abnormality. Laboratory findings, along with imaging, showed normal results. The event monitor failed to detect any arrythmias. We report a case of inappropriate sinus tachycardia secondary to viral infection as a diagnosis of exclusion.

scholarly journals Correcting Hypokalemia in Hospitalized Patients Does Not Decrease Risk of Cardiac Arrhythmias

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Weston Harkness ◽  
Paula Watts ◽  
Michael Kopstein ◽  
Oliwier Dziadkowiec ◽  
Gregory Hicks ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrhythmias ◽  
Potassium Level ◽  
Hospitalized Patients ◽  
Retrospective Case ◽  
Exact Test ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
History Of ◽  
Clinically Significant

Background. It is currently standard practice to correct hypokalemia for the purpose of preventing cardiac arrhythmias in all hospitalized patients. However, the efficacy of this intervention has never been previously studied. Objective. The objective of our study was to evaluate whether patients without acute coronary syndrome or history of arrhythmias were at increased risk of clinically significant cardiac arrhythmias if their potassium level was not corrected to ≥3.5 mEq/L. Design. A retrospective case control study. Setting. A community hospital. Participants. We enrolled selected patients who had episodes of hypokalemia during their hospital stay and were monitored on telemetry. Patients were split into groups based on success of replacing serum potassium to ≥3.5 mEq/L after 24 hours. Measurements. The primary outcome was the development of an arrhythmia. Arrhythmias included supraventricular tachycardia, atrial fibrillation, atrial flutter, Mobitz type II second-degree or third-degree AV block, ventricular tachycardia, or ventricular fibrillation. A one-tailed Fisher’s exact test and logistic regression were used for analysis. Results. A total of 1338 hypokalemic patient days were recorded. Out of these days, 22 arrhythmia events (1.6% of patient days) were observed, 8 in the uncorrected group (1% patient days) and 14 in the corrected group (2.6% patient days). We found no statistically significant relationship between successfully correcting potassium to ≥3.5 mEq/L and number of arrhythmic events (p=0.037, OR = 2.38 (95% CI: 0.99, 6.03)). Logistic regression revealed that correction of potassium does not seem to be significantly related to arrhythmias (β = 0.869, p=0.0517). Conclusions. In the acute care setting, we found that patients with hypokalemia whose potassium level did not correct to ≥3.5 mEq/L were not at increased odds of having an arrhythmia. This study suggests that the common practice of checking and replacing potassium is likely inconsequential.

Rapid screening for cardiac arrhythmias in competition draft horses

2019 ◽  
Vol 15 (4) ◽  
pp. 291-298 ◽  
Author(s):  
L.R. Gallant ◽  
S.I. Jacob ◽  
E.M. Tadros ◽  
J.S. Woodrow ◽  
M.T. Hines ◽  
...  
Keyword(s):  
Cardiac Arrhythmias ◽  
Poor Performance ◽  
Rapid Screening ◽  
Recording Device ◽  
Performance History ◽  
P Waves ◽  
Handheld Device ◽  
Qt Intervals ◽  
History Of ◽  
Clinically Significant

Cardiac arrhythmias may cause decreased performance and sudden death during exercise. Our objectives were: (1) to determine prevalence of unrecognised arrhythmias in a population of competition draft horses by performing short duration screening electrocardiograms (ECGs) at rest; and (2) to assess utility of a commercial handheld device for recording equine ECGs. Owners or trainers of 244 draft horses (age 0.5-16 years), including 82 Percherons, 69 Belgians, 69 Clydesdales, 11 Belgian mules, 8 Shires, and 5 Percheron mules, were queried to determine signalment, performance history, and known arrhythmias. All horses were auscultated for 30 s and ECGs were obtained in 204 horses using a handheld recording device (AliveCor®). ECGs were reviewed for quality and used to determine heart rate (HR) and rhythm. When ECG tracing quality permitted, PQ and QT intervals were also measured. ECGs displaying RR intervals adequate for HR determination and rhythm assessment were recorded from 161 horses (79%) while tracings with consistent P waves, QRS complexes, and T waves were recorded from only 47 horses (23%). Four arrhythmias were detected by both auscultation and ECG: atrial fibrillation (1), premature complexes (1), and second-degree atrioventricular block (2). None of these horses had a history of poor performance or previous recognition of an arrhythmia. The prevalence of unrecognised, and potentially clinically significant, arrhythmias in draft horses at rest appears to be low (2/244; 0.8%, 95% confidence interval 0.1-2.9%). Longer recordings at rest, as well as recordings during and immediately after exercise, would likely have revealed a higher prevalence of arrhythmias.

Pregnancy-related inappropriate sinus tachycardia: A cohort analysis of maternal and fetal outcomes

2021 ◽  
pp. 1753495X2199019
Author(s):  
Alexander Sharp ◽  
Charlotte Patient ◽  
Janet Pickett ◽  
Mark Belham
Keyword(s):  
Sinus Tachycardia ◽  
Cohort Analysis ◽  
Clinical Findings ◽  
Pharmacological Therapy ◽  
Fetal Outcomes ◽  
Inappropriate Sinus Tachycardia ◽  
Background Rate ◽  
Coronary Syndrome ◽  
History Of ◽  
In Pregnancy

Background Little literature exists regarding the syndrome of inappropriate sinus tachycardia during pregnancy. We aimed to further understand the natural history of inappropriate sinus tachycardia in pregnancy, and to explore maternal and fetal outcomes. Methods A retrospective, observational cohort analysis of 19 pregnant women who presented with inappropriate sinus tachycardia. Results 42% attended the emergency department on more than 1 occasion with symptoms of inappropriate sinus tachycardia; 32% required hospital admission and 26% required pharmacological therapy. There were no maternal deaths, instances of heart failure or acute coronary syndrome, and no thromboembolic or haemorrhagic complications during pregnancy. Rates of caesarean section were similar to the background rate of our unit (32% and 27%, respectively). Rates of induction were notably elevated (58% vs 25%). Conclusion Inappropriate sinus tachycardia in pregnancy is associated with high rates of hospitalization and induction of labour, which may not be mandatory given the clinical findings in this group of women.

scholarly journals Clinical and Laboratory Improvement in Hyperadrenergic Postural Orthostatic Tachycardia Syndrome (POTS) after COVID-19 Infection

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Rebecca A. Ocher ◽  
Erika Padilla ◽  
Jonathan C. Hsu ◽  
Pam R. Taub
Keyword(s):  
Heart Rate ◽  
Sinus Tachycardia ◽  
Symptomatic Improvement ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Av Block ◽  
Event Monitoring ◽  
Inappropriate Sinus Tachycardia ◽  
History Of ◽  
The Impact ◽  
Catecholamine Levels

A 32-year-old woman with a history of symptomatic supraventricular tachycardia, inappropriate sinus tachycardia, and hyperadrenergic POTS was treated with ivabradine and metoprolol. She then presented with bradycardia and Mobitz II second-degree AV block on event monitoring six weeks after COVID-19 infection. Her post-viral workup revealed normalization of catecholamine levels and significant symptomatic improvement in heart rate. To the authors’ knowledge, this is the first reported case of improvement in POTS after COVID-19 infection. As our understanding of COVID-19 continues to improve, it will be vital to better understand the impact of COVID-19 dysautonomia on cardiac patients.

scholarly journals Heart rate increase and inappropriate sinus tachycardia after cryoballoon pulmonary vein isolation for atrial fibrillation

2021 ◽  
Author(s):  
C. van Deutekom ◽  
B. A. Mulder ◽  
H. F. Groenveld ◽  
R. G. Tieleman ◽  
A. C. P. Wiesfeld ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Sinus Tachycardia ◽  
Rate Increase ◽  
Holter Monitoring ◽  
Entire Group ◽  
Inappropriate Sinus Tachycardia ◽  
History Of

Abstract Background Cryoballoon pulmonary vein isolation (PVI) is a common therapy for atrial fibrillation (AF). While moderately increased sinus rhythm heart rate (HR) after PVI has been observed, inappropriate sinus tachycardia (IST) is a rare phenomenon. We aimed to investigate the prevalence and natural history of an abnormal sinus HR response after cryoballoon PVI. Methods We included 169/646 (26.2%) patients with AF undergoing PVI with available Holter recordings before and 3, 6 and 12 months after the procedure. Patients with AF on Holter monitoring were excluded. Mean HR increase ≥ 20 bpm or an IST-like pattern (mean HR > 90 bpm or > 80 bpm when beta-blocking agents were used) following PVI was categorised as abnormal sinus HR response. Results Following PVI, mean HR ± standard deviation increased in the entire group from 63.5 ± 8.4 to 69.1 ± 9.9 bpm at 3 months (p < 0.001), and to 71.9 ± 9.4 bpm at 6 months (p < 0.001). At 12 months, mean HR was 71.2 ± 10.1 bpm (p < 0.001). Only 7/169 patients (4.1%) met criteria for abnormal sinus HR response: mean HR was 61.9 ± 10.6 bpm (pre-ablation), 84.6 ± 9.8 bpm (3 months), 80.1 ± 6.5 bpm (6 months) and 76.3 ± 10.1 bpm (12 months). Even at 12 months, mean HR was significantly different from that pre-ablation in this group (p = 0.033). However, in patients meeting IST-like pattern criteria, mean HR at 12 months was no longer significantly different from that pre-ablation. Conclusion Few patients had an abnormal sinus HR response after PVI. Peak HR was observed 3 months after PVI, but HR was still significantly increased 12 months post-ablation compared with pre-ablation. An IST-like pattern was rarely observed. In these patients, HR decreased to pre-ablation values within a year.

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