scholarly journals Evaluation of children with cardiac murmur using Nadas criteria

2018 ◽  
Vol 5 (2) ◽  
pp. 363 ◽  
Author(s):  
Mary James ◽  
Poornima K. N. ◽  
Praveen Jacob Ninan
Keyword(s):  
Heart Disease ◽  
Screening Test ◽  
Structural Heart Disease ◽  
Age Group ◽  
Cardiac Murmur ◽  
Medical College ◽  
Intercurrent Illness ◽  
History Of ◽  
Study Population ◽  
Minor Criteria

Background: Pediatricians often encounter children with heart murmurs during routine follow up visits or while assessment of intercurrent illness. Clinical differentiation between pathologic and innocent murmurs would be important. It is important to identify those children who need further evaluation. The aim of the study was to evaluate whether Nadas criteria can be applied as a screening test to decide on further workup.Methods: This was a prospective descriptive study done in Government T. D. Medical College, Alappuzha over a period of 12 months from July 2013 to June 2014. All children in the age group one month to 12 years, attending the outpatient department were screened for presence of murmur of grade 2 and more. They were further evaluated carefully. They were also studied for association of variables like maternal age, birthweight, dysmorphism and family history of heart disease. Nadas criteria was then applied to the study population. A score of 2 and 1 were given to major and minor criteria respectively.Results: 3070 children were screened. 150 children were detected to have murmur of grade2 and more.66 children were detected to have a structural heart disease by an echo study.74% of the study population in the age group <1 year had a heart disease.8 out of 78 children with a Nadas score of 1 and 10 out of 24 with a score of 2 had a heart disease. All with a score 3 and more had congenital heart disease (CHD).Conclusions: Nadas criteria can be used as screening test with a sensitivity of 87% and specificity of 83%. 

scholarly journals Etiological Profile of Atrial Fibrillation (AF) In Nepalgunj Medical College: A Hospital Based Study

2018 ◽  
Vol 14 (2) ◽  
pp. 23-25
Author(s):  
A Kidwai
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
College Teaching ◽  
Structural Heart Disease ◽  
P Wave ◽  
Age Group ◽  
Western Countries ◽  
Medical College ◽  
Common Etiology ◽  
Artery Disease

Introduction: Atrial fibrillation (AF) is the commonest cardiac arrhythmia encountered in clinical practice. The hall mark sign of atrial fibrillation is an irregular rhythm in ECG with no obvious P wave. In Western countries, Coronary Artery Disease (CAD) is the commonest cause of AF. Plenty of data and studies are available regarding the epidemiology and etiology of AF in the Western Population but similar studies and data in Nepal are scarce. This study was therefore conducted with an objective to establish the etiological profile of atrial fibrillation patients in mid western Nepal.Materials and Methods: This was a hospital based study, carried out in the Department of Internal Medicine, Nepalgunj Medical College Teaching Hospital, Nepalgunj, for a duration of 1 year from th th 14 September 2013 to 13 September 2014. A total of 74 consecutive cases diagnosed as AF were included in the study on the basis of inclusion and exclusion criteria.Results: A total of 74 consecutive patients were included in the study. The mean age of the subjects was 39.2 years. The majority of the subjects were below 50 years of age (70.27%). There were only 2 subjects below 19 and 3 patients above 70 years of age. Out of the 74 patients 52(70.2%) were from the age group of below 50 years of age. In western countries the incidence is higher in the elder population. Rheumatic heart disease was the most common etiology in this study with a total of 29 (39.2%) cases. CAD in our study was seen in 12 patients (16.2%). Overall structural heart disease was seen in 64(86.5%) cases and in the rest of the cases echocardiography was normal.Conclusion: This study has shown that the etiological profile of AF is different in patients attending our hospital situated in mid-western Nepal from western countries. Unlike the western countries AF is more common in the younger age group and the most common etiology in Nepal is RHD, whereas in western countries it is CAD.JNGMC, Vol. 14 No. 2 December 2016, Page: 23-25

scholarly journals Natural history of the electrical axis during the first four weeks of life

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Paerregaard ◽  
J Kock ◽  
C Pihl ◽  
A Pietersen ◽  
K.K Iversen ◽  
...  
Keyword(s):  
Heart Disease ◽  
Heart Diseases ◽  
Structural Heart Disease ◽  
Funding Source ◽  
Axis Deviation ◽  
General Population Study ◽  
Gestation Age ◽  
History Of ◽  
The Right ◽  
Heart Foundation

Abstract Background The QRS axis represents the sum of the amplitudes and orientation of the ventricular depolarization. In newborns, the QRS axis is generally directed downward and to the right and left axis deviation (LAD) may be associated with heart disease. Accurate interpretation of abnormalities in the QRS axis may facilitate early diagnosis of heart diseases in newborns. Purpose To describe the evolution of the QRS axis during the first four weeks of life and provide updated, digitalized, normal values from healthy newborns. Methods Electrocardiograms from 12,317 newborns (age 0–28 days) included in a regional, prospective, general population study from 2016–2018 were analyzed. Electrocardiograms were obtained and analyzed with a computerized algorithm with manual validation. The algorithm calculated the QRS mean axis using the net amplitudes of three leads I, II, and III. The four main QRS axis classifications were: “adult normal” axis (+1° to +90°), left axis deviation (LAD, 0° to −90°), right axis deviation (RAD, +91° to +180°), and extreme axis deviation (EAD, +181° to +270°). Echocardiograms were performed according to standard guidelines. Only newborns with an echocardiography excluding structural heart disease were included. Results Electrocardiograms from 12,317 newborns with a median age at examination of 12 days (52% boys) were included. The median QRS axis was 119° at the ages 0–7 days and shifted leftwards to 102° at the ages 22–28 days (p&lt;0.001). We found that girls had significant less pronounced right axis deviation than boys (111° vs 117°, p&lt;0.001) and that increasing gestational age was associated with more pronounced right axis deviation (104° vs 116°, p&lt;0.05). Infant size did not affect the axis (p&gt;0.05). Only 0.5% had LAD (0° to −90°) and 1.1% had an axis within the interval +240° to +30° indicating that a QRS axis in this expanded interval is unusual in healthy newborns. Conclusion The QRS axis showed a gradual leftward-shift during the first four weeks of life and was affected by sex and gestation age but unaffected by infant size. LAD occurred in only 0.5% of the newborns. Our data serve as updated reference values, which may facilitate clinical handling of newborns. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): This work was supported by the Danish Children Heart Foundation, Snedkermester Sophus Jacobsen and wife Astrid Jacobsen's foundation (Grant 19-R112-A5248-26048), the Research Council at Herlev-Gentofte Hospital and Toyota-Fonden, Denmark.

scholarly journals Additive beneficial effects of beta blockers in the prevention of symptomatic heart failure

2016 ◽  
Vol 72 (1) ◽  
Author(s):  
Alberto Genovesi Ebert ◽  
Furio Colivicchi ◽  
Marco Malvezzi Caracciolo ◽  
Carmine Riccio
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Heart Disease ◽  
Beta Blockers ◽  
Structural Heart Disease ◽  
Symptomatic Heart Failure ◽  
Post Hoc Analysis ◽  
Lv Dysfunction ◽  
History Of ◽  
Post Hoc

The prevention of symptomatic heart failure represents the treatment of patients in the A and B stages of AHA/ACC heart failure classification. Stage A refers to patients without structural heart disease but at risk to develop chronic heart failure. The major risk factors in stage A are hypertension, diabetes, atherosclerosis, family history of coronary artery disease and history of cardiotoxic drug use. In this stage, blockers hypertension is the primary area in which beta blockers may be useful. Beta blockers seem not to be superior to other medication in reducing the development of heart failure due to hypertension. Stage B heart failure refers to structural heart disease but without symptoms of heart failure. This includes patients with asymptomatic valvular disease, asymptomatic left ventricular (LV) dysfunction, previous myocardial infarction with or without LV dysfunction. In asymptomatic valvular disease no data are available on the efficacy of beta blockers to prevent heart failure. In asymptomatic LV dysfunction only few asymptomatic patients have been enrolled in the trials which tested beta blockers. NYHA I patients were barely 228 in the MDC, MERIT and ANZ trials altogether. The REVERT trial was the only trial focusing on NYHA I patients with LV ejection fraction less than 40%. Metoprolol extended release on top of ACE inhibitors ameliorated LV systolic volume and ejection fraction. A post hoc analysis of the SOLVD Prevention trial demonstrated that beta blockers reduced death and development of heart failure. Similar results were reported in post MI patients in a post hoc analysis of the SAVE trial (Asymptomatic LV failure post myocardial infarction). In the CAPRICORN trial about 65% of the patients were not taking diuretics and then could be considered asymptomatic. The study revealed a reduction in mortality and a non-significant trend toward reduction of death and hospital admission for heart failure. Conclusions: beta blockers are not specifically indicated in stage A heart failure. On the contrary, in most of the stage B patients, and particularly after MI, beta blockers are indicated to reduce mortality and, probably, also the progression toward symptomatic heart failure.

scholarly journals Helicobacter pylori infection and its correlates among the patients of peptic perforation and gastric carcinoma

2020 ◽  
Vol 7 (5) ◽  
pp. 1518
Author(s):  
Subhendu Bikas Saha ◽  
Sabyasachi Bakshi ◽  
Tapas Mandal
Keyword(s):  
Gastric Carcinoma ◽  
High Frequency ◽  
Age Group ◽  
Morbid Condition ◽  
Exclusion Criteria ◽  
Chronic Alcoholic ◽  
Female Ratio ◽  
History Of ◽  
Study Population ◽  
H Pylori

Background: Presence of H. pylori infection was found associated with peptic perforation and gastric carcinoma. Present study tried to estimate the prevalence of H. pylori infection in those patients and to find out the correlates of H. pylori infection.Methods: After matching the inclusion and exclusion criteria, all cases of diagnosed peptic perforation and gastric carcinoma were taken for this prospective, single center, observational study.Results: Among the study population, gastric carcinoma was found in higher age group; whereas peptic perforation was found in lower age group; male and female ratio was 2:1 in both groups of patient. Laborer and housewives were mostly affected in both cases. Gastric carcinoma was more prevalent in urban residents, opposite was seen in peptic perforation. Most patients in two groups had no previous co-morbid condition. Use of NSAIDs was found in high frequency in both groups. Most of the patients were chronic alcoholic and chronic smoker, and most of them had history of taking spicy foods more than twice in a week.Conclusions: H. pylori infection was found in high frequency in both group of patients, and it was higher in peptic perforation. The study establishes the association of H. pylori with the gastric carcinoma and peptic perforation.

scholarly journals Risk Factors of Stroke in Young and Old Age Group Admitted in a Tertiary Level Hospital, Dhaka - A Comparative Study

2014 ◽  
Vol 27 (2) ◽  
pp. 94-100
Author(s):  
Md. Nurul Amin Miah ◽  
MA Azhar ◽  
Aminur Rahman ◽  
Durba Halder ◽  
Md. Akteruzzaman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Old Age ◽  
Transient Ischemic Attack ◽  
Oral Contraceptive Pill ◽  
Age Group ◽  
Old Patients ◽  
History Of ◽  
Ischemic Attack ◽  
Stroke In Young

Background: Stroke is an important cause of death and disability. Prevalence of stroke in Bangladesh differs with age. The risk factors in young differ in comparison to old age group. In this study risk factors of stroke in young in comparison to old age group were evaluated. Objectives: To compare the risk factors associated with stroke in young adult and to those of old age group. Methodology: This comparative study conducted in the department of Medicine and Neurology, Sir Salimullah Medical College & Mitford Hospital, Dhaka from January 2008 to June 2009. One hundred two stroke patient of above 15 years of age were confirmed by CT scan or MRI of brain those were included in young and old age groups. The risk factors of stroke were defined in terms of hypertension, diabetes mellitus, dyslipidaemia, ischemic heart diseases, valvular heart disease, history of transient ischemic attack or stroke, smoking and oral contraceptive pill. Results: Of total 102 cases 17 were young adults and 85 old patients between 19 to 100 years. Mean age young adult was 39.76 (± 6.379) and old age was 65.06 (± 11.238). 61.7% were male & 38.2% were female and the ratio was 1.6:1. Amongst male 58.8% patients were smoker in each age group and only 2.9% old patients were alcoholic. Only 17.6% had previous history of transient ischemic attack or stroke in each age group. 58.8% of young and 48.2% of old were hypertensive. 7% old patients had history of ischemic heart disease. 5.9% of young and 2.4% of old patients had valvular heart disease but no patient had vasculitis. 16.7% old patients had diabetes mellitus. 4.9% of total patients (young 11.8% and 3.5% old) were oral contraceptive pill user. Out of all patients 24.7% old patients and 5.9% young adult was dyslipidaemic. Among all patients 66.7% patients had the Ischemic stroke and 33.3% patients had the hemorrhagic stroke. 68.2% old patients and 58.8% young patients had Ischemic stroke; 31.8% old patients and 41.2% young patients had hemorrhagic stroke. Conclusion: In young age group smoking, transient ischemic attack or stroke, hypertension, valvular heart disease, oral contraceptive pill and in old age group smoking, transient ischemic attack or stroke, hypertension, Ischemic heart disease, diabetes mellitus and dyslipidaemia were found significant risk factors for development of stroke. So modification of risk factors may reduce the incidence of stroke. Bangladesh Journal of Neuroscience 2011; Vol. 27 (2) : 94-100 DOI: http://dx.doi.org/10.3329/bjn.v27i2.17576

scholarly journals A PROSPECTIVE OBSERVATIONAL STUDY ON PREVALENCE OF HYPOTHYROIDISM IN A TERTIARY CARE TEACHING HOSPITAL

2018 ◽  
Vol 10 (6) ◽  
pp. 23
Author(s):  
N. Swathi ◽  
Voleti Vijaya Kumar ◽  
M. Farjana ◽  
M. Vishnu Vardhan ◽  
M. Munendra ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Tertiary Care ◽  
Age Group ◽  
Medical College ◽  
Study Population ◽  
Age Limit ◽  
N 93 ◽  
A Prospective Study ◽  
Group Distribution ◽  
Positive Results

Objective: To determine the prevalence of hypothyroidism in a rural population of Nandyal.Methods: A prospective study was conducted in Santhiram medical college and general hospital, Nandyal from July 2017 to December 2017, to study the prevalence of hypothyroidism among the population. Results: In this study, 1000 patients were evaluated for the thyroid functioning, among them n=104(10.4%) showing positive results in hypothyroidism. The positive 104 patients showed that n=63 (60.57%) of the population are in the age limit of 21-40. Out of the same population are n=11 (10.6%) are male and female are n=93 (89.43%). In age group distribution more prevalence was observed in 21-30 y of age group n=36 (34.61%). In this study, sub-clinical hypothyroidism was prevalent in females n=80 (76.92%) than males n=10 (9.61%).Conclusion: Our study demonstrates that hypothyroidism was higher in a female with age group as 21-40 y and there is a significant prevalence of hypothyroidism in the study population.

scholarly journals Determinants of development of permanent atrial fibrillation and its treatment

EP Europace ◽  
1999 ◽  
Vol 1 (1) ◽  
pp. 35-39 ◽  
Author(s):  
L. Gianfranchi ◽  
M. Brignole ◽  
C. Menozzi ◽  
G. Lolli ◽  
N. Bottoni
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Risk Group ◽  
Pacemaker Implantation ◽  
Structural Heart Disease ◽  
High Risk Group ◽  
Symptom Duration ◽  
Permanent Atrial Fibrillation ◽  
History Of

Abstract We evaluated the rate of progression of permanent atrial fibrillation (AF) and identified clinical factors that predict this event in 63 consecutive patients who had undergone AV junctional ablation and DDDR pacemaker implantation for drug-refractory paroxysmal atrial fibrillation/flutter. Immediately after ablation, anti-arrhythmic drugs were discontinued in all cases. Permanent AF was con-sidered to have developed if AF was present on two consecutive 6-monthly examinations with no interim documented sinus rhythm. During a mean follow-up of 23±16 months, 22 (35%) of the 63 patients developed permanent AF. The actuarial estimate of progression of permanent AF was 22%, 40% and 56%, respectively, 1, 2 and 3 years after ablation. Age and underlying heart disease were independent predictors of progression of permanent AF. Only one (6%) of 16 patients with idiopathic AF had permanent AF (low risk group). Among the 47 patients with structural heart disease, permanent AF developed in 18 (62%) of the 29 who were aged >75 years or had >12 arrhythmic episodes per year and a symptom duration >4 years (high risk group), but only in three (17%) of the remaining 18 patients who did not (intermediate risk group). In conclusion, during a 3-year follow-up period, about half of the patients with a history of drug-refractory paroxysmal AF did not develop permanent AF after AV junctional ablation and dual-chamber pacemaker implantation, even in the absence of anti-arrhythmic drug therapy. Moreover, subgroups of patients whose risk of permanent AF progression differed were identified on the basis of simple baseline clinical variables. The results of this study form the necessary background for the correct management of patients after AV junction ablation and for the planning of future trials in this field.

scholarly journals Socio-Demographic Characteristics of Teenage Pregnancy: Experience of 50 Cases of Bangladesh

2018 ◽  
Vol 16 (1) ◽  
pp. 3-7
Author(s):  
Rumi Farhad Ara ◽  
Jahangir Alam
Keyword(s):  
Teenage Pregnancy ◽  
Cross Sectional Study ◽  
Demographic Characteristics ◽  
Age Group ◽  
Monthly Income ◽  
Cross Sectional ◽  
Medical College ◽  
Slum Dwellers ◽  
Study Population ◽  
Common Group

Background: Teenage pregnancy is a huge problem in developed as well as developing countries.Objective: The purpose of the present study was to see the socio-demographic characteristics of teenage pregnant mother.Methodology: This cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Dhaka Medical College & Hospital, Dhaka, Bangladesh and Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh from April to July 1999 for a period of four (4) months. The teenager mothers with the age group of 11 to 19 years who were admitted in the study period was selected as study population. At the time of entry, all relevant parameters like religion, residence, occupation, education and monthly income were recorded in a predesigned data sheet.Result: A total number of 50 teenager mothers were recruited for this study. Majority of the study population were Muslim which was 45(90.0%) cases followed by Hindu which was 3(6.0%) cases. Maximum were non-city dweller which was 26(52.0%) cases followed by city and slum dwellers which were 16(32.0%) cases and 8(16.0%) cases respectively. Majority of the study were housewife which was 49(98.0%) cases. Monthly income was less than 3000 taka in 29(58.0%) cases. Majority of the study population were completed the primary education level which was 26(52.0%) cases. Married was found in 49(98.0%) cases.Conclusion: In conclusion Muslim non-city dwellers housewife were the most common group of teenager motherJournal of Science Foundation 2018;16(1):3-7

scholarly journals Endothelial Function as a Possible Significant Determinant of Cardiac Function during Exercise in Patients with Structural Heart Disease

2009 ◽  
Vol 2009 ◽  
pp. 1-8 ◽  
Author(s):  
Bonpei Takase ◽  
Takashi Akima ◽  
Akimi Uehata ◽  
Masayuki Ishihara ◽  
Akira Kurita
Keyword(s):  
Heart Disease ◽  
Endothelial Function ◽  
Cardiac Function ◽  
Brachial Artery ◽  
Stress Testing ◽  
Structural Heart Disease ◽  
Output Flow ◽  
Study Population ◽  
The Mean ◽  
Flow Mediated Vasodilation

This study was investigated the role that endothelial function and systemic vascular resistance (SVR) play in determining cardiac function reserve during exercise by a new ambulatory radionuclide monitoring system (VEST) in patients with heart disease. The study population consisted of 32 patients. The patients had cardiopulmonary stress testing using the treadmill Ramp protocol and the VEST. The anaerobic threshold (AT) was autodetermined using the V-slope method. The SVR was calculated by determining the mean blood pressure/cardiac output. Flow-mediated vasodilation (FMD) was measured in the brachial artery to evaluate endotheilial function. FMD and the percent change f'rom rest to AT in SVR correlated with those from rest to AT in ejection fraction and peak ejection ratio by VEST, respectively. Our findings suggest that FMD in the brachial artery and the SVR determined by VEST in patients with heart disease can possibly reflect cardiac function reserve during aerobic exercise.

P4784Efficacy and safety of dronedarone by duration of atrial fibrillation history: a post-hoc analysis of the ATHENA trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Blomstrom-Lundqvist ◽  
N Marrouche ◽  
S Connolly ◽  
V Corp Dit Genti ◽  
M Wieloch ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
New York ◽  
Heart Disease ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
Efficacy And Safety ◽  
History Of ◽  
Summary Relative Risk ◽  
Post Hoc ◽  
Symptom Recurrence

Abstract Background Atrial fibrillation (AF) is known to progress over time and the effectiveness of antiarrhythmic therapy may vary based on the duration of a patient's AF history. Outcomes with dronedarone (DRO) based on duration of AF/atrial flutter (AFL) history have not been previously characterized. Purpose To evaluate the efficacy and safety of DRO by time since first known AF/AFL episode in patients studied in the ATHENA trial. Methods 2859 (61.8%) patients from ATHENA with documented first known AF/AFL episode (of 4628 total patients randomized) were included in the analysis. Among these patients, first AF/AFL episode was reported at <3 months (shorter history), 3 to <24 months (intermediate), and ≥24 months (longer) in 1296 (45.3%), 845 (29.6%) and 718 (25.1%) patients, respectively. AF/AFL recurrence was evaluated in patients in sinus rhythm at baseline by ECG during study visits or symptom recurrence. Results Demographics (age, sex) were similar across all groups. Patients with longer AF/AFL history tended to have higher prevalence of coronary heart disease and structural heart disease; and were more likely to have AF/AFL (by 12-lead ECG) at baseline (30%) compared to 26% and 16% for intermediate and shorter history groups. Patients with a longer AF history likely had a prior ablation for AF/AFL (7%) vs patients with an intermediate (2%) or shorter AF/AFL history (1%), and more likely required cardioversion during the study (24%) vs intermediate (17%) and shorter history groups (11%). Outcomes and efficacy are reported in Table 1. Rates of treatment-emergent adverse events (TEAEs), serious TEAEs, permanent drug discontinuations, and deaths were similar across all AF/AFL groups. Table 1. Outcomes and efficacy summary Relative Risk, dronedarone (DRO) vs placebo (PBO)1 (95% CI)1,2 AF/AFL <3 months AF/AFL 3 to <24 months AF/AFL ≥24 months PBO (n=626) DRO (n=670) PBO (n=429) DRO (n=416) PBO (n=363) DRO (n=355) First CV hospitalization3 or death (any cause) 0.79 (0.65, 0.96) 0.72 (0.56, 0.92) 0.84 (0.66, 1.07) First CV hospitalization 0.78 (0.64, 0.96) 0.70 (0.55, 0.91) 0.82 (0.63, 1.05) Death (any cause) 0.82 (0.54, 1.24) 0.85 (0.43, 1.68) 1.13 (0.61, 2.10) First AF/AFL recurrence4 0.80 (0.65, 0.97) 0.67 (0.53, 0.84) 0.81 (0.65, 1.02) 1Cox regression model. 2On study period, all randomized patients. 3Main reason was AF/other supraventricular rhythm disorders. 4On selected patients in sinus rhythm at baseline (AF/AFL <3 months: PBO n=514, DRO n=529; 3 to <24 months: PBO n=288, DRO n=312; ≥24 months: PBO n=252, DRO n=250). CV = Cardiovascular. Conclusions Nearly half the patients in ATHENA had a shorter history (<3 months) of AF/AFL prior to randomization. Patients with a longer history of AF/AFL had a greater burden of AF/AFL based on baseline rhythm status, ablation history, and cardioversions required post randomization. Despite these differences, clinical outcomes, efficacy, and safety of DRO appeared to be generally consistent irrespective of duration of AF/AFL history. Acknowledgement/Funding Sanofi, New York, New York, United States of America

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