On the P-wave model of a single electrocardiogram lead

Summary We describe a parametric model for the P-wave of a single electrocardiogram (ECG) lead trajectory. Though previously met in the bioengineering literature, the model was not treated in a complete parametric fashion. The paper fills the gap by making use of both frequentist and Bayesian approaches. Supporting real data example is provided. Further potential applications are also discussed.

Does education degree affect the patient’s attitude towards the treatment after myocardial infarction?

SummaryObjectives. To assess the association between education degree and attitude towards the treatment after myocardial infarction (MI).Design and Methods. The participants of this cross-sectional study were 191 (140 men and 51 women) outpatients in a period of 3 months – 5 years after acute MI (mean age 59 ± 9.2 years) from Vilnius University Hospital Santaros Klinikos. All patients were asked to complete two questionnaires: “Quality of Life and Treatment after Myocardial Infarction” and “Cholesterol-lowering Drugs Consumption Peculiarities”. The data was analyzed using the SPSS software.Results. The education degree (a higher (post-secondary education provided by a college or university) vs. a lower (secondary or vocational education) education degree) had similar influence on the patients’ occasional concern (43.2%; n = 35 vs. 52.9%; n = 55, respectively; p = 0.226) and on the frequent concern (25.9%; n =21 vs. 26.9%; n = 28, respectively; p = 0.226) about MI. Patients with a higher education degree were more likely to identify themselves as the main subjects in MI treatment in comparison with patients that had a lower education degree (30.5%; n = 25 vs. 15.2%; n = 16, respectively, p = 0.033). More educated patients found it easier to follow up the doctor’s treatment plan than less educated patients (23.2%; n = 19 vs. 9.5%; n = 10, respectively; p = 0.035).Conclusions. More educated patients are more likely to follow up the doctor’s treatment plan and see it easier than less educated patients. Thus, more attention should be paid to less educated patients in order to increase their own impact on their post-MI treatment.

Association of high sensitivity C-reactive protein and metabolic syndrome components in middle-aged subjects without overt cardiovascular disease in LitHiR primary prevention programme

Summary Objectives: Circulating levels of inflammatory markers such as high sensitivity C-reactive protein (hs-CRP) have been reported to be associated with increased risk of cardiovascular disease (CVD), as well as with metabolic syndrome (MetS). Therefore, our objectives were to investigate the associations between hs-CRP levels and individual MetS components as well as to analyse if hs-CRP levels are linked with the number of MetS components present in middle-aged subjects. Design and methods: A cross-sectional study included 4628 middle-aged MetS subjects from the Lithuanian High Cardiovascular Risk primary prevention programme (LitHiR) from 2011 to 2020. MetS was diagnosed according to the National Cholesterol Education Program ATP III modified criteria. CRP was measured by a validated high-sensitivity assay. A hs-CRP cutpoint of 5 mg/l was used to differentiate high and low hs-CRP groups. Results: The mean value of hs-CRP was 3.23 ± 4.04 mg/l, and significantly increased as the number of components of MetS increased (p < 0.001). The concentration of serum hs-CRP was significantly associated with waist circumference, systolic and diastolic blood pressure, and fasting blood glucose (all p < 0.001). However, no statistically significant associations were found between hs-CRP and serum triglycerides (p = 0.340) or serum high-density lipoprotein cholesterol (p = 0.148). Conclusions: Serum hs-CRP increased progressively with increased waist circumference, blood pressure, fasting blood glucose in middle-aged subjects with MetS. The higher values of hs-CRP were more often present in obese subjects and women. The incremental rise in mean serum hs-CRP level was found with an increasing number of MetS components.

Is the increase of uric acid associated with the components of the metabolic syndrome?

Summary Objectives: There is increasing evidence that metabolic syndrome (MetS) may be associated with increased uric acid levels. Previous studies indicate that hyperuricaemia is an independent risk factor for cardiovascular disorders. We sought to determine the association of serum uric acid (SUA) with MetS components and other cardiovascular risk factors among middle aged Lithuanians with MetS. Design and methods: A cross-sectional study was conducted in 2018. A total of 705 subjects aged 40 to 65 years with MetS diagnosed using NCEP ATP III criteria were included. None of the participants had previously diagnosed cardiovascular, cerebrovascular, peripheral artery or end-stage oncological disease. Blood tests and all anthropometric measurements were obtained using standard methods. Subjects were divided into 2 groups: with hyperuricaemia and without hyperuricaemia. Results: Hyperuricaemia was found in 33.3% of subjects. Mean serum uric acid level increased as the number of metabolic factors increased. Participants with hyperuricaemia had abnormal waist circumference (p < 0.001), higher systolic (p = 0.001) and diastolic blood pressure (p = 0.003), higher levels of triglycerides and, lower levels of high-density lipoprotein cholesterol (p < 0.001). Subjects in hyperuricaemia group were more likely to be alcohol users (p = 0.034), to have diabetes (p = 0.02) and higher body mass index (p < 0.001). Their creatinine levels were statistically significantly higher (p < 0.001). Conclusions: Our analysis showed that serum uric acid is associated with MetS and other cardiovascular risk factors. The study found a statistically significant association with the four out of five components of the MetS (excluding plasma glucose) as well as with alcohol consumption, and renal function indicators (creatinine, eGFR).

Ventricular tachycardia in a patient with cardiac haemochromatosis and normal left-ventricular ejection fraction

Summary We describe a rare case of ventricular arrhythmia in a patient with cardiac haemochromatosis related to iron overload in the myocardium and without evidence of systolic dysfunction or heart failure. This case stresses the utility of cardiac magnetic resonance imaging for the early identification of iron overload in the heart and starting appropriate treatment.

Retrospective analysis of complications and survival in patients with acute inferior myocardial infarction accompanied by right ventricular myocardial infarction

Summary Right ventricular myocardial infarction (RVMI) accompanies about 30–50% of inferior wall myocardial infarction. RVMI is associated with higher rates of cardiogenic shock, atrioventricular block, atrial fibrillation, increased mortality rates. The topic requires a scientific update, as only a few studies have been made on RVMI during the past decade. We aimed to analyse the impact of RVMI on inferior myocardial infarction. Design and methods: Retrospective study included 310 patients with documented inferior myocardial infarction (with and without RVMI) between January 2013 and January 2014. Data on baseline characteristics, mortality, in-hospital complications: cardiogenic shock and rhythm and conduction disorders was collected. Results: In 102 (32.9%) patients with inferior myocardial infarction, RVMI was present and 208 (67.1%) cases were without RVMI involvement. RVMI patients had higher rate of rhythm and conduction disturbances than patients without RVMI involvement: atrioventricular block (OR 3.8, 95% CI 2.0–7.1, p < 0.001), atrial fibrillation (OR 1.6, 95% CI 0.9–2.9, p = 0.001), also higher incidence of cardiogenic shock (OR 2.6, 95% CI 1.7–3.9, p < 0.001). Mortality rates after 24 months were higher in RVMI group (OR 1.8, 95% CI 1.2–3.8, p = 0.034). No significant difference was found on in-hospital mortality. Conclusions: Right ventricular involvement complicates the long-term mortality and outcomes after inferior myocardial infarction. It is related to a higher incidence of in-hospital complications, especially I–III degree AV block and atrial fibrillation. However, influence on long-term mortality needs further investigation.

Spontaneous regression of severe aortic stenosis after massive embolization in a patient with antiphospholipid syndrome

Summary We present a case of probably unreported aortic stenosis evolution in a patient with primary antiphospholipid syndrome (APS). A female patient, 54 years old, with a history of recurrent deep venous thrombosis, an episode of pulmonary embolism and was positive for APS antibodies. She was kept on warfarin and aspirin. The patient was admitted with acute pulmonary edema and severe aortic stenosis. While preparing for aortic valve surgery, the patient developed acute stroke, and a week later developed concurrent acute ischemia of both lower limbs. Emergency surgery salvaged the lower limbs and follow up transthoracic echocardiography showed marked regression of the thickening of the aortic valve leaflets, only mild aortic stenosis and moderate aortic regurgitation. Aortic valve surgery was cancelled, and the patient was kept on warfarin and aspirin. Conclusion Development of severe aortic stenosis is uncommon in primary APS, and this scenario of spontaneous improvement from a severe to a mild aortic stenosis, is probably unreported before.

Primary prevention strategy for cardiovascular disease in Lithuania

Summary Cardiovascular diseases are the main cause of premature death worldwide. More than half of deaths were caused by cardiovascular diseases in 2017 in Lithuania. Primary prevention programmes encourage both medical staff and general population to pay attention to potential health issues as well as attempt to eradicate risk factors causing cardiovascular diseases. “A Funding Programme for the Screening and Preventive Management of the High Cardiovascular Risk Individuals” published in Lithuania has been implemented as of 2006. Analysis of the results of the programme shows that the prevalent cases of arterial hypertension are gradually declining. However, the prevalence of dyslipidaemia is still not decreasing. The prevalence of other modifiable cardiovascular disease risk factors has erratic trends with a slight overall decline. Consequently, mortality rate of cardiovascular diseases has decreased by more than one third among middle-age population over the past 10 years. Having higher availability of the anti-hypertensive and anti-lipid medications already achieved, the future plans include the aim of further reducing elevated blood pressure and effectively treating dyslipidaemia. In order to implement a strategy that focuses on smoking prevention, promotion of healthy nutrition and physical activity, a significant contribution is required from the state authorities.

Neurogenic stress cardiomyopathy following aneurysmal subarachnoid haemorrhage: a literature review

Summary Neurogenic stress cardiomyopathy (NSC) is defined as transient cardiac dysfunction occurring after primary brain injury, such as aneurysmal subarachnoid haemorrhage, and characterised by left ventricular systolic dysfunction with reduced ejection fraction and abnormalities of regional wall motion. It may also be suspected if elevated levels of cardiac biomarkers and ECG abnormalities are present. It is a reversible condition with favourable long-term prognosis if diagnosed and treated timely, however, NSC is associated with higher rates of early mortality and complications, including pulmonary oedema, cardiogenic shock, delayed cerebral ischaemia. Early diagnosis of the NSC is important in order to prevent these complications and reduce mortality. Management of the NSC is complicated and a multidisciplinary approach is usually required.

Cocaine-induced myocardial injury

Summary We report a case of 37-year-old male, who was admitted to the Vilnius University hospital Santaros Klinikos emergency department suffering from acute chest pain. ECG and elevated troponin level confirmed ST-elevation myocardial infarction, although coronary angiogram had not shown hemodynamically significant changes in coronary arteries. Patient admitted after using cocaine a day ago. To conclude, myocardial infarction is rare, but serious consequence of cocaine use. Clinicians should consider interrogating all young patients presented to the emergency department with acute chest pain for cocaine use.