Endocrine dysfunction has an adverse impact on the cardiovascular system that may be due to an endocrine abnormality that leads to electrocardiogram (EKG) changes. The EKG changes due to endocrine disorder can be reve...Endocrine dysfunction has an adverse impact on the cardiovascular system that may be due to an endocrine abnormality that leads to electrocardiogram (EKG) changes. The EKG changes due to endocrine disorder can be reversible and irreversible and treating underlying disease can reverse EKG changes in some cases. In this article, we review the electrocardiogram manifestations of various endocrine disorders.展开更多
Objective:To investigate the differences in risk factors and prognosis between young and elderly patients with acute ST-segment elevation myocardial infarction(STEMI)so as to provide a basis for the prevention of youn...Objective:To investigate the differences in risk factors and prognosis between young and elderly patients with acute ST-segment elevation myocardial infarction(STEMI)so as to provide a basis for the prevention of young patients with acute STEMI.Methods:Patients initially diagnosed with STEMI in the 920"Hospital of Joint Logistic Support Force of PLA from January 1,2018 to December 31,2022 were retrospectively enrolled in this study.A total of 235 STEMI patients aged≤45 years old and 532 STEMI patients aged≥65 years old were screened.The baseline characteristics,laboratory indicators,clinical characteristics,coronary angiography,SYNTAX score and major adverse cardiovascular events(MACE)during 1-year follow-up were analyzed and compared.Results:A total of 767 STEMI patients were enrolled,including 235 in the young group and 532 in the elderly group.Among the STEM patients in the young group,224 cases were male,and smoking and drinking were common.Compared with the elderly group,the young group had shorter hospital stays and more family history of ischemic heart disease(IHD).The level of low-density lipoprotein in the young group was higher than that in the old group,while the level of high-density lipoprotein in the young group was lower than that in the old group.The level of high uric acid and homocysteine in the young group was significantly higher than that in the old group.The main cause of STEMI in the young group was fatigue,and the most common symptom was angina pectoris.Coronary angiography showed that single vessel disease was more common in the young group than in the elderly group,and the lesion in the young group was the left anterior descending artery.The SYNTAX score was significantly lower in the young group than in the elderly group according to the anatomical characteristics of coronary artery disease.In the forest plot,diabetes mellitus and a family history of IHD showed a trend of major adverse cardiovascular events(MACE)in both groups.Conclusion:Males,smokers,alcohol drinkers and family history of ischemic heart disease are more common in young patients.Common risk factors include fatigue,hyperuricemia,hyperlipidemia and so on.In addition,age itself is an independent risk factor.Management of diabetes,hyperuricemia,and homocysteine levels is essential to reduce the incidence of cardiovascular events in young patients.By controlling these factors,the incidence of young patients with acute STEMI can be effectively prevented and the corresponding prevention and treatment basis can be provided.展开更多
Background There are limited data on the prevalence of electrocardiographic (ECG) abnormalities, and their value for predicting a major adverse cardiovascular event (MACE) in patients at high cardiovascular risk. This...Background There are limited data on the prevalence of electrocardiographic (ECG) abnormalities, and their value for predicting a major adverse cardiovascular event (MACE) in patients at high cardiovascular risk. This study aimed to determine the prevalence of ECG abnormalities in patients at high risk for cardiovascular events, and to identify ECG abnormalities that significantly predict MACE. Methods Patients aged ≥ 45 years with established atherosclerotic disease (EAD) were consecutively enrolled from the outpatient clinics of the six participating hospitals during April 2011 to March 2014. The following data were collected: demographic data, cardiovascular risk factors, history of cardiovascular event, physical examination, ECG and medications. ECG was analyzed using Minnesota Code criteria. MACE included cardiovascular death, non-fatal myocardial infarction, and hospitalization due to unstable angina or heart failure. Results A total of 2009 patients were included, 1048 patients (52.2%) had established EAD, and 961 patients (47.8%) had multiple risk factors (MRF). ECG abnormalities included atrial fibrillation (6.7%), premature ventricular contraction (5.4%), pathological Q-wave (Q/QS)(21.3%), T-wave inversion (20.0%), intraventricular ventricular conduction delay (IVCD)(7.3%), left ventricular hypertrophy (LVH)(12.2%), and AV block (12.5%). MACE occurred in 88 patients (4.4%). Independent predictors of MACE were chronic kidney disease, EAD, and the presence of atrial fibrillation, Q/QS, IVCD or LVH by ECG. Conclusions A high prevalence of ECG abnormalities was found. The prevalence of ECG abnormalities was high even among those with risk factors without documented cardiovascular disease.展开更多
As a result of research, high prevalence of arterial hypertension has been identified in the group of patients with coronary heart disease aged 60 and older. Most often, occurring form of arterial hypertension among g...As a result of research, high prevalence of arterial hypertension has been identified in the group of patients with coronary heart disease aged 60 and older. Most often, occurring form of arterial hypertension among geriatric patients is isolated systolic arterial hypertension (ISAH). The comparison of two ethnic groups of the population has showed higher levels of systolic and diastolic blood pressure (SBP and DBP) in the group of patients of non-indigenous nationality, rather than Yakut patients. Correlation was recorded in the group of non-indigenous patients as they age. Significant increase in the level of SBP was identified in the group of senile and long-livers than in the elderly. Detection of ECG signs of LVH showed the lowest specificity of Cornell voltage criterion comparing to Sokolow-Lyon criterion with its more often occurrence. ECG-signs of left ventricle hypertrophy are significantly more often established by Sokolow-Lyon criterion for men, Cornell voltage—for women. Correlation has been found between the presence of LVH and combination of Cornell voltage criterion with both Gubner-Ungerleider and Sokolow-Lyon criteria.展开更多
AIMTo investigate validity of electrocardiographic(ECG)criteria for left ventricular hypertrophy(LVH)in young adults.METHODS Retrospectively,echocardiograms showing LVH and concomitant electrocardiograms were collecte...AIMTo investigate validity of electrocardiographic(ECG)criteria for left ventricular hypertrophy(LVH)in young adults.METHODS Retrospectively,echocardiograms showing LVH and concomitant electrocardiograms were collected in patients 18 to 39 years old.A control group of patients without LVH was collected.Using echocardiogram as the gold standard,electrocardiograms were analyzed using common voltage criteria.RESULTS Study included 100 subjects(52%male,mean age=28±6.8 years,96%Hispanic or African-American)with 50%LVH prevalence.Sensitivity and specificity for SokolowLyon criteria were 24%(95%CI:13.5%-38.4%)and 88%(95%CI:74.9%-95%).For Cornell criteria,sensitivity was 32%(95%CI:19.9%-46.8%)and specificity 98%(95%CI:87.9%-99.8%).For R in a VL criteria,sensitivity was 12%(95%CI:4.9%-25%)and specificity 100%(95%CI:91.1%-100%).CONCLUSION In young adults common ECG voltage criteria have low sensitivities and high specificities similar to other age groups.Low sensitivities preclude these ECG criteria from serving as effective screening tests.展开更多
<strong>Objective:</strong> <span style="font-family:Verdana;">To determine the early electrocardiographic changes in a cohort of ambulatory cameroonian COVID-19 patients treated with hydro...<strong>Objective:</strong> <span style="font-family:Verdana;">To determine the early electrocardiographic changes in a cohort of ambulatory cameroonian COVID-19 patients treated with hydroxychlo</span><span style="font-family:Verdana;">- </span><span style="font-family:;" "=""><span style="font-family:Verdana;">roquine and Azithromycin. </span><b><span style="font-family:Verdana;">Design:</span></b><span style="font-family:Verdana;"> Prospective study. </span><b><span style="font-family:Verdana;">Setting:</span></b><span style="font-family:Verdana;"> Treatment centres of the city of Yaounde, Cameroon, from May 7</span><sup><span style="font-size:12px;font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> to 24</span><sup><span style="font-size:12px;font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> 2020. </span><b><span style="font-family:Verdana;">Participants:</span></b><span style="font-family:Verdana;"> We enrolled 51 consecutive confirmed COVID-19 on RT-PCR who having mild forms of COVID-19 and treated by hydroxychloroquine 200</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">mg twice daily during seven #days plus Azithromycin 500 mg the first day and 250 mg the remaining 4 days as per national standard. </span><b><span style="font-family:Verdana;">Main Outcomes Measures:</span></b><span style="font-family:Verdana;"> The</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">primary end-point was the change in QTc interval between day 0 (D0), day 3 (D3) and day 7 (D7). Secondary endpoints were changes in all other cardiac electrical conductivity patterns and the occurrence of clinical arrhythmic events during the course of treatment. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The population (29 men and 22 women) was aged 39 ± 11 years (range 17 to 61 years). Mean Tisdale score was 3.35 ± 0.48. No significant change from baseline (D0) of QTc was observed at D7 (429 ± 27 ms at D0 versus 396 ± 26 ms at D7;p = 0.27). A reduction of heart rate was observed between the D0 and D7 (75 ± 13 bpm versus 70 ± 13 bpm, p = 0.02) with increased QRS duration between D0 and D7 (95 ± 10 ms versus 102 ± 17 ms, p = 0.004). No symptomatic arrhythmic events occurred during the treatment course. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">No life-threatening modification of the QT interval was observed in non-severe COVID-19 patients treated ambulatory with hydroxychloroquine and azith</span></span><span style="font-family:Verdana;">romycin. Studies are needed in critical-ill and older patients.</span>展开更多
Objective To investigate the impact of microvascular obstruction(MVO)on the global and regional myocardial function by cardiac magnetic resonance feature-tracking(CMR-FT)in ST-segment-elevation myocardial infarction(S...Objective To investigate the impact of microvascular obstruction(MVO)on the global and regional myocardial function by cardiac magnetic resonance feature-tracking(CMR-FT)in ST-segment-elevation myocardial infarction(STEMI)patients after percutaneous coronary intervention.Methods Consecutive acute STEMI patients who underwent cardiac magnetic resonance imaging 1-7 days after successful reperfusion by percutaneous coronary intervention treatment were included in this retrospective study.Based on the presence or absence of MVO on late gadolinium enhancement images,patients were divided into groups with MVO and without MVO.The infarct zone,adjacent zone,and remote zone were determined based on a myocardial 16-segment model.The radial strain(RS),circumferential strain(CS),and longitudinal strain(LS)of the global left ventricle(LV)and the infarct,adjacent,and remote zones were measured by CMRFT from cine images and compared between patients with and without MVO using independent-samples t-test.Logistic regression analysis was used to assess the association of MVO with the impaired LV function.Results A total of 157 STEMI patients(mean age 56.66±11.38 years)were enrolled.MVO was detected in 37.58%(59/157)of STEMI patients,and the mean size of MVO was 3.00±3.76 mL.Compared with patients without MVO(n=98),the MVO group had significantly reduced LV global RS(t=-4.30,P<0.001),global CS(t=4.99,P<0.001),and global LS(t=3.51,P=0.001).The RS and CS of the infarct zone in patients with MVO were significantly reduced(t=-3.38,P=0.001;t=2.64,P=0.01;respectively)and the infarct size was significantly larger(t=8.37,P<0.001)than that of patients without MVO.The presence of LV MVO[OR=4.10,95%CI:2.05-8.19,P<0.001]and its size[OR=1.38,95%CI:1.10-1.72,P=0.01],along with the heart rate and LV infarct size were significantly associated with impaired LV global CS in univariable Logistic regression analysis,while only heart rate(OR=1.08,95%CI:1.03-1.13,P=0.001)and LV infarct size(OR=1.10,95%CI:1.03-1.16,P=0.003)were independent influencing factors for the impaired LV global CS in multivariable Logistic regression analysis.Conclusion The infarct size was larger in STEMI patients with MVO,and MVO deteriorates the global and regional LV myocardial function.展开更多
Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest...Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest pain accompanied by profuse sweating for 3 hours and underwent emergency percutaneous coronary intervention (PCI) at a local hospital. The procedure revealed left main stem occlusion with subsequent left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA). After the procedure, the patient experienced hemodynamic instability, recurrent ventricular fibrillation, and critical condition, thus transferred to our hospital for further treatment. Symptoms and signs: The patient is in a comatose state, unresponsive to stimuli, with bilateral dilated pupils measuring 2.0 mm, exhibiting reduced sensitivity to light reflex, and recurrent fever. Coarse breath sounds can be heard in both lungs, with audible moist rales. Irregular breathing pattern is observed, and heart sounds vary in intensity. No pathological murmurs are auscultated in any valve auscultation area. Diagnostic methods: Coronary angiography results at the local hospital showed complete occlusion of the left main stem, and left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA) was performed. However, the distal guidewire did not pass through. After admission, blood tests showed a Troponin T level of 1.44 ng/ml and a Myoglobin level of 312 ng/ml. The platelet count was 1390 × 10<sup>9</sup>/L. Von Willebrand factor (vWF) activity was measured at 201.9%. Bone marrow aspiration biopsy showed active bone marrow proliferation and platelet clustering. The peripheral blood smear also showed platelet clustering. JAK-2 gene testing was positive, confirming the diagnosis of primary thrombocytosis. Treatment methods: The patient is assisted with mechanical ventilation and intra-aortic balloon counterpulsation to improve coronary blood flow. Electrolyte levels are closely monitored, especially maintaining plasma potassium levels between 4.0 and 4.5 mmol/l. Hydroxyurea 500 mg is administered for platelet reduction. Anticoagulants and antiplatelet agents are used rationally to prevent further infarction or bleeding. Antiarrhythmic, lipid-lowering, gastroprotective, hepatoprotective, and heart failure treatment are also provided. Clinical outcome: The family members chose to withdraw treatment and signed for discharge due to a combination of reasons, including economic constraints and uncertainty about the prognosis due to the long disease course. Acute myocardial infarction has gradually become one of the leading causes of death in our country. As a “green channel” disease, corresponding diagnostic and treatment protocols have been established in China, and significant progress has been made in emergency care. There are strict regulations for the time taken from the catheterization lab to the cardiac intensive care unit, and standardized treatments are provided to patients once they enter the intensive care unit. Research results show that the incidence of acute myocardial infarction in patients with primary thrombocythemia within 10 years is 9.4%. This type of disease is rare and difficult to cure, posing significant challenges to medical and nursing professionals. In order to benefit future patients, we have documented individual cases of treatment and nursing care for these patients. The research results show that these patients exhibit resistance to traditional oral anticoagulant drugs and require alternative anticoagulants. Additionally, there are significant differences in serum and plasma potassium levels among patients. Therefore, when making clinical diagnoses, it is necessary to carefully distinguish between the two. Particularly, nursing personnel should possess dialectical thinking when supplementing potassium levels in patients in order to reduce the incidence of malignant arrhythmias and mortality rates.展开更多
[Objectives]To observe the effect of Guanxin-V Mixture combined with Sacubitril Valsartan on cardiac function in patients after PCI for acute ST-segment elevation myocardial infarction(STE-MI).[Methods]41 cases of STE...[Objectives]To observe the effect of Guanxin-V Mixture combined with Sacubitril Valsartan on cardiac function in patients after PCI for acute ST-segment elevation myocardial infarction(STE-MI).[Methods]41 cases of STEMI patients(qi and yin deficiency and blood stasis and obstruction)hospitalized in Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine from January 2020 to June 2021 were randomly divided into 21 cases in the treatment group and 20 cases in the control group,and the two groups were given standardized Western medicine treatment as soon as possible after PCI.The control group was treated with Sacubitril Valsartan,and the treatment group was treated with Guanxin-V Mixture on the basis of treatment in the control group.The patients in the two groups were treated for 3 months,and the TCM syndrome score,left ventricular ejection fraction(LVEF),and N-Terminal Pro-Brain Natriuretic Peptide(NT-proBNP),interleukin-6(IL-6),and high-sensitivity C-reactive protein(hs-CRP)levels,and the incidence of heart failure and adverse reactions in the two groups after treatment were recorded.[Results]After the treatment,the TCM syndrome score and serum NT-proBNP,IL-6 and hs-CRP levels of the two groups significantly decreased(P<0.05),and the levels of the treatment group were significantly lower than those of the control group(P<0.05);the LVEF of the two groups significantly increased(P<0.05),and the level of the treatment group was significantly higher than that of the control group(P<0.05).Comparison of the incidence of heart failure and adverse reactions in the two groups showed no statistically significant differences(P>0.05).[Conclusions]Guanxin-V Mixture combined with Sacubitril Valsartan could significantly improve cardiac function in STEMI patients undergoing PCI,and its effect may be related to the suppression of inflammatory response.展开更多
Objective:To investigate and thoroughly understand the physical examination results of retired employees from a certain unit in Beijing,analyze their bone mineral density(BMD),and identify risk factors that may indica...Objective:To investigate and thoroughly understand the physical examination results of retired employees from a certain unit in Beijing,analyze their bone mineral density(BMD),and identify risk factors that may indicate osteoporosis.This provides a reference for the individualized prevention,identification,and control of osteoporosis among retired employees.Methods:The bone mineral density and potential factors of 148 retired employees from a unit in 2023 were analyzed and categorized into osteoporosis and non-osteoporosis groups.Key factors from the physical examinations of the two groups were compared.Spearman’s correlation analysis was used to determine the correlation between key factors and osteoporosis.Significant key factors were included in a regression analysis.A multivariate binary logistics regression was employed to identify risk factors indicative of osteoporosis.Results:Correlation analysis revealed that gender,age,and ECG ST-segment length were significantly associated with osteoporosis.Regression analysis showed that for each additional year of age,the likelihood of developing osteoporosis increased by 1.058 times;females were 2.865 times more likely to develop osteoporosis compared to males;the longer the ECG ST-segment,the higher the likelihood of osteoporosis.Conclusion:Gender,age,and ECG ST-segment length are significantly associated with osteoporosis.These indicators can provide reference points for early identification,early intervention,and reducing the incidence of osteoporosis in clinical settings.展开更多
文摘Endocrine dysfunction has an adverse impact on the cardiovascular system that may be due to an endocrine abnormality that leads to electrocardiogram (EKG) changes. The EKG changes due to endocrine disorder can be reversible and irreversible and treating underlying disease can reverse EKG changes in some cases. In this article, we review the electrocardiogram manifestations of various endocrine disorders.
基金Science and Technology Project of Department of Science and Technology of Yunnan Province(Project No.:202102AY070001-030)The Talent Training Fund of the Joint Logistics Support Force(Project No.:20220105)Science and Technology Project of the 920^(th) Hospital of the Joint Logistics Support Force(Project No.:2020YGD11)。
文摘Objective:To investigate the differences in risk factors and prognosis between young and elderly patients with acute ST-segment elevation myocardial infarction(STEMI)so as to provide a basis for the prevention of young patients with acute STEMI.Methods:Patients initially diagnosed with STEMI in the 920"Hospital of Joint Logistic Support Force of PLA from January 1,2018 to December 31,2022 were retrospectively enrolled in this study.A total of 235 STEMI patients aged≤45 years old and 532 STEMI patients aged≥65 years old were screened.The baseline characteristics,laboratory indicators,clinical characteristics,coronary angiography,SYNTAX score and major adverse cardiovascular events(MACE)during 1-year follow-up were analyzed and compared.Results:A total of 767 STEMI patients were enrolled,including 235 in the young group and 532 in the elderly group.Among the STEM patients in the young group,224 cases were male,and smoking and drinking were common.Compared with the elderly group,the young group had shorter hospital stays and more family history of ischemic heart disease(IHD).The level of low-density lipoprotein in the young group was higher than that in the old group,while the level of high-density lipoprotein in the young group was lower than that in the old group.The level of high uric acid and homocysteine in the young group was significantly higher than that in the old group.The main cause of STEMI in the young group was fatigue,and the most common symptom was angina pectoris.Coronary angiography showed that single vessel disease was more common in the young group than in the elderly group,and the lesion in the young group was the left anterior descending artery.The SYNTAX score was significantly lower in the young group than in the elderly group according to the anatomical characteristics of coronary artery disease.In the forest plot,diabetes mellitus and a family history of IHD showed a trend of major adverse cardiovascular events(MACE)in both groups.Conclusion:Males,smokers,alcohol drinkers and family history of ischemic heart disease are more common in young patients.Common risk factors include fatigue,hyperuricemia,hyperlipidemia and so on.In addition,age itself is an independent risk factor.Management of diabetes,hyperuricemia,and homocysteine levels is essential to reduce the incidence of cardiovascular events in young patients.By controlling these factors,the incidence of young patients with acute STEMI can be effectively prevented and the corresponding prevention and treatment basis can be provided.
基金supported by the Heart Association of Thailand under the Royal Patronage of H.M. the King, National Research Council of Thailand
文摘Background There are limited data on the prevalence of electrocardiographic (ECG) abnormalities, and their value for predicting a major adverse cardiovascular event (MACE) in patients at high cardiovascular risk. This study aimed to determine the prevalence of ECG abnormalities in patients at high risk for cardiovascular events, and to identify ECG abnormalities that significantly predict MACE. Methods Patients aged ≥ 45 years with established atherosclerotic disease (EAD) were consecutively enrolled from the outpatient clinics of the six participating hospitals during April 2011 to March 2014. The following data were collected: demographic data, cardiovascular risk factors, history of cardiovascular event, physical examination, ECG and medications. ECG was analyzed using Minnesota Code criteria. MACE included cardiovascular death, non-fatal myocardial infarction, and hospitalization due to unstable angina or heart failure. Results A total of 2009 patients were included, 1048 patients (52.2%) had established EAD, and 961 patients (47.8%) had multiple risk factors (MRF). ECG abnormalities included atrial fibrillation (6.7%), premature ventricular contraction (5.4%), pathological Q-wave (Q/QS)(21.3%), T-wave inversion (20.0%), intraventricular ventricular conduction delay (IVCD)(7.3%), left ventricular hypertrophy (LVH)(12.2%), and AV block (12.5%). MACE occurred in 88 patients (4.4%). Independent predictors of MACE were chronic kidney disease, EAD, and the presence of atrial fibrillation, Q/QS, IVCD or LVH by ECG. Conclusions A high prevalence of ECG abnormalities was found. The prevalence of ECG abnormalities was high even among those with risk factors without documented cardiovascular disease.
文摘As a result of research, high prevalence of arterial hypertension has been identified in the group of patients with coronary heart disease aged 60 and older. Most often, occurring form of arterial hypertension among geriatric patients is isolated systolic arterial hypertension (ISAH). The comparison of two ethnic groups of the population has showed higher levels of systolic and diastolic blood pressure (SBP and DBP) in the group of patients of non-indigenous nationality, rather than Yakut patients. Correlation was recorded in the group of non-indigenous patients as they age. Significant increase in the level of SBP was identified in the group of senile and long-livers than in the elderly. Detection of ECG signs of LVH showed the lowest specificity of Cornell voltage criterion comparing to Sokolow-Lyon criterion with its more often occurrence. ECG-signs of left ventricle hypertrophy are significantly more often established by Sokolow-Lyon criterion for men, Cornell voltage—for women. Correlation has been found between the presence of LVH and combination of Cornell voltage criterion with both Gubner-Ungerleider and Sokolow-Lyon criteria.
文摘AIMTo investigate validity of electrocardiographic(ECG)criteria for left ventricular hypertrophy(LVH)in young adults.METHODS Retrospectively,echocardiograms showing LVH and concomitant electrocardiograms were collected in patients 18 to 39 years old.A control group of patients without LVH was collected.Using echocardiogram as the gold standard,electrocardiograms were analyzed using common voltage criteria.RESULTS Study included 100 subjects(52%male,mean age=28±6.8 years,96%Hispanic or African-American)with 50%LVH prevalence.Sensitivity and specificity for SokolowLyon criteria were 24%(95%CI:13.5%-38.4%)and 88%(95%CI:74.9%-95%).For Cornell criteria,sensitivity was 32%(95%CI:19.9%-46.8%)and specificity 98%(95%CI:87.9%-99.8%).For R in a VL criteria,sensitivity was 12%(95%CI:4.9%-25%)and specificity 100%(95%CI:91.1%-100%).CONCLUSION In young adults common ECG voltage criteria have low sensitivities and high specificities similar to other age groups.Low sensitivities preclude these ECG criteria from serving as effective screening tests.
文摘<strong>Objective:</strong> <span style="font-family:Verdana;">To determine the early electrocardiographic changes in a cohort of ambulatory cameroonian COVID-19 patients treated with hydroxychlo</span><span style="font-family:Verdana;">- </span><span style="font-family:;" "=""><span style="font-family:Verdana;">roquine and Azithromycin. </span><b><span style="font-family:Verdana;">Design:</span></b><span style="font-family:Verdana;"> Prospective study. </span><b><span style="font-family:Verdana;">Setting:</span></b><span style="font-family:Verdana;"> Treatment centres of the city of Yaounde, Cameroon, from May 7</span><sup><span style="font-size:12px;font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> to 24</span><sup><span style="font-size:12px;font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> 2020. </span><b><span style="font-family:Verdana;">Participants:</span></b><span style="font-family:Verdana;"> We enrolled 51 consecutive confirmed COVID-19 on RT-PCR who having mild forms of COVID-19 and treated by hydroxychloroquine 200</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">mg twice daily during seven #days plus Azithromycin 500 mg the first day and 250 mg the remaining 4 days as per national standard. </span><b><span style="font-family:Verdana;">Main Outcomes Measures:</span></b><span style="font-family:Verdana;"> The</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">primary end-point was the change in QTc interval between day 0 (D0), day 3 (D3) and day 7 (D7). Secondary endpoints were changes in all other cardiac electrical conductivity patterns and the occurrence of clinical arrhythmic events during the course of treatment. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The population (29 men and 22 women) was aged 39 ± 11 years (range 17 to 61 years). Mean Tisdale score was 3.35 ± 0.48. No significant change from baseline (D0) of QTc was observed at D7 (429 ± 27 ms at D0 versus 396 ± 26 ms at D7;p = 0.27). A reduction of heart rate was observed between the D0 and D7 (75 ± 13 bpm versus 70 ± 13 bpm, p = 0.02) with increased QRS duration between D0 and D7 (95 ± 10 ms versus 102 ± 17 ms, p = 0.004). No symptomatic arrhythmic events occurred during the treatment course. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">No life-threatening modification of the QT interval was observed in non-severe COVID-19 patients treated ambulatory with hydroxychloroquine and azith</span></span><span style="font-family:Verdana;">romycin. Studies are needed in critical-ill and older patients.</span>
文摘Objective To investigate the impact of microvascular obstruction(MVO)on the global and regional myocardial function by cardiac magnetic resonance feature-tracking(CMR-FT)in ST-segment-elevation myocardial infarction(STEMI)patients after percutaneous coronary intervention.Methods Consecutive acute STEMI patients who underwent cardiac magnetic resonance imaging 1-7 days after successful reperfusion by percutaneous coronary intervention treatment were included in this retrospective study.Based on the presence or absence of MVO on late gadolinium enhancement images,patients were divided into groups with MVO and without MVO.The infarct zone,adjacent zone,and remote zone were determined based on a myocardial 16-segment model.The radial strain(RS),circumferential strain(CS),and longitudinal strain(LS)of the global left ventricle(LV)and the infarct,adjacent,and remote zones were measured by CMRFT from cine images and compared between patients with and without MVO using independent-samples t-test.Logistic regression analysis was used to assess the association of MVO with the impaired LV function.Results A total of 157 STEMI patients(mean age 56.66±11.38 years)were enrolled.MVO was detected in 37.58%(59/157)of STEMI patients,and the mean size of MVO was 3.00±3.76 mL.Compared with patients without MVO(n=98),the MVO group had significantly reduced LV global RS(t=-4.30,P<0.001),global CS(t=4.99,P<0.001),and global LS(t=3.51,P=0.001).The RS and CS of the infarct zone in patients with MVO were significantly reduced(t=-3.38,P=0.001;t=2.64,P=0.01;respectively)and the infarct size was significantly larger(t=8.37,P<0.001)than that of patients without MVO.The presence of LV MVO[OR=4.10,95%CI:2.05-8.19,P<0.001]and its size[OR=1.38,95%CI:1.10-1.72,P=0.01],along with the heart rate and LV infarct size were significantly associated with impaired LV global CS in univariable Logistic regression analysis,while only heart rate(OR=1.08,95%CI:1.03-1.13,P=0.001)and LV infarct size(OR=1.10,95%CI:1.03-1.16,P=0.003)were independent influencing factors for the impaired LV global CS in multivariable Logistic regression analysis.Conclusion The infarct size was larger in STEMI patients with MVO,and MVO deteriorates the global and regional LV myocardial function.
文摘Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest pain accompanied by profuse sweating for 3 hours and underwent emergency percutaneous coronary intervention (PCI) at a local hospital. The procedure revealed left main stem occlusion with subsequent left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA). After the procedure, the patient experienced hemodynamic instability, recurrent ventricular fibrillation, and critical condition, thus transferred to our hospital for further treatment. Symptoms and signs: The patient is in a comatose state, unresponsive to stimuli, with bilateral dilated pupils measuring 2.0 mm, exhibiting reduced sensitivity to light reflex, and recurrent fever. Coarse breath sounds can be heard in both lungs, with audible moist rales. Irregular breathing pattern is observed, and heart sounds vary in intensity. No pathological murmurs are auscultated in any valve auscultation area. Diagnostic methods: Coronary angiography results at the local hospital showed complete occlusion of the left main stem, and left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA) was performed. However, the distal guidewire did not pass through. After admission, blood tests showed a Troponin T level of 1.44 ng/ml and a Myoglobin level of 312 ng/ml. The platelet count was 1390 × 10<sup>9</sup>/L. Von Willebrand factor (vWF) activity was measured at 201.9%. Bone marrow aspiration biopsy showed active bone marrow proliferation and platelet clustering. The peripheral blood smear also showed platelet clustering. JAK-2 gene testing was positive, confirming the diagnosis of primary thrombocytosis. Treatment methods: The patient is assisted with mechanical ventilation and intra-aortic balloon counterpulsation to improve coronary blood flow. Electrolyte levels are closely monitored, especially maintaining plasma potassium levels between 4.0 and 4.5 mmol/l. Hydroxyurea 500 mg is administered for platelet reduction. Anticoagulants and antiplatelet agents are used rationally to prevent further infarction or bleeding. Antiarrhythmic, lipid-lowering, gastroprotective, hepatoprotective, and heart failure treatment are also provided. Clinical outcome: The family members chose to withdraw treatment and signed for discharge due to a combination of reasons, including economic constraints and uncertainty about the prognosis due to the long disease course. Acute myocardial infarction has gradually become one of the leading causes of death in our country. As a “green channel” disease, corresponding diagnostic and treatment protocols have been established in China, and significant progress has been made in emergency care. There are strict regulations for the time taken from the catheterization lab to the cardiac intensive care unit, and standardized treatments are provided to patients once they enter the intensive care unit. Research results show that the incidence of acute myocardial infarction in patients with primary thrombocythemia within 10 years is 9.4%. This type of disease is rare and difficult to cure, posing significant challenges to medical and nursing professionals. In order to benefit future patients, we have documented individual cases of treatment and nursing care for these patients. The research results show that these patients exhibit resistance to traditional oral anticoagulant drugs and require alternative anticoagulants. Additionally, there are significant differences in serum and plasma potassium levels among patients. Therefore, when making clinical diagnoses, it is necessary to carefully distinguish between the two. Particularly, nursing personnel should possess dialectical thinking when supplementing potassium levels in patients in order to reduce the incidence of malignant arrhythmias and mortality rates.
基金Supported by National Natural Science Foundation of China(81774229)Nanjing Chinese Medicine Young Talent Cultivation Program(ZYQ20027)+3 种基金Natural Science Foundation of Nanjing University of Chinese Medicine(XZR2021052)Discipline(Academic)Reserve Talent Training Program of Nanjing Hospital of Chinese Medicine(YRC2016-CZL)Nanjing Traditional Chinese Medicine Science and Technology Special Fund Project(ZYQN202203)Traditional Chinese Medicine Preparation Research Project in Nanjing Medical Institutions(NJCC-ZJ-202315).
文摘[Objectives]To observe the effect of Guanxin-V Mixture combined with Sacubitril Valsartan on cardiac function in patients after PCI for acute ST-segment elevation myocardial infarction(STE-MI).[Methods]41 cases of STEMI patients(qi and yin deficiency and blood stasis and obstruction)hospitalized in Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine from January 2020 to June 2021 were randomly divided into 21 cases in the treatment group and 20 cases in the control group,and the two groups were given standardized Western medicine treatment as soon as possible after PCI.The control group was treated with Sacubitril Valsartan,and the treatment group was treated with Guanxin-V Mixture on the basis of treatment in the control group.The patients in the two groups were treated for 3 months,and the TCM syndrome score,left ventricular ejection fraction(LVEF),and N-Terminal Pro-Brain Natriuretic Peptide(NT-proBNP),interleukin-6(IL-6),and high-sensitivity C-reactive protein(hs-CRP)levels,and the incidence of heart failure and adverse reactions in the two groups after treatment were recorded.[Results]After the treatment,the TCM syndrome score and serum NT-proBNP,IL-6 and hs-CRP levels of the two groups significantly decreased(P<0.05),and the levels of the treatment group were significantly lower than those of the control group(P<0.05);the LVEF of the two groups significantly increased(P<0.05),and the level of the treatment group was significantly higher than that of the control group(P<0.05).Comparison of the incidence of heart failure and adverse reactions in the two groups showed no statistically significant differences(P>0.05).[Conclusions]Guanxin-V Mixture combined with Sacubitril Valsartan could significantly improve cardiac function in STEMI patients undergoing PCI,and its effect may be related to the suppression of inflammatory response.
文摘Objective:To investigate and thoroughly understand the physical examination results of retired employees from a certain unit in Beijing,analyze their bone mineral density(BMD),and identify risk factors that may indicate osteoporosis.This provides a reference for the individualized prevention,identification,and control of osteoporosis among retired employees.Methods:The bone mineral density and potential factors of 148 retired employees from a unit in 2023 were analyzed and categorized into osteoporosis and non-osteoporosis groups.Key factors from the physical examinations of the two groups were compared.Spearman’s correlation analysis was used to determine the correlation between key factors and osteoporosis.Significant key factors were included in a regression analysis.A multivariate binary logistics regression was employed to identify risk factors indicative of osteoporosis.Results:Correlation analysis revealed that gender,age,and ECG ST-segment length were significantly associated with osteoporosis.Regression analysis showed that for each additional year of age,the likelihood of developing osteoporosis increased by 1.058 times;females were 2.865 times more likely to develop osteoporosis compared to males;the longer the ECG ST-segment,the higher the likelihood of osteoporosis.Conclusion:Gender,age,and ECG ST-segment length are significantly associated with osteoporosis.These indicators can provide reference points for early identification,early intervention,and reducing the incidence of osteoporosis in clinical settings.