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https://www.readbyqxmd.com/read/28815597/cardiac-action-potential-repolarization-re-visited-early-repolarization-shows-all-or-none-behaviour
#1
Beatriz Trenor, Karen Cardona, Javier Saiz, Denis Noble, Wayne Giles
In healthy mammalian hearts the action potential (AP) waveform initiates and modulates each contraction, or heartbeat. As a result, action potential height and duration are key physiological variables. In addition, rate-dependent changes in ventricular action potential duration (APD), and variations in APD at a fixed heart rate, are both reliable biomarkers of electrophysiological stability. Present guidelines for the likelihood that candidate drugs will increase arrhythmias rely on small changes in APD and Q-T intervals as criteria for Safety Pharmacology decisions...
August 17, 2017: Journal of Physiology
https://www.readbyqxmd.com/read/28803619/basis-and-ecg-measurement-of-global-ventricular-repolarization
#2
Robert L Lux
Ventricular repolarization and its manifestation in the T wave of the electrocardiogram have long been a focus of clinical and experimental electrocardiology. In this short article, we shall review the basics of cellular and organ repolarization electrophysiology, the classical and emerging methods of measuring global repolarization, and methodology that relates directly measured cardiac indices of repolarization to the body surface electrocardiogram.
July 12, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28793302/safety-of-adrenaline-use-in-anaphylaxis-a-multicentre-register
#3
Victòria Cardona, Laia Ferré-Ybarz, Mar Guilarte, Nuria Moreno-Pérez, Catalina Gómez-Galán, Eva Alcoceba-Borràs, Maria Belén Delavalle, Teresa Garriga-Baraut
BACKGROUND: The use of intramuscular adrenaline to treat anaphylaxis is suboptimal, despite being the first-line treatment recommended by national and international anaphylaxis guidelines. Fear of potentially severe side effects may be one of the underlying factors. The aim of this study was to assess the incidence and severity of adverse side effects after the use of adrenaline in anaphylaxis, as well as potential risk factors. METHODS: Observational study based on a multicenter online registry of cases of adrenaline administration for suspected anaphylaxis...
August 9, 2017: International Archives of Allergy and Immunology
https://www.readbyqxmd.com/read/28791782/predicting-short-term-risk-of-arrhythmia-among-patients-with-syncope-the-canadian-syncope-arrhythmia-risk-score
#4
Venkatesh Thiruganasambandamoorthy, Ian G Stiell, Marco L A Sivilotti, Brian H Rowe, Muhammad Mukarram, Kirtana Arcot, Kenneth Kwong, Andrew D McRae, George A Wells, Monica Taljaard
BACKGROUND: Syncope can be caused by serious occult arrhythmias not evident during initial emergency department (ED) evaluation. We sought to develop a risk-tool for predicting 30-day arrhythmia or death after ED disposition. METHODS: We conducted a multicenter prospective cohort study at six tertiary-care EDs and included adults (≥16 years) with syncope. We collected standardized variables from clinical evaluation, and investigations including ECG and troponin at index presentation...
August 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28774770/the-misleading-electrocardiogram-midventricular-takotsubo-masquerading-as-anterior-wall-stemi
#5
Sonal Pruthi, Semaan Kobrossi, Rajeev Bartaula, Debanik Chaudhuri
Midventricular Takotsubo cardiomyopathy (TC) is a relatively rare variant of stress induced cardiomyopathy, wherein there is akinesis of only the mid-ventricular segment with or without hyperkinesis of apical and basal ventricular segments. The ECG findings of TC typically do not include ST segment elevation in V1-V2 and are unlikely to be associated with reciprocal changes in inferior leads. The presence of these changes argues strongly in favor of anterior wall STEMI. In our patient, the ECG had changes strongly suggestive of STEMI, however had normal coronaries on cardiac catheterization...
July 27, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28765984/-acute-chest-pain
#6
REVIEW
M Möckel, T Störk
Patients presenting with acute chest pain are a challenge for attending physicians in private practice and specialists for emergency and acute medicine in hospitals because a wide spectrum of diagnoses may be the cause, ranging from acute myocardial infarction (AMI) to harmless muscular tension. The evaluation of patients with acute chest pain follows basic principles independent of the setting: A thorough clinical investigation by the responsible physician including medical history and physical examination, followed by a 12-channel electrocardiogram (ECG) and further focused diagnostics...
August 1, 2017: Der Internist
https://www.readbyqxmd.com/read/28757765/pulseless-electrical-activity-in-acute-massive-pulmonary-embolism-during-thrombolytic-therapy
#7
Han-Hua Yu, Jing-Ren Jeng
We report a case of acute pulmonary embolism with hemodynamic instability diagnosed by a computed tomography pulmonary angiogram. The patient developed pulseless electrical activity during systemic thrombolytic therapy with recombinant tissue plasminogen activator. Successful return of spontaneous circulation was achieved after immediate cardiopulmonary resuscitation with chest compressions for 6 min. His electrocardiogram (ECG) on arrival in the emergency department displayed sinus tachycardia, an S wave in lead I, a Q wave in lead III, incomplete right bundle branch block (RBBB), T-wave inversion (TWI) in leads V1-V3, ST elevation in leads aVR and V1, and ST depression in leads I, II, III, aVF, and V4-V6...
January 2017: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
https://www.readbyqxmd.com/read/28755998/loperamide-induced-torsades-de-pointes-a-case-series
#8
Kenneth D Katz, Robert D Cannon, Matthew D Cook, Alexandra Amaducci, Ryan Day, Joshua Enyart, Glenn Burket, Lauren Porter, Timothy Roach, Jennifer Janssen, Karl E Williams
Loperamide is an over-the-counter, inexpensive, antidiarrheal opioid that can produce life-threatening toxicity at high concentrations. CASE REPORT 1: A 28-year-old man with a history of depression and substance abuse disorder (SUD) presented to the emergency department (ED) with shortness of breath and lightheadedness. He ingested large amounts of loperamide daily. The patient's initial electrocardiogram (ECG) demonstrated sinus rhythm, right axis deviation, undetectable PR interval, QRS 168 ms, and QTc 693 ms...
July 26, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28751844/anmco-sit-consensus-document-telemedicine-for-cardiovascular-emergency-networks
#9
Pasquale Caldarola, Michele Massimo Gulizia, Domenico Gabrielli, Marco Sicuro, Luisa De Gennaro, Massimo Giammaria, Niccolò Brenno Grieco, Daniele Grosseto, Roberto Mantovan, Marco Mazzanti, Alberto Menotti, Natale Daniele Brunetti, Silva Severi, Giancarmine Russo, Gian Franco Gensini
Telemedicine has deeply innovated the field of emergency cardiology, particularly the treatment of acute myocardial infarction. The ability to record an ECG in the early prehospital phase, thus avoiding any delay in diagnosing myocardial infarction with direct transfer to the cath-lab for primary angioplasty, has proven to significantly reduce treatment times and mortality. This consensus document aims to analyse the available evidence and organizational models based on a support by telemedicine, focusing on technical requirements, education, and legal aspects...
May 2017: European Heart Journal Supplements: Journal of the European Society of Cardiology
https://www.readbyqxmd.com/read/28744962/inverse-estimation-of-cardiac-activation-times-via-gradient-based-optimisation
#10
Siri Kallhovd, Mary M Maleckar, Marie E Rognes
Computational modeling may provide a quantitative framework for integrating multi-scale data to gain insight into mechanisms of heart disease, identify and test pharmacological and electrical therapy and interventions, and support clinical decisions. Patient-specific computational cardiac models can help guide such procedures, and cardiac inverse modelling is a promising alternative to adequately personalize these models. Indeed, full cardiac inverse modelling is currently becoming computationally feasible; however, fundamental work to assess the feasibility of emerging techniques is still needed...
July 25, 2017: International Journal for Numerical Methods in Biomedical Engineering
https://www.readbyqxmd.com/read/28743479/integrating-heart-rate-variability-vital-signs-electrocardiogram-and-troponin-to-triage-chest-pain-patients-in-the-ed
#11
Jeffrey Tadashi Sakamoto, Nan Liu, Zhi Xiong Koh, Dagang Guo, Micah Liam Arthur Heldeweg, Janson Cheng Ji Ng, Marcus Eng Hock Ong
BACKGROUND: Current triage methods for chest pain patients typically utilize symptoms, electrocardiogram (ECG), and vital sign data, requiring interpretation by dedicated triage clinicians. In contrast, we aimed to create a quickly obtainable model integrating the objective parameters of heart rate variability (HRV), troponin, ECG, and vital signs to improve accuracy and efficiency of triage for chest pain patients in the emergency department (ED). METHODS: Adult patients presenting to the ED with chest pain from September 2010 to July 2015 were conveniently recruited...
July 17, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28742643/sensitive-troponin-i-and-stress-testing-in-the-emergency-department-for-the-early-management-of-chest-pain-using-2-hour-protocol
#12
Shahriar Dadkhah, Zakaria Almuwaqqat, Samian Sulaiman, Husein Husein, Quang Nguyen, Saad Ali, Tuncay Taskesen
BACKGROUND: Despite improvements in identifying high-risk patients with non-ST segment ACS (acute coronary syndrome), low risk patients presenting with atypical chest pain and non-diagnostic Electrocardiogram (ECG) continued to undergo unnecessary admissions and testing. Since 1992, our chest pain protocol included using 4-hour serial biomarkers from ED admission in combination with stress testing to evaluate these patients. Our study aimed at determining whether a new accelerated diagnostic protocol using sensitive cardiac troponin I (cTnI) 2 hours after admission to the ED followed by stress testing is safe and effective in emergency settings, allowing for appropriate triage, earlier discharge and reducing costs...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28739614/apical-ballooning-takotsubo-syndrome-with-concurrent-st-segment-elevation-myocardial-infarction
#13
Mohsin A Hussain, Andrew T Cox, Rachel Bastiaenen, Abhiram Prasad
We present the case of a 61-year-old woman admitted with chest pain and an ECG demonstrating ST-segment elevation in the lateral leads. Emergency coronary angiography demonstrated an occluded obtuse marginal branch. Percutaneous intervention was unsuccessful as the lesion could not be crossed with a wire. Left ventriculography and transthoracic echocardiography demonstrated hypokinesis of the entire apex but preserved contractility of the basal segments, consistent with a diagnosis of apical ballooning syndrome (ABS)...
July 24, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28731986/the-effect-of-sex-on-heart-rate-variability-at-high-altitude
#14
Christopher John Boos, Emma Vincent, Adrian Mellor, John O'Hara, Caroline Newman, Richard Cruttenden, Phylip Scott, Mark Cooke, Jamie Matu, David Richard Woods
There is evidence to suggest that high altitude (HA) exposure leads to a fall in heart rate variability (HRV) that is linked to the development of acute mountain sickness (AMS). The effects of sex on changes in HRV at HA and its relationship to AMS are unknown. METHODS: HRV (5-minute single lead ECG) was measured in 63 healthy adults (41 men and 22 women) aged 18-56 years at sea level (SL) and during a HA trek at 3619m, 4600m and 5140m respectively. The main effects of altitude (SL, 3619, 4600 and 5140m) and sex (men vs women) and their potential interaction were assessed using a Factorial Repeated Measures ANOVA...
July 20, 2017: Medicine and Science in Sports and Exercise
https://www.readbyqxmd.com/read/28719739/graphene-electronic-tattoo-sensors
#15
Shideh Kabiri Ameri, Rebecca Ho, Hongwoo Jang, Li Tao, Youhua Wang, Liu Wang, David M Schnyer, Deji Akinwande, Nanshu Lu
Tattoo-like epidermal sensors are an emerging class of truly wearable electronics, owing to their thinness and softness. While most of them are based on thin metal films, a silicon membrane, or nanoparticle-based printable inks, we report sub-micrometer thick, multimodal electronic tattoo sensors that are made of graphene. The graphene electronic tattoo (GET) is designed as filamentary serpentines and fabricated by a cost- and time-effective "wet transfer, dry patterning" method. It has a total thickness of 463 ± 30 nm, an optical transparency of ∼85%, and a stretchability of more than 40%...
July 27, 2017: ACS Nano
https://www.readbyqxmd.com/read/28719614/beat-id-towards-a-computationally-low-cost-single-heartbeat-biometric-identity-check-system-based-on-electrocardiogram-wave-morphology
#16
Joana S Paiva, Duarte Dias, João P S Cunha
In recent years, safer and more reliable biometric methods have been developed. Apart from the need for enhanced security, the media and entertainment sectors have also been applying biometrics in the emerging market of user-adaptable objects/systems to make these systems more user-friendly. However, the complexity of some state-of-the-art biometric systems (e.g., iris recognition) or their high false rejection rate (e.g., fingerprint recognition) is neither compatible with the simple hardware architecture required by reduced-size devices nor the new trend of implementing smart objects within the dynamic market of the Internet of Things (IoT)...
2017: PloS One
https://www.readbyqxmd.com/read/28712527/clinical-presentation-to-the-emergency-department-predicts-subarachnoid-hemorrhage-associated-myocardial-injury
#17
Khalil M Yousef, Elizabeth Crago, Theodore F Lagattuta, Marilyn Hravnak
INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH) is frequently seen in emergency departments. Secondary injury, such as subarachnoid hemorrhage-associated myocardial injury (SAHMI), affects one third of survivors and contributes to poor outcomes. SAHMI is not attributed to ischemia from myocardial disease but can result in hypotension and arrhythmias. It is important that emergency nurses recognize which clinical presentation characteristics are predictive of SAHMI to initiate proper interventions...
July 13, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28710236/complement-factor-b-mutation-associated-ahus-and-myocardial-infarction
#18
Natália Noronha, Filipa Dias Costa, Andrea Dias, Alexandra Dinis
A 6-month-old female infant was referred with a 3-day history of low-grade fever, slight nasal congestion and rhinorrhoea. On admission, the clinical findings were unremarkable and she was discharged home. However, she became progressively more listless with a decreased urine output and was once again seen in the emergency department. Analytically she was found to have metabolic acidosis, hyperkalaemia, thrombocytopaenia, anaemia and schistocytes in the peripheral blood smear. Based on these findings, the diagnosis of haemolyticâ-uremic syndrome was made...
July 14, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28702812/characterisation-of-human-av-nodal-properties-using-a-network-model
#19
Mikael Wallman, Frida Sandberg
Characterisation of the AV-node is an important step in determining the optimal form of treatment for supraventricular tachycardias. To integrate and analyse patient-specific measurements, mathematical modelling has emerged as a valuable tool. Here we present a model of the human AV-node, consisting of a series of interacting nodes, each with separate dynamics in refractory time and conduction delay. The model is evaluated in several scenarios, including atrial fibrillation (AF) and clinical pacing, using simulated and measured data...
July 13, 2017: Medical & Biological Engineering & Computing
https://www.readbyqxmd.com/read/28701321/pituitary-adenylate-cyclase-activating-polypeptide-pacap-drives-cardiorespiratory-responses-to-heat-stress-in-neonatal-mice
#20
Karlene T Barrett, John Andrew Daubenspeck, Richard J A Wilson
The neuropeptide, pituitary adenylate cyclase-activating polypeptide (PACAP), has emerged as a principal and rate-limiting regulator of physiological stress responses in adult rodents and has been implicated in SIDS (Sudden Infant Death Syndrome). Recent studies show that PACAP plays a role in neonatal cardiorespiratory responses to hypoxia, hypercapnia and hypothermia, but not hyperthermia, which is often associated with SIDS. Here we tested the hypothesis that, consistent with a role in SIDS, PACAP is involved in regulating the neonatal cardiorespiratory responses to severe heat...
July 12, 2017: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
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