Electrocardiography/methods

IJCS

Original Article

Electrocardiogram as Part of the Evaluation of Children and Adolescents Before Starting Physical Exercise

Diego Lineker Marquetto Silva et al. Rossano Cesar Bonatto Celia de Paula Pimenta Bonatto Carlos Roberto Padovani José Roberto Fioretto

Abstract

Background:

Children and adolescents should be encouraged to participate in sports; however, physicians should screen for cardiac abnormalities that can lead to sudden death. The European Society of Cardiology, the Brazilian Society of Cardiology and the Brazilian Society of Sports Medicine indicate performing an electrocardiogram (ECG) in evaluating athletes, while the American Heart Association indicates complementary exams only when there is a personal or family history of cardiovascular diseases or changes in clinical examination.

Objectives:

To evaluate the need for an ECG in evaluating children and adolescents before starting physical activities.

Methods:

We recruited 983 children and adolescents who practiced physical activities for anthropometric assessment, clinical examination and conventional ECG at rest. Variables were analysed using the Goodman test with a significance level of 5%.

Results:

Participants had a higher incidence of overweight, obesity and severe obesity compared to standard World Health Organization (WHO) values. The most common finding in clinical examination was heart murmur (18.5% of participants). Electrocardiographic changes were found in 3.3% of participants, including paroxysmal supraventricular tachycardia and pre-excitation syndrome, which may be responsible for sudden death, even in asymptomatic individuals with no personal or family history of heart disease and no abnormality on clinical examination.

Conclusions:

ECG revealed arrhythmias that were not detected by clinical examination and may precede sudden death in individuals subjected to physical exertion, indicating its role in the assessment of children and adolescents before starting regular physical exercise.

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IJCS

Editorial

Cardiotrophin-1 in Patients with Acute Coronary Syndromes: Does it Have a Role?

Humberto Villacorta

Acute coronary syndromes are among the most common diagnoses in the emergency department (ED). It has been estimated that 300,000 to 400,000 cases are seen each year in Brazil. The diagnosis of acute myocardial infarction (AMI) is made on the basis of symptoms, electrocardiogram, and biological markers of myocardial necrosis. Troponins are the most specific cardiac markers, and in the era of highly sensitive assays, they have been shown to make the exclusion of AMI in the ED more rapid, being particularly helpful in patients with atypical presentations.

Cardiotrophin-1 (CT-1) is a member of the interleukin-6 superfamily of proinflammatory cytokines. It is expressed in many tissues, including heart and vessels. CT-1 is upregulated in cardiac fibroblasts and cardiomyocytes in response to mechanical, humoral, metabolic, and hypoxic stress (). It is elevated in the myocardium and plasma of heart failure (HF) patients and has also been associated with hypertension, diabetes, cardiac hypertrophy, and fibrosis, both in patients and experimental studies., CT-1 is expressed after an AMI and seems to be involved in the healing and remodeling process that occurs after myocardial infarction., In the study by Freed et al., CT-1 was able to initiate each of the processes related to scar formation, including fibroblast migration and proliferation, and collagen synthesis.

[…]

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IJCS

Editorial

Relevance of Animal Models and Echocardiogram for Hypertensive Disease Studies

Karyne Pollo de Souza et al. Christianne Brêtas Viera Scaramello

Hypertension is the main risk factor for the development of cardiovascular diseases, such as cerebrovascular and ischemic heart diseases, as well as for premature death worldwide. The prevalence of this condition was about 30% in low-, middle- and high-income countries in 2010. Cardiovascular pharmacotherapy and lifestyle changes constitute important measures to manage cardiovascular diseases, and the reduction of blood pressure is a fundamental strategy to prevent and treat them. Systemic arterial hypertension is a clinical multifactorial condition. The underlying mechanisms of hypertensive disease are complex, which is why it is essential to elucidate them. Many animal models of hypertension can serve this purpose, most of which were developed considering the probable causes of this condition, such as high salt intake and renin-angiotensin-aldosterone system overactivity. It is important that each model exploit a single pathway to hypertension development.

Spontaneously hypertensive rats (SHR) are genetically modified animals commonly chosen for several studies, including antihypertensive drugs screening. They provide an inexpensive experimental model and have a hypertensive phenotype similar to human patients. There are also endocrine models of hypertension, including the administration of deoxycorticosterone acetate (plus salt) and N-ω-nitro-L-arginine methyl- ester (L-NAME). According to the literature, both SHR and L-NAME models are related to sympathetic overactivity.^,

[…]

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IJCS

Original Article

Analysis of Conduction Intervals in Normal Electrophysiological Studies: Establishment of Reference Values the Brazilian Population

Tiago Luiz Luz Leiria et al. Catarine Benta Lopes dos Santos Roberto Tofani Sant'anna Julia Santana Trombetta … Gabriela Osterkamp Marcelo Lapa Kruse Leonardo Martins Pires Gustavo Glotz Lima

Abstract

Background

In the investigation of cardiac rhythm disorders, a normal electrophysiological (EPS) study is associated with a favorable prognosis. One of the normality criteria is established by conduction intervals within expected range.

Objective

To establish reference values in EPS for the intracavitary conduction intervals (PA, AH and HV) in a Brazilian population.

Methods

A retrospective cohort study of the first 1,500 patients submitted to EPS ablation was performed at Instituto de Cardiologia do Rio Grande do Sul, Brazil. The EPS was considered normal if the test was performed for diagnostic purpose; absence of induced arrhythmias; and conduction intervals within the expected range. The REDCap software was used for data collection and management, and the SPSS Statistics 22.0 used for data analysis. Continuous variables were compared with Student’s t-test for independent samples and categorical variables with the chi-square test (X ² ). Values of p ≤ 0.05 were considered significant.

Results

A total of 124 (8.3%) with EPS considered normal were included; mean age was 52 ± 21 years, and 63 were male. The mean values in milliseconds of PA, AH and HV were 23 ± 9, 88 ± 25 and 44 ± 7, respectively. The PA, AH, and HV percentile ranges were 13 – 25, 81-107 and 40 – 52, respectively. When the patients were divided into three age groups (1 to 18 years, 19 to 64 years and 65 or more), we observed that the group of older patients had significantly higher values of PA, AH and HV compared with younger patients.

Conclusion

This study showed that intracavitary conduction intervals in a sample of the Brazilian population were similar to previously published studies. Elderly patients tend to have higher values of intracavitary conduction intervals in EPS. Future studies including broader age ranges could enable the acquisition of more reliable and reproducible reference values. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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IJCS

Original Article

Electrocardiographic Abnormalities in Hypertension Models

Ana Gabriela Conceição-Vertamatti et al. Filipy Borghi Larissa Yuri Ishizu Gustavo Trevisan Costa … Luiz Alberto Ramos Miguel Arcanjo Areas Dora Maria Grassi-Kassisse

Abstract

Background:

Hypertensive condition can lead to abnormalities in heart structure and electrical activity. The electrocardiogram (ECG) is a recording of the electrical activity of the heart and widely used to diagnose and detect heart problem.

Objective:

We conducted a comparative ECG analysis between two hypertension models (L-NAME and SHR) and their controls (Wistar and Wistar-Kyoto) at six and 15 ^th week of age.

Methods:

Blood pressure was measured at the end of the 15 ^th week, and electrocardiography was performed at six and 15 weeks of age in anaesthetized rats. Data normality was confirmed by Kolmogorov-Smirnov test followed by unpaired Student’s t-test and the Mann-Whitney for parametric and non-parametric data, respectively. Results are expressed as mean ± SD. The accepted level of significance was set at p < 0.05.

Results:

L-NAME exhibited prolongation of JT and QT intervals and SHR showed a decrease in heart rate when compared to Wistar-Kyoto and L-NAME. Wistar-Kyoto exhibited short PR interval with increased QRS complex, and only QT prolongation at 15 weeks compared to Wistar.

Conclusions:

All the hypertension models used in this study featured an increase in blood pressure. However, while SHR showed cardiac dysfunction, L-NAME exhibited changes in ventricular performance. These results may guide future studies on different types and models of hypertension.

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IJCS

Case Report

Complete Resolution of Electrocardiographic Changes Induced by Acute Chagas Myocarditis

Joseane Elza Tonussi Mendes Rossette do Valle et al. Luiz Carlos de Abreu Raimundo Barbosa Barros Rodrigo Daminello Raimundo … Andrés Ricardo Pérez Riera Isabel Sorpreso

Abstract

We present a case of a female adolescent with severe acute Chagas myocarditis, acquired by oral transmission in an endemic area in the Brazilian western Amazon, who had electrocardiographic changes normalized after empirical treatment with the antiparasitic drug benznidazole combined with conventional treatment for severe heart failure.

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IJCS

Original Article

Telecardiology on the Diagnostic Support of Chest Pain in Twenty-Two Emergency Care Units (UPA 24h) in The State of Rio de Janeiro

Simone Farah et al. Bruno Rustum Andréa Rogério Casemiro da Silva Alexandra Monteiro

Abstract

Background:

Telecardiology may be a useful support in diagnosis and management of chest pain.

Objective:

Evaluate the application of telecardiology to support the differential diagnosis of chest pain in patients admitted to Emergency Care Units.

Method:

Observational, retrospective and documental study of 5,816 patients admitted with supposedly cardiological chest pain in twenty two Emergency Care Units in the state of Rio de Janeiro. Data were tabulated and analyzed by Excel^® software, using simple descriptive statistics, from the database of the Cardiology Consultancy Nucleus.

Results:

Diagnostic disagreement was found in 1,593 (27.39%) cases. Of these, 1,477 (92.72%) were diagnosed locally as non-ST-elevation myocardial infarction (non-STEMI), 74 (4.64%) as acute myocardial infarction with ST-segment elevation (STEMI), 40 (2.52%) as acute pulmonary edema (APE) and 2 (0.12%) as tachyarrhythmia. Intensive care referral was requested to 100% of these patients. After telecardiology, the diagnoses were: 385 (24.17%) unstable angina, 289 (18.14%) congestive heart failure, 212 (13.31%) APE, 174 (10.92%) STEMI, 152 (9.54%) hypertensive emergency, 113 (7.09%) acute chronic renal failure, 89 (5.59%) non-STEMI, 89 (5.59%) pneumonia, 39 (2.45%) sepsis, 26 (1.63 %) myopericarditis, 20 (1.26%) tachyarrhythmia and 5 (0.31%) orovalvar disease. The outcome after telecardiology was 1,178 discharges (73.94%), 338 (21.21%) referrals, 62 (3.90%) deaths and 15 (0.95%) unknown.

Conclusion:

Telecardiology was effective in chest pain diagnosis and management, optimizing hospital admission in the public health system.

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