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Editorial

Simplified Algorithm for Differential Diagnosis of Tachycardias with Wide QRS. Is this the Best Way to Train Young Doctors?

To make the correct diagnosis of ventricular tachycardia in an emergency room (ER), with little time for decision-making and based only on the electrocardiogram is a challenge that depends on a lot of preparation by the doctor. Any instrument that facilitates and streamlines this process, especially increasing the degree of accuracy, is also worthy of praise, especially considering that the physician on duty is not always a cardiologist, or even less likely an arrhythmologist, sufficiently trained to make an accurate diagnosis.

An episode of ventricular tachycardia, supraventricular tachycardia (in a patient with a previous conduction disorder or with a conduction aberrancy) and supraventricular tachycardia caused by anomalous bundles may show similar electrocardiographic tracings, which are sometimes very difficult to differentiate, making the medical decision a risk to the patient’s life. To make this differentiation possible, several algorithms have been created that use electrocardiographic signals to assist and allow the correct diagnosis to be made and, consequently, to establish the adequate treatment, as in the case of the Brugada algorithm which is widely known (and that in fact is a combination of Brugada and Wellens criteria), as well as Vereckei and Pava criteria among others. All the created algorithms have sensitivity and specificity (S/E) variables that make them more or less accurate; however, in the same proportion, these algorithms can be simpler, or more complex (depending on the operator’s better training and greater time to reach the diagnosis).

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Original Article

Independent Predictors of Late Presentation in Patients with ST-Segment Elevation Myocardial Infarction

Juliane Araujo Rodrigues et al. Karina Melleu Márcia Moura Schmidt Carlos Antonio Mascia Gottschall … Maria Antonieta Pereira de Moraes Alexandre Schaan de Quadros

Abstract

Background:

In patients with acute ST-segment elevation myocardial infarction (STEMI), the time elapsed from symptom onset to receiving medical care is one of the main mortality predictors.

Objective:

To identify independent predictors of late presentation in patients STEMI representative of daily clinical practice.

Methods:

All patients admitted with a diagnosis of STEMI in a reference center between December 2009 and November 2014 were evaluated and prospectively followed during hospitalization and for 30 days after discharge. Late presentation was defined as a time interval > 6 hours from chest pain onset until hospital arrival. Multiple logistic regression analysis was used to identify independent predictors of late presentation. Values of p < 0.05 were considered statistically significant.

Results:

A total of 1,297 patients were included, with a mean age of 60.7 ± 11.6 years, of which 71% were males, 85% Caucasians, 72% had a mean income lower than five minimum wages and 66% had systemic arterial hypertension. The median time of clinical presentation was 3.00 [1.40-5.48] hours, and approximately one-quarter of the patients had a late presentation, with their mortality being significantly higher. The independent predictors of late presentation were Black ethnicity, low income and diabetes mellitus, and a history of previous heart disease was a protective factor.

Conclusion:

Black ethnicity, low income and diabetes mellitus are independent predictors of late presentation in STEMI. The identification of subgroups of patients prone to late presentation may help to stimulate prevention policies for these high-risk individuals.

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Artigo Original

Emergency service admission time and in-hospital mortality in acute coronary syndrome

Julio Yoshio Takada et al. Larissa Cardoso Roza Rogério Bicudo Ramos Solange Desiree Avakian … José Antonio Franchini Ramires Antonio de Pádua Mansur

BACKGROUND: The relationship between admission time to an emergency service and in-hospital outcomes in acute coronary syndrome (ACS) is controversial. Admission during off-hours would be associated with worse prognosis. OBJECTIVE: To assess the influence of admission time on prolonged hospitalization and mortality for ACS patients, regarding regular hours (7AM-7PM) and off-hours (7PM-7AM). METHODS: The study assessed prospectively 1,104 consecutive ACS patients. In-hospital mortality and length of hospital stay > 5 days were the outcomes analyzed. RESULTS: Admission during regular hours was greater as compared with that during off-hours (63% vs. 37%; p < 0.001). Unstable angina was more prevalent during regular hours (43% vs. 32%; p 5 days were as follows: age [OR 1.042 (95%CI: 1.025 – 1.058), p < 0.001]; ejection fraction (EF) [OR 0.977 (95%CI: 0.966 – 0.988), p < 0.001]; NSTEMI [OR 1.699 (95%CI: 1.221 – 2.366), p = 0.001]; and smoking [OR 1.723 (95%CI: 1.113 – 2.668), p = 0.014]. Predictive factors for in-hospital mortality were as follows: age [OR 1.090 (95%CI: 1.047 – 1.134), p < 0.001]; EF [OR 0.936 (95%CI: 0.909 – 0.964), p < 0.001]; and surgical treatment [OR 3.781 (95%CI: 1.374 – 10.409), p = 0.01]. CONCLUSION: Prolonged length of hospital stay and in-hospital mortality in ACS patients do not depend on admission time.

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Simplified Algorithm for Differential Diagnosis of Tachycardias with Wide QRS. Is this the Best Way to Train Young Doctors?

Independent Predictors of Late Presentation in Patients with ST-Segment Elevation Myocardial Infarction

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Emergency service admission time and in-hospital mortality in acute coronary syndrome

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