Shared care – current aspects
Peter Edwards, Stephen Jones, Dennis Shale, Mark Thursz in Shared Care, 2018
In the field of ischaemic heart disease, a 1991 report discussed guidelines and a new request form that were provided by a group of cardiologists to facilitate the provision of an open access exercise electrocardiography service. In a 1994 survey substantial variation was found to exist in the design and operation of shared care schemes for the management of chronic diseases such as diabetes. The larger schemes with more than 1000 patients were for thyroid disease, rheumatoid arthritis, diabetes, hypertension and drug use. Waiting times at outreach clinics tend to be shorter, and managers accept that patients benefit because of ease of access. It is hoped that the DIALECTS project will help to develop the infrastructure which will in time help clarify some of the problems, with the ultimate goal of optimal care for diabetic patients. The main product – the improvement of diabetic care – was an outcome that would need clinical evaluation over a period of time.
Exercise testing patients with cardiovascular disease
Robert B. Schoene, H. Thomas Robertson in Making Sense of Exercise Testing, 2018
The first diagnostic clinical application of a progressive work exercise test used 12-lead electrocardiography (ECG) measurements to detect coronary artery disease. Diagnostic exercise electrocardiography remains an essential part of a cardiopulmonary exercise test (CPET), although primarily as a safety measure to detect exercise-associated rhythm abnormalities or ischemia. The chapter discusses the following: diagnostic exercise ECG, exercise-associated rhythm abnormalities, patterns of cardiac response in heart failure patients, patterns of ventilation response in heart failure patients, risk stratification based on CPET findings and exercise-associated autonomic abnormalities. The ECG criterion for exercise-induced ischemia with the best balance between sensitivity and specificity is the development of at least a 1-mm horizontal or downsloping ST segment during or after exercise and persistence of that depression during the exercise recovery period. The most common CPET manifestation of postural orthostasis tachycardia syndrome is a failure to increase systolic pressure with maximal exercise effort.
Heart Rate Variability Analysis in Frequency Domain
Mesut Sahin, Howard Fidel, Raquel Perez-Castillejos in Instrumentation Handbook for Biomedical Engineers, 2020
The twentieth century, with the generalized use of electrocardiography (ECG or EKG) in clinical settings, marked the start of the quest to unravel the relationship between heart rate variability (HRV) and disease. The details of the physiological basis of HRV remain an open question and are the subject of intensive research. A number of parameters have been defined to analyze HRV and they can be organized into two main categories: time-domain and frequency-domain parameters. The variability of the heart rate can also be expressed in terms of frequency such that rapid (or slow) changes in heart rate are described by high (or low) frequencies. The study of HRV requires equipment that is capable of recording the heartbeat continuously for some periods of time (for example, detection of very low frequency in HRV requires recordings of at least 24 h) and without causing distress to the subject under study.
Dancers’ heart: Cardiac screening in elite dancers
Published in European Journal of Sport Science, 2020
George S. Metsios, Matthew Wyon, Kiran Patel, Nick Allen, Yiannis Koutedakis
Using electrocardiography and echocardiography, we screened elite men and women ballet dancers for abnormal cardiovascular conditions using an observation design with blinded clinical analysis of cardiac function tests. Fifty-eight (females n = 33) elite professional ballet dancers (age: 26.0 ± 5.7 years, body mass index: 19.9 ± 2.2 kg/m2) with no past or present history of cardiovascular disease volunteered. Participants were assessed via a 12-lead electrocardiography and two-dimensional echocardiography for cardiac function. Electrocardiography revealed that 83% of the dancers demonstrated normal axis, while 31% had incomplete right bundle branch block and 17% had sinus bradycardia; none showed any abnormal findings. Findings from the echocardiography were also normal for all participants and comparable to their counterparts in other sports. Significant differences (p < 0.05) were detected in almost all studied echocardiographic parameters between males and females. In conclusion, heart function and structure seem to be normal in elite ballet dancers, placing them at low risk for sudden cardiac death and performance-related cardiovascular complications. Larger samples are required to confirm these findings.
Electrocardiographic Findings in Bovine Leukosis: A Case Report
Published in Journal of Applied Animal Research, 1995
Mateos Gabriela, Sumano Héctor, Ramirez Jose, Yabuta Adolfo Kunio
Mateos, T.G., Sumano, L.H., Ramirez, L.J. and Yabuta, O.A.K. 1995. Electrocardiographic findings in bovine leucosis: A case report. J. Appl. Anim. Res., 7: 183–187. Electrocardiography is being steadily incorporated in clinical work with cattle. Four monthly electrocardiograms (ECG) were taken in a cow early in the course of a case, later diagnosed as bovine leukosis. A steady disarrangement of the ECG was observed but no relationship could be found of any changes with earlier reports. Neverthless, a dear involvement of the heart in this case of bovine leukosis could have offered a clue for a faster diagnosis. The use of electrocardiography under regular basis in the cattle is advocated.
Recurrent takotsubo syndrome in a patient with myotonic dystrophy 1
Published in Acute Cardiac Care, 2014
Josef Finsterer, Claudia Stöllberger, Dita Demirtas, Martin Gencik, Irene Ohnutek, Anette Hornykewycz
Objectives: Stress-induced cardiomyopathy (takotsubo-syndrome, TTS) and its recurrence have not been described in myotonic dystrophy-1. Case report: The patient was a 47-year-old female who was suspected to suffer from myotonic dystrophy-1 at 20 years of age, upon the typical clinical presentation and the electrophysiological findings. During weaning from general anesthesia for resectioning of a pelvic tumour she developed ventricular fibrillation, but was successfully resuscitated. During coronary angiography two days later she experienced recurrent QT-prolongation, torsades de pointes, and ventricular fibrillation, but was successfully resuscitated again each time. Echocardiography and electrocardiography were indicative of TTS, which was confirmed by normal findings on echocardiography and electrocardiography two months later. Ten months after the first TTS she developed dyspnea, leg edema, and anginal chest pain. Recurrence of TTS was diagnosed upon a typical electrocardiography and echocardiography findings. Shortly after onset of the second TTS, she unexpectedly died from sepsis. Conclusions: TTS may also occur in patients with myotonic dystrophy-1 induced by stress from surgery, respiratory insufficiency, or infection. In patients with myotonic dystrophy-1, takotsubo-syndrome may recur and may represent a previously unreported feature of cardiac involvement in myotonic dystrophy-1.
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