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Purpose of Review: The risk of cardiovascular complications due to SARS-CoV-2 are significantly increased within the first 6 months of the infection. Patients with COVID-19 have an increased risk of death, and there is evidence that many may experience a wide range of post-acute cardiovascular complications. Our work aims to provide an update on current clinical aspects of diagnosis and treatment of cardiovascular manifestations during acute and long-term COVID-19. Recent Findings: SARS-CoV-2 has been shown to be associated with increased incidence of cardiovascular complications such as myocardial injury, heart failure, and dysrhythmias, as well as coagulation abnormalities not only during the acute phase but also beyond the first 30 days of the infection, associated with high mortality and poor outcomes. Cardiovascular complications during long-COVID-19 were found regardless of comorbidities such as age, hypertension, and diabetes; nevertheless, these populations remain at high risk for the worst outcomes during post-acute COVID-19. Emphasis should be given to the management of these patients. Treatment with low-dose oral propranolol, a beta blocker, for heart rate management may be considered, since it was found to significantly attenuate tachycardia and improve symptoms in postural tachycardia syndrome, while for patients on ACE inhibitors or angiotensin-receptor blockers (ARBs), under no circumstances should these medications be withdrawn. In addition, in patients at high risk after hospitalization due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days improved clinical outcomes compared with no extended thromboprophylaxis. Summary: In this work we provide a comprehensive review on acute and post-acute COVID-19 cardiovascular complications, symptomatology, and pathophysiology mechanisms. We also discuss therapeutic strategies for these patients during acute and long-term care and highlight populations at risk. Our findings suggest that older patients with risk factors such as hypertension, diabetes, and medical history of vascular disease have worse outcomes during acute SARS-CoV-2 infection and are more likely to develop cardiovascular complications during long-COVID-19. [ABSTRACT FROM AUTHOR]

Multifocal atrial tachycardia (MAT) is an arrhythmia frequently seen in the elderly whose prevalence increases with aging. These arrhythmias may eventually lead to more chaotic arrhythmias such as atrial fibrillation (AF) and flutter. MAT is frequently mistaken for AF in electrocardiogram (ECG). The importance of differentiating MAT from AF is that the former requires no anticoagulation and, therefore, avoids the risks associated with their administration. It is also important to realize that the elderly have multiple conditions such as senile tremors and Parkinson's disease which may cause mechanical movement artifacts in resting ECGs mimicking cardiac arrhythmias leading to incorrect interpretation of ECGs. Educating physicians about the electrocardiographic appearance of atrial dysrhythmias and the recognition of the confounding artifacts can prevent unnecessary use of treatment which could potentially cause adverse effects in the patient.

Objective: To compare the effectiveness of combining Magnesium Sulphate with Amiodarone vs Magnesium Sulphate to prevent cardiac arrhythmias in Coronary Artery Bypass Grafting (CABG) patients. Study Design: Quasi-Experimental Study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan, from Jul 2022 to Mar 2023. Methodology: Two hundred and sixty-two (n=262) Coronary Artery Bypass Graft patients, eligible for the study, were enrolled through consecutive sampling and divided into group A - experiment group (3 mg/kg amiodarone+30 mg/kg magnesium sulphate was given, n1=131) and group B- control group (30 mg/kg magnesium sulphate was given, n2=131) by non-random allocation lottery method at the removal of the aortic cross-clamp. The statistical package for social science, SPSS version 26:00 was used to analyse the data. Mean±SD was calculated for continuous variables whereas for categorical variables, percentages and frequencies were calculated. Chi-square test was utilized to find the association and student t-test was applied to find the mean difference between the study groups. Results: Study participants consisted of 194(74.1%) males and 68(26.0%) females. The patients' mean age was 57.29±9.88 years and 58.30±10.69 years respectively, in group-A and group-B. The frequency of pre and post-operative cardiac dysrhythmias was considerably different in both groups. In group-A, 22(16.7%) patients developed dysrhythmias, while in control group,dysrhythmias occurred in 49 (37.4%) patients (p-value

Audience: This scenario was developed to educate emergency medicine residents on the diagnosis and management of ventricular tachycardia (VT) that is refractory to single dose anti-arrhythmic management. Background: Electrical storm, defined as three or more episodes of sustained VT, ventricular fibrillation, or appropriate shocks from an implantable cardioverter defibrillator within 24 hours,1 has a mortality rate up to 14% in the first 48 hours.2 Ventricular tachycardia may present in a heterogenous fashion, not only with stable versus unstable clinical presentations, but also with different electrocardiographic morphologies and etiologies.1 Understanding how to rapidly diagnose, treat, and utilize second or third-line treatments is vital in the setting of refractory ventricular tachycardia rather than relying on the success of first-line agents. Appreciation for what medications are readily available in your crash cart and medication dispensing cabinet is critical for timely management for refractory ventricular tachycardia. Educational Objectives: At the conclusion of the simulation session, learners will be able to: 1) identify the different etiologies of VT, including structural heart disease, acute ischemia, and acquired or congenital QT syndrome; 2) describe confounding factors of VT, such as electrolyte abnormalities and sympathetic surge; 3) describe how to troubleshoot an unsuccessful synchronized cardioversion, including checking equipment connections, increasing delivered energy, and changing pad placement; 4) compare and contrast treatments of VT based on suspected underlying etiology; 5) describe reasons to activate the cardiac catheterization lab other than occlusive myocardial infarction; and 6) identify appropriate disposition of the patient to the cardiac catheterization lab. Educational Methods: This session was conducted using high-fidelity simulation, followed by a debriefing session and lecture on the diagnosis, differential diagnosis, and management of VT. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. This scenario may also be run as an oral board case. Research Methods: Our residents are provided a survey at the completion of the debriefing session so they may rate different aspects of the simulation, as well as provide qualitative feedback on the scenario. Results: The local institution's simulation center's electronic feedback form is based on the Center of Medical Simulation's Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form3 with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7. Twelve learners completed a feedback form. This session received 6 and 7 scores (consistently effective/very good and extremely effective/outstanding, respectively) other than three isolated 5 scores. The lowest average score was 6.67 for Before the simulation, the instructor set the stage for an engaging learning experience. The highest average score was 7 for The instructor helped me see how to improve or how to sustain good performance. The form also includes an area for general feedback about the case at the end. Illustrative examples of feedback include: Excellent care and debrief. Specific scores are available upon request. Discussion: This is a cost-effective method for reviewing VT diagnosis and management. The case may be modified for appropriate audiences, such as describing what medications may be readily available in a freestanding emergency department or pre-hospital setting. [ABSTRACT FROM AUTHOR]

Multifocal atrial tachycardia (MAT) is an arrhythmia frequently seen in the elderly whose prevalence increases with aging. These arrhythmias may eventually lead to more chaotic arrhythmias such as atrial fibrillation (AF) and flutter. MAT is frequently mistaken for AF in electrocardiogram (ECG). The importance of differentiating MAT from AF is that the former requires no anticoagulation and, therefore, avoids the risks associated with their administration. It is also important to realize that the elderly have multiple conditions such as senile tremors and Parkinson's disease which may cause mechanical movement artifacts in resting ECGs mimicking cardiac arrhythmias leading to incorrect interpretation of ECGs. Educating physicians about the electrocardiographic appearance of atrial dysrhythmias and the recognition of the confounding artifacts can prevent unnecessary use of treatment which could potentially cause adverse effects in the patient. [ABSTRACT FROM AUTHOR]

Bupropion toxicity can cause cardiogenic shock, ventricular dysrhythmias, and death. Clinical and electrocardiographic factors associated with adverse cardiovascular events in bupropion toxicity have not been well-studied. This study aimed to identify factors associated with adverse cardiovascular events in adult patients with isolated bupropion exposures. This retrospective cohort study queried the National Poison Data System from 2019 through 2020. We included patients 20 years or older with acute or acute-on-chronic single-agent bupropion exposures evaluated in a healthcare facility. Exclusion criteria were confirmed non-exposure, withdrawal as a reason for exposure, lack of follow-up, documentation that exposure was probably not responsible for the effects, and missing data. The primary outcome was adverse cardiovascular events, defined as the presence of any of the following: vasopressor use, ventricular dysrhythmia, myocardial injury, or cardiac arrest. Independent variables were age, the intentionality of exposure, seizures, tachycardia, QRS widening, and QTc prolongation. Multivariable logistic regression was performed to test for independent associations between independent variables and adverse cardiovascular events. Of 4,640 patients included in the final analysis (56.7% female, 56.5% suspected suicidal intent), 68 (1.47%) experienced an adverse cardiovascular event. Age (odds ratio 1.03; 95% confidence intervals 1.02–1.05), single seizure (odds ratio 9.18; 95% confidence intervals 4.24–19.9) and complicated seizures (odds ratio 38.9; 95% confidence intervals 19.3–78.1), QRS widening (odds ratio 3.01; 95% confidence intervals 1.62–5.59), and QTc prolongation (odds ratio 1.76; 95% confidence intervals 1.00–3.10) were independently associated with adverse cardiovascular events. No patients with unintentional exposure experienced adverse cardiovascular events, prohibiting intentionality from inclusion in the regression model. In the post hoc subgroup analysis of intentional exposures, age, single and complicated seizures, and QRS widening remained independently associated with adverse cardiovascular events. Increasing age, seizures, QRS widening, and QTc prolongation were associated with adverse cardiovascular events in bupropion exposures. Adverse cardiovascular events did not occur in unintentional exposures. Further research is needed to develop screening tools and treatments for bupropion cardiotoxicity. [ABSTRACT FROM AUTHOR]

(1) Background: Long COVID syndrome is a significant cause of morbidity in COVID-19 patients who remain symptomatic with varied clinical presentations beyond three weeks. Furthermore, the relevance of considering cardiovascular outcomes in post-COVID-19 syndrome is important in the current COVID-19 pandemic; (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this systematic review and meta-analysis. Systematic searches were conducted from multiple databases without language restrictions until October 8, 2022, to find studies evaluating cardiovascular outcomes such as arrhythmias, myocardium and pericardium diseases, coronary vessel disease, and thromboembolic disorders in post-COVID cases. The pooled odds ratio (OR), and standard mean difference (SMD) with their corresponding 95% confidence intervals (CI) were computed to find the association; (3) Results: Altogether, seven studies with a total of 8,126,462 (cases: 1,321,305; controls: 6,805,157) participants were included in the meta-analysis. Pooled odds ratios of cardiovascular outcomes were significantly higher in post-COVID cases (OR > 1, p < 0.05) than in controls. However, the mortality (OR: 4.76, p = 0.13), and heart rate variability (SMD: −0.06, p = 0.91) between cases and controls were not statistically significant; (4) Conclusions: Significant cardiovascular sequelae in long COVID syndrome highlight the importance of careful cardiac monitoring of COVID-19 patients in the post-COVID phase to address cardiovascular complications as soon as possible; larger-scale prospective studies are required for accurate estimation. [ABSTRACT FROM AUTHOR]

Cardiovascular events continue to be the leading cause of acute, on-duty deaths for firefighters. Conducted in a hazardous environment, firefighting imposes a unique physiological strain on the body. The high cardiovascular strain of firefighting leads to increased risk for cardiac events, espe)cially among individuals with underlying cardiovascular disease (CVD). The COVID-19 pandemic has added an additional concern about cardiac events in the fire service. Emerging evidence shows increased risk for cardiovascular conditions, even after acute infection has resolved. The fire service needs to be aware of this post-COVID-19 risk to avert unnecessary cardiac injury and fatalities. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 is the virus that causes COVID-19 and COVID pneumonia and is known to cause cardiovascular abnormalities with electrocardiogram (ECG) disturbances in affected patients. A 47-year-old male patient presented to the emergency department (ED) for the management of COVID-like symptoms. Initial diagnostics included an ECG, which showed significant rhythm changes. Progression of COVID-19 disease compounds myocardial injury with corresponding new-onset ECG anomalies such as QT-segment changes, bundle branch blocks, ST-segment disturbances, and other rhythm abnormalities. This case presentation illustrates ECG changes associated with cardiovascular disease progression. [ABSTRACT FROM AUTHOR]

Background: COVID-19 infection started in China and became a pandemic, the SARSCoV-2 virus mainly affects the respiratory system but can insult the cardiovascular system as well, higher rate of cardiac arrhythmias noted during the pandemic, and many studies showed that COVID-19 (especially hospitalized patients) can develop different types of arrhythmias which cause higher mortality rate. Objective: To assess the incidence of dysrhythmias and their types and outcomes in hospitalized patients with COVID-19 in Erbil city. Patients and Methods: Patients with documented COVID-19 infection admitted in Erbil Teaching Hospital respiratory care unit and coronary care unit from 1-8-2020 to 30-10-2020 had been included (255 patients) in this cross-sectional study, demographic data, and outcomes were reported, the ECG analyzed by cardiologists and the type of arrhythmia documented. Results: Mean age was 47±12 years, 61% of the patients were male, 25% of them had previous cardiac diseases, 20% diabetes, 16% multiple comorbidities, 8% hypertension, 8% obesity and 23% had no comorbidities, 20.7% of in-hospital patients developed dysrhythmias, 5.9% of them developed sinus tachycardia, 4.7% atrial fibrillation, 3.9% ventricular premature contractions, 2% ventricular fibrillation, 1.9% ventricular tachycardia and 1.9% heart blocks. Most of the patients who developed ventricular arrhythmias, atrial fibrillation, and heart block had previous comorbidities 82%, 62%, and 80% respectively. Arrhythmias caused a higher in-hospital mortality rate (39.6% versus 21.7%) especially among male patients (mortality rate in male patients 43% compared with female patients 33%). Conclusion: Most of the admitted cases were male. Most of them had comorbidities especially previous cardiac diseases. Sinus tachycardia, atrial fibrillation, and ventricular extra-systoles were the most frequent arrhythmias. The mortality rate was increased by arrhythmias mainly in male patients. [ABSTRACT FROM AUTHOR]

Abstract Objectives Targeted temperature management is the recommended therapy for comatose patients after an out‐of‐hospital cardiac arrest resuscitation due to the reduction in neurological damage and improved outcomes. However, there may result in electrocardiographic instability depending on the degree of targeted temperature management, including minor or life‐threatening dysrhythmias or conduction delays. This project aims to describe the frequency of ECG interval changes and clinically relevant dysrhythmias in targeted temperature management patients. Methods This is a retrospective observational study from January 2009 to December 2015. Patients who qualified for the study had a non‐traumatic cardiac arrest with a return of spontaneous circulation, received targeted temperature management at 33.5°C for 24 hours followed by 16 hours of rewarming. ECG interval changes and dysrhythmias were recorded immediately after return of spontaneous circulation, and at 24 and 48 hours post return of spontaneous circulation. Results A total of 322 patients (age 61.0 ± 16.9 years) had targeted temperature management initiated during the study period, of which 169 had complete data and 13 died prior to completing 24 hours of hypothermia. There were statistically significant changes during targeted temperature management in heart rate (96.7 ± 26.0/min before targeted temperature management; 69.5 ± 19.1/min during, P < 0.001), QRS duration (115.1 ± 32.6 ms before targeted temperature management; 107.8 ± 27.9 ms during targeted temperature management, P < 0.001), and QTc (486.3 ± 52.8 ms before targeted temperature management; 526.9 ± 61.7 ms during targeted temperature management, P < 0.001). There were cardiac dysrhythmias that received treatment during cooling and rewarming. Conclusion During the period of targeted temperature management and rewarming, we observed few self‐limiting ECG interval changes and no clinically significant dysrhythmias in this population during the period of targeted temperature management.

(1) Background: Long COVID syndrome is a significant cause of morbidity in COVID-19 patients who remain symptomatic with varied clinical presentations beyond three weeks. Furthermore, the relevance of considering cardiovascular outcomes in post-COVID-19 syndrome is important in the current COVID-19 pandemic; (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this systematic review and meta-analysis. Systematic searches were conducted from multiple databases without language restrictions until October 8, 2022, to find studies evaluating cardiovascular outcomes such as arrhythmias, myocardium and pericardium diseases, coronary vessel disease, and thromboembolic disorders in post-COVID cases. The pooled odds ratio (OR), and standard mean difference (SMD) with their corresponding 95% confidence intervals (CI) were computed to find the association; (3) Results: Altogether, seven studies with a total of 8,126,462 (cases: 1,321,305; controls: 6,805,157) participants were included in the meta-analysis. Pooled odds ratios of cardiovascular outcomes were significantly higher in post-COVID cases (OR > 1, p < 0.05) than in controls. However, the mortality (OR: 4.76, p = 0.13), and heart rate variability (SMD: −0.06, p = 0.91) between cases and controls were not statistically significant; (4) Conclusions: Significant cardiovascular sequelae in long COVID syndrome highlight the importance of careful cardiac monitoring of COVID-19 patients in the post-COVID phase to address cardiovascular complications as soon as possible; larger-scale prospective studies are required for accurate estimation.

Diphenhydramine is frequently misused and ingested recreationally for its antihistaminergic and antimuscarinic effects and is often involved in both serious and fatal poisonings, either in isolation or in combination with other xenobiotics. This analysis sought to determine which patient and encounter characteristics were associated with severe outcome after diphenhydramine overdose. This is an analysis of the multi-center ToxIC registry (2010–2016). Descriptive analysis of all cases with diphenhydramine listed as the "primary agent" contributing to toxicity were included. Analysis sought to determine which patient and encounter characteristics were associated with severe outcome, defined as occurrence of seizure, ventricular dysrhythmia, or intubation. To determine which patient and encounter characteristics were individually associated with severe outcome, we performed chi-square tests. Fisher's exact tests were used in the case of sparse data. We also performed multivariable logistic regression to further determine independent risk factors for severe outcome in diphenhydramine overdose. Eight hundred and sixty-three cases remained after exclusion with 15.6% (n = 135) of all patients having one or more severe outcome. The most common severe outcome was seizures which occurred in 98 (11.6%) of all ingestions. Females comprised 59.1% (n = 510) of all ingestions. Most ingestions were intentional (86.0%, n = 742) with the most common known reason for an intentional ingestion being self-harm, accounting for 37.5% (n = 324) of all ingestions. Self-harm ingestions and ingestions in males were more commonly associated with intubation. When examining outcomes by age, there were no significant differences overall or in any individual outcome except intubation in which children 0–12 were less likely to be intubated as compared to teens and adults. Signs and symptoms most strongly associated with a severe outcome included acidemia (pH < 7.2), QRS prolongation (QRS > 120 ms), and elevated anion gap (AG > 20). Acidemia, QRS prolongation, and elevated anion gap are associated with severe outcomes in diphenhydramine toxicity. Further research is warranted to determine their predictive characteristics. [ABSTRACT FROM AUTHOR]

Objectives: Impairment of cardiac function and arrhythmias often coexist in patients with liver diseases. Many studies have proved this coexistence and put forward various theories toward its pathophysiology. This narrative review tries to find the answers with supporting evidence on five main questions: * Do high serum bilirubin levels have a strong association with cardiac arrhythmias? * Can corrected QT interval (QTc) be relied upon for predicting a risk factor toward imminent arrhythmias? * Is there an association between QTc prolongation and mortality? * Are high serum bilirubin and cardiac dysfunction closely associated? * What is the probable pathophysiology behind this association? Materials and methods: Clinical evidence was obtained by using search engines, namely, Cochrane Library, PubMed, and Google Scholar. Studies published in journals in the English language, between January 1969 and December 2019, which mentioned the relationship between cardiac arrhythmia and liver disease, were included. We used the keywords: jaundice, bilirubin, arrhythmia, ECG, QTc interval, QT dispersion, liver, and cirrhosis. Relevant animal or human studies answering the five main questions were extracted and reviewed. Conclusion: The evidence included in our review sheds light on the fact that approximately 50% of liver cirrhosis cases develop cirrhotic cardiomyopathy (CC) and there has been an association between liver abnormalities and cardiac pathology. The present review also supports that there exists a strong association between high levels of serum bilirubin levels and cardiac arrhythmias, QTc value can be relied upon as a risk factor for predicting imminent arrhythmias, and that it is associated with mortality. Its basic pathophysiology can be explained by the potential action of bile acids in prolonging the QT interval. It also causes cardiac hypertrophy and apoptosis of cardiomyocytes leading to cardiac dysfunction. [ABSTRACT FROM AUTHOR]

Background: Flecainide is a class Ic antidysrhythmic agent used to prevent and treat both ventricular and supraventricular tachycardias, including atrial fibrillation, atrioventricular nodal re-entrant tachycardia, and Wolff-Parkinson-White syndrome. Flecainide can cause serious side effects, including cardiac arrest, dysrhythmias, and heart failure. Despite its growing use, the presenting signs and symptoms of flecainide toxicity are not familiar to most clinicians. In particular, our patient's particular presentation of acute kidney injury (AKI) resulting in flecainide accumulation is high risk for missed diagnosis in the emergency department.Case Report: A 58-year-old woman presented with altered mental status and hypoxia that was later found to be secondary to sepsis. Medical history was notable for atrial fibrillation, for which she was on flecainide. Laboratory results were notable for hypokalemia and an AKI. Her wide complex tachycardia on admission was ultimately attributed to flecainide toxicity in the setting of AKI. Six days after presentation, it was found that her flecainide level was in the toxic range at 2.02 μg/mL (normal range 0.20-1.00 μg/mL, toxic >1.50 μg/mL). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Flecainide intoxication is rare but serious due to the potential for cardiogenic shock. Its diagnosis can be difficult, as the flecainide serum level may take days to result. This case demonstrates the necessity of keeping flecainide toxicity on the physician's differential for patients who are taking the drug, as well as what electrocardiogram findings suggest it as the etiology. Treatment can be lifesaving if initiated promptly. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of combining Magnesium Sulphate with Amiodarone vs Magnesium Sulphate to prevent cardiac arrhythmias in Coronary Artery Bypass Grafting (CABG) patients. Study Design: Quasi-Experimental Study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan, from Jul 2022 to Mar 2023. Methodology: Two hundred and sixty-two (n=262) Coronary Artery Bypass Graft patients, eligible for the study, were enrolled through consecutive sampling and divided into group A - experiment group (3 mg/kg amiodarone+30 mg/kg magnesium sulphate was given, n1=131) and group B-control group (30 mg/kg magnesium sulphate was given, n2=131) by non-random allocation lottery method at the removal of the aortic cross-clamp. The statistical package for social science, SPSS version 26:00 was used to analyse the data. Mean±SD was calculated for continuous variables whereas for categorical variables, percentages and frequencies were calculated. Chi-square test was utilized to find the association and student t-test was applied to find the mean difference between the study groups. Results: Study participants consisted of 194(74.1%) males and 68(26.0%) females. The patients' mean age was 57.29±9.88 years and 58.30±10.69 years respectively, in group-A and group-B. The frequency of pre and post-operative cardiac dysrhythmias was considerably different in both groups. In group-A, 22(16.7%) patients developed dysrhythmias, while in control group, dysrhythmias occurred in 49 (37.4%) patients (p-value <0.001). Conclusion: Combined prophylactic therapy with amiodarone and magnesium sulphate significantly reduced the per and post-operative dysrhythmias in CABG surgeries. [ABSTRACT FROM AUTHOR]

Aim: This study assessed cardiac performance and iron in subjects aged 12-36 months with breath-holding spells (BHSs).Methods: We consecutively recruited 40 subjects (55% male) experiencing BHSs from the general paediatric outpatients department at the Children's Hospital, Ain Shams University, Egypt, from 2015 to 2016. The 20 matched comparisons were mainly healthy siblings. The workup included iron levels and electrocardiograms.Results: The age at the onset of BHSs was 5-24 months with a median monthly frequency of 13. Almost two-thirds of the patients had cyanotic spells, and one-third had pallid spells, lasting 25-90 seconds. Lower serum iron levels and higher QT dispersion and T-wave dispersion were recorded in patients than the comparison group, and 4.8% had dysrhythmia and bradycardia. We observed higher durations of bradycardia during attacks and higher occurrences of dysrhythmia during cyanotic spells, which were more frequent in patients with prolonged or frequent BHSs.Conclusion: Our study of patients aged 12-13 months supported the theory of autonomic dysfunction in BHSs. The ECG findings, especially in patients with prolonged or frequent spells, need to be studied further to evaluate the risk of life-threatening events. Iron deficiency may play a role in autonomic dysfunction in patients with BHSs. [ABSTRACT FROM AUTHOR]

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Smart watches, which are a rapidly developing technology that can record and store personal health data such as heart rate, oxygen saturation, ECG, and sports activities. We presented a patient who applied to the emergency department due to palpitation and he recorded an ECG output with a smart watch before admission. In this case, we emphasized that the use of smart watches in the prehospital period can help the diagnosis process of dysrhythmias in the hospital setting. [ABSTRACT FROM AUTHOR]

We evaluated the effect of the antipsychotic olanzapine on electrical activity of rat hearts under conditions of ischemic- reperfusion injury. We focused on the prolongation of the corrected QT interval as a risk factor for the incidence of different types of dysrhythmias. Pretreatment with olanzapine showed prolongation of the corrected QT interval as well as increased incidence of dysrhythmias in following order: ventricular premature beats > bigeminies > trigeminies > salvos. We also observed an increase in the frequency of episodes of ventricular tachycardia of about 64% and the average duration of ventricular tachycardia was more than doubled under the conditions of the ischemic-reperfusion injury.

Purpose: Sevoflurane is known to prolong the QT interval. This study aimed to determine the effect of the interaction between intravenous anesthetics and sevoflurane on the QT interval. Methods: The study included 48 patients who underwent lumbar spine surgery. Patients received 3 μg/kg fentanyl and were then randomly allocated to either Group T, in which they received 5 mg/kg thiamylal, or Group P, in which they received 1.5 mg/kg propofol, at 2 min after administration of fentanyl injection for anesthetic induction. Vecuronium (1.5 mg/kg) and sevoflurane (3 % inhaled concentration) were administered immediately after loss of consciousness and tracheal intubation was performed 3 min after vecuronium injection. Heart rate (HR), mean arterial pressure (MAP), bispectral index score (BIS), and the heart rate-corrected QT (QTc) interval on a 12-lead electrocardiogram were recorded immediately before fentanyl administration (T1), 2 min after fentanyl injection (T2), immediately before intubation (T3), and 2 min after intubation (T4). Results: There were no significant differences between the two groups in baseline patient characteristics. BIS and MAP significantly decreased after anesthesia induction in both groups. At T3, MAP in Group T was higher than in Group P, while HR had reduced in both groups. The QTc interval was prolonged after anesthesia induction in Group T, but did not change at any time point in Group P. The QTc interval after anesthesia induction in Group T was longer than in Group P. Conclusion: We concluded that an injection of propofol could counteract QTc interval prolongation associated with sevoflurane anesthesia induction. [ABSTRACT FROM AUTHOR]

Syncope is a frequent symptom characterizing a wide group of pathologies with very different prognosis. By this reason, it is necessary a careful risk stratification for a better patient management. For this aim medical history and physical examination are fundamental. Diagnostic exams complete and confirm diagnostic suspiciousness formulated by medical history and examination, but rarely give elements for unexpected diagnosis. Correct identification of pathological mechanism of syncope and determination of associated clinical risk allow the best patient management avoiding dangerous discharge but also, in relation to increasingly limited resources, inappropriate hospitalizations.

Background: Symptomatic tachycardia is a common admission diagnosis in the emergency department (ED). This can be a life-threatening condition and requires immediate attention. Supraventricular tachycardia (SVT) is commonly treated with adenosine, and successful treatment is limited to atrioventricular (AV) node-dependent SVTs as adenosine causes a transient heart block. However, there are limited data available for instances when the recommended dosing regimen (6 mg, 12 mg, 12 mg) fails to terminate SVT.Case Report: A 33-year old man was evaluated in the ED with an electrocardiogram revealing a regular narrow complex tachycardia with a heart rate of 180 beats/min and a rhythm consistent with SVT. He reported experiencing 3 days of fatigue, myalgias, palpitations, and dyspnea on exertion, but was otherwise hemodynamically stable. Attempts at chemical cardioversion with standard doses of adenosine (6 mg, 12 mg, and 12 mg) were given without success. After consultation with the cardiology service, additional doses of 24 mg and then 36 mg of adenosine were administered. The last dose of 36 mg produced sustained conversion and return to a normal sinus rhythm. The patient later underwent radiofrequency ablation of a left-sided orthodromic reciprocating accessory pathway. After 3 months of medical management, the patient had an implantable cardiac defibrillator placed for prevention of sudden cardiac death. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Each case of SVT demands immediate attention from an emergency physician. It is imperative that providers be aware of the limitations of adenosine and when it may be appropriate to deviate from standard dosing recommendations. This is in addition to collaborating with an expert in cardiac electrophysiology when initial management tactics are not successful. [ABSTRACT FROM AUTHOR]

Background: The numbers of patients in acute care hospitals who require cardiac monitoring are increasing. Unpredictable fluctuations in patient flow may result in shortages of telemetry beds for patients who need this level of care. Objective: The aims of this study were to design and implement cardiac monitoring education for all medical-surgical nursing staff in a level I trauma center. Methods: This is a descriptive, quantitative performance improvement study. A multidisciplinary implementation plan was developed with biomedical engineering and physical facilities coordinating structural changes and nursing coordinating education and clinical competency. The nursing educational plans included a dysrhythmia course and testing, a clinically based competency, and a statistical analysis of the dysrhythmia test. The impact of this project was evaluated looking at areas transitioned, telemetry beds available, cardiac dysrhythmia education workshops, and dysrhythmia test results. Results: The implementation of cardiac monitoring was completed over 2 years. Monitored medical-surgical beds increased from 132 to 282 beds. The nursing education expanded hospital-wide to clinical areas requesting standardization of nursing practice. Conclusions: In addition to expanding the number of monitored beds and decompression of critical care beds, benefits included increased level of staff competence, standardization of cardiac monitoring practices throughout the facility, and validation of the cardiac dysrhythmia test. [ABSTRACT FROM AUTHOR]

There have been recent concerns regarding the risk of serious adverse events, such as cardiac dysrhythmia and atrial fibrillation (AF), associated with bisphosphonate use in osteoporosis. This open-label, non-randomized, crossover pilot study evaluated short-term effects of zoledronic acid and placebo on the occurrence of cardiac dysrhythmias and prodysrhythmic profile in postmenopausal women with osteoporosis and low risk of cardiac dysrhythmias. Fifteen postmenopausal women (mean age 70.7 ± 6.9 years) with osteoporosis received placebo infusion on day 1 and zoledronic acid 5 mg on day 7. Standard 12-lead resting EKG measured QT parameters at baseline and up to 24 h after infusion. Continuous 24-h EKG assessed dysrhythmic events and heart rate variability (HRV) for 24 h after infusion. There were no statistically significant differences in resting EKG parameters between placebo and zoledronic acid: QTc (404.28 ± 9.28 and 410.63 ± 18.43 ms), no significant differences in mean serum electrolytes at baseline and after infusion, and no significant association between QT/QTc parameters and serum electrolytes before and after each infusion (QTc: 401.83 ± 17.73 for zoledronic acid and 404.65 ± 16.79 for placebo). There was no significant difference in HRV parameters between placebo and zoledronic acid, and no dysrhythmias were recorded at rest or with 24 h EKG monitoring. Zoledronic acid does not produce dysrhythmia or prodysrhythmic effects in the short term. Among possible mechanisms proposed for cardiac dysrhythmias with zoledronic acid, no serum electrolyte or autonomous nervous system balance perturbations have been reported. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine the influence of the previous use of digoxin on the hospital mortality and complications of patients admitted because of acute coronary syndrome (ACS). We analyzed the data of patients included in the ARIAM-Andalucia Registry, which involves 49 hospitals in Andalucia, Spain, from 2007 to 2012. Patients on digoxin treatment prior to their admission because of ACS constituted the digoxin group (DG), and were compared with the group of patients not on digoxin. Logistic regression and propensity score matching were used to analyze the differences. We included 20,331 patients, of whom 244 (1.2 %) were on digoxin. DG patients were older (73.1 vs 63.7 years old), more often women, and had more diabetes, hypertension, previous myocardial infarction, heart failure, stroke, atrial fibrillation, peripheral vascular disease, obstructive pulmonary disease or kidney disease. On univariate analysis, DG patients had significantly higher hospital mortality (13.5 vs 5.3 % P < 0.001), and more cardiogenic shock, but less ventricular fibrillation, and no differences in atrioventricular block, stroke or reinfarction. After the multivariate analysis, DG had no significant influence on hospital prognosis [odds ratio (OR) 1.21, 95 % confidence interval 0.79-1.86]. The analysis of a propensity-matched cohort of 464 patients (232 DG and 232 NoDG) did not find differences in hospital mortality (13.4 vs 13.4 %) nor other complications. In our cohort of ACS patients, the previous treatment with digoxin was not associated with an increase in dysrhythmic complications nor was an independent predictor of mortality during hospitalization. [ABSTRACT FROM AUTHOR]

Objective. To analyze the pattern of dysrhythmias and arterial blood pressure changes occurring in acute drug intoxications. Method. Retrospective study concerning medical records from six years, regarding patients from Toxicology Clinic of Emergency Hospital of Iasi, Romania, admitted for acute drug poisoning. Arterial blood pressure values and patterns of abnormal electrocardiogram occurring in the first 6 hours after admission were analyzed. Results. 695 cases of acute drug poisonings were analyzed. Hypertension was encountered in 6.6%, and hypotension was observed in 14.1% of the patients. Hypotension occurred in a significant percent in cardiovascular drugs (48.6%) and barbiturates poisonings (25.8%). Tachycardia was documented in 26.5% of the patients, bradycardia being found in 8.3% of the cases. Tachycardia was frequently associated with polimedication (36.8%), benzodiazepines (12.6%) followed by anticonvulsants (8.2%) and barbiturates (7.7%). Bradycardia was documented in 30.4% of the polimedication poisoning cases, 17.9% of barbiturates, 16.1% of cardiovascular drugs and 8.9% of the benzodiazepine poisoning cases. Only 14.8 % of the patients have rhythm and conduction disturbances other than tachycardia or bradycardia. On electrocardiogram, the most frequent finding was ischemia, followed by conduction abnormalities. Supraventricular arrhythmia was rarely encountered, in only 12 cases while ventricular arrhythmia was even rarest (one case of ventricular tachycardia). Conclusion: Cardiac toxic effects were rare in acute drug poisonings cases admitted in our clinic, manifested especially as moderate clinical forms and drug-induced coma. The study did not reveal any life-threatening or cases of deaths. [ABSTRACT FROM AUTHOR]

There have been conflicting reports on whether propofol prolongs, shortens, or does not change QT interval. The aim of this study was to determine the effect of target-controlled infusion (TCI) of propofol on heart rate-corrected QT (QTc) interval during anesthetic induction. We examined 50 patients undergoing lumbar spine surgery. Patients received 3 μg/kg of fentanyl and were randomly allocated to one of the following 2 groups. Group S patients received 5 mg/kg of thiamylal followed by sevoflurane, 5 % at the inhaled concentration. Group P patients received propofol using TCI system at 5 μg/mL for 2 min followed by 3 μg/mL. Tracheal intubation was performed after vecuronium administration. Heart rate (HR), mean arterial pressure (MAP), bispectral index score (BIS), and QTc interval in 12-lead electrocardiogram were recorded at the following time points: just before fentanyl administration (T1), 2 min after fentanyl injection (T2), 1 min after thiamylal injection or 2 min after the start of TCI (T3), just before intubation (T4), and 2 min after intubation (T5). BIS and MAP significantly decreased after anesthetic induction in both groups. HR decreased after anesthetic induction and recovered after tracheal intubation in group P, whereas it did changed in group S throughout the study period. QTc interval was shortened at T3 and T4 in group P, but prolonged at T3, T4, and T5 in group S, as compared with T1. Propofol TCI shortens QTc interval, whereas sevoflurane prolongs QTc interval during anesthetic induction. [ABSTRACT FROM AUTHOR]

Helicobacter pylori virulent strains have been shown to affect cardiovascular diseases through molecular mimicry mechanisms. Silent autoimmune myocarditis has been hypothesized to be the cause of idiopathic dysrhythmias (IA). The aim of this study is to assess the prevalence of virulent H. pylori strains in patients affected by IA. In this study,54 patients (40 men, mean age 44 ± 17 years) affected by IA and 50 healthy subjects (34 men, mean age 45 ± 9) were evaluated. IA, defined as dysrhythmias with no evidence of other cardiac pathology, were either supraventricular (SVA, 23 patients; mean age 45 ± 15 years) or ventricular (VA, 31 patients; mean age 42 ± 18 years). H. pylori infection and gastrointestinal (GI) symptoms were evaluated. H. pylori strains expressing the cytotoxin-associated gene A ( cagA) and the vacuolating-cytotoxin A ( vacA) were also assessed through western blot. The prevalence of H. pylori is similar in IA patients and in controls (42 vs. 44%; p > 0.05); H. pylori infection is observed in 48 and 39% of the patients are affected by SVA and VA, respectively. The prevalence of CagA-positive strains is increased in IA patients compared to controls (65 vs. 42%; p < 0.01); similarly, the prevalence of VacA-positive strains is also increased in IA patients (74 vs. 46%; p < 0.006). Excluding belching, infected patients did not show any difference in GI symptoms, when compared to non-infected subjects. From this study it is concluded that there is an epidemiological link between CagA and VacA-positive H. pylori strains in IA patients. [ABSTRACT FROM AUTHOR]

Objective: In this article, we will examine the most common emergency department presentations of eating disorder patients, review the pathophysiologic changes that lead to such presentations, and discuss the appropriate management of each patient. Method: Literature review of current practices. Results: This article serves as a guide for ED physicians caring for patients with eating disorders. It can also serve to improve communication between mental health specialists and emergency room physicians when transferring care of a patient to the ED. Discussion: Patients with anorexia and bulimia nervosa present to ED with a multitude of vague complaints. It is crucial for ED physicians to recognize that such complaints stem from an underlying eating disorder to understand the pathophysiology behind such complaints. This in turn will lead to appropriate management of patient symptoms, which can often be complex for the provider and stressful for the patient. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012) [ABSTRACT FROM AUTHOR]

Palpitations are a common symptom in children and adolescents presenting to the emergency department. The differential diagnosis can range from benign etiologies to life-threatening dysrhythmias. Although the most common causes of palpitations in pediatric patients are benign, the emergency department physician is charged with determining which patients would require immediate management, workup, and referral to a cardiologist. This article will specifically address the symptom of palpitations in pediatric patients, isolating it from the more frequently reviewed subject of chest pain. [Copyright &y& Elsevier]

Abstract: Background: The full extent of cardiovascular morbidity in inflammatory bowel disease is not well understood. Objective: To comprehensively study the association of different cardiovascular diseases in hospitalized patients with inflammatory bowel disease (IBD) using a large database. Methods: We used the Nationwide Inpatient Sample (NIS) database to perform a cross-sectional study. The study group was defined as all hospitalized patients between ages 18–60 years included in the NIS 2006 database with a discharge diagnosis of IBD, as per the International Classification of Diseases - Clinical Modification, 9th revision (ICD-9-CM) codes. Individuals in the same age group whose hospital discharge records did not note IBD were identified as the control group. Cardiovascular diseases, identified by the ICD-9-CM codes, were studied comprehensively for their association with IBD using multivariate logistic regression analysis. Odds ratios were calculated adjusting for relevant patient comorbidities. Results: IBD was found to be strongly associated with mesenteric ischemia (adjusted odds ratio (aOR), 3.4; 95% confidence interval (CI), 2.9–4.0) and venous thrombotic diseases (aOR, 1.38; 95% CI, 1.25–1.53). Age and gender stratified analysis revealed that IBD is positively associated with dysrhythmias in females aged 18–39 years (aOR, 2.05; 95% CI, 1.72–2.44). We did not find an increased risk of other cardiovascular diseases in IBD patients. Conclusions: Our study substantiates the previously reported associations of mesenteric ischemia and venous thrombotic disorders with IBD. Our study also suggests that young females with IBD might have an increased risk for dysrhythmias. [Copyright &y& Elsevier]