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Part 4: Biometric Applications; International audience; In this work deals about the efficient intracardial ECG analysis algorithm. The main focus was design an optimal detection method for intracardial signals based on essential intracardial measuring methods and basic principles of gathering and processing data from invasive catheters. Intracardial ECG analysis is further important step in heart behavior understanding, especially it’s electric manners. Detailed signal description generated in heart,together with heart function knowledge can provide us with an useful information about heart’s condition or it’s diseases. Designed detection methodis able to mark significant points in intracardial records, compute it‘s elemental parameters and important time intervals. Incurred algorithm was designed and tested on intracardial records provided by Cardiology Clinic of Hospital IKEM – Praha, and Electrophysiology Laboratory of Hospital Podlesi – Trinec.

Genetics have undoubtedly become an integral part of biomedical science and clinical practice, with important implications in deciphering disease pathogenesis and progression, identifying diagnostic and prognostic markers, as well as designing better targeted treatments. The exponential growth of our understanding of different genetic concepts is paralleled by a growing list of genetic terminology that can easily intimidate the unfamiliar reader. Rendering genetics incomprehensible to the clinician however, defeats the very essence of genetic research: its utilization for combating disease and improving quality of life. Herein we attempt to correct this notion by presenting the basic genetic concepts along with their usefulness in the cardiology clinic. Bringing genetics closer to the clinician will enable its harmonious incorporation into clinical care, thus not only restoring our perception of its simple and elegant nature, but importantly ensuring the maximal benefit for our patients.

The fast moving field of genomic medicine is already impacting on clinical care and cardiologists are fortunate to be in a position to benefit early from the transformative advances in genomics. However, the challenges associated with genomics in the clinic in general, and with next generation sequencing technologies in particular, are significant and cardiologists need to be prepared if they wish to surf the wave of genomic opportunity. This paper presents an overview of the implications of next generation sequencing for clinical diagnostics and personalised medicine in the cardiology clinic.

We investigated the socio-demographic characteristics, blood and pulse pressure, and end organ damage of hypertensive patients applying to an outpatient cardiology clinic in southeastern Anatolia. End organ damage in 100 consecutive hypertensive patients was defined by left ventricular hypertrophy, retinopathy, and albuminuria. The determined independent risk factors of left ventricular hypertrophy were advanced age and low educational level; of nephropathy were high pulse pressure and unawareness of the name of anti-hypertensive drug; and for retinopathy were high pulse pressure and female gender. In order to prevent end organ damage, the most important aspect to focus on is patient training and pulse pressure.

Introduction : La fibrillation auriculaire est le trouble du rythme soutenu le plus frequent dans la pratique quotidienne (14,15%), dont la gravite est liee a ses complications hemodynamiques et thromboemboliques surtout cerebrales. Objectifs : Etudier les caracteristiques epidemiologiques et etiologiques de la fibrillation auriculaire chez l’adulte noir togolais en milieu hospitalier. Materiel et methodes : Il s’est agit d’une etude prospective, realisee sur une periode de deux ans (du 1er janvier 2008 au 31 decembre 2009) et qui a porte sur 143 cas de fibrillation auriculaire hospitalises a la clinique cardiologique du CHU-Campus de Lome. Resultats : Au cours de cette etude, la fibrillation auriculaire etait le trouble de rythme auriculaire le plus frequent dans la pratique quotidienne avec un taux de prevalence de 14,56 %. L’âge moyen des malades etait de 45,29 ± 11,58 ans, avec une predominance masculine (55,8%). La fibrillation auriculaire etait associee a une cardiopathie sous jacente dans 91,2% des cas, alors qu’aucune etiologie n’etait retrouvee dans 3,2% des cas. Les etiologies les plus frequentes etaient representees par les cardiomyopathies hypertensives (34,3%), les cardiomyopathies dilatees d’allure primitives (23,7%) et les valvulopathies rhumatismales (7%) Conclusion : La fibrillation auriculaire est frequente chez l’adulte noir togolais. Ses etiologies sont dominees par l’hypertension arterielle et les cardiomyopathies dilatees. complications and stoke. Aim : Our aim was to study epidemiologic and etiologic aspects of atrial fibrillation in black togolese in hospital circle. Material and et methods : It was a prospective study realized during two years (1st january 2008 to 31st december 2009), relative to 143 cases hospitalized at the cardiology clinic of the campus university hospital of Lome, the authors have studied the epidemiologic and etiologic aspects of atrial fibrillation in hospital circle. Results : The atrial fibrillation was the most frequent atrial arrhythmia in the practice with a prevalence of 14.15%. The average age of patients was 45.29 ± 11.58 years, with male predominance (55.8%). Atrial fibrillation was associated to a cardiac disease in 91.2 % of cases, where as none etiology was founded in 3.2% of cases. The most frequent aetiologies were hypertensive cardiomyopathies (34.3%), primitive dilated cardiomyopathies (23.7%) and rheumatic valvulopathies (7%). Conclusion : Atrial fibrillation is a frequent arrhythmia in black adult togolese in hospital circle. The most aetiologies are hypertension and dilated cardiomyopathies.

We investigated the prevalence and indications of digoxin use in elderly patients presenting to a cardiology outpatient clinic of a tertiary hospital in Turkey.On a prospective basis, the study included 800 consecutive patients aged 70 or over (mean age 77 ± 6 years) who presented to our cardiology outpatient clinic. There were 124 patients (15.5%) receiving digoxin. All the patients underwent transthoracic echocardiography. Digoxin use was considered inappropriate if the patient had normal left ventricle systolic function or if there was no atrial fibrillation (AF).The reasons for use of long-term digoxin were persistent AF (n=55, 44.4%), heart failure (HF) (n=51, 41.1%), and paroxysmal AF (n=8, 6.5%). The exact reason could not be determined in 10 patients (8.1%). Digoxin use was based on appropriate indications in 76 patients (61.3%), whereas 48 patients (38.7%) were taking digoxin with inappropriate indications. Of 51 patients for whom HF was the only reason for digoxin therapy, diagnosis of HF was incorrect in 30 patients (24.2%). Other inappropriate indications were paroxysmal AF and undetermined indication for digoxin prescription. Concerning digoxin dose, 24 patients (19.4%) received one tablet (0.25 mg) and 30 patients (24.2%) received a half tablet (0.125 mg) on a daily basis, while 10 patients (8.1%) used six tablets per week with one day off (0.214 mg/day) and 60 patients (48.4%) took five tablets per week with two days off (0.179 mg/day). The median daily dose was 0.182 mg/day. Digoxin dose was higher than the recommended doses for elderly patients in 75.8% of the patients.Our findings show that nearly 40% of elderly patients receive digoxin with inappropriate indications and 75% of these patients take digoxin at higher doses than the recommended doses for this age group.

Background The purpose of this study was to assess patient awareness of the coronary heart disease (CHD) risks posed by air pollution. Methods We distributed a questionnaire to 500 patients at a University of Michigan cardiology clinic. Results More than half of patients (n = 264, 53%) did not believe that air pollution was "proven" or "likely" to cause CHD, whereas a similar percentage (n = 284, 57%) were not previously aware of its association with CHD. Most patients (n = 459, 92%) reported that a health care provider had not informed them of the potential CHD risks posed by air pollution nor discussed ways to lower their exposure (n = 471, 94%). Conclusion Patients were mostly unaware of the CHD risks posed by air pollution. These findings suggest that a serious knowledge gap exists among at-risk patients regarding this important CHD risk factor and support the need for educational efforts targeting patients and health care providers alike.

Today, the many instruments for various signal processing are important component of medical practice. This study proposes the application, which can be useful in determination of ECG changes of patients with cardiac resynchronization therapy. The application, created in MATLAB, is based on algorithms, which are derived from mathematical functions and wavelet transform. We test the application on patients' data of cardiology clinic of hospital IKEM in Prague and we made great experimental results.

Cardiologists pay great attention to the treatment of coronary heart disease (IHD), as well as prevention, improving the already known and developing new methods. Of the latter, laser therapy is of particular interest, in particular, the use of low-intensity laser radiation is promising, which is quickly gaining a place among the known non-drug methods of treatment in therapeutic practice.

BACKGROUND The prevalence of high-density lipoprotein cholesterol (HDL-C) in patients who have achieved low-density lipoprotein cholesterol (LDL-C) targets in the current era of universal statin therapy remains unknown. We conducted a study to determine the prevalence of low HDL-C in patients with documented coronary artery disease, and to determine the lipid-lowering treatment patterns in secondary prevention of coronary artery disease. METHODS In this retrospective cohort analysis, data were obtained from the electronic database of a cardiology clinic. The Joint British Society 2 criteria were used defining low HDL-C as less than 1 mmol/l in males and less than 1.2 mmol/l in females. We compared the prevalence of low HDL-C across the following categories of LDL-C: less than 2, 2-2.5, and greater than 2.5 mmol/l. RESULTS Two thousand and eighty-seven patients with a mean age of 64.34±11.94 years constituted the study sample. About 36.6% of patients in this study were found to have low HDL-C. Irrespective of sex, low HDL-C was prevalent across all levels of LDL-C, but interestingly this was most prevalent in patients with a LDL-C less than 2 mmol/l (43.06%). HDL-C level of 1.16±0.97 mmol/l in patients with LDL-C less than 2 mmol/l was significantly lower than 1.22±0.33 mmol/l in patients with LDL-C greater than 2 mmol/l, P value less than 0.01. There was a poor correlation between levels of HDL-C and LDL-C in the study population irrespective of sex or statin therapy. CONCLUSION This study shows widely prevalent low HDL-C levels in high-risk patients across the spectrum of LDL-C levels despite statin therapy. There was no correlation between the LDL-C and HDL-C levels implying their independent relationship and, thus, the need to treat them independently.

The Internet is a relatively new method of delivering strategies for health behavior change. The purpose of this study was to determine the feasibility of delivering a physical activity intervention by the Internet to improve outcomes in adults with the metabolic syndrome. Twenty-two participants (16 males; 6 females) were recruited from a cardiology clinic database, age range 32-66 years. Participants were randomly assigned to the Internet intervention ( n = 12) or the usual care ( n = 10) group. The mean total dose, in terms of the time the intervention Web site was accessed was 2 hours over 6 weeks, which was greater than the time spent delivering usual care. Overall, participants_ evaluations of the Internet intervention were positive. The costs of development and delivery of the Internet intervention were less than that of a consultation and follow-up in the cardiology clinic for this sample. The Internet intervention appears feasible for testing in a larger study.

A 2-year-old twin boy was referred to a cardiology clinic for long-standing cyanosis. He had been born to a healthy 36-year-old mother. The diamnionic, dichorionic twin pregnancy had been complicated by maternal cholestasis, which had been treated with ursodiol. Amniocentesis had been performed, and

Born in 1950, Keith Copelin Ferdinand is the son of a third-grade teacher and a laboratory technician. In 1965, Hurricane Betsy severely damaged his family’s home and took his grandfather’s life. After two days on the roof of their home and one night on the roof of Hardin Elementary School, the Ferdinand family temporarily moved in with relatives on Louisiana Avenue. Keith went on to excel at St. Augustine High School, and in 1968, he entered Cornell University on a full academic scholarship, financed by L.L. Nunn, who in 1910 founded the Telluride House where Keith lived while in Ithaca, New York. In front of Cornell’s Willard Straight Hall, he decided to devote his life to providing medical care for the community that reared him. Sixteen years later, he and his wife, Daphne Pajeaud Ferdinand, then a registered nurse, opened Heartbeats Life Center, a cardiology clinic, on Poland Avenue in the Upper Ninth Ward. During its twenty-one-year history, more than ten thousand patients were treated at Heartbeats, with its board-certified cardiologists and full-service work-ups.

Purpose: The role of physicians in the overall management of hypertension and their adherence to the JNC VII, WHO/ISH and ESH guidelines were examined in this study. Method: Case notes of hypertensive patients diagnosed between 1 January 2004 and 30 September 2005, in the Cardiology Clinic of University of Benin Teaching Hospital were retrieved for evaluation. They were assessed for adherence to the JNC VII, WHO/ISH and ESH guidelines, in the management of hypertension. Result: Five hundred and one case notes were used in the study. Prevalence of hypertension was highest in the Grade 2 category (36%). More women (60%) than men (40%) were affected, with a diagnostic mean systolic blood pressure (SBP); male (164.0mmHg ± 21.9), female (163.7 mmHg ± 18.8) and mean diastolic blood pressure (DBP); male (100.1 mmHg ± 13.2), female (97.3 mmHg ± 13.1). After commencing treatment, mean SBP and DBP for male and female were (131.8 mmHg ± 11.6; 84.3 mmHg ± 7.5), and (132.3 mmHg ± 11.5 83.2 mmHg ± 7.6), respectively. The commonest co-morbidity was diabetes mellitus (18%). Co-morbidity was commonest in Grade 2 (34%) and Grade 3 hypertension (34%). Almost half of the subjects (49%) were on a two-drug combination while 14% were on monotherapy. Calcium channel blockers were the most commonly prescribed anti-hypertensive drug (31%) followed by diuretics (30%). In combination drug regimen, diuretics were the commonest (74%). There was no evidence of body weight management in hypertension. Conclusion: Physicians in this hospital fairly complied with the stated guidelines, but do not appear to have recommended lifestyle modifications to their hypertensive patients. Keywords: Adherence, Guidelines, Hypertension, Management. Tropical Journal of Pharmaceutical Research Vol. 7 (2) 2008: pp. 945-952

A one-stop outpatient cardiology clinic was set up at the Vic General Hospital in Spain in 1996. The aims were to provide patients with a rapid response, and to ensure that, on the same day, they saw a specialist and were referred for any relevant investigations required, primarily echocardiography, exercise testing, and Holter monitoring. We report experience from 10 years of follow-up, involving 19,515 consultations. The mean waiting time for a consultation was 3 days. We analyzed the reasons for the consultations, the investigations carried out, and the reductions in follow-up visits and hospital admissions. Primary care physicians' level of satisfaction was increased by this approach. The one-stop clinic proved feasible in clinical practice and proved robust during the follow-up period. This clinical model was beneficial for patients, was highly acceptable to primary care physicians, reduced the need for patients to contact the hospital, and, possibly, reduced hospital admissions.

A 58-year-old male was referred to our outpatient cardiology clinic for evaluation of atrial fibrillation, fatigue, dizziness and exertional dyspnoea. He had suffered recurrent pneumonia in childhood. Beside an irregular pulse, the physical examination was normal. Electrocardiography showed atrial fibrillation (ventricular response of 60 to 70 beats/min), a right bundle branch block and nonspecific repolarisation abnormalities. Pulmonary vascular redistribution was visible on chest X-ray (figure 1).

Alan J Bank, Ryan M Gage United Heart and Vascular Clinic, St Paul, MN, USA Objective: Scribes are increasingly being used in clinics to assist physicians with documentation during patient care. The annual effect of scribes in a real-world clinic on physician productivity and revenue has not been evaluated. Methods: We performed a retrospective study comparing the productivity during routine clinic visits of ten cardiologists using scribes vs 15 cardiologists without scribes. We tracked patients per hour and patients per year seen per physician. Average direct revenue (clinic visit) and downstream revenue (cardiovascular revenue in the 2 months following a clinic visit) were measured in 486 patients and used to calculate annual revenue generated as a result of increased productivity. Results: Physicians with scribes saw 955 new and 4,830 follow-up patients vs 1,318 new and 7,150 follow-up patients seen by physicians without scribes. Physicians with scribes saw 9.6% more patients per hour (2.50±0.27 vs 2.28±0.15, P

Methods: A University-based cardiologist’s clinic notes were analyzed; patients were asked to have a fasting lipid profile a week prior to the clinic visit in Year 1. Poor compliance was noted and prompted a same day as clinic visit measurement of lipids if a patient could not comply with laboratory appointment (fasting or non-fasting) in year 2, with further lipid management conducted by phone. Patients with documented coronary artery disease were included. A total of 100 encounters were analyzed for each year.

Carcinoid tumors are rare, with an incidence of 1 in 100,000 of the general population. Carcinoid heart disease can be the initial presentation of carcinoid tumors in up to 20-50% of the cases. A 25-year-old woman presenting to our outpatient cardiology clinic with a 4-year history of progressive

Objective We hypothesized that a cardiologist-initiated motivational discussion during a routine general cardiology clinic visit that included an exercise ‘contract' signed by the patient, physician and a witness, would increase self-reported days per week of exercise. Methods A short-term pilot intervention was provided to forty consecutive general cardiology clinic patients who were enrolled in 2005. They were asked to answer the question "How many days each week do you exercise" prior to the motivational discussion and at routine follow-up. Each participant signed an exercise ‘contract' and agreed to exercise for at least 15 min everyday. Results Participants had an average follow-up of 3.2 (1.7) months. The initial visit mean days of exercise per week were 3.1 (1.9). At follow-up, mean days of exercise per week were 4.0 (1.8), ( p =0.04). Conclusion This simple rapid intervention was associated with increased self-reported days per week of exercise.

Hypertension, a major cause of CVD, is frequently associated with dyslipidaemia and overweight. These risk factors have sex differences that need local study. This work aims to evaluate the pattern of plasma lipids and BMI in male and female hypertensives. Fifty hypertensives attending the Cardiology Clinic of University of Ilorin Teaching Hospital, and fifty sex matched controls, were involved in the study. Conditions that can cause dyslipidaemia were ruled out in the subjects. Plasma TC, TG, HDL-C, LDL-C and BMI were determined. Plasma TC (4.80mmol/L ± 2.27 vs. 3.20mmol/L), HDL-C (1.16mmol/L ± 0.37 vs. 0.93mmol/L ± 0.41), LDL-C (3.62mmol/L ± 1.30 vs. 2.28mmol/L ± 1.01) and BMI (27.20kg/m 2 ± 6.57 vs. 23.37kg/m 2 ± 4.75) were higher in hypertensives. Plasma TG (1.14mmol/L ± 0.71 vs. 0.83mmol/L ± 0.29) and HDL-C (1.22mmol/L ± 0.42 vs. 1.05mmol/L ± 0.25) were higher in female hypertensives than in male hypertensives. Management of hypertension in our environment should involve the screening and control of dyslipidaemia and overweight. It should recognize possible differences in the pattern of dyslipidaemia. The finding of higher LDL-C and lower HDL-C in male hypertensives, suggest that they are more likely to have poorer lipid pattern than females. Nigerian Medical Practitioner Vol. 49(1&2) 2006: 3-6

Cardiovascular disease is the leading cause of morbidity and mortality for adults in developed countries. Many risk factors responsible for the development of cardiovascular disease are associated with behavior. We studied whether encouraging patients to be accountable for their own lifestyle choices would lead to improvements in subjective and objective health measures in 26 consecutive general cardiology clinic patients. Our hypothesis was, that after a simple brief cardiologist-initiated motivational discussion during a routine general cardiology clinic visit that included a weight loss "contract" signed by the patient, physician and a witness, patients would be more likely to lose weight or to remain the same weight as compared to historical controls. We found that intervention patients were more likely to lose weight or to remain the same weight, (p

BackgroundCardiovascular treatment guidelines for stable patients who are regularly followed up at medical center clinics have long been practiced and are intended to improve arteriosclerosis and atherosclerosis in these patients. The present study investigated the prevalence of arteriosclerosis and atherosclerosis in patients attending one such clinic, and explored the potential for better care.MethodsA total of 124 outpatients randomly selected from 586 stable outpatients on regular visits to the same senior cardiologist were invited to receive measurements of brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) using a novel device during their clinic visits. Abnormally high baPWV was defined using the age- and sex-stratified reference ranges obtained from a previous community survey.ResultsThe prevalence of high baPWV in the studied outpatients was 24.2% and the prevalence of low ABI (< 0.9) was 8.1%. Based on the reports of baPWV and ABI at the point of care, medications were adjusted in 56 patients (45.2%). In 22 patients who had adjusted antihypertensive medication and repeat examinations of baPWV and ABI at subsequent visits, systolic blood pressure fell by 11 mmHg (p = 0.012), and baPWV fell by 0.2 m/s (p = 0.001).ConclusionAbnormal baPWV and ABI are not uncommon in stable patients who are regularly followed up at a cardiology clinic where treatment guidelines are completely followed. Fast assessment of arteriosclerosis and atherosclerosis at the point of care may provide better care for this group of patients.

Objective: To determine the diagnostic potential of a hand carried cardiac ultrasound (HCU) device (OptiGo, Philips Medical Systems) in a cardiology outpatient clinic and to compare the HCU diagnosis with the clinical diagnosis and diagnosis with a full featured standard echocardiography (SE) system. Methods: 300 consecutive patients took part in the study. The HCU examination was performed by an experienced echocardiographer before patients visited the cardiologist. The echocardiographer noted whether the HCU device was able to confirm or reject the referral diagnosis, which abnormality was detected, and whether SE investigation was necessary. Physical examination by a cardiologist followed and thereafter, whenever required, a complete study with an SE was carried out. The HCU data were compared with the clinical diagnosis of the cardiologist and the SE diagnosis in a blinded manner. Results: The cardiologist referred 203 of 300 patients for an SE study and 13 patients for transoesophageal echocardiography. In 84 patients no further examination was considered necessary. HCU echocardiography was able to confirm or reject the suspected clinical diagnosis in 159 of 203 (78%) patients. In 44 of 203 (22%) patients SE Doppler was needed. Agreement between the HCU device and the SE system for the detection of major abnormalities was excellent (98%). The HCU device missed 4% of the major findings. Among the 84 patients not referred for an SE, the HCU device detected unsuspected major abnormalities missed with the physical examination in 14 (17%). Conclusion: Integration of an HCU device with the physical examination augments the yield of information.

A 16-year-old boy was referred to our cardiology clinic for investigation of his heart murmur. He had mild exertional dyspnea. On physical examination, the patient appeared well and nondysmorphic. General physical examination showed no abnormalities except a grade 2/6 pansystolic murmur near the right sternal border. Laboratory findings were within normal limits …

Background Despite the detrimental effects of smoking on the cardiovascular system, a significant number of patients with coronary heart disease continue to smoke. We aimed to record compliance to medication and attitude towards recommended lifestyle changes in patients who suffered from myocardial infarction (MI) and continued to smoke after the coronary event. Methods A total of 1011 consecutive patients ( 6 months) were recruited during the period 2000–2003 from the outpatient cardiology clinic of a district general hospital. All patients were interviewed and blood was taken for lipid measurements. Glycosylated haemoglobin (HbA 1 c ) was also measured in all diabetics. Results Three hundred and twenty-nine (32.5%) patients reported smoking at interview, while 338 (33.5%) were ex-smokers of whom 278 (45.8% of all smokers) had quit smoking after MI and 344 (34%) had never smoked. Persistent smokers had significantly lower high-density lipoprotein cholesterol levels than nonsmokers (1.03±0.28 vs. 1.09±0.29 mmol/l, p =0.001). Persistent smokers with diabetes had poorer glycaemic control than nonsmoker diabetic patients as indicated by HbA 1c levels (8±1.7% vs. 7.2±1.3%, p =0.001). Fewer persistent smokers were taking hypolipidaemic drugs than nonsmokers (31% vs. 40.3%, p =0.005). Finally, persistent smokers were less frequently performing regular exercise than nonsmokers (42% vs. 51%, p =0.008). Conclusions Patients who remain smokers after MI have a more negative attitude towards health aspects, are less compliant with their medications, and therefore constitute a high-risk subgroup, which requires special attention and should be professionally encouraged and supported to stop smoking.

The availability of cardiac ultrasound is limited in developing countries. We evaluated the feasibility and diagnostic capability of a hand-carried cardiac ultrasound device in 126 patients (age 44 +/- 24 years) referred for consultation to a cardiology clinic in rural Mexico. The hand-carried cardiac ultrasound device identified 86 cardiac findings and obviated the need for further comprehensive echocardiographic evaluation in 90% of patients (113 of 126).

One hundred fifty-eight patients (76 men and 82 women) presenting to an outpatient cardiology clinic with a new complaint of angina were prospectively followed to determine if there was a gender bias in the management of suspected coronary artery disease when physicians trained in cardiology managed their care. Overall, there were no differences in the percentage of women who underwent noninvasive evaluation, invasive evaluation, and treatment of suspected coronary artery disease compared with men.

Background: Hypertension is a major public health concern globally and is associated with high morbidity and mortality in sub-Saharan Africa. Although antihypertensive therapy is effective in lowering blood pressure, a large proportion of patients do not have optimal blood pressure control. Aims: To describe the prescribing pattern and utilization of antihypertensive drugs and assess blood pressure control in a rural reference tertiary hospital in Nigeria. Methods: We conducted a cross-sectional study of 212 adult patients with hypertension attending the cardiology clinic of the Federal Medical Centre, Ido-Ekiti, Nigeria, between February 2012 and July 2012. Anthropometric, clinical and therapeutic data were collected using a pre-tested pro forma. Data analysis was done using SPSS 16.0 software (IBM, Chicago, Il, US). P value < 0.05 (two-sided test) was considered to be statistically significant. Results: We study 212 adults with hypertension, 48.1% of whom were male and the male-to-female ratio was 0.9. The mean age (± SD) of the patients was 61.5±15.1 years. Thirty two (15.1%), 95 (44.8%), 67 (31.6%) and 18 (8.5%) patients were on mono-, dual-, triple- and quadruple therapy respectively. Diuretics (84.9%) and calcium channel blockers (56.6%) were the most frequently used antihypertensive drugs. Blood pressure was controlled in only 45.3% of patients. Dual- and triple-therapy produced more patients with controlled blood pressure (dual-therapy, p=0.30; triple-therapy, p=0.11). Conclusions: Our study showed that diuretics were the most frequently prescribed class of antihypertensive drugs in our rural tertiary hospital as in many studies from urban centres in Nigeria and sub-Saharan Africa. Consistent with the global trend, the rate of controlled blood pressure among hypertensive patients was low, with combination therapy achieving control in more patients.

OBJECTIVE: The purpose was to understand the illness experiences of patients with congestive heart failure and their family members. DESIGN AND SETTING: The study design was a focused ethnography that took place in 1 outpatient cardiology clinic, 2 outpatient heart failure clinics, and informants' homes located in a large metropolitan city in southeast Texas. SAMPLE: The sample consisted of 28 informants (patients, n = 16; family members, n = 12). METHOD: Data were collected from observations, participant observations, demographic forms, chart reviews, and interviews. Interviews were open-ended, semistructured, in-depth, and audiotaped. A thematic analysis process was conducted through domain analysis and constructing data into themes and subthemes. FINDINGS: Patients with congestive heart failure and their family members experience a process of disruption, incoherence, and reconciling. Reconciling emerged as the salient experience described by informants and was manifested as struggling, participating in partnerships, finding purpose and meaning in the illness experiences, and surrendering.

Background: Various models of cardiology service are available in district general hospitals (DGH) in UK, like Joint cardiology clinics, Paediatric telecardiology, local paediatricians with expertise in cardiology (PEC) and cardiac technicians. Objective: To assess the Paediatric Cardiology Services provided by local PEC at Frimley Park Hospital by combining good clinical evaluation, echocardiography skills and support of tertiary paediatric cardiology centre in the absence of telemedicine. PEC attends once a week cardiology clinic at tertiary centre as honorary consultants. Design and Methods: Retrospective analysis of all the referrals to tertiary paediatric cardiology centre between October 2008 to February 2010. Data from the Proforma was collated in Excel and was analysed using simple statistical methods and percentage calculations. Results: 80/92 referrals were analysed. The reasons for referral were: clinical 82.5%, family history 5%, and rhythm disturbances 11%. Acyanotic congenital heart disease (CHD) was diagnosed in 64% (of which 64% left to right, 29.4% obstructive lesions and 8% regurgitant lesions) and 8.75% of cases were diagnosed as cyanotic CHD. All cyanotic CHD were picked up immediately after birth. 10% were found to have rhythm disturbances (SVT, WPW). 2.5% of cases were classed as life threatening. 20% required interventions and 12.5% of the referral were normal and discharged. Conclusions: Cardiology service provided by PEC with support from tertiary cardiology centre is safe and effective even in the absence of telemedicine. Weekly access to tertiary paediatric cardiology service by PEC provides continuous medical education, constructive feedback and opportunity to discuss non-urgent cases thereby avoiding unnecessary referrals.

Objective Scribes have been used in the emergency department to improve physician productivity and patient interaction. There are no controlled, prospective studies of scribe use in the clinic setting. Methods A prospective controlled study compared standard visits (20 minute follow-up and 40 minute new patient) to a scribe system (15 minute follow-up and 30 minute new patient) in a cardiology clinic. Physician productivity, patient satisfaction, physician–patient interaction, and revenue were measured. Results Four physicians saw 129 patients using standard care and 210 patients with scribes during 65 clinic hours each. Patients seen per hour increased (P < 0.001) from 2.2 ± 0.3 to 3.5 ± 0.4 (59% increase) and work relative value units (wRVU) per hour increased (P < 0.001) from 3.5 ± 1.3 to 5.5 ± 1.3 (57% increase). Patient satisfaction was high at baseline and unchanged with scribes. In a substudy, direct patient contact time was lower (9.1 ± 2.0 versus 12.9 ± 3.4 minutes; P < 0.01) for scribe visits, but time of patient interaction (without computer) was greater (6.7 ± 2.1 versus 1.5 ± 1.9 minutes; P < 0.01). Subjective assessment of physician–patient interaction (1–10) was higher (P < 0.01) on scribe visits (9.1 ± 0.9 versus 7.9 ± 1.1). Direct and indirect (downstream) revenue per patient seen was $142 and $2,398, with $205,740 additional revenue generated from the 81 additional patients seen with scribes. Conclusion Using scribes in a cardiology clinic is feasible, produces improvements in physician–patient interaction, and results in large increases in physician productivity and system cardiovascular revenue., Video abstract

PP-103 UNUSUAL LIPID LOWERING DRUGS-ASSOCIATED NEUROPSYCHIATRIC ADVERSE EVENTS M.C. Sumerkan, E. Kaya, S. Bulur, S.B. Sozen, G. Guler, E. Guler, A. Surgit, M.A. Agirbasli, S. Oksuz. Cardiology Clinic, Duzce Ataturk State Hospital, Duzce, Turkey; Department of Pharmacology, Duzce University Faculty of Medicine, Duzce, Turkey; Department of Cardiology, Duzce University Faculty of Medicine, Duzce, Turkey; Psychiatry Clinic, Duzce Ataturk State Hospital, Duzce, Turkey; Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey; Chief of the Hospital, Duzce Ataturk State Hospital, Duzce, Turkey

AIM: The aim of the study, Coronary Artery Disease (CAD) diagnosed with identification of individuals in specific behaviors to improve health, health status and related factors to determine the levels of detection. METHODS: This descriptive study of data types of the Gulhane Military Medical Academy (GATA) Hospital cardiology clinic in December 2009 - February 2010 were collected. The study group, at least 6 months before the diagnosis of CAD area, between the ages of 20-65 individuals who accept and participate in the study (n = 300) formed. Sociodemographic characteristics and health behaviors of the personal information form for the 33-item, 52-item scale of a healthy lifestyle behaviors and health status of the single-item scale working group of the detection technique applied to the face-to-face interview. The aim of the study, Coronary Artery Disease (CAD) for the development of health behaviors in the case of individuals diagnosed with the identification, health status and related factors to determine the levels of detection. The statistical analysis techniques such as Mann Whitney U and Kruskal-Wallis were used for the comparison. RESULTS: Of the group 57,7% were males, 46,3% were 50-59 years of age and 56,3% were higher education graduates. As regard to total Health Promotion Life-Style Profile Scale scores statistically significant differences had been found between age, gender, education, disease period, occupation and chronic condition groups. As regard to the average PHSS scores statistically significant differences had been found between age, education, body mass index, disease period, occupation, chronic condition and CAD related course groups (p

AIM: The objective of this study was designed to determine use of the complementary treatment (CT) methods which are used among people with heart disease. METHODS: This study was planned between March 2011 and May 2011 as a descriptive design. The population of this study composed all heart patients who were hospitalized in a university hospital cardiology clinic, 102 patients who volunteered to participate in the study of simple randomly selected patients, aged 18 and older, at least six months before the diagnosis of any heart disease, conscious. The data were collected by face to face interview. Before study informed consent was taken from institues and patients. The data were evaluated by SPSS 11.5 package program, percentage, average, and chi-square. The data were collected using a questionnaire containing sociodemographic and disease- related characteristics. RESULTS: The mean age of patients was 60.73 ± 15 years and 43% of women, 57% men and most of these patients were married. 35.3 % of the patients use CT methods. 33.3% of patients were nonherbal supplements (22.5% multivitamins), herbal treatments were used by 84.4%, and other treatments (28.2 %). 94% of patients methods of CT use found that did not say health care providers. 47% of them used these methods because of useful, feels so good 33%, medical treatment was not effective 8%, the defense of the body to increase 6%, and less side effects % 6. There was no relationship between sociodemographic characteristics and using of TT (p>0.05). CONCLUSION: One-third of patients with heart patients were used complementary therapies. Herbal treatments were the most preferred method.

Ellis-van Creveld syndrome (EvC) is a rare autosomal recessive chondroectodermal dysplasia, associated with mutations in the EVC1 and EVC2 genes (4p16). The management of EvC is multidisciplinary, and early diagnosis is of the utmost importance for efficient and timely treatment. The main prognostic determinant is presence of a heart defect. The authors describe the case of a 42-year-old man referred to our outpatient cardiology clinic, following surgical repair of an atrial septal defect. He had presented to different medical specialties on numerous occasions since childhood, but remained without a clear diagnosis for more than 40 years. This case reinforces the need for a holistic view when assessing a patient with congenital heart disease. Moreover, this illustrates the importance of communication and discussion between different medical specialties.

Background: Electrocardiograms (ECGs) are sent via facsimile by pediatricians and psychiatrists to cardiologists for assessment. The validity of this method of transmission has not been established. Methods: ECGs were collected from 100 consecutive patients from the cardiology clinic of the Children's Hospital at Montefiore. The ECGs were faxed and also electronically faxed (efax) and printed. Two electrophysiologists (EP1 and EP2) interpreted the intervals on original, faxed, and efaxed ECGs and intervals (RR, PR, and QT) were compared. A three-way analysis of variance to examine differences between raters, among ECG intervals, and among methods (repeated factor) was performed. Because no interaction terms were significant, a Duncan's multiple range test was used to evaluate where differences occurred among the three intervals and three methods, given these main effects were significant. Results: The difference between raters EP1 and EP2 was not significant (P = 0.6681). Although the interval measurements of the faxed and efaxed ECGs were not significantly different from each other (P > 0.05), each was significantly different from the original across all three ECG intervals and both raters (P = 0.0138). The RR interval yielded mean (SD) values for the original, faxed, and efaxed methods of 0.6986 seconds (0.2074), 0.6646 seconds (0.1938), and 0.6838 seconds (0.1935), respectively. For the QT interval, the mean (SD) values for the original, faxed, and efaxed methods were 0.3370 seconds (0.0524), 0.32134 seconds (0.0466), and 0.3284 seconds (0.0515), respectively. Conclusions: ECG transmission via facsimile or efax may introduce significant distortion of the intervals. Alternative means of sending ECGs for interpretation should be considered. PACE 2011; 34:1283–1287)

Background: In developed countries cardiac disease remains the single largest cause of indirect maternal mortality. Despite this many countries lack a strategic approach to the problem. We describe the first Australian experience of a multidisciplinary obstetric-cardiology clinic.Method: A retrospective review was undertaken on women referred to our institution's obstetric cardiology service between April 2008 and March 2010.

A 59-year-old man was seen in the Cardiology Clinic with a long history of recurrent syncope. These episodes would occur predictably during sexual intercourse at the point of ejaculation. He experienced prodromal symptoms including lightheadedness followed by syncope for approximately 10 s, with gradual recovery. To prevent injury the couple would place mattresses around the bed to …

We describe the main features of our computerized Database for the management of an out-patient cardiology clinic.