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Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The author comments on calculating a corrected QT interval (QTc) in acute care settings and the significant role of pharmacists in QTc interpretation. Topics discussed include standards for pharmacists in assessing the risk of QTc prolongation, the methods used to correct QT values, and factors to be considered in assessing the risk of torsades de pointes.

Objective: The index of cardio-electrophysiological balance (iCEB) is a new non-invasive marker that can be used to predict malignant ventricular arrhythmias. Pediatric studies on iCEB are limited in number. Our study aimed to determine the range of its values in different age groups among school-age children. Material and Methods: The study included patients aged 5-17 admitted to Gülhane Training and Research Hospital Pediatric Cardiology Outpatient Clinic between March 2020 and March 2022 without a history of chronic disease, cardiac disease, arrhythmia, or cardiac surgery. Participants were categorised into ages 5-8, 9-12, and 13-17. The iCEB and iCEBc values were calculated and compared between groups. Results: The total number of 1303 cases were categorised into the 5-8 (n=270), 9-12 (n=389), and 13-17 (n=644) age groups. The mean iCEB and iCEBc values for all age groups were 4.39±0.53 and 5.16±0.53, respectively. Any difference was not detected among age groups of 5-8, 9-12, and 13-17 years in terms of iCEB and iCEBc values (4.42±0.56, 4.39±0.53 and 4.39±0.52 vs. 5.19±0.56, 5.15±0.55 and 5.16±0.52, respectively). However, a significant difference was found between male (n=699) and female (n=604) patients in terms of mean iCEB (4.23±0.52 vs. 4.59±0.47) and iCEBc (4.98±0.53 vs. 5.38±0.46) values (p <0.001). Conclusion: iCEB and iCEBc values in school-age children did not differ according to age groups. However, these values differed between boys and girls. This study is the first to reveal normal ranges of iCEB and iCEBc values in school-age children. [ABSTRACT FROM AUTHOR]

Copyright of Farmacia is the property of Societatea de Stiinte Farmaceutice Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of SEMS-Journal is the property of Schwiez Zschr Sportmed Sporttraumatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Introduction Atrial fibrillation (AFib) is a common dysrhythmia and a risk factor for stroke and heart failure. Early detection and treatment are key to avoiding complications (especially in sustained AFib). Here, we systematically review the potential of wearable smartwatches (WSWs) to screen for AFib. Method A literature search was conducted, and only those validation studies were shortlisted where the screening ability of WSWs was compared with EKG, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Kappa statistic were provided. Result Twelve studies were included with a combined sample size of 1,075,088. Most validation measures of WSWs were above 90% and comparable with KardiaBand by AliveCor (KB), which is an FDA-approved device to detect AFib. Conclusion WSWs have the potential to reliably and continuously screen for AFib and detect it in a timely manner. The inconclusive results produced by WSWs are a significant problem. Once the inconclusive results are rectified, WSWs may be used for widespread screening of AFib in those people who are at high risk of developing AFib.

Lithium induced cardiotoxicity is associated with several electrocardiographic (ECG) findings. The most commonly observed cardiac effects include QT prolongation, Twave abnormalities, and to lesser extent SA node dysfunction and ventricular arrythmias. We present a case of a 13-year-old female with acute lithium overdose whodeveloped Mobitz I, a manifestation of lithium associated cardiotoxity not previously reported. The patient had no significant past medical history and presented to the emergency department 1 h after intentional overdose of 10 tablets of unknown drug. Parents reported that the patient had visited her grandmother, who "regularly took many different kinds of medications," earlier that same evening. On physical examination the patient had reassuring vital signs, was in no acute distress,cardiopulmonary examination was normal, had clear sensorium, and no evidence of a toxidrome. On serological examination complete blood count, chemistries panel, and liver function tests did not show significant derangements. 4 h post-ingestion acetaminophen concentration was 28 mcg/ml and below indication for n-acetylcysteine antidote therapy. During her ED course she showed evidence of Mobitz I (Wenckebach) on 12-lead ECG. No prior ECGs were available for comparison. Medical toxicology was consulted at that time given concern for potential cardiotoxicity from an unknown xenobiotic. Serum dioxin and lithium concentrations were subsequently requested. Serum digoxin concentration was undetectable. Serum lithium concentrations was 1.7 mEq/L (0.6-1.2 mEq/L therapeutic range). The patient was treated with intravenous hydration at twice maintenance rate. Repeat lithium concertation 14 h post-ingestion was undetectable. During her admission, the patient remained hemodynamically stable and asymptomatic despite occasional episodes of Mobitz I, lasting seconds to minutes. Repeat 12-lead ECG obtained 20 h post-ingestion showed normal sinus rhythm. Cardiology recommendations included ambulatory Holter monitoring upon discharge and follow-up in clinic within two weeks. The patient was medically cleared after 36 h of monitoring and discharged after psychiatric evaluation. Our case demonstrates that patients who develop a new Mobitz I atrioventricular block of unclear etiology in the setting of acute ingestion should be screened for lithium exposure, even if otherwise free of more typical manifestations of lithium toxicity.

Introduction: Atrial fibrillation (AFib) is a common dysrhythmia and a risk factor for stroke and heart failure. Early detection and treatment are key to avoiding complications (especially in sustained AFib). Here, we systematically review the potential of wearable smartwatches (WSWs) to screen for AFib. Method: A literature search was conducted, and only those validation studies were shortlisted where the screening ability of WSWs was compared with EKG, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Kappa statistic were provided. Result: Twelve studies were included with a combined sample size of 1,075,088. Most validation measures of WSWs were above 90% and comparable with KardiaBand by AliveCor (KB), which is an FDA-approved device to detect AFib. Conclusion: WSWs have the potential to reliably and continuously screen for AFib and detect it in a timely manner. The inconclusive results produced by WSWs are a significant problem. Once the inconclusive results are rectified, WSWs may be used for widespread screening of AFib in those people who are at high risk of developing AFib. [ABSTRACT FROM AUTHOR]

Copyright of Spor Hekimligi Dergisi/Turkish Journal of Sports Medicine is the property of Turkish Journal of Sports Medicine / Spor Hekimleri Dernegi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Duzce University Journal of Science & Technology is the property of Duzce University Journal of Science & Technology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

* Heart rate variability (HRV) operationalizes the successive beat-to-beat fluctuations over a defined period of time, is derived from the time series of successive R-R intervals using various context-dependent metrics, and reflects the complex dynamic modulation of the heart's chronotropic response to physiological and/or pathological perturbations. * HRV metrics are used as markers of human cardiovascular health and risk stratification, or as measures of load quantification, exercise response and performance, respectively. * However, a valid use of HRV in the fields of sports medicine and exercise science requires careful consideration of the specific measurement principle of the recording device, standardized assessment, preprocessing, analysis, and context-sensitive interpretation. [ABSTRACT FROM AUTHOR]

Copyright of Herzschrittmachertherapie und Elektrophysiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción: La forma clínica cardiaca es la principal causa de morbimortalidad de la enfermedad de Chagas, y su patogenia estaría relacionada con alteraciones del sistema nervioso autónomo que afectarían la fisiología cardiovascular. Objetivos: Comparar los valores de frecuencia cardiaca, presión arterial y las alteraciones electrocardiográficas de pobladores infectados con T. cruzi y sujetos control. Material y métodos: estudio analítico, observacional, transversal; realizado en el valle de Vítor de Arequipa en el período 2004-2005. Se estudiaron 75 voluntarios mayores de 15 años de edad, distribuidos en 25 seropositivos y 50 seronegativos para T. cruzi, pareados por edad y sexo. Se midió frecuencia cardiaca, presión arterial y se realizó electrocardiografía estándar, comparándose los resultados en ambos grupos. Resultados: Los valores de frecuencia cardiaca y presión arterial fueron similares entre los sujetos infectados con T. cruzi y los controles, al igual que la presencia de bradicardia sinusal, hipotensión e hipertensión arterial. En 40% de los sujetos seropositivos hubo alteraciones electrocardiográficas, y en sujetos control en 26% diferencia estadísticamente no significativa. Las alteraciones más frecuentes en ambos grupos fueron los cambios inespecíficos de repolarización, bradicardia sinusal, hemibloqueo anerior izquierdo, extrasistolias supraventriculares. Se presentó bloqueo completo de rama derecha y hemibloqueo anterior izquierdo en personas infectadas con T. cruzi menores de 40 años. Conclusiones: La prevalencia de alteraciones cardiovasculares fue similar en población infectada con T. cruzi y sujetos control. Las alteraciones al EKG más frecuentes no son las típicamente descritas en enfermedad de Chagas.

Copyright of Die Kardiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose of review: To summarize the expanding role of artificial intelligence (AI) in cardiac electrophysiology. Recent findings: AI is uniquely powered to integrate variable data-streams and consider complex non-linear relationships. Deep learning algorithms can consider aspects in data with unappreciated relevance in order to produce results that are impossible with other methods. The wide adoption of wearable technologies necessitated the development of accurate algorithms to identify cardiac rhythms. Similarly, algorithms use electrocardiograms to make arrhythmic diagnosis, localize arrhythmias, and uncover pathologies such as contractile dysfunction or valvular disease. AI use in imaging and intracardiac electrogram interpretation may enhance efficiency and reproducibility. AI dramatically improves prognostication including for sudden cardiac death, response to catheter ablations, and cardiac resynchronization therapy. AI also holds promise to potentially guide catheter ablation of the future. Summary: AI may improve availability, accuracy, and efficiency of electrophysiologic treatments as well as aid in translational research. Ethical and legal challenges will need to be addressed. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to evaluate the cardiac findings of patients with Infantile hemangiomas (IH) prior to propronalol treatment and to compare our findings with literature data and verify the need for detailed cardiac screening. Materials and Methods: We performed a single-center retrospective review of patients diagnosed with IH who underwent cardiac screening between October 2021 and October 2022. Charts were reviewed and symptoms, heart rate, blood pressure, electrocardiogram, and echocardiogram findings were recorded for each patient. Results: Of the 50 patients, 30 were female. The mean age and weight were 7.1±7.3 months and 7.6±3.0 kg. Electrocardiography screening did not reveal any contraindication for treatment. Propranolol significantly reduced heart rate and systolic blood pressure (baseline: 120.2±10.5 bpm/89.6±17.6 mmHg; 1st week: 118.5±10.4 bpm/88.7±17.5 mmHg; 2nd week: 117.8±9.5 bpm/88.7±17.3 mmHg; 2nd month: 116.5±9.4 bpm/88.6±17.3 mmHg). Diastolic pressure reduction was significant only between 'baseline- 1st week and 'baseline- 2nd month (58.9±15.6 vs 58.2±15.8 mmHg; 58.9±15.6 vs 57.9±15.5 mmHg, respectively). Conclusion: Screening electrocardiography and hospitalization for initiation of propranolol therapy is not necessary in most infants. Given the low frequency of complications, it seems medical history and physical examination are the cornerstones for safe initiation and monitoring of β-blocker treatment. Electrocardiography and BP control should be part of the pretreatment evaluation in high-risk patients. [ABSTRACT FROM AUTHOR]

Background: Methadone is one of the most useful opioids that can be used to achieve many therapeutic goals, and also it may be abused as an illicit drug. Methadone can cause different gastrointestinal, neurological, and cardiac complications. This study was performed to obtain a better understanding of the cardiac side effects of methadone in patients with methadone poisoning. Methods: This cross-sectional study was performed on 210 samples in Sina Hospital of Hamadan in a one-year period from March 2019 to March 2020. After assessing patients who had methadone poisoning and completing their demographic information and evaluation of changes in patients' EKGs, the data was collected and analyzed by SPSS 16 software. Results: Out of 210 participants, 178 (84.8%) were males and the rest were females. The average age of the studied patients was 39.56 years old. The study found that 6.1% of methadone-poisoned patients were illiterate. It was found in this study that the most common cardiac complications of methadone intoxication were sinus tachycardia (20%), QT interval prolongation (6.64%), and sinus bradycardia (4.3%), respectively; nevertheless, 66.2% of patients did not have any EKG abnormalities. Conclusion: According to the findings, it is necessary to have continuous cardiac monitoring for patients with methadone intoxication and by transferring such findings to medical centers, steps can be taken to use methadone more intelligently.

Aim: It is known that cardiac involvement may occur in patients with COVID-19 infection. And one of the best diagnostic tools of cardiac involvement is the ECG. The aim of this study is to investigate the common ECG findings in COVID-19 infection and the effect of these findings on the prognosis. Material and Method: 215 patients who applied to our emergency department between 04.06.2022 and 04.08.2022 and met the criteria for inclusion in the study were included in this study. All patient results and ECG images were accessed from the hospital data recording system. The results were used for statistical analysis. Results: Of 215 patients, 118 were female and 97 were male, and the mean age was 58±21 years. Of these patients, 52 were hospitalized in the service and 17 were hospitalized in intensive care units, and 146 patients were discharged from the emergency department. The most common ECG finding was ST-T wave change. It was observed that there was a correlation between the detection of VT in the ECG and the intensive care unit admission. It was observed that the ECG findings of the patients had no effect on the prognosis. Conclusion: All ECG findings can be seen in patients admitted to the emergency department with COVID-19 infection. The most common ECG finding is ST-T wave change. In addition, long QTc, sinus tachycardia and AF are also common. However, no correlation was found between ECG findings and disease prognosis.

We compared four methods to screen emergency department (ED) patients for an early electrocardiogram (ECG) to diagnose ST-elevation myocardial infarction (STEMI) in a 5-year retrospective cohort through observed practice, objective application of screening protocol criteria, a predictive model, and a model augmenting human practice. We measured screening performance by sensitivity, missed acute coronary syndrome (ACS) and STEMI, and the number of ECGs required. Our cohort of 279,132 ED visits included 1397 patients who had a diagnosis of ACS. We found that screening by observed practice augmented with the model delivered the highest sensitivity for detecting ACS (92.9%, 95%CI: 91.4–94.2%) and showed little variation across sex, race, ethnicity, language, and age, demonstrating equity. Although it missed a few cases of ACS (7.6%) and STEMI (4.4%), it did require ECGs on an additional 11.1% of patients compared to current practice. Screening by protocol performed the worst, underdiagnosing young, Black, Native American, Alaskan or Hawaiian/Pacific Islander, and Hispanic patients. Thus, adding a predictive model to augment human practice improved the detection of ACS and STEMI and did so most equitably across the groups. Hence, combining human and model screening––rather than relying on either alone––may maximize ACS screening performance and equity. [ABSTRACT FROM AUTHOR]

Copyright of Bagcilar Medical Bulletin / Bağcılar Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Firat Universitesi Saglik Bilimleri Veteriner Dergisi is the property of Firat Universitesiu, Saglik Bilimleri Enstitusu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objective of this study was to determine whether seated cervical manipulation produced changes in autonomic nervous system activity, as measured by heart rate variability and plasma norepinephrine levels. Ninety-five healthy young adults (ages 20-48 years) were recruited into a single-blinded physiological study, with 47 randomized to a seated cervical manipulation and 44 randomized to a sham procedure. Heart rate variability in the frequency domain, and plasma norepinephrine levels were measured prior to, immediately following, and 5 minutes following the intervention. Electrocardiograms were obtained from 39 subjects in the sham group and 43 subjects in the manipulation group. No statistically significant changes were found in measures of heart rate variability in the frequency domain in either the manipulation or sham groups. Blood samples were obtained from 22 subjects in the sham group and 27 subjects in the manipulation group. Plasma norepinephrine levels, as measured by spectrophotometry, declined in both groups from pre- to immediately postintervention, and they remained at decreased levels 5 minutes after the interventions. There were no statistically significant differences between groups in pre- or postintervention norepinephrine levels. Measures of heart rate variability and plasma norepinephrine levels did not show that seated cervical manipulation produced short-term changes in autonomic nervous system activity compared to a sham procedure in healthy young adults. [ABSTRACT FROM AUTHOR]

Background Continuity of care (CoC) is an important component of health care delivery that can have cost implications and improve patient outcomes. We analysed data obtained from the Department of Veterans Affairs to examine the relationship between CoC and use of image-oriented diagnostic tests in patients with comorbid chronic conditions. Methods A longitudinal, retrospective cohort study involving participants ≥18 years old, with comorbid diabetes and chronic kidney disease. We used a multivariate linear regression model to test whether greater care continuity, measured using a care continuity index (CCI), is associated with less frequent use of diagnostic tests. Results Total of 267,442 patients and 8,142,036 tests were included. Of the diagnostic tests we chose to evaluate, the 4 most frequently ordered tests were X-ray (45.6%), electrocardiogram (EKG, 16.8%), computerized tomography (CT, 13.4%), and magnetic resonance imaging (MRI, 3.4%). Overall, greater CCI was associated with fewer use of tests (P < 0.001). A 1 standard deviation (SD, 0.27) increase in CCI was associated with 4.2% decrease (P < 0.001) in number of tests. But a mixed pattern existed. For X-ray and EKG, greater continuity was associated with less testing, 6.2% (P < 0.001) and 3.3% (P < 0.05) reductions, respectively. Whereas, for CT and MRI, greater continuity was associated with more testing, 2.3% (P < 0.001) and 1.4% increases (P < 0.01), respectively. Conclusion Overall, greater CoC was associated with fewer use of tests, representing a greater presumed efficiency of care. This has implications for designing health care delivery. [ABSTRACT FROM AUTHOR]

Background: Atrial Fibrillation (Afib) can lead to stroke and heart failure, and early detection of Afib is an effective method of preventing these life-threatening conditions. An estimated 2.7 million Americans are living with Afib1, a number that is expected to rise dramatically in the coming years. Methods: The aim of this demonstration project was to create an additional access point in the community at local pharmacies for Afib screening, detection, and referral to physicians for follow up and initiation of evidence-based therapy when appropriate. This prospective research study was conducted with 14 community pharmacies across the US, in which a total of 650 patients were screened for Afib. Pharmacists conducted SAFEty Risk Assessments that consisted of completion of a stroke risk scorecard and EKG determination utilizing AliveCor’s KardiaMobile® 6L device. Results: In 552 (82.5%) of 669 total EKG readings, a “normal” rhythm was detected, and in 117 (17.5%) EKG readings an abnormal detection occurred. A total of 12 out of 650 patients (1.8%) received EKG readings of Afib, which is greater than double the expected prevalence of Afib in the US (0.81%), a statistically significant finding (p < 0.0001). Other notable findings included 42 (6.3%) EKG readings of Wide QRS, and 26 (3.9%) EKG readings of tachycardia. A total of 44 patients were referred to physicians for follow up on their risk for Afib. Conclusions: Community pharmacies offer a unique, valuable access point for patients to receive Afib screenings. Pharmacists are well positioned to make a significant contribution in the health of their patients and increase the value of team-based health care.

Lithium induced cardiotoxicity is associated with several electrocardiographic (ECG) findings. The most commonly observed cardiac effects include QT prolongation, Twave abnormalities, and to lesser extent SA node dysfunction and ventricular arrythmias. We present a case of a 13-year-old female with acute lithium overdose whodeveloped Mobitz I, a manifestation of lithium associated cardiotoxity not previously reported. The patient had no significant past medical history and presented to the emergency department 1 h after intentional overdose of 10 tablets of unknown drug. Parents reported that the patient had visited her grandmother, who “regularly took many different kinds of medications,” earlier that same evening. On physical examination the patient had reassuring vital signs, was in no acute distress,cardiopulmonary examination was normal, had clear sensorium, and no evidence of a toxidrome. On serological examination complete blood count, chemistries panel, and liver function tests did not show significant derangements. 4 h post-ingestion acetaminophen concentration was 28 mcg/ml and below indication for n-acetylcysteine antidote therapy. During her ED course she showed evidence of Mobitz I (Wenckebach) on 12-lead ECG. No prior ECGs were available for comparison. Medical toxicology was consulted at that time given concern for potential cardiotoxicity from an unknown xenobiotic. Serum dioxin and lithium concentrations were subsequently requested. Serum digoxin concentration was undetectable. Serum lithium concentrations was 1.7 mEq/L (0.6–1.2 mEq/L therapeutic range). The patient was treated with intravenous hydration at twice maintenance rate. Repeat lithium concertation 14 h post-ingestion was undetectable. During her admission, the patient remained hemodynamically stable and asymptomatic despite occasional episodes of Mobitz I, lasting seconds to minutes. Repeat 12-lead ECG obtained 20 h post-ingestion showed normal sinus rhythm. Cardiology recommendations included ambulatory Holter monitoring upon discharge and follow-up in clinic within two weeks. The patient was medically cleared after 36 h of monitoring and discharged after psychiatric evaluation. Our case demonstrates that patients who develop a new Mobitz I atrioventricular block of unclear etiology in the setting of acute ingestion should be screened for lithium exposure, even if otherwise free of more typical manifestations of lithium toxicity

The electrocardiogram waveforms of adult zebrafish and those of humans are remarkably similar. These electrocardiogram similarities enhance the value of zebrafish not only as a research model for human cardiac electrophysiology and myopathies but also as a surrogate model in high throughput pharmaceutical screening for potential cardiotoxicities to humans, such as QT prolongation. As such, in vivo electrocardiography for adult zebrafish is an electrical phenotyping tool that is necessary, if not indispensable, for cross-sectional or longitudinal in vivo electrophysiological characterizations. However, too often, the lack of a reliable, practical, and cost-effective recording method remains a major challenge preventing this in vivo diagnostic tool from becoming more readily accessible. Here, we describe a practical, straightforward approach to in vivo electrocardiography for adult zebrafish using a low-maintenance, cost-effective, and comprehensive system that yields consistent, reliable recordings. We illustrate our protocol using healthy adult male zebrafish of 12-18 months of age. We also introduce a rapid real-time interpretation strategy for quality validation to ensure data accuracy and robustness early in the electrocardiogram recording process.

Introduction: Electrocardiogram (EKG) interpretation is integral to emergency medicine (EM).1 In 2003 Ginde et al. found 48% of emergency medicine (EM) residency directors supported creating a national EKG curriculum.2 No formal national curriculum exists, and it is unknown whether residents gain sufficient skill from clinical exposure alone.Methods: The authors sought to assess the value of this EKG curriculum, which provides exposure to critical EKG patterns, a framework for EKG interpretation when the diagnosis is not obvious, and implementation guidelines and open access to any interested residency. The Foundations of Emergency Medicine (FoEM) EKG I course launched in January 2016, followed by EKG II in July 2017; they are benchmarked to post-graduate year 1 (PGY) and PGY2 level learners, respectively. Selected topics included 15 published critical EKG diagnoses and 33 selected by the authors.5 Cases included presenting symptoms, EKGs, and Free Open Access Medical Education (FOAM) links. Full EKG interpretations and question answers were provided.Results: Enrollment during 2017-2018 included 37 EM residencies with 663 learners in EKG I and 22 EM residencies with 438 learners in EKG II. Program leaders and learners were surveyed annually. Leaders indicated that content was appropriate for intended PGY levels. Leaders and learners indicated the curriculum improved the ability of learners to interpret EKGs while working in the emergency department (ED).Conclusion: There is an unmet need for standardization and improvement of EM resident EKG training. Leaders and learners exposed to FoEM EKG courses report improved ability of learners to interpret EKGs in the ED. [West J Emerg Med. 2020;21(1)52-57.]

This study proposes an electrocardiogram (ECG) signal stitching scheme to detect arrhythmias in drivers during driving. When the ECG is measured through the steering wheel during driving, the data are always exposed to noise caused by vehicle vibrations, bumpy road conditions, and the driver's steering wheel gripping force. The proposed scheme extracts stable ECG signals and transforms them into full 10 s ECG signals to classify arrhythmias using convolutional neural networks (CNN). Before the ECG stitching algorithm is applied, data preprocessing is performed. To extract the cycle from the collected ECG data, the R peaks are found and the TP interval segmentation is applied. An abnormal P peak is very difficult to find. Therefore, this study also introduces a P peak estimation method. Finally, 4 × 2.5 s ECG segments are collected. To classify arrhythmias with stitched ECG data, each time series' ECG signal is transformed via the continuous wavelet transform (CWT) and short-time Fourier transform (STFT), and transfer learning is performed for classification using CNNs. Finally, the parameters of the networks that provide the best performance are investigated. According to the classification accuracy, GoogleNet with the CWT image set shows the best results. The classification accuracy is 82.39% for the stitched ECG data, while it is 88.99% for the original ECG data. [ABSTRACT FROM AUTHOR]

Assess whether changing an emergency department (ED) chest pain pathway from utilizing the Thrombolysis in Myocardial Infarction (TIMI) score for risk stratification to an approach utilizing the History, EKG, Age, Risk, Troponin (HEART) score was associated with reductions in healthcare resource utilization. A retrospective, quasi-experimental study using difference-in-differences and interrupted time series specifications evaluated all ED patients with a chest pain encounter from 8/2015 to 7/2019 at a large academic medical center. We included patients age ≥ 18 with negative troponin testing discharged from the ED. Our standardized care pathway utilized TIMI for risk stratification until 09/2017 and HEART thereafter. We evaluated patients undergoing hospital-based cardiac diagnostic testing (CDT), length of stay (LOS), and 30-day Major Adverse Cardiovascular Events (MACE) at the intervention site before and after the pathway change and compared these outcomes to a similar control site within the health system for the difference-in-differences specification. During the study period, 6.3% (450 of 7117) of patients in the TIMI cohort and 7.2% (546 of 7623) in the HEART cohort among 400,965 total ED visits underwent CDT. In a multivariable analysis, transition to the HEART pathway was associated with greater odds of receiving CDT (odds ratio 2.88 [95% CI 1.21 to 6.86]), a reduction in LOS of 34 min (95% CI 2.2 to 67.6), and no significant difference in 30-day MACE. The transition from TIMI to HEART was associated with mixed consequences for healthcare resource utilization, including increased CDT but reduced length of stay. [ABSTRACT FROM AUTHOR]

Background: Methadone is one of the most useful opioids that can be used to achieve many therapeutic goals, and also it may be abused as an illicit drug. Methadone can cause different gastrointestinal, neurological, and cardiac complications. This study was performed to obtain a better understanding of the cardiac side effects of methadone in patients with methadone poisoning. Methods: This cross-sectional study was performed on 210 samples in Sina Hospital of Hamadan in a one-year period from March 2019 to March 2020. After assessing patients who had methadone poisoning and completing their demographic information and evaluation of changes in patients' EKGs, the data was collected and analyzed by SPSS 16 software. Results: Out of 210 participants, 178 (84.8%) were males and the rest were females. The average age of the studied patients was 39.56 years old. The study found that 6.1% of methadone-poisoned patients were illiterate. It was found in this study that the most common cardiac complications of methadone intoxication were sinus tachycardia (20%), QT interval prolongation (6.64%), and sinus bradycardia (4.3%), respectively; nevertheless, 66.2% of patients did not have any EKG abnormalities. Conclusion: According to the findings, it is necessary to have continuous cardiac monitoring for patients with methadone intoxication and by transferring such findings to medical centers, steps can be taken to use methadone more intelligently. [ABSTRACT FROM AUTHOR]

Copyright of Online Turkish Journal of Health Sciences (OTJHS) / Online Türk Sağlık Bilimleri Dergisi is the property of Oguz KARABAY and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ventricular tachycardia (VT) is a type of broad complex tachycardia originating from a focus in the ventricle. It is one of the four important rhythms which can lead to cardiac arrest. Accurate and timely diagnosis of true VT is the cornerstone for proper management in the emergency department (ED). We present an interesting case of an electrocardiographic artifact mimicking VT, which led to a diagnostic dilemma in the ED. [ABSTRACT FROM AUTHOR]

Penelitian mengenai sistem monitoring kesehatan jantung secara otomatis banyak dilakukan, namun masih belum menghasilkan output yang maksimal. Permasalahan utama dari penelitian yang sudah ada adalah akurasi sistem monitoring yang masih rendah terutama pada kondisi sinyal EKG yang mengandung noise. Pada penelitian ini dirancang sistem deteksi yang tahan noise melalui pengembangan algoritma kombinasi, serta dirancang prototipe hardware dan software sistem pelayanan bagi pasien dalam memonitoring kesehatan jantung. Algortima kombinasi menggunakan Wavelet dan Artificial Neural Network (ANN). Output sinyal hasil proses denoising dimasukkan dalam proses klasifikasi menggunakan ANN dan output deteksi berupa kondisi sinyal EKG yang menggambarkan keadaan jantung normal atau abnormal. Proses denoising dirancang menggunakan Wavelet dengan mengujicobaan beberapa tipe Wavelet Daubechies, Symlet, serta Coiflet pada sinyal EKG yang mengandung noise. Hasil penelitian menunjukkan bahwa algoritma kombinasi mampu memperbaiki performa sistem deteksi konvensional pada proses monitoring kesehatan jantung. Software monitoring serta prosedur pelayanan pasien juga dirancang berbasis website dan menggunakan teknologi internet of thngs.