According to the expert opinion of the Working Group on Noninvasive Electrocardiology and Telemedicine of the Polish Cardiac Society, the interpretation (and report) of an electrocardiogram (ECG) consists of 10 steps. For the sake of simplicity, it is possible to simplify these rules to 7 steps. The aim of this article is to help refresh the clinical aspects of ECG interpretation and to hopefully clarify the confusion surrounding it.
Pewien wąski nurt późnomodernistycznej architektury eksponujący rozwiązania techniczne jako elementy formy architektonicznej określa się – high tech, co jednoznacznie wskazuje na technologię zaawansowaną. W świetle purystycznych form architektury wczesnego modernizmu idee high tech jawią się raczej jako poszukiwania oryginalności przez odkrywanie współczesnej ornamentyki.
Architectural design takes place in a certain cultural space. I f the space is not expressive enough for the artist, observer or passer-by, architects create their individual worlds where original artworks shaping space appear. And the audience accepts it with understanding.
According to the expert opinion of the Working Group on Noninvasive Electrocardiology and Telemedicine of the Polish Cardiac Society, the interpretation (and report) of an electrocardiogram (ECG) consists of 10 steps. For the sake of simplicity, it is possible to simplify these rules to 7 steps. The aim of this article is to help refresh the clinical aspects of ECG interpretation and to hopefully clarify the confusion surrounding it.
Introduction: Syncope is defined as transient loss of consciousness, due to decrease in brain perfusion. The most frequent mechanism is vasovagal syncope. In many patients, the cause of syncope remains unspecified, despite an extensive diagnostic work-up. Tilt-test (TT) is an acknowledged diagnostic tool for syncope. Currently, the so-called Italian protocol of TT is most widely used. Vasovagal syncope is caused by impaired circulatory regulation in response to orthostatic stress. One of the available tools to examine the influence of the nervous system on the circulation is the analysis of heart rate variability (HRV). Despite numerous publications concerning HRV parameters and autonomic regulation in patients with syncope, direct comparisons and metaanalysis of the results is impossible, due to variability of TT protocols and study group specifications. Aim of the study: As there is no uniform model of HRV during TT, we aimed to analyze HRV parameters during TT (performed according to the Italian protocol) in patients with vasovagal syncope, in order to determine the possible application of HRV measurements in clinical practice in that group of patients. Detailed objectives were: (1) analysis and comparison of HRV in patients with and without the history of syncope; (2) analysis of HRV changes in consecutive stages of TT; (3) identification of possible HRV differences between patients with positive and negative TT results. Materials and methods: Patients between 18 and 50 years of age were qualified for the study, if they had a history of at least 2 incidents of syncope or presyncope within the preceeding 6 months, and if signs and symptoms indicated the vasovagal mechanism. The study group included 150 patients: 100 consecutive patients with a postive TT result (POS), and 50 consecutive patients with a negative TT result (NEG). The control group (CG) comprised 50 volunteers with no history of syncope nor presyncope, matched according to age and sex to the study group. In all patients a TT was performed according to the Italian protocol, with paced breathing at a rate of 15/min. Time-domain (meanRR, SDNN, RMSSD, pNN50) and frequency-domain (abs_LF, abs_HF, rel_LF, rel_HF, norm_LF, norm_HF, LF/HF) HRV parameters were analyzed and compared at different stages of TT in the study groups as specified above. Results: 100 patients at the age of 18-44 years were included in the POS group, 50 patients at the age of 18-39 years in the NEG group, and 50 volunteers at the age of 20-39 in the CG. Volunteers in the control group developed unexpectedly high percentage of positive TT (14 patients). For consistency of analysis, the CG was thus subdivided according to the result of the TT into CG_POS (positive result of TT) – 14 patients, and CG_NEG (negative result of TT) – 36 patients. Based on HRV analaysis, no significant differences in HRV values were noted between patients with a history of syncope and positive or negative result of TT. Upright tilt resulted in HRV changes of the same direction and value in syncopal patients in the POS and NEG goup, as well as in patients in the CG_NEG group. Conclusion: HRV values and changes of those values at subsequent stages of TT were not different between syncopal patients with postive or negative TT result, or negative TT control group. The Italian protocol of TT may be associated with a surprisingly high percentage of false positive results.
Background. Learning detailed construction of individual structures in the heart is by all means essential for better understanding of pathologic variations which may occur within its constitution or beyond. In recent years there have appeared relatively few publications on septal papillary muscles co-creating valvular apparatus of the right atrioventricular orifice. Material and methods. The paper presents preliminary results of microscopic evaluation of septal papillary muscles in hearts of elderly people. The observations were conducted on the material of 10 human hearts of both sexes, 66-97 years of age, with no pathological lesions or malformations, originated from the collection of the Department of Clinical Anatomy of Gdansk Medical University. Results. A significant diversity of papillary muscle tissue structure was stated, and as such it can influence on the function of valvular apparatus. No elements of conduction system were observed within these structures. Geriatria 2012; 6: 207-211.
PL
Wstęp. Poznanie szczegółowej budowy poszczególnych struktur serca z całą pewnością jest konieczne dla właściwego zrozumienia zmian patologicznych, jakie mogą pojawić się w jego obrębie lub poza nim. W ostatnich latach pojawiają się stosunkowo nieliczne publikacje traktujące o mięśniach brodawkowatych przegrodowych, współtworzących aparat zastawkowy prawego ujścia przedsionkowo-komorowego. W pracy przedstawiono wstępne wyniki obserwacji mikroskopowych mięśni brodawkowatych przegrodowych w sercach osób starszych. Materiał i metody. Obserwacje poczyniono na materiale 10 serc ludzkich obojga płci, w wieku 66-97 lat, pozbawionych zmian patologicznych i wad rozwojowych, pochodzących ze zbiorów Zakładu Anatomii Klinicznej Gdańskiego Uniwersytetu Medycznego. Wnioski. Stwierdzono istotne zróżnicowanie tkankowe badanych mięśni, które może rzutować na funkcjonowanie aparatu zastawkowego. W strukturach tych nie odnotowano obecności elementów układu przewodzącego. Geriatria 2012; 6: 207-211.
Introduction Syncope is defined as transient loss of consciousness, due to decrease in brain perfusion. The most frequent mechanism is vasovagal syncope. In many patients, the cause of syncope remains unspecified, despite an extensive diagnostic work-up. Tilt-test (TT) is an acknowledged diagnostic tool for syncope. Currently, the so-called Italian protocol of TT is most widely used. Vasovagal syncope is caused by impaired circulatory regulation in response to orthostatic stress. One of the available tools to examine the influence of the nervous system on the circulation is the analysis of heart rate variability (HRV). Despite numerous publications concerning HRV parameters and autonomic regulation in patients with syncope, direct comparisons and metaanalysis of the results is impossible, due to variability of TT protocols and study group specifications. Aim of the study As there is no uniform model of HRV during TT, we aimed to analyze HRV parameters during TT (performed according to the Italian protocol) in patients with vasovagal syncope, in order to determine the possible application of HRV measurements in clinical practice in that group of patients. Detailed objectives were: (1) analysis and comparison of HRV in patients with and without the history of syncope; (2) analysis of HRV changes in consecutive stages of TT; (3) identification of possible HRV differences between patients with positive and negative TT results. Materials and methods Patients between 18 and 50 years of age were qualified for the study, if they had a history of at least 2 incidents of syncope or presyncope within the preceeding 6 months, and if signs and symptoms indicated the vasovagal mechanism. The study group included 150 patients: 100 consecutive patients with a postive TT result (POS), and 50 consecutive patients with a negative TT result (NEG). The control group (CG) comprised 50 volunteers with no history of syncope nor presyncope, matched according to age and sex to the study group. In all patients a TT was performed according to the Italian protocol, with paced breathing at a rate of 15/min. Time-domain (meanRR, SDNN, RMSSD, pNN50) and frequency-domain (abs_LF, abs_HF, rel_LF, rel_HF, norm_LF, norm_HF, LF/HF) HRV parameters were analyzed and compared at different stages of TT in the study groups as specified above. Results 100 patients at the age of 18-44 years were included in the POS group, 50 patients at the age of 18-39 years in the NEG group, and 50 volunteers at the age of 20-39 in the CG. Volunteers in the control group developed unexpectedly high percentage of positive TT (14 patients). For consistency of analysis, the CG was thus subdivided according to the result of the TT into CG_POS (positive result of TT) – 14 patients, and CG_NEG (negative result of TT) – 36 patients. Based on HRV analaysis, no significant differences in HRV values were noted between patients with a history of syncope and positive or negative result of TT. Upright tilt resulted in HRV changes of the same direction and value in syncopal patients in the POS and NEG goup, as well as in patients in the CG_NEG group. Conclusion HRV values and changes of those values at subsequent stages of TT were not different between syncopal patients with postive or negative TT result, or negative TT control group. The Italian protocol of TT may be associated with a surprisingly high percentage of false positive results.
Background: New-onset atrial fibrillation (NOAF) is one of the complications of acute myocardial infarction (AMI), and is associated with poor outcome. The aim of the study was clinical and laboratory assessment of patients with NOAF in AMI. Material and methods: This is a retrospective, single-centre study of AMI patients with NOAF, who were admitted to Clinical Centre of Cardiology of the University Clinical Centre in Gdansk, from January 2016 to June 2018. The medical history, echocardiography parameters, AMI localization and infarcted-related artery as well as laboratory parameters at the admission and at the moment of NOAF onset were taken into further analyses. Results: From 1155 consecutive AMI patients 103 (8.9%) with NOAF were enrolled into the study. A significant increase in C-reactive protein (CRP) and high-sensitive Troponine I (hsTnI) level, whereas significant decrease in potassium and hemoglobin level was observed at the moment of NOAF in comparison to admission. Conclusions: Our study suggests that markers of inflammation (CRP), myocardial necrosis (hsTnI), hemoglobin and serum potassium may be associated with NOAF in the setting on AMI. The aforementioned parameters are generally available and may be used as an inexpensive and rapid way to select patients who are at high risk of developing NOAF.
Introduction. False chordae tendineae are described in the literature as fibrous-muscular bundles present in ventricles, not interconnecting, unlike „true” chordae, with atrioventricular valves. In the literature there are numerous reports suggesting significant influence of the structures on electromechanical processes in the heart. Objective. The aim of this study was to evaluate an ultrastructure of the false chordae tendineae in the right ventricle of the heart, mainly in terms of the presence of conduction system elements within their area. Material and methods. Material for research consisted of 40 human adults’ hearts of both sexes (24♂, 16♀), aged from 18 to 59. 114 chordae in total were examined. Location of muscle tissue, fibrous elements and the presence of blood vessels were studied. Special attention was paid to the observation of the type of muscle tissue in chordae tendineae (due to reports, concerning presence within their elements of cardiac conduction system). Results. Basic scheme of the build of false chordae tendineae in the right ventricle of a human heart presents as follows: it constitutes of a muscle bundle consisting of working muscle tissue of the ventricles surrounded by a layer of connective tissue and from the outside covered by endocardium. In the examined material, obvious bifurcation of the right branch of the bundle of His transiting into false chordae tendineae, was not found. However, single muscle fibers were observed running in the connective tissue, being a continuation of the deepest layer of the endocardium (22 cases – 19,3% of false chordae endineae). This location is typical for Purkinje fibers. Morphology of these structures in some cases could correspond with distal segments of conductive system of the heart (lack of striations, brightness around the nuclei). Conclusions. Obvious bifurcations of the right branch of the bundle of His were not observed, however ingle muscle fibers were seen, which may correspond with Purkinje fibers. Geriatria 2012; 6: 212-218
PL
Wstęp. Mianem strun ścięgnistych rzekomych, określane są pasma włóknisto-mięśniowe przebiegające w komorach serca, niełączące się w odróżnieniu od strun „prawdziwych" z zastawkami przedsionkowo-komorowymi. Większość opisów tych elementów dotyczy lokalizacji lewokomorowej, analizy strun komory prawej należą do rzadkości. Cel pracy. Celem pracy była mikroskopowa ocena strun ścięgnistych rzekomych w prawej komorze serca, głównie w aspekcie obecności elementów układu przewodzącego. Materiał i metody. Materiał do badań stanowiło 40 serc ludzi dorosłych, obojga płci (24♂, 16♀) w wieku od 18 do 59 lat. W sumie zbadano 114 struny. Po wstępnej obróbce utrwalonych skrawków, były one cięte co 10 μm, a następnie barwione metodą Massona w modyfikacji Goldnera. Pomiary przeprowadzono przy użyciu oprogramowania Motic Images 2.0 Plus, natomiast analizę statystyczną z wykorzystaniem programu Statistica 9.1 (testy chi-kwadrat, Kruskal-Wallis).Wyniki. Wszystkie badane struny miały podobną budowę histologiczną z niewielkimi odchyleniami, uwarunkowanymi głównie wielkością, a mniejszym stopniu lokalizacją. Mięśniówka występowała w postaci dwóch form: 1) jednolitego pasma z niewielką ilością zrębu łącznotkankowego, lub 2) kilku cienkich pasemek o zmiennym przekroju połączonych większą ilością tkanki łącznej. Mięśniówka stanowiła największą objętościowo składową strun ścięgnistych rzekomych. Nie stwierdzono istotnej zależności pomiędzy zawartością tkanki mięśniowej a płcią i wiekiem. W większości badanych preparatów można było prześledzić przejście pasma mięśniowego struny do podwsierdziowej mięśniówki sąsiadujących struktur. Tkanka łączna, występowała głównie w postaci dobrze rozbudowanej warstwy podwsierdziowej. Naczynia krwionośne, można było stwierdzić na całej długości przebiegu strun. W badanym materiale nie znaleziono wyraźnych rozgałęzień prawej odnogi pęczka Hisa, wnikających do strun ścięgnistych rzekomych. Wnioski. Stwierdzono zbliżoną budowę histologiczną wszystkich badanych strun – zawsze obecne były: pasmo mięśniowe, zrąb łącznotkankowy oraz pojedyncze lub mnogie naczynia krwionośne. Nie znaleziono wyraźnych rozgałęzień prawej odnogi pęczka Hisa, były jednak widoczne pojedyncze włókna mięśniowe, mogące odpowiadać włóknom Purkinjego. Geriatria 2012; 6: 212-218.
Background Anatomy assessment using Computer Tomography (CT) and Magnetic Resonance (MRI) is performed in patients undergoing pulmonary vein isolation (PVI). The aim of this analysis was to investigate whether electroanatomical 3D map and CT/MRI image integration using the CartoMerge system improves efficacy, reduces procedure time or fluoroscopy usage. Materials and methods 57 patients undergoing PVI were divided in two groups: “Merge” (n=45 pts) and “non-Merge” (n=14 pts) depending on usage of image integration. PV isolation during procedure (acute PVI), procedure time, fluoroscopy time, number of radio frequency (RF) applications and AF recurrence during follow-up (Merge group: 12-24 months, non-Merge group: 9-18 months) were analyzed. Results Intra-procedural PVI was equal in both groups (93%). Long-term efficacy, defined as absence of AF recurrence, was insignificantly higher in the Merge group (69,8% vs 50%, p=0,11793). Procedure time was significantly longer in the Merge group – 239,1 (±55,5) min. vs 192,4 (±44,5). Fluoroscopy time was similar in both groups 29,9 (±12,23) vs 24,6 (±26,5) min, (p=0,579). Number of RF applications was significantly higher in the Merge group 48,5 (±25,2) vs 27,2 (±14,9). Conclusions CartoMerge did not improve the rate of acute PVI, long-term effectivity or fluoroscopy time. In the non-Merge group the procedure time was shorter and the number of applications was significantly smaller.
Background: Anatomy assessment using Computer Tomography (CT) and Magnetic Resonance (MRI) is performed in patients undergoing pulmonary vein isolation (PVI). The aim of this analysis was to investigate whether electroanatomical 3D map and CT/MRI image integration using the CartoMerge system improves efficacy, reduces procedure time or fluoroscopy usage. Materials and methods: 57 patients undergoing PVI were divided in two groups: “Merge” (n=45 pts) and “non-Merge” (n=14 pts) depending on usage of image integration. PV isolation during procedure (acute PVI), procedure time, fluoroscopy time, number of radio frequency (RF) applications and AF recurrence during follow-up (Merge group: 12-24 months, non-Merge group: 9-18 months) were analyzed. Results: Intra-procedural PVI was equal in both groups (93%). Long-term efficacy, defined as absence of AF recurrence, was insignificantly higher in the Merge group (69,8% vs 50%, p=0,11793). Procedure time was significantly longer in the Merge group – 239,1 (±55,5) min. vs 192,4 (±44,5). Fluoroscopy time was similar in both groups 29,9 (±12,23) vs 24,6 (±26,5) min, (p=0,579). Number of RF applications was significantly higher in the Merge group 48,5 (±25,2) vs 27,2 (±14,9). Conclusions: CartoMerge did not improve the rate of acute PVI, long-term effectivity or fluoroscopy time. In the non-Merge group the procedure time was shorter and the number of applications was significantly smaller.
Background New-onset atrial fibrillation (NOAF) is one of the complications of acute myocardial infarction (AMI), and is associated with poor outcome. The aim of the study was clinical and laboratory assessment of patients with NOAF in AMI. Material and methods This is a retrospective, single-centre study of AMI patients with NOAF, who were admitted to Clinical Centre of Cardiology of the University Clinical Centre in Gdansk, from January 2016 to June 2018. The medical history, echocardiography parameters, AMI localization and infarcted-related artery as well as laboratory parameters at the admission and at the moment of NOAF onset were taken into further analyses. Results From 1155 consecutive AMI patients 103 (8.9%) with NOAF were enrolled into the study. A significant increase in C-reactive protein (CRP) and high-sensitive Troponine I (hsTnI) level, whereas significant decrease in potassium and hemoglobin level was observed at the moment of NOAF in comparison to admission. Conclusions Our study suggests that markers of inflammation (CRP), myocardial necrosis (hsTnI), hemoglobin and serum potassium may be associated with NOAF in the setting on AMI. The aforementioned parameters are generally available and may be used as an inexpensive and rapid way to select patients who are at high risk of developing NOAF.
Background Hypertrophic Cardiomyopathy (HCM) is one of the most common genetic myocardial diseases. Transthoracic echocardiography which includes speckle tracking technique is tool for HCM diagnosis and monitoring the course of the disease. The aim of this study was to compare clinical and echocardiographic parameters in HCM patients older and younger than 60 years old (yo). Material and methods We prospectively enrolled 53 HCM patients, who were divided into two groups: younger and older than 60 yo. Clinical parameters, standard echocardiographic indices, as well as strain parameters were assessed and compared between the groups. Results The older subgroup was characterized by a higher prevalence of coronary artery disease. In the younger subgroup the incidence of atrial fibrillation was quite high, which occurs far more often than in the general population. Echocardiographic analysis showed worse diastolic function in older, as well as lower volume of the LV. The global longitudinal strain was worse in <60 patients. The 3D strain parameters differed significantly between the groups: the area and radial strains were worse in younger patients. Conclusions HCM patients older and younger than 60 yo differ significantly in terms of clinical and echocardiographic parameters.
Background: Hypertrophic Cardiomyopathy (HCM) is one of the most common genetic myocardial diseases. Transthoracic echocardiography which includes speckle tracking technique is tool for HCM diagnosis and monitoring the course of the disease. The aim of this study was to compare clinical and echocardiographic parameters in HCM patients older and younger than 60 years old (yo). Material and methods: We prospectively enrolled 53 HCM patients, who were divided into two groups: younger and older than 60 yo. Clinical parameters, standard echocardiographic indices, as well as strain parameters were assessed and compared between the groups. Results: The older subgroup was characterized by a higher prevalence of coronary artery disease. In the younger subgroup the incidence of atrial fibrillation was quite high, which occurs far more often than in the general population. Echocardiographic analysis showed worse diastolic function in older, as well as lower volume of the LV. The global longitudinal strain was worse in <60 patients. The 3D strain parameters differed significantly between the groups: the area and radial strains were worse in younger patients. Conclusions: HCM patients older and younger than 60 yo differ significantly in terms of clinical and echocardiographic parameters.
JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.