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Diagnostic problems of acute coronary syndrome in ambulance service

100%
Zagawa S., Leszczyński P., Bakalarski P., Fedorov S.
Critical Care Innovations
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2018
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vol. 1
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issue 1
25-33
EN
INTRODUCTION: Acute coronary syndromes are one of the leading causes of death due to cardiovascular diseases. The diagnosis is made on the basis of the clinical picture, ECG record and laboratory tests. Diagnosis of critical myocardial ischemia in pre-hospital conditions is a challenge for emergency medical teams. MATERIAL AND METHODS: In order to determine the level of knowledge and the ability to recognize and deal with patients with acute coronary syndrome tests were carried out among fifty employees of the emergency medical service (doctors, nurses and paramedics) in the region of central Poland. Statistical analysis was carried out using the normality test of the Shapiro-Wilk distribution and non-parametric chi-square test of independence. The results were considered significant at the level p < 0,05. RESULTS: In the field of diagnostics, doctors obtained the result of 73.20% (SD ± 32.23), paramedics: 52.00% (SD ± 24.51), and nurses: 30.00% (SD ± 13.75). Correct treatment was best implemented by paramedics who obtained an average of 51.11% (SD ± 34.98). In turn, doctors gave 49.33% (SD ± 39.05) correct answers, and nurses 43.22% (SD ± 34.17). There was no statistical dependence of the test results on the profession (ᵡ² = 1.13; p> 0.05), nor being the head of the emergency medical team (ᵡ² = 0,43; p>0,05). CONCLUSIONS: The level of preparation of ambulance service personnel in the field of identifying and dealing with patients with suspected acute coronary syndrome is insufficient. Further research is indicated indicating the greatest substantive deficiencies of emergency doctors, paramedics and emergency nurses to implement the necessary professional development.
PL
WSTĘP: Ostre zespoły wieńcowe są jedną z głównych przyczyn zgonów z powodu chorób sercowo-naczyniowych. Diagnozę stawia się na podstawie obrazu klinicznego, zapisu ekg oraz badań laboratoryjnych. Rozpoznanie krytycznego niedokrwienia mięśnia sercowego w warunkach przedszpitalnych stanowi wyzwanie dla zespołów ratownictwa medycznego. MATERIAŁ I METODY: W celu określenia poziomu wiedzy i umiejętności rozpoznawania oraz postępowania z pacjentem z ostrym zespołem wieńcowym przeprowadzono testy wśród pięćdziesięciu pracowników systemu Państwowego Ratownictwa Medycznego (lekarzy, pielęgniarek i ratowników medycznych) w rejonie centralnej Polski. Analizę statystyczną przeprowadzono za pomocą testu normalności rozkładu Shapiro-Wilka oraz testu nieparametrycznego chi-kwadrat niezależności. Wyniki uznano za istotne na poziomie p < 0,05. WYNIKI: W zakresie diagnostyki lekarze uzyskali wynik 73,20% (SD ± 32,23), ratownicy medyczni: 52,00% (SD ± 24,51), a pielęgniarki: 30,00% (SD ± 13,75). Poprawne postępowanie najlepiej potrafili wdrożyć ratownicy medyczni, którzy uzyskali średnią 51,11% (SD ± 34,98). Z kolei lekarze udzielili 49,33% (SD ± 39,05) poprawnych odpowiedzi, zaś pielęgniarki 43,22% (SD ± 34,17). Nie wykazano zależności statystycznej wyników testu z wykonywanym zawodem (ᵡ² = 1,13; p>0,05), ani pełnieniem funkcji kierownika zespołu ratownictwa medycznego (ᵡ² = 0,43; p>0,05). WNIOSKI: Poziom przygotowania personelu zespołów ratownictwa medycznego w zakresie rozpoznawania i postępowania z pacjentem z podejrzeniem ostrego zespołu wieńcowego jest niewystarczający. Wskazane są dalsze badania wskazujące na największe braki merytoryczne lekarzy systemu, ratowników medycznych i pielęgniarek systemu, aby wdrożyć niezbędne doskonalenie zawodowe.
2
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An echocardiographic tool for the interatrial conduction disorders – old dog, new tricks?

100%
Zawadzki J. M., Gajek J. J., Sławuta A., Kozłowski D., Zaborniak G., Kudliński B.
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EN
Background: Bachmann’s bundle plays a crucial role in the physiology of interatrial signal conduction. In the 1970s, Bayes de Luna introduced the definition of interatrial blocks (IABs), which negatively influence atrioventricular (AV) synchrony and left atrial (LA) activation. We aimed to assess the potential of LA strain technology in evaluating the mechanics of LA in patients with correct conduction and IABs. Additionally, we measured the parameters of regurgitation in pulmonary veins (PV), which depend on the type of interatrial conduction. Material and methods: The study group comprised 51 patients (26M, 25F) with symptomatic COVID-19 and sinus rhythm. Our study analyzed their medical history, electrocardiography (ECG) and echocardiography, including the LA strain parameters. Results: Global peak atrial longitudinal strain (PALS) depended on P wave duration, LA volume, left ventricular ejection fraction (LV EF) and inferior pulmonary veins (PV) regurgitation parameters. Global peak atrial contractile strain (PACS) statistically depends on the LV EF, LA volume and the P wave morphology. Conclusions: The presence of IABs negatively influences PACS and PALS. Examining LA strain is complementary to accurate ECG, which may be helpful in everyday clinical practice, particularly in diagnosing heart failure with preserved ejection fraction (HFpEF) and as a predictor of new episodes of atrial fibrillation (AF).
3
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Method in the Chaos – a step-by-step approach to ECG interpretation

100%
Kozłowski D.
European Journal of Translational and Clinical Medicine
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2018
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vol. 1
|
issue 1
76-92
EN
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.
4
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Light-dark dependence of electrocardiographic changes during asphyxia and reoxygenation in a rat model

100%
Bačová I., Švorc P., Kundrík M., Fulton B.
Open Medicine
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2011
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vol. 6
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issue 1
89-97
EN
The aim of this study was to evaluate the effect of ventilation on electrocardiographic time intervals as a function of the light-dark (LD) cycle in an in vivo rat model. RR, PQ, QT and QTc intervals were measured in female Wistar rats anaesthetized with both ketamine and xylazine (100 mg/15 mg/kg, i.m., open chest experiments) after adaptation to the LD cycle (12:12h) for 4 weeks. Electrocardiograms (ECG) were recorded before surgical interventions; after tracheotomy, and thoracotomy, and 5 minutes of stabilization with artificial ventilation; 30, 60, 90 and 120 seconds after the onset of apnoea; and after 5, 10, 15, and 20 minutes of artificial reoxygenation. Time intervals in intact animals showed significant LD differences, except in the QT interval. The initial significant (p<0,001) LD differences in PQ interval and loss of dependence on LD cycle in the QT interval were preserved during short-term apnoea-induced asphyxia (30–60 sec) In contrast, long-term asphyxia (90–120 sec) eliminated LD dependence in the PQ interval, but significant LD differences were shown in the QT interval. Apnoea completely abolished LD differences in the RR interval. Reoxygenation restored the PQ and QT intervals to the pre-asphyxic LD differences, but with the RR intervals, the LD differences were eliminated. We have concluded that myocardial vulnerability is dependent on the LD cycle and on changes of pulmonary ventilation.
5
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Light-dark dependence of electrocardiographic changes during asphyxia and reoxygenation in a rat model

100%
Bačová I., Švorc P., Kundrík M., Fulton B.
Open Medicine
|
2010
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vol. 5
|
issue 5
611-619
EN
The aim of this study was to evaluate the effect of ventilation on electrocardiographic time intervals as a function of the light-dark (LD) cycle in an in vivo rat model. RR, PQ, QT and QTc intervals were measured in female Wistar rats anaesthetized with both ketamine and xylazine (100 mg/15 mg/kg, i.m., open chest experiments) after adaptation to the LD cycle (12:12h) for 4 weeks. Electrocardiograms (ECG) were recorded before surgical interventions; after tracheotomy, and thoracotomy, and 5 minutes of stabilization with artificial ventilation; 30, 60, 90 and 120 seconds after the onset of apnoea; and after 5, 10, 15, and 20 minutes of artificial reoxygenation. Time intervals in intact animals showed significant LD differences, except in the QT interval. The initial significant (p<0,001) LD differences in PQ interval and loss of dependence on LD cycle in the QT interval were preserved during short-term apnoea-induced asphyxia (30–60 sec) In contrast, long-term asphyxia (90–120 sec) eliminated LD dependence in the PQ interval, but significant LD differences were shown in the QT interval. Apnoea completely abolished LD differences in the RR interval. Reoxygenation restored the PQ and QT intervals to the pre-asphyxic LD differences, but with the RR intervals, the LD differences were eliminated. We have concluded that myocardial vulnerability is dependent on the LD cycle and on changes of pulmonary ventilation.
6
Publication available in full text mode
Content available

Method in the Chaos – a step-by-step approach to ECG interpretation

100%
Kozłowski D.
European Journal of Translational and Clinical Medicine
|
2018
|
vol. 1
|
issue 1
76-92
EN
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.
7
Publication available in full text mode
Content available

A 5.5 μW 42 nV/√Hz Chopper stabilized Amplifier for Biomedical Application with Input Impedance Enhancement

86%
Adesara A., Naik A., Adesara A., Naik A.
International Journal of Electronics and Telecommunications
|
2021
|
vol. 67
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issue 3
8
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Electrocardiographic changes in pregnancy and postpartum period

72%
Kandzia T., Markiewicz-Łoskot G.
Annales Academiae Medicae Silesiensis
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2016
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vol. 70
9-14
EN
Pregnancy and labor, though a physiological and natural time in a woman’s life, are associated with many changes to the woman’s body. The overall blood volume, cardiac output and heart rate of a pregnant woman differ significantly from pre-pregnancy time. This again has a significant effect on the electrical activity of the heart. Abnormal electric activity of the heart might be confused with an ongoing or commencing heart disease. Moreover, pregnancy, labour and especially the post partum period are also known to increase the risk of cardiac events including arrhythmia, myocardial infarction or even sudden cardiac death, especially in women with a present cardiac disease like LQTS (Long QT Syndrome). In order to reduce the occurrence of adverse cardiac events and enable their early detection and diagnosis, there is a need for a more thorough understanding of electrocardiographic changes occurring during pregnancy. Unfortunately, data regarding changes of the electric activity of the heart during pregnancy are scarce. The aim of this work is to give an outline on the electric activity changes of the heart of a pregnant woman. The available data confirm that intense changes in the cardiovascular system caused by pregnancy strongly affect the electrical activity of the heart.
PL
Ciąża i poród, choć należą do fizjologicznego i naturalnego czasu w życiu kobiety, wiążą się z wieloma zmianami w jej organizmie. Całkowita objętość krwi, rzut serca i tętno u kobiet w ciąży znacznie odbiegają od wartości przedciążowych. Zmiany te mają znaczący wpływ na aktywność elektryczną serca. Zmieniona aktywność elektryczna serca może być mylona z trwającą lub nowo powstałą chorobą serca. Ponadto w okresie ciąży, porodu, a również połogu w sposób istotny zwiększa się ryzyko zdarzeń sercowych, w tym zaburzeń rytmu, zawału serca lub nawet nagłej śmierci sercowej, zwłaszcza u kobiet z chorobą serca w wywiadzie, takich jak LQTS (zespół wydłużonego odcinka QT). W celu zmniejszenia występowania niepożądanych zdarzeń sercowych oraz umożliwienia ich wcześniejszego wykrywania i diagnostyki istnieje potrzeba bardziej dogłębnego zrozumienia zmian elektrokardiograficznych zachodzących w okresie ciąży. Niestety, dane dotyczące zmian elektrokardiograficznych w ciąży są nieliczne. Celem naszej pracy poglądowej jest przedstawienie zarysu zmian elektrycznej aktywności serca u kobiety ciężarnej. Dostępne wyniki badań dowodzą, że intensywne zmiany w układzie krążenia spowodowane ciążą silnie wpływają na aktywność elektryczną serca.
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