A 6-month-old male Ragdoll cat presented with exercise intolerance. On physical examination, there was a grade 2/6 systolic murmur at the right apex. Diagnostic tests, including SpO2 measurement, blood tests, radiography, echocardiography, contrast echocardiography, and electrocardiography, were performed. Severe right atrial dilation, tricuspid valve leaflets and orifice displacement, right ventricular atrialization, septal leaflet adherence, anterior leaflet tethering, and right atrioventricular junction dilation were noted on echocardiography, alongside a right-to-left atrial septal defect. Cor triatriatum dexter and left ventricular aneurysm were observed. We diagnosed this case as having Ebstein anomaly with rare congenital heart deformities; which is rare in cats.
It has recently become possible to record electrical activity originating from abnormally conducting myocardium from the body surface with high - gain amplification and averaging technique. These signals, which result from delayed ventricular activation(late potentials), have been recorded in patients with documented ventricular tachyarrythmia. Several electrode lead system for detecting ventricular late potential were introduced. Pyramidal electrode lead system(PLS) is useful. Also interpretation of SAECG in the young could be of value in detecting those at risk for episodic ventricular tachycardia, but suffer from a lack of data in normal young people. Selection of subjects : For this study, normal healthy young adult volunteers (age: mean 24 years) were recruited from the medical students at Yeungnam University Hospital, Internal Medicine. Twenty fourths male and seventeenths female subjects were selected. All subjects had normal resting ECGs as judged from both the standard 12 channel lead and echocardiography, and none had a history of cardiovascular disease. All subjects were considered to be in good general physical condition. Signal-averaged electrocardiography : In order to obtain low noise recordings with a small number of averaging cycles, all subject ware asked to relax completely in the supine position. Silver/silver chloride electrodes were attached after the skin was cleaned with alcohol, to constitute classic flank lead system(FLS) and pyramidal lead system(PLS). Signals were recorded and processed using a commercially available microprocessor-augmented ECG cart(Marquette Electronics, USA) suitable for portable bedside recording. There was no difference between normal values, determined by FLS and PLS at high pass filtering of 25 Hz and 80 Hz, but significant, difference was found in HFLAD and RMS-40 of 40 Hz(p<0.05). These results will provide a basis for interpretations of SAECG, determined by FLS and PLS in healthy young adults with normal QRS duration.
Purpose: Myocardial perfusion scintigraphy is a useful technique to diagnose and to predict prognosis in patients with suspected or known coronary artery disease. The purpose of the present study is to evaluate the prognostic value of normal exercise $^{99m}Tc$-MIBI myocardial perfusion single photon emission computed tomography (SPECT) and to analyze results with regard to those of exercise electrocardiography or coronary angiography. Materials and Methods: We evaluated 301 patients (mean age $52{\pm}10$ years, 166 males and 135 females) with normal exercise $^{99m}Tc$-MIBI myocardial perfusion SPECT performed for suspected coronary artery disease. Subject were evaluated for cardiac events and followed for 8-55 months (mean $19{\pm}10$ months) after imaging. Results: During the follow-up period, there was no cardiac death but only one non-fatal myocardial infarction (event rate 0.21% per year). In addition, only one patient underwent coronary revascularization. There was no significant difference in cardiac event rate between patients with positive (n=27) and negative (n=235) exercise electrocardiography (p:NS). There was no cardiac event in 17 patients who underwent coronary angiography (4 patients with >50% luminal narrowing, 2 patients with vasospasm and 11 patients with no significant lesion). Conclusion: Patients with normal exercise $^{99m}Tc$-MIBI myocardial perfusion SPECT has a very low risk for cardiac events regardless of exercise electrocardiographic and coronary angiographic findings.
Journal of the Korea Academia-Industrial cooperation Society
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v.18
no.6
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pp.381-388
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2017
The CPR guidelines emphasize the delivery of effective chest compressions but do not address the effects of chest compressions on CPR providers. This study determined the effects of chest compressions on healthy adult firefighters' symptoms, hemodynamics, and electrocardiography after performing multiple cycles of CPR. Healthy adult firefighters were trained in CPR and performed CPR on mannequins. The provider vital signs, electrocardiography, and fatigue scores were determined immediately before CPR, after 5cycles of CPR, and after 10 cycles of CPR. In addition, the presence of clinical symptoms among the providers was determined after CPR; 39 firefighters participated in the study. Their mean age was $35.54{\pm}10.26years$. Many providers developed fatigue, shortness of breath, and dizziness. Significant changes in heart rate (p=0.000), respiratory rate (p=0.010), end-tidal CO2(p=0.000), O2 saturation(p=0.000), and pulse pressure (p=0.000) were observed after both 5 and 10 cycles of CPR. One participant developed sinus dysrhythmia and premature ventricular contractions after 10 cycles of CPR. The delivery of chest compression results in fatigue and hemodynamic alterations in many young healthy adults after performing 5 or 10 cycles of CPR. The CPR guidelines and education should take into consideration the effects of chest compressions on CPR providers.
In order to determine the prevalence rate and find out the sexual difference of abnormal electrocardiographic findings manifested by computerized EKG, which is equipped with auto-analyzing function, a total of 2,083 electrocardiograms that were taken from population over 20 years-old from October 1996 to February 1997 were studied according to their age, gender and blood pressure. 1. Using the electrocardiography with auto-analyzing function, 33 kinds of abnormal findings were manifested. The prevalence rate of abnormal findings was 52.8% in male and 43.7% in female. Among them, the most common finding was sinus brady-cardia found in 17.6% of male and 15.4% of female. Left ventricular hypertrophy by voltage criteria, minimal voltage of left ventricular hypertrophy, left axis deviation and atrial fibrillation were more common in male than in female statistically. Both of nospecific T wave and ST segment abnormality were more common in female than in male statistically. 2. Thirty-three kinds of abnormal findings were manifested. They revealed one abnormal finding alone or combined with some other ones making 128 kinds of abnormal finding. The most common abnormal finiding that manifested alone was right axis deviation (100%), then myocardial ischemia (95.7%) the next. The most common abnormal finding that complexed with other abnormal findings were left anterior fascicular block(percentage of single manifestation, 26.2%) and nonspecific T wave abnormality(percentage of single manifestation; 32.9%). Also, combination of sinus bradycardia and minimal voltage of left ventricular hypertrophy, and combination of sinus bradycardia and left ventricular hypertrophy were included in 25th sequences of abnormal findings. 3. The prevalence rate of abnormal electrocardiographic findings were higher in older group, hypertensive group, and the group of higher systolic or diastolic pressure in both sexes. 4. Abnormal findings that commonly manifested with sinus bradycardia were voltage criteria or minimal voltage of left ventricular hypertrophy(38.6%): sinus arrhythmia(10.5%): nonspecific T wave or ST segment abnormality(18.4%) and first degree AV block(7.2%) in descending order. 5. The most common site which manifested myocardial ischemia was posterior and inferior wall with equal percentage of 23.4%. And then anterior wall(19.1%), and antero-lateral wall and septum with equal percentage of 10.6% was noted in descending order.
Journal of Korean Institute of Industrial Engineers
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v.40
no.3
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pp.325-332
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2014
High cognitive workload decreases a driver's ability of judgement and response in traffic situation and could result in a traffic accident. Electrocardiography (ECG) has been used for evaluation of drivers' cognitive workload; however, individual differences in ECG response corresponding to cognitive workload have not been fully considered. The present study developed an evaluation method of individual driver's cognitive workload based on ECG data, and evaluated its usefulness through an experiment in a driving simulator. The evaluation method developed by the present study determined the optimal ECG evaluation condition for individual participant by analysis of area under the receiver operating characteristic curve (AUC) for various conditions (total number of conditions = 144) in terms of four aspects (ECG measure, window span, update rate, and workload level). AUC analysis on the various conditions showed that the optimal ECG evaluation condition for each participant was significantly different. In addition, the optimal ECG evaluation condition could accurately detect changes in cognitive workload for 47% of the total participants (n = 15). The evaluation method proposed in the present study can be utilized in the evaluation of individual driver's cognitive workload for an intelligent vehicle.
Atrial fibrillation(AF). chronic or paroxysmal is the most frequent arrhythmia in human subjects Duration of P wave in signal-averaged electrocardiography(SAECG) reflects intra-atrial conduction time and therefore. could be used as an electrophysiological marker for atrial conduction chance at the earthy stave. So we apply the analysis method using SAECG to diagnose Paroxysmal atrial fibrillation(PAF) . Subjects Participated for the study consisted of two groups: a control group(n=34) of normal healthy volunteers and a group of AF Patients(n=38) with a documented history of PAF but no other history of cardiac disease. We evaluated the effect of several filtering and determination methods to find the starting and ending feints of the P wavy on its duration. To increase the measurement reliability of P wave duration. the automatic detection method was proposed. Also. to increase the detection rate for PAF risk, the decision threshold value was optimized using receiver operation characteristics(ROC) curve. Results showed that the highest statistical difference (p〈0.001) of the P wane duration between controls and subjects was obtained at the Processing condition, using absolute threshold vague(8.75 $\mu N$) , a least mean square(LMS) high pass filter and 30 Hz cutoff frequency. The most outstanding difference(sensitivity 88 % specificity 64.4 %) between controls and subjects was obtained at the decision threshold value of 112 ms.
Kim, Eun Young;Yoo, Cheol Seung;Jung, Dong Chung;Yi, Sang Hoon;Chung, In-Won;Kim, Yong Sik;Ahn, Yong Min
Korean Journal of Biological Psychiatry
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v.27
no.1
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pp.1-8
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2020
Objectives In electroconvulsive therapy (ECT) research and practice, the precise determination of seizure duration is important in the evaluation of clinical relevance of the ECT-induced seizure. In this study, we have developed computerized algorithms to assess the duration of ECT-induced seizure. Methods Subjects included 5 males and 6 females, with the mean age of 33.1 years. Total 55 ECT sessions were included in the analysis. We analyzed the standard deviation of a finite block of electroencephalography (EEG) data and the change in the local slope of RR intervals in electrocardiography (ECG) signals during ECT-induced seizure. And then, we compared the calculated seizure durations from EEG recording (EEG algorithm) and ECG recording (ECG algorithm) with values determined by consensus of clinicians based on the recorded EEG (EEG consensus), as a gold standard criterion, in order to testify the computational validity of our algorithms. Results The mean seizure durations calculated by each method were not significantly different in sessions with abrupt flattened postictal suppression and in sessions with non-abrupt flattened postictal suppression. The intraclass correlation coefficients (95% confidence interval) of the three methods (EEG algorithm, ECG algorithm, EEG consensus) were significant in the total sessions [0.79 (0.70-0.86)], the abrupt flattened postictal suppression sessions [0.84 (0.74-0.91)], and the non-abrupt flattened postictal suppression sessions [0.67 (0.45-0.84)]. Correlations between three methods were also statistically significant, regardless of abruptness of transition. Conclusions Our proposed algorithms could reliably measure the duration of ECT-induced seizure, even in sessions with non-abrupt transitions to flat postictal suppression, in which it is typically difficult to determine the seizure duration.
Background: In the patients with thoracic injury, we suspect simultaneous cardiac contusion or concussion. We analyzed the patients with possible cardiac injury by electrocardiography, serum creatine kinase (CK), creatine kinase isoenzyme fraction (CK-MB) screening, followed by two dimentional echocardiogram (2-DE) to access the severity of injury. Material and Method: From January 1997 to April 1998, 15-month retrospective study of suspicious myocardial injury was undertaken in including 24 patients admitted for suspected cardiac injury. All patients with history or signs of blunt chest injury were checked serially and the serial CK, CK-MB fraction, electrocardiography (EKG) analysis screening were followed by 2-DE. Result: The age range was between 20-40 years and were predominant male patients in(M:F=3:1). Most common causes of injury were traffic accidents, 15 patients(62.5%). Associated injuries involved multiple rib fractures, sternal fracture and such. EKG findings on the cardiac concussion were within normal limits, EKG findings on the cardiac contusion were nonspecific ST and T wave abnormality. In cardiac contusion patients, CK-MB fraction did not increase significantly on admission but on 2nd, 3rd, 4th hospital days, it increased significantly (p=0.0080, 0.0130, 0.0130). The average admission days were 9.22 in concussion and 26.18 in contusion patients(p=0.0075). Most common complication was the adult respiratory distress syndrome(7 cases), 5 out of the patients with ARDS were mechanically ventilated. There were no deaths. Conclusion: We believe the serial checks of CK-MB, EKG and subsquent two-dementional echocardiographic sector scanning are presently the most sensitive indicators available for structural and functional cardiac injury.
Objective: Segmented cardiac cine magnetic resonance imaging (MRI) is the gold standard for cardiac ventricular volumetric assessment. In patients with difficulty in breath-holding or arrhythmia, this technique may generate images with inadequate quality for diagnosis. Real-time cardiac cine MRI has been developed to address this limitation. We aimed to assess the performance of retrospective electrocardiography-gated real-time cine MRI at 3T for left ventricular (LV) volume and mass measurement. Materials and Methods: Fifty-one patients were consecutively enrolled. A series of short-axis cine images covering the entire left ventricle using both segmented and real-time balanced steady-state free precession cardiac cine MRI were obtained. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and LV mass were measured. The agreement and correlation of the parameters were assessed. Additionally, image quality was evaluated using European CMR Registry (Euro-CMR) score and structure visibility rating. Results: In patients without difficulty in breath-holding or arrhythmia, no significant difference was found in Euro-CMR score between the two techniques (0.3 ± 0.7 vs. 0.3 ± 0.5, p > 0.05). Good agreements and correlations were found between the techniques for measuring EDV, ESV, EF, SV, and LV mass. In patients with difficulty in breath-holding or arrhythmia, segmented cine MRI had a significant higher Euro-CMR score (2.3 ± 1.2 vs. 0.4 ± 0.5, p < 0.001). Conclusion: Real-time cine MRI at 3T allowed the assessment of LV volume with high accuracy and showed a significantly better image quality compared to that of segmented cine MRI in patients with difficulty in breath-holding and arrhythmia.
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