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Effects of cardiac arrhythmias on echocardiographic examination. Fusion of E and A waves in sinus tachycardia (A), significant post-extrasystolic increase of peak systolic gradient in aortic stenosis (B), and variability in cycle length and the absence of organized atrial activity in atrial fibrillation (C).
Source publication
Cardiac arrhythmias refer to any abnormality or disturbance in the normal activation sequence of the myocardium and may be indicative of structural heart disease as well as the cause of significant cardiovascular complications and sudden cardiac death. The following review summarizes the current state-of-the-art knowledge on the role of echocardiog...
Contexts in source publication
Context 1
... sinus tachycardia, the R-R intervals shorten and the duration of diastolic filling is mainly reduced, compared with systolic ejec- tion time. Left ventricular volumes and LVEF may be under- estimated and transmitral Doppler E/A ratio can be changed, resulting in the fusion of E and A waves in significant tachycardia 74 (Fig. 5A). When E wave is higher than 20 cm/s at the onset of A wave, the estimation of E/A ratio is inaccurate and should be avoided. The evaluation of valvular stenosis is also challenging as maximal valve opening is underestimated because of under- sampling. Doppler velocities and mean pressure gradients are overestimated in atrio-ventricular valves, while pressure-half time cannot be accurately measured at heart rates >100 bps. In general, the echocardiographer should aim at the highest possible temporal resolution to avoid undersampling and seek higher sweep-speeds, more than 100 mm/s, for measuring Doppler time integrals whenever necessary. Furthermore, for the estimation of valvular stenosis, the reduction of heart rate to 80-100 bps should be preferred. 75 ...
Context 2
... beats disturb the diastolic flow of the preceding beat and enhance the ventricular contraction of the upcoming beat because of prolonged diastolic filling. The evaluation of systolic and diastolic indices is inaccurate during bigeminal rhythm, and as a general rule, the echocardiographer should avoid the cardiac cycles before and after the ectopic beats. Sometimes, ectopic beats may provide important information that otherwise is not noticeable during regular sinus rhythm. A significant post-extrasystolic increase of peak systolic gradient in aortic stenosis implies the presence of contractile reserve or can be considered as an index of stenosis severity 75 (Fig. 5B). Moreover, the prolonged interval after an ectopic beat can lead to the separation of E and A fused waves and consequently to the evaluation of the filling pattern in a patient with atrioventricular block. 72 ...
Context 3
... variability in cycle length and the absence of organized atrial activity (Fig. 5C) limits the accuracy of LV systolic and diastolic function. IVRT <65 ms, DT < 150 ms, E/E septal' >11 are among the most useful parameters for the evaluation of filling pressures in patients with AF. 76 As a general rule, echocardiographic analysis should take into consideration the average of at least 10 consecu- tive cycles for 2D and Doppler measurements or the cardiac cycle corresponding to an optimal heart rate (60-80 bpm). 77 ...
Context 4
... sinus tachycardia, the R-R intervals shorten and the duration of diastolic filling is mainly reduced, compared with systolic ejec- tion time. Left ventricular volumes and LVEF may be under- estimated and transmitral Doppler E/A ratio can be changed, resulting in the fusion of E and A waves in significant tachycardia 74 (Fig. 5A). When E wave is higher than 20 cm/s at the onset of A wave, the estimation of E/A ratio is inaccurate and should be avoided. The evaluation of valvular stenosis is also challenging as maximal valve opening is underestimated because of under- sampling. Doppler velocities and mean pressure gradients are overestimated in atrio-ventricular valves, while pressure-half time cannot be accurately measured at heart rates >100 bps. In general, the echocardiographer should aim at the highest possible temporal resolution to avoid undersampling and seek higher sweep-speeds, more than 100 mm/s, for measuring Doppler time integrals whenever necessary. Furthermore, for the estimation of valvular stenosis, the reduction of heart rate to 80-100 bps should be preferred. 75 ...
Context 5
... beats disturb the diastolic flow of the preceding beat and enhance the ventricular contraction of the upcoming beat because of prolonged diastolic filling. The evaluation of systolic and diastolic indices is inaccurate during bigeminal rhythm, and as a general rule, the echocardiographer should avoid the cardiac cycles before and after the ectopic beats. Sometimes, ectopic beats may provide important information that otherwise is not noticeable during regular sinus rhythm. A significant post-extrasystolic increase of peak systolic gradient in aortic stenosis implies the presence of contractile reserve or can be considered as an index of stenosis severity 75 (Fig. 5B). Moreover, the prolonged interval after an ectopic beat can lead to the separation of E and A fused waves and consequently to the evaluation of the filling pattern in a patient with atrioventricular block. 72 ...
Context 6
... variability in cycle length and the absence of organized atrial activity (Fig. 5C) limits the accuracy of LV systolic and diastolic function. IVRT <65 ms, DT < 150 ms, E/E septal' >11 are among the most useful parameters for the evaluation of filling pressures in patients with AF. 76 As a general rule, echocardiographic analysis should take into consideration the average of at least 10 consecu- tive cycles for 2D and Doppler measurements or the cardiac cycle corresponding to an optimal heart rate (60-80 bpm). 77 ...
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Background
First-line ablation for atrial fibrillation (AF) reduces the risk of recurrent atrial arrhythmias compared to medical therapy. However, the prognostic benefit of early AF ablation remains undetermined. Herein, we aimed to evaluate the effects of early AF ablation compared to medical therapy.
Methods
Using data from phase II/III of the G...
Citations
... Two-dimensional echocardiography with Doppler is known to assist in identifying rhythm disorders. 10 Mitral inflow Doppler helps differentiate between atrial flutter and fibrillation when the surface ECG is not diagnostic. Similarly, an abnormal septal motion helps differentiate between left bundle branch block and intraventricular conduction delays in borderline surface ECG findings. ...
... While many newborns may initially tolerate the early stages of SVT without significant complications, prolonged SVT lasting beyond 6-12 h can lead to the development of heart failure due to a reduction in stroke volume. Continuous monitoring and follow-up are recommended to assess and manage cardiac function, ensuring the neonate's wellbeing and preventing long-term complications [14,15] . ...
... Moreover, the coexistence of SVT with other congenital heart diseases or arrhythmias, metabolic and systemic conditions can obscure the accurate diagnosis. Consequently, achieving a definitive diagnosis and effective management of SVT in neonates necessitates a comprehensive diagnostic approach and vigilant monitoring [4,[14][15][16] . ...
Introduction and importance
Neonatal supraventricular tachycardia (SVT) poses unique challenges in diagnosis and management, with refractory cases requiring synchronized cardioversion being exceptionally rare. This case report explores the presentation and management of refractory SVT in a neonate, emphasizing the significance of sharing such clinical scenarios.
Case presentation
A 16-day-old neonate, born via emergency cesarean section, presented with respiratory distress, poor feeding, and vomiting. Initial diagnosis of SVT was made on the basis of ECG changes. Initial attempts with adenosine failed, leading to the recurrence of tachycardia. Despite amiodarone administration, the tachycardia persisted, prompting synchronized cardioversion. Post-cardioversion, the neonate was managed with oral medications, showing sustained improvement.
Clinical discussion
This case report highlights a neonate with refractory supraventricular tachycardia (SVT), requiring synchronized cardioversion, presenting a rare and challenging scenario. The report addresses diagnostic challenges, treatment approaches, and potential mechanisms for refractory SVT, such as delayed presentation and resistance to adenosine. Emphasizing individualized care plans and vigilant monitoring, this report is a valuable resource for healthcare professionals, contributing to neonatal cardiology understanding and emphasizing the importance of early recognition and effective interventions. Ongoing follow-up and successful outcomes underscore the need for sustained management strategies.
Conclusion
This case report sheds light on the rarity of refractory SVT in neonates, emphasizing the complexities in diagnosis and management. Successful synchronized cardioversion and subsequent oral therapy highlight the need for a multifaceted approach in neonatal SVT cases. The implications for clinical practice underscore the importance of awareness and continued research in neonatal cardiology and emergency medicine.
... [1] Belirgin sinüs bradikardisinin olduğu bir hastada ventriküllerin diyastolik dolumu uzar (Şekil 2), sonuç olarak ventriküler boyut ve atım hacmi artar. [9] Bunun dışında, kapak darlıkları varlığında ortalama basınç gradiyenti Şekil 1. Sinüs taşikardisi olan iki farklı hastaya ait "pulse-wave" Doppler kullanılarak yapılan mitral içe akım (inflow) kayıtları. (A) Kalp hızı 110/dk olan bir hastada E ve A dalgalarının tam füzyonu izlenmektedir; (B) Kalp hızı 101/dk olan bir diğer hastada E ve A dalga füzyonu ile birlikte atriyal kasılmanın (A dalgası) erken diyastolik mitral akım hızının (E dalga hızının) 20 cm/sn'ye düşmesinden önce (sarı çizgi) meydana geldiği görülmektedir. ...
... Bu nedenle SlV dolum basınçları değerlendirilirken erken vurudan önceki ve sonraki kalp atımları dikkate alınmamalıdır. [9] Dolayısıyla ventriküler bigemine ritim varlığında (Şekil 4b) dolum basınçları ve sistolik fonksiyonları değerlendirmek için kullanılan ekokardiyografik değişkenlerin doğruluk payları daha düşüktür. VEA esnasında, mekanik etki (AV kapakların kapanması) sonucu atriyal kasılma ile oluşturulan ventriküler dolum engellendiği için mitral daha az etkilenir. ...
... Meanwhile, ECG is of crucial importance for analyzing and identifying various arrhythmias, which reflect the degree of myocardial damage, the corresponding development process, and the functional structure of both atria and ventricles [3,12]. A few research scholars have related medical evidence of ECG toward arrhythmias with the latest experimental study, see [3,4,12,23,29], and the references therein. ...
... found during echocardiography are all recognised risk factors for paroxysmal AF, which can remain subclinical for a long time. The first manifestation of arrhythmia is sometimes an ischaemic stroke [20][21][22][23][24][25][26][27]. Assessing the size of the left atrium seems particularly useful. ...
Cardiac arrhythmias are one of the main causes of death worldwide; therefore, early detection is essential to save the lives of patients who suffer from them and to reduce the cost of medical treatment. The growth of electronic technology, combined with the great potential of Deep Learning (DL) techniques, has enabled the design of devices for the early and accurate detection of cardiac arrhythmias. This article carries out a Systematic Literature Review (SLR) through a Systematic Mapping study and Bibliometric Analysis, through a set of relevant research questions (RQs), in relation to DL techniques applied to the automatic detection and classification of cardiac arrhythmias using electrocardiogram (ECG) signals, during the period 2017-2023. To identify the most pertinent scholarly articles, the PRISMA 2020 methodology was employed by quering the following databases: Scopus, IEEE Xplore, and PhysioNet Challenges, resulting in a total of 494 publications being retrieved. This study also includes a bibliometric analysis aimed at tracing the evolution of the primary technologies utilized in the automatic detection and recognition of cardiac arrhythmias. Additionally, it evaluates the performance of each technology, offering insights crucial for guiding future research endeavors.
Aims
The aim of this study was to examine the effect of Reiki in patients with cardiac disease
Methods and results
This study was a single-blind, pre-post-test, randomized, placebo-controlled study. Patients from the cardiology outpatient clinic of a training and research hospital were randomized into three groups: Reiki (n = 22), sham (placebo) (n = 21), and control (no treatment) (n = 22). Data were collected using a personal information form, biochemical parameters, cortisol levels, Beck Anxiety Inventory, and electrocardiography analysis. The Reiki group received Reiki to nine main points for 30 min, while the sham Reiki group received the same points during the same period without starting energy flow. On day two, performed Distance Reiki for 30 minutes. After one week, the researchers administered the Beck Anxiety Inventory, assessed the biochemical parameters and cortisol levels, and analyzed the electrocardiography again. Of the patients, 52.3% were male and 47.7% were female, and the mean age (years) is 60.45 ± 9.67 years. The control group had a significantly higher posttest cortisol level than the other groups (p = 0.002). According to the post-hoc analysis, there was a significant difference between the Reiki versus control groups and sham versus control groups (p = 0.002). The control group had a significantly higher post-test cortisol level than the pre-test cortisol level (p = 0.008). Reiki group had a significantly lower mean posttest Beck Anxiety Inventory score than the other groups (p < 0.001). There was no difference between the electrocardiography results of the groups (p > 0.05).
Conclusion
Reiki reduces blood cortisol levels and anxiety levels in patient with cardiac diseases.
Multi-dimensional analysis in echocardiography has attracted attention due to its potential for clinical indices quantification and computer-aided diagnosis. It can utilize various information to provide the estimation of multiple cardiac indices. However, it still has the challenge of inter-task conflict. This is owing to regional confusion, global abnormalities, and time-accumulated errors. Task mapping methods have the potential to address inter-task conflict. However, they may overlook the inherent differences between tasks, especially for multi-level tasks (e.g., pixel-level, image-level, and sequence-level tasks). This may lead to inappropriate local and spurious task constraints. We propose cross-space consistency (CSC) to overcome the challenge. The CSC embeds multi-level tasks to the same-level to reduce inherent task differences. This allows multi-level task features to be consistent in a unified latent space. The latent space extracts task-common features and constrains the distance in these features. This constrains the task weight region that satisfies multiple task conditions. Extensive experiments compare the CSC with fifteen state-of-the-art echocardiographic analysis methods on five datasets (10,908 patients). The result shows that the CSC can provide left ventricular (LV) segmentation, (DSC = 0.932), keypoint detection (MAE = 3.06mm), and keyframe identification (accuracy = 0.943). These results demonstrate that our method can provide a multi-dimensional analysis of cardiac function and is robust in large-scale datasets.
