Journal of electrocardiology
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There is a discordance between ECG and imaging modalities in the diagnosis of ventricular aneurysm (VA) consequent to an old myocardial infarction. A hypothesis is being proposed that this discordance, which results in electrocardiograms (ECGs) not showing ST-segment elevations (+ST) in patients with proven by imaging modalities to have VA (false negative, low diagnostic sensitivity), may be due to "ST-segment counterpoise," rendering the ECG isoelectric. ⋯ Also, a misalignment of the apex longitudinal axis with the left ventricular inflow axis due to myocardial remodeling from the VA (boot-shaped heart) when the apex and another myocardial region are involved with VA leads to +ST cancellation and a false-negative ECG for VA. ST-segment counterpoise as a mechanism rendering the ECG falsely negative for VA can be tested in the future if studies of patients with VA adopt in their methodologies a systematic reporting of severity and topography [corrected] of the regional left ventricular contraction abnormalities, as recommended by the American Society of Echocardiography.
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Emergency medical services (EMS), hospital emergency departments, and cardiologists have taken steps to reduce time to reperfusion therapy by implementation of aggressive acute myocardial infarction treatment and triage protocols. Data indicate that significant myocardial salvage requires reperfusion within 2 hours, and the current American College of Cardiology guideline is 90 minutes after hospital emergency department admission. ⋯ Initial gains in the time from hospital arrival to percutaneous coronary intervention, attributed to acquisition of the ECG in the prehospital setting, were not sustained over 10 years.
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Case reports and unblinded studies suggest that human immunodeficiency virus (HIV) disease is associated with QT prolongation and torsade de pointes ventricular tachycardia. Hepatitis C coinfection is common in patients with HIV disease, and cirrhosis is also associated with QT prolongation. We therefore undertook a systematic analysis of the role of liver injury, nutritional state, and coinfection with hepatitis C in the etiology of QT prolongation in HIV disease. ⋯ Human immunodeficiency virus and hepatitis C infections both independently prolong QTc. Coinfection with hepatitis C greatly increases the likelihood of clinically significant QTc prolongation in patients with HIV disease.
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Many studies demonstrated that a prolonged heart rate-corrected QT interval (QTc) increases the risk of malignant ventricular arrhythmias and sudden death. ⋯ Our study demonstrated a significant positive relationship between the QTc interval and baseline blood pressure in a Chinese hypertensive population.
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This study investigated the treatment of ventricular tachycardia (VT) after repair of tetralogy of Fallot or double outlet of the right ventricle. ⋯ In patients with drug-refractory VT originating from the right ventricle late after congenital heart disease, and when their left ventricular function do not deteriorate, combined therapy for radiofrequency catheter ablation with class III antiarrhythmic agents might effective and should be considered as a therapeutic option.