Approach to the Evaluation and Management of Wide Complex Tachycardias

Wide complex tachycardia (WCT) refers to a cardiac rhythm of more than 100 beats per minute with a QRS duration of 120 ms or more on the surface electrocardiogram (ECG). It often presents a diagnostic dilemma for the physician particularly in determining its site of origin, which can be ventricular or supraventricular. In one series, only 32% of clinicians correctly diagnosed ventricular tachycardia (VT) in patients who presented with WCT1. Prompt diagnosis of the etiology of WCT is, however, essential since immediate care is frequently required. Diagnostic and therapeutic errors can produce poor outcome especially when ventricular tachycardia is not recognized.2,3 WCT that is grossly irregular typically represents atrial fibrillation with aberrant conduction or preexcitation. If its rate exceeds 200 beats per minute, the likelihood of atrial fibrillation with conduction over an accessory pathway should be entertained. In this article, we will discuss the approach to the evaluation and management of regular WCT

Risk of Death and Recurrent Ventricular Arrhythmias in Survivors of Cardiac Arrest Concurrent With Acute Myocardial Infarction

Patients with concurrent CA and AMI were found to be at high risk of recurrent VA, with VA-free survival rates significantly worse than those of patients with AMI but no CA, and comparable to those with CA only. Accordingly, these patients should be considered for ICD implantation

Predictors of Mortality Amongst Recipients of Implantable Cardioverter Defibrillators for Secondary Prevention of Cardiac Arrest

BACKGROUND: Implantable Cardioverter-defibrillators (ICD) reduce mortality in survivors of cardiac arrest (CA). We investigated the predictors of mortality after ICD implantation in survivors of CA. METHODS: Retrospective review of clinical records and social security death index of all patients who received an ICD in a preexisting database of survivors of CA at the University of Pittsburgh Medical Center was performed. Multivariate analyses using the Cox proportional hazard model were performed with backward elimination to identify independent predictors of the time to death, and Kaplan-Meier curves were plotted. RESULTS: Eighty patients (64 men) with a mean age of 64.4+/-12.5 years were followed for 4.7+/-2.3 years after ICD implantation. Survival rates were 93.8%, 65% and 50% at 1, 5, and 10 years, respectively. Independent predictors of time to death were determined to include age (hazard ratio (HR) = 1.91 per 10-year increase, p = 0.003), serum creatinine > or = 1.3 mg/dL (HR = 2.56, p = 0.004), and QRS width >120 ms (HR = 5.14, p = 0.012). CONCLUSIONS: In this sample of ICD recipients secondary to CA, older age, elevated serum creatinine, and wider QRS duration were independent predictors of mortality. The presence of more than one risk factor in the same patient was associated with higher mortality rates. Whether interventions such as biventricular pacing can offset this increase risk of death warrants further investigation

Asociación entre síntomas depresivos maternos y comunicación verbal efectiva en niños(as) de 9-36 meses de edad: Sub-análisis ENDES 2020

Antecedentes: El presente estudio fue realizado en el año 2020, año extraordinario por efecto de la pandemia por COVID-19. Objetivo: Determinar la asociación entre síntomas depresivos maternos y comunicación verbal efectiva (CVE) en niños(as) entre 9 a 36 meses de edad, Perú́ 2020. Método: El diseño del estudio fue transversal, analítico, secundario de la ENDES 2020. La población fue el binomio madre – hijo(a) entre los 9 - 36 meses. El indicador de CVE se evaluó mediante preguntas según tramo evolutivo utilizando como instrumento el Inventario de Battelle. Se empleo el instrumento PHQ-9 para evaluar los síntomas depresivos maternos (SDM) en los últimos 14 días y modificado para el último año. Para el análisis estadístico se utilizó un modelo de regresión lineal generalizado y se reportaron los resultados en forma de razón de prevalencia (RP). Resultados: El indicador CVE fue logrado por el 36,8% de los niños(as) entre 9 a 36 meses. La prevalencia de SDM en los últimos 14 días y último año fue de 4,9% y 10,4% respectivamente. Además, el 27,0% de niños(as) de madres con síntomas depresivos tienen menor probabilidad de tener una CVE adecuada en comparación con aquellos niños(as) de madres que no presentan esta sintomatología (RP 0,73 IC 95% 0,54 a 0,99 p = 0,042). Conclusiones: Los síntomas depresivos maternos en el último año tienen una asociación significativa con una CVE inadecuada en niños(as) peruanos de 9-36 meses. Variables que resultaron asociadas a una CVE adecuada fue la edad en meses, el sexo femenino y un peso al nacer mayor a 2,500 gramos.Background: This study analyzed a national survey conducted in 2020, an extraordinary year due to the COVID-19 pandemic. Purpose: This study aims to determinate the association between maternal depressive symptoms (MDS) and effective verbal communication (EVC) in children between 9-36 months, Perú 2020. Methodology: A cross-sectional study design, secondary of the ENDES 2020. The participants were the mother-child binomial between 9-36 months. The ECV indicator was evaluated by questions according to age, using the Battelle Inventory as an instrument. The PHQ-9 instrument was used to assess maternal depressive symptoms in the last 14 days and modified for the last year. For statistical analysis, a generalized lineal regression model was used, and results were reported in the form of prevalence ratio (PR). Results: The ECV indicator was achieved by 36,8% of children between 9-36 months. The prevalence of MDS in the last 2 weeks and in the last year was 4,9% and 10,4% respectively. In addition, 27,0% of children of mothers with depressive symptoms are less likely to have an adequate ECV compared to those children who theirs mothers doesn’t have depressive symptoms (PR 0,73 IC 95% 0,54 a 0,99 p = 0,042). Conclusion: Maternal depressive symptoms in the past year have a significant association with inadequate ECV in children between 9-36 months. Variables that were associated with an adequate ECV were age in months, female sex, and birthweight greater than 2,500gr.Tesi