A GI Proposal to Display ECG Digital Signals Wirelessly Real-time Transmitted onto a Remote PC

The sensors, as wireless communication system, comply the 7-layer model Open Systems Interconnection (OSI). In this paper, a point-to-point transmission model was used. The ECG signal is transmitted from the Router Sensor (RS) to an end Coordinator Node (CN) plugged-in to the laptop via USB port; RS acquires ECG signal in analogical mode, and is also responsible with sampling, quantization and sending it wirelessly direct to CN. The distance between RS and CN is a single-hop transmission, and does not exceed the range of the XBeeS2Pro transceivers. The communication protocol is ZigBee. Remote viewing of the transmitted signal is performed on a Graphical Interface (GI) written under MATLAB, after the signal has been digitized; the choice of MATLAB was motivated by future developments. Particular aspects will be highlighted, so that the reader to be edified about the results obtained during laboratory experiments. Recording demonstrate that the purpose exposed in title has been reached: Direct link in Real-Time was established, and the digital ECG signal received is reconstituted accurately on MATLAB GI; signal received on laptop is compared with the analog signal displayed on oscilloscope

Predictive factors of atrioventricular conduction disorders

Atrioventricular conduction disorders represent an alteration in the normal function of the heart’s electrical conduction system, a system that connects the atria and ventricles through the atrio-ventricular node and the His-Purkinje system. Consequently, bradycardia can develop and lead to the occurrence of symptoms (dizziness, loss of consciousness, tachyarrhythmias, heart failure phenomena). Identifying patients at risk of developing atrioventricular conduction disorders will allow early interventions on risk factors and improvements in prognosis. This narrative review explores the risk factors that determine the development and progression of atrioventricular conduction disorders. We will discuss traditional risk factors (age, sex, arterial hypertension, ischemic cardiac disease, diabetes, chronic kidney disease), but also risk factors that are currently being researched (genetic predisposition and inflammatory markers). Finally, we will discuss the limitations and challenges of predicting risk factors for atrioventricular conduction disorders

Predictors of Peripheral Artery Disease Progression. Is there Any Role for Vascular Age?

Abstract Background. Peripheral artery disease (PAD) is a distinct atherosclerotic syndrome marked by stenosis or occlusion of the arteries, particularly of the lower extremities. The major risk factors for PAD are similar to those for coronary and cerebrovascular disease, comprising smoking, hypertension, hypercholesterolemia and diabetes. The factors involved in the progression of PAD are less well defined. Vascular age (VA) is represented by the apparent age of the vascular system derived from the associated cardiovascular risk factors. This concept has been used so far mainly in primary prevention, being usefull for communication with the patient. Aim. The purpose of the study was to investigate the factors involved in the progression of arterial stenosis in patients already having PAD. Moreover, we tried to determine the utility of VA in increasing patient compliance with therapeutic decisions. Methods. Between 1st February 2015 - 31st December 2015, 270 consecutive patients (pts) referred for vascular echo-Doppler assessment were enrolled in the study. 106 pts with non-significant arterial stenosis were prospectively evaluated. All pts underwent complete clinical examination, carotid, femoral ultrasound, echocardiography and laboratory evaluation. Presence of atherosclerotic plaques in the carotid arteries were recorded. Medical history, drug use, smoking behavior, blood pressure, duration of diabetes, presence of premature atherosclerotic PAD in relatives, characterized by disease diagnosis before the age of 50 years, were evaluated. Serum total cholesterol (TC), HDL cholesterol (HDL-C), serum glucose, A1c hemoglobine (HbA1c), serum creatinine, estimated glomerular filtration rate (eGFR) were determined. VA was estimated using Framingham score and intima-media thickness (IMT). The primary end-point was the occurrence of significant peripheral artery stenosis (PAS), defined as a two-fold increase Doppler velocity across the stenosis. Results. At baseline, median age of enrolled pts was 57 years, with male predominance (69,8%). Less than 40% had high blood pressure (39.3%), 36.4% had treated hypertension. The median left ventricular mass index (LVMI) was 108.5 g/m2 and concentric hypertrophy was present in 29.9% of patients. Patients with hypertension had LVMI of 113.12 g/m2 and those without hypertensiun, had 105.6 g/m2. Diabetes mellitus (DM) was present in 20.6% of patients, majority treated (88%). Among them, 10.3% had more than 10 years duration of DM. Median HbA1c was 5.8%. The majority of the patients are smokers (75.5%). Mean pack-years of smoking was 29.8. During the 4.5 years follow-up, 31.25% quit smoking. The median ejection fraction (EF) was 51.6%. The median TC concentration was 191.6 mg/dl and median HDL-c level was 62.9 mg/dl. 45.8% of the patients received treatment with statins. Premature atherosclerotic PAD in relatives was present in 25.2 % of the patients, and carotid atheromas (CA) in 35.5%. Aortic calcifications (AC) were found in 37.4% of the patients. Median arterial elastance (Ea) was 2.07 mmHg/ml. Median serum creatinine was 1.03 mg/dl and eGFR was 75.6 ml/ml/1.73 m2. Median value of the VA calculated by IMT (VA-IMT) was 65.5 years and the median VA calculated by cardiovascular risk factors (VA-RF) was 62.9 years. After 4.5 years of follow-up, 35 (32.7%) patients developed significant PAS. 22 patients had popliteal artey stenosis (62.85%) and 13 patients had superficial femoral artery stenosis (37.15%). During the 4.5 years follow-up, 25 patients (31.25%) quit smoking. Median age of population who developed significant PAS at follow-up was 62.6 years and 39.2% were males. Individuals who developed stenosis tended to be smokers, older, receiving hypertensive and statin therapy, having diabetes, especially more than 10 years duration, having dyslipidemias and CA. They all had higher VA-IMT and VA-RF values compared to patients that did not develop PAS. Median value of VA-IMT was 72.6 years and VA-RF was 74.2 years (p&lt;0,001 for both parameters). They also had significantly higher values of Ea, with median value of 2.16 mmHg/ml. There were no statistically significant differences between the two groups in cardiac performance, LV mass, percentage of LV concentric hypertrophy, presence of AC, premature PAD in relatives, renal function and blood pressure values. In logistic regression analysis, pack-years of smoking, HbA1c %, presence of CA and HDL-C were independently associated with significant PAS progression. From the 25 patients which quit smoking, only 6 developed significant PAS (24%), as compared to 29 (52.7%) from the 55 patients which remained active smokers (p =0.016). Conclusion. We demonstrated that some of the classical cardiovascular risk factors were involved in PAD progression: smoking, dyslipidemia, diabetes, carotid atherosclerosis. At multivariate analysis the independent variables associated with PAD progression were pack-years of smoking, glycosilated hemoglobin and HDL-cholesterol values and presence of CA. VA assessed by cardiovascular risk scales and by directly measured IMT both predict the progression of PAD, as did Ea, but without independent predictive value for the outcome. Nevertheless, VA was usefull in comunicating with the patients, influencing their perception of disease progression and adherence to therapy, improving shared decision making, mainly quitting smoking. We have shown that even after 4.5 years of smoking cessation there was a measurable effect on PAD progression.</jats:p

Blood Pressure Control in Hypertensive Patients with Type 2 Diabetes Mellitus

Abstract Introduction and objective. Blood pressure (BP) goals and glycemic targets are only reached in 40% and 50% of patients, respectively. The objective of this observational retrospective cohort study was analyzing BP control with antihypertensive therapy in patients with diabetes mellitus (DM) and arterial hypertension (HTN) in clinical practice. Methods. 156 hospitalized hypertensive patients with type 2 DM were divided into 2 groups (G): G1 - uncomplicated and G2 - complicated DM, with micro- and macrovascular involvement, followed retrospectively for 2 years. BP control with antihypertensives was analyzed with respect to DM control, complications, hospital readmissions for cardiovascular disease and all-cause mortality. Results. Of the 156 patients, 71 (45.6%) males, mean age 66.7 ± 9.8 years, 94 (60.3%) were included in G2. Ninety-one patients (58.3%) were rehospitalized, G2 patients having a significantly higher risk of readmission (p=0.006). BP was controlled in 57.7% patients at first, and in 59.3% patients on the last hospitalization, while DM was initially controlled in 49.3% patients, and in 54.9% on the last readmission. The number of antihypertensive drug classes was significantly higher in G2 (3.5 vs 3.1, p=0.03). Fifteen (9.6%) patients were initially on fixed-dose combinations (FDC). All-cause mortality after 2 years was 12.2%, strongly associated with DM complications (p=0.005), with a protective effect from controlled DM (p=0.045). Conclusion. More than forty percent of the patients had uncontrolled long term HTN with frequent re-hospitalizations and increased mortality. Better BP control could be achieved by changing therapy, notably by FDC, promoting patient adherence.</jats:p

Uric Acid, Oxidative Stress and Inflammation in Chronic Heart Failure with Reduced Ejection Fraction

Background. Oxidative stress (OS) and inflammation are major mechanisms involved in the progression of chronic heart failure (CHF). Serum uric acid (sUA) is related to CHF severity and could represent a marker of xanthine-oxidase activation. The relationship between sUA, oxidative stress (OS) and inflammation markers was assessed in patients with moderate-severe CHF and reduced left ventricular (LV) ejection fraction (EF)

A Rare Cause of Deep Vein Thrombosis in a Young Orchestra Conductor

Upper extremity deep vein thrombosis (DVT) of the axillary/subclavian veins is rare (5–10% of DVT). After clinical suspicion and duplex ultrasound, anticoagulation, surgical decompression and sometimes thrombolysis are mandatory due to complications. We discuss the case of a young healthy orchestra conductor with primary DVT of the left upper extremity and concomitant left shoulder musculo-tendinous traumatic injury. Symptoms of both conditions and subtle signs of upper extremity DVT delayed the diagnosis until full-blown DVT occurred. After successful anticoagulation and surgical TOS (thoracic outlet syndrome) decompression, evolution was favorable, without recurrent thrombosis

A GI Proposal to Display ECG Digital Signals Wirelessly Real-time Transmitted onto a Remote PC

The sensors, as wireless communication system, comply the 7-layer model Open Systems Interconnection (OSI). In this paper, a point-to-point transmission model was used. The ECG signal is transmitted from the Router Sensor (RS) to an end Coordinator Node (CN) plugged-in to the laptop via USB port; RS acquires ECG signal in analogical mode, and is also responsible with sampling, quantization and sending it wirelessly direct to CN. The distance between RS and CN is a single-hop transmission, and does not exceed the range of the XBeeS2Pro transceivers. The communication protocol is ZigBee. Remote viewing of the transmitted signal is performed on a Graphical Interface (GI) written under MATLAB, after the signal has been digitized; the choice of MATLAB was motivated by future developments. Particular aspects will be highlighted, so that the reader to be edified about the results obtained during laboratory experiments. Recording demonstrate that the purpose exposed in title has been reached: Direct link in Real-Time was established, and the digital ECG signal received is reconstituted accurately on MATLAB GI; signal received on laptop is compared with the analog signal displayed on oscilloscope