L'arrêt cardiaque est principalement d'étiologie cardio-vasculaire. Dans le contexte actuel des arrêts cardiaques extrahospitaliers, 20 à 25% des victimes présentent une fibrillation ventriculaire. Environ 3 à 5% des personnes sont sauvées sans séquelle neurologique. La survie à un arrêt cardiaque extrahospitalier dépend d'une prise en charge précoce et rapide de la victime. Les premiers témoins actifs réalisant la réanimation cardio-pulmonaire combinée à l'utilisation d'un défibrillateur sont ainsi un maillon important pour sauver la victime.Notre objectif principal est d'améliorer le taux de survie à un arrêt cardiaque extrahospitalier. Une première voie d'investigation est de proposer un fonctionnement de défibrillateur optimal combinant judicieusement les différents modules de détection embarqués (détection de fibrillation ventriculaire, détection de massage cardiaque, détection d'interférences électromagnétiques) afin de réduire les temps de pause péri-choc durant la procédure de réanimation. En effet, pendant ces temps, dits « hands-off » en anglais, aucun geste de secours n'est administré au patient qui, lui, voit d'une part sa pression de perfusion coronarienne chuter, d'autre part la probabilité de succès des tentatives de défibrillation décroître. C'est pourquoi une deuxième voie d'investigation porte sur la prédiction de l'efficacité de choc. Dans ce contexte, nous proposons de combiner des paramètres de l'électrocardiogramme dans les domaines temporel, fréquentiel et de la dynamique non-linéaire. Un classifieur bayésien utilisant le modèle de mélange de gaussiennes a été appliqué aux vecteurs de paramètres les plus prédicteurs de l'issue de la défibrillation et l'algorithme Espérance-Maximisation a permis de mener à bien la procédure d'apprentissage des paramètres du modèle probabiliste représentant les distributions conditionnelles de classe.L'ensemble des méthodes proposées a permis d'atteindre des résultats prometteurs pour à la fois réduire les temps de pause péri-choc et prédire l'efficacité de défibrillation et ainsi espérer améliorer le taux de survie à un arrêt cardiaque / The cardiac arrest is mainly of cardiovascular etiology. In the actual context of out-of-hospital cardiac arrests, 20 to 25% of the victims present a ventricular fibrillation. About 3 to 5% of the victims are saved without neurological damage. The chance of surviving a cardiac arrest outside an hospital depends on the early and fast support of the victim. The first active witnesses performing cardiopulmonary resuscitation combined with the use of a defibrillator are an important link to save the victim.Our main objective is to improve survival rate in out-of-hospital cardiac arrest cases. A first way of investigation is to propose an optimal functioning of defibrillator combining wisely the different processes of detection embedded (ventricular fibrillation detection, chest compressions detection, electromagnetic interferences detection), in order to reduce the peri-shock pauses during the resuscitation procedure. In fact, during these pauses, known as "hands-off" pauses, no emergency action is provided to the patient, what is correlated to a drop of the coronary pression, but also to a decrease of the chance of successful defibrillation. That is the reason why, a second way of investigation is based on the prediction of the efficiency of defibrillation. In this context, we propose to use a combination of parameters extracted from electrocardiogram in time, frequency and non-linear dynamics domains. A bayesian classifier using a gaussian mixture model was applied to the vectors of parameters, which are the most predictor of the defibrillation outcome and the algorithm Expectation-Maximization allowed to learn the parameters of the probabilistic model representing the class conditional distributions.All of the proposed methods allowed to reach promising results for both reducing the peri-shock pauses and predicting the efficiency of defibrillation in hope to improve the survival rate in cardiac arrest cases

Introdução: A cardiomiopatia hipertrófica (CMH) é definida, como a hipertrofia miocárdica ocorrida na ausência de doença cardíaca ou sistêmica, sendo a mais prevalente das cardiopatias de transmissão genética e a principal causa de morte súbita em jovens e atletas. A única opção de tratamento para prevenção dessa complicação é a indicação do cardiodesfibrilador implantável (CDI). Alguns marcadores de risco foram identificados, como: pacientes que sobreviveram à parada cardíaca por fibrilação ventricular, episódio de taquicardia ventricular sustentada; história familiar precoce de MSC; síncope inexplicada; espessura septal >= 30 mm; taquicardia ventricular não sustentada (TVNS) no Holter; queda da pressão sistólica (PAS) > 20 mmHg ou aumento < 20 mmHg no esforço. Entretanto, a sensibilidade e especificidade desses critérios são limitadas, tornando necessário o conhecimento de novos métodos diagnósticos com capacidade de predizer MSC. A micro-alternância da onda T (MAOT) é utilizada como ferramenta diagnóstica na estratificação de pacientes com riscos de desenvolver arritmias ventriculares malignas e MSC auxiliando na indicação do CDI. Na CMH há poucos estudos realizados com objetivos e resultados diferentes e, atualmente, uma nova metodologia na realização desses exames foi desenvolvida, não sendo testada nesta população. Os objetivos do presente estudo foram: caracterizar os valores da MAOT pela metodologia Média Móvel Modificada (MMM) e avaliar a associação de seus resultados com os fatores de risco clínicos para MSC. Metodologia: Foram selecionados 132 pacientes com CMH que foram divididos em dois grupos: 1) Alto Risco, 67 pacientes, que apresentavam, pelo menos, um fator de risco para morte súbita cardíaca (história familiar de morte súbita; síncope inexplicada; espessura septal do miocárdio >=30 mm; taquicardia ventricular não sustentada; queda da pressão sistólica no teste de esforço) e 2) Baixo Risco, 65 pacientes, sem fatores de risco. A idade média foi de 37 ± 11,3 anos, sendo 63% do sexo masculino. A média da espessura de septo interventricular foi 23,9 ± 6,2 mm, da fração de ejeção 72 ± 8,1% e 26% apresentavam forma obstrutiva da doença. A MAOT foi avaliada pelo teste ergométrico com protocolo Naughton modificado, com dois fatores de atualização (FaT) 1/8 e 1/32, de forma quantitativa e qualitativa (positivo e negativo) e com três formas de análises: considerando todas as derivações do eletrocardiograma (plano periférico, frontal e ortogonal); desconsiderando os resultados do plano periférico e desconsiderando as derivações ortogonais. Resultados: A aferição da MAOT com FaT 1/8 apresentou maior sensibilidade em comparação com FaT 1/32 (FaT 1/8 MAOTméd. = 69,2 uV a 78,2 uV vs FaT 1/32 MAOTméd. = 33,2 uV a 38,7 uV, p < 0,01), resultando nas análises quantitativas de valores maiores da micro-alternância (MAOTmáx. - FaT 1/8 = 528 uV vs 124 uV = FaT 1/32, p < 0,01) e na análise qualitativa maior número de exames positivos (MAOT positiva - FaT 1/8 = 57,5% vs 19,0% = FaT 1/32). Os pacientes do grupo Alto risco apresentavam maiores valores de MAOT (Alto Risco MAOT média = 101,4 uV vs 54,3 uV Baixo Risco, p < 0,001) e 84% apresentavam exame positivo (56/67). A MAOT mostrou associação significativa com os fatores de risco para MSC: espessura septal >= 30 mm (p < 0,001), TVNS no Holter 24 h (p = 0,001), história familiar de MSC (p = 0,006) e queda da pressão arterial no esforço (p = 0,02). No rastreamento de pacientes de Alto risco, com ponto de corte de 53 uV o teste apresentou sensibilidade e especificidade de 84% e 71%, com acurácia de 0,77 (IC de 95%: 0,69 a 0,86). Conclusões: Os melhores resultados da MAOT pela metodologia Média Móvel Modificada foram encontrados analisando todas as derivações eletrocardiográficas (plano periférico, horizontal e derivações ortogonais), realizados de forma quantitativa, com Fator de Atualização 1/8 e ponto de corte para positividade 53 uV. A MAOT demonstrou associação significativa com a maioria dos fatores de risco clínicos apresentando boa acurácia no rastreamento dos pacientes de Alto Risco para MSC / Introduction: Hypertrophic cardiomyopathy (HCM) is defined as the myocardial hypertrophy in the absence of cardiac or systemic disease, being the most common genetic transmission cardiopathy and responsible for sudden cardiac death (SCD) in young adults and athletes. The first-line treatment option for prevention of SCD is the implantable cardioverter-defibrillator (ICD). Some clinical factors have been identified as high risk for the occurrence of SCD: history of cardiac resuscitation for ventricular fibrillation, episode of sustained ventricular tachycardia, family history of premature SCD, unexplained syncope, ventricular septal thickness >= 30 mm; nonsustained ventricular tachycardia (NSVT) in Holter and inadequate response of blood pressure to exercise: decrease in systolic blood pressure (SBP) > 20 mmHg or increase < 20 mmHg during effort. These criteria, however, are limited in sensitivity and specificity and new diagnostic methods have been required. The microvolt T-wave alternans (MTWA) is used as a diagnostic tool to identify high-risk patients predisposed to malignant ventricular arrhythmias and SCD. Therefore, MTWA may be helpful to indicate ICD. There are no reports in the literature concerning the use of MTWA in HCM. This research aims to evaluate the values of MTWA by modified moving average (MMA) method and the association with clinical factors for SCD. Methods: We enrolled 132 patients with HCM that were divided into two groups: 1) High Risk (HR) group, 67 patients, that had at least one risk factor for sudden cardiac death (family history of SCD; unexplained syncope; ventricular septal thickness >= 30 mm; nonsustained ventricular tachycardia; inadequate response of blood pressure to exercise) and 2) Low Risk (LR) group, 65 patients, without risk factors. The most participants were male (63%) and their mean age was 37 (± 11.3) years. All individuals were evaluated by echocardiography: 23,9 ± 6,2 mm interventricular septal thickness; 72 ± 8.1% ejection fraction and 26% left ventricular outflow gradient of more than 30 mmHg. Patients performed exercise stress testing with modified Naughton Protocol. In the present study, MTWA was assessed with the MMA method, updating factor (UF) 1/8 and 1/32, quantitative and qualitative way (positive and negative). In addition, the values of the MTWA were evaluated in three ways: all the leads of electrocardiogram; disregarding the leads of peripheral plane; disregarding the orthogonal leads. Results: The analysis of MTWA with UF 1/8 showed greater sensitivity compared with UF 1/32 (Mean MTWA, UF 1/8 = 69.2 uV to 78.2 uV vs UF 1/32 = 33.2 uV to 38.7 uV, p < 0.01). Like this, in quantitative and qualitative (positive and negative) analysis of MTWA, the values were larger in the group of UF 1/8 (UF1/8 = 528 uV vs UF 1/32 = 124 uV, p < 0.01/ Positive MTWA, UF 1/8 = 57.5% vs UF 1/32 = 19.0%, p < 0.01). The patients of High Risk group presents higher values of MTWA (HR = 101.4 uV vs LR = 54.3 uV, p < 0.001) and 84% had the positive test. The MTWA was significantly associated with risk factors for SCD: ventricular septal thickness >= 30 mm (p < 0.001), NSVT (p = 0.001), family history of SCD (p = 0.006), inadequate response of blood pressure to exercise (p = 0.02). In the analysis of high risk group, using a cutoff value of 53 uV, we observed a sensitivity of 84%, specificity of 71% and accuracy of 0.77 (95% confidence interval: 0.69 to 0.86). Conclusions: The best results of MTWA by MMA method were found by analyzing all lead ECG (frontal and peripheral plane and orthogonal leads), using UF 1/8, quantitative analysis and cut-off value 53 uV. The MTWA was significantly associated with clinical risk factors, showing a good accuracy, and can be used to effectively select high-risk patients for SCD

Modificações na fisiologia do organismo da mulher ocorrem durante a gravidez em conseqüência às alterações hormonais, anatômicas e metabólicas. No sistema circulatório a modificação mais significativa é o aumento do débito cardíaco a partir do primeiro trimestre da gestação. Mulheres portadoras de cardiopatias podem apresentar graves complicações durante o período gestacional devido à inapropriada adaptação à sobrecarga hemodinâmica, mesmo em pacientes consideradas em capacidade funcional favorável, no início da gestação. A literatura carece de estudos dos efeitos dos anestésicos locais com ou sem vasoconstritor utilizados nos procedimentos odontológicos, sobre os parâmetros cardiovasculares de mulheres gestantes portadoras de valvopatias e seus conceptos. A escassez científica fez deste tema nosso objetivo de estudo: avaliar e analisar parâmetros da cardiotocografia, como freqüência cardíaca, motilidade fetal e contrações uterinas e de pressão arterial e eletrocardiográficos da gestante portadora de doença valvar reumática quando submetida à anestesia local com lidocaína, com e sem vasoconstritor, durante procedimento odontológico restaurador. Para tanto, a monitorização ambulatorial da pressão arterial (MAPA) e a eletrocardiografia ambulatorial (Holter) materna, ambas obtidas durante 24 horas e a cardiotografia (CTG) de 31 portadoras de cardiopatia reumática entre a 28ª e 37ª semana de gestação, nos períodos: (1) basal - 60 minutos antes do procedimento para MAPA e Holter e 20 minutos para CTG; (2) procedimento - 56+15,5minutos (média+desvio padrão); (3) pós-procedimento - 20 minutos; e (4) média das 24 horas para freqüência cardíaca e extra-sístoles e média da vigília e do sono para pressão arterial, permitiu a análise da variação desses parâmetros, utilizando-se lidocaína 2% sem vasoconstritor e lidocaína 2% com epinefrina 1:100.000, compondo-as em dois grupos. Demonstrou-se redução significativa nos valores de freqüência cardíaca materna durante o procedimento somente quando comparado aos demais períodos (p<0,001). Quando comparados os dois grupos, não houve diferença (p>0,05). Houve ocorrência de arritmia cardíaca em 9 (29,0%) pacientes, sendo 7 (41,8%) do grupo que recebeu anestesia com adrenalina. A pressão arterial materna não apresentou diferença quando comparamos os períodos ou os grupos (p>0,05). O mesmo ocorreu (p>0,05) nas análises comparativas dos parâmetros fetais obtidos por meio da CTG - número de contrações, nível e variabilidade da linha de base, número de acelerações da freqüência cardíaca fetal e padrão de reatividade fetal. Concluiu-se que o uso da lidocaína 2% associado à adrenalina mostrou-se seguro em procedimento odontológico durante a gestação de mulheres com cardiopatia valvar reumática. / During pregnancy, the organic systems of a woman are subjected to physiological modifications consequential to hormonal, anatomic and metabolical alterations. The most significant modification in the circulatory system is an increased cardiac output from the first three months of gestation. Women with heart disease may present with severe complications during the gestational period, because of inappropriate adaptation of her body to this hemodynamic overload, even those patients who are thought to have an appropriate functional capacity during early pregnancy. There are scant studies in the literature on the effects of local anesthetics, with and without vasoconstrictor, used in dental procedures on the cardiovascular variables of pregnant women with valvar disease, as well as on their concepti. Driven by this shortage, we decided to have this subject studied, by assessing and analyzing cardiotachographic parameters, such as heart rate, fetal motility and uterine contractions, in addition to blood pressure and electrocardiographic variables, in pregnant women with rheumatic valvar disease who undergo local anesthesia with lidocaine, with and without vasoconstrictor, during restorative dental procedure. For this, 31 rheumatic heart disease patients who were in their 28th to 37th week of gestation, had 24-hour ambulatory monitoring of their blood pressure (BP) and Holter electrocardiography (Holter-ECG), and cardiotocography (CTG), performed during: (1) baseline - 60 minutes before the procedure for BP and Holter- ECG monitoring, and 20 minutes before the procedure for CTG; (2) procedure - 56±15.5 minutes (mean±SD); (3) post-procedure - 20 minutes; and (4) mean 24-hour heart rate and extrasystoles measurement, and mean wake and sleeping periods BP monitoring. Variation of the above variables was analyzed in two groups, one with infusion of a 2% solution of lidocaine with vasoconstrictor, and the other with infusion of a 2% solution of lidocaine with epinephrine 1:100.000. The maternal heart rate values obtained during the procedure showed a significant reduction only in comparison with the other time periods (P<0.001). The comparison of the two groups did not reveal any significant difference (P>0.05). Cardiac arrhythmia was detected in 9 (29.0%) patients, 7 of them (41.8%) from the group who received anesthetics with epinephrine. Maternal blood pressure did not show any significant difference neither between time periods, nor between groups (P>0.05). The same occurred in the comparative analysis of the fetal parameters obtained during CTG -number of contractions, level and variability from baseline, number of fetal heart rate accelerations and fetal reactivity pattern. Our conclusion was that the use of 2% solution of lidocaine in association with epinephrine proved safe during dental procedure in pregnant women with rheumatic valvar cardiopathy.

Luis Calandre Ibáñez (Cartagena 23/3/1890-Madrid 29/9/1961), estudió Medicina en Madrid, siendo discípulo de Cajal, Achúcarro y Madinaveitia en Madrid y de Nicolai y Benda en Alemania. Realizó estudios de Histología sobre la esructura de la fibra cardiaca, para comprender mejor la fisiopatología del corazón, campo de su especial dedicación, siendo uno de los introductores de la electrocardiografía en España, estudiando especialmente los trastornos del ritmo basándose en ella.Fundó y dirigió el Laboratorio de Anatomía Microscópica de la Residencia de Estudiantes (1914-1931). Fue Jefe del Servicio de Cardiología del Hospital Central de la Cruz Roja y Director del Hospital de Carabineros durante la guerra civil (1937.1939). Publicó más de setenta artículos en revistas especializadas y ocho libros de contenido científico. Fundó y dirigió la revista "Archivos de Cardiología y Hematología" (1920-1936). Desarrolló una intensa labor social, política y cultural y al finalizar la guerra civil fue procesado y condenado padeciendo el exilio interior y el olvido científico. / Luis Calandre Ibáñez (Cartagena 1890-Madrid 1961), studied medicine in Madrid, where he was a disciple of Cajal, Achúcarro and Madinaveitia and then of Nicolai and Benda in Germany. He specialised in cardiac physiopathology, and studied histology on the struc Civil war. He published more than seventy articles in specialist journals and eightscientificbooks. He founded and directed the journal "Archivos de Cardiología y Hematología" (1920-1936). Intensely involved in social, political and cultural activities, he was tried and sentenced at the

Este trabalho apresenta a proposta de um protocolo de comunicação de dados integrando tecnologias de internet das coisas, computação móvel e armazenamento em nuvem, aplicado ao telemonitoramento sob demanda de sinais fisiológicos. O objetivo do trabalho foi adquirir, transmitir, armazenar, receber e permitir a visualização sob demanda, mantendo a integridade da representação do sinal biomédico para a análise médica, sem alterar a mobilidade do paciente em monitoramento. O trabalho utiliza um canal de ECG, para adquirir o sinal de eletrocardiografia do paciente, que é conectado via Bluetooth com um dispositivo de computação móvel. O dispositivo de computação móvel, com acesso a internet sem fio, envia o sinal fisiológico através do protocolo proposto para uma base segura de armazenamento de informações em nuvem, podendo ser acessada sob demanda por um especialista para realizar a avaliação médica. O telemonitoramento sob demanda permite ao especialista: visualizar e analisar dados recentes, como se fosse um monitoramento remoto em tempo real do paciente; e visualizar e analisar dados anteriores que estão armazenados na nuvem, semelhante à análise de um exame realizado previamente. O protocolo proposto possui características de segurança da informação, mantendo a integridade da representação no tempo do sinal fisiológico, ainda que dados sejam corrompidos. O trabalho envolveu o uso de tecnologias recentes aplicadas às necessidades de registros de sinais fisiológicos. Estas tecnologias estão em evolução, os padrões não estão consolidados, ocorrendo alterações à medida que novas necessidades vão sendo apresentadas, assim como novas soluções venham a ser desenvolvidas. Como dispositivo de computação móvel foi utilizado neste trabalho um tablet, podendo ser utilizado um smartphone. O protocolo para este trabalho foi utilizado com o sinal de um canal de eletrocardiografia, podendo ser modificado para atender outras necessidades, incluindo outros sinais fisiológicos. Neste trabalho foi utilizado como sinal fisiológico o sinal de um simulador de ECG. / This work shows a proposal for a data communication protocol integrating internet of things technologies, mobile computing and cloud storage, applied to on-demand remote monitoring physiological signals. The aim of this work was to acquire, transmit, store, receive and allow the on-demand visualization, keeping the integrity of the biomedical signals representation for medical analysis, without changing the mobility of the patient being monitored. The work uses an ECG channel to acquire the patient’s electrocardiography signal, which is linked via Bluetooth to a mobile computing device. The mobile computing device, with wireless internet access, sends the physiological signal through the proposed protocol to a safe base of cloud information storage, which can be accessed on demand by a specialist to do the medical evaluation. On-demand remote monitoring allows the specialist to visualize and analyze recent data, as if it were real time remote monitoring of the patient, and visualize and analyze previous data that are stored in the cloud, similar to an analysis of a previously made exam. The proposed protocol has information security features, keeping the integrity of the time representation of the physiological signal, even if the data are corrupted. The work involved the use of new technologies applied to the necessity of physiological signals record. These technologies are evolving. The patterns are not consolidated, and changes are made as new necessities are presented and new solutions developed. For this work, it was used a tablet as a computing mobile device. However, a smartphone could also be used. The protocol was used with an electrocardiography channel signal, which can be modified to attend other necessities, including other physiological signals. As a physiological signal, for this work, it was used an ECG simulator signal.

Introdução: A cardiomiopatia hipertrófica (CMH) é definida, como a hipertrofia miocárdica ocorrida na ausência de doença cardíaca ou sistêmica, sendo a mais prevalente das cardiopatias de transmissão genética e a principal causa de morte súbita em jovens e atletas. A única opção de tratamento para prevenção dessa complicação é a indicação do cardiodesfibrilador implantável (CDI). Alguns marcadores de risco foram identificados, como: pacientes que sobreviveram à parada cardíaca por fibrilação ventricular, episódio de taquicardia ventricular sustentada; história familiar precoce de MSC; síncope inexplicada; espessura septal >= 30 mm; taquicardia ventricular não sustentada (TVNS) no Holter; queda da pressão sistólica (PAS) > 20 mmHg ou aumento < 20 mmHg no esforço. Entretanto, a sensibilidade e especificidade desses critérios são limitadas, tornando necessário o conhecimento de novos métodos diagnósticos com capacidade de predizer MSC. A micro-alternância da onda T (MAOT) é utilizada como ferramenta diagnóstica na estratificação de pacientes com riscos de desenvolver arritmias ventriculares malignas e MSC auxiliando na indicação do CDI. Na CMH há poucos estudos realizados com objetivos e resultados diferentes e, atualmente, uma nova metodologia na realização desses exames foi desenvolvida, não sendo testada nesta população. Os objetivos do presente estudo foram: caracterizar os valores da MAOT pela metodologia Média Móvel Modificada (MMM) e avaliar a associação de seus resultados com os fatores de risco clínicos para MSC. Metodologia: Foram selecionados 132 pacientes com CMH que foram divididos em dois grupos: 1) Alto Risco, 67 pacientes, que apresentavam, pelo menos, um fator de risco para morte súbita cardíaca (história familiar de morte súbita; síncope inexplicada; espessura septal do miocárdio >=30 mm; taquicardia ventricular não sustentada; queda da pressão sistólica no teste de esforço) e 2) Baixo Risco, 65 pacientes, sem fatores de risco. A idade média foi de 37 ± 11,3 anos, sendo 63% do sexo masculino. A média da espessura de septo interventricular foi 23,9 ± 6,2 mm, da fração de ejeção 72 ± 8,1% e 26% apresentavam forma obstrutiva da doença. A MAOT foi avaliada pelo teste ergométrico com protocolo Naughton modificado, com dois fatores de atualização (FaT) 1/8 e 1/32, de forma quantitativa e qualitativa (positivo e negativo) e com três formas de análises: considerando todas as derivações do eletrocardiograma (plano periférico, frontal e ortogonal); desconsiderando os resultados do plano periférico e desconsiderando as derivações ortogonais. Resultados: A aferição da MAOT com FaT 1/8 apresentou maior sensibilidade em comparação com FaT 1/32 (FaT 1/8 MAOTméd. = 69,2 uV a 78,2 uV vs FaT 1/32 MAOTméd. = 33,2 uV a 38,7 uV, p < 0,01), resultando nas análises quantitativas de valores maiores da micro-alternância (MAOTmáx. - FaT 1/8 = 528 uV vs 124 uV = FaT 1/32, p < 0,01) e na análise qualitativa maior número de exames positivos (MAOT positiva - FaT 1/8 = 57,5% vs 19,0% = FaT 1/32). Os pacientes do grupo Alto risco apresentavam maiores valores de MAOT (Alto Risco MAOT média = 101,4 uV vs 54,3 uV Baixo Risco, p < 0,001) e 84% apresentavam exame positivo (56/67). A MAOT mostrou associação significativa com os fatores de risco para MSC: espessura septal >= 30 mm (p < 0,001), TVNS no Holter 24 h (p = 0,001), história familiar de MSC (p = 0,006) e queda da pressão arterial no esforço (p = 0,02). No rastreamento de pacientes de Alto risco, com ponto de corte de 53 uV o teste apresentou sensibilidade e especificidade de 84% e 71%, com acurácia de 0,77 (IC de 95%: 0,69 a 0,86). Conclusões: Os melhores resultados da MAOT pela metodologia Média Móvel Modificada foram encontrados analisando todas as derivações eletrocardiográficas (plano periférico, horizontal e derivações ortogonais), realizados de forma quantitativa, com Fator de Atualização 1/8 e ponto de corte para positividade 53 uV. A MAOT demonstrou associação significativa com a maioria dos fatores de risco clínicos apresentando boa acurácia no rastreamento dos pacientes de Alto Risco para MSC / Introduction: Hypertrophic cardiomyopathy (HCM) is defined as the myocardial hypertrophy in the absence of cardiac or systemic disease, being the most common genetic transmission cardiopathy and responsible for sudden cardiac death (SCD) in young adults and athletes. The first-line treatment option for prevention of SCD is the implantable cardioverter-defibrillator (ICD). Some clinical factors have been identified as high risk for the occurrence of SCD: history of cardiac resuscitation for ventricular fibrillation, episode of sustained ventricular tachycardia, family history of premature SCD, unexplained syncope, ventricular septal thickness >= 30 mm; nonsustained ventricular tachycardia (NSVT) in Holter and inadequate response of blood pressure to exercise: decrease in systolic blood pressure (SBP) > 20 mmHg or increase < 20 mmHg during effort. These criteria, however, are limited in sensitivity and specificity and new diagnostic methods have been required. The microvolt T-wave alternans (MTWA) is used as a diagnostic tool to identify high-risk patients predisposed to malignant ventricular arrhythmias and SCD. Therefore, MTWA may be helpful to indicate ICD. There are no reports in the literature concerning the use of MTWA in HCM. This research aims to evaluate the values of MTWA by modified moving average (MMA) method and the association with clinical factors for SCD. Methods: We enrolled 132 patients with HCM that were divided into two groups: 1) High Risk (HR) group, 67 patients, that had at least one risk factor for sudden cardiac death (family history of SCD; unexplained syncope; ventricular septal thickness >= 30 mm; nonsustained ventricular tachycardia; inadequate response of blood pressure to exercise) and 2) Low Risk (LR) group, 65 patients, without risk factors. The most participants were male (63%) and their mean age was 37 (± 11.3) years. All individuals were evaluated by echocardiography: 23,9 ± 6,2 mm interventricular septal thickness; 72 ± 8.1% ejection fraction and 26% left ventricular outflow gradient of more than 30 mmHg. Patients performed exercise stress testing with modified Naughton Protocol. In the present study, MTWA was assessed with the MMA method, updating factor (UF) 1/8 and 1/32, quantitative and qualitative way (positive and negative). In addition, the values of the MTWA were evaluated in three ways: all the leads of electrocardiogram; disregarding the leads of peripheral plane; disregarding the orthogonal leads. Results: The analysis of MTWA with UF 1/8 showed greater sensitivity compared with UF 1/32 (Mean MTWA, UF 1/8 = 69.2 uV to 78.2 uV vs UF 1/32 = 33.2 uV to 38.7 uV, p < 0.01). Like this, in quantitative and qualitative (positive and negative) analysis of MTWA, the values were larger in the group of UF 1/8 (UF1/8 = 528 uV vs UF 1/32 = 124 uV, p < 0.01/ Positive MTWA, UF 1/8 = 57.5% vs UF 1/32 = 19.0%, p < 0.01). The patients of High Risk group presents higher values of MTWA (HR = 101.4 uV vs LR = 54.3 uV, p < 0.001) and 84% had the positive test. The MTWA was significantly associated with risk factors for SCD: ventricular septal thickness >= 30 mm (p < 0.001), NSVT (p = 0.001), family history of SCD (p = 0.006), inadequate response of blood pressure to exercise (p = 0.02). In the analysis of high risk group, using a cutoff value of 53 uV, we observed a sensitivity of 84%, specificity of 71% and accuracy of 0.77 (95% confidence interval: 0.69 to 0.86). Conclusions: The best results of MTWA by MMA method were found by analyzing all lead ECG (frontal and peripheral plane and orthogonal leads), using UF 1/8, quantitative analysis and cut-off value 53 uV. The MTWA was significantly associated with clinical risk factors, showing a good accuracy, and can be used to effectively select high-risk patients for SCD

Modificações na fisiologia do organismo da mulher ocorrem durante a gravidez em conseqüência às alterações hormonais, anatômicas e metabólicas. No sistema circulatório a modificação mais significativa é o aumento do débito cardíaco a partir do primeiro trimestre da gestação. Mulheres portadoras de cardiopatias podem apresentar graves complicações durante o período gestacional devido à inapropriada adaptação à sobrecarga hemodinâmica, mesmo em pacientes consideradas em capacidade funcional favorável, no início da gestação. A literatura carece de estudos dos efeitos dos anestésicos locais com ou sem vasoconstritor utilizados nos procedimentos odontológicos, sobre os parâmetros cardiovasculares de mulheres gestantes portadoras de valvopatias e seus conceptos. A escassez científica fez deste tema nosso objetivo de estudo: avaliar e analisar parâmetros da cardiotocografia, como freqüência cardíaca, motilidade fetal e contrações uterinas e de pressão arterial e eletrocardiográficos da gestante portadora de doença valvar reumática quando submetida à anestesia local com lidocaína, com e sem vasoconstritor, durante procedimento odontológico restaurador. Para tanto, a monitorização ambulatorial da pressão arterial (MAPA) e a eletrocardiografia ambulatorial (Holter) materna, ambas obtidas durante 24 horas e a cardiotografia (CTG) de 31 portadoras de cardiopatia reumática entre a 28ª e 37ª semana de gestação, nos períodos: (1) basal - 60 minutos antes do procedimento para MAPA e Holter e 20 minutos para CTG; (2) procedimento - 56+15,5minutos (média+desvio padrão); (3) pós-procedimento - 20 minutos; e (4) média das 24 horas para freqüência cardíaca e extra-sístoles e média da vigília e do sono para pressão arterial, permitiu a análise da variação desses parâmetros, utilizando-se lidocaína 2% sem vasoconstritor e lidocaína 2% com epinefrina 1:100.000, compondo-as em dois grupos. Demonstrou-se redução significativa nos valores de freqüência cardíaca materna durante o procedimento somente quando comparado aos demais períodos (p<0,001). Quando comparados os dois grupos, não houve diferença (p>0,05). Houve ocorrência de arritmia cardíaca em 9 (29,0%) pacientes, sendo 7 (41,8%) do grupo que recebeu anestesia com adrenalina. A pressão arterial materna não apresentou diferença quando comparamos os períodos ou os grupos (p>0,05). O mesmo ocorreu (p>0,05) nas análises comparativas dos parâmetros fetais obtidos por meio da CTG - número de contrações, nível e variabilidade da linha de base, número de acelerações da freqüência cardíaca fetal e padrão de reatividade fetal. Concluiu-se que o uso da lidocaína 2% associado à adrenalina mostrou-se seguro em procedimento odontológico durante a gestação de mulheres com cardiopatia valvar reumática. / During pregnancy, the organic systems of a woman are subjected to physiological modifications consequential to hormonal, anatomic and metabolical alterations. The most significant modification in the circulatory system is an increased cardiac output from the first three months of gestation. Women with heart disease may present with severe complications during the gestational period, because of inappropriate adaptation of her body to this hemodynamic overload, even those patients who are thought to have an appropriate functional capacity during early pregnancy. There are scant studies in the literature on the effects of local anesthetics, with and without vasoconstrictor, used in dental procedures on the cardiovascular variables of pregnant women with valvar disease, as well as on their concepti. Driven by this shortage, we decided to have this subject studied, by assessing and analyzing cardiotachographic parameters, such as heart rate, fetal motility and uterine contractions, in addition to blood pressure and electrocardiographic variables, in pregnant women with rheumatic valvar disease who undergo local anesthesia with lidocaine, with and without vasoconstrictor, during restorative dental procedure. For this, 31 rheumatic heart disease patients who were in their 28th to 37th week of gestation, had 24-hour ambulatory monitoring of their blood pressure (BP) and Holter electrocardiography (Holter-ECG), and cardiotocography (CTG), performed during: (1) baseline - 60 minutes before the procedure for BP and Holter- ECG monitoring, and 20 minutes before the procedure for CTG; (2) procedure - 56±15.5 minutes (mean±SD); (3) post-procedure - 20 minutes; and (4) mean 24-hour heart rate and extrasystoles measurement, and mean wake and sleeping periods BP monitoring. Variation of the above variables was analyzed in two groups, one with infusion of a 2% solution of lidocaine with vasoconstrictor, and the other with infusion of a 2% solution of lidocaine with epinephrine 1:100.000. The maternal heart rate values obtained during the procedure showed a significant reduction only in comparison with the other time periods (P<0.001). The comparison of the two groups did not reveal any significant difference (P>0.05). Cardiac arrhythmia was detected in 9 (29.0%) patients, 7 of them (41.8%) from the group who received anesthetics with epinephrine. Maternal blood pressure did not show any significant difference neither between time periods, nor between groups (P>0.05). The same occurred in the comparative analysis of the fetal parameters obtained during CTG -number of contractions, level and variability from baseline, number of fetal heart rate accelerations and fetal reactivity pattern. Our conclusion was that the use of 2% solution of lidocaine in association with epinephrine proved safe during dental procedure in pregnant women with rheumatic valvar cardiopathy.

This master’s thesis deals with the automatic detection of myocardial infarction in ECG. Semester work consists of two parts. The theoretical part provides a description of the electrical conduction system of the heart, spreading of electrical activity through the heart muscle, the methods of ECG scanning and the ECG curve. There are also mentioned the causes of myocardial ischemia and various methods of its detection. Another part is devoted to high-frequency ECG, analysis of HFQRS and clinical studies which describe the use of high-frequency ECG in diagnosis of myocardial infarction. In the practical part is proposed an algorithm using low-frequency components ECG and an algorithm using high-frequency components ECG for automatic detection of myocardial infarction. The proposed algorithms are implemented in programming environment MATLAB and tested on signals from the PTB database. The final part of the master‘s thesis is devoted to the comparison of the success of myocardial infarction by means of low frequency and high frequency components of ECG and comparison of achieved results with results from clinical studies.

<p>Ishemijska bolest srca najče&scaron;će nastaje kao posledica razvoja aterosklerotskih promena na koronarnim krvnim sudovima koji dovode do suženja lumena i posledičnog pada protoka arterijske krvi u području vaskularizacije. Akutni oblik koronarne bolesti koji zahteva hitnu primenu reperfuzione terapije je ST elevirani infarkt miokarda. EKG ima veliki značaj u postavljanju dijagnoze ali i u proceni uspe&scaron;nosti same reperfuzije. &Scaron;irina QRS kompleksa jedan je od EKG parametara čija dinamika promena može ukazati na uspe&scaron;nost pPKI i veličinu infarktne zone. Evaluacija &scaron;irine QRS kompleksa kao prediktora veličine infarkta miokarda i reperfuzije nakon pPKI kod pacijenata sa STEMI. Ispitivanje je sprovedeno kao prospektivna, opservaciona klinička studija na Klinici za kardiologiju, Instituta za kardiovaskularne bolesti Vojvodine u periodu od januara 2016. do decembra 2018. godine. U isptivanje je uključeno 200 pacijenata sa STEMI kod kojih je urađena pPKI. Na osnovu dužine trajanja tegoba formirane su dve grupe od po 100 pacijenata. Grupa A kod kojih je totalno ishemijsko vreme bilo &lt;6h i grupa B kod kojih je totalno ishemijsko vreme između 6 i 12h. . Sprovedeno je EKG praćenje radi procene &scaron;irine QRS kompleksa intrahospitalno (pre procedure, odmah nakon pPKI kao i posle 1h i 72h) i na dve vizite ambulantno tokom &scaron;estomesečnog praćenja (nakon mesec dana i &scaron;est meseci). Ehokardiografija je urađena kod svih pacijenata intrahospitalno i na &scaron;estomesečnom ambulantnom pregledu. &Scaron;irine QRS kompleksa su korelirane sa rezultatima interventne procedure procenjene TIMI protokom i TMPG, dinamikom kardiospecifičnih enzima i ehokardiografskim nalazima. U istraživanje je uključeno 71% mu&scaron;karaca i 29% žena, prosečna starost uzorka iznosila je 60.6&plusmn;11.39. Dužina trajanja tegoba značajno se razlikovala između grupa. U grupi A tegobe su trajale prosečno 120 minuta (90-180), dok su u grupi B trajale 420 minuta (360-600) (p&lt;0.0005). DTB nije se značajno razlikovao, 42 minuta (31-54.5) u odnosu na 40.5 minuta (34.5-55) (p=0.818). Prosečna &scaron;irina QRS kompeksa na EKG-u pre pPKI nije se značajno razlikovala između grupa, 100 msec (90-110) u odnosu na 100 msec (93-110) (p=0.308). Nakon reperfuzije uočena je značajna razlika u &scaron;irini QRS kompleksa između grupa na svim intrahospitalnim kao i EKG-ima načinjenim tokom perioda praćenja. QRS kompleks je &scaron;iri kod pacijenata iz grupe B (p&lt;0.0005). Pacijenti iz grupe A koji su imali prohodnu infarktnu arteriju sa TIMI 3 protokom pre implantacije stenta imali su značajno uži QRS kompleks na incijilanom EKG-u u odnosu na pacijente kod kojih je IRA bila sub/okludirana sa TIMI protokom &le;2 (p=0.001). U grupi B prohodna infarktna arterija sa TIMI 3 protokom nije značajno uticala na &scaron;irinu QRS kompleksa na inicijalnom EKG-u (p=0.144). Na EKG-ima nakon procedure QRS kompleks bio je značajno &scaron;iri kod pacijenata kod kojih je TIMI protok &le;2, ali samo za grupu pacijenata koja se javila unutar 6h od početka tegoba (p=0.001). QRS kompleks kod pacijenata koji su se javili nakon 6h od početka tegoba jeste bio uži, ali bez statistički značajne razlike (p=0.336). Pearsonovim testom registrovano je postojanje negativne korelacije &scaron;irine QRS kompleksa i istisne frakcije leve komore, ali i pozitivne korelacije sa WMSI i indeksiranim end sistolnim i end dijastolnim volumenom. ROC analizom pokazano je da ukoliko je QRS kompleks &scaron;iri od 89 msec nakon mesec dana, 8.5 puta je veći rizik od snižene EF na &scaron;estomesečnoj kontroli (p&lt;0.0005, AUC=0.808, cut-off=89msec.). ROC analiza pokazala je i da ukoliko je QRS kompleks &scaron;iri od 99msec 1h nakon procedure, 5 puta je veći rizik od pojave MACE (p&lt;0.0005, AUC=0.744, cut-off=99msec). Izvedena su dva matematička modela zasnovana na &scaron;irini QRS kompleksa koja vr&scaron;e predikciju snižene EF i pojave MACE tokom perioda praćenja. &Scaron;irina QRS kompleksa je pokazatelj reperfuzije kod pacijenata sa STEMI kod kojih se načini revaskularizacija unutar 6h od nastanka tegoba. &Scaron;irina QRS kompleksa mesec dana nakon STEMI predstavlja nezavisni prediktor snižene EF. Pro&scaron;irenje preko 89msec 8.5 povećava rizik od snižene EF. &Scaron;irina QRS kompleksa jedan sat nakon pPKI predstavlja nezavisni prediktor za MACE. Pro&scaron;irenje preko 99msec 5 puta povećava rizik od neželjenog kardiolo&scaron;kog događaja. Izvedena su dva matematička modela koja koriste &scaron;irinu QRS kompleksa i sa visokom precizno&scaron;ću vr&scaron;e predikciju MACE-a, odnosno snižene EF nakon &scaron;est meseci.&nbsp;</p> / <p>Ischemic heart disease most commonly occurs as a result of the atherosclerotic changes in the coronary vessels that lead to the narrowing of the lumen and consequent fall in arterial blood flow in the vascularization area. An acute form of coronary artery disease requiring immediate reperfusion therapy is ST-elevation myocardial infarction. The ECG is of great importance not only in making the diagnosis but also in evaluating the success of the reperfusion itself. The duration of the QRS complex is one of the ECG parameters whose change in dynamics can indicate the success of pPCI as well as the size of the infarct zone. Evaluation of the width of the QRS complex as a predictor of myocardial infarction size and reperfusion after pPCI in patients with STEMI. The study was conducted as a prospective, observational clinical study at the Cardiology Clinic of the Institute of Cardiovascular Diseases of Vojvodina between January 2016 and December 2018. The study included 200 patients with STEMI in whom pPCI was performed. Based on the length of discomforts two groups with 100 patients were formed. Group A had a total ischemic time &lt;6h and the total ischemic time in group B was between 6-12h. To assess the duration of the QRS complex, the ECG monitoring was performed intrahospital (before the procedure, immediately after pPCI as well as 1h and 72h after the procedure) and on two outpatient visits during the six-month follow-up period (after one month and six months). Echocardiography was performed in all patients intrahospital and at a six-month outpatient visit. The duration of the QRS complex correlated with the results of the interventional procedure that was evaluated by the TIMI flow and TMPG, the dynamics of cardiospecific enzymes and echocardiography findings. The survey included 71% of men and 29% of women with an average age of 60.6 &plusmn; 11.39. The duration of the discomforts varied significantly between the groups. In group A the discomforts lasted 120 minutes in an average (90-180), while they lasted 420 minutes in group B (360-600) (p &lt;0.0005). DTB did not differ significantly, 42 minutes (31-54.5) versus 40.5 minutes (34.5-55) (p = 0.818). The average duration of the QRS complex on the ECG before pPCI did not differ significantly between the groups, 100 msec (90-110) versus 100 msec (93-110) (p = 0.308). After the reperfusion, a significant difference in the duration of the QRS complex was observed between the groups at all intrahospital ECGs and the ECGs performed during the follow-up period. The QRS complex was broader in group B patients (p &lt;0.0005). Group A patients who had a patent infarct artery with TIMI 3 flow before the stent implantation had a significantly narrower QRS complex on the initial ECG compared to the patients whose IRA was sub / occluded with TIMI flow &le;2 (p = 0.001). In group B, the patent infarct artery with TIMI 3 flow did not significantly affect the duration of the QRS complex at the initial ECG. (p = 0.144). At the post-procedural ECGs the QRS complex was significantly broader in patients with TIMI flow &le;2, but only in the group of patients who arrived within 6 h from the onset of discomforts (p = 0.001). The QRS complex in patients who arrived 6 h after the onset of discomforts was narrower but without statistically significant difference (p = 0.336). The Pearson test registered the existence of a negative correlation of the QRS complex width and the left ventricular ejection fraction, but also a positive correlation with the WMSI and index end-systolic and end-diastolic volumes. The ROC analysis showed that if the QRS complex was wider than 89 msec after one month, there was an 8.5 times higher risk of decreased EF at the six-month control examination (p &lt;0.0005, AUC = 0.808, cut-off = 89msec.). The ROC analysis also showed that if the QRS complex was wider than 99msec 1h after the procedure, there was a 5 times higher risk of MACE (p &lt;0.0005, AUC = 0.744, cut-off = 99msec). Two mathematical models based on the width of the QRS complex were derived that predicted the lowered EF and the occurrence of MACE during the monitored period. The width of the QRS complex is an indicator of reperfusion in patients with STEMI who undergo revascularization within 6 hours from the onset of discomforts. The width of the QRS complex one month after STEMI is an independent predictor of decreased EF. Broadening over 89msec increases the risk of lowered EF for 8.5 times. The width of the QRS complex one hour after pPCI represents an independent predictor of MACE. Broadening over 99msec increases the risk of an adverse cardiac event 5 times. Two mathematical models have derived that use the width of the QRS complex and predict MACE with high precision as well as reduced EF after six months.</p>

Trötthet i trafiken är ett stort problem i samhället. Det är särskilt farligt att trött framföra tunga lastbilar i trafiken eftersom dessa fordon är stora och har ofta livsavgörande roller vid inblandning i trafikolyckor. För att angripa problemet har det i denna rapport studerats kring vilket sömnstadie som är lämpligast att vakna under, i syfte att vakna pigg och alert samt vilka typer av tekniker och metoder som är lämpliga för att portabelt kunna detektera Rapid-Eye-Movement. Tidigare arbeten och studier har gjorts som påvisar att uppväckning i REM-sömn är optimalt för att känna sig alert. De valda metoderna är baserade på varianter av väletablerade tekniker som används för identifiering av sömnsteg. Elektrookulografi används för att mäta ögonrörelser med hjälp av fyra elektroder som är placerade på huvudet. Kroppsrörelser upptäcks genom en accelerometer som fästs på armen. Pulsmätningar görs och används för att räkna ut pulsvariansen under sömnen. Målet är att skapa en prototyp som ska känna av när användaren är i REM-sömn och sedan väcka användaren. Detta arbete är uppdelat i två inbyggda system som görs mellan två olika examensarbeten. Resultatet blev tre sensorer som fungerar individuellt. På grund av tidsbrist och en längre felsökning blev prototypen inte färdigställd. Innan sensorerna kan tillämpas i en produkt krävs det att ytterligare tester genomförs under monitorering av en sömnspecialist. / Tiredness in traffic is a major problem in society. It is especially dangerous to drive heavy trucks when tired because these vehicles are large and often have vital roles when involved in traffic accidents. To address the problem, this degree project has studied which sleep stage is most appropriate to wake up during, in order to wake up sharp and alert, and what types of techniques and methods are suitable for portable detection of Rapid-Eye-Movement. Previous work and studies have been done which indicates that awakening during REM sleep is optimal for feeling alert. The chosen methods are based on variants of well-established techniques that are used to identify sleep stages. Electrooculography is used to measure eye movements using four electrodes placed on the head. Body movements are detected by an accelerometer attached to the arm. Pulse measurements are made and used to calculate the pulse variation during sleep. The goal is to create a prototype which will know when the user is in REM sleep and then wake the user up. This work is divided into two embedded systems that are made between two different degree projects. The result was three sensors that worked individually. Due to lack of time and a longer troubleshooting, the prototype was not completed. Before the sensors can be used in a product, additional tests are required under the supervision of a sleep specialist.