Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 5 uppsatser.

No description available.

In response to the augmented haemodynamic load placed upon the heart by intense and prolonged exercise, various forms of physiological remodelling are elicited. The resultant cardiac structural, functional and electrical adaptations are coined the athlete’s heart. Due to the nature of the remodelling, in some cases these adaptations may however overlap with the diagnostic criteria for varying pathological conditions, often related to sudden cardiac death. Several variables are associated with the athlete’s heart including age, sex, sport, body size, and ethnicity. Ethnicity is of particular importance as athletes of an African/Afro-Caribbean ethnicity demonstrate a greater prevalence of abnormal changes suggestive of pathology. There is however paucity in the literature of the athlete’s heart among other ethnicities. For this reason Study 1 investigated the impact of Arabic ethnicity upon the structure, function and electrophysiology of the heart in male athletes. Study 1 identified that while Arabic athletes had larger hearts than Arabic controls, they had significantly smaller hearts than their Black and Caucasian athletic counterparts. While Black athletes had a significantly greater prevalence of training unrelated/abnormal ECG findings, Arabic and Caucasian both had similar levels of training unrelated/abnormal findings, suggesting the European Society of Cardiology guidelines for ECG interpretation in athletes are applicable for the ethnicity. Study 2 investigated another important facet of the athlete’s heart, which is body size. Study 2 identified that while there was a progressive relationship between body size and cardiac dimensions, the previously identified upper limits of cardiac structural remodelling were applicable even among those with a body surface area (BSA) over 2.3m2. Among the cohort of athletes with a BSA >2.3m2, Black athletes demonstrated significantly greater wall thickness’ than Caucasian and Arabic athletes. The second aspect to the thesis highlighted how the findings of Study 1 and 2 impact upon pre-participation screening. While debate still exists around the most effective methodology to screen for pathological cardiac conditions, several organisations mandate the use of the echocardiography alongside the resting 12-Lead ECG. Study 3 established that should echocardiography be limited to use as a follow up investigation, significant cost benefits could be elicited (47% reduction). The premise of this significant cost reduction was that no pathological case was identified by echocardiography in isolation. While still found to be useful in confirming pathology, significantly, in our study the investigation failed to identify two cases of hypertrophic cardiomyopathy. Study 4 investigated the implications of adopting modified ECG interpretation guidelines in light of the criticism that ECG screening should be avoided due to a high false positive rate. Utilising an ethnically diverse cohort, Study 4 demonstrated that using the ‘Refined’ criteria reduced the false positive rate from 22% when using the 2010 ESC guidelines to 5%. Importantly both criteria achieved 100% sensitivity, highlighting the importance of the ECG in cardiovascular screening.

Made available in DSpace on 2014-06-11T19:23:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-12-07Bitstream added on 2014-06-13T20:29:49Z : No. of bitstreams: 1 braganholi_df_me_araiq_parcial.pdf: 104237 bytes, checksum: e3996c0a9549c5f5ea02263aa29adb8f (MD5) Bitstreams deleted on 2014-10-03T16:24:42Z: braganholi_df_me_araiq_parcial.pdf,Bitstream added on 2014-10-03T16:27:39Z : No. of bitstreams: 2 braganholi_df_me_araiq_parcial.pdf.txt: 24116 bytes, checksum: 4311db628427328ebb1b15b5edcab15d (MD5) 000694394.pdf: 608461 bytes, checksum: dceff09293ceb64124b8735297fa48e3 (MD5) Bitstreams deleted on 2014-10-03T16:33:16Z: 000694394.pdf,Bitstream added on 2014-10-03T16:43:30Z : No. of bitstreams: 2 braganholi_df_me_araiq_parcial.pdf.txt: 24116 bytes, checksum: 4311db628427328ebb1b15b5edcab15d (MD5) 000694394.pdf: 608461 bytes, checksum: dceff09293ceb64124b8735297fa48e3 (MD5) Bitstreams deleted on 2014-10-03T16:48:56Z: 000694394.pdf,Bitstream added on 2014-10-03T16:49:47Z : No. of bitstreams: 1 000694394.pdf: 608461 bytes, checksum: dceff09293ceb64124b8735297fa48e3 (MD5) Bitstreams deleted on 2014-10-27T11:47:10Z: 000694394.pdf,Bitstream added on 2014-10-27T11:48:05Z : No. of bitstreams: 1 000694394.pdf: 608461 bytes, checksum: dceff09293ceb64124b8735297fa48e3 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Morte súbita cardíaca (MSC) é um dos maiores problemas de saúde pública no mundo, afetando cerca de 335 mil pessoas por ano nos EUA e aproximadamente 712 pessoas por dia no Brasil, predominantemente na faixa etária mais produtiva. Principalmente em jovens, as causas são desordens cardíacas com anormalidades estruturais e arritmogênicas de origens genéticas; além disso, alguns medicamentos podem influenciar na susceptibilidade a MSC ou a doenças cardiovasculares. Como a morte pode ocorrer num período máximo de uma hora após o início dos sintomas e não ser decorrente de trauma ou violência, o diagnóstico da causa de morte pode ser dificultado. A análise genética nestes casos é muito útil para ajudar a identificá-la e informar aos parentes próximos sobre um possível fator genético de risco pré-existente. Este trabalho propôs padronizar as reações de PCR e SNaPshot em multiplex para analisar 11 SNPs (single nucleotide polymorphisms) relacionados à MSC (NEWTON-CHEH et al. 2009) em grupos de familiares brasileiros com histórico de insuficiência cardíaca para uma futura utilização na Genética Forense e Médica, entretanto, o multiplex contendo 8 SNPs mostrou ser mais eficiente . Para tanto, amostras foram coletadas de indivíduos com histórico familiar de: coronariopatia, cardiomiopatia hipertrófica ou familiar próximo que sofreu ataque cardíaco e, indivíduos sem este histórico utilizados como controles. As análises não apresentaram diferenças significativas entre o grupo de indivíduos com histórico e controle, mas, os dados são compatíveis com as freqüências conhecidas dos SNPs. Também identificou-se um provável fator hereditário para o SNP rs4725982 em uma das famílias / Sudden cardiac death (SCD) is a major public health problems worldwide, affeting about 335,000 people per year in the U.S. and approximately 712 people per day in Brazil, predominantly in the most productive age group. Especially in young people, the causes are structural abnormalities of cardiac disorders and genetic origins of arrhythmogenic, in addition, some medications may influence susceptibility to SCD or cardiovascular disease. As death can occur whitin a maximum of one hour after onset of symptoms and not be due to trauma or violence, the diagnosis of the cause of the death can be difficult. Genetic analysis in these cases is very useful to help identify them and inform close relatives about a possible genetic risk factor pre-existing. This work proposed to standardize the PCR and SNaPshot multiplex to analyze 11 SNPs (single nucleotide polymorphisms) related to the SCD (NEWTON-CHEH et al. 2009) in Brazilian familial groups with a history of heart failure for future use in Forensic Genetics and Medical. For this, samples were collected from individuals with a family history of heart disease, hypertrophic cardiomyophathy or close relative who suffered a heart attack, and individuals without this history used as controls. The analysis showed no siginificant differences between the group of the individuals with a history and control, but the data are compatible with the frequencies of known SNPs. It also identified a probable hereditary factor for the SNP rs4725982 in one of the studied families

Orientador: Regina Maria Barretto Cicarelli / Banca: Rogério Nogueira de Oliveira / Banca: Greiciane Gaburro Panetto / Resumo: Morte súbita cardíaca (MSC) é um dos maiores problemas de saúde pública no mundo, afetando cerca de 335 mil pessoas por ano nos EUA e aproximadamente 712 pessoas por dia no Brasil, predominantemente na faixa etária mais produtiva. Principalmente em jovens, as causas são desordens cardíacas com anormalidades estruturais e arritmogênicas de origens genéticas; além disso, alguns medicamentos podem influenciar na susceptibilidade a MSC ou a doenças cardiovasculares. Como a morte pode ocorrer num período máximo de uma hora após o início dos sintomas e não ser decorrente de trauma ou violência, o diagnóstico da causa de morte pode ser dificultado. A análise genética nestes casos é muito útil para ajudar a identificá-la e informar aos parentes próximos sobre um possível fator genético de risco pré-existente. Este trabalho propôs padronizar as reações de PCR e SNaPshot em multiplex para analisar 11 SNPs (single nucleotide polymorphisms) relacionados à MSC (NEWTON-CHEH et al. 2009) em grupos de familiares brasileiros com histórico de insuficiência cardíaca para uma futura utilização na Genética Forense e Médica, entretanto, o multiplex contendo 8 SNPs mostrou ser mais eficiente . Para tanto, amostras foram coletadas de indivíduos com histórico familiar de: coronariopatia, cardiomiopatia hipertrófica ou familiar próximo que sofreu ataque cardíaco e, indivíduos sem este histórico utilizados como controles. As análises não apresentaram diferenças significativas entre o grupo de indivíduos com histórico e controle, mas, os dados são compatíveis com as freqüências conhecidas dos SNPs. Também identificou-se um provável fator hereditário para o SNP rs4725982 em uma das famílias / Abstract: Sudden cardiac death (SCD) is a major public health problems worldwide, affeting about 335,000 people per year in the U.S. and approximately 712 people per day in Brazil, predominantly in the most productive age group. Especially in young people, the causes are structural abnormalities of cardiac disorders and genetic origins of arrhythmogenic, in addition, some medications may influence susceptibility to SCD or cardiovascular disease. As death can occur whitin a maximum of one hour after onset of symptoms and not be due to trauma or violence, the diagnosis of the cause of the death can be difficult. Genetic analysis in these cases is very useful to help identify them and inform close relatives about a possible genetic risk factor pre-existing. This work proposed to standardize the PCR and SNaPshot multiplex to analyze 11 SNPs (single nucleotide polymorphisms) related to the SCD (NEWTON-CHEH et al. 2009) in Brazilian familial groups with a history of heart failure for future use in Forensic Genetics and Medical. For this, samples were collected from individuals with a family history of heart disease, hypertrophic cardiomyophathy or close relative who suffered a heart attack, and individuals without this history used as controls. The analysis showed no siginificant differences between the group of the individuals with a history and control, but the data are compatible with the frequencies of known SNPs. It also identified a probable hereditary factor for the SNP rs4725982 in one of the studied families / Mestre

Abstract Short QT syndrome is an inherited arrhythmia disorder characterized by a short QT interval, typical T-wave and ST-segment morphology and an increased risk of sudden cardiac death. The purpose of this thesis was to study the epidemiology and prognosis of the subjects with short QT intervals. Special attention was paid to the ECG changes that could illustrate the prognosis of subjects with short QT interval. The first study comprised a group of patients with short QT syndrome. We report clinical presentation, ECG morphology, the prevalence of genetic mutations and the results of therapies in this group of patients. The second study population consisted of 10 822 randomly selected middle-aged subjects followed up for 29 ± 10 years. QT intervals were measured using three correction methods for the heart rate in order to assess the prevalence and prognosis of those subjects with short QT intervals. The third population consisted of three patients with short QT syndrome and nine controls. Holter recordings were analyzed to compare transmural dispersion of repolarization between patients and controls and also to study their capability to change repolarization indexes from baseline to maximal values. In the fourth study ECGs from 10 patients with short QT syndrome were compared with ECGs of 12 asymptomatic subjects with short QT intervals. The aim was to find ECG abnormalities that would predict the outcome of the patients. We found 62% of patients to be symptomatic, 34% had cardiac arrest. Atrial fibrillation was common. Most of the patients received an ICD or were placed on hydroquinidine. The prevalence of QTc < 320ms was 0.10% and QTc < 340ms was 0.4%, respectively. Mortality or other serious symptoms did not differ between subjects and controls. We also found that the TPE/QT ratio as an index for abnormal transmural dispersion of repolarization was high compared to controls. Short QT syndrome patients had also lesser capacity to change the QT interval, indicating blunted autonomic response in SQTS. Ten SQTS patients had significantly shorter Jpoint–Tpeak interval and higher TPE/QT ratio compared to controls. In conclusion, shorter than normal QT interval might represent a novel short QT syndrome. However, in the general community short QT interval can reflect only the extreme end of the normal Gaussian distribution of QT intervals and these subjects carry a good prognosis. TPE/QT ratio and Jpoint–Tend intervals can be used as risk stratifiers in subjects with short QT intervals.

Marfan's syndrome is a common connective tissue disease with different musculoskeletal, ophthalmic and cardiac manifestations. Marfan's patients carry increased risk for cardiac arrhythmias. Only three cases of atrial flutter in Marfan's patients are described in the literature. We report a fourth case of a young Marfan's patient who presents with typical atrial flutter after motor vehicle accident. After electrical cardioversion, sinus rhythm was restored but he had recurrent atrial flutter on follow up. The patient then underwent electrophysiological study and successful radiofrequency catheter ablation of the flutter circuit. Since discharge, the patient has had no documented arrhythmias on follow up.

No description available.

No description available.

Abstract Physical activity with regular physical exercise (PE) has long been advocated because it lowers morbidity and mortality. However, there have been concerns about a transiently increased risk of adverse cardiac events such as sudden cardiac death (SCD) during PE. Our aim was to identify risk factors related to SCD during PE and clarify the effect of PE on cardiovascular well-being in the general population. In study I we found out that male gender as well as coronary artery disease (CAD), cardiac hypertrophy and myocardial scarring as autopsy-findings were clearly more common among exercise-related SCD. Typical northern activities in skiing and snow shoveling were among the three most common types of PE alongside cycling. In study II we analyzed the previously recorded electrocardiograms (ECG) of victims of SCD. Fragmented QRS complex (fQRS) in anterior leads was a common finding among subjects who died during exercise, especially among subjects with a prior diagnosis of CAD. In study III, we collected retrospectively out-of-hospital sudden cardiac arrest (SCA) data in Northern Ostrobothnia between the years 2007 and 2012. The subjects who suffered SCA in relation to PE were younger and previously healthier, and they had more often a shockable rhythm as the initial rhythm. There was a markedly better prognosis for hospital discharge when SCA occurred during PE. In study IV, we noticed a decrease in cardiac mortality in subjects who were physically active or became active during follow-up in a population of 1,746 stable CAD patients. A similar effect could be seen affecting SCD mortality. No increase in cardiac mortality could be seen among those with the highest levels of habitual PE. In conclusion, ischemic heart disease and male gender, especially when fQRS is present in anterior leads, are characteristics related to exercise-related SCD. On the other hand, when SCA takes place during PE, the prognosis is markedly better compared to SCA occurring at rest. An active lifestyle is also linked to decreased cardiac mortality. / Tiivistelmä Säännöllinen aktiivinen elämäntapa on yhteydessä pienempään fyysisten ja psyykkisten sairauksien riskiin. Tutkimuksissa on kuitenkin havaittu raskaampaan liikuntaan liittyvä väliaikaisesti lisääntynyt akuutin sydäntapahtuman, kuten äkkikuoleman, riski. Väitöskirjatutkimuksessa tutkitaan rasitukseen liittyvän sydänperäisen äkkikuoleman erityispiirteitä ja fyysisen aktiivisuuden merkitystä hyvinvoinnille. Ensimmäisessä osajulkaisussa havaittiin, että rasitukseen liittyvissä kuolemissa oli ruumiinavauslöydöksenä merkittävästi enemmän sepelvaltimotautia, sydänlihaksen arpeutumista ja sydänlihaksen liikakasvua verrattuna äkkikuolemiin levossa. Miessukupuoli oli selkeästi yliedustettuna rasituspopulaatiossa, sillä peräti 94 % oli miehiä. Yleisimmät rasitusmuodot olivat hiihto, pyöräily ja lumenluonti. Toisessa osatutkimuksessa tutkittiin edeltävien EKG-muutosten yhteyttä rasitusperäisiin äkkikuolemiin. Havaitsimme, että QRS-kompleksin pirstoutuminen etuseinäkytkennöissä oli selkeästi yleisempi löydös rasitusryhmässä. Tämä löydös oli erityisen merkittävä sepelvaltimotautipotilailla. Kolmas julkaisu sisältää tiedot sairaalan ulkopuolisista sydänpysähdyksistä Pohjois-Pohjanmaalla vuosina 2007–2012. Tässä aineistossa havaitsimme, että rasitukseen liittyvän sydänpysähdyksen alkurytmi oli useammin defibrilloitava, potilaat olivat nuorempia ja terveempiä, ja maallikkoelvytys aloitettiin useammin. Rasituksessa elottomaksi menneillä oli suhteellisen hyvä selviämisennuste. Neljännessä tutkimuksessa havaitsimme selkeästi paremman ennusteen niillä stabiilia sepelvaltimotautia sairastaneilla, jotka olivat liikunnallisesti aktiivisia. Sydänperäinen kuolleisuus oli pienempi myös niillä potilailla, jotka onnistuivat lisäämään liikunnallista aktiivisuuttaan. Samankaltainen tulos todettiin sydänperäisten äkkikuolemien osalta. Sepelvaltimotauti ja miessukupuoli ovat hyvin yleisiä löydöksiä, kun sydänperäinen äkkikuolema tapahtuu rasituksessa. Myös QRS-kompleksin pirstoutuminen etuseinäkytkennöissä liittyi rasitusperäisiin kuolemiin. Toisaalta potilaan ennuste selvitä on selkeästi parempi sydänpysähdyksen tapahtuessa rasituksessa. Osoitimme myös, että liikunnallinen aktiivisuus ja sen pienikin lisäys parantavat sepelvaltimotautipotilaiden ennustetta.