INDICADOR Falta de
7. PROPUESTA DE MEJORA 1 Título de la propuesta
5.1: Socio-demographic data.
A total of four hundred and ten subjects (410) were referred for ECG in the one year period; 205 of this number had cardiac diseases and another subset of 205 had no cardiac diseases. There were 213 males and 197 females; (Table 1). Their ages, occupational as well as educational levels were comparable in both groups (p<0.05).
Among the cardiac patients, more were married than in the control group (p<0.05).
5.2: Distribution of subjects into age groups.
The age distribution of cardiac and non-cardiac cases are shown in Table 2. the difference in age distribution was not statistically significant (X2=0.000; df=4;
p=1.000).
5.3: Cardiac Disorders and SVT.
The prevalence of SVT as seen in different Cardiac diagnoses is shown in Table 3.
The frequency distribution of SVT in the different Cardiac cases were as follows:
EMF – 100%, IHD – 100%, RHD and Cor Pulmonale – 50% each and DCM – 40%.
Others were HBP – 6% and CVD – 40%. There were no cases of SVT observed in patients with Pericaditis, VSD abd Pulmonary Thrombo-embolism. The following were found to be statistically significant: IHD, DCM, RHD and EMF (p<0.05).
5.4: ECG Parameters
Results are shown in Table 4a & b.
5.5 Distribution of SVT among Cardiac and Non-cardiac controls.
Table 5 shows that SVT occurred only in Cardiac patients. These results are statistically significant (X2=25.67; p=0.001).
5.6: Frequency of Distribution of SVT in Age groups
The distribution of SVT is shown in Table 6. Results show that SVT was most common in persons older than 60 years of age; these results are statistically significant; (X2=17.63; df=4; p=0.001).
5.7: SVT (Types and Age Distribution)
The frequency distribution of the different types of SVT is shown in Figure 11. The most frequent type of SVT was Atrial fibrillation, which occurred in 3.90% of the population. Atrial flutter, the next most common SVT occurred in 1.95% of the study group. Parocymal atrial tachycardia occurred in 0.48%. These results are however not statistically significant; (X2=4.303; df=4; p=0.05). No cases of multifocal atrial tachycardia of A-V nodal re-entrant tachycardia were seen in the study group.
5.8: SVT and Gender
Distribution of SVT by gender is as shown in Figure 12. There was a higher frequency of SVT in females than in males. However, results are not statistically significant; (X2=1.06; df=2; p=0.588).
5.9: Distribution of SVT Types with Gender
Results show female preponderance with distribution of SVT. These results, shown in Figure 13 are not statistically significant. (X2=0.14; df=2; p=0.933).
5.10: Arrhythmogenic factors in Cardiac subjects.
Factors known to predispose to arrhythmias that were present in these patients are shown in Table 7, and these include Aneurysmal dilatation of t he right atrium (100%), myocardial infarction (100%), Left Atrial enlargement (10.34%), Left Ventricular Hypertrophy (11.37%) and prolonged QT interval. These were confirmed by 2D Echocardiography where applicable. Only aneurismal dilatation of the right atrium was statistically significant (p<0.05).
5.11: BMI Distribution and incidence of SVT
As can be seen in Table 8 the incidence of SVT was greatest at BMI>30 (X2=10.56;
df=3; p=0.01).
5.12: Na+ Level and SVT distribution
Results show that SVT occurred in those with normal serum Sodium level.
5.13: K+ Level and SVT distribution
Results showed that SVY was present in those with normal Potassium level Table 10. (X2=101.51; df=2; p=0.0001).
5.14: Smoking and SVT distribution
Cigarette smoking did not exert any significant influence on the frequency of SVT Table 11. (X2=3.56; df=2; p=>0.05).
5.15: Snuffing and SVT Prevalence
Tobacco snuffing, also did not exert any significant influence on the frequency of SVT (Table 12) (X2=1.46; df=2; p=0.482).
5.16: Alcohol intake and SVT Prevalence.
Non-usage of alcohol did not seem to protect the patients from SVT (Table 13);
(X2=24.48; df=2; p=0.05).
5.17: Cardiac Stimulants and SVT.
Use of tea and kolanut exerted significant influence on incidence of SVT in this study (Figure 14) p<0.05. However, use of coffee did not significantly influence incidence of SVT p>0.05.
5.18: Outcome.
Results show outcome of admission with SVT. Atrial fibrillation had a discharged/responded rate of 50%; the rate of thromboembolic phenomena was 18.75% and he death rate was 25%. Atrial flutter had 62.50%
discharged/responded rate with 12.50% death rate was 25% of those on admission left against medical advice. There was no case of thromboembolism observed in the group with Atril flutter. PAT had 50% death rate while 50% of those on admission left against medical advice and 50% had thromboembolid phenomena. (Table 14). These values are not statistically significant p>0.05.
5.19: Comparison of Outcome.
Results show a comparison of Outcome of Cardiac admission for those with and without SVT. These results show that the subset without SVT had a
considerably better response/discharge rate than the other group (93.33% as
against 20.00%). The death rate of the group without SVT was much lower than that of the second group (3.91% as against 23.08%); the rate of thromboembolic phenomena in the subset without SVT was 1.21% while that of the subset with SVT was 15.38%. 1.21% of Cardiac patients without SVT left against medical advice.
Cardica patients with SVT had a higher rate of ill-timed discharges with a value of 2.42%. (Table 15) A comparison of the results obtained from these two subsets was statistically significant (X2=28.48; df=3; p=0.0001).
5.20: ECG Tracings.
This shows some f the ECG tracings obtained in the course of the study. (Figures 15 A, B and C).
A. Atrial Tachycardia;
B. Atrial Flutter;
C. Atrial Fibrillation.
5.21: Digital Echocardiographic Photograph.
This shows a 2-D echo-photograph of Right aneurismal atrial dilatation seen in one of the patients with a diagnosis of Right-sided EMF in the course of this study. The dilated chamber measured 19064cm with an area of 688.22cm2. The photograph was printed on Inkjet Glossy Photo paper. The page preceding the photograph shows an ECG tracing obtained from the same patient. (Figure 16A and B)
Table 1: Socio-demographic data of Cardiac and Non-cardiac subjects
DATA CARDIAC NON-CARDIAC STATISTICS
Gender X2 = 0.00; p=0.921
Male 106(51.8%) 107(52.4%)
Female 99(48.2%) 98(47.4%)
Total 205(100.0%) 205(100.0%)
Mean age 54.28 48.14 T-test=1.60;
df=408; p=0.10
SD 17.85 14.33
Education X2 = 4.12; df=3;
p=0.25
None 32(16.0%) 27(13.0%)
Primary 60(29.0%) 75(36.6%)
Secondary 41(20.0) 46(22.7%)
Tertiary 72(35.0%) 57(27.2%)
Total 205(100.0%) 205(100.0%)
Occupation X2 = 9.05; df=5;
p=0.11
None 23(11.21%) 23(11.36%)
Semi-skilled 46(22.44%) 56(27.27%)
Skilled 30(14.63%) 43(20.45%)
Professional 41(20.00%) 23(11.36%)
Pensioner 44(21.46%) 37(18.18%)
Student 21(10.24%) 23(11.36%)
Total 205(100.0%) 205(100.0%)
Marital Status X2 = 7.13; df=3;
p=0.001
Single 34(16.59%) 113(34.09%)
Married 146(71.22%) 74(56.82%)
Separated 5(2.44%) 9(56.82%)
Widowed 20(9.76%) 9(4.55%)
Total 205(100.0%) 205(100.0%)
Table 2: Distribution of subjects into age groups
AGE GROUPS CARDIAC NON-CARDIAC
< 30 36(17%) 36(17%)
30-39 32(15%) 32(15%)
40-49 44(21%) 44(21%)
50-59 37(18%) 37(18%)
60 56(27%) 56(27%)
TOTAL 205(100%) 205(100%)
Table 3: Cardiac Disorders and SVT
Cardiac Disorders
SVT Present
(No)
Total No of Subjects
% with SVT
Statistics P value/
Fisher exact
HBP 11 166 6.63 0.802
RHD 5 10 50 0.002*
DCM 4 14 40 0.050*
CVD 2 5 40 0.090
EMF 2 2 100 0.015*
IHD 1 1 100 0.004*
C/Pulmonale 1 2 50 0.210
Pericarditis 0 1 0 0.800
VSD 0 1 0 0.720
PTE 0 1 0 0.880
* - statistically significant.
Table 4a: ECG Parameters
Parameters Cardiac % Non-cardiac % Heart Rate (bpm)
Range 25-200 - 50-150 -
Mean 83.52+10.22 81.64+15.70
Axes QRS
Range -45o - +75o - -5o - +105o -
Mean 29.32+10.22 38.88+11.50
T wave
Range -40o - +70o - -12o - +95o -
Mean 25.40+10.22 35.34+10.46
P wave
Range -42o - +65o - -5o - +90o -
Mean 28.02+13.45 30.82+12.87
QT Interval (seconds)
Range 0.36 - 0.45 - 0.32 - 0.52 -
Mean 0.40+15.99 0.40+15.23
QTC Interval
Range 0.33 - 0.90 - 0.32 - 0.81 -
Mean 0.46+11.55 0.42+12.03
Hypertrophy Pattern LVH:
Araoye’s Criteria 38 18.53 3 1.46
Estes’ Criteria 35 17.07 4 1.95
Echocardiography 44 21.46 2 0.97
RVH 1 0.48 0 0
LAE
Marcuz Index 45 21.95 3 1.46
Morris Index 62 30.24 5 2.43
Echocardiography 58 28.29 2 0.97
RAE 0 0 0 0
Infarction Pattern 1 0.48 0 0
Table 4b: ECG Parameters
CARDIAC RYTHM CARDIAC % NON-CARDIAC %
Sinus Rhythm 133 64.87 193 94.15
Sinus
Tachycardia 17 8.29 9 4.39
Sinus Bradycardia 1 0.48 0 0
Premature Beat
Atrial 1 0.48 0 0
Junctional 1 0.48 0 0
Ventricular 26 12.68 3 1.46
Escape Rythm
Atrial 0 0 0 0
Junctional 0 0 0 0
Ventricular 0 0 0 0
SVT
PAT 2 0.97 0 0
MAT 0 0 0 0
AF 16 7.80 0 0
AFUL 8 3.90 0 0
NR 0 0 0 0
VT
Tachycardia 0 0 0 0
Fibrillation 0 0 0 0
Flutter 0 0 0 0
Total 205 100 205 100
Table 5: Frequency Distribution of SVT
SVT CARDIAC NON-CARDIAC TOTAL
PRESENT 26
(6.34%)
0 (0.00%)
26 (6.34%)
ABSENT 179
(43.66%)
205 (50.00%)
364 (93.66%)
TOTAL 205
(50.00%)
205 (50.00%)
410 (100.00%)
Table 6: Frequency Distribution of SVT in Age groups
Age (Years) SVT Cases No SVT TOTAL
< 30 5(6.94%) 67(93.06%) 72(100.00%) 30-39 0(0.00%) 64(100.00%) 64(100.00%) 40-49 4(4.54%) 84(95.45%) 88(100.00%) 50-59 3(4.05%) 71(95.95%) 74(100.00%)
60 14(12.50%) 98(87.50%) 112(100.00%)
TOTAL 26 384 410
FIGURE 11
0 1 2 3 4 5 6 7 8 9
F R E Q .
< 3 0 3 0 -3 9 4 0 -4 9 5 0 -5 9 > 6 0
A G E G R O U P S F R E Q . O F S V T T Y P E S B Y A G E
P A T M A T A F L U A F N R
FIGURE 12
D I S T R I B U T I O N O F S V T A N D G E N D E R
4 % 3 % 4 4 %
4 9 %
M a l e / a M a l e / p F e m a l e / p F e m a l e / a
FIGURE 13
a = without SVT p = with SVT
0 1 2 3 4 5 6 7 8 9 1 0
P A T M A T A F A F I B N R
S V T T Y P E S
F R E Q U E N C Y O F S V T T Y P E S A N D G E N D E R
M A L E F E M A L E
Table 7: Arrhythmoenic factors in Cardiac subjects: those with/without SVT compared
Risk factors SVT Present SVT Absent Total Aneurysmal Rt.
Atrial 2 0 0
Enlargement (100.00%) (0.00%) (100.00%)
Myocardial 1 0 1
Infarction (100.00%) (0.00%) (100.00%)
LVH 5 39 44
(11.37%) (88.63%) (100.00%)
Lt. Atrial 6 52 58
Enlargement (10.34%) (89.66%) (100.00%)
Prolonged QTC 3 56 59
Interval (>0.44) (5.08%) (94.92%) (100.00%)
Table 8: BMI Distribution and incidence of SVT
BMI SVT
(A)
NO SVT (B)
TOTAL
< 20 4 21 25
(16.00%) (84.00%) (100%)
20 - 25 9 96 105
(8.57%) (91.43%) (100%)
26 - 30 4 41 45
(8.89%) (91.11%) (100%)
> 30 9 21 30
(30.00%) (70.00%) (100%)
A – Cardiac patients with SVT B – Cardiac patients without SVT
Table 9: Na+ Level and SVT Distribution
Normal (135 – 145mmol/l TOTAL
Cardiac + SVT 26 26
(6.34%)
Cardiac - SVT 179 179
(43.65%)
Control 205 205
(50.00%)
TOTAL 410 410
(100.00%)
(There were no group s of patients with either hyponatraemia or hypernatraemia.) Cardiac + SVT – Cardiac patients with SVT
Cardiac - SVT – Cardiac patients without SVT
Table 10: K+ Level and SVT Distribution
K+ Level Low (<3.5mmol/l)
Normal (3.5-5.5mmol/l)
TOTAL
Cardiac + SVT 0 26 26
(0.00%) (7.5%)
Cardiac - SVT 66 113 179
(100.00%) (32.84%)
Control 0 205 205
(0.00%) (59.59%)
TOTAL 66 344 410
(100.00%) (100.00%)
(There were no group of patients with hyperkalaemia.) Cardiac + SVT – Cardiac patients with SVT
Cardiac - SVT – Cardiac patients without SVT
Table 11: Smoking and Prevalence of SVT
Qty per Week SVT (+) Cardiac SVT (-) Cardiac Non-Cardiac TOTAL Non-smokers 26(100.00%) 179 (90.98%) 169 (90.37%) 374
< 10 Sticks 0 (0.00%) 16 (8.13%) 14 (7.49%) 30
> 10 Sticks 0 (0.00%) 2 (1.02%) 4 (2.14%) 6
TOTAL 26 (100.00%) 97 (100.00%) 187(100.00%) 410
Cardiac + SVT – Cardiac patients with SVT Cardiac - SVT – Cardiac patients without SVT
Table 12: Snuffing and SVT Prevalence
Snuffing Yes No TOTAL
Cardiac + SVT 3(9.38%) 23 (6.08%) 26
Cardiac - SVT 11 (34.38%) 168 (44.44%) 179
Control 18 (56.25%) 187 (49.47%) 205
TOTAL 32 (100.00%) 378 (100.00%) 410
Cardiac + SVT – Cardiac patients with SVT Cardiac - SVT – Cardiac patients without SVT
Table 13: Alcohol intake and SVT Prevalence
Alcohol intake week
SVT+Cardiac SVT-Cardiac Control TOTAL
Non-drinkers 23
(88.46%)
142 (79.33%)
151 (73.65%)
316
< 14 units (Female) 3 (11.54%)
37 (20.67%)
41 (20.00%)
81
< 21 units (Male)
> 14 units (Female) 0 (0.00%)
0 (0.00%)
13 (6.34%)
13
> 21 units (Male)
TOTAL 26 179 205 410
Cardiac + SVT – Cardiac patients with SVT Cardiac - SVT – Cardiac patients without SVT
Figure 14
Card + SVT = SVT Cases;
Card – SVT = No SVT.
P R E V A L E N C E O F S V T A N D U S E O F C A R D I A C S T I M U L A N T S
0 2 0 4 0 6 0 8 0 1 0 0 1 2 0 1 4 0 1 6 0 1 8 0 2 0 0
C o f f e e K / n u t T e a
%
C o n t r o l C a r d - S V T C a r d + S V T
Table 14: Types of SVT and Outcome
OUTCOME PAT No (%) AFLU No
(%)
AF No (%) TOTAL
Responded/Discharged 0(0.00) 5(62.50) 8(50.00) 13
Thromno-embolism 1(50.00)¶ 0(0.00) 3(18.75) 4
LAMA 1(50.00) ¶ 2(25.00) 1(6.25) 4
Death 1(50.00) 1(12.50) 4(25.00) 6
TOTAL 3*(100.00) 8(100.00) 16(100.00) 27*
* - number of events (27 in all)
¶ - these two events occurred in one patient
Table 15: Comparison of outcome
Thrombo-embolism
Death LAMA Responded/
Discharged
Total
SVT (+) 4*(15.38%) 6(23.08%) 4*(15038%) 13(50.00%) 26(100.00%)
SVT (-) 2(1.12%) 7(3.91%) 2(1.12%) 154(93.33%) 165(100.00%)
SVT (+) = SVT cases;
SVT (-) = No SVT;
* - These two events occurred in one patient. However 26 is used as denominator as this was the total number of Cardiac patients.
FIGURE 15A: ATRIAL TACHYCARDIA
FIGURE 15B: ATRIAL FLUTTER
FIGURE 15C: ATRIAL FIBRILLATION
FIGURE 16A: AN ECG TRACING SHOWING ATRIAL FIBRILLATION FROM THE PATIENT WHOSE ECHOCARDIOGRAPHIC PICTURE APPEARS OVERLEAF.
FIGURE 16B: AN ECHOCARDIOGRAPHIC PHOTOGRAPH SHOWING ANEURYSMAL RIGHT ATRIAL DILATATION MEASURING 19.64CM
LV – LEFT VENTRICLE RV – RIGHT VENTRICLE LA – LEFT ATRIUM RA - RIGHT ATRIUM