exudates and Arrhythmias--Cardiac

Thrombolytic therapy is a well-established therapy in acute myocardial infarction (AMI), reducing mortality and infarct size. This study is a retrospective analysis of survival and complications after the use of streptokinase at Hospital Universiti Sains Malaysia. Streptokinase was first used here in March 1990. Between then and February 1992, 126 patients were admitted to the Coronary Care Unit. Thirty-two patients who fulfilled our criteria for thrombolytic treatment were given an hour intravenous infusion of 1.5 MU streptokinase, and started on aspirin. A control group of 64 patients selected from before March 1990, and matched for age, sex and site of infarct, was given standard therapy. The survival at 4 weeks post-AMI was 91% in the streptokinase therapy group and 91% in both groups (p > 0.05). The complications encountered were reperfusion arrhythmias (2 patients), hypotension(1), maculopapular rash(1) and gum bleeding(1). None of these complications were statistically increased when compared to the control group and none resulted in the death of a patient. We conclude that streptokinase therapy can be given safely in a rural Malaysian setting. Our survival and complication rates are comparable with other published series.

Topics: Adult; Aged; Arrhythmias, Cardiac; Female; Humans; Hypotension; Infusions, Intravenous; Malaysia; Male; Middle Aged; Myocardial Infarction; Retrospective Studies; Streptokinase; Survival Rate; Thrombolytic Therapy

Cardiovascular disease continues to be one of the most prevalent medical conditions in modern society, especially among elderly citizens. As the leading cause of deaths worldwide, further improvements to the early detection and prevention of these cardiovascular diseases is of the utmost importance for reducing the death toll. In particular, the remote and continuous monitoring of vital signs such as electrocardiograms are critical for improving the detection rates and speed of abnormalities while improving accessibility for elderly individuals. In this paper, we consider the design and deployment characteristics of a remote patient monitoring system for arrhythmia detection in elderly individuals. Thus, we developed a scalable system architecture to support remote streaming of ECG signals at near real-time. Additionally, a two-phase classification scheme is proposed to improve the performance of existing ECG classification algorithms. A prototype of the system was deployed at the Sarawak General Hospital, remotely collecting data from 27 unique patients. Evaluations indicate that the two-phase classification scheme improves algorithm performance when applied to the MIT-BIH Arrhythmia Database and the remotely collected single-lead ECG recordings.

Topics: Aged; Algorithms; Arrhythmias, Cardiac; Databases, Factual; Electrocardiography; Humans; Malaysia; Signal Processing, Computer-Assisted

Topics: Adult; Anti-Arrhythmia Agents; Antithyroid Agents; Anxiety; Arrhythmias, Cardiac; Dyspnea; Graves Disease; Humans; Hypokalemic Periodic Paralysis; Malaysia; Male; Methimazole; Muscle Weakness; Neurologic Examination; Potassium; Propranolol; Propylthiouracil; Sleep Initiation and Maintenance Disorders; Tremor; Weight Loss

Many of the costs associated with prehospital care in developed countries are covered in budgets for fire suppression, police services, and the like. Determining these costs is therefore difficult. The costs and benefits of developing a prehospital care system for Kuala Lumpur, Malaysia, which now has essentially no emergency medical services (EMS) system, were estimated. Prehospital therapies that have been suggested to decrease mortality were identified. A minimal prehospital system was designed to deliver these treatments in Kuala Lumpur. The potential benefit of these therapies was calculated by using statistics from the United States corrected for demographic differences between the United States and Malaysia. Costs were extrapolated from the current operating budget of the Malaysian Red Crescent Society. Primary dysrhythmias are responsible for almost all potentially survivable cardiac arrests. A system designed to deliver a defibrillator to 85% of arrests within 6 minutes would require an estimated 48 ambulances. Kuala Lumpur has approximately 120 prehospital arrhythmic deaths per year. A 6% resuscitation rate was chosen for the denominator, resulting in seven survivors. Half of these would be expected to have significant neurological damage. Ambulances cost $53,000 (US dollars) to operate per year in Kuala Lumpur; 48 ambulances would cost a total of $2.5 million. Demographic factors and traffic problems would significantly increase the cost per patient. Other therapies, including medications, airway management, and trauma care, were discounted because both their additional cost and their benefit are small. Transport of patients (including trauma) is now performed by police or private vehicle and would probably take longer by ambulance. A prehospital system for Kuala Lumpur would cost approximately $2.5 million per year. It might save seven lives, three of which would be marred by significant neurological injury. Developing countries would do well to consider alternatives to a North American EMS model.

Topics: Arrhythmias, Cardiac; Cost Savings; Cost-Benefit Analysis; Developing Countries; Emergency Medical Services; Health Care Costs; Health Planning; Heart Arrest; Humans; Malaysia; Models, Organizational; North America; Program Development; Survival Analysis; Urban Health

Topics: Adult; Aged; Arrhythmias, Cardiac; Coronary Care Units; Female; Heart Failure; Humans; Malaysia; Male; Middle Aged; Myocardial Infarction