Cardiovascular disease is common in chronic obstructive pulmonary disease (COPD) and raised troponin is common in exacerbations. However, the prevalence of myocardial infarction following hospitalisation for exacerbation of COPD is unknown.Patients aged o40 yrs hospitalised with acute exacerbation of COPD (n5242) with o10 packyrs of cigarette smoking were included in a prospective case series conducted in four hospitals. Patients whose primary presenting complaint was chest pain or who had an alternative diagnosis were excluded. Chest pain histories, serial ECGs and troponin levels were obtained.The mean¡SD age was 69¡9 yrs; 108 (45%) patients were male and almost half were current smokers. 124 (51%; 95% CI 48-58%) patients had chest pain, which was exertional in 62 (26%). 24 (10%) had raised troponin, among whom, 20 (8.3%; 95% CI 5.1-12.5%) had chest pain and/or serial ECG changes, fulfilling the 2007 Universal Definition of Myocardial Infarction. Neither chest pain (p50.77) nor serial ECG changes (p50.39) were associated with raised troponin.Raised troponin, chest pain and serial ECG changes are common in patients admitted to hospital with exacerbation of COPD. Overall, one in 12 patients met the criteria for myocardial infarction. Whether these patients would benefit from further cardiac investigation is unknown.KEYWORDS: Chest pain, chronic obstructive pulmonary disease, ECG, myocardial infarction, troponin C oronary heart disease is a major cause of mortality in chronic obstructive pulmonary disease (COPD) [1,2]. Both conditions share common risk factors, such as smoking and socioeconomic status, and reduced forced expiratory volume in 1 s (FEV1), a characteristic feature of COPD, is an independent risk factor for cardiovascular mortality [3].In studies using routine clinical data, diagnosis with myocardial infarction (MI) appears to be more common following exacerbations in patients with COPD [4,5], while raised troponin has been found to be associated with increased mortality in exacerbation of COPD [6][7][8],Coronary events may present without chest pain [9], can be missed even in simple chest pain presentations [10] and may be more likely to be missed in patients presenting with acute exacerbation of COPD who also report acute breathlessness and chest tightness.Raised troponin is common in patients admitted to hospital with exacerbation of COPD [6][7][8]; however, we are unaware of any prospective study that has investigated this group for clinical or electrocardiography features of MI.Therefore, we undertook a prospective case series to identify the prevalence of MI in patients admitted to hospital with acute exacerbation of COPD. The prevalence of MI was calculated along with 95% confidence intervals using the exact binomial test. In exploratory analyses, associations between patient characteristics and raised troponin concentrations were examined using Fisher's exact test, for which we report all associations where the p-value was ,0.10. Analyses were performed using SAS version 9.2 (SAS In...

The University of Glasgow 12/15 lead ECG analysis program has been in continuous development for over 20 years. It has been adapted to meet the needs of different users and keep abreast of changes in terminology as well as new morphological features described in the literature. It is applicable to neonates as well as adults and takes account of racial variation in wave amplitudes. It has a capability for comparing serially recorded ECGs using one of two different approaches.The many varying features of the software have led to the introduction of the descriptor Uni-G (unique) ECG analysis program.

Participants with lower 10-second HRV have worse performance in reaction time and processing speed and experience steeper decline in their processing speed, independent of medications, cardiovascular risk factors, and comorbidities.

E levated heart rate and reduced heart rate variability -the beat-to-beat variation in heart rate intervals -both reflect an altered balance of the autonomic nervous system tone characterized by increased sympathetic and/ or decreased parasympathetic activity.1-3 Sympathetic overactivity has been linked to a procoagulant state and also to risk factors for atherosclerosis, including metabolic syndrome, obesity and subclinical inflammation.2-4 Moreover, increased heart rate is related to atherosclerosis, not only as an epiphenomenon of sympathetic overactivity, but also through hemodynamic mechanisms, such as high pulsatile shear stress, which leads to endothelial dysfunction. 5Atherosclerosis has been linked to increased risk of functional decline in older people via cardiovascular events. 6 As the world population is aging, the burden of functional disability is expected to increase.6 It has been hypothesized that heart rate and heart rate variability are markers of frailty, an increased vulnerability to stressors and functional decline. 7 However, the direct link between these 2 parameters and risk of functional decline has not been fully established, and it is uncertain whether this association is independent of cardiovascular comorbidities.In this study, we examined whether heart rate and heart rate variability were cross-sectionally and longitudinally associated with functional status in older adults at high risk of cardiovascular disease, independent of cardiovascular risk factors and comorbidities. Methods Study design and participants

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Among current-generation computer-based electrocardiographs, clinically small but statistically significant differences exist between ECG interval measurements by individual algorithms. Measurement differences between algorithms for QRS duration and for QT interval are larger in long QT interval subjects than in normal subjects. Comparisons of population study norms should be aware of small systematic differences in interval measurements due to different algorithm methodologies, within-individual interval measurement comparisons should use comparable methods, and further attempts to harmonize interval measurement methodologies are warranted.

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