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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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J Wave Syndrome: Clinical Diagnosis, Risk Stratification and Treatment.

Kamal K Sethi1, Kabir Sethi1, Surendra K Chutani1

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Journal of Atrial Fibrillation
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J wave syndrome, including Early Repolarization Syndrome, is a significant cause of sudden cardiac death. Research focuses on its electrical, genetic, and ionic mechanisms for better risk stratification and treatment.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Genetics

Background:

  • J wave syndrome has evolved from a benign ECG finding to a proarrhythmic condition linked to idiopathic ventricular fibrillation and sudden cardiac death.
  • Early Repolarization Syndrome (ER) and Brugada Syndrome (BrS) are key J wave syndromes, distinguished by J wave localization on ECG (inferior/lateral vs. right precordial leads).
  • The Ito current, a rapid outward potassium current, governs early ventricular repolarization, with transmural gradients implicated in arrhythmogenesis.

Approach:

  • This review synthesitsizes current research on the electrical genesis, genetics, and ionic mechanisms underlying J wave syndromes.
  • It examines the morphological characteristics differentiating benign and malignant J wave patterns.
  • The review discusses epidemiological data, clinical presentations, and challenges in risk stratification and management.

Key Points:

  • Faster Ito current in ventricular epicardium versus endocardium creates an electrical gradient, potentially driving phase 2 re-entry and ventricular arrhythmias.
  • Quinidine's efficacy in preventing Ito current supports the proposed arrhythmogenic mechanism.
  • J waves are prevalent in young individuals, athletes, and Black populations, complicating risk assessment for sudden cardiac death.

Conclusions:

  • Accurate diagnosis and risk stratification for J wave syndromes remain challenging, particularly in cases with isolated ECG abnormalities.
  • While implantable cardioverter-defibrillators are indicated for survivors of ventricular fibrillation, therapeutic consensus is lacking for other patients.
  • Emerging strategies like radiofrequency ablation for epicardial substrate in Brugada Syndrome warrant further critical evaluation.