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Cardiac arrhythmias in adults with hypertension in a resource-constraint setting

Year 2013, Volume: 3 Issue: 3, 155 - 160, 01.09.2013

Abstract

Introduction: Hypertension is a common disease globally and it is of public health significance. The objective was to determine the prevalence and pattern of arrhythmias and the associated factors in adults with systemic hypertension in a tertiary hospital in a resource-constraint setting. Materials and Methods: It was a cross-sectional study which included the resting 12-lead electrocardiograms of adult patients aged 18 years and above with hypertension attending the Cardiology Unit of the Federal Medical Centre, Ido-Ekiti, Nigeria. Results: Resting electrocardiogram of 602 adult Nigerians with hypertension were studied. 340 (56.5%) were males and 262 (43.5%) females. The mean age of the patients was 58.3±10.7 years. Ninety eight (16.3%) patients had arrhythmia. Compared with those without arrhythmia, patients with arrhythmia were older (62.3±12.8 vs. 56.1±13.2, p =0.03 ), had a higher prevalence of QTc prolongation (14.3% vs. 6.0%, p = 0.041) and left ventricular hypertrophy (24.5% vs 12.7%, p = 0.026), and more likely to be in heart failure (32.7% vs. 8.5%, p < 0.001). Conclusion: The study shows a prevalence of 16.3% of arrhythmia among adult Nigerians with hypertension. Premature ventricular complex and atrial fibrillation are the most frequent arrhythmias. Older age, higher systolic and diastolic blood pressure and left ventricular hypertrophy and QTc prolongation are associated with arrhythmia.

References

  • 1. Kearney PM, Whelton M, Reynolds K, et al. Worldwide prevalence of hypertension: a systematic review. J Hypertens 2004; 22(1):11–9.
  • 2. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365(9455):217–23.
  • 3. Le Heuzey JY, Guize L. Cardiac prognosis in hypertensive patients. Am J Med 1988; 84: 65–8.
  • 4. Akinkugbe OO. The epidemiology of hypertension in Africa. In: Akinkugbe, ed.Cardiovascular diseases in Africa. CibaGeigy, 1976: 91-100.
  • 5. Adedoyin RA, Mbada CE, Balogun MO, et al. Prevalence and pattern of hypertension in a semiurban community in Nigeria.Eur J Cardiovasc PrevRehabil 2008, 15(6):683-7.
  • 6. Ofuya Z: The incidence of hypertension among a select population of adults in the Niger Delta region of Nigeria. Southeast Asian J Trop Med Public Health2007; 38(5): 947-9.
  • 7. Oladipo B, Akinkungbe. Current epidemiology of hypertension in Nigeria. Archives of Ibadan Medicine 2001; 1(1): 4- 8.
  • 8. Oladapo OO, Salako L, Sodiq O, et al. A prevalence of cardiometabolic risk factors among a rural Yoruba south-we Nigerian population: a population-based survey. Cardiovasc J Afr. 2010 Jan-Feb; 21(1):26-31.
  • 9. Yildirir A, Batur MK, Oto A. Hypertension and arrhythmia: blood pressure control and beyond. Europace2002; 4:175– 82. 10. The AFFIRM Investigators. Baseline characteristics of patients with atrial fibrillation: the AFFIRM study. Am Heart J 2002; 143: 991-1001.
  • 11. Madu EC, Baugh DS, Gbadebo TD, et al. Effect of ethnicity and hypertension on atrial conduction: evaluation with highresolution P wave signal averaging. ClinCardiol 2001; 24: 597-602.
  • 12. Levy D, Anderson KM, Savage DD, et al.Risk of ventricular arrhythmias in left ventricular hypertrophy: theFramingham heart study. Am J Cardiol 1987; 60: 560-5.
  • 13. Siegel D, Hulley S, Black D, et al. Diuretics, serum and intracellular electrolyte levels and ventricular arrhythmias in hypertensive men. JAMA 1992; 267: 1083–9.
  • 14. James MA, Jones JV. Systolic wall stress and ventricular arrhythmias: the role of acute changes in blood pressure in the isolated working rat heart. ClinSci 1990; 79: 499-504.
  • 15. Zehender M, Meinertz T, Hohnloser S, et al. Prevalence of circadian variations and spontaneous variability of cardiac disorders and ECG changes suggestive of myocardial ischemia in systemic arterial hypertension. Circulation 1992; 85: 1808–15.
  • 16. Schwartz P, Larovere MT, Vanoli E. Autonomic nervous system and sudden death. Experimental basis and clinical observations for post-myocardial risk stratification. Circulation 1992; 85: 177-191.
  • 17. Aidietis A, Laucevicius A, Marinskis G. Hypertension and cardiac arrhythmias. Curr Pharm Des 2007; 13:2545–55.
  • 18. Wolk R. Arrhythmogenic mechanisms in left ventricular hypertrophy. Europace 2000; 2(3):216–23.
  • 19. Chobaman AU, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure: JNC 7 report. JAMA 2003; 289: 2560-2572
  • 20. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003; 1983-1992
  • 21. Kligfield P, Gettes LS, Bailey JJ, et al.Recommendations for the standardization and interpretations of electrocardiogram. Part I: The Electrocardiogram and Its Technology: A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology. Circulation 2007; 115:1306-24.
  • 22. Bazett HC. An analysis of the time-relations of electrocardiograms. Heart 1920; (7): 353–70.
  • 23. Busari O, Opadijo G, Olarewaju T,et al. Electrocardiographic correlates of microalbuminuria in adult Nigerians with essential hypertension. Cardiol J. 2010; 17(3):281-7.
  • 24. Kiatchoosakun S, Pachirat O, Chirawatkul A,et al. Prevalence of cardiac arrhythmias in Thai community. J Med Assoc Thai. 1999; 82(7):727-33.
  • 25. Krittayaphong R, Bhuripanyo K,Punlee K,et al.Effect of Atenolol on Symptomatic Ventricular Arrhythmia without Structural Heart Disease: A Randomized Placebo-Controlled Study. Am Heart J. 2002;144(6)
  • 26. Lok NS, Lau CP. Prevalence of palpitations, cardiac arrhythmias and their associated risk factors in ambulant elderly.Int JCardiol. 1996;54:3231-6.
  • 27. Mbewu A, Mbanya JC, Cardiovascular disease. In: Jamison DT, Feachem RG, Makgoba MW, et al., editors. Disease and mortality in Sub-Sahara Africa. Washington (DC): World Bank; 2006. Chapter 21. Available from: http://www.ncbi.nlm.nih.gov/books/NBK2294. Accessed January 21, 2013.
  • 28. Barrett PA, Peter CT, Swan HJC, et al. The frequency and prognostic significance of electrocardiographic abnormalities in clinically normal individuals. Prog Cardiovasc Dis 1981;23:299-319.
  • 29. Buxton AE, Waxman HL, Marchlinski FE, et al. Right ventricular tachycardia: clinical and electrophysiologic characteristics. Circulation 1983;68:917-27.
  • 30. Sung RJ, Shen EN, Morady F, et al. Electrophysiologic mechanism of exercise induced sustained ventricular tachycardia. Am J Cardiol 1983;51:525-30.
  • 31. Lerman BB, Stein KM, Markowitz SM. Idiopathic right ventricular outflow tract tachycardia: a clinical approach. Pacing Clin Electrophysiol 1996;19:2120-37.
  • 32. Hayashi H, Fujiki A, Tani M, et al. Role of sympathovagal balance in the initiation of idiopathic ventricular tachycardia originating from right ventricular outflow tract. Pacing Clin Electrophysiol 1997;20:2371-7.
  • 33. Assantachai P, Panchavinnin P, Pisalsarakij D.An electrocardiographic survey of elderly Thai people in the rural community.J Med Assoc Thai. 2002;85(12):1273-9.
  • 34. Niwa K, Warita N, Sunami Y,et al. Prevalence of arrhythmias and conduction disturbances in large population-based samples of children. Cardiol Young. 2004; 14(1): 68-74.
  • 35. Wakida Y, Okamoto Y, Iwa T, et al. Arrhythmias in centenarians. Pacing Clin Electrophysiol. 1994; 17: 2217-21.
  • 36. Basile G, Cucinotta MD, Figliomeni P, et al. Electrocardiographic changes in centenarians: a study on 42 subjects and comparison with the literature.Gerontology2012;58(3):216-20..
  • 37. Yamaguchi I, Ito I. Electrocardiographic changes and arrhythmias in the elderly. J Cardiol Suppl. 1988; 19: 49-57.
  • 38. Alan S. G, Elaine M H, Kathleen A P et al.Prevalence of Diagnosed Atrial Fibrillation in Adults: National Implications for Rhythm Management and Stroke Prevention: the AnTicoagulation and Risk Factors In Atrial Fibrillation (ATRIA) StudyFREE. JAMA 2001; 285 (18):2370-5.
  • 39. Lip GY, Tean KN, Dunn FG. Treatment of atrial fibrillation in a district general hospital. Br Heart J.1994; 71:92-95.
  • 40. Benjamin EJ, Wolf PA, D'Agostino RB, et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation.1998; 98:946-52.
  • 41. Braunwald E. The pathogenesis of heart failure: Then and now. Medicine. 1991;70:68-9.
  • 42. Onwuanyi A, Taylor M. Acute decompensated heart failure: pathophysiology and treatment. Am J Cardiol. 2007;99(6B):25D-30D.
  • 43. Kajstura J, Leri A, Finato N, et al.Myocyte proliferation in end-stage cardiac failure in humans. ProcNatlAcad Sci. 1998; 95(15):8801-5.
  • 44. Cohn JN. Structural basis for heart failure. Ventricular remodeling and its pharmacological inhibition. Circulation. 1995;91 (10):2504-7.
  • 45. Marriot HJ, Conover MB. Advanced Concepts in Arrhythmias. 3rd ed. Philadelphia, Pa: Mosby Inc; 1998.
  • 46. Noda T, Shimizu W, Satomi K, et al. Classification and mechanism of Torsade de Pointes initiation in patients with congenital long QT syndrome. Eur Heart J.2004;25 (23):2149-54.
  • 47. Antzelevitch C, Sicouri S. Clinical relevance of cardiac arrhythmias generated by afterdepolarizations. Role of M cells in the generation of U waves, triggered activity and torsade de pointes. J Am CollCardiol. 1994; 23(1):259-77.
  • 48. Nguyen PT, Scheinman MM, Seger J. Polymorphous ventricular tachycardia: clinical characterization, therapy, and the QT interval. Circulation. 1986;74(2):340-9.
  • 49. Lankipalli RS, Zhu T, Guo D, et al. Mechanisms underlying arrhythmogenesis in long QT syndrome. J Electrocardiol. 2005;38:69-73.
  • 50. Roden DM. Long QT Syndrome. N Engl J Med.2008;358(2):169-76.
  • 51. Goldenberg I, Moss AJ. Long QT syndrome. J Am CollCardiol. Jun 17 2008;51(24):2291-300.

Hipertansiyonu Olan Erişkinlerde Kaynak Kısıtlı Ortamda Kardiyak Aritmiler

Year 2013, Volume: 3 Issue: 3, 155 - 160, 01.09.2013

Abstract

Amaç: Hipertansiyon, tüm dünyada toplum sağlığı önemi olan yaygın bir hastalıktır. Amaç kaynak kısıtlı ortamda, üçüncü basamak hastanede sistemik hipertansiyonu olan erişkinlerde aritmi prevelansı, paternleri ve ilişkili faktörleri belirlemektir. Materyal ve metod: Nijerya, Ido-Ekiti'de Federal Tıp Merkezinin Kardiyloji ünitesine hipertansiyon ile başvuran 18 yaş ve üzeri erişkin hastalarda 12 derivasyonlu istirahat elektrokrdiyogramını kapsayan kesitsel bir araştıradır. Sonuçlar: Altıyüziki (602) erişkin Nijeryalının istirahat elektrokardiyogramı çalışıldı. 340'ı erkek (%56.5) ve 262'i (%43.5) kadındı. Hastalaron ortalama yaşları 58.3±10.7 yıldı. Doksansekiz hastada (%16.3) aritmi mevcuttu. Aritmisi olmayanlar ile karşılaştırıldığında, aritmisi olan hastalar daha yaşlıydı (62.3±12.8 vs. 56.1±13.2, p =0.03), QTc uzaması (14.3% vs. 6.0%, p = 0.041), sol ventriküler hipertrofisi (24.5% vs 12.7%, p = 0.026) prevelansı daha yüksekti ve kalp yetmezliğinde olmaya yatkındı (32.7% vs. 8.5%, p < 0.001). Tartışma: Bu araştırma hipertansiyonu olan erişkin Nijeryalılardaaritmi prevelansının %16.3 olduğunu göstermiştir. Erken ventriküler kompleks ve atrial fibrilasyon en sık aritmilerdir. Daha yaşlı olma, yüksek sistolik ve diastolik kan basıncı ve sol ventriküler hipertrofi ve QTc uzaması aritmi ile ilişkilidir.

References

  • 1. Kearney PM, Whelton M, Reynolds K, et al. Worldwide prevalence of hypertension: a systematic review. J Hypertens 2004; 22(1):11–9.
  • 2. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365(9455):217–23.
  • 3. Le Heuzey JY, Guize L. Cardiac prognosis in hypertensive patients. Am J Med 1988; 84: 65–8.
  • 4. Akinkugbe OO. The epidemiology of hypertension in Africa. In: Akinkugbe, ed.Cardiovascular diseases in Africa. CibaGeigy, 1976: 91-100.
  • 5. Adedoyin RA, Mbada CE, Balogun MO, et al. Prevalence and pattern of hypertension in a semiurban community in Nigeria.Eur J Cardiovasc PrevRehabil 2008, 15(6):683-7.
  • 6. Ofuya Z: The incidence of hypertension among a select population of adults in the Niger Delta region of Nigeria. Southeast Asian J Trop Med Public Health2007; 38(5): 947-9.
  • 7. Oladipo B, Akinkungbe. Current epidemiology of hypertension in Nigeria. Archives of Ibadan Medicine 2001; 1(1): 4- 8.
  • 8. Oladapo OO, Salako L, Sodiq O, et al. A prevalence of cardiometabolic risk factors among a rural Yoruba south-we Nigerian population: a population-based survey. Cardiovasc J Afr. 2010 Jan-Feb; 21(1):26-31.
  • 9. Yildirir A, Batur MK, Oto A. Hypertension and arrhythmia: blood pressure control and beyond. Europace2002; 4:175– 82. 10. The AFFIRM Investigators. Baseline characteristics of patients with atrial fibrillation: the AFFIRM study. Am Heart J 2002; 143: 991-1001.
  • 11. Madu EC, Baugh DS, Gbadebo TD, et al. Effect of ethnicity and hypertension on atrial conduction: evaluation with highresolution P wave signal averaging. ClinCardiol 2001; 24: 597-602.
  • 12. Levy D, Anderson KM, Savage DD, et al.Risk of ventricular arrhythmias in left ventricular hypertrophy: theFramingham heart study. Am J Cardiol 1987; 60: 560-5.
  • 13. Siegel D, Hulley S, Black D, et al. Diuretics, serum and intracellular electrolyte levels and ventricular arrhythmias in hypertensive men. JAMA 1992; 267: 1083–9.
  • 14. James MA, Jones JV. Systolic wall stress and ventricular arrhythmias: the role of acute changes in blood pressure in the isolated working rat heart. ClinSci 1990; 79: 499-504.
  • 15. Zehender M, Meinertz T, Hohnloser S, et al. Prevalence of circadian variations and spontaneous variability of cardiac disorders and ECG changes suggestive of myocardial ischemia in systemic arterial hypertension. Circulation 1992; 85: 1808–15.
  • 16. Schwartz P, Larovere MT, Vanoli E. Autonomic nervous system and sudden death. Experimental basis and clinical observations for post-myocardial risk stratification. Circulation 1992; 85: 177-191.
  • 17. Aidietis A, Laucevicius A, Marinskis G. Hypertension and cardiac arrhythmias. Curr Pharm Des 2007; 13:2545–55.
  • 18. Wolk R. Arrhythmogenic mechanisms in left ventricular hypertrophy. Europace 2000; 2(3):216–23.
  • 19. Chobaman AU, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure: JNC 7 report. JAMA 2003; 289: 2560-2572
  • 20. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003; 1983-1992
  • 21. Kligfield P, Gettes LS, Bailey JJ, et al.Recommendations for the standardization and interpretations of electrocardiogram. Part I: The Electrocardiogram and Its Technology: A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology. Circulation 2007; 115:1306-24.
  • 22. Bazett HC. An analysis of the time-relations of electrocardiograms. Heart 1920; (7): 353–70.
  • 23. Busari O, Opadijo G, Olarewaju T,et al. Electrocardiographic correlates of microalbuminuria in adult Nigerians with essential hypertension. Cardiol J. 2010; 17(3):281-7.
  • 24. Kiatchoosakun S, Pachirat O, Chirawatkul A,et al. Prevalence of cardiac arrhythmias in Thai community. J Med Assoc Thai. 1999; 82(7):727-33.
  • 25. Krittayaphong R, Bhuripanyo K,Punlee K,et al.Effect of Atenolol on Symptomatic Ventricular Arrhythmia without Structural Heart Disease: A Randomized Placebo-Controlled Study. Am Heart J. 2002;144(6)
  • 26. Lok NS, Lau CP. Prevalence of palpitations, cardiac arrhythmias and their associated risk factors in ambulant elderly.Int JCardiol. 1996;54:3231-6.
  • 27. Mbewu A, Mbanya JC, Cardiovascular disease. In: Jamison DT, Feachem RG, Makgoba MW, et al., editors. Disease and mortality in Sub-Sahara Africa. Washington (DC): World Bank; 2006. Chapter 21. Available from: http://www.ncbi.nlm.nih.gov/books/NBK2294. Accessed January 21, 2013.
  • 28. Barrett PA, Peter CT, Swan HJC, et al. The frequency and prognostic significance of electrocardiographic abnormalities in clinically normal individuals. Prog Cardiovasc Dis 1981;23:299-319.
  • 29. Buxton AE, Waxman HL, Marchlinski FE, et al. Right ventricular tachycardia: clinical and electrophysiologic characteristics. Circulation 1983;68:917-27.
  • 30. Sung RJ, Shen EN, Morady F, et al. Electrophysiologic mechanism of exercise induced sustained ventricular tachycardia. Am J Cardiol 1983;51:525-30.
  • 31. Lerman BB, Stein KM, Markowitz SM. Idiopathic right ventricular outflow tract tachycardia: a clinical approach. Pacing Clin Electrophysiol 1996;19:2120-37.
  • 32. Hayashi H, Fujiki A, Tani M, et al. Role of sympathovagal balance in the initiation of idiopathic ventricular tachycardia originating from right ventricular outflow tract. Pacing Clin Electrophysiol 1997;20:2371-7.
  • 33. Assantachai P, Panchavinnin P, Pisalsarakij D.An electrocardiographic survey of elderly Thai people in the rural community.J Med Assoc Thai. 2002;85(12):1273-9.
  • 34. Niwa K, Warita N, Sunami Y,et al. Prevalence of arrhythmias and conduction disturbances in large population-based samples of children. Cardiol Young. 2004; 14(1): 68-74.
  • 35. Wakida Y, Okamoto Y, Iwa T, et al. Arrhythmias in centenarians. Pacing Clin Electrophysiol. 1994; 17: 2217-21.
  • 36. Basile G, Cucinotta MD, Figliomeni P, et al. Electrocardiographic changes in centenarians: a study on 42 subjects and comparison with the literature.Gerontology2012;58(3):216-20..
  • 37. Yamaguchi I, Ito I. Electrocardiographic changes and arrhythmias in the elderly. J Cardiol Suppl. 1988; 19: 49-57.
  • 38. Alan S. G, Elaine M H, Kathleen A P et al.Prevalence of Diagnosed Atrial Fibrillation in Adults: National Implications for Rhythm Management and Stroke Prevention: the AnTicoagulation and Risk Factors In Atrial Fibrillation (ATRIA) StudyFREE. JAMA 2001; 285 (18):2370-5.
  • 39. Lip GY, Tean KN, Dunn FG. Treatment of atrial fibrillation in a district general hospital. Br Heart J.1994; 71:92-95.
  • 40. Benjamin EJ, Wolf PA, D'Agostino RB, et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation.1998; 98:946-52.
  • 41. Braunwald E. The pathogenesis of heart failure: Then and now. Medicine. 1991;70:68-9.
  • 42. Onwuanyi A, Taylor M. Acute decompensated heart failure: pathophysiology and treatment. Am J Cardiol. 2007;99(6B):25D-30D.
  • 43. Kajstura J, Leri A, Finato N, et al.Myocyte proliferation in end-stage cardiac failure in humans. ProcNatlAcad Sci. 1998; 95(15):8801-5.
  • 44. Cohn JN. Structural basis for heart failure. Ventricular remodeling and its pharmacological inhibition. Circulation. 1995;91 (10):2504-7.
  • 45. Marriot HJ, Conover MB. Advanced Concepts in Arrhythmias. 3rd ed. Philadelphia, Pa: Mosby Inc; 1998.
  • 46. Noda T, Shimizu W, Satomi K, et al. Classification and mechanism of Torsade de Pointes initiation in patients with congenital long QT syndrome. Eur Heart J.2004;25 (23):2149-54.
  • 47. Antzelevitch C, Sicouri S. Clinical relevance of cardiac arrhythmias generated by afterdepolarizations. Role of M cells in the generation of U waves, triggered activity and torsade de pointes. J Am CollCardiol. 1994; 23(1):259-77.
  • 48. Nguyen PT, Scheinman MM, Seger J. Polymorphous ventricular tachycardia: clinical characterization, therapy, and the QT interval. Circulation. 1986;74(2):340-9.
  • 49. Lankipalli RS, Zhu T, Guo D, et al. Mechanisms underlying arrhythmogenesis in long QT syndrome. J Electrocardiol. 2005;38:69-73.
  • 50. Roden DM. Long QT Syndrome. N Engl J Med.2008;358(2):169-76.
  • 51. Goldenberg I, Moss AJ. Long QT syndrome. J Am CollCardiol. Jun 17 2008;51(24):2291-300.
There are 50 citations in total.

Details

Primary Language Turkish
Journal Section Original Research
Authors

Olusegun Adesola Busari This is me

Timothy Olusegun Olarewaju This is me

Rotimi Oluyombo This is me

Emmanuel Olaleye Olalekan This is me

Publication Date September 1, 2013
Published in Issue Year 2013 Volume: 3 Issue: 3

Cite

APA Busari, O. A., Olarewaju, T. O., Oluyombo, R., Olalekan, E. O. (2013). Hipertansiyonu Olan Erişkinlerde Kaynak Kısıtlı Ortamda Kardiyak Aritmiler. Çağdaş Tıp Dergisi, 3(3), 155-160.
AMA Busari OA, Olarewaju TO, Oluyombo R, Olalekan EO. Hipertansiyonu Olan Erişkinlerde Kaynak Kısıtlı Ortamda Kardiyak Aritmiler. J Contemp Med. September 2013;3(3):155-160.
Chicago Busari, Olusegun Adesola, Timothy Olusegun Olarewaju, Rotimi Oluyombo, and Emmanuel Olaleye Olalekan. “Hipertansiyonu Olan Erişkinlerde Kaynak Kısıtlı Ortamda Kardiyak Aritmiler”. Çağdaş Tıp Dergisi 3, no. 3 (September 2013): 155-60.
EndNote Busari OA, Olarewaju TO, Oluyombo R, Olalekan EO (September 1, 2013) Hipertansiyonu Olan Erişkinlerde Kaynak Kısıtlı Ortamda Kardiyak Aritmiler. Çağdaş Tıp Dergisi 3 3 155–160.
IEEE O. A. Busari, T. O. Olarewaju, R. Oluyombo, and E. O. Olalekan, “Hipertansiyonu Olan Erişkinlerde Kaynak Kısıtlı Ortamda Kardiyak Aritmiler”, J Contemp Med, vol. 3, no. 3, pp. 155–160, 2013.
ISNAD Busari, Olusegun Adesola et al. “Hipertansiyonu Olan Erişkinlerde Kaynak Kısıtlı Ortamda Kardiyak Aritmiler”. Çağdaş Tıp Dergisi 3/3 (September 2013), 155-160.
JAMA Busari OA, Olarewaju TO, Oluyombo R, Olalekan EO. Hipertansiyonu Olan Erişkinlerde Kaynak Kısıtlı Ortamda Kardiyak Aritmiler. J Contemp Med. 2013;3:155–160.
MLA Busari, Olusegun Adesola et al. “Hipertansiyonu Olan Erişkinlerde Kaynak Kısıtlı Ortamda Kardiyak Aritmiler”. Çağdaş Tıp Dergisi, vol. 3, no. 3, 2013, pp. 155-60.
Vancouver Busari OA, Olarewaju TO, Oluyombo R, Olalekan EO. Hipertansiyonu Olan Erişkinlerde Kaynak Kısıtlı Ortamda Kardiyak Aritmiler. J Contemp Med. 2013;3(3):155-60.