ECG: Findings in CNS disorders

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ECG: Findings in CNS disorders

  1. 1. ECG QUIZ PROF(DR).G.SUNDARAMURTHY M2 UNIT DR.DILIP HARINDRAN SECOND YEAR PG RESIDENT
  2. 2. PRESENTATION • A 73 YEAR OLD MALE CAME WITH COMPLAINTS OF DIFFICULTY IN USING LEFT UPPER LIMB AND LOWER LIMB SINCE MORNING. A KNOWN DIABETIC AND HYPERTENSIVE. • O/E PR - 64/MIN, BP - 160/100 MM HG, GCS -8/15 CNS - LEFT HEMIPLEGIA. • ECG WAS TAKEN FOR THE PATIENT WHICH SHOWED,
  3. 3. INTERPRETATION • NORMAL SINUS RHYTHM • RATE - 75/MIN • P WAVE - NORMAL MORPHOLOGY, REDUCED VOLTAGE IN LIMB LEADS • PR INTERVAL NORMAL • QRS COMPLEX NORMAL MORPHOLOGY, LOW VOLTAGE IN LIMB LEADS • QT INTERVAL PROLONGED - 500MS AND DEEP ANTEROLATERAL T WAVE INVERSIONS (CAN BE DUE TO CNS INVOLVEMENT OR MYOCARDIAL ISCHEMIA).
  4. 4. DISCUSSION • ECG FINDINGS OF ACUTE CNS DISORDERS INCLUDE: 1. LARGE UPRIGHT T WAVES IN PRECORDIAL LEADS 2. INCREASED QRS VOLTAGE 3. DEEPLY INVERTED T WAVES IN PRECORDIAL LEADS 4. PROLONGED QT INTERVAL 5. PROMINENT U WAVES IN PRECORDIAL LEADS
  5. 5. • OTHERS FINDINGS INCLUDE: 1. T WAVE NOTCHING 2. LOSS T WAVE AMPLITUDE 3. DIFFUSE ST SEGMENT ELEVATION 4. ABNORMAL Q WAVES 5. RHYTHM ABNORMALITIES LIKE AF, VT, SINUS BRADYCARDIA OR TACHYCARDIA CAN OCCUR.
  6. 6. • ECG CHANGES ASSOCIATED WITH ACUTE CNS EVENTS CAN MIMIC - 1. ACUTE MYOCARDIAL INFARCTION 2. LEFT VENTRICULAR HYPERTROPHY 3. RIGHT VENTRICULAR HYPERTROPHY 4. PERICARDITIS 5. ANTIARRHYTHMIC DRUG EFFCTS
  7. 7. FIND THE IMPOSTER
  8. 8. ANSWER • TRACINGS A, B AND C SHOW ATRIAL FIBRILLATION WITH IRREGULARLY IRREGULAR RHYTHMS; FIBRILLATORY WAVES OF VARYING AMPLITUDE AND MORPHOLOGY; ABSENCE OF DISCRETE P WAVES. • TRACING D SHOWS MAT. IT USUALLY PRESENTS WITH ATRIAL RATE OF >100BPM, 3 OR MORE DIFFERENT P WAVE MORPHOLOGIES, AND VARYING PP AND PR INTERVAL. DEFINITE P WAVES AND ATRIAL DEPOLARIZATIONS ARE NOTED WHICH ARE NOT THERE IN A, B AND C.

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