Case 002
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A 58-year-old man collapsed after an argument and was found unconscious with pale and cyanotic skin. An ECG showed sinus tachycardia with complete heart block and two different ventricular escape rhythms. Chest X-ray found mild lung congestion. Further testing found dilated left ventricle with impaired function. Differential diagnosis includes acute myocarditis, coronary spasm, and atypical Takotsubo cardiomyopathy given the stressor of the argument. Lyme disease from Borrelia burgdorferi, which can cause complete heart block, has also been reported in Taiwan.
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Brugada syndrome Dr. Raj Santan
Brugada syndrome is the most common cause of sudden death in men < 40 years of age in south asia with no pre existing cardiac abnormalities, this presentation will help you understand brugada syndrome ...
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Brugada Syndrome is a genetic cardiac condition characterized by abnormal ECG patterns and risk of sudden cardiac death. It is caused by mutations in the SCN5A gene which encodes cardiac sodium channels. Patients typically present with syncope or sudden death and have a distinctive pattern on ECG of ST segment elevation in leads V1-V3. Risk stratification focuses on history of symptoms like syncope as inducible arrhythmias on electrophysiological study have poor predictive value. Treatment involves medical management with quinidine or device therapy with an ICD for high-risk patients. Lifestyle modifications like avoiding fever or medications that affect sodium channels are also recommended.
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2. Further history revealed symptoms of hyperthyroidism. Tests confirmed Graves' disease.
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This document discusses several electrocardiogram patterns that can indicate risk of sudden cardiac death. It presents six case studies and the corresponding ECG patterns:
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2) Brugada syndrome in a 36-year-old with chest pain, shown by ST elevation in right precordial leads.
3) Arrhythmogenic right ventricular dysplasia in a 28-year-old with dizziness, shown by epsilon waves and T wave inversion.
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This document provides information on a case of Brugada syndrome in a 70-year-old female patient. Key details include:
- The patient presented with a month of fever and breathlessness and was referred for ECG changes. Exams found wheezing and tremors.
- Tests included a normal echocardiogram and negative troponin. A Holter monitor found no arrhythmias.
- The document then provides background on Brugada syndrome, including its genetic basis, ECG patterns, diagnosis, management with ICDs and drugs, and drugs to avoid due to risk of arrhythmias.
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Brugada Syndrome is a genetic cardiac condition characterized by an abnormal ECG pattern and increased risk of sudden cardiac death. It is caused by mutations that result in loss of function of cardiac ion channels, most commonly sodium channels encoded by SCN5A. The ECG typically shows ST segment elevation in leads V1-V3. Brugada Syndrome presents variably from asymptomatic to sudden cardiac death, usually during sleep. Drug challenges may help diagnose when the ECG is unclear. An ICD is recommended for those with symptoms or inducible arrhythmias on electrophysiological study to prevent sudden death.
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A 73-year-old male presented with left upper and lower limb weakness. He has a history of diabetes and hypertension. On examination, his pulse was 64 beats/min, blood pressure was 160/100 mmHg, and he had left-sided hemiplegia. An ECG showed normal sinus rhythm, prolonged QT interval of 500ms, and deep anterolateral T wave inversions, which could be due to central nervous system involvement or myocardial ischemia. ECG findings associated with acute central nervous system disorders include prolonged QT interval and deeply inverted T waves in precordial leads.
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Long QT Syndrome Associated Syncope
- Long QT syndrome (LQTS) is a condition where a patient's EKG shows abnormal heart rhythms and susceptibility to rapid and chaotic heartbeats. This can cause fainting or seizures.
- Fainting, also known as syncope, is the temporary loss of consciousness caused by low blood flow to the brain. It can be triggered in LQTS patients by startling events or changes in mood like excitement or fear.
- Before losing consciousness, an LQTS patient may experience blurred vision, lightheadedness, or weakness. Startling sounds or mood changes are common triggers for fainting in people with LQTS.
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Ekg Cases Jul09.Level One Part 1
Some additional potential causes of resting sinus tachycardia in an elderly person include:
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- Pulmonary embolism
- Pneumonia/respiratory infection
- Anemia
- Medication effects (e.g. from diuretics)
- Electrolyte abnormalities like hypokalemia or hyperthyroidism
- Atrial fibrillation or other arrhythmias
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This document contains a series of 15 medical cases presented as images and descriptions. Each case includes radiographic or photographic images, descriptions of patient presentations, and questions about diagnoses and management. Key details provided in the cases include abnormal chest x-ray findings, ECG interpretations, skin lesions, complications of medical procedures and trauma, and congenital anomalies identified on imaging.
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2. VT can be idiopathic, focal, or associated with structural heart disease such as ischemic or non-ischemic cardiomyopathy.
3. Treatment depends on the type and cause of VT but may include medications, implantable cardioverter defibrillators (ICDs), and catheter ablation which can be curative for some idiopathic VT cases.Ventricular fibrillation eMedicine Article
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A 60-year-old male with multiple comorbid issues presented to the emergency room with chest pain. An ECG showed tall T waves and right bundle branch block. A CT/PET stress test revealed a small inferolateral infarct and significant peri-infarct ischemia. The patient was referred to cardiology to rule out acute coronary syndrome.
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ECG: Digitalis Effect / MAT / AF
A 41-year-old female presented with breathlessness, palpitations, and chest pain for 3 days. She has a history of valvular heart disease surgery 14 years ago. On examination, she was dyspneic, tachycardic, and had pedal edema. ECG showed atrial fibrillation with a rate of 160 beats/minute. Echocardiogram revealed moderate mitral stenosis and mild tricuspid regurgitation with enlarged left atrium and moderate mitral annular calcification. The patient was diagnosed with atrial fibrillation likely due to rheumatic heart disease.
Ecg test 2
This document contains an ECG test with multiple questions and answers. It discusses cases of:
1. A 60-year-old patient with diabetes, hypertension and chest pain, showing an anterior STEMI with inferior ischemia.
2. A 55-year-old woman with shortness of breath and fatigue, showing a low-voltage ECG and echocardiogram revealing pericardial effusion due to severe hypothyroidism.
3. A 60-year-old with chest pain, showing an anteroseptal STEMI with diffuse ischemia.
ECG: Atrial Dissociation
This ECG shows atrial dissociation in a 70-year-old male with a history of hypertension, coronary artery disease, and cardiac transplantation 6 months prior. Atrial dissociation is seen as two independent sets of P waves with varying PP and PR intervals. Atrial dissociation occurs when each atrium beats separately due to blockage of the Bachmann's bundle interatrial pathway. It can occur in orthotopic and heterotopic heart transplant patients as the posterior atrial wall is retained but denervated after orthotopic transplant.
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A 35-year-old male chronic alcoholic presented with a week-long headache and blurry vision. On examination, he had right lateral rectus palsy. CT brain showed hyperdensity in the right frontal region, right transverse sinus, and hypodensity in the superior sagittal sinus, suggestive of parenchymal hemorrhage with cortical vein thrombosis or calcified granuloma. MRI brain found a hemorrhagic lesion in the right high parietal lobe, absence of flow voids in sinuses, and T1 hyperintensity in sinuses confirming sinus thrombosis, which was shown on MR venography. The patient was diagnosed with cerebral vein thrombosis based on imaging findings.
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2. Frequent PVCs can themselves cause cardiomyopathy, but ablation of PVCs has been shown to improve left ventricular ejection fraction and size in some cases. PVC ablation is generally safe and well-tolerated.
3. For managing VT in advanced heart failure, a multidisciplinary team approach is important. Options discussed include various antiarrhythmic drugs, early VT ablation, and hemodynamic support such as percutaneous left ventricular assist devices during ablation procedures.
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This document contains an ECG quiz that tests the reader's ability to interpret electrocardiograms and diagnose cardiac conditions. It includes 10 multiple choice questions about various ECG readings showing conditions like acute myocardial infarction in different areas of the heart, pericarditis, effects of thrombolysis, and more. The questions aim to evaluate the reader's skill in locating areas of injury, categorizing vessel disease, differentiating disease mimics, and assessing risk of heart block.
EKG Patterns of SCD - Can't Miss EKG Patterns for Generalist & Psychiatrist
This document discusses several electrocardiogram patterns that can indicate risk of sudden cardiac death. It presents six case studies and the corresponding ECG patterns:
1) Wolf-Parkinson-White syndrome seen in a 34-year-old with palpitations, shown by a short PR interval and delta wave.
2) Brugada syndrome in a 36-year-old with chest pain, shown by ST elevation in right precordial leads.
3) Arrhythmogenic right ventricular dysplasia in a 28-year-old with dizziness, shown by epsilon waves and T wave inversion.
4) Long QT syndrome in a 44-year-old with dizziness and
The so Called Brugada Syndrome The True History
The syndrome of sudden Death, right bundle branch block and ST elevation was firstly described by A.Nava and B. Martini in 1988-1989, and only five years later by the Brugada Brothers. The ECG pattern is due to a conduction disturbance of the RVOT, caused by fibrofatty substitution of that structure.
Brugada
This document provides information on a case of Brugada syndrome in a 70-year-old female patient. Key details include:
- The patient presented with a month of fever and breathlessness and was referred for ECG changes. Exams found wheezing and tremors.
- Tests included a normal echocardiogram and negative troponin. A Holter monitor found no arrhythmias.
- The document then provides background on Brugada syndrome, including its genetic basis, ECG patterns, diagnosis, management with ICDs and drugs, and drugs to avoid due to risk of arrhythmias.
Brugada syndrome
Brugada Syndrome is a genetic cardiac condition characterized by an abnormal ECG pattern and increased risk of sudden cardiac death. It is caused by mutations that result in loss of function of cardiac ion channels, most commonly sodium channels encoded by SCN5A. The ECG typically shows ST segment elevation in leads V1-V3. Brugada Syndrome presents variably from asymptomatic to sudden cardiac death, usually during sleep. Drug challenges may help diagnose when the ECG is unclear. An ICD is recommended for those with symptoms or inducible arrhythmias on electrophysiological study to prevent sudden death.
ECG: Findings in CNS disorders
A 73-year-old male presented with left upper and lower limb weakness. He has a history of diabetes and hypertension. On examination, his pulse was 64 beats/min, blood pressure was 160/100 mmHg, and he had left-sided hemiplegia. An ECG showed normal sinus rhythm, prolonged QT interval of 500ms, and deep anterolateral T wave inversions, which could be due to central nervous system involvement or myocardial ischemia. ECG findings associated with acute central nervous system disorders include prolonged QT interval and deeply inverted T waves in precordial leads.
Long QT Syndrome Associated Syncope
Long QT Syndrome Associated Syncope
- Long QT syndrome (LQTS) is a condition where a patient's EKG shows abnormal heart rhythms and susceptibility to rapid and chaotic heartbeats. This can cause fainting or seizures.
- Fainting, also known as syncope, is the temporary loss of consciousness caused by low blood flow to the brain. It can be triggered in LQTS patients by startling events or changes in mood like excitement or fear.
- Before losing consciousness, an LQTS patient may experience blurred vision, lightheadedness, or weakness. Startling sounds or mood changes are common triggers for fainting in people with LQTS.
Cbp on vt (1)
This patient is a 72-year-old male who presented with ventricular tachycardia. He has a history of ischemic heart disease, myocardial infarction, and coronary artery bypass grafting. Diagnostic tests showed ventricular tachycardia, metabolic acidosis, acute kidney injury, cardiogenic shock, NSTEMI, and aspiration pneumonia. He received treatment including shock, intubation, hemodialysis, and medications. Nursing care involved ongoing monitoring, managing medications and side effects, and patient/family education.
Ekg Cases Jul09.Level One Part 1
Some additional potential causes of resting sinus tachycardia in an elderly person include:
- Heart failure
- Myocardial ischemia/infarction
- Pulmonary embolism
- Pneumonia/respiratory infection
- Anemia
- Medication effects (e.g. from diuretics)
- Electrolyte abnormalities like hypokalemia or hyperthyroidism
- Atrial fibrillation or other arrhythmias
Slide Presentaton/ Quiz Israr bashir
This document contains a series of 15 medical cases presented as images and descriptions. Each case includes radiographic or photographic images, descriptions of patient presentations, and questions about diagnoses and management. Key details provided in the cases include abnormal chest x-ray findings, ECG interpretations, skin lesions, complications of medical procedures and trauma, and congenital anomalies identified on imaging.
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1. Ventricular tachycardia (VT) is an important cause of sudden cardiac arrest and can manifest as premature ventricular contractions (PVCs) or sustained VT.
2. VT can be idiopathic, focal, or associated with structural heart disease such as ischemic or non-ischemic cardiomyopathy.
3. Treatment depends on the type and cause of VT but may include medications, implantable cardioverter defibrillators (ICDs), and catheter ablation which can be curative for some idiopathic VT cases.Ventricular fibrillation eMedicine Article
Ventricular fibrillation (VF) is a life-threatening heart rhythm disorder that usually results in cardiac arrest if not treated promptly. It occurs when the lower chambers of the heart beat in an uncoordinated, chaotic fashion, preventing the heart from pumping blood effectively. VF accounts for about 300,000 deaths per year in the United States, making it the leading cause of sudden cardiac death. It is commonly caused by coronary artery disease and often presents as the first sign of a heart attack. Prompt treatment with cardiopulmonary resuscitation and defibrillation can help restore a normal heart rhythm and prevent death from VF in some cases.
Brugada Syndrome and LQTS - the evidence
Brugada Syndrome and Long QT Syndrome are cardiac conditions that can cause abnormal heart rhythms and sudden cardiac death. For Brugada Syndrome, the key aspects of diagnosis, risk stratification, and management discussed include identifying type 1 ECG patterns, assessing risk based on exercise stress tests and signal-averaged ECGs, and treating high-risk patients with medications like quinidine or catheter ablation. For Long QT Syndrome, diagnosis involves measuring the corrected QT interval on ECG, risk stratification considers specific genetic mutations and history of syncope, and management relies on beta blockers and ICDs for high-risk patients. Both conditions require careful medical management to reduce risks of life-threatening arrhythmias.
Sudden cardiac death in structurally normal hearts
Potential causes of sudden cardiac death without structural heart disease include long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia, Brugada syndrome, early repolarization syndrome, idiopathic ventricular fibrillation, commotio cordis, and familial sudden cardiac death. These conditions are often genetic and can result in fatal arrhythmias. Evaluation of survivors and families of victims is important to determine the cause and provide appropriate treatment such as an implantable cardioverter-defibrillator.
Cardiology board cases ppt
A 60-year-old male with multiple comorbid issues presented to the emergency room with chest pain. An ECG showed tall T waves and right bundle branch block. A CT/PET stress test revealed a small inferolateral infarct and significant peri-infarct ischemia. The patient was referred to cardiology to rule out acute coronary syndrome.
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Management of pv cs and ventricular tachycardia in advanced heart failure
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Sudden cardiac death in structurally normal hearts
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Case 004
This ECG shows signs of diffuse subendocardial ischemia/infarction in a 62-year-old man with chest tightness and risk factors of diabetes, hypertension, and kidney disease. The ECG findings include left axis deviation, ST segment depression in multiple leads, and ST elevation in leads aVR and V1, suggesting involvement of the left main coronary artery or proximal LAD and LCx arteries. Cardiac enzymes were elevated. Coronary angiography revealed significant stenoses of the left main, LAD, LCx, and RCA arteries consistent with triple vessel disease.
Jc1
This document discusses hypertension (HTN) and its underlying mechanisms. It notes that HTN can be either volume-sensitive, related to sodium retention, or renin-sensitive, related to the renin-angiotensin-aldosterone system (RAAS). Long-term antihypertensive drugs target either volume by promoting sodium excretion (anti-V) or renin activity by blocking the RAAS (anti-R). The appropriate first-line treatment depends on whether a patient's HTN is predominantly volume-dependent or renin-dependent. Both drug classes aim to reduce vasoconstriction and sodium retention driving elevated blood pressure. Careful selection and titration of anti-V and anti-
Case 001
This case series documents a 57-year-old female with a history of asthma admitted for episodic dyspnea. Her ECG showed findings suggestive of cor pulmonale from COPD with right heart enlargement. Chest X-ray showed prominent pulmonary arteries. Echocardiogram showed enlarged right atrium and ventricle with moderate-severe tricuspid regurgitation. CT scan revealed filling defects in the pulmonary arteries confirming acute pulmonary embolism, an important cause of morbidity often unsuspected in COPD patients.
Jc2
1) Ambulatory blood pressure monitoring (ABPM) is better than clinic readings for diagnosing hypertension and predicting cardiovascular risk.
2) Patients can be classified as "dippers" or "nondippers" based on their blood pressure patterns over 24 hours as measured by ABPM. Nondippers have less of a drop in blood pressure at night.
3) Combining the direct renin inhibitor aliskiren with the angiotensin receptor blocker valsartan was more effective at reducing blood pressure in nondippers compared to valsartan alone, and helped convert some nondippers into dippers.
Case 3
This 73-year-old man presented with chest tightness and respiratory distress. He has a history of heart disease including prior heart attack and pacemaker implantation. Electrocardiogram showed paced rhythms, conduction abnormalities, and ST elevation suggestive of heart attack. Imaging showed enlarged heart and pulmonary congestion. Coronary angiography revealed multiple severe blockages. Due to cardiogenic shock, he was placed on devices including IABP and ECMO and started on inotropic medications and dialysis. His condition indicated emergency revascularization was needed.
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Ventricular tachycardia
Ventricular tachycardia can occur due to various causes like acute myocardial infarction, chronic infarction, dilated cardiomyopathy, etc. It is classified as sustained, non-sustained, monomorphic, polymorphic, etc. based on characteristics. Diagnosis involves ECG, echocardiogram, and monitoring. Treatment depends on hemodynamic stability and includes electrical cardioversion, antiarrhythmic drugs like amiodarone, lidocaine, ablation, and ICD implantation in selected cases. Recurrence risk is high in structurally abnormal hearts and prevention involves controlling triggers, antiarrhythmics, and ICDs.
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A 23-year-old female presented with episodes of feeling lightheaded and weak. She had a history of anorexia nervosa and had lost significant weight recently. Laboratory tests revealed low calcium, potassium, and other electrolyte abnormalities. During her emergency department stay, she experienced another episode where a rhythm strip was obtained. The rhythm strip showed a prolonged QT interval, likely the cause of her symptoms due to electrolyte abnormalities from her eating disorder.
ECG for the intensivists
ECG for Intensivists was presented by Dr Khaled Farouk at the Egyptian African Critical care Summit 2017 held at Cairo, egypt.
Hypocalcemia induced camel-hump t-wave, tee-pee sign, and bradycardia in a ca...
Hypocalcemia induced camel-hump t-wave, tee-pee sign, and bradycardia in a ca...YasserMohammedHassan1
Rationale: Electrocardiographic is a fundamental tool for a cardiologist, critical care physician, and emergency medicine specialist. The electrolyte imbalance is a very important entity in clinical medicine management. Camel-hump T-wave and the Tee-Pee sign, recently; Wavy triple and Wavy double signs of hypocalcemia (Yasser’s sign) are electrocardiographic findings linked to electrolyte deficiencies. Patient concerns: A middle-aged male car-painter patient presented to the emergency department with atypical severe twisting chest pain, hypocalcemia, hypokalemia, and hypernatremia.
Diagnosis: Hypocalcemia-induced Camel-hump T-wave, Tee Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign), and bradycardia in a car- painter. Interventions: Electrocardiography, arterial blood gases, oxygenation, and echocardiography. Lessons: The dramatic reversal of Camel-hump T-Wave, Tee-Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign) after calcium gluconate injection interpret that these signs were due to hypocalcemia. The twisting chest pain and its limited disappearance immediately after calcium gluconate injection indicate the pain can be named as “chest tetany”. Non-atropine bradycardia response is evidence that the management of the cause of bradycardia sometimes is essential e.g. hypocalcemia in the current case. Outcomes: There was a dramatic response of both clinical and electrocardiography including Camel-hump T-wave, Tee Pee sign, the wavy double sign of hypocalcemia, and bradycardia.
Ekg Cases 7 15 09 Level 2 Part 1
This document discusses strategies for interpreting EKGs in the presence of conduction abnormalities like bundle branch blocks. It provides examples of EKGs showing myocardial infarctions complicating right bundle branch block and left bundle branch block. Key points are that pathologic Q waves can still indicate infarction location, ST elevations are abnormal in bundle branch blocks, and the orientation of ST-T waves can provide clues. Recognition of infarction is still possible despite conduction delays by assessing early versus late QRS deformation.
ECG Rhythm abnormality for undergraduates
The rhythm is best analyzed by looking at a rhythm strip.
On a 12 lead ECG this is usually a 10 second recording from Lead II.
Confirm or corroborate any findings in this lead by checking the other leads.
A longer rhythm strip, recorded perhaps recorded at a slower speed, may be helpful.
Wellens SCH2013-1
This case report describes a 76-year-old female patient who presented with chest pain and was found to have Wellens syndrome, characterized by biphasic or deeply inverted T waves in the precordial leads. Further workup revealed a 95% stenosis in the proximal left anterior descending artery (LAD), which was treated with coronary artery bypass grafting. Wellens syndrome is defined as specific ECG abnormalities associated with a critical LAD stenosis. It often progresses rapidly to anterior wall myocardial infarction if not treated urgently with angiography and revascularization. This case highlights the importance of recognizing the subtle ECG findings of Wellens syndrome to identify high-risk patients and prevent adverse cardiac events.
ECG HOUR.pptx
The document discusses an 84-year-old male who presented with chest heaviness. His admission ECG showed ST-elevation myocardial infarction (STEMI) involving the right coronary artery, sinus bradycardia, atrial ischemia, and third-degree atrioventricular block. He was given streptokinase thrombolytic therapy. Follow-up ECGs showed sinus tachycardia 30 minutes later and resolution of ST elevation with residual conduction abnormalities 6 hours later, consistent with successful thrombolysis. The document reviews the systematic approach and criteria for interpreting ECGs in the context of acute coronary syndromes.
INTERESTING ECGS -- PART II
This document contains 16 medical cases involving electrocardiogram (ECG) readings and interpretations. Each case provides an ECG image and description of a patient's symptoms or medical history, and asks the reader to identify the diagnosis or next step. The document also includes explanations of various ECG patterns and conditions, such as R on T phenomenon, hyperkalemia, Brugada syndrome, lead reversals, and long QT interval with T-wave alternans. The goal is to teach readers how to properly analyze ECGs and apply that analysis to diagnosing cardiac conditions.
ECG interpretation in emergency settings
The document provides an overview of ECG interpretation in emergency settings. It discusses how to identify and diagnose common ECG changes seen in emergencies, including tachyarrhythmias, bradyarrhythmias, acute coronary syndrome, pulmonary embolism, hyperkalemia, and pericardial effusion. Specific ECG patterns are described for conditions like sinus tachycardia, supraventricular tachycardia, atrial fibrillation, ventricular tachycardia, heart block, myocardial infarction, and more. The goal is to help emergency clinicians rapidly identify and manage critical ECG findings.
Arrhythmias 2
Arrhythmias refer to abnormalities in the cardiac rhythm. There are two main types: bradycardia where the heart rate is slow, and tachycardia where the heart rate is fast. Specific arrhythmias include sinus bradycardia, various types of heart block, atrial fibrillation, atrial flutter, AV nodal re-entry tachycardia, ventricular tachycardia, and ventricular fibrillation. Diagnosis involves electrocardiography and other tests. Treatment depends on the type of arrhythmia but may include medications, catheter ablation, pacemaker implantation, or cardioversion. Lifestyle modifications and avoiding arrhythmia triggers can also help management.
Cardiac Arrhythmias
Cardiac arrhythmias are abnormalities in the heart's rhythm. There are two main types: bradycardia, a slow heart rate, and tachycardia, a fast heart rate. Various arrhythmias are described including sinus bradycardia, heart block, atrial fibrillation, atrial flutter, AV nodal reentry tachycardia, ventricular fibrillation, and ventricular tachycardia. Treatment depends on the type of arrhythmia and may include medication, cardioversion, ablation, or pacemaker implantation. Diagnosis involves ECG, echocardiogram, blood tests, and other cardiac tests. Lifestyle changes and avoiding arrhythmia triggers can help management.
ECG of the weeks
A 65-year-old man presented with presyncope and was found to have severely high blood pressure. During hospitalization, he collapsed and required CPR. His ECG after resuscitation showed ST elevations. A subsequent ECG showed a changing pattern consistent with a right bundle branch block. A CT scan revealed the patient had an acute subarachnoid hemorrhage extending into the ventricles. No antithrombotic therapy was administered due to the risk of worsening the hemorrhage. Intracranial hemorrhages can mimic acute myocardial infarction on ECG and release catecholamines that can directly damage the heart.
Thyroid and the Heart
This document discusses syncope, which is a transient loss of consciousness due to temporary reduced blood flow to the brain. It notes that syncope accounts for around 1% of emergency department visits and is a common cause of hospitalization for those over 65. Establishing the exact cause is difficult as the patient has usually recovered by the time they are examined. The document then discusses various causes of syncope and nonsyncopal attacks that can be mistaken for syncope. It provides breakdowns of common causes by age group and discusses the natural history and risk stratification of syncope of unknown cause in the emergency department.
STEMI Mimic WHAT IS IT AND HOW TO IDENTIFY IT ?
The document discusses several STEMI mimics that can present with ST segment elevation on ECG but are not actually caused by an acute myocardial infarction. These include early repolarization, left bundle branch block, electrolyte abnormalities, left ventricular hypertrophy, pulmonary embolism, left ventricular aneurysm, Brugada syndrome, pericarditis, and hypothermia. It provides details on the characteristic ECG patterns and clinical features that can help differentiate these conditions from a true STEMI.
Supraventricular tachycardia
Most people with supraventricular tachycardia don't need activity restrictions or treatment. For others, lifestyle changes, medication and heart procedures may be needed to control or eliminate the rapid heartbeats and related symptoms.
Types
Supraventricular tachycardia (SVT) falls into three main groups:
Atrioventricular nodal reentrant tachycardia (AVNRT). This is the most common type of supraventricular tachycardia.
Atrioventricular reciprocating tachycardia (AVRT). AVRT is the second most common type of supraventricular tachycardia. It's most commonly diagnosed in younger people.
Atrial tachycardia. This type of SVT is more commonly diagnosed in people who have heart disease. Atrial tachycardia doesn't involve the AV node.
Other types of supraventricular tachycardia include:
Sinus tachycardia
Sinus nodal reentrant tachycardia (SNRT)
Inappropriate sinus tachycardia (IST)
Multifocal atrial tachycardia (MAT)
Junctional ectopic tachycardia (JET)
Nonparoxysmal junctional tachycardia (NPJT)
Symptoms
The main symptom of supraventricular tachycardia (SVT) is a very fast heartbeat (100 beats a minute or more) that may last for a few minutes to a few days. The fast heartbeat may come and go suddenly, with stretches of typical heart rates in between.
Some people with SVT have no signs or symptoms.
Signs and symptoms of supraventricular tachycardia may include:
Very fast (rapid) heartbeat
A fluttering or pounding in the chest (palpitations)
A pounding sensation in the neck
Weakness or feeling very tired (fatigue)
Chest pain
Shortness of breath
Lightheadedness or dizziness
Sweating
Fainting (syncope) or near fainting
In infants and very young children, signs and symptoms of SVT may be difficult to identify. They include sweating, poor feeding, pale skin and a rapid pulse. If your infant or young child has any of these symptoms, ask your child's care provider about SVT screening.
When to see a doctor
Supraventricular tachycardia (SVT) is generally not life-threatening unless you have heart damage or other heart conditions. However, in extreme cases, an episode of SVT may cause unconsciousness or cardiac arrest.
Call your health care provider if you have an episode of a very fast heartbeat for the first time or if an irregular heartbeat lasts longer than a few seconds.
Some signs and symptoms of SVT may be related to a serious health condition. Call 911 or your local emergency number if you have an episode of SVT that lasts for more than a few minutes or if you have an episode with any of the following symptoms:
Chest pain
Shortness of breath
Weakness
Dizziness
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Causes
For some people, a supraventricular tachycardia (SVT
Brady arryhthmias
Bradyarrhythmias are caused by problems with impulse formation in the sinus node or impulse conduction through the AV node. Sinus node dysfunction can cause sinus bradycardia, sinus pause/arrest, or chronotropic incompetence. Atrioventricular block is classified as first, second, or third degree and may be caused by conditions like CAD, drugs, or infiltrative diseases. Second degree AV block is further classified as Mobitz type I or II based on PR interval characteristics. Third degree AV block causes complete dissociation between atrial and ventricular rhythms.
Basic of Pre-excitation syndrome
This document discusses pre-excitation syndrome, specifically Wolff-Parkinson-White (WPW) syndrome and Lown-Ganong-Levine (LGL) syndrome. It defines pre-excitation syndrome as having a short PR interval and usually an abnormal QRS complex due to an accessory pathway in the cardiac conduction system. Accessory pathways can connect different parts of the heart and have faster conduction velocities than the atrioventricular node. WPW syndrome is the most common type, affecting about 1.5 per 1000 people. Common symptoms include palpitations and chest discomfort due to paroxysmal tachyarrhythmias like atrioventricular reentrant tachycardia. Management involves catheter ablation
Ecg findings in life threatening conditions
This document provides an overview of ECG findings and their significance in diagnosing life-threatening conditions. It describes the basic components of an ECG tracing and then analyzes tracings from 5 patients, identifying the following life-threatening conditions: hyperkalemia, long QT interval/T-wave alternans, digitalis toxicity, artifact mimicking ventricular tachycardia, and torsade de pointes. Each case highlights key features in the tracings that indicate the condition and potential risk to the patient.
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Case 002
- 2. Interpretations Sinus/atrial tachycardia at 150/min with complete AV block. Alternating escape ventricular rhythms, one exhibiting negative (rate: 45/min) and the other positive QRS deflection (rate: 35/min) in lead II. Complete AV block is evidenced by dissociated atrial and ventricular rhythms with the atrial one having a faster rate. The presence of two escape ventricular rhythms are suggested by morphologically different QRS complexes coupled with two sets of ventricular rate. ST segment elevation is noted, but the diagnosis of myocardial ischemia/infarction can not be made due to its being a ventricular escape rhythm. RJSECGCaseSeries
- 3. Brief Hx and Physical Findings A 58-year-old man suddenly collapsed about 20 min following a heated argument with his wife. He was noted to be unconscious, and his face was pale, lips cyanotic, and whole body rigid. Reportedly he had been relatively healthy until one week prior to admission when he developed URI symptoms without fever or chills, for which he took some medications for muscle ache. On arrival at ER, he was drowsy with cold sweats and was in acute respiratory distress; BT measured 35.8 PR33, RR 28/min, and BP 122/74 mmHg. Physical findings showed no displaced PMI and there were coarse crackles in both lungs. RJSECGCaseSeries
- 4. Chest X-ray AP view shows an endotracheal tube in place and there is an increase in lung markings suggestive of mild pulmonary congestion. Of note, there is no cardiomegaly. RJSECGCaseSeries
- 7. Interpretation for ECG-2 • Subsequent ECG (30 min later after CPR) before cardiac catheterization still shows complete A-V block with an atrial rate of /min and a ventricular rate (escape rhythm) of /min; the origin of the escape ventricular rhythm seems different than those taken on admission. RJSECGCaseSeries
- 8. Cardiac Catheterization with Coronary Artery Angiography • Under temporary RV pacing (VVI) at 70 bpm LVEF measured 57%. • RCA, LCA: LAD and LCx and their branches were all patent. RJSECGCaseSeries
- 9. Echocardiographic Findings Dilated LV Impaired LV contractility with global LV hypokinesis Moderate MR RJSECGCaseSeries
- 10. Differential Diagnosis • The differential diagnosis should include acute myocarditis, diffuse coronary spasm, among many others. MRI is needed to r/o acute myocarditis. Based on the present illness, stress (Takotsubo) cardiomyopathy due to excessive surge of catecholamines, albeit atypical, should be entertained. Of interest, Lyme disease caused by a species of Gram-negative bacteria of the spirochete class of the genus Borrelia. B. burgdorferi, which not infrequently induce complete AV block, has been reported in Taiwan. RJSECGCaseSeries
- 11. Atypical Takotsubo Cardiomyopathy • Nykamp D, Titak JA. Takotsubo cardiomyopathy, or broken-heart syndrome. Ann Pharmacother 44:590- 3, 2010. • Kim S, et al. Inverted-Takotsubo pattern cardiomyopathy secondary to pheochromocytoma: a clinical case and literature review. Clin Cardiol 33:200-5, 2010. • Dande AS, et al. Inverted takotsubo cardiomyopathy. J Invasive Cardiol 23:E76-8, 2011. RJSECGCaseSeries
- 12. Take-Home Message • There are many causes of complete A-V block. In inverted Takotsubo cardiomyopathy, the basal rather than apical area of the heart is involved, which theoretically can lead to A-V conduction disturbances such as H-V interval prolongation or complete A-V block. Acknolwledgment: The Case was provided by R2王奕欣 /VS 廖國宏 of LiShin Hospital, Jhongli, Taoyuan, Taiwan, 03/13/2012. RJSECGCaseSeries
- 13. Lyme Disease in Taiwan RJSECGCaseSeries