This ECG was obtained from a man in his 70s. We have no other clinical information. It is interesting for several reasons. Giant T wave inversions The most obvious abnormalities we see on first inspection are the deeply inverted T waves in Leads V3 through V6. The T wave in V3 is biphasic. There are also T wave inversions in all of the limb leads except aVR. The precordial T wave inversions are called giant T wave inversions because they are 10 mm or more in depth. There are many causes of giant T wave inversions, including, but not limited to: myocardial ischemia, coronary artery disease and reperfusion, pulmonary edema, massive pulmonary embolism, subarachnoid hemorrhage, apical hypertrophy, post-tachycardia syndrome, and post-pacing syndrome. What else? There are no Q waves or ST elevations. The ST segments are not entirely normal in shape, being flattened in most lead. The frontal plane axis is left. Even though the ECG almost meets criteria for left ventricular hypertrophy, by exclusion ...
Purpose T wave inversion (TWI) is the electrical hallmark of cardiac conditions such as hypertrophic cardiomyopathy (HCM) or arrhythmogenic right ventricular cardiomyopathy (ARVC), which may be the substrate for sudden cardiac death in the young athlete. Such repolarization anomalies can feature on the ECG of an apparently healthy athlete and pose major diagnostic dilemmas in sports cardiology, as regular, prolonged high intensity, physical activity is associated with such repolarization changes. Athletes themselves are reluctant to detrain during the season, which makes interpreting any reversible effects of exercise on the ECG more difficult. This study aimed to investigate the effect of detraining on TWI in athletes. ...
Introduction: While right precordial T wave inversions (RPTWI) are associated with specific cardiomyopathic conditions including ARVC, they are common among trained athletes without underlying heart disease. RPTWI in athletes, particularly those that are not of Afro-Caribbean descent, remain poorly understood and represent a source of considerable clinical controversy. We therefore sought to examine the prevalence, training physiology specificity, and ECG correlates of RPTWI among asymptomatic Caucasian athletes.. Methods: Competitive collegiate Caucasian male endurance athletes (rowers, n=168) and strength-trained athletes (football players, n=162) underwent standard 12-lead ECG at the time of pre-participation screening. ECGs were analyzed for standard quantitative parameters and for the presence of RPTWI defined as TWI ≥2mm in ≥2 leads from V1 to V3.. Results: RPTWI were significantly more prevalent in endurance athletes (25%) than in strength-trained athletes (4%, p,0.001; Figure). ...
Introduction: While it has been proposed that T wave inversions (TWI) in the anterior precordial leads can be a normal finding in the ECGs of Afro-Caribbean athletes, it is uncertain whether this holds true for African-Americans. Hypothesis: TWI in the anterior precordial leads can be a non-specific marker of cardiac disease, and as a result, assuming a benign nature for TWI in the anterior leads in African-American athletes may not be appropriate. Methods: To begin to investigate this notion, we evaluated the incidence of cardiovascular death (CVD) in apparently healthy African- Americans with anterior TWI over an 11 year period. We analyzed the ECGs and CV deaths in 5334 ambulatory African Americans (average age 50 years, 8% female, average follow up of 8 years) seen at the Palo Alto VA Health Care system from 1986 until 1997. T waves were coded as inverted in V2, V3, V4 and V5 if TWI were noted to be more than 1 mm below the PR segment. The leads coded as inverted were summed to create a ...
OBJECTIVE: To investigate the value of a giant negative T wave (, or = 1.0 mV) in precordial leads of 12-lead electrocardiograms in the acute phase of Q wave myocardial infarction as a predictor of myocardial salvage. METHODS: Coronary angiographic and electrocardiographic findings, left ventricular ejection fraction in the chronic stage, and levels of cardiac enzymes were compared in patients with myocardial infarction with (group GNT, n = 31) and without (group N, n = 20) a giant negative T wave. GNT patients were divided into two subgroups according to the presence (GNT:R[+], n = 10) or absence (GNT: R[-], n = 21) of R wave recovery with an amplitude , or = 0.1 mV in at least one lead that had shown Q waves. RESULTS: The maximum level of creatine kinase and the total creatine kinase were lower in group GNT compared with group N (P , 0.05). The left ventricular ejection fraction was higher in group GNT than in group N (P , 0.05). The maximum creatine kinase and total creatine kinase were lower ...
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You systematically review the EKG. The heart rate is normal. There is a p wave before every QRS complex, but the p-wave axis is abnormal (negative in lead II). There is now an extreme rightward axis as the QRS is negative in leads I, II and avF. As you analyze the ST segments for evidence of ischemia, there appears to be T wave inversions in the inferior distribution of II, III, and avF. You start considering the differential of ectopic atrial rhythm, right axis deviation, and T wave inversions including PE or ischemia but stop yourself. You think did someone switch the leads? You take a brief look at aVR and see that the P, QRS and T waves are positive, making you even more suspicious ...
Alteration in ventricular repolarization occurs during changes in ventricular activation as may occur with ventricular pacing, bundle branch block and various arrhythmias. This may result in T wave abnormalities which persist following cessation of pacing, resolution of bundle branch block or resolution of arrhythmia. Such changes may be confused with ischemia. The phenomenon, known as cardiac memory, is reviewed here in the American Journal of Emergency Medicine. ...
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IF it would not be for the ST elevation in lead V6 - the principal finding on ECG #1 would be the ST-T wave depression in anterior (as well as right-sided) leads V1,V2,V3. Anterior ST depression and/or T wave inversion is an ECG finding that should always prompt consideration of RV strain, as occurs in acute PE (For more on ECG recognition of Acute PE - Please see My Comment at the bottom of Dr. Smiths April 5, 2019 Blog post). Other findings in ECG #1 that are potentially consistent with acute RV strain are the presence of numerous S waves (in leads I, II, III; and across all chest leads) + what could be construed as an incomplete RBBB pattern in lead V1 (with narrow terminal S waves in leads I and V6). But AGAINST acute PE as the diagnosis are: i) the History, which sounds cardiac, without hint of acute dyspnea; and, ii) the unusual ECG finding of ST-T wave depression being by far most remarkable in lead V1, and no more than modest in leads V2 and V3. Typically, with acute RV strain - ...
A method of gathering electrocardiographic data is disclosed wherein the EKG data is collected by sequentially monitoring the difference in electrical potential measured at each of at least three patient leads for a time period greater than 15 seconds, preferably for equal time periods of 20 seconds each. Although more than three leads and longer monitoring time periods may be used, a 60-second three-lead EKG data sample in accordance with the present invention is clinically sufficient to monitor cardiac function and to diagnose most cardiac dysfunctions. A system for collecting such electrocardiographic data is also disclosed. The system allows the collected data to be stored for later translation and interpretation. The stored data may also be communicated over phone lines for translation and interpretation at a remote site by trained individuals.
This webinar is designed for those staff who have experience in basic Lead II ECG interpretation and wish to learn how to analyze and interpret 12 lead ECGs. The workshop will focus on the need to know subjects of 12 Lead Electrocardiography and will include basic electrophysiology, a framework for interpretation, a review of the normal 12 Lead ECG, abnormalities, and recognition of ECG changes seen in myocardial ischemia and infarction ...
by ltwardzik829, Sep. 2005. EKG Test Prep EKG Technician Exam Practice Test Questions. It is likely that in many clinical settings youll be asked to regularly review ECGs. Write. Help us carry on by supporting the project. Ekg National Exam Study Guide , datacenterdynamics.com Prepare for your Certified EKG Technician (CET) exam with the comprehensive 106-page printed study guide and set of three different online practice tests. EKG Technician Exam , AMCA EKG Technician Certification Exam Review , Udemy Free Phlebotomy Practice Tests 2020 [100+ Questions] Certified EKG Technician (CET) Exam Application - Page 1/27. EKG practice test. Jump to Page . EKG Certification Exam study guide!! Doctoral Degree. You are on page 1 of 19. Match. This book is a bank of 350+ questions to prepare for the EKG Technician national certification exams. K. Lee, MD. Search. Get Free Ekg Tech Practice Test now and use Ekg Tech Practice Test immediately to get % off or $ off or free shipping. Epsilon a ...
In this chapter, we investigate the most recent automatic detecting algorithms on abnormal electrocardiogram (ECG) in a variety of cardiac arrhythmias. We present typical examples of a medical case study and technical applications related to diagnosing ECG, which include (i) a recently patented data classifier on the basis of deep learning model, (ii) a deep neural network scheme to diagnose variable types of arrhythmia through wearable ECG monitoring devices, and (iii) implementation of the health cloud platform, which consists of automatic detection, data mining, and classifying via the Android terminal module. Our work establishes a cross-area study, which relates artificial intelligence (AI), deep learning, cloud computing on huge amount of data to minishape ECG monitoring devices, and portable interaction platforms. Experimental results display the technical advantages such as saving cost, better reliability, and higher accuracy of deep learning-based models in contrast to conventional schemes on
ECG in hypertrophic cardiomyopathy with atrial fibrillation: Atrial activity is seen as irregular fibrillary waves suggesting atrial fibrillation. The QRS complexes have a large amplitude in chest leads overlapping between the leads. Tall R waves in lateral leads and deep S waves in anterior leads along with gross ST segment depression with T wave inversion in lateral leads are suggestive of severe left ventricular hypertrophy. The QRS width is also increased to about 120 msec mimicking left bundle branch block. The ECG is from a case of advanced hypertrophic cardiomyopathy with atrial fibrillation. Development of atrial fibrillation leads to cardiac decompensation in hypertrophic cardiomyopathy due to loss of atrial kick. In a hypertrophied ventricle the booster effect of atrial contraction is very important for diastolic filling. Even though the contribution of atrial contraction to ventricular filling in a normal person is about 15 - 20 %, it may be over 30% in an individual with diastolic ...
The discrepancy between the relatively better early outcomes and the similar or even worse long-term prognoses in patients with non-Q wave versus Q wave infarction has led to a more aggressive approach in the management of this group of patients ([3, 5, 10]). Our findings conflict somewhat with reports from the prethrombolytic era ([3-5, 9, 17-19]), in which 1-year mortality was similar or even higher in the non-Q wave infarction populations. The difference could be related to the heterogeneity of the populations, the definitions used and the use of thrombolysis ([3-9, 11]).. Another possible explanation for this disagreement is the initial ST segment deviation. In most studies of Q wave or non-Q wave infarction, the initial ST segment shift was seldom considered a prognostic marker. The observation that patients with initial ST segment depression have a worse prognosis than those with ST segment elevation and either Q wave or non-Q wave infarction ([20-23]), with the additional evidence that ...
The correlation between persistent negative T wave on basal electrocardiogram and coronary anatomy or global and regional left ventricular function was investigated in 34 patients with unstable angina defined as new onset (| 2 months), crescendo or rest angina. The patients with history of previous myocardial infarction, pathological Q waves on electrocardiogram or documented elevation of CPK were excluded. Eighteen patients (group A) showed T wave inversion (| 1 mV) in at least two leads on the basal electrocardiogram, persisting for at least 48 hours before coronary arteriography. In 16 patients (group B) the basal electrocardiogram was normal. Left ventricular volumes and ejection fraction were calculated and the regional systolic wall motion was analyzed using the area method in the 30 degrees right anterior oblique view. Hypokinesis was defined as more than 2 standard deviation below the mean value calculated in 24 normal subjects. No difference was present for age (A: 61 +/- 9 vs B: 57 +/- 9 yrs)
Is there a ECG marker for recent syncope ? Yes . This was classically described many decades ago. Following a Stokes -Adam attack when the patient recovers from the loss of consciousness a peculiar ECG pattern was observed. A typical ECG from our CCU The mechanism is not clear.It can be due to 1. Repolarisation…
GREAT case! My initial impression looking at the initial ECG was that the leads (especially leads III and aVF) just looked funny - almost as if there was some type of lead misplacement. That is, the amount of T wave inversion (especially in lead III) looked extreme - albeit both QRS and ST-T wave appearance in lead III was indeed the precise mirror-image of the QRST & ST-T wave in lead aVL …But there is no lead misplacement - as the P wave in lead II is upright, and there is global negativity in lead aVR as there is expected to be. Looking next at the chest leads - not only R wave progression, but also R wave amplitude looks uncharacteristically reduced - which if not due to large body habitus (I dont think this patients body habitus was described … ?) should raise the question if loss of R wave on this initial ECG is the result of an acute ongoing event. Regardless of questions raised by these findings - there is little doubt (as recognized by the treating ED physician) that T wave ...
Background:. The importance of ischemic ECG changes including St segment elevation, ST segment depression or T wave inversion that indicate myocardial ischemia are well established and require appropriate investigation and treatment.. However, there is an abundance of clinical situation, with apparently ischemic ECG change not indicate traditionally coronary artery related ischemia and therefore require prompt recognition and treatment of underlying condition, that may be serious and life-threatened. For example of such conditions are pericarditis, myocarditis, aortic dissection, electrolyte abnormalities, intracranial hemorrhage and hypothermia.. Together with them, an ECG ST segment changes may appeared in abdominal serious illness such as pancreatitis and cholecystitis(17,18,19,20,23). Whereas in pancreatitis various vasoactive and toxic for myocardium substances released, the cause of ST segment changes in cholecystitis are discussed and includes tachycardia , vagal reflexes, changed in ...
Background:. The importance of ischemic ECG changes including St segment elevation, ST segment depression or T wave inversion that indicate myocardial ischemia are well established and require appropriate investigation and treatment.. However, there is an abundance of clinical situation, with apparently ischemic ECG change not indicate traditionally coronary artery related ischemia and therefore require prompt recognition and treatment of underlying condition, that may be serious and life-threatened. For example of such conditions are pericarditis, myocarditis, aortic dissection, electrolyte abnormalities, intracranial hemorrhage and hypothermia.. Together with them, an ECG ST segment changes may appeared in abdominal serious illness such as pancreatitis and cholecystitis(17,18,19,20,23). Whereas in pancreatitis various vasoactive and toxic for myocardium substances released, the cause of ST segment changes in cholecystitis are discussed and includes tachycardia , vagal reflexes, changed in ...
Early repolarization pattern (ERP) on the 12-lead electrocardiogram (ECG) is associated with sudden cardiac death (SCD) and increased mortality in certain populations. The mechanism of this association has been hypothesized to relate to regional heterogeneity of epicardial and endocardial repolarization. However, whether differences in subclinical left ventricular wall thickness may affect this association is unknown (1). Individuals with ERP are more likely to meet Sokolow-Lyon ECG criteria for left ventricular hypertrophy (LVH-SL) but are paradoxically less likely to meet Cornell voltage criteria (LVH-C) (2,3). Studies to date are limited by use of ECG measurements to define LVH and are thus not sufficient to determine whether there is a relationship between left ventricular mass (LVM) and ERP. We hypothesized that participants with ERP have a higher LVM and a greater prevalence of cardiac magnetic resonance imaging-determined LVH (LVH-CMR) compared with those without ERP.. The ...
Have recently had ECG done following chest pain.Tracing showed T wave inversion and ST wave inversion in lead 3. Have then had normal Echo, stress ECG and 24 hour Holter monitor. What could be the reas...
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Intraventricular conduction delays such as LBBB and the associated ST segment-T wave abnormalities can mimic both acute and chronic ischaemic changes. Much has been written about the evaluation of the ST segment elevation in the presence of LBBB1,8; considering chest pain patients in the ED, LBBB is responsible for 15% of STE syndromes and is the second most frequently encountered electrocardiographic pattern responsible for non-ischaemic STE.17,18 LBBB, however, can also cause significant ST segment depression, and it is imperative that these electrocardiographic changes be distinguished from those that occur in the presence of ACS.3 The rule of appropriate discordance states that in LBBB, ST segment-T wave configurations are directed opposite from the major, terminal portion of the QRS complex. As such, leads with either QS or rS complexes should have significantly elevated ST segments mimicking an AMI while leads with a large monophasic R wave demonstrate ST segment depression. T waves in ...
article{3004d42f-c464-4188-bf60-ba0491925d72, author = {Bennhagen, Rolf and Sörnmo, Leif and Pahlm, Olle and Pesonen, Erkki}, issn = {1399-3046}, language = {eng}, number = {6}, pages = {773--779}, publisher = {Wiley-Blackwell}, series = {Pediatric Transplantation}, title = {Serial signal-averaged electrocardiography in children after cardiac transplantation.}, url = {http://dx.doi.org/10.1111/j.1399-3046.2005.00384.x}, volume = {9}, year = {2005 ...
This comprehensive 50 hour EKG Technician Certification Program prepares students to function as an EKG Technician. This course will include important practice and background information on anatomy of the heart and physiology, medical disease processes, medical terminology, medical ethics, legal aspects of patient contact, the Holter monitor, electrocardiography and echocardiography.. Additionally, students will practice with equipment and perform hands-on labs including introduction to the function and proper use of the EKG machine, the normal anatomy of the chest wall for proper lead placement, 12-lead placement and other clinical practices. EKG Technicians also analyze printed readings of EKG tests, measuring various cardiac intervals and complexes and determining normal vs. abnormal EKG.. EKG Technician Course Outline. ...
The QED 2000 is a complete 12 Lead Electrocardiograph (ECG) solution with ECG interpretation software. Designed to assist health care professionals in delivering the utmost quality care to patients, the ECG reading can be easily and accurately acquired, analyzed, stored and printed in one touch. With features designed to enhance portability, streamline workflow and assist in a physicians diagnosis, the QED 2000 12 Lead ECG is suitable for many environments.. The built-in ECG interpretation software assists in healthcare professionals diagnosis and screening. Our patented ECG interpretation software is a unique algorithm which analyzes the frequency components of a 10 second 12 lead resting ECG reading. Clinically tested and with a high sensitivity/specificity rate, the ECG interpretation offers a reliable and accurate analysis to support a physicians diagnosis. Segment and waveform measurement, rhythm interpretation, and myocardial ischemia sensitivity probability is generated by the QED 2000 ...
A 42-year-old man with acute renal failure is confused. His serum potassium is 8.1 mEq/L . The most likely abnormal ECG finding is: a) T wave inversion b) PR interval of 300ms c) QT interval of 0.4s d) U wave e) Tall tented T waves The correct answer is E The earliest ECG evidence of [...]. ...
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Here is a good organized approach to master ECG interpretation. Learning the art of ECG interpretation requires intellect, commitment, effort and - perhaps most importantly - an organized approach.
Signal-averaged electrocardiography (SAECG) is a special electrocardiographic technique, in which multiple electric signals from the heart are averaged to remove interference and reveal small variations in the QRS complex, usually the so-called late potentials. These may represent a predisposition towards potentially dangerous ventricular tachyarrhythmias. A resting electrocardiogram (ECG) is recorded in the supine position using an ECG machine equipped with SAECG software; this can be done by a physician, nurse, or medical technician. Unlike standard basal ECG recording, which requires only a few seconds, SAECG recording requires a few minutes (usually about 7-10 minutes), as the machine must record multiple subsequent QRS potentials to remove interference due to skeletal muscle and to obtain a statistically significant average trace. For this reason, it is important for the patient to lie as still as possible during the recording. SAECG recording yields a single, averaged QRS potential, ...
Hi Mostafa. Any other lead area(s) of the heart may show reciprocal ST depression that opposes ST elevation in another area ... so to my knowledge there is no limitation as to which leads may show this. That said, there are certain common patterns. For example - with inferior wall acute STEMI - you will virtually always see a mirror image ( = reciprocal) shape of ST depression in lead aVL compared to the pattern of ST elevation that you see in lead III. And, in high lateral infarction when you have ST elevation in aVL - you will often see a mirror-image of ST depression in the inferior leads (esp. in lead III). Proximal LAD occlusions often show reciprocal ST depression in the inferior leads - but when the LAD occlusion is more distal, you may not see any reciprocal inferior ST depression at all .... ST depression in V1,V2,V3 in association with acute inferior STEMI may reflect reciprocal ST depression, but could also be due to acute posterior infarction or to anterior ischemia. So - ...
TY - JOUR. T1 - Seizure-related cardiac repolarization abnormalities are associated with ictal hypoxemia. AU - Seyal, Masud. AU - Pascual, Franchette. AU - Lee, Chia Yuan Michael. AU - Li, Chin-Shang. AU - Bateman, Lisa M.. PY - 2011/11. Y1 - 2011/11. N2 - Purpose: Cardiac arrhythmias and respiratory disturbances have been proposed as likely causes for sudden unexpected death in epilepsy. Oxygen desaturation occurs in one-third of patients with localization-related epilepsy (LRE) undergoing inpatient video-electroencephalography (EEG) telemetry (VET) as part of their presurgical workup. Ictal-related oxygen desaturation is accompanied by hypercapnia. Both abnormal lengthening and shortening of the corrected QT interval (QTc) on electrocardiography (ECG) have been reported with seizures. QTc abnormalities are associated with increased risk of sudden cardiac death. We hypothesized that there may be an association between ictal hypoxemia and cardiac repolarization abnormalities. Methods: VET data ...
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QRS width and morphology is in a gray zone. Precise answer really requires review after conversion to sinus rhythm. That said, the QRS looks supraventricular. While one can debate if QRS width is 0.11 vs 0.12 ... the width of the monophasic R wave in lateral leads is not overly wide; the initial r in V1,2,3 is larger than is usual in lbbb; and the QRS just looks supraventricular. Remember that BOTH LAHB and LVH may slightly widen the QRS - and that is my strong hunch of what we have here - :). Delete ...
Even though the electrocardiogram (ECG) is the standard diagnostic test for the evaluation of symptoms of acute myocardial ischemia or infarction, the prognostic value of various ECG features of cardiac ischemia is ill-defined. Savonitto and colleagues conducted a retrospective study of the ECG findings among patients in the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-IIb) trial.. A total of 12,142 patients were enrolled in the GUSTO-IIb trial. To be enrolled in the study, patients had to have ECG signs of myocardial ischemia, including transient or persistent ST-segment elevation or depression of more than 0.05 mV or persistent and definite T-wave inversion of more than 0.1 mV. All patients had to have reported symptoms of cardiac ischemia at rest within 12 hours of hospital admission. Since the GUSTO-IIb trial was a comparison of heparin and desirudin, patients were excluded if they had active bleeding, a history of stroke, an elevated serum creatinine ...
TY - JOUR. T1 - Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. AU - Das, Mithilesh. AU - Maskoun, Waddah. AU - Shen, Changyu. AU - Michael, Mark A.. AU - Suradi, Hussam. AU - Desai, Mona. AU - Subbarao, Roopa. AU - Bhakta, Deepak. PY - 2010/1. Y1 - 2010/1. N2 - Background: Myocardial scar is a substrate for reentrant ventricular arrhythmias and is associated with poor prognosis. Fragmented QRS (fQRS) on 12-lead ECG represents myocardial conduction delays due to myocardial scar in patients with coronary artery disease (CAD). Objective: The purpose of this study was to determine whether fQRS is associated with increased ventricular arrhythmic event and mortality in patients with CAD and nonischemic dilated cardiomyopathy (DCM). Methods: Arrhythmic events and mortality were studied in 361 patients (91% male, age 63.3 ± 11.4 years, mean follow-up 16.6 ± 10.2 months) with CAD and DCM who received an implantable ...
Looking for online definition of electrocardiographically in the Medical Dictionary? electrocardiographically explanation free. What is electrocardiographically? Meaning of electrocardiographically medical term. What does electrocardiographically mean?
Commercial. The crucial information on Electrocardiograph market size, geographical presence, the market share of top players is presented in this report. The report begins with the analysis of Electrocardiograph overview, objectives, market scope, and market size estimation. The past, present and forecast Electrocardiograph market scenario is presented with the market concentration and market saturation analysis. The market study outcomes are based on extensive primary and secondary research with the key opinion leaders of Electrocardiograph industry. The forecast Electrocardiograph growth trajectory is presented for the year 2020 to 2027 which will shape the development plans.. The regional analysis of Global Electrocardiograph Market is considered for the key regions such as Asia Pacific, North America, Europe, Latin America and Rest of the World. The Electrocardiograph market drivers, emerging segments, industry rules and regulations along with the development plans and policies are ...
Arrhythmogenic right ventricular cardiomyopathy/dysplasia clinical presentation and diagnostic evaluation: results from the North American Multidisciplinary Study.
TY - JOUR. T1 - Site-specific twelve-lead ECG features to identify an epicardial origin for left ventricular tachycardia in the absence of myocardial infarction. AU - Bazan, Victor. AU - Gerstenfeld, Edward P.. AU - Garcia, Fermin C.. AU - Bala, Rupa. AU - Rivas, Nuria. AU - Dixit, Sanjay. AU - Zado, Erica. AU - Callans, David J.. AU - Marchlinski, Francis E.. PY - 2007/11. Y1 - 2007/11. N2 - Background: Identification of an epicardial origin for left ventricular tachycardia (LV-VT) based on electrocardiogram (ECG) criteria facilitates the approach to catheter ablation. Reported criteria, although helpful, may not apply uniformly to all LV regions. Objective: We hypothesized that unique region-specific ECG patterns identify epicardial LV-VTs in patients without myocardial infarction. Methods: The QRS morphologies during pace mapping from 402 epicardial and 234 comparable endocardial sites and 19 epicardial VTs were analyzed in 15 patients with respect to morphology and duration of all and ...
Question - ECG:MI(lateral), left ventr. hypertrophy, left anterior hemiblock, left axis deviation, T-wave near baseline (lateral,inferior), -small positive T wave (anterior), -S waves up to V6, abnormal ECG. Ask a Doctor about diagnosis, treatment and medication for Hypertension, Ask a Cardiologist
Left bundle branch blocks. In left bundle branch block (LBBB) the left ventricle is not directly activated by impulses travelling through the left bundle branch. The right ventricle, however, is still activated as normal by the right bundle branch.. The left ventricle is activated by impulses travelling through the myocardium across the septum. As this occurs more slowly than conduction through the bundle of His the QRS complex becomes widened.. Normally the septum is activated from left to right, which produces small Q waves in the lateral leads. In the presence of LBBB, however, this septal activation is reversed, which eliminates these normal septal Q waves.. The right to left depolarization of the myocardium produces deep S waves in the right praecordial leads (V1-V3) and tall R waves in the lateral leads (I, V5 and V6). It also usually causes left axis deviation. As the ventricles are activated sequentially from right to left, rather than simultaneously, the R wave in the lateral leads is ...
Agree with lead placement errors with aVR being upright. However, P wave inversion can be seen in dextrocardia as can an upright in aVR. In addition p wave inversion can be seen in junctional rythm with retrograde conduction, T wave inversion in inferior leads could indicate ischemia. So, 1st check leads, if correct would perform an ECHO, which could detect both dextrocardia and wall motion abnormalities of inferior ischemia, if normal consider EP study. Most likely leads, then consider dextrocardia, then inferior ischemia then junctional with retrograde P ...
Can left bundle branch block cause chest pain? Mammen Ninan, Jonathan W Swan Exercise-induced left bundle branch block usually indicates underlying coronary artery disease or myocardial disease. Association of left bundle branch block (LBBB) with chest pain in the absence of coronary artery disease is rare. We describe the case history of a patient with chest pain associated with left bundle branch block with normal coronary arteries and review the literature on left bundle branch block associated with chest pain.. ...
Sakamoto T, Tei C, Murayama M, Ichiyasu H, Hada Y. Giant T wave inversion as a manifestation of asymmetrical apical hypertrophy (AAH) of the left ventricle: echocardiographic and ultrasono-cardiotomographic study. Jpn Heart J. 1976;17(5):611-29. PMID: 136532. DOI: https://doi.org/10.1536/ihj.17.611 Yamaguchi H, Ishimura T, Nishiyama S, Nagasaki F, Nakanishi S, Takatsu F, et al. Hypertrophic nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy): Ventriculographic and echocardiographic features in 30 patients. Am J Cardiol. 1979;44(3):401- 12. PMID: 573056. DOI: https://doi.org/10.1016/0002-9149(79)90388-6 Eriksson MJ, Sonnenberg B, Woo A, Rakowski P, Parker TG, Wigle ED, et al. Long-term outcome in patients with apical hypertropic cardiomyopathy. J Am Cardiol. 2002;39(4):638- 45. PMID: 11849863. DOI: https://doi.org/10.1016/s0735-1097(01)01778-8 Kitaoka H, Doi Y, Casey SA, Hitomi M, Furuno T, Maron BJ. Comparision of prevalence of apical hypertrophic cardiomyopathy in ...
The disease was first described by Giovanni Maria Lancisi in 1736, who in his book De Motu Cordis et Aneurysmatibus reported a family with disease recurrence in four generations: the affected members presented with palpitations, heart failure, dilation and aneurysms of the RV and sudden death [9].. Dalla Volta et al. in 1961 reported a patient with auricularization of the RV pressure curve, emphasizing the peculiar hemodynamic picture of this non-ischemic heart muscle disease with RV behaving like an atrium [10]. However, we had to wait until the 80s to find the first clinical and pathologic series of patients with ARVC/D reported by Drs Marcus, Nava and Thiene [1-3].. Marcus et al. in 1982 reported the disease in adults, first emphasizing the origin of arrhythmias from the RV and the histopathological substrate consisting of fibro-fatty replacement of the RV free wall, accounting for epsilon wave and ventricular arrhythmias of RV origin with left bundle branch block (LBBB) morphology ...
TY - JOUR. T1 - Clinical and genetic heterogeneity of right bundle branch block and ST-segment elevation syndrome. T2 - A prospective evaluation of 52 families. AU - Priori, Silvia G.. AU - Napolitano, Carlo. AU - Gasparini, Maurizio. AU - Pappone, Carlo. AU - Della Bella, Paolo. AU - Brignole, Michele. AU - Giordano, Umberto. AU - Giovannini, Tiziana. AU - Menozzi, Carlo. AU - Bloise, Raffaella. AU - Crotti, Lia. AU - Terreni, Liana. AU - Schwartz, Peter J.. PY - 2000/11/14. Y1 - 2000/11/14. N2 - Background - The ECG pattern of right bundle branch block and ST-segment elevation in leads V1 to V3 (Brugada syndrome) is associated with high risk of sudden death in patients with a normal heart. Current management and prognosis are based on a single study suggesting a high mortality risk within 3 years for symptomatic and asymptomatic patients alike. As a consequence, aggressive management (implantable cardioverter defibrillator) is recommended for both groups. Methods and Results - Sixty patients ...
TY - JOUR. T1 - Abnormal electrocardiographic findings in athletes. T2 - Recognising changes suggestive of cardiomyopathy. AU - Drezner, Jonathan A.. AU - Ashley, Euan. AU - Baggish, Aaron L.. AU - Börjesson, Mats. AU - Corrado, Domenico. AU - Owens, David S.. AU - Patel, Akash. AU - Pelliccia, Antonio. AU - Vetter, Victoria L.. AU - Ackerman, Michael J.. AU - Anderson, Jeff. AU - Asplund, Chad A.. AU - Cannon, Bryan C.. AU - DiFiori, John. AU - Fischbach, Peter. AU - Froelicher, Victor. AU - Harmon, Kimberly G.. AU - Heidbuchel, Hein. AU - Marek, Joseph. AU - Paul, Stephen. AU - Prutkin, Jordan M.. AU - Salerno, Jack C.. AU - Schmied, Christian M.. AU - Sharma, Sanjay. AU - Stein, Ricardo. AU - Wilson, Mathew. N1 - Copyright: Copyright 2013 Elsevier B.V., All rights reserved.. PY - 2013/2. Y1 - 2013/2. N2 - Cardiomyopathies are a heterogeneous group of heart muscle diseases and collectively are the leading cause of sudden cardiac death (SCD) in young athletes. The 12-lead ECG is utilised as ...
Electrocardiograph ( EKG ) Technicians work closely with cardiovascular technologists. Technicians who specialize in electrocardiogram (EKG) testing are known as cardiographic or electrocardiograph (EKG) technicians. Electrocardiograph ( EKG ) Technicians conduct procedures and manage equipment that tests, monitors and documents electrical activity of a patients cardiovascular system. These test are used to assist cardiologists and physicians in identifying and treating cardiac and blood vessel abnormalities. These procedures are non-invasive and usually conducted as part of a routine examination before surgical procedures. These types of test include standard electrocardiogram exams, 12-lead placement, cardiac catheterization, Holter monitoring, phonocardiography, stress testing, and vectorcardiography. The tests also detect and diagnose medical illnesses such as coronary artery disease, angina, arrhythmias and pericarditis.. The electrocardiograph technician is initially responsible for ...
I read the article by Yang JH,et al with great interest, in which the authors compared 1-year prognostic impacts of angiotensin receptor blockers (ARBs) with angiotensin converting enzyme inhibitors (ACEIs) in patients with ST segment elevation myocardial infarction (STEMI) with preserved left ventricular systolic function who underwent primary percutaneous coronary intervention (PCI) [1]. I believe it would be appreciated if authors discuss the long-term survival benefit of ARBs before concluding that ARBs are as beneficial as ACEIs in STEMI patients with preserved left ventricular systolic function after PCI.. Although ARBs could be an alternative to ACEIs, a recent observational study using inverse probability of treatment weighting and propensity score matching methods revealed that patients treated with ACEIs had significantly lower long-term mortality compared with those treated with ARBs from 2 to 5 years after acute myocardial infarction [2]. This study also demonstrated that crude ...
Of the 3250 patients, 634 sufferers without visual impairment were matched with 634 individuals with visual impairment. In the propensity score-matched evaluation, patients with visual impairment had a significantly higher threat of all-cause mortality compared with individuals without visual impairment in crude model (HR 1.72, 95 CI, 1.21?.45, P ?0.003), model 1 (HR 1.71, 95 CI, 1.21?.44, P ?0.003) and model two (HR 1.69, 95 CI, 1.12?.54, P ?0.01) even soon after adjusting for sex, DM, cardiovascular disease, health insurance, education, duration of dialysis, the use of ACEi or ARB, left ventricular hypertrophy on electrocardiogram, serum creatinine, serum albumin, and HbA1c.Subgroup Analysis of All-Cause Mortality by Risk Variables According to Visual ImpairmentSubgroup analysis associations involving visual impairment and all-cause mortality in many subgroups of individuals are displayed in Figure two. In subgroup analyses, there have been no substantial interactions amongst visual impairment ...
Right bundle branch block Differential diagnosis of right bundle branch block / causes of right bundle branch block are : -pulmonary embolism
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[92 Pages Report] Check for Discount on Global and China Diagnostic Electrocardiograph (ECG) Market Research by Company, Type & Application 2013-2025 report by HeyReport. Summary Diagnostic Electrocardiograph (ECG) is the process of recording the...
On- vs. off-hours admission of patients with ST-elevation acute myocardial infarction undergoing percutaneous coronary interventions: data from a tertiary university brazilian hospital
article{11bc16ce-648f-4e73-acd6-27c5bab30fc3, author = {Hedén, Bo and Ohlsson, Mattias and Holst, Holger and Mjöman, Mattias and Rittner, Ralf and Pahlm, Olle and Peterson, Carsten and Edenbrandt, Lars}, issn = {0002-9149}, language = {eng}, number = {5}, pages = {600--604}, publisher = {Excerpta Medica}, series = {American Journal of Cardiology}, title = {Detection of frequently overlooked electrocardiographic lead reversals using artificial neural networks}, volume = {78}, year = {1996 ...
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Indirect evidence of independent atrial activity Capture beat Occasionally an atrial impulse may cause ventricular depolarisation via the normal conduction system. The resulting QRS complex occurs earlier than expected and is narrow. indd 25 conduct normally, thus making a diagnosis of supraventricular tachycardia with aberrancy unlikely. Capture beats are uncommon, and though they confirm a diagnosis of ventricular tachycardia, their absence does not exclude the diagnosis. 8 Capture beat. 9 Fusion beat. 14 s). Consequently, this arrhythmia is commonly misdiagnosed as a supraventricular tachycardia. The QRS complexes have a right bundle branch block pattern, often with a small Q wave rather than primary R wave in lead V1 and a deep S wave in lead V6. When the tachycardia originates from the posterior fascicle the frontal plane axis of the QRS complex is deviated to the left; when it originates from the anterior fascicle, right axis deviation is seen. Right ventricular outflow tract tachycardia ...
|p|The 12-lead surface electrocardiogram adjacent QTc dispersion, which is the maximum difference of corrected QT interval between two adjacent leads, is a simple method to determine regional variation in repolarization and refractoriness. The aim of this study is to evaluate adjacent QTc dispersion as a marker of susceptibility to ventricular arrhythmias after myocardial infarction. A total of 135 consecutive patients with acute myocardial infarction were enrolled in the study. Adjacent QTc, measured by lens magnifier, was calculated on the first, second and third days after acute myocardial infarction. On the second day after acute myocardial infarction, adjacent QTc dispersion was significantly greater in patients with ventricular arrhythmias (P < 0.001). Adjacent QTc dispersion on the first and fifth day after acute myocardial infarction was not associated with development of ventricular arrhythmias. On the second day after acute myocardial infarction, adjacent QTc dispersion is
In 680 patients with acute myocardial infarction the prognosis during the following 5 years was related to observations made in a standard electrocardiogram (ECG) and 24 precordial chest leads. Patients with a Q-wave infarction (based on a 12-lead standard ECG) had a mortality rate during hospitalization of 10.2% which was much higher than that in patients with a non-Q-wave infarction (1.9%, p less than 0.001). At 5 years follow-up 33.6% of those with a Q-wave infarction had died versus 28.4% of those with a non-Q-wave infarction (p greater than 0.2). Corresponding mortality rate among patients with no previous infarction (n = 587) was 32.1% and 25.2%, respectively (p = 0.17). In patients with anterior infarction and no previous infarction there was no correlation between Q- and R-wave changes in the 24 chest leads 4 days after admission to hospital and 5-year mortality rate. We thus conclude that patients with a Q-wave infarction had a higher in-hospital mortality compared with non-Q-wave ...
INTRODUCTION: In the ECG, significant ST elevation or depression according to specific amplitude criteria can be indicative of acute coronary syndrome (ACS). Guidelines state that the ST amplitude should be measured at the J point, but data to support that this is the optimal measuring point for ACS detection is lacking. We evaluated the impact of different measuring points for ST deviation on the diagnostic accuracy for ACS in unselected emergency department (ED) chest pain patients.. MATERIAL AND METHODS: We included 14,148 adult patients with acute chest pain and an ECG recorded at a Swedish ED between 2010 and 2014. ST deviation was measured at the J point (STJ) and at 20, 40, 60 and 80 ms after the J point. A discharge diagnosis of ACS or not at the index visit was noted in all patients.. RESULTS: In total, 1489 (10.5%) patients had ACS. ST amplitude criteria at STJ had a sensitivity of 28% and a specificity of 92% for ACS. With these criteria, the highest positive and negative predictive ...
The relationship between R-wave amplitude and left ventricular volume was examined using two groups of patients, undergoing diagnostic cardiac catheterisation for investigation of chest pain, who had simultaneous R-wave recording and left ventricular angiography. R-wave amplitude was measured in leads 1, 2, 3 and V4-6. Left ventricular volume was altered by nitroglycerine (n = 18) and atrial pacing (n = 13). In both groups, increase or decrease in left ventricular volume was associated with a concomitant change of R-wave amplitude. We conclude that left ventricular volume is an important determinant of surface-recorded R waves with increased amplitude reflecting increased left ventricular volume and vice versa.
Symptom-to-door time in ST segment elevation myocardial infarction: overemphasized or overlooked? Results from the AMI-McGill study. Can J Cardiol. 2008 Mar; 24(3):213-6 ...
Aims: Left bundle branch block (LBBB) is generally associated with a poorer prognosis in comparison to normal intraventricular conduction, but also in comparison to right bundle branch block which is generally considered to be benign in the absence of an underlying cardiac disorder like congenital heart disease. In this paper we evaluate the presence of possible cardiovascular pathology in a group of nurses with a low level of cardiovascular risk factors and left bundle branch block (LBBB). Methods: During the period 2009-2013, 356 nurses (mean age: 32.6 ± 11 yr) were admitted to the department of Occupational Medicine of Second University of Naples. Of these, 13 had LBBB. The evaluation of these patients has included an electrocardiogram (ECG), echocardiography, 24-h ambulatory Holter monitoring (ECG Holter), and exercise testing. Subsequently, in patients with LBBB, multislice computed coronary angiography (MSCT) has been considered. Results and Conclusion: Only in one patient we found a
Paroxysmal ventricular tachycardia is most often associated with organic heart disease and in this setting is of ominous prognostic import (1-3). Less commonly, this arrhythmia occurs in young individuals without underlying heart disease; in these patients the disorder is generally considered benign (4). However, in some of these patients the episodes of paroxysmal ventricular tachycardia may lead to syncope and sudden death (2, 5). Recently, the efficacy of the beta-adrenergic blocking drugs in the treatment of tachyarrhythmias has been recognized (6, 7), and these drugs have been employed with success in certain patients with recurrent ventricular tachycardia (8-11). Electrical pacemakers ...
Congenital long QT syndrome (LQTS) is a genetic channelopathy associated with a high incidence of sudden cardiac death in children and young adults. QT interval prolongation is typically the primary finding on the electrocardiography (ECG) recordings, but a normal QT interval may be seen in as many as 40% of patients with LQTS due to incomplete penetrance. A normal QT interval on ECG in patients with LQTS is known as hidden LQTS. An epinephrine provocation test can help in the diagnosis of hidden LQTS. This case report describes the use of an epinephrine provocation test to diagnose hidden LQTS in 3 patients who had normal QT interval and corrected QT interval on ECG and a family history of sudden cardiac death. ...
Cardiology for Finals FY1s Poornima Mohan & Ghazal Saadat Overview • • • • • • Scars Acute coronary syndromes Valvular heart disease Infective Endocarditis Dextrocardia Arrhythmias Midline sternotomy scar What is this scar? Which 3 procedures would cause this scar? What else would you look for? Grafts What could this be? What are the indications? Where else should you look? We have this patient with chest pain 66 year old with a background of DM type 2, hypertension and a 40 pack yr smoking hx. Day 1 post inguinal hernia repair. Has been having central crushing chest pain for last 15 minutes. No relief from GTN. Hot & sweaty, vomited twice. Obs: BP- 120/60 P-75 RR- 24 Sats 98% on RA What ECG features suggest an STEMI?? ST elevation in 2mm in 2 or more contigous limb leads ST elevation in 2 or more contigous chest leads New onset LBBB Posterior MI . What features suggest an to NSTEMI ??? ST depression and /or T wave inversion in 2 or more leads. Risk is assessed using the TIMI ...
In this article, we will discuss the Diagnosis of Ventricular Tachycardia. So, lets get started.. Diagnosis. The ECG helps in the diagnosis. Wide QRS complexes (>0.14 seconds), at a regular rate of >100 bpm with presence of AV dissociation (independent P-wave not related to wide QRS complexes), concordant pattern, superior QRS axis, capture beats and fusion complexes favour the diagnosis of VT. It may be monomorphic (all QRS complexes alike originating from a single focus) or polymorphic (QRS complexes are not alike suggests organ from multiple foci). Torsades de pointee is a form of polymorphic VT. It must be stressed here that in spite of all these criteria, the ECG diagnosis of VT is not only difficult but may be impossible to differentiate it from PSVT with aberrant conduction (another common cause of wide QRS tachycardia) because there is no single electrocardiographic sign which confirms the diagnosis of VT.. Following are the common causes of wide QRS tachycardia:. ...
Results: LVH was diagnosed in 17 (47%) patients (6 women and 11 men). Following ECG parameters correlated the most prominently with LVMI - RV5: r = 0.5 (p = 0.002), RV6: r = 0.61 (p = 0.0001), SV1+RV5, 6: r = 0.64 (p = 0.001), RaVL+SV3: r = 0.5 (p = 0.002), SV2+RV5, 6: r = 0.71 (p = 0.0001), SV2, 3+RV5, 6: r = 0.75 (p = 0.0001). Based on the results of ROC analysis we proposed new cut points for LVH parameters. The highest diagnostic accuracy achieved S2+SV3 > 6 mV, SV2,V3+RV5,V6 > 4 mV, RaVL+SV3 > 3.5 mV (86-89 ...
The clinical and ventricular wall motion abnormality features of takotsubo cardiomyopathy are well defined. However, the underlying pathophysiology of this disorder is not completely understood. It has been suggested that takotsubo is a clinical syndrome with a multitude of predisposing factors, triggers, and pathogenic mechanisms, whose common final outcome is transient left ventricular systolic dysfunction characterized by apical ballooning with relative sparing of the basal segments. The syndrome is often preceded by acute stress (somatic and/or emotional) followed by chest pain, electrocardiographic abnormalities, and elevated cardiac troponin levels in the absence of obstructive coronary artery disease.. Massive catecholamine release and exaggerated sympathetic activation with elevated plasma catecholamines (up to 3-fold higher compared with patients presenting with acute myocardial infarction) are thought to play pivotal roles in the pathophysiology of takotsubo cardiomyopathy (1). ...
We recruited a random sample of men aged 50-69 years from the registers of general practices in the Merton, Sutton, and Wandsworth District Health Authority area, south London. A total of 612 men were invited and 413 (67%) attended. Of these, 25 were non-white and were excluded. Information was obtained on history and symptoms of coronary heart disease, lifestyle, and socioeconomic circumstances, as described previously. Cardiovascular risk factor profiles and serological tests for H pylori and C pneumoniae were also performed as described.11 Electrocardiograms were Minnesota coded. We took tracings to indicate coronary heart disease if they showed any of the following: Q waves, ST segment depression, left bundle branch block, or T wave inversion. Only the 303 men who had complete cardiovascular risk factor profiles were included in the study.. C Reactive protein concentration was measured by in house enzyme linked immunosorbent assay (ELISA). Rabbit antihuman C reactive protein (Dako) was used ...
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Left Bundle Branch Block Differential diagnosis of left bundle branch block / causes of left bundle branch block are : -ischemic heart disease
Brugada syndrome (BrS) is among the more common familial arrhythmia syndromes, with an estimated prevalence of 1 to 5 per 10 000 persons. It is characterized by a right ventricular conduction delay, dynamic or persistent ST-segment elevations in the precordial leads V1-3 , and an elevated risk of syncope and sudden cardiac death in young adults without structural heart disease... ...