DOCSLIB.ORG

The Association Between the Pattern of Premature Ventricular Contractions and Heart Diseases: Assessment of Routine Electrocardiography in Health Examinations

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Journal of J Occup Health 2002; 44: 343–347 Occupational Health The Association between the Pattern of Premature Ventricular Contractions and Heart Diseases: Assessment of Routine Electrocardiography in Health Examinations Kazuhito HATANAKA1, Akira FUJINAMI2, Yoshihiro NISHIMOTO2, Nobuhiko ITO3 and Masahiko KOBAYASHI1 1Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 2Central Health Institute of East Japan Railway Company and 3Department of Cardiology, JR Tokyo General Hospital, Japan Abstract: The Association between the Pattern of findings applied to the observations in asymptomatic Premature Ventricular Contractions and Heart subjects. Conclusion—It is suggested that the Diseases: Assessment of Routine population without heart disease primarily has the PVCs Electrocardiography in Health Examinations: of the LBBB pattern without axis deviation and the Kazuhito HATANAKA, et al. Department of Forensic analysis of the PVC patterns (bundle branch block Medicine, Graduate School of Medicine, University pattern) and of electrical axis deviation in routine ECG of Tokyo—Objective—Premature ventricular at a routine health examination is useful for diagnosing contractions (PVCs) were observed among patients heart disease. with heart diseases. It has been suggested that the (J Occup Health 2002; 44: 343–347) sporadic left bundle branch block (LBBB) pattern of PVCs observed in healthy subjects has no relevance Key words: Premature ventricular contractions, Heart to heart diseases and the presence of this type of PVC disease, Electrocardiography, Bundle branch block, was not associated with a poor prognosis. The aim of Electrical axis deviation this study is to present and evaluate the relationship between PVC patterns on routine electrocardiography Arrhythmia is one of the markers of heart disease. (ECG) and heart diseases. Methods: The subjects Premature ventricular contractions (PVCs) are the most examined were 201 employees from one company common type of arrhythmia and PVCs are suggested to be (male 192, female 9) with PVCs (Lown grading associated with heart diseases, such as ischemic heart classification 0 or 1). The patterns of PVCs were disease, cardiomyopathy, obstructive pulmonary disease classified into the following four categories regarding 1–3) the bundle branch block pattern and electrical axis and valvular disease . In ischemic heart disease, frequent, deviation: 1) the LBBB pattern without axis deviation multiform or early-coupling (R-on-T phenomenon) PVCs (135 subjects), 2) the LBBB pattern with left axis are regarded as warning arrhythmias4, 5). PVCs also occur deviation (29 subjects), 3) the right bundle branch block in relation to various stimuli such as electrolyte (RBBB) pattern without axis deviation (22 subjects) and imbalance, tension states and central and peripheral 4) the RBBB pattern with left axis deviation (15 autonomic stimulation6). Therefore, when PVCs are subjects). Results—The presence of subjective detected by electrocardiography (ECG), a close symptoms was not significant in each category. examination is often required to investigate the presence Prevalence of heart disease was 1) 14 (10.4%), 2) 10 of underlying disease. PVCs are also provoked by (34.5%), 3) 9 (40.9%) and 4) 7 (46.7%). The subjects smoking as well as caffeine or alcohol intake3, 6, 7), so that with the LBBB pattern without axis deviation had a lower they are frequently observed in a healthy population. incidence of having heart disease than subjects with other PVC patterns (p<0.05). In addition, similar Other studies have shown that PVCs in healthy subjects are sporadic and show no connection with heart disease8–13). Received Feb 8, 2002; Accepted June 13, 2002 In the PVCs of subjects without heart disease, the left Correspondence to: K. Hatanaka, Department of Forensic bundle branch block (LBBB) pattern varied from 60 to Medicine, Graduate School of Medicine, University of Tokyo, 7– 96% and the right bundle branch block (RBBB) pattern 3–1 Bunkyo-Ku, Hongo, Tokyo 113-0033, Japan varied from 4 to 33%10–12). In the PVCs of subjects with 344 J Occup Health, Vol. 44, 2002 heart disease, the LBBB pattern varied from 18 to 22% Table 1. Characterization of premature ventricular and the RBBB pattern varied from 73 to 83%12). In contraction in 201 subjects subjects without ischemic heart disease, the LBBB pattern Pattern of PVCs No. % of group was 74%, the RBBB pattern was 17% and both pattern were 9%13). In subjects with ischemic heart disease, the LBBB without AD 135 67.2 LBBB pattern was 35%, the RBBB pattern was 46% and LBBB with LAD 29 14.4 both were 19%13). In general, most PVC patterns in RBBB without AD 22 10.9 healthy subjects show an LBBB pattern. In addition to RBBB with LAD 15 7.5 the PVC pattern, it is also useful to make other observations regarding the presence or absence of heart Total 201 100 disease on routine ECG at a health examination. We Abbreviations: PVCs=premature ventricular contractions; therefore studied the degree of electrical axis deviation LBBB=left bundle branch block; RBBB=right bundle as a useful indicator. branch block; AD=axix deviation; LAD=left axis deviation. In the present study we analyzed sporadic PVC patterns (bundle branch block pattern) and electrical axis deviation in 201 subjects in routine ECGs. We also examined the association between PVC patterns, electrical axis investigated in each category and the symptoms deviation and the presence of heart disease. associated with PVCs were detected, such as palpitations, discomfort in the chest or feeling that the heart stopped Subjects and Methods during the long pause after PVCs6). The subjects of this study were 201 employees from Statistical significance was established by chi-square one company who had one or more PVCs on a routine analysis with Bonferroni correction for multiple 12-lead ECG obtained during a health examination. There comparisons. Statistical differences were judged were 192 males and 9 females, with ages ranging from significant at p<0.05. 19 to 56 yr (mean of 44.4 yr). All subjects underwent a clinical examination for heart diseases in medical facilities Results and their medical history was reviewed. Subjects with Individual classifications are shown in Table 1. The atrial fibrillation (valvular heart disease, lone atrial heart disease diagnoses were as follows: 20 had fibrillation, ischemic heart disease, cardiomyopathy), hypertensive cardiovascular disease, 11 had ischemic conduction disturbance (atrioventricular block, left bundle heart disease, 5 had cardiomyopathy and 4 had valvular branch block, right bundle branch block, Wolff- heart disease. In excluded subjects, one at Lown’s grade Parkinson-White syndrome), who were taking 3 had neither symptoms nor heart disease and another at antiarrhythmics drugs or who showed poorly recorded Lown’s grade 4A had symptoms and ischemic heart ECG tracing were excluded from the study population. disease. Subjects corresponding to Lown’s grades14) 2–5 were also 135 subjects had the LBBB pattern without axis excluded. The QRS complexes were diagnosed as PVCs deviation, 29 had the LBBB pattern with left axis not by automatic data processing, but by physicians deviation, 22 had the RBBB pattern without axis deviation according to the following criteria: (1) premature, (2) not and 15 had the RBBB pattern with left axis deviation. preceded by a premature P wave, (3) with a duration of Of the 201 subjects, 25 had symptoms associated with 0.12 s or greater and (4) with a different morphology PVCs and 176 were asymptomatic. Of the 25 subjects from the dominant rhythm13). The RBBB pattern was with symptoms, 11 had heart disease and 29 did not. Of diagnosed when there was a QRS duration of 0.12 s or the 176 asymptomatic subjects, 29 had heart disease and greater with a QR, RSR’ or RR’ pattern in the V1 lead15). 147 did not (Table 2). The asymptomatic subjects had a The LBBB pattern was diagnosed when there was a QRS lower incidence of heart disease than the symptomatic duration of 0.12 s or greater and a predominantly negative subjects (p<0.05). QRS complex with a terminal S wave in the V1 lead16). Of the 135 subjects with the LBBB pattern without The mean electrical axis deviation was measured in the axis deviation, 16 had symptoms related to PVCs and QRS complex, and the QRS frontal-plane vector, between 119 had no symptoms. Of the 29 subjects with the LBBB –30° and –90°, was defined as left axis deviation17, 18). pattern with left axis deviation, 4 had symptoms and 25 Subjects were placed into the following four categories, had no symptoms. Of the 22 subjects with the RBBB based on their PVC patterns and electrical axis deviation: pattern without axis deviation, 3 were symptomatic and (1) LBBB pattern without axis deviation, (2) LBBB 19 were asymptomatic. Of the 15 subjects with the RBBB pattern with left axis deviation, (3) RBBB pattern without pattern with left axis deviation, 2 were symptomatic and axis deviation, (4) RBBB pattern with left axis deviation. 13 were asymptomatic. There was no significant The presence or absence of heart disease was also difference between the categories regarding the presence Kazuhito HATANAKA, et al.: Association between PVC Patterns and Heart Disease 345 Table 2. Association between symptoms and heart diseases Subjects Symptomatic (%) Asymptomatic (%) Total Heart diseases 11 (44.0) 29 (16.5) 40 No heart diseases 14 (56.0) 147 (83.5) 161 Total 25 176 201 χ2=13.1 (p<0.05) Table 3. Association between PVC patterns and symptoms Pattern of PVCs Subjects LBBB without LBBB with RBBB without RBBB with Total AD (%) LAD (%) AD (%) LAD (%) Symptomatic 16 (11.9) 4 (13.8) 3 (13.6) 2 (13.3) 25 Asymptomatic 119 (88.1) 25 (86.2) 19 (86.4) 13 (86.7) 176 Total 135 29 22 15 201 χ2=0.168 (N.S.) Abbreviations: PVCs=premature ventricular contractions; LBBB=left bundle branch block; RBBB=right bundle branch block; AD=axis deviation; LAD=left axis deviation.
Recommended publications
  • Cardiology-EKG Michael Bradley

    Cardiology-EKG Michael Bradley

    Cardiology/EKG Board Review Michael J. Bradley D.O. DME/Program Director Family Medicine Residency Objectives • Review general method for EKG interpretation • Review specific points of “data gathering” and “diagnoses” on EKG • Review treatment considerations • Review clinical cases/EKG’s • Board exam considerations EKG EKG – 12 Leads • Anterior Leads - V1, V2, V3, V4 • Inferior Leads – II, III, aVF • Left Lateral Leads – I, aVL, V5, V6 • Right Leads – aVR, V1 11 Step Method for Reading EKG’s • “Data Gathering” – steps 1-4 – 1. Standardization – make sure paper and paper speed is standardized – 2. Heart Rate – 3. Intervals – PR, QT, QRS width – 4. Axis – normal vs. deviation 11 Step Method for Reading EKG’s • “Diagnoses” – 5. Rhythm – 6. Atrioventricular (AV) Block Disturbances – 7. Bundle Branch Block or Hemiblock of – 8. Preexcitation Conduction – 9. Enlargement and Hypertrophy – 10. Coronary Artery Disease – 11. Utter Confusion • The Only EKG Book You’ll Ever Need Malcolm S. Thaler, MD Heart Rate • Regular Rhythms Heart Rate • Irregular Rhythms Intervals • Measure length of PR interval, QT interval, width of P wave, QRS complex QTc • QTc = QT interval corrected for heart rate – Uses Bazett’s Formula or Fridericia’s Formula • Long QT syndrome – inherited or acquired (>75 meds); torsades de ponites/VF; syncope, seizures, sudden death Axis Rhythm • 4 Questions – 1. Are normal P waves present? – 2. Are QRS complexes narrow or wide (≤ or ≥ 0.12)? – 3. What is relationship between P waves and QRS complexes? – 4. Is rhythm regular or irregular?
  • Abnormalities Caused by Left Bundle Branch Block - Print Article - JAAPA

    Abnormalities Caused by Left Bundle Branch Block - Print Article - JAAPA

    Marquette University e-Publications@Marquette Physician Assistant Studies Faculty Research and Physician Assistant Studies, Department Publications 12-17-2010 Abnormalities Caused by Left undB le Branch Block James F. Ginter Aurora Cardiovascular Services Patrick Loftis Marquette University, [email protected] Published version. Journal of the American Academy of Physician Assistants, Vol. 23, No. 12 (December 2010). Permalink. © 2010, American Academy of Physician Assistants and Haymarket Media Inc. Useded with permission. Abnormalities caused by left bundle branch block - Print Article - JAAPA http://www.jaapa.com/abnormalities-caused-by-left-bundle-branch-block/... << Return to Abnormalities caused by left bundle branch block James F. Ginter, MPAS, PA-C, Patrick Loftis, PA-C, MPAS, RN December 17 2010 One of the keys to achieving maximal cardiac output is simultaneous contraction of the atria followed by simultaneous contraction of the ventricles. The cardiac conduction system (Figure 1) coordinates the polarization and contraction of the heart chambers. As reviewed in the earlier segment of this department on right bundle branch block (RBBB), the process begins with a stimulus from the sinoatrial (SA) node. The stimulus is then slowed in the atrioventricular (AV) node, allowing complete contraction of the atria. From there, the stimulus proceeds to the His bundle and then to the left and right bundle branches. The bundle branches are responsible for delivering the stimulus to the Purkinje fibers of the left and right ventricles at the same speed, which allows simultaneous contraction of the ventricles. Bundle branch blocks are common disorders of the cardiac conduction system. They can affect the right bundle, the left bundle, or one of its branches (fascicular block), or they may occur in combination.
  • Parasystole in a Mahaim Accessory Pathway

    Parasystole in a Mahaim Accessory Pathway

    223 Case Report Parasystole in a Mahaim Accessory Pathway Chandramohan Ramasamy MD, Senthil Kumar MD, Raja J Selvaraj MD, DNB Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India Address for Correspondence: Dr. Raja J Selvaraj, Assistant Professor of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605006, India. E-Mail: [email protected] Abstract Automaticity has been described in Mahaim pathways, both spontaneously and during radiofrequency ablation. We describe an unusual case of automatic rhythm from a Mahaim pathway presenting as parasystole. The parasystolic beats were also found to initiate tachycardia, resulting in initial presentation with incessant tachycardia and tachycardia induced cardiomyopathy. Key words: Mahaim tachycardia, Parasystole, Automaticity Introduction Mahaim pathways are atriofascicular accessory pathways with decremental, anterograde only conduction. The most common clinical manifestation related to these pathways is antidromic reentrant tachycardia. Less commonly, the pathway may be a bystander with atrioventricular nodal reentrant tachycardia or atrial tachycardia. Rarely, automaticity has been reported from the pathway, manifesting as ectopic beats during sinus rhythm or as an automatic tachycardia [1,2]. Parasystole is a condition where an ectopic focus is unaffected by the underlying rhythm due to entrance block. Parasystole has been reported from atrial musculature, ventricular musculature
  • Brugada Syndrome Associated to Myocardial Ischemia Sindrome De Brugada Associado a Isquemia Miocárdica

    Brugada Syndrome Associated to Myocardial Ischemia Sindrome De Brugada Associado a Isquemia Miocárdica

    Brugada syndrome associated to Myocardial ischemia Sindrome de Brugada associado a isquemia miocárdica Case of Dr Raimundo Barbosa Barros From Fortaleza - Ceará - Brazil Caro amigo Dr. Andrés Gostaria de ouvir a opinião dos colegas do foro sobre este paciente masculino 56anos internado na emergência do nosso hospital dia 03 de Novembro de 2010. Relata que em abril deste ano foi internado por quadro clínico compatível com angina instável (ECG1). Na ocasião foi submetido à coronariografia que revelou lesão crítica proximal da arteria descendente anterior e lesão de 90% na porção distal da artéria coronária direita. Nesta ocasião realizou angioplastia com colocação de stent apenas na artéria descendente anterior ( ECG2 pós ATC) A artéria coronaria direita não foi abordada. O paciente evoluiu assintomático(ECG3). Em 20/09/2010 realizou cintilografia miocárdica de rotina que resultou normal. No dia 03 de novembro de 2010 procura emergência refirindo ter sofrido episódio de sincope precedido de palpitações rápidas e desconforto torácico atípico.(ECGs 4 e 5). Adicionalmente, informa que 4 horas antes da sua admissão havia apresentado febre (não documentada). Não há relato de episódio prévio semelhante ou história familiar positiva para Morte súbita em familiar jovem de primeiro grau. Dosagem seriada de CK-MB e troponina normais. Qual os diagnósticos ECGs e qual a conduta? Um abraço para todos Raimundo Barbosa Barros Fortaleza Ceará Brasil Dear friend, Dr. Andrés, I would like to know the opinion from the colleagues of the forum about this patient (male, 56 years old), admitted in the ER of our hospital, on November 3rd, 2010. He claims that in April of this year he was admitted with symptoms of unstable angina (ECG1).
  • Postural Heart Block*

    Postural Heart Block*

    Br Heart J: first published as 10.1136/hrt.44.2.221 on 1 August 1980. Downloaded from Case reports Br Heart J 1980; 44: 221-3 Postural heart block* PETER E SEDA, JOHN H McANULTY, C JOE ANDERSON From the Department of Medicine, University of Oregon Health Sciences Center, Portland, Oregon, USA SUMMARY A patient presented with orthostatic dizziness and syncope caused by postural heart block. When the patient was supine, atrioventricular conduction was normal and he was asymptomatic; when he was standing he developed second degree type II block and symptoms. The left bundle-branch block on his electrocardiogram and intracardiac electrophysiological study findings suggest that this heart block occurred distal to the His bundle. Orthostatic symptoms are usually presumed to be secondary to an inappropriate distribution of intravascular volume or to autonomic nervous system abnormalities. As shown in this patient, these symptoms may be the result of orthostatic heart block. Ambulatory monitoring may be useful in patients with orthostatic neurological symptoms, particularly when conduction abnormalities are present on the electrocardiogram. Orthostatic neurological symptoms usually result minute and regular, and increased to 90 beats a from inadequate cerebral perfusion caused by minute with some irregularity when he was upright. disturbances of the autonomic nervous system,'-3 The carotid pulse was normal, and there were no ineffective or inappropriate shifts in volume carotid bruits. The cardiac impulse was normal. http://heart.bmj.com/ distribution,4 or drugs.5 We report a patient with The second heart sound was paradoxically split. orthostatic dizziness and syncope caused by inter- There was a grade 2/6 apical systolic murmur.
  • Young Adults. Look for ST Elevation, Tall QRS Voltage, "Fishhook" Deformity at the J Point, and Prominent T Waves

    Young Adults. Look for ST Elevation, Tall QRS Voltage, "Fishhook" Deformity at the J Point, and Prominent T Waves

    EKG Abnormalities I. Early repolarization abnormality: A. A normal variant. Early repolarization is most often seen in healthy young adults. Look for ST elevation, tall QRS voltage, "fishhook" deformity at the J point, and prominent T waves. ST segment elevation is maximal in leads with tallest R waves. Note high take off of the ST segment in leads V4-6; the ST elevation in V2-3 is generally seen in most normal ECG's; the ST elevation in V2- 6 is concave upwards, another characteristic of this normal variant. Characteristics’ of early repolarization • notching or slurring of the terminal portion of the QRS wave • symmetric concordant T waves of large amplitude • relative temporal stability • most commonly presents in the precordial leads but often associated with it is less pronounced ST segment elevation in the limb leads To differentiate from anterior MI • the initial part of the ST segment is usually flat or convex upward in AMI • reciprocal ST depression may be present in AMI but not in early repolarization • ST segments in early repolarization are usually <2 mm (but have been reported up to 4 mm) To differentiate from pericarditis • the ST changes are more widespread in pericarditis • the T wave is normal in pericarditis • the ratio of the degree of ST elevation (measured using the PR segment as the baseline) to the height of the T wave is greater than 0.25 in V6 in pericarditis. 1 II. Acute Pericarditis: Stage 1 Pericarditis Changes A. Timing 1. Onset: Day 2-3 2. Duration: Up to 2 weeks B. Findings 1.
  • 'Pseudo'- Syndromes in Cardiology

    'Pseudo'- Syndromes in Cardiology

    Blood, Heart and Circulation Review Article ISSN: 2515-091X Review: ‘Pseudo’- syndromes in cardiology Mishra A1, Mishra S2 and Mishra JP2* 1Georgetown University, Washington, DC, USA 2Upstate Cardiology, Summit St, Batavia, New York, USA Abstract The term ‘pseudo’ means ‘false’, ‘pretended’, ‘unreal’, or ‘sham’ and it is likely to be of Greek origin, pseudes means false. There are a number of ‘pseudo’ terms and syndromes that we see in the practice of cardiology. Even though the meaning of pseudo is unreal or sham, however these syndromes are true entities as described below. These terms appear more ‘mimicking’ a diagnosis than being truly ‘sham’! We attempted to put together most of the ‘pseudo’-diagnoses under one heading for reference and convenience. However, every condition cannot be described here in full details and the references are available for further studies. Takotsubo cardiomyopathy (Pseudo acute myocardial • Minimal or no cardiac enzyme elevation. infarction) • No significant ST-elevation (<1 mm). This condition was first described in patients in Japan in 1990 • No pathological Q waves in precordial leads. presenting and mimicking as acute coronary syndrome (ACS) with chest pains, ST changes on ECG and mild cardiac enzyme elevation • Deeply inverted or biphasic T waves in V2-3 or sometimes V4-6. consistent otherwise with acute myocardial infarction (AMI). Imaging These changes seen during pain-free period. studies show LV apical ballooning and therefore being called Takotsubo Similar changes can be seen in the setting of chest pains along cardiomyopathy (meaning “Octopus pot”) However, coronary with above noted criteria, however without having any critical LAD angiography in these patients will at best reveal mild atherosclerosis [1].
  • Clinical Implications of Electrocardiographic Bundle Branch Block in Primary Care

    Clinical Implications of Electrocardiographic Bundle Branch Block in Primary Care

    Cardiac risk factors and prevention ORIGINAL RESEARCH ARTICLE Heart: first published as 10.1136/heartjnl-2018-314295 on 25 May 2019. Downloaded from Clinical implications of electrocardiographic bundle branch block in primary care Peter Vibe Rasmussen, 1,2 Morten Wagner Skov,2,3 Jonas Ghouse,2,3 Adrian Pietersen,4 Steen Møller Hansen,5 Christian Torp-Pedersen,5,6 Lars Køber,3,7 Stig Haunsø,2,3,7 Morten Salling Olesen,2,8 Jesper Hastrup Svendsen,3,7 Jacob Melgaard,6 Claus Graff,6 Anders Gaardsdal Holst,3,9 Jonas Bille Nielsen2,10,11 ► Additional material is ABSTRact In the primary care setting, patients are referred published online only. To view Objectives Electrocardiographic bundle branch block for 12-lead standard ECG recording based on a please visit the journal online broad range of indications, ranging from typical (http:// dx. doi. org/ 10. 1136/ (BBB) is common but the prognostic implications in heartjnl- 2018- 314295). primary care are unclear. We sought to investigate the symptoms of CV disease to more diffuse symptoms relationship between electrocardiographic BBB subtypes as well as monitoring of medical treatment (eg, QTc For numbered affiliations see and the risk of cardiovascular (CV) outcomes in a primary interval-prolonging drugs) or as part of a routine end of article. care population free of major CV disease. health check. Opportunistic ECG recordings Methods Retrospective cohort study of primary care will often result in identification of various BBB Correspondence to subtypes. However, to the best of our knowledge, Peter Vibe Rasmussen, patients referred for electrocardiogram (ECG) recording Department of Cardiology, between 2001 and 2011.
  • Intra-His Bundle Block. Clinical, Electrocardiographic, and Electrophysiologic Characteristics

    Intra-His Bundle Block. Clinical, Electrocardiographic, and Electrophysiologic Characteristics

    Andréa et al OriginalArq Bras Article Cardiol Intra-His bundle 2002; 79: 532-7. Intra-His Bundle Block. Clinical, Electrocardiographic, and Electrophysiologic Characteristics Eduardo M. Andréa, Jacob Atié, Washington A. Maciel, Nilson A. de Oliveira Jr, Luiz Eduardo Camanho, Luís Gustavo Belo, Hecio Affonso de Carvalho, Leonardo Siqueira, Eduardo Saad, Ana Claudia Venancio Rio de Janeiro, RJ - Brazil Objective - To assess the clinical, electrocardiogra- Atrioventricular block is a conduction disturbance at phic, and electrophysiologic characteristics of patients the axis formed by the atrium, AV node, His bundle, and its (pt) with intra-His bundle block undergoing an electro- branches, which may vary from a mild delay in conduction physiologic study (EPS). (first-degree atrioventricular block) to a conduction block between atria and ventricles (second- and third-degree Methods - We analyzed the characteristics of 16 pt with atrioventricular blocks) 1. second-degree atrioventricular block and symptoms of Atrioventricular block may occur at the 3 following syncope or dyspnea, or both, undergoing conventional EPS. electrophysiological levels: atrioventricular node, within 2 Results - Intra-His bundle block was documented in 16 the His bundle, and below the His bundle . These levels pt during an EPS. In 15 (94%) pt, the atrioventricular block have anatomical correlation with, respectively, the atrioven- was recorded in sinus rhythm; 4 (25%) pt had intra-His tricular node, the penetrating His bundle (within the central Wenckebach phenomenon, which correlated with Mobitz I fibrous body), and nonpenetrating His bundle (out of the (MI) atrioventricular block on the electrocardiogram. Seven central fibrous body). First-degree atrioventricular block (44%) pt had 2:1 atrioventricular block, 2 of whom were usually has a delay in the conduction within the atrioventri- asymptomatic (12.5%).
  • Abnormal ECG Findings in Athletes Normal ECG

    Abnormal ECG Findings in Athletes Normal ECG

    SEATTLE CRITERIA Abnormal ECG findings in athletes These ECG findings are unrelated to regular training or expected physiologic adaptation to exercise, may suggest the presence of pathologic cardiovascular disease, and require further diagnostic evaluation. Abnormal ECG finding Definition T wave inversion > 1 mm in depth in two or more leads V2-V6, II and aVF, or I and aVL (excludes III, aVR, and V1) ST segment depression ≥ 0.5 mm in depth in two or more leads Pathologic Q waves > 3 mm in depth or > 40 ms in duration in two or more leads (except III and aVR) Complete left bundle branch block QRS ≥ 120 ms, predominantly negative QRS complex in lead V1 (QS or rS), and upright monophasic R wave in leads I and V6 Intra-ventricular conduction delay Any QRS duration ≥ 140 ms Left axis deviation -30° to -90° Left atrial enlargement Prolonged P wave duration of > 120 ms in leads I or II with negative portion of the P wave ≥ 1 mm in depth and ≥ 40 ms in duration in lead V1 Right ventricular hypertrophy R-V1 + S-V5 > 10.5 mm and right axis deviation > 120° pattern Ventricular pre-excitation PR interval < 120 ms with a delta wave (slurred upstroke in the QRS complex) and wide QRS (> 120 ms) Long QT interval* QTc ≥ 470 ms (male) QTc ≥ 480 ms (female) QTc ≥ 500 ms (marked QT prolongation) Short QT interval* QTc ≤ 320 ms Brugada-like ECG pattern High take-off and downsloping ST segment elevation followed by a negative T wave in ≥ 2 leads in V1-V3 Profound sinus bradycardia < 30 BPM or sinus pauses ≥ 3 sec Mobitz type II 2° AV block Intermittently non-conducted P waves not preceded by PR prolongation and not followed by PR shortening 3° AV block Complete heart block Atrial tachyarrhythmias Supraventricular tachycardia, atrial fibrillation, atrial flutter Premature ventricular contractions ≥ 2 PVCs per 10 second tracing Ventricular arrhythmias Couplets, triplets, and non-sustained ventricular tachycardia *The QT interval corrected for heart rate is ideally measured with heart rates of 60-90 bpm.
  • Electrocardiography in Aortic Regurgitation: It's in the Details

    Electrocardiography in Aortic Regurgitation: It's in the Details

    THE CLINICAL PICTURE SRIDHAR VENKATACHALAM, MD, MRCP CURTIS M. RIMMERMAN, MD, MBA Department of Hospital Medicine, Cleveland Clinic Gus P. Karos Chair, Clinical Cardiovascular Medicine, Department of Cardiovascular Medicine, Cleveland Clinic The Clinical Picture Electrocardiography in aortic regurgitation: It’s in the details Although not routinely reported, the negative U wave indicates underlying FIGURE 1. The patient’s 12-lead electrocardiogram shows normal sinus rhythm and a rate of 55 beats per minute. The frontal-plane QRS complex vector is deviated leftward. Left atrial abnor- structural or mality is present, given the terminally negative P wave in lead V1 and the bifid P wave in lead II. ischemic heart Left ventricular volume overload is supported by the following findings: increased QRS complex voltage, best seen in the precordial (chest) leads, indicative of increased left ventricular mass; disease prominent septal depolarization, as reflected by Q waves in leads 4V to V6; the absence of an ST- segment or T-wave abnormality; and negative U waves in leads V4 to V6 (arrows). 72-year-old man with a 15-year history taking any cardiac drugs, and his health has A of a heart murmur presents to his cardi- previously been excellent. ologist with shortness of breath on exertion On physical examination, his pulse rate is over the past 12 months. He otherwise feels regular at 55 beats per minute, and his blood well and reports no chest discomfort, palpita- pressure is 178/66 mm Hg. Cardiac ausculta- tions, or swelling of his legs or feet. He is not tion reveals an early- to mid-diastolic murmur heard best with the patient seated and leaning doi:10.3949/ccjm.78a.10141 forward, and located at the left sternal border; CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 78 • NUMBER 8 AUGUST 2011 505 Downloaded from www.ccjm.org on October 2, 2021.
  • ST-Segment Elevation in Conditions Other Than Acute Myocardial Infarction

    ST-Segment Elevation in Conditions Other Than Acute Myocardial Infarction

    The new england journal of medicine review article current concepts ST-Segment Elevation in Conditions Other Than Acute Myocardial Infarction Kyuhyun Wang, M.D., Richard W. Asinger, M.D., and Henry J.L. Marriott, M.D. From the Hennepin County Medical Cen- cute myocardial infarction resulting from an occlusive ter, University of Minnesota, Minneapolis thrombus is recognized on an electrocardiogram by ST-segment elevation.1 (K.W., R.W.A.); and the University of South a 2-4 Florida, Tampa (H.J.L.M.). Address reprint Early reperfusion therapy has proved beneficial in such infarctions. The requests to Dr. Wang at the Hennepin earlier the reperfusion, the greater the benefit, and the time to treatment is now consid- County Medical Center, Cardiology Division, ered to indicate the quality of care. These days, when thrombolytic treatment and per- 701 Park Ave., MC 865A, Minneapolis, MN 55415. cutaneous intervention are carried out so readily, it is important to remember that acute infarction is not the only cause of ST-segment elevation. The purpose of this review is N Engl J Med 2003;349:2128-35. to describe other conditions that mimic infarction and emphasize the electrocardio- Copyright © 2003 Massachusetts Medical Society. graphic clues that can be used to differentiate them from true infarction. normal st-segment elevation and normal variants The level of the ST segment should be measured in relation to the end of the PR seg- ment, not the TP segment.5 In this way, ST-segment deviation can still be detected ac- curately, even if the TP segment is not present because the P wave is superimposed on the T wave during sinus tachycardia or if the PR segment is depressed or there is a prominent atrial repolarization (Ta) wave.