RESUMEN
A 69-year-old woman was admitted after a cardiac arrest. She developed status epilepticus and was later found to have variable morphologies of a "spiked helmet sign" (SHS) on ECGs in the setting of prolonged QT interval, raising the question of whether this sign is a manifestation of QT prolongation.
Asunto(s)
Electrocardiografía , Síndrome de QT Prolongado , Humanos , Femenino , Anciano , Síndrome de QT Prolongado/diagnóstico , Síndrome de QT Prolongado/fisiopatología , Diagnóstico Diferencial , Estado Epiléptico/etiología , Estado Epiléptico/diagnóstico , Paro Cardíaco/etiologíaRESUMEN
Wolff-Parkinson-White pattern is a relatively common electrocardiographic phenomenon caused by accessory atrioventricular (AV) conduction, which can make the diagnosis of acute myocardial infarction challenging. There is little existing literature regarding the interpretation of electrocardiograms in patients with accessory AV conduction pathways who present with acute myocardial infarction. We describe a case of electrocardiographic evolution of acute ST-segment elevation myocardial infarction in a patient with Wolff-Parkinson-White pattern, review pseudo-infarction patterns, and discuss proposed mechanisms for these repolarization abnormalities.
Asunto(s)
Fascículo Atrioventricular Accesorio , Infarto del Miocardio , Síndromes de Preexcitación , Síndrome de Wolff-Parkinson-White , Electrocardiografía , Humanos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Síndromes de Preexcitación/complicaciones , Síndromes de Preexcitación/diagnóstico , Síndrome de Wolff-Parkinson-White/complicaciones , Síndrome de Wolff-Parkinson-White/diagnósticoRESUMEN
High grade atrioventricular (AV) block, defined as 2 or more non-conducted P waves, is a common indication for permanent pacemaker implantation and can be a cause of syncope or presyncope. A 61â¯year-old male presented to the emergency department with presyncopal symptoms and high grade AV block confirmed on electrocardiogram. Continuous cardiac telemetry monitoring did not trigger any alarm notification during episodes of AV block, due to T wave overcounting. The limitations of telemetry monitoring are rarely recognized and even more rarely reported in the literature.
Asunto(s)
Bloqueo Atrioventricular/diagnóstico , Telemetría , Bloqueo Atrioventricular/terapia , Bradicardia/diagnóstico , Bradicardia/terapia , Diagnóstico Diferencial , Electrocardiografía , Humanos , Masculino , Persona de Mediana Edad , Marcapaso ArtificialRESUMEN
A 58-year-old male underwent ambulatory ECG monitoring with continuous patch monitoring (Zio XT Patch) for the complaint of episodic dyspnea. In the period of monitoring the patient suffered sudden cardiac death (SCD) with continuous ECG recording showing pronounced ST segment elevations followed by bradycardia and death. This report highlights the growing potential of continuous ST segment monitoring, and features the infrequent entity of ischemic electromechanical dissociation with bradyarrhythmia as a cause of SCD.
Asunto(s)
Arritmias Cardíacas/diagnóstico , Muerte Súbita Cardíaca , Electrocardiografía Ambulatoria , Resultado Fatal , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Narrow complex bigeminy is a common electrocardraphic finding that can be caused by second degree sinoatrial exit block or ectopic atrial bigeminy. These rhythms can be very challenging to distinguish on a 12-lead electrocardiogram. In this case of an elderly woman who presented with narrow complex bigeminy, we review the differentiating features of second degree sinoatrial exit block and ectopic atrial bigeminy.
Asunto(s)
Electrocardiografía/métodos , Bloqueo Sinoatrial/diagnóstico , Bloqueo Sinoatrial/fisiopatología , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Nodo Sinoatrial/fisiopatologíaAsunto(s)
Antiarrítmicos/efectos adversos , Aleteo Atrial/diagnóstico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Electrocardiografía/métodos , Flecainida/efectos adversos , Taquicardia Ventricular/tratamiento farmacológico , Anciano , Antiarrítmicos/uso terapéutico , Aleteo Atrial/etiología , Flecainida/uso terapéutico , Humanos , Masculino , Taquicardia Ventricular/diagnóstico , Privación de TratamientoRESUMEN
Syncope is common representing approximately 3% of ED visits and up to 6% of hospital admissions, with a cost close to 2 billion dollars per year. Diagnostic testing is often poorly sensitive and evaluations commonly lack a standardized approach. A mindful and systematic approach can increase sensitivity and improve diagnostic accuracy. A thorough history and physical exam is paramount, as conclusions drawn from the history and exam will guide further assessment. Developing a strategy for the first and, if necessary, subsequent tests will improve the accuracy of identifying the etiology of syncope and reduce cost. Although syncope has a favorable prognosis, identification of patients with structural heart disease is critical, as these patients are at greatest risk for mortality. Several risk scoring systems have been developed to help separate high risk from low risk patients.