Right-ventricular enlargement in arrhythmogenic right-ventricular cardiomyopathy is associated with decreased QRS amplitudes and T-wave negativity.

BACKGROUND: Arrhythmogenic right-ventricular cardiomyopathy (ARVC) can lead to RV dilatation. We hypothesized that electrocardiographic characteristics including QRS amplitudes in the extremity- and precordial leads, the S amplitude in lead V1 , and extent of T-wave negativity over the precordial leads are related to RV dilatation in this condition. METHODS: In 42 ARVC patients and 42 controls, we correlated total QRS amplitude in the extremity leads (∑QRSext ), precordial leads (∑QRSprec ) and in all leads (∑QRStot : summation of ∑QRSext and ∑QRSprec ), S amplitude in lead V1 and the extent of T-wave inversion in the precordial leads (V1 vs. beyond V1 ) with RV end diastolic diameter (RVEDD) by echocardiography. RESULTS: In the ARVC group, the mean age was 46 ± 14 years, 31 patients were male, 28 had an implantable cardioverter defibrillator (ICD), and 7 had a LV ejection fraction (EF) < 55%. The control group was age- and gender matched to the ARVC cohort. In contrast to controls, the ∑QRSext (regression coefficient (RC), -0.29; P = 0.020), ∑QRSprec (RC, -0.20; P = 0.015), and ∑QRStot (RC, -0.14; P = 0.009) were lower with RV dilatation in ARVC. S amplitude in lead V1 was not related to RV diameter (RC, -0.98; P = 0.088). Precordial T-wave inversion beyond lead V1 (V2 -V6 ) was associated with a larger RV diameter (RC, 8.58; P = 0.012). CONCLUSIONS: Summed QRS amplitudes in the extremity and precordial leads, and T-wave inversion beyond lead V1 are associated with RV dilatation in patients with ARVC.

Septic patients arriving with emergency medical services: a seriously ill population.

OBJECTIVE: Sepsis is a serious condition with high mortality. Early treatment improves outcome and can be initiated by emergency medical services (EMS) personnel.The primary aim of our study was to investigate how many sepsis patients are transported by EMS to the internist at the emergency department (ED). The secondary aims were to compare these EMS patients with patients who arrived at the ED otherwise and to investigate how these patients were managed. We further investigated how often the diagnosis sepsis/infection was documented by EMS. PATIENTS AND METHODS: We retrospectively retrieved all ED and EMS data of patients with sepsis who were assessed by the internist between March 2011 and March 2012. RESULTS: Half (48.0%) of 654 sepsis patients were transported by EMS. These patients were more seriously ill (more severe grades of sepsis, more admittances to the hospital/ICU) than patients who were transported otherwise. Mortality within 28 days was 19.4% compared with 6.5% in the other patients. Nevertheless, half of the EMS transports were considered not urgent, even in 34.6% of the patients with septic shock. Assessment of vital signs was not routinely performed and treatment was started in only 43.6%. The diagnosis sepsis/infection was documented in 63.4% of patients. CONCLUSION: Half of the patients with sepsis arrive at the ED by EMS. These patients are seriously ill, and although these patients are likely to benefit from early treatment, they are often transported with nonurgent rides and both assessment of vital signs and early start of treatment are not routinely performed.