- Mild cough · wheezing · loud heart sounds · Dx? [Case Reports]
- JFJ Fam Pract 2018; 67(2):95-98
- A 25-year-old man, who was an active duty US Navy sailor, went to his ship's medical department complaining of a mild cough that he'd had for 2 days. He denied having any fevers, chills, night sweats...
A 25-year-old man, who was an active duty US Navy sailor, went to his ship's medical department complaining of a mild cough that he'd had for 2 days. He denied having any fevers, chills, night sweats, angina, or dyspnea. He said he hadn't experienced any exertional fatigue or difficulty completing the rigorous physical tasks of his occupation as an engineman on the ship. The patient had no medical or surgical history of significance, and he wasn't taking any medications or supplements. On exam, he was not in acute distress and his vital signs were within normal limits. Auscultation revealed mild wheezing throughout the upper lung fields and loud heart sounds throughout his chest that were audible even with gentle contact of the stethoscope diaphragm. He had no discernible murmurs, rubs, or gallops. In light of the unusually loud heart sounds heard on exam, we performed an electrocardiogram. The EKG revealed a normal sinus rhythm, slight right axis deviation indicated by tall R-waves in V1 (also suggestive of right ventricular hypertrophy), an incomplete right bundle branch block, and a crochetage sign (a notch in the R-waves of the inferior leads). A chest x-ray revealed a normal-sized heart and dilated pulmonary vasculature suggestive of pulmonary hypertension.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- One of the key steps in interpreting an electrocardiogram (EKG) is determining the electrical axis of the heart. Being able to determine the electrical axis can give insight into underlying disease s...
One of the key steps in interpreting an electrocardiogram (EKG) is determining the electrical axis of the heart. Being able to determine the electrical axis can give insight into underlying disease states and help steer the differential diagnosis towards or away from certain diagnoses. Herein, we will discuss what makes up the electrical axis, ventricular (QRS) axis, axis classifications, various approaches to determining the electrical axis, and causes of axis deviation.
- [Clinical and electrocardiographic aspect of pulmonary embolism masking aortic dissection revealed by thoracic CT angiography]. [Case Reports]
- PAPan Afr Med J 2017; 28:3
- We here report the case of a 52-year old hypertensive, obese woman (BMI 32,46 kg/m2) with a past history of smoking and without evidence-based risk factors of venous thromboembolism, hospitalized for...
We here report the case of a 52-year old hypertensive, obese woman (BMI 32,46 kg/m2) with a past history of smoking and without evidence-based risk factors of venous thromboembolism, hospitalized for left chest pain radiating to the dorsolumbar region associated with dyspnoea. Clinical examination on hopitalization showed left blood pressure 100/60 mmHg, tachycardia 100/min, oxygen desaturation index at 88% with the patient breathing ambient air, normal cardiopulmonary auscultation, peripheral pulses palpable and no symptoms of phlebitis of the lower limbs. The ECG showed right axis deviation, S1Q3 pattern, right ventricular hypertrophy and right bundle branch block (A, B, C). The patient underwent emergency thoracic CT angiography objectifying aortic dissection from the origin of the aorta to the iliac bifurcation (Stanford A). Our patient received medical care based on blood pressure and heart rate control as well as on analgesics, with good evolution in the absence of surgical means.
- Incidence rates, correlates, and prognosis of electrocardiographic P-wave abnormalities - a nationwide population-based study. [Journal Article]
- JEJ Electrocardiol 2017 Nov - Dec; 50(6):925-932
- CONCLUSIONS: Modifiable risk factors associate with P-wave abnormalities that are common and may represent intermediate steps of atrial cardiomyopathy on a pathway leading to AF.
- Mahaim Tachycardia Induced Cardiomyopathy. [Case Reports]
- JCJ Coll Physicians Surg Pak 2016; 26(11):S80-S82
- We present the case report of a 22-year man, with incessant palpitations, chest pain, shortness of breath, and pulsations in his neck for the past 7 months. He was referred to the cardiology unit for...
We present the case report of a 22-year man, with incessant palpitations, chest pain, shortness of breath, and pulsations in his neck for the past 7 months. He was referred to the cardiology unit for workup of wide complex tachycardia (WCT). His echocardiography, 6 months earlier, had demonstrated severe left ventricular (LV) systolic dysfunction, severe global hypokinesia, mild tricuspid regurgitation (TR), and mild mitral regurgitation (MR) which resolved with medical therapy including beta-blockers. He underwent electrophysiological study, which revealed a decremental right sided atriofascicular pathway causing a WCT with left bundle branch block (LBBB) morphology and left axis deviation (LAD, Mahaim tachycardia). This was successfully ablated by radiofrequency ablation (RF) with abolition of the tachycardia. This case report highlights Mahaim tachycardia induced cardiomyopathy, a rare but curable cause of cardiomyopathy.
- The value of electrocardiography in prognosticating clinical deterioration and mortality in acute pulmonary embolism: A systematic review and meta-analysis. [Review]
- CCClin Cardiol 2017; 40(10):814-824
- The role of electrocardiography (ECG) in prognosticating pulmonary embolism (PE) is increasingly recognized. ECG is quickly interpretable, noninvasive, inexpensive, and available in remote areas. We ...
The role of electrocardiography (ECG) in prognosticating pulmonary embolism (PE) is increasingly recognized. ECG is quickly interpretable, noninvasive, inexpensive, and available in remote areas. We hypothesized that ECG can provide useful information about PE prognostication. We searched MEDLINE, EMBASE, Google Scholar, Web of Science, abstracts, conference proceedings, and reference lists through February 2017. Eligible studies used ECG to prognosticate for the main outcomes of death and clinical deterioration or escalation of therapy. Two authors independently selected studies; disagreement was resolved by consensus. Ad hoc piloted forms were used to extract data and assess risk of bias. We used a random-effects model to pool relevant data in meta-analysis with odds ratios (ORs) and 95% confidence intervals (CIs); all other data were synthesized qualitatively. Statistical heterogeneity was assessed using the I2value. We included 39 studies (9198 patients) in the systematic review. There was agreement in study selection (κ: 0.91, 95% CI: 0.86-0.96). Most studies were retrospective; some did not appropriately control for confounders. ECG signs that were good predictors of a negative outcome included S1Q3T3 (OR: 3.38, 95% CI: 2.46-4.66, P < 0.001), complete right bundle branch block (OR: 3.90, 95% CI: 2.46-6.20, P < 0.001), T-wave inversion (OR: 1.62, 95% CI: 1.19-2.21, P = 0.002), right axis deviation (OR: 3.24, 95% CI: 1.86-5.64, P < 0.001), and atrial fibrillation (OR: 1.96, 95% CI: 1.45-2.67, P < 0.001) for in-hospital mortality. Several ischemic patterns also were significantly predictive. Our conclusion is that ECG is potentially valuable in prognostication of acute PE.
- Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi-Ethnic Study of Atherosclerosis. [Journal Article]
- JAJ Am Heart Assoc 2017 May 25; 6(6)
- CONCLUSIONS: Markers of ventricular repolarization and delayed ventricular activation are able to distinguish between the future risk of HFrEF and HFpEF. These findings suggest a role for ECG markers in the personalized risk assessment of heart failure subtypes.
- Double Chambered Right Ventricle: A Rare Diagnosis. [Case Reports]
- JAJ Assoc Physicians India 2017; 65(3):96-98
- A 27 years old female was admitted to our hospital with complaints of swelling of feet and abdomen, pain abdomen and exertional dyspnea from last 1 week. On examination she was found to have congesti...
A 27 years old female was admitted to our hospital with complaints of swelling of feet and abdomen, pain abdomen and exertional dyspnea from last 1 week. On examination she was found to have congestive heart failure. Chest x-ray revealed mild cardiomegaly with left pleural effusion and electrocardiography showed right axis deviation with right ventricular hypertrophy. By echocardiography she was diagnosed to have double chambered right ventricle without any other congenital heart anomaly. She was started on medical treatment following which she recovered well and she was advised for surgery. This case is unique as usually double chambered right ventricle is associated with other cardiac malformations, common ventricular septal defect, pulmonary stenosis and aortic stenosis but no such association was present in this case.
- The prevalence of electrocardiogram abnormalities in professional divers. [Journal Article]
- DHDiving Hyperb Med 2017; 47(1):55-58
- CONCLUSIONS: No serious ECG abnormalities were identified, but IRBBB should be further investigated because of its association with persistent (patent) foramen ovale. Rapid cardiological review of ECGs could be achieved using modern communications technology, such as telecardiography, and further clinical investigations directed by specialist recommendation arranged promptly if indicated.
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- Fascicular Ventricular Tachycardia Originating From Papillary Muscles: Purkinje Network Involvement in the Reentrant Circuit. [Journal Article]
- CACirc Arrhythm Electrophysiol 2017; 10(3)
- CONCLUSIONS: Reentrant circuit of verapamil-sensitive FVT can involve the Purkinje network lying around the PMs. PM-FVT is a distinct entity that is characterized by distinctive electrocardiographic characteristics and less sensitivity to verapamil administration compared with common type FVT. Ablation targeting the mid-diastolic Purkinje potentials around the PMs during tachycardia can be effective in suppressing this arrhythmia.