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Cardiovascular medicine
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
The following ECG changes may be seen in hypothermia: bradycardia‘J’ wave – small hump at the end of the QRS complexfirst degree heart blocklong QT intervalatrial and ventricular arrhythmias
Practice Paper 2: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
This patient is hypothermic secondary to prolonged environmental exposure. Severe hypothermia can lead to coagulopathy, bradycardia, heart failure, arrhythmia and death. The ECG in severely affected patients may show an upward deflection following the R-wave of the QRS complex (J-wave). Patients with hypothermia should be re-warmed slowly at a rate no greater than 0.5°C/h, as rapid re-warming can cause vasodilatation, hypotension and circulatory collapse. Methods of re-warming include removal of wet clothing, supplying warmed humidified oxygen, applying a bear hugger device and infusing warm saline intravenously. More invasive methods of re-warming include peritoneal, pleural and bladder lavage with warmed fluid. Due to the risk of arrhythmia, hypothermic patients should be managed on a cardiac and blood pressure monitor.
The ST segment
Published in Andrew R Houghton, David Gray, Making Sense of the ECG, 2014
The J wave is a small positive deflection at the junction between the QRS complex and the ST segment (Fig. 15.18) and is usually best seen in the inferior limb leads and the lateral chest leads.
Brugada syndrome
Published in Acta Cardiologica, 2021
Haarika Korlipara, Giridhar Korlipara, Srinivas Pentyala
A drug provocation test using a sodium channel blocker (SCB) such as procainamide, ajmaline and flecainide can help to unmask a type-1 ECG pattern in BrS patients who present with a normal/nondiagnostic baseline ECG [56]. However, it is important to consider that false positives are possible in asymptomatic patients with drug-induced type-1 ECG who don’t have underlying BrS, and the reported arrhythmic risk in such subjects is very low [10]. For example, a patient surviving an explained nocturnal cardiac arrest with a finding of drug-induced type-1 Brugada pattern has a higher pre-test probability of having BrS compared to an asymptomatic patient with a negative family history referred by because of a baseline type-2 pattern who has a lower pre-test probability of having BrS [1]. Therefore, the 2016 Expert Consensus document on J-wave syndromes proposed that the diagnosis of ‘true’ BrS should be supported by the other clinical characteristics mentioned above [57].
Early repolarization pattern in the coronary slow flow phenomenon
Published in Scandinavian Cardiovascular Journal, 2018
Murat Sucu, Berzal Ucaman, Gökhan Altunbas
We used 12-lead surface ECG tracings, with the paper speed and amplitude set at 25 mm/s and 10mm/mV, respectively. Two independent investigators manually took measurements from all ECG tracings. If possible, parameters were determined in all 12 leads, and the mean results were calculated from three consecutive cardiac cycles. The R–R interval, P–R interval, T-wave duration, and polarization were specifically measured, as was the ERP, which was defined as notching or slurring of the J point (Figure 1) [4]. The J-wave amplitude was measured from leads showing the highest J-point elevation, and J waves were considered present if deflections were present immediately after the end of the QRS complex in at least two contiguous ECG leads. This ECG finding is most frequently seen in the D2, D3, and aVF leads, but can also be seen in the V4, V5, V6, D1, or aVL leads [4,5]. The notching ERP subtype, defined as a positive J-wave deflection on the terminal QRS complex (or slurring), was considered present if there was a smooth transition from the terminal QRS complex to the ST segment [4].
Recent advances in the treatment of Brugada syndrome
Published in Expert Review of Cardiovascular Therapy, 2018
Mariana Argenziano, Charles Antzelevitch
Since BrS was first described in 1992, major advances have been realized with respect to diagnosis and management of the disease. The 2016 HRS/EHRA/APHRS/SOLAECE J-Wave Syndrome Consensus Report proposed a scoring system to facilitate diagnosis of BrS taking into account electrocardiographic recordings, genetic results, clinical characteristics, and family history. Recent studies have validated this approach. ICD implantation is considered the most effective means of preventing SCD in patients with BrS. Recently, subcutaneous ICDs (S-ICDs) are being implemented and are expected to be associated with fewer complications over a lifetime, especially in younger more active individuals. The important strides in the pharmacologic approach to therapy notwithstanding, there remains an urgent need for development of cardio-selective and ion-channel-specific Ito blockers for treatment of BrS. A reduction in Ito with or without a parallel augmentation of inward current secondary to an increase in ICa or slowed inactivation of INa are important targets for drug development. These pharmacological solutions are also expected to be of benefit in other J wave syndromes, including the ERS. Our group is currently evaluating the effectiveness of natural flavone acacetin and its congeners as safe and effective therapy of both BrS and ERS. Because Ito expression is modulated by hormonal factors, antiandrogen therapy may prove helpful in severe cases, pending further clinical evidence in support of this approach. We and others are currently evaluating the effectiveness of anti-androgen therapy in experimental models of BrS.