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Dilated Cardiomyopathy
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Marco Merlo, Alessia Paldino, Giulia De Angelis, Gianfranco Sinagra
Although DCM is not typically characterized by specific ECG findings, a careful analysis can provide several clues about the etiology as well as the duration of the disease. For example, dystrophin-related DCM is generally characterized by a “posterolateral pseudonecrosis” aspect, atrioventricular blocks can suggest a mutation in LMNA, and myotonic dystrophy and Emery Dreifuss disease can be associated with sinus bradycardia and atrial standstill.17 Left atrial enlargement is frequent in DCM and is usually an expression of a long-standing disease.48 Left bundle-branch block is usually a marker of long-standing disease with prognostic and therapeutic implications.49,50 In general, the ECG is important prognostically. Antero-lateral T-wave inversion, low QRS voltages, and fragmented QRS have been reported as independent predictors of death, heart transplantation, SCD, and malignant ventricular arrhythmias in a cohort of 414 patient with DCM.51,52
Arrhythmias
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
Left bundle branch block is usually associated with heart disease (hypertension, cardiomyopathy or coronary heart disease), a small proportion of patients may progress to complete heart block, and its prognosis depends on the underlying cardiac condition.
Practice Paper 5: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
The ECG findings in this scenario are classic for left bundle-branch block (LBBB). LBBB is always pathological, and is seen in ischaemic heart disease, myocardial infarction, hypertension and cardiomyopathy. In this scenario, it is likely to be a new finding secondary to acute myocardial infarction, in which case it is an indication for thrombolysis. Since the conduction down the left bundle branch is delayed, the QRS complex is prolonged (>0.12 s) and the myocardium depolarizes from right to left, producing dominant R-waves in V6. The subsequent delayed depolarization of the left ventricle produces deep S-waves in V1 and a further R-wave in V6, which completes the ‘M’ pattern in V6. It should be noted that LBBB makes interpretation of the remaining ECG impossible.
Use of Crotalidae equine immune F(ab’)2 antivenom for treatment of an Agkistrodon envenomation
Published in Clinical Toxicology, 2021
B. Z. Wilson, J. Larsen, G. Smelski, S. Dudley, F. M. Shirazi
During the patient’s hospitalization, his pain and swelling remained well controlled (Figure 2b). His fibrinogen remained stable but his platelets slowly declined to a nadir of 132,000/mm3 at 30 h post-envenomation at which point he was given an additional 4 vials of F(ab’)2AV (Figure 3). His troponin-I climbed to a peak of 0.65 mg/mL at 17 h post-envenomation. Serial electrocardiograms demonstrated an incomplete left bundle branch block with no ischemic or transient changes. Echocardiogram demonstrated impaired left ventricular function. He was evaluated by cardiology whom recommended medical management with beta-blocker and an angiotensin converting enzyme inhibitor. Due to concerns for coagulopathy, aspirin was initially deferred on admission but started prior to discharge. The patient’s creatinine peaked at 1.91 mg/dL, and declined to 1.73 mg/dL prior to discharge. The patient’s baseline creatinine was not available.
Duchenne muscular dystrophy: an overview to the cardiologist
Published in Expert Review of Cardiovascular Therapy, 2020
Fabio de Souza, Caroline Bittar Braune, Ana Paula Cassetta Dos Santos Nucera
The current guidelines published in 2018 by the DMD Care Considerations Working Group recommends cardiological evaluation since DMD diagnosis to identify incipient signs of heart disease. Follow-up should be annual for asymptomatic patients, becoming more frequent after the onset of symptoms or changes in imaging examinations [20]. Electrocardiographic evaluation is mandatory and irreplaceable for the cardiological evaluation of DMD patients. Changes on a traditional electrocardiogram include sinus tachycardia, short PR interval, increased amplitude of R waves in right precordial leads, electrical signs of right ventricular hypertrophy, and Q waves in left lateral and precordial leads (D1, aVL, V5, V6). Q waves are narrow and deep, differing from those found in patients with ischemic disease. Inappropriate sinus tachycardia is the most described finding [21]. It is also important to note that RSr’ pattern and high R waves in V1 can be common findings in children, with no association to heart disease [22,23]. However, the presence of left bundle branch block was associated with mortality in adult MV-dependent patients [24]. Significant arrhythmias in the 24-h Holter monitoring, including unsustainable atrial and ventricular tachycardia, were rare in patients with EF > 35%, with low clinical applicability in patients with preserved EF [25].
Complete atrioventricular block in a patient with systemic sclerosis
Published in Scandinavian Journal of Rheumatology, 2019
On physical examination, we noticed that his skin was firm and thickened. Waxy, taut skin was distributed over the upper extremities, face, and trunk. Lower extremity oedema was also noticed. Anti-topoisomerase-1 antibody was positive. He was diagnosed with diffuse SSc. Chest computed tomography (CT) showed interstitial pneumonia, right pleural effusion, and pericardial effusion (Figure 1A). An abdominal ultrasound test showed ascites. Brain natriuretic peptide (BNP) was 757.1 pg/mL. The heart rate ranged from 35 to 40 beats per minute. The echocardiogram showed right atrial and ventricular dilatation. There was a moderate degree of tricuspid regurgitation, with a pressure gradient of 26 mmHg. The electrocardiogram (ECG) showed complete left bundle branch block and complete A-V block (Figure 1B). During hospitalization, a permanent pacemaker was implanted (Figure 1C). Thereafter, palpitations have not recurred, dyspnoea has improved, and BNP has decreased to 261 pg/mL. The patient was then referred to the Department of Rheumatology and received cyclophosphamide and steroid treatment.