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The axis
Published in Andrew R Houghton, Making Sense of the ECG, 2019
Right axis deviation is a feature of dextrocardia (in which the heart lies on the right side of the chest instead of the left), but the most obvious abnormality is that all the chest leads have ‘right ventricular’ QRS complexes (see Figure 14.6). Dextrocardia is discussed in more detail in Chapter 14.
Cardiogenic shock
Published in Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins, The Junior Doctor’s Guide to Cardiology, 2017
Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins
PE. Sinus tachycardia is the most common feature. There may be signs of right heart strain, such as right axis deviation or ST-segment changes in V1 and V2. The classically described SIQmTm is uncommon.
The axis
Published in Andrew R Houghton, David Gray, Making Sense of the ECG, 2014
Right axis deviation is a feature of dextrocardia (in which the heart lies on the right side of the chest instead of the left), but the most obvious abnormality is that all the chest leads have ‘right ventricular’ QRS complexes (see Fig. 14.6, p. 150). Dextrocardia is discussed in more detail on page 149.
Concurrent onset of acute lupus myocarditis, pulmonary arterial hypertension and digital gangrene in a lupus patient: a possible role of vasculitis to the rare disorders
Published in Modern Rheumatology Case Reports, 2020
Takayasu Ando, Yoshioki Yamasaki, Yukiko Takakuwa, Harunobu Iida, Yusa Asari, Kanako Suzuki, Marina Uchida, Nozomi Kotoku, Yasuhiro Tanabe, Motohiro Chosokabe, Masahide Takahashi, Kengo Suzuki, Yoshihiro J. Akashi, Hidehiro Yamada, Kimito Kawahata
A chest X-ray image demonstrated cardiomegaly (cardiothoracic ratio = 60.7%) and enlargement of the pulmonary arteries (Figure 2(A)). Electrocardiography was consistent with right axis deviation (Figure 1(C)). Pulmonary embolus study by CT showed no evidence of a thrombus in the pulmonary vasculature. Echocardiography showed evidence of left heart failure with diffuse left ventricular (LV) hypokinesis and a reduced LV EF of 28% with LV eccentric hypertrophy. Tricuspid annular plane systolic excursion (TAPSE) was decreased to 11.8 (normal >16) mm. These results suggested the presence of both right and left heart failure (Table 1). A pericardial effusion was also seen. The tricuspid regurgitation pressure gradient (TRPG) test performed on admission could not provide an adequate result because of the severe cardiac dysfunction and tachycardia. The scintigraphy with Tl and beta-methyl iodophenyl-pentadecanoic acid (BMIPP) showed patchy defects that were not explained by coronary disease, but were compatible with myocarditis (Figure 1(D)).
Simple screening tools predict death and cardiovascular events in patients with rheumatic disease
Published in Scandinavian Journal of Rheumatology, 2018
M Breunig, S Kleinert, S Lehmann, C Kneitz, M Feuchtenberger, H-P Tony, CE Angermann, G Ertl, S Störk
Each patient underwent a thorough physical examination and a structured interview concerning medical, cardiac, and rheumatological history, cardiovascular risk factors including family history (first degree relatives), as well as present and former medication. Blood and urine samples were taken for routine laboratory testing. A standard 12-lead ECG was performed and the following criteria were determined as pathological: left axis deviation or vertical axis type or right axis deviationatrial fibrillation or flutterpacemaker ECGconduction defects (first, second, or third degree atrioventricular block)complete/incomplete left or right bundle branch blockST-segment abnormalities including those suggesting myocardial ischaemia (i.e. absent R, Qs, QTc time > 440 ms, significant ST elevation/depression, negative T)pathological Sokolow–Lyon Indexother pathological patterns.
Is kratom (Mitragyna speciosa Korth.) use associated with ECG abnormalities? Electrocardiogram comparisons between regular kratom users and controls
Published in Clinical Toxicology, 2021
Mohammad Farris Iman Leong Abdullah, Kok Leng Tan, Suresh Narayanan, Novline Yuvashnee, Nelson Jeng Yeou Chear, Darshan Singh, Oliver Grundmann, Jack E. Henningfield
All participants were required to undergo an ECG test at resting state under the supervision of a cardiologist. The ECG findings of all the participants were interpreted by the cardiologist. We defined ECG abnormalities in this study as follows: first-degree heart block was defined as the prolongation of the PR interval (the distance between the onset of the atrial depolarisation [P wave] to the beginning of the ventricular depolarisation [QRS complex], which is more than 200 ms and without any missed beats) [20,21]. Sinus tachycardia was reported if the heart rate was greater than 100 beats per minute with regular heart rhythm and a normal P wave (upright, normal morphology and consistent) [22]. Sinus bradycardia was defined as a resting heart rate of fewer than 60 beats per minute with regular heart rhythm and a normal P wave (upright, normal morphology and consistent) [23]. T-wave negativity was reported if the T wave in the ECG showed a negative voltage of ≥10 mm in any lead [24]. The complete right bundle branch block was documented if the QRS duration was greater than 120 ms with leads V1 and V2 having RSR. An incomplete right bundle branch block was documented if the QRS duration was less than 120 ms with leads V1 and V2 having RSR [25]. Left axis deviation was defined when lead I was positive but lead aVF was negative (0° to −90°), and right axis deviation was defined when lead I was negative and lead aVF was positive (+90° to +180°) according to the quadrant or two-lead approach [26]. Left ventricular hypertrophy was identified based on the Sokolow–Lyon criteria (i.e., the summation of S wave depth in V1 and tallest R wave in V5–V6 was more than 35 mm) [27]. A normal corrected QT (QTc) interval in male subjects was defined as up to 430 ms, while a QTc interval above 450 ms was considered abnormal or prolonged [28]. The QTc interval was calculated using Bazett’s formula.