Practice Paper 2: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
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.
Cardiovascular medicine
Shibley Rahman, Avinash Sharma in A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
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
Reporting an ECG recording
Andrew R Houghton, David Gray in Making Sense of the ECG, 2014
Don’t overlook any additional features, such as: delta waveJ wave (Osborn wave).
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].
Atrial fibrillation in young patients
Published in Expert Review of Cardiovascular Therapy, 2018
Jean-Baptiste Gourraud, Paul Khairy, Sylvia Abadir, Rafik Tadros, Julia Cadrin-Tourigny, Laurent Macle, Katia Dyrda, Blandine Mondesert, Marc Dubuc, Peter G. Guerra, Bernard Thibault, Denis Roy, Mario Talajic, Lena Rivard
The link between J wave syndromes and AF is not well understood. A proposed pathophysiological mechanism postulates atrial vulnerability and increased dispersion of repolarization and refractoriness [43,44]. This hypothesis is supported by the KCNJ8-S422L mutation that has been associated with lone AF, BrS, and early repolarization syndrome [45–47]. This mutation induces gain of function in ATP-sensitive potassium channel current leading to shortening of the atrial action potential duration and increased atrial vulnerability [48].
Related Knowledge Centers
- Angina
- Calcium
- Hypercalcaemia
- Hypothermia
- Myocardial Infarction
- Vasospasm
- Brain
- Electrocardiography
- Qrs Complex
- St Segment