Compare the Old and New ECG: Difference between revisions

Latest revision as of 18:37, 27 January 2010

Author(s)	J.S.S.G. de Jong, MD
Moderator	J.S.S.G. de Jong, MD
Supervisor
some notes about authorship

An abnormal ECG does not prove acute cardiac disease. And a normal ECG does not exclude cardiac disease. It is necessary therefore to compare new ECG with ECG's made in the past.

Hallmarks are:

Is there a change in rhythm?
Is there a change in frequency?
Is there a change in conduction time?
Is there a change in heart axis?
Are there new pathological Q's?
Is there a change in R wave size?
Is there a change in ST?
Is there a change in T wave?

So, one has to check for changes in all 7 steps.

Change in rhythm

Example: New atrial fibrillation. Atrial fibrillation occurs in ten percent of elderly people (>70 year) without clinical symptoms. Therefore atrial fibrillation in acute dyspneic patients does not prove atrial fibrillation-induced cardiac decompensation. Also other causes (e.g. cardiac ischemia, pneumonia) should be considered. Previous ECGs could provide additional information.

Frequency

Example: Bradycardia. New sinus bradycardia of 50 beats per minute (bpm) may cause dizziness; however, long-existing bradycardias are often without symptoms. Therefore it is important to know the patient's normal frequency.

Conduction time

An increase in PQ time may be seen in elderly patients, but may also be caused by the use of medication or by ischemia. Broadening of the QRS complex may also be caused by medication or ischemia. An increase in QTc time may be caused by medication, but may also be hereditary. Comparison of a previous ECG with new ECG may provide the clue.

Heart axis

Ischemia may cause a change in the heart axis; on the other hand, a deviated heart axis caused by left anterior fascicular block may have already been present for years at the time the ECG was made (and would remain for life). Again, a previous ECG differentiates between old and new changes.

Pathological Q's

Hallmark of the comparison between old and new ECG are pathological Q's. New pathological Q's provide evidence for the occurrence of a myocardial infarction.

Increase R wave

Decrease of the R wave may be a sign of an infarction. Tamponade, cardiomyopathy and increased body size also decrease the R wave.

Increase of the R wave indicates hypertrophy of the left ventricle (leads V5-V6), or a posterior infarction (V2-V3) or a loss of body weight.

the ST segment

New elevation of the ST segment indicates an acute myocardial infarction. Chronic elevation of the ST segment may be caused by cardiac aneurysms or long-standing (several weeks) pericarditis.

T wave

T wave inversion can be caused by ischemia, disturbances in electrolytes or stress. Often no distinction can be made between these causes. T wave inversion indicates that something is possibly wrong and further investigation is needed.

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+{{nav|
+|previouspage=ST_morphology
+|previousname=Step 7: ST  morphology
+|nextpage=Conclusion
+|nextname=Step 7+2: Conclusion
+}}
+{{authors|
+|mainauthor= [[user:Drj|J.S.S.G. de Jong, MD]]
+|supervisor=
+|coauthor=
+|moderator= [[user:Drj|J.S.S.G. de Jong, MD]]
+|editor=
+}}
 __NOTOC__
 An abnormal ECG does not prove acute cardiac disease. And a normal ECG does not exclude cardiac disease. It is necessary therefore to compare new ECG with ECG's made in the past.
 Hallmarks are:
-* Is there a [[#ritmeverandering|change in rithm]]?
+* Is there a [[#ritmeverandering|change in rhythm]]?
-* Is there a [[#frequentieverandering|frequentieverandering]]?
+* Is there a [[#frequentieverandering| change in frequency]]?
 * Is there a change in [[#Geleidingstijden|conduction time]]?
-* Is there a change in [[#Hartas|cardiac axe]]?
+* Is there a change in [[#Hartas|heart axis]]?
 * Are there new [[#Pathologische Q's|pathological Q's]]?
 * Is there a change in [[#R top hoogte|R wave size]]?
@@ Line 12: / Line 25: @@
 * Is there a change in [[#T toppen|T wave]]?
-So, one have to check for changes in all 7 steps.
+So, one has to check for changes in all 7 steps.
-==Change in rithm==
+==Change in rhythm==
-Example: new atrial fibrillation. Atrial fibrillation occurs in ten percent of elderly people (>70 year) without clinical symptoms. Therefore atrial fibrillation in acute dyspnoic patients does not prove cardiac decompensation indunced by atrial fibrillation. Also other causes (e.g. cardiac ischemia, pneumonia) should be considered. Previous ECG registrations could provide additional information.
+Example: New atrial fibrillation. Atrial fibrillation occurs in ten percent of elderly people (>70 year) without clinical symptoms. Therefore atrial fibrillation in acute dyspneic patients does not prove atrial fibrillation-induced cardiac decompensation. Also other causes (e.g. cardiac ischemia, pneumonia) should be considered. Previous ECGs could provide additional information.
 ==Frequency==
-Example: bradycardia. New sinusbradycardia of 50 beats per minute may cause complaints, however, previous
+Example: Bradycardia. New sinus bradycardia of 50 beats per minute (bpm) may cause dizziness; however, long-existing bradycardias are often without symptoms. Therefore it is important to know the patient's normal frequency.
+==Conduction time==
+An increase in PQ time may be seen in elderly patients, but may also be caused by the use of medication or by ischemia. Broadening of the QRS complex may also be caused by medication or ischemia. An increase in QTc time may be caused by medication, but may also be hereditary. Comparison of a previous ECG  with new ECG may provide the clue.
+==Heart axis==
+Ischemia may cause a change in the heart axis; on the other hand, a deviated heart axis caused by left anterior fascicular block may have already been present for years at the time the ECG was made (and would remain for life). Again, a previous ECG differentiates between old and new changes.
+==Pathological Q's==
+Hallmark of the comparison between old and new ECG are pathological Q's. New pathological Q's provide evidence for the occurrence of a myocardial infarction.
+==Increase R wave==
+'''Decrease''' of the R wave may be a sign of an infarction. Tamponade, cardiomyopathy and increased body size also decrease the R wave.
+'''Increase''' of the R wave indicates hypertrophy of the left ventricle (leads  V5-V6), or a posterior infarction (V2-V3) or a loss of body weight.
+==the ST segment==
+New elevation of the ST segment indicates an acute myocardial infarction. Chronic elevation of the ST segment may be caused by cardiac aneurysms or long-standing (several weeks) pericarditis.
-kan asymptomatisch zijn bij de ene patiënt, maar een ander kan er duizelig van worden. Het is dus van belang om te weten wat iemands normale hartslag is.
+==T wave==
-==Geleidingstijden==
+T wave inversion can be caused by ischemia, disturbances in electrolytes or stress. Often no distinction can be made between these causes. T wave inversion indicates that something is possibly wrong and further investigation is needed.
-PQ verlenging ten opzichte van een oud ECG kan een teken zijn van een verouderend geleidingssysteem, invloed van medicatie of ischemie. QRS verbreding past bij ischemie of medicatie. QTc verlenging kan door medicatie komen, maar kan ook aangeboren zijn. Ook hier helpt een oud ECG.
-==Hartas==
-Een hartasdraai kan veroorzaakt worden door ischemie, maar kan ook komen door een aangeboren fysiek iets gedraaid hart zonder betekennis. Opnieuw kan een oud ECG uitkomst bieden.
-==Pathologische Q's==
-Dit is een van de belangrijkste verschillen om naar te kijken. Nieuwe pathologische Q's ten opzichte van een oud ECG, tonen aan dat er in de tussentijd een hartinfarct heeft plaatsgevonden.
-==R top hoogte==
-'''Afname''' van de R top hoogte kan teken zijn van een infarct in de tussentijd. Tamponade, cardiomyopathie en toegenomen lichaamsomvang zijn andere opties.
-'''Toename''' van R top hoogte past bij linkerventrikel hypertrofie (met name V5-V6), of een posteriorinfarct (V2-V3). Gewichtsverlies (ECG plakkers dichter op het hart)
+[[Category:ECG Course]]
-==ST segmenten==
-Nieuwe ST-elevatie past in eerste instantie bij een acuut myocardinfarct. ST-elevatie kan ook chronisch aanwezig zijn bij een aneurysma cordis en enkele weken aanwezig zijn bij een pericarditis.
-==T toppen==
-T top inversie heeft veel mogelijke oorzaken. Ischemie, electrolytenstoornissen maar ook stress is een optie. Het is meestal niet specifiek genoeg om hier een onderscheid tussen te maken. T top inversie is dus meer een teken dat er 'iets' aan de hand is. Nader onderzoek (vervolg-ECG's, laboratoriumonderzoek) kan uitwijzen wat dat dan is.