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Clinical Disorders: Difference between revisions
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==Ventricular Aneurysm== | ==Ventricular Aneurysm== | ||
The ECG pattern suggests an acute MI. All classical signs of MI may occur:; Q-waves, ST-elevations (>1mm, >4 weeks present)and T-wave inversions are present. To exclude an acute MI, comparison with old ECG's is compulsory (MI has occurred years before). | |||
==Dilated Cardiomyopathy== | ==Dilated Cardiomyopathy== | ||
Often, a LBBB or broadened QRS-complex can be seen. Additionally, aspecific ST changes are present with signs of left atrial enlargement. | |||
==Hypertrophic Obstructive Cardiomyopathy== | ==Hypertrophic Obstructive Cardiomyopathy== | ||
HOCM is | A HOCM is an heditary illness. | ||
On the ECG there are signs of [[ventricular hypertrophy|left ventricular hypertrophy]] and[P_top_morfologie|left atrial enlargement]]. | |||
==Electrolyte disturnbances== | ==Electrolyte disturnbances== | ||
See chapter: [[electrolyte disturbances]] | |||
==Hypothermia== | ==Hypothermia== | ||
In hypothermia a number of specific chnages can be seen; | |||
* | * sinubradycardia | ||
* | * prolonged QTc-interval | ||
* ST- | * ST-elevation (inferior and left precordial leads) | ||
* Osborne- | * Osborne-waves (slow deflexions at the end of the QRS-complex) | ||
[[Image:osborne.gif|thumb| An Osborne J wave]] | [[Image:osborne.gif|thumb| An Osborne J wave]] | ||
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==ECG changes after neurologic events== | ==ECG changes after neurologic events== | ||
[[Image:ECG_SAB.png|thumb| ECG | [[Image:ECG_SAB.png|thumb| ECG of a 74 year old patient with a subarachnoid hemorrhage. Note the negative T-waves and the prolonged QT interval.]] | ||
In 1938 | In 1938, Aschenbrenner <cite>Aschenbrenner</cite> noted that repolarisation abnormalities may occur after increased intracranial pressure. Since then, many publications have occurred discribing ECG changes after acute neurological events. | ||
De ECG | De ECG changes that may occur are: | ||
*ST- | *q-waves | ||
*ST- | *ST-elevations, | ||
*T- | *ST-depressions, | ||
* | *T-wave changes. Large negative T waves over the precordial leads are observed frequently. | ||
* | *prolonged QT-interval. | ||
*prominent u-waves. | |||
These abnormalites are frequently seen after [[w:Subarachnoid_hemorrhage|subarachnoid_hemorrhage (SAH)]] (if measured serially, almost every SAH patients has at least one abnormal ECG.), but also in [[w:Subdural_haematoma|subdural haematoma]], ischemic [[w:Cerebrovascular_accident|CVA]]'s, [[w:Brain_tumor|brain Tumors]], [[w:Guillain-Barre|Guillain Barré]], [[w:Epilepsy|epilepsy]] and [[w:Migraine|migraine]]. The ECG changes are generally reversible and have linited prognostic value. However, the ECG changes can be accompanied with myocardial damage and echocardiographic changes. The cause of the ECG changes is not yet cl;ear. The most common hypothesis is that of a neurotramittor "catecholaminestorm" caused by sympathtic stimulation. | |||
==Contusio cordis / Commotio cordis== | ==Contusio cordis / Commotio cordis== | ||
[[w:Cardiac_contusion|Contusio cordis]] | [[w:Cardiac_contusion|Contusio cordis]] is caused by a blunt trauma to the chest, often caused by a car- or motorbikeaccident or in martial arts<cite>Maron</cite>. Rhythmdisturbances may occur and even heartfailure. Diagnosis is made using echocardiography and laboratorytesting for cardiac enzymes. | ||
Possible ECG changes are:<cite>Sybrandy</cite> | |||
'''Not-specific | '''Not-specific changes''' | ||
*Pericarditis- | *Pericarditis-like ST elevation or PTa depression | ||
* | *Prolonged QT interval | ||
''' | '''Myocardial damage''' | ||
* | *New Q waves | ||
*ST-T segment | *ST-T segment elevation or depression | ||
''' | '''Conduction delay''' | ||
* | *Right bundelbranchblok | ||
* | *Fascicular blok | ||
*AV | *AV delay(1st, 2nd, and 3rd degree AV blok) | ||
''' | '''Arrhythmias''' | ||
* | *Sinustachycardia | ||
* | *Atrial and ventricular extrasystoles | ||
* | *Atrial fibrillation | ||
* | *Ventricular tachycardia | ||
*[[ | *[[Rhtythmdisturbances#Ventricular fibrillation|Ventricular fibrillation]] | ||
* | *Sinusbradycardia | ||
* | *Atriala tachycardia | ||
==Lown Ganong Levine Syndrome== | ==Lown Ganong Levine Syndrome== | ||
The Lown Ganong Levine Syndrome is a pre-excitation syndrome in which the atria are connected to the lower part of the AV node or bundle of His. On the ECG: | |||
* | * short PR interval, < 120 ms | ||
* | * normal QRS complex | ||
* | * no delta wave | ||
==Left and right bundelbranch block== | ==Left and right bundelbranch block== | ||
See: [[Conductiondelay]] | |||