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Clinical Disorders: Difference between revisions
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{{authors| | {{authors| | ||
|mainauthor= [ | |mainauthor= [[user:Vdbilt|I.A.C. van der Bilt, MD]] | ||
|moderator= [ | |moderator= [[T.T. Keller]] | ||
|supervisor= | |supervisor= | ||
}} | }} | ||
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==Medication== | ==Medication== | ||
===Digoxin=== | ===Digoxin=== | ||
[ | [[Image:med_digitalis.png|thumb|300px|Typical for digoxin intoxication is the oddly shaped ST-depression]] | ||
ECG changes typical for digoxin intoxication (digoxin = Lanoxin) are: | ECG changes typical for digoxin intoxication (digoxin = Lanoxin) are: | ||
*Oddly shaped ST-depression. | *Oddly shaped ST-depression. | ||
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{| | {| | ||
| | | | ||
[ | [[Image:ECG_nortr_intox.png|thumb|left|300px|An example of severe nortriptyline intoxication. The inhibitory effect on the sodium channel manifests as a broadened QRS complex and a prolonged QT interval.]] | ||
| | | | ||
[ | [[Image:ECG_TCA_intox.jpg|thumb|left|300px| Another example of severe nortriptyline intoxication.]] | ||
{{clr}} | {{clr}} | ||
|} | |} | ||
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{| | {| | ||
| | | | ||
[ | [[Image:ECG_amitr_OD_during.jpg|thumb|300px| An example of a severe amitriptyline intoxication. The inhibitory effect on the sodium channel manifests as a broadened QRS complex.]] | ||
| | | | ||
[ | [[Image:ECG_amitr_OD_before.jpg|thumb|300px| An ECG of the same patient before the intoxication.]] | ||
|} | |} | ||
</div> | </div> | ||
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==Pericarditis== | ==Pericarditis== | ||
[ | [[Pericarditis]] | ||
==Myocarditis== | |||
[[w:Myocarditis|Myocarditis]] is an inflammation of the myocardium and the interstitium. The symptoms are faint chest pain, abnormal heart rate and progressive heart failure. It can be caused by several factors: viruses, bacteria, fungi, parasites, spirochetes, auto-immune reactions, borreliosis (Lyme's disease) and HIV/AIDS. | |||
Acute peri/myocarditis causes nonspecific ST segment changes. These can be accompanied by supraventricular and ventricular rhythm disturbances and T-wave abnormalities. | Acute peri/myocarditis causes nonspecific ST segment changes. These can be accompanied by supraventricular and ventricular rhythm disturbances and T-wave abnormalities. | ||
==Pulmonary Embolism== | ==Pulmonary Embolism== | ||
See the chapter [ | See the chapter [[Pulmonary Embolism]] | ||
==Chronic Pulmonary Disease Pattern== | ==Chronic Pulmonary Disease Pattern== | ||
[ | [[File:E000004.jpg|thumb|right|An example of right ventricular hypertrophy (and right atrial enlargement) in a patient with chronic pulmonary hypertension due to peripheral embolisation.]]The ECG shows low voltage QRS complexes in leads I, II, and III and a right axis deviation. This is caused by the increased pressure on the right chamber. This leads to right ventricular hypertrophy. | ||
{{clr}} | {{clr}} | ||
==Pacemaker== | ==Pacemaker== | ||
See the chapter [ | See the chapter [[Pacemaker]] | ||
==Tamponade== | |||
[[Image:ECG000028.jpg|thumb|Electrical alternans on the ECG]] | |||
In case of tamponade, fluid collects in the pericardium. Because the pericardium is stiff, the heart is compressed, resulting in filling difficulties. This is a potentially life-threatening situation and should be treated with pericardiocentesis, drainage of the fluid. Tamponade can be the result of pericarditis or myocarditis. After a myocardial infarction a tamponade can also develop; this is called Dresslers' Syndrome. In case of cancer,increased pericardial fluid may develop. This is usually caused by pericarditis carcinomatosis, meaning that the cancer has spread to the pericardium | In case of tamponade, fluid collects in the pericardium. Because the pericardium is stiff, the heart is compressed, resulting in filling difficulties. This is a potentially life-threatening situation and should be treated with pericardiocentesis, drainage of the fluid. Tamponade can be the result of pericarditis or myocarditis. After a myocardial infarction a tamponade can also develop; this is called Dresslers' Syndrome. In case of cancer,increased pericardial fluid may develop. This is usually caused by pericarditis carcinomatosis, meaning that the cancer has spread to the pericardium | ||
The ECG shows: | The ECG shows: | ||
*Sinus tachycardia | *Sinus tachycardia | ||
*Low-voltage QRS complexes [ | *Low-voltage QRS complexes [[microvoltages]] | ||
*PR segment depression (this can also be observed in an [ | *Alternation of the QRS complexes, usually in a 2:1 ratio. Electrical alternans can also be seen in myocardial ischemia, acute pulmonary embolism, and tachyarrhythmias | ||
*PR segment depression (this can also be observed in an [[Ischemia#Atriaal_.2F_boezem_infarct|atrial infarction]]) | |||
{{clr}} | {{clr}} | ||
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==Hypertrophic Obstructive Cardiomyopathy== | ==Hypertrophic Obstructive Cardiomyopathy== | ||
A HOCM is a hereditary illness. | A HOCM is a hereditary illness. | ||
On the ECG there are signs of [ | On the ECG there are signs of [[hypertrophy|left ventricular hypertrophy]] and [[P wave morphology|left atrial enlargement]]. | ||
==Electrolyte Disturbances== | ==Electrolyte Disturbances== | ||
See chapter: [ | See chapter: [[electrolyte disturbances]] | ||
==Hypothermia== | ==Hypothermia== | ||
[ | [[Image:osborne.png|thumb|left|250px| An Osborne J wave]] | ||
<div style="float:right"> | <div style="float:right"> | ||
<gallery> | <gallery> | ||
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==ECG Changes after Neurologic Events== | ==ECG Changes after Neurologic Events== | ||
[ | [[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, Aschenbrenner <cite>Aschenbrenner</cite> noted that repolarization abnormalities may occur after increased intracranial pressure. Since then, many publications have described ECG changes after acute neurological events. | In 1938, Aschenbrenner <cite>Aschenbrenner</cite> noted that repolarization abnormalities may occur after increased intracranial pressure. Since then, many publications have described ECG changes after acute neurological events. | ||
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*Prominent u-waves. | *Prominent u-waves. | ||
These abnormalities are frequently seen after [ | These abnormalities 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_hematoma|subdural hematoma]], 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 limited prognostic value. However, the ECG changes can be accompanied with myocardial damage and echocardiographic changes. The cause of the ECG changes is not yet clear. The most common hypothesis is that of a neurotramitter "catecholamine storm" caused by sympathetic stimulation. | ||
==Cardiac Contusion== | ==Cardiac Contusion== | ||
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*Atrial fibrillation | *Atrial fibrillation | ||
*Ventricular tachycardia | *Ventricular tachycardia | ||
*[ | *[[Arrhythmias#Ventricular fibrillation|Ventricular fibrillation]] | ||
*Sinus bradycardia | *Sinus bradycardia | ||
*Atrial tachycardia | *Atrial tachycardia | ||
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* No delta wave | * No delta wave | ||
==Left and right bundle branch block== | ==Left and right bundle branch block== | ||
See: [ | See: [[Conduction_delay|Conduction delay]] | ||
==Cocaine Intoxication== | ==Cocaine Intoxication== | ||
|<!--col1-->[ | |<!--col1-->[[Image:JJ00001.jpg|200px]] | ||
{{Box| | |||
==References== | |||
<biblio> | |||
#Sybrandy pmid=12695446 | |||
#Rodger pmid=11018210 | #Rodger pmid=11018210 | ||
#Ferrari pmid=9118684 | #Ferrari pmid=9118684 | ||
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</biblio> | </biblio> | ||
}} | }} | ||
[ | [[Category:ECG Textbook]] | ||