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Clinical Disorders

62 bytes added, 19:38, 22 January 2010
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[[Image:med_digitalis.png|thumb|300px|Typical for digoxin intoxication is the odd oddly shaped ST-depression]]
ECG changes typical for digoxin intoxication (digoxin = Lanoxin) are:
*odd oddly shaped ST-depression.
*T-wave flat, negative or biphasic
*Short QT interval
*Increased u-wave amplitude
*Prolonged PR-interval
*Brady-arrhytmiasBradyarrhythmias:**SinusbradycardiaSinus bradycardia
**AV block. Including complete AV block and Wenkebach.
**Junctional tachycardia
**AtrialtachycardiaAtrial tachycardia
**Ventricular ectopia, bigemini, monomorphic ventricular tachycardia, bidirectional ventricular tachycardia
Intoxication can lead to a an SA-block or AV-block, sometimes in combination with a tachycardia. '''NB''' these effects are increased by hypokaliemiahypokalemia. In extreme high concentrations rhythmdisturbances rhythm disturbances (''ventricular tachycardia, ventricular fibrillation, atrial fibrillation'') may develop.
===Anti-arhythmicsAntiarrhythmics===* '''anti-arhythmicsarrhythmics:''' These may lead to several ECG-changes;**broad and irregulair irregular P-wave**broad QRS-complex**prolonged QT-interval (brady-, tachycardia, AV-block, ventricular tachycardia)
**prominent U-wave
**In case of intoxication, the above mentioned characteristics are more prominent
Additionally, several arrhtythmias arrhthytmias can be seen.
=== Nortriptyline intoxication ===
[[Image:ECG_nortr_intox.png|thumb|left|300px|An example of severe nortriptyline intoxication. The inhibitory effect of the sodiumchannel 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.]]
[[Image:ECG_amitr_OD_during.jpg|thumb|300px| An example of a severe amitriptylin amitriptyline intoxication. The inhibitory effect of on the sodiumchannel 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.]]
[[w:Myocarditis|Myocarditis]] is an inflammation of the myocardium and the interstitium. The symptoms are faint chestpainchest pain, abnormal heartrate heart rate and progressive heartfailureheart failure. It can be caused by several factors: viralviruses, bacterialbacteria, fungi, parasites, spirochaetspirochaetes, auto-immunereactions, borreliosis (Lyme's disease) and HIV/AIDS.
Acute peri/myocarditis causes aspecific nonspecific ST segment changes. These can be accompanied with by supraventricular and ventricular rhythmdisturbances rhythm disturbances and T-wave abnormalities.
==Pulmonary embolism==
==Chronic pulmonary disease pattern==
The ECG shows low voltaged voltage QRS-complexes in leads I, II, and III and a right axisdeviationaxis deviation. This is caused by the increased pressure on the right chamber. This leads to right ventricular hypertrophy.
[[Image:ECG000028.jpg|thumb|Electrical alternans on the ECG]]
In case of a tamponade, fluid collects in the pericardium. As the pericardium is stiff, the heart is compressed , resulting in relaxation, and thus, filling difficulties. This is a potential potentially life-threatening situation and should be treated with pericardiocentesespericardiocentesis, which is drainage of the fluid. Tamponade can be the results result of pericarditis or myocarditis. Also, after a myocardial infarction a tamponade may develop, ; this is called Dresslers' Syndrome. In case of cancer, increased pericardial fluid may develop. This is usually caused by a Pericarditis carcinomatosapericarditis carcinomatosis, meaning that the cancer has spread to the pericardium
The ECG shows:
*Sinus tachycardia
*Low-voltaged voltage QRS complexes [[microvoltages]]
*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]])
==Ventricular Aneurysm==
The ECG pattern suggests an acute MI. All classical signs of MI may occur:; Q-waves, ST-segment 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==
Often, a LBBB or broadened QRS-complex can be seen. Additionally, aspecific nonspecific ST segment changes are present with signs of left atrial enlargement.
==Hypertrophic Obstructive Cardiomyopathy==
A HOCM is an heditary hereditary illness.
On the ECG there are signs of [[hypertrophy|left ventricular hypertrophy]] and [[P wave morphology|left atrial enlargement]].
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Image:osborne_ecg.jpg|A 12 lead ECG of a patient with a body temperature of 32 degrees Celsius. Note the sinusbradycardiasinus bradycardia, the prolonged QT interval (QTc is not prolonged) and the Osborne J wave, most prominantly prominently in leads V2-V5
Image:JJ0001.jpg|An ECG of a patient with a body temperature of 28 degrees Celsius.
In hypothermia a number of specific changes can be seen;<cite>hypoth</cite>
* sinubradycardiaSinus bradycardia* prolonged Prolonged QTc-interval* ST-segment elevation (inferior and left precordial leads)
* Osborne-waves (slow deflexions at the end of the QRS-complex)
==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 repolarisation repolarization abnormalities may occur after increased intracranial pressure. Since then, many publications have occurred discribing described ECG changes after acute neurological events.
De ECG changes that may occur are:
*q-Q waves*ST-segment elevations, *ST-segment depressions, *T-wave changes. Large negative T waves over the precordial leads are observed frequently.*prolonged Prolonged QT-interval.*prominent Prominent u-waves.
These abnormalites 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_haematomaSubdural_hematoma|subdural haematomahematoma]], 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 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 neurotramittor neurotramitter "catecholaminestormcatecholamine storm" caused by sympathtic sympathetic stimulation.
==Cardiac contusion==
Cardiac contusion (in latin: contusio cordis or commotio cordis) is caused by a blunt trauma to the chest, often caused by a car- or motorbikeaccident motorbike accident or in martial arts<cite>Maron</cite>. Rhythmdisturbances may occur Rhythm disturbances and even heartfailureheart failure can occur. Diagnosis is made using echocardiography and laboratorytesting laboratory testing for cardiac enzymes.
Possible ECG changes are:<cite>Sybrandy</cite>
*AV delay(1st, 2nd, and 3rd degree AV blok)
*SinustachycardiaSinus tachycardia
*Atrial and ventricular extrasystoles
*Atrial fibrillation
*Ventricular tachycardia
*[[Arrhythmias#Ventricular fibrillation|Ventricular fibrillation]]
*SinusbradycardiaSinus bradycardia*Atriala Atrial tachycardia
==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 Short PR interval, < 120 ms* normal Normal QRS complex* no No delta wave==Left and right bundelbranch bundle branch block==
See: [[Conduction_delay|Conduction delay]]


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