Sunday, 22 November 2009

Miscellaneous conditions

Myocarditis:

The ECG findings that are mostly seen in myocarditis are diffuse T wave inversions; saddle-shaped ST-segment elevations, these can also be seen in pericarditis.

Pericarditis

Types include:

  • Serous
  • Fibrinous
  • Purulent
  • Heamorrhagic
  • Caseous
Acute vs. chronic
Acute pericarditis is more common than chronic pericarditis, and can occur as a complication of infections, immunologic conditions, or heart attack.


Clinical presentation


Chest pain, radiating to the back and relieved by sitting up forward and worsened by lying down, is the classical presentation. Other symptoms of pericarditis may include dry cough, fever, fatigue, and anxiety. Pericarditis can be misdiagnosed as myocardial infarction (heart attack), and vice versa.

The classic sign of pericarditis is a friction rub. Other signs include diffuse ST-elevation and PR-depression on ECG in all leads except aVR and V1;

PRINZMETALS ANGINA

Specific ECG ST segment changes in Prinzmetals angina are elevation rather then depression


PULMONARY EMBOLISM


ECG changes can develop in a very proportion of patient's with a pulmonary embolism, changes strongly suggestive of a diagnosis of pulmonary embolism are: 

  • S1Q3T3 pattern: large S waves in Lead I, large Q waves in V3 and T wave inversion in lead III.
  • Abnormal right axis deviationbnormal rigright

  • T wave inversion in the right precordial leads 

But, the commoner findings are non-specific T wave changes and non-specific ST segment elevation or depression. 



WOLFF-PARKINSON-WHITE SYNDROME

Wolff-Parkinson-White syndrome (WPW) is a syndrome of pr-excitation of the ventricles of the heart, this is due to an accessory abnormal electrical conduction pathway known as the bundle of kent, and vast majority of individuals remain asymptomatic throughout their entire lives, but there is a risk of sudden death associated with this syndrome, this is in rare cases due to the fact of the accessory tachyarrhythmia's   in these individuals.


LOWN-GANONG-LEVINE SYNDROME


HYPERTHYROIDISM


HYPOTHYROIDISM


BRUGADA SYNDROME


EARLY REPOLARISATION


TAKO-TSUBO SYNDROME


SUBARACHNOID HAEMORRHAGE


PIGGYBACK HEART TRANSPLANT (HETEROTOPIC)


PERICARDIAL EFFUSION


COPD


RESTRICTIVE CARDIOMYOPATHY



DILATED CARDMYOPATHY


EBSTEIN's ANOMALY


TRICUSPID ATRESIA


TETRALOGY OF FALLOT


PULMONARY STENOSIS


ANEURYSM