1/13. arrhythmogenic right ventricular dysplasia. An illustrated review highlighting developments in the diagnosis and management of this potentially fatal condition.arrhythmogenic right ventricular dysplasia is an inherited, progressive condition. Characterised by fatty infiltration of the right ventricle, it frequently results in life threatening cardiac arrhythmias, and is one of the important causes of sudden cardiac death in the young. There are characteristic electrocardiographic and echocardiographic features that all physicians need to be aware of if we are to reduce these occurrences of premature death. diagnosis with magnetic resonance imaging is discussed along with current treatment options.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/13. brugada syndrome as the cause of syncope in a 49-year-old man.We report the case of a 49-year-old man in whom a diagnosis of brugada syndrome was made after he presented to the emergency department for evaluation of a syncopal episode. The diagnosis was made by ECG changes, after the characteristic findings of peculiar downsloping ST-segment elevation in leads V(1) and V(2) and QRS morphology resembling a right bundle branch block were identified. Emergency physician recognition of this syndrome and its ECG findings is essential, because without treatment the incidence of sudden cardiac death in these patients is high.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/13. Electrocardiographic ST-segment elevation: correct identification of acute myocardial infarction (AMI) and non-AMI syndromes by emergency physicians.OBJECTIVE: To determine the emergency physician's (EP's) ability to identify the cause of ST-segment elevation (STE) in a hypothetical chest pain patient. methods: Eleven electrocardiograms (ECGs) with STE were given to EPs; the patient in each instance was a 45-year-old male with a medical history of hypertension and diabetes mellitus with the chief complaint of chest pain. The EP was asked to determine the cause of the STE and, if due to acute myocardial infarction (AMI), to decide whether thrombolytic therapy (TT) would be administered (the patient had no contraindication to such treatment). Rates of TT administration were determined; appropriate TT administration was defined as that occurring in an AMI patient, while inappropriate TT administration was defined as that in the non-AMI patient. RESULTS: Four hundred fifty-eight EPs completed the questionnaire; levels of medical experience included the following: postgraduate year 2-3, 193 (42%); and attending, 265 (58%). The overall rate of correct interpretation of the study ECGs was 94.9% (4,782 correct interpretations out of 5,038 instances). Acute myocardial infarction with typical STE, ventricular paced rhythm, and right bundle branch block were never misinterpreted. The remaining conditions were misinterpreted with rates ranging between 9% (left bundle branch block, LBBB) and 72% (left ventricular aneurysm, LVA). The overall rate of appropriate thrombolytic agent administration was 83% (1,525 correct administrations out of 1,832 indicated administrations). The leading diagnosis for which thrombolytic agent was given inappropriately was LVA (28%), followed by benign early repolarization (23%), pericarditis (21%), and LBBB without electrocardiographic AMI (5%). Thrombolytic agent was appropriately given in all cases of AMI except when associated with atypical STE, where it was inappropriately withheld 67% of the time. CONCLUSIONS: In this survey, EPs were asked whether they would give TT based on limited information (ECG). Certain syndromes with STE were frequently misdiagnosed. Emergency physician electrocardiographic education must focus on the proper identification of these syndromes so that TT may be appropriately utilized.- - - - - - - - - - ranking = 6keywords = physician (Clic here for more details about this article) |
4/13. brugada syndrome: an unusual cause of convulsive syncope.A patient who presented with a new apparent seizure was found to have abnormal electrocardiographic findings, with classic features of the brugada syndrome. He had spontaneous episodes of nonsustained ventricular tachycardia, easily inducible ventricular fibrillation at electrophysiological study in the absence of structural heart disease, and a negative neurological evaluation. These findings suggested that sustained ventricular arrhythmias known to be associated with the brugada syndrome and resultant cerebral hypoperfusion, rather than a primary seizure disorder, were responsible for the event. patients with the brugada syndrome often present with sudden death or with syncope resulting from ventricular arrhythmias. In consideration of its variability in presentation sometimes mimicking other disorders, primary care physicians and internists should be aware of its often transient electrocardiographic features.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/13. The brugada syndrome.brugada syndrome describes the syndrome of sudden cardiac death in the setting of the following electrocardiographic findings: right bundle branch block pattern with ST-segment elevation in the right precordial leads. The right bundle branch block may be incomplete while the ST segment elevation is minimal. The electrocardiographic findings are not constant. patients suspected of having brugada syndrome should be promptly referred for electrophysiological testing and treatment. Rapid referral and placement of an implantable cardioverter defibrillator (ICD) is associated with an excellent prognosis, whereas failure to diagnose this condition is associated with a high risk for sudden death. Therefore, it is imperative that all emergency physicians be familiar with the typical ECG manifestations of brugada syndrome. Three illustrative cases are presented with a review of the syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/13. Asymptomatic malposition of a pacing lead in the left ventricle: the case of a woman untreated with anticoagulant therapy for eight years.We report the case of a woman with a low-rate atrial fibrillation and a wire lead inadvertently inserted in the left ventricle through an ostium secundum defect. The malposition of the lead was diagnosed 8 years after the procedure on the basis of the presence of a right bundle branch block pattern of the paced QRS, at echocardiography and at chest X-ray. The patient, who was neither on antiaggregant nor anticoagulant therapy, was asymptomatic. Biventricular pacing is a useful tool in the therapy of patients with severe chronic heart failure and intraventricular conduction delay but the insertion of the lead in the left ventricle through the coronary sinus is not always feasible. Because a patent foramen ovale is a frequent occurrence in the adult population, we suggest that in case of an unsuccessful catheterization of the coronary sinus, the physician should search for a patent foramen ovale through which to introduce the wire lead into the left ventricle, especially if the patient is already receiving anticoagulant therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/13. brugada syndrome, manifested by propafenone induced ST segment elevation.We report a case of a 43 year old man who was diagnosed with brugada syndrome after propafenone administration for chemical cardioversion of new onset atrial fibrillation. brugada syndrome has been described in the medical literature and is thought to be responsible for the majority of sudden cardiac deaths in patients without ischaemic heart disease. This syndrome has not yet been extensively discussed in the emergency medicine literature despite its importance. Emergency physicians should consider brugada syndrome in patients who present to the emergency department with right bundle branch block and ST segment elevation in the right precordial leads, which is the classic electrocardiographic pattern of this syndrome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/13. Do we intervene inappropriately for ST elevation?ST elevation on a 12 lead ECG is one of the cardinal features of acute myocardial infarction (AMI), yet it also occurs with other clinical conditions such as spontaneous pneumothorax. Three cases are presented, all of whom had chest pain and ST elevation. All had pneumothoraces yet only one had an AMI. Thrombolysis was administered to one patient. With the current pressure on "door-to-needle" times, emergency physicians should take care to differentiate between these entities.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/13. A case of a borderline-broad complex tachycardia.Prompt and correct treatment of broad complex tachycardias in the emergency department can often be life-saving to the patient and satisfying for the emergency physician. They, however, are often a diagnostic challenge. Here, we present a case of posterior fascicular ventricular tachycardia, an idiopathic form of ventricular tachycardia that occurs in patients without coronary artery disease and verapamil sensitive. The differential diagnoses of posterior fascicular ventricular tachycardia and supraventricular tachycardia with aberrancy will also be discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/13. ECG diagnosis of acute myocardial infarction in patients with bundle branch block.The ECG diagnosis of myocardial infarction in the setting of bundle branch block is one that most physicians find difficult and that many erroneously believe to be impossible. Two case reports of a patient with right bundle branch block and of a patient with left bundle branch block are presented to illustrate instances in which the ECG diagnosis of myocardial infarction was both possible and essential. methods for detecting ECG changes that indicate acute myocardial injury in the patient with bundle branch block are presented and applied to these cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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