1/17. An unusual case of ST elevation in a 39-year-old man.A 39-year-old man presented to a university hospital emergency department with anginal chest pain, ventricular tachycardia and ST elevation in the anterolateral leads (V3 to V6, I and aVL). Due to discrepancies in the history and physical examination, thrombolysis was withheld until a past electrocardiogram could be obtained, which was unchanged. Subsequent investigations revealed no evidence of myocardial necrosis, and the patient was diagnosed with hypertrophic cardiomyopathy. This is the first reported case of hypertrophic cardiomyopathy with ST elevation as the predominant electrocardiographic abnormality. In patients with discrepancies in the clinical presentation, it is essential to obtain past elecrocardiograms to ensure appropriate utility of thrombolysis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/17. Congenital absence of pericardium as unusual cause of T wave abnormalities in a young athlete.The congenital absence of pericardium is a rare condition which may determine electrocardiographic ST-T abnormalities. The case of a 16-year-old athlete who presented T-wave abnormalities at standard electrocardiogram performed during a physical checkup is reported. Ventricular repolarization tended to normalize during exercise and in right lateral decubitus. Chest x-ray and echocardiography showed typical signs of complete absence of the left pericardium. The definite diagnosis was made by computer tomography (CT) scan. The importance of a complete investigation of athletes with T-wave abnormalities is emphasized. Diagnostic and therapeutic features of the congenital absence of pericardium are discussed.- - - - - - - - - - ranking = 0.16771691658392keywords = physical (Clic here for more details about this article) |
3/17. Electrocardiographic manifestations: aberrant ventricular conduction.Aberrant ventricular conduction is a common electrocardiographic (EKG) manifestation that occurs when the supraventricular electrical impulse is conducted abnormally through the ventricular conducting system. This results in a wide QRS complex that may be confused with a ventricular ectopic beat. This differentiation is important because the treatment and prognosis is quite different. Hemodynamically unstable patients with a wide-complex tachycardia should be promptly cardioverted. Although up to 10% of cases will defy differentiation, ventricular tachycardia and aberrant conduction can be distinguished utilizing history, physical examination, and EKG criteria. The mechanisms of aberrant ventricular conduction are discussed.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/17. Catecholaminergic polymorphic ventricular tachycardia. An important diagnosis in children with syncope and normal heart.syncope in children is primarily related to vagal hyperreactivity, but ventricular tachycardia (VT) way rarely be seen. Catecholaminergic polymorphic VT is a rare entity that can occur in children without heart disease and with a normal QT interval, which may cause syncope and sudden cardiac death. In this report, we describe the clinical features, treatment, and clinical follow-up of three children with syncope associated with physical effort or emotion and catecholaminergic polymorphic VT. Symptoms were controlled with beta-blockers, but one patient died suddenly in the fourth year of follow-up. Despite the rare occurrence, catecholaminergic polymorphic VT is an important cause of syncope and sudden death in children with no identified heart disease and normal QT interval.- - - - - - - - - - ranking = 0.16771691658392keywords = physical (Clic here for more details about this article) |
5/17. A case of torsade de pointes associated with hypopituitarism due to hemorrhagic fever with renal syndrome.We describe a 51-yr-old man presenting with syncope due to torsade de pointes. The torsade de pointes was refractory to conventional medical therapy, including infusion of isoproterenol, MgSO4, potassium, lidocaine, and amiodarone. His past history, physical findings, and hormone study confirmed that QT prolongation was caused by anterior hypopituitarism that developed as a sequela of hemorrhagic fever with renal syndrome. The long QT interval with deep inverted T wave was completely normalized 4 weeks after starting steroid and thyroid hormone replacement. Hormonal disorders should be considered as a cause of torsade de pointes, because this life-threatening arrhythmia can be treated by replacing the missing hormone.- - - - - - - - - - ranking = 0.16771691658392keywords = physical (Clic here for more details about this article) |
6/17. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia.BACKGROUND: Mutations in the cardiac ryanodine receptor gene (RyR2) underlie catecholaminergic polymorphic ventricular tachycardia (CPVT), an inherited arrhythmogenic disease occurring in the structurally intact heart. The proportion of patients with CPVT carrying RyR2 mutations is unknown, and the clinical features of RyR2-CPVT as compared with nongenotyped CPVT are undefined. methods AND RESULTS: patients with documented polymorphic ventricular arrhythmias occurring during physical or emotional stress with a normal heart entered the study. The clinical phenotype of the 30 probands and of 118 family members was evaluated, and mutation screening on the RyR2 gene was performed. Arrhythmias documented in probands were: 14 of 30 bidirectional ventricular tachycardia, 12 of 30 polymorphic ventricular tachycardia, and 4 of 30 catecholaminergic idiopathic ventricular fibrillation; RyR2 mutations were identified in 14 of 30 probands (36% bidirectional ventricular tachycardia, 58% polymorphic ventricular tachycardia, 50% catecholaminergic idiopathic ventricular fibrillation) and in 9 family members (4 silent gene carriers). genotype-phenotype analysis showed that patients with RyR2 CPVT have events at a younger age than do patients with nongenotyped CPVT and that male sex is a risk factor for syncope in RyR2-CPVT (relative risk=4.2). CONCLUSIONS: CPVT is a clinically and genetically heterogeneous disease manifesting beyond pediatric age with a spectrum of polymorphic arrhythmias. beta-Blockers reduce arrhythmias, but in 30% of patients an implantable defibrillator may be required. Genetic analysis identifies two groups of patients: patients with nongenotyped CPVT are predominantly women and become symptomatic later in life; patients with RyR2 CPVT become symptomatic earlier, and men are at higher risk of cardiac events. These data provide a rationale for prompt evaluation and treatment of young men with RyR2 mutations.- - - - - - - - - - ranking = 0.16771691658392keywords = physical (Clic here for more details about this article) |
7/17. Suppression of electrical storm by biventricular pacing in a patient with idiopathic dilated cardiomyopathy and ventricular tachycardia.This study presents a patient with idiopathic dilated cardiomyopathy who had suffered from multiple ICD shocks. amiodarone and a beta-blocker failed to suppress ventricular tachycardia. His ECG showed a very wide QRS complex with an intraventricular conduction delay, so biventricular (BV) pacing was attempted. The BV pacing successfully prevented the multiple ICD shocks accompanied with an improvement in left ventricular systolic function and physical activity.- - - - - - - - - - ranking = 0.16771691658392keywords = physical (Clic here for more details about this article) |
8/17. A 28 year old woman with ventricular tachycardia and an abnormal chest radiograph.A 28 year old white woman with no medical history presented to the emergency room with symptomatic non-sustained ventricular tachycardia. She was asymptomatic up to a few days before presentation. Her physical examination was essentially normal and hence did not help with the differential diagnosis of the problem. Bronchoscopic transbronchial biopsy led to the final diagnosis of cardiac sarcoidosis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/17. Electrocardiographic pattern of brugada syndrome disclosed by a febrile illness: clinical and therapeutic implications.BACKGROUND: Recent studies have identified a direct link between the ionic mechanisms responsible for the electrocardiographic (ECG) pattern of the Brugada syndrome (BS) and the in vitro experimental temperature, pointing to the possibility that some BS patients may display the ECG phenotype only during a febrile state, being in this setting at risk of lethal arrhythmias. CASE REPORT: A 53-year-old man referred to the emergency room for abdominal pain and fever. The ECG showed dome-shaped ST-segment elevation in V1-V3, as in the typical BS. The personal and family history were unremarkable for syncope and sudden death and physical, laboratory and ultrasound examinations were negative. On day 3, at normal body temperature, the patient's ECG returned to normal and the ECG abnormalities were later reproduced with intravenous flecainide. The patient refused the implantation of a loop recorder and was discharged after 6 days. He has remained asymptomatic during 2 years of follow-up. CONCLUSIONS: The typical ECG phenotype of BS disclosed by a febrile illness confirms the in vitro experimental data that previously established a correlation between ECG pattern of BS and temperature variations. The clinical and therapeutic implications of these findings are discussed.- - - - - - - - - - ranking = 0.16771691658392keywords = physical (Clic here for more details about this article) |
10/17. Telangiectatic erythematous cutaneous reaction to an implantable cardioverter defibrillator.A 76-year-old man developed progressive blanchable reticulate erythema at the implantation site of his third implantable cardioverter defibrillator (ICD). Despite reports of allergic contact dermatitis to implantable devices, extensive routine patch testing in our patient failed to identify a responsible allergen. The clinical presentation and pathologic evidence were consistent with reticular telangiectatic erythema that has been reported overlying pacemakers and, in the English literature recently, overlying ICDs in two patients. Reticular telangiectatic erythema is a benign reactive condition that is possibly due to a combination of aberrant local circulatory and physical forces such as heat, electric fields, or magnetic fields.- - - - - - - - - - ranking = 0.16771691658392keywords = physical (Clic here for more details about this article) |
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