ECG at a Glance - Patrick Davey 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: ECG at a Glance - Patrick Davey 2
ECG at a Glance - Patrick Davey 2
Emotion and the ECG66 Clinical syndromes Emotion and the ECGEmotion can affect the ECGEmotion can affect the ECG two ways:•Firstly, by causing asympto ECG at a Glance - Patrick Davey 2omatic ECG changes, leading to an erroneous diagnosis of lieart disease. These changes are limited to ST T wave changes (i e. not involving the development of a Q wave, or clianges to die QRS complex I.•Secondly, much more rarely, by causing 'organic' cardiac disease, such as ’Standard' myocardial i ECG at a Glance - Patrick Davey 2nfarction, anhytlunias or die syndrome of transient left ventricular dysfunction.Diagnostic difficultiesAn extraordinary common difficult problem in cECG at a Glance - Patrick Davey 2
linical practice is to decide whether an abnormal ECG reflects cardiac pathology or not. with the ECG changes being explained by anxiety or hyperventiEmotion and the ECG66 Clinical syndromes Emotion and the ECGEmotion can affect the ECGEmotion can affect the ECG two ways:•Firstly, by causing asympto ECG at a Glance - Patrick Davey 2 ECG normalizing with manoeuvres that normalize autonomic function (reassurance, rest, and anxiolytics and beta-blockers), with catecholamine infusion producing similar ECG changes. The ECG changes tn anxiety arc:•ST flattening, the commonest finding.•Frank ST depression; not rare, especially in hyp ECG at a Glance - Patrick Davey 2erventilation•T wave inversionHow does one differentiate anxiety-induced changes from those reflecting catdiac disease? Fully assessing demographics (ECG at a Glance - Patrick Davey 2
age. sex. etc. I and symptomatology are the keys to a correct diagnosis Though one can often be fairly confident that some patterns aie due to anxietyEmotion and the ECG66 Clinical syndromes Emotion and the ECGEmotion can affect the ECGEmotion can affect the ECG two ways:•Firstly, by causing asympto ECG at a Glance - Patrick Davey 2orehand that the result IS likely to negative, and the test IS required only for reassurance.ST elevation and emotion1Emotion can provoke ST segment elevation myocardial infarctions (STEMIs) U1 pre-existing coronary artery disease.2Tako-tsubo syndrome: rare, in elderly women, where stress induces re ECG at a Glance - Patrick Davey 2versible left ventricular dysfunction of a specific pattern extending beyond the territory supplied by one coronary artery (affecting parts of the antECG at a Glance - Patrick Davey 2
erior wall and apical region) giving the appearance of a Japanese octopus pot. the Tako-tsubo. The syndrome is not due to atheromatous, thrombotic corEmotion and the ECG66 Clinical syndromes Emotion and the ECGEmotion can affect the ECGEmotion can affect the ECG two ways:•Firstly, by causing asympto ECG at a Glance - Patrick Davey 2ECG shows ST segment elevation in leads V3-6. evolving tn 3 days to deep T wave inversion. T wave flattening.and then further deepening at 2-3 weeks (Fig 27.3). Cardiac specific enzyme rise is low and left ventricular dysfunction improves á 2 weeks.Hyperventilation-related ECG changesThe ECG can cha ECG at a Glance - Patrick Davey 2nge markedly with hyperventilation:•Ten per cent of normal subjects who forcibly hyperventilate develop some form of T wave inversion, characteristicaECG at a Glance - Patrick Davey 2
lly biphasic T waves, symmetrically inverted T's. and downsloping ST segment depression.•In coronary artery disease hyperventilation leads some to devEmotion and the ECG66 Clinical syndromes Emotion and the ECGEmotion can affect the ECGEmotion can affect the ECG two ways:•Firstly, by causing asympto ECG at a Glance - Patrick Davey 2odes with ST elevation in 50*4. Ten per cent of similar patients develop coronary spasm and ST elevation with physical stress, e.g. hard handgrip exercises or placing then forearm in ice water.•In patients with spontaneous chest pain with ST segment elevation, and angiograpliically nonnal coronary a ECG at a Glance - Patrick Davey 2rteries (Prinzmetal angina), hyperventilation can induce angina, chest pain and. at angiography, diffiise coronary spasm.Hyperventilation syndromePatiECG at a Glance - Patrick Davey 2
ents with the acute hypenentilation syndrome (AHS) present obviously breathless, agitated, with weakness, paresthesias and possibly syncope. Chest paiEmotion and the ECG66 Clinical syndromes Emotion and the ECGEmotion can affect the ECGEmotion can affect the ECG two ways:•Firstly, by causing asympto ECG at a Glance - Patrick Davey 2l. ST elevation or depression, or T wave inversion. Arterial blood gases arc diagnosticIn chronic hyperventilation syndrome (CHSI tire overbreathing is not overt; patients present with breathlessness and chest pam Cneuro-circulatory asthenia'). with multiple other symptoms and negative investigation ECG at a Glance - Patrick Davey 2 Arterial blood gas is abnormal tn two thirds, with low Pco, and normal pH due to renal compensation. The ECG changes are as for AHS.Arrhythmias and eECG at a Glance - Patrick Davey 2
motion•Long ỌT interval dependent arrhythmias can be provoked by emotion stress (e.g. auditory). Sudden noise (e.g. an alarm clock), on top of sleep-iEmotion and the ECG66 Clinical syndromes Emotion and the ECGEmotion can affect the ECGEmotion can affect the ECG two ways:•Firstly, by causing asympto ECG at a Glance - Patrick Davey 2orsade-dc-pointes type ventricular tachycardia. resulting in syncope or death.•Extreme anxiety can cause sudden cardiac death from malignant ventricular arrhythmia I. both in subjects with normal liearts I though occult pro-arrhythmic genetic diseases may be present I and in pro-arrhythmic condition ECG at a Glance - Patrick Davey 2s, especially left ventricular dysfunctionFig. 27.1 Anxiety-induced ST changes QT interval prolongation. Non-cardiac chest pain and anxiety . Sinus ihECG at a Glance - Patrick Davey 2
ythm. normal p wave, prominent QRS voltages I young thin patient), abnormal ST segments with inferior lead (n. II and aVF)T wave inversion, extending Emotion and the ECG66 Clinical syndromes Emotion and the ECGEmotion can affect the ECGEmotion can affect the ECG two ways:•Firstly, by causing asympto ECG at a Glance - Patrick Davey 2be actively excluded left ventricular hypertrophy, infero-lateral ischaemia (? right coronary artery). long QT syndrome (possibly genetic). After further investigation, it was concluded that the T wave QT changes were induced by hyperventilation.Fig 27 2 Anxiety-induced ST depression. Sinus tachycar ECG at a Glance - Patrick Davey 2dia heart rate 150 bmin. with a p wave preceding each R wave Normal p wave.PR interval. QRS complexes. Dramatic downward sloping ST depression lateralECG at a Glance - Patrick Davey 2
ly (V4-6). and inferiorly HI. III. aVF). There are many explanations of such an ECG The patient was prone to anxiety, recoveting from orthopaedic surgEmotion and the ECG66 Clinical syndromes Emotion and the ECGEmotion can affect the ECGEmotion can affect the ECG two ways:•Firstly, by causing asympto ECG at a Glance - Patrick Davey 2 out to be anxiety reduced ECG changes, with the immediate post-episode ECG being normal Fig. 27.3 Tako-tsubo syndrome. Woman With chest pain, small troponre rise. Pan-anterior (I. aVL. Vl-6)deep symmetrical T wave inversion High-grade left anterior descending (LAD) lesion mui! be angiographically e ECG at a Glance - Patrick Davey 2xcluded; the ventriculogram confinned the typical contractile abnormality.Emotion and the ECG Clinical syndromes 670Sudden cardiac deathEmotion and the ECG66 Clinical syndromes Emotion and the ECGEmotion can affect the ECGEmotion can affect the ECG two ways:•Firstly, by causing asymptoEmotion and the ECG66 Clinical syndromes Emotion and the ECGEmotion can affect the ECGEmotion can affect the ECG two ways:•Firstly, by causing asymptoGọi ngay
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