ST-segment Abnormalities Research Articles

The Rise and Fall of Cardiac Troponin T.

A 65-year-old man presented to the emergency department. He reported experiencing a 20-min episode of central chest pain with an aching character and no radiation. He had no significant past medical history. Serial electrocardiograms showed no ST segment or T-wave abnormalities. High-sensitivity cardiac troponin T (hs-cTnT)4 concentrations (Roche Elecsys, 99th percentile 14 ng/L, CV <10% at 13 ng/L) were …

Acute Myocardial Infarction in a 26-Year-Old Man with Normal ST-Segment

Acute myocardial infarction (AMI) is rare in young adults. The management of these patients is considered as a clinical challenge. We report the case of a 26-year-old man who was presented to the Emergency Room of Affiliated Hospital of Guilin Medical University with an acute onset of chest pain. Initially electrocardiogram (ECG) with no evidence of ST-segment abnormalities but QT prolongation a signal of sudden cardiac death, 20 minutes later, it revealed ST-segment elevation myocardial infarction (STEMI). Coronary angiography (CAG) demonstrated left main coronary artery occlusion. AMI was diagnosed based on clinical symptom, elevated cardiac biomarkers, electrocardiographic dynamic monitoring and CAG. The awareness of chest pain as possible underlying AMI symptom—especially in young patients presenting with QT prolongation—is crucial for clinical treatment, as a missed diagnosis can worsen the patient’s further prognosis. In addition, reperfusion arrhythmia is a challenge to short-term outcomes of young patients with AMI, so it is necessary to make preoperative risk stratification.

Frequency of different electrocardiographic abnormalities in a large cohort of Spanish workers.

Our aim was to describe the electrocardiographic findings of a large sample of Spanish workers from several different employment sectors. Between May 2008 and November 2010, 13 495 consecutive 12-lead resting electrocardiograms (ECGs) were obtained during health examinations of working adults aged 16-74 years in 5 cities in different regions of Spain. Of those, 13 179 ECGs suitable for interpretation were included in this study. All tracings were classified by the same cardiologist, according to the Minnesota Code criteria. The mean age of the sample was 40 years, and 73.4% were male. Frequencies of complete right bundle branch block, complete left bundle branch block, and left ventricular hypertrophy were 1.1, 0.2, and 3.6%, respectively. Major Q wave abnormalities were observed in 1.7% of the subjects, T wave abnormalities in 0.7%, early repolarization in 2.4%, and other ST segment abnormalities in 0.2%. Atrial fibrillation was present in 0.08% of the workers and atrial flutter in 0.02%. Frequencies of the Wolff-Parkinson-White pattern, Brugada pattern, long QT pattern, and short QT pattern were 0.2, 0.068, 0.038, and 0.015%, respectively. This study shows the electrocardiographic findings of a large sample of Spanish workers from several different employment sectors. The frequencies of many ECG patterns related to an adverse prognosis (left ventricular hypertrophy, complete left bundle branch block, T wave abnormalities, ST segment abnormalities, and atrial fibrillation) were low.

To Be or Not to Be … Acute Coronary Syndrome

Abstract Introduction: The association between ST segment abnormalities, elevated cardiac enzymes, and chest pain is usually a marker of acute coronary injury. However, certain other pathologies can sometimes mimic acute coronary syndromes. Case report: A 40-year-old Caucasian male, former smoker, with no other cardiovascular risk factors, presented to the Emergency Department for typical ischemic, prolonged chest pain. The ECG demonstrated inverted T waves in leads I, II, aVL, and V3 to V6. The patient presented high cardiac necrosis markers (troponin I 2.65 ng/ml). Based on these findings, the case was interpreted as non-ST segment elevation myocardial infarction, but coronary angiography excluded the presence of significant coronary lesions. The ventriculography showed an efficient left ventricle, with mild hypokinesia of the two apical thirds of the anterior left ventricular wall. Cardiac magnetic resonance imaging demonstrated areas of hypersignal on the T2-weighted imaging sequence in the left ventricular myocardium, suggestive for acute myocarditis. The patient was started on antiplatelet, beta-blocker, and angiotensin converting enzyme inhibitor, with favorable evolution. Conclusion: This case underlines the polymorphic appearance of acute myocarditis, which can often mimic an acute coronary event.

Development of a clinical prediction score for congestive heart failure diagnosis in the emergency care setting: The Brest score

ObjectiveTo derive and validate a clinical prediction rule of acute congestive heart failure obtainable in the emergency care setting. DesignDerivation of the score was performed on a retrospective 927 patients cohort admitted to our Emergency Department for dyspnea. The prediction model was externally validated on an independent 206-patient prospective cohort. Interventions and MeasuresDuring the derivation phase, variables associated with acute congestive heart failure were included in a multivariate regression model. Logistic regression coefficients were used to assign scoring points to each variable. During the validation phase, every diagnosis was confirmed by an independent adjudication committee. ResultsThe score comprised 11 variables: age ≥65 years (1 point), seizure dyspnea (2 points), night outbreak (1 point), orthopnea (1 point), history of pulmonary edema (2 points), chronic pulmonary disease (−2 points), myocardial infarction (1 point), crackles (2 points), leg edema (1 point), ST-segment abnormality (1 point), atrial fibrillation/flutter (1 point) on electrocardiography. In the validation step, 30 patients (14.6%) had a low clinical probability of acute congestive heart failure (score ≤3), of which only 2 (6.7%) had a proven acute cardiogenic pulmonary edema. The prevalence of acute congestive heart failure was 58.5% in the 94 patients with an intermediate probability (score of 4-8) and 91.5% in the 82 patients (39.8%) with a high probability (score ≥9). ConclusionThis score of acute congestive heart failure based on easily available and objective variables is entirely standardized. Applying the score to dyspneic adult emergency patients may enable a more rapid and efficient diagnostic process.

Comparison of ST-segment resolution influencing in hospital outcome after primary percutaneous coronary intervention and fibrinolysis (with streptokinase) in patients with acute ST-segment elevation myocardial infarction

Background: Coronary artery disease (CAD) is the most common cause of mortality &amp; morbidity in all over the world. Reperfusion therapy is the cornerstone for treating acute ST-segment elevation myocardial infarction. Effective reperfusion in STEMI can be achieved by either fibrinolysis or primary percutaneous coronary intervention (PPCI). PPCI generally produces better outcomes than fibrinolysis but is not widely available. ST-segment abnormalities play a fundamental role in assessment and decision making for patients with STEMI. Methods: This quasi-experimental study was conducted in the Department of Cardiology, National Heart Foundation Hospital and Research Institute. Group I underwent primary PCI and group II received fibrinolytic therapy as reperfusion therapy for acute STEMI.Results: The mean ST-segment resolutions were significantly more in group I than group II at 60 minutes (63.54±20.98 vs 33.97±15.88%, p&lt;0.001) and at 90 minutes (73.15±18.76 vs 60.06±23.33%, p&lt;0.015). However the difference is not significant at 180 minutes after procedure (74.48±18.09 vs 65.33±21.20%, p=0.064). In our study we observed that significantly higher number of patients of group II developed acute LVF (33.3% vs 6.1%, p=0.005) and cardiogenic shock (18.2% vs 3.0%, p=0.046) than group I and Rescue PCI was needed in 5 (15.2%% vs 0%, p=0.020) patients of group II than group I. Conclusion: ST-segment resolution occurs earlier and more completely after Primary percutaneous coronary intervention than fibrinolysis (with Streptokinase) with better in hospital outcome in patients with acute STEMI.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.252-256

Różne oblicza zespołu Brugadów

We present a clinical case of a 57-year-old patient with Brugada syndrome (BS), who presented with electrocardiographical features of BS type 2 in course of fever due to respiratory tract infection. Upon administration of flecainide ST segment elevation of type 1 was induced. As the patient had no clinical symptoms and no spontaneous abnormalities of ST segment, he did not receive an implantable cardioverter-defibrillator.

176-03: A three-dimensional electrophysiological computed model of ST segment abnormalities in type 1 Brugada Pattern: the key role of right ventricular outflow tract orientation in the torax

In order to assess our hypothesis we used an interactive simulation program (ECGSIM vers. 3.0.0). Our aim was to create “areas of injury” reproducing the endo-epicardial transmural gradient described by Antzelevitch, typical of BP, in two heart's 3D model respectevely with a vertical or horizontal RVOT orientation. An horizontal RVOT gives raise to abnormal BP vector directed both superiorly and anteriorly, explaining, at the same time, typical BP appearance in right precordial leads and ST segment depression in the inferior leads.

Association of Traditional Cardiovascular Risk Factors With Development of Major and Minor Electrocardiographic Abnormalities: A Systematic Review.

Electrocardiographic (ECG) abnormalities are prevalent in middle aged and are associated with risk of adverse cardiovascular events. It is unclear whether and to what extent traditional risk factors are associated with the development of ECG abnormalities. To determine whether traditional cardiovascular risk factors are associated with the presence or development of ECG abnormalities, we performed a systematic review of the English-language literature for cross-sectional and prospective studies examining associations between traditional cardiovascular risk factors and ECG abnormalities, including major and minor ECG abnormalities, isolated nonspecific ST-segment and T-wave abnormalities, other ST-segment and T-wave abnormalities, QT interval, Q waves, and QRS duration. Of the 202 papers initially identified, 19 were eligible for inclusion. We examined data analyzing risk factor associations with ECG abnormalities in individuals free of cardiovascular disease. For composite major or minor ECG abnormalities, black race, older age, higher blood pressure, use of antihypertensive medications, higher body mass index, diabetes, smoking, and evidence of left ventricular hypertrophy or higher left ventricular mass are the factors most commonly associated with prevalence and incidence. Risk factor associations differ somewhat according to types of specific ECG abnormalities. Because major and minor ECG abnormalities have important and independent prognostic significance, understanding the groups at risk for their development may inform prevention strategies focused on modifiable risk factors to reduce the burden of ECG abnormalities, which may in turn promote CVD prevention.

Lack of Association of ST-T Wave Abnormalities to Congenital Heart Disease in Neonates.

ST-T wave (STTW) abnormalities have been described in 20-40% of normal newborns. We sought to describe the associations of these Electrocardiogram (ECG) abnormalities to perinatal course and congenital heart disease (CHD). A retrospective chart review was performed on all neonatal ECGs between January 2008 and March 2013 identified from electronic medical records. Electronic medical records were reviewed for perinatal course and maternal medical conditions. Neonates <37 weeks gestation, >3 days age, requiring hemodynamic support in the first 3 days, with oxygen saturation <90% on room air, or with arrhythmias and significant abnormalities of axis and voltage were excluded from the analysis. ST segment elevation or depression of >2 mm in at least one lead and flat or inverted T waves in at least one lead except aVR were considered abnormal. Statistical relationships were explored between STTW abnormalities, perinatal variables and CHD. ECGs were performed on 1043 neonates, of which 664 were included. STTW abnormalities were found in 236 (35.5%) neonates. T wave abnormalities were identified in 191 (28.7%), ST segment abnormalities in 77 (11.6%) and both on 32 (4.8%) neonates. No relationship was found between the ECG abnormalities and perinatal variables, except maternal cefazolin administration during labor. Noncritical CHD was diagnosed by echocardiography in 59/84; STTW abnormalities were seen in 17/59 (29%) patients with and 9/25 (34%) without noncritical CHD, P = .6. STTW abnormalities on ECG are commonly found in 35.5% of normal neonates and do not predict noncritical CHD.

ST-segment abnormalities are associated with long-term prognosis in non-ST-segment elevation acute coronary syndromes: The ERICO-ECG study

IntroductionWe aimed to identify whether ST-segment abnormalities, in the admission or during in-hospital stay, are associated with survival and/or new incident myocardial infarction (MI) in 623 non-ST-elevation acute coronary syndrome participants of the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. Materials and methodsERICO is conducted in a community-based hospital. ST-segment analysis was based on the Minnesota Code. We built Cox regression models to study whether ECG was an independent predictor for clinical outcomes. ResultsMedian follow-up was 3years. We found higher risk of death due to MI in individuals with ST-segment abnormalities in the final ECG (adjusted hazard ratio: 2.68; 95% confidence interval: 1.14–6.28). Individuals with ST-segment abnormalities in any tracing had a non-significant trend toward a higher risk of fatal or new non-fatal MI (p=0.088). ConclusionsST-segment abnormalities after the initial tracing added long-term prognostic information.

Identifying the broken heart: predictors of mortality and morbidity in suspected blunt cardiac injury

BackgroundBlunt cardiac injury (BCI) is an infrequent but potentially fatal finding in thoracic trauma. Its clinical presentation is highly variable and patient characteristics and injury pattern have never been described in trauma patients. The aim of this study was to identify predictors of mortality in BCI patients. MethodsWe performed an 8-year retrospective analysis of all trauma patients diagnosed with BCI at our Level 1 trauma center. Patients older than 18 years, blunt chest trauma, and a suspected diagnosis of BCI were included. BCI was diagnosed based on the presence of electrocardiography (EKG), echocardiography, biochemical cardiac markers, and/or radionuclide imaging studies. Elevated troponin I was defined as more than 2 recordings of greater than or equal to .2. Abnormal EKG findings were defined as the presence of bundle branch block, ST segment, and t-wave abnormalities. Univariate and multivariate regression analyses were performed. ResultsA total of 117 patients with BCI were identified. The mean age was 51 ± 22 years, 65% were male, mean systolic blood pressure was 93 ± 65, and overall mortality rate was 44%. Patients who died were more likely to have a lactate greater than 2.5 (68% vs 31%, P = .02), hypotension (systolic blood pressure < 90) (86% vs 14%, P = .001), and elevated troponin I (86% vs 11%, P = .01). There was no difference in the rib fracture (58% vs 56%, P = .8), sternal fracture (11% vs 21%, P = .2), and abnormal EKG (89% vs 90%, P = .6) findings. Hypotension and lactate greater than 2.5 were the strongest predictors of mortality in BCI. ConclusionsBCI remains an important diagnostic and management challenge. However, once diagnosed resuscitative therapy focused on correction of hypotension and lactate may prove beneficial. Although the role of troponin in diagnosing BCI remains controversial, elevated troponin may have prognostic significance.

O072. An uncommon case of sinusal arrest in Cluster Headache.

It is well known how migraine attacks are strictly associated to abnormalities of cardiac rhythm. Aygun et al[1] have studied 30 patients during migraine attacks, observing abnormalities of rhythm (including sinus arrhythmia, atrial premature contraction and ventricular premature contraction), intervals greater than 0.2 seconds, corrected QT intervals greater than 0.44 seconds, T inversion and ST-segment abnormalities. However, the role of autonomic nervous system variations in migraine attack-related electrocardiographic changes remains uncertain. Moreover, in patients with migraine parasympathetic nervous system alterations were observed during normal daily activity in the headache-free period[2]. In July 2015, a 45-year-old man was referred to us for evaluation because of a recurrent migraine associated with bradycardia. He referred recurrent migraine attacks, frequently occurring at night and in the supine position. During the acute phases of the attacks he described bradycardia, and sometimes, thoracic oppression. Furthermore, our patient told us about a clinical history of panic attacks and renal colics with syncope. He is currently taking topiramate and oxygen therapy at high doses (15 lt/min) during attacks. In order to better understand the previous episodes of syncope and the phases of bradycardia occurrence during the pain attacks, we monitored his electrocardiogram for 24h. During the 24h registration, he had three attacks of migraine preceded by warning signs, one of them at night time. Analyzing the ECG, we observed sinusal rhythm, medium CF 74 bpm (28-115 bpm), normal PR interval, rare supraventricular and ventricular premature contractions. In correspondence to the migraine attacks, we observed sinus bradycardia and sinus pauses with RR maximum interval of 5.5 seconds, sometimes with the occurrence of junctional rhythm, without loss of consciousness. Considering the results of this monitoring, we decided to implant a pace-maker. This case demonstrates the importance of autonomic dysregulation in a patient with migraine, showing the need of further studies to better understand the phenomenon. Written informed consent to publication was obtained from the patient(s).

Burn-induced subepicardial injury in frog heart: a simple model mimicking ST segment changes in ischemic heart disease.

To mimic ischemic heart disease in humans, several animal models have been created, mainly in rodents by surgically ligating their coronary arteries. In the present study, by simply inducing burn injuries on the bullfrog heart, we reproduced abnormal ST segment changes in the electrocardiogram (ECG), mimicking those observed in ischemic heart disease, such as acute myocardial infarction and angina pectoris. The “currents of injury” created by a voltage gradient between the intact and damaged areas of the myocardium, negatively deflected the ECG vector during the diastolic phase, making the ST segment appear elevated during the systolic phase. This frog model of heart injury would be suitable to explain the mechanisms of ST segment changes observed in ischemic heart disease.

A model for predicting angiographically normal coronary arteries in survivors of out-of-hospital cardiac arrest.

BackgroundIt has been recommended that all survivors of out-of-hospital cardiac arrest (OHCA) have immediate coronary angiography (CAG), even though it has been reported that half of the survivors have normal coronary arteries. Our aim was to develop a model which might identify those who have angiographically normal coronary arteries. Reliable prediction would reduce unnecessary CAG.MethodsA retrospective, observational, cohort study was conducted on 47 consecutive adult survivors who received immediate CAG after resuscitation from OHCA, between June 1, 2006 and March 31, 2011. We analyzed the clinical and electrocardiographic characteristics of the survivors with and without normal coronary arteries.ResultsAll subjects had CAG. Normal coronary arteries were found in 25/47. These persons did not have diabetes mellitus (p = 0.0069) or a history of acute coronary syndrome (ACS) (p = 0.0069). Any abnormality of the ST segment or ST segment elevation on electrocardiogram (ECG) was strongly related to abnormal coronary arteries (p = 0.0045 and p = 0.0200, respectively). The partitioning model for predicting angiographically normal coronary arteries showed that all patients (8/8) with no ST segment change on their ECG had normal coronary arteries. Eight out of ten patients with ST segment abnormalities also had normal coronary arteries with a history of arrhythmia without a history of ACS.ConclusionsSurvivors of OHCA who have no history of diabetes mellitus, who have no past history of ACS, and who present with no ST segment abnormalities may not require urgent/emergent CAG. Further studies are needed to guide clinicians in the determination of emergent cardiac catheterization following resuscitation of OHCA.

Dobutamine Stress Testing as an Early Diagnostic for Radiation‐Induced Heart Disease

Radiation‐induced heart disease (RIHD) is a potentially severe side effect caused by irradiation of all or part of the heart in radiotherapy for intrathoracic and chest wall tumors. Currently, there is no recommended approach for early detection of the disease. However, dobutamine stress testing (DST) is used clinically to unmask other forms of heart disease. Our study sought to determine whether DST may represent an early diagnostic strategy to detect RIHD. Male Sprague‐Dawley rats received X‐irradiation locally to the heart via 5 fractions of 0 (sham), 6, or 9 Gy, and then animals were subjected to DST after 2, 3 and 6 months. Dobutamine was infused in increasing doses (10 ‐ 60 µg/kg/min i.v.) while echocardiography and electrocardiography were performed. At 3 months, radiation caused a dose‐dependent increase in myocardial collagen deposition and alterations in left ventricular function, both of which progressively worsened by 6 months. However, as early as 2 months after irradiation, DST dose‐dependently caused ST‐segment elevation on ECG in irradiated rats, while functional alterations were not present at this time point. The ST‐segment elevations may be an indication of myocardial ischemia. Our results suggest that DST may induce ST segment abnormalities in irradiated hearts prior to detection of functional or histological abnormalities, and thereby may represent a strategy to diagnose and treat myocardial ischemia during early RIHD to prevent later cardiac events.Supported by CA1487679 to MB (NIH/NCI)

Abstract 16851: ST Segment Variability as a Predictor of Clinical Deterioration in Hypoplastic Left Heart Syndrome

Introduction: The interstage mortality rate for hypoplastic left heart syndrome (HLHS) is high at 12%. Modalities to predict clinical decline would be useful in this high risk population. Due to cardiac conduction system anomalies in HLHS, electrocardiogram (ECG) monitoring of the ST segment is confounded. Our aim is to develop a monitor of ST variability that predicts deterioration despite the presence of an abnormal ST segment baseline. Hypothesis: Increased ST variability is associated with clinical deterioration in HLHS. Methods: A prospective, observational study was conducted at Texas Children’s Hospital using interstage recordings of 5 lead ECG. From January 2013 to January 2014, 25 subjects were admitted with HLHS; 21 had requisite ECG data for inclusion. In 11 subjects, there were 17 deterioration events, defined as rapid response team (RRT) activation. Events included 13 instances of respiratory failure with intubation and 4 instances of chest compressions. The control group included 10 subjects with no deterioration. An approach to quantify variability was developed where the ST segment vector was resolved using 3 orthogonal leads (II, V5, and aVF) and variability quantified with two metrics: 1) Displacement: distance between ST vector tips at 30 s intervals and 2) Component range: sum of ST vector tip movement in 3 dimensions over 10 min intervals. Comparison was made with the four hour window prior to RRT activation in the deterioration group against the four hour window prior to ICU discharge in the control group. Results: Four hours prior to clinical deterioration, increased ST variability was noted in both methods. For the 30 s displacement method, subjects with deterioration had a median value of 0.059 mm [IQR: 0.039 - 0.075] compared with 0.037 mm [IQR: 0.025 - 0.053] in the control group (p = 0.023). For the 10 min component range method, subjects with deterioration had a median value of 3.0 mm [IQR: 1.8 - 4.5] compared with 1.9 mm [IQR: 1.0 - 2.8] in the control group (p = 0.031). Conclusions: ST variability is increased in HLHS subjects prior to deterioration. Although conduction abnormalities limit the utility of ST monitoring in this population, quantification of ST variability may have a role in advanced systems to monitor clinical deterioration.

Abstract 13464: Underutilization of Invasive Coronary Angiography Post Out of Hospital Cardiac Arrest: is a Paradigm Shift Needed?

BACKGROUND: The immediate post-resuscitation 12-lead electrocardiogram (ECG) aids in the diagnosis of an acute coronary syndrome (ACS) following an out-of-hospital cardiac arrest (OHCA). Guidelines support immediate coronary angiography (CA) for a finding of acute ST-elevation (STE), no such recommendations exist for ST-depression (STD) post-OHCA. We aimed to assess the relationship of STE and STD on the post-resuscitation ECG with diagnostic CA findings. METHODS: A retrospective analysis of consecutive patients admitted to a Vancouver Hospital with CA capability post-OHCA, between November 2009 and December 2011. Patients were identified using the Resuscitation Outcomes Consortium Cardiac Arrest Registry and included if they had an interpretable post-resuscitation ECG. ST-segment changes &gt;0.1mV in 2 contiguous leads were deemed significant. A stenosis ≤70% (or ≤50% for left main) was defined as obstructive coronary artery disease (CAD). RESULTS: Our cohort of n=231 pts had a mean age of 65±17y and 74% were males. The presenting rhythm was ventricular tachycardia/fibrillation (49%), pulseless electrical activity (19%), asystole (17%), and unspecified (15%). The post-resuscitation ECG demonstrated STE in 33%, STD in 27% and no ST abnormality in 40%. The QRS morphology included narrow complex (42%), intraventricular conduction delay (25%), RBBB (27%), and LBBB (6%). The rate of CA was 41% (n=94), with a mean LVEF of 42%. In Table 1 below the odd ratios describe the association of STE and STD with CA findings compared to patients with no ST abnormality. CONCLUSIONS: A high proportion of patients with OHCA demonstrated ST-segment abnormalities on the post-resuscitation ECG. The association with obstructive CAD was greatest with STE, the presence of STD showed a trend towards an association with both, occlusive and obstructive CAD. A randomized clinical trial is needed to assess the utility of diagnostic CA in OHCA patients with STD on the post-resuscitation ECG.

English

OBJECTIVES: To determine the ECG changes in a group of out-patients on antipsychotics medication, and the association, if any, with factors such as gender, age, co-morbid illness and the use of concomitant medication. METHODS: Study subjects included patients 18 years and older attending the outpatient departments of Basaveshwar Teaching and General Hospitals. The subject's demographic and clinical characteristics were obtained and a resting ECG was recorded. RESULTS: Eighty patients were included in the study. The mean age of the subjects was 45.4 (standard deviation (SD) =18.2) years, with a minimum age of 18 and a maximum of 85 years. Fifty-four subjects (67.5%) had evidence of some ECG abnormalities. There was no significant difference between the occurrence of ECG abnormalities and the different age groups (p > 0.05), gender (p > 0.05), and different race groups (p > 0.05). Sixty-one subjects (76.3%) had no co-morbid medical illness and were on psychotropic medication only; of these patients 43 (70.5%) had abnormal ECG tracings (p >0.05). The ECG abnormalities recorded included abnormal rate (28.8%), abnormal ST segment (20.5%), abnormal QRS complex (17.8%), abnormal T wave (15.4%), prolonged or borderline corrected QT interval (8.2%), irregular rhythm (5.5%) and prolonged PR interval (2.7%). There was a significant positive correlation between the corrected QT interval and age (r = 0.43, p 0.05). CONCLUSION: The use of psychotropic drugs is associated with ECG changes in ordinary doses. However, this study serves to strengthen previous evidence that, although common, most of these changes are of a benign nature.

The spectrum of electrocardiographic manifestations of acute myocarditis: An expanded understanding

Background and PurposeDescriptions of the significance of ST segment or QRS abnormalities in myocarditis are limited because documentation of the diagnosis has previously required myocardial biopsy. Late gadolinium enhancement (LGE) and T2 weighted imaging in the midventricular wall on cardiac magnetic resonance imaging (CMRI) has a very good positive predictive value for the diagnosis of myocarditis. We hypothesized to reexplore the diagnostic value of these electrocardiographic (ECG) changes in myocarditis by utilizing CMRI as the reference standard. MethodsData on demographics, clinical presentation, laboratory tests, echocardiograms, coronary angiograms, and computed tomography angiography of 41 consecutive patients with definite midventricular or subepicardial LGE and T2 weighted imaging on CMRI were extracted from the available clinical records. ECGs were blindly examined by two independent readers and divided based on (a) STT changes into: 1. No STT changes, 2. STT changes but no ST elevation, 3. ST elevation (STE); and (b) the presence or absence of QRS abnormalities. Associations of these ECG changes with differences in left ventricular ejection fraction, as measured from CMRI was the main aim of this study. In addition, a complete clinical profile of these patients with myocarditis as identified by CMRI was also created. Results80% of our study population were male with a mean age of 38.6±15.5 and a paucity of traditional cardiovascular risk factors (<30%). 90% presented with chest pain with more than half having dyspnea and a viral prodrome, but fever was infrequent (15%). Peak troponin-I and creatine kinase-MB levels exceeded the upper limit of normal in latest 85%, often by more than 5 times the limit. 18% had a coronary luminal narrowing of ≥50%, while 56% had echocardiographic wall motion abnormalities. The left ventricular ejection fraction averaged 54.3±10.8%. In 24.4% of patients, the ECG was entirely normal; while 39% had STE. STT changes did not detect any differences in the ejection fraction. An abnormal QRS, which was present in 29%, was associated with a lower left ventricular ejection fraction (p=0.005). ConclusionsPatients with clinical features suggestive of myocarditis and confirmatory CMRI findings, can present with a variety of ECG findings, some of which have the potential to identify those with a worse cardiac function, and potentially with a worse prognosis.