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Exciting ECG

Exciting ECG. Jolein Huttenhuis. ECG. Are we excited?. Patient with collaps. Case. 45y, male no prior medical history just had lunch break and was walking back to go to work (construction) felt dizzy during walking collapsed and fell on his face. Case.

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Exciting ECG

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  1. Exciting ECG Jolein Huttenhuis

  2. ECG

  3. Are we excited?

  4. Patient with collaps

  5. Case • 45y, male • no prior medical history • just had lunch break and was walking back to go to work (construction) • felt dizzy during walking • collapsed and fell on his face

  6. Case • Family history: negative for sudden cardiac death and other vascular events

  7. ECG

  8. Case • OE: • no abnormalities besides some broken teeth • Lab: • Pro BNP 428 • Troponines 0,016 (2nd 0,015) • CK 293, CKMB 32

  9. Conclusion • Serious syncope • No prodromen • ECG: low QRS voltages • Face injury managedbydentalsurgeon

  10. Low QRS voltage • QRS amplitude (+ and-) • Allextremities< 5mm OR • Precordial leads <10mm • QRS amplitude • I+II+III <15mm OR • V1+V2+V3 <30mm

  11. Low QRS voltage • Cardiomyopathy • Dilated, restrictive, infiltrative • Pericarditis/myocarditis • Hypothyroidism/myxoedema • Ischemic • Physicalresistance (‘layers’) • Adipositas • Pericardialeffusion (blood/fluid) • Pleuraleffusion, pneumothorax • Hearttransplant • Equipment

  12. Case • Monitor 24h • 1x non-sust VT (RVOT) • Some bigeminie • Ultrasound • LVF, dilated • No valve disorders • MRI • Dilatation LV and RV • perimyocarditis

  13. Case Non-ischemic dilated cardiomyopathy • Perimyocarditis

  14. Case • Serology • EBV

  15. Case • Profylactic ICD • Metoprolol

  16. Conclusion • History is very important • Low QRS voltages have a broad differential and might be a clue to something serious

  17. ?

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