In cardiomyopathy, the heart muscle becomes enlarged, thick, or rigid. Pdf atypical ecg presentation in a patient with tako. In the present study, we demonstrated that although goldbergers triad is a specific ecg sign for dilated cardiomyopathy, it is not reflective of the severity of left ventricular dysfunction. Interpretation of electrocardiographic abnormalities in. Goldbergers triad in dilated cardiomyopathycan it predict. The reader will gradually notice that ecg interpretation is markedly. Diseasecausing mutations in the genes encoding structural components of the cardiac sarcomere are identified in 40%60% of.
Blood and lymphatic system disorders ctcae term grade 1 grade 2 grade 3 grade 4 grade 5. First, read the introductory chapters that explain ecg findings and provide. Furthermore, ecg localization was categorized as follows. Jun 19, 20 cardiomyopathy cardiomyopathy is a disorder of the muscle of the heart. This book takes a logical and systematic approach to ecg interpretation, beginning with the basics of normal variations and dealing in turn with atrial abnormalities, ventricular enlargement, ventricular conduction defects and ischemic heart disease. Mar 16, 2019 hypertrophic cardiomyopathy hcm is one of the most common inherited cardiac disorders affecting 1 in 500 people and is the number one cause of sudden cardiac death in young athletes. Cecchi f, olivotto i, montereggi a, et al hypertrophic cardiomyopathy in tuscany. Although lbbb is often associated with significant heart disease and is. Ecg changes in left ventricular hypertrophy lvh large rwaves in left sided leads v5, v6, i and avl and deep swaves in right sided leads v1, v2 indicate the the vector of the left ventricle is amplified. The electrocardiogram in the diagnosis and management of. Hypertrophic cardiomyopathy hcm is a genetic cardiac disease with a heterogeneous phenotypic expression. Dilated cardiomyopathy dcm is best understood as the final common response of myocardium to diverse genetic and environmental insults. The mean diameter expressed as a z score of the interventricular septum was more hypertrophied than the posterior wall of the lv 3. Methodological ecg interpretation the ecg must always be interpreted systematically.
The phenotypic expression of hypertrophic cardiomyopathy, which occurs in 1 of every 500 adults in the general population, includes massive hypertrophy involving primarily the. The most common ecg abnormalities are those associated with atrial and ventricular hypertrophy typically, left sided changes are seen but there may be signs of biatrial or biventricular hypertrophy. Prasad, md abstract dilated cardiomyopathy dcm is best understood as the. His father died suddenly at age 43 and his brother died suddenly at age 39.
Ten years before the current presentation he had an unremarkable cardiological checkup ecg, echo, x ecg. Denise antle, arnp, msn, ccrn, ccns critical care arnpcns. Cardiomyopathy national heart, lung, and blood institute. Secondary stt changes in left sided leads left ventricular hypertrophy is often accompanied by j point depression, downsloping st segment and inverted asymmetric twaves i the. Heart failure and heart muscle disease center, hadassah university hospital, jerusalem, israel.
Sensitivity and specificity of the frequently used criteria for the diagnosis. The model performed particularly well in younger patients sensitivity 95%, specificity 92%. Cardiomyopathy diagnosis and treatment mayo clinic. There are three ecg patterns associated with brugada syndrome, of which only the type 1 ecg is diagnostic. Atypical ecg presentation in a patient with takotsubo cardiomyopathy article pdf available in kardiologia polska 693. A contemporary definition for cardiomyopathy is a myocardial disorder in which the heart muscle is structurally and functionally abnormal in the absence of coronary artery disease, hypertension, valvular disease, and congenital heart disease sufficient to explain the observed myocardial. Cardiomyopathy refers to diseases of the heart muscle. Ecg reference sites and books the best of the rest. I teach ekg interpretation to 4th year medical students and provide each student with a copy of this book. Echo assessment of cardiomyopathy pdf slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The pericardium is a doublewalled sac in which the heart and the roots of the great vessels are contained figure 1. Cardiomyopathy kardeomiopahthee refers to diseases of the heart muscle. Diagnosis your doctor will conduct a physical examination, take a personal and family medical history, and ask when your symptoms occur for example, whether exercise brings on your symptoms. However, the ecg is frequently abnormal in patients with dcm.
Background ecg criteria differentiating takotsubo cardiomyopathy ttc from mainly anterior myocardial infarction mi have been suggested. In rare cases, the muscle tissue in the heart is replaced with scar tissue. However, the authors have interrogated a number of relevant advances in cardiovascular medicine, including widespread feeforservice genetic. These may mimic prior myocardial infarction, although the qwave morphology is different. Changes need to occur in at least 2 of the right precordial leads v. Raised intracranial pressure restrictive cardiomyopathy myocardial. This book is intended as an ecg curriculum that emphasizes practice. A 2sample t test was used to compare casecontrol differences. Ecg findings and hypertrophic cardiomyopathy letters to the. Those affected are at an increased risk of sudden cardiac death. Left ventricular hypertrophy results in increased precordial voltages and nonspecific st segment and twave abnormalities. When the muscle of the heart is thickened, it is known as hypertrophy. Treatment which might include medications, surgically. Table 2 lists the clinical demographics, echocardiographic data, and electrocardiographic analysis.
If your doctor thinks you have cardiomyopathy, you might need to undergo several tests to confirm the diagnosis, including. Echocardiography is an invaluable tool in the diagnosis and followup of patients with hcm. Ecg criteria to differentiate between takotsubo stress. Common terminology criteria for adverse events ctcae. Chisquare analysis was used to determine the accuracy of each screening test in identifying hc. Cardiomyopathy is a group of diseases that affect the heart muscle. Ecg from a 12yearold girl with hypertrophic cardiomyopathy. Cardiac rhythms are named after the locus of their origin.
Arrhythmogenic right ventricular cardiomyopathy arvc is an inherited cardiomyopathy that predominantly affects the right ventricle. Failure to perform a systematic interpretation of the ecg may be detrimental. Patients with symptomatic brugada syndrome may have a nondiagnostic ecg at the time of assessment e. The ecg criteria to diagnose hypertrophic obstructive cardiomyopathy hocm including the apical variant is discussed with example 12lead ecgs. New concepts in ecg interpretation alessandro capucci springer. The american heart association aha defines cardiomyopathy as a heterogeneous group of diseases of the myocardium, usually with inappropriate ventricular hypertrophy or dilatation. Deeply negative t waves in precordial leads, st segment depression and voltage criteria for left ventricular hypertrophy suggested a diagnosis of apical hypertrophic cardiomyopathy. Echocardiography in hypertrophic cardiomyopathy diagnosis. With an interdisciplinary appeal, this book, based on case reports, shows a number of new. Novel electrocardiographic criteria for the diagnosis of. The value of the 12lead electrocardiogram ecg to provide prognostic information in the deadly and disabling syndrome peripartum cardiomyopathy ppcm is unknown. Diagnosis and management of hypertrophic cardiomyopathy is a unique, multiauthored compendium of information regarding the complexities of clinical and genetic diagnosis, natural history, and management of hypertrophic cardiomyopathy hcmthe most common and important of the genetic cardiovascular diseasesas well as related issues impacting the health of trained athletes.
Dilated cardiomyopathy is the third most common cause of heart failure and the most frequent reason for heart transplantation. Asymmetrical septal hypertrophy produces deep, narrow daggerlike q waves in the lateral v56, i, avl and inferior ii, iii, avf leads. This is a middleaged male with ho with a history of heart failure with severely reduced ejection fraction due to dilated ischemic cardiomyopathy ef 510%, probably with some component of nonischemic cardiomyopathy, with ho cabg, who is status post icd placement and previous appropriate shocks for vt and biventricular pacer cardiac resynchronization therapy, who is on. It is a heterogeneous disorder, produced by mutations in multiple genes coding for sarcomeric proteins e. These diseases have many causes, signs and symptoms, and treatments. To determine the prevalence of major and minor ecg abnormalities in ppcm patients at the time of diagnosis. Hypertrophic cardiomyopathy hcm is a genetically determined heart muscle disease characterized by left ventricular lv hypertrophy lvh in the absence of a cardiac or systemic cause and has an estimated prevalence of 1. A receiver operating characteristic curve was created for each electrocardiographic screening criterion. In cardiomyopathy, the heart muscle becomes thick or rigid, which can weaken the heart.
Anemia hemoglobin hgb jun 07, 2018 this is a middleaged male with ho with a history of heart failure with severely reduced ejection fraction due to dilated ischemic cardiomyopathy ef 510%, probably with some component of nonischemic cardiomyopathy, with ho cabg, who is status post icd placement and previous appropriate shocks for vt and biventricular pacer cardiac resynchronization therapy, who is on amiodarone for. Pdf ecg criteria to differentiate between takotsubo. Killer ecg patterns litfl medical blog ecg library. From clinical practice it is possible to make accurate ecg diagnoses in some diseases and to.
Hypertrophic cardiomyopathy is a genetic cardiac disorder caused by a missense mutation in 1 of at least 10 genes that encode the proteins of the cardiac sarcomere. The right ventricle may also be dilated and dysfunctional. Novel electrocardiographic screening criterion for. Dilated cardiomyopathy is a progressive disease of heart muscle that is characterized by ventricular chamber enlargement and contractile dysfunction. If you continue browsing the site, you agree to the use of cookies on this website. Hypertrophic cardiomyopathy hcm is diagnosed on the basis of left ventricular lv hypertrophy for which there is insufficient explanation e. Differentiation of constrictive pericarditis from restrictive cardiomyopathy by. Hypertrophic cardiomyopathy hcm is one of the most common inherited cardiac disorders affecting 1 in 500 people and is the number one cause of sudden cardiac death in young athletes. These diseases have many causes, signs and symptoms as well as treatments. Jun, 2016 ecg criteria differentiating takotsubo cardiomyopathy ttc from mainly anterior myocardial infarction mi have been suggested. Determining the etiology of dilated cardiomyopathy is a key element in the management and prognosis of a patient with heart failure hf. A 69yearold man with a history of a dilated cardiomyopathy presents with several hours of palpitations and sudden onset of shortness of breath.
May 01, 2009 cardiomyopathy is an anatomic and pathologic diagnosis associated with muscle or electrical dysfunction of the heart. In order to improve the electrocardiographic ecg diagnosis of arrhythmogenic right ventricular cardiomyopathy arvc, we evaluated novel quantitative parameters of the qrs complex and the value of bipolar chest leads cf leads computed from the standard 12 leads. Echo assessment of cardiomyopathy pdf linkedin slideshare. Cardiomyopathy cardiomyopathy is a disorder of the muscle of the heart. Ecg criteria differentiating takotsubo cardiomyopathy ttc from mainly anterior myocardial infarction mi have been suggested.
Q waves and negative t waves are common electrocardiographic ecg abnormalities in patients with hypertrophic cardiomyopathy hcm. The diagnosis and evaluation of dilated cardiomyopathy. Cardiomyopathy kahrdeeomyopuhthee is a disease of the heart muscle that makes it harder for your heart to pump blood to the rest of your body. The diagnosis and evaluation of dilated cardiomyopathy alan g. Causes, signs and symptoms, pathogenesis, diagnosis, and treatment duration. Hypertrophic cardiomyopathy hcm is an important genetic heart muscle disease for which prevalence in the general population has not been completely resolved. The diagnosis and evaluation of dilated cardiomyopathy jacc. Overview of electrocardiogram diagnosis as an adjunct to litfl ekg library basics. The classic ecg finding in hypertrophic obstructive cardiomyopathy is large daggerlike septal q waves in the lateral and sometimes inferior leads due to the abnormally hypertrophied interventricular septum. The main types of cardiomyopathy include dilated, hypertrophic and restrictive cardiomyopathy. Electrocardiography is a simple investigation to perform, but accurate interpretation can be challenging. The ecg criteria book will be a nice supplement to the main text. Left bundle branch block lbbb statpearls ncbi bookshelf.
Hypertrophic cardiomyopathy hcm litfl ecg library diagnosis. The ecg above belongs to a patient with apical hypertrophic cardiomyopathy. A rigorous workup can exclude alternative causes of left ventricular lv dilation and dysfunction, identify etiologies that may respond to specific treatments, and guide family screening. Dilated cardiomyopathy dcm most prominent cm incidence 36 cases100,000 per year diagnostic criteria are lacking males and africans middle age idcm accounts for 25% of all heart failure cases. Relationship between electrocardiographic findings and cardiac. It is a nice size for students to take on clinical rotations. In most cases, cardiomyopathy causes the heart muscle to become enlarged, thick or rigid.
The same etiology may not only damage the myocardium. Deep twave inversion twi in the lateral leads is a recognized feature of apical hcm and should prompt an accurate evaluation of this morphological variant with available imaging techniques. In rare instances, diseased heart muscle tissue is replaced with scar tissue. The criterion for normal ventricular activation is a qrsinterval shorter than 0. Criteria for left ventricular hypertrophy is usually present. This book is distributed under the terms of the creative commons. Learn more about causes, risk factors, screening and prevention, signs and symptoms, diagnoses, and treatments for cardiomyopathy, and how to participate in clinical trials. Ecg findings and hypertrophic cardiomyopathy letters to. Dilated cardiomyopathy dcm litfl ecg library diagnosis. Cardiomyopathy is an anatomic and pathologic diagnosis associated with muscle or electrical dysfunction of the heart.
Male patients accounted for a slightly higher proportion of our cohort than previous reports. There are no specific ecg features unique to dcm, however the ecg is usually not normal. A contemporary definition for cardiomyopathy is a myocardial disorder in which the heart muscle is structurally and functionally abnormal in the absence of coronary artery disease, hypertension, valvular disease, and congenital heart disease sufficient to explain the observed myocardial abnormality. Guidelines summarize and evaluate all available evidence at the time of the writing. Oct 09, 2017 echo assessment of cardiomyopathy pdf slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Diagnosis and management of hypertrophic cardiomyopathy. New perspectives on the prevalence of hypertrophic. The increased r wave amplitude in right precordial leads c1c3 and a blood pressure of 11070 mmhg. Dilated cardiomyopathy dcm is a disease of the heart muscle with impaired systolic function impaired contractility which involves one or both ventricles. By definition, coronary arteries are normal in dcm. Note the presence of sinus rhythm and wide, bizarre qrs complexes. Ecg az by diagnosis litfl ecg library clinical interpretation. As the disease worsens, shortness of breath, feeling tired, and swelling of the legs may occur, due to the onset of heart failure.