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Clinical ECGs Part 2 – Arrhythmias
David J. Callans, MD, is a professor of medicine at the university of Pennsylvania, and director of the Electrophysiology Laboratory at the Hospital of the University of Pennsylvania. He is currently the physician secretary for the American Board of internal Medicine Cardiology Exam. Leonard S. Dreifus, MD, is emeritus professor of medicine at Drexel University College of Medicine, and past president of the American College of Cardiology. Here, using 14 clinical ECG’s and more than 80 slides, they explain how pathological alterations in structure and function of the heart produce ECG changes. The authors select ECGs and accompanying discussions to review the most common and important electrocardiographic contour abnormalities presenting to practicing physicians. Among the presented ECGs are those indicating anterior, inferior, posterior and anterolateral injury, including patterns such as the ‘hyperacute’ phase of myocardial infarction, the evolving phase of myocardial infarction, persistent ST elevation as a signal of aneurysm formation, left bundle branch block in the setting of acute anteroseptal and anterior myocardial infarction, acute pericarditis. The authors note that the ability to diagnose left ventricular hypertrophy by ECG is poor compared to echocardiography; but several criteria have been established to aid in this diagnosis, most commonly the Romhilt and Estes criteria. They go on to discuss right ventricular hypertrophy, its causes and characteristics, life threatening hyperkalemia, hypercalcemia, ECG-apical hypertrophic cardiomyopathy, and Wolff-Parkinson-White syndrome. Drs Callans and Dreifus recommend that those using this lecture complete their own interpretation of each ECG before seeing what the authors have to say about it. |
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