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Right Ventricular Strain EKG Pattern

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1. Right Ventricular Strain EKG Pattern

Ventricular Strain EKG Pattern Right Ventricular Strain EKG Pattern Aka: Right Ventricular Strain EKG Pattern , Electrocardiogram in Pulmonary Hypertension , S1-Q3-T3 From Related Chapters II. Diagnostics: Electrocardiogram (EKG) (partial or complete) Inversion Typically in anterior leads (V1-4) May affect inferior leads (II, III, avF) in some cases Prominent s in aVR Associated with worse prognosis in and S1-Q3-T3 Pattern (early left posterior fascicle block) S Wave in lead I Q Wave in lead III inversion (...) Right Ventricular Strain EKG Pattern Right Ventricular Strain EKG Pattern Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Right

2018 FP Notebook

2. Arrhythmogenic Right Ventricular Cardiomyopathy

to incorporate some of the emerging quantitative indices of both the RV and LV. Tissue Doppler: Tissue Doppler Derived Tricuspid Lateral Annular Systolic Velocity (TV s’) is angle dependent but Figure 1 ECG of a patient with genotype-positive ARVC and clinical features of ventricular arrhythmias and con?rmatory EP study. Note the T-wave inversion in the anterior leads (particularly V1, V2, red arrows). Abbreviations: EP, electrophysiology; ECG, electrocardiograph; ARVC, arrythmogenic right ventricular (...) , parasternal long-axis view; RVOT, right ventricle outflow tract; BSA, body surface area; PSAX, parasternal short-axis view; aVF, augmented voltage unipolar left foot lead; aVL, augmented voltage unipolar left arm lead; ARVC, arrythmogenic right ventricular cardiomyopathy; RV, right ventricular; LV, left ventricular; 2D, two dimensional; SAECG, signal-averaged electrocardiography; MRI, magnetic resonance imaging. Hypokinesis is not included in this or subsequent definitions of RV regional wall motion

2020 Cardiac Society of Australia and New Zealand

3. Right Ventricular Strain EKG Pattern

Ventricular Strain EKG Pattern Right Ventricular Strain EKG Pattern Aka: Right Ventricular Strain EKG Pattern , Electrocardiogram in Pulmonary Hypertension , S1-Q3-T3 From Related Chapters II. Diagnostics: Electrocardiogram (EKG) (partial or complete) Inversion Typically in anterior leads (V1-4) May affect inferior leads (II, III, avF) in some cases Prominent s in aVR Associated with worse prognosis in and S1-Q3-T3 Pattern (early left posterior fascicle block) S Wave in lead I Q Wave in lead III inversion (...) Right Ventricular Strain EKG Pattern Right Ventricular Strain EKG Pattern Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Right

2016 FP Notebook

4. ST-Elevation in aVR with diffuse ST-Depression: An ECG pattern that you must know and understand!

: He is in atrial fibrillation with a rapid ventricular response at a rate of around 140 bpm. There are several abberantly conducted beats. There is ST-Elevation in aVR of several millimeters and diffuse ST-Depression with the maximal depression vector towards Lead II in the limb leads and towards V5 in the precordial leads. ECG reading is all about pattern recognition. And this particular pattern of ST-Elevation in aVR with diffuse ST Depression is a very important ECG pattern that you must (...) ST-Elevation in aVR with diffuse ST-Depression: An ECG pattern that you must know and understand! Dr. Smith's ECG Blog: ST-Elevation in aVR with diffuse ST-Depression: An ECG pattern that you must know and understand! Wednesday, February 28, 2018 This case comes from Sam Ghali ( ). A 60-year-old man calls 911 after experiencing sudden onset chest pain, palpitations, and shortness of breath. Here are his vital signs: HR: 130-160, BP: 140/75, RR:22, Temp: 98.5 F, SaO2: 98% This is his 12-Lead ECG

2018 Dr Smith's ECG Blog

5. Left Ventricular Hypertrophy Related EKG Changes

Probable : 4 points Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Left Ventricular Hypertrophy Related EKG Changes." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Myocardial Disorders About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now (...) Left Ventricular Hypertrophy Related EKG Changes Left Ventricular Hypertrophy Related EKG Changes Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer

2018 FP Notebook

6. Chronic Right Ventricular Hypertrophy, or Acute Right Heart Strain? The ECG Helps Make the Diagnosis.

and Eisenmenger's syndrome, complicated by acute heart failure. The ECG was instrumental in differentiating chronic RV hypertrophy from acute right heart strain, and helped guide therapy towards left heart failure (nitroglycerine) which could be dangerous in pulmonary embolism. Posted by Steve Smith at Labels: Reactions: 9 comments: Great case and very informative. Initially looking at the ECG, I immediately thought PE based on the right ventricular strain patterns including RAD, RVH, Incomplete RBBB, S1Q3T3 (...) Chronic Right Ventricular Hypertrophy, or Acute Right Heart Strain? The ECG Helps Make the Diagnosis. Dr. Smith's ECG Blog: Chronic Right Ventricular Hypertrophy, or Acute Right Heart Strain? The ECG Helps Make the Diagnosis. Tuesday, October 2, 2012 A middle-aged, obese, non English speaking man presented as a walk-in with SOB and leg swelling. His O2 saturations were 59% on room air. Systolic BP was in the 170's. He appeared to be mildly dyspneic, in no great distress, and was speaking

2012 Dr Smith's ECG Blog

7. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis

can be challenging but relies largely on familial occurrence, left bundle-branch pattern ventricular tachyarrhythmias, ECG findings of T-wave inversion in precordial leads V 1 through V 3 , and epsilon waves, as well as right ventricular dilation or segmental wall motion abnormalities, aneurysm formation, or fatty deposition in the right ventricular wall identified with CMR imaging if substantial and unequivocal (or by biopsy tissue analysis). Diagnostic criteria for ARVC have been revised (...) With Cardiovascular Abnormalities: Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis A Scientific Statement From the American Heart Association and American College of Cardiology , MD, FACC, Chair , MD, FAHA, FACC , MD, MS, FAHA, MACC , MD, FAHA, MACC , MD, PhD , MD, FACC , MD, FAHA, FACC , and MD, FACC MD, FACCon behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical

2015 American Heart Association

8. Right Ventricular Imaging and Computer Simulation for Electromechanical Substrate Characterization in Arrhythmogenic Right Ventricular Cardiomyopathy. Full Text available with Trip Pro

Right Ventricular Imaging and Computer Simulation for Electromechanical Substrate Characterization in Arrhythmogenic Right Ventricular Cardiomyopathy. Previous studies suggested that electrical abnormalities precede overt structural disease in arrhythmogenic right ventricular cardiomyopathy (ARVC). Abnormal RV deformation has been reported in early ARVC without structural abnormalities. The pathophysiological mechanisms underlying these abnormalities remain unknown.The authors used imaging (...) and computer simulation to differentiate electrical from mechanical tissue substrates among ARVC clinical stages.ARVC desmosomal mutation carriers (n = 84) were evaluated by electrocardiography (ECG), Holter monitoring, late-enhancement cardiac magnetic resonance imaging, and echocardiographic RV deformation imaging. Subjects were categorized based on the presence of 2010 International Task Force criteria: 1) subclinical stage (n = 21); 2) electrical stage (n = 15); and 3) structural stage (n = 48). Late

2016 Journal of the American College of Cardiology

9. Evaluation and Management of Right-Sided Heart Failure

be difficult, so standardized criteria have been developed that are based on family history, ventricular dysfunction, tissue characterization, electrocardiographic changes ( ), and history of arrhythmias. The sensitivity of electrocardiographic criteria alone ( ) for the diagnosis of ARVC is low. Diagnosis requires a specific combination of major and minor criteria from the ECG, RV imaging, and family history that are reviewed in detail elsewhere. Genetic screening, although not required, may be helpful (...) on the standard ECGFiltered QRS duration ≥114 msDuration of terminal QRS <40 V (low-amplitude signal duration) 38 msRoot-mean-square voltage of terminal 40 ms ≤20 μVTerminal activation duration of QRS ≥55 ms measured from the nadir of the S wave to the end of the QRS, including R, in V 1 , V 2 , or V 3 , in the absence of complete right bundle-branch block ARVC indicates arrhythmogenic right ventricular cardiomyopathy; and SAECG, signal-averaged ECG. Adapted from Marcus et al with permission. Copyright © 2010

2018 International Society for Heart and Lung Transplantation

10. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

and minor criteria from the ECG, RV imaging, and family history that are reviewed in detail elsewhere. Genetic screening, although not required, may be helpful when screening family members of a recently diagnosed patient. , Recommendations for the role of genetic testing of probands and first-degree relatives have been published. Table 2. Revised Task Force Criteria for Electrocardiographic Diagnosis of ARVC Repolarization abnormalities Major Inverted T waves in right precordial leads (V 1 –V 3 (...) block ARVC indicates arrhythmogenic right ventricular cardiomyopathy; and SAECG, signal-averaged ECG. Adapted from Marcus et al with permission. Copyright © 2010, American Heart Association. Figure 9. ECGs in patients with right-sided heart disease. A , ECG from a patient with arrhythmogenic right ventricular cardiomyopathy. ECG from a patient with T-wave inversion in V 1 through V 4 and prolongation of the terminal activation of a 55-millisecond duration measured from the nadir of the S wave

2018 American Heart Association

11. EKG Changes in Syncope due to Arrhythmia

with right ventricular strain pattern (e.g. ) See Inversion in anterior (V1-3) or inferior (II, III, avF) leads Prominent s Pattern (S in I, Q in III, T inversion in III) EKG in Initial: Peaked s in V2-3, II, III Next: ST depression, First degree , shortening Next: with loss of s EKG in Very large amplitude s V. Efficacy EKG is low yield in syncopal patients under age 40 years old (however most warrant EKG in ED evaluation) VI. References Herbert (2014) EM:Rap 14(7): 15-6 Images: Related links (...) Changes in Syncope due to Arrhythmia EKG Changes in Syncope due to Arrhythmia Aka: EKG Changes in Syncope due to Arrhythmia , Electrocardiogram in Syncope From Related Chapters II. Precautions Intervals and duration ( , , QTc Interval) are critical to evaluate in III. Interpretation: EKG changes suggestive of Syncope due to arrhythmia Abnormal <50 bpm (consider ) Abnormal QRS or Bifascicular > 120 ms Q Waves c Interval See See Syndrome IV. Interpretation: EKG changes related to specific syndromes ST

2018 FP Notebook

12. Chest pain with NonDiagnostic ECG but Diagnostic CT Scan

is completed, and emergent angiogram +/- PCI would not be necessary. The cardiologists did not want to go to the cath lab. She had subsequent ECGs: First at 1.5 hours: This possibly shows some inferior STD, but probably it is baseline wander. This one at 5.5 hours: No significant change She was admitted on a Nitro drip. Her troponins went like this: 0.099 ng/mL 1.250 3.712 6.073 8.092 12.170 15.680 21.051 23.159 (this is not a small MI) Next day echo: The estimated left ventricular ejection fraction is 60 (...) V5 ~25mm — for Review of Criteria for ECG Diagnosis of LVH ). The next bullet tells why recognition of voltage for LVH is relevant in this case. What does this patient’s b aseline E CG show ? Was there LVH with an ST-T wave repolarization abnormality (ie, with LV “strain” ?) on the baseline ECG? IF so — then perhaps the ST segment flattening in V5,V6 with relatively small T wave amplitude in lead V6 represents the combination of baseline LV “strain” (ie, ST-T wave depression ) + hyperacute T

2019 Dr Smith's ECG Blog

13. Identification of Typical Left Bundle Branch Block Contraction by Strain Echocardiography Is Additive to Electrocardiography in Prediction of Long-Term Outcome After Cardiac Resynchronization Therapy. Full Text available with Trip Pro

-dimensional strain echocardiography (2DSE) may detect true LBBB activation.This study sought to investigate whether the absence of a typical LBBB mechanical activation pattern by 2DSE was associated with unfavorable long-term outcome and if this is additive to electrocardiographic (ECG) morphology and duration.From 2 centers, 208 CRT candidates (New York Heart Association classes II to IV, ejection fraction ≤35%, QRS duration ≥120 ms) with LBBB by ECG were prospectively included. Before CRT implantation (...) , longitudinal strain in the apical 4-chamber view determined whether typical LBBB contraction was present. The pre-defined outcome was freedom from death, left ventricular assist device, or heart transplantation over 4 years.Two-thirds of patients (63%) had a typical LBBB contraction pattern. During 4 years, 48 patients (23%) reached the primary endpoint. Absence of a typical LBBB contraction was independently associated with increased risk of adverse outcome after adjustment for ischemic heart disease

2015 Journal of the American College of Cardiology

14. A crashing patient with an abnormal ECG that you must recognize

wave with a convex upward ST segment morphology, ST segment strain morphology in the inferior and anterior leads leading to deep symmetric T-wave inversion. Why is it not Wellens??? (Wellens pattern is a term which refers to coronary reperfusion morphology in the anterior leads) The best answer is because the entire gestalt of the ECG shows acute right heart strain instead, and just does not look like Wellens after you've seen Wellens hundreds of times. It is true that the morphology of the T-wave (...) . Supporting Kosuge, found that anterior T-wave inversions were the most common ECG finding in massive PE. Posted by Pendell at Labels: , , Reactions: 6 comments: GREAT case with (as per the title) — an ECG pattern that MUST be recognized! I’d add the following comments regarding ECG signs suggestive of acute right heart strain (therefore acute PE given the clinical scenario here). First — I’d emphasize the thought that rather than any single ECG finding — RVH patterns (including acute RV “strain

2018 Dr Smith's ECG Blog

15. Nonspecific electrocardiographic abnormalities are associated with increased length of stay and adverse cardiac outcomes in prehospital chest pain. Full Text available with Trip Pro

of chest pain and course of hospitalization.This was a prospective observational study that included consecutive prehospital chest pain patients from three tertiary care hospitals in the U.S. Two independent reviewers blinded from clinical data audited the prehospital 12-lead ECG for the presence or absence of NST patterns (i.e., right or left bundle branch block, left ventricular hypertrophy with strain pattern, ventricular pacing, ventricular rhythm, or coarse atrial fibrillation). The primary (...) -3] vs. 2.0 [IQR 1-4] days, p < 0.05) independent of the etiology of chest pain.One in six prehospital ECGs of patients with chest pain has NST patterns. This pattern is associated with increased length of stay and adverse cardiac outcomes, suggesting the need of preventive measures and close follow up in such patients.Copyright © 2018 Elsevier Inc. All rights reserved.

2018 Heart & Lung

16. Left Ventricular Hypertrophy Related EKG Changes

Probable : 4 points Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Left Ventricular Hypertrophy Related EKG Changes." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Myocardial Disorders About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now (...) Left Ventricular Hypertrophy Related EKG Changes Left Ventricular Hypertrophy Related EKG Changes Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer

2015 FP Notebook

17. Prevalence and Prognostic features of Electrocardiographic Abnormalities in Acute Stroke among Africans: Findings from SIREN Full Text available with Trip Pro

was assessed using the modified Rankin Scale (mRS).Patients' mean age was 58.4 ± 13.4 years, 490 were men (55%) and 400 were women (45%), 65.5% had ischemic stroke, and 85.4% had at least 1 ECG abnormality. Women were significantly more likely to have atrial fibrillation, or left ventricular hypertrophy with or without strain pattern. Compared to ischemic stroke patients, hemorrhagic stroke patients were less likely to have atrial fibrillation (1.0% vs. 6.7%; p = 0.002), but more likely to have left (...) Prevalence and Prognostic features of Electrocardiographic Abnormalities in Acute Stroke among Africans: Findings from SIREN Africa has a growing burden of stroke with associated high morbidity and a 3-year fatality rate of 84%. Cardiac disease contributes to stroke occurrence and outcomes, but the precise relationship of abnormalities as noted on a cheap and widely available test, the electrocardiogram (ECG), and acute stroke outcomes have not been previously characterized in Africans.The

2017 Global heart

18. Electrocardiographic abnormalities and mortality in aging survivors of childhood cancer: A report from the St Jude Lifetime Cohort Study. Full Text available with Trip Pro

among survivors and controls (65.2% vs 67.5%, P = .6). Major ECG abnormalities were identified in 10.7% of survivors and 4.9% of controls (P < .001). Among survivors, the most common major abnormalities were isolated ST/T wave abnormalities (7.2%), evidence of myocardial infarction (3.7%), and left ventricular hypertrophy with strain pattern (2.8%). Anthracyclines ≥300 mg/m2 (OR 1.7 95% CI 1.1-2.5) and cardiac radiation (OR 2.1 95% CI 1.5-2.9 [1-1,999 cGy], 2.6 95% CI 1.6-3.9 [2,000-2,999 cGy], 10.5 (...) Electrocardiographic abnormalities and mortality in aging survivors of childhood cancer: A report from the St Jude Lifetime Cohort Study. Electrocardiography (ECG), predictive of adverse outcomes in the general population, has not been studied in cancer survivors. We evaluated the prevalence of ECG abnormalities and associations with mortality among childhood cancer survivors.Major and minor abnormalities were coded per the Minnesota Classification system for participants in the St Jude

2017 American Heart Journal

19. Diffuse ST depression, and ST elevation in aVR. Left main, right?

Diffuse ST depression, and ST elevation in aVR. Left main, right? Dr. Smith's ECG Blog: Diffuse ST depression, and ST elevation in aVR. Left main, right? Saturday, March 2, 2019 This ECG was recorded on a middle-aged male with sickle cell disease and diffuse pain. Sinus rhythm Left ventricular hypertrophy (LVH) Diffuse significant ST depression with ST Elevation in aVR Computerized QT = 494 ms, QTc = 538 ms What else? What do you think? Here is a Previous ECG for comparison: Baseline LVH Only (...) minimal ST depression Diffuse ST depression with ST Elevation in aVR Knotts et al. found that such ECG findings only represented left main ACS in 14% of such ECGs: Only 23% of patients with the aVR STE pattern had any LM disease (fewer if defined as ≥ 50% stenosis). Only 28% of patients had ACS of any vessel, and, of those patients, the LM was the culprit in just 49% (14% of all cases). It was a baseline finding in 62% of patients, usually due to LVH. Reference: Knotts RJ , Wilson JM, Kim E, Huang HD

2019 Dr Smith's ECG Blog

20. Right sided heart failure and tachycardia.

Right sided heart failure and tachycardia. Dr. Smith's ECG Blog: Right sided heart failure and tachycardia. Saturday, February 9, 2019 A middle-aged male presented with tachycardia, dyspnea, and 4+ bilateral leg edema. What is the rhythm? There had been an ice storm, and it was the busiest day in the history of our emergency department because of falls. I reduced 12 fractures that evening and was in constant motion. I looked at this and saw the negative component of the P-wave in V1 (...) found that this was not all new, but rather an exacerbation of a chronic problem. Not having done that, pulmonary embolism was on the differential and we obtained a CT pulmonary angiogram: This shows a massive right atrium and dilated right ventricle Another slice of the CT showing the same thing: A massively dilated right atrium Later, I looked back at the first ECG; Here it is again: It was suddenly clear to me from lead II across the bottom that this was atrial flutter. Why is there a negative

2019 Dr Smith's ECG Blog

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