Journal of electrocardiology
-
Case Reports
Wellens syndrome associated with prominent anterior QRS forces: an expression of left septal fascicular block?
Wellens syndrome is a clinical-electrocardiographic entity also referred to as left anterior descending (LAD) coronary T-wave syndrome or acute coronary T-wave syndrome. It is a complex of symptoms and signals indicating the existence of an undesirable condition secondary to critical high-grade proximal stenosis of the LAD coronary artery characterized by the association of prior history of acute coronary syndrome with little or no elevation of markers of myocardial damage (unstable angina) and characteristic electrocardiographic changes consistent with subepicardial anterior ischemic pattern (persistently symmetrical, deep negative and broad-based T waves) or plus-minus T waves with inversion of the terminal portion in the LAD coronary artery territory (V1 through V5 or V6). We present a case of a variant of Wellens syndrome that reveals association and, transitorily, the criteria described in literature for left septal fascicular block.
-
There is currently a challenge to produce an electrocardiogram (ECG) recording of waveforms that are "standard" and also achieve the "noise immunity" required for continuous monitoring. The potential solutions that have been considered are to label each torso-recorded ECG as "nonstandard, torso-recorded," designate torso placement as "standard," or to reconstruct the "equivalent distally recorded ECG." The purpose of the present study was to validate an alternative "Lund system" of proximal limb electrode sites as a clinically feasible solution to this challenge. ⋯ Indeed, the Lund system replicated distal waveforms at a clinically acceptable level. Studies of larger patient cohorts including patients with various cardiac pathologies and studies of the noise immunity attained should be performed, and the acceptability by health care professionals should be determined.
-
Electrocardiographic low QRS voltage (LQRSV) has many causes, which can be differentiated into those due to the heart's generated potentials (cardiac) and those due to influences of the passive body volume conductor (extracardiac). Peripheral edema of any conceivable etiology induces reversible LQRSV, reduces the amplitude of the P waves and T waves, decreases the duration of P waves, QRS complexes, and QT intervals, and alters in turn the measurements of the signal-averaged electrocardiogram and T wave alternans, all with enormous clinical implications.
-
Atrioventricular block is usually transient during the course of infectious myocarditis. We report the case of a patient presenting with complete infra-hisian atrioventricular block occurring in the setting of infectious myocarditis and in whom a pacemaker should be finally implanted. ⋯ Complete atrioventricular block persisted during the two years of follow-up despite otherwise complete regression of the myocarditis. We then discuss the main features of conduction disturbances complicating infectious myocarditis, including a list as complete as possible of all the causal agents possibly involved.
-
The similarity between and the number of limb lead cables play an important role in the frequency of incorrect connection of limb electrodes. Hence, a modified electrocardiogram (ECG) acquisition procedure is proposed in this brief communication, whereby the left-leg (LL) and right-leg (RL) electrode cables are combined into 1 cable, referred to as combined LL/RL cable. ⋯ The combined LL/RL cable is unique enough (being thicker) not to be mistaken with the upper limb electrode cables. The proposed modification will not in any way influence the ECG waveforms or amplitudes, and it can be expected to substantially reduce incorrect limb electrode placements.