Electrocardiogram as a Diagnostic Method for Left Ventricular Hypertrophy

BACKGROUND: The purpose of this study was to examine the sensitivity and specificity of ECG as a tool for detecting echocardiographically defined LVH in a population-based sample and to examine the impact of a variety of factors that affect the sensitivity and specificity of ECG for detection of LVH. METHODS: A total of 1,130 subjects who received a thorough medical checkup for cardiologic department voluntarily were selected. The subjects were examined using M-mode echocardiography and standard 12-lead ECG. The chi-square test was used to test for differences in sensitivity and specificity of ECG for echocardiographically defined LVH. Cochran-Mantel-Haenszel statistic was used to adjust for sex, age, and obesity and to test the association between cigarette smoking, amount of alcohol, exercise, hypertension, diabetes mellitus (DM) and sensitivity and specificity of ECG. RESULTS: Echocardiographic LVH was detected in 434 (38.4%) and electrocardiographic features of LVH were present in 146 (12.9%). ECG for diagnosis of LVH showed sensitivity of 20.0%, specificity of 91.5%, and diagnostic accuracy of 64.1%. Sensitivity of ECG for LVH was higher in persons with obesity (P=.04) or hypertension (P=.04). Specificity of ECG for LVH was lower in persons with hypertension (P=.003) CONCLUSION: ECG has a low sensitivity and a high specificity for echocardiographically defined LVH. Attention must be paid to carefully interpret ECG for diagnosis of LVH in persons with obesity or hypertension, because the rate of false positives and negatives can be increased.

A Case of Late Postpartum Eclampsia 14 Days after Delivery / 대한간질학회지

Eclampsia is a syndrome characterized by pregnancy-induced hypertension, edema, proteinuria, and generalized tonic-clonic convulsions, occurring between 20 and 40 weeks of gestation or within 48 hours of postpartum. A convulsion that shows up more than 48 hours after delivery is late postpartum eclampsia. A 40-year-old woman was admitted due to a headache and generalized tonic-clonic seizures in 14 days of postpartum. Two months prior to the admission, she had been admitted to the hospital because of mild proteinuria. Her blood pressure on arrival was 160/100 mmHg. There were no focal neurologic signs. She was given lorazepam and valproate sodium intravenously and her convulsion was stopped. A brain MRI showed multiple bilateral high signal intensities in the both deep white matter and the parieto-occipital cortex. Cerebral angiography showed a diffuse vasospasm. We report a patient with late postpartum eclampsia occurring 14 days after parturition whose seizures was accompanied by preceding headache and proteinuria as a pre-eclamptic sign.