Complex uninterpretable electrocardiogram and syncope

Electrocardiogram(ECG) is an essential component as diagnostic modalities in cardiovascular diseases. A wide spectrum of diseases can be diagnosed by ECG. Conduction disturbances manifest in ECG with characteristics manner. Sometimes these manifestations are not interpretable with the current concept of cardiovascular physiology. Here I have reported such an interesting ECG which is complex and difficult to interpret

Coronary Angiographic Profile in Patients with Conduction System Disorder Requiring Permanent Cardiac Pacing.

Background: The association between conduction disturbances and atherosclerotic coronary artery disease has been investigated in a few small studies in the early 1970s and the study result was inconclusive. Thereafter some investigators found in their separate study that a group of patients with conduction disturbances that required permanent pacemaker who had coronary atherosclerotic disease that might be responsible for conduction disturbances. Method: 40 consecutive patients that required permanent pacemaker and 40 control patients were investigated. The coronary angiographic study was performed in both groups which included classification of pathological coronary anatomy, qualitative assessment of flow and stenosis severity. Results: The location of the lesions was found significantly different between two groups. 14 patients(35%) of 40 study patients had type IV lesion, whereas only 2 patients(5%) of 40 control patients had type IV lesion (p=0.001). Flow quality was found poor in more patients in study group specially that had type IV lesion. Severity of the lesions in the LAD & RCA was found identical in both groups. Conclusion: It may be concluded that the location of the lesions rather than diffuse coronary atherosclerosis might be responsible for a subset of patients with conduction disturbances that required permanent pacemaker.

Aneurysm of Sinus of Valsalva Dissecting into Interventricular Septum: A Possible Cause of Complete Atrioventricular Block

Dissection of the interventricular septum by aneurysm of sinus of Valsalva is a rare lesion and has poor prognosis. However, it can be diagnosed noninvasively with echocardiography and managed well by surgical repair. A 55 year old female was readmitted due to aggravated exertional dyspnea. She was implanted with permanent pace-maker due to complete atrioventricular (AV) block of recent onset at a community hospital. Previous diastolic murmur near aortic area was changed to a new continuous murmur. The diagnosis of an aneurysm of sinus of Valsalva dissected into the interventricular septum was confirmed by routine two-dimensional echocardiography. The neck of the aneurysm was closed primarily with patch and aortic valve replacement was done. The pro-gnosis was good. The finding of AV block of recent onset and obscure origin in a young patient should alert the physician to the possibility of an aneurysm of sinus of Valsalva and warrants systematic echocardiography.

Estudo da etiologia do bloqueio do Ramo Esquerdo em Porto Alegre / Etiologic Evaluation of Left Bundle Branch Block in

PURPOSE--To determine the type of cardiac disease causing left bundle branch block (LBBB) in Porto Alegre, Brazil, and to assess the role of associated left axis deviation (-30 degrees or more in the frontal plane) in order to identify a specific etiology of LBBB. METHODS--Through reports from the assistant physicians or through examination of the patients, the underlying heart disease in 264 cases of LBBB was assessed. The chi-square test was used to determine a possible association between left anterior hemiblock LBBB and one or more specific type of underlying heart disease. RESULTS--Systemic arterial hypertension (30.7), ischemic heart disease (30.3), valvar heart disease (8.7), cardiomyopathies (7.5), idiopathic degenerative disease of the conduction system (1.6) and miscellaneous heart diseases (1.2) were the underlying heart diseases. The presence of LBBB did not indicate any specific type of cardiac disease. CONCLUSION--The causes of LBBB in Porto Alegre are the same as reported in the international medical literature. Upward and leftward deviation (> or = -30 degrees) of QRS axis in the frontal plane did not show statistical significant association with any type of underlying cardiac disease.

Objetivo - Estudar a doença cardíaca subjacente ao bloqueio de ramo esquerdo (BRE) na Grande Porto Alegre e avaliar se o desvio do eixo de QRS ao plano frontal para cima e para a esquerda está associado a determinada etiologia do BRE. Métodos - Foram estudados 264 casos de BRE com diagnóstico cardiológico determinado através de informação do médico assistente ou de entrevista com o próprio paciente. Casos com eixo SÂS de-30º no plano frontal receberam também o diagnóstico de hemibloqueio anterior esquerdo (HBAE). Utilizou-se o teste do qui-quadrado para o estudo de associação. Resultados - Hipertensão arterial sistêmica (50,7%), cardiopatia isquêmica (30,7%), valvopatias (8,7%), miocardiopatias (7,5%), doença degenerativa do sistema de condução (1,6%) e cardiopatias diversas (1,2%) foram as causas. Presença de HBAE não permitiu prever o tipo de cardiopatia. Conclusão - As causas de BRE na área de Porto Alegre são semelhantes às observadas na literatura internacional. O desvio do eixo do QRS para a esquerda não mostrou associação estatisticamente significante com o tipo de cardiopatia subjacente