ABSTRACT
An obese 57-year-old man with the obstructive sleep apnea syndrome had partial tracheostomy occlusion and palpitations. Continuous ECG monitoring demonstrated atrial flutter, occasional premature ventricular beats, and a high degree of atrioventricular block during apneic episodes. A 7-s period of ventricular asystole was demonstrated during one such episode. Revision of the tracheostomy produced an improvement in the patient's condition.
Subject(s)
Atrial Flutter/complications , Sleep Apnea Syndromes/complications , Airway Obstruction/complications , Airway Obstruction/therapy , Electrocardiography , Heart Block/complications , Humans , Male , Middle Aged , Sleep Apnea Syndromes/therapy , TracheotomySubject(s)
Coronary Disease/diagnostic imaging , Rheumatic Heart Disease/diagnostic imaging , Vectorcardiography , Adult , Aged , Female , Humans , Male , Middle Aged , RadiographyABSTRACT
A 47-year-old man experienced palpitations and shortness of breath following push-up exercises. Because of paroxysmal atrial fibrillation and fatigue, the patient underwent investigation. Echocardiography and cardiac catheterization indicated the diagnoses of mitral valve prolapse and rupture of the chordae tendineae. This report represents the first description of such a sequence of events.
Subject(s)
Chordae Tendineae/injuries , Physical Exertion , Echocardiography , Electrocardiography , Humans , Male , Middle Aged , Mitral Valve Prolapse/etiology , PhonocardiographyABSTRACT
Standard electrocardiograms (ECG) and Frank vectorcardiograms (VCG) were obtained in 43 consecutive patients in sinus rhythm who had echocardiographic evidence of left atrial enlargement (left atrial internal dimension greater than 4.0 cm; x +/- 1SD = 4.7 +/- 0.5 cm). High gain VCG P loop measurements for the study group were: maximal posterior magnitude, 0.11 +/- 0.03 mv; duration, 106 +/- 14 msec and ratio of maximal posterior to maximal anterior P vector magnitudes, 3.2 +/- 1.4. Thirty of 43 (70%) patients with echocardiographic determined left atrial enlargement had VCGs diagnostic of that condition. Utilizing New York Heart Association criteria for left atrial enlargement, 17 of 43 patients (40%) had ECGs which were diagnostic. Fifteen of 43 (35%) subjects manifested both ECG and VCG criteria for left atrial enlargement and only two patients had diagnostic ECGs and normal VCGs. It is concluded that analysis of high gain VCG P loops provides a 30% higher yield for the diagnosis of echocardiographically determined left atrial enlargement when compared with P wave examination on the standard ECG.
Subject(s)
Cardiomyopathy, Hypertrophic/diagnosis , Echocardiography/methods , Electrocardiography/methods , Vectorcardiography/methods , Adult , Aged , Cardiomyopathies/diagnosis , Cardiomyopathy, Hypertrophic/physiopathology , Coronary Disease/diagnosis , Diagnosis, Differential , Female , Heart Atria/physiopathology , Humans , Male , Middle Aged , Pulmonary Heart Disease/diagnosis , Rheumatic Heart Disease/diagnosisSubject(s)
Bundle-Branch Block/physiopathology , Cardiomyopathies/physiopathology , Heart Valve Diseases/physiopathology , Myocardial Infarction/physiopathology , Vectorcardiography/methods , Adult , Aged , Angiocardiography , Coronary Disease/physiopathology , Electrocardiography , Female , Heart Aneurysm/physiopathology , Heart Conduction System/physiopathology , Humans , Male , Middle AgedABSTRACT
Standard 12 lead electrocardiograms (ECG) and timed Frank vectorcardiograms (VCG) were recorded in 53 subjects with atrial fibrillation. Thirty-eight patients had echocardiographically documented left atrial enlargement (greater than 4.0 cm) and 15 patients had normal atrial dimensions. The magnitude of the largest "f" wave component during an average cycle length was measured in lead V1 of the ECG and the horizontal plane VCG running loop. Relative sensitivies for detection of left atrial enlargement were: VCG, 25/38 (66%) and ECG 10/38 (26%). An enlarged left atrial internal dimension was diagnosed by the VCG alone in 21 of the 38 subjects (55%). In the group of 15 patients with normal echocardiographic left atrial internal dimensions the prevalence of ECG false positive diagnosis for enlarged left atrial size was 6% in contrast with 0% for the VCG. It is concluded that: 1) the timed Frank VCG is superior to the ECG for the detection of echocardiographically demonstrable left atrial enlargement; 2) the timed VCG and ECG represent complementary techniques for identifying patients with abnormally large left atria; and 3) large fibrillatory waves are rarely observed on the ECG or VCG when the left atrial internal dimension is echographically normal.
