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Exciting ECG

This case study delves into a patient's sudden collapse with low QRS voltages on ECG. Explore the diagnostic journey, differential diagnoses, and management strategies for serious syncopal episodes. Learn about the importance of comprehensive history-taking and potential underlying conditions.

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Exciting ECG

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Presentation Transcript

  1. Exciting ECG Jolein Huttenhuis

  2. ECG

  3. Are we excited?

  4. Patient with collaps

  5. Case • 45y, male • no prior medical history • just had lunch break and was walking back to go to work (construction) • felt dizzy during walking • collapsed and fell on his face

  6. Case • Family history: negative for sudden cardiac death and other vascular events

  7. ECG

  8. Case • OE: • no abnormalities besides some broken teeth • Lab: • Pro BNP 428 • Troponines 0,016 (2nd 0,015) • CK 293, CKMB 32

  9. Conclusion • Serious syncope • No prodromen • ECG: low QRS voltages • Face injury managedbydentalsurgeon

  10. Low QRS voltage • QRS amplitude (+ and-) • Allextremities< 5mm OR • Precordial leads <10mm • QRS amplitude • I+II+III <15mm OR • V1+V2+V3 <30mm

  11. Low QRS voltage • Cardiomyopathy • Dilated, restrictive, infiltrative • Pericarditis/myocarditis • Hypothyroidism/myxoedema • Ischemic • Physicalresistance (‘layers’) • Adipositas • Pericardialeffusion (blood/fluid) • Pleuraleffusion, pneumothorax • Hearttransplant • Equipment

  12. Case • Monitor 24h • 1x non-sust VT (RVOT) • Some bigeminie • Ultrasound • LVF, dilated • No valve disorders • MRI • Dilatation LV and RV • perimyocarditis

  13. Case Non-ischemic dilated cardiomyopathy • Perimyocarditis

  14. Case • Serology • EBV

  15. Case • Profylactic ICD • Metoprolol

  16. Conclusion • History is very important • Low QRS voltages have a broad differential and might be a clue to something serious

  17. ?

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