ECG: Findings in CNS disorders
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Transcript of ECG: Findings in CNS disorders
ECG QUIZPROF(DR).G.SUNDARAMURTHYM2 UNITDR.DILIP HARINDRANSECOND YEAR PG RESIDENT
PRESENTATION
• A 73 YEAR OLD MALE CAME WITH COMPLAINTS OF DIFFICULTY IN USING LEFT UPPER LIMB AND LOWER LIMB SINCE MORNING. A KNOWN DIABETIC AND HYPERTENSIVE.
• O/E PR - 64/MIN, BP - 160/100 MM HG, GCS -8/15 CNS - LEFT HEMIPLEGIA.
• ECG WAS TAKEN FOR THE PATIENT WHICH SHOWED,
INTERPRETATION• NORMAL SINUS RHYTHM• RATE - 75/MIN• P WAVE - NORMAL MORPHOLOGY, REDUCED
VOLTAGE IN LIMB LEADS• PR INTERVAL NORMAL• QRS COMPLEX NORMAL MORPHOLOGY, LOW
VOLTAGE IN LIMB LEADS• QT INTERVAL PROLONGED - 500MS AND DEEP
ANTEROLATERAL T WAVE INVERSIONS (CAN BE DUE TO CNS INVOLVEMENT OR MYOCARDIAL ISCHEMIA).
DISCUSSION
• ECG FINDINGS OF ACUTE CNS DISORDERS INCLUDE:
1. LARGE UPRIGHT T WAVES IN PRECORDIAL LEADS
2. INCREASED QRS VOLTAGE3. DEEPLY INVERTED T WAVES IN PRECORDIAL
LEADS4. PROLONGED QT INTERVAL5. PROMINENT U WAVES IN PRECORDIAL LEADS
• OTHERS FINDINGS INCLUDE:1. T WAVE NOTCHING2. LOSS T WAVE AMPLITUDE3. DIFFUSE ST SEGMENT ELEVATION4. ABNORMAL Q WAVES5. RHYTHM ABNORMALITIES LIKE AF, VT, SINUS
BRADYCARDIA OR TACHYCARDIA CAN OCCUR.
• ECG CHANGES ASSOCIATED WITH ACUTE CNS EVENTS CAN MIMIC -
1. ACUTE MYOCARDIAL INFARCTION2. LEFT VENTRICULAR HYPERTROPHY3. RIGHT VENTRICULAR HYPERTROPHY4. PERICARDITIS5. ANTIARRHYTHMIC DRUG EFFCTS
FIND THE IMPOSTER
ANSWER• TRACINGS A, B AND C SHOW ATRIAL FIBRILLATION
WITH IRREGULARLY IRREGULAR RHYTHMS; FIBRILLATORY WAVES OF VARYING AMPLITUDE AND MORPHOLOGY; ABSENCE OF DISCRETE P WAVES.
• TRACING D SHOWS MAT. IT USUALLY PRESENTS WITH ATRIAL RATE OF >100BPM, 3 OR MORE DIFFERENT P WAVE MORPHOLOGIES, AND VARYING PP AND PR INTERVAL. DEFINITE P WAVES AND ATRIAL DEPOLARIZATIONS ARE NOTED WHICH ARE NOT THERE IN A, B AND C.
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