ECG Webinar Series

ECG Webinar SeriesEpisode 8: Cardiomyopathy & Brugada

29th June 2020 at 19:00

Presented by:

Mr Innes Eaton

Paramedic Practitioner

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ECG Webinar Series | Episode 8 | Cardiomyopathy & Brugada

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Warning!



Session Plan

• Hypertrophic Cardiomyopathy

• Dilated Cardiomyopathy

• Arrhythmogenic RV Cardiomyopathy

• Takotsubo Cardiomyopathy

• Specialised Cardiomyopathies

• Brugada Syndrome

• Q&A Session



Case Study 1



• 17 y/o male

• Collapsed playing football

• Short syncope

• Ambulance called

• Feels faint when he stands

• Funny feeling in chest

• RR 26, SpO2 96%, HR 288, BP 58/35

• RR 28, SpO2 98%, HR 112, BP 101/52

Case Study 1



Interactive Quiz



HCM



• Hereditary Condition

• Thickening and stiffening of

the LV myocardium

• Results in ‘cellular disarray’

• Cellular disarray makes the

ventricle more susceptible to

unstable ventricular rhythms

• Hx of syncope is worrying!

Classification

• Asymmetrical (with/without

LVOT obstruction)

• Symmetrical

• Apical

HCM



Diagnostic Criteria

• LVH

• Deep, narrow Q-Waves in

lateral & inferior leads

Apical HCM



Diagnostic Criteria

• LVH

• Precordial giant TWI

DCM



• Sometimes hereditary

• Massive infarct

• Myocarditis

• Alcoholism

• Autoimmune disease

• PPCM

• Chronic severe HTN

• Results in ‘baggy’ LV

DCM – ECG Findings



• Hypertrophy – Atrial & Ventricular

• LBBB

• Low limb lead voltages (at odds with hypertrophy)

• Frequent PVCs

• Ventricular arrhythmias (VT/VF)

ARVC



• Hereditary condition

• Results in breakdown of the

myocytes, particularly in RV wall

• Scar/fatty tissue replaces

missing myocytes

• RV function is impaired

• Can spread to LV

• Associated with the Epsilon wave

• Prone to arrhythmias

ARVC



Epsilon Wave (V1)

Fontaine Bipolar Leads

ARVC



Case Study 2



• 45 y/o male

• Chest pain

• Nausea

• Diaphoresis

• Cardiogenic shock

• Recent bereavement

• RR 20, SpO2 98%, HR 72, BP 118/75, T 36.9°C, BM 6.2

Case Study 2



Interactive Quiz



Warning!



TCM



• Thought to be caused by stress

• Broken heart syndrome

• Results in temporary reshaping

of the LV

• Can mimic an AWMI

• Generally settles with time

• Treat as an MI until proven

otherwise!

Restrictive Cardiomyopathy (RCM)



• Rare condition

• Poorly understood

• Most common in young children

• Myocytes are replaced by scar

tissue

• Results in stiffening of the

myocardium in the LV

• Associated with

hemochromatosis, amyloidosis

and sarcoidosis

• Associated with some cancer tx

Left Ventricular Noncompaction (LVNC)



Peripartum Cardiomyopathy (PPCM)



• Rare complication of late pregnancy/post-partum

• Affects women over 30 predominantly

• Poorly understood

• Similar pathophysiology to DCM

• Good prognosis

Brugada Syndrome



• Calcium channel deficiency

• Results in sudden cardiac death

• Hearts are structurally normal

• Transient ECG changes brought on by:• Fever

• Ischaemia

• Drugs

• Hypothermia

• Hypokalaemia

Brugada Syndrome



Brugada Sign

• Coved ST >2mm in any

V1-3 followed by TWI

Type 2

• Saddleback ST >2mm

in any V1-3

Type 3

• Either type 1 or 2

with <2mm ST

Brugada Syndrome



• Diagnosis requires Brugada Sign (type 1) plus any one:• VF or polymorphic VT

• FHx of SCD <45 y/o

• Similar ECG findings in immediate family

• Inducibility of VT

• Syncope

• Nocturnal agonal respirations

Brugada Syndrome



Thank You!



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