Andrés Ricardo Pérez Riera

Acquired Long QT Interval: A Case Series of Multifactorial QT Prolongation

Acquired long QT (LQT) interval is thought to be a consequence of drug therapy and electrolyte disturbances.

Correlation of electrocardiographic left ventricular hypertrophy criteria with left ventricular mass by echocardiogram in obese hypertensive patients

INTRODUCTION Left ventricular hypertrophy (LVH) and obesity are important cardiovascular risk factors. This study evaluates the influence of obesity on the diagnostic performance of the most used electrocardiographic criteria for LVH in hypertensive patients. METHODS One thousand two hundred four outpatients from the Hypertensive Unit of the Hospital São Paulo, São Paulo, SP, Brazil, were studied. All underwent 12-lead electrocardiogram and echocardiogram. The most known electrocardiographic criteria for LVH were assessed and compared with the left ventricular mass index obtained by echocardiogram in obese and nonobese groups of hypertensive patients. RESULTS The populations mean age was 57.4 +/- 4.7 years; 351 were men (29.1%) and 853 women (70.8%). Cornell voltage, Cornell duration, Sokolow-Lyon voltage, Romhilt-Estes criteria, and R wave in aVL 11 mm or higher showed a positive correlation with left ventricular mass index (P < .05). Notwithstanding, there were no changes regarding specificity for obese or nonobese characteristics. However, sensitivity had a statistically significant decrease in obese patients in regard to Sokolow-Lyon voltage and Romhilt-Estes criteria and strain pattern (P < .05). CONCLUSION Cornell voltage and Cornell duration criteria, Perugia score, R wave in aVL, and QTc variable had no significant changes in diagnostic sensitivity in the obese patients.

Brugada phenocopy in a patient with pectus excavatum: systematic review of the ECG manifestations associated with pectus excavatum.

Brugada phenocopies (BrP) have emerged as new clinical entities that are etiologically distinct from true Brugada syndrome (BrS). BrP are characterized by an ECG pattern that is phenotypically identical to true BrS (type 1 or type 2); however, BrP are caused by various other factors such as mechanical mediastinal compression, myocardial ischemia, pericarditis, myocarditis, pulmonary embolism, and metabolic disturbances. We report a case of an electrocardiographic BrP in a patient with pectus excavatum deformity in the absence of true BrS using currently defined BrP diagnostic criteria. A systematic review of ECG manifestations associated with pectus excavatum is also discussed.

Diretriz de interpretação de eletrocardiograma de repouso

Jose Alves Pinho (BA), Mario Sergio de Carvalho Bacellar (BA),Demostenes G. Lima Ribeiro (CE), Rubens Nassar Darwich (MG),Antonio Luiz Pinho Ribeiro (MG), Marcelo Marcos Eloy Dunda (PB),Helio Germiniani (PR), Francisco Faustino Franca (PE),Laurindo Saraiva (PE), Clebia Maria Rios Ribeiro (PE),Paulo Ginefra (RJ), Iseu Gus (RS), Eney Fernandes (SC),Andres Riera (SC), Anisio Pedrosa (SP),Antonio Americo Friedman (SP), Antonio Carlos Firmiani (SP),Cesar Grupi (SP), Claudio Pinho (SP),Eduardo Vilaca Lima (SP), Elisabeth Kaiser (SP),Fabio Sandoli Brito (SP), Gilberto Luiz Castro Vinhas (SP),Helio Schwartz (SP), Jose Grindler (SP), Jose Luiz Aziz (SP),Marcio Figueiredo (SP), Marcos S. Molina (SP),Martino Martinelli (SP), Nancy Tobias (SP),Paulo Cesar R. Sanches (SP), Paulo Jorge Moffa (SP),Severino Attanes Neto (SP), Silvana Nishioka (SP)

Kearns-Sayre syndrome: electro-vectorcardiographic evolution for left septal fascicular block of the his bundle

The Kearns-Sayre syndrome is a neuromyopathic disorder associated with mitochondrial abnormalities and characterized by the triad of chronic external ophthalmoplegia, atypical pigmentary retinopathy, and progressive conduction system disorders. Ragged red muscle fibers that seem to contain an excess of altered mitochondria are observed. The disease affects both sexes alike, during the first or the second decade of life. The following manifestations are observed: central bilateral sensorineural deafness, pyramidal signs, ataxia, asymmetrical ptosis, external ophthalmoplegia, and progressive muscular weakness secondary to myopathy associated with a significant increase of proteins of cephalorachidian liquid. A variety of endocrinopathies may occur.

Brief Review of the Recently Described Short QT Syndrome and Other Cardiac Channelopathies

There are many diseases related to ion‐channel disorders, so‐called “channelopathies.” Hereditary short QT syndrome is a clinical‐electrocardiographic entity with autosomal‐dominant mode of transmission and it is the most recently described channelopathy. The syndrome may affect infants, children, or young adults with strong positive family background of sudden cardiac death. Short QT syndrome is characterized by short QT and heart‐rate‐corrected QTc intervals. It is frequently associated with tall‐, peaked‐, and narrow‐based T waves that are reminiscent of the typical “desert tent” T waves of hyperkalemia. There is a high tendency for paroxysmal atrial fibrillation due to the heterogeneous abbreviation of action potential duration and refractoriness of atrial myocytes. The arrhythmia can also be induced by programmed electrical stimulation.

Wellens syndrome associated with prominent anterior QRS forces: an expression of left septal fascicular block?

Wellens syndrome is a clinical-electrocardiographic entity also referred to as left anterior descending (LAD) coronary T-wave syndrome or acute coronary T-wave syndrome. It is a complex of symptoms and signals indicating the existence of an undesirable condition secondary to critical high-grade proximal stenosis of the LAD coronary artery characterized by the association of prior history of acute coronary syndrome with little or no elevation of markers of myocardial damage (unstable angina) and characteristic electrocardiographic changes consistent with subepicardial anterior ischemic pattern (persistently symmetrical, deep negative and broad-based T waves) or plus-minus T waves with inversion of the terminal portion in the LAD coronary artery territory (V1 through V5 or V6). We present a case of a variant of Wellens syndrome that reveals association and, transitorily, the criteria described in literature for left septal fascicular block.

Vector electrocardiographic alterations after percutaneous septal ablation in obstructive hypertrophic cardiomyopathy: possible anatomic causes

OBJECTIVE Analyze the dromotropic disturbances (vector-electrocardiographic), and the possible anatomic causes, provoked by selective alcohol injection in the septal branch, for percutaneous treatment, of obstructive hypertrophic cardiomyopathy. METHODS Ten patients with a mean age of 52.7 years underwent percutaneous septal ablation (PTSA) from october 1998; all in functional class III/IV). Twelve-lead electrocardiogram was performed prior to and during PTSA, and later electrocardiogram and vectorcardiogram according to Franks method. The patients were followed up for 32 months. RESULTS On electrocardiogram (ECG) prior to PTSA all patients had sinus rhythm and left atrial enlargement, 8 left ventricular hypertrophy of systolic pattern. On ECG immediately after PTSA, 8 had complete right bundle-branch block; 1 transient total atrioventricular block; 1 alternating transient bundle-branch block either right or hemiblock. On late ECG 8 had complete right bundle-branch block confirmed by vectorcardiogram, type 1 or Grishman. CONCLUSION Septal fibrosis following alcohol injection caused a predominance of complete right bundle-branch block, different from surgery of myotomy/myectomy.

Sensibilidade do eletrocardiograma na hipertrofia ventricular de acordo com gênero e massa cardíaca

BACKGROUND: Several factors are known to interfere with electrocardiogram (ECG) sensitivity when diagnosing Left Ventricular Hypertrophy (LVH), with gender and cardiac mass being two of the most important ones OBJECTIVE: To evaluate the influence of gender on the sensitivity of some of the criteria used to detect LVH, according to the progression of ventricular hypertrophy degree. METHODS: According to gender and the degree of LVH at the echocardiogram, the patients were divided in three groups: mild, moderate and severe LVH. ECG sensitivity to detect LVH was assessed between men and women, according to the LVH degree. RESULTS: Of the 874 patients, 265 were males (30.3%) and 609, females (69.7%). The [(S + R) X QRS], Sokolow-Lyon, Romhilt-Estes, Perugia and strain criteria showed high discriminatory power in the diagnosis of LVH between men and women in the three groups with LVH, with a superior performance in the male population and highlighting the importance of the [(S + R) X QRS] and Perugia scores. Conclusion: The diagnostic sensitivity of the ECG increases with the cardiac mass. The examination is more sensitive in men, highlighting the importance of the [(S + R) X QRS] and Perugia scores. CONCLUSION: The diagnostic sensitivity of the ECG increases with the cardiac mass. The examination is more sensitive in men, highlighting the importance of the [(S + R) X QRS] and Perugia scores.

The characteristics of T-U–wave morphologies and left ventricular arrhythmias in type 1 Andersen-Tawil syndrome

www.elsevier.com/locate/jelectrocard The characteristics of T-U–wave morphologies and left ventricular arrhythmias in type 1 Andersen-Tawil syndrome Li Zhang, Woodrow Benson, Robert L. Lux, Andres Ricardo