David Luke Glancy

Narrow-QRS and Wide-QRS Tachycardias

In a woman with rheumatic heart disease, atrial flutter with a rapid ventricular response, and congestive heart failure, treatment with digoxin slows conduction in the atrioventricular node and thus allows atrioventricular conduction to occur by way of a previously unrecognized accessory pathway.

Syncope and Dyspnea and Pulmonary Embolism.

Failure to recognize ECG features consistent with acute cor pulmonale in a man with new onset syncope and dyspnea resulted in death from undiagnosed pulmonary emboli.

Dizziness Playing the Saxophone Secondary to Hypertrophic Cardiomyopathy.

A decrease in left ventricular volume increases the severity of left ventricular outflow tract obstruction in patients with obstructive hypertrophic cardiomyopathy, formerly called idiopathic hypertrophic subaortic stenosis. Because of this, a musician with the condition develops dizziness playing his saxophone which requires repeated and prolonged Valsalva maneuvers.

Type I Second Degree Atrioventricular Block in a Woman With Remote Repair of a Ventricular Septal Defect

In a 45-year-old woman with syncope, an electrocardiogram revealed intermittent asymptomatic type I second degree atrioventricular block, right bundle branch block and left anterior fascicular block. An echocardiogram documented concentric left ventricular hypertrophy and right ventricular dilatation and hypokinesia. Because the patient did not have second degree atrioventricular block at the time of an electrophysiological study, the atrioventricular node, the left posterior fascicle, and the His bundle all remain potential sites for the type I second degree atrioventricular block on her initial electrocardiogram.

An 18-Year-Old Woman Who Was Found Down

An 18-year-old woman was found unresponsive by her mother. After the patient spontaneously regained consciousness, an electrocardiogram showed a markedly prolonged QT interval thought to be due to congenital long QT1. An implantable cardioverter defibrillator was placed. After being free of symptoms for 1 year, she spontaneously developed torsades de pointes that was successfully terminated by the defibrillator.

Angiosarcoma of the Heart Presenting as Subacute Pericarditis

A young woman, who presented with what appeared to be subacute pericarditis, was found to have primary angiosarcoma of the heart, a condition that is nearly always fatal regardless of the therapy.

Repeat the Electrocardiogram

A 71-year-old diabetic woman with intermittent chest pain and left bundle branch block was admitted to the hospital for further assessment. A repeat electrocardiogram showed new anterior T-wave inversions concordant with the QRS complexes. Thus, she had myocardial ischemia, and coronary arteriography revealed left main and triple vessel coronary disease. She went for urgent coronary artery bypass operation.

Hypotension and Left Bundle Branch Block

A 69-year-old man with chronic kidney disease and no chest pain had the new onset of hypotension. An electrocardiogram revealed left bundle branch block and inferior ST-segment elevation concordant with the QRS complexes in leads II and aVF, a pattern diagnostic of acute inferior myocardial infarction. Coronary arteriography showed triple vessel disease with complete occlusion of the right. He was treated with an intraaortic balloon pump and percutaneous coronary intervention, followed by coronary artery bypass operation at a nearby hospital.

Painless Mini-Wellens Sign 5 Minutes After Exercise in a Man With Previously Undiagnosed Total Occlusion of the Left Anterior Descending and Right Coronary Arteries

A 60-year-old man with no coronary artery history and a normal resting electrocardiogram came to the hospital with his second stroke and underwent a treadmill exercise test before carotid endarterectomy. He had no chest pain and stopped because of leg pain. Five minutes after exercise he developed terminal T-wave inversion in leads V3 and V4 that lasted 7 minutes. The T-wave pattern resembled the Wellens pattern that has usually been seen after intense preinfarction rest pain and has usually lasted hours, days, or even weeks. Coronary arteriography showed complete occlusion of the left anterior descending and right coronary arteries.

Syncope on a Hot Summer Day

In a 63-year-old man, episodes of ventricular tachycardia causing syncope and myocardial infarction are the first manifestations of triple vessel coronary disease in the absence of arteriographic evidence of a fresh occlusion.