ECG - Active Learning Conversation Around a 50M from Malaysia with a history of Sudden Cardiac Death in the family
[7/14, 7:19 PM] Professor 1: 50 year old Diabetic Male from Malaysia, with history of Sudden Cardiac Death in family, came for routine check..
[7/14, 7:21 PM] PG Student 1: Brugada syndrome
[7/14, 7:42 PM] Professor 1: 10 Steps of Decoding the ECG 👣
A. Heart Rate ⌚
B. Analyse and name the rhythm 🎶
C. Conduction normal or abnormal? 🚷
D. Axis of the QRS Complex ↘
E. Hypertrophy or enlargement of any chamber 💗
F. Ischemia or infarction ♈
G. Clinical Context 🥵
H. Additional features ⛎
I. Final Interpretation 📝
J. Consult resources! 📲
[7/14, 7:42 PM] Professor 1: Maybe,.. may be not.. let's see tomorrow..🤓
Thanks for attempting..
[7/14, 8:35 PM] MBBS UG Student 1: I think it's Brugada Syndrome too.
[7/14, 8:38 PM] Professor 2: Please detail your inputs as per the ten steps mentioned above.
[7/14, 9:04 PM] MBBS UG Student 1: -Diagnosis : Brugada Syndrome
-Normal standardisation
-Heart rate is around 100 bpm (Narrow QRS Complex Sinus Tachycardia)
-Normal Rhythm
-Normal Axis
-Normal P wave
-Normal PR interval
-Coved ST segment elevation >2mm in leads V1-V3 followed by a negative T wave. (Brugada Sign)
-Normal QT interval
-Family history of sudden cardiac death.
-Treatment : ICD
[7/14, 9:38 PM] Professor 2: What could be the reason for that coved ST segment elevation in Brugada? 🤔
[7/14, 10:01 PM] MBBS UG Student 1: "The presence of a deeply notched action potential in the RV epicardium, but not in
endocardium, would be expected to induce a transmural current that would contribute to
elevation of the ST-segment in the right precordial leads. The spike-and-dome configuration
may also prolong the epicardial action potential, thus contributing to a rapid reversal of the
transmural gradients and inscription of an inverted T-wave."
[7/14, 10:12 PM] Professor 2: 👍
[7/15, 8:58 PM] Professor 1: I congratulate and appreciate all those who attempted and shared their Valuable Knowledge..
👏🏽👏🏽
[7/15, 8:58 PM]Professor 1: Etiology of sudden cardiac arrest/sudden cardiac death..
🌴 90% are due to primary myocardial processes:
these include
1) Acquired structural heart diseases like
🌱coronary artery disease
🌱 Most cardiomyopathy
2) congenital heart diseases
3) inherited structural heart diseases like
🌱 Hypertrophic cardiomyopathy
🌱 Familial dilated cardiomyopathy
🌱 Arrhythmogenic right ventricular dysplasia.
🌴 the rest 10% cases of sudden cardiac death are due to primary electrical processes..
These include
🌱Channelopathies..
🍒 Long or short QT syndrome.
🍒 Brugada syndrome
🍒 Catecholaminergic polymorphic VT
🌱 Acquired long QT syndrome: due to drugs, or electrolyte disorders..
🌱 Wpw syndrome
🌱Commodio cordis (VF triggered by blunt trauma to the chest wall)
[7/15, 9:00 PM] Professor 1: Excluded in this classification are:
🥬 Massive pulmonary embolism
🥬 Aortic dissection
🥬 Master stroke..
All of these are causes of sudden death...
But the primary mechanism is outside the heart💞
[7/15, 9:01 PM] Professor 1: Let us study the ecg...
[7/15, 9:01 PM] Professor 1: Most of the points are covered here.. I will not repeat it..
If anyone find any discrepancy, please bring it to our notice.
[7/15, 9:02 PM] Professor 1: But I am a little old school..🤗
I will try to approach It Like a student..🧐
[7/15, 9:04 PM] Professor 1: This is the pattern we were expecting..
Possibly thinking of right bundle branch block..
And we may not be completely wrong...
Let's see how much wrong or correct we are...😊
[7/15, 9:05 PM] Professor 1: The only issue We had is presence of St elevation like pattern in right side precordial leads...
[7/15, 9:08 PM] Professor 1: Focus on V1 V2 V3...
This is a pseudo rbbb pattern with St elevation...🧯
The J point is where QRS complex ends (meets the Isoelectric line)...
In this ECG, the J point is elevated more than two millimetre..🧐
Where is convexity aur school of the ST segment..
Descending terminal St elevation..
Negative T wave..
[7/15, 9:10 PM] Professor 1: This is an example of the most serious form of Brugada...
Aka type 1 Brugada...🧯
The characteristic findings as rightly pointed...
Are known as "brugada sign"
SHARK FIN APPEARANCE
[7/15, 9:13 PM] Professor 1: What is type 2 brugada..?
[7/15, 9:15 PM] Professor 1: It is similar pseudo rbbb with St elevation .
The ST elevation, Rather J point elevation is more than or equal to 2 millimetre..
Saddleback ST-T segment.
Terminal St elevation greater than or equal to 1 millimetre..
Positive or sometimes biphasic T wave...
This is type 2 Brugada.
TYPE 3 BRUGADA
[7/15, 9:18 PM] Professor 1: J point elevation more than or equal to 2 mm..
Saddleback ST-T segment..
Terminal ST elevation lesser than 1 mm🧯
Positive T wave...
References :
Comments
Post a Comment