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ECG Abnormalities_Part 21

Saturday, July 21, 2012

69 year old female with a past history of breast cancer presents with dyspnea on exertion and dizziness. Her vital signs are BP 80/40, HR 120, RR 24, and oxygen saturation 88% on room air. Physical exam revealed crepitations at the left lung base, distant heart sounds, and elevated jugular venous pressures especially with inspiration. Her ECG is given below. Also provided is a simultaneous recording of her arterial line pressue tracing and inspirometer.
What are the abnormal ECG findings?
What is the diagnosis?

ANSWER

The ECG findings are:
1) Sinus tachycardia
2) Low voltage
3) PAC (2nd beat from the last on rhythm strip)
4) Poor R wave progression

Diagnosis is cardiac tamponade. Malignancy is the most common cause for a pericardial effusion resulting in increased intrapericardial pressures causing the right atrium and right ventricle to collapse in diastole.This results in hypotension and tachycardia and can be life threatening. The ECG findings of cardiac tamponade include low voltage on the ECG and "electricle alternans" where each QRS complex alternates from normal voltage to low voltage.Arterial line pressue tracing shows her systolic blood pressure dramtically drop with inspiration.This phenomenon which occurs in cardiac tamponade is called "pulsus paradoxus" and can be measured non-invasively using a blood pressure cuff.


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16 Responses to ECG Abnormalities_Part 21

  1. Pulmonary Embolism

     
  2. Sacchin Says:
  3. cardiac tamponade / pericardial effusion ??

     
  4. pericardial effuison

     
  5. Anonymous Says:
  6. pericardial effusion

     
  7. Anonymous Says:
  8. pulmonary embolism

     
  9. Unknown Says:
  10. Tamponade from pericardial effusion, EKG shows low voltage in all leads and electric alternans in tracing. Hope this is correct.

     
  11. ridho's MD Says:
  12. pericardial effusion

     
  13. Anonymous Says:
  14. derrame pericardico: bajo voltaje + alternacia electrica. la clinica es sugestiva de taponamiento. hay q tener en cuenta en ecg parece tener s1 q3 t3 a tener encuenta dx diferncial de tep.

     
  15. Anonymous Says:
  16. trias beck...Hypotension,increase jugular venous pressure,muffle heart sound..dx syok distributive e.c suspek cardiac tamponade...

     
  17. Anonymous Says:
  18. pulmonary edema

     
  19. Anonymous Says:
  20. heart failure. since jvp increase with resp with hypotension & nearly good o% saturation likely it is cardio myopathy

     
  21. Taponamiento cardiaco debido a derrame pericardico, lo que trea aumento de presion venosa yugular. ECK muestra taquicardia sinusal, y alternancia electrica de comlejo QRS.

     
  22. Anonymous Says:
  23. Low voltage is evident.lead II and lead v4 shows some arrythmia too.with the clinical interpretation as increased jvp, hypotension, tachy and previous hx of ca strongly suggests malignant effusion....mostly likely cardiac tamponade

     
  24. Chris Law Says:
  25. heart rate says trying to get O2 to body. Low sats says not enough O2 so trying to compensate. Therefore problem lies in the lungs. Higher breathing says that she is drawing air in but not enough. Blockage in lung. Pulmonary embolism.

     
  26. That is an extremely smart written article. I will be sure to bookmark it and return to learn extra of your useful information. Thank you for the post. I will certainly return.

     
  27. This is wonderful. I am not quite familiar with the internet, but I believe that what I just read is some good material. Thanks for continuing to write such wonderful articles. God bless.

     

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