26
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Glancy DL, Subramaniam PN, Rodriguez JF. Lower Extremity Paralysis. Am J Cardiol 2016; 118:1609-1610. [PMID: 27634026 DOI: 10.1016/j.amjcard.2016.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/27/2022]
Abstract
Severe hypokalemia in the absence of other electrolyte abnormalities, the result of diarrhea, caused striking electrocardiographic changes, generalized weakness, flaccid paralysis of the lower extremities, and biochemical evidence of mild skeletal and cardiac rhabdomyolysis in a 33-year-old man. Repletion of potassium reversed all abnormalities in 24 hours.
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27
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Glancy DL, Mills TA. ECG of the Month: Wide-QRS Tachycardias. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2016; 168:215-217. [PMID: 28045691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 61-year-old man came from out of state to attend a football game. He felt well during the game, but when he stood up to leave, he became dizzy and dyspneic. The symptoms lasted 15 to 20 minutes, and when the paramedics arrived, they diagnosed an idioventricular rhythm and brought the patient to the emergency department where a 12-lead electrocardiogram (ECG) was recorded (Figure 1).
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28
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Glancy DL, Hanna EB. New-Onset Retrosternal Chest Pressure. Proc (Bayl Univ Med Cent) 2016; 29:430-431. [DOI: 10.1080/08998280.2016.11929501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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29
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Glancy DL, Cochran GA, Helmcke FR. ECG Case of the Month: Heart Failure in a Man from Chile. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2016; 168:180-181. [PMID: 27797350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 49-year-old man visiting New Orleans from Chile comes to the hospital complaining of exertional dyspnea for 2 months with the more recent onset of ankle edema. He is a slender man with a blood pressure of 91/60 mmHg, crackles at both lung bases, and markedly distended neck veins. His cardiac rhythm is irregular. A soft murmur of mitral regurgitation and a soft S-3 are heard at the left ventricular apex. All four pedal pulses are easily palpable. Epigastric tenderness is noted on palpation; although the patient has a history of peptic ulcer disease, the tenderness is probably due to an enlarged left lobe of his liver, the result of hepatic congestion from his heart failure. A chest radiograph shows generalized cardiomegaly with an especially large left ventricle. Pulmonary congestion and small bilateral pleural effusions also are noted. The Figure shows the electrocardiogram recorded on admission.
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30
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Glancy DL, Atluri P. Headache and Abdominal Pain in a Young Woman. Proc (Bayl Univ Med Cent) 2016; 29:305. [DOI: 10.1080/08998280.2016.11929445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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31
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Glancy DL. ECG of the Month: Subtle ECG Change in a 31 Year-Old Man with Recent Chest Pain. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2016; 168:146-147. [PMID: 27598900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 31-year-old man had an hour of pain across the upper portion of his chest anteriorly, and it radiated down the inner aspects of both arms. The pain came while he was walking and gradually disappeared as he sat quietly. Six Rolaid tablets did not seem to alter the pain. The pain was unaccompanied by dyspnea, sweating, nausea or vomiting. The night before the patient had had similar pain relieved by Rolaids and belching. After the second episode of pain, he went to the emergency department of a local hospital where an ECG was recorded.
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Glancy DL, Atluri P. ECG Of The Month: Sepsis, ARDS, and Tracheal Intubation. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2016; 168:113-114. [PMID: 27389383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A furuncle on the leg of a 23-year-old woman led to methicillin-resistant staphylococcus aureus sepsis and adult respiratory distress syndrome (ARDS) requiring tracheal intubation in the intensive care unit (ICU). Initially her electrocardiograms (ECGs) showed sinus tachycardia, but otherwise were unchanged from prior ECGs. A week into her ICU stay a different rhythm occurred.
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33
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Glancy DL. Chest Pain, Heart Murmur, and Changing Electrocardiograms. Am J Cardiol 2016; 117:1542-3. [PMID: 26970813 DOI: 10.1016/j.amjcard.2016.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 11/24/2022]
Abstract
Physical examination, electrocardiograms, and an echo-Doppler study document multiple consequences of a right coronary arterial occlusion.
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Glancy DL, Vijitbenjaronk P. Holter monitor recordings in a man who snores. Proc AMIA Symp 2016; 29:163-4. [PMID: 27034554 PMCID: PMC4790556 DOI: 10.1080/08998280.2016.11929399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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35
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Glancy DL. ECG Of the Month: Suicide. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2016; 168:66-67. [PMID: 27383860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Apparently depression ran in this man's family, and when he took an overdose of his tricyclic antidepressant, he also took the tricyclics of his mother and his sister. Most patients who die of an overdose of a tricyclic antidepressant are pronounced dead without reaching a hospital, and those who die after arriving in the emergency room do so within a few hours.2 Central nervous system toxicity of tricyclic antidepressants may manifest as confusion, agitation, hallucinations, coma, myoclonus, or seizures. Generalized seizures often presage cardiopulmonary arrest,2 and within 20 seconds of the ECG with evidence of generalized seizure activity shown here, the QRS duration increased from 188 ms to 212 ms, and the patient died soon thereafter.
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Glancy DL, Quintal RE, McShurley TD. Electrocardiogram read by the computer as arm-lead reversal. Proc AMIA Symp 2016; 29:85-6. [PMID: 26722184 DOI: 10.1080/08998280.2016.11929375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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37
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Glancy DL, Chen A. ECG Case of the Month: IRREGULARLY IRREGULAR CARDIAC RHYTHM IN AN 87-YEAR-OLD WOMAN. MULTIFOCAL ATRIAL TACHYCARDIA; RIGHT BUNDLE BRANCH BLOCK. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2016; 168:27-28. [PMID: 26986865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Multifocal atrial tachycardia; right bundle branch block. The rhythm is totally irregular at a rate of 103 beats/min and originally was read as atrial fibrillation. Close examination, however, reveals a P wave before each QRS and ≥ 3 different P- wave morphologies with no dominant morphology. These are the criteria for multifocal atrial tachycardia MAT, also known as chaotic atrial rhythm,1 chaotic atrial tachycardia,2 and chaotic atrial mechanism.3 The wide QRS complexes ≥ 0.12 s with broad S waves in leads I, aVL, and the lateral precordial leads and broad R or R´ waves in leads aVR and V1 indicate right bundle branch block. MAT is frequently seen in patients with acute pulmonary or other non-cardiac disease and tends to resolve when the underlying disease is brought under control. Patients with MAT also tend to have bouts of other arrhythmias,2 and 3 months earlier this.
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Kawji MM, Glancy DL. ST-Segment Elevation With Exercise. Am J Cardiol 2015; 116:1948-9. [PMID: 26498696 DOI: 10.1016/j.amjcard.2015.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
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39
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Subramaniam PN, Ahmed J, Glancy DL. Presenting complaint of a low heart rate. Am J Cardiol 2015; 116:1643-4. [PMID: 26386903 DOI: 10.1016/j.amjcard.2015.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
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40
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Glancy DL, Drennan RH. ECG of the Month: ECG in an 81-Year-Old Woman. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2015; 167:275-276. [PMID: 26741688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Sinus bradycardia (48 beats/min), long P-R interval (0.29 s), long QT interval (0.53 s with QTc of 0.47 s), and prominent J waves suggest hypothermia; non-specific ST abnormality.
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Atluri P, Glancy DL. Bigeminal Rhythm in a Woman With Palpitations, Dyspnea, and Fatigue. Am J Cardiol 2015; 116:1483-4. [PMID: 26342517 DOI: 10.1016/j.amjcard.2015.07.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/24/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
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42
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Glancy DL, Khuri BN, Mustapha JA, Menon PV, Hanna EB. Myocardial infarction with ventricular septal rupture and cardiogenic shock. Proc (Bayl Univ Med Cent) 2015; 28:512-3. [PMID: 26424959 DOI: 10.1080/08998280.2015.11929327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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43
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Kawji MM, Glancy DL. Inferior Q Waves and Left Bundle Branch Block. Am J Cardiol 2015; 116:822-3. [PMID: 26141202 DOI: 10.1016/j.amjcard.2015.05.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/17/2015] [Accepted: 05/17/2015] [Indexed: 11/16/2022]
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44
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Kawji MM, Glancy DL. ECG of the Month:Changing Morphology of a Wide-QRS Tachycardia. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2015; 167:235-236. [PMID: 27159602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
An obese 49-year-old man with a history of systemic arterial hypertension, diabetes mellitus, dyslipidemia, three myocardial infarcts, an ischemic cardiomyopathy, a four-vessel coronary artery bypass operation 7 years earlier, and implantation of a cardioverter-defibrillator 2 years earlier comes to the hospital with palpitations and dyspnea. An ECG is recorded.
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Hanna EB, Glancy DL. Subtle Electrocardiographic Abnormalities. Am J Cardiol 2015; 116:669-70. [PMID: 26081067 DOI: 10.1016/j.amjcard.2015.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/01/2015] [Accepted: 05/01/2015] [Indexed: 11/17/2022]
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46
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Kawji MM, Glancy DL. Chest Pain and a Wide QRS Tachycardia. Am J Cardiol 2015; 116:487-8. [PMID: 26025469 DOI: 10.1016/j.amjcard.2015.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 11/28/2022]
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47
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Glancy DL, Mendoza DK, Nair RG. Worsening Dyspnea in a 38-Year-Old Woman. Proc (Bayl Univ Med Cent) 2015; 28:369-70. [DOI: 10.1080/08998280.2015.11929278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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48
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Kawji MM, Glancy DL. Electrocardiogram in a 35-Year-Old Man. Am J Cardiol 2015; 116:162. [PMID: 25937351 DOI: 10.1016/j.amjcard.2015.02.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 10/23/2022]
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49
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Glancy DL, Pothineni KR. ECG of the Month:A Forty-Year-Old Woman with a History of a Cardiac Operation at Age 5 Years. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2015; 167:196-197. [PMID: 27159515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
There is a sinus P wave in front of each QRS, and the rate is 122 beats/min. The QRS voltage is large and meets many criteria for left ventricular hypertrophy: RI > 13 mm (1.3 mV); RaVF > 19 mm; SaVR > 14 mm; SV1 > 24 mm; SV2 > 30 mm; RV6 > 26 mm; RV6 > RV5; SV1 + RV5 or RV6 > 35 mm; SV2 + RV5 or RV6 > 45 mm; RaVL + SV3 > 20 mm in a woman.1 In addition, there are two non-voltage criteria for LVH: QRS duration = 0.11 s and typical repolarization changes: J-point depression with a downsloping ST segment into an inverted T wave and a more rapid upslope back to the baseline. The prolonged QRS duration and repolarization changes are also typical of incomplete left bundle branch block (ILBBB). LVH is present in most patients with complete LBBB,2,3 and probably in most with ILBBB. The patient underwent aortic valvotomy at age 5 to relieve congenital stenosis. Although different valvular morphologies can result in aortic stenosis, when hemodynamically significant stenosis is present in infancy or early childhood the valve is usually unicuspid/unicommissural. Aortic valvotomy can greatly reduce the left ventricular outflow obstruction in such patients, but the majority eventually need reoperation. This usually means aortic valve replacement. This woman now has severe aortic stenosis and regurgitation with not only left but also right ventricular failure, which is a late development with pure aortic valve disease. She needs aortic valve replacement. Unfortunately having one severe disease does not preclude another, and her operative course will be complicated by multiple sclerosis which she developed some 12 years ago.
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Glancy DL, King TD, Glancy CF, King NB, Morgan J. Myocardial Infarction and Left Ventricular Hypertrophy Seen on an Infant's Electrocardiogram. Am J Cardiol 2015; 115:1779-80. [PMID: 25918028 DOI: 10.1016/j.amjcard.2015.02.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/05/2015] [Accepted: 02/05/2015] [Indexed: 11/17/2022]
Abstract
The clinical and electrocardiographic features of anomalous left coronary artery from the pulmonary trunk, ALCAPA, a frequently fatal congenital cardiac malformation, are described in an 8 1/2-month-old female.
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