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Glancy DL, Hanna EB. Continuous murmur and cardiac failure in a 53-year-old woman. Proc AMIA Symp 2013; 26:408-9. [PMID: 24082423 PMCID: PMC3777102 DOI: 10.1080/08998280.2013.11929021] [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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77
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Glancy DL, Ali MJ. Epigastric pain in a 63-year-old woman. Atrial flutter with 2:1 atrioventricular block; acute inferoposterior myocardial infarction. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2013; 165:286-287. [PMID: 24350531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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78
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Glancy DL, Chen A, Pothineni KR. Pauses in the Electrocardiogram of a Woman with Chest Pain and Lightheadedness. Proc (Bayl Univ Med Cent) 2013; 26:275-6. [DOI: 10.1080/08998280.2013.11928981] [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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79
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Glancy DL, Jaligam VR. ECG of the month. ECG in a cyanotic 22-year-old woman who had a cardiac operation in early childhood. Normal sinus rhythm; biatrial enlargement; right axis deviation of the QRS complex; biventricular enlargement with repolarization abnormality. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2013; 165:228-229. [PMID: 24133787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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80
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Ali RZ, Nguyen TM, Pothineni KR, Wadgaonkar SU, Glancy DL. Electrocardiogram consistent with anterolateral myocardial injury in the setting of a spontaneous right-sided pneumothorax. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2013; 165:134-136. [PMID: 24015424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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81
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Glancy DL, Chen A. ECG of the month. Electrocardiogram in an attempted suicide. Sinus bradycardia with an atrial escape complex, followed by a junctional escape rhythm with isorhythmic atrioventricular dissociation; voltage criteria for left ventricular hypertrophy. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2013; 165:166-167. [PMID: 24015434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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82
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Glancy DL. A 21-Year-Old Pregnant Woman with Congenital Heart Disease. Proc (Bayl Univ Med Cent) 2013; 26:174-6. [DOI: 10.1080/08998280.2013.11928952] [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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83
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Glancy DL, Gaines TG. ECG of the month: Found down. Marked sinus bradycardia. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2013; 165:97-98. [PMID: 23734540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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84
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Glancy DL, Ahmed J, Ayalloore SG, LeLorier PA, Diwan PM, Helmcke FR. ECG of the month. Irregular rhythm in a 25-year-old man with three prior cardiac operations. Coarse atrial fibrillation with a rapid ventricular response, left anterior fascicular block, left ventricular hypertrophy with repolarization abnormality. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2013; 165:40-41. [PMID: 23550397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The patient underwent closure of an atrial septal defect at age 3, had a leaking "mitral" valve repaired at age 9, and at age 13 had a "mitral" valve replacement. He began taking warfarin sodium at that time and remained symptom-free until 10 days before his initial visit here when he presented to another hospital with dyspnea and palpitations. Treatment there consisted of lisinopril 10 mg qd, carvedilol 6.25 mg bid, aldactone 25 mg qd, furosemide 40 mg qd, digoxin 0.25 mg qd, and a continuation of warfarin sodium 7.5 mg qd. An echocardiogram showed a left ventricular ejection fraction of 20%. After diuresis, he was referred to our cardiology clinic. On his initial visit here, his heart rate was an irregular 120 beats/min, his blood pressure was 106/77 mmHg, and closing and opening snaps of a normally functioning mechanical mitral valvular prosthesis were heard. He was obese (height, 5' 9"; weight, 272 lbs). An electrocardiogram was recorded (Figure 1).
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Glancy DL, Ali RZ. Electrocardiogram in a Man Who Drove Off the Road. Proc (Bayl Univ Med Cent) 2013; 26:43-4. [DOI: 10.1080/08998280.2013.11928913] [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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86
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Glancy DL, Atluri P, Heck H, Duet J, Ehsan K, Jaligam V, Helmcke F. ECG of the month. Cardiac failure and stroke in a 43-year-old woman. Coarse atrial fibrillation indicating left atrial enlargement and left ventricular hypertrophy with repolarization abnormality. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2012; 164:343-345. [PMID: 23437451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 43-year-old woman with a long history of heavy cigarette smoking was in good health until she developed fatigue, dyspnea on exertion, and paroxysmal nocturnal dyspnea approximately three months before admission to our hospital. Four weeks before admission, she was admitted to another hospital for the sudden onset of a right hemiparesis. She was noted to be in atrial fibrillation, and cardiac catheterization and angiocardiography revealed triple-vessel coronary arterial disease and moderately severe mitral regurgitation. Because of repeated episodes of paroxysmal nocturnal dyspnea, she was referred to our hospital for cardiac surgery. On admission, an electrocardiogram was recorded (Figure).
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Glancy DL, Nguyen TM, Bratschi SS, Khuri BN. Electrocardiogram in a Man with Chest Pain and Widespread Atherosclerotic Disease. Proc (Bayl Univ Med Cent) 2012; 25:357-8. [DOI: 10.1080/08998280.2012.11928876] [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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88
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Glancy DL, Rochon BJ, Ilie CC, Parker JM, Jones MB, Atluri P. Global T-wave inversion in a 77-year-old woman. Proc (Bayl Univ Med Cent) 2012; 22:81-2. [PMID: 19169407 DOI: 10.1080/08998280.2009.11928480] [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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89
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Glancy DL, Hanna EB, Ilie CC. Irregular cardiac rhythm in a woman with asthma. Proc (Bayl Univ Med Cent) 2012; 25:159-60. [PMID: 22481848 DOI: 10.1080/08998280.2012.11928816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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90
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Glancy DL, Lelorier PA, Ilie CC, Ayalloore SG. Bigeminal Rhythm Ix. Proc (Bayl Univ Med Cent) 2012; 25:281. [DOI: 10.1080/08998280.2012.11928851] [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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91
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Glancy DL, Drennan RH. ECG of the month: Bigeminal rhythm X. Sinus rhythm with monomorphic ventricular bigeminy and ventriculophasic sinus arrhythmia. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2012; 164:223-224. [PMID: 22957355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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92
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Glancy DL, Ayalloore S, Ilie C, Ali M, Hanna E, LeLorier P, Lathia V. ECG of the month: a subtle sign of dual atrioventricular nodal pathways. Sinus rhythm with second-degree atrioventricular (AV) block, Type I, with each Wenckebach sequence being terminated by a premature, retrograde, reentrant P wave; left ventricular hypertrophy with repolarization changes. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2012; 164:157-158. [PMID: 22870515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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93
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Glancy DL. On Being Dr. J. Willis Hurst's Chief Resident in Medicine. Am J Cardiol 2012. [DOI: 10.1016/j.amjcard.2011.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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94
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Lopez C, Ilie CC, Glancy DL, Quintal RE. Goldberger's electrocardiographic triad in patients with echocardiographic severe left ventricular dysfunction. Am J Cardiol 2012; 109:914-8. [PMID: 22177001 DOI: 10.1016/j.amjcard.2011.10.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 10/28/2011] [Accepted: 10/28/2011] [Indexed: 01/19/2023]
Abstract
In 1982, Goldberger described an electrocardiographic triad (SV1 or SV2 + RV5 or RV6 ≥ 3.5 mV, total QRS amplitude in each of the limb leads ≤ 0.8 mV, and R/S ratio < 1 in lead V4) that was 70% sensitive and > 90% specific for detecting severe left ventricular (LV) dysfunction. To confirm his sensitivity results, in 51 consecutive patients (36 men) aged 28 to 84 years (mean 56) with LV ejection fractions ≤ 20%, the electrocardiographic triad was sought in the electrocardiogram (ECG) recorded closest in time to the echocardiographic study. All 51 patients had systemic arterial hypertension. Evidence of ischemia was present in 7 and absent in 38, and in 6 patients, ischemic status was unknown. In 49 patients, New York Heart Association functional class was available: class II in 8, class III in 32, and class IV in 9. LV ejection fractions ranged from 4% to 20% (mean 14%), and LV internal end-diastolic diameters ranged from 5.7 to 8.6 cm (mean 6.6). Left atrial anteroposterior diameters ranged from 2.9 to 6.1 cm (mean 4.7) and were ≥ 4.0 cm in 47 of the 51 patients. The right ventricular cavity was enlarged in 22 patients. SV1 or SV2 + RV5 or RV6 was ≥ 3.5 mV in 29 of the 51 ECGs; total QRS amplitude was ≤ 0.8 mV in each of leads I, II, and III in 10; and the R/S ratio was < 1 in lead V4 in 37. Only 1 of the 51 ECGs met all 3 criteria. In contrast to Goldberger's finding of the triad to be 70% sensitive for severe LV dysfunction, in this study, the triad was found to be only 2% sensitive. The difference is likely due to his patients' having idiopathic dilated cardiomyopathy, whereas those in this study had hypertensive cardiomyopathy with or without ischemia. Also, in this study, 1 specific ECG was used for each patient, whereas Goldberger reviewed all of the patients' ECGs looking for the triad. In conclusion, Goldberger's triad is a sensitive or insensitive marker for severe LV dysfunction depending on the patient population and the number of ECGs reviewed.
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Ehsan K, Johnson GM, Glancy DL. ECG of the month. Weakness and near syncope in a 79-year-old woman. Sinus bradycardia and arrhythmia, high-grade second degree atrioventricular (AV) block. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2012; 164:48-49. [PMID: 22533115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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96
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Mabry C, Kleinpeter MA, Glancy DL. Woman with Congenital Hiv Infection and Medication-Induced Fanconi Syndrome. Proc (Bayl Univ Med Cent) 2012; 25:90-3. [DOI: 10.1080/08998280.2012.11928797] [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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97
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Glancy DL, Atluri P, Wang WL, Risher WH, Helmcke FR. ECG of the month: ECG in a man with a diagnosis of asthma. Normal sinus rhythm, left atrial enlargement, right axis deviation of the QRS complex, right ventricular hypertrophy and nonspecific T-wave change including a slightly long QT interval. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2011; 163:342-343. [PMID: 22324096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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98
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Glancy DL. A tribute to Charles V. Sanders, MD, on the occasion of his receiving the 2011 Spirit of Charity Award. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2011; 163:334-335. [PMID: 22324094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Dr. D. Luke Glancy, MD, presented the following speech at the Spirit of Charity Gala, October 14, 2011, at the Sheraton Hotel, New Orleans. The speech, which is reprinted here in its entirety, was for Dr. Charles V. Sanders, MD, on the occasion of his receiving the 2011 Spirit of Charity Award.
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Hanna EB, Jaligam V, Glancy DL. A novel hemodynamic observation: worsening of tricuspid regurgitation with dobutamine infusion during a hemodynamic study. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2011; 163:325-327. [PMID: 22324092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Dobutamine has been shown to improve right ventricular contractility and cardiac output in right ventricular failure. However, the effect of dobutamine in the select group of patients with severe tricuspid regurgitation (TR) has not been described previously. We report the case of a patient with severe TR and right heart failure who developed ventricularization of right atrial pressure after dobutamine infusion. This highlights the potential worsening of TR and right heart failure in patients with TR receiving dobutamine.
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Glancy DL, Daniels CL, Jaligam VR, Ali RZ, Lelorier PA. Electrocardiogram of a Man with a Single-Chamber Cardioverter/Defibrillator. Proc (Bayl Univ Med Cent) 2011; 24:348-9. [DOI: 10.1080/08998280.2011.11928756] [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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