4 ο ΠΑΝΕΛΛΗΝΙΟ ΑΡΡΥΘΜΙΟΛΟΓΙΚΟ ΣΥΝΕΔΡΙΟ Φροντιστηριακό Μάθημα ΗΚΓ Το ΗΚΓ στις Μυοκαρδιοπάθειες και στην Περικαρδίτιδα Γ.Ν.Α. «Ο Ευαγγελισμός» Ξυδώνας Σωτήριος, MD, PhD, FESC Εργαστήριο Ηλεκτροφυσιολογίας και Βηματοδότησης Μονάδα Καρδιακής Ανεπάρκειας Β Καρδιολογικό Τμήμα, Γ.Ν.Α. «Ο Ευαγγελισμός»
Conflict of Interest Bayer, Boehringer-Ingelheim, Boston Scientific, Elpen, Medtronic, Merck, Novartis, Pfizer, Servier
Classification of Inherited Cardiomyopathy Morphological Features Eur Cardiol Rev 2016;11:96 101.
HCM Common ECG findings LVH with associated ST T wave abnormalities Deep, narrow Q waves ( dagger-like ) in the lateral > inferior leads Giant precordial Twave inversions in apical HCM LA enlargement WPW (short PR, delta wave) Arrhythmias: AF, SVT, PAC, PVC, VT
HCM Dagger-like Q waves E Burns, lifeinthefastlane.com
HCM Dagger-like Q waves ΙΑΤΡΕΙΟ ΜΥΟΚΑΡΔΙΟΠΑΘΕΙΩΝ ΑΡΡΥΘΜΙΟΛΟΓΙΚΟ ΙΑΤΡΕΙΟ
HCM LVH, deep narrow q waves Am J Emerg Med. 2007:25:72-9.
HCM LVH, deep q waves ΙΑΤΡΕΙΟ ΜΥΟΚΑΡΔΙΟΠΑΘΕΙΩΝ ΑΡΡΥΘΜΙΟΛΟΓΙΚΟ ΙΑΤΡΕΙΟ
HCM Am J Emerg Med. 2007:25:72-9.
HCM Apical Am J Roentgenol 2007:189:1344-52.
HCM Apical E Burns, lifeinthefastlane.com
HCM Apical ΙΑΤΡΕΙΟ ΜΥΟΚΑΡΔΙΟΠΑΘΕΙΩΝ ΑΡΡΥΘΜΙΟΛΟΓΙΚΟ ΙΑΤΡΕΙΟ
HCM Apical ΙΑΤΡΕΙΟ ΜΥΟΚΑΡΔΙΟΠΑΘΕΙΩΝ ΑΡΡΥΘΜΙΟΛΟΓΙΚΟ ΙΑΤΡΕΙΟ
DCM Common ECG findings LA enlargement -> may progress to AF Biatrial enlargement LVH or biventricular enlargement LBBB (RBBB can also occur) Left axis deviation. Poor R wave progression with QS in V1-4 ( pseudo-infarction pattern). PVCs and ventricular bigeminy (seen with severe DCM).
DCM Myocarditis ΙΑΤΡΕΙΟ ΜΥΟΚΑΡΔΙΟΠΑΘΕΙΩΝ ΑΡΡΥΘΜΙΟΛΟΓΙΚΟ ΙΑΤΡΕΙΟ
DCM Myocarditis ΙΑΤΡΕΙΟ ΜΥΟΚΑΡΔΙΟΠΑΘΕΙΩΝ ΑΡΡΥΘΜΙΟΛΟΓΙΚΟ ΙΑΤΡΕΙΟ
DCM LVH, RVH, LAE E Burns, lifeinthefastlane.com
DCM LVH, LAE
DCM LVH, LAE, RAE E Burns, lifeinthefastlane.com
DCM LVH, LBBB like, Right axis E Burns, lifeinthefastlane.com
DCM AF and LBBB E Burns, lifeinthefastlane.com
Arrhythmogenic Right Ventricular Cardiomyopathy Inherited myocardial disease associated with paroxysmal VAs and SCD Fibro-fatty replacement of the RV 2 nd most common cause of SCD in young people (after HOCM), causing up to 20% of SCD in patients <35 yrs Autosomal dominant trait, with variable penetrance and expression Naxos Disease: autosomal recessive form associated with woolly hair and skin changes Men > women (3:1) 1 : 5.000
Arrhythmogenic Right Ventricular Cardiomyopathy Epsilon wave (most specific finding, seen in 30% of patients) T wave inversions in V 1 -V 3 (85% of patients) Prolonged S wave upstroke of 55ms in V 1 -V 3 (95% of patients) Localized QRS widening of 110ms in V 1 -V 3 VT episodes with LBBB morphology (right ventricular VT)
Arrhythmogenic Right Ventricular Cardiomyopathy E Burns, lifeinthefastlane.com
Arrhythmogenic Right Ventricular Cardiomyopathy Br J Sports Med 2009;43:669 676.
Arrhythmogenic Right Ventricular Cardiomyopathy Br J Sports Med 2009;43:669 676.
Arrhythmogenic Right Ventricular Cardiomyopathy Br J Sports Med 2009;43:669 676.
Arrhythmogenic Right Ventricular Cardiomyopathy ΙΑΤΡΕΙΟ ΜΥΟΚΑΡΔΙΟΠΑΘΕΙΩΝ ΑΡΡΥΘΜΙΟΛΟΓΙΚΟ ΙΑΤΡΕΙΟ
Arrhythmogenic Right Ventricular Cardiomyopathy ΙΑΤΡΕΙΟ ΜΥΟΚΑΡΔΙΟΠΑΘΕΙΩΝ ΑΡΡΥΘΜΙΟΛΟΓΙΚΟ ΙΑΤΡΕΙΟ
Restrictive Cardiomyopathy Least common form of cardiomyopathy. It occurs in the advanced stages of myocardial infiltrative disease hemochromatosis, amyloidosis, sarcoidosis. Low voltage QRS complexes. AF may occur due to LAE Conduction disturbances due to infiltration of the cardiac conducting system septal granuloma formation in sarcoidosis may lead to BBB and AV block pseudo-infarction Q waves healing granulomas in sarcoidosis
RCM Common ECG findings Low voltage QRS complexes Non-specific ST / T changes Bundle branch blocks AV (3rd degree AV block may occur in sarcoidosis) Pathological Q waves Atrial and ventricular dysrhythmias
RCM AF and LBBB
Left Ventricular Non-Compaction Subtypes and ECG findings 1. Benign LVNC 2. LVNC with arrhythmias 3. Dilated LVNC 4. Hypertrophic LVNC 5. Hypertrophic Dilated LVNC 6. Restrictive LVNC 7. Right Ventricular or Biventricular LVNC hypertrophy by voltage criteria (either LVH or biventricular hypertrophy) T wave inversion ST abnormalities / strain LA enlargement left axis deviation QTc prolongation 8. LVNC with congenital heart disease Lancet 2015; 386: 813 25.
Left ventricular non-compaction Lancet 2015; 386: 813 25.
Left ventricular non-compaction Eur Heart J 2015:36;2921 2964.
Left ventricular non-compaction ΙΑΤΡΕΙΟ ΜΥΟΚΑΡΔΙΟΠΑΘΕΙΩΝ ΑΡΡΥΘΜΙΟΛΟΓΙΚΟ ΙΑΤΡΕΙΟ
Pericardial Diseases Work-up Eur Heart J 2015:36;2921 2964.
Acute Pericarditis Common ECG findings Stage 1 widespread ST and PR with reciprocal changes in avr (occurs during first 2w) Stage 2 normalization of ST changes; generalized T wave flattening (1-3w) Stage 3 flattened T waves become inverted (3 to several weeks) Stage 4 ECG returns to normal (several weeks onwards)
Acute Pericarditis Eur Heart J 2015:36;2921 2964.
Acute Pericarditis ΙΑΤΡΕΙΟ ΜΥΟΚΑΡΔΙΟΠΑΘΕΙΩΝ ΑΡΡΥΘΜΙΟΛΟΓΙΚΟ ΙΑΤΡΕΙΟ
Acute Pericarditis ΙΑΤΡΕΙΟ ΜΥΟΚΑΡΔΙΟΠΑΘΕΙΩΝ ΑΡΡΥΘΜΙΟΛΟΓΙΚΟ ΙΑΤΡΕΙΟ
Γ.Ν.Α. «Ο Ευαγγελισμός»
Takotsubo Syndrome J Med Sci 2014:83:250-254.
Takotsubo Syndrome J Med Sci 2014:83:250-254.
Takotsubo Syndrome World J Cardiol 2016;8:413-424.
Dilated Cardiomyopathy ICH Dilated cardiomyopathy commonly occurs following massive anterior MI due to extensive myocardial necrosis and loss of contractility Non-ICH Most cases are idiopathic Up to 25% are familial (primarily autosomal dominant, some types are X-linked) Other Viral myocarditis Alcoholism Toxins - Drugs (e.g. doxorubicin) Autoimmune disease peripartum cardiomyopathy
Constrictive Pericarditis vs Restrictive Cardiomyopathy Eur Heart J 2015:36;2921 2964.