INTRODUCTIONAtherosclerotic coronary artery thrombosis is the most common cause of acute myocardial infarction.

CLINICAL PICTUREA 30-year-old lady presented with acute peripartum massive anterior ST segment myocardial infarction and cardiogenic shock. This was due to acute Stanford type A aortic dissection with the intimal flap occluding the left coronary ostium. The initial diagnosis was not apparent. Echocardiography confirmed the diagnosis.

TREATMENT AND OUTCOMEShe underwent emergency surgical repair (Bentall procedure). Pathology confirmed underlying idiopathic cystic medial degeneration.

CONCLUSIONA high index of clinical suspicion is required in acute myocardial infarction presenting without traditional cardiovascular risk factors.

Acute Disease ; Adult ; Aneurysm, Dissecting ; complications ; diagnosis ; surgery ; Aortic Aneurysm ; complications ; diagnosis ; surgery ; Echocardiography ; Electrocardiography ; Female ; Humans ; Myocardial Infarction ; etiology ; physiopathology ; Pregnancy ; Pregnancy Complications, Cardiovascular ; Shock, Cardiogenic ; etiology

INTRODUCTIONDigital storage of echocardiographic data offers logistical advantages over videotape archival. However, limited information is available on the accuracy of clinically compressed digitised examinations, an important consideration for patient safety.

MATERIALS AND METHODSTransthoracic echocardiograms of 520 consecutive patients were prospectively acquired digitally and on videotape. Two echocardiologists, in consensus, reported studies in both formats sequentially. Using the videotape as a reference, the significance of any reported differences was graded from both imaging and clinical standpoints, and the reasons for these differences identified.

RESULTSFrom an imaging perspective, differences between digital and videotaped studies were absent or minor in 459 cases (88%), fairly significant in 55 (11%) and very significant in 6 (1%). The main reasons for the observed differences were inadequate acquisition of optimal views (59%), an insufficient number of acquired cardiac cycles (25%) and suboptimal image quality (9%). These differences were considered to be of possible or definite clinical importance in 21 (4%) and 8 (2%) cases, respectively. In multinominal logistic regression models, the only independent predictor of significant difference between digitised and videotaped images was study complexity. Regardless of case complexity, most diagnostic errors arising from digital review were attributable to technical failure rather than observer error.

CONCLUSIONSThe potential for important errors arising from exclusive reporting of clinically compressed digital echocardiograms is small. Digital echocardiography, as practiced in a routine clinical setting, offers a patient-safe alternative to videotape review.

Echocardiography ; methods ; standards ; Humans ; Image Processing, Computer-Assisted ; Prospective Studies ; Safety ; Singapore ; Videotape Recording

Long QT interval is an important finding that is often missed by electrocardiogram interpreters. Long QT syndrome (inherited and acquired) is a potentially lethal cardiac channelopathy that is frequently mistaken for epilepsy. We present a case of long QT syndrome with multiple cardiac arrests presenting as syncope and seizures. The long QTc interval was aggravated by hypomagnesaemia and drugs, including clarithromycin and levofloxacin. Multiple drugs can cause prolongation of the QT interval, and all physicians should bear this in mind when prescribing these drugs.
Adult ; Defibrillators, Implantable ; Electrocardiography ; Heart Rate ; Humans ; Long QT Syndrome ; complications ; congenital ; diagnosis ; therapy ; Male ; Risk Factors ; Seizures ; complications

We discuss two cases of incessant atrial tachycardia (AT), including the presentation and clinical course. It is important to differentiate AT from other causes of supraventricular tachycardia, such as atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT), as it would have implications on clinical management. Electrocardiographic features of AT, especially the presence of an AV Wenckebach phenomenon with 'grouped beating', are critical for differentiating AT from AVRT and AVNRT. It is also vital to identify the P waves and their relations to QRS on electrocardiography, as this would aid in the differentiation of various supraventricular tachycardias.
Aged ; Diagnosis, Differential ; Electrocardiography ; Electrophysiology ; Female ; Heart Conduction System ; abnormalities ; Hemodynamics ; Humans ; Male ; Respiration ; Tachycardia ; diagnosis ; Tachycardia, Atrioventricular Nodal Reentry ; diagnosis ; Tachycardia, Supraventricular ; diagnosis ; Tricuspid Valve ; physiopathology