P wave abnormalities are commonly found on ECG. However, they are seldom discussed and may also be neglected during ECG interpretion. In this article, we discuss two common types of P wave abnormalities, 'P mitrale' and 'P pulmonale'. The former was found in a patient with mitral valve stenosis, while the latter was from a patient with pulmonary hypertension. Echocardiography is important in evaluating the causes of P wave abnormalities.
Adult ; Anticoagulants ; therapeutic use ; Atrial Fibrillation ; diagnosis ; Cardiology ; methods ; Electrocardiography ; methods ; Exercise Tolerance ; Female ; Heart Atria ; abnormalities ; Humans ; Hypertension, Pulmonary ; diagnosis ; Male ; Middle Aged

Aged ; Cardiac Catheters ; Combined Modality Therapy ; Coronary Restenosis ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Paclitaxel ; administration & dosage ; therapeutic use ; Percutaneous Coronary Intervention ; instrumentation ; Stents ; Treatment Outcome ; Tubulin Modulators ; administration & dosage ; therapeutic use

The causes of abnormal T waves on electrocardiography are multiple and varied. Careful clinical history taking and physical examination are necessary for accurate identification of the cause of such abnormalities. Subsequent targeted specialised cardiac investigations, such as echocardiography or coronary angiography, may be of importance in the diagnosis of the underlying cardiac pathology. We present two cases of T wave inversions with markedly different aetiologies.
Aged, 80 and over ; Angioplasty, Balloon, Coronary ; methods ; Aortic Valve Insufficiency ; diagnosis ; diagnostic imaging ; surgery ; Cardiomyopathy, Hypertrophic ; diagnosis ; Coronary Angiography ; methods ; Echocardiography, Doppler ; methods ; Electrocardiography ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; therapy ; Sampling Studies ; Severity of Illness Index ; Treatment Outcome

ST segment elevation is one of the most important electrocardiographic features that need to be recognised. Although ST segment elevation myocardial infarction is one of the main causes of this abnormality, there are other non-ischaemic causes that are also important. We discuss reversible apical ballooning syndrome or Takotsubo cardiomyopathy, pericarditis and a case of ST segment elevation due to 'early repolarisation pattern'.
Cardiology ; methods ; Coronary Angiography ; methods ; Dyslipidemias ; complications ; Electrocardiography ; methods ; Female ; Humans ; Leukemia, Myeloid, Acute ; complications ; Male ; Middle Aged ; Myelodysplastic Syndromes ; complications ; Myocardial Infarction ; complications ; diagnosis ; Myocardial Ischemia ; pathology ; Prostatic Neoplasms ; complications ; Respiratory Tract Infections ; complications

The causes of low voltage complexes on the electrocardiogram (ECG) are variable; however, they are not commonly discussed. An ECG with small QRS amplitudes may initially look unremarkable to the unwary, but some of the underlying conditions may be critical. Although imperfect, the ECG is still a useful, noninvasive and readily available tool for the screening of these underlying conditions. We present two cases with low voltage complexes in the ECG. The first case highlights how the findings on ECG and subsequent echocardiogram led to the diagnosis of a rare case of cardiac amyloidosis. In the second case, a screening electrocardiogram alerted the physicians to a life-threatening condition, that of a large pericardial effusion with cardiac tamponade.
Aged ; Cardiac Tamponade ; diagnosis ; etiology ; physiopathology ; Diagnosis, Differential ; Electrocardiography ; Female ; Heart Conduction System ; physiopathology ; Humans ; Male ; Middle Aged ; Pericardial Effusion ; diagnosis ; physiopathology

Diabetes mellitus is responsible for diverse cardiovascular complications such as accelerated atherosclerosis, increased plaque burden and diffuse coronary lesions. It is also a major risk factor for myocardial infarction, stroke and peripheral vascular disease. Here, we present two cases. The first patient had subtle changes in the ECGs, with severe coronary artery disease requiring coronary artery bypass grafting, while the second had deep T wave inversion in the ECG and was found to have normal coronary arteries and nonischaemic cardiomyopathy. Although ECG failed to show the severity of the disease, it is invaluable as a simple, noninvasive test to aid in diagnosis. Our two cases stress the importance of a high index of suspicion and the low threshold for investigations in the diabetic population.
Aged ; Biomarkers ; analysis ; Combined Modality Therapy ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Stenosis ; diagnosis ; therapy ; Diabetes Complications ; diagnosis ; drug therapy ; surgery ; Diagnosis, Differential ; Electrocardiography ; Humans ; Male ; Middle Aged ; Pulmonary Edema ; diagnosis ; therapy ; Radiography, Thoracic

INTRODUCTIONThis study aimed to examine the long-term clinical outcomes of coronary fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in a real-world population in an Asian tertiary centre.

MATERIALS AND METHODSAll patients who underwent FFR measurement for intermediate coronary lesions in our centre from June 2002 to December 2009 were enrolled. A threshold of FFR ≤0.75 was used for revascularisation. All the patients were prospectively followed-up for major adverse cardiac events (MACE) of death, myocardial infarction (MI), target vessel revascularisation (TVR) and stent thrombosis.

RESULTSBased on FFR measurement, 368 (57%) patients were treated medically while 278 (43%) underwent revascularisation. At a mean follow-up duration of 29.7 ± 16 months, 53 (14.4%) patients in the medical therapy group and 32 (11.5%) patients in the revascularised group experienced MACE (P = 0.282). There were no statistical differences in all the clinical endpoints between the 2 groups.

CONCLUSIONMedical therapy based on FFR measurement is associated with low incidences of MACE at long-term follow-up.

Adult ; Aged ; Aspirin ; therapeutic use ; Coronary Stenosis ; complications ; diagnosis ; therapy ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; methods ; Platelet Aggregation Inhibitors ; therapeutic use ; Retrospective Studies ; Ticlopidine ; analogs & derivatives ; therapeutic use ; Treatment Outcome

Angina Pectoris ; diagnosis ; Blood Pressure ; Coronary Angiography ; Coronary Artery Disease ; diagnosis ; Electrocardiography ; Exercise Test ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Singapore

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

Pulmonary embolism (PE) poses a challenge to physicians, as it can be difficult to diagnose but results in significant mortality and morbidity in patients. Diagnosing PE requires an integrated approach using clinical findings, electrocardiography (ECG), blood investigations and imaging modalities. Abnormalities in ECG are common among patients with massive acute PE and can serve as a prognostic indicator. In this article, we describe the ECG presentations of two patients diagnosed with PE, and review the literature on the various types of ECG presentations and their role in predicting the prognosis of PE.
Anticoagulants ; administration & dosage ; Blood Pressure ; Echocardiography ; Electrocardiography ; methods ; Female ; Hemorrhage ; complications ; Humans ; Hypertension ; complications ; Male ; Middle Aged ; Prognosis ; Pulmonary Embolism ; diagnosis ; Stroke ; complications