Electrocardiography ; Humans ; Tachycardia, Sinus/diagnosis*

Supraventricular tachycardia (SVT) refers to a heterogeneous group of arrhythmias localized within the upper part of the heart (the His bundle or above). In general, the term SVT does not include atrial fibrillation. Common forms of SVT include atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, focal atrial tachycardia, and atrial flutter. Other, less common arrhythmias also fall under the category of SVT, including inappropriate sinus tachycardia and junctional reentrant/ectopic tachycardia. Paroxysmal supraventricular tachycardia refers to AVNRT and AVRT. SVTs can be identified and classified by clinical manifestation/physical examination, ECG, and/or electrophysiologic analysis.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrial Flutter ; Bundle of His ; Diagnosis, Differential* ; Electrocardiography ; Heart ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Sinus ; Tachycardia, Supraventricular*

Arrhythmias in the neonatal period are not uncommon, and may occur in neonates with a normal heart or in those with structural heart disease. Neonatal arrhythmias are classified as either benign or nonbenign. Benign arrhythmias include sinus arrhythmia, premature atrial contraction, premature ventricular contraction, and junctional rhythm; these arrhythmias have no clinical significance and do not need therapy. Supraventricular tachycardia, ventricular tachycardia, atrioventricular conduction abnormalities, and genetic arrhythmia such as congenital long-QT syndrome are classified as nonbenign arrhythmias. Although most neonatal arrhythmias are asymptomatic and rarely life-threatening, the prognosis depends on the early recognition and proper management of the condition in some serious cases. Precise diagnosis with risk stratification of patients with nonbenign neonatal arrhythmia is needed to reduce morbidity and mortality. In this article, I review the current understanding of the common clinical presentation, etiology, natural history, and management of neonatal arrhythmias in the absence of an underlying congenital heart disease.
Arrhythmia, Sinus ; Arrhythmias, Cardiac* ; Atrial Premature Complexes ; Diagnosis* ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Infant, Newborn ; Mortality ; Natural History ; Prognosis ; Tachycardia, Supraventricular ; Tachycardia, Ventricular ; Ventricular Premature Complexes

A previously healthy 61-year-old man presented to the emergency department with chest pain and dyspnoea for 6 hours. Examination revealed distress with an apical pansystolic murmur. Initial electrocardiogram showed sinus tachycardia and ST elevation in leads II, III, and aVF compatible with an inferior ST-elevation myocardial infarction. Point-of-care echocardiography in the emergency department showed a flail anterior mitral leaflet and severe mitral regurgitation, leading to a provisional diagnosis of papillary muscle rupture. Emergency cardiac catheterization showed 100%, 80%, and 70% occlusion of the middle right coronary, left anterior descending, and left circumflex arteries, respectively. An emergency triple vessel coronary artery bypass grafting and mitral valve replacement was performed. Posteromedial papillary muscle rupture resulting in mitral regurgitation was confirmed intraoperatively. The patient recovered uneventfully. In the absence of primary percutaneous coronary intervention, thrombolysis decisions should be made with extreme caution if mechanical complications of ST-elevation myocardial infarction are suspected.
Arteries ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Artery Bypass ; Diagnosis* ; Echocardiography ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Middle Aged ; Mitral Valve ; Mitral Valve Insufficiency ; Myocardial Infarction* ; Papillary Muscles* ; Percutaneous Coronary Intervention ; Point-of-Care Systems* ; Rupture* ; Tachycardia, Sinus ; Ultrasonography*

We present the case of a patient who developed new-onset asymptomatic sinus tachycardia after undergoing treatment for a right ventricular myocardial infarction. Even after excluding heart failure, infection and bleeding, the sinus tachycardia persisted. Computed tomography pulmonary angiography showed multiple bilateral pulmonary emboli. The vital sign abnormality resolved after treatment with an anticoagulant. We postulate that the pulmonary emboli originated from thrombi that were formed in the infarcted and dysfunctional right ventricle. Pulmonary embolism is a very rare complication of right ventricular myocardial infarction, and patients usually present with pleuritic chest pain. Our case highlights that asymptomatic sinus tachycardia could be a presenting feature of pulmonary embolism after the occurrence of a right ventricular myocardial infarction. A high index of suspicion is warranted in order to detect this potentially lethal complication.
Adult ; Echocardiography ; Electrocardiography ; Heart Ventricles ; diagnostic imaging ; Humans ; Male ; Myocardial Infarction ; complications ; diagnosis ; Pulmonary Embolism ; complications ; diagnosis ; Tachycardia, Sinus ; diagnosis ; etiology

Adolescent ; Atrial Appendage ; Diagnostic Errors ; Female ; Humans ; Tachycardia, Ectopic Atrial ; diagnosis ; Tachycardia, Sinus ; diagnosis

BACKGROUND: Some controversy still exists concerning the operative indications of coronary fistulas. Nevertheless, a short-term and long-term outcomes are excellent with surgical interventions. In this study, we assessed our surgical results on this disease entity during the last 20 years. Anatomic diversity was described as well. MATERIAL AND METHOD: From April 1986 to March 2005, 20 patients with coronary fistulas underwent surgical correction in Seoul National University Children's Hospital. Their medical records were reviewed retrospectively. RESULT: Twelve patients (60%) were asymptomatic prior to surgery. All had electrocardiogram and echocardiogram and all but 3 had coronary angiogram preoperatively. Anatomically, none of them had two or more coronary fistulas. The sites of origin were left coronary system in 11 patients and right in 9. The draining sites were right ventricle in 11, right atrium in 3, left ventricle in 3, main pulmonary artery in 2, and superior vena cavae in 1. All of the involved, the coronary arteries were dilated or aneurismal. In 1 case, there was atherosclerotic change but no ischemic evidence in preoperative electrocardiogram. Operative techniques included external obliteration (13), internal obliteration (5), and both (2). External obliteration was done by ligation of the fistulous tract only in 7 patients, by fistula ligation plus plication in 3 and by plication or patch closure via fistulotomy in 3. There was no operative mortality. All of postoperative morbidities including transient sinus arrhythmia (2), complete atrioventricular block (1), decreased left ventricular function (2), ventricular tachycardia (1), pericarditis (1), and seizure (1) improved on discharge. The mean follow-up was 55.1+/-50.2 months (4.0 months~18.0 years) and there were no recurrences of fistula. There was 1 second operation for aortic root aneurysm, which developed after external patch closure of right coronary fistula. CONCLUSION: We demonstrated here that coronary fistulas can be cured with excellent clinical outcome and low operative risk under precise diagnosis. Understanding the anatomic diversity will help to construct surgical plans.
Aneurysm ; Arrhythmia, Sinus ; Atrioventricular Block ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Fistula* ; Follow-Up Studies ; Heart Atria ; Heart Ventricles ; Humans ; Ligation ; Medical Records ; Mortality ; Pericarditis ; Pulmonary Artery ; Recurrence ; Retrospective Studies ; Seizures ; Seoul ; Tachycardia, Ventricular ; Vena Cava, Superior ; Ventricular Function, Left

BACKGROUND AND OBJECTIVES: Aggressive medical management, such as thrombolytic therapy, is necessary to save the lives of patients with acute severe pulmonary thromboembolism (PTE). The ECG changes associated with PTE are usually nonspecific, but severe PTE can produce some specific ECG findings. The purpose of this study was to determine the role of 12-lead ECG in the diagnosis of PTE, as well as the evaluation of its severity in therapeutic decision making. SUBJECTS AND METHODS: We analyzed 42 patients (60.5+/-14.9 years, 17 men), in whom PTE had been confirmed by chest CT angiography or radionuclide ventilation-perfusion scan, and 63 control patients (60.3+/-16.5 years, 21 men), who had various cardiovascular diseases, with the exception of PTE. The systolic pulmonary artery pressure (sPAP) was estimated by Doppler echocardiography. RESULTS: Among the finding derived from the 12-lead ECG, the sinus tachycardia (35.7 vs. 12.7%, p=0.005), a QRS axis over 90 degree (28.5 vs. 7.9%, p=0.005), the S1Q3T3 sign (45.2 vs. 23.8%, p=0.021) and T-wave inversion at V2-4 (31.0 vs. 14.3%, p=0.040) were more common in the PTE than the control group. There were no significant ECG changes in 3 patients (7.1%) in the PTE group. In the PTE group, the T-wave amplitudes at leads II and aVF showed correlation with the sPAP (r=-0.400, p=0.009; r=-0.321, p=0.038, respectively). A T-wave amplitude greater than 0.5 mm at lead II was predictive of severe pulmonary hypertension (50 mmHg) in patients with PTE, with a sensitivity, specificity, positive predictive value and negative predictive value of 59.3, 86.7, 88.9 and 54.2%, respectively (OR=6.532, 95% CI, 1.592 to 26.785). CONCLUSION: The use of common ECG abnormalities as diagnostic tools of PTE was limited, due to their low sensitivity, despite the high specificity. However, the T-wave amplitude (cut-off value=0.5 mm) at lead II was very simple and useful in distinguishing patients with severe pulmonary thromboembolism from those without.
Angiography ; Axis, Cervical Vertebra ; Cardiovascular Diseases ; Decision Making ; Diagnosis* ; Echocardiography, Doppler ; Electrocardiography* ; Humans ; Hypertension, Pulmonary ; Pulmonary Artery ; Pulmonary Embolism* ; Sensitivity and Specificity ; Tachycardia, Sinus ; Thrombolytic Therapy ; Tomography, X-Ray Computed

PURPOSE: For tachycardic patients not in need of immediate cardioversion, the International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care emphasize specific rhythm diagnosis and avoidance of simplistic overuse of adenosine. The purpose of this study was to identify the rhythms for which adenosine was inappropriately prescribed at the emergency department after the International Guidelines 2000 had been adopted. METHODS: We retrospectively investigated 128 tachycardic patients who had been prescribed adenosine at the emergency department from September 2000 to March 2003. Patients were divided into two groups. The Appropriate Use Group was comprised of patients for whom had been prescribed for narrow QRS-complex tachycardia on the initial ECG. The Inappropriate Use Group was comprised of patients for whom adenosine had been prescribed for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin on the initial ECG. RESULTS: Of the 128 patients, 31 (24.2%) were in the Inappropriate Use Group. Among them, atrial fibrillation was involved in 15, atrial flutter in 3, atrial tachycardia in 2, sinus tachycardia in 8, and wide QRS-complex tachycardia of unknown origin in 3. CONCLUSION: Approximately 24% of the emergency department patients who were treated with adenosine received the medication unnecessarily for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin. Additional education on electrocardiographic recognition of tachyarrhythmias, and the Tachycardia Algorithms of Guidelines 2000 may be necessary for residents of emergency department.
Adenosine* ; Atrial Fibrillation ; Atrial Flutter ; Cardiopulmonary Resuscitation ; Diagnosis ; Education ; Electric Countershock ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Retrospective Studies ; Tachycardia ; Tachycardia, Sinus

OBJECTIVE: To evaluate the cardiac function and to explore the importance of the evaluation of cardiac function in patients with Duchenne muscular dystrophy (DMD). METHOD: Thirty-nine patients with DMD without any symptoms of heart problems underwent physical examinations and cardiac monitoring including the arterial carbon dioxide (CO2) screening. Thirty one patients underwent pulmonary function test. RESULTS: Among 39 patients 27 showed abnormal electrocardiographic findings such as ventricular hypertrophy, ischemic change, atrial hypertrophy, T wave inversion, sinus tachycardia and ST elevation. 24 patients showed abnormal echocardiographic findings such as abnormal ejection fraction, dilated cardiomyopathy (DCMP), filling abnormality of left ventricle, global hypokinesia and reduced systolic function. 17 patients showed low ejection fraction (below 59%) and 4 of them were diagnosed as DCMP. There were significant correlations between age and ejection fraction (r= 0.552, p<0.01), between functional level and ejection fraction (r= 0.607, p<0.01) and between vital capacity and ejection fraction (r=0.547, p<0.01). However, ejection fraction showed no significant correlations with arterial CO2. CONCLUSION: Routine evaluation of the cardiac function, at least from 10 years of age, and proper treatment following early diagnosis of heart problems were necessary in patients with DMD, because they possibly have been severely affected by cardiac problems without any clinical symptoms.
Carbon Dioxide ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Deoxycytidine Monophosphate ; Early Diagnosis ; Echocardiography ; Electrocardiography ; Heart ; Heart Ventricles ; Humans ; Hypertrophy ; Hypokinesia ; Mass Screening ; Muscular Dystrophy, Duchenne* ; Physical Examination ; Respiratory Function Tests ; Tachycardia, Sinus ; Vital Capacity