Basic surface electrocardiogram interpretation for the pharmacist

2021 ◽  
Author(s):  
Philip Mar ◽  
Joseph S Van Tuyl ◽  
Michael J Lim
Keyword(s):  
Ventricular Hypertrophy ◽  
Myocardial Injury ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Invaluable Tool ◽  
Clinical Conditions ◽  
Electrocardiogram Interpretation ◽  
Electrocardiogram Ecg ◽  
Cardiovascular Care ◽  
Surface Electrocardiogram

Abstract Purpose The electrocardiogram (ECG) is an invaluable tool for clinicians that provides important information about a patient’s heart. As clinical pharmacists play an ever-increasing role in cardiovascular care, ECG interpretation is an important skill with which to become familiar. Summary The ECG provides information on both electrical and biomechanical aspects of the heart. Electrical information such as the rhythm, rate, and axis of the electrical activity can all be provided by the ECG. Biomechanical information about the heart, such as the presence of ventricular hypertrophy and repolarization changes that may be associated with ischemia or myocardial injury, can also easily be gleaned from the ECG. Furthermore, the ECG plays a central role in both the diagnosis and treatment of common clinical conditions such as atrial fibrillation, ischemic heart disease, and QT interval prolongation Conclusion The ECG is one of the most commonly performed diagnostic tests, and clinicians should become familiar with its basic interpretation.

scholarly journals The effects of thioridazine on the QTc interval - cardiovascular safety in a South African setting

2005 ◽  
Vol 11 (2) ◽  
pp. 5
Author(s):  
Cathlene Seller ◽  
Piet Oosthuizen
Keyword(s):  
South African ◽  
Torsade De Pointes ◽  
Qtc Interval ◽  
Line Treatment ◽  
Interval Prolongation ◽  
First Line ◽  
Qt Interval Prolongation ◽  
Baseline Values ◽  
Electrocardiogram Ecg ◽  
African Setting

Background. Thioridazine has long been used as a first-line antipsychotic in South Africa without any apparent problems. Recently the American Food and Drug Administration (FDA) and Novartis have warned of potentially lethal arrhythmias that may result from the use of thioridazine. Abnormal QT-interval prolongation on the electrocardiogram (ECG) seems to be the most reliable indicator of risk of arrhythmias, such as torsade de pointes and ventricular fibrillation.Objective. The purpose of this study was to determine whether these warnings are of clinical relevance in a setting where there are already a limited number of antipsychotics available.Method. Thirty hospitalised subjects who required switching from a high-potency to a low-potency antipsychotic were included. All subjects were commenced on thioridazine 300 mg per day and had an ECG 1 week after initiation and 48 hours after each dose adjustment. QTc was determined using Bazett’s formula.Results. Thioridazine induced a significant increase (p = 0.0001) in QTc interval from baseline values of 400.6 (± 27.3) milliseconds to 429.1 (± 44.2) milliseconds. The QTc interval increased to above 450 milliseconds in 7 subjects (23%) and thioridazine was discontinued in 2 subjects because of a QTc interval greater or equal to 500 milliseconds.Conclusion. Thioridazine caused a significant, although asymptomatic, increase in QTc interval in almost one-quarter of subjects who received the medication as second-line treatment. Thioridazine should no longer be used as a first-line treatment and if used it should be accompanied by regular ECG monitoring.

scholarly journals COVID-19 and Cardiovascular Complications: An Updated Review

2021 ◽  
Vol 9 (F) ◽  
pp. 712-719
Author(s):  
Januar Wibawa Martha
Keyword(s):  
Myocardial Injury ◽  
Treatment Strategies ◽  
Cardiovascular Complications ◽  
Cytokine Release ◽  
Interval Prolongation ◽  
Coronary Syndrome ◽  
Qt Interval Prolongation ◽  
Coagulation Abnormalities ◽  
Global Pandemic ◽  
Plaque Destabilization

COVID-19 has become a global pandemic. Patients with pre-existing comorbidities such as hypertension, diabetes, and cardiovascular disease (CVD) are associated with greater severity and higher mortality. COVID-19 can cause cardiovascular complications, including myocardial injury, myocarditis, heart failure, acute coronary syndrome, and coagulation abnormalities. Possible pathophysiology and molecular pathways driving these disease processes are cytokine release syndrome, RAAS system dysregulation, plaque destabilization and coagulation disorders  Myocarditis is one concern among persons who received mRNA-Based COVID-19 vaccines. There are several cardiovascular complications that are possibly caused by COVID-19 treatments, such as QT interval prolongation, arrhythmia, and hypotension. Due to increasingly recognized CVD damage in COVID-19, we need to understand about COVID-19 related to cardiovascular complications and treatment strategies.

scholarly journals Ventricular Arrhythmia Precipitated by Severe Hypocalcaemia Secondary to Primary Hypoparathyroidism

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
S. Ashwin Reddy
Keyword(s):  
Ventricular Arrhythmia ◽  
Sinus Rhythm ◽  
Cardiac Arrhythmias ◽  
Qt Interval ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Electrocardiogram Ecg ◽  
Severe Hypocalcaemia

Hypocalcaemia causes neuromuscular and myocardial symptoms, including QT interval prolongation, and cardiac arrhythmias. Prompt detection and calcium replacement may reverse the pathology, following which the underlying cause should be diagnosed and treated to prevent recurrence. I present the case of a young man presenting with collapse who was found to have sinus rhythm with significant QT interval prolongation on admission electrocardiogram (ECG) associated with profound hypocalcaemia secondary to primary hypoparathyroidism.

Myocardial remodelling induced by repeated low doses of isoproterenol

2009 ◽  
Vol 87 (8) ◽  
pp. 641-651 ◽  
Author(s):  
Andrea Mikušová ◽  
Eva Kráľová ◽  
Lucia Tylková ◽  
Marta Novotová ◽  
Tatiana Stankovičová
Keyword(s):  
Ventricular Hypertrophy ◽  
Mitochondrial Fission ◽  
Repeated Administration ◽  
Left Ventricular ◽  
Interval Prolongation ◽  
Isolated Hearts ◽  
Qt Interval Prolongation ◽  
Myocardial Remodelling ◽  
T Tubules ◽  
Cytoplasmic Processes

In the present work, the effect of isoproterenol on the electrical properties of the rat heart and on the cytoarchitecture of the surviving cardiomyocytes was studied. Myocardial remodelling was induced by the daily administration of 5 mg/kg isoproterenol (Iso) for 7 days. Administration resulted in a significant increase (52%) in the ratio of left ventricular weight to body weight. ECG voltage criteria confirmed the presence of left ventricular hypertrophy. QT interval prolongation by 23% and 58% was found in Iso rats and in the corresponding isolated hearts, respectively. Spontaneously beating Iso hearts had a higher incidence of dysrhythmias. The surviving cardiomyocytes showed an irregular shape with cytoplasmic processes rich in ribosomes and rough endoplasmic reticulum. In these regions, myofibril disorganization and mitochondrial fission were observed. A greatly increased incidence of caveolae was seen in the plasma membrane and in the mouth of t-tubules. The membranes of t-tubules showed vesiculation, especially near the dyads. Repeated administration of isoproterenol led to hypertrophy, characterized by the existence of myocytes with simultaneous signs of both mature and postnatally developing cardiomyocytes. Structural microheterogeneities at the level of individual cells may represent one of the factors leading to electrical imbalance in the myocardial tissue remodelled by isoproterenol.

Electrocardiogram Recognition and Ablation of Atrial Tachycardia

2011 ◽  
Vol 3 (1) ◽  
pp. 80
Author(s):  
Alexander Feldman ◽  
Jonathan M Kalman ◽  
◽  
Keyword(s):  
Catheter Ablation ◽  
Atrial Tachycardia ◽  
Primary Treatment ◽  
P Wave ◽  
Wave Morphology ◽  
Focal Atrial Tachycardia ◽  
Mapping Techniques ◽  
Electrocardiogram Ecg ◽  
Surface Electrocardiogram

Focal atrial tachycardia (AT) is a relatively uncommon cause of supraventricular tachycardia, but when present is frequently difficult to treat medically. Atrial tachycardias tend to originate from anatomically determined atrial sites. The P-wave morphology on surface electrocardiogram (ECG) together with more sophisticated contemporary mapping techniques facilitates precise localisation and ablation of these ectopic foci. Catheter ablation of focal AT is associated with high long-term success and may be viewed as a primary treatment strategy in symptomatic patients.

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