Abstract 3268: Ethnic Differences in the 12 Lead -EKG - Relevance to the Cardiovascular Evaluation for Hypertrophic Cardiomyopathy in Athletes

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
John Rawlins ◽  
Michael Papadakis ◽  
Carey Edwards ◽  
Sandeep Basavarajaiah ◽  
Sanjay Sharma
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Cardiac Mri ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Black Athletes ◽  
St Segment Elevation ◽  
T Wave ◽  
St Segment ◽  
Phenotypic Features ◽  
Cardiovascular Evaluation

Introduction Cardiac adaptation to intense physical exercise is associated with physiological increases in cardiac dimensions that are reflected on the EKG. The EKG changes in Caucasian athletes (WA) are established, however, there is a paucity of data in black athletes (BA) who constitute an increasing proportion of elite athletes in Western countries. We sought to identify differences (if any) in EKG characteristics between BA and WA participating in similar sporting disciplines. Methods Between 2007– 8, 222 nationally ranked male BA aged 14 –35 and 496 WA of similar age, size and range of sporting disciplines underwent a EKG and standard 2-D echocardiography. All athletes with a left ventricular wall thickness > 12mm and deep T wave inversion (> −0.2 mV) underwent Holter monitor, exercise stress test, and cardiac MRI to exclude phenotypic features of hypertrophic cardiomyopathy (HCM). Results Black athletes had a greater prevalence of voltage criteria for left ventricular hypertrophy (LVH) (57% vs 42%; p < 0.005), ST segment elevation (76% vs 33%; p < 0.001) and T wave inversions (25% vs 4%; p < 0.001) compared with WA. ST segment elevation in all athletes was confined to the anterior precordial leads but 50% BA exhibited a unique convex ST segment elevation pattern that was absent in WA. There was no correlation between T wave inversions and LVH at echocardiography or cardiac MRI. Indeed none of the BA with T wave inversions displayed any phenotypic features of HCM. Conclusion Black athletes exhibit different adaptive responses to exercise than WA. Deep T wave inversions and convex ST segment elevation are common in BA, with or without LVH and may overlap with HCM. These results have significant implications during pre-participation screening. There is the potential risk of generating a false positive diagnosis of HCM and lead to unnecessary exclusion from competitive sport, if data derived from WA, used to identify an abnormal EKG, is incorrectly extrapolated to BA.

Abstract 4840: Tako-Tsubo Cardiomyopathy without Apical Ballooning - Results of the German Tako-Tsubo Registry

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Anastasios Athanasiadis ◽  
Birke Schneider ◽  
Johannes Schwab ◽  
Uta Gottwald ◽  
Ellen Hoffmann ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Ejection Fraction ◽  
Wall Motion ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
T Wave ◽  
Wave Inversion ◽  
St Segment ◽  
Tako Tsubo Cardiomyopathy

Background : The German tako-tsubo cardiomyopathy (TTC) registry has been initiated to further evaluate this syndrome in a western population. We aimed to assess different patterns of left ventricular involvement in TTC. Methods : Inclusion criteria were: 1) acute chest symptoms, 2) reversible ECG changes (ST-segment elevation±T-wave inversion), 3) reversible left ventricular dysfunction with a wall motion abnormality not corresponding to a single coronary artery territory, 4) no significant coronary artery stenoses. Results : A total of 258 patients (pts) from 33 centers were included with a mean age of 68±12 years. Left ventriculography revealed the typical pattern of apical ballooning in 170 pts (66%) and an atypical mid-ventricular ballooning with normal wall motion of the apical and basal segments in 88 pts (34%). Mean age (68±11 vs 67±13 years) and gender distribution (150 women/20 men vs 80 women/8 men) were similar in both groups. Triggering events were present in 78% of the pts with apical ballooning (35% emotional, 34 physical and 9% combination) and in 75% of the pts with mid-ventricular ballooning (39% emotional, 25% physical and 11% combination). As assessed by left ventriculography, ejection fraction was significantly lower in pts with mid-ventricular ballooning (50±15% vs 45±13%, p=0.006). There was no difference in right ventricular involvement. Creatine kinase and troponin I were comparable in both groups. The ECG on admission showed ST-segment elevation in 87% of pts with apical ballooning and in 78% of pts with mid-ventricular ballooning. T-wave inversion was seen in 70% of the pts irrespective of the TTC variant. A Q-wave was significantly less present in pts with mid-ventricular ballooning (30% vs 16%, p=0.04). The QTc interval during the first 3 days was not different among both groups. Conclusion : A variant form with mid-ventricular ballooning was observed in one third of the pts with TTC. Left ventricular ejection fraction was significantly lower in these pts, although they revealed significantly less Q-waves on the admission ECG. All other parameters were similar and confirm the concept that apical and mid-ventricular ballooning represent two different manifestations of the same syndrome.

ECG features and arrhythmias in takotsubo syndrome

ESC CardioMed ◽  
2018 ◽  
pp. 1298-1301
Author(s):  
Federico Migliore ◽  
Sebastiano Gili ◽  
Domenico Corrado
Keyword(s):  
Left Ventricular ◽  
Stunned Myocardium ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
T Wave ◽  
Wave Inversion ◽  
Qt Interval Prolongation ◽  
St Segment ◽  
Reversible Left Ventricular Dysfunction ◽  
Repolarization Abnormalities

Takotsubo syndrome (TTS) is typically characterized by dynamic electrocardiographic (ECG) repolarization changes, which consist of mild ST-segment elevation on presentation (acute phase) followed by T-wave inversion with QT interval prolongation within 24–48 h after presentation (subacute phase). It is noteworthy that subacute ECG repolarization abnormalities of TTS resemble those of the so-called Wellens’ ECG pattern, which is characterized by transient T-wave inversion in the anterior precordial leads as a result of either myocardial ischaemia or other non-ischaemic conditions, all characterized by a reversible left ventricular dysfunction (‘stunned myocardium’).

scholarly journals Midventricular Hypertrophic Cardiomyopathy with Apical Aneurysm: Potential for Underdiagnosis and Value of Multimodality Imaging

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Archana Sivanandam ◽  
Karthik Ananthasubramaniam
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
African American Woman ◽  
Multimodality Imaging ◽  
American Woman ◽  
Implantable Defibrillator ◽  
Left Ventricular ◽  
Apical Region ◽  
St Segment Elevation ◽  
St Segment ◽  
Apical Aneurysm

We illustrate a case of midventricle obstructive HCM and apical aneurysm diagnosed with appropriate use of multimodality imaging. A 75-year-old African American woman presented with a 3-day history of chest pain and dyspnea with elevated troponins. Her electrocardiogram showed sinus rhythm, left atrial enlargement, left ventricular hypertrophy, prolonged QT, and occasional ectopy. After medical therapy optimization, she underwent coronary angiography for an initial diagnosis of non-ST segment elevation myocardial infarction. Her coronaries were unremarkable for significant disease but her left ventriculogram showed hyperdynamic contractility of the midportion of the ventricle along with a large dyskinetic aneurysmal apical sac. A subsequent transthoracic echocardiogram provided poor visualization of the apical region of the ventricle but contrast enhancement identified an aneurysmal pouch distal to the midventricular obstruction. To further clarify the diagnosis, cardiac magnetic resonance imaging with contrast was performed confirming the diagnosis of midventricular hypertrophic cardiomyopathy with apical aneurysm and fibrosis consistent with apical scar on delayed enhancement. The patient was medically treated and subsequently underwent elective implantable defibrillator placement in the ensuing months for recurrent nonsustained ventricular tachycardia and was initiated on prophylactic oral anticoagulation with warfarin for thromboembolic risk reduction.

scholarly journals Electrocardiographic Findings in Takotsubo Cardiomyopathy: ECG Evolution and Its Difference from the ECG of Acute Coronary Syndrome

2014 ◽  
Vol 8 ◽  
pp. CMC.S14086 ◽  
Author(s):  
June Namgung
Keyword(s):  
Acute Coronary Syndrome ◽  
Takotsubo Cardiomyopathy ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Qtc Interval ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
T Wave ◽  
Wave Inversion ◽  
St Segment

Background Electrocardiogram (ECG) manifestations of takotsubo cardiomyopathy (TC) produce ST-segment elevation or T-wave inversion, mimicking acute coronary syndrome (ACS). We describe the ECG manifestation of TC, including ECG evolution, and its different points from ACS. Methods We studied 37 consecutive patients (age 67 ± 15 years, range 23-89, M:F = 12:25) from March 2004 to November 2012 with a diagnosis of TC who were proven to have apical ballooning on echocardiography or left ventricular angiography and normal coronary artery. We analyzed their standard 12-lead ECGs, including rate, PR interval, QRS duration, corrected QT (QTc) interval, ECG evolutions, and arrhythmia events. Results Two common ECG findings in TC were ST-segment elevation (n = 13, 35%) and T inversion (n = 24, 65%), mostly in the precordial leads. After ST-segment resolution, in a few days (3.5 days), diffuse and often deep T-wave inversion developed. Eight patients (22%) had transient Q-waves lasting a few days in precordial leads. No reciprocal ST-segment depression was noted. T-wave inversion continued for several months. QT prolongation (>440 milliseconds) was observed in 37 patients (97%). There were no significant life-threatening arrhythmias except atrial fibrillation (n = 6, 16%). Conclusion There are distinct differences between the ECGs of TC and ACS. These differences will help to differentiate TC from ACS.

Abstract 13901: Spatial Distribution of the Late Gadolinium Enhancement on Cardiac MRI Strongly Affects Maximal T-wave Alternans Sites on the 12-lead Holter ECG in Hypertrophic Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Naka Sakamoto ◽  
Nobuyuki Sato ◽  
Ahmed Talib ◽  
Keisuke Otsu ◽  
Eitaro Sugiyama ◽  
...  
Keyword(s):  
Spatial Distribution ◽  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
Cardiac Mri ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Gadolinium Enhancement ◽  
T Wave ◽  
Significant Difference ◽  
T Wave Alternans

[Background]: Late gadolinium enhancement (LGE) on cardiac MRI (CMR) predicts the mortality in hypertrophic cardiomyopathy (HCM) patients. T-wave alternans (TWA) is a potential cardiac mortality predictor. However, whether LGE localization affects TWA is unclear. [Purpose]: To elucidate the localization relationship between the LGE and maximal TWA lead (TWAmax-lead) and maximal TWA voltage (TWAmax) using 12-lead Holter ECGs (Holter12) in HCM. [Methods]: Holter12s and CMR were performed in 46 HCM patients. TWA was assessed using a modified moving average method and the TWAmax was determined in each lead. The average transmural LGE extent was scored using a 4 point score (Score 0:no LGE, 1:1-25%, 2:26-50%, 3:51-75%, 4:76-100%) in 12 left ventricular segments and the sum (LGEtotal) was calculated. Left ventricular LGE sites were classified into anterior, septal, inferior, and lateral. Corresponding ECG lead groups were defined as V3-4 for anterior, V1-2 for septal, II, III, aVF for inferior, and I, aVL, and V5-6 for lateral. The TWAmax was analyzed depending on the Score of the 5 stages, and the coincidence between the LGE distribution and TWAmax-lead was investigated. Furthermore, the differences in the TWAmax, LGEtotal, and left ventricular ejection fraction (LVEF) in the presence or absence of ventricular tachycardia (VT) were also studied. [Results]: The TWAmax was 50±11μV for Score=0, 54±13μV for Score=1, 61±18μV for Score=2, 67±20μV for Score=3, and 47±16μV for Score=4. The TWAmax for Scores 2 and 3 was significantly greater than for Score=0 (p<0.001, p<0.001, respectively), but there was no significant difference between Scores 1 and 4, and Score=0 (p=0.14, p=0.41). The TWAmax-lead revealed scores ranging from 1 to 3 in all segments. The LGEtotal and TWAmax were significantly greater in patients with VT (n=23) than without (17±7 vs. 10±7 [p<0.01], 83±17μV vs. 64±18μV [p<0.001], respectively). The LVEF did not statistically differ between the two groups (48±16% vs. 54±10%, p=0.21). [Conclusions]: The LGE distribution correlated with the TWA, i.e., a 50-75% transmural extent of the LGE yielded the maximal local TWA. The spatial distribution of the LGE strongly affects myocardial repolarization abnormalities indicated by TWA as VT substrates in HCM.

Self-limited myocarditis presenting with chest pain and ST segment elevation in adolescents after vaccination with the BNT162b2 mRNA vaccine

2021 ◽  
pp. 1-4
Author(s):  
Jihyun Park ◽  
Dona R. Brekke ◽  
Andras Bratincsak
Keyword(s):  
Chest Pain ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Cardiac Mri ◽  
Left Ventricular ◽  
Adolescent Males ◽  
Elevated Troponin ◽  
St Segment Elevation ◽  
St Segment

Abstract Two adolescent males presented within 3 days after the first and second dose of the BNT162b2 vaccine with chest pain. Elevated troponin levels, ST segment elevation, and enhancement of the myocardium in cardiac MRI suggested myocarditis. Left ventricular function remained normal, symptoms resolved, and patients were discharged in 4 days. BNT162b2 vaccine may be associated with self-limited myocarditis in youth.

scholarly journals Cardiac Rupture—The Most Serious Complication of Takotsubo Syndrome: A Series of Five Cases and a Systematic Review

2021 ◽  
Vol 10 (5) ◽  
pp. 1066
Author(s):  
Małgorzata Zalewska-Adamiec ◽  
Hanna Bachórzewska-Gajewska ◽  
Sławomir Dobrzycki
Keyword(s):  
Female Gender ◽  
Left Ventricular ◽  
Cardiac Rupture ◽  
Control Group ◽  
Mechanical Complication ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
Glucose Levels ◽  
Risk Of Death ◽  
St Segment

Background: The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient. Methods: In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria. Results: Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84; p = 0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; p = 0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; p < 0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; p < 0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III. Conclusions: Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG).

Sign in / Sign up

Export Citation Format

Share Document