ECG Disease Patterns
ECG Disease Patterns
 

Arrhythmogenic Right Ventricular Dysplasia

 
 
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Overview

  • Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited disorder in which there is fibro-fatty replacement of the right ventricular myocardium. The condition is the second most common of sudden cardiac death in young people.
  • The most classic ECG finding in ARVD is epsilon waves. Patients with ARVD may develop ventricular tachycardia, which is of right ventricular origin (with left bundle branch morphology).
    •  
    • ECG Findings in ARVD

    • Epsilon wave - a small upward deflection in leads V1-V3
    • T wave inversion in leads V1-V3
    • Localised QRS widening in leads V1-V3
    • Ventricular tachycardia with left bundle branch morphology
Last updated on April 18th, 2020
 
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Ali A, Butt N, Sheikh AS. Early repolarization syndrome: a cause of sudden cardiac death. World journal of cardiology. 2015 Aug 26;7(8):466.
 Balci B. Tombstoning ST-elevation myocardial infarction. Current cardiology reviews. 2009 Nov 1;5(4):273-8.
Barbati G, Caprioglio F. de Winter’s Pattern: An Unusual but Very Important Electrocardiographic Sign to Recognize. CJC Open. 2020 Jan 1;2(1):22-5.
Benito B, Brugada R, Brugada J, Brugada P. Brugada syndrome. Progress in cardiovascular diseases. 2008 Jul 1;51(1):1-22.
Birnbaum Y, Drew BJ. The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis. Postgraduate medical journal. 2003 Sep 1;79(935):490-504.
Childers R. Teaching electrocardiogram interpretation. Journal of electrocardiology. Volume 39, Issue 4, October 2006, Pages 426–429.
Chua CE, Choi E, Khoo EY. ECG changes of severe hypokalemia. QJM: An International Journal of Medicine. 2018 Aug 1;111(8):581-2.
 Coppola G, Carita P, Corrado E, Borrelli A, Rotolo A, Guglielmo M, Nugara C, Ajello L, Santomauro M, Novo S. ST segment elevations: Always a marker of acute myocardial infarction?. indian heart journal. 2013 Aug 31;65(4):412-23.
Crotti L, Celano G, Dagradi F, Schwartz PJ. Congenital long QT syndrome. Orphanet journal of rare diseases. 2008 Dec;3(1):18.
de Winter RJ, Verouden NJ, Wellens HJ, Wilde AA. A new ECG sign of proximal LAD occlusion. New England Journal of Medicine. 2008 Nov 6;359(19):2071-3.
Edhouse J, Brady WJ, Morris F. Acute myocardial infarction—Part II. Bmj. 2002 Apr 20;324(7343):963-6.
 Edhouse J, Thakur RK, Khalil JM. ABC Of Clinical Electrocardiography: Conditions Affecting The Left Side Of The Heart.BMJ: British Medical Journal. 2002; 324: 1264-1267.
Eisenberg MJ, De Romeral LM, Heidenreich PA, Schiller NB, Evans Jr GT. The diagnosis of pericardial effusion and cardiac tamponade by 12-lead ECG: a technology assessment. Chest. 1996 Aug 1;110(2):318-24.
 Fuchs RM, Achuff SC, Grunwald L, Yin FC, Griffith LS. Electrocardiographic localization of coronary artery narrowings: studies during myocardial ischemia and infarction in patients with one-vessel disease. Circulation. 1982;66:1168-1176.
Goldstein DS. The electrocardiogram in stroke: relationship to pathophysiological type and comparison with prior tracings. Stroke. 1979 May;10(3):253-9.
 Hanna EB, Glancy DL. ST-segment depression and T-wave inversion: classification, differential diagnosis, and caveats. Cleve Clin J Med. 2011;78:404-414.
Hanna ED, Hanna EB. Atrioventricular Accessory Pathways: Mechanisms, Electrocardiograms, and Associated Arrhythmias. Southern medical journal. 2016 Oct;109(10):670-6.
 Harrigan RA, Jones K. ABC of clinical electrocardiography. Conditions affecting the right side of the heart. BMJ. 2002; 324(7347): 1201-4. Hayden GE, Brady WJ, Perron AD, Somers MP, Mattu A. Electrocardiographic T-wave inversion: differential diagnosis in the chest pain patient. The American journal of emergency medicine. 2002 May 31;20(3):252-62. Herring N, Paterson DJ. ECG diagnosis of acute ischaemia and infarction: past, present and future. QJM : monthly journal of the Association of Physicians. 2006; 99: 219-230.
Hollar L, Hartness O, Doering T. Recognizing Wellens’ syndrome, a warning sign of critical proximal LAD artery stenosis and impending anterior myocardial infarction. Journal of community hospital internal medicine perspectives. 2015 Jan 1;5(5):29384.
Holstege CP, Eldridge DL, Rowden AK. ECG manifestations: the poisoned patient. Emergency Medicine Clinics. 2006 Feb 1;24(1):159-77.
Ishikawa K, Pipberger HV. Critical evaluation of the twin peaked P wave (“Pseudo-P mitrale”) in orthogonal electrocardiograms. Journal of Electrocardiology. 1980;13:181-184.
John TJ, John K, Jansen van Rensburg R, Kyriakakis C. Hypercalcaemia and a short QT interval. QJM: An International Journal of Medicine. 2020 Jan 1;113(1):55-6.
Keating L, Morris FP, Brady WJ. Electrocardiographic features of wolff-parkinson-white syndrome. Emergency medicine journal. 2003 Sep 1;20(5):491-3.
 Khan, IA Clinical and therapeutic aspects of congenital and acquired long QT syndrome.Am J Med2002;112,58-66.
Kuusela J, Larsson K, Shah D, Prajapati C, Aalto-Setälä K. Low extracellular potassium prolongs repolarization and evokes early afterdepolarization in human induced pluripotent stem cell-derived cardiomyocytes. Biology open. 2017 Jun 15;6(6):777-84.
Lee A, Lindemann J, Davison O, Wright D, Denman R. Spontaneous transformation of a concealed to manifest posteroseptal accessory pathway requiring epicardial ablation. Journal of arrhythmia. 2018 Jun;34(3):312-4.
Leenhardt A, Lucet V, Denjoy I, Grau F, Ngoc DD, Coumel P. Catecholaminergic polymorphic ventricular tachycardia in children: a 7-year follow-up of 21 patients. Circulation. 1995 Mar 1;91(5):1512-9.
Levis JT. ECG diagnosis: Hypothermia. The Permanente journal. 2010;14(3):73.
Marcus FI, Zareba W. The ECG in right ventricular cardiomyopathy/dysplasia. how can the ecg assist in understanding the pathological and functional changes of the heart in this disease?. Journal of electrocardiology. 2009 Mar;42(2):136-e1.
Marinella MA. Electrocardiographic manifestations and differential diagnosis of acute pericarditis. American family physician. 1998 Feb 15;57(4):699.
Mattu A, Brady WJ, Perron AD. Electrocardiographic manifestations of hypothermia. The American journal of emergency medicine. 2002 Jul 1;20(4):314-26.
 Meek S, Morris F. ABC Of Clinical Electrocardiography: Introduction. British Medical Journal 2002; Vol. 324, No. 7335; pp. 470-473 Mieghem CV, Sabbe M, Knockaert D. The Clinical Value of the ECG in Noncardiac Conditions. Chest. 2004; 125: 1561-1576. Money-Kyrle, Andrew. ECG interpretation made simple. GP (Nov 12, 2010): 36-37.
Morris F, Brady WJ. ABC of clinical electrocardiography: acute myocardial infarction—part I. Bmj. 2002 Apr 6;324(7341):831-4.
Napolitano C, Splawski I, Timothy KW, Bloise R, Priori SG. Timothy syndrome. InGeneReviews®[Internet] 2015 Jul 16. University of Washington, Seattle.
Nguyen HL, Pieper GH, Wilders R. Andersen–Tawil syndrome: clinical and molecular aspects. International journal of cardiology. 2013 Dec 5;170(1):1-6.
Nishi SP, Barbagelata NA, Atar S, Birnbaum Y, Tuero E. Hypercalcemia-induced ST-segment elevation mimicking acute myocardial infarction. Journal of electrocardiology. 2006 Jul 1;39(3):298-300.
 Nora Goldschlager, and Galen Wagner. Electrocardiogram interpretation. Journal of Electrocardiology, 2007-07-01, Volume 40, Issue 4, Pages 326-326.
Okada M, Yotsukura M, Shimada T, Ishikawa K. Clinical implications of isolated T wave inversion in adults: Electrocardiographic differentiation of the underlying cause of this phenomenon. Journal of the American College of Cardiology. 1994 Sep 1;24(3):739-45.
Petrov DB. An epsilon wave on electrocardiogram. BMJ. 2018 Jun 7;361:k1673.
Pflaumer A, Davis AM. Guidelines for the diagnosis and management of catecholaminergic polymorphic ventricular tachycardia. Heart, Lung and Circulation. 2012 Feb 1;21(2):96-100.
Porela P, Kytö V, Nikus K, Eskola M, Airaksinen KE. PR depression is useful in the differential diagnosis of myopericarditis and ST elevation myocardial infarction. Annals of Noninvasive Electrocardiology. 2012 Apr 1;17(2):141-5.
Postema PG, Wolpert C, Amin AS, Probst V, Borggrefe M, Roden DM, Priori SG, Tan HL, Hiraoka M, Brugada J, Wilde AA. Drugs and Brugada syndrome patients: review of the literature, recommendations, and an up-to-date website (www. brugadadrugs. org). Heart Rhythm. 2009 Sep 1;6(9):1335-41.
Purushothaman S, Salmani D, Prarthana KG, Bandelkar SM, Varghese S. Study of ECG changes and its relation to mortality in cases of cerebrovascular accidents. Journal of natural science, biology, and medicine. 2014 Jul;5(2):434.
Ramires TG, Sant’Anna J, Pais J, Picarra BC. Wellens’ syndrome: a pattern to remember. Case Reports. 2018 Apr 10;2018:bcr-2018.
 Rashford S. Acute Pleuritic Chest Pain. Australian Family Physician. 2001; 30(9). Rautaharju, P.M., Surawicz, B. and Gettes, L.S., 2009. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology. Journal of the American College of Cardiology, 53(11), pp.982-991. Seidenberg PH, Haynes J. Pericarditis: diagnosis, management, and return to play. Current sports medicine reports. 2006 Mar 1;5(2):74-9. Somers MP, Brady WJ, Perron AD, Mattu A. The prominant T wave: electrocardiographic differential diagnosis. The American journal of emergency medicine. 2002 May 31;20(3):243-51. Surawicz B, Childers R, Deal BJ, Gettes LS. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society endorsed by the International Society for Computerized Electrocardiology. Journal of the American College of Cardiology. 2009 Mar 17;53(11):976-81.
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Mickley H, Crea F, Van de Werf F, Bucciarelli-Ducci C. Fourth universal definition of myocardial infarction (2018). European heart journal. 2019 Jan 1;40(3):237-69.
 Vincent, GM Long QT syndrome.Cardiol Clin2000;18,309-325. W.M. Jackman, K.J. Friday, J.L. Anderson, E.M. Aliot, M. Clark, R. Lazzara. The long QT syndrome: a critical review, new clinical observations and a unifying hypothesis. Prog Cardiovasc Dis, 31 (1988), p. 115.
Weatherell H. Digoxin and the heart. Br J Cardiol. 2015 Aug; 22: 96-7.
Weiss JN, Qu Z, Shivkumar K. Electrophysiology of hypokalemia and hyperkalemia. Circulation: Arrhythmia and Electrophysiology. 2017 Mar;10(3):e004667.
Wilde AA, Antzelevitch C, Borggrefe M, Brugada J, Brugada R, Brugada P, Corrado D, Hauer RN, Kass RS, Nademanee K, Priori SG. Proposed diagnostic criteria for the Brugada syndrome: consensus report. Circulation. 2002 Nov 5;106(19):2514-9.
Xanthopoulos A, Skoularigis J. Diagnosis of Acute Pericarditis. E-Journal or Cardiology Practice. 2017 Sept; 15.
Zhang L, Liu L, R Kowey P, H Fontaine G. The electrocardiographic manifestations of arrhythmogenic right ventricular dysplasia. Current Cardiology Reviews. 2014 Aug 1;10(3):237-45.
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