Cardiomyopathy electrocardiogram

Fig. 8.1 Examples of 12 lead high frequency QRS electrocardiograms from a patient with ischemic cardiomyopathy (A) and an age and gender matched healthy control (B)...

A 39-year-old man died suddenly 1 hour after taking a single oral dose of haloperidol 5 mg (14). He had myasthenia, alcoholic hepatitis, and electrolyte abnormalities due to inadequate nutritional state. His electrocardiogram showed prolongation of the QTC interval (460 ms). Autopsy showed a cardiomyopathy but no explanation for sudden death. 

A 64-year-old woman with systemic lupus erythematosus took chloroquine for 7 years (cumulative dose 1000 g). She developed sjmcope, and the electrocardiogram showed complete heart block a permanent pacemaker was inserted. The next year she presented with biventricular cardiac failure, skin hyperpigmentation, proximal muscle weakness, and chloroquine retinopathy. Coronary angiography was normal. An echocardiogram showed a restrictive cardiomyopathy. A skeletal muscle biopsy was characteristic of chloroquine myopathy. Chloroquine was withdrawn and she improved rapidly with diuretic therapy. 

Cardiomyopathy is the most common chemotherapy-associated cardiac toxicity. Myocardial ischemia, pericarditis, arrhythmias, miscellaneous electrocardiogram (ECG) changes, and angina occur much less frequently. The anthracyclines (da-unorubicin, doxorubicin, epirubicin, and idarubicin) have the highest consistent risk for cardiomyopathy, which is cumulative dose related. There is evidence that high-dose cyclophosphamide, mitoxantrone, and fluorouracil also pose an increased risk of cardiac damage. The concurrent use of traztuzu-mab with an anthracycline and cyclophosphamide is associated with a risk of cardiac dysfunction, but the consequences of sequential use are not yet known. 

In chronic disease, patients present with cardiomyopathy and heart failure. Electrocardiograms are usually abnormal, demonstrating extrasystoles, first-degree heart block, right bundle-branch block, and other serious conduction disturbances. Degeneration... 

Cardiomyopathy [SED-15, 824 SEDA-32, 95], successfully treated with high-dose olanzapine, has been reported in a 17-year-old adolescent after the dose of clozapine was increased by 25 mg/day for 4 days to 375 mg/day after an initial dose of 275 mg/day [72 ]. His electrocardiogram showed a slightly prolonged QT<. interval, creatine kinase activity was raised at 462 U/1 (reference range 45-245 U/1), and there was reduced left ventricular function with left ventricular hypertrophy. The shortening fraction was 25% (reference range 30-42%). 

Fig. 11.8 Stepwise algorithm for management of heart failure patients who are nonresponders to CRT. AV = atrioventricular CXR = chest X-ray EKG = electrocardiogram Htx = heart transplant LV = left ventricular LVAD = left ventricular assist device MR = mitral regurgitation RV = right ventricular VV = interventricular. Cardiac ischemia is evaluated in patients with ischemic cardiomyopathy. Evidence of dyssynchrony includes septal to posterior wall motion delay > 130ms, intraventricular mechanical delay >40ms, and tissue Doppler imaging > 65 ms. (Reproduced witih permission from Aranda JM, Woo GW, Schofield RS, et al. J Am Coll Cardiol 2005 46 2193-8.)...

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