Heart failure electrocardiogram

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... 

BP, blood pressure BUN, blood urea nitrate CBC, complete blood cell count ECC, electrocardiogram HF, heart failure HR, heart rate K+, potassium SCr, serum creatinine SOB, shortness of breath. 

The safety of perflenapent has been evaluated in multicenter phase II studies in 146 patients with congestive heart failure (NYHA class III or IV, mean age 68 years), of whom 99 received perflenapent and 47 received isotonic saline, and in 134 patients with severe chronic obstructive pulmonary disease (FEVi no more than 60% of predicted, mean age 65 years), of whom 91 received perflenapent and 43 received isotonic saline (13). Blood pressure, heart rate, respiratory rate, oxygen saturation, the electrocardiogram, FEVi, complete serum biochemistry, hematology, and mental state were assessed. Adverse events were mild and required no treatment. There was no significant difference in the incidence of adverse reactions between those given perflenapent (15%) and those given placebo (11%). The most frequent adverse events with perflenapent were vasodilatation (n = 8), taste disturbance (n = 6), nausea (n = 5), and headache (n = 3). 

Figure 12.3 Base-apex electrocardiograms from an 11 -year-old horse that presented in congestive heart failure, (a) Before treatment, with ventricular tachycardia (b) Conversion to normal sinus rhythm was achieved with 5 liters 0.64% solution quinidine giuconate, infused at approximately 1 l/h. No specific cause was identified, although echocardiography revealed a segmental area of hypomotile ventricular myocardium, suggestive of ischaemia. The horse was euthanased 3 weeks later after recurrence of the arrhythmia.

Cardiovascular Cardiomegaly, myocardial ischemia, murmurs, and abnormal electrocardiogram patients with SCD have lower blood pressure (BP) than the normal population normal BP values for SCD should be used for diagnosis of hypertension ("relative" hypertension) heart failure usually is related to fluid overload... 

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.)...

Left ventricular hypertrophy (LVH) can lead to heart failure or myocardial infarction. The rhythm strips shown here illustrate key electrocardiogram changes of LVH as they occur in selected leads a large S wave (shaded area below left) in V, and a large R wave (shaded area below right) in V5. If the depth (in mm) of the S wave in V, added to the height (in mm) of the R wave in Vj exceeds 35 mm, then the patient has left ventricular hypertrophy. 

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. 

---