mimicers Flashcards
LVH
Dilatation
Increase in diameter of a heart chamber caused by volume overload
Hypertrophy
Increase in thickness of a heart chamber because of chronic pressure overload
Enlargement
Implies presence of dilatation or hypertrophy or both
Increases QRS amplitude
Often associated with ST depression and asymmetric T-wave inversion
ST segment can be dragged out which may mimic ST elevation
V1 or V2 S wave vs V5 or V6 total to 35
lead 1 negative AVL positive
BER
Benign early repolarisation (BER: AKA ‘high-take off; J-point elevation) is an ECG pattern most commonly seen in young, healthy patients < 50 years of age.
Widespread concave ST elevation, most prominent in the mid- to left precordial leads (V2-5).
Notching or slurring at the J-point.
Prominent, slightly asymmetrical T-waves that are concordant with the QRS complexes
ST elevation is usually < 2mm in the precordial leads and < 0.5mm in the limb leads,
J point notch
LVH ecg
Look at V1 and determine the depth of the S wave by counting in millimeters the amount of negative deflection measuring from the baseline to the most negative point in V1.
Look at V5 and V6 and determine which lead has the tallest R wave.
Determine the height of the taller R wave in millimeters (count the small boxes).
Add the height of the taller R wave and the deeper S wave.
If the number is equal to or greater than 35, suspect LVH.
Concordance
Concordance refers to ST-segments and T waves that deflect in the same direction as the end portion of the QRS complex.
In patients with left bundle branch block (LBBB) or ventricular paced rhythm, infarct diagnosis based on the ECG is difficult.
The baseline ST segments and T waves tend to be shifted in a discordant direction (“appropriate discordance”), which can mask or mimic acute myocardial infarction.
However, serial ECGs may show dynamic ST segment changes during ischaemia.
A new LBBB is always pathological and can be a sign of myocardial infarction.
Smith-modified Sgarbossa Criteria
modification of the rule for excessive discordance.
≥ 1 lead with ≥1 mm of concordant ST elevation ( 5)
≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST (3) depression
≥ 1 lead anywhere with 5 mm STE and proportionally excessive discordant STE, as defined by ≥ 25% of the depth of the preceding S-wave. (3)
Mimicers
LVH LBBB BER Pericarditis Ventricular rhythms
