PVCs and AV Block in a Young Adult?

===================================MY Comment by KEN GRAUER, MD (4/9/2020):===================================The patient is a man in his 30s with a long history of smoking — who presents to the ED with a history of severe dizziness, near syncope, and chest discomfort over the past few days. His initial ECG and long lead II rhythm strip is shown in Figure-1.QUESTIONS:How would you interpret the ECG and rhythm strip shown in Figure-1?Is it likely that AV block is the cause of his symptoms?Figure-1: The initial 12-lead ECG in this case (See text).My THOUGHTS: There are 2 parts to this case: #1) Interpretation of the cardiac rhythm; and, #2) Interpretation of the 12-lead ECG in light of the History.Acknowledgment: I was not completely certain about all aspects of the cardiac rhythm from the single tracing shown in Figure-1. That said — my hope is that working through my sequential thought process will prove insightful.Interpretation in Figure-1 of the cardiac rhythm is not simple. Some sinus P waves are seen — and there are 4 PVCs on this tracing. The question was raised about the possibility of AV block — and the PR interval in front of the narrow beats does not remain the same (ie, the PR interval is longer in front of beats #3 and 13 — and it is shorter in front of beats #5 and 8 — compared to the PR interva...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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Over the last several decades, we have witnessed a dramatic shift in the congenital heart disease population from mostly children to now adults by a two-thirds margin. The diverse anatomies and physiologies, surgical procedures, and adult co-morbidities, has created the most unique population in cardiovascular medicine - adults with congenital heart disease (ACHD). Patients with ACHD may develop complex arrhythmias, valvular heart disease, heart failure, pulmonary hypertension and require complex advanced imaging, electrophysiologic, transcatheter, and/or surgical interventions to improve their quality of life.
Source: Cardiology Clinics - Category: Cardiology Authors: Tags: Preface Source Type: research
ConclusionsAppropriate shocks were relatively common in an ACHD ICD population followed long ‐term. Device‐related morbidity was significant. Although risk factors have been established for TOF, and to a lesser extent TGA, risk stratification for ICD implantation in ACHD remains challenging.This article is protected by copyright. All rights reserved
Source: Pacing and Clinical Electrophysiology : PACE - Category: Cardiology Authors: Tags: DEVICES Source Type: research
===================================MY Comment by KEN GRAUER, MD (6/1/2020):===================================YOU are asked to interpret the ECG shown in Figure-1. Unfortunately, no history is available to assist.WHAT are the diagnostic possibilities for the rhythm?What are the prognostic implications of this rhythm?Figure-1: The initial ECG in the ED. Please note that the long lead II rhythm strip is not simultaneously obtained with the 12-lead tracing above it. (See text).MY THOUGHTS on ECG #1: My initial impression on looking at the ECG...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Conclusion: This systematic review is aimed at summarizing all COVID-19 cases with a cardiac involvement published in paediatric age and trying to explain the underlying mechanisms responsible for COVID-19-related myocardial damage.What is Known:• Coronaviruses proved to be able to jump from animals to humans.• The outbreak of COVID-19 started from China (Dec 2019) and became pandemic.What is New:• Even in childhood, COVID-19 is not without the risk of cardiac involvement.• Myocarditis, heart failure, and arrhythmias are among the possible manifestations.
Source: European Journal of Pediatrics - Category: Pediatrics Source Type: research
Salas-Pacheco JL Abstract Sudden cardiac arrest (SCA) and sudden death (SD) continues to be a global public health problem, although the true incidence is unknown, it is estimated that they are responsible for 30% of cardiac origin mortality and may represent 20% of total mortality in adults. Unfortunately, the majority of cases occur in the general population, at the out-of-hospital level, in homes and in people who were not known to have heart disease. Although the majority of SCD victims are considered to be of cardiac origin and more frequent ischemic, it is not possible to rule out other causes only with the...
Source: Archivos de Cardiologia de Mexico - Category: Cardiology Authors: Tags: Arch Cardiol Mex Source Type: research
FM, Senior-Sánchez JM Abstract Objective: Heart disease in pregnancy can cause clinical deterioration and maternal-fetal death. It is essential to evaluate risk factors related to complications. Method: Observational, analytical retrospective cohort study with a non-probabilistic convenience sample of pregnant women with congenital or acquired heart disease, corrected or not, or arrhythmias requiring urgent intervention. Patients with mild or moderate valvular regurgitation, mild valvular stenosis, patients without echocardiography or without delivery information were excluded. The outcome was a compo...
Source: Archivos de Cardiologia de Mexico - Category: Cardiology Authors: Tags: Arch Cardiol Mex Source Type: research
ConclusionsCMR may identify cases of structural heart disease in subjects with OT PVCs and apparently normal electrocardiogram and echocardiogram examinations. A preliminary screening with CMR may be considered before any further invasive electrophysiology assessment and therapeutic planning.
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
AbstractBackgroundWe aimed to evaluate the incidence, type and management of supraventricular tachyarrhythmias (SVT) during the first year of life in a retrospective, population ‐based, single‐center study during a 10‐year period.MethodsThe analyzed patient cohort is based on data from the only specialized center managing all cases of neonatal and infant SVTs between 2009 and 2018 in the Slovak Republic (5.5 million population). A total of 116 consecutive patients  
Source: Pacing and Clinical Electrophysiology : PACE - Category: Cardiology Authors: Tags: ELECTROPHYSIOLOGY Source Type: research
Conclusion3D-EAM systems offer significant advantages in the management of challenging arrhythmias, and the introduction of novel algorithms underpins improvements in patients ’ outcomes. Given the increasing sophistication of these systems, however, a close collaboration among cardiac electrophysiologists, engineers and technicians is highly needed in order to get the best from the available technology.
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
J, Laurent G, Laux D, Mansourati J, Marijon E, Ovaert C, Sacher F, Sadoul N, Taieb J, Waldmann V, Warinfresse K, Defaye P, Piot O, Boveda S, Working Group of Pacing, Electrophysiology of the French Society of Cardiology, the Affiliate Group of Paediatric, Adult Congenital Cardiology of the French Society of Cardiology Abstract The population of patients with congenital heart disease (CHD) is continuously increasing, and a significant proportion of these patients will experience arrhythmias because of the underlying congenital heart defect itself or as a consequence of interventional or surgical treatment. Arrhyth...
Source: Archives of Cardiovascular Diseases - Category: Cardiology Authors: Tags: Arch Cardiovasc Dis Source Type: research
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