4Patient - Sent from Pre-admission clinic because of ECG findings “I feel fine, I don’t know what the big deal is!”Asymptomatic, resting comfortablyObese, 50 years old, male.Meds: Spironolactone, lisinoprilT- 36.7, HR 70, BP – 205/118, RR 12, 96 % RAThoughts?
5“Oh, and by the way I have these bilateral adrenal tumors.” Chart shows a recent diagosis of bilateral adrenal tumors -> hypercortisolemiaDoes this change anything?
7The Ultimate “Pimp” Question What are the “classic” ECG manifestations of pheochromocytoma???
8ECG in Pheo No “classic” ECG Often present with ST elevation in a variety of patterns, mimicking acute infarctionCan also present with other ST-T changes, most commonly T wave inversionsQTc often prolonged – risk of arrythmiasCase series – 25 patients with eventual diagnosis of pheo – 17 had abnormal ECG findings, 6 had initial diagnosis of acute STEMI - > urgent angiography - > all were normalCardiovascular Manifestations of Pheocromocytoma.AM J Em Med, 18:5; : 2000.ECG manifestations of endocrine disease. Heart 2001, 86; 679.
26Hypothermia T < 35.0 Tremor arifact One of earliest signs – secondary to shiveringSlowing of sinus rate - > bradycardiaProlongation of PR and QT intervalsOsborn/J wave
27Osborn or J wave “Camel Hump sign” Extra deflection off of terminal portion of QRS and ST segment takeoffSize correlates directly with degree of hypothermiaUsually present when temp < 32.0 deg. CCan occur in HyperCa, Massive head injury, subarachnoid hemmorrhage
28Back to the case Cardiology consulted Not concerned about an acute event because patient completely asymptomaticDecided to admit patient for pre-op workup since he next in queue for surgeryLed to angiogram - > normalBooked for surgery