4 Patient - 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?
7 The Ultimate “Pimp” Question What are the “classic” ECG manifestations of pheochromocytoma???
8 ECG 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.
26 Hypothermia T < 35.0 Tremor arifact One of earliest signs – secondary to shiveringSlowing of sinus rate - > bradycardiaProlongation of PR and QT intervalsOsborn/J wave
27 Osborn 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
28 Back 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