Presentation on theme: "Navpreet Sahsi. ED Doc to Bed 9 - Sent from Pre-admission clinic because of ECG findings - I feel fine, I dont know what the big deal is! - Asymptomatic,"— Presentation transcript:
ED Doc to Bed 9
- Sent from Pre-admission clinic because of ECG findings - I feel fine, I dont know what the big deal is! - Asymptomatic, resting comfortably - Obese, 50 years old, male. - Meds: Spironolactone, lisinopril - T- 36.7, HR 70, BP – 205/118, RR 12, 96 % RA - Thoughts?
Oh, and by the way I have these bilateral adrenal tumors. Chart shows a recent diagosis of bilateral adrenal tumors -> hypercortisolemia Does this change anything?
What are the classic ECG manifestations of pheochromocytoma???
No classic ECG Often present with ST elevation in a variety of patterns, mimicking acute infarction Can also present with other ST-T changes, most commonly T wave inversions QTc often prolonged – risk of arrythmias Case series – 25 patients with eventual diagnosis of pheo – 17 had abnormal ECG findings, 6 had initial diagnosis of acute STEMI - > urgent angiography - > all were normal Cardiovascular Manifestations of Pheocromocytoma.AM J Em Med, 18:5; : ECG manifestations of endocrine disease. Heart 2001, 86; 679.
Peaked T waves P wave flattening, PR prolongation, eventual loss of p waves QRS widening Sine wave appearance
Depression of T waves ST depression (> 0.5 mm) Appearance of U waves
Sinus brady Low voltage complexes Prolonged pr and qt intervals Flattened or inverted T waves Pericardial effusions occur in 30% of patients and may account for some of the changes
Sinus Tach – 40 % A. Fib – 10 – 22 % Nonspecific ST-T abnormalities – 25 % Interventricular conduction disturbances – LAFB most common – 15 %
Shortenes plateau phase (phase 2) of action potential and shortens effective refractory period ST shortening Short QT interval
T < 35.0 Tremor arifact One of earliest signs – secondary to shivering Slowing of sinus rate - > bradycardia Prolongation of PR and QT intervals Osborn/J wave
Camel Hump sign Extra deflection off of terminal portion of QRS and ST segment takeoff Size correlates directly with degree of hypothermia Usually present when temp < 32.0 deg. C Can occur in HyperCa, Massive head injury, subarachnoid hemmorrhage
Cardiology consulted Not concerned about an acute event because patient completely asymptomatic Decided to admit patient for pre-op workup since he next in queue for surgery Led to angiogram - > normal Booked for surgery