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ECG Markers of Sudden Cardiac Death
Dr Syed Raza
Causes of sudden cardiac death
Case 1
34 years female presents with sudden onset palpitation and dizziness.
Previously fit and well.
BP : 100/60
Delta Wave
Wolf Parkinson White Syndrome (WPW syndrome)
An accessory pathway, bundle of Kent, exists between atria and ventricles causing faster electrical conduction and early depolarization of ventricles (pre-excitation)
• short PR interval, less than 3 small squares (120 ms) • slurred upstroke to the QRS indicating pre-excitation
(delta wave) • broad QRS • secondary ST and T wave changes
Accessory Pathways
Orthodromic atrioventricular re-entry tachycardia (AVRT)
Antidromic atrioventricular re-entry tachycardia (AVRT)
Case 2
36 years old gentleman presents with atypical chest pain.
Brother died suddenly at the age of 30
Brugada Syndrome
• A syndrome characterized by ST-segment elevation in right precordial leads (V1 to V3) that is unrelated to ischemia, electrolyte disturbances, or obvious structural heart disease was reported as early as 1953
• The electrocardiographic signature of the syndrome is dynamic and often concealed, but can be unmasked by potent sodium channel blockers such as flecainide, ajmaline, and procainamide
ST elevation with RBBB in right precordial leads
Types of Brugada
Drug challenge test
• 28 years old female• Dizziness and palpitation• History of syncope a year ago
Arrhythmogenic Right Ventricular Dysplasia (ARVD)
• Epsilon waves• Right ventricular strain (T wave inversion in
V1, V2 and V3)
Epsilon waves
• 44 years old male• Sudden onset of dizziness and collapse
Polymorphic Ventricular Tachycardia(Torsade De Pointes)- ‘Twisting of spikes’
Long QT Syndrome
• Normal QTc interval is 440 ms.
QT interval changes with Heart RateQT interval will decrease with increase in HRQT interval will increase with decresae in HRSubtract 0.02 s from QT for every 10 bpm increase in heart rate
Corrected QT (QTC) = Bazett's Formula = QT Interval / √ (RR interval)
Normal QTc ≤ 440 msec
Some causes of prolonged QT
• Congenital : Romano Ward Syndrome, Jervell Lange Neilson Syndrome
• Acquired
• CAD• Cardiomyopathy• Electrolyte disturbances : Hypokalemia, Hypomagnesaemia, • Drugs : Anti-Arrhythmics, Anti-depressants, psychotropic, Anti-histamines,• Hypothyroid• Hypothermia
QTc of > 470 ms in male and > 480 ms in female is considered significantly abnormal.
A longer QTc puts the patient at increased risk for torsade de pointes.
Short QT interval syndrome
• Recently recognized – 2000• Young healthy individuals, structurally normal
heart.• Genetic disorder- AD• K channels• QTc less than 340 ms• QTc rarely affected by HR• May present with VT/VF/PAF, SCD
• 26 years old female• High pressure job, lots of anxiety• Collapsed in the gym while on treadmill.
Catecholaminergic Polymorphic Ventricular Tachycardia
• Genetic mutation of calcium channels.• Presents as SCD, palpitation or syncope in 1st
or 2nd decade • Precipitated by emotional or physical stress• Treatment : B-blocker, Verapamil
ICD
Cardiac sympathetic denervation
Case 5
• 24 years M• Atypical chest pain while playing football.• Intermittent feeling faint• Systolic murmur
12 lead ECG: Is he having an MI ?
Hypertrophic Cardiomyopathy
Thank You
