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We know that Left Ventricular Hypertrophy (LVH) when diagnosed on an ECG, is associated with a higher mortality and cardiovascular morbidity. The gold standard for diagnosis is Cardiac Echocardiography, or ventricular mass measurements by MRI. The ECG however can provide a helpful screening tool for patients, alerting us for the need for further investigations. How do you determine if the ECG shows LVH? MEMBERS go to LVH under the ECG section to read about:
The SEAMENS' SIGN This is a new proposed sign from the recent literature(1). The Seamens Sign is as follows: If any of the QRS Complexes in the precordial leads in a 12 lead ECG, touch or cross another QRS complex, this is defined as LVH. This was a retrospective chart review of 2184 patient records in a Quartenary Centre and looked at consecutive patients with an ECG and a trans thoracic echocardiogram, performed within 90 days of each other. The Primary Endpoint was to determine if the Seamens' Sign was non inferior in confirming LVH compared to other criteria. Conclusion When compared to the Sokolow-Lyon criteria and the Cornell criteria for males, the Seamens' Sign was non-inferior in confirming LVH on an ECG. Below is the example. 
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Syncope is not uncommon, occurring in up to 25% of children before 18 years of age. Most causes are benign, however we need to be aware of the of 3 major groups as these can be very serious diagnoses:
Definition of Syncope Syncope in children and adults is a symptom, not a condition. It is up to us to determine the cause. The definition of syncope involves three components:
CaseA 12 yo presents to the emergency department. He is unwell and has had some episodes of syncope. His investigations in the ED result in the diagnosis of Viral Encephalitis. He develops the rhythm shown below and at the same time drops his conscious state. What does the ECG show? What is the diagnosis? What would you do now?  What is the diagnosis?
Ventricular Tachycardia Do you have an approach to Paediatric Syncope?Below you will find my approach to the child with syncope. Read more on this on the website, and also watch the video lecture.  Watch the Lecture A 40 yo male is brought in by ambulance following a collapse His GCS at the scene was 3 Paramedics found his rhythm to be VT? and he was given 11 shocks and 5mg of Adrenaline in total. On arrival he has an undetectable BP. He is maxed out on an adrenaline infusion. He has an LMA and has spontaneous assisted respirations The ECG is shown below. What do you think are the important changes  What would you treat this patient with, acutely? He is maxed out on an adrenaline infusion. (a)Adrenaline (b)Calcium Gluconate (c)Amiodarone (d)Potassium (e)Atropine ANSWER
The answer is d. This is the ECG of hypokalaemia. Notice the PR prolongation, ST depression and U waves. See the ECG changes below. . . . . .  What are the causes of this condition?
What is the treatment? Was it really VT or something else? What is the issue with Adrenaline in this case? A 38 yo male presents with sharp stabbing central chest pain. It changes with breathing. He feels worst when he is lying down. He is haemodynamically stable. An ECG is done. What does it show?  WHAT DOES THE ECG SHOW? Using the ECG in 20 Seconds Approach:
 REMEMBER: When looking for ST elevation or depression, use the T-P line as the isoelectric line.
DIAGNOSIS The diagnosis is most likely pericarditis. The history is very indicative of that. The characteristics of the pain ie., that is it worst on lying down indicate pericarditis. Although there appears to be a pleuritic component, there is no real other history of a PE and the ECG does not show a right axis or S1Q3T3 etc. In the ECG itself:
 WHAT TO DO NEXT
Who needs admission and who can be discharged?
What is Spodick's Sign and how good is it? What are the stages of Pericarditis? What is the treatment? Is there a role for glucocorticoids? |
AuthorDr Peter Kas 
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February 2023
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