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t o r e g . c o m
Dr. Mete ALPASLAN
Cardiac amyloidosis and the ECG
ECG abnormalities that may be seen in patients with cardiac amyloidosis
Low voltage
Bundle branch block
Atrioventricular conduction defects
Abnormal Q waves (pseudoinfarction pattern)
Abnormal QRS axis
Supraventricular arrhythmias (atrial fibrillation, etc.)
Ventricular arrhythmias
Reference
Tex Heart Inst J 2012;39:750-755.
ECG 1a. A 66 years-old woman had been implanted a pacemaker for sick sinus syndrome 4 months ago.
Because of syncope and self-limited polymorphic ventricular tachycardia (VT) attack,
her pacemaker was later upgraded to a dual-chamber ICD.
The above ECG was recorded at the time of ICD implantation. The QT interval is normal.
The ECG above has been used with the permission of Texas Heart Institute Journal.
Click here for a more detailed ECG
Click here to go to the relevant article of the Texas Heart Institute Journal
ECG 1b. The above ECG belongs to the same patient. It was recorded one month after the ECG 1a.
Her ICD was delivering shocks for VT attacks.
Atrial pacing at an interval of 60/minute, prolonged QT interval (QTc 550 ms), low voltage in limb leads and
a pseudoinfarct pattern (QS waves in anteroseptal leads) are seen in the above ECG.
Prolonged P wave duration denotes interatrial block (which is not rare during atrial pacing).
The ECG above has been used with the permission of Texas Heart Institute Journal.
Click here for a more detailed ECG
Click here to go to the relevant article of the Texas Heart Institute Journal
ECG 1c. The above ECG belongs to the same patient.
A ventricular ectopy occurring during the vulnerable period of the preceding T wave starts a polymorphic VT attack.
The basic rhythm is atrial pacing at a rate of 60/minute.
Prolonged P wave duration denotes interatrial block (which is not rare during atrial pacing).
The ECG above has been used with the permission of Texas Heart Institute Journal.
Click here for a more detailed ECG
Click here to go to the relevant article of the Texas Heart Institute Journal
ECG 1d. The above ECG belongs to the same patient and shows another polymorphic VT attack.
The ECG above has been used with the permission of Texas Heart Institute Journal.
Click here for a more detailed ECG
Click here to go to the relevant article of the Texas Heart Institute Journal
ECG 2. The above ECG belongs to a 50 years-old woman with Multiple Myeloma.
ECHOcardiography showed normal left ventricular (LV) systolic function with diffuse LV hypertrophy (1.4 cm wall thickness).
She does not have hypertension. Indeed, she has hypotension.
Increased left ventricular wall thickness is probably due to cardiac amyloidosis.
Left axis deviation is seen.
Unlike LV hypertrophy due to chronic hypertension, this ECG does not show increased voltage.
Hematologist Assoc. Prof. Dr. Ender Soydan has donated the above ECG to our website.
Click here for a more detailed ECG
ECG abnormalities that may be seen in patients with cardiac amyloidosis
Low voltage
Bundle branch block
Atrioventricular conduction defects
Abnormal Q waves (pseudoinfarction pattern)
Abnormal QRS axis
Supraventricular arrhythmias (atrial fibrillation, etc.)
Ventricular arrhythmias
Reference
Tex Heart Inst J 2012;39:750-755.
ECG 1a. A 66 years-old woman had been implanted a pacemaker for sick sinus syndrome 4 months ago.
Because of syncope and self-limited polymorphic ventricular tachycardia (VT) attack,
her pacemaker was later upgraded to a dual-chamber ICD.
The above ECG was recorded at the time of ICD implantation. The QT interval is normal.
The ECG above has been used with the permission of Texas Heart Institute Journal.
Click here for a more detailed ECG
Click here to go to the relevant article of the Texas Heart Institute Journal
ECG 1b. The above ECG belongs to the same patient. It was recorded one month after the ECG 1a.
Her ICD was delivering shocks for VT attacks.
Atrial pacing at an interval of 60/minute, prolonged QT interval (QTc 550 ms), low voltage in limb leads and
a pseudoinfarct pattern (QS waves in anteroseptal leads) are seen in the above ECG.
Prolonged P wave duration denotes interatrial block (which is not rare during atrial pacing).
The ECG above has been used with the permission of Texas Heart Institute Journal.
Click here for a more detailed ECG
Click here to go to the relevant article of the Texas Heart Institute Journal
ECG 1c. The above ECG belongs to the same patient.
A ventricular ectopy occurring during the vulnerable period of the preceding T wave starts a polymorphic VT attack.
The basic rhythm is atrial pacing at a rate of 60/minute.
Prolonged P wave duration denotes interatrial block (which is not rare during atrial pacing).
The ECG above has been used with the permission of Texas Heart Institute Journal.
Click here for a more detailed ECG
Click here to go to the relevant article of the Texas Heart Institute Journal
ECG 1d. The above ECG belongs to the same patient and shows another polymorphic VT attack.
The ECG above has been used with the permission of Texas Heart Institute Journal.
Click here for a more detailed ECG
Click here to go to the relevant article of the Texas Heart Institute Journal
ECG 2. The above ECG belongs to a 50 years-old woman with Multiple Myeloma.
ECHOcardiography showed normal left ventricular (LV) systolic function with diffuse LV hypertrophy (1.4 cm wall thickness).
She does not have hypertension. Indeed, she has hypotension.
Increased left ventricular wall thickness is probably due to cardiac amyloidosis.
Left axis deviation is seen.
Unlike LV hypertrophy due to chronic hypertension, this ECG does not show increased voltage.
Hematologist Assoc. Prof. Dr. Ender Soydan has donated the above ECG to our website.
Click here for a more detailed ECG