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Cardiomyopathy and ECG EKG
Hi guys,
Anyone here with ECG EKG knowledge?
I would like to find out peoples opinions on cardiomyopathy's in particular. And how they result in isoline changes on the ECG EKG.
I was having a debate with somebody recently, they protested that cardiomyopathy's (mainly chamber enlarging one's such as hypertrophic cardiomyopathy, arvc, dilated cardiomyopathy) have a false negative rate of around 30%!
I disagreed with them. If your heart muscle is truly enlarged, the electrical activity WILL be intercepted and therefore produce changes. Let's say athletic heart syndrome, if you detrain over 3-6 months then the heart will shrink somewhat and the ECG manifestations will vanish. But this isn't an overnight thing. That's why I can't understand how cardiomyopathy could be missed.
Anyone here with ECG EKG knowledge?
I would like to find out peoples opinions on cardiomyopathy's in particular. And how they result in isoline changes on the ECG EKG.
I was having a debate with somebody recently, they protested that cardiomyopathy's (mainly chamber enlarging one's such as hypertrophic cardiomyopathy, arvc, dilated cardiomyopathy) have a false negative rate of around 30%!
I disagreed with them. If your heart muscle is truly enlarged, the electrical activity WILL be intercepted and therefore produce changes. Let's say athletic heart syndrome, if you detrain over 3-6 months then the heart will shrink somewhat and the ECG manifestations will vanish. But this isn't an overnight thing. That's why I can't understand how cardiomyopathy could be missed.
Hello, due to when you actually asked your question, I'm not sure if you will even see my response. I not only worked as an EKG technician, I also had a daughter who had a severe non-obstructive concentric hypertrophic cardiomyopathy. I can tell you that there are several things the EKG can tell a doctor including if there is a hypertrophic form of cardiomyopathy. My daughter's EKG complexes literally shot right off the graft and as her heart disease got worse, her EKG had to be run on a half standard and then on a quarter standard. She also had WPW, SSS a RBBB and a LBBB as well as a Mahiem Fiber all electrical issues with her heart. All of those issues can be picked up on the EKG as well.
It can.
For several reasons...
1. Anything related to the RV basically is barely looked at. Only avr and some of lead V1 and V2 look at that side.
2. In terms of the lv... It's not a perfect science. We are looking at electrical activity as a corresendence to a hypertrophy or dilation. Dilation is very like not to show anything at all. Hypertrophy, well that's very dependent on if that if the out flow tract is really being utalized to full potential.
Just about every test put there has a at least an 20% false negative rate.
For several reasons...
1. Anything related to the RV basically is barely looked at. Only avr and some of lead V1 and V2 look at that side.
2. In terms of the lv... It's not a perfect science. We are looking at electrical activity as a corresendence to a hypertrophy or dilation. Dilation is very like not to show anything at all. Hypertrophy, well that's very dependent on if that if the out flow tract is really being utalized to full potential.
Just about every test put there has a at least an 20% false negative rate.
5 Comments
thanks for replying,
in response to your first comment, that's more in the way of inability to read the ECG correctly and inexperience. I have learnt most of what i know by putting my head down in books, watching lectures, trailing cardiac risk in the young's research. i baffle most of the g.p's and health assistants down the E.R because of what i know. i think ethnicity plays a role in the "so called" 20 odd % of false negatives, as well as inexperience and in a very very small percentage, inadequate ECG recording (by which i personally would just repeat anyway if any artifacts etc). this is shown in some of cardiac risk in the young's work. they've made it very very close in terms of sensitivity through the ECG, if im correct maybe the mid 90s % wise. i think it just depends on WHO is looking at it in alot of cases. i alone have had in excess of 60 resting ECG's in the past 5 years. they say for every 30 ecgs taken, 1 will be a false positive or false negative. none of mine have been with the exception of a extended qtc due to my heart rate being above 100bpm and the machine using a bad algorithm for high heart rates.
obviously were only discussing ECG recordings here, not echo-cardiograms. which presumably would catch the very few cases that may slip through the screening?.
in response to your first comment, that's more in the way of inability to read the ECG correctly and inexperience. I have learnt most of what i know by putting my head down in books, watching lectures, trailing cardiac risk in the young's research. i baffle most of the g.p's and health assistants down the E.R because of what i know. i think ethnicity plays a role in the "so called" 20 odd % of false negatives, as well as inexperience and in a very very small percentage, inadequate ECG recording (by which i personally would just repeat anyway if any artifacts etc). this is shown in some of cardiac risk in the young's work. they've made it very very close in terms of sensitivity through the ECG, if im correct maybe the mid 90s % wise. i think it just depends on WHO is looking at it in alot of cases. i alone have had in excess of 60 resting ECG's in the past 5 years. they say for every 30 ecgs taken, 1 will be a false positive or false negative. none of mine have been with the exception of a extended qtc due to my heart rate being above 100bpm and the machine using a bad algorithm for high heart rates.
obviously were only discussing ECG recordings here, not echo-cardiograms. which presumably would catch the very few cases that may slip through the screening?.
I'm not sure where you are getting your facts... But unless you have coronary issues ekg is pretty useless. And even in micro coronary circuit kind of useless. I have an lad fistula and it never has popped on ekg. EVER.
Echo is super subjective.
Have you ever read one?
Not to mention that you really can't get a good window for the RV in most patients during echo.
Really the only way to truly check cardiac fucntion is through thorough testing.
1. Ekg... If unrevieling
2. Echo... If unrevieling
3. Stress echo... If unrevieling
4. Cmr or coronary cta depending on age and symptoms possible both... Again unreveiling or equivical
5.rhc with exertion
6. Rhc and lhc
Are you medical?
Echo is super subjective.
Have you ever read one?
Not to mention that you really can't get a good window for the RV in most patients during echo.
Really the only way to truly check cardiac fucntion is through thorough testing.
1. Ekg... If unrevieling
2. Echo... If unrevieling
3. Stress echo... If unrevieling
4. Cmr or coronary cta depending on age and symptoms possible both... Again unreveiling or equivical
5.rhc with exertion
6. Rhc and lhc
Are you medical?
I'm not sure where you are getting your facts... But unless you have coronary issues ekg is pretty useless. And even in micro coronary circuit kind of useless. I have an lad fistula and it never has popped on ekg. EVER.
Echo is super subjective.
Have you ever read one?
Not to mention that you really can't get a good window for the RV in most patients during echo.
Really the only way to truly check cardiac fucntion is through thorough testing.
1. Ekg... If unrevieling
2. Echo... If unrevieling
3. Stress echo... If unrevieling
4. Cmr or coronary cta depending on age and symptoms possible both... Again unreveiling or equivical
5.rhc with exertion
6. Rhc and lhc
Are you medical?
Echo is super subjective.
Have you ever read one?
Not to mention that you really can't get a good window for the RV in most patients during echo.
Really the only way to truly check cardiac fucntion is through thorough testing.
1. Ekg... If unrevieling
2. Echo... If unrevieling
3. Stress echo... If unrevieling
4. Cmr or coronary cta depending on age and symptoms possible both... Again unreveiling or equivical
5.rhc with exertion
6. Rhc and lhc
Are you medical?
Have a degree or masters? no i dont. am i cardiac trained, technically yes. but only to read ecg's.
Most physicians believe pretty much what you have just expressed, that the ecg isnt very valuable. I have the strong belief that it is. The problem is that most physicians are just that .... physicians. Not trained on what conditions cause what specific or even non specific electrical changes on the recording.
From trailing onto some of cardiac risk in the youngs work, it has been proved that 90-95 % of HCM patients have an abnormal ecg recording. The fact is, maybe 10-20 % of them have non specific changes, and with the lack of presenting symptoms, slip through the net.
I 100 % agree with you on the RV, and its difficult to see much on a 2d echo.
I wonder if an MRI would be better at viewing it?.
That being said, if you know what your looking at, you can scope some info on the RV from v1 on the recording.
But once again i just want to highlight, my question was based solely on cardiomyopathy's. Blockages, micro blockages and even anomalous coronary arteries are commonly not seen on ecg's.
Most physicians believe pretty much what you have just expressed, that the ecg isnt very valuable. I have the strong belief that it is. The problem is that most physicians are just that .... physicians. Not trained on what conditions cause what specific or even non specific electrical changes on the recording.
From trailing onto some of cardiac risk in the youngs work, it has been proved that 90-95 % of HCM patients have an abnormal ecg recording. The fact is, maybe 10-20 % of them have non specific changes, and with the lack of presenting symptoms, slip through the net.
I 100 % agree with you on the RV, and its difficult to see much on a 2d echo.
I wonder if an MRI would be better at viewing it?.
That being said, if you know what your looking at, you can scope some info on the RV from v1 on the recording.
But once again i just want to highlight, my question was based solely on cardiomyopathy's. Blockages, micro blockages and even anomalous coronary arteries are commonly not seen on ecg's.
Well I hoped I helped answer it in some capacity.
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