These ECG scans of poor quality were sent to me by a young colleague who started practicing as a family doctor. From the anamnesis there is little information: a male of 39 years of age with a pronounced cognitive deficit making productive contact impossible. Skin of the scalp and face with traces of scars and in abrasions (syncope?). Relatives are only two younger sisters with the same mental retardation.
Very difficult to interpret due to unsteady baseline and lot of artefacts. Basically sinus beats followed by ectopics in bigeminy. P morphology looks fairly normal. QRS of sinus beats appear normal with axis of +60 and T inversion V1 to V3 with no significant QT prolongation. Alternate ectopic beats are rather narrow QRS and morphologically similar to sinus conducted beats, at least in chest leads - likely to be supraventricilar.
No gross abnormalities and I cannot relate the ECG to the neurological problem.
Thanks Tatiyana.
Hi Dear Dr A. George Koshy
I fully agree with you, but I am somewhat confused by strongly deformed terminal part of QRST complex due to atrial bigeminic ectopy. ST depression is observed in leads avR, V1-V2 and opposite ST considerable elevation in other leads of the every ectopic complexes. Is it really can be such artifacts?
Best
The signals represented in the graphs cannot be described; other shots are necessary in order to extract information.
Dear colleague Tatiyana,
it should be a supraventricular bigeminy. As seen in V3 ST- segment follows a brugadatype pattern which should be due to strong artefact, when related to aVL. In the "normal" complexes preterminal T-Inversion can be seen precordial. If a newly conducted ECG could produce a somewhat steady baseline it would be of great help.
Very similar ECG changes can be seen in patients suffering from Guillain Barre Syndrome, although changes (ST-Segment elevation) are unlikely to occur in every other beat. They would occur persistently. Plus the siblings seem to be affected as well mentally. Unlikely to occur in all three of them.
Muscledystrophia and Myasthenia are likely to produce ECG changes, would not match family history though, since patients are not likely to make 39 years, women are conductors and mental retardation is unlikely to occur.
ECG changes and family history could be related to what is called Kearns-Sayre-Syndrome. It affects the mitochondrial DNA leading to changes in myocardium its electric conductibility and mental retardation.
In some cases it has been shown to be inherited through mitochondrial, autosomal dominant, or autosomal recessive inheritance. I do have to admit three siblings to be affected would be very very unlikely.
Nevertheless ophthalmology should be advised.
Very interesting case. Thank you for sharing!
Regards
