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[Problems in the interpretation of changes in the ST segment after emergency cardioversion]
J A García Robles1, R Pérez Pandelo, A Almazán Ceballos
1Servicio de Cardiología, Hospital General Gregorio Marañón, Madrid.
Revista Clinica Espanola
|November 1, 1991
Summary
Continuous current cardioversion (CV) can cause ST segment changes and elevated cardiac enzymes, mimicking acute myocardial infarction (AMI). Careful ECG and enzyme monitoring can help rule out AMI after CV.
Area of Science:
- Cardiology
- Electrophysiology
- Diagnostic Medicine
Context:
- Cardioversion using continuous current (CV) can induce electrocardiogram (ECG) abnormalities.
- These changes, including ST segment and T wave alterations, may be accompanied by elevated creatine phosphokinase (CPK) levels.
- Such findings can be misdiagnosed as acute myocardial infarction (AMI).
Purpose:
- To describe cases of transient ST segment alterations following CV.
- To highlight the importance of differentiating CV-induced changes from actual acute myocardial infarction (AMI).
Summary:
- The study presents five cases experiencing transient ST segment changes post-CV.
- These alterations occurred in patients with regular tachycardias and atrial fibrillation with fast ventricular response.
- Cardiac enzyme (CPK, CPK-MB) and ECG monitoring were performed, showing abnormal CPK in all cases, but AMI was ruled out.
Impact:
- CV-induced ECG and enzyme changes necessitate careful evaluation to avoid misdiagnosis of AMI.
- ECG and enzymatic monitoring are crucial for excluding AMI after CV.
- Technetium-99m pyrophosphate imaging may be considered if diagnostic uncertainty persists.