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Crochetage Sign: An Invaluable Independent ECG Sign in Detecting ASD
1Department of Anaesthesia and Critical Care Medicine, Down Town Hospital, Guwahati, India.
Insights
The crochetage sign on an electrocardiogram (ECG) can help diagnose atrial septal defects (ASD) in critically ill patients, especially when echocardiography is not feasible. This simple ECG finding is crucial for identifying congenital heart disease at the bedside.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Intensive Care Medicine
Background:
- Congenital heart disease diagnosis can be challenging in intensive care units, particularly with respiratory distress.
- Electrocardiography (ECG) offers valuable insights for diagnosing and managing cardiac conditions.
Observation:
- A 25-year-old female presented with acute respiratory distress post-delivery.
- Echocardiography was not feasible due to poor echo window and patient positioning limitations.
- ECG revealed right axis deviation, right bundle branch block (RBBB), and the crochetage sign in inferior leads.
Findings:
- The crochetage sign, characterized by notching in the R wave apex of inferior leads (2,3,aVF), indicated the presence of an atrial septal defect (ASD).
- The diagnosis of ASD was subsequently confirmed via echocardiography after patient stabilization.
Implications:
- The crochetage sign is a valuable, independent ECG finding for diagnosing ASD, especially in resource-limited settings or when echocardiography is unavailable.
- This highlights the importance of bedside ECG interpretation in critical care for timely diagnosis of congenital heart disease.
Abstract:
Bedside diagnosis of congenital heart disease is sometimes very difficult in patient presenting with respiratory distress in intensive care unit. However, an ECG can provide abundant information regarding its presence and its management. A 25-year-old female presented with sudden onset of respiratory difficulty and shortness of breath, following delivery one day back. Echocardiography could not be done as a poor echo window was obtained and patient could not lie down supine. However, ECG revealed right axis deviation, RBBB, and notching in the apex of the R wave in inferior leads 2,3,aVF (crochetage sign). This is directed to the presence of ASD, which was confirmed with echocardiography after stabilization of patient. We would like to illustrate the importance of simple bedside ECG finding of crochetage sign in the diagnosis of ASD when echocardiography is not possible or available in underdeveloped countries. How to cite this article: Sarma A. Crochetage Sign: An Invaluable Independent ECG Sign in Detecting ASD. Indian J Crit Care Med 2021;25(2):234-235.
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