Critical ECGs from Non-cardiologic Patients

  • Irene Giannini
  • Cristina Pierandrei
  • Alessia Quaranta


The chapter deals with interesting ECGs coming from other than cardiologic patients.

Cardiologists face several clinical situations that cause ECG abnormalities, involving either conduction or repolarization intervals and rhythm.

Pregnancy is a paraphysiological condition that leads to haemodynamic changes and heart remodelling, thus predisposing to supraventricular arrhythmias whose drug response is not predictable.

Acute abdomen showing atypical chest pain often mimics cardiac ischaemia due to elevated cardiac enzymes matched with changes in the repolarization phase. In these cases, abdominal ultrasound could be useful to rule out the diagnosis.

Neurological disorders’ acute onset in older patients should raise the suspicion of pulmonary embolism in case of loss of consciousness, confusion and dyspnoea.

Also a stressful acute event such as intracranial bleeding could trigger stress cardiomyopathy known as Takotsubo syndrome.

These are just some settings where cardiologists have to manage between differential diagnoses and only deep pathophysiological knowledge will lead them to the right ECG interpretation.


  1. 1.
    Zipes DP, Camm AJ, Borggrefe M. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death—executive summary: a report of the American College of cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur Heart J. 2006;27:2099–140.CrossRefGoogle Scholar
  2. 2.
    Ghosh N, Luk A, Derzko C, et al. The acute treatment of maternal supraventricular tachycardias during pregnancy: a review of the literature. J Obstet Gynaecol Can. 2011;33(1):17–23.CrossRefGoogle Scholar
  3. 3.
    Fujitani S, Baldisseri MR. Hemodynamic assessment in a pregnant and peripartum patient. Crit Care Med. 2005;33:S354–61.CrossRefGoogle Scholar
  4. 4.
    Thornburg KL, Jacobson SL, Giraud GD, et al. Hemodynamic changes in pregnancy. Semin Perinatol. 2000;24(1):11–4.CrossRefGoogle Scholar
  5. 5.
    Kuo PH, Wang KL, Chen JR, et al. Maternal death following medical treatment of paroxysmal supraventricular tachycardia in late gestation. Taiwan J Obstet Gynecol. 2005;44:291–3.CrossRefGoogle Scholar
  6. 6.
    Kron J, Conti JB. Arrhythmias in the pregnant patient: current concepts in evaluation and management. J Interv Card Electrophysiol. 2007;19:95–107.CrossRefGoogle Scholar
  7. 7.
    Blomstrom-Lundqvist C, Scheinman MM, Alio EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias—executive summary. J Am Coll Cardiol. 2003;42:1493–531.CrossRefGoogle Scholar
  8. 8.
    Pollack ML. ECG manifestations of selected extracardiac diseases. Emerg Med Clin North Am. 2006;24:133–43.CrossRefGoogle Scholar
  9. 9.
    Doorey AJ, Miller RE. Get a surgeon, hold the cardiologist: electrocardiogram falsely suggestive of myocardial Infarction in acute cholecystitis. Del Med J. 2001;73:103–4.PubMedGoogle Scholar
  10. 10.
    Ryan ET, Pak PH, DeSanctis RW. Myocardial infarction mimicked by acute cholecystitis. Ann Intern Med. 1992;116:218–20.CrossRefGoogle Scholar
  11. 11.
    Vacca G, Battaglia A, Grossini E, et al. Tachycardia and presser responses to distention of the gallbladder in the anesthetized pig. Med Sci Res. 1994;22:697–9.Google Scholar
  12. 12.
    Rubio-Tapia A, Garcia-Leiva J, Asensio-Lafuente E, et al. Electrocardiographic abnormalities in patients with acute pancreatitis. J Clin Gastroenterol. 2005;39(9):815–8.CrossRefGoogle Scholar
  13. 13.
    Lowenstein L, Hussein A. Transient ischemic ECG changes in a patient with acute cholecystitis without a history of ischemic heart disease. Harefuah. 2000;138(6):449–50.PubMedGoogle Scholar
  14. 14.
    McGinn S, White PD. Acute cor pulmonale resulting from pulmonary embolism. JAMA. 1935;104(17):1473–80.CrossRefGoogle Scholar
  15. 15.
    Kosuge M, Kimura K, Ishikawa T, et al. Electrocardiographic differentiation between acute pulmonary embolism and acute coronary syndromes. Am J Cardiol. 2007;99(6):817–21.CrossRefGoogle Scholar
  16. 16.
    Petrov DB. Appearance of right bundle branch block in electrocardiograms of patients with pulmonary embolism as a marker for obstruction of the main pulmonary trunk. J Electrocardiol. 2001;34(3):185–8.CrossRefGoogle Scholar
  17. 17.
    Ferrari M, Imbert A, Chevalier T, et al. The ECG in pulmonary embolism. Predictive value of negative T waves in precordial leads-80 case reports. Chest. 1997;111(3):537–43.CrossRefGoogle Scholar
  18. 18.
    Stein PD, Dalen JE, McIntyre KM, et al. The electrocardiogram in acute pulmonary embolism. Prog Cardiovasc Dis. 1975;17(4):247–57.CrossRefGoogle Scholar
  19. 19.
    Yoshinaga T, Ikeda S, Shikuwa M, et al. Relationship between ECG findings and pulmonary artery pressure in patients with acute massive pulmonary thromboembolism. Circulation. 2003;67(3):229–32.CrossRefGoogle Scholar
  20. 20.
    Sreeram N, Ceriex EC, Smeets JL, et al. Value of the 12-lead electrocardiogram at hospital admission in the diagnosis of pulmonary embolism. Am J Cardiol. 1994;73(4):298–303.CrossRefGoogle Scholar
  21. 21.
    Sommargren CE. Electrocardiographic abnormalities in patients with subarachnoid hemorrhage. Am J Crit Care. 2007;11:48–56.Google Scholar
  22. 22.
    Byer E, Ashman R, Toth LA. Electrocardiograms with large, upright T waves and long QT intervals. Am Heart J. 1947;33(6):796–806.CrossRefGoogle Scholar
  23. 23.
    Catanzaro JN, Meraj PM, Zheng S, et al. Electrocardiographic T-wave changes underlying acute cardiac and cerebral events. Am J Emerg Med. 2008;26(6):716–20.CrossRefGoogle Scholar
  24. 24.
    Dogan A, Tunc E, Ozturk M, et al. Electrocardiographic changes in patients with ischaemic stroke and their prognostic importance. Int J Clin Pract. 2004;58(5):436–40.CrossRefGoogle Scholar
  25. 25.
    Komamura K, Fukui M, Iwasaku T, et al. Takotsubo cardiomyopathy: pathophysiology, diagnosis and treatment. World J Cardiol. 2014;6(7):602–9.CrossRefGoogle Scholar
  26. 26.
    Looi JL, Wong CW, Lee M, et al. Usefulness of ECG to differentiate Takotsubo cardiomyopathy from acute coronary syndrome. Int J Cardiol. 2015;199:132–40.CrossRefGoogle Scholar
  27. 27.
    Guerra F, Giannini I, Capucci A. The ECG in the differential diagnosis between takotsubo cardiomyopathy and acute coronary syndrome. Expert Rev Cardiovasc Ther. 2017;15(2):137–44.CrossRefGoogle Scholar
  28. 28.
    Guerra F, Rrapaj E, Pongetti G, et al. Differences and similarities of repolarization patterns during hospitalization for Takotsubo cardiomyopathy and acute coronary syndrome. Am J Cardiol. 2013;112(11):1720–4.CrossRefGoogle Scholar
  29. 29.
    Lee VH, Connolly HM, Fulgham JR, et al. Tako-tsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: an underappreciated ventricular dysfunction. J Neurosurg. 2006;105:264–70.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Irene Giannini
    • 1
  • Cristina Pierandrei
    • 1
  • Alessia Quaranta
    • 1
  1. 1.Clinica di Cardiologia e AritmologiaUniversità Politecnica delle MarcheAnconaItaly

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