array:24 [
  "pii" => "S2174204918304276"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2018.04.011"
  "estado" => "S300"
  "fechaPublicacion" => "2018-12-01"
  "aid" => "1275"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "sco"
  "cita" => "Rev Port Cardiol. 2018;37:1011"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 446
    "formatos" => array:3 [
      "EPUB" => 83
      "HTML" => 209
      "PDF" => 154
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S2174204918304288"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2018.12.010"
    "estado" => "S300"
    "fechaPublicacion" => "2018-12-01"
    "aid" => "1324"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "prv"
    "cita" => "Rev Port Cardiol. 2018;37:1013"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 422
      "formatos" => array:3 [
        "EPUB" => 73
        "HTML" => 215
        "PDF" => 134
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">RECOMMENDED ARTICLE OF THE MONTH</span>"
      "titulo" => "Brief Comment Video to the Recommended Article of the Month"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "1013"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Breve Coment&#225;rio V&#237;deo ao Artigo Recomendado do M&#234;s"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918304288?idApp=UINPBA00004E"
    "url" => "/21742049/0000003700000012/v1_201812280741/S2174204918304288/v1_201812280741/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2174204918304264"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2017.08.011"
    "estado" => "S300"
    "fechaPublicacion" => "2018-12-01"
    "aid" => "1328"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Rev Port Cardiol. 2018;37:1009&#46;e1-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 482
      "formatos" => array:3 [
        "EPUB" => 78
        "HTML" => 242
        "PDF" => 162
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Feasibility of use of magnesium reabsorbable scaffolds in complex coronary artery disease&#58; True bifurcation&#44; multiple overlapping scaffolds and chronic total occlusion treatment"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "1009&#46;e1"
          "paginaFinal" => "1009&#46;e3"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Exequibilidade de <span class="elsevierStyleItalic">stents</span> bioabsorb&#237;veis de magn&#233;sio na doen&#231;a coron&#225;ria complexa&#58; bifurca&#231;&#227;o verdadeira&#44; <span class="elsevierStyleItalic">stents</span> sobrepostos m&#250;ltiplos e tratamento da oclus&#227;o cr&#243;nica total"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1856
              "Ancho" => 2500
              "Tamanyo" => 588892
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography images of the left anterior descending &#40;LAD&#41; and circumflex &#40;CX&#41; arteries&#44; showing adequate apposition with partial covering of the struts&#46; PCI&#58; percutaneous coronary intervention&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jerem&#237;as Bay&#243;n, Melisa Sant&#225;-&#193;lvarez, Raymundo Ocaranza-S&#225;nchez, Carlos Gonz&#225;lez-Juanatey"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Jerem&#237;as"
              "apellidos" => "Bay&#243;n"
            ]
            1 => array:2 [
              "nombre" => "Melisa"
              "apellidos" => "Sant&#225;-&#193;lvarez"
            ]
            2 => array:2 [
              "nombre" => "Raymundo"
              "apellidos" => "Ocaranza-S&#225;nchez"
            ]
            3 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Gonz&#225;lez-Juanatey"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918304264?idApp=UINPBA00004E"
    "url" => "/21742049/0000003700000012/v1_201812280741/S2174204918304264/v1_201812280741/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
    "titulo" => "Do they just look like spikes or are they actual spikes&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:1 [
        "paginaInicial" => "1011"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Jos&#233; Lu&#237;s Martins, Jesus Viana, Jos&#233; Santos"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Jos&#233; Lu&#237;s"
            "apellidos" => "Martins"
            "email" => array:1 [
              0 => "zeluismartins&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Jesus"
            "apellidos" => "Viana"
          ]
          2 => array:2 [
            "nombre" => "Jos&#233;"
            "apellidos" => "Santos"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Department of Cardiology&#44; Baixo Vouga Hospital Centre&#44; Aveiro&#44; Portugal"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Parece ou s&#227;o mesmo <span class="elsevierStyleItalic">spikes</span>&#63;"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 754
            "Ancho" => 2500
            "Tamanyo" => 309903
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#58; Electrocardiogram &#40;ECG&#41; showed widened QRS complexes with sine wave appearance&#59; B&#58; ECG showed sinus rhythm with pacemaker-mediated ventricular conduction&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0020" class="elsevierStylePara elsevierViewall">A 58-year-old woman with a history of idiopathic dilated cardiomyopathy and a cardiac resynchronization therapy device &#40;CRT-D&#41; for primary prevention came to the emergency room with &#8220;poorly characterized chest pain&#44;&#8221; present three hours prior to arrival&#44; and asthenia&#46; On physical examination&#44; she was unresponsive and pale&#46; Her blood pressure was 61&#47;28 mmHg and her heart rate 85 bpm&#46; Electrocardiogram &#40;ECG&#41; showed widened QRS complexes with sine wave appearance &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#46; Arterial blood gas analysis showed hyperkalemia with 8&#46;5 mmol&#47;L&#46; The patient received urgent treatment with fluids&#44; calcium gluconate&#44; dextrose and an insulin infusion while the ECG was monitored&#46; An additional ECG showed sinus rhythm with pacemaker-mediated ventricular conduction &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#46; Hyperkalemia triggers progressive electrocardiographic changes&#44; beginning with peaked T waves and PR prolongation&#46; More severe potassium elevations can result in QRS widening and loss of P waves&#44; with the eventual formation of a sine-wave pattern&#44; as seen here&#46; The rhythm can also degenerate into ventricular fibrillation&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:1 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-06-26"
    "fechaAceptado" => "2018-04-08"
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 754
            "Ancho" => 2500
            "Tamanyo" => 309903
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#58; Electrocardiogram &#40;ECG&#41; showed widened QRS complexes with sine wave appearance&#59; B&#58; ECG showed sinus rhythm with pacemaker-mediated ventricular conduction&#46;</p>"
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003700000012/v1_201812280741/S2174204918304276/v1_201812280741/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9915"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Images in cardiology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003700000012/v1_201812280741/S2174204918304276/v1_201812280741/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918304276?idApp=UINPBA00004E"
]
Share
Journal Information
Vol. 37. Issue 12.
Pages 1011 (December 2018)
Share
Share
Download PDF
More article options
Vol. 37. Issue 12.
Pages 1011 (December 2018)
Image in Cardiology
Open Access
Do they just look like spikes or are they actual spikes?
Parece ou são mesmo spikes?
Visits
2777
José Luís Martins
Corresponding author
zeluismartins@gmail.com

Corresponding author.
, Jesus Viana, José Santos
Department of Cardiology, Baixo Vouga Hospital Centre, Aveiro, Portugal
This item has received

Under a Creative Commons license
Article information
Full Text
Download PDF
Statistics
Figures (1)
Full Text

A 58-year-old woman with a history of idiopathic dilated cardiomyopathy and a cardiac resynchronization therapy device (CRT-D) for primary prevention came to the emergency room with “poorly characterized chest pain,” present three hours prior to arrival, and asthenia. On physical examination, she was unresponsive and pale. Her blood pressure was 61/28 mmHg and her heart rate 85 bpm. Electrocardiogram (ECG) showed widened QRS complexes with sine wave appearance (Figure 1A). Arterial blood gas analysis showed hyperkalemia with 8.5 mmol/L. The patient received urgent treatment with fluids, calcium gluconate, dextrose and an insulin infusion while the ECG was monitored. An additional ECG showed sinus rhythm with pacemaker-mediated ventricular conduction (Figure 1B). Hyperkalemia triggers progressive electrocardiographic changes, beginning with peaked T waves and PR prolongation. More severe potassium elevations can result in QRS widening and loss of P waves, with the eventual formation of a sine-wave pattern, as seen here. The rhythm can also degenerate into ventricular fibrillation.

Figure 1.

A: Electrocardiogram (ECG) showed widened QRS complexes with sine wave appearance; B: ECG showed sinus rhythm with pacemaker-mediated ventricular conduction.

(0.3MB).
Conflicts of interest

The authors have no conflicts of interest to declare.

Copyright © 2018. Sociedade Portuguesa de Cardiologia
Download PDF
Idiomas
Revista Portuguesa de Cardiologia (English edition)
Article options
Tools
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.