Image in Cardiology
Do they just look like spikes or are they actual spikes?
Parece ou são mesmo spikes?
José Luís Martins
, Jesus Viana, José Santos
Corresponding author
Department of Cardiology, Baixo Vouga Hospital Centre, Aveiro, Portugal
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PCI: percutaneous coronary intervention.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jeremías Bayón, Melisa Santá-Álvarez, Raymundo Ocaranza-Sánchez, Carlos González-Juanatey" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Jeremías" "apellidos" => "Bayón" ] 1 => array:2 [ "nombre" => "Melisa" "apellidos" => "Santá-Álvarez" ] 2 => array:2 [ "nombre" => "Raymundo" "apellidos" => "Ocaranza-Sánchez" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "González-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?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "1011" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Luís Martins, Jesus Viana, José Santos" "autores" => array:3 [ 0 => array:4 [ "nombre" => "José Luís" "apellidos" => "Martins" "email" => array:1 [ 0 => "zeluismartins@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Jesus" "apellidos" => "Viana" ] 2 => array:2 [ "nombre" => "José" "apellidos" => "Santos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Cardiology, Baixo Vouga Hospital Centre, Aveiro, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Parece ou são mesmo <span class="elsevierStyleItalic">spikes</span>?" ] ] "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: Electrocardiogram (ECG) showed widened QRS complexes with sine wave appearance; B: ECG showed sinus rhythm with pacemaker-mediated ventricular conduction.</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 (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 (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A). 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 (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B). 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.</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.</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: Electrocardiogram (ECG) showed widened QRS complexes with sine wave appearance; B: ECG showed sinus rhythm with pacemaker-mediated ventricular conduction.</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" ]
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