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Challenges in Clinical Electrocardiography |

Uncommon Etiology of Abnormal Spikes on Electrocardiogram

Sebastian Reif, MD1; Maximilian Tiller, MD2; Ellen Hoffmann, MD1
[+] Author Affiliations
1Department of Cardiology, Städtisches Klinikum München–Bogenhausen, Munich, Germany
2Department of Gastroenterology and Hepatology and Gastrointestinal Oncology, Städtisches Klinikum München–Bogenhausen, Munich, Germany
JAMA Intern Med. 2014;174(3):458-459. doi:10.1001/jamainternmed.2013.13666.
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A 75-year-old woman was referred to our pacemaker/implantable cardioverter-defibrillator (ICD) clinic with an abnormal electrocardiogram (ECG). The ECG (Figure, A) showed abnormal spikes compared with a regular ECG (without spikes) (Figure, B) of the same patient performed 3 months earlier, prompting a referral for device interrogation. Clinical manifestations such as dizziness, lightheadedness, syncope, or signs and symptoms of congestive heart failure were absent. The patient’s vital signs were normal.

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Two Different Electrocardiograms of the Same Patient

A, Electrocardiogram showing abnormal spikes (arrowheads) in April 2009; B, electrocardiogram without spikes in January 2009.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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