Schiavone William A, Majdalany David S
Cleveland Clinic Heart and Vascular Institute, Cleveland, OH 44120, USA.
Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA.
J Pers Med. 2024 Mar 29;14(4):367. doi: 10.3390/jpm14040367.
The electrocardiogram is the first test that is undertaken when evaluating a patient's heart. Diagnosing congenital heart disease in an adult (ACHD) can be facilitated by knowing the classical electrocardiographic (EKG) findings. These EKG findings often result from the congenital defect that prevents a part of the cardiac conduction system from occupying its normal anatomic position. When these classical EKG findings are not present, the clinician should consider alternate diagnoses. As the patient with congenital heart disease ages, with native anatomy or after surgical or device repair, the EKG can be used to assess the patient's status and to decide if and when treatment requires adjustment. This is because the electrocardiogram (EKG) can diagnose the hypertrophy or enlargement in a cardiac chamber that results from the congenital defect or anomaly and can diagnose an arrhythmia that might compromise an otherwise stable anatomy. While ACHD often involves intracardiac shunting, in many cases the abnormality only involves cardiac electrical conduction block or ventricular repolarization. These life-threatening diseases can be diagnosed with an EKG. This review will demonstrate and explain how the EKG can be used to diagnose and follow adults with congenital heart disease. When coupled with history and physical examination, the value of the EKG in ACHD will be apparent. A diagnosis can then be made or a differential diagnosis proposed, before an imaging study is ordered.
心电图是评估患者心脏时首先进行的检查。了解经典的心电图（EKG）表现有助于诊断成人先天性心脏病（ACHD）。这些EKG表现通常源于先天性缺陷，该缺陷使心脏传导系统的一部分无法占据其正常的解剖位置。当不存在这些经典的EKG表现时，临床医生应考虑其他诊断。随着先天性心脏病患者年龄增长，无论是保持原生解剖结构还是经过手术或器械修复后，心电图都可用于评估患者的状况，并决定是否以及何时需要调整治疗。这是因为心电图（EKG）可以诊断出由先天性缺陷或异常导致的心脏腔室肥大或扩大，还可以诊断出可能危及原本稳定解剖结构的心律失常。虽然ACHD常涉及心内分流，但在许多情况下，异常仅涉及心脏电传导阻滞或心室复极化。这些危及生命的疾病可以通过EKG诊断。本综述将展示并解释EKG如何用于诊断和随访成人先天性心脏病患者。当与病史和体格检查相结合时，EKG在ACHD中的价值将显而易见。然后在进行影像学检查之前，即可做出诊断或提出鉴别诊断。
