Transcript Arrhythmias - Modest Mango

Recognizing
Cardiac arrhythmias
Normal anatomy
Normal ECG
Normal ECG
Classification - tachys
Atrial
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AF
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Atrial
Flutter
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PAC
Junctional
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Paroxysmal
SVT (PSVT)
Junctional
Tachycardia
Ventricular
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VT
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VF
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PVC
Broad Complex
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Classification - bradys
Atrial
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Sinus
brady
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Sick sinus
syndrome
Junctional
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Junctional
Escape
Ventricular
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Ventricular
Escape
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Atrial Fibrillation
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Atrial dilation & decreased
CO
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RAAS activation
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Protease stimulation
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Progressive atrial fibrosis
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Fragmented, asynchronous
depolarizations
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Atrial Fibrillation
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AF - Classification
AF Type
Definition
New-onset
No previous episodes
Paroxysmal
Recurrent episodes of < 7 days duration
Persistent
Recurrent episodes of > 7 days duration
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Valvular
PermanentAF?
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Lone AF?
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Secondary AF?
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Symptomatic AF?
Long-term episode
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AF - Causes
Primary Cardiac Causes
Other Cause
Coronary artery disease
Hypertension
Valvular disease
Lung disease
Hypertrophic cardiomyopathy
Hyperthyroidism
Congenital heart disease
Medications, alcohol
Pericardial disease
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symptoms
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Palpitations
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Breathlessnes
s
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•
•
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Lightheaded
Fatigue
Chest pain
Exercise
intolerance
DDX
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Tachyarrhythmias
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Flutter
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Panic attack/anxiety
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Drugs
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Caffeine/alcohol
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Symp. Agents
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Stimulants
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Diagnosis
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Heart failure
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Echo evidence of
stroke risk
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Alcohol
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Regurg/stenosis
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Thyroid
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Atrial flutter
Ectopic loop (reentrant pathway) of atrial
electrical activity, usually precipitated by a PAC
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Differences to AF
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P waves clearly visible in characteristic ‘sawtooth’
pattern
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Comment on degree of block 2:1, 3:1, 4:1 etc
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More sensitive to electrical CV
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Less sensitive to chemical CV.
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RFA useful because of the reentrant nature.
PAC
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Premature Atrial Contractions
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Common, not necessarily pathological
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P wave is abnormal due to ectopic focus
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P wave may be isolated or may have resulting QRS.
Junctional tachys
PSVT
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Paroxysmal Supra-Ventricular Tachycardia
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AVNRT and AVRT (nodal or accessory pathway)
AVNRT
FP
SP
FP
SP
FP
SP
AVRT
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Atrioventricular Reentrant
Tachycardia
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(Wolf Parkinson White
(WPW) Syndrome)
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Narrow complex
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P wave may be inverted
and straight after T wave.
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Monomorphic
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VT
Usually due to MI scarring causing an aberrant focal
automaticity or a reentrant pathway like flutter
Polymorphic
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Usually abnormality of repolarization - prolonged
QT eg.
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Needs electrical cardioversion if pulseless, or
progresses to VF
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If < 30 seconds = non-sustained VT
VF
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Causes: Trauma (physical or electrical), CAD, MI, cardiomyopathies, sudden cardiac
death, congenital heart disease etc...
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Most have no hx of heart disease
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Though often have many risk factors - smoking, hyperlipidaemia, DM.
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Episodes outwith hospital have 2-25% long term survival
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many survivors are comatose/permanently brain damaged.
Seemingly random pattern
No identifiable P or QRS rhythm
Wandering baseline
Heart block
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1st degree AV block (prolonged PR)
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2nd degree AV block
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Mobitz I (lengthening PR til dropped QRS)
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Mobitz II (intermittently dropped P waves)
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3rd degree AV block (complete)
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Infranodal block
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Left BBB
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Left Anterior Fascicular Block
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Left Posterior Fascicular Block
Right BBB
mobitz ii
lBBB
AF
PSVT - AVRT
Atrial flutter
1st degree AV Block
RBBB
Polymorphic vt - ecg
TORSADES
mobitz 1
Premature Atrial Complexes
3rd degree
Monomorphic vt
PSVT - AVNRT
VF
ECG simulator
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