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Learn about diagnosing and managing cardiac arrhythmias, including SVT, AFib, MAT, AVNRT, AVRT, and more. Explore ECG findings and treatment approaches for different arrhythmia types. Helpful information for healthcare professionals.
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Morning report ECG Elias B Hanna, MD LSU New Orleans, Cardiology
QRS width Narrow complex tachycardia QRS<120 ms =SVT
QRS width Narrow complex tachycardia QRS<120 ms =SVT Irregularly irregular 1.Afib 2.MAT (P waves of ≥3 different morphologies)
QRS width Narrow complex tachycardia QRS<120 ms =SVT Irregularly irregular Regular or regularly irregular 1.Afib 2.MAT (P waves of ≥3 different morphologies)
QRS width Narrow complex tachycardia QRS<120 ms =SVT Irregularly irregular Regular or regularly irregular Beside sinus tachy 1.AVNRT 2.AVRT 3.Atrial tachycardia 4.Atrial flutter 1.Afib 2.MAT (P waves of ≥3 different morphologies)
Dual AV node pathways and AVNRT Some individuals have dual AV node pathways (up to 20% of individuals). Normally, conduction spreads through the fast pathway and gets blocked in the slow pathway. However, after a PAC, the electrical activity cannot spread through the fast pathway (which is still in a refractory period), but can get conducted through the slow pathway which then conducts both down to the ventricle and up to the atrium, through the recovered “fast pathway”, thus creating a tachycardia with retrograde P waves
AV node AV node Accessory pathway AVRT (after PAC or PVC) AV node Accessory pathway Similar process happens in case of accessory pathway that is conducting retrogradely. We have 2 pathways that create a reentrant circuit after a PAC or PVC.
Arrows point to the retrograde P that is superimposed on ST segment and looks as a notch on ST segment Retrograde P wave Pseudo-r’ in V1 + Pseudo S in inf leads
ECG of the previous pt in sinus rhythm after adenosine. Note the difference (no “pseudo-r’ “ or “pseudo S”)
QRS width Narrow complex tachycardia QRS<120 ms =SVT Irregularly irregular Regular or regularly irregular Look for P waves 1.Afib 2.MAT (P waves of ≥3 different morphologies) Assess RP interval Sawtooth P, esp. rate~150 -Atrial flutter Short RP (<1/2 RR) -AVNRT -AVRT -Atrial tachycardia Long RP (>1/2 RR) -Atrial tachycardia -Atypical AVNRT