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Morning report ECG

Morning report ECG. Elias B Hanna, MD LSU New Orleans, Cardiology. What is the diagnosis?. 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

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Morning report ECG

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  1. Morning report ECG Elias B Hanna, MD LSU New Orleans, Cardiology

  2. What is the diagnosis?

  3. QRS width Narrow complex tachycardia QRS<120 ms =SVT

  4. QRS width Narrow complex tachycardia QRS<120 ms =SVT Irregularly irregular 1.Afib 2.MAT (P waves of ≥3 different morphologies)

  5. 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)

  6. 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)

  7. 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

  8. 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.

  9. 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

  10. ECG of the previous pt in sinus rhythm after adenosine. Note the difference (no “pseudo-r’ “ or “pseudo S”)

  11. 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

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