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Recognizing Cardiac arrhythmias

Recognizing Cardiac arrhythmias. Normal anatomy. Normal ECG. Normal ECG. Broad Complex. Classification - tachys. Atrial. Junctional. Ventricular. AF Atrial Flutter PAC. Paroxysmal SVT (PSVT) Junctional Tachycardia. VT VF PVC. Mark Henderson. Classification - bradys. Atrial.

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Recognizing Cardiac arrhythmias

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  1. Recognizing Cardiac arrhythmias

  2. Normal anatomy

  3. Normal ECG

  4. Normal ECG

  5. Broad Complex Classification - tachys Atrial Junctional Ventricular • AF • Atrial Flutter • PAC • Paroxysmal SVT (PSVT) • Junctional Tachycardia • VT • VF • PVC Mark Henderson

  6. Classification - bradys Atrial Junctional Ventricular • Sinus brady • Sick sinus syndrome • Junctional Escape • Ventricular Escape Mark Henderson

  7. Atrial Fibrillation • Atrial dilation & decreased CO • RAAS activation • Protease stimulation • Progressive atrial fibrosis • Fragmented, asynchronous depolarizations Mark Henderson

  8. Atrial Fibrillation Mark Henderson

  9. AF - Classification • Valvular AF? • Lone AF? • Secondary AF? • Symptomatic AF? Mark Henderson

  10. AF - Causes Mark Henderson

  11. symptoms DDX • Tachyarrhythmias • Flutter • Panic attack/anxiety • Drugs • Caffeine/alcohol • Symp. Agents • Stimulants • Palpitations • Breathlessness • Lightheaded • Fatigue • Chest pain • Exercise intolerance Mark Henderson

  12. Diagnosis • Heart failure • Echo evidence of stroke risk • Alcohol • Regurg/stenosis • Thyroid Mark Henderson

  13. Atrial flutter Ectopic loop (reentrant pathway) of atrial electrical activity, usually precipitated by a PAC Mark Henderson

  14. Differences to AF • P waves clearly visible in characteristic ‘sawtooth’ pattern • Comment on degree of block 2:1, 3:1, 4:1 etc • More sensitive to electrical CV • Less sensitive to chemical CV. • RFA useful because of the reentrant nature.

  15. PAC • Premature Atrial Contractions • Common, not necessarily pathological • P wave is abnormal due to ectopic focus • P wave may be isolated or may have resulting QRS.

  16. FP SP FP SP FP SP Junctional tachys PSVT • Paroxysmal Supra-Ventricular Tachycardia • AVNRT and AVRT (nodal or accessory pathway) AVNRT

  17. AVRT • Atrioventricular Reentrant Tachycardia • (Wolf Parkinson White (WPW) Syndrome) • Narrow complex • P wave may be inverted and straight after T wave.

  18. VT • Monomorphic • Usually due to MI scarring causing an aberrant focal automaticity or a reentrant pathway like flutter • Polymorphic • Usually abnormality of repolarization - prolonged QT eg. • Needs electrical cardioversion if pulseless, or progresses to VF • If < 30 seconds = non-sustained VT

  19. VF • Causes: Trauma (physical or electrical), CAD, MI, cardiomyopathies, sudden cardiac death, congenital heart disease etc... • Most have no hx of heart disease • Though often have many risk factors - smoking, hyperlipidaemia, DM. • Episodes outwith hospital have 2-25% long term survival • many survivors are comatose/permanently brain damaged. Seemingly random pattern No identifiable P or QRS rhythm Wandering baseline

  20. Heart block • 1st degree AV block (prolonged PR) • 2nd degree AV block • Mobitz I (lengthening PR til dropped QRS) • Mobitz II (intermittently dropped P waves) • 3rd degree AV block (complete) • Infranodal block • Left BBB • Left Anterior Fascicular Block • Left Posterior Fascicular Block • Right BBB

  21. mobitz ii

  22. lBBB

  23. AF

  24. PSVT - AVRT

  25. Atrial flutter

  26. 1st degree AV Block

  27. RBBB

  28. Polymorphic vt - ecgTORSADES

  29. mobitz 1

  30. Premature Atrial Complexes

  31. 3rd degree

  32. Monomorphic vt

  33. PSVT - AVNRT

  34. VF

  35. ECG simulator http://www.skillstat.com/tools/ecg-simulator

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