ECG: Atrial Bigeminy

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ECG: Atrial Bigeminy

  1. 1. INTERESTING ECG OF THE WEEK FROM PROF.DR.NOORUL AMEEN’S UNIT
  2. 2.  58 year old male Mr.Kannan, who came to hypertension OP for routine checkup No H/o chest pain, palpitation or syncope Known smoker for past 20 years – 10 cigarettes per day Not an acoholic Not a K/C/o DM, CAD, COPD, BA, PTB, Epilepsy, Thyr oid disease
  3. 3. Examination Conscious Oriented Afebrile CVS - S1S2 +, No murmur RS – NVBS + No added sounds P/A – soft CNS – NFND PR – 84 / min, regularly irregular BP – 140 / 90 mmHg
  4. 4.  ECG shows alternate complexes with 2 population of P waves P-P interval : 0.6 sec and 1 sec Alternating PR interval : 0.04 sec and 0.05 sec Normal axis QRS duration - 0.8 sec QT interval 0.4 sec No ST – T changes Incomplete compensatory pause Fixed coupling interval
  5. 5. ATRIAL BIGEMINY DISCUSSION  Due to an ectopic from a single irritable focus in either of the atria CAUSES  Stress  Exercise • Drugs  Sympathetic over activity •Caffeine  Smoking •Theophylline  Alcoholism •Cocaine •Digoxin  Hyperthyroidism •Amphetamine  COPD •Isoproterenol  RHD
  6. 6. INCOMPLETE COMPENSATORYPAUSE It is a feature of atrial ectopic Sum of the pre and post ectopic interval is less than the sum of two consequetive intervals MECHANISM  Transit time required to enter sinus node and reset it followed by the time required for ensuring sinus discharge to traverse sino-atrial juntion and depolarise atria  But In VPD  No influence on SA node  No re-setting of SA node  Complete compensatory pause
  7. 7. FIXED COUPLING INTERVAL Interval between the extra-systole and the preceding beat tends to be the same for all unifocal extra-systoles
  8. 8. LOCALISATION RIGHT ATRIAL  Negative / biphasic in V1  Positive followed by negative LEFT ATRIAL  Positive or biphasic in V1  Negative followed by positive
  9. 9. A P-wave algorithm constructed on the basis of findings from 130 atrial tachycardias correctly localized the focus in 93%
  10. 10. In Our ECG, Atrial ectopic localises to High Crista (LeftAtrium)
  11. 11. MECHANISM OF ATRIAL BIGEMINALRHYTHM  Sinus rhythm with alternate atrial extrasystole  Sinus rhythm with alternate sinus extra systole  Sins rhytym with alternate AV nodal extra systole conducted retrograde to atria  Sinus rhythm with alternate ventricular extrasystole conducted to the atria  Sinus rhythm with 3 : 2 SA block  AV nodal rhythm with 3: 2 retrograde AV block
  12. 12. DIFFERENTIAL DIAGNOSIS Sinus arrhythmia 3 : 2 atrial block 2 : 1 atrial flutter
  13. 13. SIGNIFICANCE Usually benign Can be a forerunner of atrial tachycardias and atrial fibrillations
  14. 14. THANK YOU

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