ECG: Digitalis Effect / MAT / AF

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ECG: Digitalis Effect / MAT / AF

  1. 1. PROF.DR.P.VIJAYARAGHAVAN’S UNIT DR.V.MANIKANDAN
  2. 2.  A 41 YEAR OLD FEMALE CAME WITH C/O  BREATHLESSNESS  PALPITATION FOR A DURATION OF 3 DAYS PATIENT WAS APPARENTLY NORMAL 3 DAYS BACK,STARTED DEVELOPING BREATHLESSNESS INITIALLY ON EXERTION NOW AT REST.H/O OF ORTHOPNEA PRESENT.H/O CHEST PAIN PRESENT. PAST H/O:H/O OF SURGERY DONE FOR VALVULAR HEART DISEASE 14 YEARS BACK. PATIENT HAS NOT BEEN TAKING MEDICATIONS FOR PAST 1 WEEEK.
  3. 3.  CONSCIOUS,ORIENTED  DYSPNEIC,TACHYPNEIC  PEDAL EDEMA(+)  NO PALLOR,CYANOSIS,CLUBBING  VITALS:  PULSE:140/MT,IRREGULARLY IRREGULAR,VARIABLE VOLUME  B.P:110/70  JVP-ELEVATED  CVS:S1,S2 HEARD,S1 LOUD,MDM(+)  R.S:NVBS HEARD,B/L BASAL CREPTS PRESENT  P/A -SOFT
  4. 4. REPEAT ECG
  5. 5.  A 12 LEAD ECG WITH,  RATE-160/minute, irregular  Varying RR interval  Axis 90 to 120  Definite discrete p waves not seen.  RVH with ST-T changes.  Rpt. ECG shows fibrillatory waves.
  6. 6. Possibilities:  Digitalis effect  Multifocal Atrial Tachycardia  Atrial Fibrillation
  7. 7. ECHO FINDINGS:  MODERATE MS,MILD TR  LA DILATED,NO PHT  MVA-1.3 SQ.CM
  8. 8.  Low amplitude baseline oscillations and an irregularly irregular ventricular rhythm.  The f waves have a rate of 300 to 600 beats /min.  Variable in shape,amplitude and timing.  Distingushing feature from flutter is absence of uniform and regular atrial activity in other laeds of ecg  chaotic atrial depolarization  the atria contract irregularly and very rapidly producing variable R-R intervals  no regular p waves are identifiable and the baseline is undulating
  9. 9.  RHEUMATIC HEART DISEASE,  HYPERTENSION,  ISCHEMIC HEART DISEASE,  PERICARDITIS,  THYROTOXICOSIS,  ALCOHOL INTOXICATION,  MITRAL VALVE PROLAPSE, AND  DIGITALIS TOXICITY
  10. 10.  Cardiac arrythmia  Wandering atrial pacemaker  The electrical impulse is generated at a different focus within the atria of the heart each time.
  11. 11.  Decompensated chronic lung disease  Congestive heart failure  Digitalis toxicity  Hypokalemia  Methylxanthine toxicity MANAGEMENT: 1. TREATMENT OF UNDERLYING CAUSE 2. ANTIARRYTHMICS OFTEN INEFFECTIVE 3. VERAPAMIL OR AMIODARONE HAVE BEEN USEFUL 4. POTTASIUM AND MAGNESIUM REPLACEMNT EFFECTIVE. 5. ABLATION USEFUL IN SOME CASES.
  12. 12. •ECG CHARACTERISTICS: •DISCRETE P WAVES WITH AT LEAST 3 DIFFERENT MORPHOLOGIES • ABSENCE OF ONE DOMINANT ATRIAL PACEMAKER • ATRIAL RATE BETWEEN 100 AND 130. • THE PP, PR, AND RR INTERVALS ALL VARY.
  13. 13. •LEFT ATRIAL ENLARGEMENT •RIGHT QRS AXIS DEVIATION •A WIDE FRONTAL PLANE QRS-T ANGLE •ATRIAL FIBRILLATION •A PRECORDIAL MORPHOLOGY WHICH MAY MANIFEST ANY ONE OF THE FOLLOWING FEATURES A RELATIVELY NORMAL,NEUTRAL OR UNREMARKABLE PRESENTATION, RIGHT VENTRICULAR SYSTOLIC OVERLOAD RIGHT VENTRICULAR DIASTOLIC OVERLOAD

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