ECG - Junctional Arrhythmia & Ventricular Arrhythmia


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Brief explanation of Junctional arrhythmia and Ventricular Arrhythmia. Slide 15, 16 and 18 are animations but cannot be viewed through the slide. Mail me if you need the animation or visit the website on the reference (number 7) and choose the animation according to your preference.

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ECG - Junctional Arrhythmia & Ventricular Arrhythmia

  2. 2. INTRODUCTION  Student should be able to understand what is junctional and ventricular arrhythmias  Students should be able to identify these two arrhythmias through electrocardiograph  Student should know the classification that comes below these two arrhythmias
  3. 3. CLASSIFICATIONS JUNCTIONAL ARRHYTHMIA AV Nodal Reentrant Tachycardia Junctional Rhythm VENTRICULAR ARRHYTHMIA Premature Ventricular Contraction Ventricular tachycardia Ventricular fibrillation
  4. 4. JUNCTIONAL ARRHYTHMIA AV Nodal Reentrant Tachycardia -A type of supraventricular tachycardia (SVT); above the bundle of His -Reentry circuit forms within or just next to the AV node -Slow pathway is located inferior and slightly posterior to the AV node, often following the anterior margin of the coronary sinus.
  5. 5. -common AVNRT; anterograde conduction is via the slow pathway and the retrograde conduction is via the fast pathway -uncommon AVNRT; anterograde conduction is via the fast pathway and the retrograde conduction is via the slow pathway
  6. 6. ECG - P wave that falls after the QRS complex
  7. 7. Junctional Rhythm -Abnormal heart rhythm resulting from impulses coming from a locus of tissue in the area of the AV node -AV node as the pacemaker -Retrograde conduction ECG - Without a P wave or with an inverted P wave. - Retrograde P waves refers to the depolarization from the AV node back towards the SA node
  8. 8. VENTRICULAR ARRHYTHMIA Cause: 1. Sudden electrical shock of the heart 2. Ischemia of the heart muscle, of its specialized conducting system 3. Both
  9. 9. Normal person: After electrical impulses reach the ventricles, they die off  Because all the ventricular muscle is in refractory phase
  10. 10. Types of Ventricular Arrhythmias  Premature Ventricular Contraction  Ventricular Tachycardia   Ventricular Flutter   Up to 200 bpm 200-350 bpm Ventricular Fibrillation  350-500 bpm
  11. 11. Premature Ventricular Contraction  Heartbeat is initiated by Purkinje fibres in the ventricles rather than by the SA node  Ventricles contract first and before the atria have optimally filled the ventricles with blood, which means that circulation is inefficient
  12. 12. ECG
  13. 13. Ventricular Tachycardia -ventricular QRS complexes are highly polymorphic analogous to the ventricular extra systoles Ventricular Flutter -ECG shows large Ventricular Fibrillation ECG -fast oscillation; main and -small potential terminal deflections fluctuations in rate -rhythm can no longer be -Retrograde conduction to the atria differentiated is almost always blocked; thus, undisturbed atrial activity is scattered with P waves without any relation to QRS complexes. -amplitude -appearance *a fatal condition
  14. 14. CIRCUS MOVEMENTS AS THE BASIS FOR VENTRICULAR FIBRILLATION  Define circus movements: ‘Re-entry’ of the impulse into muscle that has already been excited  Why?  Pathway around the circle is too long; dilated heart  Velocity of conduction becomes decreased; blockage of Purkinje system, ischemia of the muscle or high blood potassium levels  Refractory period of the muscle might become greatly shortened; drugs (epinephrine) or after repetitive electrical
  15. 15. CONCLUSION Junctional arrhythmia;  AV nodal reentrant tachycardia  Junctional Rhythm Ventricular arrhythmia;  Premature Ventricular Contraction  Ventricular Tachycardia  Ventricular Flutter  Ventricular Fibrillation
  16. 16. REFERENCES 1. AK JAIN Medical Physiology, 3rd edition 2. Davidson's Principles and Practice of Medicine, 21st Edition 3. 4. 5. American Heart Association. (2012, September 05).Ventricular fibrillation. Retrieved from Ventricular-Fibrillation_UCM_324063_Article.jsp 6. Mayo Clinic Staff. (2011, November 01). Diseases and conditions ventricular fibrillation. Retrieved from 7. American Heart Association. (n.d.). Arrhythmias (ventricular fibrillation). Retrieved from 8. 9.