Ecg in single ventricle

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12 Lead ECG of single ventricle

Published in: Health & Medicine, Spiritual

Ecg in single ventricle

  1. 1. ECG in single ventricle SIMPLICITY IS THE FINEST ART
  2. 2. SV of LV morphology with NRGA
  3. 3. Van Praagh et al.1964 1. Type A, DILV ; absence of right ventricular sinus. 2. Type B, DIRV; absence of left ventricular sinus. 3. Type C, Double-inlet ventricle of mixed morphology (absence of the ventricular septum); and 4. Type D, Double-inlet ventricle of indeterminate or undifferentiated morphology.
  4. 4. Single ventricle  Apply to a double-inlet/single inlet or common-inlet ventricle opening into one ventricular chamber
  5. 5. 1858, Thomas Peacock “The auricular sinuses are separated by a more or less complete septum, and there are generally two auriculo- ventricular apertures, while the ventricle is either wholly undivided or presents only a very rudimentary septum. The arteries which are given off are usually two in number—an aorta and a pulmonary artery”
  6. 6. ANATOMY  A=NON INVERTED AND NO PS  B=INVERTED +NO PS  C=NON INVERVETED +PS  D=INVERTED+PS
  7. 7. VENTRICULAR TOPOLOGY
  8. 8. Refresh yours as the conductions bundles just rounds around the pulmonary artery Sometimes anterior, sometimes posterior, then right side and then left side
  9. 9. Normal development  Ventricular components of the conduction axis are carried on the crest of the muscular ventricular septum, and the atrioventricular node, or in some instances nodes, is formed at the point, or points, of union of the septum with the atrioventricular junctions
  10. 10. Abnormalities continued….  Ring of specialized tissue with AV ring-forms special node anterolateral.  AV connection affects location of AV node  Location of rudimentary ventricle-decides location of contact B/W septum and conduction tissue.  Atrial Situs –sidedness of SA node and AV node.
  11. 11. Morphologic left ventricle Non inverted outlet Inverted outlet  A long non branching penetrating bundle runs down the right parietal wall of the single ventricle toward the outlet foramen before bifurcating into right and left bundle branches  Inlet portion of the ventricular mass absent  The QRS axis is directed inferior and to the right, away from the inverted outlet chamber and toward the main ventricular mass  The posterior AV node is hypoplastic and does not form a His bundle or establish a ventricular connection  A well-developed anterior accessory AV node gives rise to the His bundle and establishes atrioventricular connections  Penetrating bundle encircles the outflow tract of the single ventricle before branching at the outlet foramen  The left bundle branch is concordant with left ventricular morphology of the single left ventricle and Right bundle branch is concordant with the outlet chamber
  12. 12. SV-LV-INVERTED OUTLET-ANGIOGRAM
  13. 13. Morphologic Right Ventricle  An inlet septum is also lacking in univentricular hearts with a morphologic right ventricle  Outflow tract is rudimentary posterior trabecular pouch  However, the ventricular segment between the morphologic right ventricle and the trabecular pouch extends to the crux where a regular posterior AV node and His bundle are formed  Distribution of the bundle branches apparently depends on the right/left orientation of the trabecular pouch
  14. 14. morphologically indeterminate  No outlet chamber, no trabecular pouch  No the inlet septum nor trabecular septal tissue reaches the crux  AV node is anterior or anterolateral  Penetrating bundles descend as single fascicles among free-running trabeculae.
  15. 15. ECG  Features depends upon  Anatomic variations  Ventricular morphology  Physiologic derangements  When pulmonary blood flow is increased ,P waves show left atrial or biatrial abnormalities  When pulmonary blood flow is reduced P waves show right atrial abnormalities  The PR interval tends to be normal with normal atrioventricular conduction despite an elongated nonbranching penetrating bundle
  16. 16. Non inverted outlet +morphologic LV  QRS axis tends to be directed leftward and superior—left axis deviation axis deviation  Initial depolarization is anterior and leftward, so small Q waves occasionally appear in left precordial leads  Left ventricular hypertrophy  Pulmonary blood flow is increased and the single ventricle is volume overloaded  Precordial QRS complexes then exhibit voltages of remarkably great amplitude and patterns that are stereotyped  precordial leads may show a dominant R wave in leadV1 and large equidisphasic RS complexes in midprecordial leads
  17. 17. LV morphology and inverted outlet  the QRS axis is inferior and to the right, directed away from the inverted outlet chamber toward the main ventricular mass
  18. 18. Conduction problem  PR interval prolongation  Complete heart block is occasional and progressive  The P wave axis shifts to the left, so tall peaked right atrial P waves appear in mid and left precordial leads . This pattern also occurs with noninversion of the outlet chamber ventricular depolarization is clockwise, so Q waves appear in leads 2, 3, and aVF  Because initial forces of ventricular depolarization are posterior and leftward, Q waves may be present in right precordial leads but not in left precordial leads
  19. 19.  Even though the univentricular heart is morphologically a left ventricle, In univentricular hearts with a morphologic right ventricle and a trabecular pouch,.
  20. 20. Morphologic right ventricle  Atrioventricular conduction is normal because a regular posterior AV node and His bundle are formed at the crux  Right axis deviation and tall stereotyped precordial R waves  The QRS axis is usually rightward but occasionally is leftward and superior
  21. 21.  AV conduction abnormal  PR prolongred—CHB  P wave ◦ left axis ◦ Tall peaked RT atrial P waves in mid to left precordial leads  QRS axis inferior and right  Clockwise loop-Q in 2,3,aVF  Q in RT precordial leads  Dominant R in V1 and RS in mid precordial leads DILV-inverted outlet chamber ECG
  22. 22.  DILV-noninverted outlet chamber ◦ PR normal ◦ P wave-  LAE in increased PBF  RAE in decreased PBF ◦ QRS axis away from inverted outlet chamber ◦ LAD- Counterclockwise loop ◦ Small Q in left leads ◦ Stereotyped complexes ECG
  23. 23.  Dominant RV  Normal posterior AV node and HIS bundle  RAD  Tall stereotyped R in precordial leads.
  24. 24. Summary DOMINANT VENTRICLE LEFT (A) RIGHT(B) COMMON AND INDETERMINATE(C&D) ABNORMAL ANTERIOR ACCESSORY NODE INVERTED NON INVERTED ANTERIOR TO PA LATERAL TO PA No septum Normal TOPOLOGY RT(NON INV) LT (INV) SLING OF CONDUCTION TISSUE BETWEEN ANT AND REG NODE
  25. 25. Very difficult ! I can not hear that

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