Atrial fibrillation (af) and flutter
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This document discusses atrial fibrillation (AF), including its causes, symptoms, diagnosis, and treatment options. AF is an irregular, rapid heart rhythm that can cause strokes and heart failure. It is common in the elderly and can be caused by heart disease, hyperthyroidism, lung cancer, and other conditions. Treatment involves rate or rhythm control with medications, cardioversion, ablation procedures, or anticoagulation to prevent strokes. The document provides details on evaluating, diagnosing, and managing AF and atrial flutter.
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Restrictive cardiomyopathy
This document provides information on restrictive cardiomyopathy (RCM), including its definition, classification, etiology, symptoms, diagnosis, and treatment. Some key points:
- RCM is characterized by diastolic dysfunction with a stiffened myocardium that impairs ventricular filling. It is usually not associated with ventricular dilation or hypertrophy.
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Atrial fibrillation & Atrial flutter
Atrial fibrillation and atrial flutter are types of arrhythmia where the heart beats irregularly. Atrial fibrillation occurs when rapid, irregular electrical signals cause the heart's upper chambers (atria) to beat very fast and irregularly. Atrial flutter is similar but the heart beats fast in a regular pattern. These conditions are diagnosed through electrocardiograms which detect abnormal heart rhythms. Holter monitors and event recorders can also detect arrhythmias over longer periods of time when symptoms occur. Complications include stroke and heart failure, so treatment focuses on rate or rhythm control and preventing clots.
Restrictive cardiomyopathy
Restrictive cardiomyopathy is characterized by stiff ventricles that do not fill properly, though systolic function is usually preserved initially. It can be caused by infiltrative diseases, fibrosis, or other processes that restrict ventricular filling. On echocardiogram, restrictive cardiomyopathy shows impaired ventricular filling and enlarged atria, while cardiac catheterization reveals elevated diastolic pressures and a distinctive "square root sign" pressure tracing. Treatment focuses on managing symptoms and underlying causes if identifiable, though prognosis is often poor without transplantation.
P wave (ECG) - Dr. Akif Baig
The P wave is the first positive deflection on the ECG.
It represents atrial depolarisation.
Normal duration: < 0.12 s (< 120ms or 3 small squares)
Heart Failure
This document provides an overview of heart failure, including its pathophysiology, types, clinical presentation, investigations, and management. Heart failure occurs when the heart cannot pump enough blood to meet the body's needs and can develop due to conditions that weaken the heart such as heart attacks or high blood pressure. Symptoms depend on whether the left side, right side, or both sides of the heart are affected. Management involves treating the underlying cause, reducing symptoms through medications, lifestyle changes, and addressing complications.
Atrial fibrillation
Atrial fibrillation is an irregular heartbeat caused by rapid and chaotic electrical activity in the atria. There are three main types - paroxysmal which comes and goes for less than 2 days, persistent for over 7 days and likely to recur, and permanent which cannot be reverted. Causes include hypertension, obesity, heart disease, alcohol, smoking, and other chronic conditions. Symptoms include fatigue, palpitations, dizziness, and chest pain. Diagnosis involves ECG, echocardiogram, Holter monitor and other tests. Treatment options include rate control with medications, rhythm control with antiarrhythmics like amiodarone, cardioversion, catheter ablation, or a pacemaker. A
Atrial fibrillation causes,pathogenesis, clinical presentation 2013
Atrial fibrillation is the most common cardiac arrhythmia. It is characterized by irregular heart rhythms without distinct P waves due to irregular activation of the atria. The prevalence increases with age and is higher in men. Risk factors include hypertension, heart disease, heart failure, thyroid disorders, obesity, and lung disease. If left untreated, atrial fibrillation can lead to stroke, heart failure, reduced quality of life, and death. The pathogenesis involves multiple activation wavelets in the atria which causes the muscle to shorten its refractory period, making further arrhythmias more likely. Atrial fibrillation is classified based on its pattern and duration.
P wave abnormalities in ECG
The document discusses P wave abnormalities seen on electrocardiograms (ECGs). It describes the normal features of P waves and various abnormalities including right and left atrial enlargement.
Case 1 ECG shows bifid P waves consistent with left atrial enlargement likely due to mitral stenosis.
Case 2 ECG shows tall peaked P waves consistent with right atrial enlargement (P pulmonale) likely due to pulmonary hypertension.
Case 3 ECG shows inverted P waves with a short PR interval consistent with a junctional rhythm possibly due to incomplete treatment of streptococcal pharyngitis.
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This document provides information on restrictive cardiomyopathy (RCM), including its definition, classification, etiology, symptoms, diagnosis, and treatment. Some key points:
- RCM is characterized by diastolic dysfunction with a stiffened myocardium that impairs ventricular filling. It is usually not associated with ventricular dilation or hypertrophy.
- Causes include infiltrative diseases of the myocardium (e.g. amyloidosis, sarcoidosis), endomyocardial fibrosis, and genetic/familial factors.
- Symptoms are related to reduced cardiac output and include dyspnea, fatigue, arrhythmias. Diagnosis involves echocardiogram, cardiac catheterization and MRI to evaluate
Atrial fibrillation & Atrial flutter
Atrial fibrillation and atrial flutter are types of arrhythmia where the heart beats irregularly. Atrial fibrillation occurs when rapid, irregular electrical signals cause the heart's upper chambers (atria) to beat very fast and irregularly. Atrial flutter is similar but the heart beats fast in a regular pattern. These conditions are diagnosed through electrocardiograms which detect abnormal heart rhythms. Holter monitors and event recorders can also detect arrhythmias over longer periods of time when symptoms occur. Complications include stroke and heart failure, so treatment focuses on rate or rhythm control and preventing clots.
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Restrictive cardiomyopathy is characterized by stiff ventricles that do not fill properly, though systolic function is usually preserved initially. It can be caused by infiltrative diseases, fibrosis, or other processes that restrict ventricular filling. On echocardiogram, restrictive cardiomyopathy shows impaired ventricular filling and enlarged atria, while cardiac catheterization reveals elevated diastolic pressures and a distinctive "square root sign" pressure tracing. Treatment focuses on managing symptoms and underlying causes if identifiable, though prognosis is often poor without transplantation.
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Normal duration: < 0.12 s (< 120ms or 3 small squares)
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Atrial fibrillation
Atrial fibrillation is an irregular heartbeat caused by rapid and chaotic electrical activity in the atria. There are three main types - paroxysmal which comes and goes for less than 2 days, persistent for over 7 days and likely to recur, and permanent which cannot be reverted. Causes include hypertension, obesity, heart disease, alcohol, smoking, and other chronic conditions. Symptoms include fatigue, palpitations, dizziness, and chest pain. Diagnosis involves ECG, echocardiogram, Holter monitor and other tests. Treatment options include rate control with medications, rhythm control with antiarrhythmics like amiodarone, cardioversion, catheter ablation, or a pacemaker. A
Atrial fibrillation causes,pathogenesis, clinical presentation 2013
Atrial fibrillation is the most common cardiac arrhythmia. It is characterized by irregular heart rhythms without distinct P waves due to irregular activation of the atria. The prevalence increases with age and is higher in men. Risk factors include hypertension, heart disease, heart failure, thyroid disorders, obesity, and lung disease. If left untreated, atrial fibrillation can lead to stroke, heart failure, reduced quality of life, and death. The pathogenesis involves multiple activation wavelets in the atria which causes the muscle to shorten its refractory period, making further arrhythmias more likely. Atrial fibrillation is classified based on its pattern and duration.
P wave abnormalities in ECG
The document discusses P wave abnormalities seen on electrocardiograms (ECGs). It describes the normal features of P waves and various abnormalities including right and left atrial enlargement.
Case 1 ECG shows bifid P waves consistent with left atrial enlargement likely due to mitral stenosis.
Case 2 ECG shows tall peaked P waves consistent with right atrial enlargement (P pulmonale) likely due to pulmonary hypertension.
Case 3 ECG shows inverted P waves with a short PR interval consistent with a junctional rhythm possibly due to incomplete treatment of streptococcal pharyngitis.
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The document discusses the diagnosis and management of various cardiac arrhythmias, outlining the assessment of patients' histories, ECG findings, and treatment options including medications, referral indications, and procedures. Case studies are provided examining scenarios involving bradycardias, conduction abnormalities, tachycardias, and their management in both stable and unstable patients.Arrhythmias
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Brady arryhthmias
Bradyarrhythmias are caused by problems with impulse formation in the sinus node or impulse conduction through the AV node. Sinus node dysfunction can cause sinus bradycardia, sinus pause/arrest, or chronotropic incompetence. Atrioventricular block is classified as first, second, or third degree and may be caused by conditions like CAD, drugs, or infiltrative diseases. Second degree AV block is further classified as Mobitz type I or II based on PR interval characteristics. Third degree AV block causes complete dissociation between atrial and ventricular rhythms.
Sinus Node Dysfunction
The sinus node is the dominant pacemaker of the heart located in the right atrium. Sinus node dysfunction can cause abnormal automaticity or conduction, resulting in bradycardic rhythms like sinus bradycardia, sinus pauses, or tachycardic rhythms like inappropriate sinus tachycardia. Evaluation involves surface ECG, exercise testing, drug challenge, and invasive electrophysiological study if needed to diagnose sinus node disorders.
Atrial fibrillation
1. Atrial fibrillation (AF) is a common arrhythmia where abnormal electrical signals in the atria cause an irregular heartbeat.
2. AF increases the risk of stroke by 5 times and is associated with increased mortality, hospitalization, and decreased quality of life.
3. Management involves rate or rhythm control as well as anticoagulation to prevent stroke, with treatment depending on factors like symptoms, age, and stroke risk level.
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WIDE QRS TACHYCARDIA
1) The document defines wide complex tachycardia as a rhythm with a QRS duration ≥120ms and heart rate >100 bpm.
2) The main causes listed are ventricular tachycardia (80% of cases) and supraventricular tachycardia with aberrancy.
3) Key features that can help differentiate the underlying rhythm include QRS duration, axis, morphology, and the presence or absence of AV dissociation on electrocardiogram.
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This document discusses arrhythmias, which are abnormalities in the heart's rhythm. Arrhythmias can be too fast (tachycardia) or too slow (bradycardia) and can occur in the heart's upper chambers (atria) or lower chambers (ventricles). While some arrhythmias are not life-threatening, others can cause cardiac arrest or sudden death. The causes of arrhythmias include physical conditions, heart disease, other systemic diseases, electrolyte imbalances, and toxins. Diagnosis involves tests such as EKGs, Holter monitors, and stress tests. Treatment includes anti-arrhythmic drugs that block sodium, potassium, calcium, or beta channels, as well
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Atrial Flutter
Atrial flutter is a common arrhythmia caused by an abnormal electrical circuit in the atria, causing the heart rate to exceed 250 bpm. Common symptoms include palpitations, shortness of breath, and chest discomfort. Treatment options include medications to slow the heart rate, electrical cardioversion, antiarrhythmic drugs, and catheter ablation to scar the flutter circuit. People with atrial flutter have an increased risk of stroke.
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This document discusses arrhythmias, including their causes, symptoms, diagnosis, and treatment. Arrhythmias can be caused by cardiac issues like heart attacks or non-cardiac issues like drugs or metabolic imbalances. Common symptoms include palpitations, chest pain, fainting, and breathlessness. Diagnosis involves blood tests, ECGs, heart monitoring, and imaging. Treatment depends on the type of arrhythmia but may include medications, cardioversion, or pacemakers. The document provides details on evaluating and managing common arrhythmias like bradycardia, atrial fibrillation, and ventricular tachycardia.
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This document provides an overview of cardiac arrhythmias for medical students. It begins by describing the normal conduction pathways in the heart and ECG patterns. It then classifies arrhythmias as rapid and regular, rapid and irregular, slow and regular, or slow and irregular based on heart rate and rhythm. Common types of arrhythmias are defined such as sinus tachycardia, atrial fibrillation, heart block, and ventricular fibrillation. Causes, characteristics, treatments, and examples of patients with various arrhythmias are outlined. The document also discusses antiarrhythmic drug classifications and indications for procedures like ablation and pacemakers.
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Arrhythmia Recognition & Management
5th-year medical student seminar presentation under the supervision of Dr. Faisal Khan, a cardiologist.
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ECG- Atrial Fibrillation, CXR-P/A view-Cardiomegaly,
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16 arrhythmias2009
This document provides an overview of cardiac arrhythmias including their classification, mechanisms, clinical manifestations, diagnostic approaches and management strategies. It discusses various specific arrhythmias in detail such as atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular arrhythmias, sick sinus syndrome and heart block. Treatment options covered include pharmacological therapies using different classes of antiarrhythmic drugs, procedures like cardiac ablation and use of devices like pacemakers.
Diagonosis and management of Arrhythmia final Dr. Onn Akbar Ali Adelaide Hilt...
Diagonosis and management of Arrhythmia final Dr. Onn Akbar Ali Adelaide Hilt...Onn Akbar Ali MBBS ; FRACP; FCSANZ
The document discusses the diagnosis and management of various cardiac arrhythmias, outlining the assessment of patients' histories, ECG findings, and treatment options including medications, referral indications, and procedures. Case studies are provided examining scenarios involving bradycardias, conduction abnormalities, tachycardias, and their management in both stable and unstable patients.Arrhythmias
Arrhythmias are abnormal heart rhythms that can be caused by issues with the heart's electrical conduction system or structural problems with heart muscles or valves. Common causes include ischemia, electrolyte imbalances, cardiomyopathy, and genetic conditions. Arrhythmias are classified based on heart rate, regularity, site of origin in the heart, and ECG characteristics. They are often due to reentry circuits, abnormal automaticity, or heart block. Treatment involves medications to suppress arrhythmias or restore normal rhythm, ablation procedures, or pacemakers.
Brady arryhthmias
Bradyarrhythmias are caused by problems with impulse formation in the sinus node or impulse conduction through the AV node. Sinus node dysfunction can cause sinus bradycardia, sinus pause/arrest, or chronotropic incompetence. Atrioventricular block is classified as first, second, or third degree and may be caused by conditions like CAD, drugs, or infiltrative diseases. Second degree AV block is further classified as Mobitz type I or II based on PR interval characteristics. Third degree AV block causes complete dissociation between atrial and ventricular rhythms.
Sinus Node Dysfunction
The sinus node is the dominant pacemaker of the heart located in the right atrium. Sinus node dysfunction can cause abnormal automaticity or conduction, resulting in bradycardic rhythms like sinus bradycardia, sinus pauses, or tachycardic rhythms like inappropriate sinus tachycardia. Evaluation involves surface ECG, exercise testing, drug challenge, and invasive electrophysiological study if needed to diagnose sinus node disorders.
Atrial fibrillation
1. Atrial fibrillation (AF) is a common arrhythmia where abnormal electrical signals in the atria cause an irregular heartbeat.
2. AF increases the risk of stroke by 5 times and is associated with increased mortality, hospitalization, and decreased quality of life.
3. Management involves rate or rhythm control as well as anticoagulation to prevent stroke, with treatment depending on factors like symptoms, age, and stroke risk level.
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This document presents information on various types of atrial arrhythmias. It discusses premature atrial complexes, atrial tachycardia, multifocal atrial tachycardia, atrial flutter, atrial fibrillation, and wandering atrial pacemaker. For each type, it covers etiology, characteristics, and treatment approaches. The document is presented by Baby Haokip from the College of Nursing, NEIGRIHMS.
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The document discusses various types of valvular heart disease including stenosis, regurgitation, mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, tricuspid stenosis, tricuspid regurgitation, pulmonary stenosis and pulmonary regurgitation. For each condition, the causes, consequences, clinical presentation, investigations, and management are described. Common investigations like echocardiography and treatments like valve replacement surgery are also summarized.
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This document provides an overview of heart failure, including definitions, epidemiology, etiology, signs and symptoms, diagnosis, and treatment. Heart failure is defined as a condition where the heart loses its ability to pump sufficient blood to the body. It may involve the left ventricle, right ventricle, or both, and can be acute or chronic. Common causes include coronary artery disease, defective heart valves, arrhythmias, cardiomyopathy, and hypertension. Diagnosis involves echocardiogram, BNP levels, and chest x-rays. Treatment includes lifestyle changes, medications to reduce preload and afterload, increase contractility, and eliminate fluid, as well as surgical procedures like angioplasty, bypass, or
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1) The document defines wide complex tachycardia as a rhythm with a QRS duration ≥120ms and heart rate >100 bpm.
2) The main causes listed are ventricular tachycardia (80% of cases) and supraventricular tachycardia with aberrancy.
3) Key features that can help differentiate the underlying rhythm include QRS duration, axis, morphology, and the presence or absence of AV dissociation on electrocardiogram.
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Cardiac arrhythmias are abnormalities in the heart's rhythm. There are two main types: bradycardia, a slow heart rate, and tachycardia, a fast heart rate. Various arrhythmias are described including sinus bradycardia, heart block, atrial fibrillation, atrial flutter, AV nodal reentry tachycardia, ventricular fibrillation, and ventricular tachycardia. Treatment depends on the type of arrhythmia and may include medication, cardioversion, ablation, or pacemaker implantation. Diagnosis involves ECG, echocardiogram, blood tests, and other cardiac tests. Lifestyle changes and avoiding arrhythmia triggers can help management.
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Arrhythmia
This document discusses arrhythmias, which are abnormalities in the heart's rhythm. Arrhythmias can be too fast (tachycardia) or too slow (bradycardia) and can occur in the heart's upper chambers (atria) or lower chambers (ventricles). While some arrhythmias are not life-threatening, others can cause cardiac arrest or sudden death. The causes of arrhythmias include physical conditions, heart disease, other systemic diseases, electrolyte imbalances, and toxins. Diagnosis involves tests such as EKGs, Holter monitors, and stress tests. Treatment includes anti-arrhythmic drugs that block sodium, potassium, calcium, or beta channels, as well
ecg
The document defines and classifies different types of arrhythmias. It discusses the etiology, symptoms, electrocardiogram characteristics and treatment options for various arrhythmias including sinus arrhythmia, atrial fibrillation, ventricular tachycardia, premature contractions, and more. Anti-arrhythmia medications are also categorized based on their mechanisms of action.
CHF
Congestive heart failure (CHF) results from any structural or functional cardiac disorder that impairs the ventricle's ability to fill with or eject blood. It is diagnosed based on history, physical exam, chest x-ray, EKG, and echocardiogram. Treatment focuses on restoring normal cardiopulmonary physiology by using ACE inhibitors, beta-blockers, diuretics, and addressing pulmonary complications. Management involves evaluating the patient's stage of CHF and functional classification to determine appropriate pharmacotherapy and monitoring according to guidelines from the American Heart Association.
Pericardial diseases
The document discusses various pericardial diseases including acute pericarditis, constrictive pericarditis, pericardial effusion, and cardiac tamponade. It provides details on the anatomy and functions of the pericardium, pathophysiology, clinical features, diagnostic tests, and management of these conditions. Key points include that pericardial diseases can present with non-specific symptoms, clinical suspicion is important for diagnosis, and treatment depends on underlying etiology and presence of hemodynamic compromise. Differentiating constrictive pericarditis from restrictive cardiomyopathy is important as treatment approaches differ significantly.
Atrial Flutter
Atrial flutter is a common arrhythmia caused by an abnormal electrical circuit in the atria, causing the heart rate to exceed 250 bpm. Common symptoms include palpitations, shortness of breath, and chest discomfort. Treatment options include medications to slow the heart rate, electrical cardioversion, antiarrhythmic drugs, and catheter ablation to scar the flutter circuit. People with atrial flutter have an increased risk of stroke.
Bundle branch blocks
Bundle branch blocks occur when the left or right bundle branch is blocked, preventing normal conduction of electrical impulses through the ventricles. Right bundle branch block is usually benign but can worsen prognosis in acute myocardial infarction by indicating occlusion of the proximal left anterior descending artery. Left bundle branch block is more serious as it can mask signs of myocardial infarction and worsen prognosis in acute infarction. The Sgarbossa criteria can help diagnose myocardial infarction in the presence of left bundle branch block. Left anterior and posterior hemiblocks involve conduction abnormalities localized to one side of the ventricles.
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This document discusses dysrhythmias, which are disorders of the heart's electrical conduction or rhythm. Dysrhythmias can be diagnosed by electrocardiogram and may cause changes in blood pressure or pumping of the heart. Common types of dysrhythmias discussed include normal sinus rhythm, sinus bradycardia, sinus tachycardia, premature atrial complexes, atrial flutter, and atrial fibrillation. Nursing management focuses on treating the underlying cause, controlling heart rate, and preventing complications like stroke.
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This document provides an overview of cardiac arrhythmias for medical students. It begins by describing the normal conduction pathways in the heart and normal sinus rhythm on an electrocardiogram. It then classifies arrhythmias as rapid and regular, rapid and irregular, slow and regular, or slow and irregular based on heart rate and rhythm. Various types of tachycardias and bradycardias are defined, along with their typical electrocardiogram presentations and common causes. Causes, presentations, and treatments of atrial fibrillation, atrial flutter, supraventricular tachycardia, Wolff-Parkinson-White syndrome, heart block, and ventricular tachycardia are summarized. Catheter ablation techniques
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This document provides an overview of atrial fibrillation (AF) and paroxysmal supraventricular tachycardia (PSVT). It defines these conditions and describes their typical ECG patterns, mechanisms, clinical presentations, diagnostic evaluations, and treatment approaches including medications, procedures like cardioversion and ablation. Key points include: AF can be paroxysmal, persistent or permanent, and is caused by mechanisms like reentry and ectopic automaticity; evaluation involves assessing thromboembolic risk with scores like CHA2DS2-VASc; treatment focuses on rate or rhythm control with medications or ablation, while preventing thromboembolism with anticoagulation; PSVT often presents with abrupt
af afl ppt, Virbhan
This document discusses atrial fibrillation (AF), atrial flutter, and atrial tachycardia. It covers the electrocardiographic features of each condition and how to differentiate them. It also discusses the classification, epidemiology, mechanisms, causes, clinical features, diagnostic evaluation, and prevention of thromboembolism for AF based on the 2014 AHA/ACC/HRS guideline. Key points include that AF can be paroxysmal, persistent, long-standing persistent, or permanent; the CHA2DS2-VASc score is used to assess stroke risk; and anticoagulation options depend on stroke risk.
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This document discusses different types of cardiomyopathy, including dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), and restrictive cardiomyopathy. DCM is characterized by enlarged heart chambers and reduced systolic function. HCM involves thickened heart muscle and potential outflow tract obstruction. Restrictive cardiomyopathy restricts heart filling due to stiff heart muscles. The causes, clinical presentations, diagnostic evaluations, and management strategies are described for each type of cardiomyopathy.
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Samir rafla ecg arrhythmia for medical students- added amr kamal
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Tetrodotoxin
Tetrodotoxin is a potent neurotoxin found in marine animals like pufferfish. It blocks sodium channels, preventing action potentials and paralyzing neurons and muscles. Poisoning symptoms range from numbness to respiratory failure and death. The toxin is produced by various bacteria in marine life. While rare, poisoning is more common where pufferfish is regularly consumed. There is no antidote, so treatment focuses on supportive care and monitoring until the toxin is cleared from the body.
ECG S
1) The Sgarbossa criteria provide guidelines for diagnosing acute myocardial infarction in patients with left bundle branch block (LBB) or ventricular paced rhythm on electrocardiogram (ECG), as these conditions can obscure ECG changes.
2) The original Sgarbossa criteria included three criteria involving concordant or discordant ST segment changes greater than 1mm. The modified criteria expanded this to include proportionally excessive discordant ST elevation.
3) Different types of STEMI are described based on the location of maximal ST elevation, including anterior, inferior, lateral, posterior, and right ventricular STEMI, each with characteristic ECG patterns.
ECG I
This document discusses interventricular conduction delay and raised intracranial pressure as seen on electrocardiograms (ECGs). It defines interventricular conduction delay and lists various causes including fascicular blocks, bundle branch blocks, ventricular hypertrophy, dilatation, electrolyte abnormalities, toxins, pre-excitation, and arrhythmogenic cardiac conditions. It then discusses raised intracranial pressure and the associated ECG findings of widespread T-wave inversions, QT prolongation, and bradycardia as part of the Cushing reflex, indicating imminent brainstem herniation. Massive intracranial hemorrhages such as subarachnoid hemorrhage are the most common causes
ECG H
The document discusses various electrolyte abnormalities and their ECG manifestations, including hypercalcemia, hypocalcemia, hyperkalemia, hypokalemia, hypomagnesia, hyperthyroidism, hypothyroidism, and hypothermia. For each condition, it provides the normal and abnormal ranges for the electrolyte levels and describes the associated ECG changes such as peaked T waves, QT prolongation, low QRS voltage, bradycardia, and arrhythmias. The document serves as a reference for clinicians to recognize ECG patterns caused by electrolyte and endocrine abnormalities.
ECG F
1) Fascicular ventricular tachycardia is the most common form of idiopathic ventricular tachycardia originating from the left ventricle. It typically presents in young patients without structural heart disease.
2) It has characteristic ECG features including a monomorphic ventricular rhythm with fusion complexes and AV dissociation. The QRS duration is between 100-140 ms with a short RS interval of 60-80 ms. It also shows a right bundle branch block pattern and axis deviation.
3) Posterior fascicular ventricular tachycardia, which arises near the left posterior fascicle, shows a right bundle branch block pattern with left axis deviation. Anterior fascicular ventricular tachycardia arises
ECG E
The document discusses several electrocardiogram (ECG) findings and rhythms including ectopic atrial tachycardia, atrial tachycardia, electrical alternans seen in massive pericardial effusion which produces low QRS voltage, electrical alternans and tachycardia, escape rhythms like junctional escape rhythms where the pacemaker rate decreases down the conducting system, and ventricular escape rhythms. It also discusses the terminology of junctional rhythms and includes literature references.
ECG D
The document discusses De Winter's T waves, which are characterized by three key findings on ECG: upsloping ST depression in precordial leads, tall symmetric T waves in precordial leads, and ST elevation in aVR. It also summarizes the ECG patterns seen in dextrocardia, including right axis deviation, positive complexes in aVR, and dominant S waves in precordial leads. Finally, it outlines the ECG features of digoxin effect and toxicity, such as biphasic T waves, shortened QT, and the dysrhythmia of supraventricular tachycardia with a slow ventricular response seen in digoxin toxicity.
ECG C
Massive carbamazepine overdose of more than 50 mg/kg can cause cardiotoxicity due to sodium channel blockade, which may be detectable on ECG as subtle QRS widening or first-degree AV block. Dilated cardiomyopathy is characterized by ventricular dilatation and reduced ejection fraction below 40%, commonly presenting with symptoms of biventricular failure. Chronic obstructive pulmonary disease can cause prominent P waves in inferior leads, exaggerated ST segments, low QRS voltage especially in V4-V6, and may show an SV1-SV2-SV3 pattern.
ECG B
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This document discusses atrioventricular nodal reentrant tachycardia (AVNRT). It states that AVNRT is the most common cause of palpitations in structurally normal hearts. It can occur spontaneously or be provoked. There are three main types - slow-fast AVNRT which is most common and shows no visible P waves, fast-slow AVNRT where P waves are visible after the QRS, and slow-slow AVNRT where P waves appear before the QRS. The tachycardia rate is typically between 140-280 beats per minute and is regular. AVNRT occurs due to a reentry circuit within the atrioventricular node.
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This document summarizes different types of atrioventricular (AV) blocks seen on electrocardiograms (ECGs). It describes first-degree AV block as a PR interval over 200ms. Second-degree AV block, Mobitz type I (Wenckebach phenomenon) shows progressive PR prolongation until a blocked pulse. Mobitz type II shows intermittent non-conducted pulses without PR prolongation. High-grade second-degree AV block has a P:QRS ratio of 3:1 or higher, with an extremely slow ventricular rate. Third-degree or complete heart block shows no relationship between atrial and ventricular rates. Causes include myocardial infarction, drugs, and conduction system disease. Treatment ranges from
ECG A: first part.
This document provides an overview of several cardiac arrhythmias and conditions including:
1. Accelerated idioventricular rhythm (AIVR), which results when an ectopic ventricular pacemaker exceeds the sinus node rate. AIVR is seen post-myocardial infarction and features a regular rhythm between 50-110 bpm with three or more QRS complexes.
2. Atrial flutter, a supraventricular tachycardia caused by a reentry circuit in the right atrium with a rate of around 300 bpm. The ventricular rate is determined by AV conduction.
3. Atrial fibrillation, the most common sustained arrhythmia characterized by irregularly irregular rhythm without
Cardiorenal syndrome
1) Cardiorenal syndrome commonly occurs in patients with acute decompensated heart failure and is associated with poor outcomes. It involves a complex interaction between hemodynamic alterations and activation of neurohormonal systems that affects both the heart and kidneys.
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The document discusses various categories of risks associated with food, including foodborne hazards of microbial origin, nutritional hazards, environmental contaminants, naturally occurring toxicants, and food additives. It notes that foodborne diseases of microbial origin pose the greatest risks. Nutritional hazards can arise from deficiencies or excesses. Environmental contaminants can enter the food supply from industrial or natural sources. Naturally occurring toxicants are found in some foods. Food additives present minimal risks when consumed within permitted levels. The document also outlines categories of potential benefits from foods, including health benefits, supply benefits, hedonic benefits, and convenience benefits.
Benefits and risks of additives
This document discusses the benefits and risks of food additives. The benefits include making foods safer, more nutritious, and longer lasting through the use of preservatives and antioxidants. Additives also provide greater variety of foods and lower prices. However, there are also risks. There is a lack of data on the long term health effects of combinations of additives. Some additives are associated with "junk foods" that are low in nutrients. While direct toxic effects are unlikely at legal levels, some individuals may have hypersensitivity reactions. Some animal studies also indicate potential cancer and reproductive issues, but no direct evidence in humans. The risks must be weighed against the benefits on a case by case basis.
Types of food additives
The document discusses different types of food additives and how they are classified. It describes preservatives like antimicrobials, antioxidants and antibrowning agents. Nutritional additives add vitamins, minerals and fiber. Coloring agents and flavors are used to enhance appearance and taste. Texturizing agents modify texture and mouthfeel. Additives are identified by International Numbering System codes or E numbers from the European Union.
Effector phase in immune mediated drug hypersensitivity
This document discusses antibody-mediated and T cell-mediated drug hypersensitivity. It describes how drugs can act as haptens and stimulate T and B cell responses, leading to IgE production and immediate hypersensitivity reactions. It also discusses the p-i concept where drugs can directly interact with T cell receptors and cause reactions without prior sensitization, particularly in the skin which contains many resident immune cells.
T cell stimulation by drugs
1. Small molecule drugs can become immunogenic by undergoing bioactivation into chemically reactive metabolites that covalently bind to proteins, forming hapten-carrier complexes.
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Atrial fibrillation (af) and flutter
- 1. Atrial fibrillation (AF) and flutter Domina Petric, MD
- 2. Atrial fibrillation Chaotic, irregular atrial rhythm at 300- 600 bpm. The AV node responds intermittently: irregular ventricular rate. Cardiac output drops by 10-20%. AF is common in the elderly. The main risk is embolic stroke.
- 3. AF causes heart failure heart ischaemia arterial hypertension myocardial infarction pulmonary embolism mitral valve disease pneumonia
- 4. AF causes hyperthyroidism caffeine alcohol post-operative AF hypokalemia hypomagnesemia
- 5. AF causes cardiomyopathy constrictive pericarditis sick sinus syndrome lung carcinoma atrial myxoma endocarditis haemochromatosis idiopatic
- 6. Symptoms asymptomatic chest pain palpitations dyspnoea faintness
- 7. Signs Irregularly irregular pulse! The apical pulse is greater than the radial rate. First heart sound is of variable intensity. There may be signs of left ventricular failure.
- 8. Image source: Lifeinthefastlane.com Absent P waves, irregular QRS complexes.
- 9. Blood tests Urea, electrolytes, kreatinine Cardiac enzymes Thyroid function tests
- 10. Other tests Echocardiography: left atrial enlargement, mitral valve disease, poor left ventricle function and other structural abnormalities.
- 11. Conversion of atrial fibrillation Within 48 hours from acute onset, propafenone 600 mg per os in patients without structural heart disease. Within 48 hours, amiodarone 300 mg per os in patients with structural heart disease. Electrocardioversion!
- 12. Conversion of atrial fibrillation >48 hours Immediate electrocardioversion: transesophageal echocardiography + 5000 IJ LMWH OR Electrocardioversion after 3 weeks of warfarin therapy.
- 13. Conversion of atrial fibrillation Immediate electrocardioversion after period of 48 hours can be done only if transoesophageal echocardiography shows that the heart is thrombus free.
- 14. Alternative drug cardioversion Amiodarone iv. 5 mg/kg over 1 h, then 900 mg over 24 hours via a central line. Amiodarone 200 mg every 8 hours for 1 week, 200 mg every 12 hours next week and 100-200 mg every 24 hours as a maintenance therapy. Flecainide 2 mg/kg iv. over 10-30 minutes, max. 150 mg OR 300 mg per os.
- 15. Flecainide It can be used only if the patient is stable and there is no known ischaemic heart disease or Wolff- Parkinson-White syndrome.
- 16. Chronic AF
- 17. Rate control Beta blocker (BB) or rate-limiting Ca-blocker (CB). Alternatives are digoxin and amiodarone. BB should not be combined with diltiazem and verapamil!
- 18. Rhythm control Rhythm control is prefered in: symptomatic patients congestive cardiac failure younger patients patients presenting for the first time with lone AF AF from a corrected precipitant (electrolytes disbalance)
- 19. Rhythm control Electrocardioversion! Pharmacological cardioversion! AV node ablation! Maze procedure! Pacing! Pulmonary vein ablation!
- 20. Acute anticoagulation LMWH in preparation for electrocardioversion. Warfarin can also be used for elective electrocardioversion preparation.
- 22. Contraindications for warfarin bleeding diathesis platelets <50 x 109/L compliance issues frequent falls NSAID use past intracranial bleeds low haemoglobin
- 23. Chronic anticoagulation Dabigatran is a direct thrombin inhibitor. There is no need for regular laboratory INR monitoring and dose adjustment. Dose is 110 mg every 12 hours per os. Contraindications for dabigatran are severe renal and liver impairment, active bleeding, lesion at risk of bleeding, low level of clotting factors.
- 24. Interactions with dabigatran heparin clopidogrel NSAIDS GPIIb/IIIa antagonists p-glycoprotein inhibitors like verapamil, amiodarone, clarithromycin
- 25. Atrial flutter ECG: continous atrial depolarisation, heart rate usually 300 bpm, but very variable, sawtooth baseline and 2:1 AV block.
- 27. Treatment Anticoagulation and electrocardioversion Amiodarone, sotalol or BB Cavotricuspid isthmus ablation
- 28. Literature Oxford Handbook of Clinical Medicine. Longmore M. Wilkinson I. B. Baldwin A. Elizabeth W. Ninth edition. Lifeinthefastlane.com