Cardiac arrhythmias with atrioventricular block
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This document describes four types of atrioventricular (AV) block: 1) First degree AV block - characterized by a prolonged but constant PR interval with all impulses conducted to the ventricles. 2) Second degree AV block Mobitz type 1 (Wenckeback phenomenon) - characterized by intermittent failure to conduct impulses to the ventricles with progressive PR prolongation until a dropped beat. 3) Second degree AV block Mobitz type 2 - characterized by intermittent failure to conduct impulses to the ventricles with a constant PR interval but some P waves not followed by QRS complexes. 4) Third degree (complete) AV block - characterized by total failure of
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Cardiac arrhythmias originating in the ventricles
This document discusses various types of cardiac arrhythmias originating in the ventricles including ventricular ectopics, ventricular tachycardia, torsades de pointes, and ventricular fibrillation. Ventricular ectopics are abnormal heartbeats that originate in the ventricles and present with wide and bizarre QRS complexes. Ventricular tachycardia is defined as 3 or more successive ventricular ectopics occurring at a rate greater than 120 beats per minute. Ventricular fibrillation is a chaotic, low amplitude rhythm that requires immediate defibrillation to restore an organized heartbeat.
Cardiac arrhythmias originating in sinus node modified
This document describes different types of sinus arrhythmias:
- Sinus tachycardia has a heart rate over 100 bpm but under 140 bpm, with regular rhythm and normal P waves.
- Sinus bradycardia has a heart rate under 60 bpm, with regular rhythm and normal P waves.
- Sinus arrhythmia has a heart rate of 60-100 bpm with a slightly irregular rhythm from respiration and normal P waves.
- Sinus block causes dropped beats when impulses from the SA node are blocked, seen on ECG as absent PQRST complexes with normal rhythm afterwards.
Atrial arrhythmias(2)
This document discusses various arrhythmias of the atria including atrial ectopic beats, atrial tachycardia, atrial flutter, and atrial fibrillation. It provides details on the characteristic electrocardiogram patterns of each condition, including descriptions of the P waves, QRS rate and rhythm, and QRS width. Atrial ectopic beats involve premature impulses from the atria. Atrial tachycardia has a regular rapid heart rate between 150-200 bpm. Atrial flutter sees sawtooth flutter waves in the baseline at a rate of 300 bpm. Atrial fibrillation is characterized by irregular rapid impulses that prevent effective atrial emptying.
Ventricular arrythmia
1. Premature ventricular contractions are early occurring, widened QRS complexes originating from the left or right ventricle that have a distinct morphology different from the normal sinus rhythm.
2. Ventricular tachycardia is defined as three or more successive ventricular complexes at a rate greater than 100 beats per minute and shows atrioventricular dissociation.
3. Ventricular fibrillation is identified by the complete absence of properly formed QRS complexes and P waves, with irregular ventricular activation above 300 beats per minute leading to cardiac arrest.
Premature Atrial complexes
The document discusses three types of atrial premature complexes:
1. Normally conducted complexes which have an early P wave that conducts normally with a PR interval that may be normal, increased, or decreased and a QRS similar to sinus rhythm.
2. Non-conducted complexes where an early P wave is not followed by a QRS and the P wave is often hidden in the T wave.
3. Complexes with aberrant conduction where the early P wave is followed by a QRS with an abnormal conduction pattern most commonly right bundle branch block but sometimes left bundle branch block.
Wolff–Parkinson–White syndrome
Wolff-Parkinson-White syndrome is caused by an abnormal accessory electrical pathway between the atria and ventricles that can bypass the AV node and allow rapid conduction, potentially causing palpitations, dizziness and other symptoms; the condition is usually asymptomatic but can cause tachyarrhythmias due to orthodromic or antidromic conduction along the accessory pathway; treatment involves catheter ablation to destroy the accessory pathway or medications to control the heart rate during arrhythmias.
Ventricular arrhythmias
Ventricular arrhythmias originate in the ventricles and include premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation. Ventricular tachycardia is defined as three or more consecutive ventricular beats at a rate over 100 beats per minute and can be caused by mechanisms like reentry, automaticity, and triggered activity. Polymorphic ventricular tachycardia includes conditions like torsades de pointes and Brugada syndrome. Acute management of sustained ventricular tachycardia includes termination attempts using antiarrhythmic drugs or cardioversion, while long term prevention focuses on drugs, ablation, or implantable cardioverter defibrillators depending on symptoms and left ventricular function.
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This document describes different types of sinus arrhythmias:
- Sinus tachycardia has a heart rate over 100 bpm but under 140 bpm, with regular rhythm and normal P waves.
- Sinus bradycardia has a heart rate under 60 bpm, with regular rhythm and normal P waves.
- Sinus arrhythmia has a heart rate of 60-100 bpm with a slightly irregular rhythm from respiration and normal P waves.
- Sinus block causes dropped beats when impulses from the SA node are blocked, seen on ECG as absent PQRST complexes with normal rhythm afterwards.
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This document discusses various arrhythmias of the atria including atrial ectopic beats, atrial tachycardia, atrial flutter, and atrial fibrillation. It provides details on the characteristic electrocardiogram patterns of each condition, including descriptions of the P waves, QRS rate and rhythm, and QRS width. Atrial ectopic beats involve premature impulses from the atria. Atrial tachycardia has a regular rapid heart rate between 150-200 bpm. Atrial flutter sees sawtooth flutter waves in the baseline at a rate of 300 bpm. Atrial fibrillation is characterized by irregular rapid impulses that prevent effective atrial emptying.
Ventricular arrythmia
1. Premature ventricular contractions are early occurring, widened QRS complexes originating from the left or right ventricle that have a distinct morphology different from the normal sinus rhythm.
2. Ventricular tachycardia is defined as three or more successive ventricular complexes at a rate greater than 100 beats per minute and shows atrioventricular dissociation.
3. Ventricular fibrillation is identified by the complete absence of properly formed QRS complexes and P waves, with irregular ventricular activation above 300 beats per minute leading to cardiac arrest.
Premature Atrial complexes
The document discusses three types of atrial premature complexes:
1. Normally conducted complexes which have an early P wave that conducts normally with a PR interval that may be normal, increased, or decreased and a QRS similar to sinus rhythm.
2. Non-conducted complexes where an early P wave is not followed by a QRS and the P wave is often hidden in the T wave.
3. Complexes with aberrant conduction where the early P wave is followed by a QRS with an abnormal conduction pattern most commonly right bundle branch block but sometimes left bundle branch block.
Wolff–Parkinson–White syndrome
Wolff-Parkinson-White syndrome is caused by an abnormal accessory electrical pathway between the atria and ventricles that can bypass the AV node and allow rapid conduction, potentially causing palpitations, dizziness and other symptoms; the condition is usually asymptomatic but can cause tachyarrhythmias due to orthodromic or antidromic conduction along the accessory pathway; treatment involves catheter ablation to destroy the accessory pathway or medications to control the heart rate during arrhythmias.
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- The P wave is used to identify atrial enlargement, while changes in the QRS complex indicate ventricular hypertrophy. Increased duration, amplitude or axis deviation serve as indicators.
- Right atrial enlargement increases the first part of the P wave amplitude. Left atrial enlargement increases the terminal P wave amplitude in V1 and the P wave duration.
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Low doses of dopamine cause vasodilation of the renal and mesenteric arteries, increasing renal blood flow and sodium excretion. Moderate doses increase myocardial contractility and stroke volume, raising cardiac output while possibly slightly elevating diastolic blood pressure. Higher doses increase peripheral resistance and reduce urine output. Adverse reactions include headache, nausea, vomiting, angina, respiratory difficulties, and decreased blood pressure.
Metaraminol
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Non invasive ventilation
Ventilation can be controlled by setting volume or pressure for each breath. In volume mode, tidal volume is fixed but pressure needed varies with lung compliance. In pressure mode, pressure is fixed and tidal volume varies with compliance. Non-invasive ventilation includes continuous positive airway pressure (CPAP) which maintains continuous pressure throughout breaths and pressure support (PS) which provides additional inspiratory support with a lower expiratory pressure. Flow during non-invasive ventilation depends on set pressure, respiratory drive, resistance, and leaks. Ventilators can be triggered by changes in pressure or flow, with flow triggering being more sensitive. Inspiratory assistance can stop based on decreasing flow rate or a set flow threshold.
Iabp wave forms
This document discusses intra-aortic balloon pump (IABP) timing and its effects on hemodynamics. It notes that early IABP inflation increases afterload and left ventricular work, reducing cardiac output. Delayed IABP inflation results in inadequate diastolic augmentation and no reduction in afterload or increase in diastolic perfusion pressure. Late IABP deflation dramatically increases afterload, causing late aortic valve opening and severely reduced cardiac output, seen on the pressure waveform as a higher assisted end-diastolic pressure and lower assisted systolic pressure compared to unassisted pressures.
Atropine
Atropine is an anticholinergic drug that works by blocking the effect of vagal stimulation on the heart, leading to an increased heart rate. It is administered via intramuscular injection and reaches peak plasma concentration within 30 minutes, with effects lasting 4-6 hours as it is metabolized in the liver. Atropine can interact with other anticholinergic drugs to increase both therapeutic and adverse effects, and has various contraindications such as myasthenia gravis, glaucoma, and gastrointestinal obstructive diseases.
Modes of invasive mechanical ventilation
This document discusses different modes of mechanical ventilation:
- Assist control-volume control (AC-VCV) delivers breaths at a preset tidal volume and rate whether triggered by the ventilator or patient.
- Assist control-pressure control (AC-PCV) delivers each breath at a preset inspiratory pressure with a variable tidal volume.
- Synchronized intermittent mandatory ventilation (SIMV) attempts to synchronize mandatory breaths with spontaneous efforts and reserves time for spontaneous breaths within a preset interval.
- Pressure support ventilation (PSV) provides an increase in pressure above PEEP triggered by patient effort, requiring the patient to have respiratory drive.
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Dobutamine is a positive inotropic drug that acts directly on cardiac beta-1 receptors to increase myocardial contractility and enhance stroke volume, resulting in increased cardiac output and decreased pulmonary capillary wedge pressure within 1-2 minutes. Common adverse reactions include nausea, headache, respiratory distress, angina, palpitations, tachycardia, hypertension and ventricular ectopic beats. Dobutamine is contraindicated in atrial fibrillation, ventricular arrhythmias and phaeochromocytoma.
Adrenaline(1)
Adrenaline stimulates alpha and beta adrenoceptors. At low doses, it has predominantly beta adrenoceptor actions that improve myocardial contractility, increase cardiac rate, and improve conduction. In low doses, adrenaline decreases peripheral vascular resistance and blood pressure. In large doses, it activates alpha receptors, increasing resistance and blood pressure. Common interactions include with beta-blockers, entacapone, digitalis, and anesthetics. Adverse reactions include nervousness, tachycardia, tremors, sweating, hypertension, nausea, and vomiting. Contraindications include diabetes, glaucoma, hypertension, heart disease, and hyperthyroidism.
Arterial blood gases
This document defines and discusses key components measured in a blood gas analysis:
- PaO2 and SaO2 measure oxygen levels in blood plasma and hemoglobin, with normal ranges helping assess oxygenation status.
- pH indicates hydrogen ion concentration, with values below 7.35 indicating acidosis and above 7.45 indicating alkalosis.
- PaCO2 measures carbon dioxide levels in plasma and helps evaluate ventilation, with low or high values signifying different types of respiratory acidosis or alkalosis.
- HCO3- reflects kidney function and normal bicarbonate levels, with low or high values indicating metabolic acidosis or alkalosis.
- Other measures like base excess/deficit,
High frequency oscillatory ventilation
High frequency oscillatory ventilation (HFOV) delivers very small, high frequency breaths to open collapsed alveoli and improve gas exchange. It maintains a constant high mean airway pressure to prevent alveolar collapse and uses smaller tidal volumes to reduce lung injury compared to conventional ventilation. Gas exchange occurs through several mechanisms, including bulk flow, gas mixing through oscillations, and diffusion. Practitioners adjust the mean airway pressure, amplitude, and frequency to control oxygen and carbon dioxide levels. HFOV is used as a rescue therapy for severe ARDS and lung injury when conventional ventilation fails. Potential complications include pneumothorax, hemodynamic effects, infection risks, and difficulties with transport and monitoring.
Noradrenaline
Noradrenaline acts as a neurotransmitter between sympathetic postganglionic nerves and the organs they innervate. When an action potential reaches the nerve terminal, noradrenaline is released into the synaptic cleft and binds to alpha adrenoreceptors on nearby cells. This causes vasoconstriction and increases both systolic and diastolic blood pressure, raising mean arterial pressure. Noradrenaline interacts with various other drugs and medications and can cause side effects like anxiety, dizziness, and tremors. It should be used cautiously in patients with certain medical conditions.
Amiodarone
Amiodarone is used to prevent and treat serious atrial and ventricular arrhythmias. It works by increasing the refractory period in cardiac tissues, decreasing automaticity of Purkinje fibers, and prolonging AV conduction. Amiodarone can interact with several other drugs by increasing their plasma concentrations through inhibition of metabolism, such as digoxin, flecainide, phenytoin, and warfarin. Common adverse reactions include dizziness, bitter taste, headache, flushing, nausea, vomiting, constipation, ataxia, weight loss, tremor, parasthesiae, photosensitivity, and blue-grey skin discoloration.
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EKG Module
This ECG shows three different rhythms: atrial flutter, a sinus beat, and atrial fibrillation. Atrial flutter has a sawtooth pattern best seen in certain leads and an atrial rate of 250-350 bpm with a regular ventricular rate half the atrial rate. Atrial fibrillation has irregular undulations representing disorganized atrial activation without contraction. This ECG also shows third-degree heart block with independent atrial and ventricular rhythms, indicated by an atrial rate of 88 bpm and ventricular rate of 50 bpm.
Arrythmias and ek gs 1
1. The document discusses various types of arrhythmias including normal sinus rhythm, altered automaticity, reentry, and conduction block.
2. Specific arrhythmias covered include sinus bradycardia, sinus tachycardia, junctional tachycardia, ectopic atrial tachycardia, AV nodal reentrant tachycardia, AV reentrant tachycardia, atrial flutter, atrial fibrillation, and ventricular tachycardia.
3. The document provides tips for diagnosing arrhythmias by examining heart rate, rhythm regularity, QRS width, P wave presence, and relationship between P waves and QRS complexes.
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This document provides information on various types of arrhythmias including:
- Supraventricular arrhythmias like atrial flutter and atrial fibrillation which involve rapid and irregular atrial rhythms.
- Re-entry supraventricular tachycardia which is caused by an extra connection between the atria and ventricles.
- Wolff-Parkinson-White syndrome which results from an abnormal accessory pathway that can cause supraventricular tachycardia.
- Ventricular arrhythmias like ventricular tachycardia and ventricular fibrillation which involve rapid and life-threatening rhythms originating in the ventricles.
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Arrythmias and ek gs 1
This document discusses various types of arrhythmias, their mechanisms, and EKG characteristics. It covers normal sinus rhythm, altered automaticity such as sinus bradycardia and tachycardia, reentry mechanisms including AV nodal reentrant tachycardia and atrial flutter, conduction blocks, and helpful questions for identifying unknown arrhythmias based on rate, rhythm regularity, QRS width, P waves, and relationship between P waves and QRS complexes.
ecg.ppt
The document provides an overview of how to read electrocardiograms (ECGs). It begins by explaining the normal cardiac conduction system and the electrical signals seen on an ECG, including the P wave, QRS complex, and T wave. It then discusses various cardiac rhythms and conduction abnormalities such as sinus rhythm, different types of atrioventricular block, and bundle branch block. The document also covers ECG interpretation criteria like rate, rhythm, intervals, and changes indicating ischemia. Overall, the document serves as a basic guide for understanding the fundamentals of electrocardiography.
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This document discusses different types of atrioventricular (AV) junctional blocks. It defines 1st, 2nd, and 3rd degree AV blocks and describes their characteristics. 1st degree AV block involves a prolonged PR interval. 2nd degree AV block, type I shows progressive PR interval lengthening until one P wave is blocked. 2nd degree, type II involves occasional blocked P waves. 3rd degree AV block completely blocks P waves in the AV junction, so the atria and ventricles contract independently. The document provides examples of ECG rhythms demonstrating each type of AV block.
ABNORMAL ECG PART-2: CONDUCTION DIFFICULTY .
This document discusses different types of conduction blocks that can occur in an ECG. It describes first-degree AV block, characterized by a prolonged PR interval but normal conduction ratio of 1:1. Second-degree AV block is divided into Mobitz type I (Wenckebach) where the PR interval lengthens until a P wave fails to conduct, and Mobitz type II where there is a fixed PR but dropped beats. Third-degree AV block is complete heart block where the atria and ventricles contract independently. ST segment changes can indicate myocardial ischemia or infarction, with elevation associated with transmural MI and depression with non-transmural MI.
Conduction
This document provides an overview of various conduction disturbances, including sinoatrial exit block, AV blocks, bundle branch blocks, and fascicular blocks. It describes the electrocardiographic findings and clinical implications of first-, second-, and third-degree forms of each type of block. Causes such as ischemia, cardiomyopathy, and inherited conduction system diseases are discussed. The prevalence of different blocks increases with age. Bundle branch blocks may occur after surgery involving the right ventricle. Permanent pacemaker implantation is indicated for advanced forms of block.
44 E C G
The 11-step method provides a systematic approach to reading EKGs:
1. Gather data such as heart rate, intervals, and axis.
2. Diagnose rhythm, conduction blocks, enlargement, and infarction by applying specific criteria.
3. Potential diagnoses are identified through disturbances of rhythm, conduction, hypertrophy, and ischemia. The relationship between P waves and QRS complexes helps determine block types.
44 E C G
The 11-step method provides a systematic approach to reading EKGs:
1. Gather data such as heart rate, intervals, and axis.
2. Diagnose rhythm, conduction blocks, enlargement, and infarction by applying specific criteria.
3. Potential diagnoses are identified through disturbances of rhythm, conduction, hypertrophy, and ischemia. The four questions framework is used to characterize rhythms.
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This document discusses the anatomy and physiology of the atrioventricular node and bundle of His, which conduct electrical impulses from the atria to the ventricles. It describes the types of atrioventricular block including first, second, and third degree block. It also discusses electrocardiographic features used to diagnose different types of AV block and lists potential causes of AV conduction disturbances. Pacing is identified as the main treatment for symptomatic AV block.
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This document discusses various types of conduction disturbances including sinoatrial exit block, AV blocks, bundle branch blocks, and fascicular blocks. It provides details on the definitions, electrocardiogram findings, causes and prevalence of each type. The document concludes with guidelines on indications for permanent pacemaker implantation for acquired AV block, bifascicular/trifascicular block, and after myocardial infarction.
Psvt
1. The document describes various types of narrow complex tachycardia (NCT), including atrial fibrillation, atrial flutter, multifocal atrial tachycardia, atrial tachycardia, atrioventricular nodal reentrant tachycardia (AVNRT), and atrioventricular reentrant tachycardia (AVRT).
2. Key aspects that help differentiate the NCTs include the presence or absence of P waves, regularity of the rhythm, P wave morphology, and the RP and PR intervals.
3. Aspects like an irregular rhythm with no P waves indicate atrial fibrillation, while regular rhythms with varying
Conduction defects - Hoang Cuong HMU - Source: ECGwaves.com
This document provides an overview of conduction defects (disturbances) including different types of atrioventricular (AV) blocks and intraventricular conduction delays. It describes the ECG criteria and characteristics of first-, second-, and third-degree AV blocks as well as right and left bundle branch blocks. Causes, clinical implications, localization, and treatment approaches for various conduction abnormalities are also discussed.
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This document discusses different types of narrow complex tachycardia seen on ECGs. It describes supraventricular tachycardia (SVT) as a narrow complex tachycardia with a QRS width less than 120 ms. SVT can present as irregularly irregular rhythms consistent with atrial fibrillation or multifocal atrial tachycardia, or as regular or regularly irregular rhythms consistent with AV nodal reentrant tachycardia, AV reentrant tachycardia, atrial tachycardia, or atrial flutter. It provides details on dual AV node pathways and how they can lead to AV nodal reentrant tachycardia. It also describes
ECG - Conduction defects - Hoang Van Cuong HMU
This document discusses conduction defects that cause atrioventricular (AV) blocks. It defines three degrees of AV block based on the level and severity of conduction delay: first-degree AV block involves prolonged conduction but all impulses pass through, second-degree involves some blocked impulses, and third-degree (complete heart block) means no impulses pass through. Mobitz type 1 and 2 refer to variants of second-degree block. Causes include fibrosis, ischemia, medications, electrolyte abnormalities. Treatment depends on severity but may include atropine, pacemakers for more advanced blocks.
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All About ECG
The ECG represents the electrical activity of the heart. It can provide insight into cardiac pathophysiology by analyzing the distinctive waveforms of each cardiac event. The ECG can identify arrhythmias, ischemia, infarction, pericarditis, chamber hypertrophy, and electrolyte disturbances. The standard 12-lead ECG consists of 3 limb leads, 3 augmented limb leads, and 6 precordial leads, which provide different views of the heart. Analysis of the P wave, PR interval, QRS complex, ST segment, T wave, and QT interval can reveal normal sinus rhythm or abnormalities that require further investigation.
ECG.pptx
In these presentation we explained about basic require knowledge for ECG who were working in area of critical care, Casualty,ICU.
Here topic discussed is
Basic ECG
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Avrt and avnrt
1. AVNRT and AVRT are types of supraventricular tachycardia involving abnormal pathways for electrical conduction between the atria and ventricles.
2. AVNRT is caused by a reentry circuit within the AV node, while AVRT involves an accessory pathway bypassing the AV node.
3. There are different subtypes of AVNRT and AVRT depending on which pathways are involved in the antegrade and retrograde directions. Typical AVNRT involves a slow-fast pathway while typical AVRT involves orthodromic conduction over an accessory pathway.
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Cardiac arrhythmias with atrioventricular block
- 1. 1. First degree AV block 2. Second degree AV block Mobitz type 1 (Wenckeback phenomenon) 3. Second degree AV block Mobitz type 2 4. Third degree (complete) AV block
- 2. Image: linfeinthefastlane.com There is a delay in the conduction of impulses to the ventricles usually at the AV node. It is characterised by a prolonged, but constant PR interval. All the impulses are conducted to the ventricles but delayed. QRS rate: usually normal QRS rhythm: usually regular QRS width: normal width and morphology P waves: present and constant morphology PR interval is prolonged (>0.20s/5small squares) . But each P wave is followed by a QRS complex.
- 3. Image: www.sw.org Not all the P waves are conducted to ventricles. Intermittent failure of transmission of the atrial impulse to the ventricles. It is characterised by a progressive prolongation of the PR interval until an impulse fails to be conducted to the ventricles resulting in a dropped beat or QRS complex QRS rate: usually 85/min QRS rhythm: Irregular QRS width: normal P waves: present and constant morphology Not every P wave is followed by a QRS, but every QRS complex is preceded by a P wave. PR interval progressively lengthens until a QRS complex is dropped. In 3:1 AV block every 3rd P wave is not conducted to the ventricles Missed beat
- 4. Image: www.sw.org Characterised by intermittent failure of atrial impulse conduction to the ventricles. The block is usually at the level of the bundle branches, commonly resulting in wide QRS complex. PR interval remains constant in the conducted beats but some of the P waves are not followed by a QRS complex. QRS rate: depends on the number of dropped beats; may be normal or bradycardiac. QRS rhythm: Usually irregular due to dropped beats QRS width: Usually wide (0.12s/more than 3 small squares) with bundle branch block pattern, may be normal with and morphology P waves: present and constant morphology Not every P wave is followed by a QRS (dropped beat), but every QRS complex is preceded by a P wave. PR interval is constant but may be prolonged In high degree AV block, multiple consecutive P waves are not conducted with uniform PR interval for conducted beats. no QRS no QRS
- 5. Image: www.Ims.resus.org.uk Total failure of conduction between atria and ventricle. Characterised by AV dissociation; No relation between P waves and QRS P P P P P P