1. The document discusses various ECG emergencies including narrow complex tachycardia, wide complex tachycardia, bradycardia, asystole, pulseless electrical activity, and myocardial infarction.
2. Treatment approaches for different arrhythmias are outlined, including electrical cardioversion for unstable ventricular tachycardia and defibrillation for pulseless ventricular fibrillation.
3. Management strategies for bradycardic rhythms like sinus bradycardia depend on severity and include atropine or pacing, while complete heart block may require withdrawal of aggravating medications.
ECG in Emergency Department - Advances in ACS ECGDr.Mahmoud Abbas
ECG in Emergency Department -Advances in ACS ECG. Lecture presented by Dr Hesham Ibrahim at the Egyptian Critical Care Summit , the leading educational event and medical exhibition in Egypt.
ECG in Emergency Department - Advances in ACS ECGDr.Mahmoud Abbas
ECG in Emergency Department -Advances in ACS ECG. Lecture presented by Dr Hesham Ibrahim at the Egyptian Critical Care Summit , the leading educational event and medical exhibition in Egypt.
Tachycardias are broadly categorized based upon the width of the QRS complex on the electrocardiogram (ECG). A narrow QRS complex (<120 milliseconds) reflects rapid activation of the ventricles via the normal His-Purkinje system, which in turn suggests that the arrhythmia originates above or within the His bundle (ie, a supraventricular tachycardia). The site of origin may be in the sinus node, the atria, the atrioventricular (AV) node, the His bundle, or some combination of these sites. A widened QRS (≥120 milliseconds) occurs when ventricular activation is abnormally slow. The most common reason that a QRS is widened is because the arrhythmia originates below the His bundle in the bundle branches, Purkinje fibers, or ventricular myocardium (eg, ventricular tachycardia). Alternatively, a supraventricular arrhythmia can produce a widened QRS if there are either pre-existing or rate-related abnormalities within the His-Purkinje system (eg, supraventricular tachycardia with aberrancy), or if conduction occurs over an accessory pathway. Thus, wide QRS complex tachycardias may be either supraventricular or ventricular in origin.
A 45 years old lady presented with generalized weakness and palpitations. She is a diagnosed case of chronic renal failure with Diabetes mellitus and Hypertension. Her serum K+ level is 6.8 meq/L. She had the following ECG.
Case; A 54 years old gentleman complained of chest discomfort on exertion for the last 5 months. He is smoker for 10 years, diabetic for 5 years and hypertensive for 3 years. He had the following ECG.
Case: A 25 years old gentleman presented with chest pain and fever .He was normotensive, non-smoker and non-diabetic. His pulse 128b/min and BP-130/80 mm Hg. Troponin I was normal.
Case: A 58 years old gentleman complained of severe central chest pain with excessive sweating 5 days back. He is smoker for 7 years, diabetic for 5 years and hypertensive for 4 years. His BP-90/70 mm Hg. He had the following ECG.
Wolff–Parkinson–White syndrome (WPW) is one of several disorders of the conduction system of the heart that are commonly referred to as pre-excitation syndromes. WPW is caused by the presence of an abnormal accessory electrical conduction pathway between the atria and the ventricles. Electrical signals travelling down this abnormal pathway (known as the bundle of Kent) may stimulate the ventricles to contract prematurely, resulting in a unique type of supraventricular tachycardia referred to as an atrioventricular reciprocating tachycardia.The incidence of WPW is between 0.1% and 0.3% in the general population.Sudden cardiac death in people with WPW is rare (incidence of less than 0.6%), and is usually caused by the propagation of an atrial tachydysrhythmia (rapid and abnormal heart rate) to the ventricles by the abnormal accessory pathway.
Ventricular tachycardia are difficult to understand. it is classified in to two types. 1. VT in structurally normal heart, 2. VT in heart with structural diseases. I have tried to simplify the VT in structurally normal heart, which may be helpful to many students and learners.
This presentation describes the epidemiology, initial assessment, investigation and emergency department management of a patient with atrial fibrillation. Some new research evidences are also discussed to answer some dilemmas.
Tachycardias are broadly categorized based upon the width of the QRS complex on the electrocardiogram (ECG). A narrow QRS complex (<120 milliseconds) reflects rapid activation of the ventricles via the normal His-Purkinje system, which in turn suggests that the arrhythmia originates above or within the His bundle (ie, a supraventricular tachycardia). The site of origin may be in the sinus node, the atria, the atrioventricular (AV) node, the His bundle, or some combination of these sites. A widened QRS (≥120 milliseconds) occurs when ventricular activation is abnormally slow. The most common reason that a QRS is widened is because the arrhythmia originates below the His bundle in the bundle branches, Purkinje fibers, or ventricular myocardium (eg, ventricular tachycardia). Alternatively, a supraventricular arrhythmia can produce a widened QRS if there are either pre-existing or rate-related abnormalities within the His-Purkinje system (eg, supraventricular tachycardia with aberrancy), or if conduction occurs over an accessory pathway. Thus, wide QRS complex tachycardias may be either supraventricular or ventricular in origin.
A 45 years old lady presented with generalized weakness and palpitations. She is a diagnosed case of chronic renal failure with Diabetes mellitus and Hypertension. Her serum K+ level is 6.8 meq/L. She had the following ECG.
Case; A 54 years old gentleman complained of chest discomfort on exertion for the last 5 months. He is smoker for 10 years, diabetic for 5 years and hypertensive for 3 years. He had the following ECG.
Case: A 25 years old gentleman presented with chest pain and fever .He was normotensive, non-smoker and non-diabetic. His pulse 128b/min and BP-130/80 mm Hg. Troponin I was normal.
Case: A 58 years old gentleman complained of severe central chest pain with excessive sweating 5 days back. He is smoker for 7 years, diabetic for 5 years and hypertensive for 4 years. His BP-90/70 mm Hg. He had the following ECG.
Wolff–Parkinson–White syndrome (WPW) is one of several disorders of the conduction system of the heart that are commonly referred to as pre-excitation syndromes. WPW is caused by the presence of an abnormal accessory electrical conduction pathway between the atria and the ventricles. Electrical signals travelling down this abnormal pathway (known as the bundle of Kent) may stimulate the ventricles to contract prematurely, resulting in a unique type of supraventricular tachycardia referred to as an atrioventricular reciprocating tachycardia.The incidence of WPW is between 0.1% and 0.3% in the general population.Sudden cardiac death in people with WPW is rare (incidence of less than 0.6%), and is usually caused by the propagation of an atrial tachydysrhythmia (rapid and abnormal heart rate) to the ventricles by the abnormal accessory pathway.
Ventricular tachycardia are difficult to understand. it is classified in to two types. 1. VT in structurally normal heart, 2. VT in heart with structural diseases. I have tried to simplify the VT in structurally normal heart, which may be helpful to many students and learners.
This presentation describes the epidemiology, initial assessment, investigation and emergency department management of a patient with atrial fibrillation. Some new research evidences are also discussed to answer some dilemmas.
This presentation is a simplified version of the various types of cardiac arrythmias seen in pediatric age groups. We have discussed supraventricular tachycarsias and prolonged QT syndrome in details here. Hope everyone finds it useful.
A 30-year-old man presented to the emergency department with palpitations and tachycardia.He had been experiencing sore throat, fevers, andmyalgias for the past day.He became
alarmed when he awoke from sleep with strong palpitations and a heart rate greater
than 200/min documented on his smartwatch.Hehad similar symptoms1 year ago andwas diagnosed with and treated for supraventricular tachycardia (SVT). A subsequent outpatient
echocardiogram revealed a structurally normal heart; results of a follow-up electrocardiogram (ECG) were also normal
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
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4. Answer
Sinus Tachycardia – physiologic response to a stressor
Stressors include: hypoxia, hypovolemia, fever, anxiety, pain, hyperthyroidism, and exercise.
Certain drugs, such as stimulants (eg, nicotine, caffeine), medications (eg, atropine,
salbutamol), recreational drugs (eg, cocaine, amphetamines, ecstasy), and hydralazine, can also
induce the condition
Rx; address the underlying stressor
5.
6. Answer:
Atrial flutter – “sawtooth” pattern
Rx – tachycardia algorithm
If the patient is hypotensive or unstable, immediate cardioversion with sedation must be performed.
If the patient is stable, vagal maneuvers can be used to slow the heart rate and to convert to sinus rhythm.
If vagal maneuvers are not successful, adenosine can be used in increasing doses.
If adenosine does not work, atrioventricular (AV) nodal blocking agents like calcium channel blockers or
beta-blockers should be used, as most patients who present with PSVT have AV nodal reentrant tachycardia
(AVNRT) or AV reentrant tachycardia (AVRT). These arrhythmias depend on AV nodal conduction and therefore
can be terminated by transiently blocking this conduction
Since atrial fibrillation and atrial flutter increase risk of stroke or cerebrovascular accidents, anticoagulation is
usually recommended.
12. Answer
Atrial fibrillation - chaotic atrial depolarization
Treatment goals include the following:
1.Conversion to normal sinus rhythm
2.Keeping the patient in normal sinus rhythm
3.Control of ventricular rate
4.Preventing thromboembolic disease
Beta-blockers and calcium channel blockers are first-line agents for rate control in AF. These
drugs can be administered either intravenously or orally.
Patients with newly diagnosed AF and patients awaiting electrical cardioversion can be started on
intravenous heparin (activated partial thromboplastin time [aPTT] of 45-60 seconds) or low-
molecular-weight heparin (1 mg/kg bid).
13.
14.
15. Answer
AVNRT - AVNRT occurs when a reentrant circuit is present within the AV node itself. In this
situation, there are two separate conduction pathways within the AV node instead of just one
(present in about 5% of the general population).
This is sometimes termed “dual AV nodal physiology”. One pathway is slower and has a short
refractory period while the other is faster and has a long refractory period. Normal conduction
occurs through the faster pathway with the long refractory period.
If a premature atrial contraction (PAC) or less commonly a premature ventricular contraction
(PVC) occurs at the right time, the normal conduction pathway will still be refractory, so the
action potential will conduct through the fast AV nodal pathway with the shorter refractory
period instead. After this action potential reaches the ventricles or atrium, it will conduct back
through the normal AV nodal conduction pathway since it will no longer be refractory and a
reentrant circuit will be created.
20. Answer
Ventricular tachycardia
Rx - VT associated with loss of consciousness or hypotension is a medical emergency
necessitating immediate cardioversion. In a normal-sized adult, this is typically accomplished
with a 100- to 200-J biphasic cardioversion shock administered according to standard Advanced
Cardiovascular Life Support (ACLS) protocols
Pulseless VT, in contrast to other unstable VT rhythms, is treated with immediate
defibrillation.
Shock administration should be followed by immediate chest compressions, airway
management with supplemental oxygen, and vascular access with administration of
vasopressors.
21.
22.
23. Answer
Ventricular Fibrillation
Electrical external defibrillation remains the most successful treatment of ventricular fibrillation (VF).
A shock is delivered to the heart to uniformly and simultaneously depolarize a critical mass of the
excitable myocardium. The objective is to interfere with all reentrant arrhythmia and to allow any
intrinsic cardiac pacemakers to assume the role of primary pacemaker
AHA algorithm (refer previous slide)
Lack of response to standard defibrillation algorithms is challenging.
After initial amiodarone bolus, consider continued amiodarone therapy with 1 mg/min IV for 6
hours, then 0.5 mg/min for 18 hours.
If ongoing ischemia is the suspected cause of recurrent VF, consider emergent cardiac catheterization
and possible angioplasty even in the absence of STEMI, and intra-aortic balloon pump placement.
For patients with prolonged and refractory inhospital cardiogenic arrest that included VF/VT, it has
been shown that extracorporeal cardiopulmonary resuscitation was associated with improved
neurologically intact survival.This study was performed in a large tertiary center with an ongoing
protocol for this advanced experimental care.
26. Sinus Bradycardia
Rx – depends on the cause ( refer algorithm)
Intravenous access, supplemental oxygen, and cardiac monitoring should be initiated
In symptomatic patients, intravenous atropine may be used.
In rare cases, transcutaneous pacing may need to be initiated.
31. 3rd
Degree Block
All patients should be receiving advanced life support (ACLS) with continuous cardiac
monitoring, as per local protocols. In all patients, oxygen should be administered and
intravenous (IV) access established. Maneuvers likely to increase vagal tone (eg, Valsalva
maneuvers, painful stimuli) should be avoided. Atropine can be administered but should be
given cautiously
The first, and sometimes most important, medical treatment for heart block is the withdrawal
of any potentially aggravating or causative medications. Many antihypertensive, antianginal,
antiarrhythmic, and heart failure medications cause AV block that resolves after withdrawal of
the offending agent.
Review patient medication lists upon presentation to help rule out medication-induced or
medication-aggravated heart block. Common drugs that induce AV block include beta-blockers,
calcium channel blockers, antiarrhythmics, and digoxin.
36. Anterior STEMI
Intravenous access, supplemental oxygen, pulse oximetry
Immediate administration of aspirin en route
Nitroglycerin for active chest pain, given sublingually or by spray
If STEMI is present, the decision as to whether the patient will be treated with thrombolysis or
primary PCI should be made within the next 10 minutes. Treatment options include the
immediate start of IV thrombolysis in the ED or the immediate transfer of the patient to the
cardiac catheterization laboratory for primary percutaneous transluminal coronary angioplasty
(PTCA).
The AHA recommends the initiation of beta-blockers to all patients with STEMI (unless beta-
blockers are contraindicated)