The document provides an overview of junctional and ventricular arrhythmias, including definitions, classifications, and electrocardiographic (ECG) characteristics. It explains different types of junctional arrhythmias, such as AV nodal reentrant tachycardia and junctional rhythm, as well as ventricular arrhythmias like premature ventricular contraction, ventricular tachycardia, and ventricular fibrillation. References are included for further reading on these topics and their implications in heart physiology.

1. ECG
JUNCTIONAL &
VENTRICULAR
ARRHYTHMIAS
MARYAM JAMILAH BINTI ABDUL HAMID
082013100002
IMS BANGALORE

2. INTRODUCTION

Student should be able to understand what is
junctional and ventricular arrhythmias

Students should be able to identify these two
arrhythmias through electrocardiograph

Student should know the classification that
comes below these two arrhythmias

3. CLASSIFICATIONS
JUNCTIONAL
ARRHYTHMIA
AV Nodal Reentrant
Tachycardia
Junctional Rhythm
VENTRICULAR
ARRHYTHMIA
Premature Ventricular
Contraction
Ventricular tachycardia
Ventricular fibrillation

4. JUNCTIONAL ARRHYTHMIA
AV Nodal Reentrant Tachycardia
-A type of supraventricular tachycardia (SVT); above
the
bundle of His
-Reentry circuit forms within or just next to the AV node
-Slow pathway is located inferior and slightly posterior
to the
AV node, often following the anterior margin of
the coronary
sinus.

5. -common AVNRT; anterograde conduction is via the
slow pathway and the retrograde conduction is via the
fast pathway
-uncommon AVNRT; anterograde conduction is via the
fast pathway and the retrograde conduction is via the
slow pathway

6. ECG
- P wave that falls after the QRS complex

7. Junctional Rhythm
-Abnormal heart rhythm resulting from impulses
coming from a locus of tissue in the area of
the AV node
-AV node as the pacemaker
-Retrograde conduction
ECG
-
Without a P wave or with an inverted P wave.
-
Retrograde P waves refers to the depolarization from the AV node
back towards the SA node

9. VENTRICULAR ARRHYTHMIA
Cause:
1. Sudden electrical shock of the heart
2. Ischemia of the heart muscle, of its
specialized conducting system
3. Both

10. Normal person:
After electrical impulses reach the
ventricles, they die
off
 Because all the ventricular muscle is in
refractory phase

11. Types of Ventricular
Arrhythmias

Premature Ventricular Contraction

Ventricular Tachycardia


Ventricular Flutter


Up to 200 bpm
200-350 bpm
Ventricular Fibrillation

350-500 bpm

12. Premature Ventricular Contraction

Heartbeat is initiated by Purkinje fibres in
the ventricles rather than by the SA node

Ventricles contract first and before the atria
have optimally filled the ventricles with
blood, which means that circulation is
inefficient

13. ECG

14. Ventricular
Tachycardia
-ventricular QRS
complexes are highly
polymorphic
analogous to the
ventricular extra
systoles
Ventricular Flutter
-ECG shows large
Ventricular
Fibrillation
ECG
-fast
oscillation; main and
-small potential
terminal deflections
fluctuations in rate
-rhythm
can no longer be
-Retrograde
conduction to the atria
differentiated
is almost always
blocked; thus,
undisturbed atrial
activity is scattered
with P waves without
any relation to QRS
complexes.
-amplitude
-appearance
*a fatal condition

17. CIRCUS MOVEMENTS AS THE
BASIS FOR VENTRICULAR
FIBRILLATION

Define circus movements:
‘Re-entry’ of the impulse into muscle that has already
been excited

Why?

Pathway around the circle is too long; dilated heart

Velocity of conduction becomes decreased; blockage of
Purkinje system, ischemia of the muscle or high blood
potassium levels

Refractory period of the muscle might become greatly
shortened; drugs (epinephrine) or after repetitive electrical

19. CONCLUSION
Junctional arrhythmia;

AV nodal reentrant tachycardia

Junctional Rhythm
Ventricular arrhythmia;

Premature Ventricular Contraction

Ventricular Tachycardia

Ventricular Flutter

Ventricular Fibrillation

20. REFERENCES
1.
AK JAIN Medical Physiology, 3rd edition
2.
Davidson's Principles and Practice of Medicine, 21st Edition
3.
http://en.wikipedia.org/wiki/AV_nodal_reentrant_tachycardia
4.
http://en.wikipedia.org/wiki/Premature_ventricular_contraction
5.
American Heart Association. (2012, September 05).Ventricular fibrillation.
Retrieved from
http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/
Ventricular-Fibrillation_UCM_324063_Article.jsp
6.
Mayo Clinic Staff. (2011, November 01). Diseases and conditions
ventricular fibrillation. Retrieved from http://www.mayoclinic.org/diseasesconditions/ventricular-fibrillation/basics/definition/CON-20034473
7.
American Heart Association. (n.d.). Arrhythmias (ventricular fibrillation).
Retrieved from
http://watchlearnlive.heart.org/CVML_Player.php?moduleSelect=arrhyt
8.
http://www.drsegal.com/medstud/ecg/junction.htm
9.
http://en.wikipedia.org/wiki/Junctional_rhythm