ICCU ECGs
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1. A 65-year-old woman presented with a fall and hip fracture. Her ECG showed complete heart block with a ventricular rate of 45 beats per minute, requiring a permanent pacemaker. 2. A 50-year-old woman with rheumatic heart disease was in atrial fibrillation with a controlled ventricular rate of 60-65 beats per minute on her ECG. The ECG showed signs of digoxin use and possible hypokalemia, requiring questions about appetite and potassium levels. 3. A 20-year-old woman presented with chest pain and her ECG showed a pattern consistent with Wolff-Parkinson-White syndrome type B with right posterior accessory pathway location
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The Long QT Syndrome: Overview and Management The Long QT Syndrome: Overvie...
Long QT Syndrome is a genetic disorder characterized by a prolonged QT interval on electrocardiogram that can cause dangerous arrhythmias and sudden cardiac death. Symptoms include unexplained fainting, seizures, or sudden death, especially with exercise or emotions. Treatment involves beta blockers, implantable cardioverter defibrillators, or left stellate ganglionectomy depending on risk level and genotype. Ongoing research seeks to better understand genotype-phenotype relationships and develop mutation-specific therapies.
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The document discusses various types of ventricular arrhythmias including premature ventricular contractions, ventricular couplets, ventricular tachycardia, idioventricular rhythm, non-sustained and sustained ventricular tachycardia, monomorphic and polymorphic ventricular tachycardia, and ventricular fibrillation. It notes potential symptoms of these arrhythmias can include palpitations, dizziness, lightheadedness, syncope, and sudden cardiac arrest. Treatment options discussed include direct current cardioversion for hemodynamically unstable patients and intravenous amiodarone for stable patients.
Long QT Syndrome
1) A 70-year-old woman presented with fever for 20-25 days and was found to have bradycardia and a prolonged QT interval, consistent with acquired prolonged QT syndrome.
2) She later developed ventricular tachycardia and cardiac arrest. Electrical cardioversion was required to restore sinus rhythm.
3) A temporary pacemaker was inserted and she was monitored in the intensive care unit. Her QT interval gradually normalized over the next few days with treatment.
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Long QT Syndrome is a genetic disorder characterized by a prolonged QT interval on electrocardiogram that can cause dangerous arrhythmias and sudden cardiac death. Symptoms include unexplained fainting, seizures, or sudden death, especially with exercise or emotions. Treatment involves beta blockers, implantable cardioverter defibrillators, or left stellate ganglionectomy depending on risk level and genotype. Ongoing research seeks to better understand genotype-phenotype relationships and develop mutation-specific therapies.
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Long QT Syndrome Associated Syncope
- Long QT syndrome (LQTS) is a condition where a patient's EKG shows abnormal heart rhythms and susceptibility to rapid and chaotic heartbeats. This can cause fainting or seizures.
- Fainting, also known as syncope, is the temporary loss of consciousness caused by low blood flow to the brain. It can be triggered in LQTS patients by startling events or changes in mood like excitement or fear.
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This case report describes a 37-year-old male with recurrent ventricular tachycardia due to long QT syndrome. The patient experienced multiple episodes of sudden unconsciousness triggered by physical exertion. Electrocardiograms showed a prolonged QT interval over 500 milliseconds. The patient was treated with intravenous and oral amiodarone to revert episodes of ventricular tachycardia, as well as prescribed propranolol. He was advised to receive an implantable cardiac defibrillator but did not follow up. The long QT syndrome is a primary electrical disease characterized by an abnormally prolonged QT interval that can cause dangerous arrhythmias and sudden cardiac death if left untreated.
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This document provides an overview of various cardiac arrhythmia syndromes including Brugada syndrome, long QT syndrome, short QT syndrome, arrhythmogenic right ventricular dysplasia, Wolff-Parkinson-White syndrome, and hypertrophic cardiomyopathy. It discusses the clinical features, ECG findings, diagnostic criteria, and disposition for each condition. Key advice includes carefully examining leads V1-V3 for abnormalities, being aware of rare conditions like short QT syndrome, and consulting cardiology when these complex syndromes are suspected.
Ventricular tachycardia
The document discusses various types of ventricular arrhythmias including premature ventricular contractions, ventricular couplets, ventricular tachycardia, idioventricular rhythm, non-sustained and sustained ventricular tachycardia, monomorphic and polymorphic ventricular tachycardia, and ventricular fibrillation. It notes potential symptoms of these arrhythmias can include palpitations, dizziness, lightheadedness, syncope, and sudden cardiac arrest. Treatment options discussed include direct current cardioversion for hemodynamically unstable patients and intravenous amiodarone for stable patients.
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1) A 70-year-old woman presented with fever for 20-25 days and was found to have bradycardia and a prolonged QT interval, consistent with acquired prolonged QT syndrome.
2) She later developed ventricular tachycardia and cardiac arrest. Electrical cardioversion was required to restore sinus rhythm.
3) A temporary pacemaker was inserted and she was monitored in the intensive care unit. Her QT interval gradually normalized over the next few days with treatment.
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This patient is a 72-year-old male who presented with ventricular tachycardia. He has a history of ischemic heart disease, myocardial infarction, and coronary artery bypass grafting. Diagnostic tests showed ventricular tachycardia, metabolic acidosis, acute kidney injury, cardiogenic shock, NSTEMI, and aspiration pneumonia. He received treatment including shock, intubation, hemodialysis, and medications. Nursing care involved ongoing monitoring, managing medications and side effects, and patient/family education.
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A 14-year-old girl presented with episodes of giddiness and transient loss of consciousness. Her ECG showed a 2:1 atrioventricular block with a heart rate of 45 beats per minute and bizarre T-wave inversions. This is consistent with Stokes-Adams attacks due to intermittent complete heart block. The level of the block needs to be confirmed with HIS bundle electrogram recording but it is likely infranodal given the abnormal QRS morphology. Permanent pacemaker implantation is recommended for recurrent syncopal attacks from complete heart block.
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This document discusses ventricular tachycardia (VT) clusters and incessant VT. It defines a VT cluster as 3 or more sustained VTs within 24 hours. Treatment options discussed include antiarrhythmic drugs, ablation, anesthesia, and LVAD. Amiodarone, lidocaine, and procainamide dosages are provided. Left stellate ganglion blockade is suggested as superior to antiarrhythmic drugs for electrical storms. The document also discusses therapies for VT including ablation and digitalis toxicity management.
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This document provides an overview of the approach to evaluating and diagnosing wide complex tachycardias. It begins with definitions of terms like wide complex tachycardia, ventricular tachycardia, and supraventricular tachycardia. It then discusses the importance of making an accurate diagnosis to avoid inappropriate treatment. Various ECG criteria are presented to help distinguish ventricular from supraventricular rhythms based on features like AV dissociation, QRS morphology, axis, and precordial patterns. Specific criteria for right bundle branch block and left bundle branch block morphologies are also outlined. The document emphasizes taking a stepwise approach and considering clinical history in narrowing the differential diagnosis of wide complex tachycardias.
Adult tachycardia
1) When encountering a patient with tachycardia, first check if they have a pulse and if they are stable or unstable. Then treat according to the ACLS tachycardia algorithm.
2) For stable tachycardia, further assess if the QRS is narrow or wide, regular or irregular to determine the likely rhythm and appropriate treatment.
3) Unstable tachycardia requires immediate synchronized cardioversion without delay.
Ventricular tachycardia
This document describes the case of a 77-year-old male who was found unconscious on the street by EMS with a heart rate of 250 beats per minute. He has a history of atrial fibrillation, hypertension, diabetes, and had a pacemaker inserted in 2014. Initial workup found ventricular tachycardia. He received amiodarone and cardioversion with temporary success. Over the following days he experienced recurrent arrhythmias and heart failure exacerbation. Angiography found no obstructive coronary artery disease. An ICD was implanted for secondary prevention of further lethal arrhythmias given his cardiomyopathy and recurrent instabilities.
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1. Ventricular tachycardia (VT) is an important cause of sudden cardiac arrest and can manifest as premature ventricular contractions (PVCs) or sustained VT.
2. VT can be idiopathic, focal, or associated with structural heart disease such as ischemic or non-ischemic cardiomyopathy.
3. Treatment depends on the type and cause of VT but may include medications, implantable cardioverter defibrillators (ICDs), and catheter ablation which can be curative for some idiopathic VT cases.Management of pv cs and ventricular tachycardia in advanced heart failure
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3. For managing VT in advanced heart failure, a multidisciplinary team approach is important. Options discussed include various antiarrhythmic drugs, early VT ablation, and hemodynamic support such as percutaneous left ventricular assist devices during ablation procedures.
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This document discusses various types of tachyarrhythmias categorized by their anatomical location and electrophysiological mechanisms. It describes atrial arrhythmias including sinus tachycardia, atrial fibrillation, atrial flutter, and atrial tachycardia. It also discusses atrioventricular node reentrant tachycardia, atrioventricular reentrant tachycardia, junctional tachycardia, and ventricular arrhythmias including monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, and ventricular fibrillation. Key features and mechanisms of each type are outlined to aid in diagnosis and classification.
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Supraventricular tachycardia
Most people with supraventricular tachycardia don't need activity restrictions or treatment. For others, lifestyle changes, medication and heart procedures may be needed to control or eliminate the rapid heartbeats and related symptoms.
Types
Supraventricular tachycardia (SVT) falls into three main groups:
Atrioventricular nodal reentrant tachycardia (AVNRT). This is the most common type of supraventricular tachycardia.
Atrioventricular reciprocating tachycardia (AVRT). AVRT is the second most common type of supraventricular tachycardia. It's most commonly diagnosed in younger people.
Atrial tachycardia. This type of SVT is more commonly diagnosed in people who have heart disease. Atrial tachycardia doesn't involve the AV node.
Other types of supraventricular tachycardia include:
Sinus tachycardia
Sinus nodal reentrant tachycardia (SNRT)
Inappropriate sinus tachycardia (IST)
Multifocal atrial tachycardia (MAT)
Junctional ectopic tachycardia (JET)
Nonparoxysmal junctional tachycardia (NPJT)
Symptoms
The main symptom of supraventricular tachycardia (SVT) is a very fast heartbeat (100 beats a minute or more) that may last for a few minutes to a few days. The fast heartbeat may come and go suddenly, with stretches of typical heart rates in between.
Some people with SVT have no signs or symptoms.
Signs and symptoms of supraventricular tachycardia may include:
Very fast (rapid) heartbeat
A fluttering or pounding in the chest (palpitations)
A pounding sensation in the neck
Weakness or feeling very tired (fatigue)
Chest pain
Shortness of breath
Lightheadedness or dizziness
Sweating
Fainting (syncope) or near fainting
In infants and very young children, signs and symptoms of SVT may be difficult to identify. They include sweating, poor feeding, pale skin and a rapid pulse. If your infant or young child has any of these symptoms, ask your child's care provider about SVT screening.
When to see a doctor
Supraventricular tachycardia (SVT) is generally not life-threatening unless you have heart damage or other heart conditions. However, in extreme cases, an episode of SVT may cause unconsciousness or cardiac arrest.
Call your health care provider if you have an episode of a very fast heartbeat for the first time or if an irregular heartbeat lasts longer than a few seconds.
Some signs and symptoms of SVT may be related to a serious health condition. Call 911 or your local emergency number if you have an episode of SVT that lasts for more than a few minutes or if you have an episode with any of the following symptoms:
Chest pain
Shortness of breath
Weakness
Dizziness
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Causes
For some people, a supraventricular tachycardia (SVT
Syncope and the ECG
The document provides information on electrocardiogram (ECG) findings and their significance in patients presenting with syncope. It discusses diagnostic criteria and risk stratification tools for evaluating causes of syncope, including the CHESS criteria and San Francisco Syncope Rule. Important ECG findings that warrant further investigation or indicate an underlying cardiac condition are highlighted, such as arrhythmias, conduction abnormalities, signs of ischemia, and structural heart disease. Specific arrhythmias and cardiac conditions like long QT syndrome and Brugada syndrome are also reviewed in the context of evaluating syncope.
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This document discusses risk factors, stages, management, and treatment of sudden cardiac death (SCD). It identifies key risk factors for SCD including older age, male sex, coronary artery disease history, high cholesterol, hypertension, smoking, and abnormal heart rhythms. The stages of SCD are described as prodromal, acute symptoms, and circulatory disturbances leading to biological death. Management involves evaluating the patient, performing CPR, using defibrillation and other advanced life support measures, post-resuscitation treatment, and long-term management. Specific protocols are provided for basic life support including CPR, advanced life support, and treating ventricular tachycardia or fibrillation.
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The document provides information about various cardiac conditions that can be identified on ECGs, echocardiograms, chest x-rays and other cardiac tests. It describes the findings and diagnoses for 12 different clinical cases, including polymorphic atrial tachycardia, preexcited atrial fibrillation, AV nodal reentrant tachycardia, Brugada syndrome, R-on-T phenomenon, hypokalemia, catecholaminergic polymorphic ventricular tachycardia, atrial lead dislodgment, atrial flutter, pulmonary and aortic pressures in ventricular septal defect, and intra-aortic balloon pump positioning.
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A 14-year-old girl presented with episodes of giddiness and transient loss of consciousness. Her ECG showed a 2:1 atrioventricular block with a heart rate of 45 beats per minute and bizarre T-wave inversions. This is consistent with Stokes-Adams attacks due to intermittent complete heart block. The level of the block needs to be confirmed with HIS bundle electrogram recording but it is likely infranodal given the abnormal QRS morphology. Permanent pacemaker implantation is recommended for recurrent syncopal attacks from complete heart block.
Ventricular tachycardia
This document discusses ventricular tachycardia (VT) clusters and incessant VT. It defines a VT cluster as 3 or more sustained VTs within 24 hours. Treatment options discussed include antiarrhythmic drugs, ablation, anesthesia, and LVAD. Amiodarone, lidocaine, and procainamide dosages are provided. Left stellate ganglion blockade is suggested as superior to antiarrhythmic drugs for electrical storms. The document also discusses therapies for VT including ablation and digitalis toxicity management.
Brugada Syndrome, Sbcc 2012
Brugada Syndrome is a genetic cardiac condition characterized by abnormal ECG patterns and risk of sudden cardiac death. It is caused by mutations in the SCN5A gene which encodes cardiac sodium channels. Patients typically present with syncope or sudden death and have a distinctive pattern on ECG of ST segment elevation in leads V1-V3. Risk stratification focuses on history of symptoms like syncope as inducible arrhythmias on electrophysiological study have poor predictive value. Treatment involves medical management with quinidine or device therapy with an ICD for high-risk patients. Lifestyle modifications like avoiding fever or medications that affect sodium channels are also recommended.
Wide complex tachycardia
This document provides an overview of the approach to evaluating and diagnosing wide complex tachycardias. It begins with definitions of terms like wide complex tachycardia, ventricular tachycardia, and supraventricular tachycardia. It then discusses the importance of making an accurate diagnosis to avoid inappropriate treatment. Various ECG criteria are presented to help distinguish ventricular from supraventricular rhythms based on features like AV dissociation, QRS morphology, axis, and precordial patterns. Specific criteria for right bundle branch block and left bundle branch block morphologies are also outlined. The document emphasizes taking a stepwise approach and considering clinical history in narrowing the differential diagnosis of wide complex tachycardias.
Adult tachycardia
1) When encountering a patient with tachycardia, first check if they have a pulse and if they are stable or unstable. Then treat according to the ACLS tachycardia algorithm.
2) For stable tachycardia, further assess if the QRS is narrow or wide, regular or irregular to determine the likely rhythm and appropriate treatment.
3) Unstable tachycardia requires immediate synchronized cardioversion without delay.
Ventricular tachycardia
This document describes the case of a 77-year-old male who was found unconscious on the street by EMS with a heart rate of 250 beats per minute. He has a history of atrial fibrillation, hypertension, diabetes, and had a pacemaker inserted in 2014. Initial workup found ventricular tachycardia. He received amiodarone and cardioversion with temporary success. Over the following days he experienced recurrent arrhythmias and heart failure exacerbation. Angiography found no obstructive coronary artery disease. An ICD was implanted for secondary prevention of further lethal arrhythmias given his cardiomyopathy and recurrent instabilities.
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1. Ventricular tachycardia (VT) is an important cause of sudden cardiac arrest and can manifest as premature ventricular contractions (PVCs) or sustained VT.
2. VT can be idiopathic, focal, or associated with structural heart disease such as ischemic or non-ischemic cardiomyopathy.
3. Treatment depends on the type and cause of VT but may include medications, implantable cardioverter defibrillators (ICDs), and catheter ablation which can be curative for some idiopathic VT cases.Management of pv cs and ventricular tachycardia in advanced heart failure
1. This document discusses therapeutic options and novel approaches for managing premature ventricular contractions (PVCs) and ventricular tachycardia (VT) in patients with advanced heart failure.
2. Frequent PVCs can themselves cause cardiomyopathy, but ablation of PVCs has been shown to improve left ventricular ejection fraction and size in some cases. PVC ablation is generally safe and well-tolerated.
3. For managing VT in advanced heart failure, a multidisciplinary team approach is important. Options discussed include various antiarrhythmic drugs, early VT ablation, and hemodynamic support such as percutaneous left ventricular assist devices during ablation procedures.
Toxicology and the ECG
This document discusses toxicology and ECG interpretation in poisoned patients. It provides an overview of the cardiac conduction system and how specific drugs can affect it. Drugs that block sodium channels can cause a wide QRS complex, while potassium channel blockers prolong the QT interval and increase risk of Torsades de Pointes. A systematic approach to ECG interpretation is outlined, examining rate, rhythms, intervals, and morphology. Management strategies are presented for various cardiotoxic drugs like beta blockers, calcium channel blockers, sodium channel blockers, and cardiac glycosides.
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A 60-year-old male with multiple comorbid issues presented to the emergency room with chest pain. An ECG showed tall T waves and right bundle branch block. A CT/PET stress test revealed a small inferolateral infarct and significant peri-infarct ischemia. The patient was referred to cardiology to rule out acute coronary syndrome.
Tachyarrhythmia Management
This document discusses various types of tachyarrhythmias categorized by their anatomical location and electrophysiological mechanisms. It describes atrial arrhythmias including sinus tachycardia, atrial fibrillation, atrial flutter, and atrial tachycardia. It also discusses atrioventricular node reentrant tachycardia, atrioventricular reentrant tachycardia, junctional tachycardia, and ventricular arrhythmias including monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, and ventricular fibrillation. Key features and mechanisms of each type are outlined to aid in diagnosis and classification.
Drug induced QT prolongation
This document discusses QT prolongation and Torsades de Pointes (TdP), a type of ventricular arrhythmia. It provides background on the QT interval and factors that can cause prolongation and TdP. Certain drugs are noted to block potassium channels and prolong the QT interval, with some drugs like cisapride, erythromycin, and sotalol commonly associated with TdP. The document outlines how to measure the QT interval and correct it for heart rate, and notes values that indicate normal vs prolonged intervals. Images of ECG strips demonstrate characteristic patterns seen with TdP.
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Similar to ICCU ECGs
Supraventricular tachycardia
Most people with supraventricular tachycardia don't need activity restrictions or treatment. For others, lifestyle changes, medication and heart procedures may be needed to control or eliminate the rapid heartbeats and related symptoms.
Types
Supraventricular tachycardia (SVT) falls into three main groups:
Atrioventricular nodal reentrant tachycardia (AVNRT). This is the most common type of supraventricular tachycardia.
Atrioventricular reciprocating tachycardia (AVRT). AVRT is the second most common type of supraventricular tachycardia. It's most commonly diagnosed in younger people.
Atrial tachycardia. This type of SVT is more commonly diagnosed in people who have heart disease. Atrial tachycardia doesn't involve the AV node.
Other types of supraventricular tachycardia include:
Sinus tachycardia
Sinus nodal reentrant tachycardia (SNRT)
Inappropriate sinus tachycardia (IST)
Multifocal atrial tachycardia (MAT)
Junctional ectopic tachycardia (JET)
Nonparoxysmal junctional tachycardia (NPJT)
Symptoms
The main symptom of supraventricular tachycardia (SVT) is a very fast heartbeat (100 beats a minute or more) that may last for a few minutes to a few days. The fast heartbeat may come and go suddenly, with stretches of typical heart rates in between.
Some people with SVT have no signs or symptoms.
Signs and symptoms of supraventricular tachycardia may include:
Very fast (rapid) heartbeat
A fluttering or pounding in the chest (palpitations)
A pounding sensation in the neck
Weakness or feeling very tired (fatigue)
Chest pain
Shortness of breath
Lightheadedness or dizziness
Sweating
Fainting (syncope) or near fainting
In infants and very young children, signs and symptoms of SVT may be difficult to identify. They include sweating, poor feeding, pale skin and a rapid pulse. If your infant or young child has any of these symptoms, ask your child's care provider about SVT screening.
When to see a doctor
Supraventricular tachycardia (SVT) is generally not life-threatening unless you have heart damage or other heart conditions. However, in extreme cases, an episode of SVT may cause unconsciousness or cardiac arrest.
Call your health care provider if you have an episode of a very fast heartbeat for the first time or if an irregular heartbeat lasts longer than a few seconds.
Some signs and symptoms of SVT may be related to a serious health condition. Call 911 or your local emergency number if you have an episode of SVT that lasts for more than a few minutes or if you have an episode with any of the following symptoms:
Chest pain
Shortness of breath
Weakness
Dizziness
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Causes
For some people, a supraventricular tachycardia (SVT
Syncope and the ECG
The document provides information on electrocardiogram (ECG) findings and their significance in patients presenting with syncope. It discusses diagnostic criteria and risk stratification tools for evaluating causes of syncope, including the CHESS criteria and San Francisco Syncope Rule. Important ECG findings that warrant further investigation or indicate an underlying cardiac condition are highlighted, such as arrhythmias, conduction abnormalities, signs of ischemia, and structural heart disease. Specific arrhythmias and cardiac conditions like long QT syndrome and Brugada syndrome are also reviewed in the context of evaluating syncope.
ECG Rhythm abnormality for undergraduates
The rhythm is best analyzed by looking at a rhythm strip.
On a 12 lead ECG this is usually a 10 second recording from Lead II.
Confirm or corroborate any findings in this lead by checking the other leads.
A longer rhythm strip, recorded perhaps recorded at a slower speed, may be helpful.
Ecg workshop
A 23-year-old female presented with episodes of feeling lightheaded and weak. She had a history of anorexia nervosa and had lost significant weight recently. Laboratory tests revealed low calcium, potassium, and other electrolyte abnormalities. During her emergency department stay, she experienced another episode where a rhythm strip was obtained. The rhythm strip showed a prolonged QT interval, likely the cause of her symptoms due to electrolyte abnormalities from her eating disorder.
Thyroid and the Heart
This document discusses syncope, which is a transient loss of consciousness due to temporary reduced blood flow to the brain. It notes that syncope accounts for around 1% of emergency department visits and is a common cause of hospitalization for those over 65. Establishing the exact cause is difficult as the patient has usually recovered by the time they are examined. The document then discusses various causes of syncope and nonsyncopal attacks that can be mistaken for syncope. It provides breakdowns of common causes by age group and discusses the natural history and risk stratification of syncope of unknown cause in the emergency department.
Ecg !
1. The document describes 4 ECG findings from patients presenting with various symptoms. The first case shows ventricular bigeminy in a patient with chest pain. The second case shows sinus tachycardia with S1Q3T3 pattern in a bedridden patient with breathlessness, indicating pulmonary embolism. The third case shows ventricular tachycardia in a patient recently diagnosed with myocardial infarction. The fourth case provides the Brugada criteria used to diagnose Brugada syndrome.
Family medicine presentation1120111final
A 28-year-old school teacher and mother of 3 children presented with chest pain and palpitations. Her ECG showed normal sinus rhythm. A 53-year-old male with a history of pontine hemorrhage presented with chest pain. His two sets of cardiac enzymes were normal and his ECG showed NSR with LVH and LV strain pattern. A 65-year-old male with a history of recurrent heart failure and non-ischemic cardiomyopathy was admitted to the CCU and his ECG showed NSR with LBBB.
ECG life in the fastlane.pptx
This ECG shows ventricular tachycardia in a middle-aged patient presenting with palpitations and dizziness. Key findings include a regular broad complex tachycardia with northwest axis and an atypical RBBB pattern in V1 with a taller left "rabbit ear", indicating ventricular tachycardia rather than supraventricular tachycardia with aberrant conduction. Immediate treatment is needed given the life-threatening nature of sustained ventricular tachycardia.
0 ecg arrhythmia for medical students samir rafla
This document provides an overview of cardiac arrhythmias for medical students. It begins with an introduction to conduction pathways and ECG patterns. It then classifies arrhythmias as rapid and regular, rapid and irregular, or slow and regular. Specific arrhythmias are defined and their causes discussed, including sinus tachycardia, sinus bradycardia, supraventricular tachycardias, atrial fibrillation, Wolff-Parkinson-White syndrome, atrial flutter, ventricular tachycardia, heart block, and sudden cardiac death. Treatment options are also reviewed for many of the arrhythmias.
ECG Monitoring (Basic of ECG)
The document discusses electrocardiography (ECG or EKG) and defines its key components. An ECG records the electrical activity of the heart through electrodes placed on the skin. It analyzes elements like the P wave, QRS complex, ST segment, T wave, and intervals between them like the PR and QT. Abnormalities in these components can indicate various heart conditions. The document provides details on normal values and clinical significance of an ECG reading.
Ecg case
This document contains 6 ECG readings from patients presenting with various chest complaints. For each reading, it provides the clinical interpretation of the ECG findings and recommends next steps in management, such as administering thrombolytics, referring for angiography, or implanting a pacemaker. Common presentations included prior heart attacks, heart block, acute myocardial infarction, and supraventricular tachycardia. The recommended treatments were aimed at addressing the underlying cardiac issues and providing symptom relief.
Chest pain evaluation dr md toufiqur rahman dm fcps facc frcp fesc faha fscai...
Chest pain evaluation dr md toufiqur rahman dm fcps facc frcp fesc faha fscai...PROFESSOR DR. MD. TOUFIQUR RAHMAN
This document provides information on evaluating and diagnosing chest pain, including differential diagnoses and case scenarios. It outlines objectives of establishing a differential diagnosis for chest pain and knowing how to diagnose conditions like myocardial infarction (MI), pulmonary embolism (PE), pneumothorax, and aortic dissection. Common etiologies of chest pain are described. Case scenarios provide examples of applying history, physical exam findings, and test results to arrive at probable diagnoses for various patient presentations of chest pain. Key investigations and management strategies for conditions like MI are also reviewed.ECG reading
The document discusses the history and importance of the electrocardiogram (ECG or EKG). It notes that while the ECG was initially not thought to find extensive clinical use, it is now one of the most commonly performed cardiovascular tests, with over 100 million performed annually in the US. The document then provides information on indications for ECGs, the components of an ECG, basic principles of ECG interpretation including intervals and patterns, and abnormalities that can be identified on an ECG.
DECIPHERING COMMON ECG FINDINGS IN ED.pptx
ECG in ED. What usually missed and underestimate ECG. STEMI equivalent ST depression. Tachy and brady.
A doctor in ED must know this.
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.
ECG evaluation by history and tracings -1
ECG, Electrocardiogram, Ventricular Tachycardia, Supraventricular Tachycardia, Acute myocardial infarction, pacemaker ECG,
Severe Aortic Stenosis with Ischemic Heart Disease. (Management of TAVI) - Pa...
Pathology case presentation - Severe Aortic Stenosis with Ischemic Heart Disease.
(Management of TAVI)
Ecg example
This document contains 17 questions about ECG interpretations with corresponding answers. Each question provides an ECG reading and clinical scenario, and the answers analyze the ECG findings and provide a diagnosis. Some of the conditions addressed include atrial fibrillation, atrial flutter, ventricular tachycardia, STEMI, non-STEMI, Brugada syndrome, WPW syndrome, hyperkalemia, pulmonary embolism, pericarditis, hypothermia, and more. The document serves as a teaching aid with examples of ECG interpretations for various cardiac conditions and presentations.
Pe
The ECG shows a pattern of right ventricular hypertrophy with a large R wave in lead V1 and deep S wave in lead V6, suggesting enlarged right ventricle. This, along with the juvenile T wave pattern of inverted T waves in the precordial leads from birth to age 8, are consistent with the normal developmental changes described in the document as the left ventricle increases in dominance from birth through childhood. The document provides an overview of normal pediatric ECG patterns and intervals across age groups as well as common arrhythmias and abnormalities.
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Chest pain evaluation dr md toufiqur rahman dm fcps facc frcp fesc faha fscai...
Chest pain evaluation dr md toufiqur rahman dm fcps facc frcp fesc faha fscai...
Supraventricular tacchyarrhythmias a breif discussion
Supraventricular tacchyarrhythmias a breif discussion
Severe Aortic Stenosis with Ischemic Heart Disease. (Management of TAVI) - Pa...
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More from Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
PEDIATRIC SUDDEN CARDIAC DEATH, SYNCOPE, INHERITABLE ARRHYTHMIAS
PEDIATRIC SUDDEN CARDIAC DEATH, SYNCOPE, INHERITABLE ARRHYTHMIASDr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
Syncope refers to a sudden, transient loss of consciousness due to decreased blood flow to the brain. In children and adolescents, cardiac abnormalities causing syncope are rare, and the most common causes are autonomic syncope, vasovagal syncope, and postural hypotension. Evaluation of syncope in children aims to determine if there is an increased risk of sudden cardiac death. Factors suggesting a cardiac cause include lack of prodrome, palpitations, exercise-induced syncope, family history of cardiac issues or early death, and prior known cardiac disease. These patients should be referred to a cardiologist to evaluate for potential inherited cardiac conditions like Brugada syndrome or long QT syndrome.FETAL CARDIAC SCREENING
The document outlines a talk on fetal cardiac screening. It discusses the impact of screening from both a health and parental perspective. Screening allows for planning delivery at centers equipped for any needed care. It can identify life-threatening conditions for in utero treatment or help avoid unnecessary post-birth testing and transport. Parents benefit from informed decisions and preparation. The talk explores current practices and potential future directions for improving screening.
SYNCOPE, SUDDEN CARDIAC DEATH AND INHERITED ARRHYTHMIAS
This document discusses syncope in children and adolescents, providing definitions of syncope and sudden cardiac death. It notes that cardiac abnormalities are a rare cause of syncope in children unlike in adults. Various types of autonomic syncope are described including vasovagal, postural hypotension, and dyautonomia. Evaluation for cardiac syncope is recommended to determine risk of death. Specific cardiac conditions like Brugada syndrome, long QT syndrome, short QT syndrome, and catecholaminergic polymorphic ventricular tachycardia are discussed. The take home message is to consider arrhythmias with any exertional or unexplained syncope and to evaluate family history of sudden cardiac death or arrhythmias.
PEDIATRIC CARDIOLOGY CASE SCENARIOS
This document discusses two case scenarios involving pediatric cardiology patients. The first scenario is about a 12-year-old boy who is overweight due to a sedentary lifestyle involving online schooling, TV watching, and eating fast and junk food. The second scenario describes a 14-year-old active boy whose grandfather died at age 49 and who has elevated cholesterol and LDL levels. The document discusses the long-term cardiovascular risks of obesity and high cholesterol in childhood, including increased blood pressure, lipids, and future risk of atherosclerosis. It recommends addressing these risks through lifestyle changes, physical activity, healthy eating, and early screening and treatment when needed, including behavioral interventions and statin prescriptions in rare cases of familial hyper
PERCUTANEOUS DEVICE CLOSURE OF AORTO- PULMONARY WINDOW (RESIDUAL)
PERCUTANEOUS DEVICE CLOSURE OF AORTO- PULMONARY WINDOW (RESIDUAL) Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document discusses the percutaneous closure of a residual aortopulmonary window in a 2-year-old boy using a second occlusion device. The boy was originally treated for an aortopulmonary window at 2 months of age, but follow up showed a residual 4mm window. A second device, an ADO-II 6x6, was successfully deployed above the original device with no residual shunt seen. The boy was discharged the next day with both devices in position and no complications. The summary demonstrates the feasibility of using a second occlusion device to treat residual defects after an initial device closure procedure.LONG TERM OUTCOMES OF POST OPERATIVE CHILD WITH CONGENITAL HEART DISEASES
LONG TERM OUTCOMES OF POST OPERATIVE CHILD WITH CONGENITAL HEART DISEASESDr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
Long term Post operative care of a child with CHD involves monitoring for potential issues like reintervention due to lesion recurrence, arrhythmias, and thromboembolism. It also requires assessing schooling, neurodevelopment, exercise capacity, and providing guidance on marriage, pregnancy, and contraception. Children with repaired lesions are most at risk for reintervention and arrhythmias compared to those with completely corrected or palliated lesions. While outcomes have improved, lifelong multidisciplinary care is generally needed due to the risk of ongoing medical, developmental, and social issues.WHEN TO REFER TO A PEDIATRIC CARDIOLOGIST
This document discusses the timing of interventions for congenital heart defects (CHDs) in pediatric patients. It involves balancing factors like hemodynamic severity, natural history of the defect, procedural outcomes, and institutional experience. There is a trend toward early correction which avoids adverse consequences and is now feasible and realistic in Indian centers with excellent results. The document then discusses scenarios involving ventricular septal defects, atrial septal defects, and patent ductus arteriosus, when intervention is recommended based on symptoms, size of defect, and age/weight of the patient. It notes most CHDs can now be corrected with long-term survival and without need for reintervention in 85-90% of cases.
PEDIATRIC ECHOCARDIOGRAPHY: APICAL AND PARASTERNAL VIEWS
PEDIATRIC ECHOCARDIOGRAPHY: APICAL AND PARASTERNAL VIEWSDr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document provides an overview of various echocardiographic views used to visualize cardiac structures and diagnose pathologies. It describes the apical and parasternal views including the 4-chamber, 5-chamber, 2-chamber, and short-axis views. Each view is explained in terms of the structures seen and pathologies that can be identified. Measurement techniques like Simpson's method for ejection fraction are also summarized.WHEN TO REFER A CHILD TO A PEDIATRIC CARDIOLOGIST FOR INTERVENTION
WHEN TO REFER A CHILD TO A PEDIATRIC CARDIOLOGIST FOR INTERVENTIONDr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document discusses the timing of interventions for various congenital heart defects (CHDs) in pediatric patients. It provides several case scenarios to illustrate the decision-making process. The key factors in determining when to intervene include the hemodynamic severity of the defect, its predicted natural history, procedural outcomes, and institutional experience. Early correction is generally preferred to avoid complications, and is now feasible in selected centers with excellent results. The document reviews timing guidelines for specific defects such as ventricular septal defects and patent ductus arteriosus. It also describes treatment options such as surgical closure or transcatheter device closure for different CHDs.PEDAITRIC OBESITY AND HYPERLIPEDEMIA
A 12-year-old child is overweight with a BMI of 31 kg/m2 due to a sedentary lifestyle. Obesity increases the risk of high blood pressure, diabetes, and cardiovascular disease over the long term. Management involves promoting outdoor physical activity and healthy eating habits.
A 14-year-old boy has a family history of early death from cardiovascular disease. Though active, he has elevated cholesterol levels placing him at risk for future cardiovascular problems. Early detection and lifestyle modifications can help prevent disease progression.
Screening children's cholesterol levels starting at age 10 and 19 allows for early identification of risk and targeted prevention and treatment approaches like lifestyle changes and low-dose statin therapy for those at highest risk
Micronutrient deficiency In Children
Micronutrient deficiency is common among children globally. At least 50% of children aged 6 months to 5 years suffer from one or more micronutrient deficiencies such as iron, iodine, folate, and vitamin A. The reasons for the high prevalence include inadequate intake of nutritious foods, poor absorption of minerals and vitamins, frequent infections, and consumption of refined foods. Micronutrients play an important role in brain development during the first 1,000 days of life. Complementary feeding starting at 6 months is important to meet increased nutrient needs but current practices in India are often inadequate. Ensuring adequate nutrition through home-made preparations, breastfeeding, and fortified complementary foods can help bridge nutrition
DYSBIOSIS IN CHILDREN BORN BY CAESAREAN SECTION
1. Caesarean section delivery disrupts the normal pattern of microbial colonization in infants, dominating their gut with bacteria from the human skin and oral cavity rather than vaginal and enteric bacteria acquired during a vaginal birth.
2. Microbial dysbiosis resulting from C-section delivery has been associated with increased risk of conditions like asthma, obesity, food allergies, and inflammatory bowel disease later in life.
3. Restoring a healthy gut microbiota in infants born by C-section through breastfeeding and probiotic supplementation may help reduce the risk of these long-term health issues, though more research is still needed.
PEDIATRIC CARDIAC SERVICES IN INDIA: WHERE DO WE ACTUALLY STAND?
PEDIATRIC CARDIAC SERVICES IN INDIA: WHERE DO WE ACTUALLY STAND?Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document discusses the current state of pediatric cardiac services in India. It notes that India has a high birth prevalence of congenital heart disease (CHD), with approximately 242,390 children born with CHD each year. However, the availability of advanced cardiac care is very limited, with only 9 high-volume centers performing over 500 surgeries per year. While an estimated 43,000 children are born annually with serious forms of CHD requiring treatment, only around 8,500 (20%) currently receive optimal cardiac care. The document outlines several challenges facing the improvement and expansion of pediatric cardiac services in India, including limited resources, infrastructure, and trained staff. It proposes various strategies to address these issues, such as establishing more specializedHeart diseases in children
1. Heart diseases in children, specifically congenital heart diseases (CHDs), are not as rare as once thought, occurring in 8-10 out of every 1,000 live births and representing the most common birth defect.
2. CHDs can present in a variety of ways from cyanosis and congestive heart failure in neonates to symptoms appearing later in childhood. Determining if a CHD is present, whether it involves cyanosis, and the specific malformation involved requires consideration of various clinical criteria and tests.
3. Proper diagnosis and management is important as some CHDs depend on persistent ductal circulation after birth for survival, requiring treatment with prostaglandins to keep the ductus arteriosus
CONGENITAL HEART DISEASES: A SIMPLIFIED APPROACH
This document provides an overview of congenital heart diseases (CHDs):
1. CHDs are defects in heart structure and function that exist at birth, though symptoms may not appear until childhood or later. They occur in approximately 1% of live births and are a leading cause of birth defect mortality.
2. CHDs can be acyanotic (without cyanosis) or cyanotic (with cyanosis) and include defects such as ventricular septal defects (VSD), atrial septal defects (ASD), patent ductus arteriosus (PDA), tetralogy of Fallot, and transposition of the great arteries.
3. While the exact causes of most CHDs are unknown
Examination of Cardio Vascular System (CVS): Pediatrics+ APPROACH TO A CHILD ...
Examination of Cardio Vascular System (CVS): Pediatrics+ APPROACH TO A CHILD ...Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document provides an overview of examining the cardiovascular system in pediatric patients and approaching a child with suspected congenital heart disease (CHD). It discusses taking a history, performing a general physical exam, assessing vital signs, inspecting the precordium, palpating pulses and heart sounds, and auscultating for murmurs. The key steps in approaching a child with possible CHD are determining if it is cyanotic or acyanotic, assessing pulmonary blood flow and pulmonary artery pressure, and identifying any duct-dependent lesions.TACHYPNIC NEOANTE: IS IS A CHD: APPROACH TO A CHILD WITH CONGENITAL HEART DIS...
TACHYPNIC NEOANTE: IS IS A CHD: APPROACH TO A CHILD WITH CONGENITAL HEART DIS...Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
A 2 day old term neonate presented with tachypnea and a heart rate of 90%, raising suspicion of a congenital heart disease (CHD). To determine if the neonate had a CHD, the doctor considered performing a hyperoxia test, applying Nada's criteria, and conducting an echocardiogram. If a CHD was confirmed, the next steps would be to determine if the child had cyanotic or acyanotic heart disease, increased or normal pulmonary blood flow, pulmonary arterial hypertension, and duct dependency to guide referral to a pediatric cardiologist.Cath meet 25020202 (TGA, VSD, PS FOR PA PRESSURES)
- The document summarizes a cardiac catheterization report for a 16-month-old female patient with a history of cyanosis, murmur, and failure to gain weight appropriately who was diagnosed with congenital heart disease.
- Examination findings included cyanosis, low oxygen saturation, murmur, and signs of right ventricular hypertrophy. Previous echocardiogram showed dextro-transposition of the great arteries, ventricular septal defect, and pulmonary stenosis.
- The cardiac catheterization measured pressures in the heart chambers and major vessels. It found elevated pulmonary artery and right-sided heart pressures consistent with pulmonary hypertension. Calculations from the data determined abnormal pulmonary and systemic vascular resistances and a low ratio of
Cath meet 03022020 (VSD PAH FOR REVERSIBILITY, PVR)
- The patient is a 3 year old female with a history of lung infections as an infant and diagnosis of congenital heart disease requiring surgery at age 1 year.
- Examination found signs of right heart enlargement and a loud heart murmur. Echocardiogram showed a large ventricular septal defect with left-to-right shunting and mild pulmonary artery hypertension.
- Cardiac catheterization was performed and found severe pulmonary artery hypertension with right ventricular and pulmonary artery pressures elevated. Oxygen saturations were low in the veins and pulmonary artery.
THALASSEMIA: VENTRICULAR DYSFUNCTION ASSESSMENT
This study assessed 33 multi-transfused thalassemic children with iron overload using tissue Doppler imaging (TDI), strain imaging (SI), and conventional 2D echocardiography compared to 32 healthy controls. While 2D echocardiography showed higher left ventricular dimensions and mass in thalassemic children, ejection fraction and diastolic parameters were normal. TDI velocities were normal at the septum but lower at the lateral wall in thalassemic children. SI and strain rate imaging parameters were significantly lower in thalassemic children across all measured segments. The study concludes that while ejection fraction remains normal with 2D echocardiography, TDI and SI can detect early and regional myocardial involvement not seen with conventional
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PEDIATRIC SUDDEN CARDIAC DEATH, SYNCOPE, INHERITABLE ARRHYTHMIAS
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SYNCOPE, SUDDEN CARDIAC DEATH AND INHERITED ARRHYTHMIAS
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LONG TERM OUTCOMES OF POST OPERATIVE CHILD WITH CONGENITAL HEART DISEASES
LONG TERM OUTCOMES OF POST OPERATIVE CHILD WITH CONGENITAL HEART DISEASES
PEDIATRIC ECHOCARDIOGRAPHY: APICAL AND PARASTERNAL VIEWS
PEDIATRIC ECHOCARDIOGRAPHY: APICAL AND PARASTERNAL VIEWS
WHEN TO REFER A CHILD TO A PEDIATRIC CARDIOLOGIST FOR INTERVENTION
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PEDIATRIC CARDIAC SERVICES IN INDIA: WHERE DO WE ACTUALLY STAND?
PEDIATRIC CARDIAC SERVICES IN INDIA: WHERE DO WE ACTUALLY STAND?
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TACHYPNIC NEOANTE: IS IS A CHD: APPROACH TO A CHILD WITH CONGENITAL HEART DIS...
Cath meet 25020202 (TGA, VSD, PS FOR PA PRESSURES)
Cath meet 25020202 (TGA, VSD, PS FOR PA PRESSURES)
Cath meet 03022020 (VSD PAH FOR REVERSIBILITY, PVR)
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#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun W...
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ICCU ECGs
- 1. ICCU ECGs OCT 25,2020 DR. KAMAL MURTAZA MD, DNB, DNB SS (PEDIATRIC CARDIOLOGY)
- 2. Case scenario: 1 65y/ lady Past h/o few attacks of dizziness Presently had a fall in bathroom and had hip fracture Found to have bradycardia: ECG
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- 4. Interpretation Complete Heart Block with ventricular rate of 45/ min. Ventricular escape rhythm has wide QRS complexes and abnormal T waves Needs permanent pacemaker insertion
- 5. Case scenario: 2 50 y/ lady with known h/o rheumatic heart disease Had been in heart failure, but that had been treated and she was no longer breathless ECG: What does it show? What questions might you ask her?
- 7. Interpretation Atrial fibrillation with ventricular rate of 60-65/ min (well controlled), normal axis, normal QRS complexes Downward sloping ST segment best seen in leads V5-V6 (REVERSE TICK): Means digoxin has been given Prominent U waves in V2: Could be hypokalemia Ask patient about her appetite: Earliest symptom of digoxin toxicity is appetite loss with nausea+ vomiting Hypokalemia increases toxic effects of digoxin
- 8. Case scenario:3 20y/ lady presented to ER with an episode of chest pain At examination: Free of pain, normal vitals ECG
- 10. Interpretation Sinus rhythm, regular HR of app 70/ min, normal axis Short PR interval (100ms), Prolonged QRS interval (160ms), QTc: 460 ms aVR shows ST elevation; I, II, aVL, aVF, V5-6 shows ST depression Delta waves best seen in lateral leads WPW Type B pattern, AP location: Right posterior or posterolateral
- 11. Case scenario: 4 12 years old, male child k/c/o chronic renal failure Admitted with respiratory distress and oliguria ECG
- 13. Interpretation Prolonged PR interval Broad, bizarre QRS complexes merging with both preceding P wave and subsequent T wave Peaked P waves Hyperkalemia
- 14. Case scenario: 5 47 years lady Presented with acute onset of severe dyspnea Vitals: 95/42, RR: 30/min, spo2: 88% ECG
- 16. Interpretation Sinus rhythm with regular HR of 102/ min, normal axis (90 deg) Normal PR interval (160ms), Prolonged QRS (120ms), QTc: 410 ms ST elevation: aVR ST depression: I, II, III, V4,5,6 T invention in 111, aVR, V1,2,3 S wave lead I RSR’ patternV1,V2 D/Ds: Pulmonary embolism/ ACS With clinical stem of hypoxia, hypotension and pre-syncope: PE more likely
- 17. THANK YOU