Torsades De Pointes
•Download as PPT, PDF•
8 likes•6,784 views
Torsades de pointes is a type of ventricular tachycardia where the QRS complex twists around the isoelectric baseline on an ECG. It is associated with a prolonged QT interval from long QT syndrome. Torsades de pointes can be triggered by an R-on-T premature ventricular contraction and can degenerate into ventricular fibrillation if not treated. Treatment involves withdrawing any offending drugs, administering magnesium sulfate, antiarrhythmic medications, and electrical cardioversion or defibrillation as needed.
Report
Share
Report
Share
![Presentation ,[object Object],[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
Recommended
Torsades de-pointes
Torsade de pointes is a type of ventricular tachycardia associated with a prolonged QT interval on an electrocardiogram. It is caused by early afterdepolarizations and transmural reentry in the ventricles. Risk factors include hypokalemia, hypomagnesemia, female gender, heart failure, congenital long QT syndrome, and use of drugs that prolong the QT interval by blocking potassium currents. Management involves removing the offending drug, correcting electrolyte abnormalities, overdrive pacing, magnesium supplementation, and use of beta blockers, antiarrhythmics, or an implantable cardioverter-defibrillator in high risk patients.
Long QT Syndrome
The document discusses Long QT Syndrome (LQTS), an inherited heart condition characterized by an abnormally prolonged QT interval on electrocardiograms. It describes the causes and types of LQTS, including LQT1, LQT2 and LQT3, which are associated with different genetic mutations and ECG patterns. The main symptoms of LQTS are syncope and cardiac arrest, typically in children or teenagers. Diagnosis involves measuring the QT interval and identifying risk factors. Treatment focuses on beta-blockers, lifestyle changes and implantable cardioverter-defibrillators for high-risk patients.
Arrhythmias
This document discusses different types of cardiac arrhythmias including bradyarrhythmias which are slow heart rhythms and tachyarrhythmias which are fast heart rhythms. It describes specific arrhythmias like sinus bradycardia, atrial fibrillation, atrial flutter, atrioventricular reciprocating tachycardia, ventricular fibrillation, and ventricular tachycardia. It also discusses diagnostic studies, management through lifestyle changes and medications, and treatment options like cardioversion, pacemakers, surgery, and ablation for various arrhythmias.
Myocardial infarction (MI) ecg localisation
This document discusses various non-coronary causes of ST-elevation on electrocardiograms (ECGs) including ventricular aneurysms, pericarditis, early repolarization patterns, left ventricular hypertrophy, left bundle branch block, hypothermia, cardioversion, intraventricular hemorrhage, hyperkalemia, Brugada pattern, type 1C antiarrhythmic drugs, hypercalcemia, pulmonary embolism, hypothermia, myocarditis, and tumor invasion of the left ventricle. It then discusses left ventricular aneurysms, early repolarization, acute pericarditis, hyperkalemia, hypothermia, increased intracranial pressure, Brugada syndrome, Tak
HOCM Hypertrophic cardiomyopathy
This document discusses hypertrophic cardiomyopathy (HCM), including its definition, causes, variants, pathophysiology, clinical presentation, diagnostic workup, and management. Key points include:
- HCM is defined by left and/or right ventricular hypertrophy, usually involving the septum with a thickness over 15mm. It is commonly caused by genetic mutations affecting cardiac proteins.
- Presentation can range from being asymptomatic to symptoms of heart failure, angina, or syncope. Exams may reveal murmurs and EKGs often show abnormal patterns. Echocardiograms and cardiac catheterization are used for diagnosis and assessment.
- Management involves medications like beta-blockers to reduce
Cardiac arrhythmias
Cardiac arrhythmias are abnormalities in the heart's rhythm that can cause symptoms ranging from palpitations to sudden death. The two main types are bradycardias, which are slow heart rates below 60 bpm, and tachycardias, which are fast heart rates over 100 bpm. Arrhythmias can arise from problems in the sinus node, atria, AV junction, or ventricles due to issues with automaticity or re-entry of electrical impulses. Common arrhythmias include sinus tachycardia/bradycardia, premature beats, atrial fibrillation, and heart blocks. Treatment depends on the specific arrhythmia and symptoms but may include lifestyle changes, medications
Narrow QRS Tachycardia
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.
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.
Recommended
Torsades de-pointes
Torsade de pointes is a type of ventricular tachycardia associated with a prolonged QT interval on an electrocardiogram. It is caused by early afterdepolarizations and transmural reentry in the ventricles. Risk factors include hypokalemia, hypomagnesemia, female gender, heart failure, congenital long QT syndrome, and use of drugs that prolong the QT interval by blocking potassium currents. Management involves removing the offending drug, correcting electrolyte abnormalities, overdrive pacing, magnesium supplementation, and use of beta blockers, antiarrhythmics, or an implantable cardioverter-defibrillator in high risk patients.
Long QT Syndrome
The document discusses Long QT Syndrome (LQTS), an inherited heart condition characterized by an abnormally prolonged QT interval on electrocardiograms. It describes the causes and types of LQTS, including LQT1, LQT2 and LQT3, which are associated with different genetic mutations and ECG patterns. The main symptoms of LQTS are syncope and cardiac arrest, typically in children or teenagers. Diagnosis involves measuring the QT interval and identifying risk factors. Treatment focuses on beta-blockers, lifestyle changes and implantable cardioverter-defibrillators for high-risk patients.
Arrhythmias
This document discusses different types of cardiac arrhythmias including bradyarrhythmias which are slow heart rhythms and tachyarrhythmias which are fast heart rhythms. It describes specific arrhythmias like sinus bradycardia, atrial fibrillation, atrial flutter, atrioventricular reciprocating tachycardia, ventricular fibrillation, and ventricular tachycardia. It also discusses diagnostic studies, management through lifestyle changes and medications, and treatment options like cardioversion, pacemakers, surgery, and ablation for various arrhythmias.
Myocardial infarction (MI) ecg localisation
This document discusses various non-coronary causes of ST-elevation on electrocardiograms (ECGs) including ventricular aneurysms, pericarditis, early repolarization patterns, left ventricular hypertrophy, left bundle branch block, hypothermia, cardioversion, intraventricular hemorrhage, hyperkalemia, Brugada pattern, type 1C antiarrhythmic drugs, hypercalcemia, pulmonary embolism, hypothermia, myocarditis, and tumor invasion of the left ventricle. It then discusses left ventricular aneurysms, early repolarization, acute pericarditis, hyperkalemia, hypothermia, increased intracranial pressure, Brugada syndrome, Tak
HOCM Hypertrophic cardiomyopathy
This document discusses hypertrophic cardiomyopathy (HCM), including its definition, causes, variants, pathophysiology, clinical presentation, diagnostic workup, and management. Key points include:
- HCM is defined by left and/or right ventricular hypertrophy, usually involving the septum with a thickness over 15mm. It is commonly caused by genetic mutations affecting cardiac proteins.
- Presentation can range from being asymptomatic to symptoms of heart failure, angina, or syncope. Exams may reveal murmurs and EKGs often show abnormal patterns. Echocardiograms and cardiac catheterization are used for diagnosis and assessment.
- Management involves medications like beta-blockers to reduce
Cardiac arrhythmias
Cardiac arrhythmias are abnormalities in the heart's rhythm that can cause symptoms ranging from palpitations to sudden death. The two main types are bradycardias, which are slow heart rates below 60 bpm, and tachycardias, which are fast heart rates over 100 bpm. Arrhythmias can arise from problems in the sinus node, atria, AV junction, or ventricles due to issues with automaticity or re-entry of electrical impulses. Common arrhythmias include sinus tachycardia/bradycardia, premature beats, atrial fibrillation, and heart blocks. Treatment depends on the specific arrhythmia and symptoms but may include lifestyle changes, medications
Narrow QRS Tachycardia
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.
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.
Ventricular tachycardia
Ventricular tachycardia can occur due to various causes like acute myocardial infarction, chronic infarction, dilated cardiomyopathy, etc. It is classified as sustained, non-sustained, monomorphic, polymorphic, etc. based on characteristics. Diagnosis involves ECG, echocardiogram, and monitoring. Treatment depends on hemodynamic stability and includes electrical cardioversion, antiarrhythmic drugs like amiodarone, lidocaine, ablation, and ICD implantation in selected cases. Recurrence risk is high in structurally abnormal hearts and prevention involves controlling triggers, antiarrhythmics, and ICDs.
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.
Supraventricular tachycardias
This document discusses supraventricular tachycardias (SVT). It defines different types of SVT including paroxysmal SVT, which is common in emergency rooms. Quality of life is often poor for those with paroxysmal SVT. The document discusses mechanisms of SVT including reentry circuits, enhanced automaticity, and triggered activity. It provides details on differentiating AV nodal reentrant tachycardia from AV reentrant tachycardia using electrocardiogram findings. Treatment options discussed include carotid sinus massage, adenosine, and catheter ablation.
Tachyarrhythmias
This document provides guidance on the assessment and treatment of arrhythmias presenting in the emergency department. It outlines an approach of first determining hemodynamic stability, then distinguishing between narrow and wide complex tachycardias, and finally determining the specific arrhythmia and appropriate treatment. For unstable patients with any arrhythmia, synchronized direct current cardioversion is recommended. Further treatment is tailored based on whether the arrhythmia has narrow or wide QRS complexes and is regular or irregular.
WIDE QRS TACHYCARDIA
1) The document defines wide complex tachycardia as a rhythm with a QRS duration ≥120ms and heart rate >100 bpm.
2) The main causes listed are ventricular tachycardia (80% of cases) and supraventricular tachycardia with aberrancy.
3) Key features that can help differentiate the underlying rhythm include QRS duration, axis, morphology, and the presence or absence of AV dissociation on electrocardiogram.
Sick sinus syndrome
This document defines and describes sick sinus syndrome, which is a dysfunction of the sinoatrial node that can cause abnormal heart rhythms like bradycardia, tachycardia, and alternating slow and fast rhythms. It may be caused by certain drugs, aging, or underlying heart conditions. Symptoms can include fatigue, dizziness, and fainting. Diagnosis involves an electrocardiogram showing arrhythmias. Treatment options include medications or a pacemaker if symptoms are severe. The document also briefly discusses different types of heart block.
Brady arryhthmias
Bradyarrhythmias are caused by problems with impulse formation in the sinus node or impulse conduction through the AV node. Sinus node dysfunction can cause sinus bradycardia, sinus pause/arrest, or chronotropic incompetence. Atrioventricular block is classified as first, second, or third degree and may be caused by conditions like CAD, drugs, or infiltrative diseases. Second degree AV block is further classified as Mobitz type I or II based on PR interval characteristics. Third degree AV block causes complete dissociation between atrial and ventricular rhythms.
Wpw syndrome
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.
ECG -QRS complex
The document discusses the results of a study on the effects of a new drug on memory and cognitive function in older adults. The double-blind study involved giving either the new drug or a placebo to 100 volunteers aged 65-80 over a 6 month period. Testing showed those receiving the drug experienced statistically significant improvements in short-term memory retention and processing speed compared to the placebo group.
Ventricular tachycardia
Ventricular tachycardia is a fast heart rhythm originating from the ventricles with a rate over 100 bpm. It is classified based on duration (sustained vs non-sustained), morphology (monomorphic, polymorphic, sinusoidal), and symptoms. Causes include structural heart disease, electrolyte abnormalities, drugs, and prolonged QT interval. Diagnosis involves ECG criteria showing ventricular origin. Treatment depends on hemodynamic stability and may include antiarrhythmic drugs, implantable cardioverter-defibrillator, catheter ablation, or surgery. Recurrent ventricular tachycardia is managed long term with devices, drugs, and treatment of underlying causes.
Tachy Arrhythmias - Approach to Management
Tachyarrhythmias are disorders of heart rhythm which may present with a tachycardia i.e. a heart rate >100 bpm.
This article provides an overview of tachyarrhythmias in general and goes on to cover the most common tachyarrhythmias in more detail. The acute management of tachyarrhythmias, in an emergency setting, will be covered in the 'Acute' section of the fastbleep website.
Tachyarrhythmias are clinically important as they can precipitate cardiac arrest, cardiac failure, thromboembolic disease and syncopal events. As such, they crop up time and time again in exam papers and on the wards.
Tachyarrhythmias are classified based on whether they have broad or narrow QRS complexes on the ECG. Broad is defined as >0.12s (or more than 3 small squares on the standard ECG). Narrow is equal to or less than 0.12s. Broad QRS complexes are slower ventricular depolarisations that arise from the ventricles. Narrow complexes are ventricular depolarisations initiated from above the ventricles (known as supraventricular). One important exception is when there is a supraventricular depolarisation conducted through a diseased AV node. This will produce wide QRS complexes despite the rhythm being supraventricular in origin.
Genesis of cardiac arrhythmias
The document discusses the anatomy and physiology of the cardiac conduction system and the mechanisms of cardiac arrhythmias. It describes the following:
1. The location and function of the sinoatrial node, atrioventricular node, bundle of His, bundle branches and Purkinje fibers that make up the cardiac conduction system.
2. The mechanisms that can cause arrhythmias including disorders of impulse formation like abnormal automaticity and triggered activity, as well as disorders of impulse conduction like reentry.
3. Specific arrhythmias like atrial flutter and fibrillation that are caused by reentry mechanisms in the atria, and how conditions like ion channel abnormalities and electrical remodeling can contribute to these arrhythm
ECG approach to arrhythmias 2017
This document provides an overview of approaches to arrhythmias from an electrophysiological perspective. It begins by classifying bradyarrhythmias and tachyarrhythmias based on location and rate. Common supraventricular arrhythmias like AV nodal reentrant tachycardia, atrial flutter, and atrial fibrillation are described. Ventricular arrhythmias including nonsustained and sustained VT are also covered. The document reviews ECG interpretation and provides examples of various arrhythmias, discussing distinguishing characteristics and treatment approaches. Case examples include sinus bradycardia with heart block, Wenckebach block, junctional escape rhythms, atrial flutter, AVNRT, preexcitation
Bradyarrhythmia Management
This document discusses different types of bradyarrhythmias which are heart rates less than 60 beats per minute. The types include sinus bradycardia, sick sinus syndrome, and AV blocks of varying degrees. Causes include drugs, ischemia, structural issues, and electrolyte imbalances. Treatment depends on whether the bradycardia is stable or unstable. For stable patients, no treatment may be needed but unstable patients require treatment of the underlying cause if known and use of drugs like atropine, epinephrine, or isoproterenol to increase heart rate. Pacing may also be used through temporary or permanent pacemakers.
Atrial enlargement
Biatrial enlargement is diagnosed when criteria for both right and left atrial enlargement are present on the same ECG.
The diagnosis of biatrial enlargement requires criteria for LAE and RAE to be met in either lead II, lead V1 or a combination of leads.
Bundle branch blocks
Bundle branch blocks occur when the left or right bundle branch is blocked, preventing normal conduction of electrical impulses through the ventricles. Right bundle branch block is usually benign but can worsen prognosis in acute myocardial infarction by indicating occlusion of the proximal left anterior descending artery. Left bundle branch block is more serious as it can mask signs of myocardial infarction and worsen prognosis in acute infarction. The Sgarbossa criteria can help diagnose myocardial infarction in the presence of left bundle branch block. Left anterior and posterior hemiblocks involve conduction abnormalities localized to one side of the ventricles.
Dobutamine stress echocardiography
This document summarizes dobutamine stress echocardiography (DSE). Key points include:
- DSE uses the drug dobutamine to simulate exercise and increase heart rate, contractility, and myocardial oxygen demand to detect ischemia.
- It is useful for evaluating ischemia, viability, and valvular dysfunction in patients unable to exercise.
- The document reviews the DSE protocol, interpretation of wall motion abnormalities, indications, side effects, and applications for assessing ischemic heart disease, viability, valvular stenosis like mitral and aortic stenosis, and pulmonary hypertension.
SINOATRIAL (SA) node
This document discusses the anatomy, function, and assessment of the sinus node and sinus node dysfunction. It begins with an overview and description of the sinus node anatomy. It then discusses symptoms, diagnostic testing approaches including ECG, exercise testing, drug challenges, and long-term monitoring. Invasive assessment methods like sinus node recovery time and sinoatrial conduction time are also covered. The document provides details on performing, interpreting, and limitations of these invasive tests. Treatment options are also briefly mentioned.
Tachyarrhythmias
The document discusses tachyarrhythmias and provides details about various types. It begins by defining tachyarrhythmia as an abnormal cardiac rhythm with a heart rate over 100 beats per minute. There are three main causes of tachyarrhythmia: abnormal automaticity, triggered activity, and re-entry. Several types of tachyarrhythmia are then described in detail, including sinus tachycardia, atrial tachycardia, ventricular ectopic beats, and supraventricular tachyarrhythmias. Diagnosis involves analyzing features of the electrocardiogram such as heart rate, rhythm, QRS width, and P wave morphology.
Takayasu arteritis
Takayasu arteritis is a rare type of vasculitis that causes inflammation of the aorta and its main branches, which can lead to narrowed or aneurysmal arteries. It most commonly affects young Asian women. Treatment aims to relieve arterial inflammation and prevent complications through medications like glucocorticoids and immunosuppressants, though the condition can be challenging to manage long-term. Diagnosis involves examining blood tests, imaging of arteries, and ruling out other conditions through angiography, MRI, or ultrasound.
Ventricular tachycardia, ventricular flutter, and ventricular fibrillation di...
Differential diagnosis and treatment of ventricular tachycardia, flutter, and ventricular fibrillation
Cardiac dyrrythmias
A cardiac dysrhythmia (also called an arrhythmia) is an abnormal rhythm of your heartbeat. It can be slower or faster than a normal heart rate. It can also be irregular. It can be life-threatening if the heart cannot pump enough oxygen-rich blood to the heart itself or the rest of the body.
More Related Content
What's hot
Ventricular tachycardia
Ventricular tachycardia can occur due to various causes like acute myocardial infarction, chronic infarction, dilated cardiomyopathy, etc. It is classified as sustained, non-sustained, monomorphic, polymorphic, etc. based on characteristics. Diagnosis involves ECG, echocardiogram, and monitoring. Treatment depends on hemodynamic stability and includes electrical cardioversion, antiarrhythmic drugs like amiodarone, lidocaine, ablation, and ICD implantation in selected cases. Recurrence risk is high in structurally abnormal hearts and prevention involves controlling triggers, antiarrhythmics, and ICDs.
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.
Supraventricular tachycardias
This document discusses supraventricular tachycardias (SVT). It defines different types of SVT including paroxysmal SVT, which is common in emergency rooms. Quality of life is often poor for those with paroxysmal SVT. The document discusses mechanisms of SVT including reentry circuits, enhanced automaticity, and triggered activity. It provides details on differentiating AV nodal reentrant tachycardia from AV reentrant tachycardia using electrocardiogram findings. Treatment options discussed include carotid sinus massage, adenosine, and catheter ablation.
Tachyarrhythmias
This document provides guidance on the assessment and treatment of arrhythmias presenting in the emergency department. It outlines an approach of first determining hemodynamic stability, then distinguishing between narrow and wide complex tachycardias, and finally determining the specific arrhythmia and appropriate treatment. For unstable patients with any arrhythmia, synchronized direct current cardioversion is recommended. Further treatment is tailored based on whether the arrhythmia has narrow or wide QRS complexes and is regular or irregular.
WIDE QRS TACHYCARDIA
1) The document defines wide complex tachycardia as a rhythm with a QRS duration ≥120ms and heart rate >100 bpm.
2) The main causes listed are ventricular tachycardia (80% of cases) and supraventricular tachycardia with aberrancy.
3) Key features that can help differentiate the underlying rhythm include QRS duration, axis, morphology, and the presence or absence of AV dissociation on electrocardiogram.
Sick sinus syndrome
This document defines and describes sick sinus syndrome, which is a dysfunction of the sinoatrial node that can cause abnormal heart rhythms like bradycardia, tachycardia, and alternating slow and fast rhythms. It may be caused by certain drugs, aging, or underlying heart conditions. Symptoms can include fatigue, dizziness, and fainting. Diagnosis involves an electrocardiogram showing arrhythmias. Treatment options include medications or a pacemaker if symptoms are severe. The document also briefly discusses different types of heart block.
Brady arryhthmias
Bradyarrhythmias are caused by problems with impulse formation in the sinus node or impulse conduction through the AV node. Sinus node dysfunction can cause sinus bradycardia, sinus pause/arrest, or chronotropic incompetence. Atrioventricular block is classified as first, second, or third degree and may be caused by conditions like CAD, drugs, or infiltrative diseases. Second degree AV block is further classified as Mobitz type I or II based on PR interval characteristics. Third degree AV block causes complete dissociation between atrial and ventricular rhythms.
Wpw syndrome
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.
ECG -QRS complex
The document discusses the results of a study on the effects of a new drug on memory and cognitive function in older adults. The double-blind study involved giving either the new drug or a placebo to 100 volunteers aged 65-80 over a 6 month period. Testing showed those receiving the drug experienced statistically significant improvements in short-term memory retention and processing speed compared to the placebo group.
Ventricular tachycardia
Ventricular tachycardia is a fast heart rhythm originating from the ventricles with a rate over 100 bpm. It is classified based on duration (sustained vs non-sustained), morphology (monomorphic, polymorphic, sinusoidal), and symptoms. Causes include structural heart disease, electrolyte abnormalities, drugs, and prolonged QT interval. Diagnosis involves ECG criteria showing ventricular origin. Treatment depends on hemodynamic stability and may include antiarrhythmic drugs, implantable cardioverter-defibrillator, catheter ablation, or surgery. Recurrent ventricular tachycardia is managed long term with devices, drugs, and treatment of underlying causes.
Tachy Arrhythmias - Approach to Management
Tachyarrhythmias are disorders of heart rhythm which may present with a tachycardia i.e. a heart rate >100 bpm.
This article provides an overview of tachyarrhythmias in general and goes on to cover the most common tachyarrhythmias in more detail. The acute management of tachyarrhythmias, in an emergency setting, will be covered in the 'Acute' section of the fastbleep website.
Tachyarrhythmias are clinically important as they can precipitate cardiac arrest, cardiac failure, thromboembolic disease and syncopal events. As such, they crop up time and time again in exam papers and on the wards.
Tachyarrhythmias are classified based on whether they have broad or narrow QRS complexes on the ECG. Broad is defined as >0.12s (or more than 3 small squares on the standard ECG). Narrow is equal to or less than 0.12s. Broad QRS complexes are slower ventricular depolarisations that arise from the ventricles. Narrow complexes are ventricular depolarisations initiated from above the ventricles (known as supraventricular). One important exception is when there is a supraventricular depolarisation conducted through a diseased AV node. This will produce wide QRS complexes despite the rhythm being supraventricular in origin.
Genesis of cardiac arrhythmias
The document discusses the anatomy and physiology of the cardiac conduction system and the mechanisms of cardiac arrhythmias. It describes the following:
1. The location and function of the sinoatrial node, atrioventricular node, bundle of His, bundle branches and Purkinje fibers that make up the cardiac conduction system.
2. The mechanisms that can cause arrhythmias including disorders of impulse formation like abnormal automaticity and triggered activity, as well as disorders of impulse conduction like reentry.
3. Specific arrhythmias like atrial flutter and fibrillation that are caused by reentry mechanisms in the atria, and how conditions like ion channel abnormalities and electrical remodeling can contribute to these arrhythm
ECG approach to arrhythmias 2017
This document provides an overview of approaches to arrhythmias from an electrophysiological perspective. It begins by classifying bradyarrhythmias and tachyarrhythmias based on location and rate. Common supraventricular arrhythmias like AV nodal reentrant tachycardia, atrial flutter, and atrial fibrillation are described. Ventricular arrhythmias including nonsustained and sustained VT are also covered. The document reviews ECG interpretation and provides examples of various arrhythmias, discussing distinguishing characteristics and treatment approaches. Case examples include sinus bradycardia with heart block, Wenckebach block, junctional escape rhythms, atrial flutter, AVNRT, preexcitation
Bradyarrhythmia Management
This document discusses different types of bradyarrhythmias which are heart rates less than 60 beats per minute. The types include sinus bradycardia, sick sinus syndrome, and AV blocks of varying degrees. Causes include drugs, ischemia, structural issues, and electrolyte imbalances. Treatment depends on whether the bradycardia is stable or unstable. For stable patients, no treatment may be needed but unstable patients require treatment of the underlying cause if known and use of drugs like atropine, epinephrine, or isoproterenol to increase heart rate. Pacing may also be used through temporary or permanent pacemakers.
Atrial enlargement
Biatrial enlargement is diagnosed when criteria for both right and left atrial enlargement are present on the same ECG.
The diagnosis of biatrial enlargement requires criteria for LAE and RAE to be met in either lead II, lead V1 or a combination of leads.
Bundle branch blocks
Bundle branch blocks occur when the left or right bundle branch is blocked, preventing normal conduction of electrical impulses through the ventricles. Right bundle branch block is usually benign but can worsen prognosis in acute myocardial infarction by indicating occlusion of the proximal left anterior descending artery. Left bundle branch block is more serious as it can mask signs of myocardial infarction and worsen prognosis in acute infarction. The Sgarbossa criteria can help diagnose myocardial infarction in the presence of left bundle branch block. Left anterior and posterior hemiblocks involve conduction abnormalities localized to one side of the ventricles.
Dobutamine stress echocardiography
This document summarizes dobutamine stress echocardiography (DSE). Key points include:
- DSE uses the drug dobutamine to simulate exercise and increase heart rate, contractility, and myocardial oxygen demand to detect ischemia.
- It is useful for evaluating ischemia, viability, and valvular dysfunction in patients unable to exercise.
- The document reviews the DSE protocol, interpretation of wall motion abnormalities, indications, side effects, and applications for assessing ischemic heart disease, viability, valvular stenosis like mitral and aortic stenosis, and pulmonary hypertension.
SINOATRIAL (SA) node
This document discusses the anatomy, function, and assessment of the sinus node and sinus node dysfunction. It begins with an overview and description of the sinus node anatomy. It then discusses symptoms, diagnostic testing approaches including ECG, exercise testing, drug challenges, and long-term monitoring. Invasive assessment methods like sinus node recovery time and sinoatrial conduction time are also covered. The document provides details on performing, interpreting, and limitations of these invasive tests. Treatment options are also briefly mentioned.
Tachyarrhythmias
The document discusses tachyarrhythmias and provides details about various types. It begins by defining tachyarrhythmia as an abnormal cardiac rhythm with a heart rate over 100 beats per minute. There are three main causes of tachyarrhythmia: abnormal automaticity, triggered activity, and re-entry. Several types of tachyarrhythmia are then described in detail, including sinus tachycardia, atrial tachycardia, ventricular ectopic beats, and supraventricular tachyarrhythmias. Diagnosis involves analyzing features of the electrocardiogram such as heart rate, rhythm, QRS width, and P wave morphology.
Takayasu arteritis
Takayasu arteritis is a rare type of vasculitis that causes inflammation of the aorta and its main branches, which can lead to narrowed or aneurysmal arteries. It most commonly affects young Asian women. Treatment aims to relieve arterial inflammation and prevent complications through medications like glucocorticoids and immunosuppressants, though the condition can be challenging to manage long-term. Diagnosis involves examining blood tests, imaging of arteries, and ruling out other conditions through angiography, MRI, or ultrasound.
What's hot (20)
Similar to Torsades De Pointes
Ventricular tachycardia, ventricular flutter, and ventricular fibrillation di...
Differential diagnosis and treatment of ventricular tachycardia, flutter, and ventricular fibrillation
Cardiac dyrrythmias
A cardiac dysrhythmia (also called an arrhythmia) is an abnormal rhythm of your heartbeat. It can be slower or faster than a normal heart rate. It can also be irregular. It can be life-threatening if the heart cannot pump enough oxygen-rich blood to the heart itself or the rest of the body.
Atrial Tachycardia
Atrial tachycardia is a type of supraventricular tachycardia where the atria beat too fast, independently of the ventricles. It can have different causes such as enhanced automaticity, triggered activity, or reentry. On ECG, it typically shows a narrow QRS complex with an atrial rate of 100-250 bpm and regular or irregular conduction to the ventricles. Evaluation involves assessing the P wave morphology and determining the mechanism and site of origin through cardiac monitoring and electrophysiological studies. Treatment depends on the underlying cause but may include medications, catheter ablation, or surgery.
Atrial Tachycardia by Dr Aziz
Atrial tachycardia is a type of supraventricular tachycardia where the atria beat too fast, independently of the ventricles. It can have different causes such as enhanced automaticity, triggered activity, or reentry. On ECG, it typically shows a narrow QRS complex with an atrial rate of 100-250 bpm and regular or irregular conduction to the ventricles. Evaluation involves assessing the P wave morphology and determining the mechanism and site of origin through cardiac monitoring, imaging, or electrophysiological study. Treatment depends on the underlying cause but may include medications, catheter ablation, or surgery.
ecg
The document defines and classifies different types of arrhythmias. It discusses the etiology, symptoms, electrocardiogram characteristics and treatment options for various arrhythmias including sinus arrhythmia, atrial fibrillation, ventricular tachycardia, premature contractions, and more. Anti-arrhythmia medications are also categorized based on their mechanisms of action.
Mitral regurgitation by dr kalpana chetia
Mitral regurgitation - rheumatic heart disease is the commonest cause of MR. It coexists with MS and AR, particularly Ar
IDENTIFICATION AND APPROACH TO BRADYARRHYTHMIAS .pptx
Explanation of SA Nodal and AV nodal block , ECG changes , identification clinical features and presentation of patients to emergency department, their approach and medical linea of treatment
ACUTE CORONARY SYNDROME.pptx
Acute coronary syndrome (ACS) refers to unstable angina and myocardial infarction and is usually caused by rupture of an atherosclerotic plaque leading to coronary artery thrombosis. It is characterized by prolonged chest pain and cardiac enzyme elevations. Diagnosis involves electrocardiogram showing ST segment changes and elevated troponin levels. Treatment focuses on reperfusion therapy, antiplatelets, anticoagulants, and lifestyle modifications to prevent future events. Prognosis depends on extent of myocardial damage, with in-hospital mortality over 10% and 5-year survival rates around 75% for those who survive the initial event.
Cardiomyopathy
This document provides an overview of cardiomyopathy, focusing on its three main types: dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy. It defines cardiomyopathy as a disease of the heart muscle not caused by other structural heart issues. For each type, it discusses presentation, causes, morphology, clinical features, investigations and management. Dilated cardiomyopathy involves an enlarged heart with reduced function, while hypertrophic cardiomyopathy features abnormal thickening and restrictive cardiomyopathy impaired diastolic function. The document presents detailed information on evaluating and treating each form of cardiomyopathy.
CARDIAC ARRYTHMIAS.ppt mbbs
cardiac arrhythmias are abnormal heart rhythms that occur when the electrical signals controlling the heart beat are not working properly.
these can include tachycardia ,Bradycardia,atrial fibrillation and more.
Heart block
Atrioventricular heart block occurs when electrical signals between the atria and ventricles are interrupted or delayed. There are three types - first degree causes a prolonged PR interval, second degree is intermittent conduction with Mobitz types I and II, and third degree is complete block. Causes include myocardial infarction, medications, infections, degeneration. Symptoms range from none in first degree to bradycardia, hypotension, syncope in higher degrees. Treatment depends on symptoms but may include medication changes, temporary pacing, and permanent pacemaker for chronic cases.
Hypertrophic cardiomyopathy.pptx
This document provides an overview of hypertrophic cardiomyopathy (HCM). It defines HCM as marked thickening of the left ventricle not caused by other conditions like hypertension. HCM can cause chest pain and shortness of breath due to obstructed blood flow. Diagnosis is made via echocardiogram showing thickened walls. Treatment focuses on symptom management with medications and potentially surgery. Implantable cardioverter-defibrillators are recommended for high-risk patients to prevent sudden cardiac death from arrhythmias. The document reviews genetic causes, clinical presentation, diagnostic tests and surgical/medical management options for HCM in detail over multiple sections.
Proarrhythmia
This document defines proarrhythmia and describes the types, mechanisms, and risks of proarrhythmic effects caused by antiarrhythmic drug therapy. Proarrhythmia is the provocation of new arrhythmias or worsening of existing ones during antiarrhythmic drug treatment. Common types include torsades de pointes caused by drugs that prolong the QT interval, monomorphic ventricular tachycardia from sodium channel blockers, and abnormal conduction from effects on the AV node. Antiarrhythmic drugs work by blocking ion channels but can disturb the heart's normal rhythm due to unintended effects on conduction and repolarization. Careful monitoring is needed when using these medications to detect and prevent dangerous proarrhythmias
May 6, 2009
The ECG shows evidence of hyperkalemia including peaked T waves and PR prolongation. Hyperkalemia is commonly seen in patients with chronic renal failure. While the T waves are subtly peaked, they are narrow-based, supporting the diagnosis of hyperkalemia. Chronic renal failure should be suspected as the underlying cause.
Cardiomyopathiesclassification,oetiology and treatment
This document discusses different types of cardiomyopathies including their classification, etiology, and treatment. It focuses on dilated cardiomyopathy (DCM), providing details on its classification, causes, clinical presentation, diagnosis, and management. It also discusses other forms of cardiomyopathy such as hypertrophic cardiomyopathy (HCM), describing its characteristic left ventricular hypertrophy and outflow tract obstruction. The document aims to comprehensively classify and describe different cardiomyopathies for medical professionals.
Cardiomyopathies
This document discusses various types of cardiomyopathies:
- Dilated cardiomyopathy is caused by an unknown etiology and results in left ventricular dilatation and systolic dysfunction. It is a common cause of heart failure.
- Hypertrophic cardiomyopathy involves abnormal thickening of the heart muscle and can lead to outflow obstruction. It is a common cause of sudden death in young athletes.
- Restrictive cardiomyopathy causes stiff ventricles and impaired ventricular filling due to disorders like amyloidosis. It presents with symptoms of right and left heart failure.
- Other rare types discussed include arrhythmogenic right ventricular dysplasia and obliterative cardiomyopathy. Diagnosis involves imaging and endomyocardial biopsy
Management of VENTRICULAR TACHYCARDIA (VT)
This document discusses the classification and management of ventricular arrhythmias. It is divided into sections on classification by clinical presentation, electrocardiography, disease entity. Management of VT in structurally abnormal hearts is discussed, including those related to coronary artery disease, dilated cardiomyopathy, bundle branch reentrant tachycardia, arrhythmogenic right ventricular dysplasia, and other conditions. Clinical presentation, mechanisms, diagnostic testing, and treatment options are summarized for each condition.
Valvular Heart Disease-Fifth year students-27-7-22 . Samir Rafla.pptx
This document provides an overview of mitral stenosis, including its etiology, pathophysiology, symptoms, physical exam findings, diagnostic testing, and management. Key points include:
- Mitral stenosis is usually caused by rheumatic fever and leads to thickening and fusion of the mitral valve leaflets.
- It causes elevated left atrial pressure and pulmonary hypertension over time.
- Symptoms include dyspnea and hemoptysis due to pulmonary congestion. Physical exam may reveal a diastolic murmur and opening snap.
- Echocardiogram can assess the severity of stenosis while ECG often shows left atrial enlargement. Treatment involves managing pulmonary congestion, rate control for
Cardiac Dysrhythmias.
This document summarizes disorders of heart rate, rhythm, and conduction. It discusses various types of arrhythmias including their causes, symptoms, diagnosis using electrocardiograms, and potential treatments. Specific arrhythmias covered include sinus bradycardia, sinus tachycardia, atrial fibrillation, atrial flutter, and supraventricular and ventricular rhythms. Management strategies such as electrical cardioversion, antiarrhythmic medications, catheter ablation, and anticoagulation are described.
Anesthesia for children with long QT syndrome
This document discusses long QT syndrome (LQTS) in children, including causes, diagnosis, treatment, and considerations for anesthesia management. It describes how LQTS results from genetic mutations affecting cardiac ion channels, causing prolonged ventricular repolarization and risk of dangerous arrhythmias. Diagnosis involves calculating the QT interval from ECG and applying the Schwartz criteria. Treatment focuses on beta-blockers, antiarrhythmic drugs, pacemakers or ICDs. Anesthesia requires avoiding triggers of arrhythmias and prolonging the QT interval through careful drug selection and electrolyte management.
Similar to Torsades De Pointes (20)
Ventricular tachycardia, ventricular flutter, and ventricular fibrillation di...
Ventricular tachycardia, ventricular flutter, and ventricular fibrillation di...
IDENTIFICATION AND APPROACH TO BRADYARRHYTHMIAS .pptx
IDENTIFICATION AND APPROACH TO BRADYARRHYTHMIAS .pptx
Cardiomyopathiesclassification,oetiology and treatment
Cardiomyopathiesclassification,oetiology and treatment
Valvular Heart Disease-Fifth year students-27-7-22 . Samir Rafla.pptx
Valvular Heart Disease-Fifth year students-27-7-22 . Samir Rafla.pptx
Torsades De Pointes
- 1. Torsades de pointes Torsades de pointes , or simply torsades is a French term that literally means "twisting of the points." It was first described by Dessertenne in 1966 and refers to a specific variety of ventricular tachycardia that exhibits distinct characteristics on the ECG.
- 3. Characteristic tracing showing the "twisting" (blue line) of a torsade de pointes
- 8. Lead II EKG showing Torsades being shocked by an Implantable cardioverte-defibrillator back to the patients baseline cardiac rhythm .