Wpw transition to svt ecg 2019
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A 47-year-old man presents with intermittent palpitations that have increased in frequency. An ECG shows Wolff-Parkinson-White syndrome transitioning to a supraventricular tachycardia over 200 bpm. Options for treatment include observation, electrical cardioversion, or chemical cardioversion using drugs that slow accessory pathway conduction without blocking the AV node, such as procainamide. The safest option is likely observation with cardioversion standby given the patient's history of self-terminating episodes.
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2. Atrial flutter is caused by reentry in the right and left atrium, presenting with rapid, regular P-waves at a rate of 250-400 BPM and an irregular ventricular response.
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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.
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A 45-year-old female presented with difficulty breathing, palpitations, and sweating for 4 hours. An ECG showed Wolff-Parkinson-White (WPW) syndrome, characterized by a short PR interval, delta wave, and widened QRS complex. WPW is a congenital condition involving an accessory pathway that allows supraventricular impulses to bypass the AV node and activate the ventricles early. Treatment options include antiarrhythmic drugs or radiofrequency ablation to destroy the accessory pathway.
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ventricular premature complexes and idioventricular rhythm identification is important in the ICU ..they may run into arryhthmias..look over my seminar...
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Ventricular arrythmia
1. Premature ventricular contractions are early occurring, widened QRS complexes originating from the left or right ventricle that have a distinct morphology different from the normal sinus rhythm.
2. Ventricular tachycardia is defined as three or more successive ventricular complexes at a rate greater than 100 beats per minute and shows atrioventricular dissociation.
3. Ventricular fibrillation is identified by the complete absence of properly formed QRS complexes and P waves, with irregular ventricular activation above 300 beats per minute leading to cardiac arrest.
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There are two main types of tachyarrhythmias: supraventricular tachycardia (SVT) originating above the ventricles, and ventricular tachycardia (VT) originating in the ventricles. VT is more serious and can lead to cardiac death, while SVT is usually not lethal. The electrocardiogram (ECG) is used to distinguish between SVT and VT based on whether the QRS complex is narrow or wide. Tachyarrhythmias can cause symptoms like palpitations, dizziness, and chest pain. Diagnostic tests are needed to fully evaluate tachyarrhythmias.
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The document discusses various types of arrhythmias that can be identified from an electrocardiogram (ECG) analysis. It describes normal AV conduction with a PR interval between 0.12-0.2 seconds and abnormalities that can cause shorter or variable PR intervals. It then defines and discusses first, second and third-degree atrioventricular blocks based on prolonged or irregular PR intervals. The document also defines right and left bundle branch blocks which cause delayed activation of the right or left ventricle, leading to widened QRS complexes over 0.12 seconds on ECG. Specific patterns for each type of block are described.
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The document discusses various cardiac arrhythmias including:
1. Sinus tachycardia originates from the sinus node with a heart rate of 100-180 BPM due to abnormal automaticity.
2. Atrial flutter is caused by reentry in the right and left atrium, presenting with rapid, regular P-waves at a rate of 250-400 BPM and an irregular ventricular response.
3. Atrial fibrillation is caused by multiple wavelets of reentry in the right and/or left atrium, with a heart rate over 400 BPM, irregular rhythm, and irregular ventricular response.
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This document discusses atrial flutter with 2:1 atrioventricular block. Key points include:
- There is a narrow complex tachycardia at 150 bpm with no visible P waves. Flutter waves are seen at 300 bpm in one lead.
- This is indicative of atrial flutter with a 2:1 block, resulting in a heart rate of 150 bpm.
- Flutter waves can be difficult to see with 2:1 block. Regular rates of 150 bpm suggest this rhythm, especially if extremely consistent.
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This document discusses pre-excitation syndrome, specifically Wolff-Parkinson-White (WPW) syndrome and Lown-Ganong-Levine (LGL) syndrome. It defines pre-excitation syndrome as having a short PR interval and usually an abnormal QRS complex due to an accessory pathway in the cardiac conduction system. Accessory pathways can connect different parts of the heart and have faster conduction velocities than the atrioventricular node. WPW syndrome is the most common type, affecting about 1.5 per 1000 people. Common symptoms include palpitations and chest discomfort due to paroxysmal tachyarrhythmias like atrioventricular reentrant tachycardia. Management involves catheter ablation
Ventricular arrhythmias
Ventricular arrhythmias originate in the ventricles and include premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation. Ventricular tachycardia is defined as three or more consecutive ventricular beats at a rate over 100 beats per minute and can be caused by mechanisms like reentry, automaticity, and triggered activity. Polymorphic ventricular tachycardia includes conditions like torsades de pointes and Brugada syndrome. Acute management of sustained ventricular tachycardia includes termination attempts using antiarrhythmic drugs or cardioversion, while long term prevention focuses on drugs, ablation, or implantable cardioverter defibrillators depending on symptoms and left ventricular function.
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Wolf Parkinson Syndrome By Dr Hasan Mahmud.
Wolff-Parkinson-White Syndrome is characterized by a short PR interval and delta waves on the electrocardiogram due to an extra pathway between the atria and ventricles. It can cause supraventricular tachycardia when conduction occurs down the normal and/or accessory pathways. Treatment depends on stability and includes medications, cardioversion, ablation, or lifestyle changes. Catheter ablation has high success rates but recurrence is still possible.
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Arrhythmias refer to abnormalities in the cardiac rhythm. There are two main types: bradycardia where the heart rate is slow, and tachycardia where the heart rate is fast. Specific arrhythmias include sinus bradycardia, various types of heart block, atrial fibrillation, atrial flutter, AV nodal re-entry tachycardia, ventricular tachycardia, and ventricular fibrillation. Diagnosis involves electrocardiography and other tests. Treatment depends on the type of arrhythmia but may include medications, catheter ablation, pacemaker implantation, or cardioversion. Lifestyle modifications and avoiding arrhythmia triggers can also help management.
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
All info about ecg
The document provides information about electrocardiograms (ECGs), including what an ECG is, the types of pathology that can be identified from ECGs, ECG paper specifications, heart anatomy and the normal ECG signal, ECG leads, determining heart rate from ECGs, common rhythms, P waves, the PR interval, the QRS complex, identifying left and right bundle branch block, identifying left and right ventricular hypertrophy, Q waves, the ST segment and T waves. Key details are provided about normal ECG measurements and the signs of various cardiac conditions.
defibrillation and cardioversion
The document discusses defibrillation and cardioversion. Defibrillation delivers energy without synchronization to the cardiac cycle, while cardioversion delivers synchronized energy. Both terminate abnormal rhythms and allow normal sinus rhythm to resume. Defibrillation is indicated for pulseless ventricular tachycardia and ventricular fibrillation, while cardioversion is used for supraventricular tachycardia, atrial fibrillation, and atrial flutter. Biphasic shocks are now preferred over monophasic shocks as they are more effective at lower energy levels.
Approach to a patient with PR interval abnormality in ECG
The PR interval is the time from the onset of the P wave to the start of the QRS complex.
It reflects conduction through the AV node.
The normal PR interval is between 120 – 200 ms (0.12-0.20s) in duration (three to five small squares).
If the PR interval is > 200 ms, first degree heart block is said to be present.
PR interval < 120 ms suggests pre-excitation (the presence of an accessory pathway between the atria and ventricles) or AV nodal (junctional) rhythm.
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Dr nigat
A wide complex tachycardia (WCT) can be caused by either ventricular tachycardia (VT) originating outside the normal conduction system, or supraventricular tachycardia (SVT) with aberrant conduction or pre-excitation. Diagnosing the underlying rhythm of a WCT is challenging due to the variety of potential causes and limitations of diagnostic tests/criteria. Initial focus should be on patient stability and identifying high-risk features like structural heart disease that increase the likelihood of VT. A careful history, physical exam, and ECG can provide clues but are imperfect, so urgent therapy may be needed while further evaluating the rhythm.
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.
Ekg Cases 7 15 09 Level 2 Part 1
This document discusses strategies for interpreting EKGs in the presence of conduction abnormalities like bundle branch blocks. It provides examples of EKGs showing myocardial infarctions complicating right bundle branch block and left bundle branch block. Key points are that pathologic Q waves can still indicate infarction location, ST elevations are abnormal in bundle branch blocks, and the orientation of ST-T waves can provide clues. Recognition of infarction is still possible despite conduction delays by assessing early versus late QRS deformation.
Ekg presentation
This document provides an overview of EKG waveforms and arrhythmias. It discusses the electrical activity and associated muscle movements in the atria and ventricles that produce the different waves of the EKG. Common arrhythmias like AV block, atrial flutter, and atrial fibrillation are described. The characteristics of normal sinus rhythm as well as abnormal rhythms including premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation are summarized. The document provides a guide for interpreting EKG readings to identify arrhythmias and dysrhythmias.
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.
Supra ventri cular arrhythmia 2021
This document discusses various types of supraventricular arrhythmias including sinus arrhythmia, premature atrial contractions, atrial flutter, atrial fibrillation, AV nodal reentry SVT, and AV reentry SVT. It provides details on the characteristics, mechanisms, and features seen on ECG for each type. Common arrhythmias in neonates such as premature atrial contractions, atrial flutter, and different forms of supraventricular tachycardia are also mentioned. The classification of tachycardias based on site of origin and rhythm is summarized.
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.
Similar to Wpw transition to svt ecg 2019 (20)
Approach to a patient with PR interval abnormality in ECG
Approach to a patient with PR interval abnormality in ECG
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A 75-year-old woman fell and landed on her outstretched right hand, causing swelling and tenderness in her wrist. An x-ray revealed a Barton's fracture of the distal radius, where the fracture line runs horizontally through the joint on an AP view and vertically on a lateral view. The fracture fragment was displaced proximally on the volar surface, indicating joint instability. Most patients with this intra-articular fracture requiring open reduction and internal fixation to regain stability and reduce arthritis risk, even if conservative treatment is considered for an older patient.
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A 54-year-old woman presents with fever, shortness of breath, and chest pain. On examination, linear bruises are seen on her back consistent with a folk remedy called "coining" used to relieve symptoms. While coining may provide partial relief, the presenting symptoms could indicate serious underlying medical conditions like pneumonia or pulmonary embolism that require diagnosis and treatment. The patient's care should involve pursuing these potential diagnoses through further evaluation rather than focusing on the folk remedy.
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A 67-year-old man presented to the emergency department with a swollen right hand after being bitten by his cat three days prior. The clinical photo and ultrasound showed spreading cellulitis and abscess formation in the area of maximal redness and swelling. Cat bites carry a high risk of infection from Pasteurella species, particularly involving nearby tendons and joints. The man should be admitted and started on intravenous antibiotics, and his abscess should be opened, cleaned, and debrided in surgery.
Acetabular fracture
A 65-year old man crashed his bike into a group of cyclists and fell to the ground complaining of right hip pain. An x-ray showed he had a comminuted fracture of the right acetabulum with medial displacement of fragments. A CT scan was recommended to further characterize the injury and inform surgical planning. His treatment options included closed reduction, open reduction, or an acute acetabular prosthesis given the displacement.
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A 79-year-old man was brought to the emergency department after being found collapsed at home. He has a history of diabetes, hypertension, a stroke with residual weakness, and depression. His ECG shows slow atrial fibrillation and Osborne waves, consistent with a body temperature of 29.5°C, indicating moderate to severe hypothermia. Hypothermia is often caused by an underlying condition that leaves the patient unable to rewarm themselves, such as trauma, neurological issues, drugs, endocrine problems, or infection. Treatment focuses on rewarming with a forced air blanket and providing glucose to generate heat.
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A 37-year old man injured his right ankle after stepping in a pothole while jogging. His ankle appears deformed with the foot displaced laterally and posteriorly. The skin over the lower tibia also appears stretched and pale. This clinical presentation is most consistent with a fracture dislocation at the ankle joint. The priorities are to provide analgesia, reduce the injury in the emergency department to preserve skin integrity, and obtain an x-ray for orthopedic guidance before definitive repair. Initial analgesia could include nitrous oxide and narcotics, with additional sedation like propofol or ketamine if needed despite his fasting status.
Takotsubo cardiomyopathy 2019
A 68-year-old woman presented to the emergency department with chest pain and shortness of breath. Tests showed elevated troponin and ECG changes suggestive of a heart attack. A ventriculogram revealed ballooning of the left ventricular apex, consistent with Takotsubo cardiomyopathy. Takotsubo is a stress-induced heart condition where the heart enlarges at the apex. It is thought to be caused by high catecholamine levels due to life stress. While initial symptoms mimic a heart attack, prognosis is generally good with typical recovery and low mortality around 1-3%.
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The x-ray shows a posterior dislocation of the footballer's right shoulder. Key signs on the x-ray include a symmetrical "light bulb" shaped humeral head and widening of the gleno-humeral joint space. There is also likely a fracture fragment at the inferior rim of the glenoid. The injury should be managed by reducing the dislocation under procedural sedation using traction, abduction, and external rotation, known as the Milch method.
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The ECG shows changes suggestive of acute myocardial ischemia, including tall, peaked T waves in leads V2-V4 and possible ST elevation in leads V1 and III. The most important interventions are to give aspirin, heparin, and regular ECGs looking for ST elevation. The man likely needs urgent coronary angiography if ST elevation appears, or angiography soon otherwise, to treat his acute coronary syndrome.
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Raccoon eyes 2019
A 38-year-old man presents to the emergency department with a headache and nausea after being involved in a bar room brawl while intoxicated the previous night. On examination, he has bilateral bruising around his eyes known as "raccoon eyes" or "panda eyes", which is strongly suggestive of a base of skull fracture given his history of trauma. He will need a head CT scan to further characterize any skull fracture and assess for other significant injuries such as intracranial hemorrhage. He may require neurosurgical consultation and hospitalization for symptom management and monitoring.
Laryngeal injury 2019
A 13-year-old boy was injured after crashing a quad bike into a rope stretched across the track. While he was able to get up and walk away with only a sore neck, the doctor is concerned about potential injuries to his airway, cervical spine, or arteries in his neck. A CT scan and CT angiography are recommended to check for injuries to his larynx or fractures as well as tears or dissections of his carotid or vertebral arteries since his mechanism of injury carries risks of damage to these structures.
Dengue fever 2019
A 22-year old man recently returned from Timor with a fever, headache, body aches and pains, and now a rash. Given his symptoms and travel history, the most likely diagnosis is dengue fever. Blood tests should be performed to check for malaria, as well as a full blood count, electrolytes, liver and kidney function. A diagnosis of dengue can be confirmed by detecting antibodies in follow-up blood samples. With rest and over-the-counter pain medication, most dengue cases can be managed without hospitalization.
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A 22-year old man recently returned from Timor with a fever, headache, body aches and pains, and now a rash. Given his symptoms and travel history, the most likely diagnosis is dengue fever. Blood tests should be performed to check for malaria, as well as a full blood exam, electrolytes, liver and kidney function. While dengue can often be managed as an outpatient, this patient should stay for observation and treatment of symptoms like fever and pain with paracetamol and fluids.
Bifasicular block ecg 2019
A 77-year-old woman presented to the emergency department after losing consciousness at church for about 30 seconds. Her ECG showed signs of a bifascicular block indicating issues with the right and left bundles of the heart's conduction system. Due to her unprovoked loss of consciousness and abnormal ECG, she is at risk of having another episode of complete heart block and should be admitted for monitoring. She may ultimately require a permanent pacemaker given the conduction abnormalities shown on her ECG in the absence of a reversible cause.
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A 7-year-old boy complained of thigh pain after jumping from play equipment. An x-ray showed a lucency in his proximal right femur that appears to be a benign bone cyst. As he presented after injury, further investigation with MRI is recommended to check for possible micro-fractures. Treatment options include observation with activity limitation or potential surgery, as cysts sometimes resolve on their own but fracture could require healing.
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Wpw transition to svt ecg 2019
- 1. A 47 year old man presents to the ED with intermittent palpitations. Although he can recall episodes occurring occasionally over perhaps the last 6 months, they have become much more frequent and prolonged over the past 2 days. Each time he says he can “..feel my heart racing…” and becomes light headed, although he has not collapsed. He denies chest pain. He is usually well and is on no regular long-term medications. •Describe and interpret the ECG •What options are there for treating him ? •What is likely the best of these options ?
- 3. The ECG shows a transition about 6 seconds into the trace from one that shows typical features of Wolff-Parkinson-White (WPW) syndrome to one of a regular broad complex, but supraventricular, tachycardia. The signs of WPW here are a short PR interval (<0.12sec) and a slurred upstroke (known as a Delta wave) to the slightly widened QRS, and most obvious in V2 & V3. The tachycardia is very rapid (>200bpm) regular and broad but there is clearly a P wave before each QRS. So this will be an “antidromic” re-entrant tachycardia where the atrial impulses are conducted to the ventricles by the accessory pathway and not through the normal path via the AV node. The options that are worthy of consideration are: •“Observe” - monitor as his history suggests self-terminating episodes. •Electrical cardioversion with cautious procedural sedation. •Chemical cardioversion using agents that slow accessory pathway conduction but don’t further block the AV node. The best of these is procainamide (currently unavailable in Australia) & perhaps flecainide. The safest option is likely observation in a monitored area with DC cardioversion if needed (i.e. for prolonged arrhythmia or CVS collapse). Be careful to avoid AV blockers (especially verapamil and Beta blockers).