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ECG - Narrow complex tachycardia


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ECG - Narrow complex tachycardia

  1. 1. Prof.P.Vijayaragavan unit. Dr.Vijayalakshmi.M7unit.
  2. 4. <ul><li>Rate: 180/min. </li></ul><ul><li>Rhythm: Narrow complex supraventricular tachycardia. </li></ul><ul><li>Axis:LAD -80 degree. </li></ul><ul><li>PR interval not determined. </li></ul><ul><li>QRS:80msec. </li></ul><ul><li>Diagnosis:Narrow QRS complex tachycardia . </li></ul>
  3. 5. <ul><li>Tachycardia,Pseudo “r” wave (hidden “P”) seen in lead V1. </li></ul><ul><li>RP interval 60 msec. </li></ul><ul><li>PR interval 280msec. </li></ul><ul><li>Short RP interval,Long PR interval AV NODAL REENTERANT TACHYCARDIA . </li></ul>
  4. 6. <ul><li>The QRS complex is normal in contour and duration . Often the P wave is buried in the QRS or seen just after the end of the QRS and causes subtle alteration in the QRS complex that results in a pseudo ‘s’ or pseudo ‘r’ which may be recognized only in comparison to the QRS complex in normal rhythm. Cycle length and or QRS alternans can occur usually when the rate is very fast. </li></ul>
  5. 7. <ul><li>AVNRT- most common type of reentrant tachycardia. </li></ul><ul><li>Common in females. </li></ul><ul><li>Occurs in 3 rd or 4 th decade. </li></ul><ul><li>Types ; </li></ul><ul><li>1)Typical-slow –fast pathway (alpha pathway) 95% </li></ul><ul><li>2)Atypical AVNRT-fast-slow pathway .5%. </li></ul><ul><li>3)Slow-slow pathway. 2%. </li></ul><ul><li>4)Slow –accessory pathway, rare. </li></ul>
  6. 8. <ul><li>Slow or alpha pathway has short refractory period and slow conduction. </li></ul><ul><li>Fast pathway has fast conduction and long refractory period. </li></ul><ul><li>Re-entry occurs when there are two pathways with different conduction properties and there should be unidirectional block. </li></ul>
  7. 9. <ul><li>The mechanism of PSVT is classified on the basis of R-P interval. </li></ul><ul><li>Short RP interval tachycardia- </li></ul><ul><li>RP interval is <50% of RR interval. </li></ul><ul><li>1)AVNRT typical. </li></ul><ul><li>2)Orthodromic AV reentrant tachycardia (o-AVRT) </li></ul><ul><li>Sinus tachycardia or ectopic atrial tachycardia with first degree AV block. </li></ul><ul><li>4)Junctional tachycardia. </li></ul>
  8. 10. <ul><li>Long RP interval tachycardia. </li></ul><ul><li>RP interval is > 50% of RR interval. </li></ul><ul><li>1)Sinus tachycardia or ectopic atrial tachycardia with normal PR interval. </li></ul><ul><li>2)Atypical AVNRT. </li></ul><ul><li>3)O-AVRT . </li></ul>
  9. 11. <ul><li>AVNRT </li></ul><ul><li>1.Most common. </li></ul><ul><li>2.Common in females. </li></ul><ul><li>3.Micro reentry. </li></ul><ul><li>4.slow-fast pathway. </li></ul><ul><li>5.Initiated by APC with prolonged PR interval. </li></ul><ul><li>6.Simultaneous activation of atrium and ventricles. </li></ul><ul><li>AVRT </li></ul><ul><li>1.Less common. </li></ul><ul><li>2.Common in males. </li></ul><ul><li>3.Macro reentry. </li></ul><ul><li>4.AV node Accessory pathway </li></ul><ul><li>5.Initiated by APC with short or normal PR interval. </li></ul><ul><li>6.Sequential activation of atrium and ventricles. </li></ul>
  10. 12. <ul><li>AVNRT </li></ul><ul><li>7.Rate <200/min. </li></ul><ul><li>8.P usually buried in QRS complexes. </li></ul><ul><li>9.Pseudo ‘r’ pseudo ‘s’ seen, and pseudo RBB pattern seen. </li></ul><ul><li>10.RP-interval is <70msec. </li></ul><ul><li>11.QRS alternans rare. </li></ul><ul><li>AVRT </li></ul><ul><li>7.Rate >200/min. </li></ul><ul><li>8.P wave usually seen after QRS complexes. </li></ul><ul><li>9.Not seen. </li></ul><ul><li>10.RP interval >70msec. </li></ul><ul><li>11.QRS alternans common. </li></ul>
  11. 13. <ul><li>AVNRT </li></ul><ul><li>12.Aberrancy rare. </li></ul><ul><li>13.BBB does not alters the rate. </li></ul><ul><li>14.Ventricles not required for reentry. </li></ul><ul><li>15.It is possible in the presence of AV block also. </li></ul><ul><li>AVRT </li></ul><ul><li>12.Aberrancy common. </li></ul><ul><li>13. BBB alters the rate. </li></ul><ul><li>14. Ventricles required for reentry. </li></ul><ul><li>15.Not possible in the presence of AV block. (not continuous) </li></ul>
  12. 14. <ul><li>Clinical features- </li></ul><ul><li>AV nodal re entry commonly occurs in patients who have no structural heart disease and in the adults of 3 rd or 4 th decade. </li></ul><ul><li>Palpitation, nervousness, anxiety to angina, heart failure, syncope or shock. </li></ul><ul><li>The prognosis for the patients without heart disease is good. </li></ul>
  13. 15. TREATMENT <ul><li>Sedation, Reassurance, Vagal maneuvers. </li></ul><ul><li>1.Carotid sinus massage. </li></ul><ul><li>2.Gag reflex. </li></ul><ul><li>3.Immersion of face into chilled water. (children) </li></ul><ul><li>4.Coughing. </li></ul><ul><li>5.Recumbent position with leg elevation. </li></ul><ul><li>6.Valsalva maneuver. </li></ul><ul><li>7.Muller maneuver. </li></ul>
  14. 16. <ul><li>Drugs-Adenosine 6 mg initially then 12mg followed by 12 mg. IV-rapidly given.90 percent gets success. </li></ul><ul><li>Verapamil 5-10 mg IV. Or diltiazem0.25 to 0.35mg per kg. in two minutes given ,success 90 percent. </li></ul><ul><li>Digitalis –slow onset of action and has longer effect.0.5mg every 2-4hrs. Total dose< 1.5mg per 24 hrs. B-Blockers may be given . </li></ul>
  15. 17. <ul><li>If cardiac decompensation occurs consider DC shock. Energy 10 to 50 J. </li></ul><ul><li>Overdrive pacing may be useful . </li></ul><ul><li>For recurrence; Calcium channel antagonist, B-Blockers, Digitalis. </li></ul><ul><li>Radiofrequency Ablation ; More than 95% effective .Complete cure is possible, Long term effect. And has low incidence of complications. </li></ul>
  16. 18. THANK YOU