ECG: Reciprocating tachycardia

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ECG: Reciprocating tachycardia

  1. 1. ECG of the week<br />Prof.Dr.MAHESH KUMAR’s unit<br />Dr.T. Balamurugan, PG<br />
  2. 2. 46 year old female, admitted in ICCU with <br />c/o palpitation----------- 4 hrs<br />
  3. 3.
  4. 4. ECG<br />Heart rate- 190<br />Rhythm regular<br />QRS duration- 60 ms<br />R-R interval –regular & 320 ms<br />P’ visible after QRS complexes <br /> R-P’ interval 80 ms (shortened)<br />
  5. 5. Diagnosis <br />Narrow complex tachycardia<br />
  6. 6.
  7. 7. Heart rate- 72/min<br />Rhythm- regular<br />QRS duration- 130 ms<br />Slurred upstroke of QRS complex (delta wave)<br />P-R interval –90 ms (shortened)<br />Q-T interval –480 ms<br />
  8. 8. Paroxysmal tachycardias in WPW syndrome<br />
  9. 9.
  10. 10. Mechanism of reciprocating tachycardia in WPW syndrome<br /> Sinus impulse activating atria<br /> (normal P wave) <br /> conduction of sinus impulse through bypass may be blocked, but conducted in usual manner through AV node, activating ventricles (normal QRS wave) <br />
  11. 11. activation front on reaching ventricles, conducted retrogradely, activating atria retrogradely<br />Retrograde P’ wave<br />Inverted P’ wave in L2,3,aVF<br />
  12. 12. Returning reciprocal impulse, after reaching atria<br />Conducted anterogradely through normal AV nodal conduction, activating ventricles <br />Re-enter bypass once again, activating atria……………<br />Reciprocating tachycardia<br />
  13. 13. Since anterograde conduction to the ventricles occurs through normal pathway, pre-excitation doesn’t take place & delta waves not recordable<br />When ECG recorded during this phase, manifestations of WPW syndrome not evident in ECG ‘Concealed WPW syndrome’<br />
  14. 14.
  15. 15. THANK YOU<br />

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