Recognizing
Cardiac arrhythmias
Normal anatomy
Normal ECG
Normal ECG
Classification - tachys
Atrial
•
AF
•
Atrial
Flutter
•
PAC
Junctional
•
•
Paroxysmal
SVT (PSVT)
Junctional
Tachycardia
Ventricular
•
VT
•
VF
•
PVC
Broad Complex
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Classification - bradys
Atrial
•
Sinus
brady
•
Sick sinus
syndrome
Junctional
•
Junctional
Escape
Ventricular
•
Ventricular
Escape
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Atrial Fibrillation
•
Atrial dilation & decreased
CO
•
RAAS activation
•
Protease stimulation
•
Progressive atrial fibrosis
•
Fragmented, asynchronous
depolarizations
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Atrial Fibrillation
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AF - Classification
AF Type
Definition
New-onset
No previous episodes
Paroxysmal
Recurrent episodes of < 7 days duration
Persistent
Recurrent episodes of > 7 days duration
•
Valvular
PermanentAF?
•
Lone AF?
•
Secondary AF?
•
Symptomatic AF?
Long-term episode
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AF - Causes
Primary Cardiac Causes
Other Cause
Coronary artery disease
Hypertension
Valvular disease
Lung disease
Hypertrophic cardiomyopathy
Hyperthyroidism
Congenital heart disease
Medications, alcohol
Pericardial disease
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symptoms
•
Palpitations
•
Breathlessnes
s
•
•
•
•
Lightheaded
Fatigue
Chest pain
Exercise
intolerance
DDX
•
Tachyarrhythmias
•
Flutter
•
Panic attack/anxiety
•
Drugs
•
Caffeine/alcohol
•
Symp. Agents
•
Stimulants
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Diagnosis
•
Heart failure
•
Echo evidence of
stroke risk
•
Alcohol
•
Regurg/stenosis
•
Thyroid
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Atrial flutter
Ectopic loop (reentrant pathway) of atrial
electrical activity, usually precipitated by a PAC
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Differences to AF
•
P waves clearly visible in characteristic ‘sawtooth’
pattern
•
Comment on degree of block 2:1, 3:1, 4:1 etc
•
More sensitive to electrical CV
•
Less sensitive to chemical CV.
•
RFA useful because of the reentrant nature.
PAC
•
Premature Atrial Contractions
•
Common, not necessarily pathological
•
P wave is abnormal due to ectopic focus
•
P wave may be isolated or may have resulting QRS.
Junctional tachys
PSVT
•
Paroxysmal Supra-Ventricular Tachycardia
•
AVNRT and AVRT (nodal or accessory pathway)
AVNRT
FP
SP
FP
SP
FP
SP
AVRT
•
Atrioventricular Reentrant
Tachycardia
•
(Wolf Parkinson White
(WPW) Syndrome)
•
Narrow complex
•
P wave may be inverted
and straight after T wave.
•
Monomorphic
•
•
VT
Usually due to MI scarring causing an aberrant focal
automaticity or a reentrant pathway like flutter
Polymorphic
•
Usually abnormality of repolarization - prolonged
QT eg.
•
Needs electrical cardioversion if pulseless, or
progresses to VF
•
If < 30 seconds = non-sustained VT
VF
•
Causes: Trauma (physical or electrical), CAD, MI, cardiomyopathies, sudden cardiac
death, congenital heart disease etc...
•
Most have no hx of heart disease
•
Though often have many risk factors - smoking, hyperlipidaemia, DM.
•
Episodes outwith hospital have 2-25% long term survival
•
many survivors are comatose/permanently brain damaged.
Seemingly random pattern
No identifiable P or QRS rhythm
Wandering baseline
Heart block
•
1st degree AV block (prolonged PR)
•
2nd degree AV block
•
Mobitz I (lengthening PR til dropped QRS)
•
Mobitz II (intermittently dropped P waves)
•
3rd degree AV block (complete)
•
Infranodal block
•
•
Left BBB
•
Left Anterior Fascicular Block
•
Left Posterior Fascicular Block
Right BBB
mobitz ii
lBBB
AF
PSVT - AVRT
Atrial flutter
1st degree AV Block
RBBB
Polymorphic vt - ecg
TORSADES
mobitz 1
Premature Atrial Complexes
3rd degree
Monomorphic vt
PSVT - AVNRT
VF
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