cardiac rhytmn abnormalities

MD – AUCMS Program

CARDIOVASCULAR SYSTEM

(Meet the Expert Session )

“Cardiac Rythmn Abnomalities on ECG”Sem2 Year2

9 May, 2013 10:30 am-12:30 amStudent’s Copy

Prepared by:

Naomi Joy Dilodilo, MD,Lecturer

Cardiovascular System


Introduction:

Heart has a rhythmic capability to beat and pump blood to our body and remarkably, does so without fail, throughout our life. The rhythm has been destined to beat in certain prefixed numerical limits and with certain regularity. Arrhythmias are disorders characterized by abnormal beating of the heart. Arrhythmias can occur in a healthy heart and be of minimal consequence. At the same time they may co-exist with diseased heart and may be life-threatening or may cause, stroke, heart failure or sudden death.

An arrhythmia occurs when the normal electrical cycle of the heart is disturbed. Normally, tiny currents activate the upper part of the heart, just before the bottom part of the heart, which are the muscular chambers that pump blood around the body. Fast arrhythmias are referred to as 'tachyarrhythmias'. When the heart goes too slowly due to a failure of electrical activation, it is referred to as a brady arrhythmia. Most arrhythmias arising from the top of the heart are troublesome but not life-threatening. Many arrhythmias arising from the lower of the heart, are life-threatening.

Recognition of Prior Learning : Electrical Conduction System of the Heart Basic Interpretation of 12 Lead ECG

o Standard Limb Lead Electrode Placemento Chest leads

Electrical Components of ECG Tracing Methods of Calculating Heart rate

o Counting the Large Boxeso Counting the Small Boxeso Six Second ECG Strip

Basic ECG Interpretationo Rateo Regularityo P waveo PR Intervalo QRS Intervalo QT Intervalo Dropped beatso Pauseo QRS complex grouping

Objectives:At the end of the session, the students should be able to: Know about Cardiac Rhythm Abnormalities on ECG

Describe and explain the abnormal ECG findings in the various types of arrhythmias:- Bradyarrhythmias

o Sinus node dysfuntiono AV conduction disturbances – 1st, 2nd and 3rd degree AV blocks, AV dissociation

- Tachyarrhythmiaso Premature complexes – Atrial premature complexes (APCs), AV junctional complexes, Ventricular

premature complexes (VPCs)o Sinus tachycardiao Atrial fibrillation, Atrial fluttero Paroxysmal supraventricular tachycardiao Ventricular tachycardia.Ventricular flutter. Ventricular fibrillation



Interpret abnormal ECG patterns listed above using examples Interpretation of ECG Tracings: Rate, Rhythmn, PR Interval, QRS comlex

CASE 1:

Rate: ______________ Rhythmn:_____________ PR Interval:____________QRS:______________ CASE 2:

Rate: ______________ Rhythmn:_____________ PR Interval:____________QRS:______________

Sinus bradycardia is normal in athletes and during sleep. In acute MI, it may be protective and beneficial or the slow rate may compromise cardiac output. Certain medications, such as beta blockers, may also cause sinus bradycardia.

CASE 3:


Sinus tachycardia may be caused by exercise, anxiety, fever, hypoxemia, hypovolemia, or cardiac failure.



CASE 4:


CASE 5:


CASE 6:




CASE 7:


CASE 8:

In Patients with heart disease, frequent PAC’s may precede paroxysmal supraventricular tachycardia (PSVT), A-fib, or A-flutter


CASE 9:


SVT maybe related to caffeine intake, nicotine, stress, or anxiety in healthy adults



CASE 10:


CASE 11:The patient might feel palpitations, dizziness, lightheadedness or anxiety


CASE 12:


CASE 13:



A-Fib is usually a chronic arrhythmias associated with underlying heart disease. Signs and symptoms depend of ventricular response rate


CASE 14:

Rate: ______________ Rhythmn:_____________ PR Interval:___________QRS:_____________

CASE 15:

Patients may sense the occurrence of PVC’s as skipped beats. Becaause the ventricles are only partially filled, the PVC frequently does not generate a pulse.


CASE 16:




CASE 17:

It is important to confirm the presence of absence of pulses because monomorphic VT maybe perfusing or non-perfusing. Monomorphic VT will probably deteriorate into VF or unstable VT if sustained and not treated.


CASE 18:


CASE 19:

If there is no pulse or cardiac output rapid intervention is critical. The longer delay, the less chance of conversion.




CASE 20:

Always confirm asystole by checking the ECG in two different leads. Also search to identify underlying ventricular fibrillation.


CASE 21:

Usually A-V block is benigh, but is associated with an acute MI, it may lead to further A-V defects.


CASE 22:

This rhythm maybe be caused by medication such as beta blockers, digoxin and calcium chanel blockers. Ischemia involving the right coronary artery is another cause.




CASE 23

Resulting bradycardia can compromise cardiac output and lead to complete AV block. This rhythm often occurs with the cardiac ischemia or an MI.


CASE 24:


CASE 25:




Practice: Do you recognize the pattern?

ECG Tracing 1:

Answer:_____________________________

ECG Tracing 2:

Answer:_____________________________

ECG Tracing 3:

Answer: __________________________________

ECG Tracing 4:

Answer: __________________________________



ECG Tracing 5:

Answer: __________________________________

ECG Tracing 6:

Answer: __________________________________

ECG Tracing 7:

Answer: __________________________________

ECG Tracing 8:

Answer: __________________________________



ECG Tracing 9:

Answer: __________________________________

ECG Tracing 10:

Answer: __________________________________

ECG Tracing 11:

Answer: __________________________________

References:

Shirley A. Jones, MS Ed, MHA, EMT-P, ECG Notes, Intepretation and Management Guide; F. A. Davis Company • Philadelphia


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