PATIENT WITH ARRHYTHMIA IN DENTIST S OFFICE. Małgorzata Kurpesa, MD., PhD. Chair&Department of Cardiology

Size: px
Start display at page:

Download "PATIENT WITH ARRHYTHMIA IN DENTIST S OFFICE. Małgorzata Kurpesa, MD., PhD. Chair&Department of Cardiology"

Transcription

1 PATIENT WITH ARRHYTHMIA IN DENTIST S OFFICE Małgorzata Kurpesa, MD., PhD. Chair&Department of Cardiology Medical University of Łódź

2 The heart is made up of four chambers Left Atrium Right Atrium Left Ventricle Right Ventricle

3 What makes the heart pump? Natural Electric Impulses Which stimulate heart muscle to contract The heart is made primarily of muscle When the muscle contracts, it squeezes the blood through the heart and out to the lungs or to the body

4 Normal pathway for electricity to travel through the heart SA node AV node Bundle of His Left bundle branch Right bundle branch = Myocardium contracts

5 SA Node (inherent rate of ) When we lose power! Atrial foci (inherent rate of 60 80) Junctional foci (inherent rate of 40 60) Ventricular foci (inherent rate of 20 40) The lower the level in the heart, where the foci is located that is doing the pacing, the lower is the inherent rate (heart rate) produced by that area). A foci is a potential pacemaker (or cell) that is capable of pacing in emergency situations.

6

7 I II III

8 What is an arrhythmia? Normal cardiac function relies on the flow of electrical impulses through the heart in an exquisitely coordinated fashion. Any abnormality in this rhythm of the heart is by definition an arrhythmia.

9 COMMON SYMPTOMS OF CARDIAC ARRHYTHMIAS 1.Palpitations 2. Hemodynamic dysfunction Dizziness Syncope Chest pain

10 CARDIAC CONDUCTION SYSTEM AV node Bundle of His SA node Right bundle branch Electrophysiologically the Purkinje heart fibre is two-chambered with the atrial and ventricular myocardium separated from each other by the fibrous tissue of the atrioventricular rings. The only link between the two chambers of the atria and the ventricles, is a thin muscular bridge, the AV conduction system Left bundle branch

11 DIVISION OF ARRHYTHMIAS 1.. SUPRAVENTRICULAR ISOLATED PREMATURE BEATS TACHYCARDIA ATRIAL FIBRILLATION AND ATRIAL FLUTTER 2. VENTRICULAR ISOLATED PREMATURE BEATS TACHYCARDIA (INCLUDING TORSADE DE POINTES ) VENTRICULAR FIBRILLATION

12 DIVISION OF ARRHYTHMIAS 1. BRADYARRHYTHMIAS HR < 60/min 2. TACHYARRHYTHMIAS HR > 100/min

13 SINUS BRADYCARDIA

14 SINUS ARREST AND SINOATRIAL EXIT BLOCK Sinus Arrest SA Exit Block

15 Sinus Rhythm Junctional Rhythm Ventricular Rhythm

16 Premature Beats Not a rhythm, just a single early beat Three Options: If it arises from the Atria, it will have a normal PR Interval This is a Premature Atrial Contraction or PAC If it arises from the Junctional area, it will have a PR Interval which is less than normal or no P wave at all This is a Premature Junctional Contraction or PJC If it arises from the Ventricular area, it will be a QRS which is wide and bizarre shaped This is a Premature Ventricular Contraction or PVC

17 No P Wave SR with P Wave Close to QRS PJC SR with PJC A wide bizarre QRS Junctional Rhythm with PVC

18 Variability of Ventricular Ectopy with Age Effect of age on probability (%) of having more than a given number of PVCs per 24 hours in subjects with normal hearts. 60% 50% 40% 30% 20% 10% > 0 PVCs > 50 PVCs > 100 PVCs Data from Kostis JB. Circulation. 1981;63(6): % Age

19 Ventricular bigeminy = every other beat is a PVC Ventricular trigeminy = every 3rd beat is a PVC

20 Ventricular Tachycardia (VT) 3 or more ventricular beats in a row Rate > 100 bpm 6 beats of VT

21 I I II III

22 Ventricular Fibrillation (VF) Squiggly line

23

24 VF is a type of cardiac arrest, for there is no pumping action by the heart. It requires immediate CPR and defibrillation

25 ICD Indications Generally Used in cases where there was a previous cardiac arrest Or, patients with undetermined origin or continued VT or VF despite medical interventions

26 Atrial Flutter Can count the # of flutter waves (F waves) Atrial Fibrillation (Afib) Atrial Fibrillation (Afib) Unable to count the # of waves

27 ATRIAL FIBRILLATION f

28

29 AF: Anticoagulation - General Points AF most common significant rhythm disorder Prevalence: 1.5%-3% of patients in their 60s 5%-7% of patients in their 70s 10% of patients in their 80s AF most potent common risk factor for stroke Relative risk = 5 Patients with AF can be stratified according to risk of stroke Feinberg WM e al. Arch Intern Med 1995;155:469 Wolf PA et al. Stroke1991;22:983

30 ATRIAL FIBRILLATION INCREASES THE EMBOLIC RISK ESPECIALLY THE RISK OF ISCHEMIC STROKE TO REDUCE THIS RISK PATIENTS WITH AF SHOULD BE TRAETED WITH ORAL ANTICOAGULANTS ORAL ANTICOAGULANTS - ANTIVITAMINS K : WARFARIN, ACENOCUMAROL TREATMENT WITH ORAL ANTIVITAMINS K PROLONGS THE BLEEDING TIME THE DOSE OF ORAL ANTIVITAMINS K DEPENDS ON THE PROTHROMBIN INDEX (INR) WHICH SHOULD BE PROLONGED 2,5 3,5 TIMES

31 INR 3 = TIME OF BLEEDING IS 3 TIMES LONGER THAN NORMAL UNDER SUCH CIRCUMSTANCES THERE IS HIGHER PROBABILITY OF PROLONGED BLEEDING DURING SURGICAL PROCEDURE HOWEVER TOOTH EXTRACTION IS NOT CONTRAINDICATED FOR PATIENTS RECEIVING ORAL ANTICOAGULANTS

32 lightest Types of Atrio A Ventricular Blocks First Degree 1 AVB Second Degree Wenckebach/Mobitz I Mobitz II worst Third Degree 3 AVB

33 First Degree AV Block (1º AVB) PR interval >.20 ms A // V

34 Mobitz I: Wenckebach PR interval gradually longer until a QRS is dropped B indicates a Blocked Beat Pattern is repeated Typically not harmful normal longer longer dropped QRS

35 Mobitz II PR interval consistent except some QRS missing Harmful--may indicate serious heart disease or progress to 3rd degree block Blocked QRS

36 3rd Degree AV Block (3º AVB) Atria & ventricles act independently Regular P waves Regular QRS complexes But P waves and QRS not working together blocked normal blocked blocked short blocked normal blocked

37 Pacemaker Basics Provides electrical stimuli to cause cardiac contraction when intrinsic cardiac activity is inappropriately slow or absent Sense intrinsic cardiac electric potentials

38 Pacemaker Indications Absolute indications Sick sinus syndrome Symptomatic sinus bradycardia Tachy-brady syndrome Afib with slow ventricular response 3 rd degree heart block Chronotropic incompetence Inability to increase heart rate to match exercise

39 Bigger s classification 1. Benign arrhythmia different kinds of premature beats,, no structural heart disease,, no sustained ventricular tachycardia - good prognosis 2. Potential malignant arrhythmia - different kinds of premature beats,, no sustained VT, structural heart disease, various degree of left ventricular dysfunction 3. Malignant arrhythmia - different kinds of premature beats, episode of ustained VT or VF, presence of structural heart disease and left ventricular dysfunction poor prognosis

-RHYTHM PRACTICE- By Dr.moanes Msc.cardiology Assistant Lecturer of Cardiology Al Azhar University. OBHG Education Subcommittee

-RHYTHM PRACTICE- By Dr.moanes Msc.cardiology Assistant Lecturer of Cardiology Al Azhar University. OBHG Education Subcommittee -RHYTHM PRACTICE- By Dr.moanes Msc.cardiology Assistant Lecturer of Cardiology Al Azhar University The Normal Conduction System Sinus Node Normal Sinus Rhythm (NSR) Sinus Bradycardia Sinus Tachycardia

More information

Rate: The atrial and ventricular rates are equal; heart rate is greater than 100 bpm (usually between bpm).

Rate: The atrial and ventricular rates are equal; heart rate is greater than 100 bpm (usually between bpm). Sinus Bradycardia Regularity: The R-R intervals are constant; the rhythm is regular. Rate: The atrial and ventricular rates are equal; heart rate is less than 60 bpm. P wave: There is a uniform P wave

More information

CORONARY ARTERIES. LAD Anterior wall of the left vent Lateral wall of left vent Anterior 2/3 of interventricluar septum R & L bundle branches

CORONARY ARTERIES. LAD Anterior wall of the left vent Lateral wall of left vent Anterior 2/3 of interventricluar septum R & L bundle branches CORONARY ARTERIES RCA Right atrium Right ventricle SA node 55% AV node 90% Posterior wall of left ventricle in 90% Posterior third of interventricular septum 90% LAD Anterior wall of the left vent Lateral

More information

Arrhythmia Management Joshua M. Cooper, MD, FHRS, FACC

Arrhythmia Management Joshua M. Cooper, MD, FHRS, FACC Arrhythmia Management Joshua M. Cooper, MD, FHRS, FACC Professor of Medicine Director of Cardiac Electrophysiology Temple University Health System Plumbing Electrical System Bradyarrhythmias Sinus Node

More information

CRC 431 ECG Basics. Bill Pruitt, MBA, RRT, CPFT, AE-C

CRC 431 ECG Basics. Bill Pruitt, MBA, RRT, CPFT, AE-C CRC 431 ECG Basics Bill Pruitt, MBA, RRT, CPFT, AE-C Resources White s 5 th ed. Ch 6 Electrocardiography Einthoven s Triangle Chest leads and limb leads Egan s 10 th ed. Ch 17 Interpreting the Electrocardiogram

More information

2017 BDKA Review. Regularity Rate P waves PRI QRS Interpretation. Regularity Rate P waves PRI QRS Interpretation 1/1/2017

2017 BDKA Review. Regularity Rate P waves PRI QRS Interpretation. Regularity Rate P waves PRI QRS Interpretation 1/1/2017 1. 2017 BDKA Review 2. 3. 4. Interpretation 5. QT 6. 7. 8. 9. 10. QT 11. 12. 13. 14. 15. 16. 17. 18. QT 19. 20. QT 21. 22. QT 23. 24. Where are pacer spikes? Before the P wave or before the QRS complex?

More information

Cardiac Implanted Electronic Devices Pacemakers, Defibrillators, Cardiac Resynchronization Devices, Loop Recorders, etc.

Cardiac Implanted Electronic Devices Pacemakers, Defibrillators, Cardiac Resynchronization Devices, Loop Recorders, etc. Cardiac Implanted Electronic Devices Pacemakers, Defibrillators, Cardiac Resynchronization Devices, Loop Recorders, etc. The Miracle of Living February 21, 2018 Matthew Ostrom MD,FACC,FHRS Division of

More information

TEST BANK FOR ECGS MADE EASY 5TH EDITION BY AEHLERT

TEST BANK FOR ECGS MADE EASY 5TH EDITION BY AEHLERT Link download full: http://testbankair.com/download/test-bank-for-ecgs-made-easy-5thedition-by-aehlert/ TEST BANK FOR ECGS MADE EASY 5TH EDITION BY AEHLERT Chapter 5 TRUE/FALSE 1. The AV junction consists

More information

Basic Dysrhythmia Interpretation

Basic Dysrhythmia Interpretation Basic Dysrhythmia Interpretation Objectives 2 To understand the Basic ECG To understand the meaning of Dysrhythmia To describe the normal heart conduction system. To describe the normal impulse pathways.

More information

EKG Abnormalities. Adapted from:

EKG Abnormalities. Adapted from: EKG Abnormalities Adapted from: http://www.bem.fi/book/19/19.htm Some key terms: Arrhythmia-an abnormal rhythm or sequence of events in the EKG Flutter-rapid depolarizations (and therefore contractions)

More information

Paroxysmal Supraventricular Tachycardia PSVT.

Paroxysmal Supraventricular Tachycardia PSVT. Atrial Tachycardia; is the name for an arrhythmia caused by a disorder of the impulse generation in the atrium or the AV node. An area in the atrium sends out rapid signals, which are faster than those

More information

Basic EKG Interpretation. Nirja Parikh, PT, DPT

Basic EKG Interpretation. Nirja Parikh, PT, DPT Basic EKG Interpretation Nirja Parikh, PT, DPT Electrocardiogram (EKG) Using surface electrodes record the electrical activity of the heart electrical activity (usually) correlates to mechanical function

More information

Course Objectives. Proper Lead Placements. Review the ECG print paper. Review the mechanics of the Myocardium. Review basics of ECG Rhythms

Course Objectives. Proper Lead Placements. Review the ECG print paper. Review the mechanics of the Myocardium. Review basics of ECG Rhythms ECG Interpretations Course Objectives Proper Lead Placements Review the ECG print paper Review the mechanics of the Myocardium Review basics of ECG Rhythms How Leads Work The ECG Leads we use are Bipolar

More information

UNDERSTANDING YOUR ECG: A REVIEW

UNDERSTANDING YOUR ECG: A REVIEW UNDERSTANDING YOUR ECG: A REVIEW Health professionals use the electrocardiograph (ECG) rhythm strip to systematically analyse the cardiac rhythm. Before the systematic process of ECG analysis is described

More information

Arrhythmic Complications of MI. Teferi Mitiku, MD Assistant Clinical Professor of Medicine University of California Irvine

Arrhythmic Complications of MI. Teferi Mitiku, MD Assistant Clinical Professor of Medicine University of California Irvine Arrhythmic Complications of MI Teferi Mitiku, MD Assistant Clinical Professor of Medicine University of California Irvine Objectives Brief overview -Pathophysiology of Arrhythmia ECG review of typical

More information

1 Cardiology Acute Care Day 22 April 2013 Arrhythmia Tutorial Course Material

1 Cardiology Acute Care Day 22 April 2013 Arrhythmia Tutorial Course Material 1 Cardiology Acute Care Day 22 April 2013 Arrhythmia Tutorial Course Material Arrhythmia recognition This tutorial builds on the ECG lecture and provides a framework for approaching any ECG to allow the

More information

Arrhythmia Study Guide 3 Junctional and Ventricular Rhythms

Arrhythmia Study Guide 3 Junctional and Ventricular Rhythms Arrhythmia Study Guide 3 Junctional and Ventricular Rhythms JUNCTIONAL RHYTHMS The AV Junction (Bundle of His and surrounding cells) only acts as pacemaker of the heart when the SA Node is not firing normally

More information

Junctional Premature Contraction (JPC)

Junctional Premature Contraction (JPC) Where s the PAC? Junctional Premature Contraction (JPC) A junctional premature contraction (JPC) is a beat that originates prematurely in the AV node. It can occur sporadically or in a grouped pattern.

More information

National Coverage Determination (NCD) for Cardiac Pacemakers (20.8)

National Coverage Determination (NCD) for Cardiac Pacemakers (20.8) Page 1 of 12 Centers for Medicare & Medicaid Services National Coverage Determination (NCD) for Cardiac Pacemakers (20.8) Tracking Information Publication Number 100-3 Manual Section Number 20.8 Manual

More information

2) Heart Arrhythmias 2 - Dr. Abdullah Sharif

2) Heart Arrhythmias 2 - Dr. Abdullah Sharif 2) Heart Arrhythmias 2 - Dr. Abdullah Sharif Rhythms from the Sinus Node Sinus Tachycardia: HR > 100 b/m Causes: o Withdrawal of vagal tone & Sympathetic stimulation (exercise, fight or flight) o Fever

More information

EKG Competency for Agency

EKG Competency for Agency EKG Competency for Agency Name: Date: Agency: 1. The upper chambers of the heart are known as the: a. Atria b. Ventricles c. Mitral Valve d. Aortic Valve 2. The lower chambers of the heart are known as

More information

EKG Rhythm Interpretation Exam

EKG Rhythm Interpretation Exam as EKG Rhythm Interpretation Exam Name: Date: ID# Unit Assume each strip is a 6 second strip. Passing is 80%. 1. Identify the following rhythm: a. Asystole b. Ventricular fibrillation c. Atrial fibrillation

More information

Cardiac Cycle. Each heartbeat is called a cardiac cycle. First the two atria contract at the same time.

Cardiac Cycle. Each heartbeat is called a cardiac cycle. First the two atria contract at the same time. The Heartbeat Cardiac Cycle Each heartbeat is called a cardiac cycle. First the two atria contract at the same time. Next the two ventricles contract at the same time. Then all the chambers relax. http://www.youtube.com/watch?v=frd3k6lkhws

More information

Step by step approach to EKG rhythm interpretation:

Step by step approach to EKG rhythm interpretation: Sinus Rhythms Normal sinus arrhythmia Small, slow variation of the R-R interval i.e. variation of the normal sinus heart rate with respiration, etc. Sinus Tachycardia Defined as sinus rhythm with a rate

More information

EKG Intermediate Tips, tricks, tools

EKG Intermediate Tips, tricks, tools Birmingham Regional Emergency Medical Services System 2018 ALCTE Summer Conference EKG Intermediate Tips, tricks, tools Brian Gober, MAT, ATC, NRP, CSCS Education Services Manager ECC Training Center Coordinator

More information

Lab Activity 24 EKG. Portland Community College BI 232

Lab Activity 24 EKG. Portland Community College BI 232 Lab Activity 24 EKG Reference: Dubin, Dale. Rapid Interpretation of EKG s. 6 th edition. Tampa: Cover Publishing Company, 2000. Portland Community College BI 232 Graph Paper 1 second equals 25 little boxes

More information

Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: WPW Revised: 11/2013

Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: WPW Revised: 11/2013 Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: WPW Revised: 11/2013 Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of the

More information

Chapter 9. Learning Objectives. Learning Objectives 9/11/2012. Cardiac Arrhythmias. Define electrical therapy

Chapter 9. Learning Objectives. Learning Objectives 9/11/2012. Cardiac Arrhythmias. Define electrical therapy Chapter 9 Cardiac Arrhythmias Learning Objectives Define electrical therapy Explain why electrical therapy is preferred initial therapy over drug administration for cardiac arrest and some arrhythmias

More information

Chad Morsch B.S., ACSM CEP

Chad Morsch B.S., ACSM CEP What Is Cardiac Stress Testing? Chad Morsch B.S., ACSM CEP A Cardiac Stress Test is a test used to measure the heart's ability to respond to external stress in a controlled clinical environment. Cardiac

More information

Electrocardiography for Healthcare Professionals

Electrocardiography for Healthcare Professionals Electrocardiography for Healthcare Professionals Chapter 7: Junctional Dysrhythmias 2012 The Companies, Inc. All rights reserved. Learning Outcomes 7.1 Describe the various junctional dysrhythmias 7.2

More information

8/20/2012. Learning Outcomes (Cont d)

8/20/2012. Learning Outcomes (Cont d) 1 2 3 4 Electrocardiography for Healthcare Professionals Chapter 7: Junctional Dysrhythmias Learning Outcomes 7.1 Describe the various junctional dysrhythmias 7.2 Identify premature junctional complexes

More information

Cardiac Arrhythmias. Cathy Percival, RN, FALU, FLMI VP, Medical Director AIG Life and Retirement Company

Cardiac Arrhythmias. Cathy Percival, RN, FALU, FLMI VP, Medical Director AIG Life and Retirement Company Cardiac Arrhythmias Cathy Percival, RN, FALU, FLMI VP, Medical Director AIG Life and Retirement Company The Cardiovascular System Three primary functions Transport of oxygen, nutrients, and hormones to

More information

REtrive. REpeat. RElearn Design by. Test-Enhanced Learning based ECG practice E-book

REtrive. REpeat. RElearn Design by. Test-Enhanced Learning based ECG practice E-book Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning based ECG practice E-book REtrive REpeat RElearn Design by S I T T I N U N T H A N G J U I P E E R I Y A W A

More information

ECG Interpretation Made Easy

ECG Interpretation Made Easy ECG Interpretation Made Easy Dr. A Tageldien Abdellah, MSc MD EBSC Lecturer of Cardiology- Hull University Hull York Medical School 2007-2008 ECG Interpretation Made Easy Synopsis Benefits Objectives Process

More information

COURSE DESCRIPTION. Rev 2.0 7/2013. Page 1 of 26

COURSE DESCRIPTION. Rev 2.0 7/2013. Page 1 of 26 COURSE DESCRIPTION Ventricular dysrhythmias (arrhythmias) are unique and potentially dangerous cardiac rhythms. They are often associated with Code Blue calls, and life and death situations. The only two

More information

Conduction disorders

Conduction disorders Conduction disorders L.V. Bogun, N.I. Yabluchansky, F.M. Abdueva, O.Y. Bichkova, A.N. Fomich, P.A. Garkavyi, A.L. Kulik, N.V. Lysenko, N.V. Makienko, L.A. Martimyanova, I.V. Soldatenko, E.E. Tomina Department

More information

ABCs of ECGs. Shelby L. Durler

ABCs of ECGs. Shelby L. Durler ABCs of ECGs Shelby L. Durler Objectives Review the A&P of the cardiac conduction system Placement and obtaining 4-lead and 12-lead ECGs Overview of the basics of ECG rhythm interpretation Intrinsic

More information

Electrocardiography for Healthcare Professionals

Electrocardiography for Healthcare Professionals Electrocardiography for Healthcare Professionals Kathryn A. Booth Thomas O Brien Chapter 10: Pacemaker Rhythms and Bundle Branch Block Learning Outcomes 10.1 Describe the various pacemaker rhythms. 10.2

More information

ECG Interpretation Cat Williams, DVM DACVIM (Cardiology)

ECG Interpretation Cat Williams, DVM DACVIM (Cardiology) ECG Interpretation Cat Williams, DVM DACVIM (Cardiology) Providing the best quality care and service for the patient, the client, and the referring veterinarian. GOAL: Reduce Anxiety about ECGs Back to

More information

Electrocardiography for Healthcare Professionals

Electrocardiography for Healthcare Professionals Electrocardiography for Healthcare Professionals Chapter 9: Ventricular Dysrhythmias 2012 The Companies, Inc. All rights reserved. Learning Outcomes 9.1 Describe the various ventricular dysrhythmias 9.2

More information

Paramedic Rounds. Tachyarrhythmia's. Sean Sutton Dallas Wood

Paramedic Rounds. Tachyarrhythmia's. Sean Sutton Dallas Wood Paramedic Rounds Tachyarrhythmia's Sean Sutton Dallas Wood Objectives At the end of this session, the paramedic will be able to: State the key components of the cardiac conduction pathway, along with the

More information

UNDERSTANDING ELECTROPHYSIOLOGY STUDIES

UNDERSTANDING ELECTROPHYSIOLOGY STUDIES UNDERSTANDING ELECTROPHYSIOLOGY STUDIES Testing and Treating Your Heart s Electrical System A Problem with Your Heart Rhythm The speed and pattern of a heartbeat is called the heart rhythm. The rhythm

More information

Cardiology Flash Cards

Cardiology Flash Cards Cardiology Flash Cards EKG in a nut shell www.brain101.info Conduction System www.brain101.info 2 Analyzing EKG Step by step Steps in Analyzing ECG'S 1. Rhythm: - Regular _ Sinus, Junctional or Ventricular.

More information

Arrhythmias. Pulmonary Artery

Arrhythmias. Pulmonary Artery Arrhythmias Introduction Cardiac arrhythmia is an irregularity of the heart beat that causes the heart to beat too slowly, too fast, or irregularly. There are different types of arrhythmias. Most arrhythmias

More information

Please check your answers with correct statements in answer pages after the ECG cases.

Please check your answers with correct statements in answer pages after the ECG cases. ECG Cases ECG Case 1 Springer International Publishing AG, part of Springer Nature 2018 S. Okutucu, A. Oto, Interpreting ECGs in Clinical Practice, In Clinical Practice, https://doi.org/10.1007/978-3-319-90557-0

More information

Rhythm ECG Characteristics Example. Normal Sinus Rhythm (NSR)

Rhythm ECG Characteristics Example. Normal Sinus Rhythm (NSR) Normal Sinus Rhythm (NSR) Rate: 60-100 per minute Rhythm: R- R = P waves: Upright, similar P-R: 0.12-0.20 second & consistent P:qRs: 1P:1qRs Sinus Tachycardia Exercise Hypovolemia Medications Fever Substances

More information

Bradydysrhythmias and Atrioventricular Conduction Blocks

Bradydysrhythmias and Atrioventricular Conduction Blocks Emerg Med Clin N Am 24 (2006) 1 9 Bradydysrhythmias and Atrioventricular Conduction Blocks Jacob W. Ufberg, MD*, Jennifer S. Clark, MD Department of Emergency Medicine, Temple University School of Medicine,

More information

Dr. Schroeder has no financial relationships to disclose

Dr. Schroeder has no financial relationships to disclose Valerie A Schroeder MD MS Assistant Professor University of Kansas Medical Center READING THE WAVES- THE HEART S ELECTRICAL MESSAGE FINANCIAL DISCLOSURE Dr. Schroeder has no financial relationships to

More information

Dr.Binoy Skaria 13/07/15

Dr.Binoy Skaria  13/07/15 Dr.Binoy Skaria binoyskaria@hotmail.com binoy.skaria@heartofengland.nhs.uk 13/07/15 Acknowledgement Medtronic, Google images & Elsevier for slides Natalie Ryan, Events Manager, HEFT- for organising the

More information

EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs

EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs Dear EHRA Member, Dear Colleague, As you know, the EHRA Accreditation Process is becoming increasingly recognised as an important step for

More information

PERMANENT PACEMAKERS AND IMPLANTABLE DEFIBRILLATORS Considerations for intensivists

PERMANENT PACEMAKERS AND IMPLANTABLE DEFIBRILLATORS Considerations for intensivists PERMANENT PACEMAKERS AND IMPLANTABLE DEFIBRILLATORS Considerations for intensivists Craig A. McPherson, MD, FACC Associate Professor of Medicine Constantine Manthous, MD, FACP, FCCP Associate Clinical

More information

Cardiac Arrhythmias in Sleep

Cardiac Arrhythmias in Sleep Cardiac Arrhythmias in Sleep Only 53 Slides! Gauresh H Kashyap, MD, FACP, FCCP, FAASM 1 2 Cardiac Arrhythmias in Sleep Out of 400 Patients with OSA, 48% had some Arrhythmias 20% - 2 PVCs/min 7% - Bradycardia

More information

Cardiac Arrhythmia How to approach นพ.พ น จ แกวส วรรณะ หน วยโรคห วใจและหลอดเล อด

Cardiac Arrhythmia How to approach นพ.พ น จ แกวส วรรณะ หน วยโรคห วใจและหลอดเล อด Cardiac Arrhythmia How to approach นพ.พ น จ แกวส วรรณะ หน วยโรคห วใจและหลอดเล อด EKG paper is a grid where time is measured along the horizontal axis. Each small square is 1 mm in length and represents

More information

Chapter 16: Arrhythmias and Conduction Disturbances

Chapter 16: Arrhythmias and Conduction Disturbances Complete the following. Chapter 16: Arrhythmias and Conduction Disturbances 1. Cardiac arrhythmias result from abnormal impulse, abnormal impulse, or both mechanisms together. 2. is the ability of certain

More information

physiology 6 Mohammed Jaafer Turquoise team

physiology 6 Mohammed Jaafer Turquoise team 15 physiology 6 Mohammed Jaafer 22-3-2016 Turquoise team Cardiac Arrhythmias and Their Electrocardiographic Interpretation Today, we are going to talk about the abnormal excitation. As we said before,

More information

ECGs and Arrhythmias: Family Medicine Board Review 2012

ECGs and Arrhythmias: Family Medicine Board Review 2012 Overview ECGs and Arrhythmias: Family Medicine Board Review 2012 Jess Waldura, MD University of California, San Francisco walduraj@nccc.ucsf.edu Bundle branch blocks Quick review of ischemia Arrhythmias

More information

Basic ECG Interpretation Module Notebook

Basic ECG Interpretation Module Notebook Basic ECG Interpretation Module Notebook ECG_Notebook_04.27.05 Page 1 of 142 Basic ECG Interpretation Table of Contents Module Objectives... 3 Module Outline... 6 Lesson I... 6 Lesson II... 8 Lesson III...

More information

ECG Interpretation and Clinical Significance

ECG Interpretation and Clinical Significance Confirming Pages ECG Interpretation and Clinical Significance Chapter Outline 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 Learning Outcomes Key Terms Introduction (p. 114) Identifying the Components of the

More information

ECG ABNORMALITIES D R. T AM A R A AL Q U D AH

ECG ABNORMALITIES D R. T AM A R A AL Q U D AH ECG ABNORMALITIES D R. T AM A R A AL Q U D AH When we interpret an ECG we compare it instantaneously with the normal ECG and normal variants stored in our memory; these memories are stored visually in

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure (review

More information

The ECG Course. Boone County Fire Protection District EMS Education

The ECG Course. Boone County Fire Protection District EMS Education The ECG Course Level I G rated material AV Blocks What Causes AV Block? Long list of bad things that includes ischemia and.. Old age / disease Medications or drugs Electrolyte imbalances Physiologic Blocks

More information

Catheter Ablation. Patient Education

Catheter Ablation. Patient Education Catheter Ablation Patient Education Allina Health System Your heart has four chambers. Two upper chambers (atria) pump blood to the two lower chambers (ventricles). In order for the heart to pump, it requires

More information

Lake EMS Basic EKG Review: Atrial Rhythms. The Lake EMS Quality Development Team

Lake EMS Basic EKG Review: Atrial Rhythms. The Lake EMS Quality Development Team Lake EMS Basic EKG Review: Atrial Rhythms The Lake EMS Quality Development Team This program is the Intellectual Property of Lake Emergency Medical Services Use of this program is limited to training and

More information

Cardiac Telemetry Self Study: Part One Cardiovascular Review 2017 THINGS TO REMEMBER

Cardiac Telemetry Self Study: Part One Cardiovascular Review 2017 THINGS TO REMEMBER Please review the above anatomy of the heart. THINGS TO REMEMBER There are 3 electrolytes that affect cardiac function o Sodium, Potassium, and Calcium When any of these electrolytes are out of the normal

More information

ECG S: A CASE-BASED APPROACH December 6,

ECG S: A CASE-BASED APPROACH December 6, ECG S: A CASE-BASED APPROACH December 6, 2018 1 Faculty Disclosure Faculty: Lorne Gula MD, FRCPC Professor, Western University Cardiologist, Hearth Rhythm Specialist Director, Electrophysiology Laboratory,

More information

CRITICAL CARE OF THE CARDIAC PATIENT WEBINAR VET 2017

CRITICAL CARE OF THE CARDIAC PATIENT WEBINAR VET 2017 CRITICAL CARE OF THE CARDIAC PATIENT WEBINAR VET 2017 The Heart The heart is undoubtedly the most important organ in the body. Unfortunately, when it is not functioning properly, it can have dire consequences.

More information

Practice Questions.

Practice Questions. IBHRE Prep Practice Questions Question 1 The relative refractory yperiod of the ventricular myocardium corresponds to which of the following phases of the action potential? A. (0) B. (1) C. (2) D. (3)

More information

Patient Resources: Arrhythmias and Congenital Heart Disease

Patient Resources: Arrhythmias and Congenital Heart Disease Patient Resources: Arrhythmias and Congenital Heart Disease Overview Arrhythmias (abnormal heart rhythms) can develop in patients with congenital heart disease (CHD) due to thickening/weakening of their

More information

ECGs: Everything a finalist needs to know. Dr Amy Coulden As part of the Simply Finals series

ECGs: Everything a finalist needs to know. Dr Amy Coulden As part of the Simply Finals series ECGs: Everything a finalist needs to know Dr Amy Coulden As part of the Simply Finals series Aims and objectives To be able to interpret basic ECG abnormalities To be able to recognise commonly tested

More information

ECGs and Arrhythmias: Family Medicine Board Review 2009

ECGs and Arrhythmias: Family Medicine Board Review 2009 Rate Rhythm Intervals Hypertrophy ECGs and Arrhythmias: Family Medicine Board Review 2009 Axis Jess (Fogler) Waldura, MD University of California, San Francisco walduraj@nccc.ucsf.edu Ischemia Overview

More information

How To Think About Rhythms and Conduction

How To Think About Rhythms and Conduction How To Think About Rhythms and Conduction Frank Yanowitz, MD Professor of Medicine (Cardiology) University of Utah School of Medicine Medical Director, IHC ECG Services Intermountain Healthcare http://ecg.utah.edu

More information

I have no conflicts of interest relative to this lecture.

I have no conflicts of interest relative to this lecture. PATHWAYS AROUND THE PITFALLS OF EKG RHYTHM INTERPRETATION Donald D. Brown, MD April 4, 2019 I have no conflicts of interest relative to this lecture. OBJECTIVES FOR PATHWAYS AROUND PITFALLS OF EKG RHYTHM

More information

SIMPLY ECGs. Dr William Dooley

SIMPLY ECGs. Dr William Dooley SIMPLY ECGs Dr William Dooley Content Basic ECG interpretation pattern Some common (examined) abnormalities Presenting ECGs in context Setting up an ECG Setting up an ECG 1 V1-4 th Right intercostal space

More information

Appendix D Output Code and Interpretation of Analysis

Appendix D Output Code and Interpretation of Analysis Appendix D Output Code and Interpretation of Analysis 8 Arrhythmia Code No. Description 8002 Marked rhythm irregularity 8110 Sinus rhythm 8102 Sinus arrhythmia 8108 Marked sinus arrhythmia 8120 Sinus tachycardia

More information

Cardiac arrhythmias. Janusz Witowski. Department of Pathophysiology Poznan University of Medical Sciences. J. Witowski

Cardiac arrhythmias. Janusz Witowski. Department of Pathophysiology Poznan University of Medical Sciences. J. Witowski Cardiac arrhythmias Janusz Witowski Department of Pathophysiology Poznan University of Medical Sciences A 68-year old man presents to the emergency department late one evening complaining of increasing

More information

Electrocardiography for Healthcare Professionals

Electrocardiography for Healthcare Professionals Electrocardiography for Healthcare Professionals Kathryn A. Booth Thomas O Brien Chapter 5: Rhythm Strip Interpretation and Sinus Rhythms Learning Outcomes 5.1 Explain the process of evaluating ECG tracings

More information

4. The two inferior chambers of the heart are known as the atria. the superior and inferior vena cava, which empty into the left atrium.

4. The two inferior chambers of the heart are known as the atria. the superior and inferior vena cava, which empty into the left atrium. Answer each statement true or false. If the statement is false, change the underlined word to make it true. 1. The heart is located approximately between the second and fifth ribs and posterior to the

More information

Full file at

Full file at MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) What electrical event must occur for atrial kick to occur? 1) A) Atrial repolarization B) Ventricular

More information

Arrhythmia 341. Ahmad Hersi Professor of Cardiology KSU

Arrhythmia 341. Ahmad Hersi Professor of Cardiology KSU Arrhythmia 341 Ahmad Hersi Professor of Cardiology KSU Objectives Epidemiology and Mechanisms of AF Evaluation of AF patients Classification of AF Treatment and Risk stratification of AF Identify other

More information

ECG interpretation basics

ECG interpretation basics ECG interpretation basics Michał Walczewski, MD Krzysztof Ozierański, MD 21.03.18 Electrical conduction system of the heart Limb leads Precordial leads 21.03.18 Precordial leads Precordial leads 21.03.18

More information

PACIFIC MEDICAL TRAINING Arrhythmia Interpretation

PACIFIC MEDICAL TRAINING Arrhythmia Interpretation PACIFIC MEDICAL TRAINING Arrhythmia Interpretation Introduction Activity Summary Target Audience Educational Objectives Nursing Educational Objective Faculty Physician Continuing Medical Education Nursing

More information

FLB s What Are Those Funny-Looking Beats?

FLB s What Are Those Funny-Looking Beats? FLB s What Are Those Funny-Looking Beats? Reading Assignment (pages 27-45 in Outline ) The 5-Step Method ECG #: Mearurements: Rhythm (s): Conduction: Waveform: Interpretation: A= V= PR= QRS= QT= Axis=

More information

Cardiac Arrhythmias. For Pharmacists

Cardiac Arrhythmias. For Pharmacists Cardiac Arrhythmias For Pharmacists Agenda Overview of the normal Classification Management Therapy Conclusion Cardiac arrhythmias Overview of the normal Arrhythmia: definition From the Greek a-, loss

More information

X-Plain Atrial Fibrillation Reference Summary

X-Plain Atrial Fibrillation Reference Summary X-Plain Atrial Fibrillation Reference Summary Introduction Atrial fibrillation is a common heart condition that affects approximately 2.5 million Americans every year. Atrial fibrillation requires immediate

More information

Matters of the Heart: Comprehensive Cardiology SARAH BEANLANDS RN BSCN MSC

Matters of the Heart: Comprehensive Cardiology SARAH BEANLANDS RN BSCN MSC Matters of the Heart: Comprehensive Cardiology SARAH BEANLANDS RN BSCN MSC Who am I? Class Outline Gross anatomy of the heart Trip around the heart Micro anatomy: cellular and tissue level Introduction

More information

Answer: The electrical current has difficulty traveling down the normal conduction pathway.

Answer: The electrical current has difficulty traveling down the normal conduction pathway. 1 Electrocardiography for Healthcare Professionals Chapter 8: Heart Block Dysrhythmias 2 3 4 5 6 Learning Outcomes 8.1 Describe the various heartblock dysrhythmias 8.2 Identify first degree heartblock

More information

Anesthesia Assistants Review Course

Anesthesia Assistants Review Course American Association of Oral and Maxillofacial Surgeons Anesthesia Assistants Review Course Four Seasons Las Vegas February 24-25, 2018 Las Vegas, Nevada Anesthesia Assistants Review Course EKG Lecture

More information

Indications for Permanent Pacing Joe Gallinghouse, M.D. Texas Cardiac Arrhythmia Austin, Texas

Indications for Permanent Pacing Joe Gallinghouse, M.D. Texas Cardiac Arrhythmia Austin, Texas Indications for Permanent Pacing Joe Gallinghouse, M.D. Texas Cardiac Arrhythmia Austin, Texas Remember the Suture! Impulse Formation and Conduction Disturbances Cardiac Electrical Anatomy Sinoatrial Node

More information

Chapter 20 (2) The Heart

Chapter 20 (2) The Heart Chapter 20 (2) The Heart ----------------------------------------------------------------------------------------------------------------------------------------- Describe the component and function of

More information

Management strategies for atrial fibrillation Thursday, 20 October :27

Management strategies for atrial fibrillation Thursday, 20 October :27 ALTHOUGH anyone who has had to run up a flight of steps or has had a frightening experience is quite familiar with a racing heartbeat, for the more than 2 million Americans who suffer from atrial fibrillation

More information

15 16 September Seminar W10O. ECG for General Practice

15 16 September Seminar W10O. ECG for General Practice 15 16 September 2012 Seminar W10O ECG for General Practice Speaker: Ms Natasha Eaton ECG for General Practice Speaker: Natasha Eaton Cardiac CNC Executive Representative Electrocardiography The graphic

More information

a lecture series by SWESEMJR

a lecture series by SWESEMJR Electrolyte disturbances Hypokalaemia Decreased extracellular potassium increases excitability in the myocardial cells and consequently the effect of very severe hypokalaemia is ventricular arrhythmia.

More information

a lecture series by SWESEMJR

a lecture series by SWESEMJR Arrhythmias Automaticity- the ability to depolarize spontaneously. Pacemakers: Sinoatrial node: 70 bpm AV-nodal area: 40 bpm His-Purkinje: 20-40 bpm it Mechanisms of arrhythmias 1. Increased automaticity

More information

Anti arrhythmic drugs. Hilal Al Saffar College of medicine Baghdad University

Anti arrhythmic drugs. Hilal Al Saffar College of medicine Baghdad University Anti arrhythmic drugs Hilal Al Saffar College of medicine Baghdad University Mechanism of Arrhythmia Abnormal heart pulse formation Abnormal heart pulse conduction Classification of Arrhythmia Abnormal

More information

The Electrocardiogram

The Electrocardiogram The Electrocardiogram Chapters 11 and 13 AUTUMN WEDAN AND NATASHA MCDOUGAL The Normal Electrocardiogram P-wave Generated when the atria depolarizes QRS-Complex Ventricles depolarizing before a contraction

More information

Electrocardiography Abnormalities (Arrhythmias) 7. Faisal I. Mohammed, MD, PhD

Electrocardiography Abnormalities (Arrhythmias) 7. Faisal I. Mohammed, MD, PhD Electrocardiography Abnormalities (Arrhythmias) 7 Faisal I. Mohammed, MD, PhD 1 Causes of Cardiac Arrythmias Abnormal rhythmicity of the pacemaker Shift of pacemaker from sinus node Blocks at different

More information

CSI Skills Lab #5: Arrhythmia Interpretation and Treatment

CSI Skills Lab #5: Arrhythmia Interpretation and Treatment CSI 202 - Skills Lab #5: Arrhythmia Interpretation and Treatment Origins of the ACLS Approach: CSI 202 - Skills Lab 5 Notes ACLS training originated in Nebraska in the early 1970 s. Its purpose was to

More information

EKG Practice. Homan Wai

EKG Practice. Homan Wai EKG Practice Homan Wai Objectives Learn EKG by Examples Learn by repetition Learn by repetition Learn by repetition Learn by repetition Learn by repetition Learn by repetition Learn by repetition Details

More information

Huseng Vefali MD St. Luke s University Health Network Department of Cardiology

Huseng Vefali MD St. Luke s University Health Network Department of Cardiology Huseng Vefali MD St. Luke s University Health Network Department of Cardiology Learning Objectives Establish Consistent Approach to Interpreting ECGs Review Essential Cases for Paramedics and first responders

More information

Review Packet EKG Competency This packet is a review of the information you will need to know for the proctored EKG competency test.

Review Packet EKG Competency This packet is a review of the information you will need to know for the proctored EKG competency test. Review Packet EKG Competency 2015 This packet is a review of the information you will need to know for the proctored EKG competency test. Normal Sinus Rhythm Rhythm: Regular Ventricular Rate: 60-100 bpm

More information