Case-Based Practical ECG Interpretation for the Generalist
|
|
- Willa Martin
- 5 years ago
- Views:
Transcription
1 Case-Based Practical ECG Interpretation for the Generalist Paul D. Varosy, MD, FACC, FAHA, FHRS Director of Cardiac Electrophysiology VA Eastern Colorado Health Care System Associate Professor of Medicine University of Colorado, Denver
2 Disclosures None
3 Overview ECG Basics Methodological Approach to Reading ECGs Differentiation of Supraventricular Arrhythmias SVT classification Atrial Fibrillation vs. Atrial Flutter WPW Syndrome Recognition and management of a long QT interval Review
4 Please see slide at presentation
5 Please see slide at presentation
6 Please see slide at presentation
7 RA LA LL
8 RA I LA LL
9 RA I LA II LL
10 RA I LA II III LL
11 RA I LA avr II III LL
12 RA I LA avr avl II III LL
13 RA I LA avr avl II avf III LL
14 RA I LA avr avl II avf III Einthoven s Triangle LL
15 Please see slide at presentation
16 Please see slide at presentation
17 Please see slide at presentation
18 The Modern 12-Lead ECG
19 The Modern 12-Lead ECG One of the quintessential tools of Cardiology
20 Approach to the 12-Lead ECG Rate Rhythm Intervals Axis QRS Morphology (Infarction, Hypertrophy) ST Segment and T Waves
21 Measuring ECG Intervals At 25 mm/sec paper speed: Large boxes are 0.2 sec (200 msec) Small boxes are 0.04 sec (40 msec)
22 Please see slide at presentation
23 Please see slide at presentation
24 Please see slide at presentation
25 Please see slide at presentation
26 Please see slide at presentation
27 Supraventricular Tachycardia (SVT) SVT is common Prevalence of ~1/500 Incidence of ~90,000 new cases per year AVNRT accounts for 50-60% of all SVT Dual AV Node Physiology Present in as many as 30-40% Only a small percentage have clinical SVT
28 SVT: Differential Diagnosis Sinus tachycardia Atrial tachycardia Atrial flutter Atrioventricular nodal reentrant tachycardia (AVNRT) Orthodromic atrioventricular reentrant tachycardia (AVRT) Junctional tachycardia Paroxysmal form of junctional reciprocating tachycardia (PJRT)
29 Subcategorizing SVT: P wave No P or P-in-QRS Short RP Long RP
30 Subcategorizing SVT: P wave No P or P-in-QRS Short RP Long RP Helps to focus the differential diagnosis!!
31 No P or P in QRS R R
32 No P or P in QRS Differential diagnosis: AVNRT Atrial flutter AT with 1 st degree AV block JT Much less likely AVRT
33 Please see slide at presentation
34 Please see slide at presentation
35 AVNRT: Atrioventricular Nodal Reentrant Tachycardia
36 Short RP R P R RP interval
37 Short RP Differential diagnosis: AVRT AVNRT AT with 1 st degree AV conduction delay JT
38 Please see slide at presentation
39 Please see slide at presentation
40 AVRT: Atrioventricular Reentrant Tachycardia.
41 Long RP R P R RP interval
42 Long RP Differential diagnosis: Sinus tachycardia Atrial tachycardia AVNRT (atypical form) Junctional tachycardia AVRT
43 Please see slide at presentation
44 Atrial Tachycardia Focal arrhythmia arising in either right or left atrium Several arrhythmia mechanisms are possible Automatic Triggered Micro-reentrant Most common site is the right atrial crista terminalis near the sinus node
45 Please see slide at presentation
46 Differentiating Atrial Fibrillation from Flutter Atrial Fibrillation Disorganized atrial activity Irregularly-irregular ventricular response Atrial Flutter Organized atrial activity intraatrial macro-reentry Often regular rapid ventricular response (2:1 conduction ~150 bpm)
47 Differentiating Atrial Fibrillation from Flutter Atrial Fibrillation Rate control generally possible Ablation is sometimes successful (improves symptoms in 50-60%) Moderate risk of complications (5-10%) Atrial Flutter Rate is difficult to control Ablation is highly successful (>95% cure) Ablation is low risk (<2%)
48 Please see slide at presentation
49 Please see slide at presentation
50 Please see slide at presentation
51 Please see slide at presentation
52 Please see slide at presentation
53 Case 1 30 yo man awoke on a Saturday morning with sudden onset palpitations, dyspnea, and presyncope. This episode followed an evening of drinking substantially more than usual with friends. No known medical problems. Came to the ED for medical attention.
54 Please see slide at presentation
55 Please see slide at presentation
56 Case 1 30 yo man awakened with palpitations, dyspnea, and presyncope Tachycardic, irregular, but otherwise normal exam Abnormal ECG Normal Echocardiogram
57 Case 1 30 yo man awakened with palpitations, dyspnea, and presyncope Wolff-Parkinson-White Syndrome with preexcited atrial fibrillation
58 Accessory Pathway
59 Wolff-Parkinson-White Syndrome Sinus ECG shows evidence of pre-excitation Typical episodes of tachycardia Orthodromic AVRT Antidromic AVRT SVT with pre-excitation (most commonly atrial fibrillation with pre-excitation)
60 Tachycardias with Accessory Pathways Atrioventricular Reentrant Tachycardia (AVRT) A reentrant arrhythmia involving Atrium AV Node/His-Purkinje system Ventricle Accessory Pathway Orthodromic: down the conduction system (Narrow complex) Antidromic: (Wide complex) SVT with pre-excitation up the conduction system
61 Please see slide at presentation
62 Please see slide at presentation
63 Treatment of Accessory Pathway- Mediated Tachycardias Medical: AVRT: AV nodal blockers (adenosine, etc) Atrial fibrillation with pre-excitation: NO AV BLOCKERS: Risk of V Fib!!! Procainamide slows conduction in pathway Electrical: cardioversion if unstable Radiofrequency ablation Almost always curative!
64 Please see slide at presentation
65 Please see slide at presentation
66 Case 1 30 yo man awakened with palpitations, dyspnea, and presyncope Underwent successful RF catheter ablation of a posteroseptal accessory pathway
67 Please see slide at presentation
68 Case 2 60 yo man with multiple episodes of syncope, all occurring in the setting of urination. Katz JAMA Internal Med 2013;173:
69 Case 2 60 yo man with multiple episodes of syncope, all occurring in the setting of urination. He has a history of IV drug use currently in remission on methadone therapy. Katz JAMA Internal Med 2013;173:
70 Please see slide at presentation
71 ECG Recognition of a prolonged QT Interval All 12 leads can be used, V2 and V3 may be best to exclude U waves Rule of thumb: If the QT interval is more than half the RR, it s probably too long QT correction several approaches to account for changes with HR Bazett QTc = QT RR Fridericia Nomogram
72 Please see slide at presentation
73 Acquired Long QT Prolonged QTc found in up to 1% of hospitalized patients Risk Factors: Electrolyte disturbances (K, Mg, Ca) Hypothyroidism Anorexia Bradycardia Structural heart issues (LVH, reduced LVEF) Medications (antiarrhythmics, psychotropic drugs, antibiotics, etc.)
74
75 Case 3 19 yo woman with palpitations and lightheadedness. Her mother died suddenly at age 25.
76 Please see slide at presentation
77 Please see slide at presentation
78 Congenital Long QT Syndrome Much less common than acquired QT prolongation 1/2000 Clinical syndromes: Romano-Ward (Autosomal dominant, cardiac only) Jervell and Lange-Nielsen (Autosomal recessive, sensorineural deafness) 300+ mutations in ~20 genes identified Phenotypes LQT1 events with exercise (especially swimming) (35%) LQT2 events with auditory stimuli (25%) LQT2 and LQT3 events during sleep (10%)
79 Please see slide at presentation
80 Please see slide at presentation
81 Please see slide at presentation
82 Please see slide at presentation
83 Congenital Long QT Syndrome - Management Avoid exacerbating factors (medications, etc.) Beta Blockers (especially LQT1) propranolol, nadolol preferred Pacing and/or ICD if symptoms/events on beta blocker Sports debate about restriction
84 Review ECG Basics Methodological Approach to Reading ECGs Differentiation of Supraventricular Arrhythmias SVT classification Atrial Fibrillation vs. Atrial Flutter WPW Syndrome Recognition and management of a long QT interval Review
WPW syndrome and AVRT
WPW syndrome and AVRT Myung-Yong Lee, MD, PhD Division of Cardiology Department of Internal Medicine School of Medicine Dankook University, Cheonan, Korea Supraventricular tachycardia (SVT) Paroxysmal
More informationSupraventricular Tachycardia (SVT)
Supraventricular Tachycardia (SVT) Bruce Stambler, MD Piedmont Heart Atlanta, GA Supraventricular Tachycardia Objectives Types and mechanisms AV nodal reentrant tachycardia (AVNRT) AV reciprocating tachycardia
More informationARRHYTHMIAS IN THE ICU
ARRHYTHMIAS IN THE ICU Nora Goldschlager, MD MACP, FACC, FAHA, FHRS SFGH Division of Cardiology UCSF IDENTIFIED VARIABLES IN ARRHYTHMOGENESIS Ischemia/infarction (scar) Electrolyte imbalance Proarrhythmia
More informationHuseng 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 informationARRHYTHMIAS IN THE ICU: DIAGNOSIS AND PRINCIPLES OF MANAGEMENT
ARRHYTHMIAS IN THE ICU: DIAGNOSIS AND PRINCIPLES OF MANAGEMENT Nora Goldschlager, M.D. MACP, FACC, FAHA, FHRS SFGH Division of Cardiogy UCSF CLINICAL VARIABLES IN ARRHYTHMOGENESIS Ischemia/infarction (scar)
More informationEmergency 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 informationClinical Cardiac Electrophysiology
Clinical Cardiac Electrophysiology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of
More informationSupraventricular Tachycardia (SVT)
Supraventricular Tachycardia (SVT) Daniel Frisch, MD Cardiology Division, Electrophysiology Section Thomas Jefferson University Hospital daniel.frisch@jefferson.edu Short RP Are these the Mid same RP tachycardias?
More informationArrhythmia 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 informationCase #1. 73 y/o man with h/o HTN and CHF admitted with dizziness and SOB Treated for CHF exacerbation with Lasix Now HR 136
Tachycardias Case #1 73 y/o man with h/o HTN and CHF admitted with dizziness and SOB Treated for CHF exacerbation with Lasix Now HR 136 Initial Assessment Check Telemetry screen if pt on tele Telemetry
More informationEHRA Accreditation Exam - Sample MCQs Invasive cardiac electrophysiology
EHRA Accreditation Exam - Sample MCQs Invasive cardiac electrophysiology Dear EHRA Member, Dear Colleague, As you know, the EHRA Accreditation Process is becoming increasingly recognised as an important
More informationDr.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 informationAblation Update and Case Studies. Lawrence Nair, MD, FACC Director of Electrophysiology Presbyterian Heart Group
Ablation Update and Case Studies Lawrence Nair, MD, FACC Director of Electrophysiology Presbyterian Heart Group Disclosures No financial relationships to disclose Objectives At the conclusion of this activity,
More informationAtrial Fibrillation and Common Supraventricular Tachycardias. Sunil Kapur MD
Atrial Fibrillation and Common Supraventricular Tachycardias Sunil Kapur MD Cardiac Electrophysiology Brigham and Women s Hospital Instructor, Harvard Medical School No disclosures Cardiac Conduction:
More informationChapter 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 informationECG 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 informationa 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 informationNathan Cade, MD Brandon Fainstad, MD Andrew Prouse, MD
Nathan Cade, MD Brandon Fainstad, MD Andrew Prouse, MD OBJECTIVES 1. Identify the basic electrophysiology of the four causes of wide complex tachycardia. 2. Develop a simple framework for acute management
More informationParoxysmal 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 informationBasic electrocardiography reading. R3 lee wei-chieh
Basic electrocardiography reading R3 lee wei-chieh The Normal Conduction System Lead Placement avf Limb Leads Precordial Leads Interpretation Rate Rhythm Interval Axis Chamber abnormality QRST change What
More informationStep 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 informationCLINICAL CARDIAC ELECTROPHYSIOLOGY Maintenance of Certification (MOC) Examination Blueprint
CLINICAL CARDIAC ELECTROPHYSIOLOGY Maintenance of Certification (MOC) Examination Blueprint ABIM invites diplomates to help develop the Clinical Cardiac Electrophysiology MOC exam blueprint Based on feedback
More informationTACHYARRHYTHMIAs. Pawel Balsam, MD, PhD
TACHYARRHYTHMIAs Pawel Balsam, MD, PhD SupraVentricular Tachycardia Atrial Extra Systole Sinus Tachycardia Focal A. Tachycardia AVRT AVNRT Atrial Flutter Atrial Fibrillation Ventricular Tachycardia Ventricular
More informationSupraventricular Arrhythmias. Reading Assignment. Chapter 5 (p17-30)
Supraventricular Arrhythmias Reading Assignment Chapter 5 (p17-30) The Supraventricular Rhythms In Our Lives Site of Origin Single Events Slow Rates Intermediate Rates Fast Rates (>100 bpm) Sinus Sinus
More informationECG 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 informationPediatrics ECG Monitoring. Pediatric Intensive Care Unit Emergency Division
Pediatrics ECG Monitoring Pediatric Intensive Care Unit Emergency Division 1 Conditions Leading to Pediatric Cardiology Consultation 12.7% of annual consultation Is arrhythmias problems Geggel. Pediatrics.
More informationVentricular Preexcitation (Wolff-Parkinson-White Syndrome and Its Variants) 柯文欽醫師 國泰綜合醫院心臟內科主治醫師 臺北醫學大學講師
Ventricular Preexcitation (Wolff-Parkinson-White Syndrome and Its Variants) 柯文欽醫師 國泰綜合醫院心臟內科主治醫師 臺北醫學大學講師 The Nobel Prize in Physiology or Medicine 1924 "for his discovery of the mechanism of the electrocardiogram"
More informationREtrive. 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 informationReturn to Basics. ECG Rate and Rhythm. Management of the Hospitalized Patient September 25, 2009
Management of the Hospitalized Patient September 25, 2009 ECG Refresher and Update 2009 Return to Basics Determine rate and rhythm Determine intervals and axes Define morphology of P-QRS-T-U Compare with
More information12 Lead ECG Interpretation: The Basics and Beyond
12 Lead ECG Interpretation: The Basics and Beyond Cindy Weston, DNP, RN, CCRN, CNS-CC, FNP-BC Assistant Professor Texas A&M University College of Nursing cweston@tamhsc.edu Objectives Review the basics
More informationECGs on the acute admission ward. - Cardiology Update -
ECGs on the acute admission ward - Cardiology Update - Dr Simon Fynn Consultant Cardiologist Papworth Hospital, Cambridge RCP London Oct 2017 ECG 1 1. AF with BBB 2. Pre-excited AF 3. SVT with BBB 4.
More informationPaediatric ECG Interpretation
Paediatric ECG Interpretation Dr Sanj Fernando (thanks to http://lifeinthefastlane.com/ecg-library/paediatric-ecginterpretation/) 3 yo boy complaining of abdominal pain and chest pain Child ECG vs Adult
More informationSupraventricular Tachycardia: From Fetus to Adult. Mohamed Hamdan, MD
Supraventricular Tachycardia: From Fetus to Adult Mohamed Hamdan, MD Learning Objectives Define type of SVT by age Describe clinical approach Describe prenatal and postnatal management of SVT 2 SVT Across
More information10 ECGs No Practitioner Can Afford to Miss. Objectives
10 ECGs No Practitioner Can Afford to Miss Mary L. Dohrmann, MD Professor of Clinical Medicine Division of Cardiovascular Medicine University of Missouri School of Medicine No disclosures Objectives 1.
More informationThe most common. hospitalized patients. hypotension due to. filling time Rate control in ICU patients may be difficult as many drugs cause hypotension
Arrhythmias in the critically ill ICU patients: Approach for rapid recognition & management Objectives Be able to identify and manage: Atrial fibrillation with a rapid ventricular response Atrial flutter
More informationPlease 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 informationReturn to Basics. Normal Intervals & Axes. ECG Rate and Rhythm
Return to Basics Management of the Hospitalized Patient October 15, 2010 ECG Refresher and Update 2010 Determine rate and rhythm Determine intervals and axes Define morphology of P-QRS-T-U Compare with
More informationFLB 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 information2) 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 informationAPPROACH TO TACHYARRYTHMIAS
APPROACH TO TACHYARRYTHMIAS PROF.DR.MD.ZAKIR HOSSAIN PROFESSOR AND HEAD DEPARTMENT OF MEDICINE SZMCH TACHYARRYTHMIA Cardiac arrythmia is a disturbance of electrical rhythm of heart. Cardac arrythmia with
More informationPEDIATRIC SVT MANAGEMENT
PEDIATRIC SVT MANAGEMENT 1 INTRODUCTION Supraventricular tachycardia (SVT) can be defined as an abnormally rapid heart rhythm originating above the ventricles, often (but not always) with a narrow QRS
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,500 108,000 1.7 M Open access books available International authors and editors Downloads Our
More informationDysrhythmias 11/7/2017. Disclosures. 3 reasons to evaluate and treat dysrhythmias. None. Eliminate symptoms and improve hemodynamics
Dysrhythmias CYDNEY STEWART MD, FACC NOVEMBER 3, 2017 Disclosures None 3 reasons to evaluate and treat dysrhythmias Eliminate symptoms and improve hemodynamics Prevent imminent death/hemodynamic compromise
More informationSustained tachycardia with wide QRS
Sustained tachycardia with wide QRS Courtesy from Prof. Antonio Américo Friedmann. Electrocardiology Service of University of Faculty of São Paulo. Opinions from colleagues Greetings to everyone, In a
More informationLONG RP TACHYCARDIA MAPPING AND RF ABLATION
LONG RP TACHYCARDIA MAPPING AND RF ABLATION Dr. Hayam Eldamanhoury Ain shams univeristy Arrhythmia is a too broad topic SVT is broadly defined as narrow complex ( unless aberrant conduction ) Requires
More informationA request for a log book extension must be put in writing and sent to BHRS, Unit 6B, Essex House, Cromwell Business Park, Chipping Norton,
7 7. A request for a log book extension must be put in writing and sent to BHRS, Unit 6B, Essex House, Cromwell Business Park, Chipping Norton, Oxfordshire OX7 5SR. E-mail: admin@bhrs.com. Tel: 01789 867
More informationParamedic 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 informationArrhythmias (I) Supraventricular Tachycardias. Disclosures
Arrhythmias (I) Supraventricular Tachycardias Amy Leigh Miller, MD, PhD Cardiovascular Electrophysiology, Brigham & Women s Hospital Disclosures None Short R-P Tachycardia REGULAR with 1:1 P/R relationship
More informationECGs 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 informationThe Efficient and Smart Methods for Diagnosis of SVT 대구파티마병원순환기내과정병천
The Efficient and Smart Methods for Diagnosis of SVT 대구파티마병원순환기내과정병천 Differentiation Supraventricular Origin from Ventricular Origin on ECG. QRS-Complex Width. 1. Narrow QRS-Complex Tachycardia (
More informationPalpitations and Management of Arrhythmias. Palpitations. Differential Diagnosis. Differential Diagnosis. Differential Diagnosis
Palpitations and Management of Arrhythmias Fernando Vega, M.D. 7/8/2011 Fernando Vega, M.D. 1 7/8/2011 Fernando Vega, M.D. 2 Palpitations A sensory symptom An unpleasant awareness of the forceful, rapid
More informationAntiarrhythmic Drugs
Antiarrhythmic Drugs DR ATIF ALQUBBANY A S S I S T A N T P R O F E S S O R O F M E D I C I N E / C A R D I O L O G Y C O N S U L T A N T C A R D I O L O G Y & I N T E R V E N T I O N A L E P A C H D /
More informationECG QUIZ Luc DE ROY Brussels Belgium Disclosure in relation to this topic: none
ECG QUIZ Luc DE ROY Brussels Belgium Disclosure in relation to this topic: none TEST EXAMPLE What is the colour of this rectangle? 1. Blue? 2. Red? 3. Purple? 4. Green? 5. Yellow? 6. 1 and 3? 7. Any of
More informationCATHETER ABLATION FOR TACHYCARDIAS
190 CATHETER ABLATION FOR TACHYCARDIAS MASOOD AKHTAR, M.D. T ACHY ARRHYTHMIAS constitute a major cause of mortality and morbidity. The most serious manifestation of cardiac arrhythmia is sudden cardiac
More informationUNDERSTANDING 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 informationECG 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 informationArrhythmic 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 informationCore Content In Urgent Care Medicine
Palpitations/Arrhythmias Ebrahim Barkoudah, MD Clinical Instructor in Internal Medicine Harvard Medical School Assistant in Internal Medicine & Pediatrics Massachusetts General Hospital MGH Chelsea Chelsea,
More informationArrhythmias_for_6_c..docx. Олена Костянтинівна Редько
Arrhythmias_for_6_c..docx Олена Костянтинівна Редько 2015 Ключові терміни: 3 Зміст Ключові терміни: Arrhythmias 3 3 Ключові терміни: 4 Arrhythmias Ключові терміни: An irregular heart rhythm, Atrial flutter,
More informationECG Workshop. Jared W Magnani, MD, MSc University of Pittsburgh UPMC Heart and Vascular Institute Pittsburgh, PA March 24, 2017
ECG Workshop Jared W Magnani, MD, MSc University of Pittsburgh UPMC Heart and Vascular Institute Pittsburgh, PA March 24, 2017 Overview and Objectives Review a differential for supraventricular tachycardia
More informationLecture outline. Electrical properties of the heart. Automaticity. Excitability. Refractoriness. The ABCs of ECGs Back to Basics Part I
Lecture outline The ABCs of ECGs Back to Basics Part I Meg Sleeper VMD, DACVIM (cardiology) University of Florida Veterinary School Electrical properties of the heart Action potentials Normal intracardiac
More informationPAEDIATRIC ECG Dimosthenis Avramidis, MD.
PAEDIATRIC ECG Dimosthenis Avramidis, MD. Consultant Mitera Children s Hospital Athens Greece S. Associate 1st Cardiology Dpt Evangelismos Hospital Athens Greece 5 y/o with sinus tach Background ECG changes
More informationELECTROCARDIOGRAPH. General. Heart Rate. Starship Children s Health Clinical Guideline
General Heart Rate QRS Axis T Wave Axis PR Interval according to Heart Rate & Age P Wave Duration and Amplitude QRS Duration according to Age QT Interval R & S voltages according to Lead & Age R/S ratio
More informationthe ECG, 6 mg of intravenous adenosine was administered as a fast bolus through a large bore intravenous cannula in
(arrows). Electrocardiography Series Singapore Med.1 2011, 52(3) 146 CME Article Regular narrow complex tachycardia Singh D, Teo S G, Poh K K V Hr JL1 11 VL VF WA, Fig. I ECG shows regular narrow complex
More informationCOMMON ARRHYTHMIAS Diagnosis and Therapy
COMMON ARRHYTHMIAS Diagnosis and Therapy Zachary D. Goldberger, MD, FACC, FHRS Assistant Professor of Medicine Division of Cardiology UW School of Medicine Harborview Medical Center FINANCIAL OR OTHER
More informationReturn to Basics. ECG Rate and Rhythm. Management of the Hospitalized Patient October 4, 2007
Management of the Hospitalized Patient October 4, 2007 ECG Refresher for the Hospitalists Return to Basics Determine rate and rhythm Determine intervals and axes Define morphology of P-QRS-T-U Compare
More informationMiscellaneous Stuff Keep reading the Outline
Miscellaneous Stuff Keep reading the Outline Welcome to the 5-Step Method ECG #: Mearurements: Rhythm (s): Conduction: Waveform: Interpretation: A= V= PR= QRS= QT= Axis= 1. Compute the 5 basic measurements:
More informationDefinition, Diagnosis and Treatment of Tachycardia
3 Definition, Diagnosis and Treatment of Tachycardia Anand Deshmukh The Cardiac Center of Creighton University, Omaha, Nebraska USA 1. Introduction 1.1 Anatomy of the human cardiac conduction system 1.1.1
More informationFast & Slow Tachy & Brady Arrhythmias DAVID STULTZ, MD, FACC KPN HEART & VASCULAR AUGUST 7, 2017
Fast & Slow Tachy & Brady Arrhythmias DAVID STULTZ, MD, FACC KPN HEART & VASCULAR AUGUST 7, 2017 Normal EKG EKG boxes Heart Rate 1 big box = 200ms 1 small box = 40ms Big Boxes Between QRS complexes Heart
More informationYou Don t Want to Miss This One! Focus on can t miss EKG tracings
You Don t Want to Miss This One! Focus on can t miss EKG tracings Renaissance St. Louis Grand Hotel Convention Center October 23, 2014 David K. Tan, M.D., EMT-T, FAAEM EMS Section Chief, Division of Emergency
More informationCase Report Focal Left Atrial Tachycardia in a Patient with Left Ventricular Noncompaction
Case Reports in Medicine Volume 2013, Article ID 430862, 4 pages http://dx.doi.org/10.1155/2013/430862 Case Report Focal Left Atrial Tachycardia in a Patient with Left Ventricular Noncompaction Shailendra
More informationUNDERSTANDING 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 informationConcise Review for Primary-Care Physicians
Concise Review for Primary-Care Physicians Narrow QRS Complex Tachycardias STEPHEN J. PIEPER, M.D., AND MARSHALL S. STANTON, M.D. Regular narrow QRS complex tachycardias are a common problem encountered
More informationSudden cardiac death: Primary and secondary prevention
Sudden cardiac death: Primary and secondary prevention By Kai Chi Chan Penultimate Year Medical Student St George s University of London at UNic Sheba Medical Centre Definition Sudden cardiac arrest (SCA)
More informationECGs 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 informationABCs 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(living in the fast lane)
(living in the fast lane) Presented by M.D. Cardiology IT S A group of ECG and Electrophysiological abnormalities in which The atrial impulses are conducted partly or completely, PREMATURELY, to the ventricles
More informationHR: 50 bpm (Sinus) PR: 280 ms QRS: 120 ms QT: 490 ms Axis: -70. Sinus bradycardia with one ventricular escape (*)
1? HR: 50 bpm (Sinus) PR: 280 ms QRS: 120 ms QT: 490 ms Axis: -70 1 Sinus P waves? 2 sinus cycles The pause (2 sinus cycles) suggests that the sinus fired (?) but did not conduct to the atria (i.e., missing
More informationECGs: 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 informationRapid Fire ECG Challenge: Putting Your Interpretation Skills to the Test. Evert Torrejon, MD Sociedad Peruana Cardiologia Presenter
Rapid Fire ECG Challenge: Putting Your Interpretation Skills to the Test Evert Torrejon, MD Sociedad Peruana Cardiologia Presenter Male 36 years old, athlete, with prior to start swimming, gastric discomfort
More informationAtrial Fibrillation 10/2/2018. Depolarization & ECG. Atrial Fibrillation. Hemodynamic Consequences
Depolarization & ECG Atrial Fibrillation How to make ORDER out of CHAOS Julia Shih, VMD, DACVIM (Cardiology) October 27, 2018 Depolarization & ECG Depolarization & ECG Atrial Fibrillation Hemodynamic Consequences
More informationUncommon forms of AV reentry: atrio and fasciculo-ventricular fibers, slow conducting fibers. Jesus Almendral, Madrid, Spain
Uncommon forms of AV reentry: atrio and fasciculo-ventricular fibers, slow conducting fibers Jesus Almendral, Madrid, Spain Common forms of AV reentry Accessory pathways: Upper insertion: atrium Lower
More informationINTERESTING ECGS. Wide-complex tachycardias 11/13/ yr male with acute ant wall MI, S/P primary PTCA
INTERESTING ECGS V S Prakash Prof, & Head Dept. of Cardiology M S Ramaiah Hospitals 50 yr male with acute ant wall MI, S/P primary PTCA Pt. underwent successful PAMI An hour later,in the CCU Ventricular
More informationECG 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 informationChapter 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 informationManagement of Arrhythmias The General Practitioners role
Management of Arrhythmias The General Practitioners role Rohan Gunawardena MD, FRCP, FCCP, FACC Consultant Cardiac Electrophysiologist National Hospital of Sri Lanka Arrhythmias not common Palpitations
More informationECG 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 informationCRC 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 informationECG INTERPRETATION MANUAL
Lancashire & South Cumbria Cardiac Network ECG INTERPRETATION MANUAL THE NORMAL ECG Lancashire And South Cumbria Cardiac Physiologist Training Manual THE NORMAL ECG E.C.G CHECKLIST 1) Name, Paper Speed,
More informationRepetitive narrow QRS tachycardia in a 61-year-old female patient with recent palpitations
Journal of Geriatric Cardiology (2018) 15: 193 198 2018 JGC All rights reserved; www.jgc301.com Case Report Open Access Repetitive narrow QRS tachycardia in a 61-year-old female patient with recent palpitations
More informationPractical Approach to Arrhythmias
Outline Practical Approach to Arrhythmias Julia Shih, VMD, DACVIM (Cardiology) October 27, 2018 Conduction System ECG Acquisition ECG Interpretation Heart rate Rhythm Arrhythmias Tachyarrhythmias Supraventricular
More informationKnowing is not enough; we must apply. Willing is not enough; we must do.
Cardiovascular Boot Camp Basic Training Day 2: Cardiac Arrhythmias and Emergency Treatment Overview Cardiac Arrhythmias: Physiologic Links to Recognition and Management NTI 2014 Denver 2014 Karen Marzlin
More informationECG Workshop. Carolyn Shepherd And Anya Horne UWE Principles of Cardiac Care
ECG Workshop Carolyn Shepherd And Anya Horne UWE Principles of Cardiac Care ECG workshop case study1 44 Year old male. Reports SOB, Lethargy, tiredness. PMH: Hypertension, nil else. What tests? What treatment?
More informationDebate: Asymptomatic Patients with Ventricular Preexcitation Require EP Testing for Risk Stratification. Carlo Pappone, MD, PhD, FACC
Debate: Asymptomatic Patients with Ventricular Preexcitation Require EP Testing for Risk Stratification Carlo Pappone, MD, PhD, FACC The Wolff-Parkinson-White Syndrome Demographics Δ waves detectable on
More informationAsymptomatic patient with WPW
Asymptomatic patient with WPW Dimosthenis Avramidis, MD. Arrythmiologist Mitera Children s Hospital Athens Greece Scientific Associate 1st Cardiology Dpt Evangelismos Hospital Athens Greece Preexcitation
More informationStudy methodology for screening candidates to athletes risk
1. Periodical Evaluations: each 2 years. Study methodology for screening candidates to athletes risk 2. Personal history: Personal history of murmur in childhood; dizziness, syncope, palpitations, intolerance
More informationTHE ELECTROCARDIOGRAM A UBIQUITOUS AND COST-EFFECTIVE DIAGNOSTIC TOOL FOR THE FAMILY MEDICINE REFRESHER COURSE MARCH 8, 2019
THE ELECTROCARDIOGRAM A UBIQUITOUS AND COST-EFFECTIVE DIAGNOSTIC TOOL FOR THE FAMILY MEDICINE REFRESHER COURSE MARCH 8, 2019 Major Clinical Disorders Pulmonary Embolism 69 y/o woman with dyspnea and an
More informationDiploma in Electrocardiography
The Society for Cardiological Science and Technology Diploma in Electrocardiography The Society makes this award to candidates who can demonstrate the ability to accurately record a resting 12-lead electrocardiogram
More informationBasic Electrophysiology Protocols
Indian Journal of Cardiology ISSN-0972-1622 2012 by the Indian Society of Cardiology Vol. 15, (3-4), 27-37 [ 27 Review Article Shomu Bohora Assistant Professor, Deptt. of Cardiology, U.N. Mehta Institute
More informationARTICLE. Supraventricular Tachycardia in Infancy. Catherine D. DeAngelis, MD. In most infants, SVT is due to an accessory atrioventricular
Supraventricular Tachycardia in Infancy Evaluation, Management, and Follow-up Susan P. Etheridge, MD; Victoria E. Judd, MD ARTICLE Background: Supraventricular tachycardia (SVT) occurs frequently in infancy.
More information