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Conduction disorders/arrythmias (Atrial fibrillation/flutter (Signs and…
Conduction disorders/arrythmias
Bundle branch block
Left BBB
Normal direction of septal depolarisation is reversed
Impulse spreads first to RV via right bundle branch and then to LV via the septum
Extension on QRS and elimination of Q waves in lateral leads
Tall R waves in leads I, V5-6 and deep S waved in V1-3
Broad R waves in lateral leads I, aVL, V5-6
Reduction in efficacy of heart beat - as normally ventricles contract simultaneously, here the right contracts before the left has a signal
May benefit from pacemaker if experiencing symptoms
Right BBB
Activation of right ventricle is delayed as depolarisation has spread across the septum from the left ventricle
Broad QRS, wide S waves in lateral leads I, aVL and V5-6
ST depression and T wave inversion in V1-3
M shaped QRS complex
No overall cardiac function compromise
Benign condition - no need for treatment
But investigate underlying cause
Atrial fibrillation/flutter
Irregularly irregular rhythym
QRS <120ms
Irregular
No P waves
Signs and symptoms
Chest pain
Dyspnoea
Palpitations
Syncope
Appearance on ECG - saw tooth
Reduced CO
Treatment
Rate and rhythm control (via beta blocker with dioxin if needed and cardioversion) and anticoagulation
Atrioventicular block
2nd degree, Mobitz type 1
Distance between P and QRS lengthens until one unconducted P wave alone
2nd degree, Mobitz type 2
Constant PR interval followed by one P wave without a QRS
1st degree
Prolonged PR interval
Normal 120-200ms
3rd degree
Complete
No consistency in PR interval
No relationship between P waves and QRS complex
Abnormal PR interval
Risk factors and diagnostic features
Aged >50-60 years
Syncope
Underlying CVD e.g. ACS
HR <40 bpm
Hypertension
Paraoxysmal supraventricular tachycardia
Sudden onset, patient normally fit and well
Symptoms/diagnostic features
Palpitations
Syncope
Fatigue
Chest pain
Previous heart disease diagnosis
Treatment
Adenosine initially
If no response, it is not SVT, suggesting sinus tachycardia
If ongoing/reccurent - catheter ablation
Risk factors
OTC cold and flu remedies containing phenylepinephrine
Substance misuse
ECG findings
Very fast regular tachycardia
Some inverted P waves in inferior leads
Ventricular tachycardia
ECG findings
Wide QRS complex - 3 consecutive
Rate >100bpm
Symptoms
Usually asymptomatic
Brief palpitations
Sustained
Treatment
Unpredictability and dangerousness of sustained VT means Implantable cardioverter defibrillator (ICD) is recommended
Symptoms/diagnostic features
Weak pulse, syncope, dizziness, chest discomfort, dyspnoea
tachycardia
Hypotension
Investigations
ECG
Troponin I
Unsustained
Self-terminating event
Spontaneously resolving in <30 seconds
Treatment
Non-indicated, treat underlying heart condition
Slower than SVT
Ventricular fibrillation/flutter
Shockable
Most serious cardiac rhythm disturbance
Very little productive pumping - therefore decreased CO
Treatment
Defibrillation following observation of signs of cardiac arrest
Prevention
ICD's and anti-arrhythmic medications
ECG findings
No discernable pattern