ECGs and Conduction syndromes
*WPW Syndrome = Wolf-Parkinson White Syndrome
WPW Case examples
Clinical Case
Clinical Case
Notes:
- note that
Notes:
- WPW syndrome key is that there is electrical conduction excaping from the atrium into the ventricles and bypassing the AV node
- you see a P wave, but then a sharp up curve with no Q downstroke from the septal conduction, because it goes through the WPW hole and straight into the ventricles
WPW ECG Triad
- short wide and no Q
1 = Short PR interval
2 = wide qRs complex
3 = missing Q and upstroke WPW hole = delta wave
*AV Block
- AV --> bundle branches during PR interval
- all AV blocks have changes in PR intervals, dropped beats or independent P waves and qRs
3rd Degree = complete AV Block
- Atrial and ventricles beat independent of each other
- P waves and qRs are completely independent
- 3rd degree AV Blcok = "Separate TICKS on ECG"
Clinical Cases
Clinical Case
Notes:
- note that
Clinical Case
Atrial Fibrillation and Flutter
- A fib has triad including irreg irreg
- Atrial flutter has regular rhythm, but "sawtooth waves"
Atrial Fibrillation
- A Fib triad
--> irregularly irregular heart rhythm (with no P waves)
--> palpitations
--> tachycardia
Atrial Flutter
- saw tooth edges on ECG
- reenry circuit within atrium along venotricuspid isthmus
--> reason why there are normal ventricle qRs and saw tooth continuous P waves from the right atrium
Case examples
Clinical Case
Notes:
- note that
Clinical Case
*Torsades de Pointes
- Ventricular tachycardia that looks like sine wave
*Tachycardias
- Ventricular
- supraventricular
Ventricular Tachycardias
- stay within the ventricles, NO reentery through Bundle of Kent, etc.
Causes of Ventricular tachycardia
- Prolongued QT interval
--> can be congenital LQTS
*LQTS = long QT syndrome
- can be congenital LQTS
- caused by electrolyte imbalance
--> hypo K+ and hypomagnesium - drug-induced
ECG *Physiology
BASICS
Notes:
- PR interval
--> normal < 200 msec - qRs complex
--> normal < 120 msec
ECG and Muscle *Contractions
-
Speed of Conduction
- "Park AT Venture AVenue"
- fastest to slowest
- SA node fastest
--> all others speed up from slowest AV --> fastest Perkinje fibres
3rd degree AV Blcok = "Separate TICKS on ECG"
- separate = Atrium and ventricles are completely independent of each other
--> P waves and qRs are separate - separate TICKS = AV 3rd degree block caused by LIME disease
Lyme Disease Carditis
- different types of AV block come from a Lyme disease infection
- initial present with NON-itchy bullseye rash from Tick
--> out in the forest
Clinical Cases
Clinical Case
Notes:
- note that
Clinical Case
Clinical Cases
Clinical Case
Notes:
- note that
Clinical Case
Clinical Case
Clinical Case
Notes:
- note that
Torsades de pointes = TdP
Drug-induced LQTS
- "MiQQy T triple big MAAAC"
"MiQQy T triple big MAAAC"
- MiQQy T = QT interval prolonged
- M = Macrolides and Fluroquinolones
- A = Antiemetics
- A = Antipsychotics and Antidepressants (TCA's)
- C = Class1A / 3 anti ARs (K+ channels phase 3)
"QuinT -essential episode of Everybody Loves RAYMOND..."
- QT Raymond- Ward Syndrome = KCH
Congenital LQTS
- many genetic mutations
- type 1 and 2 = K+ channel blockage
--> block depol from K+ and prolongue QT - can result in V tach
