1 / 11

Morning report ECG

This report by Dr. Elias B. Hanna, MD, presents an in-depth analysis of narrow complex tachycardia, focusing on the differential diagnosis of supraventricular tachycardia (SVT), atrial fibrillation (AFib), and multifocal atrial tachycardia (MAT). It explores the significance of QRS width (QRS < 120 ms) and the characteristics of irregularly irregular rhythms. Key points include the evaluation of P waves, recognition of dual AV node pathways, and the mechanisms behind AV nodal reentrant tachycardia (AVNRT) and AV reentrant tachycardia (AVRT).

kimberley-curry
Télécharger la présentation

Morning report ECG

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Morning report ECG Elias B Hanna, MD LSU New Orleans, Cardiology

  2. What is the diagnosis?

  3. QRS width Narrow complex tachycardia QRS<120 ms =SVT

  4. QRS width Narrow complex tachycardia QRS<120 ms =SVT Irregularly irregular 1.Afib 2.MAT (P waves of ≥3 different morphologies)

  5. QRS width Narrow complex tachycardia QRS<120 ms =SVT Irregularly irregular Regular or regularly irregular 1.Afib 2.MAT (P waves of ≥3 different morphologies)

  6. QRS width Narrow complex tachycardia QRS<120 ms =SVT Irregularly irregular Regular or regularly irregular Beside sinus tachy 1.AVNRT 2.AVRT 3.Atrial tachycardia 4.Atrial flutter 1.Afib 2.MAT (P waves of ≥3 different morphologies)

  7. Dual AV node pathways and AVNRT Some individuals have dual AV node pathways (up to 20% of individuals). Normally, conduction spreads through the fast pathway and gets blocked in the slow pathway. However, after a PAC, the electrical activity cannot spread through the fast pathway (which is still in a refractory period), but can get conducted through the slow pathway which then conducts both down to the ventricle and up to the atrium, through the recovered “fast pathway”, thus creating a tachycardia with retrograde P waves

  8. AV node AV node Accessory pathway AVRT (after PAC or PVC) AV node Accessory pathway Similar process happens in case of accessory pathway that is conducting retrogradely. We have 2 pathways that create a reentrant circuit after a PAC or PVC.

  9. Arrows point to the retrograde P that is superimposed on ST segment and looks as a notch on ST segment Retrograde P wave Pseudo-r’ in V1 + Pseudo S in inf leads

  10. ECG of the previous pt in sinus rhythm after adenosine. Note the difference (no “pseudo-r’ “ or “pseudo S”)

  11. QRS width Narrow complex tachycardia QRS<120 ms =SVT Irregularly irregular Regular or regularly irregular Look for P waves 1.Afib 2.MAT (P waves of ≥3 different morphologies) Assess RP interval Sawtooth P, esp. rate~150 -Atrial flutter Short RP (<1/2 RR) -AVNRT -AVRT -Atrial tachycardia Long RP (>1/2 RR) -Atrial tachycardia -Atypical AVNRT

More Related