1. Cardiovascular 2 Phase 2 Michelle Mair
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2. Aims Arrhythmias: Atrial fibrillation Atrial flutter Heart block
Sinus tachycardia
SVTs
Ventricular ectopics
Prolonged QT syndrome
Aberrant pathways
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3. ECGs
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4. 1) Heart Rate 2) Heart Rhythm 3) Cardiac axis 4) P waves 5)P-R interval 6) QRS complex 7) ST segment 8) T waves
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5. Cardiac axis Normal Axis Positive AVR AVL Positive I Positive II III
AVF
Positive
Positive
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6. Cardiac axis Right Axis Deviation Negative AVR AVL Positive I PositiveII
III
AVL
AVR
AVF
Positive
Positive
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7. Cardiac axis Left Axis Deviation Positive AVR AVL I Negative NegativeII
III
AVL
AVR
AVF
Negative
Negative
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8. Irregularly irregular rhythm Varying rate Absent p waves
Atrial Fibrillation
Irregularly irregular rhythm
Varying rate
Absent p waves
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9. Atrial Fibrillation Types:
Paroxysmal= spontaneous termination within 7 days, most commonly in 48 hours
Persistent= not self-limiting, lasting longer than 7 days or prior to cardioversion
Permanent= long standing (over 1 year) not terminated by cardioversion
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10. Atrial Fibrillation Causes: Hypertension Coronary artery disease
Valve disease (especially mitral valve)
Hyperthyroidism
Infection
Idiopathic
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11. Atrial Fibrillation Presentation: Asymptomatic Palpitations
Breathlessness/dyspnoea
Dizziness/syncope
Chest discomfort
Stroke/TIA
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12. Atrial Fibrillation Investigations: ECG
Bloods: FBC, TFTs, LFTs, U&Es (coagulation screen)
CXR
Echo
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13. Atrial Fibrillation Complications: Stroke/ TIA – increased six-fold
Heart failure
Cardiomyopathy
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14. Atrial Fibrillation Management:
Rate control- beta-blockers or rate-limiting sodium channel blocker e.g. Verapamil
Rhythm control- pharmacological or electrical cardioversion
- left atrial ablation
- pace and ablate strategy
3) Thromboprophylaxis- use CHA2DS2-VASc score
- warfarin therapy
- apixiban, dibigitran, rivaroxiban
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15. Atrial Flutter ‘saw tooth’ pattern Atrial rates of 240-340
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16. Atrial Flutter Causes: Coronary heart disease Atrial dilatation
Open heart surgery
Hypertension
COPD
Obesity
Thyrotoxicosis
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17. Atrial Flutter Presentation: Asymptomatic Palpitations Fatigue
Dyspnoea
Syncope
Heart failure
TIA
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18. Atrial Flutter Investigations: ECG CXR
TFTs, FBC, ESR, U&Es, LFTs, clotting
Echo
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19. Atrial Flutter Management: Catheter radiofrequency ablation
Electrical/Pharmacological cardioversion
Anti-coagulants
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20. Heart Block Types: First degree = prolonged P-R interval [>200ms]
Second degree
Third degree = both present but no association between P wave and QRS complex
Mobitz I (Wenckebach) = gradual progressive P-R prolongation before a QRS complex is dropped
Mobitz II = same P-R interval followed by absent QRS complex
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21. Heart Block First degree Mobitz I Mobitz II Third degree b) a) c) d)
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22. Heart Block a) b) Third degree Mobitz II d) c) First degree Mobitz I
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23. Heart Block Causes: First degree: Athletes Myocarditis Hypokalaemia
Hypomagnesaemia
Medications
Second degree:
Athletes
Post MI
Lyme disease
Medications
Third degree:
Complication of heart surgery
Coronary heart disease
Radiotherapy
Infection
Hypertension
Medications
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24. Heart Block Symptoms First degree: - asymptomatic Mobitz I:
light-headedness
dizziness
syncope
Mobitz II:
chest pain
shortness of breath
tiring on exertion
postural hypotension
Third degree:
- light-headedness
- dizziness
- fainting
- fatigue (extreme tiredness)
- chest pain
- slow heart beat (bradycardia)
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25. Heart Block Management: Transcutaneous pacing Pacemaker
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26. Supraventricular Tachycardia
Supraventricular = above the ventricle
SA node overridden and another part of the heart triggers faster impulses
The heart rate must be FAST and REGULAR
Types:
Atrio-ventricular nodal re-entry tachycardia
Atrial tachycardia
Wolff-Parkinson White syndrome
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27. SVT Atrio-ventricular nodal re-entry tachycardia Most common
Seen in people aged 20-30
Electrical short circuit in centre of the heart
Usually no underlying cause
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28. SVT Atrial tachycardia Arises from anywhere in the atria
Usually no underlying cause
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29. SVT Wolff-Parkinson White syndrome
Accessory pathway between atria and ventricles
Congenital abnormality
May get palpitations, severe dizziness or syncope
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30. SVT Presentation: Tachycardia Palpitations Dizziness Breathlessness
Chest discomfort
Asymptomatic
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31. SVT Management: Self-resolving Adenosine
Long term digoxin, beta-blocker, verapamil
Catheter ablation
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32. The Peer Teaching Society is not liable for false or misleading information…

33. Sinus Tachycardia Normal heart rate: 60-100bpm Causes: Pain Exercise
Fever
Anxiety
Dehydration
Anaemia
Sepsis
Heart failure
Hyperthyroidism MI PE
Stimulant use
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34. Sinus Tachycardia Treatment: Treat underlying cause
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35. Questions
A 51 year old gentleman is complaining of palpitations. He is a smoker and you find his blood pressure is 145/92. He has an underactive thyroid for which he take Levothyroxine. His ECG shows an irregularly irregular rhythm.
Name this condition
………………………………………
What his main risk factor for developing this?
………………………………………….
What is the first line treatment of this condition?
Give the class of drug suitable for this
…………………………………………
Give a complication of this condition?
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36. Questions
A man comes into hospital looking very unwell. His vital signs are:
-Temp :39.5
SpO2 : 95% on air
BP: 110/65
HR: 135bpm
He is found to have a pneumonia causing sepsis
List 4 other cause of sinus tachycardia
………………………………………………..
………………………………………………...
……………………………………………….
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37. Questions
You are asked to review a ECG of a lady admitted to your ward. You notice that the P-R interval is irregular and that after every now and then there is an absent QRS complex
You diagnose heart block
Which type of heart block does she have?
…………………………………………………………
Give 2 symptoms that she might be experiencing
………………………………………………………….
What treatment does she require?
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