1. Cardiovascular Module
DR. FAWAD AHMAD RANDHAWA
MBBS ( King Edward Medical College)
M.C.P.S; F.C.P.S. ( Medicine)
F.C.P.S. ( Endocrinology)
Assistant Professor of Endocrinology
King Edward Medical University

2. Objectives
By the end of this session the participants should be able to understand the basic concepts about Stokes Adam’s syndrome and premature ventricular contraction (PVC)

3. Stokes Adam’s Syndrome

4. Basic Physiology
Heart's electrical system is made up of three main parts:
The sinoatrial (SA) node, located in the right atrium of your heart
The atrioventricular (AV) node, located on the interatrial septum close to the tricuspid valve
The His-Purkinje system, located along the walls of your heart's ventricles

6. Pathophysiology
Normal heartbeat passing from the hearts upper to lower chambers is interrupted. This result in a condition called a “heart block.” When a heart block occurs the heart rate usually slows considerably. This can result in inadequate blood flow to the brain and fainting.

7. Clinical Symptoms
Loss of consciousness is usually between about 10 and 30 seconds.
Pallor, followed by flushing on recovery, can be reported.
Pulse during an episode, will be slow, usually less than 40 beats per minute.
Recovery is fairly rapid
Typically heart block is seen on the ECG during an attack.

8. Etiology Coronary Artery Disease and so tends to occur in the elderly.
Congenital Heart Block.
Familial tendency

10. Normal ECG- understanding the tracing

13. Ventricular Ectopic Beat
Ventricular contraction before the underlying rhythm would normally depolarise the ventricle

14. Premature ventricular contraction (PVC):
Ventricles fire an early impulse which causes the heart to beat earlier causing irregularity in the heart rhythm.

15. Premature ventricular contraction (PVC):
The resultant heartbeat morphology on the ECG often appears wider and taller than that seen with the underlying rhythm.

16. Premature ventricular contraction (PVC)

17. Etiology Ventricular ectopic beats may indicate heart disease,
Sympathetic stimulation (e.g., stress, alcohol, caffeine, medication, cocaine, or amphetamines) or
Over half the population have silent, or asymptomatic, ventricular ectopics.

18. Types/Patterns of PVC Bigeminy (every other beat),
Trigeminy (every third beat), or 
Quadrigeminy (every fourth beat)
Multifocal

19. Ventricular Bigeminy

20. Ventricular Trigeminy

21. Multifocal Ventricular Ectopics

22. Take Home Message
Stokes Adam’s syndrome results from inadequate blood flow to the brain due to slowing of heart rate
PVC signifies that ventricles are contracting on their own independent of electrical impulse from SA node so that the P wave is absent and there is broad complexes on ECG.

23. Thank you for bearing with me