Pathological Arrhythmias/ Tachyarrhythmias - Examrace · PDF filePathological Arrhythmias/...
Transcript of Pathological Arrhythmias/ Tachyarrhythmias - Examrace · PDF filePathological Arrhythmias/...
Pathological Arrhythmias/ Tachyarrhythmias
caused by:
� 1.Ectopic focus:
✁ Extrasystole or premature beat. If discharge is occasional.
Can be:
✁ Atrial Extrasystole
✂ Vevtricular Extrasystole
✄ ✄ ✄ ☎ ✆ ✝ ✞ ✟ ✠ ✞ ✡ ✆ ☎ ✡ ☛ ✟
✄ �✁ 2.Cardiac Arrhythmia
Caused by
✂ Ectopic focus discharging repetitively & rate is higher than SAN
☎ Circus movement
✆ ✆ ✆ ✝ ✞ ✟ ✠ ✡ ☛ ✠ ☞ ✞ ✝ ☞ ✌ ✡
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Circus movement
� 1. Wave of excitation continue to travel indefinitely in myocardium
✁ 2. Retrograde conduction due to transient block in bundle of HIS
✁ 3. Wolff-Parkinson-White Syndrome
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
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CARDIAC ARRHYTHMIAS
ATRIAL VENTRICULAR
FLUTTER
EXTRASYSTOLE
FIBRILLATION
FLUTTER
FIBRILLATION
HR 220
HR 200-350
HR 300-500
EXTRASYSTOLE
V. Tachycardia
� � � ✁ ✂ ✄ ☎ ✆ ✝ ☎ ✞ ✂ ✁ ✞ ✟ ✆
Atrial arrhythmias
Following
� Atrial extrasystole ✄ atrial premature cont. are frequently present in healthy persons
✁ Paraoxysmal atrial Tachycardia
� Atrial flutter
✁ Atrial fibrillation
✂ ✂ ✂ ☎ ✆ ✝ ✞ ✟ ✠ ✞ ✡ ✆ ☎ ✡ ☛ ✟
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� Pulse deficit
✁ Definition - A deficit of pulse in relation to heart rate is called pulse deficit.
✂ Causes :
Premature contraction
Atrial fibrillation
✄ ✄ ✄ ☎ ✆ ✝ ✞ ✟ ✠ ✞ ✡ ✆ ☎ ✡ ☛ ✟
Premature contration
� During premature contraction, heart contracts ahead of time & if ventricles are not filled properly stroke volume decreases & in such cond. pulse wave passing to periphery may be so weak that it is not felt at the radial artery.
✁ ✁ ✁ ✂ ✄ ☎ ✆ ✝ ✞ ✆ ✟ ✄ ✂ ✟ ✠ ✝
Atrial fibrillation
� Irregular adequate filling of ventricles results in pulse deficit
✁ ✁ ✁ ✂ ✄ ☎ ✆ ✝ ✞ ✆ ✟ ✄ ✂ ✟ ✠ ✝
Atrial Flutter
SAW TOOTHED ECG
� � � ✁ ✂ ✄ ☎ ✆ ✝ ☎ ✞ ✂ ✁ ✞ ✟ ✆
Atrial Fibrillation
� � � ✁ ✂ ✄ ☎ ✆ ✝ ☎ ✞ ✂ ✁ ✞ ✟ ✆
Ventricular Arrhythmias
� Ventricular tachycardia✄ Broad, bizarre QRS complex
✁ Ventricular Flutter, Ventricular Fibrillation ✂ Clinically ventricular asystole
☎ ☎ ☎ ✆ ✝ ✞ ✟ ✠ ✡ ✟ ☛ ✝ ✆ ☛ ☞ ✠
Ventricular Tachycardia
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..
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Fibrillatory waves
� � � ✁ ✂ ✄ ☎ ✆ ✝ ☎ ✞ ✂ ✁ ✞ ✟ ✆
Paroxysmal Tachycardia
� Is a bout of tachycardia which begins & ends suddenly (paroxysm= a sudden outburst)
✁ A bout can last for several minutes
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
1.Paroxysmal Atrial (atrial rate= 160-220/ min) Tachycardia
2.Atrioventricular junctional Tachycardia (atrial rate= 120-200/ min)
3.Ventricular Tachycardia (ventricular rate= 140-220/ min)
Paroxysmal supraventricular Tachycardia includes Atrial & Junctional Tachycardia
� � � ✁ ✂ ✄ ☎ ✆ ✝ ☎ ✞ ✂ ✁ ✞ ✟ ✆
Myocardial Ischemia
� Myocardial ischaemia -Is interruption in blood supply of heart.
✁ Irreversible changes & death of muscle cells
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
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ECG changes in MI
� Defect in infarcted Ecg changes in
Cells over lying leads
1.Rapid Repolarization ST seg elevation
✄ ✁ ✂ ☎ ✆ ✝ ☎ ✞ ✟ ☎ ✠ ✡ ☛ ☞ ✌ ✌
3.Delayed Depolarization ✍
✎ ✎ ✎ ✏ ✑ ✒ ✓ ✔ ✕ ✓ ✖ ✑ ✏ ✖ ✗ ✔
ECG findings in MI
Findings in ant. Infarct:
Time Changes Leads
� Hrs aft. Inf. ST ele. I,aVL & V3-6
ST dep. II,III& aVF
� Hrs to days Q wave I,aVL,&V5-6
✁ ✁ ✁ ✂ ✄ ☎ ✆ ✝ ✞ ✆ ✟ ✄ ✂ ✟ ✠ ✝
✄ ✄� Weeks ---- Q wave & QS complex persists
ST seg. becomes isoelectric
T wave inverted
✁ Late years -- QS complex persists, T wave normal
✂ ✂ ✂ ☎ ✆ ✝ ✞ ✟ ✠ ✞ ✡ ✆ ☎ ✡ ☛ ✟
✄�
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ECG✄ Ionic Changes
Hyperkalemia (✁ K+)-Dangerous & lethal
� Tall & peaked T wave
� Prolongation of QRS complex
� Paralysis of atria
� Vent. Arrhythmias
✂ RMP decreases
☎ ☎ ☎ ✆ ✝ ✞ ✟ ✠ ✡ ✟ ☛ ✝ ✆ ☛ ☞ ✠
ECG in hypokalemia
� Hypokalemia (☎ K+)-less dangerous
✁ PR interval prolonged
✁ U wave prominent
✁ T wave invertion in chest leads
✂ ✂ ✂ ✄ ✆ ✝ ✞ ✟ ✠ ✞ ✡ ✆ ✄ ✡ ☛ ✟
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hypercalcemia
Hypercalcemia (✁ Ca++)
� Enhances myocardial contractility
� Heart stops in systole
(Clinically this level is not reached)
Hypocalcemia (☎ ✂ ✄ ++)
✆ ST seg. prolonged
✝ ✝ ✝ ✞ ✟ ✠ ✡ ☛ ☞ ✡ ✌ ✟ ✞ ✌ ✍ ☛
Effect of Sodium
� Sodium level has little effect
✁ ☎ ✂ ✄ +----Low voltage ECG
✆ ✆ ✆ ✝ ✞ ✟ ✠ ✡ ☛ ✠ ☞ ✞ ✝ ☞ ✌ ✡
ECG: Uses
� Detection of HR
✁ Ectopic focus
✁ Heart block
✁ MI
✁ Axis deviation
� Electrolyte imbalance
✁ Research
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
ECG limitation
� False negative
✁ False positive
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
HIS
Ele
ctro
gra
m
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� Cardiac Cycle
Includes various changes in heart from beat to beat
✁ Mechanical changes/cardiodynamics
✁ Electrical changes
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
Events during cardiac Cycle
� Atria & ven. are two separate units connected by conducting tissue only Main events are
Atrial contraction
Atrial relaxation
Ventricular contraction
Ventricular relaxation
✁ ✁ ✁ ✂ ✄ ☎ ✆ ✝ ✞ ✆ ✟ ✄ ✂ ✟ ✠ ✝
Atrial cycle
� Total duration of one cycle is 0.8 sec (HR 75/mit)
✁ Atrial cycle
Atrial systole-------0.1 sec
Atrial diastole------0.7 sec
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
Ventricular Diastole
� Diastole----0.5 sec
Protodiastolic phase---------0.04 sec
Isovolumic relaxation--------0.08 sec
First rapid filling--------------0.10 sec
Slow filling/ diastasis--------0.18 sec
Last rapid filling--------------0.10 sec
✁ ✁ ✁ ✂ ✄ ☎ ✆ ✝ ✞ ✆ ✟ ✄ ✂ ✟ ✠ ✝
Changes during cardiac cycle
Mechanical changes
� Valvular changes
� Pressure changes in
✁ Atria
✁ Ventricles &
✁ Aorta
� Volume changes in ventricles
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
sI HS AVC
SLV OPEN
II HS SLV Cl.PD 0.04 Sec
IMC 0.05 Sec
III HS AVO
IV HS
Diastasis 0.18
IMR 0.08 Sec
Last Rapid Filling 0.1 Sec
Max Ej. 0.1
Red. Ej. 0.15 Sec
First R.F.
0.10 Sec
Sec
� � � ✁ ✂ ✄ ☎ ✆ ✝ ☎ ✞ ✂ ✁ ✞ ✟ ✆
I HS AVC
SLV OPEN
II HS SLV Cl.PD 0.04 Sec
IMC 0.05 Sec
III HS AVO
IV HS
Diastasis 0.18
IMR 0.08 Sec
Last Rapid Filling 0.1 Sec
Max Ej. 0.1
Red. Ej. 0.15 Sec
First R.F.
0.10 Sec
Sec
� � � ✁ ✂ ✄ ☎ ✆ ✝ ☎ ✞ ✂ ✁ ✞ ✟ ✆
I HS AVC
SLV OPEN
II HS SLV Cl.PD 0.04 Sec
IMC 0.05 Sec
III HS AVO
IV HS
Diastasis 0.18
IMR 0.08 Sec
Last Rapid Filling 0.1 Sec
Max Ej. 0.1
Red. Ej. 0.15 Sec
First R.F.
0.10 Sec
Sec
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I heart Sound
Produced
EDV=135 ml
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Ventricular cycle - systole
Ventricular cycle
� Systole---------0.3 sec
Isometric/isovolumic contraction- 0.05sec
Rapid/maximum ejection---------- 0.10 sec
Reduced ejection-------------------- 0.15 sec
✁ ✁ ✁ ✂ ✄ ☎ ✆ ✝ ✞ ✆ ✟ ✄ ✂ ✟ ✠ ✝
Changes are in
� AV valve (atrioventricular)
Mitral (bicuspid)
Tricuspid
� Semilunar valves
Aortic
Pulmonary
✁ ✁ ✁ ✂ ✄ ☎ ✆ ✝ ✞ ✆ ✟ ✄ ✂ ✟ ✠ ✝
� Heart sounds
✁ Heart Sounds✄ total 4 types I, II, III,& IV
✂ I & II heard by stethoscope
✂ III & IV picked by phonocardiography
✂ Period between I & II--Systolic period
✂ Period between II & I☎ Diastolic period
✆ ✆ ✆ ✝ ✞ ✟ ✠ ✡ ☛ ✠ ☞ ✞ ✝ ☞ ✌ ✡
I & II Heart Sounds
SYSTOlic DIASTOLIC PERIOD
ECG
� � � ✁ ✂ ✄ ☎ ✆ ✝ ☎ ✞ ✂ ✁ ✞ ✟ ✆
� I H.S.
First heart sound
Mechanism of generation:
✁ Vibrations of closing valve
✁ Turbulance of blood
✁ Vibrations of ventricular wall
Two components Mitral & Tricuspid
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
Characteristics I HS
Are:
� Prolonged & soft-----Lubb
� Duration-------0.15 sec
� Frequency ---25---45 Hz
Auscultation- Best heard in Mitral & Tricuspid areas
✁ ✁ ✁ ✂ ✄ ☎ ✆ ✝ ✞ ✆ ✟ ✄ ✂ ✟ ✠ ✝
Auscultation- I HS
� Mitral Area (near apex beat)-Lt. V ICS
slightly inside the mid clavicular line
✁ Tricuspid Area -Lt V ICS near sternal border
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
Significance
� Marks beginning of systole
✁ Duration & intensity indicates condition of myocardium & A-V valves.
✁ Proper closure of A-V valves
✁ Coincides with R wave of ECG
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
Abnormalities of I HS
� Faint sound-
✁ Weak myocardium
✁ PR interval prolonged
✂ Calcific mitral stenosis
✁ Mitral incompetence
✄ Intense sound-
✂ more force of contraction
☎ ☎ ☎ ✆ ✝ ✞ ✟ ✠ ✡ ✟ ☛ ✝ ✆ ☛ ☞ ✠
� Intense sound (loud) -
✁ more force of contraction
✁ Mitral stenosis
✂ Short PR interval
✄ ✄ ✄ ☎ ✆ ✝ ✞ ✟ ✠ ✞ ✡ ✆ ☎ ✡ ☛ ✟
� Splitting of Mitral & Tricuspid by 10 to 30 ms. is normal
✁ Split sound---- bundle branch block.
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
II HS
Mechanism of generation;
� Closure of semilunar valves
� Oscillation of Aortic & Pulmonary walls
� Oscillation of blood column in Aorta & Pulmonary artery
✁ ✁ ✁ ✂ ✄ ☎ ✆ ✝ ✞ ✆ ✟ ✄ ✂ ✟ ✠ ✝
Auscultation-II HS
� ✁ ✂ ✄ ✂ ☎ ✆ ✝ ✄ ✞ ✟ ✆ ✞ ☎ ✟ ✠ ✡ ✞ ☛ ✝ ☞ ✌ ✍ ✎ ✏
✑ Duration------0.12 sec
✑ Frequency----50 Hz.
Auscultation✒ Best at Aortic & Pulmonary
Areas
✓ Aortic Area--Rt. II ICS near the sternum
✑ Pulm. Area✔ Lt. II ICS near the sternum
✕ ✕ ✕ ✖ ✗ ✘ ✙ ✚ ✛ ✙ ✜ ✗ ✖ ✜ ✢ ✚
Splitting of -II HS
� It has two components Aortic & Pulmonary
Normal splitting
✁ During inspiration-----0.04 sec
✁ During expiration------0.02 sec
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
Signifance -II HS
� Marks end of systole & beginning of diastole
✁ Clear sound indicates perfect closure of semilunar valves & there is no (incompetence)
� Coincides with end of T wave of ECG
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
Applied aspects
� Intensified if Aortic or pulmonary press.
Is high
✁ Splitting in Bundle branch block
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
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III HS
� Mechanism- Vibrations of ventricular wall caused by rapidly entering blood
✁ Characteristics- Short, soft & low pitched
Duration- 0.1 sec
✁ Auscultation- Normally not heard with stethoscope, can be recorded
� Appears between T & P waves of ECG
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
IV HS
� Mechanism- Vibration caused by last rapid filling
✁ Characteristic- Short & low pitched
✁ Duration- 0.03 sec
✁ Recorded by phonocardiography
✁ Falls between end of P wave & onset of Q wave
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
Phonocardiogram
� A microphone is applied to precordium
✁ Sounds are amplified & recorded by oscillograph
✁ The record is called phonocardiogram
✂ ✂ ✂ ✄ ☎ ✆ ✝ ✞ ✟ ✝ ✠ ☎ ✄ ✠ ✡ ✞
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� Murmurs
✁ Definition- are abnormal heart sounds produced during cardiac cycle
✂ Type of murmur Abnormality
✂ Systolic - Aortic/pulmonary Stenosis
Mitral/Tricuspid Insuffi.
✂ Diastolic - Aortic/Pulmonary Insuffi. Mitral/Tricuspid Stenosis
✄ ✄ ✄ ☎ ✆ ✝ ✞ ✟ ✠ ✞ ✡ ✆ ☎ ✡ ☛ ✟
Ca
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