Bradycardias and Tachycardias ECG Seminars Bradycardias and Tachycardias

Bradycardias: Objectives At the end of this workshop you should be able to: Recognize the following rhythm and conduction abnormalities: Sinus bradycardia First degree Av block Second degree AV block Third degree AV block Right bundle branch block Left bundle branch block

60 year old asymptomatic man on metoproplol for coronary artery disease.

24 year old man with dizziness and presyncope in the emergency department.

80 year old asymptomatic patient during a routine visit.

66 year old man asymptomatic man in pre-op for elective surgery

55 year old woman with a history of hypertension

75 year old man on a routine check-up.

48 year old man with lightheadedness in the emergency department

22 year old woman in the office with a history of one episode of syncope

Things that make your heart go pitter patter Instructions to tutors – There are 22 slides after the objectives which gives you 5 minutes per slide. Please focus on concepts and don’t worry about subtle findings you may come across. The first slide is to reorient them to ECG’s before tackling the tachycardias. When you get to AVNRT, I have inserted an explanation about reentrant tachycardias since I think the concept is one we should introduce at this stage and applies to a lot of arrhythmias. The idea is if they understand the mechanism, they will be better at reading the ECg. I hope this concept carries over into the AVRT slides. When you get to the SVT vs VT on the wide complex tachycardias, the differences may be too detailed – if you wish just focus on AV dissociation as a differentiating factor and maybe concordance since there are examples of both later. If you don’t get to the wide complex tachycardias don’t worry – let me know and I will shorten it for next year. Thanks Victoria

Objectives At the end of this half of the ECG seminar, you should be able to recognize the following tachycardias: Sinus tachycardia Atrial tachycardia Atrial flutter Atrial fibrillation Supraventricular tachycardias Narrow complex tachycardia Wide complex tachycardia

26 year old man with asthma

62 year old woman with COPD

Atrial Tachycardia Usually focal source in LA/RA rates 100-200 bpm

66 year old man with palpitations

77 year old asymptomatic man .

25 year old man with palpitations

75 year old asymptomatic woman

62 year old woman with sudden onset of palpitations in the emergency department

62 year old man with recurrent palpitations

65 year old man with dizziness

ECG - QRS Morphology 4 Questions: any YES = VT, all NO = SVT 1. Absence of RS in all precordial leads (concordance) 2. Onset R to Nadir S > 100ms any V lead 3. AV Dissociation 4. Morphology criteria in both V1-2 and V6

40 year old woman with palpitations – what is your diagnosis?