Dr Sing Khien Tiong GPST1 Arrhythmias Dr Sing Khien Tiong GPST1

AF Irregular ventricular response. No evidence of organised atrial activity. Fine fibrillatory waves seen in V1.

Atrial Flutter with 2:1 Block  There are inverted flutter waves in II, III + aVF at a rate of 300 bpm (one per big square) There are upright flutter waves in V1 simulating P waves There is a 2:1 AV block resulting in a ventricular rate of 150 bpm Note the occasional irregularity, with a 3:1 cycle seen in V1-3

Sinus brady

WPW Can be: Short PR interval Slurring upstroke QRS complex Widened QRS complex

VT Broad complex

RBBB rsr

Complete Heart Block

1st degree heart block

2:1 type 2 heart block

LBBB Broad notched or slurred R wave in leads I, aVL, V5, and V6 and an occasional RS pattern in V5 and V6 attributed to displaced transition of QRS complex.

SVT

Wenckebach ECG (Type 1) The increase in PR interval from one complex to the next is subtle. However, the difference is more obvious if you compare the first PR interval in the cycle to the last.  The P-P interval is relatively constant despite the irregularity of the QRS complexes.

Sinus rhythm with inverted T waves, prominent U waves and a long Q-U interval due to severe hypokalaemia (K+ 1.7) A premature atrial complex (beat #9 of the rhythm strip) lands on the end of the T wave, causing ‘R on T’ phenomenon and initiating a paroxysm of polymorphic VT. Because of the preceding long QU interval, this can be diagnosed as TdP.

NSR