1. Bradycardias and Tachycardias
ECG Seminars
Bradycardias and Tachycardias

2. 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

3. 60 year old asymptomatic man on metoproplol for coronary artery disease.

4. 24 year old man with dizziness and presyncope in the emergency department.

5. 80 year old asymptomatic patient during a routine visit.

6. 66 year old man asymptomatic man in pre-op for elective surgery

7. 55 year old woman with a history of hypertension

8. 75 year old man on a routine check-up.

9. 48 year old man with lightheadedness in the emergency department

10. 22 year old woman in the office with a history of one episode of syncope

11. 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

12. 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

13. 26 year old man with asthma

14. 62 year old woman with COPD

15. Atrial Tachycardia
Usually focal source in LA/RA
rates bpm

16. 66 year old man with palpitations

17. 77 year old asymptomatic man.

18. 25 year old man with palpitations

19. 75 year old asymptomatic woman

20. 62 year old woman with sudden onset of palpitations in the emergency department

21. 62 year old man with recurrent palpitations

22. 65 year old man with dizziness

23. 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

26. 40 year old woman with palpitations – what is your diagnosis?