ECG heart rhythm disorders

 

1- Premature atrial:

– The premature born prematurely, the P wave is different morphology of the wave normal P;

– The following QRS complex is fine, except in case of branch block (organic or functional) or and preexcitation.

– ESA is followed by compensatory rest

– Sometimes when ESA occurs very early, it is blocked at the NAV that is still refractory period

Atrial premature beat

Atrial premature beat

Premature ventricular

Premature ventricular

2- Ventricular extrasystoles:

– They are not preceded by a P wave; they distort the QRS longer. Repolarization is reversed with a large negative T wave. Sometimes retrograde P wave.

– The ESV may arise either VD (with appearance left behind like a right bundle branch block) and vice versa.

– Severity criteria: polymorphism; coupling (ESV falling on top of T -> phenomenon R / T); Repeat (group 2, 3 …)

– Tachycardia burst is the existence of three or more successive ESV -> severity criterion.

– When ESV consistently follows a sinus complex is called bigeminy.

Junctional tachycardia

Junctional tachycardia

3- junctional tachycardia:

– Bouveret disease: palpitation at the beginning and end abruptly and polyuria crisis waning of palpitation.

– The breakthrough comes from the extrasystole and tachycardia that often interrupts another premature beat.

– Nodal reentry tachycardia or WPW syndrome.

– The treatment of the crisis is through vagal maneuvers (Valsalva maneuver). If ATP is used (Striadyne) or a calcium antagonist.

– Maintenance treatment: (if recurrent or disabling TJ); calcium channel blockers, beta-blockers or AA class Ic (if there is an accessory pathway).

Ventricular tachycardia

Ventricular tachycardia

4- Ventricular tachycardia:

– This is a wide complex tachycardia, defined by the succession of 3 ESV or more in the frequency is> 100 / min.

– There are three criteria to affirm the original ventricular tachycardia: capture complex fusion complex, atrioventricular dissociation.

– In case of poorly tolerated TV, the only treatment is the EEC

– If the TV is well tolerated and / or asymptomatic we can try a drug Cordarone cardioversion or lidocaine.

– Maintenance treatment: amiodarone, beta blockers (especially MI); the combination of both is often effective.

Torsade de pointes

Torsade de pointes

5- advanced Twist:

– Matches a macro-reentry interest to both ventricles, each time with a different point of emergence. Their initiation is done during an ESV while repolarization expanded with a prolonged QT interval.

– ECG the appearance is that of a sawtooth have rotated around its axis.

– Causes: Metabolic (hyponatremia, hypocalcemia) have drug (bradycardia therapy, AA class Ia); Long QT

– The main complication is the transformation into ventricular fibrillation

– TDP Access is treated with magnesium IV injection, the correction of hypokalaemia or accelerating the pace (isoprenaline or training electrosystolic probe).

– Treatment of recurrence: involves the standardization of a metabolic disorder, the elimination of an overload quinidine

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