Dysrhythmia and Electrocardiography Insights

Oct 1, 2024

Lecture Notes: Dysrhythmia and Electrocardiography

Introduction

  • Speaker: Alma, Faculty at University of Maryland School of Medicine
  • Topics: Dysrhythmia, Electrocardiography, Emergency Medicine
  • Personal Context: Interest in electrocardiography partially influenced by personal experiences.

General Observations

  • Las Vegas Conferences: Many conferences are now held in Vegas.
  • Health Warnings: Las Vegas has unhealthy lifestyle options, including the Heart Attack Grill.

Key Points on Electrocardiography

Importance of Electrocardiography

  • Simple bedside skill, can be done anytime.
  • Going beyond basics can save lives.

Dysrhythmia Management

  • High risk and high payoff if correctly diagnosed.
  • V-tach or V-fib: rapid response is critical.
  • Mismanagement can lead to poor outcomes.

Types of Bradycardia

  1. Sinus Bradycardia
    • Impulse from sinus node; upright P waves in specific leads.
  2. Junctional Rhythms
    • Narrow QRS, rate 40-60, often vagal.
  3. Ventricular Rhythms
    • Wide QRS, rate 20-40.

AV Blocks

  • First-degree AV block: Long PR, not typically significant unless bradycardic.
  • Second-degree AV block: Two types
    • Mobitz I (Wenckebach): Gradually increasing PR.
    • Mobitz II: Constant PR, often wide QRS.
  • Third-degree (Complete) Heart Block: PR intervals randomly changing.

Types of Tachycardia

Narrow Regular Tachycardias

  1. Sinus Tachycardia
    • P QRS pattern, most common.
  2. SVT (Supraventricular Tachycardia)
    • Usually no clear P waves or retrograde P waves.
  3. Atrial Flutter with 2:1 Conduction
    • Two P waves per QRS, often missed.

Narrow Irregular Tachycardias

  1. Atrial Fibrillation (AFib): No distinct atrial activity.
  2. Atrial Flutter with Variable Conduction: Changing conduction ratio.
  3. Multifocal Atrial Tachycardia (MAT): Three different P wave morphologies.

Wide Regular Tachycardias

  1. Ventricular Tachycardia (V-tach): Often no P waves.
  2. Sinus Tach with Aberrant Conduction: E.g., bundle branch block pattern.

Wide Irregular Tachycardias

  1. AFib with bundle branch block.
  2. AFib with WPW (Wolff-Parkinson-White): Rapid rates, changing morphologies.

Polymorphic Ventricular Tachycardia

  • Torsades de Pointes: Occurs with prolonged QT.

Miscellaneous

  • Accelerated Idioventricular Rhythm (AIVR): Often in reperfusion arrhythmias.
  • Ventricular Fibrillation (V-fib): Should be a rhythm strip diagnosis, not a 12-lead.

Summary

  • Use PR intervals to diagnose AV blocks.
  • Key questions for tachycardia management: Is it narrow or wide? Regular or irregular? What's the atrium doing?

Hyperkalemia and Bradycardia

  • Common but underemphasized cause of bradycardia.
  • Symptoms and EKG Changes: Prolonged PR, wide QRS, loss of P wave, sine wave pattern.
  • Treatment: Calcium, bicarb; ACLS often ineffective in toxic/metabolic bradycardia.

Cases and Examples

  • Multiple cases illustrating different types of dysrhythmias and management strategies.

Break

  • 15-minute break for attendees.

Full transcript