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ECG and arrhythmia + medications by Mind Map: ECG and arrhythmia + medications
5.0 stars - 4 reviews range from 0 to 5

ECG and arrhythmia + medications

How will this come in OSPE

You will get and ECG

Give the diagnosis

What's the treatment

What's the mechanism

will not be asked about medication classes


Adult: less than 60.Child: less than the normal levels for age


P wave in front of QRS

causes, medications, beta blockers, CCB, Increased inter cranial pressure, Cushing's triade, bradycardia, hypertension, irregular breathing, hypothyroidism

Treatment, treat the cause, not symptomatic, no need for treatment, can happen in sleep or in athletes, symptomatic, Atropine, unstable, resuscitation

Not sinus (abnormal)

1st degree heart block, PR constant and prolonged, normal range 3-5, No need for treatment, generally normal and has no significance, except if you want to use it as minor criteria for rheumatic fever

2nd degree heart block, Mobitz type I (Wenchebach), progressive prolongation of PR interval, clinically not significant, can be normal finding, NO treatment, Mobitz type II, significant and needs treatment, P wave alone with no pattern (not conducted to the ventricles to produce QRS), no prolongation of PR, one of the indications for pacemaker

3rd degree heart block, no relation between atria and ventricles, each are conducting separately, causes, congenital, babies of mothers with antiphospholipid syndrome (positive anti ro anti la antibodies) like SLE, acquired, postoperative, management, symptomatic, Atropin first to increase HR, then put a pacemaker, not symptomatic, if the ventricular rate is sufficient

Asystole, Check if leads are connected first!! can detach with chest compression, give atropine and epinephrin, shock will kill the patient (it causes temporarily systole), Do chest compressions


adults: more than 100children: more than normal for age


from SA node, but faster than normal

ECG characteristics, P wave precedes the QRS, PR interval constant, Normal P wave axis (0-90 degrees), look at lead 1 and aVF, if it's positive in both it's normal axis, Normal P wave axis (0-90 degrees)

Sinus arrhythmia

Sinus tachycardia, What to do for him?, simply know the cause and treat it, Why is it fast?, fever, pain, anxiety, anemia, dehydration, Thyrotoxicosis

Sinus arrhythmia, This is due inspiration and expiration, inspiration increases venous return and heart rate, normal finding, read about pathophysiology

Not sinus (abnormal)

atrial or ventricular, atrial, Supraventricular tachycardia (SVT), SVT, It's main differential for sinus tachycardia, NO P wave, T wave is there.., mechanism, reentry is the most common mechanism, nodal, accessory pathway, Presentation, Very common and important. Most common in paediatrics, Asymptomatic, Depends on the age and duration, Palpitations (comes like chest discomfort), Heart failure, suddenly comes, suddenly goes.., Management, Treat NOW, it might cause, arrhythmia induced cardiomyopathy, Degenerate to ventricular tachycardia and ventricular fibrillation -> patient dies, Acute SVT have to be treated ASAP, No equipment, valsalva manoeuvre, ask the patient to breath against a closed mouth, carotid massage, ice bag on face for 10 seconds, these manoeuvres affect the vegal tone and reduce heart rate, With equipment, Adenosine!, very important ASAP, causes transient heart block in the AV node, half life 3-5 seconds, to the nearest vein to heart, Then flush immediately with normal saline, 2 needles at the same time, If this didn't work, or patient is not stable, Synchronized cardioversion, same defibrillation machine, but will give the shock at the QRS, if it was not at the QRS, it might cause asystole and patient dies!!, Amiodarone, usually for chronic SVT, but still u can use it, lots of side effects, hypotension, lung fibrosis, liver damage, thyroid problems, subtypes, Atrial ectopic tacycardia, in adult and children, Mechanism: abnormal automaticity, impulse coming from abnormal focus, Abnormal P wave, inverted, biphasic.., worming up and cooling down, normal, then gradually increasing to tachycardia, then gradually decreasing, not like SVT (abrupt start and end), causes, Myocarditis, Postoperative, management, resistant to cardiovesion and adenosine, Give anti arrhythmic medication, Amiodarone, Digoxin, Junctional ectopic tachicardia, Atrial flatter, mechanism, Reentry, single circuit, one abnormal focus, Treatment, Rate controle, Beta blocker, digoxin, Anticoagulant, warfarin, to prevent stroke, Cardioversion, Atrial fibrillation, mechanism, Reentry (multicircuit), Heart block is very important to have, to isolate the atrial fibrillation from making ventricular fibrillation, without block patients die.., Treatment, Rate controle, Beta blocker, digoxin, Anticoagulant, warfarin, to prevent stroke, Cardioversion, ventricular, premature ventricular contraction (PVC), abnormal or absent P wave, Number of consecutive PVCs, 1: isolated, 2: couplet, 3: triplet, more than 3: ventricular tachycardia, Pattern, Bigeminy: 1 normal then 1 abnormal, Trigeminy: 2 normal, 1 abnormal, Ventricular tachycardia, More than 4 PVCs in all leads, The patient can be stable or unstable, Common cause of arrest outside hospitals, Treatment, if stable you can start with anti arrhythmic medication first, Lidocaine, Amiodarone, if unstable, Defibrillation: shock, AED, This is monomorphic. Polymorphic like Torsades de points, Ventricular fibrillation, Irregular! a total mess, Patient is not stable. Shock immediately, Torsades de pointes, Mechanism: triggered activity, will lead to VT, going up and down from the baseline, Suspect long QT syndrome (previously), Treatment, Manage as VT, Then correct the cause of QT, electrolyte imbalance, congenital

Narrow or wide QRS, Wide QRS

Mechanisms, Reentry, The impulse enters again to make one more contraction instead of ending after 1 contraction, nodal or due to accessory pathway outside the node (used anti grade or retrograde), Abnormal automaticity, should be automatic normally, the SA node, if it's originated somewhere else other than SA node, Triggered activity, very rare, action potential initiates 2 or more contractions, example: Torsades de pointes

Other rhythm abnormality

Sick sinus syndrome

cause, myocarditis, postoperative

characteristic, tachycardia, then bradycardia, associated with syncope and arrest

Wondering SA node (wondering pacemaker)

P wave starts normal, then gradually PR interval and P wave morphology changes..

cause, myocarditis, postoperative


Anti arrhythmic (reducing HR)

Pharmacological, non classified, adenosine, block AV nodal conduction and shortens atrial refractoriness, half life is seconds, transient side effects, it makes the patient in a heart block for seconds, treats SVT, digoxin, Inhibits the Na+, K+‐ATPase pump, Prolongs AV nodal conduction and the AV nodal refractory period, blocks conduction, so good for AF. Not effective with VT, half life 36-48 hours, 4 classes (Vaughn‐Williams), Class 1: sodium channel blockers, affects rhythm, 1a, Prolong action potential duration, depress phase 0, indications: SVT, VT, prevention of VF, PVCs, examples, quinidine, protein bound, procainamid, rarely causes SLE, 1b, Shorten action potential duration, indications: VT, VF prevention, PVCs, examples, lidocaine, only parentally, not by mouth due to first pass metabolism, protein bound, Mexiletine, protein bound, might rarely cause leukopnea, 1c, like 1a but stronger, indications: life threatening VT, VF, refractory SVT, examples, Flecainide, Severe LVF decrease, Might cause sudden death, propafenone, weak CCB and beta blocker, Class 2: anti-sympathetic nervous system (most are beta blockers), lower automaticity, affects rate, Prolong AV conduction & refractoriness, indications: SVT, AF (preventing VF), examples, Esmolol, Propranolol, Metoprolol, Class 3: potassium channel blockers, Prolongs action potential, prolongs QT intervale, so the patient can enter dorsale de poinet, decrease automaticity and conduction, examples, amiodarone, can be used for anything, but many long term side effects, Dronedarone, Satalol, beta blocker, AF, VT, Dofetilide, AF and flutter, cytochrom p450 interaction, Ibutilitde, Fore conversion of AF and flutter, Class 4: calcium channel blockers, affects rate, Non dihydropyridine because they increase HR, indication: SVT, examples, Verapamil, Diltazem, IMPORTANT, All are pro arrhythmic, least is amidarone, but it has long term side effects, pulmonary fibrosis, has iodine so it cause hypo and hyper thyrodism, Most affect LVF, also amidarone is the least, worst is class 1c

Non Pharmacological, defibrillation, valsalva manoeuvre, carotid massage, ice bag on face for 10 seconds

increasing HR