Escape Rhythm

Escape Rhythm Inverted P waves – low atrial origin Varying P waves – wandering pacemaker, varying origin (COPD) P waves in 2 and V1 Bradys - Sinus brady SA node disease/Vagal tone - AV Block o First degree (delayed PR interval) o Second degree Mobitz 1, lengthening of PR until one missed Mobitz 2, fixed PR int, SA doesn’t transmit lot of them o Third degree – complete dissocation, ventricular escape rhythm - Sick sinus syndrome RBBB can be normal LBBB worse Tachyarrhythmia - SVT – narrow complex o SVT: regular AVNReentry WPW o A flutter: regular, sawtooth o AF: irregular o Atrial tachy: ectopic node - Ventricular – wide complex o Irregular = VF Similar to VT, VT often > VF shockable o Regular = VT 90% due to previous AMI/IHD already abnormal function o idiopathic VF

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Escape Rhythm

Inverted P waves low atrial origin

Varying P waves wandering pacemaker, varying origin (COPD)

P waves in 2 and V1

Bradys Sinus brady SA node disease/Vagal tone AV Block First degree (delayed PR interval) Second degree Mobitz 1, lengthening of PR until one missed Mobitz 2, fixed PR int, SA doesnt transmit lot of them Third degree complete dissocation, ventricular escape rhythm Sick sinus syndrome

RBBB can be normalLBBB worse

Tachyarrhythmia SVT narrow complex SVT: regular AVNReentry WPW A flutter: regular, sawtooth AF: irregular Atrial tachy: ectopic node Ventricular wide complex Irregular = VF Similar to VT, VT often > VF shockable Regular = VT 90% due to previous AMI/IHD already abnormal function idiopathic VF structure normal sudden death in young patients LGTS, CPVT, Brugada: inherited ion channel issues

Polymorphic VT?

LQTS Drug induced Inherited Brugada ST elev in V1, V2 Up, then slower down,unlike AMI Adenosine Wide complex iregg tachy

Treatment SVT Ablation by catheter, through femoral vein BBlockers CCB Amiodarone AF Elderly a lot AF Stroke7 CCF3 Mx Stroke prevention Warfarin: 2/3 effective, narrow therapeutic range and interaction NewOralACs? Dabigatran rivaroxaban Apixaban Thingy to put in LAappendage for warfarin contra Rate control (BB/CCBs) Rhythm control (not import. If asymp)