Presentation: Etiologies of Sinus Bradycardia Sinus bradycardia can result from a wide range of intrinsic (inherent) and extrinsic factors. Understanding these causes is essential for targeted management. Intrinsic (Inherent) Etiologies Extrinsic Etiologies Evaluation of Sinus Bradycardia Treatment and Management Differential Diagnosis of Bradyarrhythmias Prognosis Sick Sinus Syndrome (SSS) Prevalence: Approximately…

Origin of Ectopic Beats Premature contractions (“ectopics”) are classified by their origin Definition and Classification ECG Diagnostic Criteria: Compensatory Pause: Clinical significance Differential Diagnosis: Etiology and Risk Factors Clinical Presentation Evaluation Management Prognosis and Complications

Aetiology Palpitations: Associated Symptoms and Causes Cardiac:Arrhythmias Cardiac: Nonarrhythmic cardiac causes  Serious Indicators: Symptom Characteristics: Orthostatic Intolerance: Psychiatric causes Drugs and medications Extracardiac causes History Taking Key Clinical Findings with Palpitations and Suggested Diagnoses Finding Suggested diagnosis Single “Skipped” Beats Benign ectopy Feeling Of Being Unable To Catch One’s Breath…

Delayed conduction of electrical current as it passes through the conducting system May occur at any level in the conducting system (AV node, Bundle of His or bundle branch) Block in either AV node or the bundle → AV block ** Revision: PR interval → there is a problem with…

Causes of tachyarrhythmias and differentiating clinical features   Rate P-waves Variability Most common demographic Sinus Tachycardia <220 Present, normal morphology Variable Typically unwell children or systemic illness Supra Ventricular Tachycardia >220 (commonly 250-300 in infants) Absent or after QRS Fixed   AVRT including WPW   After QRS   Neonates and…

Case: Jane is a 42 yr old women who teachers at the local primary school.  She attends your surgery at lunch time complaining of feeling light headed and dizzy. Jane reports she has suffered these symptoms for one hour and has never had them before.  She is feeling palpitations and…

Wolff-Parkinson-White (WPW) Syndrome ECG features of WPW in sinus rhythm Tachyarrhythmias associated with WPW syndrome Atrioventricular reentrant tachycardia (AVRT) WPW with AF – FBI = Fast Broad Irregular tachycardia Management of AVRT For orthodromic AVRT: For antidromic AVRT: ECGS:  Main Abnormalities: Irregularly irregular broad complex tachycardia Extremely rapid ventricular rates…

DIAGNOSIS  ECG Inappropriate sinus tachycardia (IST) Postural orthostatic tachycardia syndrome (POTS)

Two main categories: AV NODE INDEPENDENT AV NODE DEPENDENT MANAGEMENT Undifferentiated Narrow Complex Tachycardia Ventricular stand-still post Adenosine AV NODE INDEPENDENT AV NODE DEPENDENT

Features: always associated with absent pulse and loss of consciousness ECG Differential diagnosis Management: Electrical cardioversion Management: Drug therapy Special circumstances

Risk factors Causes of prolonged QT Antipsychotics Antiarrhythmics Tricyclics Other antidepressants Antihistamines Others Chlorpromazine Quinidine Amitriptyline Citalopram Diphenhydramine Erythromycin Haloperidol Procainamide Doxepin Escitalopram Loratadine Clarithromycin Droperidol Disopyramide Imipramine Venlafaxine Terfenadine Quinine Quetiapine Flecainide Desipramine Bupropion   Chloroquine Olanzapine Sotalol       Hydroxychloroquine Thioridazine Amiodarone         Management

Monomorphic Polymorphic complex of normal duration. (the first of the narrower complexes is a fusion beat (the next two are capture beats) Brugada Criteria::  RS Complex R to S interval >100 msec (2.5 small boxes)  AV dissociation Morphology Criteria for VT in V1-2 and aVR AV dissociation = Ventricular rate…

TOO  FAST TOO  SLOW NARROW COMPLEX BROAD COMPLEX NARROW COMPLEX BROAD COMPLEX REGUALR IRREGULAR REGULAR IRREGULAR SVTFlutterSinus Tachy AFA-flutter with variable block VTConduction abN VFAF with LBBB Sinus (medications)AF (medications)SSS(sick sinus Syndrome)2nd degree heart block BBB3rd degree HBPoisoned Heart (hypoxia, acidosis, overdose, hypothermia) TOO  FAST TOO  SLOW Compromised Stable Compromised…

Intro Risk factors, disease associations and potentially reversible precipitants for atrial fibrillation Risk factors and disease associations Potentially reversible precipitants ObesityHypertensionType 2 diabetes/impaired glucose toleranceSmokingObstructive sleep apnoeaCoronary artery diseaseValvular heart diseaseHeart failureChronic kidney disease HyperthyroidismAlcohol excessElectrolyte abnormalitiesSepsisAnaemiaMedications Classification Presentation Investigations ECG Management Treat any underlying cause – anaemia, thyrotoxicosis etc.…

most common: birth to 13 years aged 14 to 24 years causes: