Atrial Flutter vs. Atrial Fibrillation:
Both are tachyarrhythmia, almost with same symptoms of
palpitation, dizziness or fainting, shortness of breath, and chest pain or
tightness, both increase the chance of blood clots and stroke
The main difference is that atrial fibrillation is always
irregular whereas atrial flutter usually regular rhythm
Multifocal Atrial Tachycardia (MAT) is more common in elderly
patients with chronic lung disease (e.g COPD)
Cardioversion and digoxin are not useful in the management of
Multifocal Atrial Tachycardia (MAT)
Features suggesting ventricular tachycardia (VT) rather than supra
ventricular tachycardia (SVT) with aberrant conduction are:
Atrioventricular (AV) dissociation
Fusion or capture beats
Positive QRS concordance in chest leads
Marked left axis deviation
History of ischemic heart disease (IHD)
Lack of response to adenosine or carotid sinus massage
QRS > 160 ms
Verapamil is contraindication in wide complex tachycardia as it
may causes ventricular fibrillation in patients with ventricular tachycardia
In case of V Tach in case of digoxin toxicity:
Treat with lidocaine and phenytoin; avoid Amiodarone and
Procainamide because they increase digoxin toxicity
Use DC shock when medical treatment failed
Causes of QT prolongation
Congenital: Jervell-Lange-Nielsen syndrome
Antiarrhythmics: amiodarone, sotalol, class I-a antiarrhythmic
drugs
Tricyclic antidepressants
Antipsychotics
Chloroquine
Terfenadine
Erythromycin
Electrolyte disturbance: Hypocalcemia, Hypokalemia, Hypomagnesemia
Myocarditis
Hypothermia
Subarachnoid hemorrhage
Features of complete heart block
Syncope
Heart failure
Regular bradycardia (30-50 bpm)
Wide pulse pressure
JVP: cannon waves in neck
Variable intensity of S1.
Associations of Wolff Parkinson White (WPW) syndrome:
Hypertrophic obstructive cardiomyopathy (HOCM)
Mitral valve prolapse
Ebstein's anomaly
Thyrotoxicosis
Secundum atrial septal defect (ASDII)
ECG changes in Hypothermia
Sinus bradycardia
When severe, prolonged QRS and QT intervals
A-Fib with slow ventricular response and other atrial/ventricular
dysrhythmias
Osborne J waves: “hump-like” waves at the junction of the J point
and the ST segment
Torsades de Points is a ventricular tachycardia which is
polymorphic and occurs with QT prolongation.
Samples of medications that can cause QT prolongation:
Antibiotics: macrolide antibiotic, fluoroquinolone, metronidazole
Antifungals: fluconazole, ketoconazole
Antivirals: nelfinavir
Antimalarials: chloroquine, mefloquine
Anaesthetics: halothane
Antiarrhythmics: Type IA antiarrhythmics, Type IC antiarrhythmics, Class
III antiarrhythmics
Antidepressants: Tricyclic antidepressants (TCAs)
Antipsychotics: risperidone, fluphenazine, haloperidol, clozapine, thioridiazine
Antihistamines: Diphenhydramine, Astemizole, Loratidine, Terfanadine
Second degree AV block Mobitz type 1: also known as (Wenckebach
Phenomenon): there is progressive prolongation of the PR interval before block
occurs, then the cycle well repeated
The most common type is 3 to 2 block which means that every third P
wave is blocked
Second degree AV block Mobitz type 2: Intermittent non-conducted P
waves without the progressive prolongation of the PR interval before block
occurs
Mobitz type 2 is more serious than Mobitz type 1 because it is
usually chronic and tends to progress to third degree (complete) heart block
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