ecg: digitalis effect / mat / af
TRANSCRIPT
ECG OF THE WEEK
PROF.DR.P.VIJAYARAGHAVAN’S UNITDR.V.MANIKANDAN
A 41 YEAR OLD FEMALE CAME WITH C/O BREATHLESSNESS PALPITATION FOR A DURATION OF 3 DAYSPATIENT WAS APPARENTLY NORMAL 3 DAYS BACK,STARTED DEVELOPING BREATHLESSNESS INITIALLY ON EXERTION NOW AT REST.H/O OF ORTHOPNEA PRESENT.H/O CHEST PAIN PRESENT.
PAST H/O:H/O OF SURGERY DONE FOR VALVULAR HEART DISEASE 14 YEARS BACK.PATIENT HAS NOT BEEN TAKING MEDICATIONS FOR PAST 1 WEEEK.
CASE SUMMARY:
CONSCIOUS,ORIENTED DYSPNEIC,TACHYPNEIC PEDAL EDEMA(+) NO PALLOR,CYANOSIS,CLUBBING
VITALS: PULSE:140/MT,IRREGULARLY IRREGULAR,VARIABLE VOLUME B.P:110/70 JVP-ELEVATED
CVS:S1,S2 HEARD,S1 LOUD,MDM(+) R.S:NVBS HEARD,B/L BASAL CREPTS PRESENT P/A -SOFT
CLINICAL FINDINGS
REPEAT ECG
A 12 LEAD ECG WITH, RATE-160/minute, irregular Varying RR interval Axis 90 to 120 Definite discrete p waves not seen. RVH with ST-T changes. Rpt. ECG shows fibrillatory waves.
ECG FINDINGS
Possibilities:
Digitalis effect Multifocal Atrial Tachycardia Atrial Fibrillation
ECHO FINDINGS:
MODERATE MS,MILD TRLA DILATED,NO PHTMVA-1.3 SQ.CM
Low amplitude baseline oscillations and an irregularly irregular ventricular rhythm.
The f waves have a rate of 300 to 600 beats /min. Variable in shape,amplitude and timing. Distingushing feature from flutter is absence of
uniform and regular atrial activity in other laeds of ecg chaotic atrial depolarization the atria contract irregularly and very rapidly
producing variable R-R intervals no regular p waves are identifiable and the baseline
is undulating
Atrial fibrillation ecg features
RHEUMATIC HEART DISEASE, HYPERTENSION, ISCHEMIC HEART DISEASE, PERICARDITIS, THYROTOXICOSIS, ALCOHOL INTOXICATION, MITRAL VALVE PROLAPSE, AND DIGITALIS TOXICITY
ATRIAL FIBRILLATION
Cardiac arrythmia Wandering atrial pacemaker The electrical impulse is generated at a
different focus within the atria of the heart each time.
MULTI FOCAL ATRIAL TACHYCARDIA
Decompensated chronic lung disease Congestive heart failure Digitalis toxicity Hypokalemia Methylxanthine toxicity
MANAGEMENT:1. TREATMENT OF UNDERLYING CAUSE2. ANTIARRYTHMICS OFTEN INEFFECTIVE3. VERAPAMIL OR AMIODARONE HAVE BEEN USEFUL4. POTTASIUM AND MAGNESIUM REPLACEMNT
EFFECTIVE.5. ABLATION USEFUL IN SOME CASES.
CAUSES OF MAT
MULTI FOCAL ATRIAL TACHYCARDIA
•ECG CHARACTERISTICS: •DISCRETE P WAVES WITH AT LEAST 3 DIFFERENT MORPHOLOGIES • ABSENCE OF ONE DOMINANT ATRIAL PACEMAKER• ATRIAL RATE BETWEEN 100 AND 130.• THE PP, PR, AND RR INTERVALS ALL VARY.
ECG FINDINGS IN MITRAL STENOSIS
•LEFT ATRIAL ENLARGEMENT•RIGHT QRS AXIS DEVIATION•A WIDE FRONTAL PLANE QRS-T ANGLE•ATRIAL FIBRILLATION•A PRECORDIAL MORPHOLOGY WHICH MAY MANIFEST ANY ONE OF THE FOLLOWING FEATURES A RELATIVELY NORMAL,NEUTRAL OR UNREMARKABLE PRESENTATION, RIGHT VENTRICULAR SYSTOLIC OVERLOAD RIGHT VENTRICULAR DIASTOLIC OVERLOAD
THANK YOU