how to have good rhythm even if you can’t dance · how to have good rhythm even if you can’t...
TRANSCRIPT
![Page 1: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/1.jpg)
How to Have Good
Rhythm Even if You Can’t Dance
Understanding Normal Variants & Concerning
Abnormalities John Clark MD
![Page 2: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/2.jpg)
Objectives:
● Describe benign variants in the pediatric ECG ● Describe concerning abnormalities in the pediatric ECG ● Determine to need for referral
![Page 3: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/3.jpg)
Topics
PACs PVCs SVT WPW VT, VF HCM LQT
![Page 4: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/4.jpg)
Bored review questions:
• A 16 year old, competitive swimmer presents to ER with a near drowning event. A cardiac cause is found. The most likely etiology is:
• HCM
• LQTS
• ARVD
• Commotio cordis
![Page 5: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/5.jpg)
• A 16 year old, competitive athlete presents with cardiac arrest during any sport other than swimming. The most likely etiology is:
• HCM
• LQTS
• ARVD
• Commotio cordis
![Page 6: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/6.jpg)
Bored review questions:
• A patient with known WPW shows up in SVT. All of the following medications would be appropriate except:
• Amiodarone
• Adenosine
• IV beta blocker
• IV procainamide
![Page 7: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/7.jpg)
PACs
Newborns
Benign
Resolve
Follow up 2 months
![Page 8: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/8.jpg)
![Page 9: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/9.jpg)
Three things that can happen to a PAC:
• Conducts normally - QRS looks the same as a sinus beat.
• Conducts aberrantly – QRS is wider than sinus beat.
• Blocks – no QRS after the PAC. There will be a pause after the last QRS.
![Page 10: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/10.jpg)
![Page 11: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/11.jpg)
![Page 12: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/12.jpg)
![Page 13: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/13.jpg)
PVC
![Page 14: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/14.jpg)
PVCs
Teenage
Isolated, monomorphic, suppress with exercise, normal heart, asymptomatic.
Usually found incidentally
Sometimes c/o flutter, skip, thump or need to cough
<30% vs >40%
![Page 15: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/15.jpg)
Criteria for diagnosing PVCs:
• QRS morphology always different from sinus beat (usually wide).
• Beat comes early
• AV dissociation
• Fusion beats
![Page 16: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/16.jpg)
![Page 17: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/17.jpg)
![Page 18: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/18.jpg)
![Page 19: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/19.jpg)
Supraventricular Tachycardia
• Reentrant vs automatic (ectopic)
• Infant vs toddler vs school age vs teen
• Vagal vs meds vs ablation
![Page 20: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/20.jpg)
![Page 21: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/21.jpg)
![Page 22: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/22.jpg)
Supraventricular Tachycardia
• Wolff-Parkinson-White Syndrome – short PR interval
– widened QRS
– Delta wave present
![Page 23: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/23.jpg)
![Page 24: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/24.jpg)
WPW
• Atrial fib • EPS to risk stratify
![Page 25: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/25.jpg)
VT
![Page 26: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/26.jpg)
VT
• No treatment • Meds • Ablation • ICD
![Page 27: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/27.jpg)
VT
• HCM
• 50% SCD with sports
![Page 28: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/28.jpg)
Pediatric Arrhythmias
![Page 29: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/29.jpg)
LQT
History - syncope, seizure
Family hx - SCD?
Meds, ICD, sympathectomy
![Page 30: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/30.jpg)
Bored review questions:
• A 16 year old, competitive swimmer presents to ER with a near drowning event. A cardiac cause is found. The most likely etiology is:
• HCM
• LQTS
• ARVD
• Commotio cordis
![Page 31: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/31.jpg)
Bored review questions:
• A 16 year old, competitive athlete presents with cardiac arrest during any sport other than swimming. The most likely etiology is:
• HCM
• LQTS
• ARVD
• Commotio cordis
![Page 32: How to Have Good Rhythm Even if You Can’t Dance · How to Have Good Rhythm Even if You Can’t Dance Understanding Normal ... Supraventricular Tachycardia ... WPW • Atrial fib](https://reader033.vdocument.in/reader033/viewer/2022042314/5f024ba97e708231d4038f1b/html5/thumbnails/32.jpg)
Bored review questions:
• A patient with known WPW shows up in SVT. All of the following medications would be appropriate except:
• Amiodarone
• Adenosine
• IV beta blocker
• IV procainamide