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

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