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Brief explanation of Junctional arrhythmia and Ventricular Arrhythmia. Slide 15, 16 and 18 are animations but cannot be viewed through the slide. Mail me if you need the animation or visit the website on the reference (number 7) and choose the animation according to your preference.
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ECGJUNCTIONAL & VENTRICULAR
ARRHYTHMIAS
MARYAM JAMILAH BINTI ABDUL HAMID082013100002IMS BANGALORE
INTRODUCTION
Student should be able to understand what is junctional and ventricular arrhythmias
Students should be able to identify these two arrhythmias through electrocardiograph
Student should know the classification that comes below these two arrhythmias
CLASSIFICATIONS
JUNCTIONAL ARRHYTHMIA
VENTRICULARARRHYTHMIA
Junctional Rhythm
AV Nodal Reentrant Tachycardia
Ventricular fibrillation
Ventricular tachycardia
Premature Ventricular Contraction
JUNCTIONAL ARRHYTHMIAAV Nodal Reentrant Tachycardia
-A type of supraventricular tachycardia (SVT); above thebundle of His-Reentry circuit forms within or just next to the AV node-Slow pathway is located inferior and slightly posterior to
theAV node, often following the anterior margin of the coronarysinus.-The fast pathway is usually located just superior andposterior to the AV node
-common AVNRT; anterograde conduction is via the
slow pathway and the retrograde conduction is via
the fast pathway
-uncommon AVNRT; anterograde conduction is via
the fast pathway and the retrograde conduction is
via the slow pathway
ECG- P wave that falls after the QRS complex
Junctional Rhythm-Abnormal heart rhythm resulting from impulses
coming from a locus of tissue in the area of
the AV node
-AV node as the pacemaker
-Retrograde conduction
ECG
- Without a P wave or with an inverted P wave.
- Retrograde P waves refers to the depolarization from the AV node back towards the SA node
VENTRICULAR ARRHYTHMIACause:1. Sudden electrical shock of the heart 2. Ischemia of the heart muscle, of its
specialized conducting system3. Both
Normal person:After electrical impulses reach the
ventricles, they dieoff Because all the ventricular muscle is in
refractory phase
Types of Ventricular Arrhythmias
Premature Ventricular Contraction Ventricular Tachycardia
Up to 200 bpm Ventricular Flutter
200-350 bpm Ventricular Fibrillation
350-500 bpm
Premature Ventricular Contraction
Heartbeat is initiated by Purkinje fibres
in the ventricles rather than by the SA
node
Ventricles contract first and before the
atria have optimally filled the ventricles
with blood, which means that circulation
is inefficient
ECG
Ventricular Tachycardia
Ventricular Flutter
Ventricular Fibrillation
-ventricular QRS complexes are highly polymorphic analogous to the ventricular extra systoles
-Retrograde conduction to the atria is almost always blocked; thus, undisturbed atrial activity is scattered with P waves without any relation to QRS complexes.
-ECG shows large
oscillation; main
and terminal
deflections can no
longer be
differentiated
ECG-fast-small potential fluctuations in rate-rhythm-amplitude-appearance
*a fatal condition
CIRCUS MOVEMENTS AS THE BASIS FOR VENTRICULAR FIBRILLATION
Define circus movements:‘Re-entry’ of the impulse into muscle that has already been excited
Why? Pathway around the circle is too long; dilated heart Velocity of conduction becomes decreased; blockage of Purkinje
system, ischemia of the muscle or high blood potassium levels Refractory period of the muscle might become greatly
shortened; drugs (epinephrine) or after repetitive electrical stimulation
CONCLUSION
Junctional arrhythmia; AV nodal reentrant tachycardia Junctional Rhythm
Ventricular arrhythmia; Premature Ventricular Contraction Ventricular Tachycardia Ventricular Flutter Ventricular Fibrillation
REFERENCES1. AK JAIN Medical Physiology, 3rd edition2. Davidson's Principles and Practice of Medicine, 21st Edition3. http://en.wikipedia.org/wiki/AV_nodal_reentrant_tachycardia4. http://en.wikipedia.org/wiki/Premature_ventricular_contraction5. American Heart Association. (2012, September 05).Ventricular
fibrillation. Retrieved from http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/Ventricular-Fibrillation_UCM_324063_Article.jsp
6. Mayo Clinic Staff. (2011, November 01). Diseases and conditions ventricular fibrillation. Retrieved from http://www.mayoclinic.org/diseases-conditions/ventricular-fibrillation/basics/definition/CON-20034473
7. American Heart Association. (n.d.). Arrhythmias (ventricular fibrillation). Retrieved from http://watchlearnlive.heart.org/CVML_Player.php?moduleSelect=arrhyt
8. http://www.drsegal.com/medstud/ecg/junction.htm9. http://en.wikipedia.org/wiki/Junctional_rhythm