Cardiology‎ > ‎

Learning EKG including Arrythmia







Premature Ventricular Contractions
  • Significance:
    • Symptoms (SOB, Frequent cause of palpitation) 
    • Cardiomyopathy
      • Not all patient with PVC have cardiomyopathy
      • Burden above 10-25 % if often implicated 
      • Chicen or Egg?
    • Mortality
      • increased Mortality after MI
      • increased mortality with LVH
      • EF < 35 %
        • Frequency did not provide prognostic information in this patient group 
      • Short coupled PVCs
        • < 300 ms. Risk of increased V. Tach
        • R on T phenomenon
        • Suggest short QT
  • Family history is relevant for appropriate risk stratification
  • Exercise test in select few patients
    • Esp if ischemia is a concern 
    • If provoked by exercise 
  • Location of PVC
    • mostly outflow tract
      • RVOT foci
      • LVOT foci
        • Difficult to identify the foci
        • Outfolow tracts are inter winded to each other 
    • valve annulus
      • MV annulus (5 %)
    • others...
  • Mechanism of PVC
    • cAMP mediated Ca dependent delayed activation 
    • few have macrorenterant mechanism 
  • Treatment
    • Usually dictated by symptoms
    • No specific therapy
    • Meds: 
      • BB (if they can tolerate)
        • 10-15 % patient will have 90% reduction
      • CCB (less data)
        • Fasicualr PVC, Short coupled
      • Anti-arrythmic drugs
        • may be better, but may not have survival advantage 
    • Surgery:
      • Ablation


BRADYCARDIA: 1st / 2nd / 3rd degree / Sinus - Symptomatic / Asymptomatic - etiology (drugs, MI etc) - treatment plan. 

Pacemaker 
  • Indications
    • SN dysfunction: HR < 40
    • AV Block
      • Symptomatic any type
      • Aymptomatic 
        • 3rd AV Block, Infra-husian 2nd (EP study parameters), any Mobitz II
        • 2nd AV block with rates < 40 bpm or pauses > 3s
    • Bifascicular AV block
      • Alternating BBB, syncope of unknown cause
    • Neuromuscular Diseases
    • Post-MI
      • Anterior ? vs Inferior
    • Neurocardiogenic Disorders
    • Carotid Sinus Hypersensitivity
    • ? Vasovagal syncope 
  • References 
Role of Thrombin
  • Causes Fibrin formation, 
  • Also, causes platelet activation and stabilizes the clot 
Caution in a fib vs MAT
Atrial tissue does not rely on coronary vasculature for oxygen. Hence, Stress test is done only in a symptomatic patient. 


Comments