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ysrymaCardiac Conduction SystemClassification
BradyarrhythmiaTachyarrhythmia
Mechanism
Disordersimpulse formation Disordersimpulse conduction Combination of both
Triggered Activity
AP duration abnormally long(long Q-T syndrome)Drugs prolong AP duration (K+ channel blockers  Class III antiarrhythmics)Early afterdepolarization(EAD)Delayed afterdepolarization(DAD)
 
acycaraSupraventricular Tachycardia (SVT)
Narrow QRS complexes (unless SVT with aberrancy)Source
y
 
SA node
y
 
Atrial
y
 
AV node
Types of SVTAtrial Tachyarrhythmias AV Tachyarrhythmias
From SA Node
y
 
Sinus tachycardia
y
 
Inappropriate sinus tachycardia(IST)
y
 
Sinus nodal re-entranttachycardia (SNRT)From Atrium
y
 
Atrial tachycardia
y
 
M
ultifocal atrial tachycardia
y
 
Atrial flutter
y
 
Atrial fibrillation (AF)
y
 
AV nodal re-entrant tachycardia(AVNRT)
y
 
AV re-entrant tachycardia(AVRT)
y
 
J
unctional ectopic tachycardia(
J
ET)
y
 
Nonparoxysmal junctiontachycardia (NP
J
T)
Multifocal Atrial Tachycardia
Numerousectopic atrial foci(simultaneously depolarize)Produce
y
 
3 different P wave morphologies
y
 
A narrow QRS complex (unless coexistent bundle branch block is present)
y
 
Variable PR intervals
y
 
H
eart rate  100-180 beats/minCommonly associated withchronic lung disease
M
anifestation of theophylline toxicity 
Atrial Fibrillation (AF)
Characterized by
y
 
Chaotic,disorganized depolarizationof atria
y
 
W
ith multiple impulses from atrial tissueNo effective contraction of atria(only quivering of atrial muscle)Atrial impulse travel to AV node
y
 
M
ajority are blocked
y
 
Remainder are conducted to ventricles
H
eart rate  100-180 beats/min (in healthy AV node patients)Absence of definitive atrial activity (coarse, fine atrial fibrillatory waves)Ventricular response rate irregular
Causes of AFCardiac Noncardiac
y
 
H
ypertension
y
 
I
H
D
y
 
Valvular heart disease(eg. mitral stenosis)
y
 
M
yocarditis
y
 
Pulmonary diseases
y
 
Thyrotoxicosis
y
 
Alcohol
y
 
Pulmonary embolism
y
 
Infection
E
ffects
L
oss of atrial contribution to diastolic filling of 
L
V (atrial kick)
Atrial Flutter
Characterized by
y
 
M
acroreentrant dysrhythmia
y
 
Involving atria with flutter waves being generated at 280-320 beats/minPresent with
y
 
2:1 block (can be mistaken for sinus tachycardia)
y
 
4
:1 or variable AV block
AVNRT (AV Nodal Re-entrant Tachycardia)(Junctional Reciprocating Tachycardia)
Reentry circuitforming just next to/ within AV node itself 
2 PathwaysFast Slow
Through which sinus impulsesnormally travelTypically blocked due to a longinherent refractory periodTriggered when apremature atrial impulsepasses through one of the pathways
y
 
Travels retrograde up the other pathway
y
 
Cause depolarization of atriumImpulse returns to AV node, cycle repeats
Typical AVNRT Atypical AVNRT
Common form (90%) (Slow-fast)Pathways
y
 
Anterograde slow pathway
y
 
Fast retrograde pathwayUncommon form (Fast-slow)Direction reversed
y
 
Fast anterograde pathway
y
 
Slow retrograde pathwayRetrograde P wave beyond T waveProducing an inverted P in
y
 
L
ead II
y
 
L
ead III
y
 
L
ead aVF
 
 
AV Reentrant Tachycardia (AVRT)
Result of 
2 conducting pathways 
y
 
AV node
y
 
1 bypass tractsSustained re-entry occurs over a circuit comprising of 
y
 
AV node
y
 
H
is Bundle
y
 
Ventricle
y
 
Accessory pathway
y
 
Atrium2 Types
y
 
O
rthodromic
y
 
Antidromic
Accessory pathway, Bypass tracts
 
Orthodromic Reciprocating Tachycardia (ORT)Antidromic Reciprocating Tachycardia (ART)Accessory Pathway
 
Nonparoxysmal Junctional Tachycardia
 Automaticity of AV node, coexistent AV blockNarrow-, wide-complex tachycardia (depend on where AV node impulse origin)Can occur in
y
 
Digoxin toxicity
y
 
Inferior myocardial infarction
y
 
Acute rheumatic fever
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