By ChugaHaeYo 6767

-multiple p wave
regular rhythm at rate 2:1 , 3:1 , 4:1 of atrial rate SAWTOOTH appearance -

- Embolism
- MS & MR
- TS & TR
- Heart failure
-IHD
- Pericarditis
- After cardiac surgery
-Thyrotoxicosis
- COPD
- Alcohol
- Digoxin toxicity
-Idiopathic

- Palpitation
- Fatigue & headache & dizziness & syncope ( due to CO )

ECG - RFT
- Serum electrolytes
- Blood glucose
- TFT
- drug level ( if in digoxin )

- Plasma troponin ( if suspected MI )

- CXR
- ECO ( to assist function of lt & Rt ventricles )

* If Acute flutter
DC cardioversion (20-100j))
* If pt stable
- procainamide
- BETA Blocker or Ca channel blocker ( to control Rate )
- Amiodarone ( chemical cardioversion )
* Radio frequency catheter ablation to prevent recurrent

- absence Pwave
- Irregular rhythm

- Pulmonary embolism
- MS & MR
TS & TR -

- Heart failure
-IHD
- Pericarditis
- After cardiac surgery
Thyrotoxicosis - COPD
- Alcohol
- Digoxin toxicity
- Idiopathic

- Palpitation .
- Fatigue & headache & dizziness & syncope ( due to CO )
- C/p of underlying cause

- ECG

- RFT

- Serum electrolytes
- Blood glucose
- TFT
- drug level ( if in digoxin )
- Plasma troponin ( if suspected MI )
- CXR
- ECO ( to assist function of lt & Rt ventricles )

mx underlying cause *
* If Acute flutter
- DC cardioversion (200j )
* If pt stable
- BETA Blocker or verapamil ( to control Rate )

- Amiodarone ( chemical cardioversion )

* anticoagulant or antiplatelet
- warfarin (INR 2-3 )
" For pt with " Risk Factors
( VHD . HTN . IHD . CCF . age>75 )
aspirin For pt without "Risk Factors" and pt C/I for warfarin

No wave QRS wide >3mm - rapid regular rhythm

- No Twave

- MI .
- Myocarditis .
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy .
- Chronic IHD .
Mitral valve prolapse - .

- Hypokalemia .
- Digitalis toxicity .
CCF - .

- ECG .
- CXR (Cardiomegaly ) .
- RFT .
- Cardiac Enzymes ( MI ) .
- Serum electrolytes .
- ABG ( Hypoxia + Acidosis ).
- ECO (assist function of Lt & Rt ventricles) .

*Acute hemodynamic unstable

- DC cardioversion
* Acute hemodynamic stable
Sotalol or Amiodarone or Procainamid 1
BETA blocker or Ligoncocain 2
IV mg. Sulfate (for all pt especially if have risk of
hypomagnesaemia) 3
* treat underlying cause
* for recurrent ( Radio frequency ablation and or ICD implantation )

Ventricular fibrillation
No Pwave - NO Twave
- QRS wide >3mm
- Rapid Irregular Rhymes

- MI
- Hypokalemia
- electric Shock

- loss of consciousness
- pulse absent
- respiratory ceases

- Electrical defibrillation (if not available >> CPR )

if survivor of VF & cause isn't reversible >> implantable CVD =Cardio Vascular Defibrillator

Rt_Axis_Deviation
110+ <

Causes
Children
Tall & Then adult
PE
ASD
VSD
ant. Lat. MI
chronic lung disease

30->

Causes
LBBB
obese
hyperkalemia
Emphysema

Tall Twave
<<< DDx
Acute STEMI
Hyperkalemia

inverted or low flat Twave

<< DDx
IHD
Myocarditis
Digitalis
Hypocalcaemia
Hyperkalemia
Hypomagnesaemia

<<< DDx
Hypokalemia
Drugs ( Amiodarone , Quinindine , Sotalol ...etc)

flat Pwave -

wide QRS

- peaked Twave short QT interval-

DDx_of_STsegment_elevetion
Acute STEMI -

Prinzmetal's angina pericarditis LV aneurysm LBBB cocaine abuse -

Pericarditis diffuse in all leads .

MI and angina in some leads .

cardiac enzymes MI
timing MI 20 angina

ant. MI >> V1 - V4
lat. MI >> I - aVL - V5 -V6
ant. Lat. MI >> I - aVL - V4 - V6
inf. MI >> II - III - aVF
ant. Septal >> V1- V4
septal MI >> V1-V2

- Cardiac Enzymes ( Troponin T& I )

1 4-2

- Creatin kinase (CK-MB , CK-MM , CK-BB) CK-MB more specific

2 24 peak 8 4
3
- serum myoglobin
- AST
72 48_24 peak
- LDH
14 10 4_3 peak
- CBC ( leukocytosis )
- ECR
CXR eco -

call for help ABC O2 for hypoxia CBC pain relief IV morphine *
Nitroglycerin *
B.Blocker *
Antithrombotic aspirin *
reperfusion PCI ( percutaneous coronary Intervention ) for Stent *
Thrombolytic *

C/I of THROMBOLYTIC *
absolute C/I
active internal bleeding
aortic dissection suspected
preior ischemic stroke in last 3months
preior hemorrhagic stroke
known Intracranial Neoplasm
acute active pericarditis
pregnancy
sever HTN
recent surgery for head

DDx_of_ST_Deprssion
NSTEMI

stable & unstable angina

Hypokalemia
Digitalis
cardiac hypertension

Mx_of_NSTEMI
admission call for help ABC high O2 by mask Morphine IV Metoclopramide sublingual Nitrate aspirin chewed B.blocker Heparin -

Do stress ECG *
Coronary angiography *

Rt_ventricular_hypertrophy
Rwave in V1 & V2 >5mm

PHTN pulmonary stenosis Hypertrophic cardiomyopathy -

Rwave in V5 & V6 > 5large square

Ddx
systemic HTN Aortic stenosis Hypertrophic cardiomyopathy -

RBBB LBBB ventricular extra systole ventricular tachycardia -

ventricular fibrillation -

wide QRS complex

broad notched R wave in V1& V2
(M shaped)
wide and deep Swave in V5 & V6

IHD congenital heart disease (ASD) PHTN myocarditis degenerative conduction system disease -

wide QRS complex

broad notched R wave in V5 & V6
(M shaped)
small or absent R wave followed by deep S waves in V1 & V2

causes
It's rare and most commonly seen in IHD

Ventricular_Extrasystole = premature ventricular

contraction = PVC
No Pwave
wide QRS (bizzare in shape)
Twave inversely proportion to QRS
prolonged pause after QRS

Heart_block

1st degree HB
PR interval fixed prolongation

No drop beat
QRS normal or narrow

2nd degree HB (MOBITZ I)

PR interval progressive prolongation
Dropped beat (p without QRS)
QRS normal or narrow

2nd degree HB (MOBITZ II)= wenckebach phenomenoa

Dropped beat
PR interval normal before dropped beat
Pwave with sinus rhythm
QRS wide
rd HB (complete HB)3
Pwave normal
QRS wide , regular & Slow in rate
PR interval variable ( AV dissociation)

Acute *
MI myocarditis Infections hyperkalemia DRUGS ( Digitalis , BETA blocker , Ca channel blocker & antiarrhythmic drugs)

chronic *
Idiopathic conduction degeneration congenital complete AV block Cardiomyopathy -

Asymptomatic symptomatic (hemodynamic and unstable) chest pain ~

bradycardia ~
systolic pressure <90mmHg ~
pulmonary Edema ~
dizziness & syncope ~

ECG RFT serum electrolytes TFT CXR plasma troponin (MI ) drug level ECO -

1st degree HB
No need treatment <<
2nd degree ( MOBITZ I )
if asymptomatic

No Need Treatment <<

if symptomatic
Atropine <<
Or
temporary Pacemaker <<
complete HB
permanent Pacemaker <<
Except when ass` with transient Inf. MI. Or Asymptomatic )
(congenital HB

Supraventreicular_tachycardia

No P wave
QRS narrow <3mm

regular rhythm

Anixety caffee & tobacoo Hyperthyroidism Alcohol -

palpitation Breathlessness polyuria (sometimes) -

VAGOTONIC MANEUVERS*
Carotid sinus massage .
Pressure on eyes .
Valsalva maneuver .
Self induced vomiting .
Lowering head btween knee .
DRUGs*
Adenocor .
Verapmil .
BETA blocker .
Digoxin .
DC cardioversion (in emergency*