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  • Yoga Yuniadi - Ladder Diagram

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    Zulhelmi
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    This document discusses the use of ladder diagrams to represent cardiac conduction and arrhythmias. It notes the different conduction speeds in various cardiac tissues. Key requirements for understanding ladder diagrams include knowledge of effective refractory periods, relative conduction velocities between tissues, concealed conduction, autonomic influences, and wave identification. Various arrhythmias that can be depicted using ladder diagrams are presented, including ectopic beats, concealed conduction, atrial reentry, abnormalities of AV conduction, dual AV nodal pathways, AV nodal reentrant tachycardia, ventricular tachycardia with AV dissociation. Limitations in representing abnormal automaticity and triggered rhythms are also discussed. The document encourages practicing drawing ladder diagrams to represent ECG

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    02. Yoga Yuniadi - Ladder Diagram

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    This document discusses the use of ladder diagrams to represent cardiac conduction and arrhythmias. It notes the different conduction speeds in various cardiac tissues. Key requirements for understanding ladder diagrams include knowledge of effective refractory periods, relative conduction velocities between tissues, concealed conduction, autonomic influences, and wave identification. Various arrhythmias that can be depicted using ladder diagrams are presented, including ectopic beats, concealed conduction, atrial reentry, abnormalities of AV conduction, dual AV nodal pathways, AV nodal reentrant tachycardia, ventricular tachycardia with AV dissociation. Limitations in representing abnormal automaticity and triggered rhythms are also discussed. The document encourages practicing drawing ladder diagrams to represent ECG

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    45 views32 pages

    Yoga Yuniadi - Ladder Diagram

    Uploaded by

    Zulhelmi
    This document discusses the use of ladder diagrams to represent cardiac conduction and arrhythmias. It notes the different conduction speeds in various cardiac tissues. Key requirements for understanding ladder diagrams include knowledge of effective refractory periods, relative conduction velocities between tissues, concealed conduction, autonomic influences, and wave identification. Various arrhythmias that can be depicted using ladder diagrams are presented, including ectopic beats, concealed conduction, atrial reentry, abnormalities of AV conduction, dual AV nodal pathways, AV nodal reentrant tachycardia, ventricular tachycardia with AV dissociation. Limitations in representing abnormal automaticity and triggered rhythms are also discussed. The document encourages practicing drawing ladder diagrams to represent ECG

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 32

    The Ladder Diagram

    Yoga Yuniadi
    Department of Cardiology and Vascular Medicine
    Faculty of Medicine, University of Indonesia
    National Cardiovascular Center Harapan Kita
    Conduction speed in various
    cardiac tissues
    • SA node - 0.05 m/s
    • Atrial - 1 m/s
    • AV node - 0.05 m/s
    • Bundle of His - 1 m/s
    • Purkinje system - 1-4
    m/s
    • Ventricular muscle - 1
    m/s

    SA node activity is not reflected in surface ECG


    Sinus Rhythm
    Requirements:
    Basic EP knowledge
    • Effective Refractory Periode
    • Tissue relative conduction velocity
    • Concealed Conduction
    • Autonomic Nerve Influences
    • Careful and detail waves identification
    Facing Different Tissues ERP
    Ectopic Beats
    Concealed Conduction
    Atrial Reentry
    AV Conduction
    AV Conduction Abnormality
    Dual AV Nodal Pathway
    AV Nodal Reentrant
    Tachycardia
    AV Reciprocating Tachycardia
    Ventricle Tachycardia :
    AV Dissociation

    A
    AVN
    V
    Summary

    • Ladder diagrams work best with reentry phenomenon


    • The ladder diagram represents well abnormalities of
    impulse conduction but is less explicit with abnormalities of
    impulse formation.
    Limitations
    • Abnormal automaticity :
    • after-depolarizations or
    • triggered rhythms
    • For example, a long QT interval with R-on-T
    degenerating into Torsades de Pointes
    Let do some practices …
    A case of Bradycardia:
    What is the mechanism?
    Examine the waves in detail!
    Use your basic EP knowledge
    These are Combine Mechanisms …
    Alternating QRS rate:
    What is the mechanism?
    1P2Q Phenomenon: Draw the
    correct ECG!
    Dual AV Nodal Pathways
    Draw your Ladder Diagram
    Just draw and silent…The Ladder
    diagram will tell your correct thought.
    Which one is faster: A or V?
    SVT with Abberancy
    The Induction

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