Electrocardiogram (ECG)

Elektrokardiogramm (EKG)
⼼電図（しんでんず）

Cardiology
Yoshiyasu Aizawa MD
 Part 3
3限⽬
• Arrhythmia
不整脈（ふせいみゃく）
• Mechanism
• Management
DEFINITION

• An arrhythmia is any rhythm that is not

normal sinus rhythm with normal
atrioventricular (AV) conduction.
Normal sinus rhythm
 Cardiac Arrhythmias
• An abnormality of the cardiac rhythm is called a
cardiac arrhythmia.
• Arrhythmias may cause sudden death, syncope,
heart failure, dizziness, palpitations or no
symptoms at all.
• There are two main types of arrhythmia:
• bradycardia: the heart rate is slow (< 60 b.p.m)
• tachycardia: the heart rate is fast (> 100 b.p.m)
Arrhythmia
management
Reasons to evaluate and treat
arrhythmias
• Eliminate symptoms and improve abnormal
hemodynamics which can result from arrhythmias.
• Prevent imminent death and hemodynamic
compromise due to a life-threatening arrhythmia.
• Reduce possible risks other than the direct effects
of the arrhythmia (eg, reduce stroke in patients
with atrial fibrillation).
 ARRHYTHMIAS
• Atrial premature beats (PAC)
• Ventricular premature beats (PVC)
• Bradycardias
• Sick sinus syndrome (SSS)
• Atrio-ventricular block (AVB)
• Atrial fibrillation (AF) and atrial flutter (AFL)
• Supraventricular tachycardia (SVT)
• Ventricular tachycardia (VT)
• Ventricular fibrillation (VF)
APPROACH TO THE PATIENT
• Complete history taking (aimed toward symptoms
and timing of the arrhythmia and potential
underlying diseases)
• Physical examination
• Twelve-lead ECG (if possible, during the arrhythmia
and without it)
• The ECG alone during the arrhythmia may
determine the type of arrhythmia and whether a
particular symptom is related to the arrhythmia.
Symptoms
• Palpitations
• Chest discomfort
• Neck discomfort
• Dyspnea
• Weakness
• anxietyDizziness
• Lightheadedness
• Syncope
• Sudden death
Palpitation
• Palpitations are a sensory symptom.
• They are defined as an unpleasant awareness of
the forceful, rapid, or irregular beating of the heart.
• Patients may at times describe the sensation as a
rapid fluttering in the chest, flip-flopping in the
chest, or a pounding sensation in the chest or neck,
and these descriptions may help elucidate the
cause of the palpitations.
 Palpitation
•The cause was
• cardiac in 43 %
• psychiatric in 31 %
• miscellaneous in 10 %
• eg, medication-induced, thyrotoxicosis,
caffeine, cocaine, anemia, amphetamine,
mastocytosis)
 Symptom?
Sick sinus syndrome (Bradycardia-tachycardia syndrome)

Pseudo VT = WPW syndrome + atrial fibrillation

Extrasystoles
PAC run

PSVT
Atrial fibrillation
Ventricular tachycardia

Ventricular fibrillation

Asystole
Diagnosis
• Twelve leads ECG
• Traditional Holter
• Event recorder
• Mobile continuous outpatient cardiac telemetry
• Implantable loop recorder
Holter ECG
Event monitor
ECG event recorder
Implantable loop recorder
Apple watch