ECG – ALL YOU WANTED TO KNOW, BUT YOU WERE AFRAID TO ASK ! L.Křivan Interní kardiologická klinika FN Brno D:\FN%20Brno_modra_obdelnik.jpg Nodes responsible for cardiac rhythm Electrical cardiac activity can be recorded http://2.bp.blogspot.com/-lfJHbpsFP34/UQ4w0ytLlJI/AAAAAAAAAZo/v3rJ7DBDxPY/s640/Willem_Einthoven_ECG .jpg http://3.bp.blogspot.com/-Rhv0Y6XMqaI/T0ASpZHC3FI/AAAAAAAAABg/COSReliC3Rg/s1600/Schr%C3%A1nka01.png ECG (Willem Einthoven 1893) leadIIevents ECG – limb leads limbleads ecg2 ECG- precordial leads A013c%20ECG%20chest%20leads ECG – intervals (PQ < 0.2s, QRS < 0.1s, QTc < 0.44s) SouvisejÃcà obrázek Electrical axis of the heart Výsledek obrázku pro ECG axis Výsledek obrázku pro electrical axis of the heart ¨AVB ( I.st, II.nd, III.rd) ¨RBBB ¨LBBB ¨ Conduction disorders AVB I.st degree (PQ > 0,2s) PQ = 0.28s AVB II.nd degree (2/1) AVB II.nd degree (Mobitz 3/1) C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\AVB Mobitz 3-1.jpg AVB III.rd degree (no secondary, tertiary autom. centre) AVB III.rd degree (escape rhythm from AV junction) C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\AVB III junkce .jpg AVB III.rd degree (escape ventricular rhythm) C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\AVB III.jpg Bundle branch block Výsledek obrázku pro electrical axis of the heart Výsledek obrázku pro Heart conduction system SouvisejÃcà obrázek Right bundle branch block - RBBB Positive R Negative S Left bundle branch block - LBBB Wide negative S Wide positive R ¨Premature atrial contraction ¨Atrial fibrillation ¨Atrial flutter ¨AVNRT ¨AVRT (WPW) ¨ Supraventricular arrhythmias Premature atrial contraction (PAC) nrcardio Atrial fibrillation (AF) Atrial fibrillation + slow ventricular response C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\FISI s POK.jpg Atrial flutter C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\Typický FLUSI.jpg SouvisejÃcà obrázek SouvisejÃcà obrázek saw tooth pattern II, III, aVF AVNRT (Atrio Ventricular Nodal Reentry Tachycardia) RA LA LA LV RV SN AVN AVNRT (Atrio Ventricular Nodal Reentry Tachycardia) C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\AVNRT.jpg Accessory pathway LA Preexcitation – delta wave Výsledek obrázku pro delta wave Výsledek obrázku pro cardiac accessory pathway AVRT (Atrio Ventricular Reentry Tachycardia) ORTHO SouvisejÃcà obrázek AVRT (Atrio Ventricular Reentry Tachycardia) ANTI LA SouvisejÃcà obrázek Delta wave prior to treadmill test Orthodromic tachycardia (AVRT) with RBBB Orthodromic tachycardia (AVRT) with RBBB Atrial fibrillation + accessory pathway C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\FISI + WPW.jpg ¨Premature ventricular contraction (PVC) ¨Ventricular tachycardia ¨Ventricular fibrillation ¨ Ventricular arrhythmias PVC (Premature ventricular contractions - bigeminy) C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\BGM KES.jpg SouvisejÃcà obrázek VT LBBB – like VT RBBB – like Differential diagnosis of wide complex tachycardia 1 2 3 4 Wide complex tachycardia (WCT) WCT AVRT antidromic (WPW) SVT + frequency BBB SVT + chronic BBB Ventricular tachycardia AF with frequency BBB AF + accessory pathway VT RBBB – like, VA dissociation and fusion beat Identic QRS orientation in precordial leads RS duration > 100ms 100ms Absence of typical BBB pattern File:Right bundle branch block ECG characteristics.png File:Left bundle branch block ECG characteristics.png Ventricular fibrillation (VF terminated by ICD shock) C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\FIKO s ICD výbojem.jpg ¨Subendocardial – angina pectoris ¨STE Myocardial Infarction ¨Post MI changes ¨ Ischaemia ST depressions during treadmill test STEMI in left main artery occlusion C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\STEMI AE kmen ACS.jpg C:\Users\24243\Desktop\STEMI.png STEMI in left anterior descending artery occlusion C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\STEMI AE.jpg STEMI inferior wall C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\STEMI DS.jpg STEMI anterior wall (AE) C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\STEMI PS.jpg Post STEMI with formating aneurysm of ant. wall C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\St.p. IM aneurysma.jpg Terminal rhythm - Electro mechanic dissociation http://www.emdocs.net/wp-content/uploads/2014/09/ekg9.png http://1.bp.blogspot.com/-9NH3XCPOH3A/U5RaWPf68DI/AAAAAAAAZDQ/2k2vdWIPqfg/s1600/Agonal+rhythm.jpg ¨LQT syndrome ¨Brugada syndrome ¨Catecholaminergic polymorphic VT ¨ Ionic channel disorders LQT syndrome C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\LQT.jpg LQT syndrome + TWA C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\LQT + TWA.jpg VF TdP type (Torsades de pointes) C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\TdP.jpg Brugada syndrome Autosomal hereditary disorder of genes responsible for Na and Ca channels. Brugada P., Am Coll Cardiol 1992 CPVT – Catecholaminergic polymorphic VT 1. Mutation of cardiac proteins of Ca exchange. Malignant arrhythmias during excersice 1. Bytešník., et al. Cor Vasa 2011;53(Suppl 1) ¨Anti – bradycardia pacing ¨Anti – tachycardia pacing ¨Resynchronization pacing Pacing Sinus bradycardia C:\Users\User\Desktop\EKG seminář\2019_03_30\2019_03_30\sinusová bradykardie.jpg External pacing TCP in dig toxicity http://ems12lead.com/wp-content/uploads/sites/42/2010/12/2010_12_01_TCP_01wm.jpg Temporary transvenous pacing http://img.medscape.com/pi/emed/ckb/clinical_procedures/79926-79933-80659-1765770.jpg http://img.medscape.com/pi/emed/ckb/clinical_procedures/79926-79933-80659-1765771.jpg http://img.medscape.com/pi/emed/ckb/clinical_procedures/79926-79933-80659-1765769.jpg http://europace.oxfordjournals.org/content/europace/8/5/385/F2.large.jpg?width=800&height=600 Transvenous pacing from 1958 File:Arne Larsson.jpg Arne Larsson 1915 - 2001 File:First pacemaker (Siemens-Elema 1958).jpg Elmquist + Senning 8.10.1958 Single and dual chambre PM Description VVI Schrittmacher THWZ.jpg File:Fluoroscopy pacemaker leads right atrium ventricle.png Antitachycardia pacing in ICD ¨ Defík Výsledek obrázku pro antitachycardia pacing ecg Resynchronization therapy Cardiac Resynchronization Therapy (CRT) icd cardiac