Essential arrhythmia for MBBS students required for their OSPE examination

1. ARRHYTHMIA
MD MASHIUL ALAM
MBBS MD
Assistant Professor of Cardiology, JIMCH

2. NORMAL WAVES

4. Waves and intervals

5. How to read ECG
• Check Name, age, calibration
• Rate
• Rhythm
• Axis
• Waves

6. Normal ECG findings
• Tachycardia and T wave inversion in children
• T wave inversion in V1 to V2 and inferior leads in female
• Early repolarization (ST elevation) in V2 to V4
• RBBB
• High voltage and Tall T wave in young person
• Low voltage in obese and COPD patient

9. Sinus rhythm and normal sinus rhythm

10. Arrhythmia
Tachyarrhythmia
AF, VT, VF, SVT,
JT, AT
Bradyarrhythmia
AV block, SSS

11. Tachyarrhythmia

12. Atrial Fibrillation

14. Cause: RITHI
Complication: Thromboembolism (Stroke)
Heart Failure
Shock
Treatment: Rate control
Rhythm Control
Prevention of thromboembolism- CHA2DS2VASx, HASBLED
Treatment of the cause

15. Ventricular Tachycardia

17. Cause: Ischemic Heart disease
Cardiomyopathy
Electrolyte imbalance
Complication: Heart Failure
Death
Treatment: DC shock, Amiodarone, Lignocain, IV Magnesium, Anti-
tachycardia pacing
Betablocker, Antiarrythmic drugs, ICD, Surgery

18. Ventricular fibrillation

20. Cause: same as VT
Complication: Same as VF
Treatment: Asynchronized DC shock, CPR
check underlying cause, ICD, Radiofrequency Ablation, Anti Arrhythmic
drugs

21. Supraventricular tachycardia

23. Cause: Re-entrant pathway Micro---AVNRT
Macro / Accessory pathway/ WPW syndrome/ AVRT

26. Complication: HF, Cardiac arrest, Shock
Treatment: Vagal maneuver (Carotid sinus message, Valsalva etc)
IV adenosine
IV Verapamil
Digoxin, BB, Flecainide
DC shock
Catheter ablation, BB, Verapamil

27. Bradyarrhythmia

29. AV block
1st degree 2nd degree
3rd degree or
complete

30. 1st degree
Prolonged PR interval

31. 2nd degree
• Mobitz Type I and Type II 2nd degree AV block

34. Complete heart block

36. SSS
• Bradycardia
• Sinus arrest / block
• Tachycardia – bradycardia syndrome
• Paroxysmal AF/ AT
• Associated with AV block

43. THANK YOU