DR.PRANAV,DM(Cardiology)
NIMS,Hyderabad-500082,India
NARROW QRS TACHYCARDIA
SVTs from a sinoatrial source:
Inappropriate sinus tachycardia (IST)
Sinoatrial nodal reentrant tachycardia (SNRT)
SVT...
In brief
Response to carotid sinus massage or adenosine –with
termination of arrhythmia with Pwave –AVNRT with atrial
pre...
ECG findings
Main Mechanisms and Typical Electrocardiographic Recordings of Supraventricular Tachycard
AVNRT
Presence of a narrow complex tachycardia with regular R-R
intervals and no visible p waves.
P waves are retrograde...
AV NODAL REENTRANT TACHYCARDIA
AVRT
Typical – RP interval < PR interval
RP interval > 80 milli sec
Atypical –RP interval > PR interval
Concealed bypa...
AV REENTRANT TACHYCARDIA
WPW syndrome
Two types
Orthodromic
Antidromic
Antidromic is wide complex tachycardia
In NSR detected by delta wave.
...
Orthodromic AVRT
 Short PR interval
 Normal QRS complex
 PSVT
Sinus Tachycardia
Focal Atrial Tachycardia
P wave morphology changes.
PR interval > 0.12 sec .
Second,third degree AV block can occur.
T...
Focal atrial tachycardia (LA focus)
Multifocal Atrial Tachycardia
At least three consequtive p waves with different
morphologies with a rate > 100 bpm to be ...
Multifocal Atrial Tachycardia
SANRTMicroreentrant tachycardia
Usually precipitated and terminated by premature atrial
complexes.
Atrial rate is usual...
Junctional tachycardias
Non paroxysmal – accelerated junctional rhythm
Rate < 100 bpm Usually junctional node 40-60 bpm
...
Thank you reading this.
Narrow QRS Tachycardia
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Narrow QRS Tachycardia

Tachycardias are broadly categorized based upon the width of the QRS complex on the electrocardiogram (ECG). A narrow QRS complex (<120 milliseconds) reflects rapid activation of the ventricles via the normal His-Purkinje system, which in turn suggests that the arrhythmia originates above or within the His bundle (ie, a supraventricular tachycardia). The site of origin may be in the sinus node, the atria, the atrioventricular (AV) node, the His bundle, or some combination of these sites. A widened QRS (≥120 milliseconds) occurs when ventricular activation is abnormally slow. The most common reason that a QRS is widened is because the arrhythmia originates below the His bundle in the bundle branches, Purkinje fibers, or ventricular myocardium (eg, ventricular tachycardia). Alternatively, a supraventricular arrhythmia can produce a widened QRS if there are either pre-existing or rate-related abnormalities within the His-Purkinje system (eg, supraventricular tachycardia with aberrancy), or if conduction occurs over an accessory pathway. Thus, wide QRS complex tachycardias may be either supraventricular or ventricular in origin.
Published on: Mar 3, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Narrow QRS Tachycardia

  • 1. DR.PRANAV,DM(Cardiology) NIMS,Hyderabad-500082,India NARROW QRS TACHYCARDIA
  • 2. SVTs from a sinoatrial source: Inappropriate sinus tachycardia (IST) Sinoatrial nodal reentrant tachycardia (SNRT) SVTs from an atrial source: Ectopic (unifocal) atrial tachycardia (EAT) Multifocal atrial tachycardia (MAT) Atrial fibrillation with a rapid ventricular response Atrial flutter with a rapid ventricular response Without rapid ventricular response, fibrillation and flutter are usually not classified as SVT SVTs from an atrioventricular source (junctional tachycardia): AVNRT or junctional reciprocating tachycardia (JRT) Permanent (or persistent) junctional reciprocating tachycardia (PJRT), a form of JRT which occurs predominantly in infants and children but can occasionally occur in adults AV reciprocating tachycardia (AVRT) - visible or concealed (including Wolff-Parkinson-White syndrome) Junctional ectopic tachycardia (JET)
  • 3. In brief Response to carotid sinus massage or adenosine –with termination of arrhythmia with Pwave –AVNRT with atrial premature beat . Tachycardia persists with AV block –AT,AFL,SANRT Pseudo r ‘ wave in V1 –AVNRT SHORT RP interval – AVNRT,AVRT Long RP interval – AT,SANRT,AVNRT atypical
  • 4. ECG findings
  • 5. Main Mechanisms and Typical Electrocardiographic Recordings of Supraventricular Tachycard
  • 6. AVNRT Presence of a narrow complex tachycardia with regular R-R intervals and no visible p waves. P waves are retrograde and are inverted in leads II,III,AVF. P waves are buried in the QRS complexes –simultaneous activation of atria and ventricles – most common presentation of AVNRT –66%. If not synchronous –pseudo s wave in inferior leads ,pseudo r’ wave in lead V1---30% cases . P wave may be farther away from QRS complex distorting the ST segment ---AVNRT ,mostly AVRT.
  • 7. AV NODAL REENTRANT TACHYCARDIA
  • 8. AVRT Typical – RP interval < PR interval RP interval > 80 milli sec Atypical –RP interval > PR interval Concealed bypass tract – only retrograde conduction Manifest bypass tract– both anterograde and retrograde. Electrical alternans –the amplitude of QRS complexes varies by 5 mm alternatively. Rate related BBB occuring and the rate of tachycardia is decreasing –then the bypass tract is on the same side of the block.
  • 9. AV REENTRANT TACHYCARDIA
  • 10. WPW syndrome Two types Orthodromic Antidromic Antidromic is wide complex tachycardia In NSR detected by delta wave. Can ppt into AF and VF on use of AV nodal blockers MEMBRANE ACTIVE ANTIARRHTYHMIC DRUGS are safe. CONCEALED WPW syndrome – no delta wave .less risk of AF
  • 11. Orthodromic AVRT
  • 12.  Short PR interval  Normal QRS complex  PSVT
  • 13. Sinus Tachycardia
  • 14. Focal Atrial Tachycardia P wave morphology changes. PR interval > 0.12 sec . Second,third degree AV block can occur. Tachycardia terminates with a qrs complex .. Right atrial origin– p wave inverted in V1. If biphasic in V1—initially positive then negative. Upright in lead AVL Opposite if of left atrial origin Superior origin –upright p waves in inferior leads Inferior origin –p waves are inverted in inferior leads.
  • 15. Focal atrial tachycardia (LA focus)
  • 16. Multifocal Atrial Tachycardia At least three consequtive p waves with different morphologies with a rate > 100 bpm to be present. Isoelectric baseline between p waves. Also called as choatic atrial tachycardia Mostly seen in COPD ,electrolyte abn,theophylline Rate usually does not exceed 130-140 bpm.
  • 17. Multifocal Atrial Tachycardia
  • 18. SANRTMicroreentrant tachycardia Usually precipitated and terminated by premature atrial complexes. Atrial rate is usually 120-150 bpm. IART - Large or small reentrant circuit. AV block can occur.
  • 19. Junctional tachycardias Non paroxysmal – accelerated junctional rhythm Rate < 100 bpm Usually junctional node 40-60 bpm Paroxysmal or focal junctional tachycardia is rare – automaticity. 110-250bpm. P waves may be before or after QRS complex Infrequent and nonsustained episodes –no treatment Acute termination of SVT and establish the mechanism of SVT in case of acute setting. Long term goal is abolishing the arryhthmia substrate. Precipitating factors – electrolyte imbalance,hypoxia,ischemia,hyperthyroidism to be sought out.
  • 20. Thank you reading this.

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