PROF .S. TITO’S UNITDR.Pandichelvan

ECG of the WEEK

Professor DR.TITO’ S unit

Ecg of the week

10:05

ECG shows Sinus rhythm Heart rate: 80/min PR interval:140 msec QRS duration: 80 msec QT interval: 398 msec QTc interval:453 msec ST elevation in II,III, avf, V4R, V5R, V7, V8, V9. ST depression in I, avL v4,v5

Post streptokinase Sinus rhythm 11.30 pm Heart rate- around 100/min P wave absent Qrs duration:128 msec Qt interval: 425 msec Qrs axis: around -30 degree

Accelerated Idio-ventricular rhythm

Increased ventricular automaticity Benign rhythm. Brief self limiting arrhythmia. Seen in absence of any structural heart disease

Enhanced automaticty in bundle branch or fasciculation of ventricular purkinjee system.

Abnormal QRS morphology with heart rate 50 to 110 per minute

No preceding p waves. During or after ante-grade ventricular activation, retro-

gradely conducted atrial activation seen. Inverted p waves buried in large QRS complex or t wave.

rate of the cells which are located at distal end of the pace making conducting system is low

Differential diagnosis

Dilated cardiomyopathy Acute MI Ischemic cardiomyopathy Rheumatic heart disease Acute coronary syndrome Digitalis toxicity Cocaine intoxication Post cardiac surgery

Sustained AIVR seen in acute MI and post operative. Occurs in 25% of STEMI Occurs transiently during fibrinolytic therapy. Incidence is

8-46% Considered non specific marker of reperfusion after

thrombolytic therapy. The incidence of AIVR not affected by location or infarct size Presence of AVIR after mi not associated with increased

mortality.

Thank youReference THE HEART –HURST HARRISON MARRIOT THE ECG