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1 1st degree AV blockThe normal PR interval is 0.12 - 0.20 sec, or 120 -to- 200 ms. 1st degree AV block is defined by PR intervals greater than 200 ms. This may be caused by drugs, such as digoxin; excessive vagal tone; ischemia; or intrinsic disease in the AV junction or bundle branch system.Knowledge Weavers ECG
2 three fates of PAC's: 1. normal conduction; 2. aberrant conduction; 3. non-conductionthree fates of PAC's: 1. normal conduction; 2. aberrant conduction; 3. non-conductionKnowledge Weavers ECG
3 2nd degree AV block with junctional escapes and capturesSecond degree AV block is present; conducted beats are identified by those QRS's that terminate shorter cycles than the junctional escape cycle; i.e., the 3rd and probably the 4th QRS's are captures; the other QRS's are junctional escapes.Knowledge Weavers ECG
4 2nd degree AV block, mobitz type II, with LBBBThe wide QRS complexes in lead V1 indicates LBBB. 2nd degree AV block, Mobitz II is suggested by the two fixed PR intervals prior to the nonconducted P wave. The location of the block is most likely in the right bundle, because Mobitz II is usually a sign of bilateral bundle branch disease.Knowledge Weavers ECG
5 2nd degree AV block, type IThe 3 rules of classic AV Wenckebach are: 1. decreasing RR intervals until pause; 2. the pause is less than preceding 2 RR intervals; and 3. the RR interval after the pause is greater than the RR interval just prior to pause. Unfortunately, there are many examples of atypical forms of Wenckebach wh...Wenckebach AV BlockKnowledge Weavers ECG
6 2nd degree AV block, type I (Wenckebach)2nd degree AV block, type I (Wenckebach)Knowledge Weavers ECG
7 2nd degree AV block, type I with escapes and capturesOften in the setting of 2nd degree AV block the pauses caused by nonconducted P waves are long enough to enable escape pacemakers from the junction or ventricles to take over. This example illustrates junctional escapes, labled E and captures, labled C. Note that the PR intervals for the captures ...Knowledge Weavers ECG
8 2nd degree AV block, type I, with accelerated junctional escapes and a ladder diagramThe ladder diagram illustrates a Wenckebach type AV block by the increasing PR intervals before the blocked P wave. After the blocked P wave, however, a rev-ed up junctional pacemaker terminates the pause. Note that the junctional beats have a slightly different QRS morphology from the sinus beats...Knowledge Weavers ECG
9 2nd degree AV block, type I, with junctional escapesJunctional escapes are passive, protective events whenever the heart rate slows below that of the escape mechanism. In this example of 2nd degree AV block, type I, the escapes occur following the non-conducted P waves. Arrows indicate the position of the P waves. Note that the escape beats have a...Knowledge Weavers ECG
10 3rd degree AV block rx'ed with a ventricular pacemakerIn A the ECG shows complete or 3rd degree AV block with a left ventricular escape rhythm, as evidenced by the upright QRS morphology. In B the artificial right ventricular pacemaker rhythm is shown.Knowledge Weavers ECG
11 60 cycle artifact - marquette60 cycle artifact - marquetteKnowledge Weavers ECG
12 A PAC initiates paroxysmal atrial fibrillationThe arrow indicates slight alteration of the ST-T wave by a PAC. The PAC, in turn, falls during the vulnerable period of atrial repolarization and initiates atrial fibrillation. Similar but more catastrophic events happen in the ventricles when PVC's occur during the vulnerable period, i.e. R-on-T...Knowledge Weavers ECG
13 A nonconducted PAC causes an unexpected pauseUnexpected pauses in rhythm have several causes, the most frequent being a nonconducted PAC. In this example the nonconducted PAC is seen in the ST segment of the pause. Note the change in the ST-T compared to the other ST-T waves.Knowledge Weavers ECG
14 A very subtle 1st degree AV blockWhere are the P waves??? They are hiding in the T waves as indicated by the arrows. How do we know? The PVC unmasked the sinus P wave, and now it is seen in the pause following the PVC. The PR interval is, therefore, about 500 ms.Knowledge Weavers ECG
15 A very subtle atrial tachycardia with 2:1 blockAlthough at first glance this looks like normal sinus rhythm at 95 bpm. On closer look, there are 2 P waves for every QRS; the atrial rate is 190 bpm. Note the hidden P in the T waves. This rhythm is likely due to digitalis intoxication, as are the GI symptoms.Knowledge Weavers ECG
16 AV dissociation by defaultIf the sinus node slows too much a junctional escape pacemaker may take over as indicated by arrows. AV dissociation is incomplete, since the sinus node speeds up and recaptures the entricles.Knowledge Weavers ECG
17 AV dissociation by defaultThe nonconducted PAC's set up a long pause which is terminated by ventricular escapes; note the wider QRS morphology of the escape beats indicating their ventricular origin. Incomplete AV dissociation occurs during the escape beats, since the atria are still under the control of the sinus node.Knowledge Weavers ECG
18 AV dissociation by usurpationNormal sinus rhythm is interrupted by an accelerated ventricular rhythm whose rate is slightly faster than the sinus rhythm. Fusion QRS complexes occur whenever the sinus impulse enters the ventricles at the same time the ectopic ventricular focus initiates its depolarization.Knowledge Weavers ECG
19 AV sequential pacemaker - marquette(Summary)Knowledge Weavers ECG
20 Accelerated IVR with AV dissociation - marquetteAccelerated IVR with AV dissociation - marquetteKnowledge Weavers ECG
21 Accelerated junctional rhythmAccelerated junctional rhythmKnowledge Weavers ECG
22 Accelerated junctional rhythm - marquetteAccelerated junctional rhythm - marquetteKnowledge Weavers ECG
23 Accelerated ventricular rhythm with retrograde atrial capture and echo beatsRetrograde atrial captures from an accelerated ventricular focus are occurring with increasing R-P intervals, When the longer R-P occurs, the impulse traversing the AV junction finds a route back to the ventricles, and the result is a ventricular echo.Knowledge Weavers ECG
24 Acute anterior MIAcute anterior MIKnowledge Weavers ECG
25 Acute infero-postero-lateral MIHyperacute ST segment elevation is seen in leads II, III, aVF (inferior location) and in leads V4-6 (apical lateral wall location). Hyperacute ST depression is seen in leads V1-2 (an expression of posterior wall injury). in addition there are reciprocal ST segment depression changes in leads I an...Knowledge Weavers ECG
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