ECG OF THE WEEKDR.P.VIJAYARAGHAVAN’S UNIT

DR.C.R.RAJAKUMAR

65 YRS old male came OPD C/O shortness of breath, palpitationKnown DM,SHT on regular treatmentO/E Pts GC fairPulse - 94/min, irregularly irregularBP- 100/70 mmHgCVS - S1S2 Heard ,no murmursRS - NVBS , no added soundsP/A – Soft, no organomegalyCNS- NFND

;Rate- 100/minAxis lt axis -30 sinus beat interspersed with broad QRS complexesSINUS BEAT;

P-wave predominently negative component in V1

PR interval-0.16 secondsQRS duration 0.12 secondsST depression T –inversion in L1,AVL,V5-V6Tall R wave in V5-V6[>20mm]

BROAD QRS COMPLEXES BROAD ,BIZZARE COMPLEXES[0.16 SECS]Varying morphologyRBBB PatternConstant coupling interval for most of the

complexesNo compensatory pauseSecondary ST-T changes present

INFERENCE;LAE [lt atrial enlargement]LVH [Lt ventricular enlargement]VPC[ventricular pre mature complexes]Possible site of origin [lt ventricle] MultifocalInterpolated VPCTRIPLETS

VPC [ventricular pre mature complexes]

Characterized by the pre mature occurance of a QRS complex that is abnormal in shape and has a duration usually exceeding the dominent QRS complex generally >120 milliseconds

T wave is commonly large and opposite in direction to the major deflexion of the QRS

Fully compensatory pause usually follows a VPC

Interval between the P wave of the sinus impulse immediately before the vpc and the first sinus p wave after the vpc equal to twice of the sinus cycle length

VPC MAY OCCURBigeminy-every sinus beat is followed by a VPCTrigeminy-every 2 sinus beats are followed by a VPCQuatrigeminy-every 3 sinus beats followed by a VPC 2 successive vpcs- COUPLET or PAIR 3 successive vpcs- TRIPLETINTERPOLATED VPC-is an extra systole which is,

so to speak ,sandwiched between two conducted sinus beats

3-5 consecutive impulse - SALVOS3 or more successive vpc s at a rate of 120 or more

lasting 30 seconds or more - VT from 6 consecutive ectopic impulses to runs lasting

upto 30 seconds - NON SUSTAINED VT

VPC with identical contour and coupling –single focus initiated by reentry

VPC with identical contour but varying coupling- parasystolic ventricular focus or reentry when there is delay in the reentry pathway

VPC withVariable contour but fixed coupling- single focus but transmitted variably through ventricles

VPC with variable contour and coupling- more then one focus

CLINICAL FEAUTERS;Palpitation , chest discomfort, neck pain,

hypotension, heart failurePrevalance of the VPC INCRESED BYAge , male sex, hypokalemia, infection,

ischemic or inflamed myocardium, Hypoxia,anasthesia,surgery

MANAGEMENTAbsence of heart disease – reassurance

and avoidance of potentially aggravating factors [coffee,tobcco,environmental stress or stimulants]

-Mild anxiolytic drugs,or beta blockersVPC with slow rate-atropine,isoproterenol,or

pacingVpc with fast rate- slowing heart rateMay be treated with

IV lidocaine , procainamide, propronolal,iv magnesium

Thank you