|
Medical Center Tower I 7950 Floyd Curl Drive Suite 803 San Antonio, TX 78229 tel: 210-615-9500 fax: 210-615-9600 email: office at cecst.com |
Specializing in the compassionate care of people who suffer from abnormalities of the electrical system of the heart |
Current Insurance Plans:
We accept most major commercial insurance plans. Please call for details. Medicare: We have opted out of Medicare, and are happy to care for Medicare beneficiaries on an affordable cash basis. Note: Federal law prohibits signing the Federally-mandated opt-out contract with a Medicare beneficiary who is in an emergency situation. No insurance? No problem! Consider our affordable Fee for service (direct pay). Home of the Original Personalized Medical Office SystemTM released April 5, 2013 |
| Table of Contents |
| Accelerated ventricular rhythm | |
| This is diagnosed when only ventricular escape complexes are present, and they occur at 60 to 100 beats per minute. This rhythm is usually seen in the setting of acute myocardial infarction. If the patient is in sinus rhythm, the rate of this rhythm tends to be about the same as the rate of the sinus rhythm. In this case, the two rhythms will speed up and slow down so that they alternately capture the ventricle, with characteristic periods of fusion QRS complexes during the changes in rate. This rhythm is usually benign. Because it occurs in the setting of acute myocardial infarction, patients who exhibit it are already in an intensive care unit where any malignant sequellae can be treated readily. | |
| Atrial multiform couplet | |
| This is a pair of atrial premature complexes, with differing P wave morphologies, in a row. This is unusual in normal subjects, but is itself benign. The appearance of multiform atrial couplets, especially in patients with pulmonary disease, should raise the index of suspicion for susceptibility to multifocal atrial tachycardia, atrial fibrillation, and atrial flutter. | |
| Atrial couplet | |
| This is a pair of atrial premature complexes in a row. While it is less common in normal subjects than are atrial premature complexes, it can still be benign. The appearance of atrial couplets should also raise the index of suspicion for susceptibility to atrial fibrillation, atrial flutter, and supraventricular tachycardia. | |
| Atrial premature complex | |
| This is a P wave that occurs earlier than would be expected from the sinus rate, and that usually has an abnormal morphology. It can fail to conduct through the atrioventricular node, in which case it will not result in a QRS complex. As Dr. Marriott observes, "the commonest causes of pauses are non-conducted atrial premature complexes." When it does conduct through the atrioventricular node, it can be conducted aberrantly if it traverses the bundle branches of the His-Purkinje system while one or both is in its relatively refractory period. Aberrantly conducted QRS complexes are wider than normal, and have the morphology of bundle branch block pattern. Atrial premature complexes are a normal finding in adults of all ages. The frequency can be increased during stress, with ingestion of caffeine, and with sympathomimetic drugs such as some over-the-counter cold remedies. | |
| Asystole | |
| This is diagnosed when no ventricular escape complexes are present. This is an agonal rhythm that is not consistent with life. To confirm the diagnosis, you should check another ECG lead, because fine (low amplitude) ventricular fibrillation can appear as a flatline in one lead, but should be treated with immediate countershock. If you see these rhythms, you should initiate Cardiopulmonary Resuscitation immediately. | |
| Atrioventricular dissociation | |
| This term refers to a group of three categories of rhythms in which the atrial and ventricular rhythms are unrelated to each other. The three categories are: | |
| Atrial escape complex | |
| This is a P wave that occurs later than would be expected from the sinus rate. Like all escape complexes, it can occur only when the normal cardiac pacemaker does not function, as is sinus arrest. | |
| Atrial tachycardia | |
| This is a supraventricular rhythm resulting from either an atrial automatic focus or a reentrant circuit that lies entirely within the atrium. It is characterized by a rate more than 100 beats per minute, and a P wave morphology that is usually different from that of the sinus P wave. It can be intermittent or incessant (present more than 50% of the time). When it is incessant, it can cause symptomatic dilated cardiomyopathy that is reversible with control of the tachycardia. This is an abnormal rhythm that can result from digitalis toxicity, particularly when it occurs in combination with Atrioventricular nodal block, second degree, Mobitz type I (Wenckebach). For emergency treatment of this rhythm, when the patient has hypotension, angina, or acute congestive heart failure, synchronized cardioversion with appropriate anesthesia is indicated. For short-term pharmacologic control of this rhythm, drugs that decrease AV nodal conduction (beta blockers, calcium blockers, and diltiazem) may be considered. For long-term treatment of this rhythm, consultation with a Cardiac Electrophysiologist is recommended. | |
| Atrial flutter | |
| This is a supraventricular rhythm resulting from a reentrant circuit that lies within the right atrium. It is characterized by an atrial rate of 250 to 350 beats per minute, and a ventricular response that is usually about 75, 150, or 300 beats per minute. Flutter waves are best found in ECG leads II, III, aVF, and V1. Sometimes they are located at the onset or offset of the QRS complex, and are best found by comparison with the QRS morphology in a 12-lead ECG recording obtained during sinus rhythm. Even if flutter waves are not found, this rhythm should be suspected when the ventricular rate ranges from 140 to 160 beats per minute and there is no clear evidence of atrial activity. It can occur alone, but is usually associated with hypertensive cardiomyopathy, COPD, or congestive cardiomyopathy. The new onset of either rhythm is seen in about 5% of cases of acute myocardial infarction. The clinician may also want to check for congestive heart failure, since worsening CHF can present with these rhythms. For emergency treatment of this rhythm, when the patient has hypotension, angina, or acute congestive heart failure, synchronized cardioversion with appropriate anesthesia is indicated. For short-term pharmacologic control of this rhythm, drugs that decrease AV nodal conduction (beta blockers, calcium blockers, and digoxin) may be considered. For long-term treatment of this rhythm, consultation with a Cardiologist is recommended. | |
| For information, email webmaster@cecst.com | |
| We're Listed On The San Antonio Business List | |