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DO YOU KNOW?-3

DO YOU KNOW?-3
CREATININE CHEMISTRY

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Monday 16 September 2019

SUMMARY-ECG EDUCATION-I-EXERCISES-CONTINUED-Palpitations due to diseases-3

SAMPLE ECG EXERCISES-3

1.Ventricular Tachycardia(VT-VPalpitations-1)
Fig-1
See Fig-1 and check the records by lead II which is the master lead. Check the QRS complex. It is widened more than 120 million secs (>3ss). There are 2 LS in between a consecutive R-R. Hence the heartbeats are 300/2=150 bpm. Hence it is ventricular tachycardia. The ECG records by aVL,aVF, V4, V5, and V6 all show similar trends. If VT is left untreated it leads to more serious V.Fibrillation followed by cardiac arrest.
VT is of two types. Monomorphous and Polymorphous (Torsade de Points, TDP).Fig-1 shows a monomorphous VT in which the rhythms are normal.No P-waves. That means the conductions are not from the atria, and AV nodes.
Fig-2
The Fig-2 shows a sample ECG report taken during polymorphous VT or Torsades de Points.
See the Lead-II stripe which shows the poly phases of the rhythm. The rhythm is irregular. It randomly swinging around the baseline as elevations and depressions. Check the heartbeats. It is undoubtedly above 300 bpm as we cannot count squires between any two consecutive R-R waves. Leads V1 to V6 shows swirling rhythms.No P-waves.ST segments are randomly seen elevated. Hence this is polymorphous and Torsades de Points.
The stripe of lead II shows, in the beginning, weak ventricular rhythms with long QT intervals followed by the swinging of waves around the baseline (Torsades de Points).
Causes For VT:-
1. The condition develops due to low potassium, low calcium, or low magnesium.
2.Antiarrhythmic drugs such as quinidine, procainamide(I-a), sotalol, and amiodarone (III), etc.
3.Anti depressives such as amitriptyline, imipramine
4.Antipsychotics such as haloperidol.
3.Antipsychotics such as haloperidol, droperidol, chlorpromazine
If you are taking the mentioned medicines stop to take and consult your doctor.
Treatments:-(Subjected to doctors consulting)
Magnesium sulfate, Calcium salts, or Potassium salts.
4.Beta-blockers
Torsades de Points if left untreated may lead to cardiac arrest.

VENTRICULAR FIBRILLATION(V.Fib):-

V. Fib is another kind of palpitations and is the most serious one.
Fig-3
A sample ECG taken in a patient suffered by V.Fibrillation is shown in Fig-3.
As a general concept lead-II is the hero lead whose records represent 75% of the heart's condition.
Also records by the chest lead V1 which looks the right ventricle, and  V5 and V6 which looks the left ventricles are also important. Generally all the 6 chest leads are very important because unlike the limb leads they watch ventricles very closely.
In Fig-3 in lead II, V1 and V6 are all showing the swinging waves of QRS complex.No P-waves means the ventricles are fibrillating independently. The heart rate is >300 bpm. Beats are very irregular. The conductions are not in a uniform axis. These are known as ectopic conductions.
Finally if ventricular tachycardias are not early diagnosed for correction it may result in serious consequences such as life-threatening V.Fibrillations and death.


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