Interval

Average Range Events in the heart time time during interval (sec) (sec) Atrial depolarization 0.18 0.12 to 0.2 Atrial depolarization and conduction through AV node Ventricular depolarization and atrial re-polarization Ventricular depolarization Ventricular repolarization

P wave PR interval

QRS duration

0.08

To 0.10

QT interval 0.40

To 0.43

ST 0.32 interval(QT minus QRS)

1) HEART BLOCK: - Acute MI, stenosis, cardiomyopathy, digoxin AV NODE LEVEL

BELOW AV NODE - Block at bundle or the left and right branches

1st degree: delay vent conduction : PR > 0.22s

2nd degree : some P not conducted ( QRS missing)

3re degree : regular but independent : Bundle of His generate impulse : atria 60-100, vent 40-60 bpm

2- SINUS RHYTHM BRADY

TACHY

Extrinsic causes: hypothermia, hypothyroidism, and raised ICP, drugs (beta-blockers, digitalis, and antiarrhythmic drugs). Intrinsic causes: acute ischemia, infarction of SA node. ECG changes: Prolonged R-R interval.

acute causes: exercise, emotion, pain, fever, acute heart failure, chronic causes: pregnancy, anemia, hyperthyroidism, excess catecholamine. ECG: short R-R interval.

3- Ectopic beat (extra-systoles, premature beat): Premature: contraction of heart before the time normal Mostly, due to ectopic foci in the heart, ( abnormal impulses at odd time ) - If discharges once -> ectopic beat. -discharge repetitively at rate higher than that of SA node -> rapid, irregular tachycardia. Possible causes of ectopic foci are: Local area of ischemia Small calcified plaques drugs, nicotine, or caffeine ATRIAL ECTOPIC

VENT ECTOPIC

The P wave too soon The P-R interval is shortened ( ectopic origin : near the A-V node )

bizarrely shaped prolonged and high voltage QRS complex The P wave is usually buried in the QRS of the extra-systole

The interval between the premature and the next succeeding contraction is slightly prolonged, The T wave has an electrical potential polarity opposite to the QRS which is called (compensatory pause).

Tachy-arrhythmia: Cardiac arrhythmia : disturbance in electrical rhythm of the heart; : paroxysmal or continuous : cause sudden death, syncope, heart failure, palpitation, or no symptoms. There are two mechanisms for tachycardia: 1. Increase automaticity (increase slop angle): when the tachycardia is sustained by repeated spontaneous de-polarization of an ectopic focus or single cell. 2. Re-entry: when the tachycardia is initiated by an ectopic beat but sustained by a closed loop or re-entry circuit. Most common. Reason : -Long pathway around the circle. -Decreased velocity of conduction -Shortened refractory period of the muscle ATRIAL TACHY VENT TACHY

A. Atrial fibrillation: irregular QRS. no P waves but base line may show irregular fibrillation waves.

B. Atrial flutter: ECG: regular saw-tooth-like atrial flutters waves (F waves) between QRST complexes; with rate about 300 beat/min. the QRS conducted 150 if every other one is conducted.

A. Ventricular tachycardia: it is usually a serious condition because: considerable ischemic damage initiates the lethal condition of vent fibrillation Cardiac output is decreased. The ECG changes including: a series of ventricular premature beats occurring one after another without any normal beat interspersed so QRS morphology is regular, the rate is between (140-220/min).

C. Atrial tachy-cardia: increase automaticity, rare but is sometimes is manifestation of digitalis toxicity. Rate: 150250 bpm, Rhythm: Regular P Waves: Normal (upright and uniform) but differ in shape from sinus P waves

B. Ventricular fibrillation: look like a quivering "bag of worms"( undulating waves of varying frequency and amplitude) The fibrillating ventricles cannot pump blood effectively and circulation of the blood stops. Therefore, in the absence of emergency treatment - more than a few minutes is fatal - most common myocardial infarction death is ventricular fibrillation. - stopped and converted to normal sinus rhythm by mean of electrical shock.