Awesome Advanced Arrhythmias!

Presented By: Barbara Furry, RN-BC, MS, CCRN, FAHA

Director The Center of Excellence in EducationDirector of HERO

Follow me on Twitter!CEE Med Updates@BarbaraFurryRNLike me on Facebook!

Elderly women with no history of heart disease.

1 Taller left peak ("rabbit-ear") in V1 5 rS or QS in V62 Delayed nadir (>0.07 s) in V1 6 S deeper than 15 mm in V63 Axis in "no-man's-land" 7 Independent P waves or fusion beats4 Concordance, positive or negative 8 No RS complex in any V lead

An 89-year old woman with complaining of feeling weak and dizzy for the past week.

1 Sinus tachycardia 5 Atrial tachycardia with ventricular aberration2 AV nodal reentrant tachycardia 6 Ventricular tachycardia3 Orthodromic tachycardia 7 Left bundle-branch block4 Atrial flutter with 2:1 AV conduction 8 Junctional tachycardia with retrograde conduction

A 62 year old man with a history of hypertrophic cardiomyopathy, ventricular tachycardia and an ICD.

1 Taller left peak (“rabbit-ear”) in V1 5 rS or QS in V62 Delayed nadir (>0.07 s) in V1 6 S deeper than 15 mm in V63 Axis in “no man’s land” 7 Independent P waves or fusion beats4 Concordance, positive or negative 8 No RS complex in any V lead

A 77-year old woman who has been having bouts of palpitations, sometimes with lightheadedness for many years.

1 AV nodal reentrant tachycardia (AVNRT) 5 Atrial flutter with 2:1 AV conduction2 Orthodromic tachycardia (OT) 6 Atrial flutter with 1:1 AV conduction3 AVNRT with ventricular aberration 7 Ectopic atrial tachycardia4 OT with ventricular aberration 8 Ectopic junctional tachycardia

1 Taller left peak (“rabbit-ear”) in V1 5 rS or QS in V62 Delayed nadir (>0.07 s) in V1 6 S deeper than 15 mm in V63 Axis in “no-man’s land” 7 Independent P waves or fusion beats4 Concordance, positive or negative 8 No RS complex in any V lead

A 65 year old woman who complained of SOB and an irregular heart beat.

A 62-year old woman who noticed bouts of "heart-thumping" during which she felt lethargic.

1 Taller left peak (“rabbit-ear”) in V1 5 rS or QS in V62 Delayed nadir (>0.07 s) in V1 6 S deeper than 15 mm in V63 Axis in “no-man’s land” 7 Independent P waves or fusion beats4 Concordance, positive or negative 8 No RS complex in any V lead

A 64-year old woman aware of her rapid heart beat with throbbing in her neck.

1 AV nodal reentrant tachycardia (AVNRT) 5 Atrial flutter with 2:1 AV conduction2 Orthodromic tachycardia (OT) 6 Ectopic junctional tachycardia3 Atrial tachycardia 7 Atrial tachycardia with ventricular aberration4 Atrial tachycardia with 2:1 AV conduction 8 Sinus tachycardia with 2:1 AV block

Make a note of yourchoices and click onthe green arrow below

A 75-year old man who recently complained of an uncomfortably rapid heart beat and some irregularity.

1 Taller left peak (“rabbit-ear”) in V1 5 rS or QS in V62 Delayed nadir (>0.07 s) in V1 6 S deeper than 15 mm in V63 Axis in “no-man’s land” 7 Independent P waves or fusion beats4 Concordance, positive or negative 8 No RS complex in any V lead

A 38-year old man was aware of cardiac irregularity but had no other symptoms referable to his heart.

1 Taller left peak (“rabbit-ear”) in V1 5 rS or QS in V62 Delayed nadir (>0.07 s) in V1 6 S deeper than 15 mm in V63 Axis in “no-man’s land” 7 Independent P waves or fusion beats4 Concordance, positive or negative 8 No RS complex in any V lead

This 50 year old patient is asymptomatic

1 Acute cor pulmonale 5 Left anterior hemiblock2 Acute pericarditis 6 Myxedema3 Chronic cor pulmonale 7 Pericardial effusion4 Hypertrophic cardiomyopathy 8 WPW syndrome

Brugada Syndrome Type 1

Brugada Syndrome Type 2

Brugada Syndrome Type 3

To ReviewEKG Clues That Favor VT

1. Taller left peak (“rabbit-ear”) in V12. Delayed nadir (>0.07 s) in V13. Axis in “no-man’s land” 4. Concordance, positive or negative5. rS or QS in V66. S deeper than 15 mm in V67. Independent P waves or fusion beats8. No RS complex in any V lead