Download Short R deep S in V5, V6 pathognomonic of VT

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Transcript 
Arrhythmias/Pacemakers trouble
shooting
• Magdi Sami, MD, FRCP(C), FACC
• Professor of Medicine, MCGILL Univ.
• Senior Cardiologist, MUHC
Disclosures
• No conflicts to report for this talk
Learning objectives
• Complex ECG’s arrhythmia analysis
• Basic troubleshooting of pacemaker
malfunctions.
PVC ou PAC & abberance?
What is the heart rate?What is the rhythm?
The Alan E. Lindsay ECG Learning Center ; http://medstat.med.utah.edu/kw/ecg/
33 x 6 = 198 bpm
What is the rate? The rhythm?
The Alan E. Lindsay ECG Learning Center ; http://medstat.med.utah.edu/kw/ecg/
Short R deep S in V5, V6 pathognomonic of VT
52 Y old hypertensive presented with palpitations after jogging
This is a recording from an 80 year old man. He was taking
Hytrin, Metoprolol, Adalat, Dyazide and ASA.
Pacemaker trouble shoot
Outline
1. Pacemaker codes
2. Pacemaker configuration
3. Examples
Pacemaker Codes
Position
Function
1
Chambers
Paced
2
Chambers
Sensed
3
Response to
Sensed
Stimulus
4
Rate
Modulation?
O (none)
O
O
O (non-rate
responsive)
A (atrium)
A
T (triggered)
R (rate
responsive)
V (ventricle)
V
I (inhibited)
D (both atrium &
ventricle)
Pacemaker Configurations
VOO
Indications
Temporary mode some-times used during surgery to
prevent interference from electrocautery
Pacemaker Configurations
AAI
Indications
Sick sinus syndrome in the absence of AV node
disease or atrial fibrillation.
Pacemaker Configurations
DDD
Indications
1. The combination of AV block and SSS.
2. Patients with LV dysfunction and LV hypertrophy
who need coordination of atrial and ventricular
contractions to maintain adequate CO.
Problem with Pacemaker?
Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed., 2005.
Causes:
• Threshold rise (electrolytes, drugs)
• Lead dislodgement
• Lead fracture
• RV infarct
Problem with Pacemaker?
Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed., 2005.
Causes:
• Oversensing
• Battery failure
• Internal insulation failure
• Conductor coil fracture
Problem with Pacemaker?
Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed., 2005.
Causes:
• Crosstalk
Problems with Pacemakers
Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed., 2005.
Causes:
• Undersensing
• Lead Fracture
Is this pacemaker capturing?
The Alan E. Lindsay ECG Learning Center ; http://medstat.med.utah.edu/kw/ecg/
Atrial sensed, ventricular paced
Consistent with DDD or VDD
What’s wrong?
The Alan E. Lindsay ECG Learning Center ; http://medstat.med.utah.edu/kw/ecg/
Failure to Pace
Ce patient as-t’il besoin d,un pacemaker?
Where is the block?
Second Degree A-V Block
(Mobitz I or Wenckebach)
Where is the Block?
Mobitz Type II
Third Degree A-V Bloc
ANY QUESTIONS?
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