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Questions and Answers
What does the presence of a delta wave in an ECG indicate?
What does the presence of a delta wave in an ECG indicate?
How does complete heart block (Third Degree heart block) affect atrial and ventricular contraction?
How does complete heart block (Third Degree heart block) affect atrial and ventricular contraction?
Which of the following is a common cause of myocarditis?
Which of the following is a common cause of myocarditis?
What is a typical ECG finding in dilated cardiomyopathy (DCM)?
What is a typical ECG finding in dilated cardiomyopathy (DCM)?
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Which condition is characterized by weak and floppy myocardium?
Which condition is characterized by weak and floppy myocardium?
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What is a key difference between AV node pathology and infranodal block in complete heart block?
What is a key difference between AV node pathology and infranodal block in complete heart block?
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In hypertrophic cardiomyopathy (HOCM), what is the primary abnormality found in the heart structure?
In hypertrophic cardiomyopathy (HOCM), what is the primary abnormality found in the heart structure?
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What typically happens to heart function in myocarditis?
What typically happens to heart function in myocarditis?
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Why is congenital heart block associated with underlying structural heart disease considered to have a poorer prognosis?
Why is congenital heart block associated with underlying structural heart disease considered to have a poorer prognosis?
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What is the primary feature that characterizes Supraventricular Tachycardia (SVT)?
What is the primary feature that characterizes Supraventricular Tachycardia (SVT)?
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Which type of tachycardia involves a concealed accessory pathway that can conduct at a relatively slow rate?
Which type of tachycardia involves a concealed accessory pathway that can conduct at a relatively slow rate?
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In Atrioventricular Nodal Re-entrant Tachycardia (AVNRT), where are the P waves typically located?
In Atrioventricular Nodal Re-entrant Tachycardia (AVNRT), where are the P waves typically located?
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What is a distinguishing feature of Permanent junctional reciprocating tachycardia (PJRT)?
What is a distinguishing feature of Permanent junctional reciprocating tachycardia (PJRT)?
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What mechanism is involved in Atrioventricular Re-entrant Tachycardia (AVRT)?
What mechanism is involved in Atrioventricular Re-entrant Tachycardia (AVRT)?
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What is the significance of 'P wave hunting' in diagnosing SVT?
What is the significance of 'P wave hunting' in diagnosing SVT?
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What is a common misdiagnosis of Permanent junctional reciprocating tachycardia (PJRT)?
What is a common misdiagnosis of Permanent junctional reciprocating tachycardia (PJRT)?
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What abnormality characterizes Wolff-Parkinson-White Syndrome (WPW)?
What abnormality characterizes Wolff-Parkinson-White Syndrome (WPW)?
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Study Notes
P
Paediatric ECG Abnormalities
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Supraventricular Tachycardia (SVT):
- Narrow complex tachycardia originating above the ventricles.
- Classified by atrial or AV nodal origin.
- Crucial to identify P wave position (relative to the QRS complex) during tachycardia ("P wave hunting").
- Common causes include AV nodal reentrant tachycardia and atrioventricular reciprocating tachycardia. Early recognition and management are vital.
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Supraventricular Tachycardia (SVT):
- Narrow complex tachycardia originating above the ventricles.
- Classified by atrial or AV nodal origin.
- Crucial to identify P wave position (relative to QRS complex) during tachycardia ("P wave hunting").
- Common causes include AV nodal re-entrant tachycardia (AVNRT), atrioventricular re-entrant tachycardia (AVRT, including Wolff-Parkinson-White Syndrome), permanent junctional reciprocating tachycardia (PJRT).
- AVRT: Accessory pathway connects atria and ventricles, creating a re-entrant circuit.
- Impulses can travel down AV node and up accessory pathway (orthodromic) or vice versa (antidromic).
- Retrograde P wave may be seen at end of QRS.
- AVNRT: Micro-reentrant circuit in or near AV node.
- P waves difficult to see, often hidden in QRS.
- PJRT: Type of orthodromic AVRT with concealed accessory pathway near coronary sinus.
- Characterized by long RP interval tachycardia.
- Inverted P wave(s) in inferior leads (not in sinus rhythm).
- RP interval longer than PR interval in sinus rhythm. Misdiagnosis as sinus tachycardia is common. Requires cardiology intervention, as adenosine is often ineffective.
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Wolff-Parkinson-White Syndrome (WPW):
- Conduction abnormality with accessory pathway connecting atria and ventricles.
- Accessory pathway (anterogradely) conduction faster than AV node leading to pre-excitation.
- Can lead to SVT (AVRT).
- ECG findings: Short PR interval (<100ms) and delta wave (fusion of accessory pathway and normal QRS).
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Complete Heart Block:
- Impulse not conducted from atria to ventricles.
- Usually due to AV node pathology, often congenital (structural disease or maternal antibodies, e.g., in neonatal lupus).
- SA node controls atrial rate; ventricle rate is a ventricular escape rhythm (much slower).
- Atria and ventricles contract independently.
- Narrow QRS in AV block, wide QRS in infranodal block.
- Infranodal block generally less stable and increased risk of asystole.
- ECG findings: Regular P waves and regular QRS complexes, but they are unrelated.
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Myocarditis:
- Myocardium inflammation.
- Caused by various infections (viruses, bacteria, spirochetes, fungi, etc) with a toxic effect on the myocardium.
- Systemic illness (e.g., Coxsackie) or certain drugs (e.g., anthracyclines, alcohol) are implicated.
- Often occurs alongside pericarditis.
- ECG findings: Usually exhibits sinus tachycardia and non-specific T-wave and ST-segment changes (eg, T-wave inversion)
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Dilated Cardiomyopathy (DCM):
- Weak and floppy myocardium.
- Inherited or developed result of myocarditis (secondary infection or drugs).
-
Hypertrophic Cardiomyopathy (HOCM):
- Genetic condition affecting heart sarcomeres.
- Leads to Left Ventricular Hypertrophy (LVH), unexplained by other causes.
- Highly significant due to its association with sudden cardiac death.
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Description
Explore the key concepts of Supraventricular Tachycardia (SVT) in pediatric patients. This quiz covers types of SVT, including AV nodal re-entrant and atrioventricular re-entrant tachycardias. Learn to identify P wave positions and the clinical significance of these ECG abnormalities.
