Podcast
Questions and Answers
What is the most likely cause of a ventricular premature complex (VPC) in a dog?
What is the most likely cause of a ventricular premature complex (VPC) in a dog?
- Drug administration
- Electrolyte derangements
- Heart disease (correct)
- Pain
What is the rate of a ventricular tachycardia in a dog?
What is the rate of a ventricular tachycardia in a dog?
- Greater than 250 beats per minute
- Less than 160 beats per minute
- Greater than 160 beats per minute (correct)
- Less than 40 beats per minute
What characteristic of a VPC on an ECG is considered "wide and bizarre"?
What characteristic of a VPC on an ECG is considered "wide and bizarre"?
- The QRS complex (correct)
- The ST segment
- The P wave
- The T wave
What is the most dangerous arrhythmia mentioned in the text?
What is the most dangerous arrhythmia mentioned in the text?
What condition is a potential complication of sustained ventricular tachycardia?
What condition is a potential complication of sustained ventricular tachycardia?
What is the most appropriate treatment for a dog with single VPCs without signs of hemodynamic compromise?
What is the most appropriate treatment for a dog with single VPCs without signs of hemodynamic compromise?
R-on-T phenomenon is associated with an increased risk for?
R-on-T phenomenon is associated with an increased risk for?
What is a common characteristic of a R-on-T phenomenon on an ECG?
What is a common characteristic of a R-on-T phenomenon on an ECG?
What characterizes a ventricular arrhythmia concerning the QRS complex?
What characterizes a ventricular arrhythmia concerning the QRS complex?
In dogs, what heart rate indicates tachycardia?
In dogs, what heart rate indicates tachycardia?
What can cause a fast heart rate associated with sinus rhythm in dogs?
What can cause a fast heart rate associated with sinus rhythm in dogs?
What is a notable characteristic of respiratory sinus arrhythmia in dogs?
What is a notable characteristic of respiratory sinus arrhythmia in dogs?
What does a wide QRS complex indicate in the context of an ECG?
What does a wide QRS complex indicate in the context of an ECG?
In which scenario is no treatment typically necessary?
In which scenario is no treatment typically necessary?
What is a common cause of ectopic supraventricular tachyarrhythmia?
What is a common cause of ectopic supraventricular tachyarrhythmia?
Which of the following would NOT be a likely cause of sinus tachycardia?
Which of the following would NOT be a likely cause of sinus tachycardia?
What is the expected QRS duration that indicates a wide QRS complex in dogs?
What is the expected QRS duration that indicates a wide QRS complex in dogs?
What condition could lead to a transient increase in heart rate in dogs?
What condition could lead to a transient increase in heart rate in dogs?
What is the heart rate calculation method when counting QRS complexes in a 3-second period?
What is the heart rate calculation method when counting QRS complexes in a 3-second period?
Which paper speed setting corresponds to each small (mm) box measuring 0.02 seconds?
Which paper speed setting corresponds to each small (mm) box measuring 0.02 seconds?
What is the correct method for calculating average heart rate using a standard Bic pen at 25 mm/sec?
What is the correct method for calculating average heart rate using a standard Bic pen at 25 mm/sec?
Which component of the ECG system allows you to determine whether the rhythm is controlled by the sinus node?
Which component of the ECG system allows you to determine whether the rhythm is controlled by the sinus node?
In the systematic approach to ECG interpretation, what is the first step?
In the systematic approach to ECG interpretation, what is the first step?
What does the QRS complex appearance help differentiate between?
What does the QRS complex appearance help differentiate between?
How long is a standard Bic pen when it is used for measuring heart rate at 50 mm/sec?
How long is a standard Bic pen when it is used for measuring heart rate at 50 mm/sec?
What is the normal sinus rhythm characterized by?
What is the normal sinus rhythm characterized by?
What defines an underlying sinus rhythm in an electrocardiogram (ECG)?
What defines an underlying sinus rhythm in an electrocardiogram (ECG)?
What is a common consequence of tachycardia on cardiac output?
What is a common consequence of tachycardia on cardiac output?
Which heart rhythm is specifically known to cause loss of atrio-ventricular synchrony?
Which heart rhythm is specifically known to cause loss of atrio-ventricular synchrony?
What characterizes a ventricular arrhythmia?
What characterizes a ventricular arrhythmia?
Which of the following statements about bradyarrhythmias is correct?
Which of the following statements about bradyarrhythmias is correct?
What is the primary hemodynamic consequence of atrial fibrillation at high heart rates?
What is the primary hemodynamic consequence of atrial fibrillation at high heart rates?
Which condition is described as the inability of the heart to maintain adequate output during physical exertion?
Which condition is described as the inability of the heart to maintain adequate output during physical exertion?
Which characteristic on an ECG is indicative of atrial fibrillation?
Which characteristic on an ECG is indicative of atrial fibrillation?
In which scenario is 'lone A-fib' most likely to occur?
In which scenario is 'lone A-fib' most likely to occur?
How is a supraventricular arrhythmia differentiated from a ventricular arrhythmia?
How is a supraventricular arrhythmia differentiated from a ventricular arrhythmia?
What feature is indicative of an abnormal impulse arising from the ventricular region?
What feature is indicative of an abnormal impulse arising from the ventricular region?
What does the AV node do in response to rapid atrial activity during atrial fibrillation?
What does the AV node do in response to rapid atrial activity during atrial fibrillation?
Which category includes both sinus bradycardia and atrial fibrillation?
Which category includes both sinus bradycardia and atrial fibrillation?
What is the typical heart rate associated with atrial fibrillation in dogs?
What is the typical heart rate associated with atrial fibrillation in dogs?
Why is it essential to identify the origin of a heart rhythm?
Why is it essential to identify the origin of a heart rhythm?
What is an early sign of 'lone A-fib' in giant-breed dogs?
What is an early sign of 'lone A-fib' in giant-breed dogs?
What is the most common approach to manage abnormal ventricular response rates in dogs and cats?
What is the most common approach to manage abnormal ventricular response rates in dogs and cats?
What is the expected QRS complex appearance in atrial fibrillation?
What is the expected QRS complex appearance in atrial fibrillation?
Which treatment is aimed at converting atrial fibrillation to sinus rhythm?
Which treatment is aimed at converting atrial fibrillation to sinus rhythm?
Which characteristic is NOT associated with premature ventricular complexes (PVCs)?
Which characteristic is NOT associated with premature ventricular complexes (PVCs)?
How can one identify if the premature beats have a ventricular origin?
How can one identify if the premature beats have a ventricular origin?
What does the term 'R-on-T' phenomenon refer to in ECG readings?
What does the term 'R-on-T' phenomenon refer to in ECG readings?
Which of the following is a feature of ventricular premature depolarizations?
Which of the following is a feature of ventricular premature depolarizations?
What is indicated by a QRS complex width greater than 0.06 seconds in a dog?
What is indicated by a QRS complex width greater than 0.06 seconds in a dog?
Which type of medication is commonly used to control heart rate in dogs with arrhythmias?
Which type of medication is commonly used to control heart rate in dogs with arrhythmias?
What are the building blocks for more complex ventricular arrhythmias such as ventricular tachycardia?
What are the building blocks for more complex ventricular arrhythmias such as ventricular tachycardia?
Flashcards
Systematic Approach to ECG Interpretation
Systematic Approach to ECG Interpretation
The process of analyzing an electrocardiogram (ECG) in a structured and organized manner.
Paper Speed
Paper Speed
The rate at which the ECG paper moves, typically 25 mm/sec or 50 mm/sec.
Heart Rate
Heart Rate
The number of heartbeats per minute.
Sinus Rhythm
Sinus Rhythm
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Cardiac Arrhythmia
Cardiac Arrhythmia
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Determining Sinus Node Control
Determining Sinus Node Control
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QRS Complex Appearance
QRS Complex Appearance
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Bic Pen Measurement
Bic Pen Measurement
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Atrial fibrillation (A-fib)
Atrial fibrillation (A-fib)
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What happens during Atrial fibrillation?
What happens during Atrial fibrillation?
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What is a key ECG feature of A-fib?
What is a key ECG feature of A-fib?
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What is the role of the AV node in A-fib?
What is the role of the AV node in A-fib?
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Why is the QRS complex normal in A-fib?
Why is the QRS complex normal in A-fib?
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What is one hemodynamic consequence of A-fib?
What is one hemodynamic consequence of A-fib?
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Why is sustained A-fib a concern?
Why is sustained A-fib a concern?
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How is A-fib treated?
How is A-fib treated?
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Arrhythmia
Arrhythmia
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Sinus Bradycardia
Sinus Bradycardia
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Sinus Tachycardia
Sinus Tachycardia
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Atrioventricular (AV) Block
Atrioventricular (AV) Block
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Atrial Standstill
Atrial Standstill
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Sick Sinus Syndrome
Sick Sinus Syndrome
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Atrial Premature Complexes
Atrial Premature Complexes
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Supraventricular Tachycardia (SVT)
Supraventricular Tachycardia (SVT)
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Atrial Flutter
Atrial Flutter
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Ventricular Premature Depolarizations (VPD)
Ventricular Premature Depolarizations (VPD)
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Premature Ventricular Complexes (PVCs)
Premature Ventricular Complexes (PVCs)
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Ventricular Premature Complexes (VPC)
Ventricular Premature Complexes (VPC)
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Ventricular Bradycardia
Ventricular Bradycardia
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Wide QRS Complex in VPC
Wide QRS Complex in VPC
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Ventricular Couplet
Ventricular Couplet
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Ventricular Triplet
Ventricular Triplet
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R-on-T Phenomenon
R-on-T Phenomenon
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Ventricular Arrhythmia
Ventricular Arrhythmia
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Sinus Arrhythmia
Sinus Arrhythmia
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Sinus Rhythm with Cyclic Slowing and Speeding
Sinus Rhythm with Cyclic Slowing and Speeding
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Sinus Tachycardia as a Physiologic Response
Sinus Tachycardia as a Physiologic Response
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Regularly Irregular Rhythm
Regularly Irregular Rhythm
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Regular Rhythm
Regular Rhythm
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ECG (Electrocardiogram) Characteristics
ECG (Electrocardiogram) Characteristics
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QRS Complex
QRS Complex
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Ventricular fibrillation
Ventricular fibrillation
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Ventricular tachycardia
Ventricular tachycardia
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R-on-T
R-on-T
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Ventricular Premature Contractions (VPCs)
Ventricular Premature Contractions (VPCs)
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Congestive heart failure (CHF)
Congestive heart failure (CHF)
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Single VPC
Single VPC
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Holter monitoring
Holter monitoring
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Primary myocardial diseases
Primary myocardial diseases
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Study Notes
ECG Interpretation
- A systematic approach to ECG interpretation involves several steps
- First, note the lead and paper speed settings, typically 25 mm/sec or 50 mm/sec.
- Determine the heart rate by counting QRS complexes in a 3-second period and multiplying by 20.
- Establish if there is an underlying sinus rhythm.
- Describe any rhythm abnormalities if absent.
Learning Objectives
- Students will list and discuss the steps in ECG interpretation.
- Students will identify the presence of a sinus rhythm.
- Students will define cardiac arrhythmias and normal sinus rhythm.
- Students will list the criteria of a normal sinus rhythm using ECG leads.
- Students will identify rhythms controlled by the sinus node in ECG leads.
- Students will differentiate between supraventricular and ventricular rhythms (ECG criteria)
Bic Pen Trick
- A standard Bic pen can be used to quickly estimate heart rate.
- Count the QRS complexes contained within the length of the pen.
- Multiply the result by 10 if the paper speed is 25 mm/sec or by 20 if the paper speed is 50mm/sec.
Paper Speed Settings
- 25 mm/sec: Each small box = 0.04 seconds, each big box = 0.2 seconds, 25 small boxes = 1 second
- 50 mm/sec: Each small box = 0.02 seconds, each big box = 0.1 seconds, 50 small boxes = 1 second
Sinus Rhythm
- Depolarisation begins at the sinus node, the pacemaker of the heart.
- In lead II, P waves should be positive, reflecting atrial depolarisation from the sinus node.
- There should be a P wave for every QRS complex and consistent PR intervals.
Arrhythmia Definition
- An arrhythmia is any alteration in heart rate, regularity, or normal activation sequence of the electrical heart activity
- This includes abnormal origins for the electrical activation of the heart, irregular rate, and irregular beat intervals.
Arrhythmia Significance
- Arrhythmias can result in cardiac injury from decreased cardiac output,
- Especially when rhythms are too fast (tachycardia) or too slow (bradycardia),
- Some specific arrhythmias (e.g., atrial fibrillation) affect atrio-ventricular synchrony potentially leading to sudden death.
Arrhythmia Classification
- A clinically relevant scheme exists for classifying heart rhythm abnormalities, including both bradyarrhythmias (slow heart rates) and tachyarrhythmias (fast heart rates).
- Bradyarrhythmias include sinus bradycardia, atrioventricular block, atrial standstill, and sick sinus syndrome.
- Tachyarrhythmias include sinus tachycardia, atrial premature complexes, supraventricular tachycardia, atrial fibrillation, atrial flutter, ventricular premature complexes, accelerated idioventricular rhythm, ventricular tachycardia, and ventricular fibrillation.
Supraventricular vs. Ventricular Arrhythmias
- Supraventricular arrhythmias originate from tissue above the ventricles (atria or AV junction).
- Ventricular arrhythmias originate in the ventricles.
- Ventricular arrhythmias are generally more dangerous due to potential consequences on cardiac output and function.
- ECG characteristics distinguishing the origins include QRS complex shape and width, and the presence/absence of a preceding P wave.
Sinus Arrhythmia
- Characterized by cyclic slowing and speeding of heart rate linked to respiration.
- Considered a normal finding in many physiological states, but can be exaggerated by certain diseases or conditions.
Sinus Tachycardia
- A sinus rhythm with a fast heart rate.
- Rate cutoffs for diagnosis are species-specific: e.g., dogs >160 bpm; cats >200 bpm; horses >44 bpm; cattle >80 bpm.
Atrial Fibrillation (A-fib)
- A disorganized atrial activity often associated with advanced heart disease in dogs and cats, or as a “lone” form in some cases.
- Distinguished by an irregular or “sawtooth” baseline, absence of P waves, and often having a rapid heart rate.
Ventricular Premature Complexes (VPCs)
- Abnormal impulses arising from the ventricles.
- Often appear as “wide and bizarre” complexes with a missing preceding P wave.
- Early development of VPCs, especially “R-on-T” phenomenon, increases risk for dangerous ventricular fibrillation.
Ventricular Tachycardia
- A rapid heart rhythm arising from the ventricles characterized by four or more successive VPCs.
- May be uniform (identical) or multiform (different in shape).
- A dangerous rhythm often associated with dilated cardiomyopathy.
When to Treat Ventricular Arrhythmias
- Single VPCs usually do not warrant treatment unless there are other concerns.
- Evaluate for occult complex processes in patients with recurring, frequent, or unusually shaped VPCs.
- Treat underlying causes (e.g., heart disease, electrolyte imbalances), or address other symptoms of cardiac compromise.
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