00:01
Let us continue. We will take a look at supraventricular
tachycardias. The way that this is set up
is so that we haven't given you all four.
I haven't given you all four. Tachyarrhythmia
is here so that you are not confused as to
which one is which. There was a discussion
with atrial flutter and atrial fibrillation
and we distinguished between the two very
clearly, primarily in terms of its description,
irregularly irregular would be which one?
Atrial fibrillation. If it is regular and
you have a 2:1 type of pattern, which means
two P waves for every one QRS complex, then
you have a regular rhythm and this will then
bring us to flutter and saw-tooth. So these were the two
supraventricular tachycardias
that you need to make sure that you know in
great detail and then here we will take a
look at two others. One known as multifocal
atrial tachycardia. Now we will do the same
thing. Do not allow the name to fool you,
confuse you and frustrate you, in fact, used
the name to then clue you when as to the diagnosis
of your patient. So multifocal atrial tachycardia
is once again dealing with the atria, thus,
it is a SVT, a supraventricular tachycardia.
01:18
Keep in mind that the objective at all times
is to make sure that you prevent these tachycardias
from entering the ventricles. Due to focal
pacemaker abnormalities, I will tell you what
that means in a second and what end up happening
here is a multifocal or multiple ectopic pacemaker
firing. And by a pacemaker, we are referring
to our SA node. Thus, the P wave is going
to be quite operative for us to pay attention
to, leading to tachycardia of course. Rapid
abnormal P wave, well that once again doesn't
tell you a whole lot except for the fact that
this is an SVT, right. And once again obviously here,
this is before the QRS complex. That
is so much obvious, but the abnormality in
the P wave is taking place prior too.
02:09
The patients well, here once again because
you have tachy. Well, the heart is feeling
a little pulsating thus palpations. You have
irregular heart rate, fatigue, and angina, dyspnea
well rest of these are pretty nonspecific,
you would find these with pretty much any
SVT. Here once again the causes
overlap with a
lot of SVTs including hypertension. We saw
this that atrial fibrillation, hypertension.
02:41
How do the patients could be a possible etiology
moving into atrial fibrillation. So how do
we know? Atrial fibrillation. What happen
to those P waves? They were fibrillated. In
other words, they were obscured, difficult
to find, wavy pattern, not saw-tooth, irregularly
irregular. So when we get closer to the EKG
that you are responsible for identifying,
you will take a look at the pattern of P wave
that we will see here with MAT, multifocal
atrial. IHD, ischemic heart disease; hypothyroidism,
alcohol, pulmonary embolism, well all of these
once again would result in multiple types
of SVTs and it really is up to you to make
sure that you take each one of these SVTs
that we are looking at commonly as by basically
any professional including licensing exam.
And how do you distinguish amongst the SVTs
is what we are doing, aren't we?