00:00
Alright so at this point, you think we were being redundant.
Take a look at the category for arrhythmias,
still dysarryhthmia and conduction system
diseases but up until now we have only
done SVTs. What is left? All important ventricles.
Now here once again the way that I am setting
up this for you is I'm going have you prepared for everything
when you walk into your wards, but along the
way though, we are going to then point out
those incredibly important ventricular arrhythmias
that you have to be aware of for any licensing
exam. So let us begin and by the time we are
down with the session, you will be extremely
comfortable with just about any type of arrhythmia
taking place due to a conduction system disease.
Anything that will be left thereafter will
be arrhythmias that are then secondary to
vascular diseases.
01:00
Causes of ventricular tachycardia. Before
we begin, since we were doing the ventricles,
then you tell me as to what particular complex
we are paying attention to. QRS complex only.
01:10
Here under ventricular, we will speed
things up in which a QRS complex are closer
to one another. The R wave are closer to one
another and hence, you have an increase in
heart rate. Remember greater than 100 beats
per minute. Causes include ischemia,
right ventricular
outflow tract obstruction, structural heart
diseases or medication induced. So, nothing
really specific and you really making sure or
you are trying to prevent from ventricular
arrhythmias to take place to begin with because
you are always worried about going into v.fib
and hence death. What is the definition of
ventricular tachy?
What must you find? You must find greater
than three consecutive premature ventricular
contractions. In other words, your PVCs. And
by that we mean that after the P wave, you
should be able to see a QRS complex in correlation.
But every once in a while, if we find that
a ventricular contraction or QRS complex is
taking place too early such as the PVC. Then this
is the problem especially you can find greater
than three consecutive PVCs.
02:20
The wide complex tachycardia. This is the
one that you are paying attention to on and
for your boards and or the wards. The wide
complex tachy, QRS greater than 120 milliseconds.
02:34
What does that mean in terms of seconds? 0.12.
The QRS complex is what we're referring to here. But
you had memorized at least 0.12 seconds for
QRS complex. Sustained if lasting greater
than 30 seconds. AV dissociation, what does
that mean? This would mean that the P waves
are independent of the QRS. Fusion beats, appearance
of typically differentiated. All you do here
and this last little point is extremely important
for you. RBBB and LBBB. How would you then
be able to identify or understand that your
patient is suffering from LBBB or RBBB? While
you are paying attention apart from the EKG,
which I will show you, you also want to pay
attention to the history. Correct? And so therefore
if it is RBBB, then you might then have what
is known as a wide split of your S2. If it
is an LBBB, what does that do? Well, you have
an impulse that is passing through depolarization
of the right bundle branch first. So, therefore,
you have paradoxical split. Remember those
discussions. Those are things which you want
to have firmly understood before coming here
into EKGs.