SVT | أهم النقاط من التصنيف
🔹 Sinus tachycardia
- Physiological
- Inappropriate sinus tachycardia
- SANRT: re-entry داخل/حول الـ sinus node، مع P-wave morphology مشابهة للـ sinus rhythm، وHR غالبًا 100–150/min.
🔹 Focal atrial tachycardia (FAT)
- تنشأ من single ectopic atrial focus.
- P-wave morphology غير طبيعية، وقد يساعد الـ P-wave axis في تحديد مكان الـ focus.
🔹 Multifocal atrial tachycardia (MAT)
- Rhythm سريع وغير منتظم.
- وجود ≥3 أشكال مختلفة للـ P waves.
- اختلاف واضح في PP, PR وRR intervals.
- تُشاهد خصوصًا مع COPD وcardiopulmonary disease.
- قد تمثل مرحلة انتقالية بين frequent PACs → AT → atrial flutter/AF.
🫀 ECG pearl:
≥3 P-wave morphologies + irregularly irregular rhythm = MAT
#Cardiology #SVT #ECG #AtrialTachycardia #MAT
🔹 Sinus tachycardia
- Physiological
- Inappropriate sinus tachycardia
- SANRT: re-entry داخل/حول الـ sinus node، مع P-wave morphology مشابهة للـ sinus rhythm، وHR غالبًا 100–150/min.
🔹 Focal atrial tachycardia (FAT)
- تنشأ من single ectopic atrial focus.
- P-wave morphology غير طبيعية، وقد يساعد الـ P-wave axis في تحديد مكان الـ focus.
🔹 Multifocal atrial tachycardia (MAT)
- Rhythm سريع وغير منتظم.
- وجود ≥3 أشكال مختلفة للـ P waves.
- اختلاف واضح في PP, PR وRR intervals.
- تُشاهد خصوصًا مع COPD وcardiopulmonary disease.
- قد تمثل مرحلة انتقالية بين frequent PACs → AT → atrial flutter/AF.
🫀 ECG pearl:
≥3 P-wave morphologies + irregularly irregular rhythm = MAT
#Cardiology #SVT #ECG #AtrialTachycardia #MAT
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🫀 Atrial Flutter / MRAT — ملخص سريع
🔹 Atrial flutter = macro-reentrant atrial tachycardia.
1️⃣ CTI-dependent MRAT
Typical flutter: دوران Counter-clockwise (CCW) حول الـ RA عبر الـ CTI.
Reverse typical: دوران Clockwise (CW).
2️⃣ Non-CTI-dependent MRAT
Re-entry قد ينشأ في RA أو LA.
أمثلة: حول SVC، pulmonary veins أو scar.
📈 ECG Pearls
Atrial rate غالبًا 250–350 bpm.
لا يوجد isoelectric baseline.
Sawtooth F waves.
في الـ typical flutter: F waves negative في II, III, aVF.
في reverse flutter: F waves غالبًا positive في inferior leads.
مع 2:1 AV conduction يكون ventricular rate غالبًا حوالي 150 bpm.
🎯 Take-home
Typical = CCW + negative inferior F waves
Reverse = CW + positive inferior F waves
Atypical = Non-CTI-dependent + variable morphology
🫀 ECG pattern + mechanism → يوجهان التشخيص وخطة الـ ablation.
🔹 Atrial flutter = macro-reentrant atrial tachycardia.
1️⃣ CTI-dependent MRAT
Typical flutter: دوران Counter-clockwise (CCW) حول الـ RA عبر الـ CTI.
Reverse typical: دوران Clockwise (CW).
2️⃣ Non-CTI-dependent MRAT
Re-entry قد ينشأ في RA أو LA.
أمثلة: حول SVC، pulmonary veins أو scar.
📈 ECG Pearls
Atrial rate غالبًا 250–350 bpm.
لا يوجد isoelectric baseline.
Sawtooth F waves.
في الـ typical flutter: F waves negative في II, III, aVF.
في reverse flutter: F waves غالبًا positive في inferior leads.
مع 2:1 AV conduction يكون ventricular rate غالبًا حوالي 150 bpm.
🎯 Take-home
Typical = CCW + negative inferior F waves
Reverse = CW + positive inferior F waves
Atypical = Non-CTI-dependent + variable morphology
🫀 ECG pattern + mechanism → يوجهان التشخيص وخطة الـ ablation.
سؤال اليوم لأطباء القلب 🫀
إيه الـECG finding اللي ممكن يخليك تشك في Cardiac Amyloidosis رغم وجود LVH على الـEcho؟ 🤔
إيه الـECG finding اللي ممكن يخليك تشك في Cardiac Amyloidosis رغم وجود LVH على الـEcho؟ 🤔
Cardiology Challenge 🧠
إيه الـECG clue اللي ممكن يشير إلى Left Main Coronary Artery Disease ويحتاج منك تقييم سريع؟
إيه الـECG clue اللي ممكن يشير إلى Left Main Coronary Artery Disease ويحتاج منك تقييم سريع؟
سؤال اليوم 🔍
إيه الـECG finding اللي ممكن يخليك تشك في Pulmonary Embolism رغم إن الـECG طبيعي تقريبًا؟ 🤔
إيه الـECG finding اللي ممكن يخليك تشك في Pulmonary Embolism رغم إن الـECG طبيعي تقريبًا؟ 🤔
🫀
لو لقيت ST elevation في V1–V3، إيه الـclinical context اللي يخليك تفكر في Brugada Syndrome بدل Acute MI؟
لو لقيت ST elevation في V1–V3، إيه الـclinical context اللي يخليك تفكر في Brugada Syndrome بدل Acute MI؟
ECG Pearl 🫀
لو لقيت ST elevation في V1–V3، إيه الـclinical context اللي يخليك تفكر في Brugada Syndrome بدل Acute MI؟
لو لقيت ST elevation في V1–V3، إيه الـclinical context اللي يخليك تفكر في Brugada Syndrome بدل Acute MI؟
سؤال سريع لأطباء القلب ⚡
إيه الـECG finding اللي ممكن يكون علامة مبكرة على Acute Pericarditis؟
إيه الـECG finding اللي ممكن يكون علامة مبكرة على Acute Pericarditis؟
سؤال اليوم لأطباء القلب:
إيه الـ ECG finding اللي ممكن يخليك تشك في Cardiac Amyloidosis رغم إن الـEcho بيظهر LVH؟ 🤔
إيه الـ ECG finding اللي ممكن يخليك تشك في Cardiac Amyloidosis رغم إن الـEcho بيظهر LVH؟ 🤔
سؤال اليوم 🫀
إيه الـECG pattern اللي لازم يخليك تفكر في Hyperkalemia حتى قبل ظهور الأعراض؟ ⚡
إيه الـECG pattern اللي لازم يخليك تفكر في Hyperkalemia حتى قبل ظهور الأعراض؟ ⚡
د/جمال العزب Dr_Jamal_Alazap
Photo
ECG Interpretation
Sinus rhythm with left atrial enlargement and complete left bundle branch block (LBBB).
QRS duration ≥120 ms.
Broad, notched/slurred R waves in I, aVL, V5–V6.
Absent q waves in the lateral leads.
QS/rS pattern with broad S waves in V1–V2.
Delayed intrinsicoid deflection >60 ms in the left precordial leads.
Secondary ST-T changes: ST depression and T-wave inversion in I, aVL, V5–V6.
QRS axis may be normal or leftward.
Conclusion: Sinus rhythm + Left atrial enlargement + Complete LBBB with secondary ST-T changes.
Sinus rhythm with left atrial enlargement and complete left bundle branch block (LBBB).
QRS duration ≥120 ms.
Broad, notched/slurred R waves in I, aVL, V5–V6.
Absent q waves in the lateral leads.
QS/rS pattern with broad S waves in V1–V2.
Delayed intrinsicoid deflection >60 ms in the left precordial leads.
Secondary ST-T changes: ST depression and T-wave inversion in I, aVL, V5–V6.
QRS axis may be normal or leftward.
Conclusion: Sinus rhythm + Left atrial enlargement + Complete LBBB with secondary ST-T changes.
د/جمال العزب Dr_Jamal_Alazap
A 65-year-old woman presents with one hour of central chest pain following three days of exertional dyspnoea and lethargy. BP 79/51, HR 105 reg, SpO2 93 RA
Normal sinus rhythm, rate 100 bpm
Right bundle branch block
Widespread ST depression, most notable in leads II and V4-6. Even in the context of RBBB, ST depression in V2-3 is excessively discordant
ST elevation in aVR ~1mm
Right bundle branch block
Widespread ST depression, most notable in leads II and V4-6. Even in the context of RBBB, ST depression in V2-3 is excessively discordant
ST elevation in aVR ~1mm
This ECG pattern simply represents diffuse subendocardial ischaemia due to oxygen supply-demand mismatch. It is the same ECG seen in patients that have a positive stress test. Note that ST elevation in aVR here is a reciprocal change to ST depression most marked in leads I, II and V4-6.
Some common clinical causes of this include:
Hypotension or hypoxia
Left main coronary artery (LMCA) or left anterior descending artery (LAD) stenosis/insufficiency
Severe triple vessel disease
ROSC post cardiac arrest
In the absence of ST elevation in other leads, acute coronary occlusion is rarely the cause of this ECG pattern.
Some common clinical causes of this include:
Hypotension or hypoxia
Left main coronary artery (LMCA) or left anterior descending artery (LAD) stenosis/insufficiency
Severe triple vessel disease
ROSC post cardiac arrest
In the absence of ST elevation in other leads, acute coronary occlusion is rarely the cause of this ECG pattern.
ST elevation in aVR due to LMCA or “left main” occlusion is a misnomer — such a lesion causes simultaneous anterior, posterior and lateral STEMI leading to almost instantaneous death
د/جمال العزب Dr_Jamal_Alazap
An 88-year-old man is brought in by ambulance complaining of palpitations. BP 133/75, SpO2 100, GCS 15. HR is fixed at 150 bpm. Is this atrial flutter?
Regular narrow complex tachycardia, rate 150 bpm
Left anterior fascicular block
ST depression in V2-5 is suggestive of rate-related ischaemia
There is a long R-P interval, with P waves visible buried in the end of the T wave. These are seen as an additional positive deflection in lead II. Similarly upright P waves in aVL may be easily mistaken for T waves, which are actually inverted and visible just prior
P wave axis is abnormal with a leftward deviation
The third complex is a ventricular ectopic beat (VEB). Note that if this were a functional bundle block due to rate or aberrancy, we would expect the rate to change
Left anterior fascicular block
ST depression in V2-5 is suggestive of rate-related ischaemia
There is a long R-P interval, with P waves visible buried in the end of the T wave. These are seen as an additional positive deflection in lead II. Similarly upright P waves in aVL may be easily mistaken for T waves, which are actually inverted and visible just prior
P wave axis is abnormal with a leftward deviation
The third complex is a ventricular ectopic beat (VEB). Note that if this were a functional bundle block due to rate or aberrancy, we would expect the rate to change