When both the SA node and AV node fail to conduct rhythms, ventricles act as their own pacemaker and conduct idioventricular rhythm. Dying brains: will our last hurrah be an explosion of conscious experience? It can be fatal. Dysrhythmia and arrhythmia are both terms doctors use to describe an abnormal heart rate. Any symptoms you have or any health changes you notice. Ornek E, Duran M, Ornek D, Demirelik BM, Murat S, Kurtul A, iekiolu H, etin M, Kahveci K, Doger C, etin Z. Based on a work athttps://litfl.com. There are several types of junctional rhythm. Required fields are marked *. When the sinoatrial node is blocked or depressed, latent pacemakers become active to conduct rhythm secondary to enhanced activity and generate escape beats that can be atrial itself, junctional or ventricular. An escape beat is a form of cardiac arrhythmia, in this case known as an ectopic beat. Idioventricular rhythm is a slow regular ventricular rhythm, typically with a rate of less than 50, absence of P waves, and a prolonged QRS interval. Consider your treatment options and ask questions if theres anything that isnt clear. There are several potential causes, including medical issues, medication side effects, and genetics, among others. During your exam, tell your provider about your: Your provider may perform an electrocardiogram (EKG) to check for a junctional rhythm or another type of arrhythmia. It is the natural pacemaker of the heart. Aivr (CardioNetworks ECGpedia)By CardioNetworks: [ ] CardioNetworks: Aivr.jpg (CC BY-SA 3.0) via Commons Wikimedia. Accelerated Idioventricular Rhythm Etiology A subtype of ventricular escape rhythm that frequently occurs with Ml Ventricular escape rhythm with a rate of 60110 Clinical Significance May cause decreased cardiac output if the rate slows Treatment Does not usually require treatment unless the patient becomes hemodynamically unstable AV node acts as the pacemaker during the junctional rhythm, while ventricles themselves act as the pacemaker during the idioventricular rhythm. Electrolyte abnormalities canincrease the chances ofidioventricular rhythm. 4 Things You Should Know About Your 'Third Eye', The Rhythm of Life (research featured in Medicine at Michigan), We All Have at Least Three EyesOne Inside the Head, New Technology Improves Atrial Fibrillation Detection After Stroke, Cardiac Telemetry Improves AF Detection Following Stroke, Detection of atrial fibrillation after stroke made easy with electrocardiom, http://ecgreview.weebly.com/ventricular-escape-beatrhythm.html, https://en.wikipedia.org/wiki/Ventricular_escape_beat, https://physionet.org/physiobank/database/mitdb/, http://circ.ahajournals.org/cgi/content/full/101/23/e215. People without symptoms don't need treatment, but those with symptoms may need medicine or a procedure to fix the problem. Management is clinical monitoring. The default pacemaker area is the SA node. Cardiovascular health: Insomnia linked to greater risk of heart attack. Junctional and idioventricular rhythms are cardiac rhythms. Near-death experiences exposed: Surge of brain activity, Light at the end of the tunnel for scientists studying near-death experienc, POSSIBLE HINTS OF CONSCIOUSNESS AFTER DEATH FOUND IN RATS, In Dying Brains, Signs of Heightened Consciousness, Hyperactive Brain May Create "Near Death" Visions, A Last-Second Surge of Brain Activity Could Explain Near-Death Experiences, The brains swan song: hyperactivity near death, Near-death experiences: The brains last hurrah, Could a final surge in brain activity after death explain near-death experi, Jimo Borjigin's study has been blown out of proportion, Near Death Experiences and Deus Ex: Tell It To Me in Videogames. A medical professional will select the most suitable treatment routine. Sinoatrial node and the atrioventricular node may get suppressed with structural damage or functional dysfunction potentiated by enhanced vagal tone. But opting out of some of these cookies may have an effect on your browsing experience. 3. Find out about the symptoms, types, and outlook for sinus arrhythmia. A Junctional Escape Rhythm is a sequence of 3 or more junctional escapes occurring by default at a rate of 40-60 bpm. Hafeez, Yamama. Castellanos A, Azan L, Bierfield J, Myerburg RJ. Electrical cardioversion is ineffective and should be avoided (electrical cardioversion may be pro-arrhythmogenic in patients on digoxin). [2], Diagnosis of Ventricular Escape Rhythm on the ECG, 2019 Regents of the University of Michigan | U-M Medical School, | Department of Molecular & Integrative Physiology | Complete Disclaimer | Privacy Statement | Contact Michigan Medicine. Itcommonly presents in atrioventricular (AV) dissociation due to an advanced or complete heart block or when the AV junction fails to produce 'escape' rhythm after a sinus arrest or sinoatrial nodal block. 2. Idioventricular rhythm can be seen in and potentiated by various etiologies. Terms of Use and Privacy Policy: Legal. This site uses cookies from Google to deliver its services and to analyze traffic. Chen M, Gu K, Yang B, Chen H, Ju W, Zhang F, Yang G, Li M, Lu X, Cao K, Ouyang F. Idiopathic accelerated idioventricular rhythm or ventricular tachycardia originating from the right bundle branch: unusual type of ventricular arrhythmia. A ventircular escape rhythm occurs whenever higher-lever pacemakers in AV junction or sinus node fail to control ventricular activation. ECG Diagnosis: Accelerated Idioventricular Rhythm. Depending upon the junctional escape rate, ventricular function, and clinical symptoms, these patients may benefit from permanent pacing. Junctional tachycardia (junctional ectopic tachycardia) is a rare heart rhythm that starts from a natural pacemaker, but not the one your heart normally uses. Other individuals may require a pacemaker. Required fields are marked *. However, if it is unable to function correctly, another part of the heart, known as the atrioventricular (AV) junction, may be able to control the pace of the heart. Very rarely, atrial pacing may be an option. Your hearts backup pacemakers keep your heart beating, but they might make your heartbeat slower or faster than normal. Advertising on our site helps support our mission. This series of electrical signals causes all four chambers of your heart to contract (squeeze). When the sinoatrial node is blocked or suppressed, latent pacemakers become active to conduct rhythm secondary to enhanced activity and generate escape beats that can be atrial itself, junctional or ventricular. The trigger activity is the main arrhythmogenic mechanism involved in patients with digitalis toxicity.[6]. The heart beats at a rate of less than 50 bpm. Indeed, the surface ECG frequency cannotdifferentiate escape rhythms originating near the atrioventricular node from those originating in the bundle of His. Idioventricular rhythm is benign in most cases, and appropriate patient education and reassurance are important. Regular ventricular rhythm with rate 40-60 beats per minute. A Premature Junctional Contraction (PJC) is a junctional ectopic beat that occurs prematurely. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Usually, your heartbeat starts in your sinoatrial node and travel down through your heart. Your heart responds by using one of your backup pacemakers instead. clear: left; Contributed Courtesy of Jason E. Roediger (CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0/deed.en). My next article regarding ECG interpretation will breakdown ventricular rhythms, ventricular ectopic beats, and asystole. Occasionally, especially in sinus node disease, the sinus impulse takes longer to activate than usual and a junctional escape beat or rhythm may follow, and this may lead to AV dissociation as the sinus node activates much slower than the junctional . Accelerated idioventricular rhythm (AIVR) at a rate of 55/min presumably originating from the left ventricle (LV). document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Have any questions? It usually self-limits and resolves when the sinus frequency exceeds that of ventricular foci and arrhythmia requires no treatment. Ectopic automaticity generated by abnormal calcium-dependent automatism that affects the diastolic depolarization, i.e., phase 4 action potential, is the main electrophysiological mechanism affecting the AIVR. You can learn more about how we ensure our content is accurate and current by reading our. The atria and ventricles conduct independent of each other. These signals are what make your atria contract. Atrial activity on the surface ECG may be difficult to discern when retrograde P waves are concealed within the QRS . A junctional rhythm usually isnt life-threatening, but if you have symptoms that interfere with your daily life, you may need treatment. EKG Refresher: Atrial and Junctional Rhythms. An idioventricular rhythm also occurs if the SA node becomes blocked. School Southern University and A&M College; Course Title NURS 222; Uploaded By twinzer12. Symptomatic junctional rhythm is treated with atropine. This topic reviews the evaluation and management of idioventricular rhythm. It is mandatory to procure user consent prior to running these cookies on your website. How your pacemaker is working, if you have one. A junctional escape beat is essentially a junctional ectopic beat that occurs within the underlying rhythm. So let us continue to Junctional Rhythms which occurs when the primary pacemaker of the heart is the AV node. Electrocardiography with clinical correlation is essential for diagnosis. Junctional Escape Rhythm: Rate: Usually 40-60 bpm Rhythm: Regular P waves: Usually inverted P-waves before the QRS or after the QRS. Summary Junctional vs Idioventricular Rhythm. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. If you have not done so already, I suggest you read my articles on the Hearts Electrical System, Sinus Rhythms and Sinus arrest: ECG Interpretation, and Atrial Rhythms: ECG Interpretation. Ventricles themselves act as pacemakers and conduct rhythm. Can diet help improve depression symptoms? Junctional tachycardia is caused by abnormal automaticity in the atrioventricular node, cells near the atrioventricular node or cells in the bundle of His. [2] Ventricular escape beats become ventricular escape rhythm when three or more escape beats occur in a row at a rate of 20-40 bpm. Both originate due to secondary pacemakers. In case of sale of your personal information, you may opt out by using the link. }, #FOAMed Medical Education Resources byLITFLis licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. A person should talk with a doctor if they notice any symptoms that could indicate an issue with their heart rate or rhythm. In junctional tachycardia, it is higher than 100 beats per minute, while in junctional bradycardia, it is lower than 40 beats per minute. Accelerated idioventricular rhythm is a type of idioventricular rhythm during which the heart rate goes to 50-110 bpm. It is often found in children or adults who have: During a normal heartbeat, your SA node sends a signal to the AV node, which travels to your bundle of His. An interprofessional team that provides a holistic and integrated approach is essential when noticing an idioventricular rhythm. Sinus Rhythms and Sinus arrest: ECG Interpretation, Performing a manual blood pressure check for the student nurse, Successful and Essential Nurse Communication Skills, Nurse Bullying: The Concept of Nurses Eat Their Young. It may be very difficult to differentiate junctional tachycardia from AVNRT. However, if the junctional impulseis not conducted retrogradely the atria may run an independent rhythm; this is called atrioventricular dissociation (AV dissociation) because the atrial and ventricular rhythms are dissociated from each other. A junctional rhythm is a heart rhythm problem that can make your heartbeat too slow or too fast. PR interval: Normal or short if the P-wave is present. Get useful, helpful and relevant health + wellness information. Monophasic R-wave with smooth upstroke and (more), Rhythm idioventricular. [1], Accelerated idioventricular rhythm (AIVR) results when the rate of an ectopic ventricular pacemaker exceeds that of the sinus node with a rate of around 50 to 110 bpm and often associated with increased vagal tone and decreased sympathetic tone. New comments cannot be posted and votes cannot be cast. Review the clinical context leading to idioventricular rhythm and differentiate from ventricular tachycardia and other similar etiologies. In addition to taking a persons vital signs, the doctor will likely order an ECG and review a persons medication list to help rule out medication as a possible cause. There are four types of junctional rhythms as junctional rhythm, accelerated junctional rhythm, junctional tachycardia, and junctional bradycardia. The major reason can be an advanced or complete heart block. The heart has several built-in pacemakers that help. During complete heart block (third-degree AV-block) the block may be located anywhere between the atrioventricular node and the bifurcation of the bundle of His. (adsbygoogle = window.adsbygoogle || []).push({}); Copyright 2010-2018 Difference Between. Describe the management principles and treatment modalities. The mechanism involves a decrease in the sympatheticbut an increase in vagal tone. The outlook for junctional escape rhythm is good. PhysioBank, PhysioToolkit, and PhysioNet: Components of a New Research Resource for Complex Physiologic Signals. Idioventricular rhythm is very similar to ventricular tachycardia, except the rate is less than 60 bpm and is alternatively called a "slow ventricular tachycardia." 1-ranked heart program in the United States. Slow ventricular tachycardia. Accelerated junctional rhythm: 60 to 100 BPM. The key difference between junctional and idioventricular rhythm is that pacemaker of junctional rhythm is the AV node while ventricles themselves are the dominant pacemaker of idioventricular rhythm. But sometimes, this condition can make you feel faint, weak or out of breath. So, this is the key difference between junctional and idioventricular rhythm. Sinus pause / arrest (there is a single P wave visible on the 6-second rhythm strip). } The latest information about heart & vascular disorders, treatments, tests and prevention from the No. This is called normal sinus rhythm. Junctional bradycardia: Less than 40 BPM. #mc-embedded-subscribe-form input[type=checkbox] { in Molecular and Applied Microbiology, and PhD in Applied Microbiology. Access free multiple choice questions on this topic. [2] Ventricular escape beats become ventricular escape rhythm when three or more escape beats occur in a row at a rate of 20-40 bpm. The rhythm has variable associations relative to bundle branch blocks depending on the foci site. A doctor may also perform additional testing to check for underlying conditions. We avoid using tertiary references. Gangwani MK, Nagalli S. Idioventricular Rhythm. You should contact your provider if you think your pacemaker isnt working or you have an infection. Welcome to /r/MedicalSchool: An international community for medical students. This refresher series will explore the basics of rhythm strip analysis; sinus, atrial, junctional, and ventricular rhythms; blocks, pacemakers, and 12-lead EKGs. Angsubhakorn N, Akdemir B, Bertog S, et al. AS is distinguished by bradycardia, junctional (usually narrow complex) escape rhythm, and absence of the P . When ventricular rhythm takes over, it is essentially called Idioventricular rhythm. http://creativecommons.org/licenses/by-nc-nd/4.0/ Medical therapy may also be beneficial in patients with biventricular failure to restore atrial kick with mechanism, including to increase sinus rate and atrioventricular (AV) conduction. But in more severe cases, you may have symptoms like shortness of breath or fatigue. Things to take into consideration when managing the rhythm are pertinent clinical history, which may help determine the causative etiology. When occurring in adults and elderly it is referred to asnonparoxysmal junctional tachycardia (NPJT) whereas it is referred to asjunctional ectopic tachycardia (JET) in children. The effect of thrombolytic therapy on QT dispersion in acute myocardial infarction and its role in the prediction of reperfusion arrhythmias. When the sinoatrial node is blocked or suppressed, latent pacemakers become active to conduct rhythm secondary to enhanced activity and generate escape beats that can be atrial itself, junctional . There are several potential causes of junctional rhythm. 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Sinus arrhythmia is an abnormal heart rhythm that starts at the sinus node. The conductor from a later stop takes over giving commands for your heart to beat. Whats causing my junctional escape rhythm? Having another heart condition, especially another type of arrhythmia, also puts you at a higher risk of having a junctional rhythm. Junctional escape rhythm is an abnormal rhythm that happens because your heartbeat is starting in an area thats taking over for the area that cant start a strong heartbeat. The heart has several built-in pacemakers that help control its rhythm. Jakkoju A, Jakkoju R, Subramaniam PN, Glancy DL. Cleveland Clinic is a non-profit academic medical center. sinus rhythm). so if the AV node is causing the contraction of the ventricles does that mean the SA node has failed, which means it's a junctional escape rhythm? Figure 2: Ventricular Escape Rhythm ECG Strip [1] A ventricular escape beat occurs after a pause caused by a supraventricular pacemaker failing to fire and appears late after the next expected sinus beat. #mc-embedded-subscribe-form .mc_fieldset { To prevent a junctional rhythm from getting worse, see your provider regularly. When the rate is between 50 to 110 bpm, it is referred to as accelerated idioventricular rhythm. 2. Idioventricular rhythm is a slow regular ventricular rhythm with a rate of less than 50 bpm, absence of P waves, and a prolonged QRS interval. font-weight: normal; In most cases, the patient remains completely asymptomatic and are diagnosed during cardiac monitoring. Junctional Escape Rhythm, 2. Depending on the cause, others with symptoms may need: Although getting a pacemaker is usually a safe procedure, some people can have problems afterward. Cleveland Clinic is a non-profit academic medical center. Junctional Rhythm. StatPearls [Internet]., U.S. National Library of Medicine, 19 July 2021. Instead, if ventricular conduction occurs, it is maintained by a junctional or ventricular escape rhythm. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Junctional escape rhythm is an abnormal rhythm that happens because your heartbeat is starting in an area that's taking over for the area that can't start a strong heartbeat. All rights reserved. Idioventricular rhythm is a cardiac rhythm caused when ventricles act as the dominant pacemaker. When your SA node is hurt and cant start a heartbeat (or one thats strong enough), your heartbeats may start lower down in your atrioventricular node or at the junction of your upper and lower chambers. The patient may have underlying cardiac structural etiology, ischemia as a contributory cause, orit could be secondary to anesthetic type, medication, or an electrolyte disturbance. If you have a junctional rhythm, your hearts natural pacemaker, known as your sinoatrial (SA) node, isnt working as it should. Note the typical QRS morphology in lead V1 characteristic of ventricular ectopy from the LV. Extremely slow broad complex escape rhythm (around 15 bpm). As in ventricular rhythm the QRS complex is wide with discordant ST-T segment and the rhythm is regular (in most cases). Figure 1. Medications, supplements and vitamins you take. There are also 2 ectopic Junctional Beats that you may see as well that we will discuss as well: Junctional Escape Beats and Premature Junctional Contractions (PJCs). What Happens To Your Memories After You Die? Then youll keep having follow-up appointments once or twice a year. Premature ventricular contractions (PVCs) are present. 5. It regularly causes a heart rate of less than 50, though other types can cause increased heart rate, as with different types of junctional rhythm. The main difference between Junctional Escape Rhythm, Junctional Bradycardia, Accelerated Junctional Rhythm and Junctional Tachycardia is the heart rate. The rate of spontaneous depolarisation of pacemaker cells decreases down the conducting system: Under normal conditions, subsidiary pacemakers are suppressed by the more rapid impulses from above (i.e. 15. Idioventricular rhythm can also be seen duringthe reperfusion phase of myocardial infarction, especially in patients receiving thrombolytic therapy.[3]. In occasional scenarios when there is AV dissociation leading to syncope or sustained or incessant AIVR, the risk of sudden death is increased and arrhythmia should be treated.[12]. As true for the other junctional beats and rhythms, the P-wave is retrograde (or invisible). QRS complexes are broad ( 120 ms) and may have a LBBB or RBBB morphology. Nasir JM, Durning SJ, Johnson RL, Haigney MC. Rhythmsarising in the anterior or posterior fascicle of the left bundle branch exhibit a pattern of incomplete right bundle branch block with left posterior fascicular block and left anterior fascicular block, respectively.[8]. Junctional rhythm is an abnormal cardiac rhythm caused when the AV node or His bundle act as the pacemaker. The wide monomorphic ventricular beats sounds like a ventricular escape rhythm, the rhythm rising from below the node. Retrieved June, 2016, from. Ventricular Rhythm & Accelerated Ventricular Rhythm (Idioventricular Rhythm), Pre-excitation, Atrioventricular Reentrant (Reentry) Tachycardia (AVRT) & Wolff-Parkinson-White (WPW) syndrome), Atrioventricular nodal reentry tachycardia (AVNRT), Sinus tachycardia (ST), Inappropriate Sinus tachycardia (IST) and Sinoatrial Node Reentry Tachycardia (SANRT), Management and diagnosis of tachycardias (narrow complex tachycardia and wide complex tachycardia). Identify the following rhythm. This is asymptomatic and benign. font: 14px Helvetica, Arial, sans-serif; These cookies will be stored in your browser only with your consent. Can Brain Activity Explain Near-Death Experiences? When ventricular rhythm takes over, it is essentially called Idioventricular rhythm. In an ECG, junctional rhythm is diagnosed by a wave without p wave or with inverted p wave. Ventricular escape beats occur when the rate of electrical discharge reaching the ventricles (normally initiated by the heart's sinoatrial node, transmitted to the atrioventricular node, and then further transmitted to the ventricles) falls below the base rate determined by the ventricular pacemaker cells. A junctional rhythm is when the AV node and its automaticity is what's driving the ventricles. The LBBB morphology (dominant S wave in V1) suggests a ventricular escape rhythm arising from the. Well-trained athletes may have very high Vagaltone which lowers the automaticity in the sinoatrial node to the point where cells in the AV-junction establishes an escape rhythm. It initiates an electrical impulse that travels through the hearts electrical conduction system to cause the heart to contract, or beat. Can anyone tell me what the difference between the two is? When this area controls the pace of the heart, it is known as junctional rhythm. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Your SA node sends electrical signals that control your heartbeat. Summarize how the interprofessional team can improve outcomes for patients with idioventricular rhythms. Goldberger AL, Amaral LAN, Glass L, Hausdorff JM, Ivanov PCh, Mark RG, Mietus JE, Moody GB, Peng C-K, Stanley HE. Isorhythmic dissociation, fusion or capture beats can occur when sinus and ectopic foci discharge at the same rate.[2]. Other people may need treatment for an underlying condition, such as Lyme disease or heart failure. Sinus rhythm is the rhythm of our heartbeat. [deleted] 3 yr. ago. Advertising on our site helps support our mission. For example, an individual with rheumatic fever may present with a heart murmur, fever, joint pain, or a rash. If your healthcare provider finds a junctional escape rhythm and you dont have symptoms, you probably wont need treatment. However, if you have this diagnosis and symptoms, your provider will most likely focus on the condition thats causing it. (n.d.). With the slowing of the intrinsic sinus rate and ventricular takeover, idioventricular rhythm is generated. If there are cells (with automaticity) distal to the block, an escape rhythm may arise in those cells. A persons outlook is generally positive when a healthcare professional identifies and treats the condition causing the junctional rhythm. [11], However, in reperfusion post-myocardial ischemia and cardiomyopathy, the use of beta-blockers has not shown to decrease the risk of occurrence of idioventricular rhythm.[12]. Also note, the QRS complexes are narrow as the AV node is above the ventricles. The command to beat normally starts in your sinoatrial node (SA node) and works its way down through your heart. (1980). Electrocardiography in Emergency, Acute, and Critical Care, Critical Decisions in Emergency and Acute Care Electrocardiography, Chous Electrocardiography in Clinical Practice: Adult and Pediatric, Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. You can live a healthy life with a junctional rhythm if you: Many people can manage a junctional rhythm with regular visits to their healthcare provider. One out of every 600 Americans older than 65 with a heart problem has something wrong with their sinus node. Learn about the types of arrhythmias, causes, and. When ventricular rhythm takes over, it is essentially called Idioventricular rhythm. There are many symptoms of bradycardia, including confusion and a slow pulse. Junctional escape rhythm is also seen in individuals with atrial standstill (Figure 31-9). If you do have symptoms, they may include: Numerous conditions and medicines can stop your sinoatrial node from sending electrical signals that start your heartbeat. The rate usually is less than 45 beats per minute, which helps to differentiate it from other arrhythmias. A junctional rhythm is when the AV node and its automaticity is what's driving the ventricles. Some of these conditions may be easier than others to avoid. Retrieved July 19, 2016, from, Ventricular escape beat. Your ventricles do all the contracting and pumping, but they cant pump as much blood on their own. A junctional rhythm is a type of arrhythmia (irregular heartbeat). Gangwani, Manesh Kumar. The only time its not is when the AV node overruns the SA node, then it's Accelerated Junctional. Last medically reviewed on December 5, 2022. Complications can include: You can go back to your regular activities a few days after you get a pacemaker, but youll need to wait a week to lift heavy things or drive. The QRS complex will be measured at 0.10 sec or less. Clinical electrocardiography and ECG interpretation, Cardiac electrophysiology: action potential, automaticity and vectors, The ECG leads: electrodes, limb leads, chest (precordial) leads, 12-Lead ECG (EKG), The Cabrera format of the 12-lead ECG & lead aVR instead of aVR, ECG interpretation: Characteristics of the normal ECG (P-wave, QRS complex, ST segment, T-wave), How to interpret the ECG / EKG: A systematic approach, Mechanisms of cardiac arrhythmias: from automaticity to re-entry (reentry), Aberrant ventricular conduction (aberrancy, aberration), Premature ventricular contractions (premature ventricular complex, premature ventricular beats), Premature atrial contraction(premature atrial beat / complex): ECG & clinical implications, Sinus rhythm: physiology, ECG criteria & clinical implications, Sinus arrhythmia (respiratory sinus arrhythmia), Sinus bradycardia: definitions, ECG, causes and management, Chronotropic incompetence (inability to increase heart rate), Sinoatrial arrest & sinoatrial pause (sinus pause / arrest), Sinoatrial block (SA block): ECG criteria, causes and clinical features, Sinus node dysfunction (SND) and sick sinus syndrome (SSS), Sinus tachycardia & Inappropriate sinus tachycardia, Atrial fibrillation: ECG, classification, causes, risk factors & management, Atrial flutter: classification, causes, ECG diagnosis & management, Ectopic atrial rhythm (EAT), atrial tachycardia (AT) & multifocal atrial tachycardia (MAT), Atrioventricular nodal reentry tachycardia (AVNRT): ECG features & management, Pre-excitation, Atrioventricular Reentrant (Reentry) Tachycardia (AVRT), Wolff-Parkinson-White (WPW) syndrome, Junctional rhythm (escape rhythm) and junctional tachycardia, Ventricular rhythm and accelerated ventricular rhythm (idioventricular rhythm), Ventricular tachycardia (VT): ECG criteria, causes, classification, treatment, Long QT (QTc) interval, long QT syndrome (LQTS) & torsades de pointes, Ventricular fibrillation, pulseless electrical activity and sudden cardiac arrest, Pacemaker mediated tachycardia (PMT): ECG and management, Diagnosis and management of narrow and wide complex tachycardia, Introduction to Coronary Artery Disease (Ischemic Heart Disease) & Use of ECG, Classification of Acute Coronary Syndromes (ACS) & Acute Myocardial Infarction (AMI), Clinical application of ECG in chest pain & acute myocardial infarction, Diagnostic Criteria for Acute Myocardial Infarction: Cardiac troponins, ECG & Symptoms, Myocardial Ischemia & infarction: Reactions, ECG Changes & Symptoms, The left ventricle in myocardial ischemia and infarction, Factors that modify the natural course in acute myocardial infarction (AMI), ECG in myocardial ischemia: ischemic changes in the ST segment & T-wave, ST segment depression in myocardial ischemia and differential diagnoses, ST segment elevation in acute myocardial ischemia and differential diagnoses, ST elevation myocardial infarction (STEMI) without ST elevations on 12-lead ECG, T-waves in ischemia: hyperacute, inverted (negative), Wellen's sign & de Winter's sign, ECG signs of myocardial infarction: pathological Q-waves & pathological R-waves, Other ECG changes in ischemia and infarction, Supraventricular and intraventricular conduction defects in myocardial ischemia and infarction, ECG localization of myocardial infarction / ischemia and coronary artery occlusion (culprit), The ECG in assessment of myocardial reperfusion, Approach to patients with chest pain: differential diagnoses, management & ECG, Stable Coronary Artery Disease (Angina Pectoris): Diagnosis, Evaluation, Management, NSTEMI (Non ST Elevation Myocardial Infarction) & Unstable Angina: Diagnosis, Criteria, ECG, Management, STEMI (ST Elevation Myocardial Infarction): diagnosis, criteria, ECG & management, First-degree AV block (AV block I, AV block 1), Second-degree AV block: Mobitz type 1 (Wenckebach) & Mobitz type 2 block, Third-degree AV block (3rd degree AV block, AV block 3, AV block III), Management and treatment of AV block (atrioventricular blocks), Intraventricular conduction delay: bundle branch blocks & fascicular blocks, Right bundle branch block (RBBB): ECG, criteria, definitions, causes & treatment, Left bundle branch block (LBBB): ECG criteria, causes, management, Left bundle branch block (LBBB) in acute myocardial infarction: the Sgarbossa criteria, Fascicular block (hemiblock): left anterior & left posterior fascicular block on ECG, Nonspecific intraventricular conduction delay (defect), Atrial and ventricular enlargement: hypertrophy and dilatation on ECG, ECG in left ventricular hypertrophy (LVH): criteria and implications, Right ventricular hypertrophy (RVH): ECG criteria & clinical characteristics, Biventricular hypertrophy ECG and clinical characteristics, Left atrial enlargement (P mitrale) & right atrial enlargement (P pulmonale) on ECG, Digoxin - ECG changes, arrhythmias, conduction defects & treatment, ECG changes caused by antiarrhythmic drugs, beta blockers & calcium channel blockers, ECG changes due to electrolyte imbalance (disorder), ECG J wave syndromes: hypothermia, early repolarization, hypercalcemia & Brugada syndrome, Brugada syndrome: ECG, clinical features and management, Early repolarization pattern on ECG (early repolarization syndrome), Takotsubo cardiomyopathy (broken heart syndrome, stress induced cardiomyopathy), Pericarditis, myocarditis & perimyocarditis: ECG, criteria & treatment, Eletrical alternans: the ECG in pericardial effusion & cardiac tamponade, Exercise stress test (treadmill test, exercise ECG): Introduction, Indications, Contraindications, and Preparations for Exercise Stress Testing (exercise ECG), Exercise stress test (exercise ECG): protocols, evaluation & termination, Exercise stress testing in special patient populations, Exercise physiology: from normal response to myocardial ischemia & chest pain, Evaluation of exercise stress test: ECG, symptoms, blood pressure, heart rate, performance.

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