You can learn more about how we ensure our content is accurate and current by reading our. Accelerated idioventricular rhythm (AIVR) at a rate of 55/min presumably originating from the left ventricle (LV). Idioventricular rhythm is very similar to ventricular tachycardia, except the rate is less than 60 bpm and is alternatively called a "slow ventricular tachycardia." Advertising on our site helps support our mission. The primary objective is to treat the underlying cause and/or eliminate provocativemedications. Very rarely, atrial pacing may be an option. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. http://creativecommons.org/licenses/by-nc-nd/4.0/ 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. 1. Undefined cookies are those that are being analyzed and have not been classified into a category as yet. font-weight: normal; #mergeRow-gdpr fieldset label { Treatments and outcomes can vary based on the underlying cause. Junctional Escape Rhythm: Rate: Usually 40-60 bpm Rhythm: Regular P waves: Usually inverted P-waves before the QRS or after the QRS. People without symptoms dont need treatment, but those with symptoms may need medicine or a procedure to fix the problem. Junctional Rhythm: Causes, Symptoms and Treatment - Cleveland Clinic In mild cases of junctional rhythm, you may not feel any different. [deleted] 3 yr. ago. Policy. [9], Management principles of idioventricular rhythm involve treating underlying causative etiology such as digoxin toxicity reversal if present, management of myocardial ischemia, or other cardiac structural/functional problems. During ventricular tachycardia, ECG generally shows a rate greater than 120 bpm. The following must be noted: In both cases listed above the impulse will originate in the junction between the atria and the ventricles, which is why ectopic beats and ectopic rhythms originating there are referred to as junctional beats and junctional rhythms. Other Cardiology.pdf - Cardiology Study Guide - 2021 Usually, your heartbeat starts in your sinoatrial node and travel down through your heart. [Level 5]. SA node is the default natural pacemaker of our heart and causes sinus rhythm. PR interval: Short PR interval (less than 0.12) if P-wave not hidden. [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. 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 . Junctional TachycardiaBy James Heilman, MD Own work (CC BY-SA 4.0) via Commons Wikimedia http://creativecommons.org/licenses/by-nc-nd/4.0/. Cardiovascular health: Insomnia linked to greater risk of heart attack. With regular medical care, many people live full, healthy lives with a junctional rhythm. Sinus arrhythmia is an abnormal heart rhythm that starts at the sinus node. Can diet help improve depression symptoms? 6. You are not required to obtain permission to distribute this article, provided that you credit the author and journal. What are the three types of junctional rhythms? - Sage-Answers 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. display: inline; The types and associated heart rates include: Symptoms can vary and may not be present in people with a junctional rhythm. However, if the SA node paces too slowly, or not at all, the AV junction may be able to pace the heart. During junctional rhythm, the heart beats at 40 60 beats per minute. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. As discussed in Chapter 1 the atrioventricular node does not exhibit automaticity, meaning that it does not dischargespontaneous action potentials, at least not under normal circumstances. From Wikimedia Commons User : Cardio Networks (CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0/deed.en). What is the latest research on the form of cancer Jimmy Carter has? The 12-lead ECG shown below illustrates a junctional escape rhythm in a well-trained athlete whose resting sinus rate is slower than the junctional rate. Atrioventricular Block - StatPearls - NCBI Bookshelf How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://borjigin.lab.medicine.umich.edu/research/ecm/ecm-arrhythmia-library/junctional-arrhythmias/accelerated-junctional-rhythm, https://onlinelibrary.wiley.com/doi/full/10.1002/joa3.12410, https://www.ncbi.nlm.nih.gov/books/NBK554520/, https://www.ncbi.nlm.nih.gov/books/NBK507715/, https://www.ncbi.nlm.nih.gov/books/NBK557664/, https://www.ncbi.nlm.nih.gov/books/NBK544253/, https://www.kaweahhealth.org/documents/float-pool/Arrhythmia-Study-Guide-3-Junctional-and-Ventricular.pdf, https://borjigin.lab.medicine.umich.edu/research/ecm/ecm-arrhythmia-library/junctional-arrhythmias/junctional-escape-rhythm, https://my.methodistcollege.edu/ICS/icsfs/mm/junctional_rhythm-resource.pdf?target=5a205551-09a5-4fef-a7ef-e9d1418db53a, https://www.ncbi.nlm.nih.gov/books/NBK459238/, https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-016-0645-9, https://www.ncbi.nlm.nih.gov/books/NBK531498/, https://www.texasheart.org/heart-health/heart-information-center/frequently-asked-patient-questions/can-you-explain-if-when-junctional-rhythm-is-a-serious-issue/, https://www.ncbi.nlm.nih.gov/books/NBK546663/. National Heart, Lung, and Blood Institute. Take medications as prescribed by your provider. One out of every 600 Americans older than 65 with a heart problem has something wrong with their sinus node. fainting or feeling like a person may pass out. [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. It occurs equally between males and females. 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. The more current data correlates the presence of AIVR with reperfusion with myocardial infarction during the acute phase with the suggestion of vessel opening however does not suggest it to be a marker for reperfusion during the acute phase of myocardial infarction.[6]. P waves: Usually inverted P-waves before the QRS or after the QRS. Retrieved August 08, 2016, from, MIT-BIH Arrhythmia Database. Junctional Bradycardia. Arrhythmia is an irregular heartbeat. Broad complex escape rhythm with a LBBB morphology at a rate of 25 bpm. 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. This essentially concludes the breakdown of Junctional Rhythms! Hafeez, Yamama. These cookies do not store any personal information. Required fields are marked *. Junctional rhythm may arise in the following situations: Figure 1 (below) displays two ECGs with junctional escape rhythm. What is the Difference Between Junctional and Idioventricular Rhythm New comments cannot be posted and votes cannot be cast. Types include bradyarrhythmia or supraventricular arrhythmia. 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. PR interval: Normal or short if the P-wave is present. Some common symptoms of junctional rhythm may include fatigue, dizziness, fainting, feelings of fainting, and intermittent palpitations. Do I need treatment for junctional escape rhythm? In accelerated junctional rhythm, the heartbeat will be 60 100 beats per minute. Retrieved July 19, 2016, from, Ventricular escape beat. background: #fff; It is also characterized by the absence of a p wave and a prolonged QRS interval. This topic reviews the evaluation and management of idioventricular rhythm. Junctional rhythm can also occur in young athletes and children, particularly during sleep. Cleveland Clinic is a non-profit academic medical center. Symptomatic junctional rhythm is treated with atropine. Regular ventricular rhythm with rate 40-60 beats per minute. Consider your treatment options and ask questions if theres anything that isnt clear. We do not endorse non-Cleveland Clinic products or services. Idioventricular rhythm is a cardiac rhythm caused when ventricles act as the dominant pacemaker. This is called normal sinus rhythm. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Have any questions? A normal sinus beat followed by a premature ventricular beat resets the sinus node timing cycle. It initiates an electrical impulse that travels through the hearts electrical conduction system to cause the heart to contract, or beat. As true for the other junctional beats and rhythms, the P-wave is retrograde (or invisible). These interprofessional strategies will drive better patient outcomes. School Southern University and A&M College; Course Title NURS 222; Uploaded By twinzer12. There is a complete dissociation between the atria and ventricles. Junctional rhythm (escape rhythm) and junctional tachycardia - ECG & ECHO Figure 1. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Ventricular escape rhythm (Concept Id: C0232216) - National Center for Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. The atria and ventricles conduct independent of each other. If you have a junctional rhythm, you may not have any symptoms. You may need treatment if your blood oxygen levels are too low or your symptoms bother you. 5. The main difference between Junctional Escape Rhythm, Junctional Bradycardia, Accelerated Junctional Rhythm and Junctional Tachycardia is the heart rate. A junctional escape beat is essentially a junctional ectopic beat that occurs within the underlying rhythm. Extremely slow broad complex escape rhythm (around 15 bpm). Premature beat: an aberrant impulse released from an automaticity focus which is then conducted before the sinus impulse Escape beat: an aberrant impulse released from an automaticity focus when there is failed conduction within the SA and/or AV nodes Tachycardic ectopic beat: a rapidly-firing beat causing tachycardia. sinus rhythm). Care coordination between various patient care teams to determine etiology presenting idioventricular rhythm is very helpful. A slow regular ventricular rhythm during AFL raises the question of whether it is AFL with fixed atrioventricular conduction or AFL with underlying complete heart block (CHB) and a junctional/ventricular escape rhythm. Information about your use of this site is shared with Google. PEA encompasses a number of organized cardiac rhythms, including supraventricular rhythms (sinus versus nonsinus) and ventricular rhythms (accelerated idioventricular or escape). Idioventricular rhythm is a benign rhythm, and it does not usually require treatment. They can better predict a persons success rate and overall outlook. These cookies will be stored in your browser only with your consent. Gangwani, Manesh Kumar. Your symptoms are getting worse or they prevent you from doing daily activities. But sometimes, this condition can make you feel faint, weak or out of breath. If there are cells (with automaticity) distal to the block, an escape rhythm may arise in those cells. Junctional tachycardia (junctional ectopic tachycardia) is a rare heart rhythm that starts from a natural pacemaker, but not the one your heart normally uses. Third Degree Heart Block with Junctional Escape Rhythm For example, an individual with rheumatic fever may present with a heart murmur, fever, joint pain, or a rash. In most cases, the P-wave is not visible because when impulses are discharged from the junctional area, atria and ventricles are depolarized simultaneously and ventricular depolarization (QRS) dominates the ECG. An 'escape rhythm' refers to the phenomenon when the primary pacemaker fails (the SA node) and something else picks up the slack in order to prevent cardiac arrest. The P waves (atrial activity) are said to "march through" the QRS complexes at their regular, faster rate. Many medical conditions (See Causes and Symptoms section) can cause junctional escape rhythm. Electrolyte abnormalities canincrease the chances ofidioventricular rhythm. This site uses cookies from Google to deliver its services and to analyze traffic. Identify the following rhythm. width: auto; Learn more. An interprofessional team that provides a holistic and integrated approach is essential when noticing an idioventricular rhythm. These pacemakers normally work together every time your heart pumps, and they include your: All types of junctional rhythms occur when the SA node isnt working correctly. Your ventricles do all the contracting and pumping, but they cant pump as much blood on their own. 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. StatPearls [Internet]., U.S. National Library of Medicine, 19 July 2021. Review the clinical context leading to idioventricular rhythm and differentiate from ventricular tachycardia and other similar etiologies. Hohnloser SH, Zabel M, Olschewski M, Kasper W, Just H. Arrhythmias during the acute phase of reperfusion therapy for acute myocardial infarction: effects of beta-adrenergic blockade. Also note, the QRS complexes are narrow as the AV node is above the ventricles. Ornek E, Duran M, Ornek D, Demirelik BM, Murat S, Kurtul A, iekiolu H, etin M, Kahveci K, Doger C, etin Z. However, if you have this diagnosis and symptoms, your provider will most likely focus on the condition thats causing it. Some possible causes include the following conditions and health factors: Certain medications and therapies may also cause junctional rhythm. The rate usually is less than 45 beats per minute, which helps to differentiate it from other arrhythmias. } UpToDate 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? 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. Create an account to follow your favorite communities and start taking part in conversations. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. In such scenarios, cells in the bundle of His (which possess automaticity) will not be reached by the atrial impulse and hence start discharging action potentials and an escape rhythm. Basic Arrhythmias by Gail Walraven (2016, Trade Paperback The QRS complex will be measured at 0.10 sec or less. When symptoms do occur, they typically reflect the underlying condition causing the junctional rhythm. 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. 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 . Treasure Island (FL): StatPearls Publishing; 2022 Jan-. This is asymptomatic and benign. Ventricular Premature Complexes Differential Diagnoses - Medscape When you have a junctional rhythm, your SA node stops working or sends signals that are too slow or weak. Is the ketogenic diet right for autoimmune conditions? Rhythm: ventricular: regular, atrial: absent, Rate: less than 40 beats per minute for idioventricular rhythm, Rate 50 to 110 bpm for accelerated idioventricular rhythm, QRS complex: Wide (greater than 0.10 seconds), Supraventricular tachycardia with aberrancy, Slow antidromic atrioventricular reentry tachycardia. Note the typical QRS morphology in lead V1 characteristic of ventricular ectopy from the LV. It can occur for a variety of reasons, and junctional rhythm itself is not typically a problem. Indeed, the surface ECG frequency cannotdifferentiate escape rhythms originating near the atrioventricular node from those originating in the bundle of His. The LBBB morphology (dominant S wave in V1) suggests a ventricular escape rhythm arising from the. Electrical cardioversion is ineffective and should be avoided (electrical cardioversion may be pro-arrhythmogenic in patients on digoxin). Therefore, close coordination between teams is mandatory. Access free multiple choice questions on this topic. 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 incomplete right bundle branch block is seen when the pacemaker is in the left bundle branch. ECG Basics and Rhythm Review: Junctional Rhythms - Nursology101 There are several potential causes, including medical issues, medication side effects, and genetics, among others. Rhythm will be regular with a rate of 40-60 bpm. [1] In most cases, the patient remains completely asymptomatic and are diagnosed during cardiac monitoring. Junctional vs Idioventricular Rhythmin Tabular Form As your whole heart contracts, it pumps blood out to your body. So let us continue to Junctional Rhythms which occurs when the primary pacemaker of the heart is the AV node. Junctional and ventricular escape rhythms arise when the rate of supraventricular impulses arriving at the AV node or ventricle is less than the intrinsic rate of the ectopic pacemaker. Depending upon the junctional escape rate, ventricular function, and clinical symptoms, these patients may benefit from permanent pacing. For example, consider a complete block located in the atrioventricular node. As in ventricular rhythm the QRS complex is wide with discordant ST-T segment and the rhythm is regular (in most cases). Figure 1: Ventricular Escape Beat ECG Strip[1], 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. How your pacemaker is working, if you have one. PR interval: Normal or short if the P-wave is present. This can include testing for thyroid conditions or heart failure or performing: Treatment will vary greatly depending on the underlying cause. 1-ranked heart program in the United States. 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. #mergeRow-gdpr { They often occur during sinus arrest or after premature atrial complexes. The default pacemaker area is the SA node. Analytical cookies are used to understand how visitors interact with the website. The command to beat normally starts in your sinoatrial node (SA node) and works its way down through your heart. Common complications of junctional rhythm can include: The following section provides answers to commonly asked questions about junctional rhythm. Junctional rhythm is an abnormal cardiac rhythm caused when the AV node or His bundle act as the pacemaker. Sinus pause / arrest (there is a single P wave visible on the 6-second rhythm strip). border: none; A junctional rhythm is when the AV node and its automaticity is what's driving the ventricles. However, the underlying cause of the junctional rhythm may require treatment. The conductor from a later stop takes over giving commands for your heart to beat. Various medicationssuch as digoxin at toxic levels, beta-adrenoreceptor agonistslike isoprenaline, adrenaline,anestheticagents including desflurane, halothane, and illicit drugs like cocaine have reported being etiological factorsin patientswith AIVR. The AV junction includes the AV node, bundle of His, and surrounding tissues that only act as pacemaker of the heart when the SA node is not firing normally. In this article, you will learn about rhythms arising in, or near, the atrioventricular (AV) node. (n.d.). Your symptoms should go away after you have treatment or change medications. Lifestyle, including whether you consume caffeine or use tobacco products or alcohol. Junctional Escape Beat - an overview | ScienceDirect Topics ( We avoid using tertiary references. (adsbygoogle = window.adsbygoogle || []).push({}); Copyright 2010-2018 Difference Between. A junctional escape beat is a delayed heartbeat that occurs when "the rate of an AV junctional pacemaker exceeds that of the sinus node." [2] Junctional Rhythms are classified according to their rate: junctional escape rhythm has a rate of 40-60 bpm, accelerated junctional rhythm has a rate of 60-100 bpm, and junctional tachycardia has a rate greater than 100 bpm. There are several types of junctional rhythm. Preference cookies are used to store user preferences to provide content that is customized and convenient for the users, like the language of the website or the location of the visitor. Atrial activity on the surface ECG may be difficult to discern when retrograde P waves are concealed within the QRS . Goldberger AL, Amaral LAN, Glass L, Hausdorff JM, Ivanov PCh, Mark RG, Mietus JE, Moody GB, Peng C-K, Stanley HE. If your medications are working well for you and if you have any side effects. 5. Policy. When ventricular rhythm takes over, it is essentially called Idioventricular rhythm. Basic knowledge of arrhythmias and cardiac automaticity will facilitate understanding of this article. ECG Learning Center - An introduction to clinical electrocardiography Can anyone tell me what the difference between the two is? PR interval: Normal or short if there is a P-wave present. Get useful, helpful and relevant health + wellness information. Sometimes it happens without an obvious cause. If symptoms interfere with your daily life, your provider may recommend treatment to regulate your heartbeat. It is the natural pacemaker of the heart. 1 The patient's presenting ECG shows regular flutter waves and regular QRS complexes but with varying intervals from flutter wave to QRS complex. Your atria (upper two chambers of the heart) dont get the electrical signals from your SA node. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) If you have a junctional rhythm, a small wave called a P wave is either inverted (upside down) or missing on your EKG. Save my name, email, and website in this browser for the next time I comment. Now that we have gone through rhythms generated from the SA node and atrium, we will move down to what a rhythm looks like when the AV node generates an impulse and becomes the primary pacemaker of the heart. . min-height: 0px; There are many symptoms of bradycardia, including confusion and a slow pulse. Idioventricular rhythm is a cardiac rhythm caused when ventricles act as the dominant pacemaker. Dr.Samanthi Udayangani holds a B.Sc. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://familydoctor.org/condition/arrhythmia/), (https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia), (https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/how-the-healthy-heart-works). AS is distinguished by bradycardia, junctional (usually narrow complex) escape rhythm, and absence of the P . Subsequently, the ventricle may assume the role of a dominant pacemaker. Ventricular escape beat - wikidoc Can Brain Activity Explain Near-Death Experiences? Your provider may recommend regular checkups and EKGs to monitor your heart health. Your healthcare provider will do a physical exam and ask for your medical history. The most common rhythm arising in the AV node is junctional rhythm, which may also be referred to as junctional escape rhythm. The idioventricular rhythm becomes accelerated when the ectopic focusgenerates impulsesabove its intrinsic rateleading toa heart rate between 50 to 110 beats per minute. All rights reserved. For all courses in basic or introductory cardiography Focused coverage and realistic hands-on practice help students master basic arrhythmias Basic Arrhythmias , 8th Edition , gives beginning students a strong basic understanding of the common, uncomplicated rhythms that are a foundation for further learning and success in electrocardiography. So, this is the key difference between junctional and idioventricular rhythm. When the SA is blocked or depressed, secondary pacemakers (AV node and Bundle of His) become active to conduct rhythm. Accelerated idioventricular rhythm (AIVR) at a rate of 55/min presumably originating from the left ventricle (LV). Other individuals may require a pacemaker. You can email me at Nursology01@gmail.com. Included in the structure are natural pacemakers that help regulate how often the heart beats. Ventricular Escape Rhythm: A ventricular rhythm with a rate of 20-40 bpm. The heart beats at a rate of less than 50 bpm. Junctional Rhythms | Junctional Escape Rhythms | Junctional Tachycardia By clicking Accept, you consent to the use of ALL the cookies. When ventricular rhythm takes over, it is essentially called Idioventricular rhythm. Saeed, M. (n.d.). These include: Diagnosis will likely start with a review of the persons personal and family medical history. Problems with the devices wires getting out of place. Borjigin Lab - Junctional Escape Beat - University of Michigan P-waves can also be hidden in the QRS. Accelerated ventricular rhythm (idioventricular rhythm) is a rhythm with rate at 60-100 beats per minute. When ventricular rhythm takes over, it is essentially called Idioventricular rhythm. Accelerated idioventricular rhythm is a type of idioventricular rhythm during which the heart rate goes to 50-110 bpm. A junctional rhythm usually isnt life-threatening, but if you have symptoms that interfere with your daily life, you may need treatment. Her research interests include Bio-fertilizers, Plant-Microbe Interactions, Molecular Microbiology, Soil Fungi, and Fungal Ecology. One of the causes of idioventricular rhythm is heart defect at birth. A Junctional Escape Rhythm is a sequence of 3 or more junctional escapes occurring by default at a rate of 40-60 bpm. Ventricular pacemaker cells discharge at a slower rate than the SA or AV node. Your heart responds by using one of your backup pacemakers instead. Idioventricular rhythm is similar to ventricular tachycardia, except the rate is less than 60 bpm and is alternatively called a 'slow ventricular tachycardia.' 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.