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Cardiac Aberration
Cardiac aberrancy is a type of disruption in the shape of the electrocardiogram signal, representing abnormal activation of the ventricular heart muscle via the electrical conduction system of the heart. Normal activation utilizes the bundle of His and Purkinje fibers to produce a narrow (QRS) electrical signal. Aberration occurs when the electrical activation of the heart, which is caused by a series of action potentials, is conducting improperly which can result in temporary changes in the morphology that looks like: * Left bundle branch block ** Left anterior fascicular block ** Left posterior fascicular block * Right bundle branch block This is in contrast to a permanent dysfunction of the electrical pathways that produces wide QRS complexes in one of the above patterns or combinations of patterns (ie, bifascicular block). In the context of atrial fibrillation, the Ashman phenomenon is a form of aberrancy. Aberrancy is due to prematurity in which part of the conduction ...
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Atrial Fibrillation With Rapid Ventricular Response
Atrial fibrillation (AF, AFib or A-fib) is an abnormal heart rhythm (arrhythmia) characterized by rapid and irregular beating of the atrial chambers of the heart. It often begins as short periods of abnormal beating, which become longer or continuous over time. It may also start as other forms of arrhythmia such as atrial flutter that then transform into AF. Episodes can be asymptomatic. Symptomatic episodes may involve heart palpitations, fainting, lightheadedness, loss of consciousness, or shortness of breath. Atrial fibrillation is associated with an increased risk of heart failure, dementia, and stroke. It is a type of supraventricular tachycardia. Atrial fibrillation frequently results from bursts of tachycardia that originate in muscle bundles extending from the atrium to the pulmonary veins. Pulmonary vein isolation by transcatheter ablation can restore sinus rhythm. The ganglionated plexi (autonomic ganglia of the heart atrium and ventricles) can also be a sour ...
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Right Bundle Branch Block
A right bundle branch block (RBBB) is a heart block in the Bundle branches#Structure, right bundle branch of the Electrical conduction system of the heart, electrical conduction system. During a right bundle branch block, the right ventricle (heart), ventricle is not directly activated by impulses traveling through the right bundle branch. However, the left bundle branch still normally activates the left ventricle. These impulses can then travel through the myocardium of the left ventricle to the right ventricle and depolarize the right ventricle this way. As conduction through the myocardium is slower than conduction through the bundle of His-Purkinje fibres, the QRS complex is seen to be widened. The QRS complex often shows an extra deflection that reflects the rapid depolarisation of the left ventricle, followed by the slower depolarisation of the right ventricle. Incomplete right bundle branch block An incomplete right bundle branch block (IRBBB) is a conduction abnormalit ...
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Electrocardiography
Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity through repeated cardiac cycles. It is an electrogram of the heart which is a graph of voltage versus time of the electrical activity of the heart using electrodes placed on the skin. These electrodes detect the small electrical changes that are a consequence of cardiac muscle depolarization followed by repolarization during each cardiac cycle (heartbeat). Changes in the normal ECG pattern occur in numerous cardiac abnormalities, including: * Cardiac rhythmicity, Cardiac rhythm disturbances, such as atrial fibrillation and ventricular tachycardia; * Inadequate coronary artery blood flow, such as myocardial ischemia and myocardial infarction; * and electrolyte disturbances, such as hypokalemia. Traditionally, "ECG" usually means a 12-lead ECG taken while lying down as discussed below. However, other devices can record the electrical activity of ...
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Concealed Conduction
Concealed conduction is tissue stimulation without direct effect, but leading to a change in conduction characteristics. The term "concealed" is in reference to that the conduction is not observable by electrocardiogram. A common example would be an ''interpolated PVC'' (a type of premature ventricular contraction) during normal sinus rhythm; the PVC does not cause an atrial contraction, because the retrograde impulse from the PVC does not completely penetrate the AV node. However, this AV node stimulation can cause a delay in subsequent AV conduction by modifying the AV node's subsequent conduction characteristics. Hence, the P-R interval after the PVC is longer than the baseline P-R interval. Concealed conduction can be seen in cardiac aberrancy when a bundle branch temporarily blocks due to being refractory, and conduction from the other bundle branch conceals into the blocked branch retrograde thus perpetuation the bundle branch block morphology in subsequent beats. For exam ...
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Tachycardia
Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal (such as with exercise) or abnormal (such as with electrical problems within the heart). Complications Tachycardia can lead to fainting. When the rate of blood flow becomes too rapid, or fast blood flow passes on damaged endothelium, it increases the friction within vessels resulting in turbulence and other disturbances. According to the Virchow's triad, this is one of the three conditions (along with hypercoagulability and endothelial injury/dysfunction) that can lead to thrombosis (i.e., blood clots within vessels). Causes Some causes of tachycardia include: * Adrenergic storm * Anaemia * Anxiety * Atrial fibrillation * Atrial flutter * Atrial tachycardia * Atrioventricular reentrant tachycardia * AV nodal reentrant tachy ...
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Cardiac Action Potential
Unlike the action potential in skeletal muscle cells, the cardiac action potential is not initiated by nervous activity. Instead, it arises from a group of specialized cells known as pacemaker cells, that have automatic action potential generation capability. In healthy hearts, these cells form the cardiac pacemaker and are found in the sinoatrial node in the right atrium. They produce roughly 60–100 action potentials every minute. The action potential passes along the cell membrane causing the cell to contract, therefore the activity of the sinoatrial node results in a resting heart rate of roughly 60–100 beats per minute. All cardiac muscle cells are electrically linked to one another, by intercalated discs which allow the action potential to pass from one cell to the next. This means that all atrial cells can contract together, and then all ventricular cells. Rate dependence of the action potential is a fundamental property of cardiac cells and alterations can lead to se ...
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Ashman Phenomenon
Ashman phenomenon, also known as Ashman beats, describes a particular type of wide QRS complex that is typically, but not always seen in atrial fibrillation. It is a type of cardiac aberrancy and it is more often misinterpreted as a premature ventricular complex. It is named for Richard Ashman (of New Orleans) (1890 –1969), after first being described by Gouaux and Ashman in 1947. Presentation Ashman beats are described as wide complex QRS complexes that follow a short R-R interval preceded by a long R-R interval. This short QRS complex typically has a right bundle branch block morphology and represents an aberrantly conducted complex that originates above the AV node, rather than a complex that originates in either the right or left ventricle. Cause It occurs because the duration of the refractory period of the myocardium is proportional to the R-R interval of the preceding cycle. A short R-R interval is associated with a shorter duration of action potential and vice ver ...
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Atrial Fibrillation
Atrial fibrillation (AF, AFib or A-fib) is an Heart arrhythmia, abnormal heart rhythm (arrhythmia) characterized by fibrillation, rapid and irregular beating of the Atrium (heart), atrial chambers of the heart. It often begins as short periods of abnormal cardiac cycle, beating, which become longer or continuous over time. It may also start as other forms of arrhythmia such as atrial flutter that then transform into AF. Episodes can be asymptomatic. Symptomatic episodes may involve heart palpitations, syncope (medicine), fainting, Presyncope, lightheadedness, Unconsciousness, loss of consciousness, or shortness of breath. Atrial fibrillation is associated with an increased risk of heart failure, dementia, and stroke. It is a type of supraventricular tachycardia. Atrial fibrillation frequently results from bursts of tachycardia that originate in muscle bundles extending from the Atrium (heart), atrium to the pulmonary veins. Pulmonary vein isolation by catheter ablation, trans ...
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Bifascicular Block
Bifascicular block is characterized by right bundle branch block with left anterior fascicular block, or right bundle branch block with left posterior fascicular block on electrocardiography. Complete heart block could be the cause of syncope that is otherwise unexplained if bifascicular block is seen on electrocardiography. It is estimated that less than 50% of patients with bifascicular block have high-degree atrioventricular block, although the exact incidence is unknown. The European Society of Cardiology (ESC) suggests using electrophysiology studies to look into it (EPS). When pharmacologic stress or incremental atrial pacing induces high-degree atrioventricular block, a permanent pacemaker (PPM) is recommended. If EPS is negative, long-term rhythm monitoring with an implantable loop recorder (ILR) is advised. Most commonly, it refers to a combination of right bundle branch block (RBBB) and either left anterior fascicular block (LAFB) or left posterior fascicular ...
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Left Posterior Fascicular Block
A left posterior fascicular block (LPFB), also known as left posterior hemiblock (LPH), is a condition where the left posterior fascicle, which travels to the inferior and posterior portion of the left ventricle, does not conduct the electrical impulses from the atrioventricular node. The wave-front instead moves more quickly through the left anterior fascicle and right bundle branch, leading to a right axis deviation seen on the ECG. Definition The American Heart Association The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate Heart, cardiac care in an effort to reduce disability ... has defined a LPFB as: * Frontal plane axis between 90° and 180° in adults * rS pattern in leads I and aVL * qR pattern in leads III and aVF * QRS duration less than 120 ms The broad nature of the posterior bundle as well as its dual blood supply makes i ...
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RBBB
A right bundle branch block (RBBB) is a heart block in the right bundle branch of the electrical conduction system. During a right bundle branch block, the right ventricle is not directly activated by impulses traveling through the right bundle branch. However, the left bundle branch still normally activates the left ventricle. These impulses can then travel through the myocardium of the left ventricle to the right ventricle and depolarize the right ventricle this way. As conduction through the myocardium is slower than conduction through the bundle of His-Purkinje fibres, the QRS complex is seen to be widened. The QRS complex often shows an extra deflection that reflects the rapid depolarisation of the left ventricle, followed by the slower depolarisation of the right ventricle. Incomplete right bundle branch block An incomplete right bundle branch block (IRBBB) is a conduction abnormality in the right bundle branch block. While a complete RBBB has a QRS duration of 120 ms ...
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Left Anterior Fascicular Block
Left anterior fascicular block (LAFB) is an abnormal condition of the left ventricle of the heart, related to, but distinguished from, left bundle branch block (LBBB). It is caused by only the left anterior fascicle – one half of the left bundle branch being defective. It is manifested on the ECG by left axis deviation. It is much more common than left posterior fascicular block. Mechanism Normal activation of the left ventricle (LV) proceeds down the left bundle branch, which consist of three fascicles, the left anterior fascicle, the left posterior fascicle, and the septal fascicle. The posterior fascicle supplies the posterior and inferoposterior walls of the LV, the anterior fascicle supplies the upper and anterior parts of the LV and the septal fascicle supplies the septal wall with innervation. LAFB — which is also known as left anterior hemiblock (LAHB) — occurs when a cardiac impulse spreads first through the left posterior fascicle, causing a delay in activation ...
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