4th Pediatric Infectious Diseases Conference
 
 
Home  Back   ISSN 0973 - 0958
 
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FIND DIAGNOSIS
FIND DIAGNOSIS
Find Diagnosis
Pedi Poll
Today's Poll
Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?
No, it should be used only after drug sensitivity report
Yes, under guidance of an infectious disease expert
Arrhythmias
ARRHYTHMIAS
Dr N.C.Joshi
Consultant Pediatrician,
Consultant at Nanavati Hospital,
Ex Dean:-B.J.Wadia Children's Hospital.

CONDUCTION SYSTEM

Figure 1. Conduction System

Conduction System

SINUS RHYTHM

Definition: Rhythm originating in the sinus node.

QRS COMPLEX:

Consider the following when looking at the QRS complex

  • Regular or irregular

  • How fast?

  • P-waves

  • Narrow or wide

  • P-wave axis

  • Association of P-waves to QRS

  • Narrow QRS

    • Definition:

      Infant < 80 msec
      Child < 85 msec

    • It is generally supraventricular in origin

      Generally requires activation through bundle of His

  • Wide QRS

    • It is often of ventricular origin

    • Also seen with Aberrant conduction (Rate-related versus present in sinus)

    • There may be presence of accessory connection

    • Associated with Drug-effects

    • Seen with electrolyte imbalance

    • Wide QRS of Ventricular origin

      The following is supportive of ventricular origin:

      • Positive concordance (If no RVH)

      • AV dissociation

    • Wide QRS of Aberrancy

      Fixed bundle branch block

      • Common in post-op hearts

      • Reflects conduction system disease in unoperated hearts

      Rate-related

      • Ashman phenomenon

      • Failure of bundle to consistently conduct at higher rates

      • Usually refractory period of right bundle is more than left bundle

    • Wide QRS of Accessory connection

      • Bundle Branch morphology: opposite location of accessory connection

      • May be present intermittently in sinus rhythm

    • Wide QRS of Drug effects

      • Type IA anti-arrythmics prolong

      • Tricyclic antidepressants may prolong

    • Wide QRS of Electrolytes

      • Hyperkalemia prolongs

      • Hypoxia and acidosis prolong

 
 
 
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