(精选)Sinus Arrhythmia教学课件.ppt

Right Bundle Branch Block The diagnostic criteria include 1.QRS duration is 120 ms 2.An rsr’,rsR’ or rSR’ pattern in lead V1 or V2 and occasionally a wide and notched R wave. 3.Reciprocal changes in V5,V6,I and AVL * * * * Incomplete RBBB Criteria for incomplete RBBB are the same as for complete RBBB except that the QRS duration is 120 ms * IRBBB * interventricular conduction delay IVCD Nonspecific Intraventricular Conduction Defects (IVCD) QRS duration 0.10s indicating slowed conduction in the ventricles Criteria for specific bundle branch or fascicular blocks not met * * * * bilateral bundle branch block (BBBB) interruption of cardiac impulses through both bundle branches, clinically indistinguishable from third degree (complete) heart block. * Fascicular Blocks The left bundle branch divides into two fascicles 1.Superior and anterior 2.Inferior and posterior * Types Of Fascicular Block Left anterior fascicular block Left posterior fascicular block Bifascicular Block Trifascicular Block * * Left Anterior Fascicular Block Left axis deviation , usually -45 to -90 degrees  QRS duration usually 0.12s unless coexisting RBBB  Poor R wave progression in leads V1-V3 and deeper S waves in leads V5 and V6  There is RS pattern with R wave in lead II III S wave in lead III lead II QR pattern in lead I and AVL,with small Q wave No other causes of left axis deviation * Dx Regular-Irregular Or Irregular-Irregular Regular-Irregular: SA Block type2 or SA arrest PP’ = 2 x PP SA Block type2 Irregular-Irregular: SA Block type1 vs S. arrhythmia * Sick Sinus Syndrome All result in bradycardia Sinus bradycardia (rate of ~43 bpm) with a sinus pause Often result of tachy-brady syndrome: where a burst of atrial tachycardia (such as afib) is then followed by a long, symptomatic sinus pause/arrest, with no breakthrough junctional rhythm. * SSS * Sick sinus syndrome is an indication for a permanent pacemaker. Pharmacologic treatment of atrial tachyarrhyth