Extrasystole and blocks

1. Extrasystole

2. Экстрасистолия

– a prematurely occurring beat of one of the
chambers of the heart that leads to
momentary arrhythmia but leaves the
fundamental rhythm unchanged

3.

Extrasystole is a special case of ectopic beats.
Ectopic beat is myocardial excitation of nonsinus origin.
Premature ectopic beat - extrasystole (active
rhythm disturbances)
Late ectopic beat is a replacement complex that
saves from asystole – escape beat (passive)

4.

Ventricular extrasystole
600 мс
400 мс
Atrial escape beat

5. Supraventricular ES

6. Ventricular ES

300 мс
680 мс

7.

QRS< 100 ms,
narrow
Preectopic
interval
Postectopic
interval
Compesatory pause
CP in SVES < 2RR
CP in VES ≥ 2RR
QRS > 120 ms, wide
1550 мс
1550 мс

8.

9.

10. Ventricular ES

Classification (reference criteria):
•The form
•A source
•Time of appearance
•Amount
•Allorhythmy
•Prognostic value (clinical)

11. The form (morphology)

12.

13. Time of appearance

14.

Amount:
-single
-paired

15.

16.

17. Allorhythmias

• Bigeminy
• trigeminy

18. Heart block

3 курс

19. Heart blocks

Classification:
By localization:
- Sinoatrial block
- Intra and inter atrial
- Atrioventricular block:
proximal (AVN)
distal (His Bundle)
- Bundle branch block
By duration: transitory and permanent
By origin: Structural and autonomic

20.

SN exit block
Sinus node exit block occurs when the action
potential initiated by the sinoatrial node is
suppressed or completely blocked before it leaves
the SN and reaches the atrium - therefore, the SN
block is an exit block

21.

SN exit blocks (SNEB)
N
SN
Atriums
AVN
Ventricles
SNEB I
SNEB II

22.

SNEB III degree
N
SN
A
AVN
V
Замещающий АВ комплекс

23.

24.

25.

26. AV blockade

1. Proximal, nodular (benign).
2. Distal, bundle (irreversible).
1. Transient (usually nodular): lower AMI, myocarditis, drugs,
hyper K+.
2. Persistent (often bundle): anterior AMI, idiopathic fibrosis.
1. Functional (usually nodal and up to II degree type 1) vagotonic, in athletes.
2. Structural (AMI, myocarditis, cardiomyopathy).

27. AV block I degree

N
AV block I degree
SN
A
AVN
V
p-R(Q) 320 мс

28. AV block II degree 1 type

N
SN
A
AVN
V
<200 мс
220 мс
260 мс
300 мс
220 мс

29.

AV block II degree 2 type
N
SN
A
AVN
V
200 мс
200 мс
200 мс
200 мс
200 мс

30. AV block II degree 2:1

1
2

31. AB block III degree (complete)

САУ
Предсердия
АВУ(C)
Желудочки

32.

33.

34. His bundle branch block

RHBBB
Sign of block: deformity of QRS
Completeness attribute: QRS width >120
ms

35. Causes of RBBB

Congenital heart disease
Coronary arteryt disease
PE
COPD
Pulmonary hypertension
Cardiomyopathies
Degenerative damage to the cardiac
conduction system (with aging)

36.

LBBB

37. Causes of LBBB:

AH
CAD
LVH
Myocarditis
Valve defects
Cardiopathies
Degenerative damage to the conducting
system