Basic to advanced cardio
Page 32
On the previous page, we got to the point where the patient has sinus rhythm and a center in the atrium makes a PAC (that is, a total of 2 centers in the atrium)
Now let’s assume that three centers in the atrium generate a pulse.
The important point is that, in this case, none of these centers is superior to the other, and each of them takes command of the heart for a moment!
Now the ECG of this state
Consider the figure below, where the first beat of the SA beats and creates a positive, sinusoidal P wave in lead II
The second pulse also creates a focus from the bottom of the right atrium, which, according to the direction it moves in the atria, this time creates a partial P2 wave in lead 2 (because it is perpendicular to lead 2).
But the third pulse has created a focus in the left atrium, which creates a negative P wave in lead 2 according to the direction it travels in the atria!
In short, there is no order and all 3 of these centers become the commander of the heart in a moment!
So what should we call this rhythm?
It is not a sinus! Because all the impulses did not come from the SA node!
Sinus rhythm plus PAC is not! Because in PAC, only one center interferes with the work of the SA node, but here 2 centers interfere with the SA activity.
We call this rhythm: #WPM
#Wandering_Pace_Maker
who becomes a wandering commander
Features of WPM rhythm:
1. It has a P wave
2. P waves are not similar
3. We can see at least 3 P wave models in the ECG, which indicates the 3 command centers of the heart
4. QRS wave intervals are not equal
5. QRS waves are narrow! Because, anyway, the impulses are being generated from the vestibule
Just pay attention to one point that, in WPM rhythm, more than 3 centers may be active in the vestibule
Another point about this rhythm is that, if the number of heartbeats in this rhythm reaches more than 100 per minute, we will change the name of the rhythm and put it: #MAT rhythm.
#Multifocal_Atrial_Tachycardi
which can be translated as:
Multi-focal atrial tachycardia!
So, pay attention that the MAT rhythm is actually the same as the WPM rhythm, only the number of heart beats is increased to 100.
@CCU_ICU_javanrood
This post is written by hosseini1370z