Junctional tachycardia

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Junctional tachycardia
Junctional Tachycardia.jpg
ECG showing junctional tachycardia. Narrow complex QRS. No P waves. Heart rate fast.
TreatmentAmiodarone to control the rhythm, electrical cardioversion is not used.

Junctional tachycardia is a form of supraventricular tachycardia characterized by involvement of the AV node. [1] It can be contrasted to atrial tachycardia. It is a tachycardia associated with the generation of impulses in a focus in the region of the atrioventricular node due to an A-V disassociation. [2] In general, the AV junction's intrinsic rate is 40-60 bpm so an accelerated junctional rhythm is from 60-100bpm and then becomes junctional tachycardia at a rate of >100 bpm.

Contents

Junctional tachycardia (rate about 115/min) dissociated from a slightly slower sinus tachycardia (rate about 107/min) producing one form of double tachycardia; pairs of ventricular capture (C) beats (5th, 6th, 19th, and 20th beats); see laddergram. Double tachycardia with captures.png
Junctional tachycardia (rate about 115/min) dissociated from a slightly slower sinus tachycardia (rate about 107/min) producing one form of double tachycardia; pairs of ventricular capture (C) beats (5th, 6th, 19th, and 20th beats); see laddergram.

Cause

It can be associated with digitalis toxicity. [3] It may also be due to onset of acute coronary syndrome, heart failure, conduction system diseases with enhanced automaticity, or administration of theophylline. [4]

Diagnosis

On an EKG, junctional tachycardia exhibits the following classic criteria: [2]

It can coexist with other superventricular tachycardias due to the disassociation between the SA node and the AV node. [ citation needed ]

Forms of junctional tachycardia include junctional ectopic tachycardia (JET) and atrioventricular nodal re-entrant tachycardia (AVNRT) which can be distinguished by performing electrophysiological studies. [5]

Treatment

Amiodarone is used to control the rhythm. Electrical cardioversion is not used.[ citation needed ]

See also

Related Research Articles

Bradycardia Heart rate that is below the normal range

Bradycardia is a condition typically defined wherein an individual has a resting heart rate of under 60 beats per minute (BPM) in adults, although some studies use a heart rate of less than 50 BPM. Bradycardia typically does not cause symptoms until the rate drops below 50 BPM. When symptomatic, it may cause fatigue, weakness, dizziness, sweating, and at very low rates, fainting.

Electrocardiography Method to record the electrical activity of the heart through passive electrodes placed over the skin.

Electrocardiography is the process of producing an electrocardiogram. It 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 rhythm disturbances, inadequate coronary artery blood flow, and electrolyte disturbances.

Tachycardia Heart rate that exceeds the normal resting rate

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 or abnormal.

Atrioventricular node

The atrioventricular node or AV node is a part of the electrical conduction system of the heart that coordinates the top of the heart. It electrically connects the atria and ventricles. The AV node lies at the lower back section of the interatrial septum near the opening of the coronary sinus, and conducts the normal electrical impulse from the atria to the ventricles. The AV node is quite compact.

Third-degree atrioventricular block Medical condition

Third-degree atrioventricular block is a medical condition in which the nerve impulse generated in the sinoatrial node in the atrium of the heart can not propagate to the ventricles.

Electrical conduction system of the heart Transmits signals generated usually by the sinoatrial node to cause contraction of the heart muscle

The electrical conduction system of the heart transmits signals generated usually by the sinoatrial node to cause contraction of the heart muscle. The pacemaking signal generated in the sinoatrial node travels through the right atrium to the atrioventricular node, along the Bundle of His and through bundle branches to cause contraction of the heart muscle. This signal stimulates contraction first of the right and left atrium, and then the right and left ventricles. This process allows blood to be pumped throughout the body.

Supraventricular tachycardia Abnormally fast heart rhythm arising from improper electrical activity in the upper part of the heart

Supraventricular tachycardia (SVT) is an abnormally fast heart rhythm arising from improper electrical activity in the upper part of the heart. There are four main types: atrial fibrillation, paroxysmal supraventricular tachycardia (PSVT), atrial flutter, and Wolff–Parkinson–White syndrome. Symptoms may include palpitations, feeling faint, sweating, shortness of breath, or chest pain.

AV nodal reentrant tachycardia

AV-nodal reentrant tachycardia (AVNRT) is a type of abnormal fast heart rhythm. It is a type of supraventricular tachycardia (SVT), meaning that it originates from a location within the heart above the bundle of His. AV nodal reentrant tachycardia is the most common regular supraventricular tachycardia. It is more common in women than men. The main symptom is palpitations. Treatment may be with specific physical maneuvers, medications, or, rarely, synchronized cardioversion. Frequent attacks may require radiofrequency ablation, in which the abnormally conducting tissue in the heart is destroyed.

Sinus tachycardia Medical condition

Sinus tachycardia is an elevated sinus rhythm characterized by an increase in the rate of electrical impulses arising from the sinoatrial node. In adults, sinus tachycardia is defined as a heart rate greater than 100 beats/min (bpm). The normal resting heart rate is 60–100 bpm in an average male adult and 60-90 bpm in an average female adult. Normal heart rate varies with age, from infants having faster heart rates and the elderly having slower heart rates. Sinus tachycardia is a normal response to physical exercise, when the heart rate increases to meet the body's higher demand for energy and oxygen, but sinus tachycardia can also indicate a health problem. Thus, sinus tachycardia is a medical finding that can be either physiological or pathological.

Tachycardia-induced cardiomyopathy (TIC) is a disease where prolonged tachycardia or arrhythmia causes an impairment of the myocardium, which can result in heart failure. People with TIC may have symptoms associated with heart failure and/or symptoms related to the tachycardia or arrhythmia. Though atrial fibrillation is the most common cause of TIC, several tachycardias and arrhythmias have been associated with the disease.

Ventricular escape beat

In cardiology, a ventricular escape beat is a self-generated electrical discharge initiated by, and causing contraction of, the ventricles of the heart; normally the heart rhythm is begun in the atria of the heart and is subsequently transmitted to the ventricles. The ventricular escape beat follows a long pause in ventricular rhythm and acts to prevent cardiac arrest. It indicates a failure of the electrical conduction system of the heart to stimulate the ventricles.

Inappropriate sinus tachycardia is a rare type of cardiac arrhythmia within the category of supraventricular tachycardia (SVT). IST may be caused by the sinus node itself having an abnormal structure or function, or it may be part of a problem called dysautonomia, a disturbance and/or failure of the autonomic nervous system. Research into the mechanism and etiology (cause) of inappropriate sinus tachycardia is ongoing.

Lown–Ganong–Levine syndrome (LGL) is a pre-excitation syndrome of the heart. Those with LGL syndrome have episodes of abnormal heart racing with a short PR interval and normal QRS complexes seen on their electrocardiogram when in a normal sinus rhythm. LGL syndrome was originally thought to be due to an abnormal electrical connection between the atria and the ventricles, but is now thought to be due to accelerated conduction through the atrioventricular node in the majority of cases. The syndrome is named after Bernard Lown, William Francis Ganong, Jr., and Samuel A. Levine.

Multifocal atrial tachycardia Medical condition

Multifocal atrial tachycardia (MAT) is an abnormal heart rhythm, specifically a type of supraventricular tachycardia, that is particularly common in older people and is associated with exacerbations of chronic obstructive pulmonary disease (COPD). Normally, the heart rate is controlled by a cluster of cells called the sinoatrial node. When a number of different clusters of cells outside the SA node take over control of the heart rate, and the rate exceeds 100 beats per minute, this is called multifocal atrial tachycardia.

Accelerated idioventricular rhythm Medical condition

Accelerated idioventricular rhythm is a ventricular rhythm with a rate of between 40 and 120 beats per minute. Idioventricular means “relating to or affecting the cardiac ventricle alone” and refers to any ectopic ventricular arrhythmia. Accelerated idioventricular arrhythmias are distinguished from ventricular rhythms with rates less than 40 and those faster than 120. Though some other references limit to between 60 and 100 beats per minute. It is also referred to as AIVR and "slow ventricular tachycardia."

Junctional rhythm describes an abnormal heart rhythm resulting from impulses coming from a locus of tissue in the area of the atrioventricular node, the "junction" between atria and ventricles.

Junctional ectopic tachycardia Medical condition

Junctional ectopic tachycardia (JET) is a rare syndrome of the heart that manifests in patients recovering from heart surgery. It is characterized by cardiac arrhythmia, or irregular beating of the heart, caused by abnormal conduction from or through the atrioventricular node. In newborns and infants up to 6 weeks old, the disease may also be referred to as His bundle tachycardia or congenital JET.

PR interval

In electrocardiography, the PR interval is the period, measured in milliseconds, that extends from the beginning of the P wave until the beginning of the QRS complex ; it is normally between 120 and 200 ms in duration. The PR interval is sometimes termed the PQ interval.

Atrioventricular reentrant tachycardia Medical condition

Atrioventricular reentrant tachycardia (AVRT), or atrioventricular reciprocating tachycardia, is a type of abnormal fast heart rhythm and is classified as a type of supraventricular tachycardia (SVT). AVRT is most commonly associated with Wolff–Parkinson–White syndrome, but is also seen in permanent junctional reentrant tachycardia (PJRT). In AVRT, an accessory pathway allows electrical signals from the heart's ventricles to enter the atria and cause earlier than normal contraction, which leads to repeated stimulation of the atrioventricular node.

Arrhythmia Group of conditions in which the heartbeat is irregular, too fast, or too slow

Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the heartbeat is irregular, too fast, or too slow. The heart rate that is too fast – above 100 beats per minute in adults – is called tachycardia, and a heart rate that is too slow – below 60 beats per minute – is called bradycardia. Some types of arrhythmias have no symptoms. Symptoms, when present, may include palpitations or feeling a pause between heartbeats. In more serious cases, there may be lightheadedness, passing out, shortness of breath or chest pain. While most types of arrhythmia are not serious, some predispose a person to complications such as stroke or heart failure. Others may result in sudden death.

References

  1. " junctional tachycardia " at Dorland's Medical Dictionary
  2. 1 2 ROSEN, KENNETH (1973). "Junctional Tachycardia: Mechanisms, Diagnosis, Differential Diagnosis, and Management" (PDF). Circulation. 47 (3): 654–664. doi: 10.1161/01.CIR.47.3.654 . PMID   4571060 . Retrieved March 1, 2015.
  3. "Junctional Rhythm: Overview - eMedicine" . Retrieved 2008-12-21.
  4. Aehlert, Barbara (2013). ECGs Made Easy (5th ed.). Elsevier. p. 160. ISBN   9780323170574.
  5. Srivathsan K, Gami AS, Barrett R, Monahan K, Packer DL, Asirvatham SJ (January 2008). "Differentiating atrioventricular nodal reentrant tachycardia from junctional tachycardia: novel application of the delta H-A interval". J. Cardiovasc. Electrophysiol. 19 (1): 071004055652013––. doi:10.1111/j.1540-8167.2007.00961.x. PMID   17916156.
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