<unk>  describes an abnormal heart<unk>  resulting from impulses coming from a locus of tissue in the area of the atrioventricular node, the "junction" between atria and ventricles.<unk>  can be classified into junction escape<unk> , accelerated<unk> , junctional bradycardia, and junctional tachycardia. The<unk>  can be originated by many medications that affect the sinoatrial node and make the atrioventricular node an ectopic impulses foci. Many conditions as well causes<unk>  by creating new pacemaker instead of the sinoatrial node. In<unk> , the heart beats rate are not controlled by the sinoatrial node. The new pacemaker in the<unk>  is the atrioventricular node. Common causes of<unk>  include acute MI, Acute rheumatic fever, antiarrhythmic agents, beta-blockers, calcium channel blockers, Complete heart block, Conduction system disease, Digitalis toxicity, Diphtheria, Healthy response during sleep in patients with heightened vagal tone, Heart surgery particularly valve replacement or surgery for congenital heart disease, Ischemic heart disease, Lyme disease, NSTEMI, Sick sinus syndrome, Sinus arrest, Chest trauma, Radiation therapy, Collagen vascular disease, Myocarditis, Clonidine, Reserpine, Adenosine, and Cimetidine. In the United States, the prevalence of<unk>  is 166 in 100,000 individuals with sinus node dysfunction. If left untreated,<unk>  can lead to syncope and other severe complications. Patients presenting with juncitonal<unk>  disease should be asked properly for history of other cardiac conditions as heart failure and sick sinus syndrome. Symptoms of<unk>  can be non specific and includes syncope, dizziness, and faitgue. Physical examination findings of<unk>  include pulsating veins and canon a waves in case the right atrium contracting against a closed tricuspid valve. Electrocardiogram may show QRS complexes are narrow as conduction down the His bundle is normal. The junctional rate may be slow (40-60 beats per minute) in which case the<unk>  is referred to as junctional bradycardia. The junctional rate may be rapid in which case the<unk>  is referred to as a junctional tachycardia. Asymptomatic patients with only juncitonal<unk>  and no other cardiac conditions do not require further management. The<unk>  here is due to increased vagal tone only. Patients with sinus node dysfunction should be managed cautiously as the pulse originating from other foci keeps the heart rate. Patients with<unk>  due to digoxin toxicity are given atropine and digoxin specific antibody. In children, symptomatic patients can undergo percutaneous radiofrequency ablation. Pacemaker is indicated for patients with sick sinus syndrome and complete AV block.
Junctional rhythm
Ventricular escape beat
Atopy
Wide complex tachycardia
Fusion beats
Junctional bradycardia
Low QRS voltage
Fascicular VT