2cardiac arrhytmia
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Cardiac arrhythmia
Abnormal cardiac rhythm usually involving a change in rate or regularity.
Synonym: dysrhythmia
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EtiologyPhysiological:
-sympathetic or parasympathetic control changes eg. Stress , anxiety, exercise , smoking.Hypothyroidism, hyperthyroidism, hypoadrenalism,
hyperkalemia, hypokalemia and other electrolyte changes.
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Pathological:
Valvular heart disease. Ischemic heart disease.----------MI causing death of
pacemaker cells or conducting tissue.Hypertensive heart diseases.Congenital heart disease.Cardiomyopathies.Carditis.RV dysplasia.Drug related.Pericarditis. Pulmonary diseases.Others.
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CLINICAL EVALUATIONI. PHYSICAL FINDINGS
Palpitation.Dizziness.Chest Pain.Abnormal pulse rate , rhythm or amplitudeDyspnea.Anxiety and confusion (from reduced brain perfusion)Fainting (syncope)Skin pallor or cyanosisReduced blood pressureWeaknessConvulsionsDecreased urinary outputSudden cardiac death.
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II. DIAGNOSTIC TEST RESULTS ECG
electrophysiological (EP) testing
His bundle studyIII. LAB FINDINGS:
hyperkalemia (>5mEq/L)Hypocalcemia
(<4.5mEq/L)
hypomagnesemia(<2.5mEq/L)
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Mechanism of Arrhythmogensis1. Disorder of impulse formation.
a) Automaticity.b) Triggered Activity.
1) Early after depolarization.2) Delayed after depolarization.
2. Disorder of impulse conduction.a) Block – Reentry.
b) Reflection.
3. Combined disorder.
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Nomenclature for describing arrhythmiasRate
tachycardiabradycardia
Origin:sinusatrialnodalsupraventricularre-entrantventricular
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Pattern:ectopicPremature contractionparoxysmalflutterfibrillationblocktorsadeselectromechanical dissociation
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Duration:i) paroxysmal- self terminating
episodes upto 7 daysii) persistent -non self
terminating more than 7 days
iii) permanent - not responding to cardioversion attempts
iv) recurrent: returning after once stopped.
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Strategies of Antidysrhythmic Agents
A. Alter automaticityi. decrease slope of Phase 4 depolarizationii. increase the threshold potentialiii. decrease resting (maximum diastolic) potential
B. Alter conduction velocity i. mainly via decrease rate of rise of Phase 0
upstrokeii. decrease Phase 4 slopeiii. decrease membrane resting potential and
responsivenessC. Alter the refractory period
i. increase Phase 2 plateauii. increase Phase 3 repolarizationiii. increase action
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