Arrhythmias

Principles of long and short term

management of arrythmias

Arrythmias

Stability of the patient is primarySerious signs and symptoms (shock,

hypotension, CHF,altered consciousness, severe SOB, MI, or ischeamic pain) require immediate treatment

Stable patients can be further investigated

Tachyarrythmias

Immediate synchronized DC Cardioconversion should be Performed on all unstable patients

Stable patients are assessedAccording to underlying rhythm and history

Superventricular Arrhythmias

Sinus Tachycardia- faster than 100 bpmRarely primary- treat the underlying causeDehydration, fever, hypoxia

Superventricular Arrhythmias

Paroxysmal superventricular tachycardiaarise from above the bifurcation of the Hisbundle. Approximately 90% of thesearrhythmias occur as a result of a reentrantmechanism; the remaining 10% occur as a result of increased automaticity.

treatment

DC conversion

Physical maneuvers- valsalvaPharmacologicalIn general, pharmacologic agents with AV nodal blocking

properties such as adenosine, -blockers, calcium channel blockers, and digoxin are used for the acute management and prevention of AV nodal dependent PSVT. Other antiarrhythmic agents, such as procainamide and amiodarone, which exert effects at various levels of the cardiac conduction system are used for the management and prevention of AV nodal independent PSVT.

Atrial Fibrillation

In stable patients with a rapid ventricular response, the initial goal is rate control. This can usually be achieved with -blockers, calcium channel blockers, or digoxin

Anticoagulants

Atrial flutter

Similar to AF

Patient are at less risk from coagulation

Multifocal Atrial TachycardiaRate control

Preexcitation ArrythmiasDC conversion

Ventricular Arrhythmias

Ventricular tachycardia is the most common cause of wide QRS complex tachycardia. The term VT is used when six or more consecutive ventricular beats occur. The ventricular rate is usually 150–220 beats/min, although rates slower than 120 beats/min may occur.

treatment

Unstable-DC Cardioconversion

StableTraditionally, patients with stable VT are administered an

antiarrhythmic agent for chemical cardioversion. A number of medications are available. The choice for a particular patient is often based on physician preference and experience, findings of preserved or impaired cardiac function, and the underlying cause of the VT.

Polymorphic Ventricular tachycardia

Shock em

Ventricular Fibrillation

Anti-arrhythmics

BRADYARRHYTHMIAS, CONDUCTION DISTURBANCES, & ESCAPE RHYTHMS

Unstable patients need transcutaneous pacemaking

Stable patients can be managed pharmcologically

Sinus Bradycardia

Assymptomatic Sinus Bradycardia requires no treatment

A bunch of other slow rhythms

Heart block

Speed up the heart… atropine dopamine aminophylline