cardiac arrhythmia charn sriratanasathavorn, md,facc her majesty cardiac center siriraj hospital,...
TRANSCRIPT
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CARDIAC ARRHYTHMIA
Charn Sriratanasathavorn, MD,FACC
Her Majesty Cardiac Center
Siriraj Hospital, Mahidol University
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SIMPLIFIED CARDIAC SYSTEM
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CARDIAC ARRHYTHMIA
• Cardiac Arrhythmia
• Cardiac Bradyarrhythmia
• Cardiac Tachyarrhythmia
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CARDIAC ARRHYTHMIA
• Cardiac Arrhythmia– Normal cardiac conduction system
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NORMAL CARDIAC CONDUCTION SYSTEM
• Impulse formation
• Impulse conduction
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NORMAL CARDIAC CONDUCTION SYSTEM
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THE AUTOMACITY OF SINUS NODE
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ANS and Sinus Node Function
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NORMAL CARDIAC CONDUCTION SYSTEM
• Impulse formation
• Impulse conduction
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CARDIAC ARRHYTHMIA
• Cardiac Arrhythmia– Normal cardiac conduction system– Cardiac arrhythmia mechanism
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Mechanism of Bradyarrhythmias
• Abnormal impulse formation–decrease impulse formation
• Abnormal impulse conduction
–conduction block
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Mechanism of Tachyarrhythmia
Anatomic
Abnormal impulse conduction
Automaticity Triggered Reentry
FunctionalEnhanced
Abnormal impulse formation
AbnormalEADs DADsAnisotropy
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Mechanism of triggered arrhythmias
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Mechanism of triggered arrhythmias
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Reentry arrhythmias
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Reentry circuits
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Re-entry circuit
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CARDIAC ARRHYTHMIA
• Cardiac Arrhythmia– Normal cardiac conduction system– Cardiac arrhythmia mechanism– Cardiac arrhythmia evaluation in clinical
practice
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RELATIONSHIP OF INTRACELLULAR POTENTIAL TO SURFACE EKG
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การตรวจคลื่�นไฟฟ�าหั�วใจ (EKG, ECG)
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การตรวจคลื่�นไฟฟ�าหั�วใจ (12 Lead Electrocardiogram, 12 Lead ECG)
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SIMPLIFIED CARDIAC SYSTEM
ECG
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คลื่�นไฟฟ�าหั�วใจขณะเก�ดอาการ
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CAROTID SINUS HYPERSENSITIVITY
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Holter Monitoring
?
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?
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Cardiac Arrhythmia monitoring system
• Holter monitoring system
• Event recording system
• Loop recording system– Non implantable– Implantable
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การตรวจสมรรถภาพหั�วใจด�วยการออกก!าลื่�งการตรวจสมรรถภาพหั�วใจด�วยการออกก!าลื่�ง(Exercise Stress Test)(Exercise Stress Test)
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ABNORMAL HEART RATE RESPONSE
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Electrophysiologic study
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Prolonged Sinus node recovery time
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Atrioventricular Reciprocating Tachycardia (AVRT)
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Typical Atrioventricular Nodal Reentry tachycardia ( AVNRT)
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CARDIAC ARRHYTHMIA
• Cardiac Arrhythmia– Normal cardiac conduction system– Cardiac arrhythmia mechanism– Cardiac arrhythmia evaluation in clinical
practice– Cardiac arrhythmia treatment concept
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SIMPLIFIED CARDIAC SYSTEM
Treatment
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• Treatment strategy• Short term Rx• Treat reversible /
underlying causes• Medication to increase
heart rate• Temporary pacemaker• Long term Rx• Permanent pacemaker
• Factors• Type of bradyarrhythmia
• Severity of symptoms
• Severity of underlying cardiac pathology
• Severity of co-morbid diseases
Cardiac Bradyarrhythmia-Rx
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Cardiac Tachyarrhythmia - Rx Strategies
Long term treatmentRF ablationMedicationAnticoagulationDevices (pacemaker, AICD)Surgery
Short term treatmentElectrical Therapy in unstable patients
Cardioversion, Defibrillation
Control ventricular rateVentricular rate controlRhythm control: Medical / Electrical
Identify and treat reversible causes
Considering factorsType of tachyarrhythmiaMechanism of tachyarrhythmiaUnderlying Cardiovascular pathologyLocal expertisePatient factors
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CARDIAC ARRHYTHMIA
• Cardiac Arrhythmia in general– Normal cardiac conduction system– Cardiac arrhythmia mechanism– Cardiac arrhythmia evaluation in clinical
practice– Cardiac arrhythmia treatment concept
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Thank you for your attention