Arrhythmias Principles of long and short term management of arrythmias

Arrythmias Stability of the patient is primary Serious 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 assessed According to underlying rhythm and history

Superventricular Arrhythmias Sinus Tachycardia- faster than 100 bpm Rarely primary- treat the underlying cause Dehydration, fever, hypoxia

Superventricular Arrhythmias Paroxysmal superventricular tachycardia arise from above the bifurcation of the His bundle. Approximately 90% of these arrhythmias occur as a result of a reentrant mechanism; the remaining 10% occur as a result of increased automaticity.

treatment DC conversion Physical maneuvers- valsalva Pharmacological In 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 Tachycardia Rate control Preexcitation Arrythmias DC 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 Stable Traditionally, 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