1. IN THE NAME OFGODIN THE NAME OFGOD SVTS.SAYAH

2.  All cardiac tachyarrhythmias are produced by: 1/disorders of impulse initiation :automatic 2/abnormalities of impulse conduction: re-entrant.

3. Clinical History and Physical Examination  Patients with paroxysmal arrhythmias are most often asymptomatic at the time of evaluation. Arrhythmia-related symptoms include palpitations; fatigue; lightheadedness; chest discomfort; dyspnea; presyncope; or, more rarely, syncope.

4.  With SVT, syncope is observed in approximately 15% of patients, usually just after initiation of rapid SVT or with a prolonged pause after abrupt termination of the tachycardia  Symptoms vary with the ventricular rate, underlying heart disease, duration of SVT, and individual patient perceptions.  Supraventricular tachycardia that is persistent for weeks to months and associated with a fast ventricular response may lead to a tachycardia-mediated cardiomyopathy

5. Diagnostic InvestigationsDiagnostic Investigations  A resting 12-lead ECG  An ambulatory 24-hour Holter recording  Implantable loop recorders may be helpful in selected cases  Exercise testing  Transesophageal atrial recordings

6.  Invasive electrophysiological investigation with subsequent catheter ablation may be used for diagnoses and therapy

7. SPECIFIC ARRHYTHMIASSPECIFIC ARRHYTHMIAS  A. Sinus Tachyarrhythmias  1. Physiological Sinus Tachycardia  2. Inappropriate Sinus Tachycardia  3. Postural Orthostatic Tachycardia Syndrome(autonomic dysfunction)  4. Sinus Node Re-entry Tachycardia

8. S.TAC.

9. B. Atrioventricular Nodal Reciprocating Tachycardia  is the most common form of PSVT.  It is more prevalent in females

10. AVNRT

11. C. Focal and Nonparoxysmal Junctional Tachycardia  1. Focal Junctional Tachycar  2. Nonparoxysmal Junctional Tachycardia

12. J.TAC.

13. D. Atrioventicular Reciprocating Tachycardia (Extra Nodal Accessory Pathways)  1. Sudden Death in WPW Syndrome and Risk  Stratification: The incidence of sudden cardiac death in patients with WPW syndrome: range from 0.15 to 0.39%, over 3- to 10-year follow-up

14. WPW

15. WPW

16. AVRT

17. E. Focal Atrial TachycardiasE. Focal Atrial Tachycardias  F. Macro–Re-entrant Atrial Tachycardia:  1. Isthmus-Dependent Atrial Flutter  2. Non–Cavotricuspid Isthmus-Dependent Atrial Flutter  G.ATRIAL FIBRILATION

18. AT

19. AFL

20. AF

21. Acute Management of Narrow QRS-Complex Tachycardia  vagal maneuvers  IV antiarrhythmic drugs  DC SHOCK

22. Wide-QRS tachycardiasWide-QRS tachycardias  1. preexisting bundle branch block;  2. functional bundle branch block (tachycardia- dependent phase 3 block);  3. ventricular pre-excitation;  4. aberrancy due to sodium channel-blocking antiarrhythmic drugs.  5.VT

23. WQT

24. Acute Management of Wide QRS- Complex Tachycardia  Immediate DC cardioversion is the treatment for hemodynamically unstable tachycardias  For pharmacologic termination of a stable wide QRS-complex tachycardia, IV procainamide and/or sotalol are recommended  Amiodarone is preferred, compared to procainamide and sotalol, in patients with impaired left ventricular (LV) function

25. IRREGULAR WIDE QRSIRREGULAR WIDE QRS  For termination of an irregular wide QRS-complex tachycardia (ie, pre-excited AF), DC cardioversion is recommended.  If the patient is hemodynamically stable, pharmacologic conversion using IV ibutilide, flecainide, or procainamide is appropriate.

26. AF + LBBBAF + LBBB

27. First degree avbFirst degree avb

28. Second degree avbSecond degree avb

30. CHB

31. PVC

35. VT

36. VF

37. THANKS FOR YOUR ATTENTIONTHANKS FOR YOUR ATTENTION