1. Arrhythmias introduction
Domina Petric, MD

2. Arrhythmias are common often benign
often intermittent causing diagnostic difficulty
occasionally severe causing cardiac compromise

3. Causes Cardiac Non cardiac caffeine smoking alcohol pneumonia drugs
myocardial infarction
coronary artery disease
left ventricle aneurysm
mitral valve disease
cardiomyopathy
pericarditis
myocarditis
abberant conduction pathways
caffeine
smoking
alcohol
pneumonia
drugs
metabolic imbalance
phaeochromocytoma

4. Non cardiac causes
Drugs that can cause arrhythmias are β2-agonists, digoxin, L-dopa, tricyclics, doxorubicin.
Metabolic imbalance: K+, Ca2+ , Mg2+ , hypoxia, hypercapnia, metabolic acidosis and thyroid disease.

5. Symptoms palpitation chest pain presyncope, syncope hypotension
pulmonary oedema
asymptomatic

6. O History Past medical history and family history!
Precipitating factors!
Associated symptoms: chest pain, dyspnoea, collapse.
Nature: fast or slow, regular or irregular.
Duration!
Drug history!
Onset/offset!

7. Tests Full blood count! Urea, electrolytes and creatinine! Glucose!
Calcium and magnesium ions!
TSH!

8. Tests ECG Echocardiography Excercise ECG Cardiac catheterization
24 hours ECG monitoring
Echocardiography
Excercise ECG
Cardiac catheterization
Electrophysiological studies

9. Treatment overview of most common arrhythmias
Part two
Treatment overview of most common arrhythmias

10. Bradycardia
If asymptomatic and rate >40 bpm, treatment is not necessary.
If heart rate is less than 40 bpm or patient is symptomatic, treatment is ATROPINE 0,6-1,2 mg iv. (up to maximum 3 mg).

11. Isoprenaline infusion External cardiac pacing
Bradycardia
Temporary pacing wire
Isoprenaline infusion
External cardiac pacing
Image source: Wikipaedia.org

12. Sick sinus syndrome Sinus node dysfunction can cause: bradycardia
arrest
sinoatrial block
supraventricular tachycardia alternating with bradycardia/asystole (tachy-brady syndrome)

13. Sick sinus syndrome
Atrial fibrillation and thromboembolism may also occur.
If the patient is symptomatic, pacing may be necessary.

14. Sick sinus syndrome
Image source: lifeinthefastlane.com

15. Supraventricular tachycardia
Narrow complex tachycardia (rate >100 bpm, QRS width <120 ms):
vagotonic manoeuvres
adenosine or verapamil iv.
DC (direct current) shock if patient is compromised
Maintenance therapy: beta-blockers, verapamil.

16. Atrial fibrillation/flutter
May be incidental finding.
Beta-blockers for controling ventricular rate, digoxine is usefull in heart failure with AF.

17. Conversion of atrial fibrillation
Within 48 hours from acute onset, propafenone 600 mg per os in patients without structural heart disease.
Within 48 hours, amiodarone
300 mg per os in patients with structural heart disease.

18. Conversion of atrial fibrillation
Immediate electrocardioversion:
transesophageal echocardiography IJ LMWH OR
Electrocardioversion after 3 weeks of warfarin therapy.

19. Ekg.academy.com
Atrial fibrillation
Atrial flutter

20. Ventricular tachycardia (VT)
Broad complex tachycardia (rate >100 bpm, QRS duration >120 ms)
Acute management: amiodarone or lidocaine iv.
Oral therapy: loading dose of amiodarone 200 mg every 8 hours for 7 days, 200 mg every 12 hours for next 7 days and maintenance therapy 200 mg a day.

21. Image source: Healio.com

22. Literature
Oxford Handbook of Clinical Medicine. Longmore M. Wilkinson I. B. Baldwin A. Elizabeth W. Ninth edition.
Wikipaedia.org
Lifeinthefastlane.com
Healio.com
Ekg.academy.com