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Arrythmia ratheesh

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Cardiac arrythmias
Cardiac arrythmias
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Arrythmia ratheesh

  1. 1. ARRYTHMIAS Presented by RATHEESH R.L
  2. 2. DEFINITION • The term "arrhythmia" refers to any change from the normal sequence of electrical impulses. The electrical impulses may happen too fast, too slowly, or erratically – causing the heart to beat too fast, too slowly, or erratically. When the heart doesn't beat properly, it can't pump blood effectively -American Heart Association
  3. 3. ETIOLOGY • Dysrhythmias occur as the result of various abnormalities and disease rate.
  4. 4. Cardiac conditions • Cardiomyopathy • Conduction defects • Heart failure • Myocardial cell degeneration & MI • Valve disease
  5. 5. Non cardiac condition • Acid base imbalance • Alcohol ,Caffeine & tobacco • Connective tissue disorder • Drugs & Toxicity • Electric shock, hypoxia & shock • Emotional crisis • Herbal supplements • Near drowning and poisoning • Metabolic condition
  7. 7. SINUS BRADYCARDIA • The conduction pathway is the same as that in sinus rhythm but the SA node fires at a rate less than 60beats/min.
  8. 8. Cont…Etiology: Increased vagal tone Hypothermia Increased intraocular pressure Administration of parasympathomimetic drugs & adverse drug effects Acute MI Disease condition – hypothyroidism, increased ICP & obstructive jaundice
  9. 9. Cont.. Clinical manifestation: At rest, asymptomatic Pale, cool skin, hypotension, weakness and angina. Dizziness or syncope Confusion and disorientation Shortness of breath
  10. 10. Cont… Clinical association- for aerobically trained athletes. ECG characteristics: Regular P waves by regular QRS complex
  11. 11. Cont.. Therapy: Atropine IV o.5mg to I mg Dopamine- 5 to 20µg/kg/min Epinephrine – 2 to 10µg/min Isoproterenol- 2 to 10µg/min Transcutaneous pacing
  12. 12. SICK SINUS SYNDROME • SSS also called sinus node dysfunction is a group of abnormal heart rhythms causes by malfunction of sinus node. • Bradycardia-tachycardia syndrome
  13. 13. Cont… Etiology:  Medication: digitalis, sympatholytic drugs  Sarcoidosis, amyloidosis  Cardiomyopathies  CAD
  14. 14. Cont… Symptoms: Dizziness Palpitation Chest pain Angina Shortness of breath Fatigue & headache Nausea and fainting
  15. 15. Cont… ECG Characteristics: Combination of sinoatrial and atrioventricular conduction disturbances.
  16. 16. Cont… • Treatment- artificial pacemaker
  17. 17. SINUS TACHYCARDIA • Sinus rate more than 100beats/min and is normally due to increase in sympathetic activity. • Conduction pathway is same. Discharge rate from the sinus node is increased.
  18. 18. Cont…Etiology: Physical and psychological stressors: exercise, fever,pain, hypotension, hpovolemia, anemia, hypoglycemia, MI, HF, anxiety Adrenergic stimulation Drugs Pheochromocytoma Caffeine
  19. 19. Cont… Clinical manifestation: Patients intolerance to increased heart rate Dizziness Dyspnea Hypotension Increased myocardial oxygen consumption
  20. 20. Cont… ECG characteristics: Treatment: no specific treatment Rate: more than 100 b/min Rhythm : sinus PR interval: </= 0.20sec QRS complex- normal
  21. 21. PREMATURE ATRIAL CONTRACTION PAC is a contraction originating from an ectopic focus in the atrium in a location other than the sinus node
  22. 22. Cont… Etiology: ☺Hypoxia ☺Electrolyte imbalance ☺Hyperthyroidism ☺COPD ☺Heart disease- CAD ☺Valvular disorder
  23. 23. Cont… PATHOPHYSIOLOGY: • The ectopic signal originates in the LA or RA and travels across the atria by an abnormal pathway creating a distorted P wave. • At the AV node it may stopped (non conducted PAC), delayed (lengthened PR interval) or conducted normally.
  24. 24. Cont… ECG characteristic:
  25. 25. Cont… Treatment: Beta blockers
  26. 26. ATRIAL FLUTTER • It is characterized by large re-entry circuit within the right atrium, usually encircling the tricuapid annulus • “Impulses take a circular course around the atria, setting up the flutter waves”
  27. 27. Cont… Etiology: ♥ Acute coronary syndrome ♥ Mitral and tricuspid valve disorders ♥ Hypoxia, HT, chromic lung disease ♥ Cardiomyopathy ♥ Pulmonary embolus & cor pulmonale ♥ Hyperthyroidism ♥ Drug induced
  28. 28. Cont… Clinical manifestation: Can be asymptomatic Palpitation flutter can cause decrease cardiac output--- HF ECG characteristics: Classic- saw tooth pattern & no true P wave Ventricular response- a function of AV node block or conduction of atrial impulses.
  29. 29. Cont… Treatment: Calcium channel blocker Beta adrenergic blockers To control ventricular rate
  30. 30. Cont… • Electrical cardio version • Radio frequency catheter ablation • High risk of stroke- – Anticoagulate for 3 weeks if more than 48 hours occurrence – 4 weeks – IV heparin
  31. 31. Radio frequency catheter ablation It is a procedure that can cure many types of fast heart beats. Using a special wires or catheters threaded into the heart. Here they are using radiofrequency energy.
  32. 32. ATRIAL FIBRILLATION • It is characterized by presence of multiple, interacting re-entry circuit looping around the atria. • Total disorganisation of atrial electrical activity due to multiple ectopic foci resulting in loss of effective atrial contraction
  33. 33. Cont… Etiology:  Thyrotoxicosis, alcohol intoxication, caffeine use, electrolyte disturbance, stress and cardiac surgery Atrial impulse faster than the SA node impulses, impulses take multiple , choatic, random pathways through the atria
  34. 34. Cont… Clinical manifestation: Atrial fibrillatory waves- AF with rapid ventricular response Thrombi form- 5 fold increase risk to get stroke Decreased cardiac output.
  35. 35. Cont… ECG Characteristics: “irregularly irregular rhythm- with variation in both interval & amplitude from R wave to R wave” Rate- wide ranging ventricular response to atrial rate of 300-400 beats/min
  36. 36. Cont… Treatment: ♫ Calcium channel blockers ♫ Beta adrenergic blockers ♫ Antiarrythmic drugs ♫ Anti coagulation therapy ♫ Maze procedure: • Cryoablation (use of cold) • Heat (high intensity ultrasound)
  37. 37. Cont… Rhythm control • Immediate cardio version after administration of IV heparin • To restore sinus rhythm flecainide= 2mg/kg over 30min max dose 150mg • INR to be maintained 2.0 to 3.0 for a minimum of 3 weeks
  38. 38. Cont… Rate control: o Digoxin o Beta blokers o Rate limiting calcium antagonist – Verapamil – diltiazem o Combination therapy: • Digoxin + atenolol
  39. 39. JUNCTIONAL TACHYCARDIA • It originates in the area of the AV node, primarily because the SA node has failed to fire or the signal has been blocked.
  40. 40. Cont… • Impulse from the AV node usually moves in a retrograde (backward fashion) that produce an abnormal P wave just occuring before or after QRS complex
  41. 41. PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA Ectopic focus anywhere above the bifuraction of the bundle of his. Etiology: Over exersion Emotional stress Deep inspiration RHD, CAD, COPD & CHF
  42. 42. Cont… • PATHOPHYSIOLOGY: Impulse arise and recycle repeatedly in the AV node because of areas of unidirectional block in the purkinjie fibers Reexcitation of the atria when there is a one way block
  43. 43. Cont… Clinical manifestation: Prolonged episode and HR greater than 180beats/min Decreased CO- Hypotension, dyspnea & angina Anxious and uncomfortable ECG Feature:
  44. 44. Cont… Treatment: Vagal stimulation IV adenosine IV Verapamil- 5-10mg Beta blockers Cardio version
  45. 45. PREMATURE VENTRICULAR CONTRACTION Originating ectopic focus in the ventricles. Premature occurrence of a QRS complex which is wide and distorted in shape. Multifocal PVC Unifocal PVC
  46. 46. VENTRICULAR FIBRILLATION • Ventricle consist of areas of normal myocardium alternating with areas of ischemic, injured or infracted myocardium, leading to chaotic pattern of ventricular depolarization
  47. 47. Cont… Etiology: ♯ Acute coronary syndrome ♯ Stable to unstable VT ♯ PVC’S with R on T phenomenon ♯ Multiple drug ♯ Electrolyte disturbance ♯ Hypoxia, metabolic acidosis
  48. 48. Cont… Clinical manifestation: Pulse disappears with onset of VF Collapse, unconsiousness Agonal breath Onset of reversible death
  49. 49. Cont… TREATMENT: • Defibrillation • Oxygen, CPR, INTUBATION • Epinephrine • Vasopressin • Antiarrythmic
  50. 50. PULSELESS ELECTRICAL ACTIVITY • PEA a situation in which electrical activity can be observed on the ECG, but there is no mechanical activity of the ventricles and the patient has no pulse.
  51. 51. Cont… • Cardiac conduction impulses occur in organized pattern , but this fails to produce myocardial contraction (electromechanical dissociation) or insufficient filling during diastole or ineffective contractions
  52. 52. Cont… Clinical manifestation: Collapse, unconscious Agonal respiration or apnea No pulse
  53. 53. ASYSTOLE • Total absence of ventricular electrical activity, • Occasional P wave can be seen
  54. 54. HEART BLOCK • Heart block is an abnormal heart rhythm where the heart beats too slowly (bradycardia).
  55. 55. • They are further classified as, First degree heart block ( first degree AV block)  second degree heart block (second degree AV block)  third degree heart block (third degree AV block)
  56. 56. FIRST DEGREE HEART BLOCK • First-degree atrio-ventricular block (AV block), or PR prolongation, is a disease of the electrical conduction system of the heart in which the PR interval is lengthened beyond 0.20 seconds.
  57. 57. The following are the most common causes of first- degree AV block: • Intrinsic AVN disease • Acute myocardial infarction (MI), particularly acute inferior wall MI • Myocarditis • Electrolyte disturbances (eg, hypokalemia, hypomagnesemia) • Drugs (especially those drugs that increase the refractory time of the AVN, thereby slowing conduction)
  58. 58. First Degree Heart Block (1º) • SA Node – normal • Normal P wave • AV Node conducts more slowly than normal • Prolonged PR Interval • Rest of conduction is normal • Normal QRS
  59. 59. Significance • Clinical significance • None • Treatment • None • Note – this can progress to 2º or 3º heart block
  60. 60. Second Degree Heart Block (2º) • Mobitz Type I (Wenkebach) • Mobitz Type II
  61. 61. Second Degree Heart Block (2º) Mobitz Type I (Wenkebach) • Conduction through the AV Node – progressively delayed until a drop beat is seen
  62. 62. Second-degree atrio-ventricular (AV) block, or second-degree heart block, is characterized by disturbance, delay, or interruption of atrial impulse conduction through the AV node to the ventricles.
  63. 63. CAUSES • Drugs (beta-blockers, calcium channel blockers, amiodarone) • Cardiomyopathy • rheumatic fever, myocarditis • varicella-zoster virus infection • Rheumatic diseases • Hypoxia • Hyperkalemia • Hypothyroidism • inferior wall myocardial infarction
  64. 64. Second Degree Heart Block (2º) Mobitz Type I (Wenkebach) • PR Interval prolongs with each beat until a dropped beat is seen • The PR Interval is NOT constant • After each dropped beat, the PR interval is normal and the cycle starts again
  65. 65. Significance • Clinical Significance • Slight symptoms e.g.. Lethargy, Confusion • Treatment • Pacemaker if during day &/or symptoms • No treatment if at night • Note – this can progress to 3º Heart Block
  66. 66. Second Degree Heart Block (2º) Mobitz Type II • Conduction through the AV node is constant. • PR interval is normal and constant • Occasionally a dropped beat is seen
  67. 67. Significance • Clinical significance – this is more significant disease • Treatment – pacemaker • Note – this can progress to 3º Heart Block
  68. 68. Third Degree Heart Block (3º) (Complete) • Complete failure of the AV Node • No impulses from Sinus Node will pass through to the ventricles • Some part if the conducting system will take over as pacemaker of the heart (even a myocardial cell 10-15 bpm)
  69. 69. Third-degree atrioventricular (AV) block, also referred to as third-degree heart block or complete heart block, is a disorder of the cardiac conduction system where there is no conduction through the atrioventricular node.
  70. 70. Third Degree Heart Block (3º) (Complete) • P wave rate – normal • Ventricular rate – slow • Ventricular complex may be broad • Idioventricular rhythm • Complete dissociation between P waves & QRS
  71. 71. Significance • clinical significance • Symptoms LOC, Confusion, Dizziness, Low BP • Can lead to standstill, VT or VF (stokes Adams) • Treatment - pacemaker