Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Emergency cadiac arrhythmias

852 views

Published on

HEART ARRYTHMIAS

Published in: Health & Medicine
  • Be the first to comment

Emergency cadiac arrhythmias

  1. 1. EMERGENCY CADIACEMERGENCY CADIAC ARRHYTHMIASARRHYTHMIAS EMERGENCY CADIACEMERGENCY CADIAC ARRHYTHMIASARRHYTHMIAS Cairo University Cons. cardiologist SBCC Sherif Hamed Zaky, MD
  2. 2. EMERGENCY CADIAC RRHYTHMIASEMERGENCY CADIAC RRHYTHMIAS Tachyarrhythmias :Tachyarrhythmias :  V.tachV.tach  V.FibV.Fib  Atrial Fib.Atrial Fib.  “ ““ “ TachycardiaTachycardia  S.V.TS.V.T These are serious cardiacThese are serious cardiac dysrhythmias seen mostly in ER, CCUdysrhythmias seen mostly in ER, CCU or ICU and includeor ICU and include::
  3. 3. Bradyarrhythmias:Bradyarrhythmias: ٍٍ Sinus bradycardiaSinus bradycardia  Complete heart blockComplete heart block  second degree heart blocksecond degree heart block  AsystoleAsystole Devices malfunction:Devices malfunction: PacemakersPacemakers ICDsICDs
  4. 4. TachyarrhythmiasTachyarrhythmias:: Ventricular TachycardiaVentricular Tachycardia (wide complex tachycardia management)(wide complex tachycardia management) Decision AlgorithmDecision Algorithm ?Is the patient haemodynamically unstable NOYES)unstable( Haemodynamic instability means that the arrhythmia should be addressed immediately. The following algorithm cannot be used where the ventricular response rate is irregular.
  5. 5. Is any one of the following is presentIs any one of the following is present:: ischaemic heart diseaseischaemic heart disease ,,oror heart failureheart failure,, oror past heart surgerypast heart surgery,, oror cardiac enlargementcardiac enlargement?? NONO YES )VTYES )VT(( Decision AlgorithmDecision Algorithm
  6. 6. Ischemic VTIschemic VT
  7. 7. ::Are there any RS complexes in the VAre there any RS complexes in the V leadsleads?? NO )VT(NO )VT( YESYES In any of these RS complexes, is the interval from start of R to nadir of S > 100ms? NO YES )VT( Decision AlgorithmDecision Algorithm
  8. 8. Is there AVIs there AV dissociationdissociation?? or are there fusionor are there fusion or capture beatsor capture beats?? NO (VT) YES Decision AlgorithmDecision Algorithm
  9. 9. Is there positive or negative concorance in V-leads? Decision AlgorithmDecision Algorithm
  10. 10. Predominantly negativePredominantly negative QRSQRS in at leastin at least 22 out ofout of 44 leads (leads ( I , II , V1 , V6I , II , V1 , V6 )) including essentially leadincluding essentially lead II oror V6V6 cancan diagnose VT in 90% and SVT in 100% ofdiagnose VT in 90% and SVT in 100% of cases with wide complex tachycardiacases with wide complex tachycardia.. Decision AlgorithmDecision Algorithm
  11. 11. 1 2 3 4
  12. 12. Preexcited AFPreexcited AF
  13. 13. Torsade De pointesTorsade De pointes:: Look for long QT syndromeLook for long QT syndrome (acquired- congenital) after DC(acquired- congenital) after DC cardioversion to chose propercardioversion to chose proper managementmanagement..
  14. 14. VF :VF : Ischemic heart disease & end stageIschemic heart disease & end stage cardiomyopathy of different aetiologiescardiomyopathy of different aetiologies are the most common ppt factorsare the most common ppt factors..
  15. 15. SVTSVT
  16. 16. Atrial Tachcardia/FibrillationAtrial Tachcardia/Fibrillation
  17. 17. Atrial Tachcardia/FibrillationAtrial Tachcardia/Fibrillation
  18. 18. AV- BlockAV- Block • 1o HB • 2o HB ♦ Mobitz I ♦ Mobitz II • 3o HB • High grade AV-block
  19. 19. AV- BlockAV- Block SUPRASHISSIAN INFRAAHISSIAN
  20. 20. Sinus bradycardia/AsystoleSinus bradycardia/Asystole (comlete SA-block(comlete SA-block((
  21. 21. Sinus bradycardia/AsystoleSinus bradycardia/Asystole (comlete SA-block(comlete SA-block((
  22. 22. Malfunctioning DevicesMalfunctioning Devices Permanent Pacemakers
  23. 23. LOSS OF SENSING
  24. 24. LOSS OF CAPTURE
  25. 25. ENDLESS LOOP TACHYCARDIA
  26. 26. ICDICD

×