Dr Abdul Haque Resident ER,Meeqat Hospital Madinah,KSA

1. Dr Abdul Haque
Resident ER,Meeqat Hospital
Madinah,KSA

2. An arrhythmia is a problem with the rate or
rhythm of your heartbeat. It means that your heart
beats too quickly, too slowly, or with an irregular
pattern

3.  Tachyarrhytmias
 Bradyarrhythmias

4.  Tachycardias are categorized as supraventricular
or ventricular
 Supraventricular tachycardias originate from a
focus within or above the AV node and most often
present with a narrow QRS complex; thus, they are
termed narrow-complex tachycardias.
 Ventricular tachycardias, resulting from a focus
below the AV node in the ventricular myocardium,
usually demonstrate a widened QRS complex and
are referred to as widecomplex tachycardias.

5.  Supraventricular rhythm can present with a
widened QRS complex
 aberrant ventricular conduction, the widened
 a fixed (i.e., preexisting) bundle-branch block,
rate-related conduction block, ventricular
preexcitation syndrome (i.e., Wolff-Parkinson-
White [WPW] syndrome),
 Toxic-metabolic condition.

6.  Abnormal Impulse formation
 Increase normal automaticity
 Abnormal automaticy
 Triggered activity due to early
afterdepolarization (EAD)
 Triggered activity due to delayed
afterdepolarization(DAD)
 Abnormal impulse conduction
 Reentry

7.  Normal QRS complex less than 120
milliseconds


8.  Wide-complex tachycardia QRS complex
width greater than 120 milliseconds.

10.  Sinus tachycardia,
 SANRT
 Ectopic Atrial Tachycardia
 Multifocal Atrial Tachycardia
 Atrial fibrillation,
 Atrial flutter,
 Juctional Tachycardia or Nodal tachycardia
 Paroxysmal Supraventricular Tachycardia
(AVNRT, AVRT)
AVNRT two types Typial, Atypical
AVRT ( orthodromic)

11.  Ventricular tachycardia
 Supraventricular tachycardia with aberrant
conduction.
 AVRT (antidromic)
 Ventricular tachycardia further is subdivided
into monomorphic and polymorphic forms

17.  Sinus tachycardia and multifocalatrial
tachycardia are best managed by treating the
underlying cause, rather than the dysrhythmia
specifically.
 Other narrow-complex tachycardias require
specific antidysrhythmic treatment by a
combination of vagal maneuvers, medications ,
and electrical cardioversion

18.  Basic supportive therapy in most patients
involves an IV fluid bolus to expand the
circulating intravascular volume and
supplemental oxygen.
 Vagal maneuvers heighten parasympathetic
tone and may slow electrical conduction in the
heart to a degree that abolishes sustained
reentry.
 If applied early, vagal maneuvers can convert
about 20% of patients presenting with reentrant
tachycardias, such as paroxysmal
supraventricular tachycardia and narrow-
complex tachycardia associated with WPW
syndrome.

19.  Adenosine is a very-short-acting agent that
blocks conduction through the AV node and
can interrupt sustained reentry when the AV
node is part of the circuit.
 β-Blockers and calcium channel blockers slow
conduction through the AV node and can
convert some supraventricular tachycardias,
such as reentrant supraventricular
tachycardias, and slow the ventricular response
in others, such as atrial fibrillation or flutter.

20.  Synchronized electrical cardioversion can be
used in narrow-complex tachycardias when
patients are unstable or do not respond to
pharmacologic measures.

22.  In the stable patient, pharmacologic agents
used to terminate a wide-complex tachycardia
include procainamide, amiodarone, lidocaine,
and magnesium.
 For rapid treatment, amiodarone is the
antiarrhythmic of choice, given as an IV bolus.
 Procainamide is effective for stable ventricular
tachycardia in patients with preserved left
ventricular dysfunction, given as an IV
infusion.

23.  Lidocaine is a less effective alternative.
 Magnesium is used for tachydysrhythmias
associated with QT interval prolongation, such
as torsade de pointes.
 Electrical cardioversion is the preferred
treatment for wide-complex tachycardia with
hemodynamic instability, myocardial ischemia,
or failure of pharmacologic treatment