This document provides an overview of various arrhythmias that may be encountered in ACLS situations. It discusses pulseless rhythms like ventricular fibrillation and ventricular tachycardia, which require immediate defibrillation. It also covers pulseless electrical activity, asystole, and various bradyarrhythmias and tachyarrhythmias like atrial fibrillation and atrial flutter. For each arrhythmia, it outlines characteristics like heart rate, pulse presence, ECG patterns, potential causes, and recommended treatment approaches. The goal is to help providers quickly recognize rhythms and deliver the appropriate life-saving therapy in cardiac arrest situations.

1. Arrhythmia : What you need to
know for ACLS?
Syed Raza

2. Introduction
• Rhythm recognition is a key skill that one
needs to demonstrate during cardiac arrest
situation.
• This can be life saving.
• Early defibrillation
• Decision making on the right therapy

3. Lets Keep it Simple!
• Pulseless Rhythms
• Tachyarrhythmias
• Bradyarrhythmias

4. Pulse less Electrical Rhythm

6. Ventricular Fibrillation
• Uncoordinated contractions within the
ventricles of heart.
• Due to multiple cardiac cells that function as
pacemakers and discharge electrical impulses
in a chaotic manner.
• Reduced / No cardiac output : No pulse
• Will result in Asystole if not treated.

7. • Commonest cause : Hypoxia /Ischemia
• Types : Fine and Coarse

8. Therapy
Immediate Defibrillation
CPR
I/V Amiodarone after 3 shocks

10. Ventricular Tachycardia
• Broad Complex Tachycardia (QRS > 0.12s)
• Heart rate > 180 beats /mt
• Mono-morphic
• Poly-morphic / Torsade Pointe
• Pulse less vs with pulse

11. Mono morphic VT

12. Poly morphic VT
• Torsade Pointes if Prolonged QT interval on
previous ECG

13. Treatment
• Pulseless : Defibrillation
• With pulse : stable = Amiodarone
Unstable = DC Cardio version

14. No Pulse !

15. Pulse Less Electrical Activity (PEA)
• Organized electrical activity but without a
pulse
• Usually has underlying treatable cause
• Hypovolumea and Hypoxia are the
commonest causes.
• If no underlying cause is identified, it will be
treated same as Asystole.

16. 5 Hs and 5 Ts
5 Hs
Hypovolumia
Hypoxia
Hydrogen Ion (Acidosis)
Hyperkalemia
Hypokalemia
Hypoglycemia

17. 5Ts
Toxins
Tension Pneumothorax
Tamponade
Thrombosis : Coronary
Thrombosis : Pulmonary
Trauma

19. ASYSTOLE
Follow flat line protocol – check leads and gain
Not a true rhythm
State of no electrical activity
Terminal event
Very poor prognosis : ROSC extremely unlikely
Possible underlying cause : 5Hs and 5Ts
Treatment : CPR and Epinephrine

20. First Degree AV Block

21. • PR interval is prolonged > 200ms
• No clinical significance if asymptomatic
• May lead to higher degree AV Block

22. Second Degree AV Block

23. Mobitz Type 1
• Progressive prolongation of PR interval.
• Atrial impulse (P waves) may not be conducted
through AVN and gets blocked and hence no
QRS.
• No clinical significance unless symptomatic.
Mobitz Type 2
• Non prolongation and fixed PR interval.
• Non conducted p waves
• No ventricular activity -Drop beats / No QRS
Most times Infranodal

24. Third Degree AV Block (CHB)

25. P waves with a regular pp interval
QRS complexes with a regular RR interval
QRS complex may be narrow or wide (escape
rhythm)
No relationship between P waves and QRS
complexes.

26. Treatment
• Trans cutaneous or Trans Venous pacemaker
• Atropine (0.5 mg) may be tried
Epinephrine 0.5 -1 mg /kg bw

28. Atrial Fbrillation
• No p waves preceding QRS complexes as no
coordinated atrial contractility
• Irregular (variable) RR intervals

29. Treatment
• Unstable : Synchronized DC Cardio version
• Stable : Rhythm Control vs Rate Control
• Rhythm : Amiodarone, Sotalol, Flecainide
• Rate control : Beta blocker, Calcium channel
blocker, Digoxin.
• Anticoagulant if indicated.

31. Atrial Flutter
• Atrial rate 250 – 350 /mt
• Saw Tooth Appearance
• Ventricular rate depends on Degree of AV
block
• Electrical foci usually in RA

32. Treatment
• Rate Control
• Rhythm Control
• Anti coagulant
• DCC if unstable

34. Supra Ventricular Tachycardia
• Broad term for various supra ventricular
arrhythmia
• Electrical impulses above the ventricular
electrical conducting system.
• Inverted p waves preceding or following qrs
complexes.
• Review old ECG – exclude WPW

35. Treatment
Vagal maneuver
Adenosine
•Drugs – Chemical Cardio version or Rate
control.
• Anti coagulant.
•If unstable : sync. DCC