This document discusses arrhythmias, including their causes, symptoms, diagnosis, and treatment. Arrhythmias can be caused by cardiac issues like heart attacks or non-cardiac issues like drugs or metabolic imbalances. Common symptoms include palpitations, chest pain, fainting, and breathlessness. Diagnosis involves blood tests, ECGs, heart monitoring, and imaging. Treatment depends on the type of arrhythmia but may include medications, cardioversion, or pacemakers. The document provides details on evaluating and managing common arrhythmias like bradycardia, atrial fibrillation, and ventricular tachycardia.

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
 myocardial infarction
 coronary artery disease
 left ventricle aneurysm
 mitral valve disease
 cardiomyopathy
 pericarditis
 myocarditis
 abberant conduction
pathways
Non cardiac
 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. 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
 24 hours ECG monitoring
 Echocardiography
 Excercise ECG
 Cardiac catheterization
 Electrophysiological studies

9. TREATMENT OVERVIEW OF
MOST COMMON
ARRHYTHMIAS
Part two

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. 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 + 5000 IJ LMWH
OR
 Electrocardioversion after 3 weeks
of warfarin therapy.

19. Ekg.academy.com
Atrial fibrillation

20. Ventricular tachycardia (VT)

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