Arrhythmias are abnormalities in heart rate or rhythm that arise from problems with the heart's electrical system. They can be caused by issues with impulse formation or conduction. Arrhythmias are classified as tachyarrhythmias, which involve fast heart rates, or bradyarrhythmias, which involve slow heart rates. Common arrhythmias include atrial fibrillation, atrial flutter, and various types of heart block. Diagnosis involves electrocardiography and other cardiac tests. Treatment may involve medications, cardiac ablation, implanted devices, or surgery depending on the type of arrhythmia.

1. ARRYTHMIA
PRESENTED BY,
Anjali.c
First year m.pharm
Department of pharmacy practice
Grace college of pharmacy

2. DEFINITION
• Arrhythmias are deviations from normal
heartbeat pattern. They include abnormalities
of impulse formation,such as heart
rate,rhythm,or site of impulse origin and
conduction disturbances,which disrupt the
normal sequence of atrial and ventricular
activation.

3. NORMAL ELECTRICAL ACTIVITY IN THE
HEART

4. CLASSIFICATION
 1. TACHYARRYTHMIA
a) Atrial:
o Atrial fibrillation
o Atrial flutter
o PSVT
o Automatic atrialTachycardia Atrial
extrasystols

5. b) Ventricle
oVentricular fibrillation
oVentricular flutter
oVentricular tachycardia
oProarrythmia
oTorsades depoint
oVentricular extrasystole
c) AV node
o AV nodal extra systolic paroxysmal
AV nodal tachycardia

6. 2) BRADY ARRHYTHMIA
o Sick-sinus syndrome(SSS)
o Tachy-brady syndrome
o Heart block

7. EPIDEMIOLOGY
• It is estimated that 3.9nmillion people in
USA have a cardiac rhythm disturbance
and that is result in 730000 hospital
admissions each year.
• Atrial arrhythmias are more common than
ventricular arrhythmias and atrial fibrillation
(AF) is the commonest chronic arrhythmia.
• Incidence of AF increases with age from
less than 0.1% in the 30-39 year age group
to above 1% in 70-79 year old men.
• Women have a lower risk of AF than male.

8. ETIOLOGICAL FACTORS
• Heart disease
• Myocardial infarction(MI)
• Systemic hypertension
• Hyperkalemia/hypokalemia
• Chronic obstructive pulmonary disease(COPD)
• Thyroid disorders
• Drug therapy
• Toxic doses of cardioactive drugs
• Increased sympathetic tone
• Vagal stimulation
• Metabolic disturbances
• Cor pulmonale

9. ETIOPATHOGENESIS
1) Abnormal impulse formation may stem from
• Decreased automaticity, as in escape beats and bradycardia
• Increased automaticity, as in premature beats, tachycardia, and
extrasystole
• Depolarization and triggered activity, leading to sustained
ectopic firing
2)Abnormal impulse conduction results from
• A conduction block or delay
• Reentry occurs when an impulse is rerouted through certain
regions in which it has already travelled. Thus the impulse
depolarizes the same tissue more than once, producing an
additional impulse. Reentry sites include the SA and AV nodes
as well as various accessory conditions must exist:

10. PATHOPHYSIOLOGY
Inadequate acceleration of
sinus rate
MI,HT,Coronary
spasm
Failure of sinus
impulseformation
Aortic & mitral valve stenosis
Abrupt sinus prolonged pause
Degeneration or damage of
conduction system
SA node dysfunction
AV conduction block
Atrial dysfunction
Ventricular dysfunction
CARDIAC ARRYTHMIA

11. CLINICAL MANIFESTATION
• Palpitations
• Chest pain
• Anxiety and confusion(reduced blood
perfusion)
• Dyspnea
• Skin pallor or cyanosis
• Abnormal pulse rate, rhythm or amplitude
• Reduced blood pressure
• Syncope
• Weakness
• Convulsions
• Hypotesion
• Decreased urinary output

12. DIAGNOSIS
ECG strip showing a normal
heartbeat
ECG strip showing bradycardia
ECG strip showing tachycardia
ECG

13. • Electrophysiological (EP) testing: These intra
cardiac procedures determine the location of
ectopic foci.
• Laboratory findings
• Serum potassium level˃5mEq/L reflects
Hyperkalemia
• serum calcium level˂4.5mEq/L signifies
hypocalcemia
• serum magnesium level˂2.5mEq/L signify
hypomagnesemia
• His bundle study :can locate the origin of a heart
block or reentry pattern

14. MANAGEMENT
NON-PHARMACOLOGICAL
• Lifestyle changes
• Devices: Implantable cardioverter defibrillator (ICD)
• Cardioversion: This treatment can be chemical or
electric
• Cardiac Ablation: A nonsurgical technique that
neutralizes parts of the abnormal electrical pathway
(tissue) that is causing the arrhythmia
• Cardiac Surgery
Cardiac surgery is an invasive procedure where
surgeons will remove abnormal sites

15. PHARMACOLOGICAL TREATMENT
CLASS ACTIONS DRUGS
IA Na- channel block Quinidine,procainamide
Disopyramide
IB Na channel block Lidocaine,mexiletine
IC Na –channel block Flecainide,Propafenone
II Beta-blockers Propranolol,esmolol
III K-channel blockers Amidarone,dofetilide
IV Ca-channel blockers Verapramil,diltiazem
V unknown mechanisms Digoxin,adenosine