This document discusses various cardiac arrhythmias including their mechanisms and treatment. It begins by describing the three main mechanisms of cardiac arrhythmia: alterations in impulse initiation (automaticity), afterdepolarizations and triggered automaticity, and abnormal impulse conduction (reentry). It then discusses various specific arrhythmias in more detail, including types of heart block, tachycardias like atrial fibrillation, flutter and sinus tachycardia, as well as treatment options like antiarrhythmic drugs, catheter ablation, and pacemakers. In summary, the document provides an overview of the conduction system of the heart and covers the pathophysiology, classification, evaluation and management of different cardiac arrhythmias.
Sa and av nodal bradyarrhythmias and the indicationSatyan Nanda
SA nodal and AV nodal bradyarrhythmias can cause symptomatic sinus bradycardia requiring pacemaker implantation. The SA node regulates heart rate and its dysfunction can be caused by drugs, autonomic dysfunction, or intrinsic sick sinus syndrome. AV nodal dysfunction may involve first-degree, Mobitz type I or II, or complete heart block. Pacemakers are indicated for symptomatic bradycardia based on electrocardiography and electrophysiological study findings. Pacemaker implantation carries risks of infection, lead issues, or abnormal pacing responses.
cardiac arrhythmias are abnormal heart rhythms that occur when the electrical signals controlling the heart beat are not working properly.
these can include tachycardia ,Bradycardia,atrial fibrillation and more.
This document discusses cardiac arrhythmias and their treatment. It begins by describing the cardiac conduction system and action potentials in nodal and non-nodal cells. It then covers mechanisms of arrhythmias including disorders of impulse formation and conduction. Various types of tachyarrhythmias are defined including SVTs originating from the sinus node, atria, or AV node. Treatment of SVTs focuses on pharmacological agents or cardioversion. The document concludes with classifications of antiarrhythmic drugs and arrhythmias.
Antiarrhythmic therapy for supraventricular arrhythmiasKyaw Win
This document provides an overview of anti-arrhythmic drug therapy for supraventricular arrhythmias. It discusses the electrophysiology of the heart, definitions of arrhythmias, and classifications of anti-arrhythmic drugs. The four main classes of anti-arrhythmic drugs are described along with their mechanisms of action and uses for treating different types of supraventricular tachyarrhythmias. Guidelines for treating atrial fibrillation and some supraventricular tachycardias are also presented.
This document discusses antiarrhythmic drug therapy and summarizes the following key points:
- Antiarrhythmic drugs are classified into four classes based on their mechanism of action and effects on the cardiac action potential. Classes I-III work by blocking sodium, calcium or potassium channels.
- Class I drugs like quinidine and procainamide work by blocking fast sodium channels, reducing the rate of depolarization. Class II drugs like propranolol are beta blockers that reduce heart rate and conduction velocity.
- Common arrhythmias treated include atrial fibrillation, ventricular tachycardia, and supraventricular tachycardias. Drug choice is based on the arrhythmia type
This document provides an overview of cardiac arrhythmias including their classification, mechanisms, clinical manifestations, diagnostic approaches and management strategies. It discusses various specific arrhythmias in detail such as atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular arrhythmias, sick sinus syndrome and heart block. Treatment options covered include pharmacological therapies using different classes of antiarrhythmic drugs, procedures like cardiac ablation and use of devices like pacemakers.
The electrocardiogram (ECG) records the electrical activity of the heart during each cardiac cycle. It detects the P wave, QRS complex, and T wave which represent atrial depolarization, ventricular depolarization, and ventricular repolarization, respectively. The ECG is used to analyze the heart rate, rhythm, and intervals between waves to diagnose cardiac conditions. Common arrhythmias include premature beats, supraventricular tachycardias like atrial flutter, and atrial fibrillation which is characterized by disorganized atrial activity and an irregular ventricular response.
1. This document discusses the approach to evaluating and diagnosing narrow complex tachycardias. It describes the main mechanisms that can cause tachycardias including enhanced automaticity, triggered activity, and reentry.
2. Specific tachycardia types are then discussed in detail including AV nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), atrial tachycardia (AT), junctional ectopic tachycardia (JET), and inappropriate sinus tachycardia. The diagnostic criteria and distinguishing characteristics of each are provided.
3. A number of other arrhythmias are also briefly covered such
Sa and av nodal bradyarrhythmias and the indicationSatyan Nanda
SA nodal and AV nodal bradyarrhythmias can cause symptomatic sinus bradycardia requiring pacemaker implantation. The SA node regulates heart rate and its dysfunction can be caused by drugs, autonomic dysfunction, or intrinsic sick sinus syndrome. AV nodal dysfunction may involve first-degree, Mobitz type I or II, or complete heart block. Pacemakers are indicated for symptomatic bradycardia based on electrocardiography and electrophysiological study findings. Pacemaker implantation carries risks of infection, lead issues, or abnormal pacing responses.
cardiac arrhythmias are abnormal heart rhythms that occur when the electrical signals controlling the heart beat are not working properly.
these can include tachycardia ,Bradycardia,atrial fibrillation and more.
This document discusses cardiac arrhythmias and their treatment. It begins by describing the cardiac conduction system and action potentials in nodal and non-nodal cells. It then covers mechanisms of arrhythmias including disorders of impulse formation and conduction. Various types of tachyarrhythmias are defined including SVTs originating from the sinus node, atria, or AV node. Treatment of SVTs focuses on pharmacological agents or cardioversion. The document concludes with classifications of antiarrhythmic drugs and arrhythmias.
Antiarrhythmic therapy for supraventricular arrhythmiasKyaw Win
This document provides an overview of anti-arrhythmic drug therapy for supraventricular arrhythmias. It discusses the electrophysiology of the heart, definitions of arrhythmias, and classifications of anti-arrhythmic drugs. The four main classes of anti-arrhythmic drugs are described along with their mechanisms of action and uses for treating different types of supraventricular tachyarrhythmias. Guidelines for treating atrial fibrillation and some supraventricular tachycardias are also presented.
This document discusses antiarrhythmic drug therapy and summarizes the following key points:
- Antiarrhythmic drugs are classified into four classes based on their mechanism of action and effects on the cardiac action potential. Classes I-III work by blocking sodium, calcium or potassium channels.
- Class I drugs like quinidine and procainamide work by blocking fast sodium channels, reducing the rate of depolarization. Class II drugs like propranolol are beta blockers that reduce heart rate and conduction velocity.
- Common arrhythmias treated include atrial fibrillation, ventricular tachycardia, and supraventricular tachycardias. Drug choice is based on the arrhythmia type
This document provides an overview of cardiac arrhythmias including their classification, mechanisms, clinical manifestations, diagnostic approaches and management strategies. It discusses various specific arrhythmias in detail such as atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular arrhythmias, sick sinus syndrome and heart block. Treatment options covered include pharmacological therapies using different classes of antiarrhythmic drugs, procedures like cardiac ablation and use of devices like pacemakers.
The electrocardiogram (ECG) records the electrical activity of the heart during each cardiac cycle. It detects the P wave, QRS complex, and T wave which represent atrial depolarization, ventricular depolarization, and ventricular repolarization, respectively. The ECG is used to analyze the heart rate, rhythm, and intervals between waves to diagnose cardiac conditions. Common arrhythmias include premature beats, supraventricular tachycardias like atrial flutter, and atrial fibrillation which is characterized by disorganized atrial activity and an irregular ventricular response.
1. This document discusses the approach to evaluating and diagnosing narrow complex tachycardias. It describes the main mechanisms that can cause tachycardias including enhanced automaticity, triggered activity, and reentry.
2. Specific tachycardia types are then discussed in detail including AV nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), atrial tachycardia (AT), junctional ectopic tachycardia (JET), and inappropriate sinus tachycardia. The diagnostic criteria and distinguishing characteristics of each are provided.
3. A number of other arrhythmias are also briefly covered such
This document provides an overview of atrial fibrillation (AF) and paroxysmal supraventricular tachycardia (PSVT). It defines these conditions and describes their typical ECG patterns, mechanisms, clinical presentations, diagnostic evaluations, and treatment approaches including medications, procedures like cardioversion and ablation. Key points include: AF can be paroxysmal, persistent or permanent, and is caused by mechanisms like reentry and ectopic automaticity; evaluation involves assessing thromboembolic risk with scores like CHA2DS2-VASc; treatment focuses on rate or rhythm control with medications or ablation, while preventing thromboembolism with anticoagulation; PSVT often presents with abrupt
This document provides an overview of tachyarrhythmias and their mechanisms. It discusses the normal cardiac conduction system and describes how abnormalities can lead to arrhythmias via mechanisms like accelerated automaticity, triggered activity, and reentry. It then focuses on atrial fibrillation, describing its classification, causes, diagnosis, and treatment approaches like rate control and anticoagulation based on stroke risk scores. The document emphasizes the importance of evaluating hemodynamic stability and controlling heart rate for arrhythmia patients.
This document discusses antiarrhythmic drugs used to treat cardiac arrhythmias. It begins by defining arrhythmias and describing the causes. It then discusses the Vaughan Williams classification system for antiarrhythmic drugs. Class I drugs like quinidine, procainamide and flecainide work by blocking sodium channels. Class II drugs like propranolol are beta blockers. Class III drugs like amiodarone work by prolonging the action potential. The document provides details on specific drugs, their mechanisms of action, uses, doses and side effects. It emphasizes restoring normal rhythm and rate while preventing more dangerous arrhythmias.
This document discusses antiarrhythmic agents and their mechanisms and classifications. It begins by describing the normal cardiac conduction pathway and different types of arrhythmias including their causes. Antiarrhythmic drugs are classified into four classes based on their effects on the cardiac action potential and ion channels. Class I drugs block fast sodium channels, class II are beta blockers, class III block potassium channels, and class IV block calcium channels. Examples from each class like quinidine, propranolol, amiodarone, and verapamil are described in more detail regarding their mechanisms and uses.
1) The document discusses perioperative arrhythmias and ACLS guidelines. It defines arrhythmias and discusses their incidence during the perioperative period.
2) It covers the electrophysiology of the conduction system and the pathogenesis of arrhythmias. Common arrhythmias discussed include sinus tachycardia, premature atrial contractions, supraventricular tachycardia, atrial flutter, atrial fibrillation, premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation.
3) For each arrhythmia, the document discusses characteristics, causes, and perioperative management guidelines based on ACLS protocols. Management may involve monitoring, addressing reversible causes, medication administration, cardioversion,
Tachyarrhythmias 2020 (for the undergraduates)salah_atta
This document provides an overview of tachyarrhythmias. It defines tachyarrhythmias as abnormal heart rhythms with a heart rate exceeding 100 beats per minute. The document classifies and describes various types of tachyarrhythmias including extrasystoles, sinus tachycardia, supraventricular tachycardias such as AV nodal reentrant tachycardia, atrial fibrillation, and ventricular tachycardias. It discusses the mechanisms, clinical presentations, diagnostic tools and management options for these arrhythmias.
This document provides information on various types of supraventricular tachyarrhythmias including AV nodal reentrant tachycardia (AVNRT), orthodromic reciprocating tachycardia (ORT), atrial tachycardia, junctional tachycardias, Wolff-Parkinson-White (WPW) syndrome, and atrial fibrillation. It discusses the mechanisms, ECG patterns, symptoms, diagnostic approaches, and management options for these arrhythmias in 1-3 sentences per type of arrhythmia.
Cardiac arrhythmias occur frequently in ICU patients, with the most common being sinus tachycardia. Arrhythmias are often seen in patients with structural heart disease and can be exacerbated by critical illness. Management involves treating any imbalances that may be triggering the arrhythmia as well as directed medical therapy. Arrhythmias in the ICU represent a major source of morbidity and increased length of stay.
This document provides an overview of perioperative arrhythmias including:
- The anatomy and physiology of the cardiac conduction system.
- Types of arrhythmias like sinus bradycardia, heart blocks, bundle branch blocks, supraventricular tachycardias, atrial flutter/fibrillation, and Wolff-Parkinson-White syndrome.
- Causes, mechanisms, ECG features, and management strategies for different arrhythmias that can occur in the perioperative period. Antiarrhythmic drugs and electrical therapies like pacing and cardioversion are discussed as treatment options.
- The incidence of arrhythmias is high during anesthesia for surgery, ranging from 4-20% for non
The document defines and classifies different types of arrhythmias. It discusses the etiology, symptoms, electrocardiogram characteristics and treatment options for various arrhythmias including sinus arrhythmia, atrial fibrillation, ventricular tachycardia, premature contractions, and more. Anti-arrhythmia medications are also categorized based on their mechanisms of action.
Atrial tachycardia is a type of supraventricular tachycardia where the atria beat too fast, independently of the ventricles. It can have different causes such as enhanced automaticity, triggered activity, or reentry. On ECG, it typically shows a narrow QRS complex with an atrial rate of 100-250 bpm and regular or irregular conduction to the ventricles. Evaluation involves assessing the P wave morphology and determining the mechanism and site of origin through cardiac monitoring and electrophysiological studies. Treatment depends on the underlying cause but may include medications, catheter ablation, or surgery.
Atrial tachycardia is a type of supraventricular tachycardia where the atria beat too fast, independently of the ventricles. It can have different causes such as enhanced automaticity, triggered activity, or reentry. On ECG, it typically shows a narrow QRS complex with an atrial rate of 100-250 bpm and regular or irregular conduction to the ventricles. Evaluation involves assessing the P wave morphology and determining the mechanism and site of origin through cardiac monitoring, imaging, or electrophysiological study. Treatment depends on the underlying cause but may include medications, catheter ablation, or surgery.
This document discusses supraventricular tachycardias (SVT). It defines different types of SVT including paroxysmal SVT, which is common in emergency rooms. Quality of life is often poor for those with paroxysmal SVT. The document discusses mechanisms of SVT including reentry circuits, enhanced automaticity, and triggered activity. It provides details on differentiating AV nodal reentrant tachycardia from AV reentrant tachycardia using electrocardiogram findings. Treatment options discussed include carotid sinus massage, adenosine, and catheter ablation.
This document provides an overview of supraventricular tachycardia (SVT), including its definition, classification, and management. It discusses 10 specific types of SVT in detail: sinus tachycardia, inappropriate sinus tachycardia, sinus node re-entrant tachycardia, postural orthostatic tachycardia syndrome, focal atrial tachycardia, multifocal atrial tachycardia, macro-re-entrant atrial tachycardias, atrioventricular nodal re-entrant tachycardia, atrioventricular re-entrant tachycardia, and non-re-entrant junctional tachycardias. For
This document discusses the management of peri-arrest arrhythmias. It defines arrhythmias and describes their assessment and general treatment options. It covers the management of specific arrhythmias like bradycardia and tachycardias. It also discusses the pharmacology of common antiarrhythmic drugs like amiodarone, atropine, digoxin. The document provides guidelines on stabilizing patients and restoring normal heart rhythm in peri-arrest settings.
The document describes several types of normal and abnormal cardiac rhythms as identified by an electrocardiogram (EKG or ECG). It provides descriptions and EKG criteria for normal sinus rhythm, sinus bradycardia, sinus tachycardia, premature atrial complexes, atrial fibrillation, atrial flutter, supraventricular tachycardia, premature junctional complexes, junctional rhythm, various degrees of atrioventricular block, premature ventricular contractions, ventricular bigeminy, and ventricular tachycardia.
1685644652805_1685644176287_1685644169732_CARDIAC ARRYTHMIAS AND MANAGEMENT...PratimaSingh928775
Cardiac arrhythmias refer to irregularities in heart rhythm. They can be characterized by rate, rhythm, origin, conduction pathways, and other factors. Causes include coronary artery disease, electrolyte imbalances, structural heart changes, and various medical conditions. Symptoms depend on the type of arrhythmia but may include palpitations, dizziness, chest pain, and fainting. Diagnosis involves EKGs, holter monitors, echocardiograms, and other tests. Treatment includes medications to restore normal rhythm or prevent dangerous arrhythmias, cardioversion, pacemakers, ablation, and defibrillators. Management depends on the specific arrhythmia and may involve drugs, ablation, cardioversion,
Bradyarrhythmias are caused by problems with impulse formation in the sinus node or impulse conduction through the AV node. Sinus node dysfunction can cause sinus bradycardia, sinus pause/arrest, or chronotropic incompetence. Atrioventricular block is classified as first, second, or third degree and may be caused by conditions like CAD, drugs, or infiltrative diseases. Second degree AV block is further classified as Mobitz type I or II based on PR interval characteristics. Third degree AV block causes complete dissociation between atrial and ventricular rhythms.
This document outlines a lecture on pediatric infective endocarditis. It discusses the epidemiology, etiology, pathogenesis, clinical manifestations, differential diagnosis, and management of IE in children. Some key points include: congenital heart disease is the most common risk factor; viridans streptococci and staphylococci are frequent causes; clinical features can include fever, heart failure, and neurological symptoms; and diagnosis involves considering other conditions like sepsis, myocarditis, or rheumatologic disorders.
This document outlines key aspects of infection prevention and control in pediatric medicine. It discusses the importance of hand hygiene, standard precautions like the use of barriers, and isolation protocols depending on the transmission route. Surgical prophylaxis is also covered, describing different wound classifications and antibiotic use. Additional measures mentioned include aseptic technique, catheter care, environmental cleansing, and reporting of infections. The overall goal is to reduce healthcare-associated infections in children through appropriate techniques.
This document provides an overview of atrial fibrillation (AF) and paroxysmal supraventricular tachycardia (PSVT). It defines these conditions and describes their typical ECG patterns, mechanisms, clinical presentations, diagnostic evaluations, and treatment approaches including medications, procedures like cardioversion and ablation. Key points include: AF can be paroxysmal, persistent or permanent, and is caused by mechanisms like reentry and ectopic automaticity; evaluation involves assessing thromboembolic risk with scores like CHA2DS2-VASc; treatment focuses on rate or rhythm control with medications or ablation, while preventing thromboembolism with anticoagulation; PSVT often presents with abrupt
This document provides an overview of tachyarrhythmias and their mechanisms. It discusses the normal cardiac conduction system and describes how abnormalities can lead to arrhythmias via mechanisms like accelerated automaticity, triggered activity, and reentry. It then focuses on atrial fibrillation, describing its classification, causes, diagnosis, and treatment approaches like rate control and anticoagulation based on stroke risk scores. The document emphasizes the importance of evaluating hemodynamic stability and controlling heart rate for arrhythmia patients.
This document discusses antiarrhythmic drugs used to treat cardiac arrhythmias. It begins by defining arrhythmias and describing the causes. It then discusses the Vaughan Williams classification system for antiarrhythmic drugs. Class I drugs like quinidine, procainamide and flecainide work by blocking sodium channels. Class II drugs like propranolol are beta blockers. Class III drugs like amiodarone work by prolonging the action potential. The document provides details on specific drugs, their mechanisms of action, uses, doses and side effects. It emphasizes restoring normal rhythm and rate while preventing more dangerous arrhythmias.
This document discusses antiarrhythmic agents and their mechanisms and classifications. It begins by describing the normal cardiac conduction pathway and different types of arrhythmias including their causes. Antiarrhythmic drugs are classified into four classes based on their effects on the cardiac action potential and ion channels. Class I drugs block fast sodium channels, class II are beta blockers, class III block potassium channels, and class IV block calcium channels. Examples from each class like quinidine, propranolol, amiodarone, and verapamil are described in more detail regarding their mechanisms and uses.
1) The document discusses perioperative arrhythmias and ACLS guidelines. It defines arrhythmias and discusses their incidence during the perioperative period.
2) It covers the electrophysiology of the conduction system and the pathogenesis of arrhythmias. Common arrhythmias discussed include sinus tachycardia, premature atrial contractions, supraventricular tachycardia, atrial flutter, atrial fibrillation, premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation.
3) For each arrhythmia, the document discusses characteristics, causes, and perioperative management guidelines based on ACLS protocols. Management may involve monitoring, addressing reversible causes, medication administration, cardioversion,
Tachyarrhythmias 2020 (for the undergraduates)salah_atta
This document provides an overview of tachyarrhythmias. It defines tachyarrhythmias as abnormal heart rhythms with a heart rate exceeding 100 beats per minute. The document classifies and describes various types of tachyarrhythmias including extrasystoles, sinus tachycardia, supraventricular tachycardias such as AV nodal reentrant tachycardia, atrial fibrillation, and ventricular tachycardias. It discusses the mechanisms, clinical presentations, diagnostic tools and management options for these arrhythmias.
This document provides information on various types of supraventricular tachyarrhythmias including AV nodal reentrant tachycardia (AVNRT), orthodromic reciprocating tachycardia (ORT), atrial tachycardia, junctional tachycardias, Wolff-Parkinson-White (WPW) syndrome, and atrial fibrillation. It discusses the mechanisms, ECG patterns, symptoms, diagnostic approaches, and management options for these arrhythmias in 1-3 sentences per type of arrhythmia.
Cardiac arrhythmias occur frequently in ICU patients, with the most common being sinus tachycardia. Arrhythmias are often seen in patients with structural heart disease and can be exacerbated by critical illness. Management involves treating any imbalances that may be triggering the arrhythmia as well as directed medical therapy. Arrhythmias in the ICU represent a major source of morbidity and increased length of stay.
This document provides an overview of perioperative arrhythmias including:
- The anatomy and physiology of the cardiac conduction system.
- Types of arrhythmias like sinus bradycardia, heart blocks, bundle branch blocks, supraventricular tachycardias, atrial flutter/fibrillation, and Wolff-Parkinson-White syndrome.
- Causes, mechanisms, ECG features, and management strategies for different arrhythmias that can occur in the perioperative period. Antiarrhythmic drugs and electrical therapies like pacing and cardioversion are discussed as treatment options.
- The incidence of arrhythmias is high during anesthesia for surgery, ranging from 4-20% for non
The document defines and classifies different types of arrhythmias. It discusses the etiology, symptoms, electrocardiogram characteristics and treatment options for various arrhythmias including sinus arrhythmia, atrial fibrillation, ventricular tachycardia, premature contractions, and more. Anti-arrhythmia medications are also categorized based on their mechanisms of action.
Atrial tachycardia is a type of supraventricular tachycardia where the atria beat too fast, independently of the ventricles. It can have different causes such as enhanced automaticity, triggered activity, or reentry. On ECG, it typically shows a narrow QRS complex with an atrial rate of 100-250 bpm and regular or irregular conduction to the ventricles. Evaluation involves assessing the P wave morphology and determining the mechanism and site of origin through cardiac monitoring and electrophysiological studies. Treatment depends on the underlying cause but may include medications, catheter ablation, or surgery.
Atrial tachycardia is a type of supraventricular tachycardia where the atria beat too fast, independently of the ventricles. It can have different causes such as enhanced automaticity, triggered activity, or reentry. On ECG, it typically shows a narrow QRS complex with an atrial rate of 100-250 bpm and regular or irregular conduction to the ventricles. Evaluation involves assessing the P wave morphology and determining the mechanism and site of origin through cardiac monitoring, imaging, or electrophysiological study. Treatment depends on the underlying cause but may include medications, catheter ablation, or surgery.
This document discusses supraventricular tachycardias (SVT). It defines different types of SVT including paroxysmal SVT, which is common in emergency rooms. Quality of life is often poor for those with paroxysmal SVT. The document discusses mechanisms of SVT including reentry circuits, enhanced automaticity, and triggered activity. It provides details on differentiating AV nodal reentrant tachycardia from AV reentrant tachycardia using electrocardiogram findings. Treatment options discussed include carotid sinus massage, adenosine, and catheter ablation.
This document provides an overview of supraventricular tachycardia (SVT), including its definition, classification, and management. It discusses 10 specific types of SVT in detail: sinus tachycardia, inappropriate sinus tachycardia, sinus node re-entrant tachycardia, postural orthostatic tachycardia syndrome, focal atrial tachycardia, multifocal atrial tachycardia, macro-re-entrant atrial tachycardias, atrioventricular nodal re-entrant tachycardia, atrioventricular re-entrant tachycardia, and non-re-entrant junctional tachycardias. For
This document discusses the management of peri-arrest arrhythmias. It defines arrhythmias and describes their assessment and general treatment options. It covers the management of specific arrhythmias like bradycardia and tachycardias. It also discusses the pharmacology of common antiarrhythmic drugs like amiodarone, atropine, digoxin. The document provides guidelines on stabilizing patients and restoring normal heart rhythm in peri-arrest settings.
The document describes several types of normal and abnormal cardiac rhythms as identified by an electrocardiogram (EKG or ECG). It provides descriptions and EKG criteria for normal sinus rhythm, sinus bradycardia, sinus tachycardia, premature atrial complexes, atrial fibrillation, atrial flutter, supraventricular tachycardia, premature junctional complexes, junctional rhythm, various degrees of atrioventricular block, premature ventricular contractions, ventricular bigeminy, and ventricular tachycardia.
1685644652805_1685644176287_1685644169732_CARDIAC ARRYTHMIAS AND MANAGEMENT...PratimaSingh928775
Cardiac arrhythmias refer to irregularities in heart rhythm. They can be characterized by rate, rhythm, origin, conduction pathways, and other factors. Causes include coronary artery disease, electrolyte imbalances, structural heart changes, and various medical conditions. Symptoms depend on the type of arrhythmia but may include palpitations, dizziness, chest pain, and fainting. Diagnosis involves EKGs, holter monitors, echocardiograms, and other tests. Treatment includes medications to restore normal rhythm or prevent dangerous arrhythmias, cardioversion, pacemakers, ablation, and defibrillators. Management depends on the specific arrhythmia and may involve drugs, ablation, cardioversion,
Bradyarrhythmias are caused by problems with impulse formation in the sinus node or impulse conduction through the AV node. Sinus node dysfunction can cause sinus bradycardia, sinus pause/arrest, or chronotropic incompetence. Atrioventricular block is classified as first, second, or third degree and may be caused by conditions like CAD, drugs, or infiltrative diseases. Second degree AV block is further classified as Mobitz type I or II based on PR interval characteristics. Third degree AV block causes complete dissociation between atrial and ventricular rhythms.
This document outlines a lecture on pediatric infective endocarditis. It discusses the epidemiology, etiology, pathogenesis, clinical manifestations, differential diagnosis, and management of IE in children. Some key points include: congenital heart disease is the most common risk factor; viridans streptococci and staphylococci are frequent causes; clinical features can include fever, heart failure, and neurological symptoms; and diagnosis involves considering other conditions like sepsis, myocarditis, or rheumatologic disorders.
This document outlines key aspects of infection prevention and control in pediatric medicine. It discusses the importance of hand hygiene, standard precautions like the use of barriers, and isolation protocols depending on the transmission route. Surgical prophylaxis is also covered, describing different wound classifications and antibiotic use. Additional measures mentioned include aseptic technique, catheter care, environmental cleansing, and reporting of infections. The overall goal is to reduce healthcare-associated infections in children through appropriate techniques.
This document contains the neonatal history of a 6 day old female infant named Baby Zigyibelu. It includes demographic and background information on the mother and father. It describes the pregnancy, delivery, and initial postpartum course. It then provides a thorough physical exam finding for each body system. The infant is growing appropriately with no significant findings noted on exam.
This document discusses drugs and medications in pregnancy. It begins by outlining the objectives of providing an overview of drug metabolism during pregnancy, discussing principles of teratogenicity, and examining the risk to the fetus from some prescription medications, environmental exposures, and illicit drugs. It then covers how maternal physiology changes during pregnancy can impact drug absorption, distribution, metabolism, and elimination. Key principles of teratology and criteria for defining teratogenicity are presented. Finally, several known or suspected teratogens like alcohol, antiepileptics, ACE inhibitors, antineoplastics, and cocaine are examined in more detail.
Cyanotic congenital heart diseases are those associated with central cyanosis. This document discusses cyanosis, its causes and influence of hemoglobin level. It also covers consequences of cyanosis like polycythemia and complications. Tetralogy of Fallot and transposition of the great arteries, two common cyanotic congenital heart diseases, are described in detail including their pathophysiology, clinical features, investigations, management and prognosis. Congenitally corrected transposition of the great arteries is also briefly discussed.
C1 lecture Breast complementary feeding.pptxyilkalmossie1
The document discusses breastfeeding and complementary feeding recommendations for infants and children. It provides guidelines on exclusive breastfeeding for the first 6 months, continued breastfeeding with solid foods introduced between 6-24 months, and assessing adequate breastfeeding. The document also outlines potential feeding problems in the first year like underfeeding, overfeeding, and colic, and recommends introducing cereals, fruits and vegetables between 6-8 months as complementary foods.
This document provides an overview of chronic obstructive pulmonary disease (COPD). It defines COPD and related terms like chronic bronchitis and emphysema. It then discusses the epidemiology, pathogenesis, pathologic changes, clinical characterization, diagnosis, assessment of severity and staging, differential diagnosis, and principles of management of COPD. The key points are that COPD is characterized by persistent respiratory symptoms and airflow limitation caused by exposure to noxious particles/gases. Cigarette smoking is the most common risk factor globally. The major pathophysiology involves inflammation and narrowing of the small airways leading to decreased airflow. Spirometry is the gold standard for diagnosis and assessment of severity. Management involves assessing/monitoring
Bronchial Asthma_C I medical students lecture.pptxyilkalmossie1
Bronchial Asthma is a common chronic disease characterized by airway inflammation and variable airflow obstruction. It affects 300 million people worldwide. The goals of asthma management are to achieve symptom control and minimize future risks through a partnership between patient and healthcare providers using a stepwise treatment approach. Initial controller treatment for most asthmatics is a low-dose inhaled corticosteroid. The addition of a long-acting beta agonist to an inhaled corticosteroid provides better asthma control, lung function and reduces exacerbation risk compared to higher dose corticosteroid alone.
Cardiomyopathies are diseases of the heart muscle that are not caused by hypertension, coronary artery disease, valvular or pericardial abnormalities. They can be classified as primary (involving the myocardium of unknown cause) or secondary (caused by a systemic disease).
The document discusses the main types of cardiomyopathy - dilated, hypertrophic and restrictive. It provides details on their definitions, causes, clinical features, diagnostic evaluations and treatments. Dilated cardiomyopathy is the most common and causes ventricular enlargement and impaired systolic function. Hypertrophic cardiomyopathy causes disproportionate left ventricular hypertrophy. Restrictive cardiomyopathy results in stiff ventricles that impede filling.
This patient is a 30-year-old man who presented with altered mental status, headache, and left-side body weakness. He has a history of recently diagnosed HIV. On examination, he has a low GCS, hypertonic limbs, and neck stiffness. Differential diagnoses include cryptococcal meningitis, tuberculous meningitis, and aseptic meningitis. Diagnostic workup should include lumbar puncture, blood tests, and brain imaging to determine the specific type of meningitis and guide treatment.
Here are the key points to include in the history for a patient presenting with an anterior neck swelling:
- Duration of swelling - how long they've had it and if it has changed over time
- How they first noticed it and if it has spread/enlarged
- Any pressure symptoms - difficulty breathing, swallowing, etc.
- Symptoms of hyperthyroidism or hypothyroidism - sweating, palpitations, weight changes, etc.
- Relationship between swelling and any symptoms - if symptoms came before, after, or at the same time
- Family history of thyroid problems
- Medications - amiodarone, lithium which can cause goiter
- Diet - iodine
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
3. MECHANISMS OF CARDIAC ARRYTHMIA
1. Alterations in Impulse Initiation: Automaticity
2. Afterdepolarizations and Triggered Automaticity
3. Abnormal Impulse Conduction: Reentry
4. AUTOMATICITY
Spontaneous (phase 4) diastolic depolarization underlies the
property of automaticity (pacemaking)
The rate of phase 4 depolarization and, therefore, the firing
rate of pacemaker cells are dynamically regulated
Normal or enhanced automaticity of subsidiary latent
pacemakers produces escape rhythms in the setting of failure
of more dominant pacemakers
7. REENTERY
Defined as a continuous repetitive propagation of an
excitatory wave traveling in a circular path, returning to its
site of origin to reactivate that site
It is the electrophysiologic mechanism responsible for most of
the clinically important arrhythmias
8. REQUIREMENTS FOR THE DEVELOPMENT OF
REENTERANCE TACHYCARDIS
The one event crucial to the development of a reentrant
tachycardia is the failure of a group of fibers to activate during
a depolarization wave
Adjacent tissue or pathways must have different
electrophysiologic properties (conduction and refractoriness)
and be joined proximally and distally, forming a circuit
Each involved pathway of the circuit must be capable of
conducting an impulse in an antegrade and retrograde
direction
9. REQUIREMENTS FOR THE DEVELOPMENT OF
REENTERANCE TACHYCARDIS
Conduction velocity in the normal unblocked pathway must be
slow enough relative to the refractoriness of the blocked
pathway to allow recovery of the previously blocked pathway
Retrograde conduction in this previously blocked pathway
must be slow enough to allow the normal pathway to recover,
and again be capable of being excited
12. Antiarrhythmic Drug Therapy
The interaction of antiarrhythmic drugs with cardiac tissues and the
resulting electrophysiologic changes are complex
o The structural similarity of target ion channels
o Regional differences in the levels of expression of channels and
transporters, which change with disease
o Time and voltage dependence of drug action
o The effect of these drugs on targets other than ion channels
13. The Vaughan-Williams classification of
antiarrhythmic action
Class I: local anesthetic effect due to blockade of Na+ current
Class II: interference with the action of catecholamines at the
adrenergic receptor
Class III: delay of repolarization due to inhibition of K+ current
or activation of depolarizing current
Class IV: interference with calcium conductance
20. CLINICAL MANIFESTATIONS OF SA NODE DYSFUNCTION
Asymptomatic
Hypotension
Syncope
Presyncope
Fatigue and weakness
In many cases, symptoms associated with SA node dysfunction are the
result of concomitant cardiovascular disease
A significant minority of patients with SSS will develop signs and
symptoms of heart failure that may be related to slow or fast heart rates
One-third to one-half of patients with SA node dysfunction will develop
HF
Up to one-quarter of patients with SA node disease will have concurrent
AV conduction disease or supraventricular tachycardia
21. Electrocardiography of SA Node Disease
1. Sinus bradycardia: by definition sinus bradycardia is a rhythm driven by
the SA node with a rate of <60 beats/min; sinus bradycardia is very common
and typically benign. Resting heart rates of <60 beats/min are very common in
young healthy individuals and physically conditioned subjects. A sinus rate of
<40 beats/min in the awake state in the absence of physical conditioning is
generally considered abnormal
2. Sinus pause and sinus arrest: sinus pauses of up to 3 s are common in
the awake athlete, and pauses of this duration or longer may be observed in
asymptomatic elderly subjects
3. Sinus exit block
4. Tachycardia (in SSS)
5. Chronotropic incompitance
22. Diagnostic Testing
Resting ECG
Holter and event monitors
Implantable ECG monitors (12 to 18 months)
Exercise testing (failure to reach 85% of predicted maximal
heart rate at peak exercise, or failure to achieve a heart rate >
100 beats/min with exercise or a maximal heart rate with
exercise less than two standard deviations below that of an
age-matched control population)
Autonomic nervous system
Electrophysiologic testing
23. Therapy of Sinoatrial Node Dysfunction
Since SA node dysfunction is not associated with increased
mortality, the aim of therapy is alleviation of symptoms
Chronic pharmacologic therapy for sinus bradyarrhythmias has
limited value (atropin, theophylin and isoproterenol)
Pace maker implantation
27. CLASSIFICATION AV BLOCK
10 AV block
20 AV block
• Mobitz type 1 or Wenckebach
• Mobitz type 2
• 30 AV block
28. FIRST DEGREE AV BLOCK
Atrioventricular impulse transmission is delayed in first degree
AV block, resulting in a PR interval longer than 200 msec
(>210 msec at slow heart rates)
The PR interval includes activation of the atrium, AV node, His
bundle, bundle branches and fascicles, and terminal Purkinje
fibers
29. SECOND DEGREE AV BLOCK
Mobitz type 1: progressive PR interval prolongation preceded a
nonconducted P wave
Mobitz type 2: the PR interval remained unchanged prior to
the P wave that suddenly failed to conduct to the ventricles
33. CLASSIFICATION OF TACHYARRYTHMIAS
SVT = supraventricular tachycardia; CSM = carotid sinus massage; AV = atrioventricular; AVNRT = AV nodal reentrant
tachycardia; AVRT = AV reciprocating tachycardia; AT = atrial tachycardia; SANRT = sinoatrial nodal reentry tachycardia; AP =
accessory pathway
34. Classification of narrow QRS complex tachycardias by
structures required for initiation and maintenance
35. PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA
The term paroxysmal supraventricular tachycardia
(PSVT) is applied to intermittent SVTs other than
AF, atrial flutter, and MAT
38. CLASSIFICATION OF SINUS TACHYCARDIA
PHYSIOLOGIC INAPPROPRIATE
Hyperthyroidism
Fever
Effective volume depletion
Anxiety
Pheochromocytoma
Sepsis
Anemia
Hypotension and shock
Pulmonary embolism
Acute coronary ischemia and myocardial
infarction
Heart failure
Chronic pulmonary disease
Hypoxia
Exposure to stimulants (nicotine, caffeine)
or illicit drugs
Inappropriate sinus tachycardia
(IST) is an unusual condition that
occurs in individuals without
apparent heart disease or other
cause for sinus tachycardia, such
as hyperthyroidism or fever
Affected patients have an elevated
resting heart rate and/or an
exaggerated heart rate response
to exercise; many patients have
both
39. SYMPTOMS OF SINUS TACHYCARDIA
Sinus tachycardia is often asymptomatic, although the patient
may complain of a rapid heart beat
Underlying cardiac disease
Decrease the cardiac output by shortening ventricular filling
time
Exacerbate coexisting myocardial and/or valvular heart disease
Increase myocardial oxygen consumption
Reduce coronary blood flow
40. TREATMENT OF SINUS TACHYCARDIA
Treatment of physiologic sinus tachycardia is directed at the
underlying condition causing the tachycardia response.
Uncommonly, beta blockers are used to minimize the
tachycardia response if it is determined to be potentially
harmful, as may occur in a patient with ischemic heart disease
and rate-related anginal symptoms.
Pharmacotherapy with beta blockers or catheter ablation can
be used for symptomatic patients with IST
42. GENERAL REMARKS ABOUT AF
AF is the most common sustained arrhythmia
Atrial fibrillation (AF) is characterized by rapid and irregular
atrial fibrillatory waves at a rate of 350 to 600
impulses/minute and, in the presence of normal
atrioventricular (AV) nodal conduction, by an irregularly
irregular ventricular response of 90 up to 140 to 170
beats/min, but it may be higher in some patients
45. CLASSIFICATION OF AF
Paroxysmal (i.e., self-terminating) — AF is classified as paroxysmal if
episodes terminate spontaneously in less than seven days, usually less than
24 hours.
Persistent AF — AF is classified as persistent if it fails to self-terminate
within seven days. Episodes may eventually terminate spontaneously, or
they can be terminated by cardioversion. A patient who has had an
episode of persistent AF can have later episodes of AF that classify as
paroxysmal (i.e., self-terminating in less than seven days).
Permanent AF — Permanent AF is considered to be present if the
arrhythmia lasts for more than one year and cardioversion either has not
been attempted or has failed.
"Lone" AF — "Lone" AF describes paroxysmal, persistent, or permanent
AF in individuals without structural heart disease
46. ETIOLOGIES OF AF
Valvular heart disease
Hypertensive heart disease
Coronary heart disease
Heart failure (10-30%)
HCMP (10-28%)
Congenital heart disease
Other types of
cardiopulmonary disease
Obesity
Hyperthyrodism
Surgery
Inflammation and infection
Autonomic dysfunction
Other supraventricular
tachyarrhythmias
Diet
Medications
Genetics
47. VALVULAR HEART DISEASE AND AF
MS,MR, and TR — 70 percent
MS and MR — 52 percent
Isolated MS — 29 percent
Isolated MR — 16 percent
Isolated AS-1%
48. CLINICAL MANIFESTATIONS OF AF
Asymptomatic
Symptoms of underlying disease
Symptoms directly related to AF(mechanisms)
• The loss of atrial contractility
• The inappropriate fast ventricular response
• The loss of atrial appendage contractility and emptying leading to the risk of clot
formation and subsequent thromboembolic events
50. GENERAL TREATMENT ISSUES
Rate control
Rhythm control
Rate Vs Rhythm control
Prevention of systemic embolization
Nonpharmacologic therapy
51. FACTORS TO BE CONSIDERED UPON DECIDING A
TREATMENT PLAN FOR AF
Is the patient hemodynamically stable
Is left ventricular function normal or impaired?
Does the patient have WPW?
Is the duration of AF less than or more than 48 hours?
Is anticoagulation indicated?
Can the patient undergo electrical cardioversion safely?
Is the ventricular rate too high?
53. RATE CONTROL (TARGET HEART RATE)
Rest heart rate <=80 beats/min
24-hour Holter average <=100 beats/min and no heart rate >110
percent of the age-predicted maximum
Heart rate <=110 beats/min in six minute walk
54. RHYTHM CONTROL
Synchronized external DC cardioversion (75-95%)
patients with AF of more than 48 hours duration, of unknown
duration, or of less than 48 hours duration in the presence of mitral
stenosis or a history of thromboembolism may have atrial thrombi
that can embolize. In such patients, cardioversion should be delayed
until the patient has been anticoagulated at appropriate levels (INR
2.0 to 3.0) for three to four weeks or shorter term anticoagulation if
screening transesophageal echocardiography has excluded atrial and
atrial appendage thrombi
pharmacologic cardioversion(30-60%)
55. INDICATIONS FOR URGENT CARDIOVERSION
Active ischemia
Significant hypotension, to which poor LV systolic function,
diastolic dysfunction, or associated mitral or aortic valve
disease may contribute
Severe manifestations of HF
The presence of a preexcitation syndrome, which may lead to
an extremely rapid ventricular rate
58. INDICATIONS FOR RHYTHM CONTROL
Persistent symptoms (palpitations, dyspnea, lightheadedness,
angina, presyncope, and heart failure) despite adequate rate
control.
An inability to attain adequate rate control
Patient preference
59. NONPHARMACOLOGIC APPROACHS
Rhythm control — There are several alternative methods to
maintain NSR in patients who are refractory to conventional
therapy, including surgery, radiofrequency catheter ablation, and
pacemakers
Rate control — Radiofrequency AV nodal-His bundle ablation with
permanent pacemaker placement or AV nodal conduction
modification are nonpharmacologic therapies for achieving rate
control in patients who do not respond to pharmacologic therapy
LAA occlusion or ligation — Since the vast majority to thrombi in
nonvalvular AF arise within or involve the left atrial appendage
(LAA), the LAA is occluded at the time of surgery in patients who
undergo cardiac surgery for other reasons. Percutaneous approaches
have also been evaluated
66. CLASSIFICATION OF ATRIAL FLUTTER
Type I or typical atrial flutter is a macroreentrant arrhythmia, in which a
depolarizing stimulus (such as a single atrial ectopic beat) excites an area of the
atrium and then travels sufficiently slowly in a pathway that is sufficiently long
that there is an "excitable gap," that is, an area behind the wave of depolarization
that has recovered its excitability and can be reactivated, thereby forming a
circuit. The slowly conducting reentrant circuit is located in the low right atrial
isthmus. The isthmus is a path between the orifice of inferior vena cava and the
annulus of the tricuspid valve.The reenterant circute may be clockwise or counterclock
wise. The flutter rate 240 to 340 beats/min.
Type II or true atypical atrial flutter seems to lack an excitable gap, is not isthmus-
dependent, and cannot be entrained. It is thought that these characteristics result from an
intraatrial reentrant circuit that is very short in contrast to the long isthmus in type I atrial
flutter.The flutter rate is 340 to 440 beats/min.
68. ETIOLOGY, CLINICAL MANIFESTATION AND MANAGEMENT
Etiology, clinical manifestations and management: similar to AF
In all patients, an effort should be made to control the ventricular rate
pharmacologically or restore sinus rhythm. Rate control with calcium antagonists
(diltiazem or verapamil), beta blockers, and/or digoxin may be difficult. Even
higher grade AV slowing, such as a 4:1 AV response, may only be transient and is
easily overcome with activity or emotional stress. Owing to the typically faster
ventricular rate, AFL tends to be poorly tolerated in comparison to AF
72. THERAPY OF WPW SYNDROME
Asymptomatic patients does not need therapy
Symptomatic patients
Ablation (catheter/surgical): best option
DC cardioversion
Pharmacologic (for patients who are not candidates for ablation)
76. CLASSIFICATION
1. Duration
Nonsustained VT: three or more consecutive ventricular beats at
a rate of greater than 100 beats/min with a duration of less than
30 seconds.There is, however, great variability in the literature in
the definition of this arrhythmia. Some definitions allow a rate of
120 beats/min or 140 beats/min
Sustained: hemodynamically unstable VT that requires
termination before 30 s or VT that is terminated by therapy from
an implantable defibrillator is also typically classified as sustained
77. CLASSIFICATION
2. Morphology
Monomorphic: a uniform QRS complex morphology during VT
Polymorphic: beat to beat change in QRS complex morphology
Ventricular flutter: appears as a sine wave on the ECG and has
a rate of >250 beats/min
Ventricular Fibrilation
80. CLINICAL MANIFESTATIONS
Ventricular rate
Presence and extent of underlying heart disease
Function of the left ventricle
Presence of atrioventricular (AV) asynchrony
Location of the myocardial focus; this is associated with a
particular, often abnormal, sequence pattern of left ventricular
activation
81. DIFERENTIATING VT FROM SVT WITH ABERRANT
CONDUCTIONS
History: presence of underlying heart disease
Physical examination: features of undelying heart disease and
evidence for AV dissociation
Maneuvers (carotid sinus pressure and pharmacologic interventions)
Baseline ECG: preexcitation and LBBB/RBBB
ECG during the attack
86. MANAGEMENT OF HEMODYNAMICALLY STABLE PATIENTS
Urgent or elective cardioversion is usually appropriate.
Following appropriate conscious sedation, an initial
synchronized shock of 100 to 200 joules (monophasic) or 50 to
100 joules (biphasic) is administered. Repeated shocks at
higher energies may be performed as necessary.
Class I and III antiarrhythmic drugs are generally reserved for
refractory or recurrent arrhythmias.
Any associated conditions should be treated, including cardiac
ischemia, heart failure, electrolyte abnormalities, or drug
toxicities
87. PREVENTION OF RECURRENCE
Identify and treat reversible causes
ICDs
Antiarrythmic drugs
Catheter ablation