This document discusses the management of various cardiac arrhythmias that present as emergencies, including tachyarrhythmias like ventricular tachycardia and fibrillation, as well as bradyarrhythmias. Algorithms are provided to guide clinicians in differentiating between ventricular tachycardia and supraventricular tachycardia based on electrocardiogram findings. Risk factors that increase the likelihood of ventricular tachycardia are outlined. Causes and management of other arrhythmias like atrial fibrillation, heart block, sinus bradycardia, and device malfunctions are also summarized. The goal is to aid clinicians in rapidly diagnosing serious arrhythmias and initiating the appropriate treatment in emergency settings

1. EMERGENCY CADIACEMERGENCY CADIAC
ARRHYTHMIASARRHYTHMIAS
EMERGENCY CADIACEMERGENCY CADIAC
ARRHYTHMIASARRHYTHMIAS
Cairo University
Cons. cardiologist SBCC
Sherif Hamed Zaky, MD

2. EMERGENCY CADIAC RRHYTHMIASEMERGENCY CADIAC RRHYTHMIAS
Tachyarrhythmias :Tachyarrhythmias :
 V.tachV.tach
 V.FibV.Fib
 Atrial Fib.Atrial Fib.
 “ ““ “ TachycardiaTachycardia
 S.V.TS.V.T
These are serious cardiacThese are serious cardiac
dysrhythmias seen mostly in ER, CCUdysrhythmias seen mostly in ER, CCU
or ICU and includeor ICU and include::

3. Bradyarrhythmias:Bradyarrhythmias:
ٍٍ Sinus bradycardiaSinus bradycardia
 Complete heart blockComplete heart block
 second degree heart blocksecond degree heart block
 AsystoleAsystole
Devices malfunction:Devices malfunction:
PacemakersPacemakers
ICDsICDs

4. TachyarrhythmiasTachyarrhythmias::
Ventricular TachycardiaVentricular Tachycardia
(wide complex tachycardia management)(wide complex tachycardia management)
Decision AlgorithmDecision Algorithm
?Is the patient haemodynamically unstable
NOYES)unstable(
Haemodynamic instability means that the arrhythmia
should be addressed immediately. The following algorithm
cannot be used where the ventricular response rate is
irregular.

5. Is any one of the following is presentIs any one of the following is present::
ischaemic heart diseaseischaemic heart disease
,,oror heart failureheart failure,, oror past heart surgerypast heart surgery,, oror
cardiac enlargementcardiac enlargement??
NONO YES )VTYES )VT((
Decision AlgorithmDecision Algorithm

6. Ischemic VTIschemic VT

7. ::Are there any RS complexes in the VAre there any RS complexes in the V
leadsleads??
NO )VT(NO )VT( YESYES
In any of these RS complexes, is the interval
from start of R to nadir of S > 100ms?
NO YES )VT(
Decision AlgorithmDecision Algorithm

8. Is there AVIs there AV
dissociationdissociation??
or are there fusionor are there fusion
or capture beatsor capture beats??
NO (VT)
YES
Decision AlgorithmDecision Algorithm

9. Is there positive or negative concorance
in V-leads?
Decision AlgorithmDecision Algorithm

11. Predominantly negativePredominantly negative QRSQRS in at leastin at least 22
out ofout of 44 leads (leads ( I , II , V1 , V6I , II , V1 , V6 ))
including essentially leadincluding essentially lead II oror V6V6 cancan
diagnose VT in 90% and SVT in 100% ofdiagnose VT in 90% and SVT in 100% of
cases with wide complex tachycardiacases with wide complex tachycardia..
Decision AlgorithmDecision Algorithm

12. 1 2
3 4

13. Preexcited AFPreexcited AF

14. Torsade De pointesTorsade De pointes::
Look for long QT syndromeLook for long QT syndrome
(acquired- congenital) after DC(acquired- congenital) after DC
cardioversion to chose propercardioversion to chose proper
managementmanagement..

15. VF :VF :
Ischemic heart disease & end stageIschemic heart disease & end stage
cardiomyopathy of different aetiologiescardiomyopathy of different aetiologies
are the most common ppt factorsare the most common ppt factors..

16. SVTSVT

17. Atrial Tachcardia/FibrillationAtrial Tachcardia/Fibrillation

18. Atrial Tachcardia/FibrillationAtrial Tachcardia/Fibrillation

19. AV- BlockAV- Block
• 1o
HB
• 2o
HB ♦ Mobitz I
♦ Mobitz II
• 3o
HB
• High grade AV-block

20. AV- BlockAV- Block
SUPRASHISSIAN
INFRAAHISSIAN

21. Sinus bradycardia/AsystoleSinus bradycardia/Asystole
(comlete SA-block(comlete SA-block((

22. Sinus bradycardia/AsystoleSinus bradycardia/Asystole
(comlete SA-block(comlete SA-block((

23. Malfunctioning DevicesMalfunctioning Devices
Permanent
Pacemakers

24. LOSS OF SENSING

25. LOSS OF CAPTURE

26. ENDLESS LOOP TACHYCARDIA

27. ICDICD