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Prepared by dr Akram Sa,adeh Attended by dr Ali Al Halabi

Prepared by dr Akram Sa,adeh Attended by dr Ali Al Halabi. Arrhythmias. Introduction. Ped. Arr. May be transient or permanent cong. Or acquired caused by atoxin or drugs surgery metabolic disorders fetal infl. The major risk:

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Prepared by dr Akram Sa,adeh Attended by dr Ali Al Halabi

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  1. Prepared by dr Akram Sa,adehAttended by dr Ali Al Halabi Arrhythmias

  2. Introduction • Ped. Arr. May be transient or permanent cong. Or acquired caused by atoxin or drugs surgery metabolic disorders fetal infl.

  3. The major risk: • Severe tachy. Or brady. may lead to : Syncope Sudden death when apt. has an arr. It is vital to determine whether is prone to deteriorate into alife threatening tachy. Or brady.

  4. management • 1. Pharmacologic agents. • 2. Transcath. radiofrequency ablation . • 3. Implantable pacemackers. • 4. Implantable cardioverter-defibrillators (ICDs).

  5. Antiarr. drugs • Problems with frequency ,copliance, S.E.,drug interactions ,and variable responses remain,and selection of a druginvolves empiricism. single vs multiple agents route.

  6. DRUG INDICATION SE INTERACTIONCLASS1A

  7. DRUG INDICATION SE INTERACTION

  8. DRUG INDICATION SE INTERACTION

  9. DRUG INDICATION SE INTERACTION

  10. DRUG INDICATION SE INTERACTION

  11. DRUG INDICATION SE INTERACTION

  12. DRUG INDICATION SE INTERACTION

  13. SINUS ARR. • Represents a normal physiologic variation in impulse discharges from the sinus node related to respirations. • If the sinus rate is slow enough ,an escape beat arises from the AV junc.

  14. Irregularities in sinus r commonly seen in premature infants . • Exaggerated by :febrile illnesses drugs Abolished by :ex. SINUS BRADY: due to slow discharge of impulses from the sinus node. Insignificant in athletes. Indicates sys. Dis., as myxedema.

  15. Sinus brady must be diff. From SA and AV block. • LBWI display great variation in sinus rate. • Sinus brady is com. And may be ass. With junc. Escape beats. • PACs r also com. • Sleep. • RX.

  16. Wandering atrial pacemaker • An intermittent shift in the pacemaker from the sinus node to an another part of the atrium. • Not uncom. Usually represents a normal varient, but may be seen in CNS disturb. Eg:SAH.

  17. Extrasystoles ……………… • by discharge of an ectopic focus . Usually isolated extrasystoles r of no clinical or prognostic significance . May be due to :organic heart dis. :drug toxicity.

  18. PAC • Common ,even in the absence of cardiac dis. • PAC may result in: normal :prolonged(aberrancy) :absent(blocked premature atrial comlexes). Depending on: the degree of prematurity of the beat(coupling interval. the preceding R-R interval(cycle length)

  19. Absent QRS complex occ. When premature impulse is conducted to the ventricle while the specialised vent. Conducting sys is partially refractory. • Premature P wave preceding the QRS that has adiff. Contour is ess. For the dx. • PAC often reset the sinus node pacemaker

  20. PVCs • May arise from any region of the ventricles. • Premature widend ,bizzare QRS complexes that r not preceded by a p wave. • Unifocal or Multifocal. • Often,followed by a compensatory pause.

  21. The presence of fusion beats ,that is,complexes with morphologic features that r intermediate between those of normal sinus beats and those of PVCs , is a clue to the ventricular origin of the extrasystole. Extrasyst. Produce a small stroke and pulse vol. than normal and if quite premature may not be audible with a stethoscope or palpable ay the radial pulse.

  22. Most pt r unaware of asingle PVC . • Some pt may be aware of a skipped beat over the precordium due to inc. Stroke vol of a normal beat following a compensetory pause. • Anxiety ,a febrile illness,or ingestion of various drugs or stimulants may cause PVCs.

  23. Benign PVCs. vs • PVCs likely to degenerate into severe arr. • Indications for further inv. of PVCs that could require suppressive therapy: 1 . 2 or more PVCs in a row. • Multifoal origin. • Inc. vent ectopic activity with ex.

  24. 4. R on T 5. Presnce of underlying h dis.

  25. Rx • reassurance • Malig. PVCs are secondary. .underlying cond. .lidocaine. .amiodarone. .maintainance.

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