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Arrhythmias introduction

Arrhythmias introduction. Domina Petric , MD. Arrhythmias are. common often benign often intermittent causing diagnostic difficulty occasionally severe causing cardiac compromise. Causes. Cardiac. Non cardiac. caffeine smoking alcohol pneumonia drugs metabolic imbalance

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Arrhythmias introduction

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  1. Arrhythmiasintroduction Domina Petric, MD

  2. Arrhythmias are • common • oftenbenign • oftenintermittentcausingdiagnosticdifficulty • occasionallyseverecausingcardiaccompromise

  3. Causes Cardiac Noncardiac caffeine smoking alcohol pneumonia drugs metabolicimbalance phaeochromocytoma • myocardialinfarction • coronaryarterydisease • leftventricleaneurysm • mitralvalvedisease • cardiomyopathy • pericarditis • myocarditis • abberantconductionpathways

  4. Noncardiaccauses • Drugsthatcancausearrhythmias are β2-agonists, digoxin, L-dopa, tricyclics, doxorubicin. • Metabolicimbalance: K+, Ca2+ ,Mg2+ ,hypoxia, hypercapnia, metabolicacidosisandthyroiddisease.

  5. Symptoms • palpitation • chestpain • presyncope, syncope • hypotension • pulmonaryoedema • asymptomatic

  6. O History • Past medicalhistoryandfamilyhistory! • Precipitatingfactors! • Associatedsymptoms: chestpain, dyspnoea, collapse. • Nature: fast or slow, regular or irregular. • Duration! • Drug history! • Onset/offset!

  7. Tests • Fullbloodcount! • Urea, electrolytesandcreatinine! • Glucose! • Calciumandmagnesiumions! • TSH!

  8. Tests • ECG • 24 hoursECG monitoring • Echocardiography • Excercise ECG • Cardiaccatheterization • Electrophysiologicalstudies

  9. Parttwo Treatmentoverviewof most commonarrhythmias

  10. Bradycardia

  11. Bradycardia • Temporarypacingwire • Isoprenalineinfusion • Externalcardiacpacing Imagesource: Wikipaedia.org

  12. Sick sinus syndrome Sinus nodedysfunctioncancause: • bradycardia • arrest • sinoatrialblock • supraventriculartachycardiaalternatingwithbradycardia/asystole (tachy-bradysyndrome)

  13. Sick sinus syndrome

  14. Sick sinus syndrome Imagesource: lifeinthefastlane.com

  15. Supraventriculartachycardia Narrowcomplextachycardia (rate >100 bpm, QRS width <120 ms): • vagotonicmanoeuvres • adenosineor verapamiliv. • DC (directcurrent) shockifpatient is compromised Maintenancetherapy: beta-blockers, verapamil.

  16. Atrialfibrillation/flutter

  17. Conversionofatrialfibrillation

  18. Conversionofatrialfibrillation Immediateelectrocardioversion: • transesophagealechocardiography + 5000 IJ LMWH OR • Electrocardioversionafter3 weeksofwarfarintherapy.

  19. Ekg.academy.com Atrialfibrillation Atrialflutter

  20. Ventriculartachycardia (VT)

  21. Imagesource: Healio.com

  22. Literature • OxfordHandbookofClinical Medicine. Longmore M. Wilkinson I. B. Baldwin A. Elizabeth W. Ninthedition. • Wikipaedia.org • Lifeinthefastlane.com • Healio.com • Ekg.academy.com

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