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Cardiology II

Cardiology II. Arrhythmias. Objectives. Describe the normal conduction in the heart Describe pathophysiology of bradycardias Describe pathophysiology of tachycardias Describe treatment of the above. Case.

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Cardiology II

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  1. Cardiology II Arrhythmias

  2. Objectives • Describe the normal conduction in the heart • Describe pathophysiology of bradycardias • Describe pathophysiology of tachycardias • Describe treatment of the above

  3. Case • A 55 year old male calls 911 because his “heart is racing.” He initially is alert, oriented, and has mild shortness of breath. On physical exam, he has a regular tachycardia at 180, and monitor shows a regular, narrow-complex tachycardia. He denies chest pain. Midway through transport, he becomes less responsive, and his blood pressure drops as he starts sweating profusely.

  4. Normal Conduction

  5. ECG waveform

  6. Normal ECG

  7. Sinus Arrhythmia

  8. Bradycardias • Caused by damage to the conduction system resulting in a “broken road” or by drugs (beta blocker, calcium channel blockers) • If due to drugs, reversible. If not, many require a permanent pacemaker • Our goal is to temporarily support the heart rate until one of those two happen. • Atropine or External Pacing are options.

  9. Sinus Bradycardia

  10. First Degree AV Block

  11. Second Degree (Type I)

  12. Second Degree (Type II)

  13. Third Degree Block

  14. Junctional Rhythm

  15. Accelerated Idioventricular

  16. Ventricular Escape

  17. Ventricular fibrillation

  18. What is this?

  19. Asystole

  20. Branch Blocks • “Hiccups” on the conduction highway past the AV node • Can involve the right bundle, the left bundle, or divisions of the left bundle

  21. Right Bundle Branch Block

  22. Left Bundle Branch Block

  23. Bifasicular Block RB/LA

  24. Bifasicular Block – RB/LP

  25. Trifasicular Block

  26. Tachycardias • Any heart rate greater than 100. • The key is using the pattern to determine what is causing the tachycardia • The treatment is even more diverse, thus, knowing the pattern is critical to choosing the correct therapy. • The three main branches of tachycardia are atrial, nodal, and ventricular

  27. Sinus Tachycardia

  28. Atrial Fibrillation

  29. Atrial Fib with Abberancy

  30. Multifocal Atrial Tachycardia

  31. Atrial Flutter

  32. Atrial Flutter

  33. AV Nodal Reentrant Tachycardia

  34. Wolfe Parkinson White

  35. Lown-Ganong-Lavine

  36. AV Reciprocating Tachycardia

  37. Ventricular Tachycardia

  38. Torsades de Pointe

  39. Miscellaneous

  40. LVH

  41. RVH

  42. Hyperkalemia

  43. Digoxin Toxicity

  44. Brugada Syndrome

  45. Wellen’s Syndrome

  46. Treatment Summary • EMT • ABCs • Call for ALS • Rapid Transport • AEMT • IV • Cardioversion of V-tach, V-fib • Paramedic • Atropine, pacing for bradycardias • Vagal Maneuvers, Adenosine for narrow complex tachyarrhythmias • Amio, cardioversion for wide complex tachyarrhythmia

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