Cardiac Arrhytmias

TACHYARRHYTHMIAS
Atrial Flutter
Saw- tooth appearance
Regular heart rate ( atrial rate 280 - 350/min)

ATRIAL FIBRILLATION (AF )

Irregularly irregular rhythm
No visible p waves or abnormal p
Normal shape QRS

Treatment (Acute Fast Atrial Fibrillation)

- Oral or IV Digoxin
- B Blockers
- IV Amiodarone
- Electrical Cardioversion

SUPRAVENTRICULAR TACHYCARDIA (SVT)

1. Regular rhythm
2. Narrow QRS complex tachycardia
3. Presence of P wave abnormalities
- Deform p waves
- No visible p wave
( p occur simultaneously with QRS which is compatible with reentry in the AV N)
-P waves occurs after T ( compatible
with reentry utilizing accesory AVN)

Treatment

- IV Adenosine
- IV Verapamil
- IV Amiodarone
- Electrical Cardioversion

VENTRICULAR TACHYCARDIA (VT)

1. Broad QRS complex ( > 0.14 s)
2. Presence of atrioventricular dissociation
3. Bifid, upright QRS with a taller first peak in V1
4. Deep S wave in V6
5. A Concordant ( same polarity) QRS direction in all chest leads ( V1 - V6)

VT (Monomorphic)

VT (Polymorphic – Torsades Pointes)

VF

Treatment

- IV Lignocaine
- IV Amiodarone
- Electrical Cardoversion* Asynchronise electrical cardioversion is usually used in VF

BRADYARRHYTHMIAS

First Degree AV Block

Bradycardia, regular rhythm
Prolongation of PR interval > 0.22s

Second Degree AV Block

(1) Mobitz type 1 ( Wenckebach )

progressive prolongation of PR interval until a P wave fails to conduct.
Regularly irregular rhythm

(2) Mobitz type 2

PR interval of the conducted beat is constant with one p is not followed by a QRS complex.

Complete Heart Block

No relation between P and QRS complex
Abnormal shaped QRS complex

Treatment
- IV Atropine
- IV Isoprenaline
- Pacemaker – Temporary internal or external, Permenant

Further Reading : Atrial Ectopics, Ventricular Ectopics, AVRT & AVNRT, Junctional & Idioventricular Ryhtm, Bundle Branch Block, Hemiblock