Arrhythmia:

Arrhythmias or dysrhythmias are abnormal heart rhythms. They can cause the heart to pump less
effectively.
Normally the heartbeat starts in the right atrium when a special group of cells sends an electrical
signal. (These cells are called the sinoatrial or SA node, the sinus node or "pacemaker" of the
heart.) This signal spreads throughout the atria and to the atrioventricular (A-V) node. The A-V
node connects to a group of fibers in the ventricles that conduct the electric signal. The impulse
travels down these specialized fibers (the His-Purkinje system) to all parts of the ventricles. This
exact route must be followed for the heart to pump properly.
Cardiac arrhythmia is the leading cause of death in the Western world. Every minute a person in
the United States dies instantly and unexpectedly, such that, in the United States alone, as many
as 400,000 people die suddenly each year. Although approximately seventy-five percent of sudden
death victims have a history of heart disease or damage, arrhythmias may strike young and
apparently healthy men and women. In addition, among those who have heart disease, it is usually
an acute lethal arrhythmia rather than sudden deterioration of the heart that kills.
Under some conditions almost all heart tissue can start a heartbeat. In other words, another part of
the heart can become the pacemaker. An arrhythmia occurs
When the heart's natural pacemaker develops an abnormal rate or rhythm;
When the normal conduction pathway is interrupted; or
When another part of the heart takes over as pacemaker.
These problems can produce a heartbeat that's either too slow or too fast. A heart rhythm that's too
slow (bradycardia) can cause fatigue, dizziness, lightheadedness, fainting or near-fainting spells.
These symptoms can be easily corrected by implanting an electronic pacemaker under the skin to
speed up the heart rhythm.
Rapid heart beating, called tachycardia or tachyarrhythmia , can produce symptoms of palpitations,
rapid heart action, dizziness, lightheadedness, fainting or near fainting if the heart beats too fast to
circulate blood effectively. Heartbeats may be either regular or irregular in rhythm.
When rapid heart beating arises in the ventricles - called ventricular tachycardia - a life-threatening
situation can arise. The most serious cardiac rhythm disturbance is ventricular fibrillation , where
the lower chambers quiver and the heart can't pump any blood. Collapse and sudden death follows
unless medical help is provided immediately.
If treated in time, ventricular tachycardia and ventricular fibrillation can be converted into normal
rhythm with electrical shock. Rapid heart beating can be controlled with medications by
identifying or destroying the focus of rhythm disturbances. Today one effective way of correcting
these life-threatening rhythms is by using an electronic device called an implantable cardioverter
/ defibrillator
Asystole:
Asystole is cardiac standstill with no cardiac output and no ventricular depolarization, as shown in
the image below; it eventually occurs in all dying patients. Pulseless electrical activity (PEA) is
the term applied to a heterogeneous group of dysrhythmias unaccompanied by a detectable pulse.
Bradyasystolic rhythms are slow rhythms; they can have a wide or narrow complex, with or
without a pulse, and are often interspersed with periods of asystole. When discussing pulseless
electrical activity, ventricular fibrillation (VF) (see the following image) and ventricular
tachycardia (VT) are excluded.
Asystole is the most severe form of heart attack. This happens when a lower chamber fails to
contract. Without contraction, blood does not flow and usually death follows. Asystole occurs
when there is no electrical activity supporting the heart, and it fails to perform. This may occur
because of a severe stroke, near drowning or failure of the ventricles to pump blood, which is
called ventricular fibrillation. When ventricular fibrillation occurs, medical professionals use a
defibrillator in attempts to jump-start the heart. Portable defibrillators are now being seen in many
areas where many people are gathered, such as an airport or stadium. These defibrillators come
with easy-to-read directions and have saved thousands of people who would have otherwise have
died. The symptoms are a hard and fast tightening of the chest wall and no pulse or breathing.
Survival statistics for asystole are extremely low.
Asystole can be primary or secondary. Primary asystole occurs when the heart's electrical system
intrinsically fails to generate a ventricular depolarization. This may result from ischemia or from
degeneration (ie, sclerosis) of the sinoatrial (SA) node or atrioventricular (AV) conducting system.
Primary asystole is usually preceded by a bradydysrhythmia due to sinus node block-arrest,
complete heart block, or both.
Reflex bradyasystole/asystole can result from ocular surgery, retro bulbar block, and eye trauma,
direct pressure on the globe, maxillofacial surgery, hypersensitive carotid sinus syndrome, or
glossopharyngeal neuralgia. Episodes of asystole and bradycardia have been documented as
manifestations of left temporal lobe complex partial seizures. These patients experienced either
dizziness or syncope. No sudden deaths were reported, but the possibility exists if asystole were
to persist. The longest interval was 26 seconds.
Secondary asystole occurs when factors outside of the heart's electrical conduction system result
in a failure to generate any electrical depolarization. In this case, the final common pathway is
usually severe tissue hypoxia with metabolic acidosis. Asystole or bradyasystole follows untreated
ventricular fibrillation and commonly occurs after unsuccessful attempts at defibrillation. This
forebodes a dismal outcome.
Diagnosis:
Hyperkalemia in emergency medicine
Hypothermia
Syncope
ECG