TACHYARRHYTHMIA

Ventricular arrhythmias broad QRS on ECG (>0.12s), indicates slow ventricular

depolarization
more dangerous than supraventricular rhythm disorders
Ventricular Premature Beats (VPBs)
Ventricular Tachycardia (VT)
Ventricular Fibrillation (VF)
1. Ventricular Premature Beats (VPBs)
Common even among healthy people, often asymptomatic & benign
Can be an indication of an underlying cardiac disorder & take on added
significance in that case
Arises when ectopic ventricular focus fires an action potential
ECG widened QRS complex as impulse travels via slow cell to cell connections
Patterns:
Bigeminy every alternate beat is a VPB
Trigeminy two normal beats precede every VPB
Couplets two consecutive VPB in a row
Triplets three consecutive VPB in a row
Treatments:
involves reassurance
if needed, symptomatic control using - blockers
in advanced structural heart disease,placement of implantable cardioverterdefibrilator (ICD)
2. Ventricular Tachycardia (VT)
Series of three or more VPBs
Common in: structural heart disease (ischemia & infarction), heart failure,
ventricular hypertrophy, primary electrical disease, valvular heart disease, &
congenital cardiac abnormality
Categories:
Sustained VT persists for >30 seconds
Non sustained VT self terminate within 30 seconds
ECG wide QRS complex with 100 200 bpm or faster
Patterns (ECG QRS complex morphology):
Monomorphic VT same and regular rate
Sustained indicates structural abnormality that supports a reentry
circuit, most common a region of myocardial scar
Polymorphic VT continuously change shape and rate varies from beat to beat
Causes: multiple ectopic foci or continuous changes of reentry circuit
Common causes: Torsades depointes & acute myocardial ischemia or
infarction
Rare causes: inherited predisposition & sudden death arise from
abnormalities of cardiac ion channels or calcium handling
Usually degenerates to VF
Symptoms (varies):
Sustained VT low cardiac output lead to syncope, pulmonary edema, or
progress to cardiac arrest (mostly have underlying depressed contractile
function)
If slow sustained VT cause only palpitations
Managements:
Acute treatment electrical cardioversion & IV of antiarrhythmic drugs if
hemodynamically stable
After sinus rhythm stored evaluation to define any underlying structural heart
disease present & to correct any aggravating factors (myocardial ischemia,
electrolyte disturbance, drug toxicities)

VT in the absence of underlying structural heart disease usually found to have

idiopathic VT
Tends to originate from foci in RV outflow tract or in septal portion of LV
Rarely life threatening
Use - blockers, calcium channel blocker or catheter ablation (use to
destroy area that causing heart rhythm problem)

Torsades de Pointes (twisting of the points)

Polymorphic VT has varying amplitudes of QRS
ECG Produced by early afterdepolarization (EAD), particularly in those who have
prolonged QT interval
Causes:
Electrolyte disturbance (hypokalemia)
Persistent bradycardia
Drugs that block cardiac K+ currents (arrhythmic agents)
Medications administered for noncardiac illnesses (erythromycin, haloperidol)
Rare group of hereditary ion channel abnormalities produces congenital QT
prolongation
Symptoms:
Light headedness or syncope
Main danger results from degeneration into VF
Treatment:
If it is drug or electrolyte induced correcting the underlying cause
Administration of intravenous Mg2+ suppress repeated episodes
Intravenous - adrenergic stimulating agents or artificial pacemaker aimed
at shortening the QT interval
If results from congenital QT prolongation - blocking drugs or
implantable defibrillator
3.

Ventricular Fibrillation
Immediately life threatening arrhythmia
Disordered, rapid stimulation of the ventricles with no coordinated contractions
Results in cessation of cardiac output & death if not quickly reversed
Common with severe underlying heart disease & major mortality in acute
myocardial infarction
Initiated by VT, which degenerates by the breakup of excitation waves into smaller
wavelets of reentry
ECG chaotic irregular appearance without discrete QRS waveforms
Therapy:
Electrical defibrillation
After achieve safe heart rhythm, correct the underlying factors of arrhythmia
Intravenous antiarrhythmic drug therapy to prevent immediate recurrence
Implantable Cardioverter Defibrillator