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Arrhythmias are
commonly encountered
in clinical practice
Presentation
Episodic palpitation
Giddiness/presyncope/syncope
Features of unstable angina
Generalized Fits
Heart failure
Thrombo embolism
CLASSIFICATION
R h y t h m D is o r d e r s
T a c h y a r r h y t h m ia s
>100 bpm
N a r r o w C o m p le x T . C .
Q R S < 0 .1 2 s
R e g u la r
I r e g u la r
B r a d y a r r h y t h m ia s
<60 bpm
B r o a d C o m p le x T . C .
Q R S > 0 .1 2 s
R e g u la r
I r e g u la r
Broad Complex
Tachycardia
In SR
Sinus tachycardia with BBB
Not in SR
Ventricular tachycardia
SVT with BBB
SUPRAVENTRICULAR
TACHYCARDIA ( SVT)
Commonest arrhythmia encountered
Haemodynamically stable
patient with SVT
Vogel maneuvers
Carotid Sinus massage
Valsalva manoevour,
Diving reflex,
DO NOT use eye ball pressure.
Pharmacological
management
IV Adenosine
IV Digoxin
IV Verapamil
Beta Blockers
IV Amiodarone
Intravenous Adenosine
Indication : SVT
Contraindications : Bronchial
Asthma
IV Adenosine
18 G Cannula
IV Push of Adenosine
IV Flush of N. Saline 20 ml
IV Adenosine
3mg (first bolus dose)
6mg
9mg
12mg
18 mg
24 mg
Maximum dose
IV Verapamil
Start with 2.5 mg
IV Digoxin
0.25 mg over an hour
0.25 mg over an hour
0.25 mg over an hour
0.25 mg over an hour
Maximum up to 1 mg
Beta blockers
IV Beta blockers
BROAD COMPLEX
TACHYCARDIAS - VT
VT OR SVT
VENTRICULAR
TACHYCARDIA
DIAGNOSTIC
CRITERIA
AV dissociation
Capture beat
Fusion beat
Negative concordance
Retrograde P ( 2:1 VA
block)
SUGGESTIVE
FEATURES
Broad QRS
complex
Axis deviation
Positive
concordance
VT showing AV
disassociation
VT showing positive
concordance
VT showing negative
concordance
VENTRICULAR
FIBRILLATION
POLYMORPHIC VT
MANAGEMENT
Initial assessment
A, B, C
CPR
Management of VT/VF
Resistant VT/VF
Management of VT
Polymorphic VT/Torsades
OR
ATRIAL
FIBRILLATION
AF WITH NARROW
COMPLEXES
ATRIAL FLUTTER
Atrial Fibrillation/Flutter
Complications:
Thrombo-embolism
Precipitate heart failure
Management of
Atrial Fibrillation/Flutter
Haemodynamically unstable
Synchronized DC shock
Anticoagulation in emergency
DC shock
Anti coagulation in AF
Other indications
Anti coagulation in AF
Warfarin
INR
therapy
around 2.5 to 3
Haemodynamically stable
BRADYARRHYTHMIAS
Classification of
Bradyarrhythmias
SA node
Sinus bradycardia
Sinus block/arrest
AV node
AV block
Nodal bradycardia
Classification of
Bradyarrhythmias
Global dysfunction of the conduction
system
Asystole
Electrolyte imbalance
Hyperkalaemia or Hypokalaemia
HYPERKALAEMIA
HYPOKALAEMIA
IDIOVENTRICULAR
RHYTHM - IVR
ASYSTOLE
Management of
Bradyarrhythmias
&
Asystolic Arrest
If unstable
Consider CPR
Reconfirm rhythm
Correct reversible factors
e.g. Hypoxia, Electrolytes, Ischemia,
With hold rate controlling drugs
Pharmacotherapy
IV Atropine
IV Isoprenaline
IV Epinephrine
Refractory bradyarrhythmias
MANAGEMENT OF
IDIOVENTRICULAR
RHYTHM
Once arrhythmia is
terminated an
ECG is mandatory
MI with LBBB
WPW Syndrome
Brugada Syndrome
DEFIBRILLATION
Indications
Haemodynamically unstable
patient with Tachyarrhythmias
DEFIBRILLATION
Haemodynamically unstable patient
Hypotension
Pulmonary oedema
Ongoing ischemia
TYPES OF
DEFIBRILLATORS
MONOPHASIC DEFIBRILLATOR
BIPHASIC DEFIBRILLATOR
WAVEFORM IN
MONOPHASIC
DEFIBRILLATION
WAVEFORM IN BIPHASIC
DEFIBRILLATION
MODE OF
DEFIBRILLATION
INDICATION FOR
SYNCHRONIZED DC
SHOCK
Tachyarrhythmias with well
recognised QRS complexes
REASONS TO GIVE
SYNCHRONIZED DC SHOCK
To avoid falling of shock wave on
vulnerable period of the T wave
To prevent occurrence of
ventricular arrhythmias
THANK YOU