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Medical history
Physical examination
Laboratory test
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Neednt therapy
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Sinus tachycardia
Junctional tachycardia
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Sinus Bradycardia
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ECG characters:
Atrial rate is around 130-150bpm;
P wave is different from sinus P wave;
P-R interval 0.12
Often appear type I or type II, 2:1 AV
block;
EP study: atrial program pacing can
induce and terminate tachycardia
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ECG characters:
Atrial rate is around 100-200bpm;
Warmup phenomena
P wave is different from sinus P
wave;
P-R interval 0.12
Often appear type I or type II, 2:1 AV
block;
EP study: Atrial program pacing cant
induce or terminate the tachycardia
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Etiology:
It can occur in patients with
normal atrial or with abnormal
atrial.
It is seen in rheumatic heart
disease (mitral or tricuspid valve
disease), CAD, hypertension,
hyperthyroidism, congenital heart
disease, COPD.
Related to enlargement of the
atria
Most AF have a reentry loop in
right atrial
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Most cases of atrial flutter are caused by a large reentrant circuit in the wall of the
right atrium
EKG Characteristics:
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Therapy:
Treat the underlying disease
To restore sinus rhythm:
Cardioversion, Esophageal Pulsation
Modulation, RFCA, Drug (III, Ia, Ic
class).
Control the ventricular rate:
digitalis. CCB, -block
Anticoagulation
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EKG Characteristics:
Absent P waves
Presence of fine fibrillatory waves which vary in
amplitude and morphology
Irregularly irregular ventricular response
Manifestation:
Affected by underlying diseases,
ventricular rate and heart function.
May develop embolism in left atrial.
Have high incidence of stroke.
The heart rate, S1 and rhythm is
irregularly irregular
If the heart rhythm is regular, should
consider about (1) restore sinus rhythm;
(2) AF with constant the ratio of AV
conduction; (3) junctional or ventricular
tachycardia; (4) slower ventricular rate
may have complete AV block.
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Therapy:
Treat the underlying disease
Restore sinus rhythm: Drug,
Cardioversion, RFCA, Maze surgery
Rate control: digitalis. CCB, -block
Antithrombotic therapy: Aspirine,
Warfarin
Therapy:
Treat underlying disease;
stopping digoxin, administer
potassium, lidocaine, phenytoin
or propranolol.
Not for DC shock
It can disappear spontaneously.
If had good tolerance, not
require therapy.
Manifestation:
Palpitation, dizziness,
syncope, angina, heart
failure and shock.
The sever degree of the
symptom is related to
ventricular rate, persistent
duration and underlying
disease
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Therapy:
AVNRT & orthodromic AVRT
Increase vagal tone: carotid sinus
massage, Valsalva maneuver.if no
successful,
Drug: verapamil, adrenosine,
propafenone
DC shock
Antidromic AVRT:
Should not use verapamil, digitalis,
and stimulate the vagal nerve.
Drug: propafenone, sotalol,
amiodarone
RFCA
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Manifestation:
Palpitation, syncope, dizziness
Arrhythmia: 80% tachycardia is
AVRT, 15-30% is AFi, 5% is AF,
May induce ventricular
fibrillation
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Therapy:
Pharmacologic therapy: orthodrome
AVRT or associated AF, AFi, may use
Ic and III class agents.
Antidromic AVRT cant use digoxin
and verapamil.
DC shock: WPW with SVT, AF or Afi
produce agina, syncope and
hypotension
RFCA
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Etiology:
Occur in normal person
Myocarditis, CAD, valve heart
disease, hyperthyroidism, Drug
toxicity (digoxin, quinidine and antianxiety drug)
electrolyte disturbance, anxiety,
drinking, coffee
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Manifestation:
palpitation
dizziness
syncope
loss of the second heart sound
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Ventricular tachycardia
Ventricular tachycardia is usually caused by reentry, and most
commonly seen in patients following myocardial infarction.
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Manifestation:
Nonsustained VT with no symptom
Sustained VT : with symptom and
unstable hemodynamic, patient
may feel palpitation, short of
breathness, presyncope, syncope,
angina, hypotension and shock.
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ECG characteristics:
Monomorphic VT: 100-250 bpm, occur
and terminate abruptly,regular
Accelerated idioventricular rhythm: a
runs of 3-10 ventricular beats, rate of
60-110 bpm, tachycardia is a capable of
warm up and close down, often seen AV
dissociation, fusion or capture beats
Tdp: rotation of the QRS axis around the
baseline, the rate from 160-280 bpm, QT
interval prolonged > 0.5s, marked U
wave
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Manifestation:
Unconsciousness, twitch, no blood
pressure and pulse, going to die
Therapy:
Cardio-Pulmonary Resuscitate (CPR)
ICD
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Block position:
Sinoatrial; intra-atrial;
atrioventricular; intra-ventricular
Block degree
Type I: prolong the conductive time
Type II: partial block
Type III: complete block
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EKG Characteristics:
Type 1 (Wenckebach)
EKG Characteristics:
Type 2
EKG Characteristics:
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EKG Characteristics:
Manifestations:
First-degree AV block: almost no
symptoms;
Second degree AV block: palpitation,
fatigue
Third degree AV block: Dizziness, agina,
heart failure, lightheadedness, and
syncope may cause by slow heart rate,
Adams-Stokes Syndrome may occurs in
sever case.
First heart sound varies in intensity, will
appear booming first sound
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Treatment:
I or II degree AV block neednt
antibradycardia agent therapy
II degree II type and III degree AV
block need antibradycardia agent
therapy
Implant Pace Maker
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Etiology:
Myocarditis, valve disease,
cardiomyopathy, CAD, hypertension,
pulmonary heart disease, drug
toxicity, Lenegre disease, Levs
disease et al.
Manifestation:
Single fascicular or bifascicular block
is asymptom; tri-fascicular block may
have dizziness; palpitation, syncope
and Adams-stokes syndrome
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Therapy:
Treat underlying disease
If the patient is asymptom; no treat,
bifascicular block and incomplete
trifascicular block may progress to
complete block, may need implant
pace maker if the patient with
syncope
Pathogenesis therapy
Stop the arrhythmia immediately if
the hemodynamic was unstable
Individual therapy
Anti-tachycardia agents
Anti-bradycardia agents
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Anti-tachycardia agents:
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Anti-tachycardia agents:
Ib class: Perfect to
ventricular tachyarrhythmia
1. Lidocaine
2. Mexiletine
Anti-tachycardia agents:
Ic class: Can be used in ventricular
and/or supra-ventricular tachycardia
and extrasystole.
1. Moricizine
2. Propafenone
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Isoprenaline
Epinephrine
Atropine
Aminophylline