Too fast or too slow.A bit about life threatening arrhythmias

A bit about life-threatening arrhythmias

1. Too fast or too slow. A Bit About Life Threatening Arrhythmias. Dr LNR González Robert Mangaliso Sobukwe Hospital(Kimberley Hospital)May 2020.

2. Types of Arrhythmias Tachyarrhythmias Tachycardia is a condition that makes your heart beat more than 100 times per minute: Supraventricular. This happens when the electrical signals in the hearts upper chambers misfire and cause the heart rate to speed up. It beats so fast that it can’t fill with blood before it contracts. That reduces blood flow to the rest of the body. Ventricular. This is a rapid heart rate that starts in your heart's lower chambers. It happens when the electrical signals in these chambers fire the wrong way. Again, the heart beats so fast that it can’t fill with blood or pump it through the rest of the body.

3. Types of Bradyarrhythmia's Bradycardia is a heart rate that’s too slow. In general, for adults, a resting heart rate of fewer than 60 BPM qualifies as bradycardia. There are several types: Sinus bradycardia. When a person has sinus bradycardia, the heart rate is less than 60 beats per minute. This slow heart rate might be normal. This type of slow heart rate is often seen in healthy, athletic people. Sinus pause (also called sinus arrest).During a sinus pause, the heart may miss one or more beats because its natural pacemaker fails to activate the electrical system throughout the rest of the heart.. AV blocks. Refers to an abnormality in the way electricity passes through the normal electrical pathways of the heart. The abnormality "blocks" the electrical impulse from continuing through the normal pathways and usually results in a slower heart rate.

4. Immediately Life Threatening in any Patient Arrhythmias that are immediately life-threatening in any patient include the following: Ventricular fibrillation (VF) Pulseless ventricular tachycardia (PVT) Ventricular asystole Pulseless electrical activity (electromechanical dissociation)……. In general: Any symptomatic fast rhythm Any symptomatic brady

5. Predisposing Conditions Primary cardiac disease : CAD,Cardiomyopathy , valvular heart disease, neoplasia, congenital, Thoracic trauma: Blunt, penetrating, electrical. Hypoxia :Respiratory disease, anaemia, thromboembolic disease, anaesthesia, hypoperfusion. Electrolyte/acid-base disorders : Potassium imbalance, calcium imbalance, magnesium imbalance, acidosis. Endocrine disease : Hypoadrenocorticism, hyperthyroidism, hypothyroidism, pheochromocytoma, diabetic ketoacidosis. Autonomic imbalance: Catecholamine excess, central nervous system (CNS) disease, vagal stimulation. Temperature: Hypothermia, hyperthermia . Inflammation: Infection, sepsis, systemic inflammatory response syndrome (SIRS), immune-mediated disease Drugs: Antiarrhythmic drugs, positive inotropic agents, anaesthetic agents, sedatives.

6. Any differences in the criteria to consider a brady or tachy to be unstable?

7. Ventricular Fibrillation Ventricular fibrillation is often a fatal arrhythmia. It occurs when the ventricular rate exceeds 400. In this setting, virtually no forward cardiac output occurs. Advanced Cardiac Life Support (ACLS) should be instituted immediately, including emergent electrical cardioversion.

8. Ventricular Tachycardia Ventricular tachycardia rhythm is primarily identified by several criteria. First, the rate is usually greater than 180 beats per minute, and the rhythm generally has a very wide QRS complex. Ventricular tachycardia starts in the heart's lower chambers.

9. Torsades de Pointes In torsade, the morphology of the QRS complexes varies from beat to beat. The ventricular rate can range from 150 beats per minute (bpm) to 250 bpm.

10. Ventricular Asystole Asystole is also known as flatline. It is a state of cardiac standstill with no cardiac output and no ventricular depolarization, as shown in the image below; it eventually occurs in all dying patients.

11. Ventricular Premature Complexes Premature ventricular contractions (PVCs) are extra heartbeats that begin in one of the heart's two ventricles. These extra beats disrupt your regular heart rhythm, sometimes causing you to feel a fluttering or a skipped beat in your chest.

12. Paroxismal SVT Paroxysmal Supraventricular Tachycardia (SVT, PSVT) Paroxysmal supraventricular tachycardia is a regular, fast (160 to 220 beats per minute) heart rate that begins and ends suddenly and originates in heart tissue other than that in the ventricles.

13. Atrial Fibrillation Atrial fibrillation is an irregular and often rapid heart rate that occurs when the two upper chambers of your heart experience chaotic electrical signals. The result is a fast and irregular heart rhythm. The heart rate in atrial fibrillation may range from 100 to 175 beats a minute.

14. Atrial Flutter Well-organized but overly rapid contractions of the atrium of the heart (usually at a rate of 250-350 contractions per minute). Flutter refers to a rapid vibration or pulsation. The difference between flutter and fibrillation is that flutter is well organized while fibrillation is not.

15. 1 st Degree AV Block First-degree atrioventricular (AV) block is defined as a PR interval of greater than 0.20 seconds on electrocardiography (ECG) without disruption of atrial to ventricular conduction . It is generally asymptomatic and without significant complications.

16. 2 nd Degree AV block Type I Type 1 Second-degree AV block, also known as Mobitz I or Wenckebach periodicity, is almost always a disease of the AV node. ... Today, Mobitz I heart block is characterized by progressive prolongation of the PR interval on consecutive beats followed by a blocked P wave (i.e., a dropped QRS complex).

17. 2nd Degree AV block Type II Second-degree AV block (Type 2) is almost always a disease of the distal conduction system located in the ventricular portion of the myocardium. The QRS on an ECG will most likely be wide because the block occurs in the His bundle or bundle branches and conduction through the ventricles is slowed.

18. 3 RD Degree AV Block Typically the patient will have severe bradycardia with independent atrial and ventricular rates, i.e. AV dissociation.

19. Paroxysmal Supraventricular Tachycardia Paroxysmal supraventricular tachycardia is a regular, fast (160 to 220 beats per minute) heart rate that begins and ends suddenly and originates in heart tissue other than that in the ventricles. Most people have uncomfortable awareness of heartbeats (palpitations), shortness of breath, and chest pain.