Arrhythmias ppt - د.جاسم

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Arrhythmias
Disturbance of heart rhythm and/or conduction.
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Sinus Bradycardia

Deviation from NSR A sinus rate of less than 60/min

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Sinus Tachycardia
Deviation from NSR -a sinus rate of more than 100/min

Sinus arrhythmia

Phasic alteration of the heart rate during respiration (the sinus rate increases during inspiration and slows during expiration

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Atrial ectopic beats (Premature Atrial Contraction)

Premature Atrial Contractions

Deviation from NSR These ectopic beats originate in the atria (but not in the SA node), therefore the contour of the P wave, the PR interval, and the timing are different than a normally generated pulse from the SA node.

Paroxysmal Supraventricular Tachycardia (PSVT(

Deviation from NSR The heart rate suddenly speeds up, often triggered by a PAC (not seen here) and the P waves are lost. Tends to occur in normal heart.

PSVT

Etiology: There are several types of PSVT but all originate above the ventricles (therefore the QRS is narrow). Most common: abnormal conduction in the AV node (reentrant circuit looping in the AV node). Rate 150-250

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Atrial Fibrillation
Deviation from NSR No organized atrial depolarization, so no normal P waves (impulses are not originating from the sinus node). Atrial activity is chaotic (resulting in an irregularly irregular rate). Common, affects 2-4%, up to 5-10% if > 80 years old

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Atrial Flutter

Deviation from NSRNo P waves. Instead flutter waves (note “sawtooth” pattern) are formed at a rate of 250 - 350 bpm.Only some impulses conduct through the AV node (usually every other impulse)

Atrial Flutter

Etiology: a large (macro) re-entry circuit, usually within the right atrium encircling the tricuspid annulus with every 2nd, 3rd or 4th impulse generating a QRS (others are blocked in the AV node as the node repolarizes).

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Premature Ventricular Contractions PVCs

Deviation from NSREctopic beats originate in the ventricles resulting in wide and bizarre QRS complexes.When there are more than 1 premature beats and look alike, they are called “uniform”. When they look different, they are called “multiform”

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Ventricular Tachycardia
Deviation from NSR Impulse is originating in the ventricles (no P waves, wide QRS).

Ventricular Tachycardia

Etiology: There is a re-entrant pathway looping in a ventricle (most common cause). Ventricular tachycardia (VT) occurs most commonly in the settings of acute MI, chronic coronary artery disease, and cardiomyopathy.

Ventricular Fibrillation

CARDIAC ARREST
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Ventricular Fibrillation

Etiology: The ventricular cells are excitable and depolarizing randomly. Rapid drop in cardiac output and death occurs if not quickly reversed

Ventricular Fibrillation

Deviation from NSR Completely abnormal.

Asystole

Heart Blocks
Partial delays or complete interruptions in the cardiac conduction pathway between the atria and ventricles The degree of block defines the type and classification of heart block
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FIRST DEGREE A-V HEART BLOCK

prolonged P-R interval is > 0.20 seconds.

FIRST DEGREE A-V HEART BLOCK

SECOND DEGREE A-V BLOCK MOBITZ TYPE I (WENCKEBACK)
The P-R interval is progressively longer until one P wave is blocked; the cycle begins again following the blocked P wave.

SECOND DEGREE A-V BLOCK MOBITZ TYPE I (WENCKEBACK

SECOND DEGREE A-V BLOCK MOBITZ TYPE II
P-R interval may be normal until one P wave is not conducted to the ventricles.

SECOND DEGREE A-V BLOCK MOBITZ TYPE II

THIRD DEGREE (COMPLETE) A-V BLOCK
Rate: atrial rate is usually normal; ventricular rate is usually less than 60/bpm. The atrial rate is always faster than the ventricular rate. . QRS: may be normal or widened depending on where the escape pacemaker is located in the conduction system Conduction: atrial and ventricular activities are unrelated due to the complete blocking of the atrial impulses to the ventricles. Rhythm: regular . Treatment modalities include: external pacing and atropine for acute, symptomatic episodes and permanent pacing for chronic complete heart block.

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THIRD DEGREE (COMPLETE) A-V BLOCK

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Bundle branch block and hemiblock

Left bundle branch block LBBB Right bundle branch block RBBB
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