Arrhythmias

2009

Arrhythmias palpitation

palpitation arrhythmias

Palpitation volume load cardic neurosis

volume load cardic neurosis palpitation

palpitation arrhythmia

heart rate 60 90

90100 High normal

100 tachycardia

60 bradycardia

S.A.Node peace maker of the heart

A.V.Node A.V.block atrial

arrhythmias

atrial tachycardia atrial fibrillation

atrial flutter

digitalis A.V. block to protect the ventricles

basic

No retrograde conduction

focus

focus in atrium atrium focus

focus atrium ventricle focus

focus S.A. node atrium atrium ventricle

focus in ventricle ventricle

atrium focus in ventricle

focus ventricle Impulses

arrhythmias ventricular tachycardia

focus ventricle

ventricle atrium focus S.A. node

atrium S.A. node ventricle focus

atrio -ventricular dissociation

no retrograde conduction

Respiratory sinus arrhythmia

Normal persons S.A. node peace maker

Inspiration reflex tachycardia

S.A. node Peace maker of the heart

Normal carotid massage vagal stimulation

vagus Inhibitory atrium ventricles

focus atrium

carotid sinus mass age suppression

focus ventricles

carotid sinus massage suppression

tachycardia focus

atrium ventricles

carotid massage

carotid massage abortion arrhythmia focus atrium

Canon wave atrio -ventricular dissociation

example

complete heart block

complete heart block atrium S.A. node ventricle idio ventricular

rhythm

harmony

contraction at the same time right side

right ventricle right atrium

ventricle valve

right ventricle contraction closure tricuspid valve

tricuspid valve closed right atrium

right atrium pressure sudden rise

neck vein

canon wave

sterno mastoid muscle

atrio ventricular dissociation ventricular tachycardia complete heart block

tachycardia bradycardia atrio ventricular dissociation

A.V. node block atrial

tachycardia

focus atrium heart

focus ventricle ventricle atriu m

carotid sinus massage Inhibitory focus atrium focus

ventricle

canon wave atrio ventricular dissociation complete

heart block ventri cular tachycardia

arrhythmia

written

Pathophysiology etio logy etiology

functional, pathological and drugs

functional heart rate

exertion Pregnancy thyrotoxicosis

functional Organic lesion Heart

Physiological thyrotoxicosis Physiology

thyrotoxicosis Pathology heartfunctional disturbance

functional bradycardia

Hypo thyrodism Obstructive jaundice Obstructive jaundice

bile salts bradycardia

Heart heart Heart rate jaundice

drugs heart rate Beta blocker Ca channel blocker Verapamil

Beta blocker diltazem

Nefidipine tachycardia

hydralazine tachycardia

Nefidipine

Ischaemic heart small dose Beta blocker

tachycardia

Nefidipine

Nefidipine

Beta blocker

tachycardia

ischaemic

symptoms palpitation

low cardic output Heart rate

Heart rate filling

cardic output

palpitation

Palpitation

palpitation

syncope hypotension

syncope cardiovascular system

arrhythmia at rest

cause rheumatic

heart Pulse regular blood

pressure

hypotensive

carotid sinus massage

carotid massage abort arrhythmia focus focus

atrium

respiratory sinus arrhythmia

Peace maker of the heart S.A. node

monitor respiratory sinus a rrhythmia

canon wave

occasional

occasional neck vein

atrio ventricular dissociation complete heart block

ventricular tachycardia

Local examination Heart

first sound tachycardia

Murmur gallop

Canon wave

contraction atrium ventricle r ight side

contraction atrium ventricle canon sound

canon sound 3rd or 4 th canon sound wave

sounds exception

invest igations

Investigations arrhythmia

arrhythmia Organic

epilepsy brain

for example epilepsy neurological renal

normal

ECHO

ECG ECG attack

Holter Holter

ECHO

48

arrhythmia

lab investigations

T3 and T4 TSH

Free T4 , free T3 and free TSH

hemoglobin serum K, Mg

investigat ions

Mg extra systole Extra systole

Hypo magnesemia Lasix lasix hypo magenesmia

Lasix hypo

hypo magenesemia

frusamide

Mg

side effect lasix

every other day

aldactone K sparing Urine K

trace elements

arrhythmia

arrhythmia Paroxysmal DC shock

Intravenous Heart sinus

In between attack

arrhythmia non paroxysmal maintenance therapy from the start

sinus Tachycardia

sinus tachycardia

focus normal S.A. node

discharge 100

etiology

functional stress , anemia, thyrotoxicosis fever

sinus tachycardia

pathological reflex tachycardia Heart failure

Heart failure digitalis small dose Beta blocker

heart rate normal

heart rate digitalized

sinus tachycardia vasodilator Nefidipine

Hydralzine Beta blocker

thyroxin

thyroxin thyroxin replacement

replacement therapy

serotonin reuptake inhibitor thyroxin

B2 agonist

COPD bronchial asthma tachycardia

sympathomimetics

symptoms

palpitation

rapid regular , exertional onset gradual

tachycardia

tachycardia

100160 150

tachycardia 150sinus

tachycardia sinus tachycardia

syncope low cardic output

sinus tachycardia itself chest pain

tachycardia chest pain sometimes tachycardia

coronary filling

sinus tachycardia

tachycardia

heart rate coronary filling

Palpitation chest pain

palpitation

decline coronary filling

Heart rate regular

150160

carotid sinus massage effective

respiratory sinus arrhythmia

Canon wave

first sound

first sound tachycardia

gallop S3 gallop left side apex

failure

heart failure reflex tachycardia manifestations

ECG sinus tachycardia

T3 and T4 anemic thyrotoxic

ECHO ECHO heart organic

ejection fraction

reflex tachycardia Heart

anxiety

120

Beta blocker

contraindication

2.5

heart rate 100

2.5stable

dose

Heart rate

anti depressant thyroxin

paroxysmal atrial tach ycardia

written

suddenly focus atrium

up to 200

focus S.A. node focus

S.A. node focus atrium

Heart focus

focus

focus Heart S.A. node

net result

paroxysmal attack of tachycardia

rapid regular

Heart rate

160 170 200hypotensio n

low cardic output focus atrium

ventricle

atrium ventricle

Canon wave

carotid sinus massage effective

etiology

Pathological Heart sympathomimetics

symptoms

sudden onset sudden offset

sudden onset exertion

sudden onset , sudden offset In between Normal attack

filling of the heart Low cardic output

Poly urea attack

Poly urea excessive excretion atrial natriuretic peptide

tachycardia

tachycardia cardic o utput

filling

cardic output

tachycardic cardic output kidney

perfusion diuresis

diuresis

atrial nat riuretic peptide

anginal pain

palpitation

attack of paroxysmal atrial tachycardia Palpitation

anginal pain decline coronary fil ling

chest pain palpitation

palpitation chest pain

chest pain Palpitation chest pain

coronary insufficiency

signs

Pulse

pulse

focus

focus atrium

respiratory sinus arrhythmia peace maker of the heart

S.A. node

carotid sinus massage

first sound

cause Mitral

Inv estigations

Investigations ECG

in between attack Holter

Organic ECHO

T3 and T4 TSH

during the attack vagal stimulation carotid sinus massage

successful50% massage successful

drug of choice Verapamil

Verapamil intravenous

verapamil saline infusion very slowly

monitoring

verapamil intravenous Hypotension

antidote calcium gloconate verapamil Ca

channel

Verapamil anti arrhythmic contractility

ejection fraction

Heart verapamil

DC shock

DC shock direct current

abort focus atrium contraction

blood pressure

shocked In failure verapamil

during attack

DC shock abort digitalis intravenous

digitalis intravenous focus

A.V. block

drug of choice Verapamil

DC shock Hypotension

Intravenous Verapamil negative

inotropic adenosine Verapamil

Hypotension Heart failure Adenosine DC

shock

DC shock Adenosine

verapamil Verapamil DC shock

In between attack

digita lis Beta blocker

sympathetic stress

attack

in between Beta blocker

thyrotoxicosis beta blocker

stress tachycardia verapamil

Beta blocker situation

catecholamine mediat ors Beta blocker

Beta blocker contraindicated

junctional or A.V. nodal tachycardia

A.V. node peace maker

Paroxysmal atrial tachycardia

the same

A.V. node peace maker

A.V. node atrium ventricle

impulse stimulate atrium ventricle

atrium and ventricul ar contraction at the same time

attack paroxysmal

paroxysmal

attack atrium ventricle

Canon wave r egular Canon

Canon

paroxysmal atrial tachycardia

paroxysmal atrial tachycardia in attacks

Paroxysmal ventricular tachycardia in attacks

Paroxysmal ventricular tachycardia ventricle focus

atrium S.A. node occasionally Canon wave

occasionally

Canon wave occasionally

A.V. node peace makerImpulse stimulateatrium ventricles

Regular canon wave

r egular canon character nodal rhythm

nodal tachycardia

ECG finding ECG

paroxysmal ventricular tachycardia

Organic heart disease

ventricular tachycardia functional

Organic

ventricular tachycardia

focus Ventricle

ventricle focus focus 200

ventricle focus attack

atrium focus

focus ventricle No retrograde conduction

attack ventricle focus

atrium S.A. node

atrio ventricular dissociation attack

Canon wave Canon Occasional

atrium S.A. node Ventricle focus

etiology

ischaemic heart disease

rheumatic heart

structure heart disease Organic heart disease

arrhythmia Myocardial infraction

ventricular fibrillation

digitalis toxicity

abuse digitalis toxicity

abuse of anti cholinergic drugs anti cholinergic drugs tricyclic

antidepressant abuse ventricular tachycardia

symptoms

palpitation sudden onset , sudden offset , rapid , regular

Heart rate

Low cardic out put

cause

ventricular tachycardia

ventricular fibrillation

180-200 cardic out put

Hypotensive

carotid massage

focus atrium

respiratory sinu s arrhythmia

Neck veins occasional Canon wave

occasional Canon wave occasional Canon sound

ECG

arrhythmia

ECG ECHO thyroid function electrolyte

during the attack DC shock

Lignocaine

In between attack

ventricular tachycardia dangerous

ventricular fibrillation

Amiodarone

Defibrillator defibrillator

cardioverter heart

Peace maker

ventricular tachycardia peace maker

Peace maker defibrillator attack of arrhythmia

sensor arrhythmia DC shock

Atrial flutter

atiral flutter flutter flutter

atrium

fibrillation atrium contract ion

flutter In between

flutter focus

Paroxysmal atrial tachycardia focus 200

atrial flutter focus 300400 atrium

focus atrium

focus atrium 300350A.V.

block

A.V. block well developed arrhythmia chronic

Paroxysmal atrial tachycardia focus 200pulse 200 -180

A.V.node

A.V. block

A.V. block A.F. paroxysmal A.F heart

rate

A.V. block building up

flutterParoxysmal tachycardia

paroxysmal atrial tachycardia

rul es paroxysmal atrial tachycardia heart rate

carotid massage

sinus atrial fibrillation

ECG

A.V. block

A.V. block A.V. block

focus

sinus atrial fibrillation

very cautio us atrial fibrillation

atrial fibrillation must be anti coagulated

arrhythmia

arrhythmia

A.F. anti coagulant

signs

focus

heart rate Low cardic out put carotid massage effective

canon

flutterparoxysmal atrial tachy cardia

focus 200 300

DC shock

verapamil

verapamil DC shock rule heart

DC shock

atrial fibrillation written

foci impulses

Impulses 400atrium

A.F.

400 ventricles

200paroxysmal

A.F.

mitral stenosis Mitral valve disease atrium

stretch dilation trigger atrial fibrillation

chronic

chronic heart dilation

organic

A.F. ventricular response

400 200180

tachycardia A.V. block

A.F. A.V. block A.F. digitalis

digi talis A.V. block slow A.F.

60

fibrillation

atrial fibrillation apical pulse r adial pulse 60

digitalis toxicity

slow A.F.

A.F.A.F.

A.F.

congenital heart , rheumatic heart and ischaemic heart

A.F.

A.F. tachycardia

tachycardia Load Heart

tachycardia filling of the heartcardic out put

A.F. Loss of atrial contraction

atrial contraction 25 filling ventricles

A.F. Low cardic out put

low cardic out put tachycardia filling atrial contraction

filling ventricles

A.F.

Low cardic out put

A.F.

A.F.

A.F. stagnation of blood atrium

Mitral stenosis

left atrial pressure

Pulmonary venous congestion

A.F. left atrium right atrium

habituation contraction

atrial pressure A.F. elevate pulmonary venous congestion

Mitral stenosis

Low cardic out put pulmonary venous congestion

intra car dic thrombosis atrial dilated

Mitral valve disease fibrillation atrium

thrombo embolism

A.F. systemic embolisation

A.F. Pulmonary embolism

left atrium right atrium dilated

mitral stenosis left atrium dilated Pulmonary hyper

tension

right sided of the heart dilated

A.F. on top left atrium right atrium

right atrium pulmonary embolism

left atrium systemic embolisation

anti coagulated

fibrillation anti coagulant

A.F.

Personality

A.F.

anti coagulant

concept

serotonin reuptake i nhibitor

Personality very aggressive

C.T. scan

A.F.

Neurological

changes in neurotransmitter

organic

Organic dementia dementia

behavior

aggressive

MRIbrain multiple brain infraction

source of embolism

anti depressant

embolism hemiplegia

emboli

brain

dementia dementia recurrent stroke

stroke dementia

weakness

fibrillation anti coagulant

etiology

rheumatic heart disease mitral valve disease congenital

dilatation atrium

systemic hypertension

systemic hypertension hypertrophy Left ventricle high

pressure Left ventricle left atrium dilated

constrictive pericarditis

constrictive preicarditis

constrictive perca rditis catching effect ventricle

ventricle dilate dilatation

pressure ventricle diastole

atrium dilatation

Infective endocarditis thyrotoxicosis

thryotoxicosis thyrocardia

Manifestations thyrotoxicosis thyrocardia

thyrocardia thyrotoxicosis

Palpitation

irregular at rest

apical radial pulse comment apical pulse radial pulse

pulse deficit

Pulse deficit

digitalized Pulse deficit

carotid sinus massage Multiple foci

foci

respiratory sinus arrhythmia

canon wave

neck vein

Loss of A wave

local examination apex

mitral valve disease cause

Investigations

ECG ECHO T3 and T4 TSH

A.F.

paroxysmal

paroxysmal

Persistent terminated

DC

chronic permanent

i.e. sinus rhythm can not be restored

chronic A.F.

hypertensive ischaemic

A.F.

paroxysmal

paroxysmal A.F.

A.F.

paroxysmal

Normal heart normal person

Paroxysmal A.F. normal

Normal

No need for treatment

stress Beta blocker in between attack

stress

A.F. very common mistake

T3 and T4TSH

Persistent A.F.

A.F. Persistent

Persistent

Paroxysmal

DC shock

persistent

A.F.

atrium

atrium atrium A.F. Atrium

atrium sinus rhythm atrium

thrombus shower

embolisation DC shock

A.F. A.F. 3 palpitation

DC shock sinus rhythm

say 12 anti coagulated

adjustment dose

PPT shift Oral anti coagulant

A.F. Palpitation cardiology

A.F.

centre

A.F.

oral anti coagulant Prothrombin time INR

anti coagulant INR

Prothrombin time Oral anti coagulant

mortality

Permanent chronic

A.V. block ventricle

anti coagulant

anti coagulant

shift oral warfarin

Extra systole

very common

etiology functional extra systole drugs

digitalis toxicity

extra systole

Palpitation palpitation occasional palpit ation occasional

irregularity

A.F. pulse deficit atrial

fibrillation

carotid massage canon

ECG

No need for treatment

extra systole

no need extra systole beta blocker

Beta blocker Irritable

extra systole dangerous

dangerous extra systole ventricular , multifocal frequent

ventricular tachycardia

extra systole

Amiodarone

Amiodarone

ventricular tachycardia in between attacks

extra systole dangerous multifocal focus

Amiodarone

sinus bradycardia

sinus bradycadia

hypo thyroidism heart block

bile salts

Increase tension

Increase tension problem solving

subarachonid haemorrhage brain tumor

increase tension

Increase tension 60

60

Parkinsonism extrasystole

extra systole

Increase tension

Under gradua tes straight

Increased tension brain tumor sub arachonoid

haemorrhage reflex bradycardia

reflex reflex systolic hypertension cushing reflex

sub arachonoid

sub arachonoid haemorrhage

diffuse T wave inversion ECG

ECG T wave Inverted

heart

sub arachonoid

sub arachonoid sudden sever headache

T wave sub arachonoid

60 regular

bradycardia carotid sinus massage

investigations

effective safe

100/70females

sympathetic

Heart lesion stenosis

ECHO

renal insfficiency

CBCBlood sugar hyper nateremia

Hypo glycemia

cortisone level

hypo tension idiopathic

females

females

un human

as

you like

test test

sickness

females

Fludrocortiso ne

aldosterone analongue

salt retention

sympathomimetics midoprine