Download - Cardiology II
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Cardiology IIArrhythmias
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ObjectivesO Describe the normal conduction in
the heartO Describe pathophysiology of
bradycardiasO Describe pathophysiology of
tachycardiasO Describe treatment of the above
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CaseO A 55 year old male calls 911 because
his “heart is racing.” He initially is alert, oriented, and has mild shortness of breath. On physical exam, he has a regular tachycardia at 180, and monitor shows a regular, narrow-complex tachycardia. He denies chest pain. Midway through transport, he becomes less responsive, and his blood pressure drops as he starts sweating profusely.
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Normal Conduction
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ECG waveform
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Normal ECG
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Sinus Arrhythmia
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BradycardiasO Caused by damage to the conduction
system resulting in a “broken road” or by drugs (beta blocker, calcium channel blockers)
O If due to drugs, reversible. If not, many require a permanent pacemaker
O Our goal is to temporarily support the heart rate until one of those two happen.
O Atropine or External Pacing are options.
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Sinus Bradycardia
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First Degree AV Block
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Second Degree (Type I)
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Second Degree (Type II)
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Third Degree Block
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Junctional Rhythm
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Accelerated Idioventricular
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Ventricular Escape
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Ventricular fibrillation
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What is this?
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Asystole
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Branch BlocksO “Hiccups” on the conduction
highway past the AV nodeO Can involve the right bundle, the left
bundle, or divisions of the left bundle
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Right Bundle Branch Block
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Left Bundle Branch Block
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Bifasicular Block RB/LA
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Bifasicular Block – RB/LP
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Trifasicular Block
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TachycardiasO Any heart rate greater than 100.O The key is using the pattern to
determine what is causing the tachycardia
O The treatment is even more diverse, thus, knowing the pattern is critical to choosing the correct therapy.
O The three main branches of tachycardia are atrial, nodal, and ventricular
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Sinus Tachycardia
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Atrial Fibrillation
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Atrial Fib with Abberancy
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Multifocal Atrial Tachycardia
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Atrial Flutter
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Atrial Flutter
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AV Nodal Reentrant Tachycardia
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Wolfe Parkinson White
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Lown-Ganong-Lavine
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AV Reciprocating Tachycardia
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Ventricular Tachycardia
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Torsades de Pointe
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Miscellaneous
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LVH
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RVH
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Hyperkalemia
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Digoxin Toxicity
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Brugada Syndrome
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Wellen’s Syndrome
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Treatment SummaryO EMT
O ABCsO Call for ALSO Rapid Transport
O AEMTO IVO Cardioversion of V-tach, V-fib
O ParamedicO Atropine, pacing for bradycardiasO Vagal Maneuvers, Adenosine for narrow complex
tachyarrhythmiasO Amio, cardioversion for wide complex
tachyarrhythmia