Arrhythmia

Arrhythmia

Prepared by Goran Ibrahim

Arkan Ali

Introduction Arrhythmias

• An abnormality of the cardiac rhythm is called a cardiac arrhythmia.

• Arrhythmias may cause sudden death, heart failure

• many arrhythmias are not life-threatening, some can cause cardiac arrest.

• Arrhythmias can occur in the upper chambers of the heart (atria) or in the lower chambers of the heart (ventricles).

• Arrhythmias may occur at any age.

Definition of arrhythmia

dysrhythmia (also known as arrhythmia or irregular heartbeat)

is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. The heartbeat may be too fast (over 100 beats per minute) or too slow (less than 60 beats per minute), and may be regular or irregular. A heart beat that is too fast is called tachycardia and a heart beat that is too slow is called bradycardia.

Type of arrhythmia

•bradycardia: the heart rate is slow (< 60 b.p.m).

•tachycardia: the heart rate is fast (> 100 b.p.m).

Classification of Arrhythmia• Abnormal heart pulse formation1. Sinus arrhythmia2. Atrial arrhythmia3. Atrioventricular junctional arrhythmia4. Ventricular arrhythmia

• Abnormal heart pulse conduction1. Sinus-atrial block2. Intra-atrial block3. Atrio-ventricular block4. Intra-ventricular block

• Abnormal heart pulse formation and conduction

Cause of arrhythmia

• Some physical condition.

• Pathological heart disease.

• Other system disease .

• Electrolyte disturbance and acid-base imbalance.

• Physical and chemical factors or toxicosis.

Symptom of arrhythmia

• Palpitations (a feeling of skipped heart beats, fluttering or "flip-flops")

• Pounding in your chest

• Dizziness or feeling light-headed

• Fainting

• Shortness of breath

• Chest pain or tightness

• Weakness or fatigue (feeling very tired)

Diagnosis

Electrocardiogram -- Also called an EKG or ECG, this test records the electrical activity of heart.

Holter monitor -- This is a portable EKG that use for 1 to 2 days. Should electrodes taped to skin.

Event monitor -- This is a device that, when push a button, will record and store heart's electrical activity for a few minutes

Stress test -- There are different kinds of stress tests. The goal is to check how much stress heart can manage before having a heart rhythm problem or not getting enough blood flow to the

heart.

treatment• Anti-arrhythmia Agents

• Anti-tachycardia agents

• Anti-bradycardia agents

Anti-tachycardia agents

• Modified Vaugham Williams classification

1. I class: Natrium channel blocker

2. II class: ß-receptor blocker

3. III class: Potassium channel blocker

4. IV class: Calcium channel blocker

5. Others: Adenosine, Digital

Phase 0

Phase 1

Phase 2

Phase 3

Phase 4

R.M.P

(Plateau Phase)

Class I:

Na + channel blockers.

- Pacemaker potential

--

-

Class III:

K + channel blockers

-Class IV:

Ca ++ channel blockers

Class II:Beta blockers

Classification of Anti-Arrhythmic Drugs

Anti-bradycardia agents

1. ß-adrenic receptor activator

2. M-cholinergic receptor blocker

3. Non-specific activator

Clinical usage

Anti-tachycardia agents• Ia class : Less use in clinic

1. Guinidine

2. Procainamide

3. Disopyramide: Side effect: like M-cholinergic receptor blocker

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

Anti-tachycardia agents

• II class: ß-receptor blocker

1. Propranolol: Non-selective

2. Metoprolol: Selective ß1-receptor blocker, Perfect to hypertension and coronary artery disease patients associated with tachyarrhythmia.

Anti-tachycardia agents

• III class: Potassium channel blocker, extend-spectrum anti-arrhythmia agent

• Amioarone: Perfect to coronary artery disease and heart failure patients

• Sotalol: Has ß-blocker effect

• Bretylium

Anti-tachycardia agents

• IV class: be used in supraventriculartachycardia

1. Verapamil

2. Diltiazem

• Others:

Adenosine: be used in supraventriculartachycardia

Anti-bradycardia agents

• Isoprenaline

• Epinephrine

• Atropine

• Aminophylline

Side Effects Associated With Antiarrhythmics

• Worsening arrhythmias• Allergic reaction• Chest pain• Fainting• Swelling of the feet or legs• Blurred vision• Shortness of breath• Abnormally fast heartbeat• Abnormally slow heartbeat

Non-drug therapy

• Cardioversion: For tachycardia especially hemodynamic unstable patient

• Radiofrequency catheter ablation (RFCA): For those tachycardia patients (SVT, VT, AF, AFL)

• Artificial cardiac pacing: For bradycardia, heart failure and malignant ventricular arrhythmia patients.

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