Arrhy thmias Principles of long and short term management of arrythmias
Dec 23, 2015
Arrhythmias
Principles of long and short term
management of arrythmias
Arrythmias
Stability of the patient is primarySerious signs and symptoms (shock,
hypotension, CHF,altered consciousness, severe SOB, MI, or ischeamic pain) require immediate treatment
Stable patients can be further investigated
Tachyarrythmias
Immediate synchronized DC Cardioconversion should be Performed on all unstable patients
Stable patients are assessedAccording to underlying rhythm and history
Superventricular Arrhythmias
Sinus Tachycardia- faster than 100 bpmRarely primary- treat the underlying causeDehydration, fever, hypoxia
Superventricular Arrhythmias
Paroxysmal superventricular tachycardiaarise from above the bifurcation of the Hisbundle. Approximately 90% of thesearrhythmias occur as a result of a reentrantmechanism; the remaining 10% occur as a result of increased automaticity.
treatment
DC conversion
Physical maneuvers- valsalvaPharmacologicalIn general, pharmacologic agents with AV nodal blocking
properties such as adenosine, -blockers, calcium channel blockers, and digoxin are used for the acute management and prevention of AV nodal dependent PSVT. Other antiarrhythmic agents, such as procainamide and amiodarone, which exert effects at various levels of the cardiac conduction system are used for the management and prevention of AV nodal independent PSVT.
Atrial Fibrillation
In stable patients with a rapid ventricular response, the initial goal is rate control. This can usually be achieved with -blockers, calcium channel blockers, or digoxin
Anticoagulants
Atrial flutter
Similar to AF
Patient are at less risk from coagulation
Multifocal Atrial TachycardiaRate control
Preexcitation ArrythmiasDC conversion
Ventricular Arrhythmias
Ventricular tachycardia is the most common cause of wide QRS complex tachycardia. The term VT is used when six or more consecutive ventricular beats occur. The ventricular rate is usually 150–220 beats/min, although rates slower than 120 beats/min may occur.
treatment
Unstable-DC Cardioconversion
StableTraditionally, patients with stable VT are administered an
antiarrhythmic agent for chemical cardioversion. A number of medications are available. The choice for a particular patient is often based on physician preference and experience, findings of preserved or impaired cardiac function, and the underlying cause of the VT.
Polymorphic Ventricular tachycardia
Shock em
Ventricular Fibrillation
Anti-arrhythmics
BRADYARRHYTHMIAS, CONDUCTION DISTURBANCES, & ESCAPE RHYTHMS
Unstable patients need transcutaneous pacemaking
Stable patients can be managed pharmcologically
Sinus Bradycardia
Assymptomatic Sinus Bradycardia requires no treatment
A bunch of other slow rhythms
Heart block
Speed up the heart… atropine dopamine aminophylline