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Transcript 
Arrhythmias
Medical Student Teaching
Tuesday 24th January 2012
Dr Karen Jones, SpR Emergency Medicine
Aims:
 Recognition of common arrhythmias
 Identification of adverse features that indicate
the risk of imminent deterioration
 Understanding the treatment options
What are arrhythmias and
why are they important?
 Rhythms that are not produced by the SA node
and transmitted through the electrical system of
the heart in the normal way
 Some abnormal rhythms may lead to cardiac
arrest or deterioration if untreated
 If you can identify an arrhythmia and institute the
correct treatment you may be able to prevent
deterioration
The Cardiac Conduction
System
I think the patient has an
arrhythmia, what should I
do?
I think the patient has an
arrhythmia, what should I
do?
 Start with ABC!
 Check for a pulse
 Give oxygen!
 Get the patient on a cardiac monitor
 Insert an iv cannula
 Assess for adverse features
 Get a 12 lead ECG
Adverse features
 Shock
 Syncope
 Heart failure
 Chest pain
 Extreme heart rate
 > 150
 < 40
What treatment options are
there?
 Do nothing
 Simple clinical interventions
 Drugs
 Electricity
Assessing a rhythm
1. Is there any electrical activity?
2. What is the rate – fast, normal or slow?
3. Is the rhythm regular or irregular?
4. Is the QRS complex narrow or wide?
5. Are there P waves?
6. Are the P waves related to the QRS
complexes?
What is the rhythm?
Asystole
What is the rhythm?
Ventricular Fibrillation
Treatment?
What is the rhythm?
Ventricular Tachycardia (VT)
Treatment?
It depends…CHECK THE
PATIENT!
 No pulse =
ELECTRICITY (Defibrillate)
 Adverse signs =
ELECTRICITY (Cardioversion)
 No adverse signs = DRUGS (Amiodarone)
What is the rhythm?
Torsades de Pointes
Treatment?
What is the rhythm?
Sinus Tachycardia
Treatment?
CHECK THE PATIENT!
 Check for a pulse and ABC
 Treat the underlying cause
 Pyrexia
 Hypoxia
 Hypovolaemia
 Pain
 Agitation
 Toxins
What is the rhythm?
AV nodal re-entry tachycardia
(Supraventricular
tachycardia SVT)
Treatment?
It depends…CHECK THE
PATIENT!
 No pulse =
CPR
 Adverse signs =
Electricity (Cardioversion)
 No adverse signs = Vagal Manoeuvres
Drugs (Adenosine)
What is the rhythm?
Atrial Fibrillation
Treatment?
It depends…CHECK THE
PATIENT!
 No pulse =
CPR
 Adverse signs =
ELECTRICITY (Cardioversion)
 No adverse signs = DRUGS
What is the rhythm?
Atrial Flutter
Treatment?
What is the rhythm?
Sinus Bradycardia
What is the rhythm?
First Degree AV Block
What is the rhythm?
Second Degree AV Block
Mobitz Type I (Wenckebach)
What is the rhythm?
Second Degree AV Block
Mobitz Type II
What is the rhythm?
Third Degree AV Block
(Complete Heart Block)
Treatment?
It depends…CHECK THE
PATIENT!
 Adverse signs =
DRUGS (Atropine)
Temporary pacing
Permanent pacing
 No adverse signs = MONITOR
TAKE HOME MESSAGES!
 Always start with ABC
 Check for adverse signs
 Get a 12 lead ECG and use the 6 step approach
 Treatment depends on the clinical state of the
patient
CHECK THE PATIENT!
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