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Transcript
Cardiology II
Arrhythmias
Objectives
O Describe the normal conduction in the heart
O Describe pathophysiology of bradycardias
O Describe pathophysiology of tachycardias
O Describe treatment of the above
Case
O 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.
Normal Conduction
ECG waveform
Normal ECG
Sinus Arrhythmia
Bradycardias
O 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.
Sinus Bradycardia
First Degree AV Block
Second Degree (Type I)
Second Degree (Type II)
Third Degree Block
Junctional Rhythm
Accelerated Idioventricular
Ventricular Escape
Ventricular fibrillation
What is this?
Asystole
Branch Blocks
O “Hiccups” on the conduction highway past
the AV node
O Can involve the right bundle, the left bundle,
or divisions of the left bundle
Right Bundle Branch Block
Left Bundle Branch Block
Bifasicular Block RB/LA
Bifasicular Block – RB/LP
Trifasicular Block
Tachycardias
O 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
Sinus Tachycardia
Atrial Fibrillation
Atrial Fib with Abberancy
Multifocal Atrial Tachycardia
Atrial Flutter
Atrial Flutter
AV Nodal Reentrant
Tachycardia
Wolfe Parkinson White
Lown-Ganong-Lavine
AV Reciprocating Tachycardia
Ventricular Tachycardia
Torsades de Pointe
Miscellaneous
LVH
RVH
Hyperkalemia
Digoxin Toxicity
Brugada Syndrome
Wellen’s Syndrome
Treatment Summary
O EMT
O ABCs
O Call for ALS
O Rapid Transport
O AEMT
O IV
O Cardioversion of V-tach, V-fib
O Paramedic
O Atropine, pacing for bradycardias
O Vagal Maneuvers, Adenosine for narrow complex
tachyarrhythmias
O Amio, cardioversion for wide complex
tachyarrhythmia