YASMINE DARWAZEHFY1 – GENERAL SURGERY

Arrhythmias

Objectives

Define bradyarrhythmia and tachyarrythmia

Know the most common brady- & tachyarrythmias

Recognise them on an ECG.

Know the main signs and symptoms, aetiology and treatments of each.

What can you see?

Types of bradyarrhythmia

Sinus Bradycardia

What can you see?

1st degree AV node block

What can you see?

Mobitz type 1 (Wenkebach)

What can you see?

Mobitz type 2

What can you see?

Complete AV block

Adult Bradycardia Algorithm

What can you see?

Sinus tachycardia

Extra-cardiac causes•Drugs•Alcohol•Stimulants e.g. caffeine•Stress•Hyperthyroidism•Infection/Sepsis

Broad and Narrow Complex tachycardias

Broad Complex Tachyarrhythmias Ventricular Tachycardia Torsades de Pointes Ventricular Fibrillation

Narrow Complex Tachyarrhythmias (Supraventricular Tachycardias) Sinus Tachycardia Atrial Tachycardia Reentrant Tachycardias (AVNRT and AVRT) Atrial Fibrillation Atrial Flutter

What can you see?

Atrial Flutter

SVT, regular Saw-tooth flutter waves. Flutter waves rate = 300 bpm Ventricular rate = 150 bpm or 100 bpm, due to AVN

block ratio of 2:1 or 3:1 Ectopic atrial beat causes a re-entrant circuit within

the atria. Causes

As for AF Hyperkalaemia Digoxin toxicity.

Treatment As for AF (discussed later) Can be differentiated from Fast AF with vagal

manouvres/adenosine.

What can you see?

Ventricular tachycardia

Broad complex tachycardia

Causes• Electrolyte derangement (hypokalaemia,

hypomagnesaemia, hypocalcaemia)• Myocardial ischaemia/infarct• Cardiomyopathy• Congenital (HOCM, long QT)

Treatment• Amiodarone• ICDs

What can you see?

Atrial Fibrillation

Atria chaotically fibrillate.Fibrillation rate between 350 & 600bpm. Variable impulse conduction through the AVNIrregularly irregular rhythmMost common arrhythmia.10% of population >80 years old.Significant morbidity due to

thromboembolic diseaseUnmanaged = 5% yearly stroke risk.

Atrial Fibrillation

Types Paroxysmal (acute onset, spontaneous termination

within 1 week) Persistent (>7 days, can be cardioverted) Permanent (> 1 year not terminated by cardioversion)

Causes Cardio (HTN, valvular disease, CAD, myositis) Pulmonary (PE, pneumonia, COPD, lung Ca) Metabolic (hyperthyroidism) Infection Drugs (alcohol, illicit drugs)

AF

Investigations Bedside – ECG/24 hour tape Bloods – FBC, U&Es, LFTs, TFTs, coag screen Imaging – CXR, echo

Management (Rate vs Rhythm) Rate –

Beta blockers Digoxin

Rhythm Cardioversion Sotalol Amiodarone (HF)

AF - CHA2DS2-VASc score

Thromboprophylaxis C – cardiac failure (1) H – HTN (1) A - >75 (2, 1 if 65-74) D – diabetes (1) S- stroke/TIA (2) Va – vascular disease Sc – female (1)0 = Low Risk1 = Moderate risk2 or more = high risk

Summary

Define bradyarrhythmia and tachyarrythmia

Know the most common brady- & tachyarrythmias

Recognise them on an ECG.

Know the main signs and symptoms, aetiology and treatments of each.

Any Questions