EMERGENCY CADIAC EMERGENCY CADIAC ARRHYTHMIASARRHYTHMIAS

EMERGENCY CADIAC EMERGENCY CADIAC ARRHYTHMIASARRHYTHMIAS

Cairo University

Cons. cardiologist SBCC

Sherif Hamed Zaky, MD

EMERGENCY CADIAC RRHYTHMIASEMERGENCY CADIAC RRHYTHMIAS

Tachyarrhythmias :Tachyarrhythmias : V.tachV.tach V.FibV.Fib Atrial Fib.Atrial Fib. “ “ “ “ TachycardiaTachycardia S.V.TS.V.T

These are serious cardiac These are serious cardiac dysrhythmias seen mostly in ER, CCU dysrhythmias seen mostly in ER, CCU

or ICU and includeor ICU and include : :

Bradyarrhythmias:Bradyarrhythmias: ٍٍ Sinus bradycardiaSinus bradycardia Complete heart blockComplete heart block second degree heart blocksecond degree heart block AsystoleAsystoleDevices malfunction:Devices malfunction:PacemakersPacemakers ICDsICDs

TachyarrhythmiasTachyarrhythmias : :

Ventricular TachycardiaVentricular Tachycardia

(wide complex tachycardia management)(wide complex tachycardia management)

Decision AlgorithmDecision Algorithm ? Is the patient haemodynamically unstable

NO YES )unstable(

Haemodynamic instability means that the arrhythmia should be addressed immediately. The following algorithm cannot be used where the ventricular response rate is irregular.

Is any one of the following is presentIs any one of the following is present: : ischaemic heart diseaseischaemic heart disease

, , oror heart failureheart failure, , oror past heart surgerypast heart surgery, , oror

cardiac enlargementcardiac enlargement??

NONO YES )VTYES )VT((

Decision AlgorithmDecision Algorithm

Ischemic VTIschemic VT

: : Are there any RS complexes in the V Are there any RS complexes in the V leadsleads? ?

NO )VT(NO )VT( YESYES

In any of these RS complexes, is the interval from start of R to nadir of S > 100ms ?

NO YES )VT(

Decision AlgorithmDecision Algorithm

Is there AV Is there AV dissociationdissociation ? ?

or are there fusion or are there fusion

or capture beatsor capture beats ? ?

NO (VT) YES

Decision AlgorithmDecision Algorithm

Is there positive or negative concorance in V-leads ?

Decision AlgorithmDecision Algorithm

Predominantly negative Predominantly negative QRS QRS in at least in at least 22

out of out of 4 4 leads ( leads ( I , II , V1 , V6I , II , V1 , V6 ) )

including essentially leadincluding essentially lead II or or V6 V6 can can diagnose VT in 90% and SVT in 100% of diagnose VT in 90% and SVT in 100% of cases with wide complex tachycardiacases with wide complex tachycardia..

Decision AlgorithmDecision Algorithm

1 2

3 4

Preexcited AFPreexcited AF

Torsade De pointesTorsade De pointes::Look for long QT syndrome Look for long QT syndrome (acquired- congenital) after DC (acquired- congenital) after DC cardioversion to chose proper cardioversion to chose proper managementmanagement..

VF :VF :Ischemic heart disease & end stage Ischemic heart disease & end stage cardiomyopathy of different aetiologies cardiomyopathy of different aetiologies are the most common ppt factorsare the most common ppt factors..

SVTSVT

Atrial Tachcardia/FibrillationAtrial Tachcardia/Fibrillation

Atrial Tachcardia/FibrillationAtrial Tachcardia/Fibrillation

AV- BlockAV- Block• 1o HB

• 2o HB ♦ Mobitz I

♦ Mobitz II

• 3o HB

• High grade AV-block

AV- BlockAV- BlockSUPRASHISSIAN

INFRAAHISSIAN

Sinus bradycardia/Asystole Sinus bradycardia/Asystole (comlete SA-block(comlete SA-block((

Sinus bradycardia/Asystole Sinus bradycardia/Asystole (comlete SA-block(comlete SA-block((

Malfunctioning DevicesMalfunctioning Devices

Permanent Pacemakers

LOSS OF SENSING

LOSS OF CAPTURE

ENDLESS LOOP TACHYCARDIA

ICDICD