yasmine darwazeh fy1 – general surgery arrhythmias
TRANSCRIPT
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