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Arrhythmias. Principles of long and short term management of arrythmias. Arrythmias. Stability of the patient is primary Serious signs and symptoms (shock, hypotension, CHF,altered consciousness, severe SOB, MI, or ischeamic pain) require immediate treatment

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Principles of long and short term management of arrythmias


Stability of the patient is primary

Serious signs and symptoms (shock, hypotension, CHF,altered consciousness, severe SOB, MI, or ischeamic pain) require immediate treatment

Stable patients can be further investigated


Immediate synchronized DC

Cardioconversion should be

Performed on all unstable patients

Stable patients are assessed

According to underlying rhythm and history

superventricular arrhythmias
Superventricular Arrhythmias

Sinus Tachycardia- faster than 100 bpm

Rarely primary- treat the underlying cause

Dehydration, fever, hypoxia

superventricular arrhythmias1
Superventricular Arrhythmias

Paroxysmal superventricular tachycardia

arise from above the bifurcation of the His

bundle. Approximately 90% of these

arrhythmias occur as a result of a reentrant

mechanism; the remaining 10% occur as a result

of increased automaticity.


DC conversion

Physical maneuvers- valsalva


In general, pharmacologic agents with AV nodal blocking properties such as adenosine, -blockers, calcium channel blockers, and digoxin are used for the acute management and prevention of AV nodal dependent PSVT. Other antiarrhythmic agents, such as procainamide and amiodarone, which exert effects at various levels of the cardiac conduction system are used for the management and prevention of AV nodal independent PSVT.

atrial fibrillation
Atrial Fibrillation

In stable patients with a rapid ventricular response, the initial goal is rate control. This can usually be achieved with -blockers, calcium channel blockers, or digoxin


atrial flutter
Atrial flutter

Similar to AF

Patient are at less risk from coagulation


Multifocal Atrial Tachycardia

Rate control


DC conversion

ventricular arrhythmias
Ventricular Arrhythmias

Ventricular tachycardia is the most common cause of wide QRS complex tachycardia. The term VT is used when six or more consecutive ventricular beats occur. The ventricular rate is usually 150–220 beats/min, although rates slower than 120 beats/min may occur.



DC Cardioconversion


Traditionally, patients with stable VT are administered an antiarrhythmic agent for chemical cardioversion. A number of medications are available. The choice for a particular patient is often based on physician preference and experience, findings of preserved or impaired cardiac function, and the underlying cause of the VT.

ventricular fibrillation
Ventricular Fibrillation


bradyarrhythmias conduction disturbances escape rhythms

Unstable patients need transcutaneouspacemaking

Stable patients can be managed pharmcologically

sinus bradycardia
Sinus Bradycardia

Assymptomatic Sinus Bradycardia requires no treatment

a bunch of other slow rhythms
A bunch of other slow rhythms

Heart block

Speed up the heart… atropine dopamine aminophylline