The Basics of Arrhythmia
Arrhythmias - the bare bones
Basic Physiology reminder
Basic ECG reminder
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Rate
Rhythm
PR interval
QRS complex
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Width
Any Q waves?
Axis
Lateral lead R wave progression
• ST and T waves
Basic ECG reminder
What is an arrhythmia?
• Abnormalities of electrical rhythm
• Supraventricular
– SVT, AF, Atrial flutter
– Re-entrant tachycardias
• Ventricular
– VT, VF, Torsdaes de pointes
• Asystole and PEA
Clinical manifestations
• Palpitations
• Syncope
• If going fast enough, can precipitate cardiac
ischaemia and chest pain
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Cardiac failure
Decreased level of consciousness
Hypoperfusion of all organs
Cardiac arrest
Common arrhythmias
Ventricular
Atrial
• AF
• VT
• A Flutter
• VF
• Paroxs. SVT
• Torsades
– AVNRT
– AVRT (WPW)
– Multifocal atrial
tachycardia
Bradyarrhytmia
• Medication
• AV block
• SSS
Ventricular fibrillation
What rhythm is it?
• Is it sinus?
• Is it going at a life-theratening rate?
– 220 minus age
• Is it regular?
– If it is ‘dead regular’ could it be A Fib?
• Is it a broad complex?
Atrial Fibrillation
• Questions to ask yourself
– What made it happen?
– How long have they been in it?
– Do they need anticoagulation?
– Do I need to slow it down?
– How do I slow it down?
Atrial fib with LBBB
How to approach a regular SVT?
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Is it AF, Aflutter, AVNRT, AVRT???
Valsalva?
Adenosine - blocks the AV node
Caution with adenosine, dig and
calcium channel blockers
• If they’re compromised, have some
paddles on
Broad complex tachycardias
• Always VT until proven otherwise!
• Look for concordance, evidence of AV
dissociation, and very wide QRS
WPW with AF
Broad complex tachycardias
• Electrolytes
– High K, Ca++
– Low K, Mg, Ca++
• Drugs (prolong QT interval)
– Methadone, amiodarone, lithium,
sotalol,quinolones, Stemetil, chlorpromazine
• Syndromes
• Ischaemia and cardiac scarring
VT with clear AV dissociation
What do you need to do?
• Try and work out what rhythm it is in
• If it’s faster than physiologic, then it’s life
threatening (220 minus age)
• If there’s suggestion of ischaemia, it’s
life threatening
• If it’s too fast - Slow it down until
• If it’s too slow – Speed it up
In an arrest
• Defib VF and VT only
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Get the paddles on!
Push hard and fast! – all the way to shock
Push onto a hard surface!
100% oxygen, 1 SMALL breath EVERY 30
seconds, SLOW and steady!