Subject 9 - Cardiac arrhythmias
(4
hours)
Part I. Classification of cardiac rhythm and conduction. Mechanisms. Arrythmia.
Paroxysmal tachycardia (atrial, nodal, ventricular )
(2 hours)
Place
Classroom , Department of Cardiology .
Purpose
Students must know:
• Classification of rhythm and conduction disorders .
• Electrophysiological mechanisms of ectopic arrhythmias (reverse input excitation wavelength ,
increasing automaticity ) and the possibility of their recognition in the clinic.
• Features of hemodynamic , clinics, flow , ECG diagnosis and differential diagnosis of ectopic
arrhythmias ( various options extrasystoles , paroxysmal tachycardia ) .
• Classification of antiarrhythmic drugs .
• Principles of treatment and prevention, especially the treatment of various clinical variants .
To Able:
• Based on the examination of the patient with heart rhythm disorder formulate the final clinical
diagnosis and treatment.
Professional orientation of students
High prevalence of cardiac arrhythmias , the need to determine their knowledge of the tactics of
the examination and treatment of patients with various cardiac diseases. The need to take
urgent action in case of emergency .
Base level of knowledges and abilities
№
Discipline
To know
1.
Anatomy
Heart Anatomical structure
2.
Histology
Structure and function of the
myocardium
and
cardiac
conduction system
3.
Biochemistry
Biochemistry
metabolism
4.
Pathophysiology
Mechanisms
disturbances
To able
myocardial To interpret lipidogramm Rate
of
rhythm
5.
Propedevtik
diseases
of
internal Semiotics
arrhythmias
of
cardiac Evaluate ECG
Plan of practical employment
№
Elements of practical employments
Time(minutes)
1. Verification of present's students
5
2. Entrance control and his analysis
10
3. Distributing
*
patients for Supervision ( card or clinical tasks )
5
4. Review
*
patients or study of educational hospital chart
20
5. Discussion of findings, formulation of previous diagnosis, determination of
methods of additional inspection of patient, interpretation of their results,
formulation of final diagnosis and plan of treatment
15
6. Exercises with clinical formulations for solving clinical situation tasks
10
7. Output control of knowledge and its evaluation
10
8. Results and final assessment of knowledge and skills of students and tasks
to self- preparation for the next lesson
5
Note: * - in the case of patients absence in clinical, practice can be made in the form of
preparation and decision of situational tasks.
List of theoretical questions addressed in class
1. Classification of rhythm and conduction disorders .
2 . Electrophysiological mechanisms of ectopic arrhythmias (reverse input excitation wavelength
, increasing automaticity ) and the possibility of their recognition in the clinic.
3 . Features of hemodynamic , clinics , current, ECG - diagnosis and differential diagnosis of
ectopic arrhythmias ( extrasystoles different options , paroxysmal tachycardia ) .
4 . Classification of antiarrhythmic drugs .
5 . Principles of treatment and prevention, especially the treatment of various clinical variants .
Method of leadthrough of practical employment *
On the first employment teacher hold instructing from accident (if there are such terms) which
registers in the magazine of teacher's signature of student prevention.
* Students answer in writing on the tests of base knowledges entrance control. Then a teacher
distributes students for kuration patients and determines them a task.
№
Task
Teasher's
students
pointing
to Teacher's note for students
1.
To provide curation of 1. Possible arrhythmias
Pay special attention to the
patient diagnosed with
characteristic clinical manifestations
2 . Signs of underlying
with
extrabeats,
and causes a variety of cardiac
disease
paroxysmal tachycardia
arrhythmias
3 . Characteristic changes in
the ECG , Holter ECG
monitoring
,
echocardiography
A teacher works in obedience to the plan of organization of employment, in the end - initial
control of knowledges. Before completion of employment teacher announce his results with the
estimation of every student and declares the theme of next session.
Forms and methods of self-control
Tests
1. Sign indicates the most likely nature of supraventricular paroxysmal tachycardia ?
A. Absence of P wave
B. QRS duration less than 0.12 sec.
C. Negative prong T.
D. Vagal negative samples .
E. Tachycardia over 200 min .
2 . Sign indicates the most likely nature of ventricular paroxysmal tachycardia ?
A. Absence of P wave
B. QRS duration greater than 0.12 seconds.
C. Negative prong T.
D. Vagal negative samples .
E. Tachycardia over 200 min .
Situational tasks
1. A young man of 16 years complains of feeling a strong heartbeat , which arose suddenly.
OBJECTIVE: Funky . Skin and mucous normal color . Tony loud heart , tachycardia, heart rate
= PS = 220 min. , BP - 130/70 mm Hg. Art. On ECG - regular rhythm , QRS = 0,09 s, P wave
can be determined. Your preliminary diagnosis . Clinical management of the patient.
2 . Male 67 years with acute myocardial infarction on the first day of the disease complain of
general weakness , shortness of breath . OBJECTIVE: Acrocyanosis . RR - 28 min . Tony heart
tones , tachycardia, blood pressure - 110/60 mm Hg. Art. On ECG - regular rhythm , RR = 0,3
with , QRS = 0,14 s, P wave can be determined. Your preliminary diagnosis . Clinical
management of the patient.
Ilustrative material
1. Table and slides classification of cardiac arrhythmias and conduction classification of
antiarrhythmic agents .
2 . Educational histories .
3 . Audiocassettes rhythm disorders .
4 . Sets ECG arrhythmia .
5 . Set situational problems with standards responses set of tests with the standards of the
responses ( according to the number of students ) .
Sources of information (literature)
Basic:
Therapy. Course of lectures. Simferopol. -2003.- 444p.
Additional:
1. Harrison's Principles of Internal Medicine 18th edition.
.org)
2. ESC Guidelines. Cardiovascular medicine. (Www.escardio.org / guidelines)
The program of preparation students to the theme
To learn:
• Classification of rhythm and conduction disorders .
• Electrophysiological mechanisms of ectopic arrhythmias (reverse input excitation wavelength ,
increasing automaticity ) and the possibility of their recognition in the clinic.
• Features of hemodynamic , clinics, flow , ECG diagnosis and differential diagnosis of ectopic
arrhythmias ( various options extrasystoles , paroxysmal tachycardia ) .
• Classification of antiarrhythmic drugs .
• Principles of treatment and prevention, especially the treatment of various clinical variants .
draw:
• ECG pattern in a paroxysm of supraventricular tachycardia .
To Able:
• Establish a definitive diagnosis of supraventricular and ventricular arrhythmias , paroxysmal
arrhythmias, assign the necessary examination and treatment.
Note the use of modern methods of instrumental examination of heart rhythm disturbances .
Theme:
(4
Cardiac arrhythmias
hours)
Part 2. Flutter (TA) and atrial fibrillation (AF). Electrophysiological mechanisms.
Classification, characteristics of hemodynamic , and clinic flow. ECG diagnosis and
differential diagnosis of TP and FP. Clinical management of differentiated therapy and
prophylaxis
(2 hours)
Place
Classroom , Department of Cardiology .
Purpose
Students must know:
• Classification of rhythm and conduction disorders .
• Electrophysiological mechanisms of TP and FP , the possibility of their recognition in the clinic.
• Features of hemodynamic , clinics, flow , ECG diagnosis and differential diagnosis of TP and
FP ( different variants of TP and FP , other arrhythmias ) .
• Classification of antiarrhythmic drugs .
• management tactics , differentiated treatment and prophylaxis of various clinical variants ( with
different disease entities , taking into account the patient's condition and hemodynamics ) .
To Able:
• Based on the examination of the patient with heart rhythm disorder formulate the final clinical
diagnosis and treatment.
Professional orientation of students
Flutter and AF are among the most common cardiac arrhythmia encountered in various disease
entities and largely determine the prognosis of the disease . Their knowledge is necessary to
determine the tactics of examination and treatment of patients with various cardiac pathology ,
to take urgent decisions in case of emergency .
Base level of knowledges and abilities
№
Discipline
To know
6.
Anatomy
Heart Anatomical structure
7.
Histology
Structure and function of the
myocardium
and
cardiac
conduction system
8.
Biochemistry
Biochemistry
metabolism
To able
myocardial To interpret lipidogramm Rate
9.
Pathophysiology
10.
Propedevtik
diseases
of
Mechanisms
disturbances
internal Semiotics
arrhythmias
of
of
rhythm
cardiac Evaluate ECG
Plan of practical employment
№
Elements of practical employments
Time(minutes)
9. Verification of present's students
5
10.Entrance control and his analysis
10
11.Distributing
*
patients for Supervision ( card or clinical tasks )
5
12.Review
*
patients or study of educational hospital chart
20
13.Discussion of findings, formulation of previous diagnosis, determination of
methods of additional inspection of patient, interpretation of their results,
formulation of final diagnosis and plan of treatment
15
14.Exercises with clinical formulations for solving clinical situation tasks
10
15.Output control of knowledge and its evaluation
10
16.Results and final assessment of knowledge and skills of students and tasks
to self- preparation for the next lesson
5
Note: * - in the case of patients absence in clinical, practice can be made in the form of
preparation and decision of situational tasks.
List of theoretical questions addressed in class
1. Classification of rhythm and conduction disorders .
2 . Electrophysiological mechanisms of TP and FP and the possibility of their recognition in the
clinic.
3 . Features of hemodynamic , clinics , current, ECG - diagnosis and differential diagnosis of TP
and FP ( different options ) .
4 . Classification of antiarrhythmic drugs .
5 . Clinical management , differentiated treatment and prophylaxis of various clinical variants (
with different disease entities , taking into account the patient's condition and hemodynamics ) .
Method of leadthrough of practical employment *
On the first employment teacher hold instructing from accident (if there are such terms) which
registers in the magazine of teacher's signature of student prevention.
* Students answer in writing on the tests of base knowledges entrance control. Then a teacher
distributes students for kuration patients and determines them a task.
№
Task
1.
To provide curation of 1. Rhythm disturbances , Pay special attention to the
patient diagnosed with presence pulse deficit
characteristic clinical manifestations
AF or Flutter
and causes a variety of abnormal
2 . Signs of underlying
heart rhythm , timing arrhythmias
disease
Teasher's
students
pointing
to Teacher's note for students
3 . Characteristic changes in
the ECG , Holter ECG
monitoring , the dimensions of
the walls and chambers of the
heart in echocardiography

A teacher works in obedience to the plan of organization of employment, in the end - initial
control of knowledges. Before completion of employment teacher announce his results with the
estimation of every student and declares the theme of next session.
Forms and methods of self-control
Tests
1. Sign indicates the most likely nature of supraventricular paroxysmal tachycardia ?
A. Absence of P wave
B. QRS duration less than 0.12 sec.
C. Negative prong T.
D. Vagal negative samples .
E. Tachycardia over 200 min .
2 . Sign indicates the most likely nature of ventricular paroxysmal tachycardia ?
A. Absence of P wave
B. QRS duration greater than 0.12 seconds.
C. Negative prong T.
D. Vagal negative samples .
E. Tachycardia over 200 min .
Situational tasks
1. A young man of 16 years complains of feeling a strong heartbeat , which arose suddenly.
OBJECTIVE: Funky . Skin and mucous normal color . Tony loud heart , tachycardia, heart rate
= PS = 220 min. , BP - 130/70 mm Hg. Art. On ECG - regular rhythm , QRS = 0,09 s, P wave
can be determined. Your preliminary diagnosis . Clinical management of the patient.
2 . Male 67 years with acute myocardial infarction on the first day of the disease complain of
general weakness , shortness of breath . OBJECTIVE: Acrocyanosis . RR - 28 min . Tony heart
tones , tachycardia, blood pressure - 110/60 mm Hg. Art. On ECG - regular rhythm , RR = 0,3
with , QRS = 0,14 s, P wave can be determined. Your preliminary diagnosis . Clinical
management of the patient.
Ilustrative material
1. Table and slides classification of cardiac arrhythmias and conduction classification of
antiarrhythmic agents .
2 . Educational histories .
3 . Audiocassettes rhythm disorders .
4 . Sets ECG arrhythmia .
5 . Set situational problems with standards responses set of tests with the standards of the
responses ( according to the number of students ) .
Sources of information (literature)
Basic:
Therapy. Course of lectures. Simferopol. -2003.- 444p.
Additional:
1. Harrison's Principles of Internal Medicine 18th edition.
.org)
2. ESC Guidelines. Cardiovascular medicine. (Www.escardio.org / guidelines)
The program of preparation students to the theme
To learn:
• Classification of rhythm and conduction disorders .
• Electrophysiological mechanisms of ectopic arrhythmias (reverse input excitation wavelength ,
increasing automaticity ) and the possibility of their recognition in the clinic.
• Features of hemodynamic , clinics, flow , ECG diagnosis and differential diagnosis of ectopic
arrhythmias ( various options extrasystoles , paroxysmal tachycardia ) .
• Classification of antiarrhythmic drugs .
• Principles of treatment and prevention, especially the treatment of various clinical variants .
draw:
• ECG pattern in a paroxysm of supraventricular tachycardia .
To Able:
• Establish a definitive diagnosis of supraventricular and ventricular arrhythmias , paroxysmal
arrhythmias, assign the necessary examination and treatment.
Note the use of modern methods of instrumental examination of heart rhythm disturbances .