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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
: : 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
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
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..