ARRHYTHMIA

y
Any changes from normal sequence of electrical impulses too fast, too slow or erratically which can lead to improper contraction of the heart.

NORMAL ELECTRICAL CONDUCTANCE OF THE HEART

y y

PR interval: electrical signal reach AV node Q wave: electrical signal passed Bundle of His -> left and right bundle branches.

y y

Q-R: contraction of left ventricle R-S: contraction of right ventricle

U wave: if too prominent; suspect hypokalemia, hypercalcemia and hyperthyroidism.

TYPE
y Atrial fibrillation  Most common, very fast and irregular contraction of the atria.  Signal not begin in SA node but start at another part in the atria/nearby pulmonary vein -> electrical signal not travel normally-> atrial fibrillate-> not able to pump blood into ventricular ->create pool of blood->thrombus-> stroke.  ECG  P wave absence  P-R interval irregular  QRS complex narrow.

Complication  Stroke  Heart failure Treatment  Prevent stroke  Restored heart rhythm/ rate

Ventricular fibrillation  Lower chamber quiver and the heart cannot pump any blood -> cardiac arrest -> medical emergency.  Disorganized electrical signal make ventricle quiver instead of pump normally -> give electrical shock (defibrillation)

Sign    ECG    Loss of responsiveness Abnormal breathing Cardiac arrest Rate : rapid and disorganized to count No discernible organized waves at all Torsade de Pointes (twisting of the point)  unique pattern of V-fib  rapid, polymorphic ventricular tachycardia with a characteristic twist of the QRS complex around isoelectrical baseline

Bradycardia  < 60 b/m  Due to  Heart Attack  Disturb the electrical activity  Imbalance of potassium in blood  Medication  Symptom  Fatigue  Dizziness  Lightheadedness  Fainting  Cardiac arrest

Complication  Heart  Syncope  Angina pectoris  Increase BP (reflex) ECG  Rate : <60 bpm  Rhythm : regular

Tachycardia  Fast heart rate that starts in the ventricle  Electrical signal in the ventricle fire abnormally ->interfere with electrical signal coming from SA node ->increase heart beat -> not allow filling time -> decrease cardiac output.  ECG  3 or more beats of ventricular origin - > 100 bpm  Rhythm: regular  P wave not seen  QRS complex widen.

Conductance disorder  Bundle branch block  Right BBB - Transmission of the electrical impulse is delayed or not conducted along the right bundle branch. - The right ventricle depolarizes by means of cell-to-cell conduction that spreads from the interventricular septum and left ventricle to the right ventricle.

 Left BBB - Transmission of the cardiac electrical impulse is delayed or fails to be conducted along the rapidly conducting fibers of the main left bundle branch or in both left anterior and posterior fascicles. - the left ventricle slowly depolarizes by means of cell-to-cell conduction that spreads from the right ventricle to the left ventricle

 Heart block  First degree heart block  Electrical impulse moves through the AV node more slowly than normal.  ECG PR interval longer than 2 second  Second degree heart block  some electrical signal from atria dont reach the ventricle-> dropped beat  P wave is blocked from initiating a QRS complex  Type I - Increase delay in each cycle before the omission. - Progressive prolongation of the PR interval then followed by blocked P wave (dropped QRS)  Type II - an unexpected nonconducted atrial impulse - the PR and R-R intervals between conducted beats are constant

 Third degree heart block  Heart electrical impulse does not pass from the hearts upper to lower chamber at all -> secondary pacemaker cell -> take over-> heart contract at slower rate.  ECG - P wave present but no relation whatsoever with QRS complex - PR interval are irregularly irregular - QRS complex widen

Complete absent of conduction between atria and ventricular.

 Long QT syndrome  Delay repolarization of the heart following a heartbeat -> increase risk of Torsade de Pointes.  Abnormal repolarizations cause differences in the refractory period of the myocytes.  Due to re-opening of L-type Ca2+ channel during platue phase of the cardiac action potential -> increase Ca2+ filling of the sarcoplasmic reticulum -> spontaneous release during repolarization ->net depolarization current.

Premature contraction  Premature atrial contractions (PAC) and Premature ventricular contractions (PVC)  Most common  Fluttering in the chest / skipped beat  Not required treatment  Due to stress, caffeine, nicotine and exercise. Other rhythm disorder  Adam stokes disease  Temporary condition that leads to fainting/syncope  Caused by slow-firing SA node ->bradycardia

 Atrial flutter  Travel fast and regular rhythm ; > 100bpm  Due to reentrant rhythm (Left/right) -> premature electrical impulse arising in the atria -> different in refractory period of atrial tissue.  ECG - Saw-tooth appearance (P wave) - R-R interval normal - QRS normal

 Sick sinus syndrome  Sick sinus syndrome is a collection of heart rhythm disorders that include: Sinus bradycardia -- slow heart rates from the natural pacemaker of the heart Tachycardias -- fast heart rates Bradycardia-tachycardia -- alternating slow and fast heart rhythms

 Sinus arrhythmia  As the anxious state of the slowing down of the heart while breathing out or during expiration and increasing of the heart beat while inhaling or during inspiration.  Affects the vagus nerve which is responsible for activating the nervous system-triggered parasympathetic input which regulates the heart beat. In simple words, the vagus nerve is left unstimulated resulting in the wrong signals to the heart and the subsequent decline in pitch of the heart rate.

 Wolff-Parkinson-White syndrome  Preexcitation of the ventricle of the heart -> Bundle of Kent -> create an electrical circuit that bypass the AV node -> tachyarrhythmia.  Classic ECG findings that are associated with WPW syndrome include the following: - Presence of a short PR interval (< 120 ms) - A wide QRS complex longer than 120 ms with a slurred onset of the QRS waveform producing a delta wave in the early part of QRS - Secondary ST-T wave changes

CAUSES
y y y y y Natural pacemaker develop an abnormal rate of rhythm Normal conductance pathway are interrupted Another part of the heart takes over as pacemaker Smoking, alcohol, certain drugs ( indirect) Increase BP, stress, heart attack

ARRHYTHMIA MATTER
y Cardiac arrest  Scarring from a prior heart attack  Cardiomyopathy  Heart medication- proarrhytmia effect (change in K and Mg)  Electrical abnormal  Blood vassel abnormal Stroke  Artial fibrillation

RISK FACTORS
y y y y y y y y Heart attack Heart failure (cardiomyopathy) Leaking/narrowing of heart valves Congenital heart defect Increase BP Infection Diabetes Over/ underproduction of thyroid hormone

SIGN AND SYMPTOM

y y y y y y y y y Palpitation Slow/fast heart beat Irregular heart beat Paused between heart beat Anxiety Weakness, dizziness and lightheadedness Fainting Sweating SOB and chest pain

DIAGNOSIS
y y y y y y y y Family history and physical examination ECG Holter and event monitor Coronary angiograpy Blood test (K+ and thyroid hormone) Chest X-ray Echocardiography Stress test

TREATMENT
y Medication  Anti-arrhythemia  Beta-blocker (metaprolol, atenolol)  Ca2+ channel blocker (verapamil,diltiazem)  Restore normal heart beat  Amiodarone  Sotalol  dronedarone  Anti-coagulant  Aspirin y Medical procedure  Pacemaker  Defibrillation/cardioversion  Implantable cardioverter defibrillation (ICD)  Catheter ablation Surgery  Repair heart valve  Maze surgery  Coronary artery bypass grafting