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Dysrhythmia and Clinical features

MONTAWATT AMNUEYPOL, MD

Action potential and Pacemaker cell


First come First serve Phase 4
SA node 60-100/min AV node 40-60/min Infra-nodal 20-30/min

Ectopic foci
Premature A/J/V complex A/J/V escape beat

Mechanism of Arrhythmia

AVR

AVL

III

II AVF

Normal ECG

Nomenclature

Dysrhythmia
Dysrhythmia
Premature complex From? Group? Combo? Tachycardia HR > 120 Supraventricular Ventricular Bradycardia HR < 60 SA node AV node

Premature complex
KILL YOU SILENCELY

Premature Complex
PAC

From

PJC PVC

Premature complex

Bigeminy Group Trigeminy Duplex Combo Triplet

Premature Complex
PAC

PAC From PJC


PJC

PVC

PVC

Premature Complex
Bigeminy Group

Trigeminy
Premature complex Duplex Triplet Combo Non-sustained Sustained

Premature Complex
Premature atrial contractions (PACs) are independent predictors of atrial fibrillation, stroke, and death (Circulation. 2012 Nov 6;126(19):2302-8).
PVC risk
Monomorphic PVC was mortality 10% in 2 years Multiple morphology or Consecutive PVC was mortality 20% in 2 years

Tachycardia
CAUSE OF PALPITATION, DYSPNEA AND CARDIAC ARREST

Tachycardia

Sinus tachycardia SA node Sinus arrhythmia Atrial tachycardia (AT) Supraventricular tachycardia (SVT) Tachycardia Ventricular arrhythmia (VA) Atrial fibrillation (AF) Atrioventricular re-entrant tachycardia (AVRT) AV node Atrial Atrial flutter (AFL)

Atrioventricular nodal re-entrant tachycardia (AVNRT)

Tachycardia
Non-sustained (<30 sec) Duration Sustained (>30 sec) Hemodynamic unstable Rate Ventricular arrhythmia (VA) ADHF Uniform Multiform Morphology Polymorphology Torsade de points Angina

Tachycardia

Supraventricular tachycardia (SVT)

Tachycardia

Sinus tachycardia SA node Sinus arrhythmia

Tachycardia

Atrial tachycardia (AT) Multifocal atrial tachycardia (MAT) Atrial flutter (AFL) Atrial fibrillation (AF)

Atrial

Tachycardia

Atrioventricular re-entrant tachycardia (AVRT)

AV node
Atrioventricular nodal reentrant tachycardia (AVNRT)

Tachycardia

Sinus tachycardia SA node Sinus arrhythmia Atrial tachycardia (AT) Supraventricular tachycardia (SVT) Tachycardia Ventricular arrhythmia (VA) Atrial fibrillation (AF) Atrioventricular re-entrant tachycardia (AVRT) AV node Atrial Atrial flutter (AFL)

Atrioventricular nodal re-entrant tachycardia (AVNRT)

Re-entrant tachycardia

Tachycardia

Uniform

Multiform Ventricular arrhythmia (VA) Morphology Polymorphology

Torsade de points

Mixed mechanism

Treatment: Medication

Treatment: Ablation

Bradycardia
CAUSE OF SYNCOPE AND DYSPNEA

Bradycardia
Sinus pause or arrest Sinus node dysfunction (Sick sinus syndrome) Brady-Tachyarrhythmia Sinus exit block Bradycardia

First degree
Second degree AV block Advanced Third degree (Complete)

Bradycardia
Sinus arrest

Sinus pause or arrest

Sinus pause

Sinus node dysfunction (Sick sinus syndrome)

Brady-Tachyarrhythmia
PAF

Sinus exit block

Bradycardia

First degree

Second degree
AV block Advanced Third degree

Complete

Treatment: Device