HEART PHYSIOLOGY

(ARRYTHMIAS)
BY
DR. MUDASSAR ALI ROOMI (MBBS, M. PHIL)
Assistant Professor Physiology

ATRIAL
FLUTTER
• Atrial flutter is a condition caused by a circus movement in the atria. the
electrical signal travels as a single large wave always in one direction
around and around the atrial muscle mass.
• Atria beat regularly at a rate of 250 – 350 beats / minute.
• All impulses from atria are not conducted to ventricles because AV node
and purkinje system have longer refractory period.

ATRIAL FLUTTER
(cont..)

• so every second or third impulse is conducted. So there is 2:1 or 3:1
rhythm and ventricular rate is 125 /min.
• in ECG we see saw tooth shaped P waves.
• Atrial flutter responds to carotid massage.
• The radial pulse is regularly irregular. (MCQ)

ATRIAL FIBRILLATION
• Atria beat irregularly at a rate of about 400 to 600/ minute. impulses from
the atria are conducted to ventricles at irregular intervals.
• Cause: frequent cause of atrial fibrillation is atrial enlargement resulting
from heart valve lesions e.g mitral stenosis.
• Mechanism:
– re-entry movements,
– division of impulses.
• ECG findings: P waves are replaced by small, irregular and low voltage
records. QRS Complexes are normal but placed at unequal distances.

ATRIAL FIBRILLATION (cont..)
• Ventricular rate is 125- 150 / minute.
• There is pulsus deficit because weak heart beats fail to be transmitted to radial
artery
• Radial pulse: there is irregularly irregular radial pulse (MCQ).
• In cases of A. Fib, There is ultimately heart failure because of the rapid heart rate;
diastole becomes too short so there is inadequate filling, less stroke volume and
less cardiac output. Also because of rapid heart rate, rest period for the heart
decreases.
• the efficiency of ventricular pumping is decreased only 20 to 30 percent. Why??
• Treatment: Digoxin, electroshock treatment

Ventricular Fibrillation
• it is a fatal condition.
• Patients who die from acute
myocardial infarction show this
just before death.
• Ventricles contract in parts not as
a whole, stroke volume
decreases, venous return will
dilate the heart.
• ECG findings: There are irregular
bizarre waves in ECG.
• Question: ventricular fibrillation
often occurs without atrial
fibrillation. Likewise, fibrillation
often occurs in the atria without
ventricular fibrillation. Why????

MECHANISM OF FLUTTER AND
FIBRILLATION

• SINGLE OR MULTIPLE FOCI THEORY: there
is a single or multiple foci which discharge
impulses at very rapid rate.
• CIRCUS MOVEMENT THEORY: there is
movement of impulses along the same
pathway again and again. And this results
into circus movement. Causes of circus
movements are:
1. long pathway
2. Decreased velocity of conduction
3. shortened refractory period
• Division of impulses or chain reaction
may lead to fibrillation. Suppose in the
heart there are refractory areas, which
may be because of in part depolarization
or may be because of infarcted areas.
These areas don’t allow the cardiac
impulse to pass. When a single impulse
reaches the refractory area so this single
impulse divides into two to avoid the
refractory area. And so on leading to
fibrillation.


Cardiac Arrest

• A final serious abnormality of the cardiac rhythmicity-conduction system is cardiac
arrest.
• This results from cessation of all electrical control signals in the heart.
• That is, no spontaneous rhythm remains.
• Cause: Cardiac arrest is especially likely to occur during deep anesthesia, when
many patients develop severe hypoxia because of inadequate respiration.
• Prognosis (outcome):
– In most instances of cardiac arrest from anesthesia, prolonged cardiopulmonary
resuscitation (many minutes or even hours) is quite successful in reestablishing a normal
heart rhythm.
– In some patients, severe myocardial disease can cause permanent or semipermanent
cardiac arrest, which can cause death.
– To treat the condition, rhythmical electrical impulses from an implanted electronic
cardiac pacemaker have been used successfully to keep patients alive for months to
years.

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