ARRHYTHMIAS

Dr Betty Teh
Consultant Interventional Cardiologist
CEO and Founder, Beating Hearts
Pathophysiology of arrhythmias

● The cardiac electrical system controls all events that occur when our heart
pumps
● The SA node is located within the wall of the right atrium
● The SA generally generate the electrical impulse that is carried to the AV node
by special conducting tissue
● Upon reaching the AVN the electrical impulse is relayed down the bundle of His
● The electrical impulse generated by the SAN causes the right and left atrium to
contract
● Depolarization of the ventricular happens shortly after
NORMAL ECG: RATE AND RHYTHM
ARRHYTHMIAS

4 groups of arrhythmias

● Extra beats
● Supraventricular tachycardia
● Ventricular tachycardia
● Bradyarrhythmias
ARRHYTHMIAS

4 groups of arrhythmias

❖ Extra beats - premature atrial, ventricular and junctional

contractions
❖ Supraventricular tachycardia - atrial fibrillation, atrial flutter and
SVTs
❖ Ventricular tachycardia - ventricular tachycardia and ventricular
fibrillation
❖ Bradyarrhythmias - sick sinus syndrome and heart blocks
SYMPTOMS OF ARRHYTHMIAS

● Palpitation
● Chest pain
● Profuse sweating
● LOC
● Giddiness
● SOB
● Reduce effort tolerance
● Leg swelling
ATRIAL ARRHYTHMIA

● Atrial tachycardia
● Atrial fibrillation
● Atrial flutter
● SVT
● AV Reentry tachycardia
ATRIAL TACHYCARDIA
ATRIAL FIBRILLATION

● Commonest arrhythmia
● Usually has underlying heart condition
● Common in the elderly
● One of the presentation of thyrotoxicosis
● Increases the risk of a stroke because of clots formation in the
atrial appendage
● Can be paroxysmal, persistent or chronic
ATRIAL FIBRILLATION
ATRIAL FIBRILLATION

● Common cause of arrhythmia

● Usually associated with age or underlying heart diseases especially
CRHD
● Very commonly seen in mitral stenosis
● Reduces cardiac output
● Increases risk of stroke
● Can be paroxysmal, persistant or chronic
ATRIAL FLUTTER
SVT
WPW SYNDROME
VENTRICULAR TACHYCARDIAS

● Ventricular premature contraction

● Accelerated idioventricular rhythm
● Ventricular tachycardia
● Ventricular fibrillation
● Torsades de point
● Arrhythmogenic right ventricular dysplasia
● Re-entry ventricular arrhythmias
VENTRICULAR ECTOPICS
VENTRICULAR TACHYCARDIA
VENTRICULAR FIBRILLATION
TORSADE DE POINTES
BRADYARRHTYMIAS

● First degree heart block - manifestation of prolonged PR interval

● Second degree heartblock
- type 1 second degree HB Mobitz1 /Wenckebach
- Type 2 second degree HB Mobitz2
● Third degree heartblock - CHB
SECOND DEGREE HB TYPE 1
SECOND DEGREE HB MOBITZ 2
COMPLETE HEART BLOCK
THANK YOU

DR Betty Teh DR Ahmad Nizar

Consultant Interventional Cardiologist Consultant Electrophysiologist

CEO and Founder of Beating Hearts Ramsay Sime Healthcare

Beacon Hospital

iHeal medical centre

drbettytehMD@gmail com