ARRHYTHMIA

ARRHYTHMIA-
• Is the medical term used for the abnormal Heartbeat-the hearbeat
can be too rapid or too slow. Arrhythmias typically results from the
short circuit or changes in the electrical system of the heart ; this
affects the heart’s ability to pump blood efficiently and inhibit the
circulation of blood in the body . Arrhythmia is a risk factor for
stroke and heart failure
• Heart disorders are the Common cause of an abnormal heart
rhythm.
• Sometimes people are aware of abnormal heartbeats , and they
feel the consiquences , such as weakness and fainting.
• The diagnosis is based on the electrocardiography
• In adult the normal heartbeat is between 60-100 beats
per minute
• A person’s heart rate varies normally in response to
exercise and stimuli such as pain and anger
• Heartbeat is considered abnormal when the heart rate is
inappropriately fast(tachycardia) , slow(bradycardia) or
irregular when electrical impulses travel along abnormal
pathway
• Treatment involves restoring the heart to a normal rhythm
and preventing further episodes
NORMAL HEART’S
ELECTRICAL PATHWAY
• First SA node initiates an electrical impulses
that flows through the right atrium and left
atrium
• This makes them contract , when the
electrical impulses reach AV node
• It’s slightly delayed , The impulses travel
down through the bundle of his , Purkinje
fibres arise from the bundle of his this fibres
elongates both to right and left ventricles
• Electrical impulses travel to ventricles
through the Purkinje fibres which makes
them contract
 CAUSES FOR ARRHYTHMIA
• The most common cause for arrhythmias is heart
disorders , particularly , coronary artery disease , heart
valve disorders and heart failure.
• Many drugs which is prescribed to treat heart disorders ,
which can lead to arrhythmias
• Some Arrhythmias are caused by anatomic abnormalities
present at birth(congenital birth defects)
• Other causes are alcohol abuse , diabetes , drug abuse ,
excessive coffee consumption , hypertension , mental
stress , smoking .
 TYPES OF ARRHYTHMIA
• There are two types of Arrhythmias
1. Fast Arrhythmia- Tachycardia
2. Slow Arrhythmia- Bradycardia

FAST ARRHYTHMIA (TACHYCARDIA) :-

• In this kind of Arrhythmia the heart beats faster than normal
• In Tachycardia the heartbeat will be more than 100 beats per
minute
 CAUSES FOR TACHYCARDIA
• Fast Arrhythmia can be triggered by exercise , smoking , emotional
stress , excessive alcohol consumption or use of drugs which
stimulate the tachycardia.
• An overactive thyroid gland (HYPERTHYROIDISM) , producing high
levels of thyroid hormone which leads to tachycardia.
• Supraventricular Tachycardia (SVT):- It is a rapid heartbeat that
starts on the collecting chambers of the heart , the atria or the
rapid generation of the impulses in the electrical pathway of the
heart.
• The types of SVT are Atrail flutter , atrial fibrillation , PSVT ,
Ventricular fibrillation.
• Atrial flutter:- Is when an extra or early electrical signal travels around the
atria in a circle instead of along the normal signal pathway .This
‘Overstimulation’ causes the atria to contract quickly Or flutter at a much
higher rate than normal most of this fluttering is blocked out by the electrical
pathway from the atria to prevent the pumping chambers of the heart , the
ventricles , from beating too fast .Atrial flutter is usually not life threatening
but can still cause chest pain , faintness or more serious heart problems
• Atrial fibrillation:-It is most common form of SVT , It is when waves of
uncontrolled Electrical signals rather than the normal regular signals , travel
through the atria from the sinus node . This uncontrolled Signals cause the
muscle fibres in the atria to contract out of time with each other , So that the
atria ‘Qiuver’ or ‘fibrillate’ . Some of this abnormal electrical activity reaches
the ventricles , causing a rapid and irregular heartbeat.
• In atrial fibrillation Condition , it does not pump regularly.Atrial
fibrillation can cause a fluttering heartbeat , An irregular pulse ,
chest pain or tightness , weakness and dizziness.Atrial fibrillation
can also increase your risk of stroke , because blood trapped in the
atria can clot.This clots may break loose from the heart may enter
the bloodstream , Travel the brain , causing a stroke
• Paroxysmol Supraventricular tachycardia(PSVT) Or Paroxysmal
tachycardia (PAT):- is when there is short circuit caused by an extra
electrical connection or pathway in the heart.It makes the heart
prone to episodes of irregular heartbeats that may last for few
hours . Although these episodes may be frightening , they are
rarely dangerous and may be very effectively treated
• Ventricular tachycardia:-Is when the ventricles beat too fast. It is
potentially very dangerous.If ventricular tachycardia becomes so
severe that the Ventricles can’t pump effectively , it can lead to
ventricular fibrillation.Ventricular fibrillation is when the electrical
signal that should trigger the heart beat spilts away in uncontrolled
waves around the ventricles.This life-threatening situation should
be corrected immediately.
2.Slow Arrhythmia:-
• In this kind of Arrhythmia the heartbeat will be slower than the
normal
• The heartbeat will be lesser than 60 beats per minute
 CAUSES FOR SLOW ARRHYTHMIA

• Slow Arrhythmia can be triggered by fatigue , hunger , digestive

disorders such as diarrhea and vomiting
• An underactive thyroid gland (hypothyroidism) , producing low
levels of thyroid hormone which leads to bradycardia.
• Production of adrenal hormones such as adrenaline and
Noradrenaline in low quantity can cause bradycardia.
• Disease contions which cause bradycardia are Sick sinus
syndrome and heart block
• Sick sinus syndrome:- Is when the natural pacemaker in
the heart malfunctions and fires too slowly , telling the
heart to beat slowly.It can be caused by the age or due to
deposition of fats in the artery that take blood from the
heart.
• Heart block is when there is block or delay in the electrical
signal from heart’s collecting chambers to the pumping
chambers.it is uncommon but can be serious.Symptoms
can be mild or severe depending on the location and
Seriousness of the blockage
 SIGNS AND SYMPTOMS OF ARRHYTHMIAS
• Most of the people with Arrhythmias don’t realize that they have the
condition
• It’s usually diagnosed when they have a periodic check-up and while being
treated for another Condition
The common symptoms of Arrhythmias are:-
• Dizziness
• Shortness of breadth
• Loss of consciousness
• Chest pain
• Light-headedness
• Fainting and collapsing
• Palpitations
SINGS OF ARRHYTHMIAS
Tachycardia :- Increased pulse rate
• Increased heart rate
• Increased respiratory rate
Bradycardia:- Decreased pulse rate
• Decreased respiratory rate
• Decreased heart rate.
 DIAGNOSIS
Often , a person’s description of symptoms can help Doctors a
preliminary diagnosis and determine the severity of Arrhythmia.The
most important consideration are whether the palpitations are
• Fast or slow
• Regular or irregular
• Brief Or prolonged
Another important consideration is whether the Arrhythmias cause
symptoms are not
Doctors also need to know whether the palpitations occur at rest or
only during strenuous or whether they Start and stop suddenly or
gradually
 ELECTROCARDIOGRAPHY
• ECG is the main diagnostic
procedure for detecting
Arrhythmias and determining
their cause
• This procedure provides a
graphical representation of
the electrical current
producing each heart beat
• Usually ECG records the
heart rhythm for only a very
short time
 HOLTER MONITOR
• Because Arrhythmias are
often intermittent a portal
ECG moniter callled Holter
Monitor is used to record
heart rhythm continuosly
• When the uses senses an
abnormal heart rhythm and
activates the monitor
• This monitor , usually worn
for 24 or 48 hours can record
sporadic Arrhythmia as a
person engages in a normal
daily activities
• TO detect dangerous Arrhythmias that occur very infrequently , doctors
sometimes insert a recording device under the skin below the left Collarbone
• That device can be left in place for long periods.
• It electronically transmits the stored recordings of abnormal heart rhythms
• This is not a painful process
Other diagnostic procedure are
• Exercise stress testing
• Blood pressure measurement during exercise
• Echocardiography- To detect anatomic abnormalities
• Electrophysiologic Testing:- In this testing , catheters with tiny electrodes at
their tip are inserted through vein and threaded into the heart .The electrodes
are used to stimulate the heart , the hearts response is monitored , so that
the type of Arrhythmias and preferred treatment is determined
NON PHARMACOLOGICAL TREATMENT

• Intake of alcohol should be avoided

• Avoid excessive consumption of caffeine
• Smoking should also be avoided
• Doing regular exercise keeps us away from Arrhythmia and also
many heart diseases
• Don’t get addicted to drugs which are given to heart disorders.
 PHARMACOLOGICAL TREATMENT
Classification of drugs Mechanism of action Comment
Pharmacological treatment
IA Na+ channel blockers Slows phase 0 depolarisation in
ventricular muscle fibres

IB Na+ chaneel blockers Shortens phase 3 repolarization in

ventricular muscle fibres

IC Na+ channel blockers Markedly slows phase 0

depolarisation in ventricular
muscle fibres

II Beta –adrenoreceptor blockers Inhibits phase 4 depolarisation in

SA and AV nodes

III K+ channel blockers Prolongs phase 3 repolarization in

ventricular muscle fibres

IV Ca2+ channel blockers Inhibits action potential in SA and

AV nodes
 CLASS IA ANTIARRHYTHMIC DRUGS:-

• These are Na+ channel blockers , Shows phase 0 depolarisation in

ventricular muscle fibres
• Mechanism of action:- Drugs bind to open and inactivated sodium
channel and prevents sodium influx, thus slowing the rapid
heartbeat
• This decreases the spontaneous depolarisation and also inhibits
the K+ channels and blocks Ca2+ channels.
• They also act as mild alpha – adrenergic blockers and also gives
anticholinergic action.
• Examples:- Quinidine, Procainamide and disopyramide.
 Drug Maximum dose Minimum dose
Quinidine 6mcg/ml 2mcg/ml
Procianamide 1g IM 0.5g IM
18mg/kg IV 15mg/kg IV
Disopyramide 800mg/day 400mg/day

• Side effects:- Large doses of Quinidine causes the Symptoms of

Cinchonism(Blured vision , headache , disorientation and
psychosis)
• If Procainamide is administered by IV it can cause hypotension
• Disopyramide has the adverse affects of dry mouth , Urinary
retention , Blured vision and constipation
CLASS I B ANTIARRHYTHMIC DRUGS
• Mechanism of action:- The class IB rapidly associate and
disassociate from the sodium channel
• Thus the action of class IB Drugs are manifested when the cardiac
cell is depolarised
• This class of drugs is useful in treating Ventricular Arrhythmias.
• In addition to sodium channel blocker. These drugs shorten the
repolarization and the duration of the action potential.
• Examples:- lidocaine (bulk) and mexiletine(bulk)
Drug Maximum dose Minimum dose
Lidocaine 4mg/kg IV 1mg/kg IV
Mexiletine 200mg 50mg
• Side effects:-Lidocain side effects iclude drowsiness , slurred
speech , paresthesia , convulsions and confusion
• Mexiletine cause nausea , Vomiting and dyspnea

CLASS IC ANTIARRHYTHMIC DRUGS

• Mechanism of action:- This drugs suppress the upstroke in Purkinje
fibres and myocardial fibres
• This causes slowing in conduction of cardiac tissues
• This also increase the action potential duration
• Examples:-Flecainide and Propafenone
 Drug Maximum dose Minimum dose

Flecainide 400mg/day 200mg/day

Propafenone 850mg/day 450mg/day

Side effects:-Flecainide is generally well tolerated

Blurred vision , nausea , dizziness occuring most
frequently.
• Propafenone cause bronchospasm due to its beta
blocking effects . They should be avoided in asthma
patients.
CLASS II ANTIARRHYTHMIC DRUGS
• Mechanism of action:-Class II drugs are generally beta blockers.
• These drugs dimish the phase 4 depolarisation and thus depress
the automaticity prolong AV conduction and decrease the heart
rate and contractility.
• These are used to treat tachycardia caused by adrenal activity and
also used to treat in condition such as atrial flutter and atrial
fibrillation.
• Examples:-Metoprolol , propranolol and esmolol
• Esmolol is only given through IV
 Drug Maximum dose Minimum dose
Metoprolol 450mg/day 100mg/day
Propranolol 640mg/day 120mg/day
Esmolol IV 200mcg/kg/min 25mcg/kg/min

• Side effects:-Metoprolol cause dizziness , tiredness ,

depression , nausea dry mouth , stomach pain.
• Propranolol cause slow heart rate , dry eyes , Diarrhea ,
hair loss , nause
• Esmolol cause Lowers BP , dizziness , Increases sweating
CLASS III ANTIARRHYTHMIC DRUGS
• Mechanism of action:- these drugs blocks the potassium
channel diminish the outward potassium current during
repolarization of cardiac cells.
• These agents prolong the action potential without altering
depolarisation They only alter repolarization.
• Examples:-Amiodarone , dronedarone , sotalol
Drug Maximum dose Minimum dose
Amiodarone 1600mg/day in serious 800mg/day
condition
Deonedarone 800mg/day 400mg/day
Sotalol 640mg/day 480mg/day
• Side effects:- Amiodarone cause Pulmonary
fibrosis , Neropathy , Hepatotoxicity , Optic
neuritics , blue grey skin decolourisation .
• Dronedarone cause Stomach pain , indigestion ,
vomiting , Nausea , feeling tide , skin rash .
• Sotalol cause Blurred vision , sweating , fast slow
or irregular heartbeat , Difficulty in breathing ,
faintness , dizziness.
 CLASS IV ANTIARRHYTHMIC DRUGS
• Class IV drugs are calcium channel blockers
• Although the voltage sensitive Calcium channel occur in many different
tissues . The major effect of calcium channel blockers is on vascular smooth
muscle and the heart
• Examples are Verapamil and Diltiazem
• Verapamil shows greater action on the heart than on vascular smooth muscle
• In the heart these two drugs bind only to open depolarised voltage sensitive
channels
• They also slows the conduction which are dependent on calcium channel such
as SA and AV nodes
• This drugs are more effective against atria than ventricular arrhythmia.
 Drugs Maximum dose Minimum dose
Verapamil 400mg/day 200mg/dg
Diltiazem 540mg/day 240mg/day

• Side effects :- Verapamil and Diltiazem cause

dizziness , slow heart beat , constipation , nausea ,
headache , tiredness , skin rash or itching.
 Artificial pacemaker:-
• Are electronic device act in
place of heart’s own
pacemaker.
• These device are implanted
under skin Usually below
the left or right clavicle
This are called as
implanted pacemaker
• They are connected to the
heart by wires , wires
usually are made up of
lead
 FUNCTIONING OF ARTIFICIAL PACEMAKER
• They are used to treat bradycardia
• They act in place of heart’s natural
pacemaker such as SA and AV
nodes
• They contain impulse
generator(that includes
battery)and wires that is
connected to heart
• Artificial pacemaker are inserted
surgically
• The wires that connects the
pacemaker are inserted into the
sub clavicle vein and threaded
toward the heart
• They are capable of sensing heart’s electrical activity
• They allow the heart to function naturally and do not start
pacing unless the heart skips to beat at an abnormal rate.
• When the heart slows below the threshold level the
artificial pacemaker starts it’s work and restore normal
rhythm
• Sometimes an electrical shock to heart can stop fast
Arrhythmia and restore normal rhythm
• Using an electric shock for this treatment is called
Cardioversion
 CARDIOVERSION
Cardioversion may be used for Arrhythmias
starting in the atria ( Atrial fibrillation)and
ventricles (ventricular fibrillation) .
However , An electric shock cannot restart a
heart which doesn’t have any electrical
activity at all
Implantable cardioverter-defibrillator:-ICD
• Most devices are implanted through the
blood vessels such as pacemaker .
• This can also be inserted below the skin
rather than through the blood vessels.
• ICD’s Continually monitor the rate and rhythm of the
heart , automatically detect fast Arrhythmia.
• And deliver either a Pacing treatment or a shock to
convert the Arrhythmia to a normal rhythm.
• Most commonly , These devices are used in people who
might otherwise die of the Arrhythmia.
• An ICD Can also act as pacemaker to overcome the slow
Arrhythmia.
• When an ICD delivers the shock , it can feel like a mild
thump in chest
• When a stronger shock is given , may feel as if they have
been Kicked.
Automated External defibrillator:-
AED
• Reqiures a minimum training for
its use
• Can detect the presence of
Arrhythmia , determine if a shock
is advisable , Deliver the shock
automatically.
• They are present in many public
places such as Air port , Sports
arenas , hotels and shopping
malls.
Destroying abnormal
tissues – Ablation
• Certain Arrhythmia can be
prevented by removing the
abnormal area by surgically
this is called Ablation
• Most probably abnormal area
is destroyed by
• Radiofrequency ablation-
delivery of energy of a
specific frequency through a
catheter with tiny electrode
at its tip that is inserted into
the heart.
THANK YOU
BY
R.KABILAN