Ventricular Tachycardia

CAUSES :
CAD, CHF, MI, electrolytes imbalance (hypokalemia),
digoxin.

Consequences:
develop into VF.
If fast and sustained, signs of hemodynamic instability
appears (chest pain, hypotension, unconsciousness)

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 Ventricular Tachycardia

Treatment:
If stable: lidocaine, cordarone
Unstable: cardioversion

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 Ventricular Fibrillation

Description:
• Rapid, irregular, ineffectual depolarization of the vent.
• No distinct QRS seen, only oscillations of the baseline
are apparent, coarse or fine.

Fine: peak-to-trough (2 to <5ml), medium or moderate: (5

to <10ml), coarse: (10 to <15ml), very coarse: (>15ml)
• the R wave striking the peak of the T wave of preceding
beat . Because of chaotic activity the muscle mass on
quivers & cardiac out put falls rapidly.
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 Ventricular Fibrillation

• Rate: too fast to count with no blood out flow.

• No distinguished ECG waves or intervals
• Coarse and fine VF

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 Ventricular Fibrillation

• Causes:
Myocardial ischemia and infarction
Hypothermia
Sever acidosis or alkalosis

• Consequences:
Loss of consciousness within seconds.
No pulse and no C.O
Fatal if no resuscitation initiated immediately.

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 Ventricular Fibrillation

• Treatment:
Defibrillation
CPR
Consider Epinephrine 1mg repeated 3-5 minutes

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 END of

Ventricular Dysrhythmias

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 Atrioventricular Blocks

These involve:
1- First degree AV block
2- Second degree AV block:
a- Mobitz I
b- Mobitz II
3- Third degree (complete) AV block

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 Atrioventricular Blocks

Disturbances in the AV conduction. The sinus beat delayed or

blocked from activating the ventricles.
Block occur at level of AV node, bundle of his, bundle branch.

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 First-degree AV block

• Description:
AV conduction prolonged and equal in time (there
is a delay).

All impulses eventually conducted to ventricles.

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 First-degree AV block

• Prolongation of AV conduction
• P wave: present and precedes each QRS
• PR: constant but exceeds the upper limit (>0.2second)
• Rate: 60 -100 bpm
• Rhythm: regular with constant prolonged PR interval 11
 First-degree AV block

Causes:
Occurs in all ages in diseased and normal heart.
PR prolongation caused by: Drugs (digitalis, B-blocker,
Ca blocker), CAD, myocarditis.

Consequences:
No hemodynamic disturbances, but, indicator of AV
conduction disturbance.
May progress to 2nd or 3rd degree blocks.

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 First-degree AV block

Treatment:
No treatment indicated for 1st degree.
Monitoring of PR for further blocks
Possibility of drug effect should be evaluated.

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Second-degree AV block, Mobitz type I (Wenckebach)

Description:
AV conduction delayed progressively with each sinus
impulse until eventually the impulse is completely
blocked from reaching the ventricles.
The cycle then repeat itself.
Mobitz I more common.

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 Second-degree AV block, Mobitz type I

• One or more of the atrial impulses fail to reach the

ventricles
• Progressive prolongation of PR interval flowed by
missing QRS
• Rate: 60 -100 bpm
• Rhythm: regular atrial, irregular ventricular
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Second-degree AV block, Mobitz type I (Wenckebach)
Causes:
Digitalis, myocarditis, inferior wall MI

Consequences:
Pt usually asymptomatic.
It is temporarily, but, if progress to 3rd degree block, a
junctional pacemaker at rate 40-60bpm take over.

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Second-degree AV block, Mobitz type I (Wenckebach)

Treatment:
D/C drug (if any cause)
Monitor pt for further blocks.
Consider temporary pace-maker

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 Second-degree AV block, Mobitz type II

Description:
Intermittent block in AV conduction
Fixed PR interval when AV conduction present &
Nonconducted P wave when block occurs

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 Second-degree AV block, Mobitz type II

• One or more of the atrial impulses fail to reach the

ventricles
• Constant normal PR interval flowed by missing QRS
• The block occur occasionally or in 2:1, 3:1 or 4:1 fashion
• Rate: 60 -100 bpm
• Rhythm: regular atrial, irregular or regular ventricular
depends on the AV block

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 Second-degree AV block, Mobitz type II
Causes:
Anterior wall MI
progressive deterioration of Mobitz type I

Consequences:
Mobitz II more danger than Mobitz I.
It is permanent, can deteriorated rapidly to 3rd degree

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 Second-degree AV block, Mobitz type II
Treatment:
Constant monitoring
Meds: atropine, cardiac pacing when symptomatic

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 Third-degree AV block or Complete Heart Block
Description:
SA node fire normally, but the impulses do not reach the
ventricles.

The ventricles stimulated from the junction (at rate 40-

60 bpm) or in the ventricles (at rate 20-40 bpm)
depending on the level of the block.

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 Third-degree AV block or Complete Heart Block

• P & QRS present, but, no relationship between them.

• Rhythm: regular atrial & ventricular but independent of
each other
• QRS: normal if originated from the AV junction or wide if
originated from the ventricles
• PP and RR interval regular, but PR variable.
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 Third-degree AV block or Complete Heart Block
Causes:
Same as other blocks.
Consequences:
Poorly tolerated
Low C.O (if the pacemaker in the ventricles)
Might be asymptomatic: if the bundle of his is the
pacemaker

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 Third-degree AV block or Complete Heart Block
Treatment:
Temporary pacing wire inserted immediately.
Then, permanent pacemaker implanted.

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