HOW TO DEAL WITH

LIFE THREATENING ARRHYTHMIAS

Haikal MD, FIHA

Clinical Electrophysiology and Devices

Cardiology Department
Gatot Soebroto Central Army Hospital
WHAT WE'LL
DISCUSS TODAY

Please describe the monitor above

What will you do if this patient came with recurrence syncope ?

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

WHAT WE'LL
DISCUSS TODAY

Please describe the monitor above

What will you do if this patient came with palpitation, BP 80/60 ?

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

OUTLINE

Cardiac Anatomy and Conduction system

ECG - Types of arrhythmia
Quick look on arrhythmias
Arrhythmias management

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

 Arrhythmia :

Cardiac Anatomy, Conduction

System and Cellular
Electrophysiology
CARDIAC ANATOMY

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
CONDUCTION SYSTEM
SA node
Rate 60 – 100 bpm

AV node
Rate 40-50 bpm

His - Purkinje

Ventricle
Rate 30 bpm

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
ECG is the most important diagnostic tools !!!

J. Intensive Care Med. 2007

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

Mechanisms of Arrhythmia
Mechanisms of Tachyarrhythmia

Automaticity Triggered activity Reentry

• Early
• normal (e.g. afterdepolarizations • Favored by slow
sinus associated with conduction (low
action potential
tachycardia) prolongation dV/dt or Vmax)
• abnormal (e.g. (torsades de pointes) • Favored by
reperfusion • Delayed cellular
arrhythmias) afterdepolarizations
associated with
heterogeneity
Ca overload and
2+

depolarization
(e.g. digoxin)

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

Mechanisms of Bradyarrhythmia

Failure of impulse Failure of impulse

formation (e.g. propagation (e.g.
sinus bradycardia) Mobitz II
atrioventricula
r nodal block)

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

Type of Arrhythmia
 Life Threatening Arrhythmia !!!

 Pulseless
VT, VF, Asistole, PEA

 With pulse
Unstable conditions :
Tachy-Arrhythmia (HR > 150 bpm)
o Hypotension?
Brady-Arrhythmia (HR < 50 bpm) o Acutely altered mental
status?
Might be stable or unstable conditions o Signsofshock?
o Ischemicchestdiscomfort
?
o Acuteheartfailure?

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

 Others Classification

 Supraventricle
Narrow QRS complex :
AF, AFL, SVT
 Ventricle
Wide QRS complex :
VT

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

 Ventricular Fibrillation
versus V. Tachycardia
Ventricular Fibrillation Ventricular Tachycardia

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

SUDDEN DEATH

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
ASYSTOLE

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PEA

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

 Quote of the Day

Tachy-Arrhythmia
SVT

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

 Atrial fibrillation versus atrial flutter

Atrial Atrial
Fibrillation Flutter

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

 Complications of Atrial
Fibrillation

Tachycardia
• SOB
• Lightheadedness
• Edema
• ↓Exercise tolerance
• Myopathy
Stroke

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

 Quote of the Day

Brady-Arrhythmia
1 Degree AV Block

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

2 Degree AV Block Mobitz type 1 & 2

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

Total AV Block

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

Quick Look on Arrhythmia?
 Step by Step

(-
)
(+)

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MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
Arrhythmia Management :
MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER
PACEMAKER INDICATIONS
 Sinus node dysfunction
 Sinus bradycardia with
symptoms
 Symptomatic
chronotropic
incompetence
 Sinus node dysfunction
and syncope
 HR < 40 while awake
 AV block
 Complete AV block
 High degree AV
block
 Symptomatic AV
block
 Mobitz II
 Exercise induced 2nd or 3rd degree
AV block
 Bifascicular block and
syncope
 Iatragenic
 Neurocardiogenic syncope
 Long QT
 Heart failure and resynchronization

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

Surgery For Arrhythmias

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

ICDs

MANAGEMENT FOR CARDIAC EMERGENCIES FOR GENERAL PRACTITIONER

THANK YOU