Ventricular Arrhythmia - Hatem Alsrour

King Saud University College of Nursing

Hatem Alsrour

Cardiac Arrhythmia Definition:

a disorder of impulse formation. An abnormal electrical conduction that changes the heart rate and rhythm. A disturbance in the heart’s rhythm.

Signs and symptoms • Symptoms of arrhythmias vary from person to

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person, and depend largely on the source of the abnormality. Some people have no symptoms at all. If symptoms are experienced, these may include any of the following: Palpitations (strong or “galloping” heartbeat) Skipped heartbeat Dizziness, fatigue or fainting (syncope) as a result of the brain not getting enough oxygen-rich blood Unexplained falls, particularly in elderly individuals Angina (chest pain, pressure or discomfort)

Diagnosis Electrocardiogram ECG (best test) Another: exercise stress test Holter monitor Intracardiac electrophysiology study (EPS) echocardiogram

Ventricular Arrhythmia Arrhythmia happen in lower champers of

heart. Major ventricular arrhythmia:  Premature Ventricular Contractions (PVCs)  Ventricular Tachycardia  Ventricular fibrillation

Premature Ventricular Contraction (PVCs) Premature ventricular contractions (PVCs) are

due to impulses originating from single or multiple areas in the ventricles. There is three type PVCs unifocal PVC, interpolated PVC, and multifocal

PVCs Causes o Ischemic heart disease o acute myocardial infarction o Digoxin toxicity o Congestive heart failure o Hypokalemia o Alkalosis o Hypoxia

PVCs Signs and Symptoms - Palpitation - Chest pain - Lightheadness - Syncope

Diagnosis - ECG

PVCs Treatment - Most acute patients with PVCs will respond to

intravenous lidocaine (1 mg/kg IV). - some patients may require procainamide.

Ventricular Tachycardia Ventricular tachycardia is the occurrence of 3

or more beats from a ventricular ectopic pacemaker at a rate greater than 100. Called V-tach or VT

Ventricular tachycardia

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120-150 beats/min

 Wide QRS  3 or more consecutive beats from the ventricle

3 or More PVCs = Ventricular Tachycardia

“Sustained V Tach”

V-Tach - Causes: • • • • • • •

Cardiomyopathy Heart failure Heart surgery Myocarditis Valvular heart disease Anti-arrhythmic medications Changes in blood chemistry (such as a low potassium level) • Changes in pH (acid-base) • Lack of enough oxygen

V-Tach - Symptoms and signs • • • • • • • • •

Chest discomfort (angina) Fainting (syncope) Light-headedness or dizziness (palpitations) Shortness of breath Absent pulse Loss of consciousness Normal or low blood pressure Rapid pulse

V-Tach Diagnosis (how we can diagnose V-Tach?) Treatment - ACLS and cardiopulmonary resuscitation (CPR) - Electrical defibrillation or cardioversion

(electric shock) - Anti-arrhythmic medications (such as lidocaine, procainamide, sotalol, or amiodarone) given IV

Torsades de pointes

Multiform Vtach with progressive changes in amplitude of QRS complexes separated by narrow transition QRS Polarity of QRS repetitively twists around an iso-electric baseline Can progress to VFib

Long QT syndrome: disorder of cardiac K or Na channel protein structure or function Correct electrolyte imbalance, esp Mag

Ventricular Fibrillation Ventricular fibrillation is the totally

disorganized depolarization and contraction of small areas of ventricular myocardium—there is no effective ventricular pumping activity. Ventricular fibrillation is never accompanied by a pulse or blood pressure. Called V-Fib or VF

Ventricular Fibrillation

Rapid and irregular ventricular arrhythmia Low amplitude QRS  primary form or from degeneration of unstable SVT

 MI, post-op, myocarditis, severe hypoxia  Digitalis and quinidine toxicity, catecholamines

V-Fib • Causes -

Congenital heart disease Electrocution accidents or injury to the heart Heart attack Heart muscle disease, including cardiomyopathies Heart surgery Ischemia (lack of oxygen to the heart muscle because of narrowed coronary arteries or shock) - Sudden cardiac death (commotio cordis), typically occurring in athletes after a trauma over the surface of the heart

V-Fib • Signs and symptoms - A person who has a VF episode will suddenly

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collapse or become unconscious, because the brain and muscles have stopped receiving blood from the heart. The following symptoms may occur within 1 hour before the collapse: Chest pain Dizziness Nausea Rapid heartbeat Shortness of breath

V-Fib • Diagnosis (how we can diagnose V-fib?) • Treatment - ACLS and cardiopulmonary resuscitation (CPR) - Electrical defibrillation - Epinephrine 1 mg IV - Anti-arrhythmia drugs (lidocaine 1.5 mg/kg,

bretylium 5 mg/kg) - Magnesium, procainamide, Amidrone

Pulseless Electrical activity & Asystole Pulseless Electrical Activity (PEA) is the presence of electrical complexes without accompanying mechanical contraction of the heart.

Asystole is the complete absence of cardiac electrical activity.

PEA & Asystole Causes causes should be diagnosed and treated: - severe hypovolemia - cardiac tamponade - Tension - Pneumothorax - Massive pulmonary embolus - Rupture of the ventricular wall

PEA & Asystole Treatment - CPR - Epinephrine 1 mg IV, followed by high-dose

therapy of 0.1 mg/kg if the first dose is not successful. Repeat epinephrine every 3 to 5 min. - Atropine 1 mg IV, up to 3 mg total, is also acceptable therapy if the electrical conduction is slow