this is a seminar about arrhythmia in sulaemani university.

1. Arrhythmia

2. Prepared by Goran Ibrahim
Arkan Ali

3. Introduction Arrhythmias
• An abnormality of the cardiac rhythm is called a
cardiac arrhythmia.
• Arrhythmias may cause sudden death, heart failure
• many arrhythmias are not life-threatening, some can
cause cardiac arrest.
• Arrhythmias can occur in the upper chambers of the
heart (atria) or in the lower chambers of the heart
(ventricles).
• Arrhythmias may occur at any age.

4. Definition of arrhythmia
dysrhythmia (also known as arrhythmia or irregular heartbeat)
is any of a group of conditions in which the electrical
activity of the heart is irregular or is faster or slower
than normal. The heartbeat may be too fast (over
100 beats per minute) or too slow (less than 60 beats
per minute), and may be regular or irregular. A heart
beat that is too fast is called tachycardia and a heart
beat that is too slow is called bradycardia.

5. Type of arrhythmia
•bradycardia: the heart rate is slow (< 60 b.p.m).
•tachycardia: the heart rate is fast (> 100 b.p.m).

6. Classification of Arrhythmia
• Abnormal heart pulse formation
1. Sinus arrhythmia
2. Atrial arrhythmia
3. Atrioventricular junctional arrhythmia
4. Ventricular arrhythmia
• Abnormal heart pulse conduction
1. Sinus-atrial block
2. Intra-atrial block
3. Atrio-ventricular block
4. Intra-ventricular block
• Abnormal heart pulse formation and
conduction

7. Cause of arrhythmia
• Some physical condition.
• Pathological heart disease.
• Other system disease .
• Electrolyte disturbance and acid-base imbalance.
• Physical and chemical factors or toxicosis.

8. Symptom of arrhythmia
• Palpitations (a feeling of skipped heart beats,
fluttering or "flip-flops")
• Pounding in your chest
• Dizziness or feeling light-headed
• Fainting
• Shortness of breath
• Chest pain or tightness
• Weakness or fatigue (feeling very tired)

9. Diagnosis
Electrocardiogram -- Also called an EKG or ECG, this test
records the electrical activity of heart.
Holter monitor -- This is a portable EKG that use for 1 to 2 days.
Should electrodes taped to skin.
Event monitor -- This is a device that, when push a button,
will record and store heart's electrical activity for a few minutes
Stress test -- There are different kinds of stress tests. The goal
is to check how much stress heart can manage before having a
heart rhythm problem or not getting enough blood flow to the
heart.

10. treatment
• Anti-arrhythmia Agents
• Anti-tachycardia agents
• Anti-bradycardia agents

11. Anti-tachycardia agents
• Modified Vaugham Williams classification
1. I class: Natrium channel blocker
2. II class: ß-receptor blocker
3. III class: Potassium channel blocker
4. IV class: Calcium channel blocker
5. Others: Adenosine, Digital

12. Phase 0
Phase 1
Phase 2
Phase 3
Phase 4
R.M.P
(Plateau Phase)
Class I:
Na + channel blockers.
- Pacemaker potential
-
-
-
Class III:
K + channel blockers
-
Class IV:
Ca ++ channel blockers
Class II:
Beta blockers
Classification of Anti-Arrhythmic Drugs

13. Anti-bradycardia agents
1. ß-adrenic receptor activator
2. M-cholinergic receptor blocker
3. Non-specific activator

14. Clinical usage
Anti-tachycardia agents
• Ia class : Less use in clinic
1. Guinidine
2. Procainamide
3. Disopyramide: Side effect: like M-
cholinergic receptor blocker

15. Anti-tachycardia agents
• Ib class: Perfect to ventricular
tachyarrhythmia
1. Lidocaine
2. Mexiletine

16. Anti-tachycardia agents
• Ic class: Can be used in ventricular and/or
supra-ventricular tachycardia and
extrasystole.
1. Moricizine
2. Propafenone

17. Anti-tachycardia agents
• II class: ß-receptor blocker
1. Propranolol: Non-selective
2. Metoprolol: Selective ß1-receptor
blocker, Perfect to hypertension and
coronary artery disease patients
associated with tachyarrhythmia.

18. Anti-tachycardia agents
• III class: Potassium channel blocker, extend-
spectrum anti-arrhythmia agent
• Amioarone: Perfect to coronary artery
disease and heart failure patients
• Sotalol: Has ß-blocker effect
• Bretylium

19. Anti-tachycardia agents
• IV class: be used in supraventricular
tachycardia
1. Verapamil
2. Diltiazem
• Others:
Adenosine: be used in supraventricular
tachycardia

20. Anti-bradycardia agents
• Isoprenaline
• Epinephrine
• Atropine
• Aminophylline

21. Side Effects Associated With
Antiarrhythmics
• Worsening arrhythmias
• Allergic reaction
• Chest pain
• Fainting
• Swelling of the feet or legs
• Blurred vision
• Shortness of breath
• Abnormally fast heartbeat
• Abnormally slow heartbeat

22. Non-drug therapy
• Cardioversion: For tachycardia especially
hemodynamic unstable patient
• Radiofrequency catheter ablation (RFCA):
For those tachycardia patients (SVT, VT, AF,
AFL)
• Artificial cardiac pacing: For bradycardia,
heart failure and malignant ventricular
arrhythmia patients.

23. Thanks
Have a nice day