Conduction disorders and rhythm disturbance

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Conduction disorders:

Conduction disorders

Atrial Fibrillation:

Atrial Fibrillation Multiple atrial foci produce impulses at a rate of 350 to 600 per minute Ventricle responds at a rate of 100 to 140 beats per minute Ventricular beats will be coming in an irregularly irregular fashion

ECG of Atrial Fibrillation:

ECG of Atrial Fibrillation

Causes of AF:

Causes of AF Valvular Heart disease Ischemic Heart Disease Hypertensive Heart Disease Congenital Heart Disease Cardiomyopathy Cardiac Failure

Causes of AF (Non Cardiac):

Causes of AF (Non Cardiac) Thyrotoxicosis Pulmonary Embolism COPD Alcohol Lone Atrial Fibrillation

Signs & Symptoms of AF:

Signs & Symptoms of AF

Investigations in AF:

Investigations in AF ECG ECHO TFT PFT and Oxygen Saturation

Management:

Management Treat the underlying cause Control the ventricular rate by Metoprolol, Diltiazem, Verapamil, Amiodarone, Digoxin Restore the sinus rhythm by DC cardioversion Drugs like Ibutilide, Dofetilide, Flecanide, Propafenone

Atrial Flutter:

Atrial Flutter Atria beats at rate of 250 to 350 Ventricle responds after every 2 nd , 3 rd , 4 th atrial beat (2 : 1, 3 : 1, 4 : 1 AV block) ECG characteristic saw – toothed waves Casuses, Investigation and Management are same as AF

ECG of Atrial Flutter:

ECG of Atrial Flutter

Heart Blocks:

Heart Blocks 1 st Degree Heart Block (AV Block) 2 nd Degree AV Block Type 1 Type 2 3 rd Degree Heart Block

Aetiology of Complete Heart Block:

Aetiology of Complete Heart Block Congenital Acquired Idiopathic fibrosis Myocardial infarction / ischaemia Inflammation – Infective Endocarditis, Chagas disease Cardiac Surgery Drugs – Digoxin, Beta blocker

Management of Heart Blocks:

Management of Heart Blocks Symptomatic second degree or complete heart block in acute MI Inj. Atropine 0.6 mg IV, repeated as necessary (upto 3 mg) IV Isoprenaline 2 mg in 500 ml 5% dextrose infusion at 10 to 60 ml / Hour Temporary pacemaker Chronic AV block Mobitz type II & complete heart block – Permanent pacemaker

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