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 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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