0071643192.pdf

BRADYDYSRHYTHMIAS

■ Sick sinus syndrome

■ Sinus arrest

TACHYDYSRHYTHMIAS

■ Atrial tachycardia

■ Multifocal atrial tachycardia

■ Atrial flutter

■ Atrial fibrillation

■ Paroxysmal supraventricular tachycardia

■ Wolfe-Parkinson-White syndrome

■ Brugada syndrome

■ AV-nodal reentrant tachycardia

■ Ventricular tachycardia

■ Torsades de pointes

■ Ventricular fibrillation

■ Sinus tachycardia

SICKSINUSSYNDROME(SSS)

CAUSES

■ Occurs as a result of disease in the sinoatrial node

■ May cause tachycardia-bradycardia syndrome in which sinus rate varies

from fast to slow and back again

■ Often manifests as syncope

ECG FINDINGS

■ Irregular rhythm with pauses in sinus activity

TREATMENT

■ Depends on presentation

■ Too slow: Rate stimulation with atropine or pacing

■ Too fast: Rate control with calcium channel or β-blockers

■ Definitive therapy: Typically a combination of permanent pacemaker

placement plus rate control medications

SINUSARREST(SINUSBLOCK)

Left untreated, SSS leads to complete cessation of SA activity.

ECG FINDINGS(SEEFIGURE1.8)

■ No P waves

■ Escape pacemaker activity

■ Usually from the AV node or bundle of His (40–60 bpm) but may be

ventricular escape (< 40 bpm).

RESUSCITATION

FIGURE 1.8. Sinus arrest with junctional escape rhythm.