1. Arrhythmia
Arrhythmia

2. Arrhythmia prebared by Waleed Sammody Mohammad Mansour Supervised by Jehad Bani Aodih

3. Basic Facts An arrhythmia is an abnormality or disturbance in the rate or rhythm of the heartbeat.

4. Arrhythmias are caused by problems with the heart's electrical system, such as abnormal formation of the electrical impulses that begin heartbeats or by a disruption of the pattern of conduction of those impulses.

5. Because the ventricles are primarily responsible for moving blood through the body, ventricular arrhythmias are often more serious than other arrhythmias.

6. CAUSES AND RISK FACTORS Causes of ventricular arrhythmias include: 1- Abnormal electrolyte (mineral, such as potassium and magnesium) levels in the blood Electrocution

7. 3- Heart attack (myocardial infarction)
4- Unstable angina (chest pain).
5- Scarring resulting from a heart attack

8. Ventricular arrhythmias include
Premature ventricular complexes (PVCs), which are premature heartbeats;
Ventricular tachycardia, an abnormally fast heartbeat; and
Ventricular fibrillation, in which the heart quivers rather than contracts.
An electrocardiogram of an episode of sustained ventricular tachycardia.

9. Premature ventricular contraction (PVC):   The ventricles fire an early impulse which causes the heart to beat earlier causing irregularity in the heart rhythm.

10. Premature ventricular contraction (PVC)

11. Ventricular Tachycardia
This is a dangerous type of rapid heart rhythm because it is usually associated with poor cardiac output (amount of blood ejected out of the heart)
It results from abnormal tissues in the ventricles generating a rapid and irregular heart rhythm.

12. Ventricular Tachycardia
Rate
Rhythm
Ventricular
> 100 bpm
Regular
Atrial
None
P-Wave
Absent
P-R Interval
QRS Complex
> .10 seconds

13. Ventricular fibrillation
All output from the heart stops, blood pressure falls rapidly, and the patient loses consciousness .
Both ventricular tachycardia and ventricular fibrillation are considered lethal arrhythmias Only ventricular fibrillation, is linked to the clinical term “sudden death.” This rhythm is not able to support life and will lead to clinical death if untreated

14. During ventricular fibrillation the heart is electrically stimulated by multiple ectopic sites so that instead of contracting rhythmically in one united wave of depolarization, the muscle actually fibrillates

15. WHAT ARE THE SYMPTOMS? Diminished or irregular pulse;
Fatigue;
Shortness of breath;
Fainting (syncope);
Low blood pressure;
Chest pain; and
Palpitations (awareness of one's own heartbeat);
Cardiac arrest.

16. Ventricular fibrillation
An electrocardiogram reflecting the irregular, pulseless electrical activity of ventricular fibrillation

17. TREATMENT APPROACH
Many cases of arrhythmias may not require treatment. Other arrhythmias can be treated by treating any underlying heart disease. Treatments for ventricular arrhythmia includes

18. Defibrillation Medication (beta-blockers and antiarrhythmic agents); Radiofrequency catheter ablation; Angioplasty; and Pacemaker implantation.

19. Heart Block
Heart Block

20. Heart block, also called atrioventricular block or A-V block, is an abnormality of the spread or flow of electrical activity from the upper heart chambers, the atria, to the lower chambers of the heart, the ventricles.

21. Atrioventricular block (AVB):  the sinus node may be generating heart beats causing the atria to contract at a normal rate, however not every electrical impulse coming from the atria is being passed down to the ventricles by the atrioventricular node due to a block in conduction.  There are various types of AV block depending upon the mechanism of block.

22. Classify heart block based on the length the delay

23. First-degree heart block
Heart beat impulses are delayed in the A-V node, but ultimately reach the ventricles. Sometimes, first-degree heart block can eventually lead to other forms of heart block. .

24. In first-degree heart block, the ECG shows one QRS wave for every P wave, but the pause is greater than normal

25. Second-degree heart block
Heart beat impulses are delayed or blocked in or around the A-V node, and some of the impulses fail to reach the ventricles; Second-degree heart block is further divided into two sub-types:
Type I second-degree heart block, also called Mobitz Type I heart block or the Wenckebach phenomenon.
Type II second-degree heart block, also called Mobitz Type II block.

26. second degree block referred to as Mobitz I or Wenckebach
Occasionally sinus impulses will pass through the AV node at slower and slower rates until excitation is actually blocked After that the cycle of delay-delay-block repeats itself
This phenomenon is a form of second degree block referred to as Mobitz I or Wenckebach.

27. Second-Degree Heart Block: Mobitz I

28. Mobitz II is another form of second-degree block
Mobitz II occurs within the context of a basic rhythm when a P wave occurs but is not followed by a QRS. This is a more serious form of second-degree block as it occurs without warning
The basic rhythm would be regular except for the periods of the block. These occur most often because there is block below the bundle of His
The P to P interval is once again regular. The QRS response, because of the “dropped beat,” will appear irregular

29. In second-degree type II block, notice that the P wave (4th bump) isn't followed by the QRS wave, because the ventricles weren't activated.

30. Third-degree heart block
Also called complete heart block, each sinus node impulse is completely interrupted in the A-V node or beyond, and the ventricles must generate their own impulse to contract. Depending on its cause, third-degree block may be transient (temporary) or permanent.
When no impulses from the atria excite the ventricle, a situation of complete block exists

31. Because they are capable of self-automaticity, a ventricular rhythm is present
Clearly this is the most serious form of heart block as the ventricles are now left on their own to beat
However, at a rate inherent to the ventricles the patient’s rhythm will significantly slow
In addition, the effect of atrial kick is lost

32. Third-degree heart block

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