CardiacArrythmias.pptVIP

Cardiac Arrhythmias Normal Sinus Rhythm Sinus Bradycardia HR 60 bpm; every QRS narrow, preceded by p wave Can be normal in well-conditioned athletes HR can be30 bpm in children, young adults during sleep, with up to 2 sec pauses Sinus bradycardia--etiologies Normal aging 15-25% Acute MI(myocardial infarction), esp. affecting inferior wall(下壁) Hypothyroidism, infiltrative diseases (sarcoid, amyloid) Hypothermia, hypokalemia SLE, collagen vasc diseases Situational: micturation, coughing Drugs: beta-blockers, digitalis, calcium channel blockers, amiodarone, cimetidine, lithium Sinus bradycardia--treatment No treatment if asymptomatic Sxs include chest pain (from coronary hypoperfusion), syncope, dizziness Office: Evaluate medicine regimen—stop all drugs that may cause Bradycardia associated with MI will often resolve as MI is resolving; will not be the sole sxs of MI ER: Atropine if hemodynamic compromise, syncope, chest pain Pacing Sinus tachycardia HR 100 bpm, regular Often difficult to distinguish p and t waves Sinus tachycardia--etiologies Fever Hyperthyroidism Effective volume depletion Anxiety Pheochromocytoma （嗜咯） Sepsis Anemia Exposure to stimulants (nicotine, caffeine) or illicit drugs Hypotension and shock Pulmonary embolism Acute coronary ischemia and myocardial infarction Heart failure Chronic pulmonary disease Hypoxia Sinus Tachycardia--treatment Office: evaluate/treat potential etiology :check TSH, CBC（complete blood cell）, optimize CHF（congestive heart failure） or COPD regimen, evaluate recent OTC drugs Verify it is sinus rhythm If no etiology is found and is bothersome to patients, can treat with beta-blocker Sinus Arrhythmia Variations in the cycle lengths between p waves/ QRS complexes Will often sound irregular on exam Normal p waves, PR interval, normal, narrow QRS Sinus arrhythmia Usually respiratory--Increase in heart rate during inspiration Exaggerated in children, young adults and athletes—decreases with age Usually asymptomat