“Any deviation from the heart’s normal sinus rhythm”

Classifications
  • Classified clinically as supraventricular or ventricular.
  • Some types of arrhythmia include:
    • Altered sinus rhythm – tachycardia or bradycardia
    • Extrasystole (ectopic beats)
    • Atrial tachycardia and atrial flutter
    • Atrial fibrillation
    • Heart block – first, second or third-degree
    • Wolf-Parkinson-White Syndrome
    • Ventricular tachycardia
    • Ventricular fibrillation
Risk Factors & Aetiology
  • History of heart problems
  • Hypertension
  • Thyroid problems
  • Diabetes
  • Smoking
  • Alcohol
  • Caffeine
Pathophysiology
  • Dependent on the type of arrhythmia but generally divided into either
    • Enhanced or abnormal impulse formation
    • Conduction disturbances
Clinical Presentation
  • Some can be asymptomatic
  • Symptoms include:
    • Palpitations
    • Chest pain
    • Syncope
    • Dyspnoea
Investigations
  • Bloods:
    • FBC, U&Es, glucose, Ca2+, Mg2+, TSH
  • Imaging:
    • Echocardiogram – structural heart disease
  • Special:
    • Stress tests
    • ECG – IHD, AF, short PR interval, long QT interval, and U waves) +/- monitoring
Management

Management is dependent on the cause.

  • Conservative:
    • Reduce alcohol intake
    • Reduce caffeine intake
  • Medical:
    • Anti-Arrhythmics (Vaughan-Williams Classification)
      1. Sodium channel blockers (Quinidine, Lidocaine)
      2. Beta-adrenoceptor blockers (Propranolol)
      3. Potassium channel blockers (Amlodipine)
      4. Calcium channel blockers (Verapamil)
    • Miscellaneous – digoxin, atropine, adenosine, ivabradine
  • Surgical:
    • Pacemaker
    • Ablation
    • ICDs
Complications
  • Thromboembolic events
  • Heart failure
  • Sudden death

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