Hello, welcome everybody, this is Doctor Bolad.
Today I will talk to you about arrhythmias.
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So let us get started with this video about cardiac arrhythmias.
Arrhythmia is a term used for any heart beating rhythm that is different from the normal sinus
rhythm with normal atrioventricular conduction.
Normal sinus rhythm originates from the sinus node in the upper portion of the right atrium.
During sinus rhythm, the heart rate is in the normal range, the P waves are normal on
the ECG, also known as EKG, and the rate is stable.
The normal sinus rate at rest has been considered to be between sixty and one hundred beats
per minute.
However, the range, defined by two standard deviations from the mean, is between 43 and
93 beats per minute for men and 52 and 94 beats per minute for women.
Slow heart rate or fast heart rate may be physiologic, meaning can be normal.
This can also be non-physiologic, meaning abnormal.
Not uncommonly, the activation rate of the sinus node initiating the pulse can vary slightly,
and this can be normal, and we refer to it as sinus arrhythmia.
Common arrhythmias encountered in clinical practice include:
- extra beats originating from the upper part of the heart.
These are referred to as premature atrial contraction
-extra beats originating from the lower part of the heart.
This is referred to as premature ventricular contraction
-slow heart rate.
with a normal pattern of electrical activation.
This is referred to as sinus bradycardia -fast heart beats originating from the lower
part of the heart.
This is referred to as ventricular tachycardia -irregular fast heart rate originating from
the upper part of the heart.
This is referred to as atrial fibrillation - regular fast heart rate originating from
the upper part of the heart, usually from a heart electrical circuit.
This can either be atrial flutter or supraventricular tachycardia.
-conduction block between the upper and lower part of the heart.
This is referred to as atrioventricular block -non-sustained fast runs of beats originating
from the lower part of the heart.
This is referred to as non-sustained ventricular tachycardia.
Patients typically seek medical care for symptoms associated with an arrhythmia.
Sometimes even asymptomatic arrhythmias require careful evaluation and management to determine
long-term risks of symptoms and potential life-threatening outcomes.
Patients may also be referred for evaluation if they have a finding or condition associated
with risk of arrhythmia, such as a short pr interval, a delta wave, a long QT interval
on an ECG, or hypertrophic cardiomyopathy identified by an echocardiogram.
Additionally, patients who have evidence of heart failure may be at risk for potentially
serious and life-threatening rhythm disturbances that require more in-depth evaluation.
The initial evaluation of a patient with an arrhythmia consists of a complete history,
physical examination, and 12-lead ECG, if possible, during the arrhythmia.
The ECG alone during the arrhythmia may determine the type of arrhythmia and whether a particular
symptom is related to the arrhythmia.
The presence and type of symptoms may determine whether any action needs to be taken.
symptoms may be related to the arrhythmia, such as palpitations, dizziness, lightheadedness,
syncope, chest discomfort, neck discomfort, dyspnea, weakness, and anxiety.
symptoms can also be related to the hemodynamic consequences of the arrhythmias such as dyspnea,
dizziness, or syncope.
While the patient's age, medical history, and physical examination may strongly suggest
the diagnosis, it generally requires documentation with an ecg or a monitor.
The ECG might be normal if the arrhythmia is episodic, so a heart monitor might be required.
You can review the types of monitors in my “heart monitors video” which is displayed
in my channel.
The goal of therapy for any arrhythmia is to improve symptoms and to prevent a potentially
serious outcome, primarily a life-threatening arrhythmia and sudden death.
Stroke prevention in patients with atrial fibrillation and atrial flutter is also an
important treatment objective.
The decision to initiate a long-term treatment strategy, whether it is with device or drug
therapy, depends upon the severity and frequency of arrhythmia-related symptoms compared to
the risks associated with the therapy itself.
The need for long-term therapy must be carefully individualized to each patient since the severity
and importance of symptoms are highly variable.
The symptoms associated with any arrhythmia can have an impact on lifestyle, occupation,
driving, and other important daily activities.
In most cases, initiation of antiarrhythmic medication will be guided by a cardiologist.
In addition, treatment sometimes requires implantation of a pacemaker, implantable cardioverter
defibrillator, or implantation of a biventricular device.
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This is Doctor Bolad, helping you with your heart health, thanks for watching, and talk
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