CVM Lecture Week4 Lecture Slides
CVM Lecture Week4 Lecture Slides
Cardiovascular
Medicine
Dr Lisa Chilton
[email protected]
Building DB087, Room TV222,
4781 5195
Dysrhythmias
Atrial Fibrillation
Figures 19-20 and 19-27, Copstead and Banasik, 3E
Abnormal Sites of Impulse Initiation
Ventricular Dysrhythmias
1. Premature Ventricular Complexes (PVCs)
A ventricle cell is excited independent of normal activation by
the conduction system
Excitation encompasses the ventricles but not the atria, so sinus
rhythm is unaffected
QRS complex is abnormal and prolonged
T wave is often inverted (repolarisation follows an abnormal
path)
PVC compensatory pause
buried P wave
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Ventricular Dysrhythmias
3. Ventricular Fibrillation (VF)
Rapid, choatic rhythm which is completely
uncoordinated
Ventricular muscle quivers rather than contracting in a
coordinated manner
CO is severely compromised
Abnormal Sites of Impulse Initiation
Ventricular Dysrhythmias
3. Ventricular Fibrillation (VF)
Same conditions which produce VT produce VF (re-entry
associated with MI, ischaemia, high catecholamine
levels and electrolyte imbalance) as VT often progresses
to VF
Treat rapidly with cardiopulmonary resuscitation and
defibrillation
If heart converts, antiarrhythmic drugs are administered
Summary 1
Abnormal sites of impulse initiation are caused by
premature APs in areas other than the conduction system
Underlying mechanisms: abnormal automaticity,
triggered activity, and re-entry of excitation
Ectopic foci may give rise to premature complexes,
tachycardia, or fibrillation in both the atria and
ventricles
Ventricular fibrillation is the most dangerous
dysrhythmia
Summary 2
Sinus rhythm may be abnormally fast (tachycardia), slow
(bradycardia), variable (atrial arrhythmias; Sick Sinus
Syndrome) or absent (sinus arrest)
Escape rhythms occur when the SA node fails and the AV
node (junctional escape) or Purkinje fibres (ventricular
escape) take over generating the pacemaker signal
Disruption of electrical conduction profoundly affects heart
rate and cardiac output (AV blocks)
Abnormal conduction pathways may undermine normal
activation of the ventricles (pre-excitation)