Common arrhythmia that one would encounter in cardiac arrest situation.

1. Arrhythmia : What you need to
know for ACLS?
Syed Raza

2. Introduction
• Rhythm recognition is a key skill that one
needs to demonstrate during cardiac arrest
situation.
• This can be life saving.
• Early defibrillation
• Decision making on the right therapy

3. Lets Keep it Simple!
• Pulseless Rhythms
• Tachyarrhythmias
• Bradyarrhythmias

4. Pulse less Electrical Rhythm

6. Ventricular Fibrillation
• Uncoordinated contractions within the
ventricles of heart.
• Due to multiple cardiac cells that function as
pacemakers and discharge electrical impulses
in a chaotic manner.
• Reduced / No cardiac output : No pulse
• Will result in Asystole if not treated.

7. • Commonest cause : Hypoxia /Ischemia
• Types : Fine and Coarse

8. Therapy
Immediate Defibrillation
CPR
I/V Amiodarone after 3 shocks

10. Ventricular Tachycardia
• Broad Complex Tachycardia (QRS > 0.12s)
• Heart rate > 180 beats /mt
• Mono-morphic
• Poly-morphic / Torsade Pointe
• Pulse less vs with pulse

11. Mono morphic VT

12. Poly morphic VT
• Torsade Pointes if Prolonged QT interval on
previous ECG

13. Treatment
• Pulseless : Defibrillation
• With pulse : stable = Amiodarone
Unstable = DC Cardio version

14. No Pulse !

15. Pulse Less Electrical Activity (PEA)
• Organized electrical activity but without a
pulse
• Usually has underlying treatable cause
• Hypovolumea and Hypoxia are the
commonest causes.
• If no underlying cause is identified, it will be
treated same as Asystole.

16. 5 Hs and 5 Ts
5 Hs
Hypovolumia
Hypoxia
Hydrogen Ion (Acidosis)
Hyperkalemia
Hypokalemia
Hypoglycemia

17. 5Ts
Toxins
Tension Pneumothorax
Tamponade
Thrombosis : Coronary
Thrombosis : Pulmonary
Trauma

19. ASYSTOLE
Follow flat line protocol – check leads and gain
Not a true rhythm
State of no electrical activity
Terminal event
Very poor prognosis : ROSC extremely unlikely
Possible underlying cause : 5Hs and 5Ts
Treatment : CPR and Epinephrine

20. First Degree AV Block

21. • PR interval is prolonged > 200ms
• No clinical significance if asymptomatic
• May lead to higher degree AV Block

22. Second Degree AV Block

23. Mobitz Type 1
• Progressive prolongation of PR interval.
• Atrial impulse (P waves) may not be conducted
through AVN and gets blocked and hence no
QRS.
• No clinical significance unless symptomatic.
Mobitz Type 2
• Non prolongation and fixed PR interval.
• Non conducted p waves
• No ventricular activity -Drop beats / No QRS
Most times Infranodal

24. Third Degree AV Block (CHB)

25. P waves with a regular pp interval
QRS complexes with a regular RR interval
QRS complex may be narrow or wide (escape
rhythm)
No relationship between P waves and QRS
complexes.

26. Treatment
• Trans cutaneous or Trans Venous pacemaker
• Atropine (0.5 mg) may be tried
Epinephrine 0.5 -1 mg /kg bw

28. Atrial Fbrillation
• No p waves preceding QRS complexes as no
coordinated atrial contractility
• Irregular (variable) RR intervals

29. Treatment
• Unstable : Synchronized DC Cardio version
• Stable : Rhythm Control vs Rate Control
• Rhythm : Amiodarone, Sotalol, Flecainide
• Rate control : Beta blocker, Calcium channel
blocker, Digoxin.
• Anticoagulant if indicated.

31. Atrial Flutter
• Atrial rate 250 – 350 /mt
• Saw Tooth Appearance
• Ventricular rate depends on Degree of AV
block
• Electrical foci usually in RA

32. Treatment
• Rate Control
• Rhythm Control
• Anti coagulant
• DCC if unstable

34. Supra Ventricular Tachycardia
• Broad term for various supra ventricular
arrhythmia
• Electrical impulses above the ventricular
electrical conducting system.
• Inverted p waves preceding or following qrs
complexes.
• Review old ECG – exclude WPW

35. Treatment
Vagal maneuver
Adenosine
•Drugs – Chemical Cardio version or Rate
control.
• Anti coagulant.
•If unstable : sync. DCC