Arrhythmias Year 4 Internal Medicine Notes OmpathStudy

Arrhythmias Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / I MED BEAUTIFUL NOTES / CVS -- ● Objectives:\n● Identify​ ​the​ ​common​ ​arrhythmias\n● Know​ ​the​ ​differential​ ​diagnosis​ ​of​ ​heart​ ​rhythm​ ​disorder.\n● Learn​ ​the​ ​treatment​ ​modalities​ ​and​ ​diagnosis​ ​of​ ​atrial​ ​fibrillation.\n● Know​ ​the​ ​risk​ ​stratification​ ​of​ ​atrial​ ​fibrillation​ ​patient. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​[​ ​Color​ ​index​ ​:​ ​ ​Important​ ​ ​ ​ ​Notes​ ​ ​ ​Extra​ ​]\n[​ ​ ​ ​ ​Editing​ ​file​ ​ ​ ​ ​ ​ ​ ​ ​ ​Feedback​ ​ ​ ​ ​ ​ ​ ​ ​ ​Share​ ​your​ ​notes​ ​ ​ ​ ​ ​ ​ ​ ​ ​Shared​ ​notes​ ​ ​ ​ ​ ​ ​ ​Twitter​ ​ ​ ​ ​] \n● Resources:\n● 435​ ​slides,​ ​434​ ​&​ ​432​ ​teams\n\n ● Done​ ​by:​ ​Khawla​ ​AlAmmari​ ​&​ ​Fahad​ ​AlAbdullatif​ ​&​ ​Mana​ ​AlMuhaideb\n● Team​ ​sub-leader:​ ​ ​Mana​ ​AlMuhaideb\n● Team​ ​leaders:​ ​Khawla​ ​AlAmmari​ ​&​ ​Fahad​ ​AlAbdullatif\n● Revised​ ​by:​ ​ ​Ahmed​ ​Al​ ​Yahya \n\n Introduction​ ​to​ ​Cardiac​ ​Arrhythmias\n\n ● The​ ​heartbeat​ ​is​ ​normally​ ​initiated​ ​by​ ​an​ ​electrical​ ​discharge​ ​from​ ​the​ ​sinoatrial​ ​(sinus)​ ​node.​ ​The​ ​atria​ ​and\nventricles​ ​then​ ​depolarize​ ​sequentially​ ​as​ ​electrical​ ​depolarisation​ ​passes​ ​through​ ​specialized​ ​conducting\ntissues.The​ ​sinus​ ​node​ ​acts​ ​as​ ​a​ ​pacemaker​ ​and​ ​its​ ​intrinsic​ ​rate​ ​is​ ​regulated​ ​by​ ​the​ ​autonomic​ ​nervous​ ​system.\n● A​ ​reduction​ ​of​ ​parasympathetic​ ​tone​ ​or​ ​an​ ​increase​ ​in​ ​sympathetic​ ​stimulation​ ​leads​ ​to​ ​tachycardia;​ ​conversely,\nincreased​ ​parasympathetic​ ​tone​ ​or​ ​decreased​ ​sympathetic​ ​stimulation​ ​produces​ ​bradycardia.​ ​The​ ​sinus​ ​rate​ ​in\nwomen​ ​is​ ​slightly​ ​faster​ ​than​ ​in​ ​men.\n● A​ ​cardiac​ ​arrhythmia​ ​is​ ​a​ ​disturbance​ ​of​ ​the​ ​electrical​ ​rhythm​ ​of​ ​the​ ​heart.​ ​Arrhythmias​ ​are​ ​often​ ​a\nmanifestation​ ​of​ ​structural​ ​heart​ ​disease​ ​but​ ​may​ ​also​ ​occur​ ​because​ ​of​ ​abnormal​ ​conduction​ ​or​ ​depolarization​ ​in\nan​ ​otherwise​ ​healthy​ ​heart.\n● An​ ​arrhythmia​ ​may​ ​be​ ​‘​supraventricular​’​ ​(sinus,​ ​atrial​ ​or​ ​junctional)​ ​or​ ​ventricular​ ​in​ ​origin.​ ​Supraventricular\nrhythms​ ​usually​ ​produce​ ​narrow​ ​QRS​ ​complexes​ ​because​ ​the​ ​ventricles​ ​are​ ​depolarized​ ​in​ ​their​ ​normal​ ​sequence\nvia​ ​the​ ​AV​ ​node​ ​and​ ​bundle​ ​of​ ​His.​ ​In​ ​contrast,​ ​ventricular​ ​rhythms​ ​produce​ ​broad,​ ​bizarre​ ​QRS​ ​complexes​ ​because\nthe​ ​ventricles​ ​are​ ​activated​ ​in​ ​an​ ​abnormal​ ​sequence.\n\n ● There​ ​are​ ​two​ ​main​ ​types​ ​of​ ​arrhythmia​ ​:​ ​(Based​ ​on​ ​rate)\n1) Bradycardia​:​ ​the​ ​heart​ ​rate​ ​is​ s​ low​ ​(<60 b.p.m.​ ​during​ ​the​ ​day​ ​or​ ​<50 b.p.m.​ ​at​ ​night)​.\nSlower​ ​heart​ ​rates​ ​are​ ​more​ ​likely​ ​to​ ​cause​ ​symptomatic​ ​arrhythmias.\n1.\n2) Tachycardia​:​ ​the​ ​heart​ ​rate​ ​is​ ​fast​ ​( 100 b.p.m.).​ ​Tachycardias​ ​are​ ​more​ ​likely​ ​to​ ​be​ ​symptomatic\nwhen​ ​the​ ​arrhythmia​ ​is​ ​fast​ ​and​ ​sustained.​ ​There​ ​are​ ​three​ ​main​ ​mechanisms​ ​of​ ​tachycardia​ ​:\n\nIncreased​ ​automaticity​ ​(In The​ ​tachycardia​ ​is​ ​produced​ ​by​ ​repeated​ ​spontaneous​ ​depolarisation​ ​of​ ​an​ ​ectopic​ ​focus, response​ ​to​ ​any​ ​kind​ ​of​ ​stress) often​ ​in​ ​response​ ​to​ ​catecholamines.\n\nRe-entry The​ ​tachycardia​ ​is​ ​initiated​ ​by​ ​an​ ​ectopic​ ​beat​ ​and​ ​sustained​ ​by​ ​a​ ​re-entry​ ​circuit​ ​.​ ​Most\ntachyarrhythmias​ ​are​ ​due​ ​to​ ​re-entry.\n\nTriggered​ ​activity It​ ​is​ ​a​ ​form​ ​of​ ​secondary​ ​depolarisation​ ​arising​ ​from​ ​an​ ​incompletely​ ​repolarized​ ​cell\nmembrane. \n\n Atrial​ ​tachyarrhythmias \nWE​ ​ARE​ ​100%​ ​SURE​ ​THAT​ ​YOU​ ​WILL​ ​UNDERSTAND​ ​EVERYTHING​ ​ABOUT​ ​AF​ ​AFTER​ ​WATCHING​ ​THIS​ ​VIDEO 1) Atrial​ ​fibrillation​ ​(AF)​ ​:\n- Atrial​ ​fibrillation​ ​(AF)​ ​is​ ​the​ ​most​ ​common​ ​sustained​ ​cardiac​ ​arrhythmia​ ​with​ ​an​ ​overall​ ​prevalence​ ​of​ ​0.5%\nin​ ​the​ ​adult​ ​population​ ​of​ ​the​ ​UK.\n➔ Atrial​ ​fibrillation​ ​accounts​ ​for​ ​1/3​ ​of​ ​all​ ​patient​ ​discharges​ ​with​ ​arrhythmia​ ​as​ ​principal​ ​diagnosis.1\n- The​ ​prevalence​ ​rises​ ​with​ ​age​,​ ​affecting​ ​1%​ ​of​ ​those​ ​aged​ ​60–64​ ​years,​ ​increasing​ ​to​ ​9%​ ​of​ ​those​ ​aged​ ​over​ ​80\nyears.\n- AF​ ​is​ ​a​ ​complex​ ​arrhythmia​ ​characterised​ ​by​ ​both​ ​:\n1) abnormal​ ​automatic​ ​firing​.\n2) The​ ​presence​ ​of​ ​multiple​ ​interacting​ ​re-entry​ ​circuits​​ ​looping​ ​around​ ​the​ ​atria.\n➔ ​ ​AF​ ​becomes​ ​sustained​ ​because​ ​of​ ​re-entrant​ ​conduction​ ​within​ ​the​ ​atria​ ​or​ ​sometimes​ ​because​ ​of\ncontinuous​ ​ectopic​ ​firing​.\n- Episodes​ ​of​ ​atrial​ ​fibrillation​ ​are​ ​initiated​ ​by​ ​rapid​ ​bursts​ ​of​ ​ectopic​ ​beats​ ​arising​ ​from​ ​conducting​ ​tissue​ ​in​ ​the\npulmonary​ ​veins​ ​or​ ​from​ ​diseased​ ​atrial​ ​tissue.\n- ​ ​Re-entry​ ​is​ ​more​ ​likely​ ​to​ ​oc