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The heart is one of the most important organs in the entire human body for the
reason that it is the major circulatory organ. It is, composed of muscle which pumps
blood throughout the body, beating approximately 72 times per minute of our lives.
The heart pumps the blood, which carries all the vital supplies which help our bodies
function and removes the waste products that we do not need. For example, the
brain requires oxygen and glucose, which, if not received continuously, will cause it
to loose consciousness. Muscles need oxygen, glucose and amino acids, as well as
the proper ratio of sodium, calcium and potassium salts in order to contract
normally. The glands need sufficient supplies of raw materials from which to
manufacture the specific secretions. If the heart ever ceases to pump blood the body
begins to shut down and after a very short period of time will die.

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Arrhythmias can develop from either altered impulse formation or altered impulse conduction. The
former concerns changes in rhythm that are caused by changes in the automaticity of pacemaker cells or
by abnormal generation of action potentials by sites other than the SA node (termed ectopic foci).
Altered impulse conduction is usually associated with complete or partial block of electrical conduction
within the heart. Altered impulse conduction commonly results in reentry, which can lead to
tachyarrhythmias.


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The symptoms of cardiac arrhythmia are not specifically life-threatening, unless left untreated, Cardiac
arrhythmia can lead to more fatal forms of rhythm disturbance, eg/ premature ventricular
depolarization may lead to ventricular fibrillation (resulting in a heart attack). The signs and symptoms
of cardiac arrhythmias can range from completely asymptomatic to loss of consciousness or sudden
cardiac death. In general, more severe symptoms are more likely to occur in the presence of structural
heart disease. For example, sustained monomorphic VT, particularly in a normal heart, may be
hemodynamically tolerated without syncope. In contrast, even non-sustained VT may be poorly
tolerated and cause marked symptoms in patients with severe LV dysfunction. Complaints such as
lightheadedness, dizziness, quivering, shortness of breath, chest discomfort, heart fluttering or
pounding, and forceful or painful extra beats are commonly reported with a variety of arrhythmias.
Frequently patients notice their arrhythmia only after checking peripheral pulses. Certain symptoms
raise the index of suspicion and can give clues to the type of arrhythmia. The presence of sustained
regular palpitations or heart racing in young patients without any evidence of structural heart disease
suggests the presence of an SVT due to atrioventricular nodal re-entry, or SVT due to an accessory
pathway. Such tachycardias may frequently be accompanied by chest discomfort, diaphoresis, neck
fullness, or a vasovagal type of response with syncope, diaphoresis, and nausea. It has been shown that
the hemodynamic consequences of SVT and VT can have an autonomic basis, recruiting vasodepressor
reflexes similar to that observed in neurocardiogenic syncope. Isolated or occasional premature beats
suggest PACs or PVCs and are benign in the absence of structural heart disease.


      
    
 

  
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Sick sinus syndrome
Sick sinus syndrome, also called Bradycardia-tachycardia syndrome is a group of abnormal heartbeats
(arrhythmias) presumably caused by a malfunction of the sinus node, the heart's "natural" pacemaker.
Sick sinus syndrome is a disorder of the sinus node of the heart, which regulates heartbeat. With sick
sinus syndrome, the sinus node fails to signal properly, resulting in changes in the heart rate.Sick sinus
syndrome is a type of bradycardia in which the sinoatrial node is not functioning as it should.


 

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Atrial fibrillation
Atrial fibrillation (AF) is an electrical rhythm disturbance of the heart affecting the atria. Abnormal
electrical impulses in the atria cause the muscle to contract erratically and pump blood inefficiently.
Atrial fibrillation is associated with many cardiac conditions, including cardiomyopathy, coronary artery
disease, valvular heart disease, ventricular hypertrophy and other associated conditions. Atrial
fibrillation has been associated with hyperthyroidism, acute alcohol intoxication, changes in the
autonomic nervous system and is common after cardiac surgery.

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Atrial flutter
Atrial flutter is a rhythmic, fast rhythm that occurs in the atria of the heart. This rhythm occurs most
often in individuals with organic heart disease (ie: pericarditis, coronary artery disease, and
cardiomyopathy). Atrial flutter is a regular, rhythmic tachycardia originating in the atria. The rate in the
atria is over 220 beats/minute, and typically about å00 beats/minute. The morphology on the surface
EKG is typically a sawtooth pattern. Atrial flutter can sometimes degenerate to atrial fibrillation.



Bundle branch block
Bundle branch block (BBB) is a disruption in the normal flow of electrical pulses that drive the heart
beat. Bundle branch block belongs to a group of heart problems called intraventricular conduction
defects (IVCD). There are two bundle branches, right and left. The right bundle carries nerve impulses
that cause contraction of the right ventricle (the lower chamber of the heart) and the left bundle carries
nerve impulses that cause contraction of the left ventricle. Bundle heart block may be caused by
damage to the heart muscle resulting from a heart attack.

Supraventricular tachycardia
Supraventricular tachycardia (SVT), also known as paroxysmal narrow complex tachycardia (PNCT), is a
disturbance of heart rhythm as a result of rapid electrical activity of the upper parts of the heart. In
these attacks the heart is beating very fast, usually at a rate between 1(0 and 2(0 per minute. In most
cases, the heart is normal and the heart rhythm is benign although uncomfortable. Palpitation is much
the commonest symptom, but there also may be dizziness or even, very occasionally, fainting.

Ventricular arrhythmias
Ventricular arrhythmias are common and are usually benign, at least in those with a structurally normal
heart. In patients with structural heart disease (usually coronary heart disease), however, ventricular
arrhythmia is an adverse prognostic factor associated with cardiac arrest and cardiac mortality.
Ventricular arrhythmias range from asymptomatic ventricular ectopy to sustained ventricular

·|C a rdi a c Ar rhy t hmia s : A C ase Rep o r t


tachycardia and cardiac arrest. Ventricular tachycardia and ventricular fibrillation are the most life-
threatening arrhythmias that require emergency treatment.

Ventricular tachycardia
Ventricular tachycardia (VT) is a wide complex cardiac rhythm originating in the ventricles. The rate is
usually between 1þ0 and 200 beats/minute and regular. There is dissociation between atrial and
ventricular activity. The rapid rate and A-V dissociation may lead to reduced cardiac filling and low
cardiac output, hypotension, and cardiac arrest. Ventricular tachycardia is a potentially lethal disruption
of normal heartbeat (arrhythmia) that may cause the heart to become unable to pump adequate blood
through the body.

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Ventricular fibrillation
Ventricular fibrillation is a condition in which disordered electrical activity causes the chambers of your
heart, ("ventricles"), to contract chaotically. When this occurs, little or no blood is pumped from the
heart. Ventricular fibrillation (VF) is an abnormal heart rhythm that causes death. It is responsible for
7þ to ·þ of sudden deaths due to heart problems. Normally, heart muscle cells squeeze (contract) in
rhythm at the same time to pump blood. These groups of cells are located in the bottom two pumping
chambers of the heart (ventricles).

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Heart block
Heart block is a disorder of the heartbeat. It occurs when electrical impulses can't pass from the atria
(upper chambers of the heart) to the ventricles (the heart's lower chambers). This may keep the
contractions of the atria from coordinating with the contractions of the ventricles , and may cause a
very slow heart rate. Heart block is common in elderly people as their hearts have undergone
degenerative (wear and tear) changes. Heart block has a variety of causes. It can sometimes be a result
of a congenital defect.

Brugada syndrome
Brugada syndrome (also known by some investigators as idiopathic ventricular fibrillation, IVF), is a
disease associated with an electrocardiographic abnormality of right bundle branch block with ST-
elevation in the right precordial leads (Figure). It has been added to the list of possible causes of sudden
death in otherwise healthy, young individuals. These patients have a propensity for life-threatening
ventricular tachyarrhythmias, particularly during sleep, but no structural heart abnormalities are found.

Õ|C a rdi a c Ar rhy t hmia s : A C ase Rep o r t


Treatment for people at high risk of sudden death is with an implantable defibrillator.

Long QT syndrome
The long QT syndrome (LQTS) is a heart condition in which there is an abnormally long delay between
the electrical excitation (or depolarization) and relaxation (repolarization) of the ventricles of the heart.
It is associated with syncope (loss of consciousness) and with sudden death due to ventricular
arrhythmias. Arrhythmias in individuals with LQTS are often associated with exercise or excitement. The
cause of sudden cardiac death in individuals with LQTS is ventricular fibrillation.

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Short QT syndrome
Short QT syndrome is a genetic disease of the electrical system of the heart. It is made up of a
constellation of signs and symptoms, made up of a short QT interval interval on EKG (ч å00 ms) that
doesn't significantly change with heart rate, tall and peaked T waves, and a structurally normal heart.
Short QT syndrome appears to be inherited in an autosomal dominant pattern, and a few affected
families have been identified. Individuals with short QT syndrome frequently complain of palpitations
and may have syncope (loss of consciousness) that is unexplained.

Wolff-Parkinson-White syndrome (WPW syndrome)


Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of the ventricles due to an
accessory pathway known as the bundle of Kent. This accessory pathway is an abnormal electrical
communication from the atria to the ventricles. Wolff-Parkinson-White syndrome is characterised by
attacks of rapid heart rate (tachycardia). The heartbeat is regulated by electrical impulses that travel
through the atria (upper chambers of the heart) to a knot of tissue known as the atrioventricular node,
and then to the ventricles.
Arrhythmias (abnormal heart rhythms or dysrhythmias) are problems that affect the electrical system
of the heart muscle, producing abnormal heart rhythms. They can cause the heart to pump less
effectively. Arrhythmias are disturbances in the normal rhythm of the heartbeat. An occasional
palpitation or fluttering is usually not serious, but a persistent arrhythmia may be life-threatening.

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