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Related Concept Videos

ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias01:25

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Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
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Class III antiarrhythmic drugs are a group of medications that can prolong action potentials in the heart. They achieve this by blocking potassium channels or enhancing inward currents from sodium channels. However, these drugs have a unique property of "reverse use-dependence," which is most pronounced at slower heart rates and can lead to torsades de pointes—a specific type of arrhythmia. However, it is essential to note that excessive QT interval prolongation—a measure of...
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Dysrhythmias VI: Management of Dysrhythmias01:25

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Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
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Dysrhythmias III: Characteristics of Dysrhythmias01:29

Dysrhythmias III: Characteristics of Dysrhythmias

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Dysrhythmias, also known as arrhythmias, are irregular heart rhythms that result from abnormal electrical activity in the heart, affecting its ability to circulate blood efficiently. Tachyarrhythmias, a subset of dysrhythmias, are characterized by abnormally fast heart rates exceeding 100 beats per minute. Here are some types of tachyarrhythmias with their distinct ECG features:Sinus Tachycardia:Sinus tachycardia presents a regular heart rhythm with an increased rate of 101-180 beats per...
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Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
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Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers01:24

Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers

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Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which...
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Related Experiment Video

Updated: Aug 5, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Esmolol Is Not the Solution: Thyroid Storm With Atrial Fibrillation.

Zaid N Herzallah1, Shreya Gupta2, Maryam D Abdulhamid1

  • 1Emergency Medicine, Rashid Hospital Trauma Center/Dubai Health Authority (DHA), Dubai, ARE.

Cureus
|March 24, 2023
PubMed
Summary

Thyroid storm with atrial fibrillation can lead to cardiac arrest when treated with esmolol. This case highlights a dangerous interaction requiring careful patient monitoring during thyroid storm management.

Keywords:
atrial fibborderline low blood pressureesmololheart failurethyroid-storm

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Area of Science:

  • Cardiology
  • Endocrinology

Background:

  • Thyroid storm is a life-threatening endocrine emergency.
  • Atrial fibrillation (AF) is a common complication of thyroid storm.
  • Management of AF in thyroid storm requires careful consideration of beta-blocker use.

Observation:

  • A 37-year-old female with thyroid storm and rapid ventricular response AF presented with no heart failure signs.
  • She received a low-dose esmolol infusion for rate control.
  • Cardiac arrest occurred shortly after esmolol initiation.

Findings:

  • This case report details a severe adverse reaction to esmolol in a patient with thyroid storm and AF.
  • It is the second reported instance of cardiac arrest following low-dose esmolol in this specific clinical scenario.
  • Highlights potential risks of beta-blockers in managing AF during thyroid storm.

Implications:

  • Clinicians should exercise extreme caution when using short-acting beta-blockers like esmolol for AF rate control in thyroid storm.
  • Further research is needed to elucidate the mechanisms behind this adverse reaction.
  • Emphasizes the critical need for vigilant monitoring of patients with thyroid storm and AF during treatment.