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Related Concept Videos

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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Disturbances in Heart Rhythm01:28

Disturbances in Heart Rhythm

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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.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
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ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias01:25

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

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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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Mechanism of Cardiac Arrhythmias01:28

Mechanism of Cardiac Arrhythmias

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Arrhythmias are irregular heart rhythms occurring when the heart's electrical impulses become abnormal. These disturbances can lead to various symptoms, depending on their severity and the underlying cause. Some common factors contributing to arrhythmias include hypoxia, ischemia, electrolyte imbalances, excessive catecholamine exposure, drug toxicity, and muscle overstretching. Arrhythmias can be classified into two main types based on the rate and site of origin of abnormal heart rhythms.
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Dysrhythmias I: Introduction01:15

Dysrhythmias I: Introduction

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Dysrhythmias refers to abnormalities in the heart's rhythm. They result from disruptions in the heart's electrical conduction system, which includes the sinoatrial(SA)node, atrioventricular(AV) node, the bundle of His, bundle branches, and Purkinje fibers.Definition and PathophysiologyDysrhythmias result from disorders of impulse formation, impulse conduction, or both. The heart contains specialized cells in the sinoatrial node, atrioventricular node, and the bundle of His and Purkinje fibers...
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Electrophysiology of Normal Cardiac Rhythm01:19

Electrophysiology of Normal Cardiac Rhythm

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The normal cardiac rhythm is a synchronized electrical activity that facilitates the regular and coordinated contraction of the heart muscle. This process is essential for efficient blood circulation throughout the body. The fundamental elements involved in establishing and maintaining this rhythm include the unique electrical properties of cardiac muscle cells, the sinoatrial (SA) node's pacemaker function, the specialized conducting system, and the ionic mechanisms underlying each phase...
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High-Resolution Endocardial and Epicardial Optical Mapping in a Sheep Model of Stretch-Induced Atrial Fibrillation
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Stable Ventricular Fibrillation: A Paradigm Rather Than Septal Shift?

Connor L Bracy1,2, Pei-Ying Kobres2,3, Michael J Hockstein3

  • 1From the Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, District of Columbia.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
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Patients with left ventricular assist devices (LVADs) can experience awake ventricular fibrillation (VF) or ventricular tachycardia (VT). These patients often tolerate the arrhythmia short-term, but it can signal increased in-hospital mortality risk.

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Area of Science:

  • Cardiology
  • Medical Devices
  • Electrophysiology

Background:

  • Awake ventricular fibrillation (VF) and ventricular tachycardia (VT) are rare, primarily occurring in patients with mechanical circulatory support.
  • Left Ventricular Assist Devices (LVADs) are crucial for end-stage heart failure management.

Purpose of the Study:

  • To describe the characteristics and outcomes of LVAD patients presenting to the emergency department (ED) with awake VF/VT.
  • To evaluate the management strategies and in-hospital mortality associated with this patient cohort.

Main Methods:

  • Retrospective review of 175 patients at a high-volume LVAD center.
  • Analysis of 19 patients who presented to the ED with awake VF/VT between December 2015 and July 2021.
  • Examination of ED and inpatient management, including hemodynamic parameters, medications, and procedures.

Main Results:

  • Nineteen LVAD patients presented with awake VF/VT, maintaining a median MAP of 70 mm Hg.
  • ED management commonly involved cardioversion (58% once, 21% multiple times), amiodarone (68%), and lidocaine (21%).
  • Inpatient care included defibrillation (37%), ablation (11%), and antiarrhythmics (84%); 26% died, with one death from recurrent VT.

Conclusions:

  • LVAD patients can exhibit short-term tolerability of sustained ventricular arrhythmias.
  • Awake VF/VT presentation in LVAD patients may be a harbinger of increased in-hospital mortality.
  • Clinical teams must be vigilant for this presentation and its implications for patient outcomes.