Differentiate between
Defibrillation Cardioversion
Emergency life saving procedure Elective planned procedure
Non synchronized shock Synchronized shock
High energy is used Low energy shock
More damage to myocardium Less damage to myocardium
Used in VT and VF Used in most of the arrthythmias (AF,
atrial flutterand stable ventricular
tachycardia except VT and VF)
Can be given at any time of cardiac cycle Can be given in ventricular contraction
(Because the rhythm is unstable and there (Delivered during the QRS complex)
is no apparent QRS or T wave) Escalate for next shock (100-200-300-
No escalating energy for next shock 360J)
Ventricular Tachycardia Ventricular fibrillation
o Heart muscles contract at regular time o Heart muscles does not show any
intervals contraction activity at regular time intervals
o Symptoms include syncope, palpitations, o Symptoms of VF include chest pain,
hemodynamic compromise, fainting, stress, nausea, breathlessness, fainting, low blood
anxiety, sensation of flopping in the chest pressure
o Fast but regular rhythm o Fast but irregular rhythm
o V tach has regular QRS Complexes in ECG o VF does not show QRS complexes in EC
o It is narrow or broad complex o VF cannot be subdivided
o Goes undetected for decades o Requires emergency attention
o Uto 200 beats per minute o 350-500 beats per minute
o Rapid rhythm from the lower chambers of o Chaotic multiple impulses spreading
the heart though heart in different areas
First degree heart Second degree heart blocks
blocks
First degree heart blocks:It is Type 1 second degree heart block(Mobitz 1 or wenckebach
a type of AV block in which heart block): It includes a gradual lengthening of the PR
every impulse is conducted to interval. It occurs because of a proloned conduction time until
the ventricles but the duration an atrial impulse is non-conducted and a QRS complex is
of AV conduction is block(missing)
prolonged. after the impulse Clinical association:
moves through the AV node, it It may be results from use of drugs such a digoxin or beta
is usually conducted normally adrenergic blockers. it may also be associated with CAD and
through the ventricles other diseases that can slow AV conduction
Clinical association: ECG characteristics:
It is usually associated with Atrial rate is normal, but ventricular rate may be slower as a
MI, CAD, rhematic fever, result of non conducted or blocked QRS complexes
hyperthyroidism, vagal Clinical significance:
stimulation, and drugs such as It results from myocardial ischemia or infarction. it may be a
digoxin, beta adrenergic warning signal for a serious AV conduction disturbance
blockers, calcium channel Treatment:
blockers If the patient is symptomatic, atropine is used to increase
ECG characteristics: HR, or a temporary pacemaker may be needed, especially
In first degree AV block, HR if the patient has experience an MI.
is normal and rhythm is regular If the patient is asymptomatic, the rhythm should be
closely observed with a transcutaneous pacemaker on
Clinical significance: standby.
It is not serious but can be a Type 11 second degree heart block(Mobitz 11 heart block):
precursor of higher degrees of In a patient with mobitz type 2 block, a blocked beat occurs
AV block. patients with first
AV degree block are suddently and is not preceded by a change in the duration of
asymptomatic the PR interval. Patient is equipped with a pacemaker, which
Treatment: cuts in to sustain a regular ventricular rhythm
There is no treatment for Clinical association:
first degree AV block. Type 2 AV block is associatedwith rhematic heart disease,
Modification to causative CAD, anterior wall MI and digitalis toxicity
medications may be ECG characteristics:
considered. Atrial rate is usually normal. Ventricular rate depends on
Patients should continue to the degree of AV block.
be monitored for any new Atrial rhthm is regular but ventricular rhythm may be
changes in heart rhythm irregular
Clinical significance:
Type 11 AV block often progresses to third degree heart
block and is associated with a poor prognosis.
The reduced HR often results in decreased CO with
subsequent hypotension and myocardial ischemia. type
11 AV block is an indication for therapy with a
permanent pacemaker
Treatment:
Temporary treatment before the insertion of a permanent
pacemaker may be necessary if the patient becomes
symptomatic. and involves the use of a temporary transvenous
or trancutaneous pacemaker
Preload After load
Definition: Definition:
Preload is the ventricular stretch at the end of Afterload is the pressure that the chambers of
the diastole the heart generate in order to eject blood out of
Affecting factors: the heart
Venous blood pressure and the rate of venous Affecting factors:
return Systemic vascular resistance and pulmonary
Occurrence: During diastole vascular resistance
Depends on: The amount of ventricular filling Occurrence: During Systole
Type of parameter: Preload is a volume Depends on: The arterial blood pressure and
vascular tone
Type of parameter: Afterload is a pressure
Type 1 second degree heart Type 11 second degree heart
block block
o ECG recorded in patient with Mobitz type In a patient with mobitz type 2 block, a
1 or wenckeback block shows progressive blocked beat occurs suddently and is not
prolongation of the PR interval until a P preceded by a change in the duration of the PR
wave is completely blocked and a interval. Patient is equipped with a pacemaker,
ventricular beat is dropped. The PR which cuts in to sustain a regular ventricular
interval of the next conducted beat is rhythm
shorter than the preceding PR interval
o Site of block: is usually AV nodal
o QRS complex: is usually normal in width Site of block: Infra nodal
QRS complex: It is usually wide
o Causes:
Degenerative changes in AV node Causes:
MI Extensive myocardial infarct
Digitalis toxicity Degenerative changes in His-purkinje
Myocardities systm
Massive calcification of mitral or aortic
Rhematic fever
valve defects
Increased Vagal tone
Effect of atropine: Frequently shorter PR Effect of atropine: No effect
interval and increases AV conduction
