Arrhythmias

Prof.Lammers
Cardiovascular module/ weeks
 Definition and causes
Arrhythmia is abnormal rhythm of the heart.
The possible causes of arrhythmias are:
1. Abnormal rhythmicity of the pacemaker
2. Shift of the pacemaker to another place in the heart
3. Block of different parts of the conducting system
4. Abnormal pathway of impulses transmission
5. Spontaneous generation of spurious impulses in all
parts of the heart.
 Types of arrhythmias
1. Abnormal sinus rhythm
2. Impulse conduction Block
3. Premature beats
4. Paroxysmal tachycardia
5. Fibrillation
 1.Abnormal sinus rhythm
Abnormal sinus rhythm is an example of abnormal
rhythmicity of the pace maker.
It could result from alteration in the strength of the
sympathetic and parasympathetic system.
Abnormal sinus rhythm are:
Tachycardia: HR>100. the possible causes are (Increase body
temprature, Increase sympathetic activity)
Bradycardia: HR<50. this is normal is athletes to allow the
heart to fill enough blood before pumping it. It could result also
from excess vagus stimulation
2.Impulse conduction block
Sinoatrial Block: the impulses are blocked in
the SA node before reaching the atrial muscles.
This will eliminate the P wave.
Atrioventricular Block: is caused when there is
ischemia, compression or inflammation of the
AV node or AV bundle.
Interventricular Block( RBBB or LBBB): in
which impulses fail to reach part of the heart
during heart cycle.
 SA block ( absent P wave)

Right bundle Branch block (RBBB): S wave is lead I, V6 & a prominent R

wave in V1
R
wave

S
wave

S
wave
Left Bundle branch block: S wave in V1 and prominent R wave in lead I and V6

S
wave
 Types of AV blocks
1st degree Block:characterized by a delay in the
conduction from the atrium to the ventricles this
is presented with Prolonged P-R interval.

P QRS T P QRS T P QRS T

Prolonged P-R interval

 Types of AV blocks
2nd Degree Block: characterized by slow impulses
conduction. Sometime the impulses are strong enough and
sometimes they are not. This is known as “ Dropped beats”
( no QRS).
This type has 2 subclasses:
Mobitz I: Progressive elongation of PR interval is associated
with drop beat.drop beat occur after progressive elongation
of PR interval
Mobitz II: elongation of PR interval is not associated with
drop beat.drop beat can occur anytime.
 Progressive elongation of P-R
Mobitz I

Mobitz II Dropped beat Dropped beat

 Types of AV block
3rd degree heart block: also known as complete
heart block. Where there is poor impulse
conduction in the AV node. It is presented in the
ECG by p wave is disassociated from QRS
complex. In this case the artial beats could be
100/min while the ventricular beats are 40/min

QRS QRS
P P P P
T
 3.Premature beats
It is also known as Extra-systole , Ectopic beats. In
this condition, the heart beats before the time of
normal contraction.
The causes of premature beat is Ectopic Foci, that
could be due to Ischemia, calcification plaque, toxic
irradiation of AV node or purkinji fibers.
The clinical manifestation of Premature beat is pulse
deficit.As the ventricles will not be able to fill
Cardiac output decreasesperipheral pulse is not felt.
 Types of Premature beats
Premature Atrial Contraction (APC): when the
atrium contracts very fast.P waves occur too soon
and PR interval is very short. The possible reason
is that the beat originates in the atrium some where
distance from the SA node.
 Types of Premature beats
Premature Junctional beat: The beat
originate from the AV node junction and it
is characterized by absent P wave

No P wave Premature Junctional beat

 Types of premature beats
Premature ventricular contraction (PVC):
abnormal QRS complex
prolonged( wide QRS)
high voltage (tall QRS)
T wave opposite the polarity of the QRS =
Prolonged/ high voltage QRS
Inverted

Premature Ventricular
contraction Inverted T wave
 4.Paroxysmal tachycardia
Paroxysmal tachycardia is a rapid rhythmical
discharge of impulses that spread throughout the
heart. It is caused by re-entrant circus
movement.
Types of paroxysmal tachycardia:
Paroxysmal supraventricular tachycardia
Paroxysmal ventricular tachycardia
 Types of paroxysmal tachycardia

Paroxysmal Supraventricular tachycardia:

during the rapid heart beat, the P wave is either
inverted or within the QRS complex. The QRS
complex should be narrow, indicating that the
impulses are generated in the atrium.

Supraventricular Tachycardia (HR=170), no P wave and a narrow QRS complex

Types of paroxysmal tachycardia

Paroxysmal ventricular tachycardia: the impulses

are generated from the ventricles which will lead to
abnormal QRS and T waves (QRS is usually wide:
indicating that impulses are generated in the
ventricles) and absent P wave. This is a serious
problem because: it does not occur unless there is a
considerable ischemic damage, and it could initiate
Ventricular fibrillation

Ventricular tachycardia: abnormal

QRS and absent T wave
 5.Fibrillation
Fibrillation result from cardiac impulses that have
gone berserk within the musclethis will
stimulate a portion of muscles to contract & other
are relaxing  the impulse will feed-back on the
same portion of muscle to re-excite them over and
over
As a result there will be abnormal coordination in
the contraction of the muscles.
 Phenomenon of re-entry circus
movement
Fibrillation result Phenomenon of re-entry circus
movement. In which there will be re-excitation of the
cardiac muscles over & over.
For re-excitation to occur, impulses should reach the
muscle after the end refractory period :
1. The pathway around the circus is enlarged (ex.dilated heart)
2. Velocity of conduction is decreased (ex.Block of purkinji
fibers)
3. Refractory period is shorten ( ex. by using some drugs)
 Types of fibrillation
Ventricular fibrillation: the most serious
arrhythmia which if not stopped in 2-3 minutes by
cardioversion >> fatal.
The ventricles are not contracting, as a result no
blood is pumped out of the ventricles & The
patient loses consciousness immediately.
The ECG pattern is showing a “saw tooth” shape
in which there is erratic, chaotic pattern of QRS
complexes
Saw tooth pattern
 Types of fibrillation
Atrial fibrillation: The atrium is not contraction
& therefore losses its effect as a primer pump to
eject the extra 25% of blood to the ventricles.
The ECG is AF is irregularly irregular and there is
no P wave
 Atrial flutter
Is another condition which is caused by circus
movement in the atria. But it is different from
atrial fibrillation because the electrical impulses
travel as a single signal always in ONE direction.
In atrial flutter, when impulses reach the AV node
they delay there. Therefore, every 2-3 beats of the
atrium is for 1 beat of the ventricles.
In the ECG we can see the flutter waves.
Flutter waves, with a
very high atrial rate and P P P P P P

low ventricular rate.

QRS QRS QRS
2 P waves for 1 QRS