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{{Infobox_Disease |
__NOTOC__
  Name          = Cardiac arrhythmia |
{| class="infobox" style="float:right;"
  Image          = EKG_VF.jpg|
|-
  Caption        = Ventricular Fibrillation or V-Fib, an example of cardiac arrhythmia. |
| [[File:Siren.gif|30px|link=Arrhythmia resident survival guide]]|| <br> || <br>
  DiseasesDB    = 15206 |
| [[Arrhythmia resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
  ICD10          = {{ICD10|I|47||i|30}} - {{ICD10|I|49||i|30}} |
|}
  ICD9          = {{ICD9|427}} |
{{CMG}}; {{AE}} {{Rim}}
  ICDO          = |
  OMIM          = |
  MedlinePlus    = 001101 |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID        = D001145 |
}}
{{SI}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}


==Overview==
==Overview==
Cardiac arrhythmia is any of a large and heterogeneous group of conditions in which there is abnormal electrical activity in the [[heart]]. The [[heart beat]] may be too fast or too slow, and may be regular or irregular. A heart beat that is too fast is called [[tachycardia]] and a heartbeat that is too slow is called [[bradycardia]]. Although many arrhythmias are not life-threatening, some can cause [[cardiac arrest]].


'''Cardiac arrhythmia''' is any of a group of conditions in which the electrical activity of the [[heart]] is irregular or is faster or slower than normal.  
==Classification of Cardiac Arrhythmia==
{{familytree/start |summary=Arrhythmia}}
{{familytree | | | | | | | | | | | | | | A01 | | | A01='''Arrhythmia'''}}
{{familytree | | | | | |,|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|.| | | | | }}
{{familytree | | | | | B01 | | | | | | | B02 | | | | | | | B03 | B01= '''[[Bradyarrhythmia]]'''| B02= '''Arrhythmia <br> with normal heart rate'''| B03= '''[[Tachyarrhythmia]]''' }}
{{familytree | | | | | |!| | | | |,|-|-|-|+|-|-|-|.| | | | |!| | | | | }}
{{familytree | | | | | |!| | | | B04 | | B05 | | B06 | | | |!| | | | | B04= '''<u>The origin of the impulse:</u><br>Atria'''| B05= '''<u>The origin of the impulse:</u><br>AV junction'''| B06= '''<u>The origin of the impulse:</u><br> Ventricles'''}}
{{familytree | | | | | |!| | | | |!| | | |!| | | |!| | | | |!| | | | | }}
{{familytree | | | | | |!| | | | B07 | | B08 | | B09 | | | |!| | | | |B07= [[Sinus arrhythmia]] <br> [[Atrial bigeminy]]| B08=[[Accelerated junctional rhythm]] <br> [[Junctional bigeminy]]| B09= [[Accelerated idioventricular rhythm]] <br> [[Ventricular bigeminy]] }}
{{familytree | | | | | |!| | | | | | | | | | | | | | | | | |!| | | | | }}
{{familytree | |,|-|-|-|+|-|-|-|.| | | | | | | | |,|-|-|-|-|^|-|-|-|.| }}
{{familytree | C01 | | C02 | | C03 | | | | | | | C04 | | | | | | | C05 | | C01= '''<u>The origin of the impulse:</u><br>Atria'''| C02= '''<u>The origin of the impulse:</u><br>AV junction'''| C03= '''<u>The origin of the impulse:</u><br> Ventricles'''|C04= '''[[SVT|Narrow complex tachycardia (SVT)]]'''| C05= '''[[Wide complex tachycardia]]''' }}
{{familytree | |!| | | |!| | | |!| | | | |,|-|-|-|^|-|.| | | | |,|-|+|-|.| |}}
{{familytree | D01 | | D02 | | D03 | | | D04 | | | | D05 | | | D06 |!| D07 |D01= '''Normal variant:'''<br>[[Respiratory sinus arrhythmia]]<br> <br>'''[[Sinus node dysfunction]]:'''<br>[[Sinus bradycardia]]<br> [[Sinoatrial block]] <br> [[Sinus arrest]] <br> [[Sick sinus syndrome]]<br><br> '''Abnormality in the atria:'''<br>[[Low atrial focus bradycardia]]<br> [[Atrial bigeminy]] <br><br> '''[[AV block|AV node dysfunction]]:'''<br>[[First Degree AV Block|First degree AV block]] <br> [[Second Degree AV Block|Second degree AV block]] <br> [[Complete or Third-Degree AV Block|Complete or third-degree AV block]]|D02= [[Junctional bradycardia|Junctional escape rhythm]] <br> [[Junctional bigeminy]]| D03=[[Isorhythmic A-V dissociation]] <br> [[Slow VT]] ([[idioventricular rhythm]])<br>[[Ventricular escape rhythm]]<br> [[Escape capture bigeminy]]|D04= '''<u>The origin of the impulse:</u><br>Atria'''| D05= '''<u>The origin of the impulse:</u><br>AV junction'''| D06= '''<u>The origin of the impulse:</u><br>Atria or AV junction'''| D07= '''<u>The origin of the impulse:</u><br> Ventricles''' }}
{{familytree | | | | | | | | | | | | |,|-|^|-|.| | | |!| | | | |!| |!| |!| }}
{{familytree | | | | | | | | | | | | E01 | | E02 | | E03 | | | E04 |!| E05 |E01= [[Atrial fibrillation]] <br> [[Atrial flutter]] <br> [[Ectopic Atrial Rhythm|Ectopic atrial rhythm]] <br> [[Multifocal Atrial Tachycardia (MAT)|Multifocal atrial tachycardia (MAT)]] <br> [[Paroxysmal Atrial Tachycardia (PAT) with Block|Paroxysmal atrial tachycardia (PAT) with block]] <br> [[Premature Atrial Contractions (PACs)|Premature atrial contractions (PAC)]] <br> [[Sinus Tachycardia|Sinus tachycardia]] <br> [[Wandering atrial pacemaker]]<br> [[Sick sinus syndrome]]| E02= [[AVNRT]] <br><br> [[AVRT]] ([[accessory pathway]]):<br>- [[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White syndrome (WPW)]]<br>- [[Lown-Ganong-Levine syndrome|Lown-Ganong-Levine syndrome (LGL)]]|E03=[[Accelerated junctional rhythm]] <br> [[Junctional ectopic tachycardia]]| E04= '''[[Wide complex tachycardias|SVTAC]]'''<br>'''([[Wide complex tachycardias|SVT with aberrant conduction]]):<br><br>'''[[Left Bundle Branch Block|Left bundle branch block]] <br> [[LAHB|Left anterior hemi-block]] <br> [[Left posterior fascicular block electrocardiogram|Lefo posterior hemi-block]] <br> [[Right Bundle Branch Block|Right bundle branch block]] <br> [[Trifascicular block]]| E05= [[Ventricular tachycardia]] <br> [[Ventricular fibrillation electrocardiogram|Ventricular fibrillation]] <br> [[Ventricular Parasystole|Ventricular parasystole]] <br> [[Ventricular bigeminy]]}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | F01 | | | | F02 | F01=  '''<u>The origin of the impulse:</u><br>Atria, AV junction or ventricles<br><br> Presence of an [[accessory pathway]]'''| F02= '''<u>The origin of the impulse:</u><br>Pacemaker'''}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | |!| | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | G01 | | | | G02 | G01= '''[[Accessory pathway]]'''<br><br>[[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White syndrome (WPW)]]<br>[[Lown-Ganong-Levine syndrome|Lown-Ganong-Levine syndrome (LGL)]]| G02= '''[[Paced rhythm]]'''<br><br>[[Pacemaker-mediated tachycardia]] <br> [[Runaway pacemaker syndrome]]<br> [[Sensor induced tachycardia]]}}
{{familytree/end}}


Some arrhythmias are life-threatening [[medical emergencies]] that can cause [[cardiac arrest]] and [[sudden death]]. Others cause aggravating symptoms, such as an awareness of a different heart beat, or [[palpitation]], which can be annoying. Some are quite minor and can be regarded as normal. Sinus arrhythmia is the mild acceleration followed by slowing of the normal rhythm that occurs with breathing. In adults the normal resting heart rate ranges from 60 beats per minute to 100 beats per minute. The normal heart beat is controlled by a small area in the upper chamber of the heart called the [[sinoatrial node]] or sinus node. The sinus node contains specialized cells that have spontaneous electrical activity that starts each normal heart beat.
==Cardiac Arrhythmias in Alphabetical Order==
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[Accelerated idioventricular rhythm]]


== Faster and slower arrythmias ==
*[[Accessory pathway]]
In an adult, a heart rate faster than 100 beats/minute is considered [[tachycardia]]. This number varies with age, as the heartbeat of a younger person is naturally faster than that of an older person's. During exercise the sinus node increases its rate of electrical activity to accelerate the heart rate. Such normal fast rate that develops is called sinus tachycardia. In contrast, arrhythmias that are due to fast, abnormal electrical activity can cause tachycardias that are dangerous. If the [[left ventricle|ventricles]] of the heart experience one of these tachycardias for a long period of time, there can be deleterious effects. Individuals may sense a tachycardia as a pounding sensation of the heart, known as [[palpitation]]s. If a tachycardia lowers blood pressure it may cause lightheadedness or dizziness, or even [[fainting]] (syncope). If the tachycardia is too fast, the pump function of the heart is impeded, and rarely may lead to [[cardiac arrest|sudden death]].


Most tachycardias are not dangerous. Anything that increases adrenaline or its effects on the heart will increase the heart rate and potentially cause palpitations or tachycardias. Causes include stress, ingested or injected substances (ie: [[caffeine]], [[amphetamines]], [[ethanol|alcohol]]&mdash;see [[Holiday heart syndrome]]), and an overactive thyroid gland ([[hyperthyroidism]]). Individuals who have a tachycardia are often advised to limit or remove exposure to any causative agent. However, these causative agents are not the only contributors to tachycardias and their prevalence has not been evaluated statistically.
*[[Andersen–Tawil syndrome]]


A slow rhythm, known as [[bradycardia]] (less than 60 beats/min), is usually not life threatening, but may cause symptoms. It may be caused by reversible causes (low oxygen, electrolyte abnormalities), or be more permanent (heart block). When it causes symptoms implantation of a permanent [[artificial pacemaker|pacemaker]] may be needed. Either dysrhythmia requires medical attention to evaluate the risks associated with the arrhythmia.
*[[Artificial pacemaker]]
 
*[[Atrial fibrillation]]
 
*[[Atrial flutter]]
 
*[[Atrial tachycardia]]
 
*[[AV nodal reentrant tachycardia]]
 
*[[AV reentrant tachycardia]]
 
*[[Bradycardia]]
 
*[[Broad complex tachycardia]]
 
*[[Bundle of His]]
 
*[[Bundle of Kent]]


== Fibrillation ==
*[[Cardiac arrhythmia following heart transplantation]]


A serious variety of arrhythmia is known as [[Ventricular fibrillation|fibrillation]]. The muscle cells of the heart normally function together, creating a single contraction when stimulated. Fibrillation occurs when the [[heart]] [[muscle]]  begins a quivering motion due to a disunity in contractile cell function. Fibrillation can affect the atrium ([[atrial fibrillation]]) or the ventricle ([[ventricular fibrillation]]); ventricular fibrillation is imminently life-threatening.
*[[Ectopic atrial rhythm]]


''Atrial fibrillation'' is the quivering, chaotic motion in the upper chambers of the heart, known as the [[Atrium (heart)|atria]]. Atrial fibrillation is often due to serious underlying medical conditions, and should be evaluated by a [[physician]]. It is not typically a medical emergency.
*[[First degree AV block]]


''Ventricular fibrillation'' occurs in the [[ventricle (heart)|ventricles]] (lower chambers) of the heart; it is always a medical emergency. If left untreated, [[ventricular fibrillation]] (VF, or V-fib) can lead to death within minutes. When a heart goes into V-fib, effective pumping of the blood stops. V-fib is considered a form of [[cardiac arrest]], and an individual suffering from it will not survive unless [[cardiopulmonary resuscitation]] (CPR) and [[defibrillation]] are provided immediately.
*[[Focal atrial tachycardia]]


CPR can prolong the survival of the [[brain]] in the lack of a normal pulse, but defibrillation is the intervention which is most likely to restore a more healthy heart rhythm. It does this by applying an electric shock to the heart, after which sometimes the heart will revert to a rhythm that can once again pump blood.
*[[Heart transplantation associated arrhythmias]]


Almost every person goes into ventricular fibrillation in the last few minutes of life as the heart muscle reacts to diminished oxygen or general blood flow, trauma, irritants, or depression of electrical impulses themselves from the brain.
*[[Idioventricular rhythm]]
{{col-break|width=33%}}


==Origin of impulse==
*[[Isorhythmic A-V Dissociation]]


When an electrical impulse begins in any part of the heart, it will spread throughout the [[myocardium]] and cause a contraction; see [[Electrical conduction system of the heart]]. Abnormal impulses can begin by one of two mechanisms: automaticity or reentry.
*[[Junctional bradycardia]]


===Automaticity===
*[[Junctional tachycardia]]


Automaticity refers to a cardiac muscle cell firing off an impulse on its own. Every cardiac cell has this potential: if it does ''not'' receive any impulses from elsewhere, its internal "pacemaker" will fire off an impulse after a certain amount of time. A single specialized location in the atrium, the [[sinoatrial node]], has a higher automaticity (a faster pacemaker) than the rest of the heart, and therefore is usually the one to start the heartbeat.
*[[Left anterior hemiblock]]


Any part of the heart that initiates an impulse without waiting for the sinoatrial node is called an ''[[Cardiac ectopy|ectopic]] focus'', and is by definition a pathological phenomenon. This may cause a single premature beat now and then, or, if the ectopic focus fires more often than the sinoatrial node, it can produce a sustained abnormal rhythm. Rhythms produced by an ectopic focus in the atria, or by the [[atrioventricular node]], are the least dangerous dysrhythmias; but they can still produce a decrease in the heart's pumping efficiency, because the signal reaches the various parts of the heart muscle with slightly different timing than usual and causes a poorly coordinated contraction.
*[[Left bundle branch block]]


Conditions that increase automaticity include [[sympathetic nervous system]] stimulation and [[Hypoxia (medical)|hypoxia]]. The resulting heart rhythm depends on where the first signal begins: if it is the sinoatrial node, the rhythm remains normal but rapid; if it is an ectopic focus, many types of dysrhythmia can result.
*[[Left posterior fascicular block]]


===Re-entry===<!-- This section is linked from [[Myocardial infarction]] -->
*[[Low atrial focus tachycardia]]
Re-entry dysrhythmias occur when an electrical impulse travels in a circle within the heart, rather than moving outward and then stopping. Every cardiac cell is able to transmit impulses in every direction, but will only do so once within a short period of time. Normally the impulse spreads through the heart quickly enough that each cell will only respond once, but if conduction is abnormally slow in some areas, part of the impulse will arrive late and will be treated as a new impulse, which can then spread backward. Depending on the timing, this can produce a sustained abnormal rhythm, such as [[atrial flutter]], a self-limiting burst of [[supraventricular tachycardia]], or the dangerous [[ventricular tachycardia]].


== Differential Diagnosis ==
*[[Lown-Ganong-Levine syndrome]]


=== AV Reentry Tachycardia with Preexcitation Complex ===
*[[Mahaim fibers]]


* Congenital
*[[Multifocal atrial tachycardia]]
* [[Drug]]s
* Emotional excitation
* Heavy exercise


=== AV Node Reentry Tachycardia Without Preexcitation ===
*[[Pacemaker mediated tachycardia]]


* [[Ddx:Cardiomyopathy|Cardiomyopathy]]
*[[Paroxysmal Atrial Tachycardia (PAT) with Block]]
* Congenital
* [[Hyperthyroidism]]
* [[Mitral valve prolapse]]


By analogy, imagine a room full of people all given these instructions: "If you see anyone starting to stand up, then stand up for three seconds and sit back down." If the people are quick enough to respond, the first person to stand will trigger a single wave which will then die out; but if there are stragglers on one side of the room, people who have already sat down will see them and start a second wave, and so on.
*[[Paroxysmal supraventricular tachycardia]]


==Diagnosis==
*[[Premature atrial contraction]]


Cardiac dysrhythmias are often first detected by simple but nonspecific means: [[auscultation]] of the heartbeat with a [[stethoscope]], or feeling for peripheral [[pulse]]s. These cannot usually diagnose specific dysrhythmias, but can give a general indication of the heart rate and whether it is regular or irregular. Not all the electrical impulses of the heart produce audible or palpable beats; in many cardiac arrhythmias, the premature or abnormal beats do not produce an effective pumping action and are experienced as "skipped" beats.
*[[Right bundle branch block]]


The simplest ''specific'' diagnostic test for assessment of heart rhythm is the [[electrocardiogram]] (abbreviated '''ECG''' or '''EKG'''). A [[Holter monitor]] is an EKG recorded over a 24-hour period, to detect dysrhythmias that may happen briefly and unpredictably throughout the day.
*[[Runaway pacemaker syndrome]]


==SADS==
*[[Second degree AV block]]


'''SADS''', or '''sudden arrhythmia death syndrome''', is a term used to describe sudden [[death]] due to [[cardiac arrest]] brought on by an arrhythmia. The most common cause of sudden death in the US is coronary artery disease. Approximately 300,000 people die suddenly of this cause every year in the US.
*[[Sensor induced tachycardia]]


Sudden Arrhythmia Death Syndrome (SADS) can also occur from other causes. Also, there are many inherited conditions and heart diseases that can affect young people that can cause sudden death. Many of these victims have no symptoms before dying suddenly. 
*[[Sick sinus syndrome]]
{{col-break|width=33%}}


Causes of SADS in young people are [[long QT syndrome]], [[Brugada syndrome]], [[Catecholaminergic polymorphic ventricular tachycardia]] and [[hypertrophic cardiomyopathy]] and [[arrhythmogenic right ventricular dysplasia]] ("arrythmia"-causing, "right ventricle"-involving, pre-cancerous malformation).
*[[Sinoatrial nodal reentry tachycardia]]


==List of common cardiac arrhythmias==
*[[Sinus arrhythmia]]


*Atrial Rhythms
*[[Sinus bradycardia]]
**[[Premature atrial contraction|Premature Atrial Contractions (PACs)]]
**[[Wandering pacemaker|Wandering Atrial Pacemaker]]
**[[Multifocal atrial tachycardia]]
**[[Supraventricular tachycardia|Supraventricular tachycardia (SVT)]]
**[[Atrial flutter]]
**[[Atrial fibrillation|Atrial fibrillation (Afib)]]
*Ventricular Rhythms
**[[Premature ventricular contraction|Premature Ventricular Contractions (PVC)]]
**[[Accelerated idioventricular rhythm]]
**[[Ventricular tachycardia]]
**[[Ventricular fibrillation]]
**[[Polymorphic ventricular tachycardia]]
*Atrial Ventricular Arrythmias
**[[AV nodal reentrant tachycardia]]
**[[AV reentrant tachycardia]]
***[[Wolff-Parkinson-White syndrome]]
***[[Lown-Ganong-Levine syndrome]]
*Junctional Arrhythmias
**[[Junctional rhythm]]
**[[Junctional tachycardia]]
**Premature junctional complex
*Heart Blocks, also known as [[atrioventricular node|AV]] blocks
**[[First degree heart block]], also known as PR prolongation
**[[Second degree heart block]]
***[[Type 1 Second degree heart block]], also known as [[Mobitz I]] or [[Wenckebach]]
***[[Type 2 Second degree heart block]], also known as [[Mobitz II]]
**[[Third degree heart block]], also known as [[complete heart block]]


== Antiarrhythmic therapies==
*[[Sinus tachycardia]]


There are many classes of antiarrhythmic medications and many individual drugs within these classes. See the article on '''[[antiarrhythmic agents]]'''.
*[[Slow VT]]


Dysrhythmias may also be treated electrically. [[Cardioversion]] is the application of electrical current across the chest wall to the heart and it is used for treatment of supraventricular or pulsed ventricular tachycardia. [[Defibrillation]] differs in that it is used for ventricular fibrillation and pulseless ventricular tachycardia, and more electricity is delivered with defibrillation than with cardioversion. In cardioversion, the recipient is either sedated or lightly [[anesthesia|anesthetized]] for the procedure. In defibrillation, the recipient has lost consciousness so there is no need for sedation. 
*[[Supraventricular tachycardia]]


Electrical treatment of dysrhythmia includes [[cardiac pacing]]. Temporary pacing may be done for very slow heartbeats, or [[bradycardia]], from [[drug overdose]] or [[myocardial infarction]]. A [[artificial pacemaker|pacemaker]] may be placed in situations where the bradycardia is not expected to recover.
*[[SVT with aberrancy]]


Atrial fibrillation can also be treated through a procedure, e.g. pulmonary vein isolation. This is performed by a cardiologist who specializes in electrophysiology and is done [[percutaneously]] with [[catheters]]. Alternatively, a maze procedure can be performed through [[cardiothoracic surgery]].
*[[Tachycardia]]


===Fatty acids===
*[[Tachycardia bradycardia syndrome]]


[[Fatty acids]] play an important role in the life and death of cardiac cells because they are essential fuels for mechanical and electrical activities of the heart.<ref>{{cite web | title=External blockade...by polyunsaturated fatty acids | url=http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=43279&pageindex=1#page | format= | publisher=pubmed}}Retrieved on 18 January 2007 </ref><ref>{{cite web | title=Antiarrythmic effects of omega-3 fatty acids | url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16919517&query_hl=87&itool=pubmed_DocSum | format= | publisher=pubmed}}Retrieved on 18 January 2007</ref> <ref>{{cite web | title=Alpha-linolenic acid, cardiovascular disease and sudden death | url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17086218&query_hl=3&itool=pubmed_DocSum | format= | publisher=pubmed}}Retrieved on 18 January 2007</ref> <ref>{{cite web | title=Omega-3 and health | url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17091903&query_hl=3&itool=pubmed_DocSum | format= | publisher=pubmed}}</ref> Retrieved on 18 January 2007
*[[Third degree AV block]]


==References==
*[[Trifascicular block]]
{{reflist|2}}
 
*[[Ventricular escape]]
 
*[[Ventricular fibrillation]]
 
*[[Ventricular parasystole]]
 
*[[Ventricular tachycardia]]


==Related Chapters==
*[[Wandering atrial pacemaker]]
*[[Clinical cardiac electrophysiology]]
*[[Antiarrhythmic agents]]
*[[Artificial pacemaker]]
*[[Electrical conduction system of the heart]]
*[[Implantable cardioverter-defibrillator]].


==Additional Resources==
*[[Wide complex tachycardias]]
* [http://www.themdtv.org The MD TV: Comments on Hot Topics, State of the Art Presentations in Cardiovascular Medicine, Expert Reviews on Cardiovascular Research]
* [http://www.clinicaltrialresults.org Clinical Trial Results: An up to dated resource of Cardiovascular Research]


*[[Wolff-Parkinson-White syndrome]]
{{col-end}}
<font color="white">{{Smallcaps|{{PAGENAME}} developed by WikiDoc.org}}</font>


{{Circulatory system pathology}}
===Causes===
{{Electrocardiography}}
{{SIB}}


===Drug Side Effect===
* [[Agalsidase beta]]
* [[Bromocriptine]]
* [[Calcium gluconate]].
* [[Caspofungin acetate]].
* [[Cefotaxime sodium]].
* [[Clomifene]].
* [[Crizotinib]].
* [[Cyclobenzaprine]].
* [[Cyclophosphamide]].
* [[Dipivefrine]]
* [[Doxorubicin Hydrochloride]].
* [[Gadoterate]]
* [[Granisetron]]
*[[Idarubicin hydrochloride]]
* [[Idursulfase]]
* [[interferon alfacon-1]]
* [[Tretinoin]].
* [[Meprobamate]]
* [[Metaproterenol]]
* [[Muromonab-CD3]]
*[[Nabilone]]
* [[Nalmefene]].
*[[Omacetaxine]]
*[[Oprelvekin]]
*[[Oxaprozin]]
* [[Oxytocin]].
* [[Pegylated interferon alfa-2b]]
* [[Pentamidine]]
* [[Pilocarpine]]
* [[Prednisolone]].
* [[Rubidium Rb 82]]
*[[Sargramostim]]
* [[Sorafenib]].
* [[Sodium phenylbutyrate]]
*  Laxatives like [[sodium sulfate, potassium sulfate and magnesium sulfate]].
*[[Teniposide]]
* [[Valdecoxib]],


[[de:Herzrhythmusstörung]]
====Contraindicated medications====
[[es:Trastornos del ritmo cardíaco]]
[[fr:Troubles de la conduction cardiaque]]
[[ko:부정맥]]
[[hr:Aritmija]]
[[it:Aritmia]]
[[he:הפרעת קצב]]
[[nl:Hartritmestoornis]]
[[new:कार्डियाक अरिदमिया]]
[[ja:不整脈]]
[[no:Arytmi]]
[[pl:Zaburzenia rytmu serca]]
[[pt:Arritmia cardíaca]]
[[ru:Аритмия]]
[[fi:Rytmihäiriö]]
[[sv:Arytmier]]
[[vi:Rối loạn nhịp tim]]
[[tr:Aritmi]]
[[uk:Аритмії серця]]
[[zh:心律失常]]


{{MedCondContrAbs|MedCond = Cardiac arrhythmia|Cyclobenzaprine|Metaproterenol|Sumatriptan}}


==References==
{{Reflist|2}}


{{WikiDoc Help Menu}}
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Latest revision as of 19:28, 23 August 2021



Resident
Survival
Guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

Cardiac arrhythmia is any of a large and heterogeneous group of conditions in which there is abnormal electrical activity in the heart. The heart beat may be too fast or too slow, and may be regular or irregular. A heart beat that is too fast is called tachycardia and a heartbeat that is too slow is called bradycardia. Although many arrhythmias are not life-threatening, some can cause cardiac arrest.

Classification of Cardiac Arrhythmia

 
 
 
 
 
 
 
 
 
 
 
 
 
Arrhythmia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bradyarrhythmia
 
 
 
 
 
 
Arrhythmia
with normal heart rate
 
 
 
 
 
 
Tachyarrhythmia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The origin of the impulse:
Atria
 
The origin of the impulse:
AV junction
 
The origin of the impulse:
Ventricles
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sinus arrhythmia
Atrial bigeminy
 
Accelerated junctional rhythm
Junctional bigeminy
 
Accelerated idioventricular rhythm
Ventricular bigeminy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The origin of the impulse:
Atria
 
The origin of the impulse:
AV junction
 
The origin of the impulse:
Ventricles
 
 
 
 
 
 
Narrow complex tachycardia (SVT)
 
 
 
 
 
 
Wide complex tachycardia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal variant:
Respiratory sinus arrhythmia

Sinus node dysfunction:
Sinus bradycardia
Sinoatrial block
Sinus arrest
Sick sinus syndrome

Abnormality in the atria:
Low atrial focus bradycardia
Atrial bigeminy

AV node dysfunction:
First degree AV block
Second degree AV block
Complete or third-degree AV block
 
Junctional escape rhythm
Junctional bigeminy
 
Isorhythmic A-V dissociation
Slow VT (idioventricular rhythm)
Ventricular escape rhythm
Escape capture bigeminy
 
 
The origin of the impulse:
Atria
 
 
 
The origin of the impulse:
AV junction
 
 
The origin of the impulse:
Atria or AV junction
 
 
The origin of the impulse:
Ventricles
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Atrial fibrillation
Atrial flutter
Ectopic atrial rhythm
Multifocal atrial tachycardia (MAT)
Paroxysmal atrial tachycardia (PAT) with block
Premature atrial contractions (PAC)
Sinus tachycardia
Wandering atrial pacemaker
Sick sinus syndrome
 
AVNRT

AVRT (accessory pathway):
- Wolff-Parkinson-White syndrome (WPW)
- Lown-Ganong-Levine syndrome (LGL)
 
Accelerated junctional rhythm
Junctional ectopic tachycardia
 
 
SVTAC
(SVT with aberrant conduction):

Left bundle branch block
Left anterior hemi-block
Lefo posterior hemi-block
Right bundle branch block
Trifascicular block
 
 
Ventricular tachycardia
Ventricular fibrillation
Ventricular parasystole
Ventricular bigeminy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The origin of the impulse:
Atria, AV junction or ventricles

Presence of an accessory pathway
 
 
 
The origin of the impulse:
Pacemaker
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Accessory pathway

Wolff-Parkinson-White syndrome (WPW)
Lown-Ganong-Levine syndrome (LGL)
 
 
 
Paced rhythm

Pacemaker-mediated tachycardia
Runaway pacemaker syndrome
Sensor induced tachycardia

Cardiac Arrhythmias in Alphabetical Order

Cardiac arrhythmia developed by WikiDoc.org

Causes

Drug Side Effect

Contraindicated medications

Cardiac arrhythmia is considered an absolute contraindication to the use of the following medications:

References


Template:WikiDoc Sources CME Category::Cardiology