Health Problems

Common in
School Age
Children

Health Problems Common in School Age

Children

Cardiac Arrythmias

Health Problems Common in School Age

Children

Cardiac arrhythmias
are any abnormality in the
normal activation
sequence of the
myocardium.

Health Problems Common in School Age

Children

There are hundreds of

different types of cardiac
arrhythmias.
The normal rhythm of the
heart, so-called normal
sinus rhythm, can be
disturbed through failure
of automaticity.

Health Problems Common in School Age

Children

Ectopic foci prematurely

exciting the myocardium on
a single or continuous basis
results in:
-premature atrial
contractions (PACs)
-premature ventricular
contractions (PVCs).

Health Problems Common in School Age

Children

Sustained tachyarrhythmias
in the atria, such as:
-atrial fibrillation,
-paroxysmal atrial
tachycardia (PAT), and
-supraventricular tachycardia
(SVT),

Health Problems Common in School Age

Children

In general, the seriousness

of cardiac arrhythmias
depends on the presence
or absence of structural
heart disease.

Health Problems Common in School Age

Children

The most common

example of a relatively
benign arrhythmia is atrial
fibrillation.

Health Problems Common in School Age

Children

Similarly common are

PACs and PVCs, which,
although a nuisance,
generally are benign in the
absence of structural
heart disease.

Health Problems Common in School Age

Children

Health Problems Common in School Age

Children

Pathophysiology
Arrhythmias falls into one of
three basic mechanisms:
1. enhanced or suppressed
automaticity,
2. triggered activity, or reentry.

Health Problems Common in School Age

Children

Automaticity is a natural
property of all myocytes.
Ischemia, scarring,
electrolyte disturbances,
medications, advancing
age, and other factors may
suppress or enhance
automaticity in various
areas.

Health Problems Common in School Age

Children

Suppression of
automaticity of the
sinoatrial (SA) node can
result in sinus node
dysfunction and in sick
sinus syndrome (SSS),
which is still the most
common indication for
permanent pacemaker
implantation

Health Problems Common in School Age

Children

Signs and symptoms

dizziness,
palpitations, and
syncope are frequent
complaints encountered.

Health Problems Common in School Age

Children

Example of ECG tracings of

patient with arhrythmias

Health Problems Common in School Age

Children

The signs and symptoms

of cardiac arrhythmias can
range from none at all to
loss of consciousness or
sudden cardiac death

Health Problems Common in School Age

Children

In general, more-severe
symptoms are more likely
to occur in the presence of
structural heart disease.

Health Problems Common in School Age

Children

Symptoms in patients with

severe LV dysfunction.
lightheadedness,
dizziness,
fluttering,
pounding,
quivering,
shortness of breath,

Health Problems Common in School Age

Children

Symptoms in patients with

severe LV dysfunction.
dizziness, chest
discomfort,
and forceful or painful
extra beats are commonly
reported with various
arrhythmias.

Health Problems Common in School Age

Children

Symptoms in patients with

severe LV dysfunction.
Often, patients notice
arrhythmias only after
checking their peripheral
pulses.

Health Problems Common in School Age

Children

Health Problems Common in School Age

Children

Diagnosis
Assessment of Structural
Heart Disease.
-history of CAD or MI
- physical examination,
check the ECG for
conduction delays, QRS
widening, previous MI, or
PVCs.

Health Problems Common in School Age

Children

Diagnosis
Assessment of Structural
Heart Disease.
Cardiac ausculation may
detect an irregular rhythm or
premature beats.
-stress testing

Health Problems Common in School Age

Children

Diagnosis
Assessment of Structural
Heart Disease.
-2 D echography, may detect
presence of CAD, LV
dysfunction.
Or valvular heart disease.
-

Health Problems Common in School Age

Children

Holter Monitoring
Identifying underlying
rhythm abnormalities.
Generally, 24- to 48-hour
baseline Holter monitoring
is useful in quantitating
and qualifying arrhythmias
in patients with frequent
symptoms.

Health Problems Common in School Age

Children

Treatment
Pacemakers and
Defibrillators
Implantation of a permanent
pacemaker requires specific
levels of evidence and
indications.

Health Problems Common in School Age

Children

Health Problems Common in School Age

Children

Since their introduction 40

years ago, pacemakers
have advanced in
sophistication, reliability,
and longevity.
Current pacemakers are
expected to last at least
10 years and leads much
longer.

Health Problems Common in School Age

Children

Antiarrhythmic
Medications
The medications
intravenous procainamide
moricizine,
flecainide,
and encainidewere
known to have potent
ventricular arrhythmia

Health Problems Common in School Age

Children

Antiarrhythmic
Medications
Quinidine was
subsequently shown to
increase mortality when
administered to patients
with atrial fibrillation.

Health Problems Common in School Age

Children

Radiofrequency ablation is
acceptable first-line
therapy for many
arrhythmias, including
atrial flutter (an atrial rate
of 240 beats/min or higher
and characteristic
negative saw tooth flutter
waves ).

Health Problems Common in School Age

Children

Health Problems Common in School Age

Children

Health Problems Common in School Age

Children

Health Problems Common in School Age

Children

Health Problems Common in School Age

Children

Health Problems Common in School Age

Children

Health Problems Common in School Age

Children