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CardiacArrhythmiasPathophysiology PDF
CardiacArrhythmiasPathophysiology PDF
ca)
Brady-arrhythmias
of Cardiac
Altered Impuse Altered Impulse
Formation Arrhythmias Conduction
Re-entry loops
↑ automaticity An impulse travels continuously around a
circular (re-entrant )path in the myocardium,
continuously depolarizing that cardiac region.
↑ SA node ↑ automaticity of latent Abnormal automaticity Triggered activity Re-entry loops occur in branched,
automaticity pacemakers (ectopic pacemakers in atrial (“R on T phenomenon”) dysfunctional/fibrotic myocardium w/:
(↑ sympathetic If the AV node and purkinje &/or ventricular myoctes) ”after-depolarizations” cause 1) Unidirectional block: when impulses can’t
stimulation of β1- fibers intrinsically depolarize If normally non-conducting extra ventricular contractions conduct forwards, but can be conducted
adrenergic faster than SA node (produce heart cells depolarize faster during their repolarization. backwards, in the piece of myocardium
receptors) “ectopic beats”), they’ll control than SA node, they’ll produce Early after-depol’s in Long QT 2) Slowed retrograde conduction velocity:
impulse formation (produce an an abnormal ectopic rhythm pts torsades de pointes backward impulse conduction speed is slow,
Usually due to myocyte injury Delayed after-depol’s in high- allows normal myocardium to repolarize so
“ectopic rhythm”) – I.e. AV
Ca2+-pts idiopathic V-tach that the impulse propagates in a loop
Junctional Tachychardia
Tachy-arrhythmias
More on Re-entry loops:
Rate of re-entrant circuits is only limited by the refractory period of
the tissues involved. Thus, re-entry can ↑ contractions >300bpm!
Re-entry loops around distinct anatomical pathways Ex. VT due to ventricular scar, A-flutter,
monophorphic tacychardia on ECG (each QRS looks the same) AVNRT, AVRT (WPW)
Re-entry loops that are disorganized and constantly changing
Polymorphic tachycardia on ECG (no distinct QRS complexes visible) Ex. Polymorphic VT, V-fib, A-fib