TY  - CHAP
M1  - Book, Section
TI  - Arrhythmia Diagnosis and Management
A1  - Gupta, Dipti
A1  - Roistacher, Nancy
A2  - Oropello, John M.
A2  - Pastores, Stephen M.
A2  - Kvetan, Vladimir
Y1  - 1
N1  - 
T2  - Critical Care
AB  - KEY  POINTSBetween  12%  and  19%  of  patients  in  intensive  care  unit  (ICU)  settings  have  sustained  arrhythmias.In  the  ICU,  the  most  common  causes  of  arrhythmias  are  infection,  electrolyte  abnormalities,  medications,  ischemia,  anemia,  hypoxia,  and  changes  in  volume  status  and  hemodynamics.Tachycardias  are  more  common  than  bradycardias  and  atrial  arrhythmias  are  more  common  than  ventricular  arrhythmias.Common  causes  of  bradycardia  include  beta-blockers,  calcium  channel  blockers,  digoxin,  narcotics,  and  antiemetics.Patients  are  less  likely  to  remain  hemodynamically  stable  with  higher  degrees  of  atrioventricular  (AV)  block  and  usually  require  temporary  pacing  (transthoracic  or  transvenous),  and  ultimately  permanent  pacing  if  the  heart  block  persists.AV  dissociation  occurs  when  there  is  loss  of  the  usual  pattern  of  atrial  and  ventricular  synchrony  and  there  is  no  association  between  P  waves  and  the  QRS  complexes.The  majority  of  atrial  tachyarrhythmias  in  the  critically  ill  patient  are  due  to  atrial  fibrillation,  atrial  flutter,  AV  nodal  reentry  tachycardia,  ectopic  atrial  tachycardia  with  rapid  ventricular  rates,  and  underlying  preexcitation  with  an  atrial  arrhythmia.For  the  hemodynamically  unstable  or  symptomatic  patient  with  AV  nodal  reentrant  tachycardia,  initial  choices  include  adenosine  or  direct  current  cardioversion  to  restore  sinus  rhythm  and  hemodynamic  stability.Multifocal  atrial  tachycardia  is  usually  associated  with  underlying  pulmonary  disease  especially  severe  chronic  obstructive  lung  disease  or  respiratory  failure  in  older,  acutely  ill  individuals.Atrial  fibrillation  is  the  most  common  dysrhythmia  in  the  critically  ill.  Recent  clinical  trials  have  demonstrated  similar  outcomes  with  rate  and  rhythm  control  strategies  for  atrial  fibrillation.Indications  for  urgent  cardioversion  in  atrial  fibrillation  include  hypotension/shock,  acute  or  ongoing  myocardial  ischemia,  congestive  heart  failure  and/or  acute  pulmonary  edema,  and  underlying  preexcitation  with  rapid  ventricular  rates  and/or  hemodynamic  instability.Torsade  de  pointes  and  other  forms  of  polymorphic  tachycardia  are  rapid  ventricular  rhythms  associated  with  hemodynamic  instability  and  a  predisposition  to  degenerate  into  ventricular  fibrillation.Patients  with  nonsustained  ventricular  tachycardias  and  ischemic  heart  disease  in  ICU  settings  should  be  given  beta-blockers  to  control  heart  rate,  blood  pressure  and  rhythm  disturbances,  electrolyte  replacement,  and  control  of  stimulatory  factors,  such  as  anemia,  pain,  and  fever.Ventricular  fibrillation  requires  emergency  defibrillation.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1136414115
ER  -