EKG tfniurniaiities and Their Treatments

' Atrial-fibrillation- if patient. is .symptomatic, first slow ventricular rate, (digoxin, beta blocker, caleitun chahnef blocker):

« If acute (onset.< ¿4 hr), cardiovert With qumklme, procainamide, or direct current cardioversion. : Jfchraniei Hirst anUc^gulate,'then eaMloyen (ifpatient wtwriv»:to-ati^ continue; digioxm .-•••

Atrial flutter Treat like atrial fibrillation. .

First «lej»ree '■ .- ^Fo treatment, but avoid beta-. Mockers and caldujai-e^imel'blocJk'ers (both'slow tobductiohj. ..

:.Second-degree.'.'' . Pacemaker or atropine only for symptomatic patient with MobM.z type I; use pacemaker for all patients.

Third degree. lawmaker

■ W5V syndrome . Use .procainamide or quinidine; avoid digoxtu and verapamil.; .•

"Vemricular tachycardia. Udocamc

: Vetnricu 1 ar l'tbril!a.ttoi! .'/mrmidtate defibrillation .

'•• .L' .•Prewwiiire ventricular ''.' Usually not treated; if severe and symptomatic, consider lidocaine.

■contractions-.

. ;Sin.ifs:bradycardia Usually not treated; use atropine in severe and symptomatic eases (after myocardial infarction); .avoid':'-.".

beta blockers, calcium channel blockers, and other conduction slowers..

. Sinus tachycardia Usually none; correct underlying cause; use beta blocker if pattern is symptomatic.

* Always cheek, tor electrolyte djsturb;H>ct\s as the cause.

. WPW'~ Wolff-Parkinson-White syndrome.

Important points:

1. Sinus tachycardia and atrial fibrillation are common presentations for hyperthyroidism; check level of thyroid- stimulating hormone.

2. Wolff-Parkinson - White syndrome commonly presents in childhood.The patient becomes dizzy or dyspneic or passes out after playing, then recovers and has no other symptoms (transient arrhythmias via accessory pathway). Look for the infamous delta wave.

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