Supraventricular Tachycardi A Case Study

Apical hypertrophic cardiomyopathy is a disease that mainly affects the apex of the heart and does not cause any obstruction. [1] These abnormalities in the heart muscle can cause a wide variety of symptoms. As the heart becomes stiff it increases the pressure in the left ventricle which can push blood back into the lungs, causing shortness of breath in exercise. Chest pain can occur as there is not enough oxygen available to the cardiac muscle due to insufficient blood supply. Palpitations and lightheadedness, along with other conditions can occur as a result of HCM. In addition to these discomforting symptoms, the patient may develop an arrhythmias that often goes unnoticed. An arrhythmia takes place as the electrical conduction of the heart is disturbed by the abnormal scattering of myocytes. The two most common arrhythmias are atrial fibrillation causing palpitations, and ventricular tachycardia that can be life threatening causing sudden death. Both conditions can be controlled with medication. [4]

Medical involvement included pharmacological intervention. An infusion of Sotalol 40mg was administered intravenously at approx 0930 over thirty minutes with continuous cardiac monitoring. Sotalol, an antiarrhythmic drug, depresses the sinus heart rate, decreases atrioventricular conduction, decreases cardiac output and decreases systolic and diastolic blood pressure (Bryant, Knights, & Salerno, 2003). As the patient was already hemodynamically compromised, a bolus of fluid (Gelofusion 500mls) was administered prior to the Sotalol infusion. The aim was to increase the circulating volume and raise blood pressure. Vital signs remained stable during the infusion, however the heart rate was neither converted to sinus rhythm or reduced to a normal rate.

- The goals of treatment include a decrease in ventricular response (to less than 100 beats/minute), prevention of stroke, and conversion to normal sinus rhythm, if possible. To accomplish this, I would expect the health care provider to initially order drugs to control the ventricular rate, such as calcium channel blockers, beta-adrenergic blockers, digoxin, and dronedarone. For some patients, pharmacologic or electrical conversion of the atrial fibrillation to normal sinus rhythm may then also be considered, such as by using amiodarone or electrical cardioversion. If the atrial fibrillation lasts for longer than 48 hours, anticoagulation therapy will be needed for 3-4 weeks before the cardioversion and for weeks after as well. If drugs or cardioversion do not work, radiofrequency catheter ablation and the Maze procedure would be expected as further options.

Arrhythmias are irregular rhythms of the heartbeat which can be fast paced or slow paced.

Tachycardia: Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate. When the heart beats rapidly, the heart pumps less efficiently and provides less blood flow to the body and the heart. The rapid heartbeat increases the workload and oxygen demand of the heart. Problems will occur with the heart as tachycardia persists over time. The heart is maintaining less oxygen, which will lead to an MI due to death of the myocardial cells. Patient will start to have angina because of this. Tachycardia is noted in many diseases and disorder like: fever endocarditis, anemia, HTN, pericarditis, abnormal heart impulses, anxiety, older age, sleep apnea, COPD, electrolyte imbalances, and many more.

At this point, we do not know exactly what are the settings, we have previous requested pacemaker operative report from Regions. Unfortunately, from what he is telling today, his date of the birth was not correct as such dose report were not same. He noted that he thinks he came back from the hospital, he has not had similar complaint or concern or report of chest pain. It should be noted that hospital records, with a troponin that was negative, 12-lead EKG was similar to the one that was obtained here, essentially identifying sinus bradycardia with first-degree AV block, left ventricular hypertrophy with repolarization abnormality. QT was prolonged, similar EKG obtained at facility also identified pretty much the same abnormality pattern. Troponin was negative. Other workup included chest x-ray in the hospital were all unremarkable. Today he is not reporting any chest pain, no shortness of breath, no nausea or emesis. He has got healed ____ scar to the left chest from pacemaker implantation which is completely healed but slightly

Ablation. During this procedure the heart tissue causing the problem is destroyed. This procedure may be done if atrial flutter lasts a long time or happens often.

Most focal AF is initiated by premature beats from the orifices of the pulmonary veins or from the myocardial sleeves inside the PV’s, and radio frequency catheter ablation of triggered foci has been shown to cure AF. 14 Experts in catheter ablation have acknowledged that pulmonary vein isolation is the primary approach for patients with AF. It has been noted that pulmonary vein ostial ablation may result in pulmonary vein stenosis, which is why most conductors have discussed going away from the ostium and towards the antrum of the pulmonary vein.14 The antrum blends into the posterior wall of the left atrium and to be able to include most of the pulmonary vein, ablation must be performed around the entire antrum along the posterior left atrium wall.14 A recent meta analysis of 31 studies including 2,800 patients found that the single procedure success rate of pulmonary vein isolation of all types of AF without anti arrhythmic drugs was 57%.14 An analysis of 34 studies enrolling a total of 3,481 patients show that the success rate without anti arrhythmic drugs increased to 71% after multiple procedures.14 However, examining data from 6 pioneering centers with greater experience in AF ablation, the success rate without anti arrhythmic drugs was 81% in 1,039 patients followed up for a period of 6 months to 2.4 years.14 Recently, two 5 year follow up studies reported that single procedure success rates without

His work led to the evolution of radiofrequency energy catheters, which use radiofrequency energy to heat the catheter tip and perform a more precise ablation than what was possible with direct current ablation. (UCSF.(2012). When cardiac ablation is performed the surgeon is targeting the diseased conductive tissue once this is done, this will assist in correcting atrial fibrillation within the heart. These surgeries can be either minimally invasive or require an open surgical approach. Cardiac ablation is achieved through a cardiac catheter this delivers radiofrequency energy or cryoenergy to the defective area this is considered to be a minimally invasive approach. The electrophysiologist will insert a catheter into the femoral vein/artery and threads it to the right or left atrium and ventricle. They will then test different areas of the heart to try and reproduce dysrhythmia upon doing this they will then ablate the area of the heart where the disturbance takes place. Another alternative would be an open surgery known as a sternotomy approach this is where a midline incision is made in the sternum of the chest. Cannulation of the superior and inferior vena cava will then take place for a cardiopulmonary bypass. The surgeon will occlude the ascending aorta and infuse cardioplegic solution into the coronary arteries. Once this is done a right and left atriotomy is performed and the targets are ablated. The atriotomies are closed, the aorta is unclamped, cardiopulmonary bypass is stopped, cannulas are removed, chest tubes will be inserted at this time and the surgical wound is closed. Upon completion of the surgery the patient is taken to the PACU and monitored for heart rhythm issues as well as, bleeding, infection, or any other complications from the procedure. ( Fuller, J. (2013).(p.922). There are

If the perkinje fibers or the AV node becomes irritated, they can begin contraction of the ventricles at speeds well above normal. Other causes of ventricular tachycardia include heart disease and medications.

Upon admission to the hospital A.R's vital signs were recorded. His blood pressure was 90/60 mmHg which is below the reference range and is indicative of hypotension. This hypotension is due to blood loss from the trauma, resulting in a decreased blood volume and therefore decreased force exerted by the blood against the vessel wall.

For starters the SA node is set in the posterior wall of the right atrium that is close to the entrance of the superior vena cave. Then with the SA node it contains many pacemaker cells, which establishes the person’s heart rate. Also it is known as the cardiac pacemaker (natural pacemaker). It is connected to the ‘large AV node which is by the internodal pathways within the arterial walls. Also it shows the action takes just about 230 msec to pass through the SA node to AV node the length of these pathways. Once it passes by the conduction cells exceed the motivation of contractile cells of mutually atria. After this action it spreads from one side to the other to the atrial surfaces by cell-to-cell contact. As the stimulus only affects

The blood flow through the heart is a complex process that is sometimes disturbed. These disturbances can be a heart attack; heart disease; atrial fibrillation; arrhythmia, when the heart beats too fast; or bradycardia, when the heart beats too slow (“Who Needs a Pacemaker?”, 2012). When these disturbances occur, doctors usually turn to pacemakers in order to help manage the symptoms. According to the Nation Heart, Lung, and Blood Institute, “a pacemaker is a small device that is placed in the chest or abdomen to help control abnormal heart rhythms (“What is a pacemaker?”, 2012).”

This allows your cardiovascular centres in your brain a little bit more latitude as far as controlling your heart rate. If you were to remove a beating heart from someone's body you would find that the heart is no longer being suppressed by the parasympathetic nervous system and it will accelerate to the same pace as the sinoatrial node. The SA node generates action potentials approximately 100 times per minute due to the physiology of the heart, its own permeability to sodium and calcium via its channels, and a host of other things. Anywhere between 80 to 100 beats per minute is normal for the SA node.

Out of 200 perforated peritonitis patients, 57% were male .The mean age was 40±7 years. Tachycardia was the commonest physical findings (65% in early intervention vs. 68% in late intervention), followed by hypotension (32% vs. 34%) and abdominal distension (32% vs. 28%) . However, abdominal pain was commonest symptoms (94% vs. 92% ) followed by altered bowel habit (65% vs. 60%) and nausea vomiting (40 % vs. 46) . Comorbid conditions were found in 16% of patients. The most common comorbidity was respiratory problems (12% vs. 16%), followed by diabetes (11% vs. 12%), renal disease (8% vs. 11%) and hypertension (8% vs. 6%) (P=0.234). Positive history of NSAID intake for more than 6months found in (12 % vs. 14) (Table 1).