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Heart Rhythm Disorders (cont.)

Ventricular Fibrillation (V Fib)

Ventricular Fibrillation is technically not a rapid heart rhythm because the heart has ceased to beat. In ventricular fibrillation, the ventricles do not have a coordinated electrical pattern and the ventricles, instead of beating, just jiggle. Since the heart doesn't beat, the body dies. This rhythm is often associated with a heart attack in which the ventricular muscle doesn't get enough blood supply (myocardial ischemia), becomes irritated, and causes the whole ventricle to stop beating. The only treatment for this is defibrillation with an electrical shock. Automated External Defibrillators (AEDs) in public places have helped decrease the mortality from sudden cardiac death, but prevention remains the mainstay to survive this event. Some people, such as those with a very weak heart muscle or who have a prior history of ventricular fibrillation will require an implantable defibrillator to prevent future episodes of sudden death and treat this rhythm. Aside from myocardial ischemia, other causes of ventricular fibrillation may include severe weakness of the heart muscle, electrolyte disturbances, drug overdose, and poisoning.

Ventricular Flutter

Ventricular Flutter is another rapid heart rate that originates in the ventricle. The causes are the same as ventricular fibrillation, but because of the electrical conduction pattern in the heart pathways, an organized signal is provided to the ventricles, allowing them to beat. This remains an emergency, because without treatment, this rhythm will degenerate to ventricular fibrillation.

Paroxysmal supraventricular tachycardia (PSVT)

Paroxysmal supraventricular tachycardia (PSVT) occurs when the pathways in the AV node or atrium allow an altered conduction of electricity, and the atrium begins firing in a regular - fast rate, sometimes more than 150 -200 times per minute. The ventricle, sensing the electrical activity coming through the AV node, beats along with each stimulation, and this tachycardia occurs.

This is rarely a life threatening event, but most people feel uncomfortable when PSVT occurs. They may become lightheaded, weak, have shortness of breath, and describe a feeling of fullness in the throat. PSVT is usually tolerated and can even stop on its own. If this is a first time event, activating EMS (emergency medical services) and calling 911 is important, since other tachycardias can be life threatening.

The treatment for PSVT are attempts at stimulating the vagus nerve to slow the heart (see vasovagal syncope above) by holding one's breath and bearing down as if to have a bowel movement. Intravenous medications are often used to break the episode. Many patients have PSVT due to congenital abnormalities in the conduction system. External causes can include hyperthyroidism, electrolyte imbalances, and the use of caffeine, alcohol, over-the-counter cold medications containing stimulants, or illegal drugs like cocaine and methamphetamine.



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