Detection and management of cardiac arrhythmias in the emergency room
Cardiac arrhythmias may vary from benign and ubiquitous ventricular ectopic beats to life threatening ventricular tachycardia and fibrillation. In this chapter we will discuss the common arrhythmias other than ventricular fibrillation and asystole as they will be discussed separately in the section on cardiac arrest.
Cardiac arrhythmias can be broadly classified into ventricular and supraventricular depending on the focus of origin and into bradyarrhythmias and tachyarrhythmias depending on the rate. A basic dictum in the management of cardiac arrhythmias may also be worth mentioning at the outset: while managing tachyarrhythmias, expect them to go on for bradyarrhythmias and vice versa. So be ready for both in any given patient. Moreover, bradyarrhythmias and pauses can precipitate pause dependent tachyarrhythmias like polymorphic ventricular tachycardia or torsades-de-pointes, a life threatening arrhythmia, which usually occurs in the setting of QT interval prolongation.