Multiprofessional Critical Care Review: Adult (2023)-10: Case Studies: Cardiac Arrhythmias (Sammy Zakaria, MD, MPH)

Video Transcription

Video Summary

In this video, the presenter discusses various case studies related to cardiac arrhythmias. The first case is a 40-year-old man with dyspnea and palpitations. The ECG shows a characteristic Brugada pattern, specifically type 1. Brugada syndrome is diagnosed when a patient has a Brugada ECG pattern and symptoms such as ventricular arrhythmias or a family history of sudden death. The management of Brugada syndrome involves avoiding triggering factors like large meals and certain medications, treating fever aggressively, and considering pharmacologic treatment with quinidine or isoprenaline. Implantable cardioverter defibrillators (ICDs) may also be recommended for patients with a history of ventricular arrhythmias. <br /><br />The second case is a 56-year-old man with delirium tremens and ectopy on the telemetry monitor. The ECG shows a prolonged QT interval, which can have various causes including electrolyte disorders, medications, and genetic long QT syndrome. Patients with long QT syndrome should avoid electrolyte abnormalities and QT prolonging medications. Treatment may involve beta blockers or antiarrhythmic medications like mexiletine. ICDs may be considered for patients with recurrent ventricular arrhythmias. <br /><br />The third case is a 65-year-old man with hypertension and hyperlipidemia who presents with acute decompensated heart failure. The ECG shows ventricular fibrillation, and the patient undergoes cardioversion. The decision to implant an ICD depends on whether the patient has ischemia-warranting revascularization, the ejection fraction, and presence of ventricular arrhythmias. <br /><br />The fourth case is an 83-year-old man with sick sinus syndrome and a malfunctioning pacemaker. The ECG shows abnormalities in atrial and ventricular sensing and pacing. Malfunctioning pacemakers can be caused by lead fractures, loose conductor pins, or insulation breaks. The patient may require a new pacemaker or lead placement. <br /><br />Overall, the video provides an overview of different cardiac arrhythmias and their management, including the use of ICDs and pacemakers.

Keywords

cardiac arrhythmias

Brugada syndrome

ventricular arrhythmias

ICDs

prolonged QT interval

long QT syndrome

beta blockers

pacemaker placement

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