الفهرس 
Anatomy and physiologyOnly 14 pages are availabe for public view
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Abstract
Arrhythmias are common in the intensive care unit and represent a major source of morbidity and increased length of stay.
Critically ill patients often have underlying heart disease, are frequently submitted to metabolic, ischemic, or neurohormonal stressors,and are therefore particularly at risk for cardiac arrhythmias.
Understanding anatomy and physiology of conductive system is the basis to understand arrhythmias. Conductive system consists of sino-atrial node, atrioventricular node, bundle of his and bundle branches.
The movement of ions across cardiac cell membranes generates the electrical potentials that activate the heart.
Mechanisms responsible for cardiac arrhythmias are generally divided into categories of disorders of impulse formation, disorders of impulse conduction, or combinations of both.
The evaluation of the patient suspected of having a cardiac rhythm disturbance varies from patient to patient and is influenced by the patient’s clinical status and symptoms. The initial evaluation begins with the performance of a careful history, physical examination and investigations. Electrocardiogram is the main diagnostic tool. Diagnosis of the cause and/or associated disorders is important. Diagnosis of specific type depends on the rate, the rhythm, the relation between P-wave and QRS complex and the shape of QRS.
VT and AF are the most frequent types of arrhythmias in ICU.
There are many possible causes of arrhythmias in critically ill patients . For example, drugs, hypoxemia, hypercarbia, electrolyte imbalance, cardiac disease, and many other factors.
Arrhythmias in the critically ill often require immediate and swift action and it is, therefore, essential that clinicians have a structured approach to the recognition and management of arrhythmias. It is important to treat the patient and the general type of rhythm rather than considering each disturbance in detail.
Successful management of all cardiac arrhythmias should be approached in stages: rapidly assess the haemodynamic status of the patient, identify the origin of the arrhythmia, correct predisposing factors, consider specific therapy, and prevent further arrhythmias.
Available lines of treatment- in general - include pharmacological treatment, electrotherapy, and surgical intervention. Understanding indications, complications and limitation of each method is important for any intensive care physician.
Finally, the proper management of arrhythmias in critically ill can improve the patient outcome in intensive care unit.