University of Nebraska Medical Center

DigitalCommons@UNMC MD Theses

College of Medicine

5-1-1964

Cardiac arrhythmias as related to anesthesia Louis N. Ludington University of Nebraska Medical Center

Follow this and additional works at: http://digitalcommons.unmc.edu/mdtheses Recommended Citation Ludington, Louis N., "Cardiac arrhythmias as related to anesthesia" (1964). MD Theses. Paper 29.

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Cardiac Arrhythmias as Related to Anesthesia

Louis Neil Ludington

Submitted in Partial Fulfillment for the Degree of Doctor of Medicine

College of Medicine, University of Nebraska

February 1, 1964

Omaha, Nebraska

CA:=r~)IAC

A.

TT J....L

q

ARRTI'ITEJ\:IAS AS REIXfED TO MTESTli7.SIA

Ch.araC~8ri.z 3~

Slow RefmJar Pulse)

B.

3.

"v. C}Jaract'3rized

an Irregular Pulse

I11CidGTIce

A. Pre-operative CJrdiac Status B.

C. A.f1ents 1. Cyclopropane 2.

--

Nitrous Oxide

h.

Fluothane

5.

Chlorofon~

l':,

~

Trilene

7. Pentothal

S. Muscle Relaxants Ci -'

. Sympathetic

amines

III. Other Factors during Anesthesj.a A. EyPOX:2.C1

C •.Refl"exes

D. Hypothernia E. Card:i.Bc ,Arrest

IV. Treatment or Reversal

based

~J.pon

abnormal sites of impulse formation or conduction path-

ways:

I. Arrhvthmias Characterized

a RaDicl ReglJlar Pulse

fA. ')" nus TachycPJ'dia

B. SUiJraventricul,"r Tachycardia

C. Atrial Flutter n

'J8ntricular Parox:ysmal Tachycarcia

A. Sinus BradycarcFa

~.-

u,

Atria-ventricular Nodal Rhythm

fl.

Aur~"cular

Standst:lll 'yith Iud Cl1lo-Ventr:'t enl ar

D. IncoI'1"Cllete Heart 320ck

E. Complete Heart Bloc}:

III. Arrhythmias Characterized by an Irregular Pulse A. Sinus Arrhythmi.a B. Sino-AuTi euTar Block

C. Premature Contractions 1. Atrial Premature Contraction 2. No r1 a 1

Prel'1ature Ccnt:C'action

3. Verltricular Prematu.re Contra.ct.ion D. Atrial Fibril1ation E. Ventricular Fibrjllatio:c1

~;odal

EsrcaDe

(2) F. Second Degree

A-V Bleck (Wenckebach Phenomenon)

Sinus tachycardia is considered 1;ymcst authorities as a rate of gr'32 ter than 100 beats ;:,-;er minute.

US1Jally thi s does not ex--

csed 150 ';eat8 per minute in adults i,:Jl~t may

"'13

180 or higher.

D:iae:-

nosis usually is rapid, regular pulse, usual1y less theJl 150, v,rhich a1 ters in rate

~md

regt,lari ty with respiration.

It is freQliently

accompanied by other clinical sjgns and symntoms such as D'?lJor and fevep.

Ust~all";,r

this tachvcardia is a result of increa,sec sympathe-

ti c tone or decreased vagal tone. caus'3S ae'e hpox:1

8!1

Perha~ss

Vle t'lree T:loSt COT'1r";On

ncdn, and hypovolemia due to blood loss.

Drugs

such as atronine 'ric' 1:le'J8ridine are a com.mon etjolc,R'Y. extreme toxicitv, 'hurns,

th~rrotoxicosis.

a,

and earJy cenf':est:ive heart

an a 1;rupt oreset cwo usually r:reater rapjcjty (140-220 beats/minu+,e) w!':tich distingnishes t 1'lem fron sinus tachycardia.

Rhythm is almost always regular.

Common causes are r1igital-

is toxicity, quinidine overdosage, con?'Astive l'leart failure, thvrotoxicosis, and !':typoxia. :rnation of ]T]j nute.

Atrial flutter is the result of rapid for-

ectopic auricular stimuli at a rate of 200-380 heats per Ho'wever, since only a percentage of these auri cular impul-

ses are transmitted to the ventric1es, the radial Dulse has a rate of 70-160 'beats per minute. degree of 'block present. nost~c

The radial pulse is denendent upon the

Carotid sinus pressure is a heJpfl11 diaf'"-

aid in fJutter with a raDid ventricular rate.

T'le Nlte

when pressure 5s released.

wjl]

In

U) contrast, tljis cOYnnression veTil.1 uS1)2J1y perm'Cmently convert 'in atrial

a ventricular tachycCirdia or ::mricular fihrillation.

In a slow ven-

tricular r'ate, ra-oid a11riculBr rate can usually be observed in the :iu[,:ular

ve~_n

Dulsations.

In flutter, the ventricul BY rate :is

ally regu18r, ',"[hich helps to differentiate ricular fi1:id 1J,3.tion.

a

~iseased

js oresent. tl.,Yf]ia.

concli tion

fr~'t1n cm-

Auricular flutter is 'uaua1.lv 8Y',c0 1]ntere0

more frer:ment,ly over the ar'''" cf sixty.

u~on

th~.s

U8U-

Atrial f1uttS'r 'las +Jwo

heart

yent£icu1.Br ?aroxysmal tachycardia js a rare arrhy-

It ::i.s alnost '?lvv ays irrroosed uuon a seriously

+otect,,1,le irreguJe,rit"1.T in rhyt1-'nn which is slig-ht. is unaffected

.-l

an'1.Fec'l hea.rt.

This arrhythmia

carotid sinus pressure.

Sj.nus bradycardia is characterized by a or less jn '1.n adult.

01J] se

rat,,,:, of hO/minute

This varies in a c':ild accord:inf to acr8.

The

r),yt1.'JJ'1 mav at times be regular "ut T']rre often +'1-]::e 'Performed.

The carotid, femoral, or radial ,mIse should

l)8

rhe second o-oerator s!1ould simultaneously ... "

Derform closed-chest cardiac massage, at (;0-80 tjmes atleast 3--J.+ m:inutes.

DeI'

Adeouacy of mass8p:e :is verified

~y

"",,.'

minute for paJ.patinR;

1-,h8 carotid :,ulsatio:l., Tnajn'SeYlar:ce of small pupils, a '.")1000 nress-

r1() :~rLllse

~_s

corn:~)riJS310n

-or;reS8::1.t yv-i t1.--j 1)

at 72