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KMID : 1201420140070010025
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Journal of Neurocritical Care
2014 Volume.7 No. 1 p.25 ~ p.32
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Cardiac Arrhythmias in the Intensive Care Units
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Nam Gi-Byoung
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Abstract
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Background: Cardiac arrhythmias in critically ill patients often cause severe hemodynamic impairment or medical complications, precipitating rapid deterioration of patients’ conditions. This manuscript describes common or fatal cardiac arrhythmias occurring in patients hospitalized at intensive care units.
Results: Differential diagnosis of wide QRS tachycardias includes ventricular tachycardias (VTs), supraventricular tachycardias with aberrant conduction and noise artifacts. Idiopathic VTs in patients with structurally normal hearts are responsive to antiarrhythmic agents and are cured by catheter ablation. Ventricular tachycardias in structural heart diseases require amiodarone for acute suppression and implantable defibrillator for longterm management. Polymorphic VTs or Torsades de Pointes are effectively suppressed by intravenous infusion of magnesium. Discontinuation of offending agents and, in some refractory cases, installation of temporary pacing is necessary. Atrial fibrillation (AF) is the most commonly observed tachyarrhythmias in intensive care settings. When combined with sepsis or congestive heart failure, AF with rapid ventricular response induces hypotension and sympathetic stimulation, which again aggravates rapid ventricular responses. This viscious cycle continues until adequate rate control measures are initiated. Intravenous amiodarone and anticoagulation are important initial management. In rare cases, electrical noises mimic ventricular tachycardias. Noises are distinguished from true VTs by identification of sharp QRS notches and stable hemodynamics during the events.
Conclusion: Proper interpretation of monitoring or standard ECG is crucial for differential diagnosis of cardiac arrhythmias occurring in intensive care units. Management should be tailored based upon arrhythmia characteristics and individual medical conditions.
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KEYWORD
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Tachycardia, Bradycardia, Intensive care
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