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Heart Rhythm Disorders (cont.)

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What is the treatment for heart rhythm disorders?

There is no one treatment for a heart rhythm abnormality. When the patient is unstable, with no pulse or blood pressure, or when they are unconscious, American Heart Association guidelines are available to direct care to hopefully restore the heart rhythm to normal and return a pulse.

For V-fib and V-tach, electricity may be the most important drug, and the heart is shocked back into a heart rhythm, hopefully compatible with life. Other common medications used in crisis situations depend upon the life-threatening rhythm and may include epinephrine (adrenalin), atropine, and amiodarone.

For patients with supraventricular tachycardia (SVT), the goal is not only to slow down the heart rate but also to identify which rhythm is present. Vasovagal maneuvers, like holding one's breath and bearing down as if to have a bowel movement may resolve the situation, or it may slow the rate temporarily to make the diagnosis. Adenosine can be injected and may convert SVT to normal sinus rhythm by slowing the electrical impulse at the AV node. It can also be used as a diagnostic challenge to help identify atrial fibrillation or atrial flutter with rapid ventricular response.

For atrial fibrillation with rapid ventricular response, the initial goal is to slow the rate and maintain normal blood pressure. Calcium channel clockers like diltiazem and beta blockers like metoprolol may be used intravenously to control rate. Digoxin is a second-line medication that may be helpful when first-line medications fail. In unstable patients, with chest pain, shortness of breath, or decreased consciousness, cardioversion with an electric shock may be required. The decision to electively convert A-fib to normal sinus rhythm depends upon the patient and situation and is often a decision left to the primary care professional. The question regarding anticoagulation also will need to be addressed.

Medically Reviewed by a Doctor on 2/18/2016


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