In hospital life-threatening arrhythmias

Life-threatening bradycardia (BR; heart rate < 50/min) and tachycardia rhythm disturbances (TR; heart rate > 100/min) require rapid therapeutic strategies both in and out of hospital. Supraventricular tachycardia (SVT) is a paroxysmal tachycardia as are sinus tachycardia, atrial tachycardia, AV-nodal reentrant tachycardia and tachycardia due to accessory pathways. All SVTs are characterized by a ventricular heart rate > 100/min and small QRS complexes (QRS with < 0.12 s) during tachycardia. It is essential to evaluate the arrhythmia history, to perform a detailed physical examination and to exactly analyze the 12-lead electrocardiogram. An exact SVT diagnosis is then possible in > 90% of patients with SVT. Ventricular tachycardia (VF) has a broad QRS complex (QRS width a parts per thousand yen0.12 s) but ventricular flutter (VFlut) and ventricular fibrillation (VF) are associated with chaotic electrophysiological findings. For acute therapy the concept of the 5As will be presented which includes adenosine, adrenaline, ajmaline, amiodarone and atropine and together with B, C and D strategies including beta blocking agents, cardioversion as well as defibrillation, the 5As concept allows a safe and effective anti-arrhythmic treatment of all life-threatening arrhythmias as well as asystole both in and outside hospital.