Medicine Arrhythmias for UPSC CMS: ECG Recognition and Emergency Management

Atrial Fibrillation#

Irregularly irregular. No P waves. Variable R-R intervals. CHA2DS2-VASc score for anticoagulation: C=1, H=1, A2=2, D=1, S2=2, V=1, A=1, Sc=1. Score >=2 = anticoagulate.

Atrial Flutter#

Sawtooth F waves. Usually 2:1 block (300 atrial rate, 150 ventricular). Treat rate (beta-blocker, diltiazem), rhythm (amiodarone), anticoagulate.

Ventricular Tachycardia#

Wide QRS (>0.12s), regular. Hemodynamically unstable = immediate synchronized cardioversion. Stable = amiodarone IV.

Ventricular Fibrillation#

Chaotic, no organized QRS. Immediate defibrillation + CPR + epinephrine + amiodarone.

Heart Blocks#

1st degree: PR >0.20s. 2nd degree Type I (Wenckebach): progressive PR prolongation. 2nd degree Type II (Mobitz): sudden dropped beats. 3rd degree: complete dissociation, atrial and ventricular rates independent.