Ventricular fibrillation diagnosis

C. Differential diagnosis. Rule out the following possible causes of ventricular premature beats, ventricular tachycardia, or ventricular fibrillation ... 

Diagnosis. Signs of acute barium toxicosis include gastroenteritis and hyperperistalsis, followed by ventricular fibrillation and extrasystoles associated with hypokalemia. 

Atrial fibrillation is commonly associated with heart failure, and the prevalence of atrial fibrillation is related to the severity of heart failure, with less than 5% affected with very mild heart failure to nearly 50% affected with advanced heart failure [66]. Heart failure and atrial fibrillation are both common cardiovascular disorders and share the same demographic risk factors, including age, history of hypertension, prior myocardial infarction, and valvular heart disease [67, 68]. Further, the incidence of heart failure increases dramatically after the diagnosis of atrial fibrillation [69]. Progression of LV dysfunction can clearly be associated with rapid ventricular rates [70-76]. Conversely, conversion to normal sinus rhythm or control of ventricular response in atrial fibrillation can improve LV function [71-74, 77]. Accordingly, rate control becomes very important in patients with heart failure and dilated cardiomyopathy, and likely even more so when ischemia from rapid rates complicate the patient s course. 

Adenosine is the treatment of choice for diagnosis and reversal of supraventricular arrhythmias. Verapamil is an alternative for the management of narrow complex tachycardias. Amiodarone is the most effective drug at reversing atrial fibrillation, and in prevention of ventricular arrhythmias, but has several adverse effects. 

Fig. 16.11 Ventricular pacing in the setting of atrial fibrillation. The top strip illustrates atrial fibrillation with ventricular pacing in VVI mode. In the bottom strip, the mode of function is VDD mode, in which sensed atrial signals trigger ventricular stimulus outputs. Atrial fibriUatory impulses are sensed, leading to ventricular pacing at a rate of 100 per minute note the increased QRS duration due to rate-dependent intraventricular conduction delay. Based on this ECG, an erroneous diagnosis of hyperkalemia could be entertained.

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