{"id":2842,"date":"2020-03-26T04:21:12","date_gmt":"2020-03-26T09:21:12","guid":{"rendered":"https:\/\/ami.advancedrenaleducation.com\/wparep\/?post_type=article&#038;p=1230"},"modified":"2025-05-09T15:58:53","modified_gmt":"2025-05-09T20:58:53","slug":"cardiac-arrhythmias","status":"publish","type":"article","link":"https:\/\/ami.advancedrenaleducation.com\/wparep\/asiapacific\/article\/cardiac-arrhythmias\/","title":{"rendered":"Cardiac Arrhythmias"},"content":{"rendered":"<div class=\"field field-name-body field-type-text-with-summary field-label-hidden\">\n<div class=\"field-items\">\n<div class=\"field-item even\">\n<h4>Risk Factors<\/h4>\n<ul>\n<li>Left ventricular hypertrophy<\/li>\n<li>Heart failure<\/li>\n<li>Ischemic heart disease<\/li>\n<li>Other factors\n<ul>\n<li>Age<\/li>\n<li>Respiratory failure<\/li>\n<li>Rapid reduction of extra-cellular volume<\/li>\n<li>Electrolyte and acid-base derangement<\/li>\n<li>Cardiac and major vascular surgery<\/li>\n<li>Digoxin therapy<\/li>\n<li>Sympathetic dysfunction<\/li>\n<li>Increased phosphate and PTH<\/li>\n<\/ul>\n<\/li>\n<li>High risk in those with reduced heart rate variability and increased QT dispersion<sup>1,2<\/sup>.<\/li>\n<\/ul>\n<h4>Diagnosis and Treatment<\/h4>\n<ul>\n<li>Draw blood samples for electrolytes, bicarbonate and glucose levels<\/li>\n<li>EKG, oxygen, IV fluids<\/li>\n<li>May need to discontinue HD. Correct electrolyte disturbance (especially potassium, calcium and magnesium)<\/li>\n<li>Cardioversion with AED (automated external defibrillator) in case patient is hemodynamically unstable and has a treatable rhythm<\/li>\n<li>Digoxin can be used to control ventricular rate in SVT.\n<ul>\n<li>Patients on digitalis might need increase of the dialysate potassium to 3- 3.5 mEq\/L to prevent hypokalemia<sup>3<\/sup>.<\/li>\n<\/ul>\n<\/li>\n<li>Amiodarone can be used in usual dose for ventricular arrhythmias<\/li>\n<li>Intracellular shift of potassium can be minimized by reducing dialysate glucose (from 200 to 100 mg\/dl), and when acid base status permits, bicarbonate level<sup>1<\/sup><\/li>\n<\/ul>\n<h4>Prevention<\/h4>\n<ul>\n<li>Avoidance of low hemoglobin levels and hypoxia during dialysis. Maintenance of optimal calcium, phosphate and PTH levels<\/li>\n<li>Oxygen use<\/li>\n<\/ul>\n<div class=\"vcex-spacing\" style=\"height:30px\"><\/div><div class=\"vcex-module vcex-divider vcex-divider-solid\" style=\"width:100%;margin-top:20px;margin-bottom:20px;border-top-width:1px;border-color:#dddddd;\"><\/div>\n<h4>References:<\/h4>\n<ol>\n<li>Erem C, Kulan K, Tuncer C, Bostan M, Mocan Z, Komsuoglu B. Cardiac arrhythmias in patients on maintenance hemodialysis. <em>Acta Cardiol<\/em> 52:25-36, 1997<\/li>\n<li>Kantarchi G, Ozener C, Tokay S, Bihorac A, Akoglu E. QT Dispersion in Hemodialysis and CAPD Patients. <em>Nephron<\/em> 91:739-741, 2002<\/li>\n<li>Anthony J Nicholls: Heart and Circulation in Daugirdas JT, Blake PG, Todd SI. Handbook of Hemodialysis. Third Edition. Lippincott Williams &amp; Wilikns. Philadelphia 2:594-596, 2001<\/li>\n<\/ol>\n<div class=\"vcex-spacing\" style=\"height:30px\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"featured_media":0,"template":"","format":"standard","meta":{"_acf_changed":false},"categories":[128],"tags":[60],"language":[41],"articles":[230],"class_list":["post-2842","article","type-article","status-publish","format-standard","hentry","category-articles","tag-intradialytic","language-english","articles-hemodialysis","entry","no-media"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Cardiac Arrhythmias - AREP Asia Pacific<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/cardiac-arrhythmias\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cardiac Arrhythmias - 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