Diagnosis and management of cardiac dysrhythmias

It is not uncommon for today’s surgeon to encounter patients with multiple comorbidities, often which are unrelated to their primary surgical disease. A common knowledge of most major medical issues, and their potential consequences, is thus critical for any surgeon who will be caring for patients postoperatively. With the increasing ability to continuously monitor patient vital signs and cardiac rhythms, the rapid identification and treatment of dysrhythmias has become common practice in the inpatient setting. Cardiac dysrhythmias in the postoperative setting have a variety of causes, with some of the most common including hypoxia, cardiac ischemia, catecholamine excess, routine medications, and electrolyte abnormalities. The most common arrhythmias in the operative or postoperative patient, aside from sinus tachycardia, is atrial fibrillation. However, there are a variety of tachyarrhythmias and even bradyarrhythmias that can occur. The acute management of most dysrhythmias is dependent upon the stability of the patient, an accurate classification of the rhythm, and an understanding of the underlying mechanisms. Management may range from simple pharmacologic intervention to cardioversion in the acutely unstable patient, and, occasionally, may even require percutaneous or transvenous pacing, pathway ablation, or implantation of pacemakers or defibrillators.