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Cardiac Arrhythmias
Risk Factors
Left ventricular hypertrophy
Heart failure
Ischemic heart disease
Other factors
Age
Respiratory failure
Rapid reduction of extra-cellular volume
Electrolyte and acid-base derangement
Cardiac and major vascular surgery
Digoxin therapy
Sympathetic dysfunction
Increased phosphate and PTH
High risk in those with reduced heart rate variability and increased QT dispersion1,2.
Diagnosis and Treatment
Draw blood samples for electrolytes, bicarbonate and glucose levels
EKG, oxygen, IV fluids
May need to discontinue HD. Correct electrolyte disturbance (especially potassium, calcium and magnesium)
Cardioversion with AED (automated external defibrillator) in case patient is hemodynamically unstable and has a treatable rhythm
Digoxin can be used to control ventricular rate in SVT.
Patients on digitalis might need increase of the dialysate potassium to 3- 3.5 mEq/L to prevent hypokalemia3.
Amiodarone can be used in usual dose for ventricular arrhythmias
Intracellular shift of potassium can be minimized by reducing dialysate glucose (from 200 to 100 mg/dl), and when acid base status permits, bicarbonate level1
Prevention
Avoidance of low hemoglobin levels and hypoxia during dialysis. Maintenance of optimal calcium, phosphate and PTH levels
Oxygen use
References:
Erem C, Kulan K, Tuncer C, Bostan M, Mocan Z, Komsuoglu B. Cardiac arrhythmias in patients on maintenance hemodialysis. Acta Cardiol 52:25-36, 1997
Kantarchi G, Ozener C, Tokay S, Bihorac A, Akoglu E. QT Dispersion in Hemodialysis and CAPD Patients. Nephron 91:739-741, 2002
Anthony J Nicholls: Heart and Circulation in Daugirdas JT, Blake PG, Todd SI. Handbook of Hemodialysis. Third Edition. Lippincott Williams & Wilikns. Philadelphia 2:594-596, 2001
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