CARDIAC ARRYTHMIASORHAN HAKLI, NP
CARDIAC CONDUCTION SYSTEM
SA NODE : -AT THE UPPER POSTERIOR PART OF THE ATRIUM-PRIMARY PACEMAKER-DISCHARGES ELECTICAL IMPULSES 60-100 A MINUTE
AV NODE :-RECEIVES IMPULSES FROM SA NODE-SLOW THE CONDUCTION AND DELAYS THE INPUT IN ORDER ATRIUMS TO VENTRICULS COMPLETELY(Atrial kick 5-30% of the CO)-BLOCK SOME OF THE IMPULSES TO PREVENT GOING THE HEART TACHY-SERVES AS A BACK UP PACEMAKER IF SA NODE FAILS (ELECTRICAL IMPULSES OF 40-60 A MINUTE)
PURKINJE FIBERS:-RECEIVES IMPULSES FROM BUNDLE BRANCHES-DISCHARGES ELECTRICAL IMPULSES 20-40A MINUTE
CAUSES OF DYSRHYTHMIASENHANCED AUTOMATICITYIncreased activity or rhythm disturbances
TRIGIRRED ACTIVITYAbnormal electric impulses when cells are at rest
RE-ENTRYSpread of an impulse through tissue already stimulated by that same impulse
ACIDOSIS HYPOXIA HYPERCALIMIA
ALCOLOSIS HYPOMAGNESIA MYOCARDIAL ISCHEMIA
HYPOXIA MYOCARDIAL INJURY ANTIARYTHMATIC MEDS
ISCHEMIA/INFARCT MEDICATIONS THAT PROLONGS REPOLARIZATION (IE.QUINIDINE)
ELECTROLYTE PROBLEMS (K-CA)
DIG.TOXICITY
ADMINISTRATION OF ATROPINE/EPINEPHRINE
EKG
HEART RATE-To determine the ventricular rate, count the QRS complex on a 6 sec paper and multiply by 10
WAVES-P wave: atrial depolarization-QRS complex :ventricular depolarization-Twave :Ventricular repolarization
INTERVALS-PR :0.12-0.20 sec-QRS :under 0.10sec-QT:under 0.38 sec
MAJOR CARDIAC ARRHYTHMIASSINUS RYTHMS
ATRIALRYTHMS
VETRICULAR RHYTHMS
ATRIO-VENTRICULAR (AV) RHYTHMS
SINUS BRADY PREMATURE ATRIAL CONTRACTION(PAC)
PREMATURE VENTRICULAR CONTRACTION(PVC)
1ST DEGREE AV BLOCK
SINUS TACHICARDIA
ATRIAL FLUTTER
VENTRICULAR TACHICARDIA
2ND DEGREE AV BLOCK TYPE I
SINUS ARRYTHMIA
ATRIAL FIBRILATION
VENTRICULAR FIBRILATION
2ND DEGREE AV BLOCK TYPE II
SINUS ARREST ASYSTOLE 3RD DEGREE AV BLOCK
SINUS RHYTMS
CHARACTERISTICS-less than 60bpm-regular PP and RR-PR 0.12-.20QRS0.10WHAT TO DO?-watch the patient for s/s of bradycardia-If symptomatic; iv access, o2, transcuteneus pacingMEDICATIONAtropine 0.5mg ivp
SINUS RHYTHMS
CHARACTERISTICS - 101-150bpm -regular PP and RR -PR 0.12-.20 QRS0.10 or less WHAT TO DO? -watch the patient for s/s of Tachycardia -correct underlying problems/Never shock ST MEDICATION Atenelol/Meteprolol (Beta blockers)
SINUS RHYTHMS
CHARACTERISTICS - usually 60-100bpm, but can be slower or faster -irregular with respiration, HR increases with
inspiration and decreases with expiration -PR 0.12-.20 QRS0.10 or less WHAT TO DO? NOTHING !!! MEDICATION If hemodynamic compromise is present ATROPINE
SINUS RHYTHMS
CHARACTERISTICS - Rate varies because of the pause -irregular rhythm -PR 0.12-.20 QRS0.10 or less WHAT TO DO? If transient and major s/s of decline monitor the pt If more than 3 sec. ATROPINE, Bedside Pacer or
Possible Permanent PM insertion MEDICATION ATROPINE
SINUS ARREST
ATRIAL RHYTHMS
CHARACTERISTICS - Rate; Depends on the underlying rhythm but usually w/i
normal limits -Regular rhythm, except the premature beats -PR may be normal or prolonged QRS0.10 or less but might be wide WHAT TO DO? NOTHING!!! Reducing stress, stimulants(coffee), treating CHF may help MEDICATION If needed beta blockers, CA blockers or anxiety meds
PREMATURE ATRIAL COMPLEX
ATRIAL RHYTHMS
AFIB
AFLUTTER
VENTRICULAR RHYTMS
PREMATURE VENTRICULAR COMPLEX
CHARACTERISTICS - Rate; Depends on the underlying rhythm -Regular rhythm, except the premature beats -PR no PR because ectopy comes from ventricles QRS more then 0.12, wide and bizarre looking WHAT TO DO? NOTHING!!! Monitor the pt, if frequent check if they have enough
cardiac output
VENTRICULAR RHYTHMS
VENTRICULAR TACHICARDIA
VENTRICULAR FIBRILATION
ASYSTOLE
ATRIOVENTRICULAR (AV) BLOCKS
CHARACTERISTICS - Rate; Depends on the underlying rhythm, but usually
normal -Regular rhythm -PR prolonged, greater than 0.20 sec QRS usually 0.10 sec or less WHAT TO DO? They are usually asymptomatic, Monitor the pt if MI is
causing the block Hold the meds that could cause the block(IE beta blockers,
CA blockers, Dig, quinidine)
FIRST DEGREE AV BLOCK
ATRIOVENTRICULAR (AV) BLOCKS
WHAT TO DO? They are usually asymptomatic, Monitor the pt Do not give ATROPINE to increase the heart rate Type II might be indication for PM Hold the meds that could cause the block(IE beta blockers,
CA blockers, Dig, quinidine) If associated with MI, watch if the block is getting worse
SECOND DEGREE AV BLOCK
TYPE -I
TYPE -II
ATRIOVENTRICULAR (AV) BLOCKS
CHARACTERISTICS - Rate; atrial rate is greater then ventricular rate -Regular ratrial (P) and regular ventricular but no
relationship between the two -P normal size and shape; PR none QRS can be narrow or wide WHAT TO DO? ATROPINE /Transcuteneus Pacing Possible permanent Pacemaker
THIRD DEGREE AV BLOCK
REFERENCES
Aehlert, B. (2006). ECGs Made Easy. Arizona: Sauthwest EMS education Inc.
Heart Blocks. (2012). Retrieved from http://www.nhlbi.nih.gov: http://www.nhlbi.nih.gov/health/health-topics/topics/hb/types.html
Huff, j. (2006). ECG Workout: Exercises in Arrhythmia Interpretation. PA: Lippincott Williams & Wilkins.
Nicod, P.; Hillis, L.; Winniford, M.D.; Firth, B.G. (February 15, 1986). Importance of the "atrial kick" in determining the effective mitral valve orifice area in mitral stenosis. The American Journal of Cardiology , Volume 57, issue 6 p. 403-407.
Sauer, W. (2012). Normal sinus rhythm and sinus arrhythmia. Retrieved from http://www.uptodate.com: http://www.uptodate.com/contents/normal-sinus-rhythm-and-sinus-arrhythmia
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