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Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
Cardiac arrythmias
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Cardiac arrythmias

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most common cardiac arrythmias

most common cardiac arrythmias

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  • 1. CARDIAC ARRYTHMIAS ORHAN HAKLI, NP
  • 2. 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 20-40 A MINUTE
  • 3. CAUSES OF DYSRHYTHMIAS ENHANCED AUTOMATICITY Increased activity or rhythm disturbances TRIGIRRED ACTIVITY Abnormal electric impulses when cells are at rest RE-ENTRY Spread 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
  • 4. 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
  • 5. MAJOR CARDIAC ARRHYTHMIAS SINUS RYTHMS ATRIAL RYTHMS 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
  • 6. SINUS RHYTMS CHARACTERISTICS -less than 60bpm -regular PP and RR -PR 0.12-.20 QRS0.10 WHAT TO DO? -watch the patient for s/s of bradycardia -If symptomatic; iv access, o2, transcuteneus pacing MEDICATION Atropine 0.5mg ivp
  • 7. 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)
  • 8. 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
  • 9. 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
  • 10. 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
  • 11. ATRIAL RHYTHMS AFIB AFLUTTER
  • 12. 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
  • 13. VENTRICULAR RHYTHMS VENTRICULAR TACHICARDIA VENTRICULAR FIBRILATION ASYSTOLE
  • 14. 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
  • 15. 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
  • 16. 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
  • 17. 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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