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Disorders of the formation or conduction (or both) of the electrical impulse within the heart Cause disturbance in heart rate, heart rhythm, or both Diagnosed by analyzing the electrocardiographic waveform named according to the site of origin of the impulse and the mechanism of formation or conduction involved

Disorders of the formation or conduction

(or both) of the electrical impulse within the heart

Cause disturbance in heart rate, heart rhythm, or both

Diagnosed by analyzing the electrocardiographic waveform

named according to the site of origin of the impulse and the mechanism of formation or conduction involved

Sites of Origin: Sinus (SA) node Atria Atrioventricular (AV) node or junction Ventricles

Sites of Origin:

Sinus (SA) node

Atria

Atrioventricular (AV) node or junction

Ventricles

Normal Sinus Rhythm Bradycardia Tachycardia Dysrhythmia Flutter Fibrillation Premature complexes Blocks

Normal Sinus Rhythm

Bradycardia

Tachycardia

Dysrhythmia

Flutter

Fibrillation

Premature complexes

Blocks

Occurs when the electrical impulse starts at a regular rate and rhythm in the sinus node and travels through the normal conduction pathway Ventricular and atrial rate : 60-100 in adults Ventricular and atrial rhythm : regular QRS shape and duration : usually normal, but may be regularly abnormal P wave : Normal and consistent shape; always in front of the QRS PR interval : Consistent interval between 0.12 and 0.20 seconds P: QRS ratio : 1:1

Occurs when the electrical impulse starts at a regular rate and rhythm in the sinus node and travels through the normal conduction pathway

Ventricular and atrial rate : 60-100 in adults

Ventricular and atrial rhythm : regular

QRS shape and duration : usually normal, but may be regularly abnormal

P wave : Normal and consistent shape; always in front of the QRS

PR interval : Consistent interval between 0.12 and 0.20 seconds

P: QRS ratio : 1:1

Impulse is created by the sinus node P to QRS ratio is 1:1 Treatment is directed at the cause and done symptomatically TYPES: Sinus Bradycardia Sinus Tachycardia Sinus Arrhythmia

Impulse is created by the sinus node

P to QRS ratio is 1:1

Treatment is directed at the cause and done symptomatically

TYPES:

Sinus Bradycardia

Sinus Tachycardia

Sinus Arrhythmia

Occurs when the sinus node creates an impulse at a slower than normal rate Ventricular and atrial rates below 60 Causes: lower metabolic needs (sleep, athletic training hypothermia, hypothyroidism) Vagal stimulation (vomiting, suctioning, severe pain, extreme emotions)

Occurs when the sinus node creates an impulse at a slower than normal rate

Ventricular and atrial rates below 60

Causes:

lower metabolic needs (sleep, athletic training hypothermia, hypothyroidism)

Vagal stimulation (vomiting, suctioning, severe pain, extreme emotions)

CAUSES: Medications (calcium channel blockers, amiodarone, beta blockers) Increased intracranial pressure Myocardial infarction TREATMENT for Symptomatic clients Atropin Sulfate O2 Administration Insertion of pacemaker

CAUSES:

Medications (calcium channel blockers, amiodarone, beta blockers)

Increased intracranial pressure

Myocardial infarction

TREATMENT for Symptomatic clients

Atropin Sulfate

O2 Administration

Insertion of pacemaker

Ventricular and atrial rates above 100 Causes: acute blood loss anemia shock hyperbulimia congestive heart failure pain hypermetabolic states fever, exercise, anxiety sympathomimetic medications Beta-blockers and Calcium channel blockers may be given

Ventricular and atrial rates above 100

Causes:

acute blood loss

anemia

shock

hyperbulimia

congestive heart failure

pain

hypermetabolic states

fever, exercise, anxiety

sympathomimetic medications

Beta-blockers and Calcium channel blockers may be given

irregular rhythm Rate increased with inspiration and decreases with expiration No hemodynamic changes, treatment is not necessary

irregular rhythm

Rate increased with inspiration and decreases with expiration

No hemodynamic changes, treatment is not necessary

TYPES: Premature Atrial Complex Atrial Flutter Atrial Fibrillation

TYPES:

Premature Atrial Complex

Atrial Flutter

Atrial Fibrillation

Single ECG complex that starts in the atrium before the next normal impulse from the sinus node P : QRS ration is 1:1 Causes: caffeine, alcohol, nicotine stretched atrial myocardial (as in hypervolemia) hypermetabolic states Atrial ischemias, injury or infarction < 6/mm: no treatment > 6/mm: Signal of worsening condition, treatment directed at the cause

Single ECG complex that starts in the atrium before the next normal impulse from the sinus node

P : QRS ration is 1:1

Causes:

caffeine, alcohol, nicotine

stretched atrial myocardial (as in hypervolemia)

hypermetabolic states

Atrial ischemias, injury or infarction

< 6/mm: no treatment

> 6/mm: Signal of worsening condition, treatment directed at the cause

atrial rate between 250 to 400 P : QRS ratio is 2-4 : 1 Associated with: valvular heart disease coronary artery disease hypertension cardiomyopathy hyperthyroidism Pulmonary disease Acute moderate to heavy ingestion of alcohol Aftermath of open heart surgery S/Sx: chest pain, SOB, low BP Treatment: Diltiazem, Beta-blockers, Digitalis > to slow the conduction to the AV node

atrial rate between 250 to 400

P : QRS ratio is 2-4 : 1

Associated with:

valvular heart disease

coronary artery disease

hypertension

cardiomyopathy

hyperthyroidism

Pulmonary disease

Acute moderate to heavy ingestion of alcohol

Aftermath of open heart surgery

S/Sx: chest pain, SOB, low BP

Treatment: Diltiazem, Beta-blockers, Digitalis > to slow the conduction to the AV node

CARDIOVERSION elective procedure; activation of synchronous electric impulse/ current countershock a method of restoring the normal rhythm of the heart of patients with increased heart rate due to arrhythmia a controlled direct-current shock, synchronized with the R wave of the ECG

CARDIOVERSION

elective procedure; activation of synchronous electric impulse/ current

countershock

a method of restoring the normal rhythm of the heart of patients with increased heart rate due to arrhythmia

a controlled direct-current shock, synchronized with the R wave of the ECG

atrial rate 350-600 Disorganized impulses from the atria Atria may quiver resulting in thrombi formation and emboli formation P wave is absent S/Sx: palpitation, fatigue, malaise, pulse deficit Treatment: Quinidine, amiodarone, Digoxin, Verapanil > to achieve conversion to sinus rhythm

atrial rate 350-600

Disorganized impulses from the atria

Atria may quiver resulting in thrombi formation and emboli formation

P wave is absent

S/Sx: palpitation, fatigue, malaise, pulse deficit

Treatment: Quinidine, amiodarone, Digoxin, Verapanil > to achieve conversion to sinus rhythm

TYPES: 1. Premature Ventricular Contractions 2. Ventricular Tachycardia 3. Ventricular Fibrillation 4. Idioventricular Rhythm 5. Ventricular Asystole

TYPES:

1. Premature Ventricular Contractions

2. Ventricular Tachycardia

3. Ventricular Fibrillation

4. Idioventricular Rhythm

5. Ventricular Asystole

Impulse starts at the ventricle and conducted before the next normal sinus impulse Cause: in healthy people, use of caffeine, nicotine, or smoke cardiac ischemia or infarction increased workload on the heart Digitalis toxicity Hypoxia, acidosis Electrolyte imbalance

Impulse starts at the ventricle and conducted before the next normal sinus impulse

Cause:

in healthy people, use of caffeine, nicotine, or smoke

cardiac ischemia or infarction

increased workload on the heart

Digitalis toxicity

Hypoxia, acidosis

Electrolyte imbalance

In the absence of disease, PVCs are not serious In the client with MI PVCs may indicate more aggressive therapy Client may report that the heart “skip a beat” Treatment: Lidocaine

In the absence of disease, PVCs are not serious

In the client with MI PVCs may indicate more aggressive therapy

Client may report that the heart “skip a beat”

Treatment: Lidocaine

3 or more PVCs in a row exceeding 100/mm Causes: similar to PVCs Stable client with sustained VT – O2 and antidysrhthmic drugs Unstable client: O2 and antidysrhymic drugs, cardioversion, cough and CPR Pulse less VT: defibrillation and CPR

3 or more PVCs in a row exceeding 100/mm

Causes: similar to PVCs

Stable client with sustained VT – O2 and antidysrhthmic drugs

Unstable client: O2 and antidysrhymic drugs, cardioversion, cough and CPR

Pulse less VT: defibrillation and CPR

rapid but disorganized ventricular rhythm No atrial activity Absence of audible heartbeat, palpable pulse and respiration Causes: electrical shock, Brugada syndrome Treatment: Defibrillation Rapidly fatal if not terminated within 3-5 minutes

rapid but disorganized ventricular rhythm

No atrial activity

Absence of audible heartbeat, palpable pulse and respiration

Causes: electrical shock, Brugada syndrome

Treatment: Defibrillation

Rapidly fatal if not terminated within 3-5 minutes

Occurs when the impulse starts in the conduction system below the AV node Commonly causes the patient to lose consciousness and other signs and symptoms of reduced cardiac output Treatment: IV Atropine as ordered bed rest

Occurs when the impulse starts in the conduction system below the AV node

Commonly causes the patient to lose consciousness and other signs and symptoms of reduced cardiac output

Treatment: IV Atropine as ordered

bed rest

Commonly called flat line without treatment, VA is fatal Treatment: CPR

Commonly called flat line without treatment, VA is fatal

Treatment: CPR

Causes: medications myocardial ischemia or infarction valvular disorders myocarditis

Causes:

medications

myocardial ischemia or infarction

valvular disorders

myocarditis

TYPES OF HEART BLOCKS First Degree AV Block Second Degree AV Block c. Third Degree AV Block/ Complete Heart Block

TYPES OF HEART BLOCKS

First Degree AV Block

Second Degree AV Block

c. Third Degree AV Block/ Complete Heart Block

Rarely cause hemodynamic change Conduction of impulse in the SA node is delayed PR interval is more than 0.02 seconds

Rarely cause hemodynamic change

Conduction of impulse in the SA node is delayed

PR interval is more than 0.02 seconds

- Type 1 : atrial impulse takes longer time for conduction than the one before it, until one impulse is fully blocked - Type 2 : only some of the atrial impulse is conducted

- Type 1 : atrial impulse takes longer time for conduction than the one before it, until one impulse is fully blocked

- Type 2 : only some of the atrial impulse is conducted

No atrial impulse is conducted to the ventricles Two impulses stimulate the heart

No atrial impulse is conducted to the ventricles

Two impulses stimulate the heart

S/Sx: SOB, chest pain, lightheadedness Treatment directed at increasing the HR to maintain normal cardiac output No treatment indicated for stable, asymptomatic patient Treatment options: Atropine SO4, pacemaker

S/Sx: SOB, chest pain, lightheadedness

Treatment directed at increasing the HR to maintain normal cardiac output

No treatment indicated for stable, asymptomatic patient

Treatment options: Atropine SO4, pacemaker

a. VAGAL MANEUVERS Vagal stimulation to terminate supraventricular tachydysrhythmias Carotid Sinus Massage Valsalva Maneuver CARDIOVERSION Synchronized countershock to convert an undesirable rhythm to stable rhythm c. DEFIBRILLATION Asynchronous countershocks used to terminate pulseless VT or VF 3 rapid consecutive shocks: 200 joules, 300 joules and 360 joules

a. VAGAL MANEUVERS

Vagal stimulation to terminate supraventricular tachydysrhythmias

Carotid Sinus Massage

Valsalva Maneuver

CARDIOVERSION

Synchronized countershock to convert an undesirable rhythm to stable rhythm

c. DEFIBRILLATION

Asynchronous countershocks used to terminate pulseless VT or VF

3 rapid consecutive shocks: 200 joules, 300 joules and 360 joules

d. AUTOMATIC EXTERNAL DEFIBRILLATOR (AED) e. IMPLANTED CARDIOVERTER DEFIBRILLATOR ANTIANTIRRHYTHMIC Class I : Na + channel blocker Quinidine, Procanamide, Disopyridamole Lidocaine Flocainaide, Propafenone Class II : Beta-blockers- propanolol, metoprolol, aenolol, esmolol Class III : K+ channel blockers- Amiodarone Class IV : Calcium channel blockers: Verapamil, Diltiazem

d. AUTOMATIC EXTERNAL DEFIBRILLATOR (AED)

e. IMPLANTED CARDIOVERTER DEFIBRILLATOR

ANTIANTIRRHYTHMIC

Class I : Na + channel blocker

Quinidine, Procanamide, Disopyridamole

Lidocaine

Flocainaide, Propafenone

Class II : Beta-blockers- propanolol, metoprolol, aenolol, esmolol

Class III : K+ channel blockers- Amiodarone

Class IV : Calcium channel blockers: Verapamil, Diltiazem

G. PACEMAKERS Implanted on the anterior chest and connected to the heart devices that provide electrical stimulation to the heart to maintain the heart rate when the client’s pacemaker fails Settings: Synchronous or demand pacemaker Asynchronous or fixed rate (preset) Overdrive pacing (to increase cardiac output) Types: Temporary Pacemakers Permanent Pacemakers Management of Dysrhythmias

G. PACEMAKERS

Implanted on the anterior chest and connected to the heart

devices that provide electrical stimulation to the heart to maintain the heart rate when the client’s pacemaker fails

Settings:

Synchronous or demand pacemaker

Asynchronous or fixed rate (preset)

Overdrive pacing (to increase cardiac output)

Types:

Temporary Pacemakers

Permanent Pacemakers

1. MONITORING AND MANAGING THE DYSRHYTHMIA To determine hemodynamic effect Evaluate: pulse rate and rhythm respiratory rate and depth breath sounds Ask for episodes of lightheadedness, dizziness, or faintness Obtain 12L ECG Administer antidysrhythmic drugs as prescribed Assess contributing factors to dysrhythmia Administer O2 inhalation as prescribed

1. MONITORING AND MANAGING THE DYSRHYTHMIA

To determine hemodynamic effect

Evaluate:

pulse rate and rhythm

respiratory rate and depth

breath sounds

Ask for episodes of lightheadedness, dizziness, or faintness

Obtain 12L ECG

Administer antidysrhythmic drugs as prescribed

Assess contributing factors to dysrhythmia

Administer O2 inhalation as prescribed

2. MINIMIZE ANXIETY Maintain a calm and reassuring attitude to foster trusting relationship Promote self confidence in living with dysrhythmia 3. PROMOTING HOME AND COMMUNITY BASED CARE Teach patient self care

2. MINIMIZE ANXIETY

Maintain a calm and reassuring attitude to foster trusting relationship

Promote self confidence in living with dysrhythmia

3. PROMOTING HOME AND COMMUNITY BASED CARE

Teach patient self care

FREE NURSING LECTURES Medical Surgical Obstetric Nursing Psychiatric Nursing Operating Room Nursing And many more…

FREE NURSING LECTURES

Medical Surgical

Obstetric Nursing

Psychiatric Nursing

Operating Room Nursing

And many more…