Cardiac arrythmias

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most common cardiac arrythmias

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Cardiac arrythmias

  1. 1. CARDIAC ARRYTHMIAS ORHAN HAKLI, NP
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 11. ATRIAL RHYTHMS AFIB AFLUTTER
  12. 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. 13. VENTRICULAR RHYTHMS VENTRICULAR TACHICARDIA VENTRICULAR FIBRILATION ASYSTOLE
  14. 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. 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. 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. 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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