in these slides cardiac conduction disorders are explained thoroughly and also relate these disorders with ECG abnormality in the ECG graph.

1. DISORDERS OF CARDIAC
CONDUCTION , HEART BLOCK,
PACEMAKER
4/16/2021
prepared by sadiq ahmad
1
Presentors
Sadiq Ahmad (TL)
Nadeem shah
Muhammad Zaid
Faculty
Humayun Khan
MEDIX COLLEGE OF HMS AND INSTIUTE OF
NURSING CHAKDARA

2. Objectives
4/16/2021
prepared by sadiq ahmad
2
After the end of this presentation the learners will be
able to ;
 Describes the conduction system of heart.
 Define dysrhythmias and conduction disorders.
 Explore different type of cardiac conduction disorders
in detail.
 Elaborate assessment, diagnosis, Nursing
interventions of different types of arrhythmias.

3. Continue…
4/16/2021
prepared by sadiq ahmad
3
 Explain the heart block and its different categories.
 Discuss the epidemiology of cardiac conduction
disorders.
 Explain dietary management for arrhythmic patient.
 Identify pacemaker and its uses in cardiac
dyrhythmias.

4. 4/16/2021
prepared by sadiq ahmad
4
 Sinus node
SA node (60-100 bpm)
AV node (40-60 bpm)
 Bundle of HIS (20-40)
 Purkinji fiber

5. Continue…
4/16/2021
prepared by sadiq ahmad
5
 Electrically Stimulation of heart is known as
depolarization and mechanically known as systolics
 Electrically heart relaxation is known as
repolarization and mechanically known as diastolic
 Heart is also control through autonomous nervous
system i-e sympathetic and parasympathetic's

6. Normal ECG and conduction system
of heart
4/16/2021
prepared by sadiq ahmad
6

7. 4/16/2021
prepared by sadiq ahmad
7

8. What would happen if sympathetic or
parasympathetic are activated??
4/16/2021
prepared by sadiq ahmad
8
 SA node are known as dominant pacemaker.
 AV node bundle of HIS and purkinji fiber is known as
subsidiary pacemaker or recessive pacemaker.

9. Conduction disorders &
dysryhythmias
4/16/2021
prepared by sadiq ahmad
9
 Is a problem with the electrical system that makes
your heart beat and controls its rate and rhythm.
 This system is called the cardiac conduction system.
 Normally, the electrical signal that makes your heart
beat travels from the top of your heart to the bottom
 A cardiac dysrhythmia is an abnormal heart beat the
rhythm may be irregular or the heart rate may be low
or high .

10. Continue…
4/16/2021
prepared by sadiq ahmad
10
 In 2003, dysrhythmias caused or contributed to
479,000 deaths.

11. Cardiac conduction disorders
4/16/2021
prepared by sadiq ahmad
11
Arise due to any
one of the two
reason
 Impulse formation
 Impulse
conduction

12. Sinus bradycardia
4/16/2021
prepared by sadiq ahmad
12
In adults when heart beats is reduced then 60 beats
/min.
Causes
 Sleeping
 Hypothermia
 Hypothyroidism
 Beta blocker

13. Sinus tachycardia
4/16/2021
prepared by sadiq ahmad
13
In adult when heart beats increased then 100
beats/min
Causes
 Sympathetic stimulation
 Hypovolumia
 Acute blood loss
 Exercise

14. Sinus arrhythmias
tachy/ brady arrhythmias
4/16/2021
prepared by sadiq ahmad
14
 A sinus arrhythmia is an irregular heartbeat that’s
either too fast or too slow.
 Some times it the formation of more then 100
while sometime cause the formation of less then
60 beats/min.

15. Atrial arrhythmias
4/16/2021
prepared by sadiq ahmad
15
Atrial arrhythmias includes
 Pre mature atrial complex(PAC)
 Atrial flutter
 Atrial fibrillations

16. Pre mature atrial arrhythmias
4/16/2021
prepared by sadiq ahmad
16
When atria start their next depolarization/stimulation
before the completion of first complex.
Causes
 Caffeine
 Alcohol
 Nicotine
 Stretched myocardium in atria.
 It seem as sinus tachycardia in ECG.

17. PAC (pre mature atrial complex)
4/16/2021
prepared by sadiq ahmad
17

18. Atrial flutter
4/16/2021
prepared by sadiq ahmad
18
 occur at atrium when rate of impulse is reach to
rang 250-400.
 This rate is 75-150 at ventricles.
 These all impulses are not conducted to ventricles .
 A therapeutics block occur at AV node.
 If these all impulse 250-400 are conducted to
ventricle a fatal situation arise known as ventricular
fibrillation.

19. Signs and symptoms
4/16/2021
prepared by sadiq ahmad
19
 Shortness of breath
 Low blood pressure
 Chest pain
Medications electro cardioversion
Dilitiazem, beta blocker

20. Atrial flutter
4/16/2021
prepared by sadiq ahmad
20

21. Atrial fibrillations
4/16/2021
prepared by sadiq ahmad
21
Rapid ,unorganized and irregular impulse at atria with
rate of 300-600/min
Causes
 advance age hypertension
 Coronary artery disease
 Pulmonary disease
 Hyperthyroidism
Signs and symptoms
 Rapid palpitations
 Malaise
 Fatigue

22. 4/16/2021
prepared by sadiq ahmad
22
 Risk of myocardial ischemia
 Small volume stroke (reduce time for ventricular filling)
 Treatment protocol is same like atrial flutter

23. Difference B/W atrial flutter and
atrial fibrillation
4/16/2021
prepared by sadiq ahmad
23

24. 4/16/2021
prepared by sadiq ahmad
24

25. Junctional rhythms
4/16/2021
prepared by sadiq ahmad
25
 SA node control rhythms normally because it is
dominant
 When AV node or surrounding area of AV node start
to control the rhythm of heart is known as junctional
rythms.
 SA node in this case produce 40-60 beat/min
 Same is produce AV node.
 Signs and symptoms and treatment same to that of
bradycardia.

26. 4/16/2021
prepared by sadiq ahmad
26

27. Junctional dysrrhythmias
4/16/2021
prepared by sadiq ahmad
27
 When the impulse is produce at the junction before
the next arrival of SA node impulse.
 This is rare as compare to pre mature atrial complex
(PAC).
Causes
 Digitalis toxicity
Treatment
 Same as for PAC

28. Reentry
4/16/2021
prepared by sadiq ahmad
28
 When a impulse cause depolarization at a site and
then reenter again to that site to cause
depolarization again and again.

29. AV node reentry
4/16/2021
prepared by sadiq ahmad
29
 When an impulse as conducted to an area in the AV
node and that impulse is re routed again and again
to that area as a result cause tachycardia .
 When this impulse is reach to the ventricle cause
ventriculartachycardia.

30. Signs and symptoms
4/16/2021
prepared by sadiq ahmad
30
 Restlessness
 Chest pain Pallor
 Hypotension
 Loss of consciousness
Treatment
 Vagal maneuvers
 Carotid sinus massage
 Parasympathetic stimulation
 Slowing contraction of AV node

31. Ventricular dysrrhythmias
4/16/2021
prepared by sadiq ahmad
31
 Pre mature ventricular complex
 Ventricular tachycardia
 Ventricular fibrillations

32. Idioventricular rhythms
4/16/2021
prepared by sadiq ahmad
32
 Conduction impulse start below the AV node
 Due to sinus node failed to produce impulse
 Sinus node conduction not reach to the AV node due to
complete heart blocks
 Then bundle of HIS start abnormal conductions

33. Ventricular asystole/straight line
4/16/2021
prepared by sadiq ahmad
33
Signs and symptoms
 Bradycardia
 Reduce cardiac output
 Loss of consciousness
 When ventricle stop electrical conduction
 If not treated immediately can be fatal.
 No respiration
 No palpable pulse
 No heart beats

34. Treatment
4/16/2021
prepared by sadiq ahmad
34
 CPR
 Atropine
 Small bolus of epinephrine 1mg IV

35. Dietary management
4/16/2021
prepared by sadiq ahmad
35
 Explain the therapeutic use digioxin.
 limit or prevent the use of potassium, calcium, and
magnesium.
 Provide information understanding of toxic signs and
symptoms to report to the healthcare provider.
 Fat in Diet should be moderate or low.
 Avoid tobacco smoke.
 Enjoy regular physical activity.

36. 4/16/2021
prepared by sadiq ahmad
36

37. HEART BLOCKS
4/16/2021
prepared by sadiq ahmad
37
First degree block
 AV node impulse not conducted to the ventricles
either it slow or stopped.
 First degree blocks
 All AV nodes impulses are conducted to the
ventricles through bundle of HIS but the rhythm is
reduced

38. 2nd degree heart blocks
4/16/2021
prepared by sadiq ahmad
38
In 2nd degree type 1st
 Impulse will be conducting but one impulse will be
block
2nd degree block type 2
 Only a few impulses will be conducting to the
ventricle from AV node.

39. 4/16/2021
prepared by sadiq ahmad
39

40. Treatment of heart blocks
4/16/2021
prepared by sadiq ahmad
40
 With hold the medications
 Small bolus of atropine IV state
 If blocks is persist then permanent pacemaker is
choice of treatment

41. Assessment
4/16/2021
prepared by sadiq ahmad
41
 Causes of dysrryhthmias
 Effect of dysrryhthmias
 History relate to cardiac problems
 Cardiac pulmonary disease
 Use of medications
Signs and symptoms
 Dizziness
 Fainting
 palpitations

42. Continue…
4/16/2021
prepared by sadiq ahmad
42
 Chest pain
 Shortness of breath
 Discomfort
 Fatigue

43. treatment
4/16/2021
prepared by sadiq ahmad
43
 External electrical activity
Defibrillation
Cardioversion
 Pacemaker
 Surgical treatment is less common but available

44. Nursing diagnosis
4/16/2021
prepared by sadiq ahmad
44
 Based on assessment data diagnose it
 Reduced cardiac output
 Anxiety related to fear due to unknown reason.
 Deficiet knowledge regarding dysrhythmias

45. Nursing interventions
4/16/2021
prepared by sadiq ahmad
45
 Reduced anxiety
 Role of every day cardiac medication on aryhthmias
 Give information to patient relate to dysrhythmias
while simple terminologies
treatment
 medication
 Beta blocker ,ca channel blocker
 Atrophin ,epinephrine

46. Pacemaker
4/16/2021
prepared by sadiq ahmad
46
 It is an electrical device which is implanted
temporary or permanently to control the rhythms of
heart.
 Permanently it is implanted when complete block is
occur.

47. 4/16/2021
prepared by sadiq ahmad
47

48. Assessment
4/16/2021
prepared by sadiq ahmad
48
 An implanted pacemaker is assess through the
following technique
 ECG
 Assessment of infection at the site of leads insertion.
 Heamothorax bleed due subclavein vein or internal
mammary artery puncture.

49. Diagnosis
4/16/2021
prepared by sadiq ahmad
49
 Risk of infection related to pacemaker leads or
generator insertion.
 Risk of ineffective coping
 Deficient knowledge regarding self-care

50. Nursing interventions
4/16/2021
prepared by sadiq ahmad
50
 Nurse check the lead insertion site for heat, redness,
swelling any unusual drainage report to the
physician.
 Promoting the coping mechanism.
 Provide humor prayer and involved the patient in
communication with others social isolation, anxiety,
depression is detect us ineffective coping
 Promote patient self care by teaching

51. References
4/16/2021
prepared by sadiq ahmad
51
 Epidemiology report from
 EKG Interpretation Lecture - Straight A
Nursing
https://www.straightanursingstudent.com/wp-
content
 Bruner and suddarth medical and surgical
nursing
 Author name cardiac nursing

52. 4/16/2021
prepared by sadiq ahmad
52

53. 4/16/2021
prepared by sadiq ahmad
53