This document discusses different types of heart block and arrhythmias. It defines first, second, and third degree heart block and their characteristic ECG patterns. It also covers different types of arrhythmias including sinus, atrial, junctional, and ventricular arrhythmias. For each type of arrhythmia, it discusses causes, ECG characteristics, clinical manifestations, and potential treatments. The document provides an overview of heart block and various cardiac arrhythmias for medical professionals.

1. HEART BLOCK
OR
ATRIO VENTRICULAR BLOCK
Mr.Mihir .M.Patel,
Nursing Tutor,
Government College of
Nursing,Siddhpur

2. Definition
 It occur when the conduction of impulses through the
AV nodal area is decreased or stopped.
Etiology
Medications e.g. Digitalis, calcium channel blocker,
beta blockers
Myocardial ischemia
Myocardial infraction
Increased vagal tone e.g. suctioning, pressure over
eye.

3. Classification
First Degree Heart Block
It occurs when all the atrial impulses are conducted
through the AV node into the ventricle at a rate slower
than the normal.
ECG Characteristics
Ventricular and artrial rate
QRS Complex: Normal
PR Interval more than 0.20 sec.
P wave : Normal

4. Cont…
Second Degree Heart Block
It occurs when all but one of the atrial impulses are
conducted through the AV node into the ventricle.
Each impulse takes a longer time than the previous
impulse
ECG characteristics
 Ventricular and atrial rate
 Rhythm:RR interval gradually shorten
 QRS Complex: normal/abnormal
 PR interval: longer with every ECG
 P wave: Normal
 P:QRS-3:2,4:3,5:4.

5. Cont….
Treatment
Inj.Atropine is administered to increase heart rate
Temporary pacemaker may be used
If patients is asymptomatic monitor the rhythm
slowly.

6. Third Degree Heart Block
It occurs when no atrial impulse is conducted through
the AV node into the ventricles. Here 2 impulses
stimulate heart, one stimulate the ventricle and other
the atria.
ECG characteristics
Ventricular and atrial rate
Rhythm:PP and RR interval are regular but not equal
PR interval :irregular
P:QRS-P waves are more than QRS complexes.

7. Clinical Manifestation
 Activity Intolerance
 Weakness
 Hypotension
 Dizziness
 Shortness of Breath
 Dyspnea
 Palpitation
 Altered mental status
 Anxiety
 Respiratory Insufficiency
 Syncope
 Seizures
 Pallor
 Decreased urine output

8. Diagnostic Evaluation
 History Collection
 Physical Examination
 12 lead ECG
 Serum Electrolyte level
 Exercise stress testing
 Holter monitoring
 Atrial Electrogram (It is similar to an ECG but is used
to monitor atrial rhythm)

9. Management
 Medical Management
 Defibrillation and Cardioversion
 CPR
 Automatic External Defrillator
 Cardiac Pacing
 Antirhythmic Drugs
Class-1 Sodium channel blocker e.g. disopramide
Class-2 Beta adrenergic blocker e.g. Metoprolol
Class-3 Potassium channel Blocker e.g. Verapamil
 Oxygen Administration
 Implantable cardioverter defibrillator
 Anti coagulation
 Reduce intake of caffeine, low fat and cholesterol

10. Surgical Management
Left Ventricular Infarctectomy
Myocardial Revascularization
Encircling Ventriculotomy

11. Nursing Management
Monitor the pt heart rhythm Properly
Monitor CO
Document dysrhythmias in ECG
Monitor the patients lab value
Administer anti dysrhythmias agents
Administer Oxygen
Minimize the anxiety

12. DYSARRHYTHMIAS
 It is the disorder of the formation or conduction of
electrical impulses within the heart altering the heart
rate ,rhythm or both potentially causing altered blood
flow.

13. Etiology
Cardiac Condition
Cardiomyopathy
Heart Failure
Myocardial cell degeneration
Myocardial infarction
Valve Disease
Other Condition
Acid Base Imbalance
Alcohol
Caffeine and tobacco intake
Connective tissue disorder
Drugs toxicity
Electric shock
Electrolyte Imbalance
Hypoxia
Shock
Metabolic Disorders
Poisoning

14. Pathophysiology
Cardiac cycle depends on a balance of basic regulatory
substance (Na,K,Ca and catecholamine)
Imbalance in the regulator can cause disturb pacing
function, conduction or myocardial contractility
Dysarrythmias

15. Classification
They are classified as the following;
Sinus node
Atrial node
Normal Junctional
Ventricular dysarrhythmias

16. Sinus Node Arrhythmias
 Sinus Bradycardia
It occures when the sinus node creates an impulse at a
slower than normal rate
Causes
Low metabolic demand
Vagal Stimulation
Increased ICP
Myocardial infarction

17. Cont…
ECG Characteristics
Ventricular and atrial rate less than 60.
Rhythm: Normal
P wave: Normal and Consistent
P:QRS ratio-1:1
Treatment
Inj.Atropine 0.5-1.0 mg/iv
IV catecholamine
Transcutaneous Pacing

18. Cont…
Sinus Tachycardia
It occures when the sinus node creates an impulse at a
faster than normal rate.
Causes
 Acute blood loss
 CCF
 Pain
 Hyper metabolic State
 Fever
 Anxiety

19. Cont…
ECG Characteristics
Ventricular and Atrial rate more than 100.
Rhythm: Normal
P Wave: Normal and consistent
P:QRS ratio-1:1

20. Cont….
Sinus Arrhythmias
It occures when the sinus node create an impulse at a
irregular rhythm, rate usually increases with
inspiration and decrease with expiration
ECG Characteristics
Ventricular and atrial rate :60-100
Rhythm Irregular
QRS Wave Abnormal
P Wave; Normal
P:QRS ratio-1:1

21. Atrial Dysarrythmias
1. Pre Mature Atrial Complex
It occurs when an electrical impulse starts in the
atrium before the normal impulse of the sinus node.
Causes
Intake of Caffeine
Alcohol
Nicotine
Anxiety
Infarction
Note: Treatment is not usually required

22. Cont….
2.Atrial flutter
It occur when the atrium creates an impulse at a rate of
250-400/min. Atrial rate is faster than AV node can
conduct not all atrial impulse enter ventricle causing a
therapeutic AV block.
Causes
Hypotension
Cardiomyopathy
Heavy alcoholism
Open Heart surgery
Management
Cardio version
Ad.B-blocker and
Digitalis

23. Cont…
3.Atrial Fibrillation
It causes a rapid,disorganised and uncontrolled
twitching of the atrial musculature.
Causes
Same as Atrial Flutter
Treatment
Cardio version
Medication: Amiodarone
Calcium Channel Blockers
Warfarin
Digoxin to improve cardiac function
Pacemaker

24. Junctional Dysarrythmias
1.Premature Junctional Complexes
It is an impulse that starts in the AV nodal area before
the next normal sinus impulse reaches AV node.
2.Junctional Rhythm
It occurs when the AV node instead of the SA node
becomes the pacemaker of the Heart
Treatment: Emergency Pacing
3.Atrioventricular Nodal reentry tachycardia
It occurs when an impulse is conducted to an area in
the AV node that causes the impulse to be re routed
back into the same area over and over again at a faster
rate.

25. Ventricular Dysarrhythmias
Premature Ventricular Complex
It is an impulse that start in the ventricle and is
conducted through the ventricle before the next normal
sinus impulse
Ventricular Tachycardia
It is defined as more than 3 PVC in a row. It is treated
with immediate defibrillation
Ventricular Fibrillation
It is rapid but disorganized ventricular rhythm that
causes ineffective waves from ventricle. No atrial
activity seen in ECG.

26. Cont…
Treatment
CPR and emergency services
Transcutaneous pacing