This document provides information on cardiac conduction systems, normal ECG rhythms, cardiac arrhythmias, and arrhythmia management. It defines normal sinus rhythm on ECG and describes the two main types of arrhythmias as bradycardia and tachycardia. Nine common arrhythmias are defined including atrial flutter, atrial fibrillation, junctional rhythm, and various ventricular arrhythmias. Treatment options for arrhythmias include electrical cardioversion, antiarrhythmic medications, and pacemakers.

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2. By
Zarish Fazil
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3.  By the end of this presentation learners will be able
to know about
 Conduction system
 Normal ECG rhythem
 Cardiac Arrhythmias
 Management of Arrhythmias
 Heart block
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6.  P wave should be positive in lead two/ three/AVF (
limbs leads) and negative in AVR
 Heart rate should be between 60bpm to 80bpm
 QRS complex should be narrow
 Every p should followed by QRS complex
 P-P R-R P-R should b constant
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7.  An abnormality of the cardiac rhythm is called
cardiac arrhythmia.
 Arrhythmias may cause sudden death,
syncope, heart failure, dizziness, palpitations
or no symptoms at all.
 There are two main types of arrhythmia:
 bradycardia: the heart rate is slow (< 60
bpm).
 tachycardia: the heart rate is fast (> 100
bpm).
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8. 1. ATRIAL FLUTTER
2. ATRIAL FIBRILLATION
3. JUNCTIONAL RHYTHM
4. VENTRICULAR TACHYCARDIAS
5. VENTRICULAR FIBRILLATION
6. VENTRICULAR ASYSTOLE
7. FIRST DEGREE ATRIOVENTRICULAR BLOCK TYPE
1
8. SECOND DEGREE ATRIOVENTRICULAR BLOCK
TYPE 2
9. THIRD DEGREE ATRIOVENTRICULAR BLOCK TYPE
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9.  The two
 "shockable" rhythms are
 Ventricular fibrillation and
 Pulseless ventricular tachycardia
 while the two
 "non–shockable" rhythms are
 Asystole and
 Pulseless electrical activity
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10.  Atrial flutter is a common abnormal heart
rhythm that starts in the atrial chambers of the
heart. When it first occurs, it is usually associated
with a fast heart rate and is classified as a type of
supraventricular tachycardia
 Occurs in atrium and creates impulses at regular
rate between 250 and 400 times per minute.
 Because the atrial rate is faster than the AV node
can conduct, all atrial impulses are not
conducted into the ventricle, causing a
therapeutic block at AV node.
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12. Ventricula
r and
Atrial rate
Ventricula
r and
atrial
rhythm
QRS P wave PR interval P:QRS
ratio
Atrial rate
range
between
250-
400bpm
Ventricula
r rate
ranges
between
75-
150bpm
Atrial
rhythm is
regular
ventricle
rhythm is
usually
regular
but may
change in
AV
conductio
n
Usually
normal,
may be
abnormal
or may be
absent
Saw-
toothed
shape;
These
waves are
referred
to as F
waves
Multiple F
waves
make it
difficult to
determine
PR
intervals.
2:1
3:1or may
be
4:1
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14.  Atrial fibrillation causes a rapid, disorganized
, and uncoordinated twitching of atrial
musculature.
 Can increase your risk of strokes, heart
failure and other heart-related complications.
 Can be transient, starting and stopping
suddenly and occurring for short time.
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16. Ventricula
r and
Atrial rate
Ventricula
r and
atrial
rhythm
QRS P wave PR interval P:QRS
ratio
Atrial rate
300 to
600bpm
Ventricula
r rate
ranges
between
120-
200bpm
Highly
irregular
Usually
normal,
may be
abnormal
No
discernibl
e P wave.
Irregular
undulatin
g waves
are seen
and are
referred
to as
fibrillatory
or F waves
Can not
be
measured
Many:1
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18.  Commonly called flat line ventricular asystole
is characterized by ABSCENT QRS COMPLEX
confirmed in two different leads
 Although P waves may be apparent for short
duration.
 There is no heart beat, no palpable pulse, and
no respiration.
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20.  Junctional rhythm or idioventricular rhythm
occur when the AV node, instead of the sinus
node becomes the pacemaker of the heart.
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22. Ventricula
r and
Atrial rate
Ventricula
r and
atrial
rhythm
QRS P wave PR interval P:QRS
ratio
Atrial and
ventricular
rate 40-
60 bpm if
P waves
are
discernibl
e
Regular Usually
normal,
may be
abnormal
May be
absent,
after the
QRS
complex,
or before
QRS; may
be
inverted
specially
in lead 2
If the P
wave is in
front of
QRS, the
PR interval
is less
than 0.12
seconds
1:1 or 0:1
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23.  No pharmacologic therapy is needed for
asymptomatic, otherwise healthy individuals
with junctional rhythms that result from
increased vagal tone. In patients with
complete AV block, high-grade AV block, or
symptomatic sick sinus syndrome (ie, sinus
node dysfunction), a permanent pacemaker
may be needed.
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24.  If P wave can not be identified, the rhythm
may be called supraventricular tachycardia
SVT, or proximal supraventricular tachycardia
(PSVT), if it had an abrupt onset, until the
underlying rhythm and resulting diagnosis is
determined.
 SVT and PSVT indicate only that the rhythm is
not ventricular tachycardia (VT) . SVT could
be atrial fibrillation, atrial flutter, or
atrioventricular reentry tachycardia among
others.
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26.  VT is defined as three or more PVCs in a row,
occurring at a rate exceeding 100 bpm.
 Usually associated with coronary artery
disease, and may precede ventricular
fibrillations.
 Ventricular tachycardia is SHOCKABLE
RHYTHM if pulseless
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28. Ventricula
r and
Atrial rate
Ventricula
r and
atrial
rhythm
QRS P wave PR interval P:QRS
ratio
Ventricula
r rate is
100-
200bpm
Atrial rate
depends
on the
underlying
rhythm.
Usually
regular
Duration
is 0.12
seconds
or longer;
shape is
more
bizarre
and
abnormal
Difficult to
detect.
If the P
wave are
seen
interval is
very
irregular
Difficult to
determine
If P waves
are
apparent,
there are
usually
more QRS
than P
wave
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29.  Ventricular fibrillation is a rapid, disorganized
ventricular rhythm that causes ineffective
quivering of the ventricle.
 No atrial activity is seen on ECG.
 This arrhythmia is always characterized by
the absence of an audible heart beat, a
palpable pulse, and respiration, because of
no coordinated cardiac activity.
 ITS SHOCKABLE RHYTHM
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31. Ventricular and Atrial
rate
Ventricular and atrial
rhythm
QRS
Ventricular rate is
greater than 300bpm
Extremely irregular
without any specific
pattern
Irregular waves, without
recognizable QRS
complex
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32.  Treatment for VF
 starts with early and effective CPR. Keeping
the brain, heart and other vital organs
perfused is very important in an arrest.
 Once the rhythm is identified as ventricular
fibrillation, a shock should be delivered
immediately. After the shock is delivered,
begin CPR again for two minutes.
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33.  Commonly called flat line ventricular asystole
is characterized by ABSCENT QRS COMPLEX
confirmed in two different leads
 Although P waves may be apparent for short
duration.
 There is no heart beat, no palpable pulse, and
no respiration.
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34.  Ventricular asystole is treated with high quality CPR with
minimum interruption
 After the initiation of CPR, intubation and establishment of
IV access are the next recommended actions with no or
minimum interruptions in chest compressions.
 After 2 minutes or five cycles of CPR, a bolus of IV
epinephrine is administered and repeated at 3 to 5
minutes intervals.
 One does of vasopressin may be administered for the first
or second does of epinephrine.
 1 mg bolus of IV atropine
 If patient still not respond resuscitation efforts are ended
 The code is called
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35.  First degree AV block occurs when all the atrial
impulses are conducted through the AV node
into the Ventricles at a rate slower than normal.
 Second degree AV block occur when there is a
repeating pattern in which a series of atrial
impulses are conducted through the AV node
into the ventricles (eg every 4 of 5 impulses are
conducted)
 Each atrial impulse takes a longer time for the
conduction than before. Until one impulse is fully
blocked
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39.  O2 inhalation
 Maintain i/v line
 Continuously cardiac monitoring
 Regularly evaluate the patients blood pressure, pulse
rate, and rhythm, and rate and depth of respiration
 Ask the patient about episodes of lightheadedness,
dizziness, or fainting.
 Obtain 12 lead ECG to track dysrhythmias, and also to
see results of antiarrhythmic medication.
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40.  Assess for the beneficial and adverse effects of each
medication
 Nurse may also administer a 6 minutes walk test
 Ask patient if any medication is being taken prior,
which can cause dysrhythmia
 eg digoxin
 Preparedness of equipment for invasive procedure
 Access patient for dizziness ,chest pain, sweating any
other symptoms
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41.  DECREASED CARDIAC OUTPUT
 ANXIETY RELATED TO FEAR OF UNKNOWN
OR DEATH
 DEFICIT KNOWLEDGE ABOUT DYSRHYTHMIAS
AND ITS TREATMENT
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