Cardiac Arrhythmia definition, classification, normal sinus rhythm, characteristics , types and management with medical ,surgical & nursing, health education and nursing diagnosis for paramedical students.

1. PRESENTED BY:
MS.HELAN MARIA,
M.Sc.(N)1ST
YEAR,
CON-SRIPMS,
CBE.
CARDIAC ARRHYTHMIA

3. Introduction:
Without a regular rate & rhythm, the heart may not
perform efficiently as a pump to circulate oxygenated
blood & other life sustaining nutrition to all of the
body’s tissues & organs with an irregular or rhythm,
the heart is considered to be dysrhythmic( arrhythmic)
 Dysrhythmia - bad rhythm
 Arrhythmia – without rhythm

4. Definition:
 An arrhythmia (also called dysrhythmia) is an
abnormal heartbeat. Arrhythmias can start in
different parts of your heart and they can be too
fast, too slow or just irregular.
- WHO
 It is an disorder of the formation or conduction (or
both) of the electrical impulse within the heart.
These disorders can cause disturbance of the heart
rate, heart rhythm or both.
- Brunner & Suddarth’s textbook of
medical surgical nursing.

5. INCIDENCE
 The prevalence of arrhythmias is expected to be 1.5% to 5%
in the general population, with atrial fibrillation being the
most common.
 Arrhythmias may or may not produce any symptoms and
can be paroxysmal, leading to difficulty in estimating true
prevalence.
 The overall presence of arrhythmia is associated with higher
morbidity and mortality.

6. ETIOLOGY
There are a number of factors that can cause a heart
arrhythmia, including:
 Heart attack or scarring of the heart tissue from a
heart attack;
 Coronary heart disease
 High blood pressure
 Smoking
 Genetics: Changes to the heart’s structure e.g.
from cardiomyopathy; Diabetes; Sleep apnea

7.  Alcohol abuse
 Excessive caffeine consumption
 Overactive thyroid gland (hyperthyroidism)
 Underactive thyroid gland (hypothyroidism)
 Drug abuse
 Stress

8. NORMAL SINUS RHYTHM
 A normal sinus rhythm (NSR) is the regular
rhythm of a healthy heart. It's caused by electrical
impulses from the heart's natural pacemaker, the
sinoatrial (SA) node.

9. CHARACTERISTICS
 ventricular & atrial rate: - 60- 100bpm
 ventricular & atrial rhythm : regular
 QRS shape & duration : normal
 P – wave: normal & always in front of the QRS
 PR interval : consistent interval 0.12 -0.20 sec
 P:QRST ratio: 1:1

10. CLASSIFICATION:
Sinus node dysrhythmia.
Atrial dysrhythmias.
Junctional dysrhythmias.
Ventricular dysrhythmias.
Conduction abnormalities.

11. SINUS NODE DYSRHYTHMIA
Sinus bradycardia.
Sinus tachycardia.
Sinus arrhythmia.

12. ATRIAL DYSRHYTHMIAS.
 Premature atrial complex.
 Atrial fibrillation
 Atrial flutter

13. JUNCTIONAL DYSRHYTHMIAS.
 Premature junctional complex
 Junctional rhythm
 Non paroxysmal junctional tachycardia
 Atrioventricular nodal reentry tachycardia

14. VENTRICULAR
DYSRHYTHMIAS.
 Premature ventricular complex.
 Ventricular fibrillation.
 Idioventricular rhythm.
 Ventricular asystole.

15. CONDUCTION
ABNORMALITIES.
First –degree AV block
 Delayed conduction from the atrium to the
ventricle (defined as a prolonged pr interval of
>200 ms) without interruption in atrial to
ventricular conduction.

16. Second-degree AV block
 Second-degree atrioventricular (AV) block is a
heart condition that occurs when some atrial
impulses are blocked from reaching the
ventricles. It's a type of "incomplete" heart block.

17. Symptoms lightheadedness and syncope.
Types
 Mobitz type I: The site of the block is usually
within the AV node.
 Mobitz type II: The site of the block is almost
always below the AV node.

18. Third-degree atrioventricular (AV) block, also
known as complete heart block (CHB),
 It is a condition that prevents electrical signals
from traveling between the heart's atria and
ventricles. This results in the atria and ventricles
beating independently, which can lead to
insufficient blood flow and life-threatening
complications.

19. SINUS BRADYCARDIA
 Sinus bradycardia is a heart rhythm where the
heart beats slower than normal, but in a regular
pattern. It's defined as a heart rate of less than 60
beats per minute (bpm) in adults.

20. CHARACTERISTIC
 Ventricular & atrial rate: < 60bpm
 Ventricular & atrial rhythm : regular
 QRS shape & duration : normal
 P – wave: normal & always in front of the QRS
 PR interval : consistent interval 0.12 -0.20 sec
 P:QRST ratio: 1:1

21. MANAGEMENT
 Atropine- 0.5mg IV bolus.
 After 3-5 mins, max dosage of 3mg will be
administer
 Dopamine /epinephrine

22. SINUS TACHYCARDIA
Sinus tachycardia is a regular heart rhythm where the heart
beats faster than normal. It's often a normal response to exercise
or stress, but it can also be a sign of an underlying condition.
Symptoms of sinus tachycardia
 Palpitations,
 Fainting, Chest pain,
 Difficulty breathing, and Dizziness.

23. CHARACTERISTICS
 ventricular & atrial rate:> 100bpm <120bpm
 ventricular & atrial rhythm : regular
 QRS shape & duration : normal
 P – wave: normal & always in front of the QRS
 PR interval : consistent interval 0.12 -0.20 sec
 P:QRST ratio: 1:1

24. MANAGEMENT
 Beta-blockers: metoprolol, nadolol, and propranolol, these
can help with tachycardia, especially during exercise
 Calcium channel blockers: verapamil can help lower your
heart rate
 Anti-arrhythmic medications: potassium or sodium
channel blockers, adenosine, digoxin, and magnesium
sulfate

25. SINUS ARRHYTHMIA
Sinus arrhythmia is a variation in the heart's rhythm that's
usually normal and indicates good heart health. It's a type of
arrhythmia, which is an abnormal heart rhythm.
 When you breathe in, your heart rate increases and the time
between heartbeats shortens.
 When you breathe out, your heart rate decreases and the time
between heartbeats lengthens.

26. CHARACTERISTIC
 Ventricular & atrial rate:60-100bpm
 Ventricular & atrial rhythm : irregular
 QRS shape & duration : normal
 P – wave: normal & always in front of the QRS
 PR interval : consistent interval 0.12 -0.20 sec
 P:QRST ratio: 1:1

27. MANAGEMENT
It does not cause any significant hemodynamic
effects & therefore is not typically treated.

28. PREMATURE ATRIAL
COMPLEX
 PAC is a single ECG complex that occurs when an
electrical impulse starts in the atrium before the
next normal impulse of the sinus node.

29. characteristics
 Ventricular & atrial rate: depends on the underlying
rhythm
 Ventricular & atrial rhythm : irregular due to early p
wave
 QRS shape & duration : due do early p wave is
abnormal
 P – wave: seen or be hidden
 PR interval : p wave is shorter than normal PR
interval 0.12 -0.20 sec
 P:QRST ratio: 1:1

30. MANAGEMENT
Treatment is not necessary but, they focus on
underlying causes e.g.: Intake of caffeine, correction
of hypokalemia

31. ATRIAL FIBRILLATION
Atrial fibrillation(afib or AF) is an irregular heartbeat that occurs
when the upper chambers of the heart beat too fast and out of
rhythm. It's the most common type of arrhythmia that lasts more
than a few seconds.
Risk factors:
 Post operative cardiac surgery
 Hypertension
 Obesity
 VHD
 Heart failure

32. CHARACTERISTIC
 Ventricular & atrial rate: atrial rate 300-600bpm ventricular
rate 120-200bpm in untreated AF
 Ventricular & atrial rhythm :highly irregular
 QRS shape & duration :usually normal maybe abnormal
 P – wave: no discernible P wave
 PR interval : cannot be measured
 P:QRST ratio: many:1

33. Management
 Beta blockers: Slow the heart rate
 Calcium channel blockers: Control the heart rate
 Digoxin: Controls the heart rate at rest
 Blood thinners: Prevent blood clots and reduce the risk of
stroke
 Anti-arrhythmics: Restore normal heart rhythm

34. ATRIAL FLUTTER
Atrial flutter is a heart rhythm abnormality that causes
the upper chambers of the heart to beat too fast.

35. CHARACTERISTICS
 Ventricular & atrial rate: -atrial rate 250-400bpm
ventricular rate 75-150bpm
 Ventricular & atrial rhythm : atrial rhythm is regular
but ventricular maybe irregular
 QRS shape & duration : usually normal, maybe
abnormal or may be absent.
 P – wave: saw-toothed shape
 PR interval :multiple f wave cannot be measure
 P:QRST ratio: 2:1,3:1or4:1

36. Management
 Adenosine IV followed by 20ml saline flush
 Elevation of arm with IV line to promote rapid
circulation of medication.
 Antiarrhythmics - amiodarone
 Beta blockers- adrenaline
 Calcium channel blockers
 Anticoagulants- prevent blood clots, such as
heparin, warfarin,

37. PREMATURE JUNCTIONAL
COMPLEX
A premature junctional complex (PJC) is an extra
heartbeat that originates in the atrioventricular (AV)
junction of the heart.
Causes:
 Heart failure
 CAD

38. CHARACTERISTICS
 P wave: may be inverted, absent, or occur after the
QRS complex
 PR interval: short or absent
 QRS complex: normal in shape and morphology

39. JUNCTIONAL RHYTHM
Junctional or idionodal rhythm occurs when the AV node
, instead of the sinus node, become the pacemaker of the
heart.

40. CHARACTERISTIC
 ventricular & atrial rate: 40-60bpm
 ventricular & atrial rhythm : regular
 QRS shape & duration : normal/abnormal
 P – wave: maybe absent after or before QRS
complex
 PR interval : PR interval is < 0.12 sec
 P:QRST ratio: 1:1 or 0:1

41. MANAGEMENT
Pacemaker therapy

42. NON PAROXYSMAL
JUNCTIONAL TACHYCARDIA
NPJT is a form of SPV originating from AV junction
with a gradual onset & termination
 it is similar to junctional rhythm

43. ATRIOVENTRICULAR NODAL
REENTRY TACHYCARDIA
It is a type of abnormal, rapid heart rhythm where
electrical signals within the atrioventricular (AV) node of
the heart loop back on themselves, creating a "reentry
circuit" that causes the heart to beat very fast, often with
sudden onset and termination

44. CHARACTERISTICS
 Ventricular & atrial rate: - 60- 100bpm
 Ventricular & atrial rhythm : regular
 QRS shape & duration : normal
 P – wave: normal & always in front of the QRS
 PR interval : consistent interval 0.12 -0.20 sec
 P:QRST ratio: 1:1

45. MANAGEMENT
 Vagal maneuvers: simple actions like coughing,
holding your breath, or applying cold water to the
face can sometimes stop an AVNRT episode.
 Adenosine: this is the first-line medication
 Calcium channel blockers: verapamil can be used.
 Beta-blockers

46. PREMATURE VENTRICULAR CONTRACTION
A ventricular premature complex (VPC), also known as
a premature ventricular contraction (PVC), is an extra
heartbeat that originates in the heart's lower
chambers. Pvc are common and usually harmless.

47. CHARACTERS
 Ventricular & atrial rate: depends on the underlying
rhythm
 Ventricular & atrial rhythm : irregular
 P – wave: visible P wave
 PR interval : consistent interval 0.12 sec
 P:QRST ratio: 0:1 ,1:1

48. MEDICAL MANAGEMENT
 Beta blocker : to lower blood pressure and reduce pvcs
 Calcium channel blockers: to lower blood pressure and
reduce pvc
 Antiarrhythmic: to control irregular heart rhythms

49. VENTRICULAR TACHYCARDIA
Ventricular tachycardia (VT) is a condition in which the
heart's lower chambers beat abnormally fast. It can be life-
threatening and may require immediate medical care.

50. Symptoms
•Chest pain
•Lightheadedness or dizziness
•Fainting
•Shortness of breath
•Palpitations
•Anxiety
•Tightness in the neck
•Tiredness

51. CAUSES
•Heart attack
•Anti-arrhythmic drugs
•Congenital heart disease
•Ischemic heart disease
•Structural heart disease
•Electrolyte imbalances

52. CHARACTERISTICS
 ventricular & atrial rate: - 100-200bpm
 ventricular & atrial rhythm : regular
 QRS shape & duration : abnormal
 P – wave: very defect to detect
 PR interval : irregular
 P:QRST ratio: difficult to determine

53. MEDICAL MANAGEMENT
Defibrillation to restore normal heart rhythm and Anti-
arrhythmic medication injections.

54. VENTRICULAR FIBRILLATION
Ventricular fibrillation (v-fib) is a life-threatening heart rhythm
disorder that causes the heart's ventricles to quiver instead of
pumping blood. It's the most common cause of sudden cardiac
death.

55. SYMPTOMS
•Chest pain, fullness, discomfort, or pressure
•Dizziness or lightheadedness
•Nausea
•Racing or erratic pulse
•Heart palpitations
•Shortness of breath

56. CAUSES
•Heart attack
•Heart disease
•Heart surgery
•Sudden blow to the chest
•Medicines
•Potassium levels in the blood

57. MANAGEMENT
 Treatment cardiopulmonary resuscitation (CPR),
 Shocks to the heart with an automated external defibrillator
(AED),
 Medications,
 Implanted devices and surgery.

58. IDIOVENTRICULAR RHYTHM
Idioventricular rhythm is a heart rhythm where the lower
chambers of the heart beat more slowly than normal. It's also
known as a "slow ventricular tachycardia”

59. CHARACTERISTICS
 A rate of less than 50 beats per minute
 No conducted P waves, andA widened QRS complex.

60. MANAGEMENT
 Atropine may be used to increase heart rate, and
verapamil,
 Antiarrhythmic drugs

61. VENTRICULAR ASYSTOLE
Ventricular asystole is a complete absence of the heart's
electrical and mechanical activity, also known as flat line.

62. MANAGEMENT
 High –quality CPR
 Assess for possible causes
Hs
 Hypoxia
 Hypovolemia
 Hydrogen ion (acid- base imbalance)
 Hypo/hyperglycemia
 Hypo/hyperkalemia
 hyperthermia

63. Ts
 Trauma
 Toxins
 Tamponade
 Tension pneumothorax
 Thrombus
CPR>INTUBATION>IV MEDICATION(emergency
med)

64. SYMPTOMS
 Tightness
 Chest pain
 Palpitation
 Sob
 Dizziness
 Fainting

65. DIAGNOSTIC EVALUATION
 History Collection
 Physical Examination
 ECG
 Echo- cardiogram
 Blood test
-electrolyte
-cardiac biomarker
 Genetic testing(if needed)

66. COMPLICATIONS
 Stroke
 Heart failure
 Sudden cardiac arrest
 Cardiogenic shock
 Chronic fatigue
 MI
 End- organ damage

67. SURGICAL MANAGEMENT
 Maze procedure
 Valve replacement
 Pacemaker & implantable cardioverter defibrillator(ICD)
 CABG
 Heart transplantation

68. NURSING DIAGNOSIS
 Decreased Cardiac Output Related to Altered heart rate
and rhythmAs evidenced by Irregular pulse
 Risk for Decreased CardiacTissue Perfusion Related to
Inadequate blood flow due to abnormal heart rhythms
 IneffectiveTissue Perfusion Related to Inadequate cardiac
output from arrhythmia as evidenced by weak pulses
 Activity Intolerance Related to Insufficient oxygenation due
to abnormal heart rhythms as evidenced by Fatigue
 Anxiety Related to Fear of life-threatening arrhythmia
episodes as evidenced by Restlessness

69. HEALTH EDUCATION
Lifestyle Changes
 Eat a healthy diet (low salt, low cholesterol, more
vegetables).
 Exercise regularly (as recommended by your doctor).
 Quit smoking and limit alcohol and caffeine.
 Reduce stress with relaxation techniques like yoga or
meditation .
 Monitor your blood pressure, cholesterol, and blood sugar.

70. Seek Emergency Help
 Call emergency services immediately if you experience:
 Severe chest pain or pressure.
 Sudden shortness of breath.
 Fainting or losing consciousness.
 A very fast or very slow heart rate that doesn’t stop.

71. Patient Self-Care & Monitoring
 Check your pulse regularly and report irregularities to your
doctor.
 Take medications as prescribed and attend all follow-up
visits.
 Wear a medical alert bracelet if you have a serious
arrhythmia.
 Educate family members on CPR in case of emergencies.

72. CONCLUSION
In conclusion ,arrhythmias are abnormal heart rhythms
that can range from harm- less to life-threating .however,
ongoing research is essential to enhance prevention, early
intervention & treatment strategies to reduce the risk of
complications like stoke and sudden cardiac arrest.