This document provides information on cardiac dysrhythmias or arrhythmias. It defines arrhythmias as abnormalities in heart rate, rhythm or impulse origin/conduction. Various types of arrhythmias are described including supraventricular arrhythmias like atrial fibrillation, ventricular arrhythmias like premature ventricular contractions, and bradyarrhythmias. Causes or risk factors of arrhythmias include age, family history, heart disease, medications and substances like caffeine. The document also discusses various inherited arrhythmia conditions.

1. CARDIAC
DYSRHYTHMIAS
Mrs. D. Melba Sahaya Sweety
M.Sc Nursing
GIMSAR

2. INTRODUCTION
• Heart rhythm problems (heart arrhythmias) occur
when the electrical impulses that coordinate the
heartbeats don't work properly, causing the heart to
beat too fast, too slow or irregularly.
• Heart arrhythmias may feel like a fluttering or racing
heart and may be harmless. However, Irregular heart
rhythms can also occur in normal healthy hearts.
Arrhythmias can also be caused by certain substances
or medications, such as caffeine, nicotine, alcohol,
cocaine, inhaled aerosols, diet pills, and cough and
cold remedies. Emotional states such as shock, fright
or stress can also cause irregular heart rhythms.
• In a healthy heart, this process usually goes smoothly,
resulting in a normal resting heart rate of 60 to 100
beats a minute.

3. DEFINITION
• Arrhythmias are deviations from normal heartbeat
pattern. They include abnormalities of impulse
formation,such as heart rate,rhythm,or site of
impulse origin and conduction disturbances,which
disrupt the normal sequence of atrial and
ventricular activation.
• Cardiac dysrhythmias are a problem with the rate
or rhythm of heartbeat caused by changes in
heart’s normal sequence of electrical impulses.
The heart may beat too quickly, called
tachycardia; too slowly, bradycardia; or with an
irregular pattern. It can be life-threatening if the
heart cannot pump enough oxygen-rich blood to
the heart itself or the rest of the body.

4. INCIDENCE
• They occur more frequently in elderly persons,
people with a long history of smoking, patients with
underlying ischemic heart disease, and patients
taking certain drugs or have various systemic
diseases. In the United States, arrhythmias are
present in 12.6% of people older than 65 years of
age,with a rate of 13.6 per 100,000 reported for
the general population. Arrhythmias directly
account for more than 36,000 deaths annually The
most common type of persistent arrhythmia is atrial
fibrillation (AF), which affects approximately 2.6
million people.
• In India The incidence of cardiac arrhythmia was
more in the age group 50-60 years (36.27%).

5. ETIOLOGY
• Any interruption to the electrical impulses that
stimulate heart contractions may result in
arrhythmia.
• Cardiac Disorders : Coronary artery disease,
other heart problems and previous heart surgery,
Narrowed heart arteries, a heart attack, abnormal
heart valves, prior heart surgery, heart failure,
cardiomyopathy and other heart damage are risk
factors for almost any kind of arrhythmia.
• High blood pressure. This increases the risk of
developing coronary artery disease. It may also
cause the walls of left ventricle to become stiff and
thick, which can change the electrical impulses
travel through the heart.

6. ETIOLOGY
• Congenital heart disease. Being
born with a heart abnormality may
affect your heart's rhythm.
•Thyroid problems. Having an
overactive or underactive thyroid gland
can raise the risk of arrhythmias.
•Diabetes. The risk of developing
coronary artery disease and high blood
pressure greatly increases with
uncontrolled diabetes.

7. ETIOLOGY
• Obstructive sleep apnea. This disorder, in
which the breathing is interrupted during
sleep, can increase the risk of bradycardia,
atrial fibrillation and other arrhythmias.
• Electrolyte imbalance. The Substances in
blood called electrolytes — such as
potassium, sodium, calcium and magnesium
— help trigger and conduct the electrical
impulses in heart. Electrolyte levels that are
too high or too low can affect the heart's
electrical impulses and contribute to
arrhythmia development.

8. ETIOLOGY
• Drugs and supplements. Certain over-the-counter
cough and cold medicines and certain prescription
drugs may contribute to arrhythmia development.
• Drinking too much alcohol. Drinking too much
alcohol can affect the electrical impulses in heart
and can increase the chance of developing atrial
fibrillation.
• Caffeine, nicotine or illegal drug use. Caffeine,
nicotine and other stimulants can cause the heart
to beat faster and may contribute to the
development of more-serious arrhythmias. Illegal
drugs, such as amphetamines and cocaine, may
profoundly affect the heart and lead to many types
of arrhythmias or to sudden death due to
ventricular fibrillation.

9. RISK FACTORS
• Risk factors that could contribute to dysrhythmia
include:
• Advancing age: People over the age of 60 are more
likely to develop dysrhythmia.
• Congenital heart defects: Certain structural or
functional heart problems may be present at birth.
• Family history: Some cases of heart disease or
conditions like Long QT syndrome can run in
families.
• Previous heart attacks or surgeries: Damage to
the heart can weaken the muscle and affect its
electrical system.

10. TYPES OF DYSRHYTHMIAS
Types of
Dysrhythmias
Supraventricular
arrhythmias Ventricular
arrhythmias
Inherited
arrhythmias
Bradyarrhythmias

11. TYPES OF DYSRHYTHMIAS
• Tachycardia: A fast heart rhythm with a rate of more
than 100 beats per minute.
• Bradycardia: A slow heart rhythm with a rate below 60
beats per minute.
• Supraventricular arrhythmias: Arrhythmias that begin
in the atria (the heart’s upper chambers). “Supra”
means above; “ventricular” refers to the lower
chambers of the heart, or ventricles.
• Ventricular arrhythmias: Arrhythmias that begin in the
ventricles (the heart’s lower chambers).
• Bradyarrhythmias: Slow heart rhythms that may be
caused by disease in the heart’s conduction system, such
as the sinoatrial (SA) node, atrioventricular (AV) node or
HIS-Purkinje network.

12. Premature atrial contractions (PACs)
Paroxysmal supraventricular tachycardia (PSVT)
Accessory pathway tachycardias (bypass tract
tachycardias)
AV nodal re-entrant tachycardia (AVNRT)
Atrial tachycardia
Atrial fibrillation
Atrial flutter
TYPES OF SUPRAVENTRICULAR
ARRHYTHMIAS

13. TYPES OF SUPRAVENTRICULAR
ARRHYTHMIAS
• Premature atrial contractions (PACs)
Early, extra heartbeats that originate in the atria.
A premature atrial contraction (PAC) is an early
beat that occurs when an ectopic site within the
atria discharges an impulse before the sinus
node impulse is discharged. PACs do not
typically cause damage to the heart and can
occur in healthy individuals with no known heart
disease.
If the ectopic site is near the SA node, the
appearance of the P wave may closely
resemble the sinus P wave Most often the P
wave morphology of the PAC is significantly
different from that of the sinus P wave
Sometimes with very premature PAC’s, the P
wave is hidden within the T wave of the
previous complex

14. • Paroxysmal
supraventricular
tachycardia (PSVT)
• A rapid but regular heart
rhythm that comes from the
atria. This type of arrhythmia
begins and ends suddenly
• R-R Interval is shortened but
is constant
• Hidden P waves
• QRS usually narrow
TYPES OF SUPRAVENTRICULAR
ARRHYTHMIAS

15. • Accessory pathway
tachycardias (bypass
tract tachycardias)
• A fast heart rhythm caused by
an extra, abnormal electrical
pathway or connection
between the atria and
ventricles. The impulses
travel through the extra
pathways as well as the usual
route. This allows the
impulses to travel around the
heart very quickly, causing
the heart to beat unusually
fast (example: Wolff-
Parkinson-White syndrome).
TYPES OF SUPRAVENTRICULAR
ARRHYTHMIAS

16. • AV nodal re-entrant
tachycardia (AVNRT)or
Junctional Tachycardia
• A fast heart rhythm caused
by the presence of more
than one pathway through
the atrioventricular (AV)
node. It is a type of
paroxysmal
supraventricular
tachycardia that results
due to the presence of a
re-entry circuit within or
TYPES OF SUPRAVENTRICULAR
ARRHYTHMIAS

17. •Atrial tachycardia
• A normal heartbeat begins with an
electrical impulse from the sinus node,
a single point in the heart's right
atrium (right upper chamber). During
atrial tachycardia, an electrical
impulse outside the sinus node fires
repeatedly, often due to a short circuit
— a circular electrical pathway.
Electricity circles the atria again and
again, causing the upper chambers to
contract more than 100 times per
minute. (A normal heart rate is
between 60 and 100 beats per minute.)
The rapid heart contractions prevent
the chambers from filling completely
between beats.
TYPES OF SUPRAVENTRICULAR
ARRHYTHMIAS

18. • Atrial fibrillation
• Atrial fibrillation is the most common irregular heart rhythm that
starts in the atria. Instead of the SA node (sinus node) directing the
electrical rhythm, many different impulses rapidly fire at once,
causing a very fast, chaotic rhythm in the atria. Because the electrical
impulses are so fast and chaotic, the atria cannot contract and/or
squeeze blood effectively into the ventricle.
• Instead of the impulse travelling in an orderly fashion through the
heart, many impulses begin at the same time and spread through the
atria, competing for a chance to travel through the AV node. The AV
node limits the number of impulses that travel to the ventricles, but
many impulses get through in a fast and disorganized manner. The
ventricles contract irregularly, leading to a rapid and irregular
heartbeat. The rate of impulses in the atria can range from 300 to 600
beats per minute.
• There are two types of atrial fibrillation. Paroxysmal is intermittent,
meaning it comes and goes and continuous is persistent.
TYPES OF SUPRAVENTRICULAR
ARRHYTHMIAS

19. • Atrial flutter
• An atrial arrhythmia caused by
one or more rapid circuits in the
atrium. Atrial flutter is similar
to atrial fibrillation, a common
disorder that causes the heart to
beat in abnormal
patterns. People with atrial
flutter have a heart rhythm
that's more organized and less
chaotic than that of atrial
fibrillation. It has atrial rates of
240-400
TYPES OF SUPRAVENTRICULAR
ARRHYTHMIAS

20. TYPES OF VENTRICULAR
ARRHYTHMIAS
Types of
ventricular
arrhythmias
Premature ventricular
contractions (PVCs)
Ventricular tachycardia
Ventricular fibrillation
Long QT

21. • Premature ventricular
contractions
A premature ventricular contraction
(PVC) is a too-early heartbeat that
originates in the ventricles and
disrupts the heart’s normal rhythm.
The pattern is a normal beat, an
extra beat (the PVC), a slight pause,
then a stronger-than-normal beat.
The heart fills with more blood
during the pause following the PVC,
giving the next beat extra force.
This pattern may occur randomly or
at definite intervals.
TYPES OF VENTRICULAR
ARRHYTHMIAS

22. • Ventricular tachycardia
• In VT the electrical signals in the ventricles go
off the wrong way. The pulses coming from your
SA node are also affected. Most regular heart
rates are in the range of 60 to 100 beats a
minute. Ventricular tachycardia can result in
rates of 170 beats a minute or even more. When
this happens, the heart’s upper chambers don’t
have time to refill and send that blood to the
ventricles. So the blood doesn’t get pumped
throughout your body the way it should.
• Ventricular tachycardia refers to a wide QRS
complex heart rhythm — that is, a QRS duration
beyond 120 milliseconds — originating in the
ventricles at a rate of greater than 100 beats per
minute.
TYPES OF VENTRICULAR
ARRHYTHMIAS

23. •Ventricular fibrillation (V-fib)
An arrhythmia that starts in your ventricle
is called ventricular fibrillation. This occurs
when the electrical signals that tell your
heart muscle to pump cause your ventricles
to quiver (fibrillate) instead. The quivering
means that your blood is not pumping blood
out to your body. In some people, V-fib may
happen several times a day. This is called
an “electrical storm.”
• Because sustained V-fib can lead to cardiac
arrest and death, it requires immediate
medical attention.
TYPES OF VENTRICULAR
ARRHYTHMIAS

24. •Long QT
• The electrical activity of the heart is produced by the
flow of ions (electrically charged particles of sodium,
calcium, potassium, and chloride) in and out of the
cells of the heart. Tiny ion channels control this flow.
• The term “long QT” refers to the heart’s electrical
activity as graphed on an electrocardiogram (ECG or
EKG). Doctors name the different waves on the ECG
graph P, Q, R, S and T. Letters Q through T correspond
to the heart cells’ “recharging” (repolarizing) after a
muscle contraction. Abnormalities in the heart cells
can slow the process of electrical recharging,
prolonging the QT interval as shown on an ECG. When
the QT interval is longer than normal, it increases the
risk for “torsade de pointes,” a life-threatening form
of ventricular tachycardia.
TYPES OF VENTRICULAR
ARRHYTHMIAS

25. TYPES OF BRADYARRHYTHMIAS
• A bradyarrhythmia is a slow heart rhythm that is
usually caused by disease in the heart’s conduction
system. Types of bradyarrhythmias include:
TYPES OF
BRADYARRHYTHMIAS
Sinus node
dysfunction
Heart
block
First-
degree
heart block
Second-
degree
heart block
Third-
degree heart
block

26. TYPES OF BRADYARRHYTHMIAS
•Sick sinus syndrome (also known as sinus
node dysfunction) is a group of related heart
conditions that can affect how the heart beats.
"Sick sinus" refers to the sino-atrial (SA) node,
which is an area of specialized cells in the heart
that functions as a natural pacemaker. The SA
node generates electrical impulses that start each
heartbeat. These signals travel from the SA node
to the rest of the heart, signalling the heart
(cardiac) muscle to contract and pump blood. In
people with sick sinus syndrome, the SA node does
not function normally. In some cases, it does not
produce the right signals to trigger a regular
heartbeat. In others, abnormalities disrupt the
electrical impulses and prevent them from
reaching the rest of the heart.It tends to cause
the heartbeat to be too slow (bradycardia),

27. TYPES OF BRADYARRHYTHMIAS
•Heart block
A delay or complete
block of the electrical
impulse as it travels
from the sinus node to
the ventricles. The
level of the block or
delay may occur in the
AV node or HIS-
Purkinje system. The
heartbeat may be
irregular and slow.

28. TYPES OF INHERITED ARRHYTHMIAS
• Inherited arrhythmia disorders include several genetic conditions that
place otherwise healthy individuals at risk for sudden cardiac death.
• Due to the fact that inherited arrhythmias are passed down from parents
to children, a family-centered approach to care is essential.
Inherited
arrhythmia
Brugada
syndrome
Congenital Long
QT syndrome
Catecholaminergic
polymorphic ventricular
tachycardia (CPVT)
Congenital
short QT
intervals
(SQT)

29. TYPES OF INHERITED ARRHYTHMIAS
• Brugada syndrome
• Brugada (brew-GAH-dah)
syndrome is a rare, but
potentially life-threatening
heart rhythm disorder that is
sometimes inherited.
• People with Brugada
syndrome have an increased
risk of having irregular heart
rhythms beginning in the
lower chambers of the heart
(ventricles).

30. • Catecholaminergic Polymorphic
Ventricular Tachycardia (CPVT)
• Refers to a hereditary disease that
is associated with exercise (or
adrenergic) As the heart rate
increases in response to physical
activity or emotional stress, it can
trigger an abnormally fast
heartbeat called ventricular
tachycardia and/or cardiac
syncope and carries an increased
risk of sudden cardiac death.
•
TYPES OF INHERITED ARRHYTHMIAS

31. Short Q-T syndrome
• It is a rare genetic type of abnormal heart rhythm that was discovered in 1999.
• The electrical activity of the heart is produced by the flow of ions (electrically
charged particles of sodium, calcium, potassium, and chloride) in and out of the
cells of the heart. Tiny ion channels control this flow. The Q-T interval is the
section on theelectrocardiogram (ECG) that represents the time it takes for the
electrical system to fire an impulse through the ventricles (lower chambers of the
heart) and then recharge. It is translated to the time it takes for the heart muscle to
contract and then recover.
• If you have SQTS, your heart beats at a normal rate, but the time it takes to
recover (the Q-T interval) is much shorter. Another difference in patients with
SQTS is that the Q-T interval does not change as the speed of the heartbeat
changes. In healthy people, the Q-T interval gets longer when the heart beats
slower and shorter when the heart beats faster.
• Normal QT
• Resting Rate: 60 bpm
• QT Interval: 350-440 milliseconds4
• Short QT
• Resting Rate: 60 bpm
• QT Interval: 210 to 340 milliseconds
TYPES OF INHERITED ARRHYTHMIAS

32. PATHOPHYSIOLOGY
Ionic changes
Due to etiological factors
Autonomic
Imbalance
Neurogenic cardiac
damage
Impaired barorecptor
reflex sensitivity
Loss of cardiac
ability to
stabilize heart
rate and BP
Degeneration or
Damage of
conduction system Dysarrhythmias
Impaired impulse
formation,Impaired
impulse conduction
system and a
combination of both.
Catacholamine
surge
Tonic opening of
calcium channel
causes prolonged
cardiomyocytes
contraction
Cardiac conduction
pathway damage
Due to impaired impulse
conductionelectrical impulses
recurrently travel in a tight circle
with in the heart
Re-entrant
Inadequate accecation
of sinus rate
Failure of impulse
formation
SA node
dysfunction
AV conduction
block
Arterial
Dysfunction

33. CLINICAL MANIFESTATION
• The Symptoms are :-
•Palpitations: A feeling of skipped heartbeats, fluttering, "flip-flops" or
feeling that the heart is "running away"
•Pounding in the chest
•Dizziness or feeling lightheaded
•Shortness of breath
•Chest discomfort
•Weakness or fatigue (feeling very tired)
•A slow heartbeat (bradycardia)
•Chest pain
•Anxiety
•confusion
•Sweating
•Fainting (syncope) or near fainting

34. DIAGNOSTIC EVALUATION
• History Collection : regarding onset, duration,
associated manifestations, aggravating factors and relieving
factors. 2) Past medical history including CVD risk factors
analysis. 3) Past health history and hospitalization 4)
Surgical history, allergy, medications, dietary habits, social
habits (tobacco, alcohol) and family history
• Physical examination : Auscultation of heart for
abnormal heart tones, slow or fast rate, irregularity,
murmur
• Electrocardiogram (ECG or EKG): A picture of the electrical
impulses travelling through the heart muscle. An ECG is
recorded on graph paper, through the use of electrodes
(small, sticky patches) that are attached to your skin on the
chest, arms and legs.

35. DIAGNOSTIC EVALUATION
•Ambulatory monitors, such as:
•Stress test: A test used to record arrhythmias
that start or are worsened with exercise. This
test also may be helpful in determining if there
is underlying heart disease or coronary artery
disease associated with an arrhythmia.
•Echocardiogram: A type of ultrasound used to
provide a view of the heart to determine if there
is heart muscle or valve disease that may be
causing an arrhythmia. This test may be
performed at rest or with activity.

36. DIAGNOSTIC EVALUATION
• Cardiac catheterization: Using a local anesthetic, a catheter
(small, hollow, flexible tube) is inserted into a blood vessel and
guided to the heart with the help of an X-ray machine. A
contrast dye is injected through the catheter so X-ray movies
of your coronary arteries, heart chambers and valves may be
taken. This test helps to determine if the cause of an
arrhythmia is coronary artery disease. This test also provides
information about how well the heart muscle and valves are
working.
• Electrophysiology study (EPS): A special heart catheterization
that evaluates the heart’s electrical system. Catheters are
inserted into the heart to record the electrical activity. The
EPS is used to find the cause of the abnormal rhythm and
determine the best treatment. During the test, the arrhythmia
can be safely reproduced and terminated.

37. DIAGNOSTIC EVALUATION
•Tilt table test (also called a passive
head-up tilt test or head upright tilt
test): Records your blood pressure and
heart rate on a minute-by-minute basis
while the table is tilted in a head-up
position at different levels. The test
results may be used to evaluate heart
rhythm, blood pressure and sometimes
other measurements as you change
position.

38. MEDICAL MANAGEMENT
Anti arrhythmic Drugs
SODIUM CHANNEL BLOCKERS
Eg:quinidine,procainamide,disopyramide,lidocaine,
propafenone
• β BLOCKERS Eg: Acebutolol ,Atenolol ,Bisoprolol,Metoprolol ,
Nadolol , Nebivolol , Propranolol .
• POTASSIUM CHANNEL BLOCKERS Eg: amiodarone,
dronedarone, bretylium, sotalol, ibutilide, and dofetilide.
• CALCIUM CHANNEL BLOCKERS Eg : Amlodipine ,Diltiazem
,Felodipine.Isradipine.Nicardipine.Nifedipine , Nisoldipine ,
Verapamil
• ANTI-COAGULANT Eg: Heparin, Warfarin
• ANTIPLATELET DRUGS Eg : Aspirin

39. MEDICAL MANAGEMENT
• SINUS BRADYCARDIA • ATROPINE (AN ANTICHOLINERGIC
DRUG) • Pacemaker therapy
• SINUS TACHYCARDIA • Treating hypovolemia should
resolve any associated tachycardia. • In certain situations
adenosine and beta- adrenergic blockers used to decrease
the heart rate
• SINUS ARREST • ATROPINE, 0.5 TO 1 MG IV, may increase
the rate. • Pacemaker therapy
• ATRIAL FLUTTER • Calcium channel blocker • Beta
adrenergic blockers • Cardioversion
• ATRIAL FIBRILLATION • Calcium channel blocker (eg:
diltiazem) • Beta adrenergic blockers (eg: metoprolol) •
Digoxin • Amiodarone • cardioversion

40. MEDICAL MANAGEMENT
• PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA
• Beta adrenergic blockers
• JUNCTIONAL TACHYCARDIA • If a patient has
symptoms with an escape junctional rhythm
atropine can be used. • In accelerated junctional
rhythm and junctional tachycardia Beta
adrenergic blockers Calcium channel blockers
Amiodarone are used for rate control •
• PREMATURE VENTRICULAR CONTRACTIONS •
Beta adrenergic blockers • Procainamide •
Amiodarone or lidocaine

41. MEDICAL MANAGEMENT
• PREMATURE VENTRICULAR CONTRACTIONS •
Beta adrenergic blockers • Procainamide •
Amiodarone or lidocaine
• VENTRICULAR FIBRILLATION Immediate initiation
of CPR and advanced cardiac life support measures
with the use of the defibrillation and definite drug
therapy
• VENTRICULAR TACHYCARDIA • Hemodynamically
stable ventricular tachycardia (with pulse) :
Amiodarone, Lidocaine • Hemodynamically
unstable ventricular tachycardia (with pulse):
cardioversion • Pulseless ventricular
tachycardia: defibrillation

42. NON –SURGICAL MANAGEMENT
•Vagal maneuvers: It isused to try to slow an
episode of supraventricular tachycardia (SVT). These
simple maneuvers stimulate the vagus nerve, sometimes
resulting in slowed conduction of electrical impulses
through the atrioventricular (AV) node of the heart.
1.Valsalva maneuver. Hold your nose, close your mouth,
and try to blow the air out. This creates pressure in your
chest that may activate the vagus nerve. Sitting or
squatting may help. Try it for 10 seconds.
2.Cough. You need to cough hard to generate pressure in
your chest and stimulate the vagus nerve. Children with
tachycardia may not be able to cough hard enough to get
a response from the vagus nerve.
3. Gag. You can try it with a finger. Your doctor might
use a tongue depressor.

43. NON – PHARMACHOLOGICAL
MANAGEMENT
4.Hold your knees against your chest: Do it for a
minute. This may work best for babies and children.
5.Cold water treatment. You might hear this called
the diving reflex. You may need to put a plastic bag
of ice on your face for 15 seconds. Or you can
immerse your face in icy cold water for several
seconds. It might also work to step into a cold
shower or a cold bath.
6.Carotid sinus massage: Only a doctor should
perform this one: Lie down and stick out your chin.
The doctor will put pressure on your carotid sinus, a
bundle of nerves surrounding the carotid artery in
your neck just below your jaw. You’ll be monitored
during the procedure.

44. NON- SURGICAL MANAGEMENT
•Cardioversion: It is a
procedure used to return an
abnormal heartbeat to a normal
rhythm. This procedure is used
when the heart is beating very fast
or irregular. This is called an
arrhythmia. With electrical
cardioversion, a high-energy shock
is sent to the heart to reset a
normal rhythm. It is different from
chemical cardioversion, in which
medicines are used to try to
restore a normal rhythm. You will
be given medicine to put you to
sleep before delivering the shocks.

45. NON - SURGICAL MANAGEMENT
• Catheter ablation: This procedure uses
energy to make small scars in your heart tissue.
They stop unusual electrical signals that move
through your heart and cause an uneven
heartbeat. Catheter ablation, also called
radiofrequency or pulmonary vein ablation, isn’t
surgery. The doctor puts a thin, flexible tube
called a catheter into a blood vessel in your leg
or neck and guides it to your heart. When it
reaches the area that’s causing the arrhythmia,
it can destroy those cells. This helps get the
heartbeat regular again. There are two main
kinds:
• Radiofrequency ablation. The doctor uses
catheters to send radiofrequency energy (similar
to microwave heat) that makes circular scars
around each vein or group of veins.
• Cryoablation. A single catheter sends a balloon
tipped with a material that freezes the tissues to
cause a scar.

46. SURGICAL MANAGEMENT
• Device implantation: You may be a candidate
for a pacemaker or implantable cardioverter-
defibrillator (ICD). A pacemaker is a small device
placed under the skin near the collarbone in a
minor surgical procedure. A wire extends from the
device to the heart. If a pacemaker detects an
abnormal heart rate, it emits electrical impulses
that stimulate your heart to beat at a normal rate.
• An ICD is a battery-powered unit implanted under
the skin near the collarbone, like a pacemaker.
One or more electrode-tipped wires from the ICD
run through veins to the heart. If it detects an
abnormal heart rhythm, it sends out low- or high-
energy shocks to reset the heart rhythm. Your
physician may recommend this device if you have a
high-risk dysrhythmia like ventricular tachycardia
or ventricular fibrillation or if you’ve had sudden
cardiac arrest.

47. SURGICAL MANAGEMENT4
• Maze procedure: Maze is a
surgical procedure used to
treat atrial fibrillation. A
doctor creates a pattern of
scar tissue (the maze) in the
upper chambers of the heart
by applying heat or cold. Or,
the doctor uses a scalpel to
make several precise incisions.
This method is more complex
and takes longer.
• Because scar tissue doesn't
carry electricity, the maze
interferes with stray electrical
impulses that cause atrial
fibrillation.

48. SURGICAL MANAGEMENT4
Coronary artery
bypass grafting
(CABG): This surgery
improves blood flow to
your heart by creating a
bypass around your
narrowed coronary
arteries using arteries or
veins taken from other
parts of your body.

49. COMPLICATION
• Stroke. Heart arrhythmias are associated with an
increased risk of blood clots. If a clot breaks loose, it can
travel from your heart to your brain. There it might
block blood flow, causing a stroke.
• Heart failure. Heart failure can result if your heart is
pumping ineffectively for a prolonged period due to a
bradycardia or tachycardia, such as atrial fibrillation.
Sometimes controlling the rate of an arrhythmia that's
causing heart failure can improve your heart's function.
•Sudden death: Ventricular dysrhythmia in people
with structural heart disease — such as a weakened heart
muscle from a previous heart attack — or undetected
Long QT syndrome can lead to sudden cardiac arrest and
death.

50. NURSING MANAGEMENT
• Monitoring and managing dysrhythmias
• Record BP, HR and rhythm, rate and depth of
respirations, and breath sounds to determine the
dysrhythmia’s hemodynamic effect.
• Ask patients about episodes of lightheadedness,
dizziness, or fainting.
• Obtain a 12-lead ECG to continuously monitor the
patient and to track the dysrhythmia.
• Administer antiarrhythmic medications as prescribed.
• Assess for factors that contribute to the dysrhythmia
(eg, caffeine, stress, non adherence to the medication
regimen) and assist the patient in making lifestyle
changes that address these issues.

51. • Minimising anxiety
• At the time of dysrhythmic event, maintain a calm and
reassuring attitude to foster a trusting relationship with the
patient and assists in reducing anxiety.
• Promote a sense of confidence in living with a dysrhythmia.
• Teaching patient self-care
• Present the information in terms that are understandable
and in a manner that is not frightening or threatening.
• Explain the importance of taking medications regularly to
maintain therapeutic serum levels of antiarrhythmic agents
• If dysrhythmia is potentially lethal, establish with the
patient and family a plan of action to take in case of an
emergency.
NURSING MANAGEMENT

52. Nursing management of patient with an
implantable cardiac device:
The patient’s heart rate and rhythm are monitored by
ECG.
The incision site is observed for bleeding, hematoma
formation or infection, which may be evidenced by
swelling, unusual tenderness, drainage & increased
warmth.
A chest x-ray is usually taken after procedure.
Patient is also assessed for anxiety, depression or anger.
In the perioperative & postoperative phases the nurse
carefully observes the patient & family with further
teaching as needed.
NURSING MANAGEMENT

53. • NURSES RESPONSIBILITIES DURING
CARDIOVERSION:
When using pads or paddles, we must observe two
safety measure.
• First, good contact must be maintained between
the pads or paddles and the patient’s skin (with a
conductive medium between them) to prevent
electrical current from leaking through the
air(arcing) when the defibrillator is discharged.
• Second, no one is to be in contact with the patient
or with anything that is touching the patient when
the defibrillator is discharged, to minimize the
chance that electrical current is conducted to
anyone other than the patient.
NURSING MANAGEMENT

54. NURSING DIAGNOSIS
• Decreased Cardiac Output related to Altered
electrical conduction and Reduced myocardial
contractility as evidenced by Palpitation.
• Activity Intolerance related to imbalance between
oxygen supply and demand as evidenced by fatigue,
dizziness,profuse sweating.
• Knowledge deficit related to Lack of information
and misunderstanding of medical condition or
therapy needs as evidenced by asking Questions and
statement of misconception

55. •Anxiety related to perceived threat of death,
possibly evidenced by increased tension,
apprehension, and expressed concerns.
•Ineffective Therapeutic Regimen
management related to complexity of therapeutic
regimen, decisional conflicts and economic
difficulties as manifested by verbalization.
•Risk for Poisoning [digitalis toxicity] may related
to limited range of therapeutic effectiveness, lack
of education/proper precautions, reduced
vision/cognitive limitations.
NURSING DIAGNOSIS

56. PREVENTIVE MEASURES
• While some risk factors like age and heredity cannot be
controlled, there are ways you can help to prevent
certain dysrhythmias or risks associated with those
dysrhythmias:
• Avoid triggers: If you have dysrhythmia, avoid
caffeine, alcohol, certain cold and cough medications,
appetite suppressants, beta blockers and psychotropic
drugs. Ask your physician for a list of these triggers.
• Be careful with supplements: Tell your physician
about any vitamins or supplements you’re taking to be
sure they don’t interact with treatment medications.
• Get regular checkups: And, if you experience new or
changing symptoms or side effects from medications,
see your physician.

57. PREVENTIVE MEASURES
• Monitor your pulse: Put the second and third fingers of
one hand on the inside of the wrist of the other hand,
just below the thumb or on the side of your neck, just
below the corner of your jaw. Count the number of
beats you feel in one full minute. Keep a record of this
to share with your physician so you can determine if
you’re experiencing a fast or slow heart rate.
• Practice good heart health: Watch what you eat,
exercise and avoid smoking.
• Take the medications as prescribed: If you’ve been
prescribed a medication to control the dysrhythmia, be
sure to take it as prescribed. if you have high blood
pressure, high cholesterol or diabetes, check with your
physician to ensure you’re taking the best medications
to manage each condition.

58. LIFESTYLE CHANGES
•Arrhythmias may be related to certain lifestyle
factors. The following life style changes can help
to limit the occurrence of arrhythmias:
•Advised the client to stop smoking.
•Asked the client to Limit the intake of alcohol.
• Instruct the client to Limit or stop using caffeine.
Some people are sensitive to caffeine and may
notice more symptoms when using caffeinated
products, such as tea, coffee, colas and some
over-the- counter medications.

59. LIFESTYLE CHANGES
• Advised the client to Avoid using stimulants. Beware
of stimulants used in cough and cold medications and
herbal or nutritional supplements. Some of these
substances contain ingredients that cause irregular
heart rhythms. Read the label and ask the doctor or
pharmacist which medication is best .
• Asked the family to be involved in client care by
learning to recognize the symptoms and how to start
CPR if needed.
• Advised the client to avoid certain activities that cause
irregular heart rhythm.