SlideShare a Scribd company logo
1 of 55
DYSRHYTHMIAS
Neelu Aryal
Lecturer
DEFINITION
• A normal sinus rhythm is the usual heart
rhythm that begins in the sinoatrial (SA) node,
is between 60 and 100 beats/min, and has
normal intervals and no aberrant or ectopic
beats.
• Dysrhythmias are disorders of the heart
rhythm.
• It is the disturbance in the electric cycle of the
heart.
• It is a disorder of the formation or conduction
(or both) of the electrical impulses within the
heart.
ETIOLOGY AND RISK FACTORS
• It results from the disturbances in three major
mechanisms:
1. Automaticity
2. Conduction
3. Reentry of impulses
1) DISTURBANCES IN AUTOMATICITY
RISK FACTORS
• Myocardial ischemia
• Decreased left ventricular function
• Valvular heart disease
• Electrolyte imbalance
• Hypoxia
• Digitalis toxicity
• Administration of atropine
2) DISTURBANCES IN CONDUCTION
RISK FACTORS
• Myocardial ischemia
• Valvular heart disease/ valvular surgery
• Inflammation of AV node
• Electrolyte imbalances
• Digitalis toxicity
• Beta blocking agents
• Myocardial infarction (especially inferior)
3) REENTRY OF IMPULSES
RISK FACTORS
• Myocardial ischemia
• Action of antidysrhythmic medications
• Myocardial fibrosis
• Bundle branch block
PATHOPHYSIOLOGY
• The significance of all dysrhythmias is their
effect on cardiac output and therefore
cerebral and vascular perfusion.
• CO=SV*HR
• During normal sinus rhythm
• The atria contract to fill and stretch the
ventricle with about 30% more blood.
• This process (atrial kick) increases the amount
of blood (SV) in the ventricles before
contractility
• This increases CO by 30%
NOTE: when the impulses originates below the
SA node or more than one area fires in the
atria to originate a beat (eg: atrial
fibrillation/atrial flutter)
Loss of atrial kick
CO falls (30%)
CLINICAL MANIFESTATIONS
The reduced CO leads to:
• Palpitations
• Dizziness
• Presyncope/syncope
• Pallor
• Diaphoresis
• Altered mentation (restlessness and agitation
to lethargy and coma)
• Shortness of breath
• Chest pain
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Hypotension
• Sluggish capillary refill
• Swelling of the extremities
• Decreased urine output
DIAGNOSTIC ASSESSMENT
1) History: 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
5) Physical examination
• Auscultation of heart for abnormal heart
tones, slow or fast rate, irregularity, murmur
6) ECG
7) Holter monitors
• Continuously record cardiac rhythm for 24
hours
8) Event monitors
• For those clients who do not experience
dysrhythmia within 24 hours period of
recording, event monitors are available
9) Invasive Electrophysiologic Studies
• It involves the positioning of a multipolar
catheter electrode into the venous system,
placing the electrode at various sites along the
atria, ventricles, His bundles, bundle branches,
accessory pathways and other structures to
record electrical activity
TYPES OF DYSRHYTHMIAS
A) Rhythms originating in sinoatrial (SA) node
• Sinus bradycardia
• Sinus tachycardia
• Sinus arrest
B) Rhythm originating in Atria
• Atrial flutter
• Atrial fibrillation
• Paroxysmal supraventricular tachycardia
• Premature atrial contraction
C) Rhythm originating in the atrioventricular
junction
• Premature junctional complex
• Junctional escape rhythm
• Junctional tachycardia
D) Rhythm originating in ventricles
• Premature ventricular contraction
• Ventricular fibrillation
• Ventricular tachycardia
A) RHYTHMS ORIGINATING IN SINOATRIAL (SA)
NODE
1) SINUS BRADYCARDIA
• A heart rhythm is initiated in the sinoatrial
node at a rate of less than 60 beats per
minute
 TREATMENT
• Atropine (an anticholinergic drug)
• Pacemaker therapy
2) SINUS TACHYCARDIA
• A heart rhythm is initiated in the sinoatrial node
at a rate greater than 100 beats per minute
TREATMENT
• It is based on underlying causes
• Treating hypovolemia should resolve any
associated tachycardia.
• In certain situations adenosine and beta-
adrenergic blockers used to decrease the heart
rate
3) SINUS ARREST
• Sinus node automaticity is decreased and impulse
are not formed when expected. This result in the
absence of P wave, the QRS complex and no
electrical activity for 3 seconds
TREATMENT
• Atropine, 0.5 to 1 mg IV, may increase the rate.
• Pacemaker therapy
B) RHYTHMS ORIGINATING IN ATRIA
1) ATRIAL FLUTTER
• It is single atrial ectopic focus firing at a rate
of 250 to 350 beats per minute resulting in a
ventricular response that is slower, usually a
multiple of the atrial rate
• P wave are replaced by flutter waves that
take on a “sawtooth appearance.”
TREATMENT
• Calcium channel blocker
• Beta adrenergic blockers
• Cardioversion
2) ATRIAL FIBRILLATION
• It is an abnormal rhythm originating from a
multiple ectopic focus in the atrium.
• It is the disorganized twitching of the atria at a
rate greater than 350 beats per minutes.
TREATMENT
• Calcium channel blocker (eg: diltiazem)
• Beta adrenergic blockers (eg: metoprolol)
• Digoxin
• Amiodarone
• cardioversion
3) PAROXYSMAL SUPRAVENTRICULAR
TACHYCARDIA
• It is a dysrhythmia originating in an ectopic
focus anywhere above the bifurcation of the
bundle of His.
TREATMENT
• Beta adrenergic blockers
C) RHYTHMS ORIGINATING IN THE
ATRIOVENTRICULAR JUNCTION
1) PREMATURE JUNCTIONAL COMPLEX
• It occurs when an ectopic beat originates
from a site in the atrioventricular junction
outside of the normal cardiac cycle.
 TREATMENT
• No treatment necessary
2) JUNCTIONAL ESCAPE RHYTHM
• It occurs when the atrial rate is slow, usually
less than 30 beats per minute, and the
atrioventricular node assumes responsibilty
for pacing the heart at a rate of 35 to 60 beats
per minute.
3) JUNCTIONAL TACHYCARDIA
• It occurs when the atrioventricular node
becomes irritable and “overrides” the sinus
impulses, becoming the primary pacemaker at
a rate of greater than 60 beats per minutes.
TREATMENT
• 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
• Cardioversion should not be used
D) RHYTHMS ORIGINATING IN VENTRICLES
1) PREMATURE VENTRICULAR CONTRACTIONS
• It is an ectopic beat originating from a site in
the ventricles outside of the normal cardiac
cycle.
TREATMENT
• Beta adrenergic blockers
• Procainamide
• Amiodarone or lidocaine
2) VENTRICULAR FIBRILLATION
• If a premature ventricular contraction falls on
a T wave, it may precipitate ventricular
fibrillation.
TREATMENT
Immediate initiation of CPR and advanced
cardiac life support measures with the use of
the defibrillation and definite drug therapy
3) VENTRICULAR TACHYCARDIA
• It occurs when there are three or more
consecutive premature ventricular
contractions.
TREATMENT
• Hemodynamically stable ventricular
tachycardia (with pulse) : Amiodarone,
Lidocaine
• Hemodynamically unstable ventricular
tachycardia (with pulse): cardioversion
• Pulseless ventricular tachycardia: defibrillation
THANK YOU

More Related Content

What's hot (20)

Cardiogenic shock
 Cardiogenic shock Cardiogenic shock
Cardiogenic shock
 
Cardiogenic shock
Cardiogenic shockCardiogenic shock
Cardiogenic shock
 
Cardiomyopathy
CardiomyopathyCardiomyopathy
Cardiomyopathy
 
Heart failure
Heart failure Heart failure
Heart failure
 
Heart Block with Nursing Management
Heart Block with Nursing ManagementHeart Block with Nursing Management
Heart Block with Nursing Management
 
MYOCARDIAL INFARCTION
MYOCARDIAL INFARCTIONMYOCARDIAL INFARCTION
MYOCARDIAL INFARCTION
 
Cardiac Arrhythmia
Cardiac Arrhythmia Cardiac Arrhythmia
Cardiac Arrhythmia
 
Myocardial infarction
Myocardial infarctionMyocardial infarction
Myocardial infarction
 
Heart block
Heart blockHeart block
Heart block
 
Pulmonary embolism1
Pulmonary embolism1Pulmonary embolism1
Pulmonary embolism1
 
Coronary heart diseases ppt
Coronary heart diseases pptCoronary heart diseases ppt
Coronary heart diseases ppt
 
Rheumatic Heart Disease
 Rheumatic Heart Disease Rheumatic Heart Disease
Rheumatic Heart Disease
 
Rheumatic heart disease
Rheumatic heart diseaseRheumatic heart disease
Rheumatic heart disease
 
Cardiac emergencies
Cardiac emergenciesCardiac emergencies
Cardiac emergencies
 
Valvular heart disease
Valvular heart diseaseValvular heart disease
Valvular heart disease
 
Pleural effusion
Pleural effusionPleural effusion
Pleural effusion
 
Cardiac emergency
Cardiac emergencyCardiac emergency
Cardiac emergency
 
Cardiac tamponade
Cardiac tamponadeCardiac tamponade
Cardiac tamponade
 
Cardiac arrest
Cardiac arrestCardiac arrest
Cardiac arrest
 
Aneurysm
Aneurysm Aneurysm
Aneurysm
 

Similar to Dysrhythmias

Similar to Dysrhythmias (20)

Arrhythmias 1DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG DNB CTS SR)
Arrhythmias 1DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG DNB CTS SR)Arrhythmias 1DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG DNB CTS SR)
Arrhythmias 1DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG DNB CTS SR)
 
ARYTHMIA.pptx
ARYTHMIA.pptxARYTHMIA.pptx
ARYTHMIA.pptx
 
Dysrhythmia.pptx
Dysrhythmia.pptxDysrhythmia.pptx
Dysrhythmia.pptx
 
Arrythmia . Anu k George
Arrythmia . Anu k GeorgeArrythmia . Anu k George
Arrythmia . Anu k George
 
CARDIAC ARRYTHMIA AND ITS MANAGEMENT.pptx
CARDIAC ARRYTHMIA AND ITS MANAGEMENT.pptxCARDIAC ARRYTHMIA AND ITS MANAGEMENT.pptx
CARDIAC ARRYTHMIA AND ITS MANAGEMENT.pptx
 
Arrythmia ratheesh
Arrythmia ratheeshArrythmia ratheesh
Arrythmia ratheesh
 
TACHYARRHYTHMIAS mechanism powerpoint .pptx
TACHYARRHYTHMIAS  mechanism powerpoint .pptxTACHYARRHYTHMIAS  mechanism powerpoint .pptx
TACHYARRHYTHMIAS mechanism powerpoint .pptx
 
Disturbance of heart rhythm
Disturbance of heart rhythmDisturbance of heart rhythm
Disturbance of heart rhythm
 
Ventricular and paced arrhythmias
Ventricular and paced arrhythmiasVentricular and paced arrhythmias
Ventricular and paced arrhythmias
 
Sick sinus syndrome
Sick sinus syndromeSick sinus syndrome
Sick sinus syndrome
 
ECG
ECGECG
ECG
 
Arrhythmias (2)
Arrhythmias (2)Arrhythmias (2)
Arrhythmias (2)
 
Arrythmia ratheesh
Arrythmia ratheeshArrythmia ratheesh
Arrythmia ratheesh
 
Anatomy, physiology & patophysiology of the cardiovascular
Anatomy, physiology & patophysiology of the cardiovascularAnatomy, physiology & patophysiology of the cardiovascular
Anatomy, physiology & patophysiology of the cardiovascular
 
BASIC KNOWLEDGE IN ARRHYTHMIAS FOR STARTERS.pptx
BASIC KNOWLEDGE IN ARRHYTHMIAS FOR STARTERS.pptxBASIC KNOWLEDGE IN ARRHYTHMIAS FOR STARTERS.pptx
BASIC KNOWLEDGE IN ARRHYTHMIAS FOR STARTERS.pptx
 
4. ANTI-ARRHYTHMIC.pptx
4. ANTI-ARRHYTHMIC.pptx4. ANTI-ARRHYTHMIC.pptx
4. ANTI-ARRHYTHMIC.pptx
 
11 Cardiac Dysrhythmias.pptx
11 Cardiac Dysrhythmias.pptx11 Cardiac Dysrhythmias.pptx
11 Cardiac Dysrhythmias.pptx
 
Arrthymias management
Arrthymias managementArrthymias management
Arrthymias management
 
Arrthymias management
Arrthymias managementArrthymias management
Arrthymias management
 
Arrhythmia
ArrhythmiaArrhythmia
Arrhythmia
 

Recently uploaded

hypo and hyper thyroidism final lecture.pptx
hypo and hyper thyroidism  final lecture.pptxhypo and hyper thyroidism  final lecture.pptx
hypo and hyper thyroidism final lecture.pptxdr shahida
 
Video capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in childrenVideo capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in childrenRaju678948
 
World Hypertension Day 17th may 2024 ppt
World Hypertension Day 17th may 2024 pptWorld Hypertension Day 17th may 2024 ppt
World Hypertension Day 17th may 2024 pptdesktoppc
 
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUEL
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS  by Dr M.KARTHIK EMMANUELCONGENITAL HYPERTROPHIC PYLORIC STENOSIS  by Dr M.KARTHIK EMMANUEL
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUELMKARTHIKEMMANUEL
 
TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...
TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...
TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...marcuskenyatta275
 
Muscle Energy Technique (MET) with variant and techniques.
Muscle Energy Technique (MET) with variant and techniques.Muscle Energy Technique (MET) with variant and techniques.
Muscle Energy Technique (MET) with variant and techniques.Anjali Parmar
 
DIGITAL RADIOGRAPHY-SABBU KHATOON .pptx
DIGITAL RADIOGRAPHY-SABBU KHATOON  .pptxDIGITAL RADIOGRAPHY-SABBU KHATOON  .pptx
DIGITAL RADIOGRAPHY-SABBU KHATOON .pptxSabbu Khatoon
 
DR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in IndiaDR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in IndiaNehamehta128467
 
5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials
5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials
5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materialsSherrylee83
 
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...Ayman Seddik
 
THORACOTOMY . SURGICAL PERSPECTIVES VOL 1
THORACOTOMY . SURGICAL PERSPECTIVES VOL 1THORACOTOMY . SURGICAL PERSPECTIVES VOL 1
THORACOTOMY . SURGICAL PERSPECTIVES VOL 1DR SETH JOTHAM
 
Dermatome and myotome test & pathology.pdf
Dermatome and myotome test & pathology.pdfDermatome and myotome test & pathology.pdf
Dermatome and myotome test & pathology.pdfniloofarbarzegari76
 
Tips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES examTips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES examJunhao Koh
 
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...marcuskenyatta275
 
SURGICAL ANATOMY OF ORAL IMPLANTOLOGY.pptx
SURGICAL ANATOMY OF ORAL IMPLANTOLOGY.pptxSURGICAL ANATOMY OF ORAL IMPLANTOLOGY.pptx
SURGICAL ANATOMY OF ORAL IMPLANTOLOGY.pptxSuresh Kumar K
 
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...Health Kinesiology Natural Bioenergetics
 
CT scan of penetrating abdominopelvic trauma
CT scan of penetrating abdominopelvic traumaCT scan of penetrating abdominopelvic trauma
CT scan of penetrating abdominopelvic traumassuser144901
 
Cardiac Impulse: Rhythmical Excitation and Conduction in the Heart
Cardiac Impulse: Rhythmical Excitation and Conduction in the HeartCardiac Impulse: Rhythmical Excitation and Conduction in the Heart
Cardiac Impulse: Rhythmical Excitation and Conduction in the HeartMedicoseAcademics
 
Failure to thrive in neonates and infants + pediatric case.pptx
Failure to thrive in neonates and infants  + pediatric case.pptxFailure to thrive in neonates and infants  + pediatric case.pptx
Failure to thrive in neonates and infants + pediatric case.pptxclaviclebrown44
 

Recently uploaded (20)

hypo and hyper thyroidism final lecture.pptx
hypo and hyper thyroidism  final lecture.pptxhypo and hyper thyroidism  final lecture.pptx
hypo and hyper thyroidism final lecture.pptx
 
Video capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in childrenVideo capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in children
 
HyperIgE syndrome: primary immune deficiency.pdf
HyperIgE syndrome: primary immune deficiency.pdfHyperIgE syndrome: primary immune deficiency.pdf
HyperIgE syndrome: primary immune deficiency.pdf
 
World Hypertension Day 17th may 2024 ppt
World Hypertension Day 17th may 2024 pptWorld Hypertension Day 17th may 2024 ppt
World Hypertension Day 17th may 2024 ppt
 
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUEL
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS  by Dr M.KARTHIK EMMANUELCONGENITAL HYPERTROPHIC PYLORIC STENOSIS  by Dr M.KARTHIK EMMANUEL
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUEL
 
TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...
TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...
TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...
 
Muscle Energy Technique (MET) with variant and techniques.
Muscle Energy Technique (MET) with variant and techniques.Muscle Energy Technique (MET) with variant and techniques.
Muscle Energy Technique (MET) with variant and techniques.
 
DIGITAL RADIOGRAPHY-SABBU KHATOON .pptx
DIGITAL RADIOGRAPHY-SABBU KHATOON  .pptxDIGITAL RADIOGRAPHY-SABBU KHATOON  .pptx
DIGITAL RADIOGRAPHY-SABBU KHATOON .pptx
 
DR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in IndiaDR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in India
 
5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials
5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials
5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials
 
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
 
THORACOTOMY . SURGICAL PERSPECTIVES VOL 1
THORACOTOMY . SURGICAL PERSPECTIVES VOL 1THORACOTOMY . SURGICAL PERSPECTIVES VOL 1
THORACOTOMY . SURGICAL PERSPECTIVES VOL 1
 
Dermatome and myotome test & pathology.pdf
Dermatome and myotome test & pathology.pdfDermatome and myotome test & pathology.pdf
Dermatome and myotome test & pathology.pdf
 
Tips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES examTips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES exam
 
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
 
SURGICAL ANATOMY OF ORAL IMPLANTOLOGY.pptx
SURGICAL ANATOMY OF ORAL IMPLANTOLOGY.pptxSURGICAL ANATOMY OF ORAL IMPLANTOLOGY.pptx
SURGICAL ANATOMY OF ORAL IMPLANTOLOGY.pptx
 
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
 
CT scan of penetrating abdominopelvic trauma
CT scan of penetrating abdominopelvic traumaCT scan of penetrating abdominopelvic trauma
CT scan of penetrating abdominopelvic trauma
 
Cardiac Impulse: Rhythmical Excitation and Conduction in the Heart
Cardiac Impulse: Rhythmical Excitation and Conduction in the HeartCardiac Impulse: Rhythmical Excitation and Conduction in the Heart
Cardiac Impulse: Rhythmical Excitation and Conduction in the Heart
 
Failure to thrive in neonates and infants + pediatric case.pptx
Failure to thrive in neonates and infants  + pediatric case.pptxFailure to thrive in neonates and infants  + pediatric case.pptx
Failure to thrive in neonates and infants + pediatric case.pptx
 

Dysrhythmias

  • 2. DEFINITION • A normal sinus rhythm is the usual heart rhythm that begins in the sinoatrial (SA) node, is between 60 and 100 beats/min, and has normal intervals and no aberrant or ectopic beats. • Dysrhythmias are disorders of the heart rhythm.
  • 3. • It is the disturbance in the electric cycle of the heart. • It is a disorder of the formation or conduction (or both) of the electrical impulses within the heart.
  • 4. ETIOLOGY AND RISK FACTORS • It results from the disturbances in three major mechanisms: 1. Automaticity 2. Conduction 3. Reentry of impulses
  • 5. 1) DISTURBANCES IN AUTOMATICITY RISK FACTORS • Myocardial ischemia • Decreased left ventricular function • Valvular heart disease • Electrolyte imbalance • Hypoxia • Digitalis toxicity • Administration of atropine
  • 6. 2) DISTURBANCES IN CONDUCTION RISK FACTORS • Myocardial ischemia • Valvular heart disease/ valvular surgery • Inflammation of AV node • Electrolyte imbalances • Digitalis toxicity • Beta blocking agents • Myocardial infarction (especially inferior)
  • 7. 3) REENTRY OF IMPULSES RISK FACTORS • Myocardial ischemia • Action of antidysrhythmic medications • Myocardial fibrosis • Bundle branch block
  • 8. PATHOPHYSIOLOGY • The significance of all dysrhythmias is their effect on cardiac output and therefore cerebral and vascular perfusion. • CO=SV*HR
  • 9. • During normal sinus rhythm • The atria contract to fill and stretch the ventricle with about 30% more blood. • This process (atrial kick) increases the amount of blood (SV) in the ventricles before contractility
  • 10. • This increases CO by 30% NOTE: when the impulses originates below the SA node or more than one area fires in the atria to originate a beat (eg: atrial fibrillation/atrial flutter)
  • 11. Loss of atrial kick CO falls (30%)
  • 12. CLINICAL MANIFESTATIONS The reduced CO leads to: • Palpitations • Dizziness • Presyncope/syncope • Pallor • Diaphoresis • Altered mentation (restlessness and agitation to lethargy and coma)
  • 13. • Shortness of breath • Chest pain • Orthopnea • Paroxysmal nocturnal dyspnea • Hypotension • Sluggish capillary refill • Swelling of the extremities • Decreased urine output
  • 14. DIAGNOSTIC ASSESSMENT 1) History: 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
  • 15. 5) Physical examination • Auscultation of heart for abnormal heart tones, slow or fast rate, irregularity, murmur 6) ECG 7) Holter monitors • Continuously record cardiac rhythm for 24 hours
  • 16. 8) Event monitors • For those clients who do not experience dysrhythmia within 24 hours period of recording, event monitors are available
  • 17. 9) Invasive Electrophysiologic Studies • It involves the positioning of a multipolar catheter electrode into the venous system, placing the electrode at various sites along the atria, ventricles, His bundles, bundle branches, accessory pathways and other structures to record electrical activity
  • 18. TYPES OF DYSRHYTHMIAS A) Rhythms originating in sinoatrial (SA) node • Sinus bradycardia • Sinus tachycardia • Sinus arrest
  • 19. B) Rhythm originating in Atria • Atrial flutter • Atrial fibrillation • Paroxysmal supraventricular tachycardia • Premature atrial contraction
  • 20. C) Rhythm originating in the atrioventricular junction • Premature junctional complex • Junctional escape rhythm • Junctional tachycardia
  • 21. D) Rhythm originating in ventricles • Premature ventricular contraction • Ventricular fibrillation • Ventricular tachycardia
  • 22. A) RHYTHMS ORIGINATING IN SINOATRIAL (SA) NODE
  • 23. 1) SINUS BRADYCARDIA • A heart rhythm is initiated in the sinoatrial node at a rate of less than 60 beats per minute  TREATMENT • Atropine (an anticholinergic drug) • Pacemaker therapy
  • 24.
  • 25. 2) SINUS TACHYCARDIA • A heart rhythm is initiated in the sinoatrial node at a rate greater than 100 beats per minute TREATMENT • It is based on underlying causes • Treating hypovolemia should resolve any associated tachycardia. • In certain situations adenosine and beta- adrenergic blockers used to decrease the heart rate
  • 26.
  • 27. 3) SINUS ARREST • Sinus node automaticity is decreased and impulse are not formed when expected. This result in the absence of P wave, the QRS complex and no electrical activity for 3 seconds TREATMENT • Atropine, 0.5 to 1 mg IV, may increase the rate. • Pacemaker therapy
  • 28.
  • 30. 1) ATRIAL FLUTTER • It is single atrial ectopic focus firing at a rate of 250 to 350 beats per minute resulting in a ventricular response that is slower, usually a multiple of the atrial rate • P wave are replaced by flutter waves that take on a “sawtooth appearance.”
  • 31.
  • 32. TREATMENT • Calcium channel blocker • Beta adrenergic blockers • Cardioversion
  • 33. 2) ATRIAL FIBRILLATION • It is an abnormal rhythm originating from a multiple ectopic focus in the atrium. • It is the disorganized twitching of the atria at a rate greater than 350 beats per minutes.
  • 34.
  • 35. TREATMENT • Calcium channel blocker (eg: diltiazem) • Beta adrenergic blockers (eg: metoprolol) • Digoxin • Amiodarone • cardioversion
  • 36. 3) PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA • It is a dysrhythmia originating in an ectopic focus anywhere above the bifurcation of the bundle of His.
  • 37.
  • 39. C) RHYTHMS ORIGINATING IN THE ATRIOVENTRICULAR JUNCTION
  • 40. 1) PREMATURE JUNCTIONAL COMPLEX • It occurs when an ectopic beat originates from a site in the atrioventricular junction outside of the normal cardiac cycle.  TREATMENT • No treatment necessary
  • 41.
  • 42. 2) JUNCTIONAL ESCAPE RHYTHM • It occurs when the atrial rate is slow, usually less than 30 beats per minute, and the atrioventricular node assumes responsibilty for pacing the heart at a rate of 35 to 60 beats per minute.
  • 43.
  • 44. 3) JUNCTIONAL TACHYCARDIA • It occurs when the atrioventricular node becomes irritable and “overrides” the sinus impulses, becoming the primary pacemaker at a rate of greater than 60 beats per minutes.
  • 45.
  • 46. TREATMENT • 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 • Cardioversion should not be used
  • 47. D) RHYTHMS ORIGINATING IN VENTRICLES
  • 48. 1) PREMATURE VENTRICULAR CONTRACTIONS • It is an ectopic beat originating from a site in the ventricles outside of the normal cardiac cycle.
  • 49.
  • 50. TREATMENT • Beta adrenergic blockers • Procainamide • Amiodarone or lidocaine
  • 51. 2) VENTRICULAR FIBRILLATION • If a premature ventricular contraction falls on a T wave, it may precipitate ventricular fibrillation. TREATMENT Immediate initiation of CPR and advanced cardiac life support measures with the use of the defibrillation and definite drug therapy
  • 52.
  • 53. 3) VENTRICULAR TACHYCARDIA • It occurs when there are three or more consecutive premature ventricular contractions.
  • 54. TREATMENT • Hemodynamically stable ventricular tachycardia (with pulse) : Amiodarone, Lidocaine • Hemodynamically unstable ventricular tachycardia (with pulse): cardioversion • Pulseless ventricular tachycardia: defibrillation