![DYSRHYTHMIA
Dysrhythmia or arrhythmia [ dys – abnormal, rhythm-
regular repeated pattern]
These are the disorders of either formation (or)
conduction (or) both of electric impulses within the
heart.
It is also called irregular heartbeat, the improper beating
of the heart, either too fast or too slow.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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ECG analysis on normal sinus rhythm and atrial arrhythmias.pptx
- 1. ECG ANALYSIS - ATRIAL ARRHYTHMIAS CLINICAL TEACHING By Krishna Priya MSc Nursing 1st year
- 2. DYSRHYTHMIA Dysrhythmia or arrhythmia [ dys – abnormal, rhythm- regular repeated pattern] These are the disorders of either formation (or) conduction (or) both of electric impulses within the heart. It is also called irregular heartbeat, the improper beating of the heart, either too fast or too slow.
- 3. DURATION OF NORMAL ECG PATTERN P wave = 0.08-0.10 sec [2 small boxes] PR interval = 0.20 sec [1 large box] QRS complex = 0.06-0.10 sec [1- 1and half small box to three small boxes] QT interval = 0.44 sec [ 2 large boxes ]
- 4. NORMAL SINUS RHYTHM A normal sinus rhythm is the usual heart rhythm that begins in SA node is between 60-100 beats/minute. It follows normal conduction pathway SA node AV node Bundle of his ,bundle branches Purkinje fibres
- 6. Rhythm – regular PP interval ,regular RR interval may vary as much as 3mm is normal P wave - one p wave preceding QRS QT interval should less than or equal to 0.40 sec
- 7. CLASSIFICATION OF ARRHYTHMIA- BASED ON ORIGIN OF ABNORMAL RHYTHM Sinus arrhythmia – Abnormal rhythm from SA node Atrial arrhythmia - from atrial myocardial tissue Nodal arrhythmia - from AV node Ventricular arrhythmia - from ventricular myocardial tissue Supraventricular arrhythmia – includes sinus arrhythmia, atrial arrhythmia, and nodal arrhythmias.
- 8. MECHANISM OF ARRHYTHMIA Disturbance in automaticity Disturbance in conductance Reentry of impulses
- 9. DISTURBANCE IN AUTOMATICITY Automaticity means many excitable tissues undergoes depolarization spontaneously, it is a normal process of generating a heart rhythm Enhanced automaticity occur when cell conduct an impulse because they were not suppressed An ectopic pacemaker occurs when a cardiac muscle cell that normally does not exhibit pacemaker potential
- 10. DISTURBANCE IN CONDUCTANCE Conduction is the speed of impulses that travels through the SA node, AV node and Purkinje fibres A rhythm slower than the intrinsic rate is bradycardia A occur faster than the intrinsic rate is tachycardia Premature beats are one that occur before the expected impulses Blocks in which impulses are generated normally but donot reach the distinction, the ECG wave is wider than normal
- 11. INTRINSIC RATES OF THE CONDUCTION SYSTEM SA node 60-100 times/min AV node 40-60 times/min Bundle of His and Purkinje fibers 20-40 times/min
- 13. Reentry of impulses occur when cardiac tissue is depolarized multiple time by the same impulses. Normally the impulse enter into the tissue causing depolarization and leaves the tissue after refractory period is over [repolarization]. It occurs along one pathway with a constant conduction velocity. Reentry of impulses occurs when two pathways are present [a slow pathway and fast pathway] two pathways can develop from anatomic abnormalities [accessory pathway, fibrosis] or functional defects such as ischemia, drug interaction
- 15. The pathways are separated by area of unexcitable tissue. As the impulses enter both pathways, the fast pathway exhibits resistance[ that will not allow the impulse to travel forward, but the impulses can travel down the slow pathway causing impulses to repeat themselves. Reentry of impulses creates some problems because some cells have been repolarized sufficiently, so they can prematurely depolarize again produce ectopic beats and rhythm disturbance
- 16. Causes include bundle of branch block , myocardial fibrosis, ischemia, anti dysrhythmic drugs
- 17. During normal sinus rhythm Atrium contract to fill and stretch the ventricle with about 30% more blood [Atrial kick] Increase amount of blood [stroke volume] in ventricles before contractibility, there by increasing cardiac output by 30% When impulse originates other than SA node there is reduced in atrial kick Decrease cardiac output leads to decrease in cerebral and vascular perfussion
- 18. In Atrial arrhythmias due to improper empty of blood into ventricle during contraction causes stagnation of blood in atrium Increased risk of clot formation leads to stroke
- 19. ECG INTERPRETATION OF DYSRHYTHMIA Calculate heart rate if irregular means using 6-second method
- 20. Measure regularity of R wave [ ventricular rhythm]
- 21. Examine P wave,the absence of P wave or an abnormality in their position with respect to QRS complex indicates that the impulses start outside the SA node [ectopic pacemaker]
- 22. Examine QRS complex in relation to P wave,in AV nodal block p wave not followed by QRS complex
- 23. TYPE ATRIAL RATE VENTRICULAR RATE P WAVE Atrial fibrillation 350-600 b/m 100-180 b/m Irregular/undulation Atrial flutter 220-350 b/m 75-175 b/m Regular /sawtooth Sinus bradycardia >100b/m >100 b/m Regular /normal Sinus Tachycardia < 60 b/m > 60 b/m Regular /normal Ventricular tachycardia Cannot calculate 70-250 b/m Absent Ventricular fibrillation can’t calculate 250-350b/m Absent
- 24. SINOATRIAL NODE ARRHYTHMIAS Based on disturbance in Automaticity 1) SINUS TACHYCARDIA: Heart rate greater than 100 b/m .P and QRS complex are in normal distribution. It often occurs in response to an increase in the sympathetic nervous system or decreased vagal tone CAUSES fever, caffeine, hyperthyroidism,emotional , stress MANAGEMENT Alleviating underlying causes, beta-blockers, calcium channel blockers, carotid massage
- 26. SINUS BRADYCARDIA Occur when SA node fire at a rate less than 60 b/m ,P wave and QRS complex are normal CAUSES Increased vagal tone [vomiting,valsava maneuver] severe hypoxia ,MI MANAGEMENT Treat underlying causes, atropine, pacemaker
- 29. SICK SINUS SYNDROME It encompasses different abnormalities of sinus node usually due to aging, also called brady tachy syndrome or SA node dysfunction.It involves Persistent bradycardia Tachycardia Sinus arrest or pause MANAGEMENT Treatment is twofold including drug to slow automaticity along with insertion of a permanent transvenous pacemaker to prevent symptomatic bradycardia
- 30. ATRIAL DYSRHYTHMIAS DISTURBANCE IN AUTOMATICITY PREMATURE ATRIAL CONTRACTION PAC are early beats arising from ectopic foci ,interrupting normal rhythm. They commonly result from enhanced automaticity of atrial muscle and can occur in both abnormal and diseased heart
- 32. CAUSES Valvular disease, atrial chamber enlargement, MI, cardioactive drug like digoxin Frequent PAC may mark the onset of atrial fibrillation or heart failure ECG PATTERN P wave are premature and often differ from normal sinus P wave in appearance and size When PAC occurs conduction may not be normal as AV node may still be refractory from the preceding beat. Thus impulse may be blocked, slowed or prolonged PR interval and PP interval is less
- 34. ATRIAL BIGEMINY Single ectopic beat followed by a normal beat
- 35. ATRIAL TRIGEMINY In which ectopic heartbeat happens every third heartbeat in rhythm
- 36. Management Beta blockers, calcium channel blockers, ablation therapy
- 37. REENTRY OF IMPULSES PAROXYSMAL ATRIAL TACHYCARDIA It is a sudden onset and termination of a rapid firing from an ectopic atrial pacemaker it is also called supraventricular tachycardia. Atrial rate 170-200 b/m CAUSES CAD,MI,caffeine,emotion,digitalis toxicity MANAGEMENT Carotid sinus massage, Valsalva maneuver, inj.adenosine, beta blockers,calcium channel blockes,ablation surgery
- 40. ATRIAL FIBRILLATION It is the most common atrial dysrhythmia, it is characterized by rapid atrial depolarization from reentrant pathway Ectopic atrial foci produce impulse between 350-600 beats/min At extreme rapid rate the entire atrium may not able to recover from one depolarization wave before another impulse begin, resulting in electronic and mechanical disorganization of the atria, without effective atrial contraction small irregular baseline undulation that vary in size and shape called F wave varies from normal p wave.
- 41. Because atrial rate is too fast and the action potential produced are of such low amplitude hence Fwave produced Impulses from atrium to ventricle is blocked ,however some may transmit which may produce increased ventricular rate upto 108-180 beats/min. Regular RR interval in atrial fibrillation indicates complete presence of AV block and P:QRS = many:1
- 43. CAUSES CAD, congestive heart failure, hypertrophic cardiomyopathy, sick sinus syndrome, fibrosis, hypertension MANAGEMENT Oral anticoagulant like warfarin ,maintain [INR 2-3] Cardioversion [depolarised all myocardial cells simultaneously, allow the SA node to resume pacemaker role. The electrical discharge is synchronized with QRS complex of client for avoiding accidental discharge during repolarization phase when the ventricles is vulnerable to develop ventricular fibrillation.
- 44. ATRIAL FLUTTER It is formed by ectopic pacemaker or by site of rapid reentry of circuit. Saw tooth atrial wave formation followed by slower , regular ventricular response. In Atrial fibrillation the atria beat irregularly. In atrial flutter beat regularly, but faster than the usual and more often than the ventricles P waves are inverted or bidirectional becauses of clockwise or anticlockwise reentrant pathway producing saw tooth pattern
- 45. Atrial rate range from 220-350 beats/min the AV node can’t conduct all impulses from atrium to ventricle hence ventricle rate is slower than atrial rate Thus the pulse which reflect the ventricular rate ,may be normal even though atrial rate may be quite rapidly
- 47. NURSING PROCESS Decreased cardiac output related to dysrhythmia Deficit knowledge about the dysrhythmia and its treatment Anxiety related to fear of unknown
- 49. BIBLIOGRAPHY 1. Suddharth &Brunner. Textbook of Medical Surgical Nursing, 13th edition: Wolter Kluwer publication; 2014.pgno 1450-1460. 2.Black JM, Hawks JH. Medical Surgical Nursing, 1st edition : Elseiver publication;2019. pgno 1458-1489. 3. Woods LS, FroelicherE , Cardiac Nursing.6th edition :Wolters Kluwer publication;2009.pgno 936-939 4.Kaur L, Kaur p. Adult Medical Surgical Nursing ,3rd edition :Lotus publication;2008 .pgno [1080-98] 5. Workman, Ignatavicus. Medical Surgical Nursing,7th edition :Evolve publication;2009 .pgno [1080-98]