The document discusses various cardiac rhythms and arrhythmias, describing normal sinus rhythm and various abnormalities including dysrhythmias originating from the sinus node, atria, AV node or ventricles. It provides details on conditions like sinus tachycardia, atrial fibrillation, ventricular tachycardia, asystole, and treatment approaches for cardiac arrest and defibrillation versus cardioversion.
Its a medical presentation describing how to approach to various cardiac arrhythmias in systematic way. Illustrated with more ECG photographs from standard sources.
Its a medical presentation describing how to approach to various cardiac arrhythmias in systematic way. Illustrated with more ECG photographs from standard sources.
In this article, we have discussed all the details about the heart block
1. Classification of heart block
2. Causes of heart block
3. Symptoms
4. signs
5. Investigations of heart block
6. and finally treatment of heart block
A cardiac dysrhythmia (also called an arrhythmia) is an abnormal rhythm of your heartbeat. It can be slower or faster than a normal heart rate. It can also be irregular. It can be life-threatening if the heart cannot pump enough oxygen-rich blood to the heart itself or the rest of the body.
ECG Rhythm Interpretation
ST Elevation and non-ST Elevation MIs
ECG Changes
ECG Changes & the Evolving MI
Left Ventricular Hypertrophy
Normal Impulse Conduction
Bundle Branch Blocks
Definition of arrhythmia - background on cardiac physiology including conduction in heart - action potential - pathogensis of arrhythmia - causes and risk factors for arrhythmia- diagnosis of arrhythmia - symptoms of tachyarrhythmias and bradyarrhythmias - investigations for arrhythmia - treatment of arrhythmia - pharmacological and other modalities of therapy for arrhythmia - managment of different types of arrhythmias
Basic EKG and Rhythm Interpretation Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Basic EKG and Rhythm Interpretation Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
In this article, we have discussed all the details about the heart block
1. Classification of heart block
2. Causes of heart block
3. Symptoms
4. signs
5. Investigations of heart block
6. and finally treatment of heart block
A cardiac dysrhythmia (also called an arrhythmia) is an abnormal rhythm of your heartbeat. It can be slower or faster than a normal heart rate. It can also be irregular. It can be life-threatening if the heart cannot pump enough oxygen-rich blood to the heart itself or the rest of the body.
ECG Rhythm Interpretation
ST Elevation and non-ST Elevation MIs
ECG Changes
ECG Changes & the Evolving MI
Left Ventricular Hypertrophy
Normal Impulse Conduction
Bundle Branch Blocks
Definition of arrhythmia - background on cardiac physiology including conduction in heart - action potential - pathogensis of arrhythmia - causes and risk factors for arrhythmia- diagnosis of arrhythmia - symptoms of tachyarrhythmias and bradyarrhythmias - investigations for arrhythmia - treatment of arrhythmia - pharmacological and other modalities of therapy for arrhythmia - managment of different types of arrhythmias
Basic EKG and Rhythm Interpretation Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Basic EKG and Rhythm Interpretation Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Ibutilide is an antiarrhythmic drug that was recently marketed for the rapid conversion of atrial fibrillation and atrial flutter. After intravenous administration, ibutilide is moderately effective in achieving prompt cardioversion to sinus rhythm, with greater efficacy in patients who have atrial flutter. Like other drugs that prolong ventricular repolarization, ibutilide administration carries a risk of excessive QT prolongation, or the acquired long-QT syndrome, with associated polymorphic ventricular tachycardia (torsade de pointes), necessitating careful patient selection and clinical monitoring during drug administration.
Every year in the US over 320,000 people (of all ages) die from Sudden Cardiac Arrest (SCA) outside of hospitals. While Fire and EMS departments do a great job trying to save these people time is not on their side. Severe brain damage occurs withing 4-6 minutes and brain death by 10 minutes.
On scene bystanders are the best chance for these victims. Prompt CPR and early use of an AED will dramatically increase the victims chance of survival. This presentation is a brief overview on how to use an Automated External Defibrillator (AED). This presentation should not take away from that fact that all people need to attend a formal CPR and AED course.
First Response Training, LLC is a West Palm Beach CPR training facility owned by Conor Devery who has over 20 years of pre hospital and critical care medical experience. First Response Training, LLC provides training for the medical and non medical communities in South Florida. Courses taught include CPR, AED, BLS, First Aid, ACLS, PALS, and EKG. For further information please contact Conor at (561) 459-0221 or vissit him at www.gotcpr.us
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
6. Basic Rhythm Strip Interpretation
1. Determine the rate. Does the atrial rate equal the
ventricular rate.
2. Is the rhythm regular/irregular?
3. Find the P wave. Is there a P wave for every
QRS?
4. Determine the PRI (Normal 0.12-0.20 sec)
5. Find the QRS (Normal <0.12seconds)
6. Any ectopic beats?
7. Find the T wave.
http:www.rnceus.com
EKG strip identification and evaluation
7. Determine heart rate
REGULAR RHYTHM – count boxes
between 2 “R” waves and divide
into 300
5
300 / 5 = 60
1 small box = .04 second 30 large boxes = 6 seconds
1 large box = .20 second 300 large boxes = 1 minute
15 large boxes = 3 seconds 1 mm = 0.1 millivolt (mV)
8. Determine heart rate
• Irregular rhythm – count R - R intervals
on a 6 sec. strip and multiply by 10
9. Normal Sinus Rhythm
• NORMAL SINUS RHYTHM IS
PRODUCED BY THE SA NODE
– P – WAVE FOLLOWS QRS COMPLEX IN A
PREDICTABLE RELATIONSHIP
– ALL “P” WAVES LOOK ALIKE, ALL QRS
COMPLEXES ARE NARROW
– R – R INTERVAL IS REGULAR
– RATE: 60 – 100 bpm
12. Sinus / Atrial dysrhythmia
• ORIGINATE FROM SA NODE OR ATRIA
(ABOVE VENTRICLES)
• CONDUCTION WITH VENTRICLE IS
UNDISTURBED
• USUALLY BENIGN & SYMPTOMATIC
• RHYTHM MAY BE IRREGULAR
16. Treatment
– MAY RESOLVE WITH TREATMENT
OF UNDERLYING CAUSE
– DRUGS WITH RATE SLOWING
EFFECT: DIGOXIN, β-BLOCKERS
– CAROTID MASSAGE
– VAGAL MANEUVER
18. CLINICAL SIGNS
C.O. IF BODY CAN’T COMPENSATE
OR IMPROVED C.O. DUE TO DIASTOLIC
FILLING TIME MAY LEAD TO ARRHYTHMIA
• TREATMENT – DEPENDS ON CAUSE:
– ATROPINE
– AVOID VALSALVA
– HOLD RATE SLOWING DRUGS
I.E.: DIGOXIN, blockers
19. Atrial Flutter
• ATRIAL RATE = 250 – 400 IMPULSES/ MINUTE
– ETIOLOGY:
• OCCURS /W HEART DISEASE
• CAD
• VALVE DISORDERS
– CLINICAL SIGNS
• “SAW TOOTH” P-WAVES, CALLED F-WAVES
• ATRIAL RATE = 250 – 400/ MIN
• AV NODE BLOCKS SOME IMPULSES
• INCOMPLETE EMPTYING OF ATRIA CAUSE RISK
FOR THROMBUS GIVE
ANTICOAGULANTS
21. Atrial Fibrillation
• CHAOTIC ELECTRICAL ACTIVITY IN
ATRIA
• ATRIA QUIVER (>500 beats/minute)
INSTEAD OF CONTRACTING AS A
UNIT
• ETIOLOGY: ADVANCED AGE
VALVE DISORDERS
CARDIOMYOPATHY
25. Synchronized Electrical
Cardioversion
Oh O2 Saturation Monitoring
Say Suction Equipment
It IV Line
Isn’t Intubation equipment
So Sedation and possibly analgesics
27. JUNCTIONAL DYSRHYTHMIAS
• IMPULSE BEGINS IN AV NODE
• VENTRICULAR RATE IS EXTREMELY
SLOW
• MONITOR FOR SYMPTOMS OF
REDUCED CARDIAC OUTPUT AND
HEMODYNAMIC INSTABILITY
28. Paroxysmal Supraventricular
Tachycardia
• ABRUPT ONSET OF HR
• ETIOLOGY: SNS STIMULATION
CARDIOMYOPATHY
• CLINICAL SIGNS:
ABRUPT ONSET/ CESSATION
S/S ARE RELATED TO C.O.
RATE = 150 – 250 bpm
30. Ventricular Arrhythmias
• ORIGINATES IN VENTRICLES
• PATIENT MAY BE SYMPTOMATIC,
REQUIRES IMMEDIATE ATTENTION
– PVC, couplet, bigeminy, trigeminy
– V-TACH (ventricular tachycardia)
– V-Fib (Ventricular fibrillation)
31. PREMATURE VENTRICULAR CONTRACTION
(PVC)
– EARLY IRREGULAR VENTRICULAR
BEATS
– QRS IS WIDE /BIZZARE
– CAN BE CHRONIC ASYMPTOMATIC
ABNORMALITY OR WARNING OF
SERIOUS DYSRHYTHMIA
34. PREMATURE VENTRICULAR CONTRACTION
(PVC)
• CLINICAL SIGNS:
– DEPEND ON FREQUENCY
– PVC SHORT DIASTOLIC FILLING TIME
C.O.
– FREQUENT PVC – SENSATION OF
PALPATIONS, SKIPPED BEATS
– BIGEMINY – PVC EVERY OTHER BEAT
– TRIGEMINY – PVC EVERY 3RD BEAT
35. PREMATURE VENTRICULAR CONTRACTION
(PVC)
• TREATMENT:
– TREAT IMPAIRED HEMODYNAMICS
– ANTIARRHYTHMICS
– OXYGEN
– MONITOR FOR PVC LANDING ON
T-WAVE
– OBSERVE FOR UNIFOCAL (VS) MULTIFOCAL
36. Ventricular Arrhythmias
• VENTRICULAR TACHYCARDIA
– 3 OR MORE PVC’s
– QRS IS WIDE/ BIZARRE
EXTREMELY SERIOUS
MAY LEAD TO LETHAL RHYTHMS
• ETIOLOGY: SAME CAUSES AS PVC, ALSO
CARDIOMYOPATHY, MYOCARDIAL
IRRITABILITY
40. V-fib
• ETIOLOGY:
SAME AS VT, PVC
SURGICAL MANIPULATION OF HEART
FAILED CARDIOVERSION
• CLINICAL SIGNS:
SAME AS CARDIAC ARREST
EKG SHOWS DISORGANIZED
RHYTHM
41. V-fib
• TREATMENT
IMMEDIATE DEFIBRILLATION X3
CPR
SURVIVAL IS < 10% FOR EVERY
MINUTE THE PATIENT REMAINS IN
V-fib
42. SCREAM for Vfib and
Pulseless VTach
1.Shock360J* monophasic, 1st and subsequent
shocks.(Shock every 2 minutes if indicated)
2.CPR After shock, immediately begin chest
compressions followed by respirations (30:2
ratio) for 2 minutes.
3.Rhythm check after 2 minutes of CPR (and
after every 2 minutes of CPR thereafter) and
shock again if indicated. Check pulse only if
an organized or non-shockable rhythm is
present.
44. CARDIAC ARREST
• VENTRICULAR ASYSTOLE
80 – 90% DUE TO V-fib
TOTAL ABSENCE OF ELECTRICAL AND
MECHANICAL ACTIVITY
• ETIOLOGY
TRAUMA
OVERDOSE
MI
• CLINICAL SIGNS
– ASYSTOLE or V-fib
– NO DEFINABLE WAVE FORMS
– ABSENCE OF VITAL SIGNS
45. Ventricular Asystole
Acronym Comments
T Transcutaneous Only effective with early
Pacemaker implementaion
E Epinephrine 1 mg IV q3-5 min
A Atropine 1 mg IV q3-5 min
46. PEA- Pulseless Electrical
Activity
• Asystole Algorithm
• PEA
• Problem search
• Epinephrine – 1mg IV/IO q3-5min
• Atropine- with a slow HR, I mg IV/IO q3-5min
• Consider termination of efforts if asystole
persists despite appropriate interventions.
47. CARDIAC ARREST
Review ACLS Guidelines 2005
TREATMENT: IMMEDIATE CPR
A. AIRWAY/ ADVANCED AIRWAY
CONTROL
B. BREATHING/ POSITIVE PRESSURE
VENTILATION
C. CIRCULATION/ CPR, START IV
D. DEFIBRILLATE (V-fib, V-tach ONLY)
E. DRUGS-Antidysrhythmic tx
48. CARDIAC ARREST
• EPINEPHRINE 1:10,000 IV PUSH
REPEAT Q 5 MIN.
• AMIODORONE:
• ATROPINE:
• VASOPRESSIN:
• CONSIDER ANTIARRHYTHMICS
• USE ACLS ALGORITHMS
49. CARDIAC ARREST
• TREATMENT: POST CARDIAC ARREST
MONITOR -
CARDIAC STATUS
RESPIRATORY STATUS
TREAT UNDERLYING CAUSE
EMOTIONAL SUPPORT
SAFE ENVIRONMENT
50. DEFBRILLATION (vs)
CARDIOVERSION
• DEFIBRILLATION
ASYNCHRONOUS ELECTRICAL DISCHARGE
THAT CAUSES DEPOLARIZATION OF ALL
MYOCARDIAL CELLS AT ONCE.
THIS ALLOWS (HOPEFULLY) THE SA NODE TO
RESTORE ITS PACEMAKER FUNCTION AND
DICTATE A REGULAR SINUS RHYTHM.
USED FOR PULSELESS V-tach AND V-fib
VOLTAGE: 200 – 360 joules (“stacked shock”)
or AED
51. CARDIOVERSION (aka)
SYNCHRONIZED CONVERSION
ELECTRICAL IMPULSE IS DISCHARGED
DURING QRS (VENTRICULAR
DEPOLARIZATION)
USUALLY TIMED /W CARDIAC MONITOR TO
PREVENT SHOCK ON
T-WAVE
USED FOR RAPID A-fib, V-tach /W PULSE AND
PERSISTENT PAT / PSVT
VOLTAGE: 50 – 100 joules
52. EQUIPMENT REVIEW
• DEFIBRILLATOR
SELECT ENERGY LEVEL, THEN CHARGE
• PADDLES
USE 25 POUNDS OF PRESSURE WHEN APPLIED TO
CHEST, Placed 2nd RICS and 5th LAAS
• CONDUCTING AGENT
GEL OR PAD WHICH ESTABLISHES SKIN CONTACT,
REDUCES SKIN BURNS
• JOULES
MEASUREMENT OF ELECTRICAL ENERGY
• DISCHARGES
NO ONE SHOULD COME IN CONTACT WITH PATIENT
OR BED DURING DISCHARGE
53. HEART BLOCK
• DEPRESSED CONDUCTION OF IMPULSE FROM
ATRIA TO VENTRICLES
• AV NODE BECOMES DEFECTIVE AND
IMPULSES (P-WAVES) ARE BLOCKED FROM
BEING TRANSMITTED TO VENTRICLES
FIRST DEGREE
SECOND DEGREE
TYPE I
TYPE II
THIRD DEGREE
54. 1° HEART BLOCK
• PR INTERVAL > 0.20 SECONDS
• CAUSES: MAY BE NORMAL VARIANT
INFERIOR WALL MI
DRUGS: DIGOXIN
VERAPAMIL
• TREATMENT:
MONITOR
OBSERVE FOR SYMPTOMS
56. 2° HEART BLOCK
• ONE OR MORE P-WAVES ARE NOT
CONDUCTED THROUGH THE
VENTRICLE
• HEART RATE - VENTRICULAR RATE
SLOW TO NORMAL
ATRIAL RATE MAY BE 2 – 4 X’s
FASTER THAN VENTRICULAR
57. 2° HEART BLOCK
CAUSES: ORGANIC HEART DISEASE
MI, Dig toxicity, B and Ca Channel
Blockers
DIGOXIN TOXICITY
SYMPTOMS
• Tx:
Monitor HR
Atropine
Temporary pacemaker
Avoid meds that decrease conductivity
2 TYPES OF 2° HEART BLOCK
MOBITZ TYPE I- Wenkeback
MOBITZ TYPE II
58. Second Degree Heart Block
Mobitz I
• PRI becomes progressively longer until
drops QRS
59. Second Degree Heart Block
Mobitz Type II
• PRI constant and regular, but in a 2:1 , 3:1
pattern
60. 3° HEART BLOCK
(COMPLETE HEART BLOCK)
• ATRIAL IMPULSES & VENTRICULAR RESPONSE
ARE IN TOTAL DISASSOCIATION
• P-WAVES ARE SEEN & ARE IRREGULAR
• QRS COMPLEX ARE SEEN & ARE IRREGULAR
(ESCAPE RHYTHM)
• NO CORRELATION BETWEEN P-WAVES & QRS
(RATE IS SLOW) – independent rhythms
61. 3° HEART BLOCK
(COMPLETE HEART BLOCK)
• CAUSES
ORGANIC HEART DISEASE
MI
DRUGS
ELECTROLYTE IMBALANCE
EXCESS VAGAL TONE
• SIGNS & SYMPTOMS
EXTREME DIZZINESS
HYPOTENSION
SYNCOPE
S/S OF C.O.
ALTERED MENTAL STATUS
64. PACEMAKER
• Indications: Speed up a slow HR or Slow down a
rapid HR
• ELECTRICAL DEVICE THAT DELIVERS
CONTROLLED ELECTRICAL STIMULUS
THROUGH ELECTRODES PLACED IN CONTACT
WITH HEART MUSCLE
• 2 PIECES
PULSE GENERATOR IMPLANTED IN CHEST
WALL UNDER R CLAVICLE
PACEMAKER ELECTRODES IMPLANTED IN
MYOCARDIAL TISSUE
66. PACEMAKER
• TEMPORARY
PACEMAKER
– USED IN
EMERGENCY
SITUATION
– FIXED
(COMPETITIVE)
PACEMAKER SENDS
STIMULUS TO
VENTRICLE AT A
FIXED RATE,
REGARDLESS OF
VENTRICULAR
ACTIVITY
67. Types of Pacemakers
Use a 5 letter code
system, first 3 used
more often:
1. Chamber being
paced: A, V, D
2. Chamber being
sensed: A, V, D, O
3. Type of response
by the PM to the
sensing: I, T, D, O
68. PATIENT TEACHING
• Carry PM ID card
• MEDI ALERT BRACELET
• Avoid swimming, golf and weight lifting
• AVOID MRI
• Check PM q3-6 mos.
• PACEMAKER SURVEILANCE
• Monitor pulse rates
• Don’t hold cell phones over generators
69. AUTOMATIC IMPLANTABLE
CARDIOVERSION DEFIBRILLATOR
(AICD)
• PROVIDES INTERNAL SHOCKS WHEN SERIOUS
ARRHYTHMIA IS DETECTED (V-tach OR V-fib)
• Has a pulse generator and a sensor that monitors
the heart
• If pt has dysrhythmia it delivers a shock which the
pt will feel
• USEFUL WHEN ARRHYTHMIA IS UNRESPONSIVE
TO MEDS OR SURGICAL ABLATION OR
IRRITABLE MYOCARDIAL TISSUE