Mohan bradycardia copy
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BRADYCARDIA
MOHAN SINGH RAISTAFF NURSEMEDICAL ICU
TELL ME AND I FORGET. TEACH ME AND I REMEMBER. INVOLVE ME AND I LEARNED.
•BENJAMIN FRANKLIN
CIRCULATION
CARDIAC PHYSIOLOGY& PARAMETER
VOLUME
SV=ENDDIASTOLIC VOLUME-ENDSYSTOLIC VOLUME
CARDIAC OUTPUT=HRXSV
AFTERLOAD AND PRELOAD
EF=STROKE VOLUME/END DIASRTOLIC VOLUME
TROPISM
INOTROPIC (CONCRACTILITY)
CHRONOTROPIC (CHANGE HEART RATE)
DROMOTROPIC (CONDUCTION VELOCITY)
BATHMOTROPIC (EXCITABULITY)
LUSITROPIC ( RELAXATION)
CONDUCTION SYSTEM
Cardiac action potential
Atrial action potential
Ventricular action potential
Effective refractory period
Pacemaker potential
CHAMBER PRESSURE
CVP, RVP,PULMONARY ARTERY PRESSURE,
LEFT ATRIAL PRESSURE, LT. VENTRICULAR PRESSURE, AORTIC PRESSURE
BLOOD PRESSURE
PULSE PRESSURE=SBP-DBP
ATREIAL BP=SYSTOLIC (90-140),DIASTOLIC (60-90)
MEAN ARTERIAL PRESSURE=SBP+(2XDBP)/3 (70-105mmHg)
Right atrial pressure (2-6mmHG)
RIGHT VENTRICULAR PRSEEURE (RVP)
SYSTOLIC (SRVP):15-25mmHG
DIASTOLIC (DRVP);0-8mmHg
PULMONARY ARTERY PRESSURE
SYSTOLIC (PASP):15-25mmHg
DIASTOLIC (PADP):8-15mmHg
ROLES OF AUTONOMIC NURVOUS SYSTEMS
SYMPATHETIC PARASYMPATHETIC
ADRENERGIC RECEPTOR
CATECHOLAMINES
EPINEPHRINE/NOREPINEPHRINE
ACETYLCHOLINE
INCREASED HEART RATE, BP,CO,
VASOCONSTRICTION,
DECREASED HR,CO,BP,VASODILATION
REST AND DIGESTFLIGHT OR FIGHT
PHYSIOLOGICAL TACHYCARDIA AND BRADYCARDIA..WHY??
human heart electrical system
INTRODUCTIONHeart rate, or heart pulse, is the speed of
the heartbeat measured by the number of heartbeats per unit of time (bpm).
The heart rate can vary according to the body's physical needs, including the need to absorb oxygen and excrete carbon dioxide.
Activities that can provoke change include physical exercises, sleep, anxiety, stress, illness, ingesting, and drugs.
The normal resting adult human heart rate ranges from 60–100 bpm.
CONT’•Bradycardia is a slow heart rate, defined as below 60 bpm
• Tachycardia is a fast heart rate, defined as above 100 bpm at rest.[
•When the heart is not beating in a regular pattern, this is referred to as an arrhythmia, These abnormalities of heart rate sometimes, but not always, indicate disease.
BRADYCARDIABradycardia: A slow heart rate, usually
defined as less than 60 beats per minute.
Relative bradycardia is used in explaining a heart rate that, although not actually below 60 BPM, is still considered too slow for the individual's current medical condition.
Absolute bradycardia A waking heart rate below 40 BPM is considered absolute bradycardia.
BRADYCARDIA IN HEALTHYDuring sleep, a slow heartbeat
with rates around 40–50 BPM is common, and is considered normal
Highly trained athletes ( athletic heart syndrome) know as atheletic bradycardia or atheletic associated
cardiomegaly.
CLASSIFICATION1.Atrialrespiratory sinus arrhythmiasinus bradycardiaSick sinus syndrome2.Atrioventricular nodalAn atrioventricular nodal bradycardia or AV
junction rhythm is usually caused by the absence of the electrical impulse from the sinus node.
3.Ventricular: A ventricular bradycardia, also known as ventricular escape rhythm or idioventricular rhythm.
Causes
General causes:1º: Abnormal pacemaker/conduction system (congenital or postsurgical Injury)infectious: SepsisAging.Heart diseases ( myocarditis, cardiomyopathy, heart block,Sick sinus syndrome,Mi)Drugs( beta blocker, calcium channel blocker, digoxin, opioid drugs, antiarrthymias drugs)
CAUSE
2º: Hs & Ts: – Hypoxia – Heart block – H+ ions (acidosis) – Hypothermia – Hyperkalemia, -hypoglycemia- hypothyroidism- hypovolemia
-Trauma (head) -Toxins-Tension pnemothorax-Temponate -Thrombosis
SIGNS AND SYMPTOMSNear-fainting or
fainting (syncope)
DizzinessWeaknessFatigueShortness of
breathChest painsLow BPcyanosis
Confusion or memory problems
Easily tiring during physical activity
Low heart rate
History & examination
R/ORisk factors
use of known causative medicationsage over 70 years
recent myocardial infarction
Surgery
cont’Hypothyroidism
electrolyte disorders
infections
exposure to toxins
infiltrative diseases
sleep apnoea
Key diagnostic factorspresence of risk factors (common)pulse rate below 50 bpm (common)dizziness/lightheadedness (common)syncope (common)fatigue (common)exercise intolerance (common)shortness of breath (common)cannon a-waves in jugular venous
pulse (common)jugular venous distension (common)
Epidemiology
Impossible to give meaningful figures on incidence and prevalence.
In most young people bradycardia is physiological.
The incidence of pathological bradycardia rises with age as the underlying causes become more frequent.
DIAGNOSIS AND TESTElectrocardiogram (ECG or EKG)EchocardiogramBlood tests:
CBCUrine ExaminationLFT, Blood glucose.
Cont’ElectrolytesCreatinineCardiac enzymes (troponin),CK-MbABGChest X-ray
MANAGEMENT Stable patients:
12 lead EKGConsult cardiology
Unstable patients: CABsACLS -Bradycardia Algorithm
Address reversible causes (Hs & Ts)
AHA ACLS Adult Bradycardia Algorithm
Bradyarrhythmia typically seen when the HR <50/min
Is bradyarrhythmia causing the symptoms?
The priority should be identify and treat underlying causeMaintain patent airway: assist breathing if necessary.Apply oxygen ( if hypoxemic; Monitor pulse oxymetryApply cardiac monitor; monitor blood pressure.I/V access12 lead ECG. If available; do not delay treatment
Is the beadyarrhythmia causing:Hypotension?Altered mental status?Signs of suck?Ischemic chest pain?Acute heart failure?
Yes
No
Monitor and
observe
Give atropine If atropine in affective;Transcutaneous pacing (OR)Dopamine infusion (OR)Epinephrine infusion
ConsiderExpert consultationTranscutaneous pacing
Doses/detailsAtropine IV dose;First 0.5mg bolusRepeat every 3-5minutes; maximum 3mgDopamine IV infusion2-10mcg/kg/minuteEpinephrine IV infusion 2-10mcg/minute
Drug calculation
Dopamine
• Preparation : 200mg in 45 NS
• 1ml=4mg=4000mcg
• Dose: 5mcg – 20mcg/kg/min
• E.g. Body wt= 50kgs
• 5mcg x 50 x 60=15000
• 15000/4000= 3.75ml/hr
• (OR)
• Desired dose*body wt in kg*0.015=dose in ml
Epinephrine/Adrenaline
•Preparation: 2mg in 49ml D5
•Strength:
1ml=0.04mg=40mcg
•Dose: 0.2mcg-1.3mcg/kg/min
E.g.
0.2 x 50 x 60=600mcg
600/40=15m/hr
NURSING INTERVENTIONAccording to patient condition, do
planning, assessment, write nursing diagnosis and provide care.
General nursing interventionIf ineffective air way/unconscious;
lateral recumbent or three-quarters prone position of the body (lateral sim’s position)
Suctioning,place air way
Cont’Monitor with pulse oxymeterGlasgow coma scaleCatheterization IV accessClose monitoring of vital signs (BP, pulse,
temperature, RR)Notify the concern physicianReassurance to patient /attendant
cont’
ECGPut patient on monitorMedication as per physician advisedInformed emergency laboratory, X-ray,
people if necessary.Assess the side affect of drugs.
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