Cardiac arrythmias

CARDIAC ARRYTHMIASORHAN HAKLI, NP

CARDIAC CONDUCTION SYSTEM

SA NODE : -AT THE UPPER POSTERIOR PART OF THE ATRIUM-PRIMARY PACEMAKER-DISCHARGES ELECTICAL IMPULSES 60-100 A MINUTE

AV NODE :-RECEIVES IMPULSES FROM SA NODE-SLOW THE CONDUCTION AND DELAYS THE INPUT IN ORDER ATRIUMS TO VENTRICULS COMPLETELY(Atrial kick 5-30% of the CO)-BLOCK SOME OF THE IMPULSES TO PREVENT GOING THE HEART TACHY-SERVES AS A BACK UP PACEMAKER IF SA NODE FAILS (ELECTRICAL IMPULSES OF 40-60 A MINUTE)

PURKINJE FIBERS:-RECEIVES IMPULSES FROM BUNDLE BRANCHES-DISCHARGES ELECTRICAL IMPULSES 20-40A MINUTE

CAUSES OF DYSRHYTHMIASENHANCED AUTOMATICITYIncreased activity or rhythm disturbances

TRIGIRRED ACTIVITYAbnormal electric impulses when cells are at rest

RE-ENTRYSpread of an impulse through tissue already stimulated by that same impulse

ACIDOSIS HYPOXIA HYPERCALIMIA

ALCOLOSIS HYPOMAGNESIA MYOCARDIAL ISCHEMIA

HYPOXIA MYOCARDIAL INJURY ANTIARYTHMATIC MEDS

ISCHEMIA/INFARCT MEDICATIONS THAT PROLONGS REPOLARIZATION (IE.QUINIDINE)

ELECTROLYTE PROBLEMS (K-CA)

DIG.TOXICITY

ADMINISTRATION OF ATROPINE/EPINEPHRINE

EKG

HEART RATE-To determine the ventricular rate, count the QRS complex on a 6 sec paper and multiply by 10

WAVES-P wave: atrial depolarization-QRS complex :ventricular depolarization-Twave :Ventricular repolarization

INTERVALS-PR :0.12-0.20 sec-QRS :under 0.10sec-QT:under 0.38 sec

MAJOR CARDIAC ARRHYTHMIASSINUS RYTHMS

ATRIALRYTHMS

VETRICULAR RHYTHMS

ATRIO-VENTRICULAR (AV) RHYTHMS

SINUS BRADY PREMATURE ATRIAL CONTRACTION(PAC)

PREMATURE VENTRICULAR CONTRACTION(PVC)

1ST DEGREE AV BLOCK

SINUS TACHICARDIA

ATRIAL FLUTTER

VENTRICULAR TACHICARDIA

2ND DEGREE AV BLOCK TYPE I

SINUS ARRYTHMIA

ATRIAL FIBRILATION

VENTRICULAR FIBRILATION

2ND DEGREE AV BLOCK TYPE II

SINUS ARREST ASYSTOLE 3RD DEGREE AV BLOCK

SINUS RHYTMS

CHARACTERISTICS-less than 60bpm-regular PP and RR-PR 0.12-.20QRS0.10WHAT TO DO?-watch the patient for s/s of bradycardia-If symptomatic; iv access, o2, transcuteneus pacingMEDICATIONAtropine 0.5mg ivp

SINUS RHYTHMS

CHARACTERISTICS - 101-150bpm -regular PP and RR -PR 0.12-.20 QRS0.10 or less WHAT TO DO? -watch the patient for s/s of Tachycardia -correct underlying problems/Never shock ST MEDICATION Atenelol/Meteprolol (Beta blockers)

SINUS RHYTHMS

CHARACTERISTICS - usually 60-100bpm, but can be slower or faster -irregular with respiration, HR increases with

inspiration and decreases with expiration -PR 0.12-.20 QRS0.10 or less WHAT TO DO? NOTHING !!! MEDICATION If hemodynamic compromise is present ATROPINE

SINUS RHYTHMS

CHARACTERISTICS - Rate varies because of the pause -irregular rhythm -PR 0.12-.20 QRS0.10 or less WHAT TO DO? If transient and major s/s of decline monitor the pt If more than 3 sec. ATROPINE, Bedside Pacer or

Possible Permanent PM insertion MEDICATION ATROPINE

SINUS ARREST

ATRIAL RHYTHMS

CHARACTERISTICS - Rate; Depends on the underlying rhythm but usually w/i

normal limits -Regular rhythm, except the premature beats -PR may be normal or prolonged QRS0.10 or less but might be wide WHAT TO DO? NOTHING!!! Reducing stress, stimulants(coffee), treating CHF may help MEDICATION If needed beta blockers, CA blockers or anxiety meds

PREMATURE ATRIAL COMPLEX

ATRIAL RHYTHMS

AFIB

AFLUTTER

VENTRICULAR RHYTMS

PREMATURE VENTRICULAR COMPLEX

CHARACTERISTICS - Rate; Depends on the underlying rhythm -Regular rhythm, except the premature beats -PR no PR because ectopy comes from ventricles QRS more then 0.12, wide and bizarre looking WHAT TO DO? NOTHING!!! Monitor the pt, if frequent check if they have enough

cardiac output

VENTRICULAR RHYTHMS

VENTRICULAR TACHICARDIA

VENTRICULAR FIBRILATION

ASYSTOLE

ATRIOVENTRICULAR (AV) BLOCKS

CHARACTERISTICS - Rate; Depends on the underlying rhythm, but usually

normal -Regular rhythm -PR prolonged, greater than 0.20 sec QRS usually 0.10 sec or less WHAT TO DO? They are usually asymptomatic, Monitor the pt if MI is

causing the block Hold the meds that could cause the block(IE beta blockers,

CA blockers, Dig, quinidine)

FIRST DEGREE AV BLOCK

ATRIOVENTRICULAR (AV) BLOCKS

WHAT TO DO? They are usually asymptomatic, Monitor the pt Do not give ATROPINE to increase the heart rate Type II might be indication for PM Hold the meds that could cause the block(IE beta blockers,

CA blockers, Dig, quinidine) If associated with MI, watch if the block is getting worse

SECOND DEGREE AV BLOCK

TYPE -I

TYPE -II

ATRIOVENTRICULAR (AV) BLOCKS

CHARACTERISTICS - Rate; atrial rate is greater then ventricular rate -Regular ratrial (P) and regular ventricular but no

relationship between the two -P normal size and shape; PR none QRS can be narrow or wide WHAT TO DO? ATROPINE /Transcuteneus Pacing Possible permanent Pacemaker

THIRD DEGREE AV BLOCK

REFERENCES

Aehlert, B. (2006). ECGs Made Easy. Arizona: Sauthwest EMS education Inc.

Heart Blocks. (2012). Retrieved from http://www.nhlbi.nih.gov: http://www.nhlbi.nih.gov/health/health-topics/topics/hb/types.html

Huff, j. (2006). ECG Workout: Exercises in Arrhythmia Interpretation. PA: Lippincott Williams & Wilkins.

Nicod, P.; Hillis, L.; Winniford, M.D.; Firth, B.G. (February 15, 1986). Importance of the "atrial kick" in determining the effective mitral valve orifice area in mitral stenosis. The American Journal of Cardiology , Volume 57, issue 6 p. 403-407.

Sauer, W. (2012). Normal sinus rhythm and sinus arrhythmia. Retrieved from http://www.uptodate.com: http://www.uptodate.com/contents/normal-sinus-rhythm-and-sinus-arrhythmia